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Introduction¹

On September 14, 2017, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the intersection of health and early childhood care and education, two key social determinants (or influencing factors) of health. The workshop was held at New York University (NYU) Langone Health in New York City. This workshop follows a 2014 roundtable workshop that considered the interface between the education and health sectors broadly, from research and metrics to cross-sectoral partnerships and financing (IOM, 2015). The 2017 workshop continued that discussion, with a deeper focus on early childhood (birth through age 5) as a critical period in human development and an important opportunity for educational and related interventions. In addition to the 2015 publication, workshop background materials provided to all participants included the report Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation (IOM and NRC, 2015) and other resources to help orient participants to contextual data relevant to this topic.

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¹ This workshop was organized by an independent planning committee whose role was limited to identification of topics and speakers. This Proceedings of a Workshop was prepared by the rapporteur as a factual summary of the presentations and discussions that took place at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine; the Health and Medicine Division; or the roundtable, and they should not be construed as reflecting any group consensus.

FOCUSING ON CHILDREN

There are a variety of reasons to focus on early childhood care and education as a population health² strategy, said Debbie Chang, the senior vice president of policy and prevention at Nemours Children’s Health System (Nemours). Early care and education programs provide an opportunity to connect with families on a routine basis to provide information and support. Sixty percent of children from birth to 5 years, Chang said, spend at least a part of every day in out-of-home settings or under non-parental care while their parents or primary caregivers are working, attending school, participating in job training, or tending to other activities. Families trust their early care and education providers as a source of information and support on child development, health, and parenting. Families see their early care providers nearly every day, and most children spend a great deal of time in early care and education settings. Children learn healthy behaviors early, and early care and education providers are key partners in that learning, Chang said. She referred participants to the work of the Nobel laureate James Heckman and colleagues, who found that children in early childhood programs that included education as well as health and nutrition interventions had improved health outcomes in adulthood, including lower levels of hypertension, metabolic syndrome, and obesity in their 30s (Campbell et al., 2014).

Early care and education programs can promote healthy behaviors through practice change (e.g., creating healthier environments, training care providers to incorporate healthy activities into daily routines and curricula) and policy change. The potential for spread and scale of changes in early care and education practices and policies is great Chang said. By weaving health promotion, preventive care, health literacy, and health care coordination into early care and education environments and making it easier for both health care providers and early care and education providers to coordinate and cooperate through policy levers, we can change the health status of entire geographies of children, Chang said.

WORKSHOP OBJECTIVES

As one of its major activities, the Roundtable on Population Health Improvement sponsors workshops for its members, stakeholders, and the public to discuss issues of importance for improving the nation’s health,

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²Kindig and Stoddart (2003) defined population health as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” and Jacobson and Teutsch (2012) proposed the term “total population health” to better acknowledge the geopolitical context to population health, its measurement, and policies, including resource allocation, that pertain to it.

said George Isham, a senior advisor at HealthPartners, a senior fellow at the HealthPartners Institute for Education and Research, and a co-chair of the roundtable. The roundtable’s vision is of a strong, healthful, and productive society, which cultivates human capital and equal opportunity. This vision rests on the recognition that outcomes such as improved life expectancy, quality of life, and health for all are shaped by interdependent social, economic, environmental, genetic, behavioral, and health care factors, and will require robust national and community-based policies and dependable resources to achieve.

The agenda for this workshop was developed by an independent planning committee that included Debbie Chang, Marquita Davis, Jennifer Frey, Jacqueline Jones, Paula Lantz, Phyllis Meadows, Larry Pasti, Morton Swartz, and Valora Washington. (The planning committee’s Statement of Task is provided in Box 1-1.) The workshop was designed to explore the intersection of health and early care and education (birth through age 5), with particular attention paid to equity,³ and across all early care and education settings. The workshop agenda was developed by the planning committee to meet the following objectives:

• Highlight what is working at the intersection of health and early care and education; discuss the importance of early care and education in achieving overall goals for early childhood development; and consider current priorities.
• Provide examples of successful initiatives focused on early care and education and health.
• Create space for conversations around the examples provided, including spread and scale for greater impact, sustainability (including funding models), the collection of relevant data, and the identification of gaps that need to be addressed.

ORGANIZATION OF THE WORKSHOP AND PROCEEDINGS

This proceedings summarizes the presentations and discussions that took place at the workshop Exploring Early Childhood Care and Education Levers to Improve Population Health. The workshop was organized around three panel sessions consisting of presentations and panel

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³ See, for example, the definition of “health equity” in a 2017 National Academies report, a definition that could similarly be applied to equity in an early childhood education context. “Health equity is the state in which everyone has the opportunity to attain full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance. In this report promoting health equity means creating the conditions where individuals and communities have what they need to enjoy full, healthy lives” (NASEM, 2017, p. 32).

discussions. Each panel session was followed by a “gallery walk” that gave participants the opportunity to reflect on the panel discussion with other attendees and respond (in writing) to specific questions that were posed on posters in a meeting room adjacent to the auditorium where the workshop took place. Upon reconvening in plenary session, the session moderators reported and summarized individual participants’ comments from the gallery walk.

The first panel explored some aspects of the evidence available at the intersection of health with early care and education, including examples of what works in practice and at the policy level to influence children’s health and development/educational outcomes (Chapter 2). The second panel shared lessons learned from cross-sector collaborations in the health and early care and education sectors (Chapter 3). The final panel focused on policy challenges and opportunities, including issues related to financing, the workforce, and equity (Chapter 4). The workshop concluded with summary remarks and reflections on the discussions by Isham and Meadows (Chapter 5). The appendixes to the proceedings include an overview of the input shared in individual participant comments during the gallery walk interactive portions of the workshop and a compendium of links and citations pertaining to the many programs described or mentioned by the day’s presenters.