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Foundations of Lifelong Health Are Built in Early Childhood
Foundations of Lifelong Health Are Built in Early Childhood
INTRODUC TION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
This publication was co-authored by the National Scientific Council on the Developing Child and the National Forum on Early
Childhood Policy and Programs, which are both initiatives of the Center on the Developing Child at Harvard University. The content of this
paper is the sole responsibility of the authors and does not necessarily represent the opinions of the funders or partners. Copies of this
document, as well as more information about the authors and the Center, are available from www.developingchild.harvard.edu.
The authors gratefully acknowledge the contributions of Kamila Mistry, Ph.D.; Anne Riley, Ph.D.; Sara Johnson, Ph.D.; Lisa Dubay, Ph.D.;
Cynthia Minkovitz, M.D., M.P.P.; and Holly Grason, M.A., of the Women’s and Children’s Health Policy Center, Johns Hopkins Bloomberg
School of Public Health.
Suggested citation: Center on the Developing Child at Harvard University (2010). The Foundations of Lifelong Health Are Built in
Early Childhood. http://www.developingchild.harvard.edu
Introduction
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child development. Health in the earliest years—actually beginning with the future mother’s health before she becomes
pregnant—lays the groundwork for a lifetime of well-being. When developing biological systems are strengthened by
positive early experiences, healthy children are more likely to grow into healthy adults. Sound health also provides a
foundation for the construction of sturdy brain architecture and the associated achievement of a broad range of abilities
and learning capacities.
Health is more than merely the absence of disease—it is of disturbing the neurobiological systems that guide physi-
an evolving human resource that helps children and adults ological and behavioral responses to stress, potentially for
adapt to the challenges of everyday life, resist infections, cope the remainder of an individual’s life. Altering these regula-
with adversity, feel a sense of personal well-being, and inter- tory mechanisms (e.g., setting the stress response system on
act with their surroundings in ways that promote successful a “short fuse”) can permanently increase the risks of acute
development. Nations with the most positive indicators of and chronic disease, and even a shortened life span, by un-
population health, such as longer life expectancy and lower dermining the normally adaptive response of the body to the
infant mortality, typically have higher levels of wealth and challenges and stressors of everyday life. These alterations to
lower levels of income inequality. In short, children’s health developing biological systems can lead to greater susceptibil-
is a nation’s wealth, as a sound body and mind enhance the ity to a wide range of illnesses well into the adult years, even
capacity of children to develop a wide range of competen- in the absence of any conscious memory of early trauma.
cies that are necessary to become contributing members of a Beyond its effect on individuals, poor health early in life
successful society.1,2 also imposes significant societal costs that are borne by those
Adverse events or experiences that occur early in child- who remain healthy. For example, when large numbers of
hood can have lifelong consequences for both physical and children become ill because they did not receive their immu-
nizations, the entire population becomes vulnerable
to epidemics of infectious diseases. Similarly, the
Health in the earliest years—actually beginning consequences of adversity and poor health in child-
hood can lead to higher rates of chronic diseases in
with the future mother’s health before she adults, such as diabetes, hypertension, cardiovascu-
lar disease, and various forms of cancer, as well as
becomes pregnant—lays the groundwork for depression, anxiety disorders, addictions, and other
mental health impairments. These conditions affect
a lifetime of well-being. all of society by reducing the productivity of the
workforce and increasing the incidence of disability,
mental well-being. That is to say, developmental and bio- the demand on medical facilities, and the costs of medical
logical disruptions during the prenatal period and earliest care. Thus, a focus on health promotion in the early child-
years of life may result in weakened physiological responses hood period—where an extensive body of evidence sup-
(e.g., in the immune system), vulnerabilities to later impair- ports the promise of effective prevention programs that can
ments in health (e.g., elevated blood pressure), and altered change the trajectory of children’s lives—can help reduce the
brain architecture (e.g., impaired neural circuits). For ex- social and economic burdens of illness, not only in child-
ample, exposure of expectant mothers to highly stressful en- hood but also throughout the adult years. This connection
vironments can influence the birth weight of their babies, between early life experiences and the health of a nation un-
and lower birth weight has been linked to substantially in- derscores the importance of strategic investments in the care
creased risk for obesity, diabetes, and cardiovascular disease and protection of pregnant women, infants, and young chil-
later in life. Traumatic experiences during childhood, such dren, and it suggests that most current attempts to prevent
as physical abuse or the adversities that accumulate for chil- adult disease and create a healthier workforce may be starting
dren reared in deep and persistent poverty, are also capable too late.
