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Early childhood health promotion and its life-course consequences. Univ. Minnesota & Federal Reserve Bank, Minneapolis MN, October 14-15, 2010. Bernard Guyer MD MPH Johns Hopkins Bloomberg School of Public Health. Defining Health & Health Problems in Early Childhood.

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Early childhood health promotion and its life-course consequences

Univ. Minnesota & Federal Reserve Bank,

Minneapolis MN, October 14-15, 2010

Bernard Guyer MD MPH

Johns Hopkins Bloomberg School of Public Health


Defining Health & Health Problems in Early Childhood

  • Health is more than absence of disease

  • Health in early childhood linked to development & growth; brain & organ systems

  • Health begins with mothers’ “girlhood,” extends through pregnancy into preschool

  • Early health problems with lifelong consequences: tobacco exposure, unintentional injury, obesity, mental illness


If concerned about health in early childhood…

  • Need to know what are the important problems to address;

  • Need to know the cost implications;

  • Need to critically investigate the effective and cost effective/beneficial interventions;

  • Need to bring reliable information to the policy-making process.

  • Need “social strategies” that work.


Objective & approach

  • In 2008, produced review for Pew: Partnership for America’s Economic Success

  • Objective: short- and long-term impact of interventions for children 0-5, including pregnancy

  • Selected 4 areas of preschool child health: Tobacco exposure, Obesity, Injury, Mental health

  • Systematic review of literature- preventive interventions and CE/CB studies- 1996-2007

  • Updated review for 2008-2010 for this paper:

    • No substantive changes in findings or conclusions


2009


Framework for review of interventionsTobacco, Obesity, Injury, Mental health


Tobacco and Child Health

  • Smoking impacts children through:

    • Prenatal exposure (10.2% of babies)

    • Environmental tobacco smoke (25-50%)

    • Teen smoking

  • Extra costs for prenatal care and complicated births due to maternal smoking are $4 B/year*

  • Direct medical cost of all pediatric disease** attributable to parental smoking $7.9 B/year

  • Could save $1 billion/year in direct medical costs with a 15% reduction in parental smoking

* Costs in this presentation have been standardized to 2006 dollars

**Birth to 18; Low birth weight, SIDS, RSV, otitis media, asthma, burns


Lifespan: Tobacco Impact and Prevention

Age period when interventions take place

Age period with continuing positive impacts of intervention


Obesity and Child Health

  • Emerging major public health problem

    • Obesity tripled in 20 years (5% to 14%)

    • 17-18% of children 6-18 overweight (2006)

  • Patterns of obesity begin in childhood

    • 50 to 80% overweight children and teens become obese adults

  • Implications for lifetime of health problems

    • Links to type 2 diabetes, cardiovascular diseases, pregnancy complications, alienation and depression


Costs of Overweight & Obesity

  • Early stage to assess cost of obesity “epidemic”

    • Cost estimate: Direct $109B; Indirect $75B (annually in 2006 dollars); Medicare and Medicaid cover 50%

  • Four-fold increase in obesity-related hospital costs for children age 6-17 from 1979-1999

    • $44 M in 1979 to $160 M in 1999 (annually in 2006 dollars)

  • Difficult to ascertain indirect costs


Lifespan: Obesity Impact and Prevention

Age period when interventions take place

Age period with continuing positive impacts of intervention


Injuries and Child Health

  • Magnitude of the problem

    • Leading causes of child death- 15,755 in 2004

    • Leading causes of hospitalization- 240,000 (<15yo)

    • Leading causes of ER visits- 9 million

    • Leading cause of disability- 150,000 permanent

  • Cost of child injury:

    • Both fatal and nonfatal injuries of children (0-4) resulted in 4.7 billion for life-long medical costs & 14 billion for both present and future productivity losses

  • Trends in injury reduction:

    • 52% decrease in rate between 1979 and 1998

    • Current approaches: public health education, safety behavior, legislative, environmental engineering, EMS


Lifespan: Impact of Injury Prevention

Age period when interventions take place

Age period with continuing positive impacts of intervention


Mental Health Disorders

  • Magnitude of the problem

    • Estimated ~20% of children-at least mild mental functional impairments.

    • For children between the ages of 1-6 years old:

      • 3.4%-6.6% have externalizing behaviors

      • 3.0%-6.6% have internalizing behaviors

  • Cost of child mental health disorders

    • The estimated cost of treating children aged 1-5 nationwide approached $864 million annually.

    • Unsolved conduct disorder is estimated to incur average societal cost of £70,000 by age 28, 10 times higher than those without conduct disorders


Lifespan: Impact of Interventions for Mental Health Disorders

Age period when interventions take place

Age period with continuing positive impacts of intervention


What we’ve learned

  • Overall magnitude of health burden

    • Early child health related to high prevalence, expensive health problems across lifespan:

  • Four health problems affect about 1/3 to ½ of U.S. birth cohort- 1.3-2.0 million;

  • Estimate that $50,000 in lifetime cost per child translates to $65-$100 Billion for the whole birth cohort

  • Most successful interventions for injury and exposure to tobacco; need more…


What we’ve learned (2)

  • Child health is more than absence of disease

    • Health is linked to development and learning

    • Children must be healthy to learn at school

    • A lifespan perspective- early antecedents

    • More than access to medical care

  • Effective policy/program based on broad public health approaches rather than on individual behavior change or medical interventions alone (e.g. tobacco, injury)

    • Multiple societal determinants

    • Multifaceted approaches; systems


What we’ve learned (3)

  • Challenges ahead:

    • Need better research on definition of health & measures in early life

    • Need more high-quality intervention studies to demonstrate long-term effects.

    • Need “attributable risk” estimates

  • “Societal investment” approach needed to promote early child health now and assure health, development, education & productivity of next generation

    • Expect return on investment; reduced lifetime costs


Acknowledgements

  • Colleagues and co-authors: Sai Ma, PhD, Kevin Frick, PhD, Alyssa Crawford, BA

  • Academic Pediatrics

  • Zanvyl & Isabelle Krieger Family Fund

  • Partnership for America’s Economic Future, Pew Charitable Trust


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