Several individual workshop participants presented reasons stakeholders should invest in young children—not only for the potential to yield high returns, both economic and psychosocial over the lifespan, to the individual child, families, and society, but also for reasons grounded in human rights. The reasons are grouped under the following headings:
- Scientific evidence suggests that investments in young children influence later development; Investments in young children can be linked to investments in societies;
- Investments in young children living in high-risk environments and those with disabilities can change life-course trajectories;
- Investments in young children, a rights-based framework, and the United Nations Sustainable Development Goals;
- Investments in families, institutional care, and other precarious living conditions;
- Investments in young children living in dangerous and unstable socioeconomic or political contexts equal investments in human rights.
Scientific Evidence Suggests That Investments in Young Children May Influence Later Development
Major advances in neuroscience, molecular biology, genomics, psychology, sociology, and other fields have shown that early experiences affect the development of brain architecture, providing a foundation for future learning, health, and well-being (Huebner et al., 2016). Primary systems, including learning and memory, speed of processing, and reward, develop in the first 3 years of life and provide the “scaffolding” for later development of higher-order neural systems, noted workshop speaker Michael Georgieff of the University of Minnesota (IOM and NRC, 2014). The brain consists of many areas and cell types, each with a different developmental trajectory. Some areas begin and end development during the fetal period, while other areas continue to develop throughout adolescence. He emphasized that early development (from the prenatal period through age 5) affects developing primary brain structures, and it is difficult to make up this development later in life. Therefore, aligning the timing and coordination of interventions based on sensitive periods of development is particularly effective, especially in resource-limited environments, said Georgieff.
Donald Bundy from the World Bank indicated that the child development community should consider children more broadly, as adolescence is also a critical period characterized by substantial physical,
cognitive, emotional, and social development (IOM and NRC, 2014). Investments in the adolescent period can sustain the gains from investments earlier in the life cycle. In fact, he added that education can change brain architecture, and several years of basic education allow individuals to think and reason differently. Georgieff conceded that adolescence offers an opportunity to “catch up” and solidify the scaffolding put into place as a young child, making follow-up and follow-on interventions critical, particularly for children who have multiple risk factors.
Investments in Young Children Can Be Linked to Investments in Societies
Research highlighted across workshops points to the early years of a child’s life as critical for bolstering cognitive and social and emotional development and laying the foundation for lifelong health and wellbeing (IOM and NRC, 2014; NASEM, 2016b). Günther Fink of the Harvard T.H. Chan School of Public Health and Norbert Schady of the Inter-American Development Bank pointed out that early investment in children’s development triggers a multiplier effect, with positive outcomes spreading across multiple sectors over the long term (IOM and NRC, 2014; NASEM, 2016b). For instance, increased access to early childhood development programs can increase equity of opportunity and reduce achievement disparities by increasing children’s early skill set (human capital) and ability to do well in school and professionally. Paul Gertler of the University of California, Berkeley, spoke about the economic productivity of these children as adults as representative of a high return on early life investments, and Parfait Eloundou-Enyegue of Cornell University also spoke about how these improvements can affect subsequent generations (IOM and NRC, 2014).
As Peter Singer of Grand Challenges Canada pointed out, we have the capacity to positively transform societies by connecting what is known about investments in children and their caregivers to what is being done (IOM and NRC, 2014). Failure to provide optimal early environments for children leads to lower income and national gross domestic product, higher rates of disease and depression, and increased crime rates, he added. In Singer’s opinion (IOM and NRC, 2014), inattention to early childhood development locks countries into a condition of poverty. Moreover, Singer noted that the neurobiology of brain development suggests that it is easier, more efficient, and more cost-effective to build strong beginnings than it is to facilitate repairs later in life. According to Gertler, early interventions aimed at children before age 2 to 3 may be particularly effective at combatting the lost potential because they can have a high rate of return by improving a child’s future development, reducing the need for pricy remediation services later in life (IOM and NRC, 2014). Schady added that continuing investments through age 8, or into elementary school, leverages earlier investments to continue to support children on a healthy developmental pathway (IOM and NRC, 2014).
