Policymakers Must Understand How Education, Health Care, and Economic Security Shape Early Child Development

Good health is closely tied to a host of nonclinical factors, known as the social determinants of health, that shape how one grows, lives, works, and plays. These factors begin exerting their influence on a person’s well-being during the earliest periods of life—a time when children are particularly vulnerable to the effects of scarcity and instability. Notably, systemic inequities in access to basic needs, such as housing, food, healthy environments, and financial security, disproportionately affect marginalized and low-income communities, exacerbating disparities that have lasting, intergenerational consequences. These social determinants, together, make up the much larger puzzle of how human social systems operate and the effect of broader community contexts on well-being throughout life.

Ensuring that support systems are robust and equitable—and that they account for the interconnected suite of social determinants—can set children and future generations on a path toward better health and greater economic security.

Understanding child development can promote holistic policymaking

A range of federally funded programs and policies have been successful in addressing social, health, and economic inequities among young children and their families—including financial support such as tax credits and cash assistance; improved health care access through Medicaid and the Children’s Health Insurance Program (CHIP); enhanced food and housing security through programs like the Supplemental Nutrition Assistance Program (SNAP) and Community Development Block Grants (CDBG); and greater educational attainment through programs like Head Start and Early Head Start. But despite the positive effects of many of these programs, historic underfunding and lack of access stymie efforts to close these gaps and ensure that all children, regardless of circumstance, have a strong start in life.

Moreover, broader social and economic policy is often not viewed as directly relevant to young children, and efforts to address early childhood inequities remain siloed. Persistent attitudes that family-related issues, including the growth and education of young children, should be handled privately and are not under the purview of the state or federal government also limit attempts by researchers and advocates to generate political investment in family support programs.

Yet decades of research show that children are shaped in meaningful and enduring ways by their environment, access to critical resources early in life, and nurturing relationships with caregivers. For this reason, early investments in child and family well-being pay for themselves, resulting in wide-reaching positive outcomes. Understanding how children develop and the interconnected ways social determinants shape that development can promote holistic policymaking practices that support long-term child and family well-being.

During times of crisis, such as the COVID-19 pandemic, the transformational impact of federal investments on families cannot be clearer. For many marginalized and low-income families, programs that make up the social safety net can often make the difference between whether they have adequate food to feed their children, access to safe and secure housing, and the financial stability to withstand economic downturns.

Although the United States continues to have one of the highest child poverty rates among industrialized nations, the expansion of the social safety net is credited with contributing to a historic decline in child poverty over the past three decades, amounting to 4.5 million more children protected from falling into poverty in 2019, compared with 1993. Additionally, expansions to the child tax credit (CTC) and food benefit programs during the COVID-19 pandemic resulted in marked reductions in child poverty over the past two years despite a tumultuous economic landscape for millions.

Congress’ failure to renew American Rescue Plan Act (ARPA) expansions to the CTC resulted in greater financial and material hardship for families with young children. Indeed, the percentage of families with children experiencing food insufficiency spiked 25 percent from January 2022 to July 2022, after families stopped receiving payments on January 15. Moreover, the expansion of work requirements for SNAP and Temporary Assistance for Needy Families (TANF) through the debt ceiling deal—the Fiscal Responsibility Act of 2023—may result in many losing coverage, as it counterintuitively introduced new barriers to workforce participation and family economic security.

Public investments in children and families have obvious benefits for recipients, but there are also spillover effects that have positive social and economic impacts on nonrecipients and future generations.

Some of the longest-running and most successful social programs have expanded eligibility to include people just above the poverty line who also qualify as low-income, as well as those well above the poverty line and a significant portion of the middle class. For instance, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), SNAP, and Medicaid have grown significantly in recent decades and now include eligibility for people with incomes above the federal poverty level. In addition, research finds that the most successful interventions in early childhood are multigenerational; positive program outcomes and social mobility rates are maximized by activating and promoting parenting skills alongside child-focused services.

Ultimately, investments that focus on the needs of young children and their families together promote long-term positive outcomes.

The perinatal period

The perinatal period is loosely defined as the developmental time frame between 20 weeks of pregnancy and four weeks postpartum. Starting during pregnancy, women’s access to prenatal health care, family economic security, a safe physical environment, and food and housing security shape the health of developing children and the context into which they are born.

The perinatal period also presents an important window of time for parent mental health screenings and services. Mental health challenges during pregnancy can affect fetal development directly through hormonal changes and increased stress on the pregnant parent and indirectly through negative health habits such as smoking or substance abuse. However, nurturing child-caregiver relationships, access to critical economic and health resources, and responsive parenting supports can promote healthy perinatal development and protect infants against these kinds of adverse childhood experiences (ACEs) known to be damaging to later health and developmental outcomes.