Preconception Prenatal
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Community Development
Nutrition During
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Sensitive
Private Sector Actions Periods Adulthood
4FUUJOHT
Workplace Home
Programs Neighborhood
capacities to promote health and prevent dis- beginning with the future mother’s pre-
ease and disability; and (4) public and private conception nutritional status and continu-
sector policies and programs that can influence ing into the early years of the young child’s
health outcomes by strengthening caregiver and growth and development.
community capacities.
Caregiver and community capacities to promote
The biology of health is defined by advances in health and prevent disease and disability refer
science that explain how experiences and envi- to the ability of family members, early child-
ronmental influences “get under the skin” and hood program staff, and the social capital pro-
interact with genetic predispositions, which vided through neighborhoods, voluntary as-
then result in various combinations of physi- sociations, and the parents’ workplaces to play
ological adaptation and disruption that affect a major supportive role in strengthening the
lifelong outcomes in learning, behavior, and foundations of child health. These capacities
both physical and mental well-being. These can be grouped into three categories: (1) time
and commitment; (2) financial, psychological,
and institutional resources; and (3) skills and
Experiences are built into our bodies and knowledge.5
significant adversity early in life can produce Public and private sector policies and programs
strengthen the foundations of health through
biological “memories” that lead to lifelong
their ability to enhance the capacities of care-
impairments in both physical and mental health. givers and communities in the multiple settings
in which children develop. Relevant policies
include both legislative and administrative ac-
findings call for us to rethink current, adult- tions that affect systems responsible for public
focused approaches to health promotion and health, child care and early education, child
disease prevention by incorporating an under- welfare, early intervention, family economic
standing of the early childhood origins of life- stability (including employment support for
long illness and disability. parents and public assistance), community de-
velopment, housing, and primary health care,
The foundations of health refer to three domains among others. It is also important to underscore
of influence that establish a context within the role that private-sector practices as well as
which the early roots of physical and mental government-sponsored programs can play in
well-being are either nourished or disrupted: strengthening the capacities of families to raise
s ! STABLE AND RESPONSIVE ENVIRONMENT OF RELA- healthy and competent children. Workplace
TIONSHIPS. This domain underscores the ex- policies related to parental leave, flexible work-
tent to which young children need consis- ing hours, and time off to care for a sick child
tent, nurturing, and protective interactions or attend a parent-teacher conference are a few
with adults that enhance their learning and examples.
behavioral self-regulation as well as help This framework suggests a new way of con-
them develop adaptive capacities that pro- ceptualizing policies and practices in multiple
mote well-regulated stress response systems. sectors, all of which affect the early childhood
s 3AFE AND SUPPORTIVE PHYSICAL CHEMICAL AND origins of lifelong health. The goal is to catalyze
BUILT ENVIRONMENTS This domain highlights informed investments and creative innovations
the importance of physical and emotional that build on a shared scientific base to achieve
spaces that are free from toxins and fear, al- significantly improved outcomes for children
low active exploration without significant and society above and beyond the impacts of
risk of harm, and provide supports for fami- existing efforts. Although the framework can be
lies raising young children. adapted to address challenges facing all nations,
s 3OUND AND APPROPRIATE NUTRITION This do- the policy and program context for this docu-
main emphasizes the foundational impor- ment is focused on current circumstances and
tance of health-promoting food intake, opportunities in the United States.
adulthood that are known risk factors for the lower-quality parental responsiveness,43 and are
development of cardiovascular disease, diabe- more likely to experience conflictive and puni-
tes, asthma, and chronic lung disease38,39 as well tive parenting behavior.41,44,45 Together, these ad-
as new evidence of elevated inflammation as verse conditions create repeated physiological
early as age 12 in children experiencing mal- and emotional disruptions that can have long-
treatment and depression, regardless of their lasting effects on health and development.