Gary Darmstadt of Stanford University School of Medicine and Zulfiqar Bhutta from the SickKids Centre for Global Child Health and Aga Khan University reported that 249 million children are at risk of not reaching their developmental potential because of stunting or exposure to poverty (Lu et al., 2016; NASEM, 2016c). If children living in extreme poverty and who are stunted grow into adults that are less able to participate in the economy, they will experience a decrease in quality of life and countries will lose much of their potential for economic growth, said Gertler (IOM and NRC, 2014). Thus, investments in
young children and their development can improve future skills in the labor market, which improves long-term economic outcomes, added Gertler (IOM and NRC, 2014).
Investments in Young Children Living in High-Risk Environments and Those with Disabilities Can Change Life-Course Trajectories
The biology of adversity and resilience demonstrates that significant stressors, beginning in utero and continuing throughout the early years, can have long-lasting effects on brain architecture and function (Shonkoff et al., 2012). Thankfully, compromised beginnings can be turned around. Children can achieve resilience when protective factors—particularly a stable and committed relationship with a supportive parent, caregiver, or other adult—outweigh other risks, according to Ann Masten from the University of Minnesota (NASEM, 2016d). She explained that a child’s resilience is dependent on the resilience of the systems that support that child, and that to build resilience, there needs to be scaffolding at different levels—so that even when support systems break down, as is often the case during disasters and times of crisis, the primary caregiver has the capacity to reorganize and reconnect with the child to continue to support his or her development (NASEM, 2016d). In fact in all contexts, promoting vulnerable children’s health and development requires supporting a caregiver’s ability to respond appropriately to deprived or distressed children, according to Vibha Krishnamurthy from the Ummeed Child Development Center(NASEM,2016c).
The social influences on a child’s health, growth, and development cut across multiple ecological contexts beyond the caregiver. As stated by several workshop speakers, children’s needs and risks are multidimensional, and tackling one issue at a time is not effective. According to Pia Rebello Britto of UNICEF (UN International Children’s Emergency Fund) and Lorraine Sherr from the University College London, evaluating the risks to young children living in low resourced settings is complex and involves consideration of social factors, politics, population demographics, religion, culture, and legal frameworks (IOM and NRC, 2015a). Thus, addressing risks at multiple levels is important in making a difference in promoting children’s health and well-being.
In certain circumstances, as Margareta Matache from Harvard University pointed out, children are exposed to an accumulation of risk factors that negatively affect early development and add to inequalities (NASEM, 2016c). For example, by being denied basic services and subjected to forced evictions, she said that Roma children can experience high levels of trauma that affect their emotional, cognitive, and social development in childhood and later in life. In addition, in Chile, 30 percent of children living in poverty are identified as having a developmental delay, according to Helia Molina of the Universidad de Santiago de Chile, as opposed to less than 15 percent of children living in higher-income settings (NASEM, 2015). Amina Abubakar from the Kenya Medical Research Institute/Wellcome Trust Research Programme showed that children living in communities with high HIV prevalence are also subject to an accumulation of risks, as they are exposed to chronic stress, lag behind in achieving developmental milestones, and tend to experience mental health problems (Abubakar et al., 2008; Devendra et al., 2013; Kamau et al., 2012).
Quentin Wodon of the World Bank noted that some of the most vulnerable young children are born to girls marrying before age 18 (NASEM, 2016d). A reason for this, Jeffrey Edmeades from the International
Center for Research on Women explained, is that early marriage often means the end of formal education (NASEM, 2016d; Stoebenau et al., 2015; UNICEF, 2014; Warner et al., 2014) and the beginning of sexual activity and childbearing, which introduces other physical and mental health issues (Nour, 2009; Plan UK, 2011; UNFPA, 2012). This directly affects a girl’s participation in the work force, educational attainment, involvement in decision making, exposure to violence, and health, said Wodon. Children of very young women can in turn become susceptible to health and developmental challenges and poverty (Duvvury et al., 2013; Parsons et al., 2015).
Several speakers put forth solutions that can support young adolescent girls and their children. Wodon emphasized it is crucial to work toward systems change, including disrupting local marriage markets and gender roles, while also empowering adolescent girls and their families to find alternatives beyond marrying at an early age (NASEM, 2016d). Studies in multiple countries have demonstrated that increasing access to funding and lowering the barriers to middle and secondary education for girls both increases attendance and lowers rates of early marriage (Baird, 2012; Duflo et al., 2015; Hallfors et al., 2015; Kalamar et al., 2016; Malhotra et al., 2011). In New York City, Angela Diaz and her colleagues at the Mount Sinai Adolescent Health Center work closely with teen parents and their children to provide services to prevent additional pregnancies and ensure that children are on a positive developmental trajectory (NASEM, 2015). Afzal Habib of Kidogo remarked that high-quality child care and education programs such as Kidogo in the informal settlements of Nairobi, Kenya, can build a foundation for equity and be a stepping stone out of poverty (NASEM, 2016d). These programs provide children with a strong start and the opportunity to reach their full developmental potential by the time they reach childbearing age, which can help break the vicious cycle of intergenerational deprivation, stated Gillian Mellsop of UNICEF (NASEM, 2016d).
