Mary E Young, Director, Center for Child Development, China Development Research Foundation, Beijing, China
As the global community comes to the end of the Millennium Development Goals period and defines new aspirations for the next 15 years, we should recognise that how the world looks in 2030 will depend on what we do for the infants and young children of today. This article looks back on progress made in the field of early childhood over recent years, and identifies the priorities that should shape the agenda to 2030.
In developing countries, where 92% of the world’s children live, one in 20 does not survive beyond the first 5 years (Wang et al., 2014). By 2030, this proportion is expected to improve to one in 40 children (Gates and Gates, 2015). But while a larger number of children will survive, they will not have the opportunity to realise their full potential, owing to deprivations in early childhood. Currently, approximately 200 million children under the age of 5 are estimated to be at risk of poor development due largely to poverty and under-nutrition. The actual number of at-risk children may be even higher (Engle et al., 2007).
Poverty and other deprivations – such as violence and abuse, insufficient nurturing and care, and limited social interaction and stimulation – have devastating, lifelong effects on young children. Early neglect is particularly potent and is often manifested as a lack of attachment between child and parent or caregiver. In our ever-changing and increasingly mobile world, families are being torn apart by conflict, natural disasters, migration, and emigration – all of which take a toll on children’s health and development, not only in the short term but also for life. One example is China which, over the past 30 years, has experienced the largest rural-to-urban migration in human history, resulting in 61 million children left behind in rural areas to be cared for by people other than their parents. Assuring that all children can develop to their fullest potential is the challenge we face for human development in 2030. The costs of not taking action to mediate the risk factors for young children are huge. As underscored in a series of The Lancet in 2011, vulnerable and disadvantaged children who are deprived of early childhood interventions experience a loss of more than two grades in school and more than 30% of income as adults (Engle et al., 2007, 2011).
Building on the early years
The Bernard van Leer Foundation has been a mainstay over the years in improving children’s lives and development. From the 1960s through the 1980s, the Foundation encouraged community agents to take the initiative and support young children’s development, on their own in their own communities. The Foundation nurtured local NGOs to help communities build their own early childhood development infrastructures, forge links among institutions and promote self-actualised development (Myers, 1992).
In 1977, PROMESA began in four small fishing communities in Colombia. Designed to improve the healthy development of young children in a home-based intervention, it was an innovative approach to meeting young children’s needs for healthcare, childcare and education by training mothers to be parent educators and community leaders. Its success as an alternative to the existing centre-based early education model led to the Government’s adoption and expansion of home-based childcare programmes. PROMESA was supported by the Bernard van Leer Foundation and others and was administered by an NGO, the Fundación Centro Internacional de Educación y Desarrollo Humano (CINDE, International Centre for Education and Human Development).
In the 1980s, in a similar fashion, the Bernard van Leer Foundation helped to pilot a network of non-formal nursery schools, as an outgrowth of the Harambee movement, rooted in and controlled by communities in Kenya. In this network, schools tested ways of improving early childhood development services. The findings were incorporated into the scaling-up of early childhood services, financed by the World Bank, in Kenya in 2001.
The Foundation’s focus on building sustainable, locally based programmes for mothers and children in communities yielded many insights on early childhood development which have been applied elsewhere. And these early initiatives by the Foundation and others concentrated national and international attention on early childhood. Large and powerful actors – multilateral, bilateral, and regional groups – now fill the stage and are taking action with well-conceived and well-constructed scripts.
The growth in research, public awareness and well-grounded practices of early childhood development over recent decades is very promising. In the past 15 years in particular, an explosion of evidence on the early years from neuroscience, economics, and social science research has converged to yield a deeper understanding of human development. We now have concrete evidence that the first 2000 days of life, before a child enters primary school, are critical and set a child’s lifetime trajectories in health, learning, and behaviour. The evidence clearly shows that a baby’s environment can modify his or her genetic blueprint and that epigenetic phenomena trigger trajectories. Prenatal stressors, mothers’ and infants’ nutrition, playtimes and interactions between a child and a parent or caregiver all contribute to the child’s development.
The United Nations’ launch of the Millennium Development Goals (MDGs) in 2000 accelerated the world’s focus on children. Three MDGs (4, 5, and 6) were aimed at reducing child and maternal mortality and infectious diseases. The knowledge base underpinning the emphasis on child survival rested on public health measures such as nutrition, sanitation, immunisation, oral rehydration, micronutrient use, bed-nets and HIV prevention. Now we must widen our attention from children’s survival to their full development, employing comprehensive, integrated approaches that engage all sectors – education, family and social protection, health and nutrition.
The world community has embraced the importance of investing in early childhood development as a priority to improve children’s outcomes and to advance human development in societies. The calls for action come from different venues. The World Bank, the Inter-American Development Bank and the African Development Bank are highlighting early childhood programmes in their lending portfolios. UNICEF is focusing on health, nutrition, education and protection as basic rights of children. In its Education for All initiative, UNESCO is working in-country to advocate for young children, develop learning outcome measures and monitor programmes. The World Health Organization has established guidelines for delivering health services at each developmental phase of childhood, beginning during pregnancy. And the United Nations Development Programme’s 2014 Human Development Report focuses on life-cycle vulnerabilities beginning in infancy and the need to promote human capability and protect the most vulnerable.
