Early Childhood Education
What is early childhood education?
Early childhood education (ECE) aims to improve the cognitive or social development of children ages 3 or 4 years.[1, 2] ECE interventions can improve all children’s developmental trajectories and act as a protective factor against the future onset of adult disease and disability. Children disadvantaged by poverty may experience an even greater benefit, since ECE programs also seek to prevent or minimize gaps in school readiness between low-income and more economically advantaged children.
All ECE programs must addresses one or more of the following: literacy, numeracy, cognitive development, socio-emotional development, and motor skills. Some programs may offer additional components, including recreation, meals, health care, parental supports, and social services. ;ECE programs may be delivered in a variety of ways and settings. State and district programs may be universally available to all children regardless of income. Georgia and Oklahoma are two examples of states that have implemented universal preschool programs for all 4-year-olds in their states. The federally funded Head Start program and other evidence-based model programs, such as the Abecedarian and Perry Preschool programs, are provided specifically for low-income and at-risk children.[2, 7, 8] Another example of a widely-implemented model program is the Child-Parent Center program, which expanded into 33 sites in MN, WI and IL through a University of Minnesota project funded by the U.S. Department of Education.
What is the public health issue?
Childhood development is an important determinant of health over the life of an individual. Early developmental opportunities can provide a foundation for children’s academic success, health, and general well-being. Preschool-aged children experience profound biological brain development and achieve 90 percent of their adult brain volume by age 6. This physiological growth allows children to develop functional skills related to information processing, comprehension, language, emotional regulation, and motor skills. [11, 12] Experiences during early childhood affect the structural development of the brain and the neurobiological pathways that determine a child’s functional development.
Positive experiences support children’s cognitive, social, emotional, and physical development, and conversely, adverse experiences can hinder it.[13, 14] Additionally, strong associations have been found between the biological effects of adverse early childhood experiences and numerous adult diseases, including coronary artery disease, chronic pulmonary disease, and cancer.[13, 14]
Children in low-income families often are exposed to a greater number of adverse early childhood experiences and environmental factors that delay or compromise their development and place them at a disadvantage for healthy growth and school readiness.[3, 15, 16] In the United States, 15.5 million children (21%) lived in families with incomes below 100% FPL in 2010. In 2010, less than half of children in families in the lowest income quartile were enrolled in center-based early childhood education programs.
What is the evidence of health impact and cost effectiveness?
Early childhood education interventions can improve children’s developmental trajectories and act as a protective factor against the future onset of adult disease and disability. ECE interventions can counteract the disadvantage some children experience, improve their social and cognitive development, and provide them with an equal opportunity to achieve school readiness, and lifelong employment, income, and health.[2, 3] Systematic reviews of studies examining the effects of ECE programs, found that they were associated with:
- Improved cognitive development[2, 19, 20]
- Improved emotional development
- Improved self-regulation
- Improved academic achievement
Additional longer-term benefits included:
- Reduction in teen birth rates
- Reduction in crime rates
Additional studies have found that ECE is associated with other positive health effects, including healthier weight (including fewer underweight, overweight, and obese children) and reduced child maltreatment.
Cost analyses of different types of ECE found that they are associated with positive benefits-to-cost ratios. Benefit-cost analyses conducted by the Washington State Institute for Public Policy (WSIPP) resulted in the following benefits to cost ratio estimates: 
- State and district early childhood education programs: $5.19:1 
- Head Start: Benefits to cost ratio $3.09:1 
A review of additional analyses examining the benefit-cost ratios of model ECE programs found that they too were associated with positive benefit to cost ratios:
- Child-Parent Centers: $5:1 
- Perry Preschool: $5:1 
- Abecedarian Project: $3:1 
ECE benefit estimates, both short and long term, included some or all of the following major components:
- Increases in maternal employment and income
- Reductions in crime, welfare dependency, and child abuse and neglect[2, 27]
- Savings in remedial education and child care costs
- Improvement in health outcomes associated with education
- Earnings gains associated with high school graduation[2, 27]
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- Blackman, J.A., Early intervention: A global perspective. Infants & Young Children, 2002. 15(2): p. 11-19.
- The Guide to Community Preventive Services, Promoting Health Equity Through Education Programs and Policies: Center-Based Early Childhood Education. The Community Guide: What Works to Promote Health 2015 October 27, 2015 [cited 2015 November 30]; Available from: Promoting Health Equity Through Education Programs and Policies: Center-Based Early Childhood Education.
