Yale School of Public Health Professor Rafael Pérez-Escamilla has a message for low- and moderate-income countries: if you want to grow your economy and uplift your people, put money into early childhood development.
“For every dollar invested in the first 1,000 days of life, a country receives about $8 in returns,” said Pérez-Escamilla, Ph.D., who recently co-authored two articles for the 2016 Lancet series on early childhood development. “The social cost of inaction is enormous. The key message to decision-makers is, if you are really serious about your country attaining the Sustainable Development Goals . . . early childhood development should be the foundation of your effort.”
Pérez-Escamilla, who specializes in nutrition and food insecurity, Professor James F. Leckman from the Yale Child Study Center, and Dr. Nicholas Alipuli, the former director for global programs of UNICEF, outlined the Lancet series’ key findings on April 8 during a session of the Yale Undergraduates for UNICEF Conference on Refugee Children at the Loria Center. A central insight, Pérez-Escamilla said, was that kindergarten is too late to start addressing crippling development deficits created by poverty, violence and poor nutrition. It is essential to invest much more in children from gestation through three years of age a highly sensitive time when the basic structure of the brain is forming at an incredible speed, he said. Those services should aim to create a nurturing environment through better food, health care and clean water to early stimulation and education, parenting skills and child protection, he said.
“Quality, quality, quality needs to be a very big focus of the future programs in this area, not just how many kids we reach,” he said.
The challenge facing developing nations is huge, Pérez-Escamilla said. The series’ authors estimate that 43 percent of children under 5 in low- and middle-income nations—some 250 million kids—are at risk. The impact will be devastating if nothing is done, Pérez-Escamilla said. Without intervention, disadvantaged children will earn about 25 percent less as adults, the series’ researchers concluded. Their societies will also suffer severe economic and social consequences. In some Sub-Saharan African countries, GDP would be 13 percent higher if these children met their potential, Pérez-Escamilla said. “These are really staggering levels of GDP that get lost as a result of poor early childhood development,” he said. By contrast, the cost of the programs to improve early childhood development through improved parenting skills and preventing maternal depression, meanwhile, is relatively small, as little as 50 to 75 additional cents per child per year, he said.
The social cost of inaction is enormous.
Rafael Pérez-Escamilla
The next question is how best to deliver these interventions? There is still much to learn, Pérez-Escamilla said. For The Lancet series, researchers looked at large, successful childhood health initiatives in India, Chile, South Africa and Bangladesh, he said. Each is different, with South Africa’s effort, for example, focused on preschool, India in community centers, Bangladesh operating out of health clinics, and Chile following a strong intersectoral approach, he said.
One common element in each country was that ordinary citizens demanded action, he said. That “led the politicians to express highly visible concern about poverty, inequity and social exclusion, which at the end of the day are the underlying causes of poor early childhood development,” Pérez-Escamilla said.
The School of Public Health sponsored Saturday’s conference, along with the Yale Child Study Center and Yale Undergraduates for UNICEF.