exam 4 chapter

Question 1

a. What is the developmental health perspective (Keating & Hertzman)? What general outcomes are implicated?

Answer 1

The developmental health perspective of early child development focuses on the “big picture” of human development, stressing the importance of early experience in lifelong health and well-being. Developmental health perspective is all about thinking in terms of populations.
Keating:
Hertzman: got to do with a state of doing well across the 3 broad domains of child development -

Question 2

1. ) The developmental health perspective

i. Hertzman: what factors make a difference?

Answer 2

• These factors begin before birth and some of them are socio-economic in nature- the more resources and control a family has makes a difference for how children do
• Parenting style – being an interactive, flexible parent provides more support than being an authoritarian
• Providing a rich language environment in the home
• Factors at the neighborhood level make a difference as well- neighborhood safety, cohesion, having mixed neighborhoods rather than poor ghettos
• Quality and accessibility to services – having access to daycare

Question 3

b. What is the life course perspective (Maureen Black)?

Answer 3

The time to invest is very early in life- by ensuring that children have the health, nutrition and learning opportunities and responsive care and protection, then children are better able to take advantage of the educational systems – as they continue more likely to then stay in school – then less likely to run into trouble

• There are inflection points- times of potential vulnerability- times when one would consider checking in or investing
• Early in life we have children transitioning from breastfeeding to solid feeding
• Around 2 years old they typically have less contact with the health system- but generally haven’t reached the education system yet
  a. This is a very vulnerable time – it’s a potential gap in children’s development
• School age often thought of as latency age – need to make sure we have high quality schools and giving children the opportunity to learn through responding
• Adolescence- need to ensure children can stay on track and help them get back on if they need help
• Investing early in life gets you a head start but doesn’t mean you’re done.

Question 4

c. What is “child well-being” as defined in this section of the text?

Answer 4

Child well-being is an “umbrella” term that encompasses learning, behaviour and health. It is a focus on strength which nurture a child’s ability to thrive in all aspects of life- physically, social-emotionally and cognitively.

Question 5

d. Know the central points of the developmental health perspective, listed at the bottom of this section.

Answer 5

• New insight about how nature and nuture interact has led to greater understanding of human development and changed traditional ways of thinking- not only about child development, but also about what determines individual and population health
• Population data show that developmental trajectories, although changeable, are heavily influenced by early experience and that what happens early in life sets the stage for what is to follow.
• The joint influences of biology and experience affect us on a cellular level. Together they determine both health and well-being and also influence vulnerability and resilience
• There is a social gradient for almost all developmental health outcomes- this means that those with fewer resources tend to be less healthy, less educated, and poorer than those with slightly more resources and so forth.
• There are exceptions to this trend, people who thrive despite poor circumstances and others who falter despite advantages. Those who do well are considered resilient but they are in the minority. A key interest in early childhood care and development (ECCD) is discovering what can make the difference for children and support resilience.

Question 6

e. Be familiar with negative and positive social determinants of health

Answer 6

• Negative:
  a. Stress
  b. Lack of control over life
  c. Prolonged racism or other discrimination
  d. Lack of resources
  e. Food insecurity
  f. Unemployment
  g. Social isolation
• Positive:
  a. Sense of belonging
  b. Being loved and nurtured
  c. Opportunities for language
  d. Supportive community
  e. Social equity
  f. Educational opportunities
  g. Job security
  h. Access to health services

Question 7

f. According to Sir Michael Marmot, to reduce inequalities in early child development and education we have to reduce inequalities in what?

Answer 7

To reduce inequalities in child development and education we need to also reduce inequalities in society.
- We should be trying to treat and care for the child but also the environment- if one gets sick we don’t want to send them back to the same environment that got them sick in the first place.

Question 8

g. Be familiar with the problems related to early life issues, as detailed in Hertzman’s video “key factors

Answer 8

• By 2nd decade of life, increase risk of:
  a. School failure
  b. Teen pregnancy
  c. Criminality
• By 3rd and 4th decade of life, more risk for:
  a. Obesity
  b. Elevated blood pressure
  c. Depression
• Late in life, increase risk for
  a. Premature aging
  b. Memory loss
  Key factors:
• both family and society
• Early child development depends upon experiences children have in the environments they grow.

Question 9

h. Martin Guhn: What are SES gradients as they apply to child development?