- Halfon, N. and M. Hochstein, Life course health development: an integrated framework for developing health, policy, and research. Milbank Quarterly, 2002. 80(3): p. 433-479.
- Anderson, L.M., et al., The effectiveness of early childhood development programs: A systematic review. American journal of preventive medicine, 2003. 24(3): p. 32-46.
- County Health Rankings & Roadmaps, Universal Pre-Kindergarten. March 11, 2015 [cited 2016 March 7]; Available from: Universal pre-kindergarten.
- Barnett, W., et al., The state of preschool 2015: State preschool yearbook. 2016, Rutgers Graduate School of Education, National Institute for Early Education Research. Availabl from: The state of preschool 2015
- Campbell, F.A., et al., Early childhood education: Young adult outcomes from the Abecedarian Project. Applied Developmental Science, 2002. 6(1): p. 42-57.
- Schweinhart, L.J., et al., Lifetime effects: the High/Scope Perry Preschool study through age 40. 2005.
- University of Minnesota, Federal $15M grant supports one of the most comprehensive childhood education programs in the nation. CE+HD News 2011 [cited 2016 June 15]; Available from: Federal $15M grant supports one of the most comprehensive childhood education programs in the nation
- VanLandeghem, K., et al., Reasons and strategies for strengthening childhood development services in the healthcare system. National Academy for State Health Policy, 2002: Portland (ME).
- Brown, T.T. and T.L. Jernigan, Brain development during the preschool years. Neuropsychology review, 2012. 22(4): p. 313-333.
- Purves, D., Neural activity and the growth of the brain. 1994: CUP Archive.
- Shonkoff, J.P., W.T. Boyce, and B.S. McEwen, Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. Jama, 2009. 301(21): p. 2252-2259.
- Boyce, W.T. and B.J. Ellis, Biological sensitivity to context: I. An evolutionary–developmental theory of the origins and functions of stress reactivity. Development and psychopathology, 2005. 17(02): p. 271-301.
- Hahn, R.A., et al., Effects of full-day kindergarten on the long-term health prospects of children in low-income and racial/ethnic-minority populations: A community guide systematic review. American journal of preventive medicine, 2014. 46(3): p. 312-323.
- Duncan, G.J., K.M. Ziol‐Guest, and A. Kalil, Early‐childhood poverty and adult attainment, behavior, and health. Child development, 2010. 81(1): p. 306-325.
- Jiang, Y., M.M. Ekono, and C. Skinner, Basic Facts about Low-income Children, Children under 18 Years, 2014, N.C.f.C.i. Poverty, Editor. 2016, Columbia University Mailman School of Public Health: New York, NY.
- Duncan, G.J. and K. Magnuson, Investing in preschool programs. The Journal of Economic Perspectives, 2013. 27(2): p. 109-132.
- Burger, K., How does early childhood care and education affect cognitive development? An international review of the effects of early interventions for children from different social backgrounds. Early childhood research quarterly, 2010. 25(2): p. 140-165.
- Camilli, G., et al., Meta-analysis of the effects of early education interventions on cognitive and social development. Teachers College Record, 2010. 112(3): p. 579-620.
- Lumeng, J.C., et al., Changes in body mass index associated with Head Start participation. Pediatrics, 2015. 135(2): p. e449-e456.
- Mersky, J.P., J.D. Topitzes, and A.J. Reynolds, Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago Child–Parent Center preschool program. Children and Youth Services Review, 2011. 33(8): p. 1454-1463.
- Washington State Institute for Public Policy, Benefit-Cost Technical Documentation: Washington State Institute for Public Policy Benefit-Cost Model. 2015: Washington State.
- Washington State Institute for Public Policy, State and district early childhood education programs. Benefit-Cost Results 2015 December 2015 [cited 2016 June 20]; Available from: State and district early childhood education programs.
- Washington State Institute for Public Policy, Head Start. Benefit-Cost Results 2015 December 2015 [cited 2016 June 20]; Available from: Head Start.
- Isaacs, J.B., Cost-Effective Investments in Children Isaacs. 2007, The Brookings Institute: Washington D.C.
- Reynolds, A.J., et al., Age 26 cost–benefit analysis of the child‐parent center early education program. Child development, 2011. 82(1): p. 379-404.