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Young Children at Risk Closing the Gap between what we know and what we Young Children at Risk Closing the Gap between what we know and what we do Mary Eming Young Early Child Development Team Human Development Network Children and Youth The World Bank

This presentation will focus on • Why early childhood? – The magnitude of the This presentation will focus on • Why early childhood? – The magnitude of the problem: Young children under threat – Global, Science, and Business imperative • Do we know what to do? – is it doable? • Challenges and Opportunities 2

 • Magnitude of Children at Risk • Magnitude of Children at Risk

Magnitude of the Problem % of Children < 5 y who are Stunted by Magnitude of the Problem % of Children < 5 y who are Stunted by Region, 2004 WHO 2006

¿Cómo podemos mejorar la nutrición? La “ventanilla de oportunidad” para mejorar la nutrición es ¿Cómo podemos mejorar la nutrición? La “ventanilla de oportunidad” para mejorar la nutrición es muy pequeña…desde antes del embarazo hasta los 18 -24 meses de edad Fuente de datos: Shrimpton y otros (2001)

% of Children < 5 y who are Poor (<$1 per day) by Region, % of Children < 5 y who are Poor (<$1 per day) by Region, 2004 WHO 2006

% of Children < 5 y who are Disadvantaged (stunted or poor or both) % of Children < 5 y who are Disadvantaged (stunted or poor or both) by Region, 2004 WHO 2006

Population of Children under 5 years & Disadvantaged by Regions, 2004 WHO 2006 Population of Children under 5 years & Disadvantaged by Regions, 2004 WHO 2006

% of Disadvantaged Children by Country Source: S. Grantham-Mc. Gregor, Y. B. Cheung, S. % of Disadvantaged Children by Country Source: S. Grantham-Mc. Gregor, Y. B. Cheung, S. Cueto, et. al. : Developmental potential in the first 5 years for children in developing countries, Lancet, 369: 60 -70, 2007.

 • What Do We Know? • What Do We Know?

Experience-Based Brain Development in the early years of life sets neurological and biological pathways Experience-Based Brain Development in the early years of life sets neurological and biological pathways that affect throughout life: • Health • Learning • Behavior

Conocimientos de la Neurociencia: Las experiencias en la primaria infancia impactan: Arquitectura cerebral Química Conocimientos de la Neurociencia: Las experiencias en la primaria infancia impactan: Arquitectura cerebral Química neuronal Expresión de genes Cognición + Emoción + Comportamiento social Todos estos Elementos son Pre-requisito para el Desarrollo Humano, Social y la Productividad Economica en la adultez

The Global Imperatives EFA Goals 1. Expand improve comprehensive early childhood care and education The Global Imperatives EFA Goals 1. Expand improve comprehensive early childhood care and education 2. Universal primary education by 2015 3. Learning and life skills programs for youth and adults 4. 50% increase in adult literacy rates by 2015 5. Gender parity by 2005 and gender equality by 2015 6. Improving quality of education MDGs 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality, and other health goals

Rates of Return to Human Development Investments Across All Ages 8 Return Per $ Rates of Return to Human Development Investments Across All Ages 8 Return Per $ Invested 6 Pre-school Programs School 4 R Job Training 2 Preschool 0 6 Post-school School Age 18 Source: P. Carneiro & J. Heckman, Human Capital Policy, NBER, 2003.

Regional trends in pre-primary A three-fold increase in pre-primary enrolments over 30 years More Regional trends in pre-primary A three-fold increase in pre-primary enrolments over 30 years More than 1 in 3 children now enrolled but huge regional differences Developed/transition countries Latin America/Caribbean East Asia/Pacific South and West Asia Arab States Sub-Saharan Africa

% of Children who Enter Grade 1 and Reach Grade 5 by Region UNESCO % of Children who Enter Grade 1 and Reach Grade 5 by Region UNESCO 2005

Gap in Children Development by Income DQ Urban middle class n=78 Urban poor n=268 Gap in Children Development by Income DQ Urban middle class n=78 Urban poor n=268 Age months Source: : Walker et al.

Vocabulary Scores by SES quartiles in 36 to 72 month old children Ecuador age Vocabulary Scores by SES quartiles in 36 to 72 month old children Ecuador age in months Source: C. Paxson, N. Schady: Cognitive development among young children in Ecuador : The roles . of wealth, health and parenting, The World Bank, Policy Research Working Paper, 3605, 2005

Later cognitive deficits associated with being in the lowest wealth quintile <3 yrs in Later cognitive deficits associated with being in the lowest wealth quintile <3 yrs in 5 longitudinal studies (SD scores) Philippines Indonesia ^Grades attained S Africa *boys Brazil^ Guatemala*

IQ scores of stunted and non-stunted Jamaican children from age 9 -24 mo to IQ scores of stunted and non-stunted Jamaican children from age 9 -24 mo to 18 y 0. 8 0. 6 Non-stunted SD score 0. 4 0. 2 0 -0. 2 Stunted. -0. 4 -0. 6 Griffiths on Griffiths Enrollment (33 -48 mo) ) (9 -24 mo) Stanford. Binet (7 -8 y) WISC-R (11 -12 y) WAIS (17 -18 y) Source: S. Grantham-Mc. Gregor, and J. Habadani: Preventing the loss of children’s developmental potential, Centre of Excellence for Early Childhood Development, Vaudreuil (Québec) April 26 -28, 2006

