1. The Global Context for Early Child Development Clyde Hertzman Head, Knowledge Hub for ECD World Health Organization’s Commission on Social Determinants of Health Director, Human Early Learning Partnership of BC President, Council on Early Child Development

2. International Commission on the Social Determinants of Health “ The goal is not an academic exercise, but to marshal scientific evidence as a lever for policy change — aiming toward practical uptake among policymakers and stakeholders in countries ”. WHO Director-General LEE Jong-Wook’s address to the World Health Assembly, May 2004

3. What good does it do to treat people's illnesses... …then send them back to the conditions that made them sick?

4. How is the Commission organized?  Michael Marmot, Chair  20 members (volunteers)  Small Secretariat in Geneva  Smaller scientific team around Marmot in London.  Meetings in-person 3-4 times per year. Pillars of work:  9 Knowledge Networks  Countries (and regions) involved  Civil society and global partners involved (World Bank, etc.)  World Health Organisation (WHO)

5. Building Health & Health Equity Priority Public Health Early Child Development Women + Gender Equity Urban Settings Social Exclusion Employment Conditions Globalization Health systemsMeasurement KNOWLEDGE NETWORK THEMES

6. 10-12 KN Members Country partners Civil Society Representation Secretariat at WHO and UCL Commissioner representatives WHO Technical Officer for ECD ECD Knowledge Network

7. ECD-KN: Starting Points  ECD means: physical, social/emotional, language/cognitive development  Biological Embedding--environments get under the skin  Determinants of ECD are found from the intimate level (family) to the broadest level (global)  These determinants matter according to how they influence the transactional and nurturant qualities of the child ’ s intimate environment

8. `Sensitive periods’ in early brain development Vision 0 1237654 High Low Years Habitual ways of responding Language Emotional control Symbol Peer social skills `Numbers’ Hearing Graph developed by Council for Early Child Development (ref: Nash, 1997; Early Years Study, 1999; Shonkoff, 2000.) “Pre-school” yearsSchool years

9. Health Problems Related to Early Life Coronary Heart Disease Non-insulin Dependent Diabetes Obesity Blood Pressure Aging and Memory Loss Mental Health (depression)

10. ECD-KN: Starting Points  ECD means: physical, social/emotional, language/cognitive development  Biological Embedding--environments get under the skin  Determinants of ECD are found from the intimate level (family) to the broadest level (global)  These determinants matter according to how they influence the transactional and nurturant qualities of the child ’ s intimate environment

11. Individual Brain and Biological Development, Genetics, Age, Sex Family, Cultural, Economic, & Social Environment Family Health Status and Dwelling Environment Residential Community Health Status and Cultural, Economic, Service & Social Environments Regional Health Status and Ecological, Economic, Policy, Political & Social Environments National Health Status, Ecological, Economic, Policy, Political & Social Environments Global Ecological, Corporate/Economic, Policy, Political & Social Environments Civil Society ECD Services & Programs Relational Community (Social ties,Tribe, Religion, etc.) Institutional/historical time

12. % Vulnerable on Early Development Indicator, by SES Mexico Kosovo Australia Canada 31.9 29.1 23.1 13.7 Rich

13. Social Gradients by Country Cuba Argentina Brazil Colombia Chile Parents' Education - Years 14 8 12 16 200 240 280 320 360 Language Score

14. Overarching Messages 1.Transactional environment is the principal social determinant of healthy child development. 2.Because of sensitive periods in brain development, early environments are the most powerful determinant of basic competencies. 3.Early development goes on to influence health, in different ways, across the life course. 4.Inequities in ECD have the capacity to threaten the level of competency needed for societal survival.

15. Key Political Messages parents/caregivers need support from community and government at all levels political leaders can play an important role in guaranteeing universal access to a range of ECD services child survival and health agendas are indivisible from ECD

16. What the Commission recommended “Equity from the start”

17. What the Commission recommended Commit to and implement a comprehensive approach to early life, building on existing child survival programs and extending interventions in early life to include social/emotional and language/cognitive development.

18. What the Commission recommended Governments build universal coverage of a comprehensive package of quality early child development programs and services for children, mothers, and other caregivers, regardless of ability to pay.

19. What is Chile doing?

20. Chile Crece Contigo + JUNJI + Junaeb + Income/Workplace/Neighborhood Policies = “the Chilean System”

21. What is Chile doing? Chile Crece Contigo + JUNJI + Junaeb + Income/Workplace/Neighborhood Policies = “the Chilean System” How does it measure up?

22. 1.The World Health Organization’s unique contribution to early child development globally 2.Generating the necessary commitment at multiple levels of society 3.Structural requirements for implementation 4.Strategies for implementation 5.Monitoring processes and outcomes related to ECD 6.Creation of a Global Alliance for Early Child Development What the ECD-KN Recommended

23. 2. Generating Commitment bringing the ‘science of ECD’ to policy by all levels of government need to do social marketing to new audiences outside the usual ECD community ‘Global Alliance’ should disseminate science of ECD use commitment to UNCRC as dissemination tool need funding base to incorporate science of ECD into policy and monitor ECD provisions of UNCRC

24. 3. Structural Requirements need for an inter-ministerial policy framework at the level of national government governments adopt child and family-friendly policies international community and governments to create inter-disciplinary opportunities for training and research in resource-poor countries government involvement of local communities

25. 4. Strategies for Implementation gov’t building ECD onto existing child survival and health platforms gov’t needs strategy for ‘scaling up’ effective programs w/o sacrificing effective characteristics gov’t to ensure free, compulsory access to school w/o gender inequities UNICEF -- create global formula for calculating ECD expenditure and ‘return on investment’ that works for poor countries

26. 5. Monitoring expand evidence base in resource-poor countries gov’t held accountable for universal birth registration local NGOs to monitor access to quality ECD services gov’t/international agencies to fund monitoring of programs and ECD outcomes

27. What do we need in monitoring? 1.Population based outcome data to tell whether or not we are making progress. 2. Data relevant to all the sectors that have responsibility. 3. Linked data that can track developmental trajectories from birth to adulthood.

28. The Early Development Instrument

29. What Does the EDI Measure?

30. All Children Included in their 5th Year of Life

33. Not Always Equal

34. Greater Area Means More Vulnerability

37. 500 Initiatives

38. What are we doing post ECD-KN?

39. Children across the globe thriving to the highest level of ECD Broadening the global alliance Strengthening the population health orientation of EHD Initiating Knowledge mobilization Providing assistance to monitor ECD- related processes Facilitating the surveillance of CRC To build/support capacities of countries to improve EHD To create and sustain a global momentum for EHD

40. The International Consortium for Population- Based Early Child Development Indicators

41. The Consortium can provide technical assistance in: Assessment of contexts EDI adaptation and pilot-testing EDI Implementation Data Analysis and mapping Dissemination of results

44. www.earlylearning.ubc.ca