INVESTMENTS TO PROMOTE CHILDREN’S HEALTH: A SYSTEMATIC LITERATURE REVIEW AND ECONOMIC ANALYSIS OF INTERVENTIONS IN THE PRESCHOOL PERIOD

Children are our future! Guyer began with a familiar quote, but for many who have worked in children’s health for a long time, he said, this statement is at best, an overused cliché, and at worst, disingenuous. In fact, the level of actual government investment in young children in the United States has declined, and projections through the year 2017 based on current federal outlays predict a further decline of between 14 and 29 percent in investment in children’s programs, the largest of which are the educational programs (Steuerle et al., 2007). The IOM report, From Neurons to Neighborhoods, emphasized the importance of infant brain development for future development and learning (IOM, 2000). Guyer and colleagues are working to build a parallel argument for the importance of investing in early childhood health, emphasizing the need to integrate a health focus into early childhood development and education.

Child health is more than simply the absence of disease and involves more than just providing access to medical care. Health is integrally linked to development and learning, and what happens in early life has implications across the life span. In addition, child health goes beyond the behavioral health of individual children. Child health is shaped by multiple determinants including social, environmental, economic, and genetic influences. Investing in early childhood health and development is a community responsibility and a communal investment.

Study Objectives and Approach

To help build this argument, Guyer and colleagues conducted a systematic literature review of both the short- and long-term effects of interventions in children from birth to 5 years of age, including the prenatal period and the period leading up to the pregnancy. Four areas of preschool child health were selected for study, including tobacco exposure, obesity, unintentional injury, and mental health, in part because they were highlighted in the Healthy People 2010 and 2000 reports. The primary objective of the review, which covers literature from 1996 to 2007, is to assess both health and cost consequences in the four focus areas across the entire life span. The group focused particularly on economic studies that reported on either cost implications or cost-benefits of interventions. While the team sought randomized clinical trials first, in many cases they have not been done, and well-designed studies, using other kinds of evaluation designs that estimate economic costs, were therefore also assessed.

Data from the literature review were adapted to a framework that pro-



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