Intergenerational Transmission of Poverty preschool child low IQ, behavior problems school Poor stimulation, health Intergenerational Transmission of Poverty preschool child low IQ, behavior problems school Poor stimulation, health and nutrition poor school achievement, behavior problems adult National Economy low education low skilled/no work high fertility depressed/stressed 10

If all these were true, do we know what to do? To start with, If all these were true, do we know what to do? To start with, • better nutrition, • essential mother and child care, and • early sustained sensory and social stimulation Program Options: • Delivery of services to young children • Education and support of parents • training and support of caregivers/paraprofessionals • Sensitization of the public, through the mass media, to the value of ECD • Promoting and strengthening community-based activities 10

Lancet paper 3 - Effects of interventions on cognitive and social-emotional development Significant results Lancet paper 3 - Effects of interventions on cognitive and social-emotional development Significant results (of total evaluations) Effect sizes Mainly centrebased 8 of 8 0. 23 to 1. 40 Mainly parentchild and parenting 5 of 6 0. 45 to 0. 8 Comprehensive 5 of 6 0. 37 to 1. 80 Type of intervention

Philippines Early Child Development Program Child age at initiation Developmental index varies by child’s Philippines Early Child Development Program Child age at initiation Developmental index varies by child’s age and duration of time in program, favoring younger children with longer duration.

Closing the Gap… Opportunities and Challenges Closing the Gap… Opportunities and Challenges

Opportunities. . Source of Brain Stimulation parent-oriented child-oriented age 0 1 2 3 4 Opportunities. . Source of Brain Stimulation parent-oriented child-oriented age 0 1 2 3 4 5 6 Components of Early Childhood Development and Parenting Centers: ECD & care (parental and non-parental) arrangements Play-based learning Prenatal & postnatal supports Nutrition programs

Implement an Overall ECD Strategy § Intervene early, often and effectively § Allocate sufficient Implement an Overall ECD Strategy § Intervene early, often and effectively § Allocate sufficient resources § Ensure relevant training New generation competent in the understanding of human development § Build systems, not just projects. Emphasize equity, sustainability, and population health. § Monitor and evaluate. Measure child development outcomes

Barriers to Implementing ECD Programs 1. Economics 2. Lack of understanding (public and professional) Barriers to Implementing ECD Programs 1. Economics 2. Lack of understanding (public and professional) 3. Lack of qualified staff 4. Lack of community ECD data 5. No commitment to equality of opportunity for all young children

World Bank Cumulative Lending for ECD by Regions (1990 -2006) $1. 7 billion over World Bank Cumulative Lending for ECD by Regions (1990 -2006) $1. 7 billion over 16 years

Still need to do much more… to close the gap Magnitude of Disadvantaged Children Still need to do much more… to close the gap Magnitude of Disadvantaged Children Lending by Region

Indicators to Monitor Differ Significantly Child Development Index (measure of child development outcome) Indicators to Monitor Differ Significantly Child Development Index (measure of child development outcome)

Monitoring Child Development Outcomes § Building monitoring systems § Collecting populationbased child outcome data Monitoring Child Development Outcomes § Building monitoring systems § Collecting populationbased child outcome data

Challenges. . Where does ECD fit in? …where cross-sector policies/programs are essential to human Challenges. . Where does ECD fit in? …where cross-sector policies/programs are essential to human capital development Age 24 Youth Development Social Protection Education 14 Health and Nutrition 18 (School-to-work, Second-chance programs, Risky behaviors, participation, crime and violence) 5 0 Early Child Development (Health/Nutrition, School Readiness, Parenting)

Challenges. . A Diverse Field Organized care and education Primary education (age 6 up) Challenges. . A Diverse Field Organized care and education Primary education (age 6 up) ECCE policies and programs for ages 3 and up -pre-primary education -non-formal education ECCE policies and programs for ages 0 to 2 -organized care and education -non-formal care or education -support to parents - parental leave Providers • Governments (national, sub-national) • Private sector (non-profit and for-profit) • International non-governmental organizations • Community-based organizations Informal care and child rearing Informal provision of care for children aged 0 to 8, by parents or extended family, mainly at home but sometimes in other family or community settings.

Chaos Health Public health Preschools Social services Parks & recreation Early intervention Municipalities Parenting Chaos Health Public health Preschools Social services Parks & recreation Early intervention Municipalities Parenting centres Family support Education Community services Local school authorities Kindergartens Child care Children’s mental health centres

Challenges … Optimal vs. Actual Investment Example of the U. S Cumulative Public Investment Challenges … Optimal vs. Actual Investment Example of the U. S Cumulative Public Investment Optimal Investment Levels Pre-school 0 Post-school School Age Source: P. Carneiro & J. Heckman, Human Capital Policy, NBER, 2003; Voices for America and the Child and Family Policy Center, Early Learning Left Out An Examination of Public Investment in Education and Development by Child Age 2004. ,

Sweden’s Public Expenditure for Children 0 -17 age old - Ultimate Goal!! Source: S. Sweden’s Public Expenditure for Children 0 -17 age old - Ultimate Goal!! Source: S. Bremberg (2006), National Institute of Public Health, Karolinska Institute, Stockholm, Sweden