The Global Context for Early Child Development

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The Global Context for Early Child Development

• Clyde Hertzman
• Head, Knowledge Hub for ECD
• World Health Organizations Commission on Social
  Determinants of Health
• Director, Human Early Learning Partnership of BC
• President, Council on Early Child Development

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International Commission on the Social
Determinants of Health

• The goal is not an academic exercise, but to
  marshal scientific evidence as a lever for policy
  change aiming toward practical uptake among
  policymakers and stakeholders in countries.

WHO Director-General LEE Jong-Wooks address to
the World Health Assembly, May 2004
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What good does it do to treat people's illnesses
...
then send them back to the conditions that made
them sick?
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How is the Commission organized?

• Pillars of work
• 9 Knowledge Networks
• Countries (and regions) involved
• Civil society and global partners involved (World
  Bank, etc.)
• World Health Organisation (WHO)

• Michael Marmot, Chair
• 20 members (volunteers)
• Small Secretariat in Geneva
• Smaller scientific team around Marmot in London.
• Meetings in-person 3-4 times per year.

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KNOWLEDGE NETWORK THEMES
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ECD Knowledge Network
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ECD-KN Starting Points

• ECD means physical, social/emotional,
  language/cognitive development
• Biological Embedding--environments get under the
  skin
• Determinants of ECD are found from the intimate
  level (family) to the broadest level (global)
• These determinants matter according to how they
  influence the transactional and nurturant
  qualities of the childs intimate environment

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Sensitive periods in early brain development
Pre-school years
School years
High
Numbers
Peer social skills
Symbol
Sensitivity
Language
Habitual ways of responding
Emotional control
Vision
Hearing
Low
1
2
3
7
6
5
4
0
Years
Graph developed by Council for Early Child
Development (ref Nash, 1997 Early Years Study,
1999 Shonkoff, 2000.)
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Health Problems Related to Early Life
Coronary Heart Disease Non-insulin Dependent
Diabetes Obesity Blood Pressure Aging and
Memory Loss Mental Health (depression)
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ECD-KN Starting Points

• ECD means physical, social/emotional,
  language/cognitive development
• Biological Embedding--environments get under the
  skin
• Determinants of ECD are found from the intimate
  level (family) to the broadest level (global)
• These determinants matter according to how they
  influence the transactional and nurturant
  qualities of the childs intimate environment

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Relational Community (Social ties,Tribe,
Religion, etc.)
ECD Services Programs
Civil Society
Family, Cultural, Economic, Social Environment
Institutional/historical time
Individual Brain and Biological Development,
Genetics, Age, Sex
Family Health Status and Dwelling Environment
Residential Community Health Status and
Cultural, Economic, Service Social Environments
Regional Health Status and Ecological, Economic,
Policy, Political Social Environments
National Health Status, Ecological, Economic,
Policy, Political Social Environments
Global Ecological, Corporate/Economic, Policy,
Political Social Environments
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Vulnerable on Early Development Indicator, by
SES
31.9
29.1
23.1
Canada
Kosovo
13.7
Australia
Mexico
Rich
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Social Gradients by Country
360
Cuba
320
Argentina
Chile
280
Brazil
Language Score
Colombia
240
200
1
4
8
12
16
Parents' Education - Years
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• Overarching Messages
• Transactional environment is the principal social
  determinant of healthy child development.
• 2. Because of sensitive periods in brain
  development, early environments are the most
  powerful determinant of basic competencies.
• 3. Early development goes on to influence health,
  in different ways, across the life course.
• 4. Inequities in ECD have the capacity to
  threaten the level of competency needed for
  societal survival.

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Key Political Messages

• parents/caregivers need support from
  community and government at all levels
• political leaders can play an important role in
  guaranteeing universal access to a range of ECD
  services
• child survival and health agendas are
  indivisible from ECD

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What the Commission recommended

• Equity from the start

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What the Commission recommended

• Commit to and implement a comprehensive
• approach to early life, building on existing
  child survival programs and extending
  interventions in early life to include
  social/emotional and language/cognitive
  development.

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What the Commission recommended

• Governments build universal coverage of a
• comprehensive package of quality early child
• development programs and services for
• children, mothers, and other caregivers,
  regardless of ability to pay.

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What is Chile doing?
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What is Chile doing?

• Chile Crece Contigo
• JUNJI
• Junaeb
• Income/Workplace/Neighborhood Policies
• the Chilean System

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What is Chile doing?

• Chile Crece Contigo JUNJI
• Junaeb
• Income/Workplace/Neighborhood Policies
• the Chilean System
• How does it measure up?

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What the ECD-KN Recommended

• The World Health Organizations unique
  contribution to early child development globally
• Generating the necessary commitment at multiple
  levels of society
• Structural requirements for implementation
• Strategies for implementation
• Monitoring processes and outcomes related to ECD
• Creation of a Global Alliance for Early Child
  Development

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2. Generating Commitment

• bringing the science of ECD to policy by all
  levels of government
• need to do social marketing to new audiences
  outside the usual ECD community
• Global Alliance should disseminate science of
  ECD
• use commitment to UNCRC as dissemination tool
• need funding base to incorporate science of ECD
  into policy and monitor ECD provisions of UNCRC

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3. Structural Requirements

• need for an inter-ministerial policy framework
  at the level of national government
• governments adopt child and family-friendly
  policies
• international community and governments to
  create inter-disciplinary opportunities for
  training and research in resource-poor
  countries
• government involvement of local communities

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4. Strategies for Implementation

• govt building ECD onto existing child survival
  and health platforms
• govt needs strategy for scaling up effective
  programs w/o sacrificing effective
  characteristics
• govt to ensure free, compulsory access to
  school w/o gender inequities
• UNICEF -- create global formula for calculating
  ECD expenditure and return on investment
  that works for poor countries

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5. Monitoring

• expand evidence base in resource-poor
  countries
• govt held accountable for universal birth
  registration
• local NGOs to monitor access to quality ECD
  services
• govt/international agencies to fund monitoring
  of programs and ECD outcomes

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What do we need in monitoring?

• Population based outcome data to tell whether or
  not we are making progress.
• 2. Data relevant to all the sectors that have
  responsibility.
• 3. Linked data that can track developmental
  trajectories from birth to adulthood.

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The Early Development Instrument
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What Does the EDI Measure?
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All Children Included in their 5th Year of Life
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Not Always Equal
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Greater Area Means More Vulnerability
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500 Initiatives
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• What are we doing post ECD-KN?

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Children across the globe thriving to the
highest level of ECD
To create and sustain a global momentum for EHD
To build/support capacities of countries to
improve EHD
Broadening the global alliance
Providing assistance to monitor ECD-related
processes
Strengthening the population health orientation
of EHD
Facilitating the surveillance of CRC
Initiating Knowledge mobilization
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The International Consortium for Population-Based
Early Child Development Indicators
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The Consortium can provide technical assistance
in
Dissemination of results
Data Analysis and mapping
EDI Implementation
EDI adaptation and pilot-testing
Assessment of contexts
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