Early Childhood Education
Interventions Addressing the Social Determinants of Health
What is early childhood education?
Early childhood education (ECE) aims to improve the cognitive and social development of children ages 3 or 4 years.[1, 2] ECE interventions can improve all children’s development 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 because 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 available to all children regardless of income. For example, Georgia and Oklahoma have implemented universal preschool programs for all 4-year-olds. Other programs, including federally funded Head Start and 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] The Child-Parent Center program is another example of a widely-implemented model program; it expanded into 33 sites in Minnesota, Wisconsin and Illinois 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 a person’s lifetime. 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 more 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, 15-17] In the United States, 15.5 million children (21%) lived in families with incomes below 100% Federal Poverty Level in 2010. Also 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 development and act as a protective factor against the future onset of adult disease and disability. ECE 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 three types of center-based ECE programs, found that they were associated with:
- Improved cognitive development[2, 19-21]
- Improved emotional development[2, 19]
- Improved self-regulation[2, 19]
- Improved academic achievement[2, 19]
ECE benefit estimates, both short- and long-term, included some or all of the following major components[2,19]:
- Increases in maternal employment and income
- Reductions in crime, welfare dependency, and child abuse and neglect
- Savings from reduced grade retention
- Savings in health care costs
- Savings in remedial education and child care costs
- Improvement in health outcomes associated with education
- Earnings gains associated with high school graduation
- Better jobs and higher earnings throughout employment years for children participating in these programs
Additional studies have found that ECE is associated with other positive health effects, including healthier weight (such as fewer underweight, overweight, and obese children).
A recent systematic economic review found that the economic benefits exceed costs for different types of ECE programs. Based on earnings gains alone, the benefit-to-cost ratios ranged from
- 3.06:1 to 5.19:1 for State and District programs
- 1.58:1 to 2.51:1 for Federal Head Start programs
- 1.76:1 to 4.39:1 for model programs
The rate of return on investment was much higher when all benefit components including earnings gains were considered. For model programs, based on total benefits, the return on every dollar invested was :
- $2.49 for the Abecedarian program
- $8.60 for the Perry Preschool
- $10.83 for Chicago Child-Parent Center
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- Hahn RA, Barnett WS, Knopf JA, et al. Early Childhood Education to Promote Health Equity: A Community Guide Systematic Review. Journal of public health management and practice 2016;22(5):E1-E8.
- Halfon N, Hochstein M. Life course health development: an integrated framework for developing health, policy, and research. Milbank Quarterly 2002;80(3):433-79.
- Anderson LM, Charles JS, Fullilove MT, et al. Providing affordable family housing and reducing residential segregation by income: a systematic review. American journal of preventive medicine. 2003;24(3):47-67.
- Robert Wood Johnson Foundation, University of Wisconsin Population Health Institute. County health rankings & roadmaps: Universal pre-kindergarten. 2015. Available at: Universal pre-kindergarten. Accessed March 7 2016.
- Barnett W, Friedman-Krauss A, Gomez R, Horowitz M, Weisenfeld G, Brown KS, JH. The state of preschool 2015: State preschool yearbook. Rutgers Graduate School of Education, National Institute for Early Education Research;2016. Available at: State of Preschool Yearbooksexternal icon
- Campbell FA, Ramey CT, Pungello E, Sparling J, Miller-Johnson J. Early childhood education: Young adult outcomes from the Abecedarian Project. Applied Developmental Science 2002;6(1): 42-57.
- Schweinhart LJ, Montie J, Xiang Z, Barnett WS, Belfield CR, Nores M. Lifetime effects: the High/Scope Perry Preschool study through age 40. 2005.
- McCormick W. Federal $15M grant supports one of the most comprehensive childhood education programs in the nation. College of Education and Human Development News. December 21, 2011.Available at: Federal $15M grant supports one of the most comprehensive childhood education programs in the nationexternal icon. Accessed May 30, 2018.
- VanLandeghem K, Curtis D, Abrams M. Reasons and strategies for strengthening childhood development services in the healthcare system. National Academy for State Health Policy; 2002.
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- Purves D. Neural activity and the growth of the brain. CUP Archive; 1994.
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- Boyce WT, Ellis BJ. Biological sensitivity to context: I. An evolutionary–developmental theory of the origins and functions of stress reactivity. Development and psychopathology. 2005;17(02):271-301.
- Hahn RA, Rammohan V, Truman BI, 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):312-23.
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- Ramon I, Chattopadhyay SK, Barnett WS, Hahn RA. Early Childhood Education to Promote Health Equity: A Community Guide Economic Review. J Public Health Manag Pract. 2018;24(1):e8-e15.
- 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):140-65.
- Camilli G, Vargas S, Ryan S, Barnett WS. Meta-analysis of the effects of early education interventions on cognitive and social development. Teachers College Record. 2010;112(3):579-620.
- Lumeng JC, Kaciroti N, Sturza J, et al. Changes in body mass index associated with Head Start participation. Pediatrics 2015;135(2): e449-e456.