1. Young Children at Risk Closing the Gap between what we know and what we do Mary Eming Young Early Child Development Team Human Development Network Children and Youth The World Bank

2. 2 This presentation will focus on Why early childhood? –The magnitude of the problem: Young children under threat –Global, Science, and Business imperative Do we know what to do? –is it doable? Challenges and Opportunities

3. Magnitude of Children at Risk

4. % of Children < 5y who are Stunted by Region, 2004 WHO 2006 Magnitude of the Problem

5. La “ventanilla de oportunidad” para mejorar la nutrición es muy pequeña…desde antes del embarazo hasta los 18-24 meses de edad Fuente de datos: Shrimpton y otros (2001) ¿Cómo podemos mejorar la nutrición?

6. % of Children < 5y who are Poor (<$1 per day) by Region, 2004 WHO 2006

7. % of Children < 5y who are Disadvantaged (stunted or poor or both) by Region, 2004 WHO 2006

8. Population of Children under 5 years & Disadvantaged by Regions, 2004 WHO 2006

9. % of Disadvantaged Children by Country Source: S. Grantham-McGregor, Y.B. Cheung, S. Cueto, et.al.: Developmental potential in the first 5 years for children in developing countries, Lancet, 369:60-70, 2007.

10. What Do We Know?

11. Experience-Based Brain Development in the early years of life sets neurological and biological pathways that affect throughout life: Health Learning Behavior

12. Conocimientos de la Neurociencia: Las experiencias en la primaria infancia impactan: Arquitectura cerebral Química neuronal Expresión de genes Cognición + Emoción + Comportamiento social Todos estos Elementos son Pre-requisito para el Desarrollo Humano, Social y la Produc- tividad Economica en la adultez

13. The Global Imperatives 1.Eradicate extreme poverty and hunger 2.Achieve universal primary education 3.Promote gender equality and empower women 4. Reduce child mortality, and other health goals 1.Expand and improve comprehensive early childhood care and education 2.Universal primary education by 2015 3.Learning and life skills programs for youth and adults 4.50% increase in adult literacy rates by 2015 5.Gender parity by 2005 and gender equality by 2015 6.Improving quality of education MDGsEFA Goals

14. Rates of Return to Human Development Investments Across All Ages Pre-school Programs School Job Training Return Per $ Invested R 2 4 6 0618 Age Pre- schoolSchool Post-school Source: P. Carneiro & J. Heckman, Human Capital Policy, NBER, 2003. 8

15. Regional trends in pre-primary Developed/transition countries Latin America/Caribbean East Asia/Pacific South and West Asia Arab States Sub-Saharan Africa A three-fold increase in pre-primary enrolments over 30 years More than 1 in 3 children now enrolled but huge regional differences

16. % of Children who Enter Grade 1 and Reach Grade 5 by Region UNESCO 2005

17. Gap in Children Development by Income DQ Age months Urban middle class n=78 Urban poor n=268 Source:: Walker et al.

18. Vocabulary Scores by SES quartiles in 36 to 72 month old children Ecuador age in months Source: C. Paxson, N. Schady: Cognitive development among young children in Ecuador : The roles of wealth, health and parenting, The World Bank, Policy Research Working Paper, 3605, 2005.

19. Later cognitive deficits associated with being in the lowest wealth quintile <3yrs in 5 longitudinal studies (SD scores) Philippines Indonesia S Africa Brazil^ Guatemala* ^Grades attained *boys

20. IQ scores of stunted and non-stunted Jamaican children from age 9-24 mo to 18 y Non-stunted. Stunted. -0.6 -0.4 -0.2 0 0.2 0.4 0.6 0.8 Griffiths on Enrollment (9-24 mo) Griffiths ) (33-48 mo) Stanford- Binet (7-8 y) WISC-R (11-12 y) WAIS (17-18 y) SD score Source: S. Grantham-McGregor, and J. Habadani: Preventing the loss of children’s developmental potential, Centre of Excellence for Early Childhood Development, Vaudreuil (Québec) April 26-28, 2006