Answer 9

The gradient effect means that there are differences at every point along a line. There are many reasons for different outcomes but in general, the gradients show clearly that the health and well-being of populations are linked to different social settings and how resources are distributed within the population

• Guhn: the children that have access to the most resources are doing relatively well and the ones who don’t are not. But there is not a cutoff- rather you see this threshold holds at every level of socioeconomic status
• Raises questions as to why in a society full of resources there are many children that do not have access- how can we make it more equitable?
• There are very stark socioeconomic gradients in regards to children’s well-being, academic achievement and other indicators of their health

Question 10

i. In the text of this section, what types of child outcomes show SES gradients?

Answer 10

• Well being and academic achievement and outcomes regarding their health are outcomes that are affected by SES

Question 11

j. Hertzman: How do families foster early child development despite lower socioeconomic circumstances?

Answer 11

having multi generation adults available to a child can be better than a nuclear family (often considered having a mother and father as a social unit). Meaning, vast family dynamics and the presence of community can be easier to acquire for places where money is low
- in western countries we have adopted that nuclear families are what is best for a child and these are the best options of nurturance. But in eastern countries, especially where education is poor, it is easy for them to create village-like families. Where many adults are involved in the nurturance of one child.

Question 12

k. How does the developmental health perspective conceptualize the effects of poverty on child development? Are children from communities with fewer resources destined to have poorer outcomes in health, leaning, and behaviour? Why or why not?

Answer 12

• The developmental health perspective helps us to understand how good condition early in life set a strong foundation for what’s to follow clearly poverty can be a major factor in jeopardizing children’s future capacity for strong, healthy adults, able to fully participate in life.

Question 13

a. Noralou Roos: how does income disparity impact children’s health across the first 10+ years of life? How do the health impacts of cancer and low-income compare?

Answer 13

• In the first year there is a big difference in the disparity of hospitalization rates. And then many of the health differences disappear after a year and a bit, 2 years.
• Kids are remarkably healthy from about age 4 to about 10-11
• When you get to the teenage years those differences start emerging again (Accidents, injuries, depression, etc.) and the differences are remarkably large as time goes on. Over this period educational differences also widen.
  ii. A study was studying how many years could be added to life expectancy if cancer was wiped out. It was found that almost 3 years could be added to life expectancy if every child was given a pill at birth that could prevent them from developing any kind of cancer. A comparison was made across Winnipeg neighbourhoods on life expectancy
• Difference between 20% of the poorest Winnipeg neighbourhoods compared to the 20% of the highest income neighbourhoods was a difference of 12 years in life expectancy for men.

Question 14

b. In Canada, what groups of children are most impacted by poverty? Which provinces have the highest poverty rates?

Answer 14

• In Canada, indigenous children are most impacted by poverty. Provincially, children in Manitoba (22% compared to the national average of 14.7%) and New Brunswick.
• Indigenous children are twice as likely to be living in poverty than their non-indigenous counterparts with the rate climbing to 60% of all children on reserves.

Question 15

c. What is the definition of extreme poverty (READ: Ending extreme poverty)? Roughly what percentage of children under the age of 5 are living in extremely poor households?

Answer 15

• Children growing up in extreme poverty require special attention. They are profoundly affected by poverty in different ways than adults and are almost certain to miss out on a good start in life.
  a. Consequences are inadequate nutrition, a lack of early stimulation and learning, and exposure to stress last a lifetime.
  b. They lead to stunted development, low levels of skills needed for life and work, limited future productivity as adults and transmission of poverty down the generations.
• Extreme poverty defined as welfare less than $1.90
• just over 19.5% of the worlds developing population are living in extremely poor households.
  a. Majority of this in Sub-Saharan Africa

Question 16

d. Maureen Black: what positive impacts have been shown by interventions with children born into poverty?

Answer 16

• Individuals that are born into poverty have shown to have a risk of earlier mortality and morbidity even if they are not poor as adults
• Children born into poverty have a higher risk of having development that is a bit more delayed than children who are born into high socioeconomic families
• HOWEVER- there are interventions that can mitigate, overcome some of those aspects of poverty.
  a. These interventions are very early parenting interventions- ensuring that children have the nutrition that they need when they need it.
  
  • starts with breastfeeding and moving into following the guidelines of nutrition
    b. Its also the kinds of early nurturance- that means hugging kids, being responsive to kids, being kind to children, listening to them, having back and forth kinds of exchanges
• Positive impacts: helps with early brain development, can mitigate and overcome health threats caused by poverty

Question 17

The social determinants of health, learning and behaviour
a. Michael Marmot: What is the main finding of the Whitehall studies? What sort of gradient is observed, and how do this phenomenon parallel what is seen in early child development?

