Young Children at Risk

Closing the Gap between what we know and what we do

Mary Eming Young

Early Child Development Team

Human Development Network Children and Youth

The World Bank

2

This presentation will focus on

• Why early childhood?

– The magnitude of the problem: Young

children under threat

– Global, Science, and Business imperative

• Do we know what to do?

– is it doable?

• Challenges and Opportunities

Magnitude of Children at Risk

•

% of Children < 5y who are Stunted by Region, 2004

WHO 2006

14.0

15.9

17.3

20.6

37.4

38.7

27.9

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

LAC

ECA

EAP

MENA

AFR

SA

World

In %

WHO 2006

Magnitude of the Problem

La “ventanilla de oportunidad” para mejorar la nutrición es muy pequeña…desde antes del embarazo hasta los 18-24 meses de edad

-2.00

-1.75

-1.50

-1.25

-1.00

-0.75

-0.50

-0.25

0.00

0.25

0.50

Edad (meses)

Pun

taje

Z d

e pe

so p

ara

la e

dad

(Cen

tro

Nac

iona

l de

Est

adís

ticas

de

Sal

ud d

e lo

s E

stad

os U

nido

s) América Latina y el Caribe

África

Asia

Fuente de datos: Shrimpton y otros (2001)

¿Cómo podemos mejorar la nutrición?

% of Children < 5y who are Poor (<$1 per day)by Region, 2004

WHO 2006

3.6

3.8

10.4

11.4

27.3

46.4

22.5

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0

MENA

ECA

LAC

EAP

SA

AFR

World

In %

% of Children < 5y who are Disadvantaged (stunted or poor or both) by Region, 2004

WHO 2006

17.8

19.1

22.4

23.1

52.5

60.6

39.1

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

ECA

LAC

MENA

EAP

SA

AFR

World

In %

Population of Children under 5 years & Disadvantaged

by Regions, 2004

WHO 2006

4.7

9.9

10.8

70.9

33.6

88.8

26.4

44.1

56.5

117.0

145.7

169.3

0.0 20.0 40.0 60.0 80.0 100.0 120.0 140.0 160.0 180.0

ECA

MENA

LAC

AFR

EAP

SA

In millions, 2004

Population of children under 5 years

Population of disadvantaged children(stunted or poor or both)

52.5%

23.1%

19.1%

60.6%

22.4%

17.8%

% of Disadvantaged Children by Country

Source: S. Grantham-McGregor, Y.B. Cheung, S. Cueto, et.al.: Developmental potential in the first 5 years for children in developing countries, Lancet, 369:60-70, 2007.

What Do We Know?

•

Experience-Based Brain Development in the early years of life sets neurological and biological pathways that affect throughout life:

• Health• Learning• Behavior

Conocimientos de la Neurociencia: Las experiencias en la primaria infancia impactan:Arquitectura cerebralQuímica neuronalExpresión de genes

Cognición+

Emoción+

Comportamiento social

Todos estos Elementos son

Pre-requisito parael Desarrollo Humano,

Social y la Produc-tividad Economica

en la adultez

The Global Imperatives

1. Eradicate extreme poverty and hunger

2. Achieve universal primary education

3. Promote gender equality and empower women

4. Reduce child mortality, and other health goals

1. Expand and improve comprehensive early childhood care and education

2. Universal primary education by 2015

3. Learning and life skills programs for youth and adults

4. 50% increase in adult literacy rates by 2015

5. Gender parity by 2005 and gender equality by 2015

6. Improving quality of education

MDGsEFA Goals

Rates of Return to Human Development Investments Across All Ages

Pre-school Programs

School

Job Training

ReturnPer $

Invested

R

2

4

6

0 6 18Age

Pre-school School Post-school

Source: P. Carneiro & J. Heckman, Human Capital Policy, NBER, 2003.

8

Regional trends in pre-primary

Developed/transition countries

Latin America/Caribbean

East Asia/Pacific

South and West Asia

Arab States

Sub-Saharan Africa

A three-fold increase in pre-primary enrolments over 30 years

More than 1 in 3 children now enrolled but huge regional differences

0

10

20

30

40

50

60

70

80

1971 1976 1981 1986 1991 1999 2004

Gro

ss e

nro

lmen

ts r

ati

os

in p

re-p

rim

ary

(%

)

% of Children who Enter Grade 1 and ReachGrade 5 by Region

UNESCO 2005

61.066.0

83.0

91.0 93.098.0

0.0

20.0

40.0

60.0

80.0

100.0

SA AFR LAC MENA EAP ECA

In %

Gap in Children Development by Income

90

100

110

120

6 to 17 18 to 29 30 to 41 42 to 53 54 to 59

DQ

Age months

Urban middle class n=78

Urban poor n=268

Source:: Walker et al.

Vocabulary Scores by SES quartiles in 36 to 72 month old children Ecuador

age in months

Source: C. Paxson, N. Schady: Cognitive development among young children in Ecuador : The roles

of wealth, health and parenting, The World Bank, Policy Research Working Paper, 3605, 2005.

Later cognitive deficits associated with being in the lowest wealth quintile <3yrs in 5 longitudinal

studies (SD scores)

-1.5

-1.1

-0.7

-0.3

0.1

0.5

Philippines Indonesia S Africa Brazil^ Guatemala*

^Grades attained *boys

IQ scores of stunted and non-stunted Jamaican children from age 9-24 mo to 18 y

Non-stunted

Stunted..