socioeconomic status.40 Socioeconomically patterned differences in
children’s emotional, cognitive, and social ex-
THE PHYSIOLOGICAL CONSEQUENCES OF periences have been linked to several aspects of
SOCIAL AND ECONOMIC DISADVANTAGE brain development, particularly within those
areas of the brain that are tied most closely to
Children who grow up in families or com- the regulation of emotion and social behavior,
munities of low socioeconomic status appear reasoning capacity, language skills, and stress
to be particularly vulnerable to the biological reactivity.46 Children from lower socioeconom-
embedding of disease risk. Researchers have ic backgrounds are more likely to show height-
hypothesized that this association may be the ened activation of stress response systems,47,48
result of excessive stress related to high rates of and some emerging research suggests that dif-
neighborhood risk factors such as crime, vio- ferences in caregiving related to income and
lence, boarded-up houses, abandoned lots, and education—such as responsiveness in parent-
inadequate municipal services.41 %CONOMICALLY child interaction—can alter the maturation
disadvantaged children also tend to live in of selected brain areas such as the prefrontal
housing that is crowded, noisy, and character- cortex.49 Animal models of early, stress-related
ized by structural defects, such as leaky roofs, changes in brain circuitry show that such mod-
rodent infestation, and inadequate heating.42 ifications can persist into adult life, altering
and they are exposed to greater air pollution emotional states, decision-making capacities,
from traffic, industrial emissions, and caregiver and bodily processes that contribute to sub-
smoking.41 Children raised in low-income envi- stance abuse, aggression, obesity, emotional in-
ronments, on average, also experience less and stability, and stress-related disorders.50,51
nurturing caregiving early in life is also asso- architecture. When appropriate responses are
ciated with better physical and mental health, missing, this can lead to a range of poor out-
fewer behavior problems, higher educational comes, including physical and mental health
achievement, more productive employment, problems later in life.62
and less involvement with social services and
the criminal justice system in adulthood.54,55 Effective self-regulation and sleep cycles.
In biological terms, a child’s environment of Another way in which the caregiving environ-
relationships can affect lifelong outcomes in ment affects the health of young children is the
emotional health, regulation of stress response extent to which the consistency, quality, and
systems, immune system competence, and the timing of daily routines shape their develop-
early establishment of health-related behaviors. ing regulatory systems. Beginning in the earliest
weeks of life, the predictability and quality of
A child’s environment of relationships can affect these experiences influence the most basic bio-
logical rhythms related to waking, eating, elimi-
lifelong outcomes in emotional health, regulation nating, and sleeping.63,64 For example, infants
who are exclusively breast-fed through about
of stress response systems, immune system 3 months of age ingest levels of nutrients and
hormones that reflect the mother’s circadian
competence, and the early establishment of rhythm (i.e., her 24-hour sleep-wake cycle) and
appear to assist in establishing better sleep pat-
health-related behaviors. terns and sleep efficiency.65
%ARLY EXPERIENCES STIMULATE A WIDE VARIETY OF
Thus, supports for families and appropriate nerve transmissions that activate different parts
training for providers of early care and educa- of the brain and other body systems. When
tion across all types of care, including informal positive experiences are repeated regularly in
arrangements as well as established centers, can a predictable fashion, the complex sequences
improve health outcomes throughout the life of neural stimulations create pathways that
course as well as enhance the current quality of become more efficient (i.e., “neurons that fire
life for young children and the adults who care together wire together.”) For example, infants
for them. who learn that being soothed and comforted
occurs shortly after they experience distress are
Secure attachments. One important way in more likely to establish more effective physi-
which responsive caregiving has long-lasting ological mechanisms for calming down when
effects on physical and mental well-being is they are aroused and are better able to learn to
through the formation of strong, positive bonds self-soothe after being put down to sleep.63,66 In
between young children and the important contrast, when eating and being put to bed oc-
adults in their lives. Securely attached infants cur at different times each day and when com-
show more positive emotion and less anxiety forting occurs unpredictably, the organization
in early childhood and have an easier time es- and consolidation of sleep-wake patterns and
tablishing relationships with teachers and peers self-soothing responses do not develop well,
at school.56,57 Attachment patterns develop and biological systems do not “learn” healthy
over the first few years of life and can influence routines and self-regulation.67
mental health and psychological functioning This finding highlights the importance of se-
throughout childhood and the adult years.56,58,59 cure, stable housing with quiet and predictable
Caregivers struggling with overwhelming prob- sleeping areas for babies. Although children dif-
lems such as depression may be unable to be fer in how much sleep they require, inadequate
sufficiently responsive to a young child during amounts lead to disruptive behavior problems,
that early period when the foundations of at- diminished cognitive performance, and greater
tachment relationships are developing.60,61 This risk for unintentional injuries.68,69 'ROWING EVI-
lack of consistent responsiveness disrupts what dence also suggests that poor sleep is associated
has been called the “serve and return” interac- with obesity in later childhood and early adult-
tion between infants and adults that is funda- hood.70,71,72 'IVEN THAT BABIES INTERNAL CLOCKS DO