21. 10 Intergenerational Transmission of Poverty preschool child low IQ, behavior problems school poor school achievement, behavior problems adult l ow education low skilled/no work high fertility depressed/stressed Poor stimulation, health and nutrition National Economy

22. 10 If all these were true, do we know what to do? To start with, better nutrition, essential mother and child care, and early sustained sensory and social stimulation Program Options: Delivery of services to young children Education and support of parents training and support of caregivers/paraprofessionals Sensitization of the public, through the mass media, to the value of ECD Promoting and strengthening community- based activities

23. Lancet paper 3 - Effects of interventions on cognitive and social-emotional development Type of intervention Significant results (of total evaluations) Effect sizes Mainly centre- based 8 of 80.23 to 1.40 Mainly parent- child and parenting 5 of 60.45 to 0.8 Comprehensive 5 of 60.37 to 1.80

24. Philippines Early Child Development Program Developmental index varies by child’s age and duration of time in program, favoring younger children with longer duration. Child age at initiation

25. Closing the Gap… Opportunities and Challenges

26. 0123456 parent-oriented child-oriented Opportunities.. Source of Brain Stimulation age Components of Early Childhood Development and Parenting Centers: ECD & care (parental and non-parental) arrangements Play-based learning Prenatal & postnatal supports Nutrition programs

27. Implement an Overall ECD Strategy  Intervene early, often and effectively  Allocate sufficient resources  Ensure relevant training New generation competent in the understanding of human development  Build systems, not just projects. Emphasize equity, sustainability, and population health.  Monitor and evaluate. Measure child development outcomes

28. Barriers to Implementing ECD Programs 1.Economics 2.Lack of understanding (public and professional) 3.Lack of qualified staff 4.Lack of community ECD data 5.No commitment to equality of opportunity for all young children

29. World Bank Cumulative Lending for ECD by Regions (1990-2006) $1.7 billion over 16 years

30. Still need to do much more… to close the gap Magnitude of Disadvantaged ChildrenLending by Region

31. Indicators to Monitor Differ Significantly Child Development Index (measure of child development outcome)

32. Monitoring Child Development Outcomes  Building monitoring systems  Collecting population- based child outcome data

33. Challenges.. Where does ECD fit in? …where cross-sector policies/programs are essential to human capital development Age 24 18 14 5 0 Health and Nutrition Education Social Protection Early Child Development (Health/Nutrition, School Readiness, Parenting) Youth Development (School-to-work, Second-chance programs, Risky behaviors, participation, crime and violence)

34. Challenges.. A Diverse Field Providers Governments (national, sub-national) Private sector (non-profit and for-profit) International non-governmental organizations Community-based organizations Informal provision of care for children aged 0 to 8, by parents or extended family, mainly at home but sometimes in other family or community settings. Primary education (age 6 up) ECCE policies and programs for ages 3 and up -pre-primary education -non-formal education ECCE policies and programs for ages 0 to 2 -organized care and education -non-formal care or education -support to parents Informal care and child rearing Organized care and education - parental leave

35. Preschools Local school authorities Public health Munici- palities Community services Parks & recreation Early intervention Health Social services Education Family support Chaos Child care Parenting centres Children’s mental health centres Kindergarten s

36. Optimal Investment Levels Pre-schoolSchool Post-school Age0 Challenges … Optimal vs. Actual Investment Example of the U.S Cumulative Public Investment Source: P. Carneiro & J. Heckman, Human Capital Policy, NBER, 2003; Voices for America and the Child and Family Policy Center, Early Learning Left Out An Examination of Public Investment in Education and Development by Child Age, 2004.

37. Sweden’s Public Expenditure for Children 0-17 age old - Ultimate Goal!! Source: S. Bremberg (2006), National Institute of Public Health, Karolinska Institute, Stockholm, Sweden