Answer 17

• Whitehall studies excluded the richest and poorest individuals in society. Yet they found a lasting “social gradient” of health among British civil servants.
• The people second from the top who have university educations, stable jobs, reasonable housing, reasonable salaries and good job prospects for the future have worse health than the ones above them. As you go down the social hierarchy, your health becomes worse.
• This gradient shows that we have to focus on the people in the middle too rather than only the poorest of the poor because their health is still worse than the people higher up- we are all involved in the gradient.

Question 18

b. Thomas Boyce: What does Boyce say is the mechanism by which disadvantaged communities relate to challenges for child development? What forms of this mechanism does Boyce mention? What biological mechanism does Boyce say is affected which contributes to intergenerational impacts?

Answer 18

• disadvantaged communities cause challenges for child development because people who live in disadvantaged households tend to face more stress (ex. Parental depression, violence, housing problems) and this stress can affect epigenetics. He mentioned that genes that lead to depression and anxiety can be turned on/off as a result of the stress.
• Based on animal studies, Boyce theorizes that increased stress and mental health challenges can cause changes to the structure of DNA which can affect development intergenerationally

Question 19

c. Craig Alexander: What are the specific economic benefits to society from investing in early childhood education?

Answer 19

For every $1 invested in ECE, there is a return of $1.20-$3.00

• For children: helps with cognitive and social development, as we know that learning starts immediately from birth, and not just at age 5 where the public education system begins.
• For parents: reduces stress and helps with work-life balance. Helps increase labor-market participation, especially among women.
• Societal: ECE relates to the labor market and skills development, as this is the first step in developing more skilled individuals, which helps to reduce poverty, increase innovation and create a more “productive” economy and reduces the money needed for social assistance programs

Question 20

d. READ: “Ready for Life” – be familiar with the Document Highlights and how many families would be lifted out of poverty by an expanded ECE program.

Answer 20

• Expanding early childhood education in Canada would increase female labour market participation, improve child outcomes (especially for disadvantaged children), and reduce Canada’s income inequality.
• By allowing more women to enter the labour force, the introduction of an expanded ECE program would result in about 23,000 families- many of them single-parent families- being lifted out of poverty
• There is a strong case for expanding ECE services due to benefits for society and the economy
• The report discusses the role played by early education in reducing inter-generational poverty by strengthening the future income promises for children while increasing the participation in the workforce by mothers. It recommends that the government provides at least 2 years of preschool education while improving the quality of the ECE program

Question 21

e. Note the material on James Heckman’s research that is similar to what was discussed in the lecture slides

Answer 21

• Programs which target early years yield highest returns; impacting lives of parents leads to permanent change in home environment that supports healthier development: 9:1 return on investment; cognitive/non-cognitive skills
• Focus on building self-control, character, motivation “non-cognitive skills”
• Children’s increased emotional regulation and decreased stress will lead to improved cognition, language and brain organization
• Investment in the foundation stage of early childhood provides a higher rate of return on investment (ROI) than investments later in life

Question 22

f. INTERACT: “Findings from Quebec” – most findings on investments in early education are American. What was found in Quebec with respect to the boost to GDP? What child outcome improved?

Answer 22

These results were found in Quebec with respect to the boost of GDP

• 70,000 more mothers are working
• Mothers pay $1.5 billion annually in taxes
• Withdraw $340 million less in social transfers (social transfers are transfers made in cash or in kind) to persons or families to lighten the financial burden of protection from various risks)
• Boosting the GDP by $5 billion
  ii. The following child outcomes were improved
• Quebec students test scores have moved from below to average the national average
• Halved child poverty rates

Question 23

Monitoring child development
g. READ: “Manitoba’s healthy baby program” – What are the two components of the Manitoba Healthy Baby Program? What effect did this have on women who received the prenatal benefit?

Answer 23

1- The prenatal income supplement: starts in the second trimester of a woman’s pregnancy, provides a maximum of $81.41 a month to low-income pregnant women up to the time that they give birth. So the maximum benefit anyone can get is less than 3 dollars a day
2- The community support programs: provides education and support programs to women in their own communities, and these are given both while the woman is pregnant and throughout her baby’s first year up to the first birthday
- Both are targeted at lower income women and their babies

Women who received the prenatal benefit had fewer low birth weight babies and preterm births

(1. 4%-9.0% reduction in low birth weight births
0. 4%-6.0% reduction in preterm births)

Question 24

h. READ: “Early development matters for Manitoba’s children” – What is the takeaway message of Figures 3 and 4?