mental to the development of healthy brain not initially differentiate day from night, how
and when they are put to sleep shapes their de- caregiving practices such as breastfeeding not
velopment of sleep-wake rhythms.63,73 only provide important opportunities for social
bonding but also help the baby develop a more
Healthy stress response systems. Just as early competent immune system.85 Conversely, inad-
experiences affect the architecture of the devel- equate caregiving and limited nurturance very
oping brain, they also shape the development early in life can have long-term (and sometimes
of other biological systems that are important permanent) effects on immune and inflam-
for health. For example, responsive caregiving matory responses, which increase the risk of
plays a key role in the normal maturation of chronic impairments such as asthma, respira-
the neuroendocrine system.74,75,76 A wealth of tory infections, and cardiovascular disease.38,39
animal research that is now being replicated in
humans demonstrates that caregiving behavior Learned health-promoting behaviors. Another
also shapes the development of circuits that reg- way in which early caregiving practices matter
ulate how individuals respond to stressful situ- is the extent to which young children develop
ations.77,78 Specifically, variations in the quality behavioral routines and patterns that influ-
and quantity of maternal care that a mother re- ence long-term health trajectories. These early
ceived in her own early life can affect how genes behaviors include a wide variety of domains:
are turned on or off in her own offspring.79,80 tooth brushing, television viewing, routine lev-
'ENES INVOLVED IN REGULATING THE BODYS STRESS els of physical activity, and risk-taking behav-
response are particularly sensitive to caregiving, iors, among many others. One example is the
as early maternal care leaves a signature on the type, amount, and frequency of foods offered
genes of her offspring that carry the instruc- to infants and toddlers, which together shape
tions for the development of physiological and the processes that affect their taste and texture
behavioral responses to adversity. That signa- preferences and their developing dietary likes
ture (known as an epigenetic marker) is a last- and dislikes. 86,87 Increasingly persuasive scien-
ing imprint that affects whether the offspring tific evidence shows that early learning of both
will be more or less likely to be fearful and food preferences and routine levels of physical
anxious later in life. 81 Consequently, early over- activity affect the risk for obesity.88
loading of the stress response system can have
a range of adverse, lifelong effects on learning, SAFE AND SUPPORTIVE CHEMICAL,
behavior, and both physical and mental health. PHYSICAL, AND BUILT ENVIRONMENTS
That said, effective programs are available that
prevent specific types of stress-inducing events, Unsafe environments are not only a threat to
such as physical or sexual abuse, and that pro- the immediate physical well-being of young
vide successful treatments for children experi- children but also jeopardize their future health
encing high levels of anxiety or chronic fear.82 and development. These threats can manifest
themselves in a variety of forms, many of which
Immunologic responsiveness. Regulatory mech- are amenable to effective preventive actions
anisms that manage stress also influence the that simply await the political will required for
body’s immune and inflammatory responses, widespread implementation.
which are essential for defending against disease.
Young children cared for by individuals who Chemical exposures. %NVIRONMENTAL TOXINS POSE
are available and responsive to their emotional a significant threat to immature biological sys-
and material needs develop well-functioning tems, as low-level exposures before or shortly
immune systems that are better equipped to after birth often produce more damaging and
deal with initial exposures to infections and to longer-lasting harm than exposures at higher
keep dormant infections in check over time.83 levels in later childhood or adult life. 89 At the
Some protections, such as maternal antibod- same level of exposure, embryos, fetuses, and
ies, are passed directly from mother to fetus children absorb much larger doses of toxins
through the placenta or from mother to infant relative to their body weight than adults, which
through breast milk. These protections confer is another reason why the adverse impacts are
important passive immunity until the infant’s greater in the prenatal period and early in life,
own antibody response is developed.84 Thus, when important developmental processes are
underway. Of all the body’s organ systems, the than those who live in neighborhoods with
brain is especially vulnerable to environmen- fewer recreational facilities.98,99 Neighborhood
tal toxicity, as even small injuries can produce features such as parks and sidewalks also influ-
significant effects on future health, learning, ence social interactions: people can come to-
AND BEHAVIOR %ARLY CHEMICAL EXPOSURES ALSO gether and develop a sense of mutual trust and
may prompt changes in other organs and tis- responsibility for the community and its in-
sues, resulting in structural malformations or habitants, which often leads to a willingness to
greater susceptibility to diseases that may even intervene on behalf of the common good.100,101
be passed on to subsequent generations.90 For This neighborhood-level phenomenon, called
example, prenatal exposure to diethylstilbestrol “collective efficacy” or social capital, has been
$%3 A DRUG PRESCRIBED FOR MANY PREGNANT linked to lower rates of childhood obesity,102
women until the 1970s, has been linked to re- better adult mental health, 103 and reduced
productive cancers in young women whose crime rates.104 Thus, zoning laws and regula-
mothers were medicated while pregnant.91 tions that influence the built environment can
In contrast to the long latency of adverse ef- have an important influence on the well-being
fects for many chemical exposures, the health im- of children and caregivers, which contributes to
pacts of some toxins are apparent much sooner. the overall health of a community.
