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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

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
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
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
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
tobacco and child 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
Lifespan: Tobacco Impact and Prevention

Age period when interventions take place

Age period with continuing positive impacts of intervention

obesity and child health
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
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
Lifespan: Obesity Impact and Prevention

Age period when interventions take place

Age period with continuing positive impacts of intervention

injuries and child health
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
Lifespan: Impact of Injury Prevention

Age period when interventions take place

Age period with continuing positive impacts of intervention

mental health disorders
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
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
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
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
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
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