In the first report of this series, the authors examine each dimension of the social determinants in the perinatal context—including access to maternal and prenatal care (health care); neighborhood health, housing security, and environmental pollution (neighborhood and physical environment); wraparound educational services (education); parental employment status, poverty, food security, and comprehensive paid leave policies (economic stability); and consequences of discrimination based on race, disability status, gender identity, and parental incarceration status (social and community context).

Each of the three reports in this series ends with a visual depicting a broad swath of policy priorities, illustrating their impact on each dimension of the social determinants.

Infancy and toddlerhood

The first three years of life mark a foundational neural and socioemotional development period that sets the stage for later learning, health, and well-being. The brain forms more than 1 million neural connections each second during the first year of life as infants rapidly consume input from the world around them. Quality interactions with responsive caregivers and early learning activities such as storytelling and singing songs help strengthen neural connections that are necessary for later learning.

However, disparities that exist at birth, neglect, and overly stressful early life experiences can also negatively affect brain and biological development. Although some amount of stress is natural and, in fact, necessary for children to develop a healthy stress response system, ongoing toxic ACEs, such as food and housing insecurity or living with a caregiver with an untreated mental health disorder, can disrupt early brain and biological development and lead to later health issues, including heart disease, diabetes, substance abuse, depression, and anxiety disorders. Yet studies on resilience have shown that even one stable, responsive relationship with a caregiver or other adult can buffer some of the harmful impacts of stress in early childhood.

In the second report of this series, the authors examine each of the social determinants in the infancy and toddlerhood context—including through access to developmental and well-baby visits, childhood immunizations, and continuous insurance coverage through the postpartum period (health care); neighborhood and environmental safety and housing conditions (neighborhood and physical environment); access to affordable infant and toddler child care and early learning opportunities (education); poverty, food and diaper insecurity, and the recent infant formula shortage (economic stability); the inequitable impact of COVID-19 and the consequences of discrimination (social and community context).

Like the first report in this series, this report depicts a range of policy priorities that affect infants and toddlers through their impact on social determinants.

Early childhood

During early childhood or preschool, access to critical resources and enriching early interactions continue to build the foundation for all subsequent development and learning. Family economic security, neighborhood safety, health care access, educational opportunity, and exposure to social factors such as discrimination can affect young children’s health and exert cumulative effects over time. Healthy early development is linked with improvements in later physical, social, and cognitive development; increased language skills; improved literacy and numeracy; better health outcomes, including lower rates of obesity, heart disease, and mental health challenges; and economic stability throughout life. In contrast, children who experience multiple adversities during early childhood have a greater risk of premature mortality in adulthood. Early childhood offers a critical developmental opportunity for intervention, when children’s brains are still rapidly developing and their susceptibility to influential early experiences can be harnessed to support their long-term well-being.

In the final report of this series, the authors examine each of the social determinants in the preschool context – including through Medicaid/CHIP coverage and continuous eligibility, well-child visits, and the effect of COVID-19 (health care); neighborhood safety, environmental racism, and the role played by the built environment (neighborhood and physical environment); access to high-quality child care, Head Start, and culturally responsive pedagogy (education); anti-poverty measures such as tax credits, and food security (economic security); and the continued effect on health of racism and implicit bias (social and community context). Consistent with both previous reports in the series, this final product includes a visual illustrating a range of policy priorities that affect children during the preschool years through their impact on the social determinants of health.

Conclusion

Much like any new form of infrastructure needs a strong foundation for stability and longevity, young children need a holistic policy landscape that supports their developmental needs to grow into healthy, successful members of their communities. Prioritizing policies and programs that center children and families reflects an understanding of development as a continuous process that absorbs the impact of broader social, environmental, and economic conditions; proactively supports individuals; and results in better lifelong outcomes across generations. Young children raised in healthy, nurturing environments by parents whose well-being, workforce participation, and financial security are supported create economy-wide benefits felt over generations. Policymakers rarely view early childhood investments as the key for addressing societal issues such as poverty, educational disparities, and health, and approach these issues retroactively rather than proactively.

However, investments that expand health care and educational access, promote anti-poverty and anti-racism efforts, and ensure a healthier physical environment from early in life have proven benefits on long-term health, educational attainment, and financial stability, paying for themselves many times over in the short and long run, and even into the next generation. Considering the unique needs of children and families, particularly during critical early stages of development, is crucial to promoting better health and well-being for all families, for years to come.