Additionally, several speakers emphasized that investing in children with disabilities can support their full inclusion into society (NASEM, 2015). According to Vesna Kutlesic from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, without the proper supports, children with disabilities are especially vulnerable and at risk of not reaching their full developmental potential (NASEM, 2016c). Moreover, several participants observed that such children are often neglected and overrepresented in numbers among the poorest sections of society (NASEM, 2015). Another risk factor is that access to education is often hindered for children with developmental delays and disabilities, stated Andy Shih from Autism Speaks (NASEM, 2016c).
As described by Shih (NASEM, 2016c), although many countries have inclusive laws and policies on paper, in practice, children with developmental delays, behavioral disorders, or disabilities are often excluded from mainstream education. Moreover, many countries have not committed to equal rights and inclusive education for children with disabilities (Raub, 2016). According to Donald Wertlieb from the Partnership for Early Childhood Development and Disability Rights (NASEM, 2016c), children with developmental delays and disabilities represent 5 to 25 percent of a country’s population, and they should be more prominently included in global efforts to build healthy, prosperous societies. The first step toward inclusion is moving education for children with disabilities from special education toward inclusive education, explained Yasmin Hussain of the Southeast Asian Ministers of Education Organization (NASEM, 2015),
with awareness that special schools for the disabled reinforce segregation and marginalization (Tsaputra, 2012).
Investments in Young Children, a Rights-Based Framework, and the United Nations Sustainable Development Goals
Released in 2015, the United Nations Sustainable Development Goals for 2030 (UN SDGs) move beyond survival to ensuring children thrive (UN, 2015). The UN SDGs were part of many workshop discussions and align well with the areas of focus of the forum. The research and practice communities are now focused on sustainability, holistic human development, and the numerous factors affecting health and well-being, said Bhutta (NASEM, 2016c). Singer encouraged workshop participants to seize on this momentum and for researchers, policy makers, and practitioners to promote “child thrival” (IOM and NRC, 2014).
Human rights, children’s rights, and rights of people with disabilities were raised as powerful platforms to make the case for investing in young children. Jonathan Todres of Georgia State University provided a high-level overview of how a child’s right to health, education, nutrition, and social protection are interrelated (NASEM, 2016c). Ziba Vaghri of the University of British Columbia (IOM and NRC, 2014) showed that international human rights conventions and treaties can be platforms to emphasize a child’s right to health, safety, and security as an obligation of the government to support children (OHCHR, 2014; UN, 2014). She also mentioned the possibility of having an international framework to protect the rights of children through monitoring and tracking progress (IOM and NRC, 2014). Workshop presenters Maureen Durkin of the University of Wisconsin and Wertlieb both noted trends in global agreements toward recognizing the human rights of people with disabilities rather than as subjects of charity and called for more inclusion of children with disabilities in early childhood development research and policy making (IOM and NRC, 2014; NASEM, 2016c).
Investments in Families, Institutional Care, and Other Precarious Living Conditions
Orphans or children who live outside of family care are similarly vulnerable, said Kutlesic (NASEM, 2016c). Unaccompanied child migrants who have been separated from their parents are more likely to experience sexual violence and trafficking; lack access to food, water, shelter, and education; and are targeted by gangs, according to Alison Parker of the Human Rights Watch (NASEM, 2016c). She underscored that often these children fear for their lives. In many cases, low-resourced families that cannot afford to take care of their own children and/or have a high level of dysfunction may not be able to adequately care for their children and may send them to live with other families. In extreme cases, children may be exploited for illegal activities (e.g., child labor, drug trafficking, prostitution) and/or end up with physically and sexually abusive caregivers and become child slaves, referred to as restaveks in Haiti. This is the case for many young Haitian children, particularly girls, according to Joan Conn from the Restavek Freedom Foundation (NASEM, 2016d). Individual speakers noted that in other instances, a combination of poverty, family dysfunction, and/or a child’s developmental delay or disability—and the absence of community services—may lead families to place their children in residential care (NASEM, 2016b,d).
