Published on Investing in Health

Investing early in children: what will it take to spur integrated action?

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Last week, the World Bank hosted the Washington, D.C., launch of The Lancet’s 2011 child development series, four years after the journal revealed that more than 200 million children under five in low- and middle-income countries were not reaching their developmental potential, due to (preventable) risk factors like stunting, iron and iodine deficiencies, and lack of cognitive stimulation. The latest research findings in The Lancet provide even greater clarity on the developmental inequality that continues to plague many millions of children.

There is increasing certainty that the biological and psychosocial insults experienced by children in utero and during the first few years of their lives will harm their developing brains and compromise their subsequent cognitive and socio-emotional development. The new evidence underscores the risks to healthy child development posed by a litany of insults: intrauterine growth restriction (fetal undernutrition), malaria, HIV infection, lead exposure, maternal depression, institutionalization, and exposure to violence. And when children suffer from cumulative, multiple risks—often part and parcel of their poor environments—especially during the sensitive early childhood period beginning before birth, the long-term effects are clearly evident in their poor academic performance, lower earning capacity, and ultimately, the intergenerational transmission of poverty.

The Lancet also discusses critically important protective factors such as breastfeeding, responsive caregiver-child interaction, opportunities for young children to play and learn, and maternal education. The authors lay out a menu of evidence-based, effective interventions covering nutrition (breastfeeding, micronutrient supplementation, good child feeding practices), health (prevention and treatment of malaria and HIV), and important contributors to child development such as young child stimulation, maternal education and mental health services, and reduced exposure to violence.

Yet the devil in the details is the how. Clearly, we have to break down technical, political, and institutional silos. Perhaps this is the ultimate test of defining and implementing an integrated approach. But we cannot placate ourselves by doing a decent job only by investing in young child nutrition or maternal and child health or pre-school programs for 3-5- year-olds. We will fall short of our goal.

Dr. Richard Horton, editor-in-chief of The Lancet and a new video released by the UNICEF Innocenti Research Centre (see videos here) posed the same blunt query as the child development series was launched: We have to ask ourselves the question: What is the point of saving a poor child’s life if we are going to abandon that child in their early years? How will we respond to it?


Leslie Elder

Senior Nutrition Specialist, Global Financing Facility

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