A recent report from the National Academies of Sciences, Engineering, and Medicine—Vibrant and Healthy Kids: Aligning Science, Practice, and Policy to Advance Health Equity—reviews the remarkable growth in the science of early brain and child development. The report reinforces what’s well known: early life experiences have a profound effect on long-term brain functioning and effects on other body systems, especially those that are related to how we handle stress and fear. This developing evidence helps clarify the mechanisms by which early life experiences (both positive and negative) impact health outcomes later in life.
Given the substantial growth in the science of early childhood development, the Robert Wood Johnson Foundation asked the National Academies to review the evidence and provide recommendations for translating science to practice, policy, and systems of care. Bringing together clinicians, neuroscientists, early childhood education experts, child development researchers, economists, and health policy experts, the National Academies committee presents recommendations in human capital investment, parent/family support, health care, and early childhood education.
The persistent health disparities in the United States, especially those associated with poverty and racism, have clear basis in these early experiences. Thus, the committee recommends bringing several income and other support programs to scale—paid family leave, universal family income, nutrition, housing assistance, and high-quality early care and education—to help strengthen the health of families and caregiver connections. These programs have demonstrated improvements in short- and long-term health outcomes, but currently reach only a small proportion of eligible households. Based on the clear evidence of the importance of child and caregiver support at all points in a child’s development—from pre-conception to prenatal to pediatric care—the committee also recommends assuring access to health care services throughout the life course. This includes Increasing access to patient- and family-centered care, ensuring access to preventive services and essential health benefits (with Medicaid as a likely source for current periods of uninsurance), and increasing culturally and linguistically appropriate outreach and services.
Medicaid (as a major insurer of children and youth in the US) and other private and public payers should innovate with new programs and financing arrangements that focus on integrating health care with social services. Several states, including Oregon, New York, and North Carolina, are already testing systems to connect kids and families with the resources they need to address the social, economic, and environmental barriers to their health. The report reviews several of these efforts and recommends that the content and delivery of health care change to include more attention to the social determinants of health; to change the structure of health care by transformation to team-based care, and to reform the financing of health care to incentivize these changes. Importantly, the report also discusses how the complex needs to strengthen child and brain development need to incorporate efforts from multiple sectors (e.g., education, social services, juvenile justice). Several states are already engaging in cross-sector goal setting and funding—a strategy needed to link health care innovations with others in basic household support and early childhood education. The National Academies report provides a roadmap to address these complex and critical problems for children in the US.