Vibrant and Healthy Kids Aligning Science, Practice, and Policy to Advance Health Equity (2019) / Chapter Skim
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9 A Roadmap for Applying the Science of Early Development
9 A Roadmap for Applying the Science of Early Development
Pages 569-578
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From page 569... ...
. The factors that drive health disparities from the preconception period through early childhood are complex, interconnected, and systemic; they result from exposures and experiences that children and families encounter throughout their lives, as well as choices they make.
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From page 570... ...
Biological and social-psychological developmental pathways interact over the entire life course to set the trajectory for positive health outcomes, but the initial trajectories are established in early life. With the opportunity to play out across an entire life course, even small changes in initial health trajectories can result in large differences in long-term outcomes.
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From page 571... ...
The Interconnected Nature of Health Disparities The systems that influence developmental and health trajectories are profoundly interconnected. The microsocial environment of children's daily lives -- families and immediate social networks -- is nested within and impacted by the key institutional systems that form the framework of society, and those institutional systems are nested within and impacted by cultural and historical forces that have shaped their essential character.
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From page 572... ...
Furthermore, holding health systems accountable for this shift through changes in equity-focused quality measures and aligned incentives that more comprehensively address health and the risks of poor health will be required. Other necessary actions include transforming the organization, payment, and delivery of health care services to allow for the adoption of integrated, whole-person care models that emphasize a life course approach and address upstream causes of poor health; facilitating the spread of multidisciplinary team-based care; developing trauma-informed systems that can respond effectively when a child is exposed to early-life adversity; and supporting cross-sector partnerships that intentionally connect health care services to the work of partners outside of the health system that are taking the lead to address the SDOH.
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From page 573... ...
Money matters -- having resources available to meet basic needs can improve health and reduce health and developmental disparities in early childhood, and public programs that provide resources to those families represent critical investments that "pay off" in the form of better outcomes for children as they enter school healthy and ready to learn and later move into adulthood. However, hinging these benefits on employment or earned income requirements that take caregivers from the home may be counterproductive for families if those requirements increase caregiver stress or hinder opportunities for developing healthy family relations, attachment between mother and child, or breastfeeding.
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From page 574... ...
• Reform health care system services to promote healthy develop ment: Redesign the content of preconception, prenatal, postpar tum, and pediatric care while ensuring ongoing access, quality, and coordination. • Create supportive and stable early living conditions: o educe child poverty and address economic and food R security, o rovide stable and safe housing, and P o liminate exposure to environmental toxicants.
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From page 575... ...
and local policy makers Reform health Increase access to preconception, HHS; Medicaid agencies; care system prenatal, postpartum, public and private payers; services to and pediatric health care federal, state, local, tribal, and promote healthy (Recommendation 5-1) territorial policy makers development Expand accountability Public and private payers; and improve quality of HRSA, CDC, CMS, perinatal preconception, prenatal, and pediatric quality postpartum, and pediatric care collaboratives, and health care– (Recommendation 5-2)
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From page 576... ...
Address the critical gaps Federal, state, tribal, and between family resources territorial policy makers and family needs through a combination of benefits that have the best evidence of advancing health equity, such as SNAP benefits, increased housing assistance, and a basic allowance for young children (Recommendation 6-6) Support and enforce efforts to Federal, state, territorial, tribal, prevent and mitigate the impact and local governments; CDC, of environmental toxicants EPA, FDA, the U.S.
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From page 577... ...
Implement Develop cross-sector initiatives For all actions in this section: initiatives across that align strategies to address policy makers and leaders in systems to barriers to data sharing and the health care, public health, support children, integration, cross-sector social service, criminal justice, families, and financing, and other challenges ECE/education, and other other caregivers to cross-sector collaboration sectors who frequently interact (Recommendation 8-1) with children and their families Enhance detection of early-life adversity and improve response systems (Recommendation 8-2)
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From page 578... ...
Department of Health and Human Services; HRSA = Health Resources and Services Administration; HUD = U.S. Department of Housing and Urban Development; OPRE = Office of Planning, Research & Evaluation; SNAP = Supplemental Nutrition Assistance Program; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children; WPSI = Women's Preventative Services Initiative.
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