8.5.1: Early Childhood Development and Education
The experience in the first 5 years of a child’s life have significant repercussions for the rest of their lives. Although much emphasis is placed on ages birth to 5, recent evidence also includes maternal health prior to conception and during pregnancy as impacting future health. Exposures of the mother to toxins, infections, or stress can all impact fetal physical and neural development - altering risks for future health outcomes, even chronic diseases and mental health issues (Center on the Developing Child at Harvard University, 2010).
Adverse childhood events (ACEs) include physical, sexual, and psychological abuse, child neglect, family dysfunction, incarceration or death of a family member, exposure to violence in the home or neighborhood, and poverty - including housing and food insecurity. Traumatic life events cause stress to children that can have immediate effects on their physiological and psychological development, and lifelong effects on their health. Adverse childhood events are linked to everything from mental health issues and substance abuse later in life, to increased risks of chronic diseases like cardiovascular disease and cancers, and can negatively affect economic and academic opportunities as well (Merrick et al., 2019). The adoption of health-risk behaviors and lack of engagement in health-promoting behaviors may be a mediating factor, as people with multiple ACEs often have maladaptive coping behaviors for future life stressors. Some evidence also points to the possibility that early life stressors also influence health outcomes independently from health behaviors, suggesting that ACEs can cause epigenetic changes (the way genes are expressed) that affect the immune, cardiovascular, and neurological systems during development, which in turn increases chronic disease risk (Soares et al., 2021). According to a cross-sectional study administered by the CDC in 2019, almost 16% of adults reported experiencing 4 or more ACEs. The authors estimated that if ACEs were prevented, this could reduce the rates of negative health outcomes such as depression by up to 44%, heart disease by up to 12%, and smoking and heavy alcohol use by up to 33% and 24% respectively (Merrick et al., 2019).
In contrast, early childhood education can have a substantial positive impact on future academic success, health behaviors and outcomes. High quality preschool, kindergarten, and elementary education is associated with lower rates of health-risk behaviors like smoking and binge drinking later on in life, as well as lower rates of risk factors for heart disease like obesity, high blood pressure, and high cholesterol at age 30 ( Early Childhood Development and Education - Healthy People 2030 , n.d.). High quality preschools and early childhood home visitation programs are also associated with a reduced risk of child abuse and neglect, and thus could help prevent ACEs and improve health outcomes in several ways (Merrick et al., 2019). See Fig. \(\PageIndex{1}\) below.
Access to high quality childcare can be a significant limiting factor for families. Due to the COVID-19 pandemic, many childcare providers were forced to take fewer children and enforce strict public health measures, or ended up closing their doors. Health concerns, loss of employment, and remote work prompted many parents to keep children at home, and as many schools were also closed, families struggled to balance childcare and employment from home. According to the U.S. Census Bureau, 35% of those with children under 5, and 54% of parents with children 5-11 years old indicated they had no type of childcare during the pandemic. One in 5 parents relied on family members for childcare. The closure of childcare facilities also caused many women to leave the workforce and become full-time caregivers; a trend which hit low-income families the hardest (U. C. Bureau, 2023c). In the years that followed, the childcare industry has progressively recovered, but as of 2022 had not yet reached pre-pandemic levels of employment (Crouse et al., 2023). As other industries also recovered and demanded a workforce, the demand for childcare also went up, and in turn the rising cost of childcare has begun to outpace wage growth and inflation in other sectors. Childcare workers have traditionally been one of the lowest paying jobs, and that trend continues despite some increases in hourly pay ( Child Care Prices, Inflation, and the End of Federal Pandemic-Era Aid in Five Charts - Equitable Growth , 2023). All of these factors can create a crisis for families: if parents cannot find or afford high-quality childcare, they may be limited to one income - or for single parents they may be forced into riskier solutions (i.e. low-quality childcare), or out of the labor force altogether. From a population standpoint, a lack of affordable childcare creates a ripple effect on other social determinants of health such as economic stability, housing and food insecurity, and social cohesion.