Lancet: Prosperity of Children, Families, Nations Threatened by Disparities in Early Childhood Development

International study led by University of Maryland School of Medicine researcher underscores the need for global action to address disparities

Baltimore, October 4, 2016—A staggeringly high proportion -- 43 percent or 250 million -- of children under age five and living in low- and middle-income countries may not reach their developmental potential due to poverty and chronic under nutrition, according to the latest series on early child development, Advancing Early Childhood Development, published today in The Lancet.

“New evidence presented in this Series underscores how influential the early years of life, especially for children under three, are on subsequent health and development,” says the lead author of the first paper in the Series and steering committee member Maureen Black, PhD, the John A. Scholl, MD and Mary Louise Scholl, MD Professor of Pediatrics at the University of Maryland School of Medicine (UM SOM). “Not just for individual children, but for their children and subsequent generations.” 

The power of early childhood development on global health, economic development, and sustainability has been recognized by international agencies, including the World Bank Group, UNICEF, and the World Health Organization. Leaders of those organizations will speak at the launch of the new Series in Washington on October 5.

Advancing Early Childhood Development: from Science to Scale is the third in a series of landmark studies, articles and commentaries on early childhood development published by The Lancet. The papers in this Series strengthen and extend the conclusions and recommendations from the 2007 and 2011 Series that poverty and adverse childhood experiences have long-term physiological and epigenetic effects on brain development and cognition, thereby negatively impacting adult health and well-being. The 2016 Series updates the science and focuses on strategies to implement effective early child development programs at scale. 

The series concluded that policies and programs based on Nurturing Care can reduce early disparities among young children, with beneficial effects that extend through life, impacting health, well-being, and wage-earning. Nurturing care – defined as responsive caregiving in a stable environment that is free from threats, sensitive to children’s health and nutrition, with ample opportunities for early learning – takes place in the context of families and communities, with support from multiple sectors – including health, nutrition, education, child and social protection.

Key Findings

Researchers set out to examine current commitments to childhood development and propose strategies to implement effective programs that take into account new scientific evidence for interventions. One such finding is that access to high quality childhood development opportunities have a positive effect on future earning potential. Disadvantaged children who do not receive nurturing care from conception through the first few years of life may forfeit a quarter of their earning capacity as adults.

The study also found that providing early, nurturing care has lifelong benefits. Failure to implement programs that help families and caregivers provide nurturing care threatens to undermine sustainable development goals. The call to action in the Series urges policymakers to look beyond the prevention and treatment of disease as a public health concern, and add nurturing care for young children as a critical factor in the overall health of all children.

Additional key findings include:

• The accumulation of adversities, beginning prior to conception and continuing throughout prenatal and early life, can disrupt brain development, attachment, and early learning. Development delays are evident in the first year, worsening during early childhood and continue throughout life.
• Coordination, monitoring, and evaluation are needed across sectors to ensure that high quality early childhood development services are available throughout early childhood and primary school.
• Action at global, national, and local levels is needed to increase political commitment to and investment in early childhood development.

“The research shows that interventions attenuate the detrimental effects of extreme poverty and other disadvantages facing millions of young children throughout the world, including Baltimore,” adds Dr. Black. “Poverty and early adversities, such as violence exposure, can disrupt early brain development, resulting in lifelong disparities through academic and behavioral problems, even extending to chronic health conditions, such as cardiovascular problems. Ensuring the health and development of young children is a wise investment that reduces disparities, promotes lifelong development, and strengthens nations.

Although since the year 2000 substantially more research has been published on childhood development and investments in childhood development programs have increased, services remain uncoordinated and of unequal quality.

“Despite an increase in focus on early childhood development, barriers remain,” says Black. “Because childhood development reaches across multiple government sectors – health, education, welfare – there is limited accountability and consistency in services. Moving forward, the Sustainable Development Goals of the United Nations endorse early child development and hold stakeholders accountable for childhood development outcomes.”

Dr. Black is also the Director of the Division of Growth and Nutrition in the Department of Pediatrics at UM SOM and Director of the interdisciplinary Growth and Nutrition Practice at the University of Maryland Children’s Hospital (UMCH).

“Dr. Black’s years-long contributions to these Lancet Series are testament to her advocacy for children and passion to use research for global change,” says UM SOM Dean E. Albert Reece, MD, PhD, MBA, who is also vice president for medical affairs at the University of Maryland and the John Z. and Akiko K. Bowers Distinguished Professor. “We commend her as she works with leaders around the world to make a difference.”

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About the University of Maryland School of Medicine

The University of Maryland School of Medicine, chartered in 1807 as the first public medical school in the United States, continues today as a leader in accelerating innovation and discovery in medicine. The School of Medicine is the founding school of the University of Maryland, and is an integral part of the 11-campus University System of Maryland. Located on the University of Maryland's Baltimore campus, the School of Medicine works closely with the University of Maryland Medical Center and Medical System to provide a research-intensive, academic and clinically based education. With 43 academic departments, centers and institutes and a faculty of more than 3,000 physicians and research scientists, plus more than $400 million in extramural funding, the School is regarded as one of the leading biomedical research institutions in the U.S.A., with top-tier faculty and programs in vaccine development, cancer, brain science, surgery and transplantation, trauma and emergency medicine, and human genomics, among other centers of excellence. The School is not only concerned with the health of the citizens of Maryland and the U.S.A., but also has a global presence, with research and treatment facilities in more than 35 countries around the world. For more information, please visit http://medschool.umaryland.edu.

About the University of Maryland Children’s Hospital

The University of Maryland Children’s Hospital is recognized throughout Maryland and the mid-Atlantic region as a resource for critically and chronically ill children. UMCH physicians and staff excel in combining state-of-the-art medicine with family-centered care. More than 100 physicians specialize in understanding how to treat conditions and diseases in children, including congenital heart conditions, asthma, epilepsy and gastrointestinal disorders. The neonatal intensive care unit (NICU) provides the highest level of care to the tiniest newborns.