Healthy starts for all: policy prescriptions

Context: The Robert Wood Johnson Foundation Commission to Build a Healthier America recommended that substantial resources be committed to ensure all children have high-quality developmental experiences through family support, child care, and early education. This article reviews and updates the evidence base informing that recommendation and explores federal and state policy challenges involved in implementing it.

Evidence acquisition: Reviews of published research, analyses of federal child health data sets, consultation with early development and state and local program experts, and site visits were conducted between 2006 and 2009, with statistics and literature reviews updated through mid-2010.

Evidence synthesis: The economic and social conditions of children's lives, especially in the early years, affect their health and development in childhood and across the life course. Forty percent of children in the U.S. live in families with incomes <200% of the federal poverty level and consequently are at higher risk of poor health and development. Recent advances in neuroscience and life course epidemiology reveal that these children are more likely to experience chronic or "toxic" stress resulting from frequent or sustained adverse experiences, increasing their lifetime risk of chronic disease. Intervening early in childhood by providing a safe, stable, nurturing, and stimulating environment can improve cognitive, emotional, and behavioral development and health outcomes in children--particularly socially and economically disadvantaged children--and both their health and social and economic well-being as adults.

Conclusions: Coordination of multiple programs and funding sources, along with higher standards of accountability for services, outcomes, and ongoing evaluation of effectiveness, are needed to ensure more effective state and local programs providing early developmental support. Federal leadership and funding are needed to ensure that children at high risk for multiple adverse exposures and their families receive attention and services as early as possible.