Answer 24

Figure 3: in Manitoba, kindergarten teachers fill out a form called EDI. It tells if they believe a child is ready for school. This study then looks at a child’s background to see what might have affected the child
- in figure 3, it showed all of the children who are in at-risk group while figure 4 shows the percentage of children not ready for school due to their risk factors. The takeaway message is what the analyses showed was that not all risk groups are created equal, but being in multiple at-risk groups was clearly worse than being in just one group. It also shows us there are a huge number of kids who are in all three groups who might struggle in school

Question 25

Scaling early child development programs

i. What is implementation science?

Answer 25

Implementation science is the study of methods to promote the adoption and integration of evidence-based practices, interventions and policies into routine health care and public health settings. Implementation research plays an important role in identifying barriers to, and enablers of, effective global health programming and policy making, and leveraging that knowledge to develop evidence-based innovations in effective delivery approaches.

Question 26

9. ) Supporting developmental health

a. Megan Gunnar: what are the long-term health and biological implications of early adversity?

Answer 26

• early years are important for society development
• early adversity increases your risk for cardiovascular diseases, diabetes, obesity and all sorts of health problems related to alcoholism. These early adversities shape the way your nucleus accumbens functions, and your dopamine system and it makes you at risk for becoming an alcoholic, if you ever start drinking
• if we want to have a society where we can solve our problems, we have to worry about what is done in the early years because to fix it is costly and not certain and it is also our biggest expense.

Question 27

Advocating for early child development
b. Kerry McCuaig & Charles Pascal: what is critical for knowledge transfer to take place from research on early child development

Answer 27

McCuaig: research policy and practice are linked but without strong communication there is no constant overdrive, there is no turnaround in that knowledge translation, and knowledge transfer does not take place. Nurses and practitioners should all engage in knowledge transfer. If there is going to be real differences in terms of what families can expect with young children it is going to take public policy changes for all.

• early education for all is a big ask, meaning we need to get to policy makers, influencers, parents, educators and the public as a whole.
• need to be able to transger information that is complex into a form that is accessible to all. Without being able to transfer this information we are losing essential practices that might seriously benefit children

Pascal: it is important to capture the public’s attention, by having some storytelling at the front of the evidence releases. Important to put the meaning of quantitative and qualitative data. It is also important to connect emotionally with the public about how lives are being changed as a result of this evidence

Question 28

Shaping public policies
c. READ: “Three Principles to Improve Outcomes for Children and Families” – what does The Harvard Center on the Developing Child recommend as 3 principles for policy makers?

Answer 28

1- Support responsive relationships for children and adults
- For children, responsive relationships with adults have a double benefit, both promoting healthy brain development and providing the buffering protection needed to prevent very challenging experiences from producing a toxic stress response. For adults healthy relationships also boost well-being, providing practical assistance and emotional support and strengthening hope and confidence, all of which are needed to survive and weather stressful situations.
2- Strengthen core life skills
- These core capabilities support our ability to focus, plan for and achieve goals, adapt to changing situations and resist impulsive behaviours. No one is born with these skills; they are developed over time through coaching and practice. Parents can pass along the same capabilities to the next generation
3- Reduce sources of stress in the lives of children and families
- Not all stress is bad, but the unremitting, severe stress that is defining feature of life for millions of children and families experiencing deep poverty, community violence, substance abuse, and/or mental illness can cause long-lasting problems for children and the adults who care for them. Reducing the pile-up of potential sources of stress will protect children directly and indirectly

Question 29

d. READ: “The relationship between income and children’s outcomes” – what does it mean that there is a nonlinear relationship between income and child outcomes (i.e., for whom does an additional dollar benefit more)? Know that earlier and longer experiences of low income are more problematic.

Answer 29

Income’s effect on child outcomes is non-linear- an additional dollar of income has a larger effect on lower-income children- if the goal is to improve child outcomes, families with lower income should be given significantly more benefits than those with more income. Income’s effect on child outcomes displays diminishing marginal returns- each additional dollar of income has a smaller impact on child outcomes than the previous dollar.