Building the foundations of social capital - investing in the early years Professor Frank Oberklaid Director, Centre for Community Child Health Royal Children’s Hospital Melbourne Policy Network Forum - Melbourne April 12, 2007

Neuroscience of brain development Brain is not mature at birth The brain organises itself through the interaction of genes responding to the local environment - a dance between genes and experience Brain is changed by experiences Relationships program brain development Adversity impacts on brain development

Influencing outcomes Biology - at present state of knowledge we cannot do much to change biology - although we can reduce the risk to the fetus - e.g. avoid substance abuse during pregnancy Environment - there is much we can do to change the environment in which young children grow and develop

Brains are built over time Brain architecture and skills are built in a hierarchical ‘bottom-up’ sequence Foundations important - higher level circuits are built on lower level circuits Skills beget skills - the development of higher order skills is much more difficult if the lower level circuits are not wired properly It is biologically and economically more efficient to get things right the first time

Brain architecture The brain is sculpted by early experiences - this determines the development of neural circuits Plasticity of the brain decreases over time and brain circuits stabilise, so it is much harder to alter later There is constant pruning of circuits that are not used - concept of developmental windows or critical periods

The importance of relationships Nurturing and responsive relationships build healthy brain architecture that provides a strong foundation for learning, behaviour and health When protective relationships are not provided, levels of stress hormones increase - this impairs cell growth, interferes with formation of healthy neural circuits, and disrupts brain architecture

Positive stress Moderate and transient stress responses - results in mild increases in stress hormone levels and short lived increases in heart rate Precipitants include the challenges of new people and situations, dealing with frustration, adult limit setting, the pain of a fall or injection Important part of healthy development as it occurs in the context of stable and supportive relationships

Tolerable stress Stress responses that can disrupt brain architecture, but are buffered by supportive relationships that facilitate adaptive coping Precipitants include death or serious illness of a loved one, parent divorce, witnessing a frightening event, major trauma or illness, a natural disaster, homelessness Generally time limited, so gives the brain opportunity to recover from potentially damaging effects

Toxic stress Strong and prolonged activation of body’s stress response in absence of buffering protection of adult support Precipitants include extreme poverty, physical or emotional abuse, chronic neglect, severe maternal depression, substance abuse, family violence Disrupts brain architecture and leads to stress management systems that have lower threshold of activation - increases risk of stress related physical and mental illness

Adversity Research on the biology of stress in early childhood helps explain some of the underlying reasons for differences in learning, behaviour and physical and mental health Any adversity or stress that impacts on the parents may affect their relationship with their young child and thus has the potential to have a negative impact on brain development - e.g. effects of rapid social change

Disordered brain circuits… Problems in childhood Beginning of pathways to problems later in life Evidence that many problems in adult life have their origins in pathways that begin in childhood

Worrying problems in childhood Child abuse and neglect School readiness - many children vulnerable Poor literacy and school achievement Mental health problems - ADHD, conduct disorders, aggressive and anti-social behaviour Obesity

Even more worrying problems in adult life Mental health problems Family violence and aggressive/anti-social behaviour Crime Poor literacy - skills shortages Welfare dependency Substance abuse Obesity and its associations

Implications for policy Need for increased government expenditure to address the challenges of poor outcomes in childhood and in adult life But in the long term such policies –Are not sustainable - there will never be sufficient resources –Are often ineffective - treating established problems is difficult (and expensive) Better to get it right the first time

The developmental trajectory and life course Outcome Age Risk factors Protective factors

Risk and protective factors Risk Factors Child Family Community School Protective Factors Child Family Community School Outcome Negative vulnerability Positive resilience

Poverty and health (0-3 years) Less likely to: Be breast fed Be fully immunised Receive well child care Have regular and consistent access to health services More likely to have: Low birth weight Developmental delay Higher incidence of SIDS Higher injury rate Suboptimal growth More frequent hospitalisations Behavioural disorders

‘Double jeopardy’ for children living in poverty Experience most health problems and more likely to be unimmunised, but live in unhealthy environments and have fragmented access to good health care Highest risk of academic failure, but attend the most disadvantaged schools Families experience the most stress but have fewest social supports Parents have the greatest need of but often have greatest difficulty in accessing services

Vocabulary Growth - First 3 Years Vocabulary Age - Months High SES Middle SES Low SES B Hart & T Risley Meaningful Differences in Everyday Experiences of Young American Children 1995

Literacy As children move from year 3 to year 5, the disparity among those meeting literacy standards grows

So what can we do? Need major shift in public policy, focusing not just on treatment but also on prevention and early intervention (fence on top of cliff rather than more ambulances at the bottom) There is evidence from successful demonstration programs that early intervention works - ie the research points to the way we can build the fences

Intervention effects and costs of social-emotional mental health problems over time (Bricker) Time High Low Cost Intervention effectiveness

So we now have... A good understanding of early influences on children’s development and of risk factors Research showing that patterns established early in life have long term consequences - crime, literacy and educational achievement, mental health, medical conditions Research demonstrating the efficacy of early intervention programs in improving outcomes later in life Add to this the economic imperative…

Cumulative Cost and Savings 0 5,000 10,000 15,000 20,000 25,000 30, Age of Child (years) Cumulative dollars per child Cumulative savings Cumulative cost

Rates of Return to Human Development Investment Across all Ages Return Per $ Invested Age R 6 Pre- School SchoolPost School Pre-school Programs School Job Training 18 Pedro Carneiro, James Heckman, Human Capital Policy, 2003

The best investment in economic development that government and the private sector can make is in the healthy development of children… Society should adopt the perspective of ‘child-development-as-economic-development.’ ‘In our view, the economic case for why we should invest in early childhood development is closed.’ Arthur J. Rolnick Senior Vice President and Director of Research Federal Reserve bank of Minneapolis

Early childhood is everybody’s business Important role for business sector –Macro level (broad economic): skilled and educated workforce, social capital, international competitiveness, preservation of democratic institutions and fair society –Micro level (workplace): attraction and retention of skilled staff, productivity, work life balance

New champions needed The business community is in a position to understands the importance of early childhood better than anybody - concerned less with the cost of programs and services but rather with the return on investment We need to forge powerful new partnerships between academics, policy makers, business community, professionals and parents Early childhood investment is both a moral imperative and makes sound economic sense

If we want to build a better world for our children and your grandchildren, then we need to care about everyone else’s children and grandchildren too. They will have an impact on the sort of world our own children and grandchildren will inherit