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

0.8

Griffiths onEnrollment(9-24 mo)

Griffiths(33-48 mo))

Stanford-Binet(7-8 y)

WISC-R(11-12 y)

WAIS(17-18 y)

SD

sco

re

Source: S. Grantham-McGregor, and J. Habadani: Preventing the loss of children’s developmental potential, Centre of Excellence for Early Childhood Development, Vaudreuil (Québec) April 26-28, 2006

10

Intergenerational Transmission of Poverty

preschool childlow IQ, behavior problems

schoolpoor school achievement,

behavior problems

adult

low education

low skilled/no work

high fertility

depressed/stressed

Poor stimulation,

health and nutrition

National

Economy

10

If all these were true, do we know what to do?

To start with,• better nutrition,• essential mother and

child care, and• early sustained

sensory and social stimulation

Program Options:• Delivery of services to young

children• Education and support of

parents• training and support of

caregivers/paraprofessionals• Sensitization of the public,

through the mass media, to the value of ECD

• Promoting and strengthening community-based activities

Lancet paper 3 - Effects of interventions on

cognitive and social-emotional development

Type of intervention

Significant results (of total

evaluations)

Effect sizes

Mainly centre-based

8 of 8 0.23 to 1.40

Mainly parent-child and parenting

5 of 6 0.45 to 0.8

Comprehensive 5 of 6 0.37 to 1.80

Philippines Early Child Development Program

-0.5

0

0.5

1

1.5

2

4 to 12 mos 13 to 16 mos 17 to 25 mos

Duration in months

Dev

elop

men

tal I

nd

ex

(z-s

core

) 2 yrs

3 yrs

4 yrs

5 yrs

6 yrs

Developmental index varies by child’s age and duration of time in program, favoring younger children with longer duration.

Child age at initiation

Closing the Gap…

Opportunities and Challenges

0 1 2 3 4 5 6

parent-oriented

child-oriented

Opportunities.. Source of Brain Stimulation

age

Components of Early Childhood Development and Parenting Centers:

ECD & care (parental and non-parental) arrangements

Play-based learning

Prenatal & postnatal supports

Nutrition programs

Implement an Overall ECD Strategy

Intervene early, often and effectively

Allocate sufficient resources

Ensure relevant trainingNew generation competent in the understanding of human development

Build systems, not just projects.Emphasize equity, sustainability, and population health.

Monitor and evaluate. Measure child development outcomes

Barriers to Implementing ECD Programs

1. Economics

2. Lack of understanding (public and professional)

3. Lack of qualified staff

4. Lack of community ECD data

5. No commitment to equality of opportunity for all young children

World Bank Cumulative Lending for ECD by Regions (1990-2006)

$1.7 billion over 16 years

28.9

32.8

122.1

151.0

504.6

840.1

0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0 900.0

ECA

EAP

MENA

AFR

SA

LAC

Lending for ECD in millions (1990-2006)

Still need to do much more…to close the gap

Magnitude of Disadvantaged Children Lending by Region

4.7

9.9

10.8

33.6

70.9

88.8

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

ECA

MENA

LAC

EAP

AFR

SA

Population of disadvantaged children under 5 years old; in millions, 2004

28.9

122.1

840.1

32.8

151.0

504.6

0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0 900.0

ECA

MENA

LAC

EAP

AFR

SA

Lending for ECD in millions (1990-2006)

Indicators to Monitor Differ Significantly

ChildDevelopment

Index

(measureof child

developmentoutcome)

Monitoring Child Development Outcomes

Building monitoring systems

Collecting population-based child outcome data

Challenges.. Where does ECD fit in? …where cross-sector policies/programs are essential to human capital development

Age24

18

14

5

0

Healt

h a

nd

N

utr

itio

n

Ed

ucati

on

Socia

l P

rote

cti

on

Early Child Development(Health/Nutrition, School Readiness, Parenting)

Youth Development(School-to-work, Second-chance programs,

Risky behaviors, participation, crime and violence)

Challenges.. A Diverse Field

Providers• Governments (national, sub-national)• Private sector (non-profit and for-profit)• International non-governmental organizations• Community-based organizations

Informal provision of care for children aged 0 to 8, by parents or extended family, mainly at home but sometimes in other family or community settings.

Primary education (age 6 up)

ECCE policies and programs for ages 3 and up -pre-primary education -non-formal education

ECCE policies and programs for ages 0 to 2 -organized care and education -non-formal care or education -support to parents

Informal care and child rearing

Organized care and education

- parental leave

Preschools

Local school

authorities

Public health

Munici-palities

Community services

Parks & recreatio

n

Early interventio

n

Health Social services Educatio

n

Family support

Chaos

Child care

Parenting centres

Children’s mental health centres

Kindergartens

Optimal Investment Levels

Pre-school School Post-school

Age0

Challenges … Optimal vs. Actual Investment

Example of the U.S

Cumulative Public Investment

Source: P. Carneiro & J. Heckman, Human Capital Policy, NBER, 2003; Voices for America and the Child and Family Policy Center, Early Learning Left Out An Examination of Public Investment in Education and Development by Child Age, 2004.

Sweden’s Public Expenditure for Children 0-17 age old - Ultimate Goal!!

Source: S. Bremberg (2006), National Institute of Public Health, Karolinska Institute, Stockholm, Sweden