The first Sustainable Development Goal (SDG) is to “ensure that all human beings can fulfil their potential in dignity and equality”.1 Protecting, promoting, and supporting early childhood development is essential to enable everyone to reach their full human potential.
In 2007, a Lancet Series estimated that 200 million children younger than 5 years in low-income and middle-income countries (LMICs) were at elevated risk of not reaching their human potential.2 A second Lancet Series in 2011 identified risks and protective factors, and growing evidence of the effectiveness of interventions to prevent loss of human potential.3, 4
In this Series on early childhood development, Paper 1 takes stock of what has been achieved in the era of the Millennium Development Goals (MDGs).5 Paper 2 reviews effective interventions and new findings in neuroscience and genetics.6 Scientific evidence confirms conception to age 3 years as the time during which adverse exposures exert the greatest harm, and effective interventions the greatest benefit. The development of young children has been neglected to date in favour of emphasis on survival and preparation for school. For this reason, the focus in this paper is on optimisation of development at scale during early childhood.6
We argue that the burden of poor development is larger than currently estimated because we lack global data to include additional risk factors. This burden makes it imperative to scale up effective interventions to protect, promote, and support early childhood development. We identify crucial elements of the pathways to successful scale-up, including political prioritisation, creation of supportive policy environments, the use of existing delivery systems to build further efforts, and affordability. Action in all sectors is important to promote early childhood development, particularly in education and in social and child protection.
Key messages
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The burden of poor child development is currently underestimated because risks to health and wellbeing go beyond stunting and extreme poverty.
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Effective interventions for early childhood development are now available and can feasibly be integrated into existing systems in health, education, and social and child protection.
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The scale-up of early child development programmes rests on political prioritisation of efforts to address deep social problems such as poverty, inequality, and social exclusion through interventions starting early in the life course.
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Policies that alleviate poverty and buttress family resources create a supportive environment to promote, protect, and support early childhood development at scale.
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Health and nutrition services are ideal starting points to scale up interventions for early childhood development. Efforts to promote nurturing care of young children built onto existing services for maternal and child health and nutrition are affordable.
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Societies around the world pay a high price, now and into the future, for not acting to protect children and promote early child development. The 43% of children younger than 5 years of age in low-income and middle-income countries, who are at elevated risk of poor development because of stunting or extreme poverty, are likely to forego about a quarter of average adult income per year. The benefits forfeited at a country level can be up to two times the gross domestic product spent on health.
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Services and interventions to support early childhood development are essential to ensuring that everyone reaches their potential over the life course and into the next generation, the vision that is core to the Sustainable Development Goals.
In this paper, we highlight the role of the health and nutrition sector as an entry point to scaling up of programmes for early childhood development. It has extensive reach to women and children during the crucial period from conception throughout early childhood, and is thus well placed to deliver early childhood development services to women, families, and the youngest children, together with education, and social and child protection. Further, there is good evidence of effectiveness, feasibility, and affordability of inclusion of interventions for early childhood development in reproductive, maternal, newborn, and child health (RMNCH) services. UNESCO,7, 8, 9 UNICEF,10 the World Bank,11 and other agencies12 are committed to promotion of early childhood development, and WHO's commitment is expressed in leadership of the Global Strategy for Women's, Children's and Adolescents' Health 2016–2030. Finally, the Strategy, supported under the UN Secretary General's Every Women Every Child initiative, offers new opportunities for linking child health, nutrition, and development.13
We address affordability by estimating the additional costs of including two scalable, evidence-based interventions for child development in the existing maternal and child health package, and the probable costs of inaction to both individuals and societies. We conclude with a call for actions that are essential for enabling all children to begin life with improved prospects for health, prosperity, and equality, essential to achieve the SDGs in “strengthened global solidarity”.