health for mothers and young children is something that clearly needs to be developed further, Guyer said.

Health problems of early childhood are antecedent to many of the health disparities and chronic diseases of adulthood. Health and economic consequences are high when followed across the entire life span. There is a body of evidence emerging that shows that something can be done about these problems by intervening early. Programs have been developed but have not been brought up to full scale, and systems are lacking. Effective programs and policies must be based on broad public health approaches, rather than relying on individual control or medical interventions alone. There are multiple societal determinants, necessitating multifaceted approaches, and there is a societal cost of failing to intervene.

As discussed earlier, much research has been done regarding tobacco exposure, and there is a great deal of ongoing research into childhood obesity. But mental health is an area that needs greater focus, and injury prevention is an area where advances have been made in the past, but renewed attention is needed. Guyer noted that literature on the effect of interventions early in life relative to reducing health disparities is also lacking.

More high-quality intervention studies are needed to demonstrate longterm effects and to convince policy makers to direct resources toward the early period of life. This is a “societal investment,” promoting early childhood health both for the sake of the child and for the sake of promoting the health of the entire population.

How can we make well-child pediatric practice address all of children’s needs for healthy development, Bruner asked, and what specifically around clinical health care practice can be done that also leads to community building? How do we address the determinants of good health that require non-medical interventions, such as exposure to lead paint and other toxins?

There are common factors that lead to racial and ethnic disparities in health: family factors such as poverty or stress; environmental factors such as safety or exposure to toxic substances; social factors including racism; and service factors including access, use, and quality of services such as