As presented by Kevin Browne of Nottingham University, institutionalization of young children can negatively affect a child’s social behavior, interaction with others, and emotional attachments (NASEM, 2016c). He added that institutionalization was associated with poor cognitive performance and language deficits in some children. Kutlesic elaborated that caring for children that are separated from their families presents a complex problem that demands evidence-based solutions, a continuum of care, and family and alternative placements for children with a diverse set of health, education, and psychosocial needs (NASEM, 2016c). Research has shown that quality of caregiving is crucial regardless of the living situation (e.g., family-based or institutional care) with a primary goal being protection of children from trauma and abuse (Gray et al., 2015; Whetten et al., 2014).
Though keeping children in well-functioning families is the preferred living situation whenever possible, for children for whom family placements are not available, short-term placements in well-run residential facilities that are small, and include quality educational programs and well-trained and responsive staff can facilitate positive developmental outcomes for these children, stated Kutlesic (NASEM, 2016c). Nonetheless, the strengthening of families and the development of community services when they are not available in local contexts is essential for moving beyond child survival toward ensuring all children thrive (Huebner et al., 2016).
Investments in Young Children Living in Dangerous and Unstable Socioeconomic or Political Contexts Can Equal Investments in Human Rights
In many regions of the world, child labor is a prevalent issue among vulnerable communities. As Parker presented, many migrant children as young as 7 years old from Central America and Mexico who now live in the United States report having worked on farms (NASEM, 2016c). This burden has led them to drop out of school, incur injuries from farm equipment, endure physical abuse, and suffer effects from the exposure to pesticides. Programs such as CocoaAction in Côte d’Ivoire and Ghana, introduced by Bill Guyton of the World Cocoa Foundation, aim to intervene and ensure sustainability by providing “productivity packages” to cocoa farmers, which include training, new planting material and fertilizers, and good agricultural practices, in conjunction with coordinated investments in community development across the areas of primary education, child labor, and women’s empowerment (NASEM, 2016d). The result, according to Guyton, is stronger families (NASEM, 2016d).
Armed conflict is a major barrier to the well-being of young children, as stated by Maysoun Chehab from UNESCO (IOM and NRC, 2014). The number of forcibly displaced people worldwide is currently at its highest since World War II, said Eskinder Negash from the U.S. Committee for Refugees and Immigrants and Mohannad Al-Nsour from the Eastern Mediterranean Public Health Network (NASEM, 2016a,c), citing 59.5 million displaced people in 2014. Al-Nsour added that more than 50 percent of Syrian refugees displaced in the Middle East are children. According to Chehab, as a result of conflict and displacement, children’s living conditions are degraded and caregivers stop sending their children to school for safety reasons. She added that schools can become recruitment targets for child soldiers, compounding the fear that caregivers have of sending their children outside of the home, even though they understand the benefits of education. Thus, crisis situations not only disrupt schooling but potentially also health and protection systems.
Health systems in times of crisis become overloaded with patients, resulting in overworked health care workers and shortages of vital medication and equipment, stated Al-Nsour (NASEM, 2016a). Negash and Jan Peeters of Ghent University both emphasized that stakeholders must ensure the protection of these vulnerable children and that early childhood services are made accessible and affordable to displaced families because if not, developing brain circuits can be disrupted as a result of this violent environment, leading to lifelong negative consequences for these children (NASEM, 2016c).
Masten stated that while there is not enough intervention research on what works best for children in different kinds of conflict situations, there is a growing body of work focused on understanding the connections among the resilience exhibited between the individual child and his or her family, community, and society as systems (NASEM, 2016a). She credited these new areas of research with better alignment among the aforementioned systems that support the child (NASEM, 2016a). Investments in children’s development, including the tools and supports they need to develop into healthy and thriving individuals, also promote the resilience of future societies, she stated. While Masten recognized a significant amount of emerging research on children living in conflict, she also offered three actionable guidelines for improved practices:
- Define the role of first responders, including those beyond emergency personnel such as educators and parents.
- Restore a sense of normalcy for children and for families.
- Promote an environment for healthy development, but do so recognizing behavioral barriers including discrimination, inequality, and recruitment into violence.