For example, lead ingestion is a well-established
risk factor for cognitive deficits across the life SOUND AND APPROPRIATE NUTRITION
course, largely because lead disrupts neurotrans-
mitter regulation of synaptic development in the Health at every stage of the life course is influ-
brain.92 Although most lead exposure is related enced by nutrition, beginning with the moth-
to lead-based paint, soil, and dust,93 recent prob- er’s pre-conception nutritional status, extend-
lems have been detected from contaminated ing through pregnancy to early infant feeding
consumer products, including toys.94 and weaning, and continuing with diet and ac-
tivity throughout childhood and into adult life.
Physical and built environments. The danger of Adequate intake of both macronutrients (e.g.,
toxic chemical exposures as an environmental protein, carbohydrates, and fats) and micronu-
threat to child health is easy to understand. Less trients (e.g., vitamins and minerals) is particu-
immediately apparent is the growing evidence larly important in the early months and years of
that the way a child’s physical environment is life, when body growth and brain development
designed, built, and maintained can also signifi- are more rapid than during any other period.
cantly affect the risk of disease, disability and in- In this context, nutrition serves as an important
jury. 95 Beyond the safety of homes and child care example of how early influences contribute to
settings, the “built” environment offers multiple developmental patterns of health over time.
opportunities to influence health-related behav- Although levels of severe hunger and mal-
iors. The availability of food choices and options nutrition that persist in many of the world’s
for healthy eating illustrates one important ex- poorest countries are rarely found in the United
ample. This can be seen in many low-income, States, food insecurity remains a problem for a
urban communities that are less likely to have subset of the population that lacks access to suf-
grocery stores that stock healthy foods such as ficient food to meet their basic needs because
fresh fruits or vegetables and more likely to have of inadequate financial resources. That said,
multiple fast-food outlets and liquor stores, all of the growing epidemic of both childhood and
which undermine good nutrition.96 adult obesity in the United States is receiving
Neighborhoods designed with parks, green far more public attention than concerns about
space, sidewalks, and playgrounds away from poor growth.
traffic offer children and their families an op- The relation between nutrition and health
portunity to play and socialize with friends and in childhood is broadly understood. The extent
other caregivers, as well as encourage greater to which the nutritional status of a pregnant
physical activity, reduce child pedestrian inju- woman can influence the long-term growth
ries, and increase social ties. 97 Children living and health of her child is less well appreciated.
in such communities tend to be more physi- Inadequate maternal nutrition during preg-
cally active and have a lesser risk for obesity nancy is associated with a range of undesirable
outcomes in the offspring, including obesity in Indeed, a smaller thymus has been linked to
childhood and adulthood as well as subsequent poor immune responsiveness from the neona-
hypertension and cardiovascular disease.9,33 tal period through adolescence. 105,107 As a re-
When mothers do not receive adequate calories sult, adults who experience prenatal and early
and nutrients while pregnant, their fetuses de- childhood under-nutrition are 10 times more
velop in anticipation of “making do” with fewer likely to die from an infection than others.106
nutritional resources. This response is ben- Successful public health efforts to improve
eficial if the post-natal environment provides maternal nutrition, even prior to conception,
minimal calories. However, if the post-natal en- have had beneficial effects on the health of both
vironment offers access to sufficient nutrients, expectant mothers and their children. For ex-
the infant’s prior adaptation becomes a liability, ample, maintaining adequate levels of folate for
predisposing children to obesity and other dis- women in their child-bearing years has impor-
eases of excess because they were prepared for tant implications for both pregnancy and the
a world of scarcity.33 Children born at very low health of the newborn,108 with folate fortifica-
birth weight also show marked insulin resis- tion of foods leading to a 20 to 30 percent reduc-
tance and other changes that put them at risk tion in neural tube defects.109,110 Nevertheless,
for diabetes.34 iron deficiency and inadequate levels of vita-
Maternal nutrition also affects the develop- mins A and D remain significant health con-
ment of the fetal and infant immune system, as cerns for many children, who need increased
the adversity of under-nutrition can stimulate levels of these nutrients to support the rapid
the release of maternal stress hormones that growth of blood cells, bones, and other tissues.