In countries and regionally, governments and NGOs are partnering to scale-up successful early childhood development interventions. Examples include Chile’s Crece Contigo (‘Chile Grows with You’), Brazil’s Better Early Child Development Program, Mexico’s Centres of Childhood Development (Centros de Desarrollo Infantil, CENDI), Pakistan’s Lady Health Visitors, and China’s recently issued National Child Development Plan (for 2014–2020) for Poverty-Stricken Areas, which targets 40 million children in 680 counties (see page 102). In addition, South Africa’s Brain Booster programme is improving young children’s pre-literacy and numeracy, and the Step by Step programme, pioneered by the Open Society in 29 countries of the Commonwealth of Independent States (CIS), continues to make a difference.
From all these venues, the key messages are:
• Start at the beginning, in the early years of childhood. Integrate childcare, nurturance and stimulation with health, nutrition, and education services.
• Get ready for success. Ensure that all children have access to comprehensive community services before they enter school, and begin with those who are most vulnerable and disadvantaged.
• Be inclusive. Incorporate early childhood into all national policies and plans across sectors.
Closing the gap
Despite the increased awareness globally of the importance of early childhood and the emergence of early childhood programmes in all regions, we still have much to do to close the gap between what we know and what we’re doing. In developing countries, in particular, we need to harness the science of early childhood development and translate it into policies and large-scale programmes for young children.
One question we have to ask ourselves is, ‘If investment in early childhood is so good, why isn’t there more of it?’ We have the knowledge and the data, but to really take off we need policies that will drive more resources, both public and private. The obstacles can be overcome with dedication and focus. Three obstacles, in particular, are inherent in early childhood interventions: the payoffs come later, not sooner; early childhood development is complex, with multiple dimensions; and changes begin in families and communities.
Policymakers and government leaders must come to appreciate that the need to invest in early childhood development is immediate and that the returns come in long-term, positive effects for children, families, societies and nations. Further, the complexity of early childhood development requires integrated approaches that encompass all levels and sectors of society. No single sector can solve the problem on its own and, as yet, there is no ministry of human development. And the necessary infrastructure for early childhood must be built from the bottom up, beginning with families in local communities, supported by a framework of national policy and a network of local, regional and national institutions.
Looking forward to 2030
Understanding that early childhood development is human development, we need to move away from traditional ministerial silos in the public sector and embrace a trans-disciplinary platform focused on early human development. As we head toward 2030, action is needed on three fronts.
1 Continue vigorously to foster global understanding and awareness of early childhood development.
• Communicate the importance of healthy brain development in early childhood for overall health, well-being, and competence of populations. Spread this knowledge to parents and caregivers, policymakers, bankers, financiers and heads of state to increase demand for early childhood development interventions.
• Promote a trans-disciplinary science of human development, involving all university disciplines, including the health sciences, economics and social sciences.
2 Expand children’s access to early childhood programmes and ensure that they are of high quality.
• Strengthen early childhood development ‘building blocks’ through training and professional development of practitioners and advancing the ingredients of quality.
• Identify what works and what does not work in early childhood interventions, to better design and scale-up successful, cost-effective options.
• Engage the private sector in investing in young children.
• Promote national decision-making that emphasises early childhood development as the first step in poverty reduction and human capital formation.
3 Assess outcomes in early childhood development.
• Design and use population measures to track children’s development based on objective assessments of the state of children, not subjective appraisals of where a child should be on a milestone chart.
• Encourage use of these data as evidence for making sound policy decisions and for aligning policies with programme evaluations.
• Seek to attain some level of universality, accountability and comparability of early childhood development measures within and among countries.
Our efforts must converge on these tasks so that we can speak in a common language globally about the trans-disciplinary dimensions of early human development and further enhance our knowledge of how to promote human development. Much of our know-how will come from lessons learned and best practices in countries that are already implementing coherent, comprehensive social policies incorporating early childhood development.
We need smart social policies and programmes for the malleable first years of childhood to improve the quality of parenting and the environments of all children and, especially, of those at greatest risk. Every child deserves a fair and equal chance to develop his or her full potential.
Engle, P.L., Black, M.M., Behrman, J.R.,Cabral de Mello, M., Gertler, P. J.,Kapiriri, L. et al. (2007). Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. The Lancet 369(9557): 229–42.
Engle, P.L, Fernald, L.C., Alderman, H., Behrman, J., O’Gara, C., Yousafzai, A. et al. and the Global Development Steering Group. (2011). Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. The Lancet 378 (9799): 1339–53.
Gates, B. and Gates, M. (2015). 2015 Gates Annual Letter: Our Big Bet for the Future. Available at: http://www.gatesnotes.com/2015-annual-letter?page=0&lang=en (accessed April 2015).
Myers, R. (1992). The Twelve Who Survive: Strengthening programmes of early childhood development in the Third World. New York, NY: Routledge, p. 319.
Wang, H., Liddell, C.A., Coates, M.M., Mooney, M.D., Levitz, C.E., Schumacher, A.E. et al. (2014). Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet 384(9947): 957–79.