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INTRODUCTION

Focusing on young children in a global context is an approach to end the cycle of poverty and improve the well-being of nations (Chan, 2013). Improving well-being necessarily begins with core elements such as health, education, nutrition, and social protection (WHO, 2003); many efforts to improve child development in the first decade of life focus on areas to meet young children’s basic needs. Young children living in low-resourced settings are vulnerable to developmental and educational risk factors, such as stunting and undernutrition, disease, caregiver depression, lack of access to quality preprimary and primary education, disabilities, poverty, and societal and familial violence (Barros et al., 2012). While each of these areas is important for children’s growth and development, there are potential increased benefits from integrated programs and coordinated policies that address more than one of these areas simultaneously, particularly for children living in low-resourced communities. One argument for a coordinated approach is the optimally receptive child needs to have a minimum degree of underlying physical, emotional, and mental health. Malnutrition caused by factors such as protein, calorie, and micronutrient deficiencies can reflect poor nutritional intake or losses attributable to metabolic conditions or infections and infestations (such as diarrheal and parasitic diseases). Positive physical, intellectual, emotional, and social development of children is likely dependent on healthy biology as well as presence of factors such as family support and nurturance and adequate resources. An integrated and coordinated “all system” approach may be the best way to guarantee that children will have the prerequisites for healthy development. This line of thinking led to the development of the Forum on Investing in Young Children Globally.

The Forum on Investing in Young Children Globally (forum)—a joint effort between the Board on Global Health and the Board on Children, Youth, and Families of the U.S. National Academies of Sciences, Engineering, and Medicine¹— was established with the goal of integrating knowledge with action in regions around the world to inform evidence-based, strategic investments in young children, birth through age 8 (nationalacademies.org/iycg). A collaboration of multidisciplinary and multisectoral experts worked over 3 years to highlight the importance of connecting an integrative science to investments in the world’s children and raise issues to the top of policy agendas, both globally and nationally. The forum’s vision was for decision makers around the world to use the best science and evidence for investing to optimize the well-being of children and their lifelong potential. The forum’s main objectives were to

• Explore the importance of an integrated science of child health and development through age 8;
• Share models of financing and program implementation at scale across social protection, education, health, and nutrition;
• Promote global dialogue on investing in young children; and
• Catalyze opportunities for intersectoral coordination at local, national, and global levels.

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¹ As of March 2016, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine continues the consensus studies and convening activities previously carried out by the Institute of Medicine (IOM).

The forum held nine workshops across five continents over 3 years. The goal was to learn from experiences in multiple regions, and engage in culturally embedded dialogue. The topics and locations of the workshops are presented in Figure 1-1 (Appendix A provides a complete list of workshop topics and links to more information).

The forum comprised experts from many sectors such as philanthropy, academic institutions, implementing agencies, nonprofit organizations, government, multilateral and bilateral institutions, and industry from around the world (Appendix B lists forum members and Appendix C lists forum sponsors). These experts represented multiple disciplines, including maternal, newborn, and child health; nutrition; early childhood education; adolescent medicine; pediatrics; policy; economics; child development; neuroscience; mental health; public health; primary health care, and child protection. Forum members and other invited experts served on workshop planning committees. Members of the planning committees selected the workshop topics; identified speakers; and presented and moderated workshop sessions. In addition, forum members, planning committee members, and other experts served as reviewers for proceedings of previously published forum workshops and highlighted the lessons learned from forum activities by writing National Academy of Medicine Perspectives papers, journal articles, and blogs. Through these activities, forum members engaged with a global audience to highlight the science and connect it to specific areas for guiding investments and approaches to these investments in children and their caregivers.

Development Across Life Stages and Critical Life Stages for Investment

The continuum of human development is shaped by biological, social, economic, and political contexts across the life course. The forum membership acknowledged this in highlighting interdisciplinary research, catalyzing dialogue across sectors, and sharing models of financing investments to support children to reach their full developmental potential. In addition, a multigenerational approach was used in the workshops to highlight the cyclical, interlocking nature of development across generations and

periods of investments that could support children’s full developmental potential. Figure 1-2 was developed by forum members and project staff through an iterative process to illustrate this broader approach to viewing investments in young children. Therefore, in addition to focusing on the period from birth to age 8 years, the forum explored development across middle childhood, adolescence, early adulthood, and late adulthood, understanding that investments during these periods can affect future generations. One example highlighted across workshops includes investments in families and other caregivers of young children (IOM and NRC, 2015a,b; NASEM, 2016b,d). Individual speakers acknowledged that these investments are made in adults but have the potential to improve children’s health and development, as caregivers can be the gatekeepers to health, education, nutritional, and protective resources.

Developmental Ecological Framework

Forum members viewed investments in young children within a developmental ecological framework, understanding that a family’s economic status and policies that support caregivers or create challenging contexts to care for young children are as important in contributing to child outcomes as child-level investments in early childhood programs and services. The framework incorporates the influences on child health and well-being and the types of investments that may be used to address those influences. These potential areas of investment are represented in Figure 1-3. The target of a child reaching her full developmental potential is enveloped by several interacting layers of possible investments, beginning with the most proximal layer, the caregiving environment. Each layer is influenced by, and interacts with, the layers around it. Thus, the caregiving environment is influenced by the social service systems in place to support them, which depend on the financing and distribution of resources, driven by political will and engagement.

Structure of the Workshops

Each workshop focused on a specific topic within the overarching umbrella of investing in young children globally. The planning committees for each workshop invited most speakers living or working in the region to present. Speakers were drawn from many sectors and disciplines to ensure a full, rich set of presentations and discussion addressing issues identified by the forum members. Context and culture were very important to the discussions, and remained embedded throughout each meeting. This synthesis attempts to identify the threads of science, policy, and practice that were woven throughout the workshops while identifying circumstances that were specifically related to supporting or inhibiting children from reaching their full developmental potential.

Across the nine workshops, speakers addressed the following questions, and thus the synthesis follows this structure:

• Why should stakeholders invest in young children? (Section 2)
• What are promising areas for investment to support young children? (Section 3)
• How can stakeholders invest in young children and what are important considerations? (Section 4)

This document summarizes the key themes of the workshops and Perspectives papers to share with stakeholders the many topics addressed to inform investing in young children globally.² The members hope their work will inform nascent efforts that will continue to explore many of the issues raised by this forum.

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² This publication has been prepared by the rapporteurs as a synthesis of the discussions that occurred at the forum workshops. The material is confined to the content of the forum and does not cover the wide international research and reading on the topic. As such, this synthesis is not comprehensive of the ongoing global work in early childhood, but gives, by way of example, an insight into the issues. Statements, recommendations, and opinions expressed are those of individual workshop participants and are not necessarily endorsed or verified by the forum or the National Academies, and they should not be construed as reflecting any group consensus.