impair thymus development in the fetus.105 The These types of deficiencies early in life can have
thymus gland is important, because it plays a adverse impacts on a wide range of cognitive,
key role in the development of the immune sys- motor, social-emotional, and neurophysiologi-
tem by incubating immature immune cells, and cal development and behavioral outcomes as
decreased thymus size in infancy is associated well as lead to chronic medical conditions such
with higher rates of infection and mortality.106 as osteoporosis, asthma, and diabetes.111,112,113
(1) TIME AND COMMITMENT (i.e., the nature and care facilities, schools, and after-school pro-
quality of time spent with children and on their grams. Finally, SKILLS comprise both political and
behalf); (2) RESOURCESboth lNANCIAL (i.e., eco- organizational capabilities that can be leveraged
nomic ability to purchase goods and services) to accomplish strategic goals.115 Thus, commu-
and PSYCHOLOGICAL EMOTIONAL AND SOCIAL (i.e., nity capacities can range from enforcement of
physical and mental health and parenting style); standards for child safety seats to the availabil-
and (3) SKILLS AND KNOWLEDGE (i.e., human capital ity of high-quality markets selling affordable
acquired through education, training, interac- fresh fruits and vegetables and the presence of
tions with child-related professionals, and per- local leaders and organizations that can mobi-
sonal experiences).5 %XTENSIVE DOCUMENTATION lize collective action.
of the important impacts of these capabilities Communities vary widely in their collec-
on child health and development is provided tive commitment, resources, and skills. For ex-
throughout this paper. ample, while there is strong evidence regarding
The fact that the majority of young children the link between quality child care and posi-
in the United States currently live in families tive child health and developmental outcomes,
with working parents provides a clear illustra- not all communities have the same level of re-
tion of the importance of this issue. The pres- sources to ensure access to affordable, quality
sures and demands of balancing parenting and options. Moreover, although problems in af-
work responsibilities, along with other changes fordability and access to quality child care are
in family structure and social roles, lead to con- an important issue for low-income neighbor-
siderable strain on time for parenting and other hoods, they also present significant challenges
caregiver capacities across the socioeconomic for middle-income communities where par-
spectrum. 114 That said, most policies and pro- ents are employed but do not qualify for public
grams for families with young children in the subsidies.116
United States are focused on either parenting To summarize, although both individual
education or financial support for those with caregivers and communities as a whole can in-
limited income. The fact that relatively limited fluence the foundations of child health, not all
attention is focused on addressing the short- have the same capacities. When necessary re-
falls in time and/or psychological resources that sources are not available, effective policies and
overwhelm many parents across all social class- programs can fill the gaps by building those
es threatens the healthy development of many under-developed or missing capacities. Healthy
children, with the greatest burdens on those children are raised by people and communi-
whose families and communities are impov- ties, not by government and professional ser-
erished and those whose children have special vices—but public policies and evidence-based
needs. interventions can make a significant difference
when caregivers and neighborhoods need assis-
COMMUNITY CAPACITIES tance. It is also important to note the potential
impacts of private-sector actions, above and
Just as children develop in an environment of beyond the effects of public policies, to address
relationships, families function within a physi- unmet needs. Creative, new strategies from
cal and social environment that is influenced by multiple sources represent vital and highly
the conditions and capacities of the communi- promising contributions to community-wide
ties in which they live. In the context of com- health that are likely to produce substantially
munity capacities, COMMITMENT is evident when greater returns across the lifespan.
child health and developmental outcomes are
monitored, and responsibility for their promo-
tion is assigned and accepted, such as through
enforcement of legislation and regulations that
affect child well-being. 2ESOURCES at the com-
munity level include services and organiza-
tions dedicated to the promotion of children’s
healthy development as well as the availability
of supportive structures such as parks, child