Early childhood health promotion and its life-course consequences

1. 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

2. 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

3. 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.

4. 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

6. 2009

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

8. 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

9. Lifespan: Tobacco Impact and Prevention Age period when interventions take place Age period with continuing positive impacts of intervention

10. 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

11. 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

12. Lifespan: Obesity Impact and Prevention Age period when interventions take place Age period with continuing positive impacts of intervention

13. 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

14. Lifespan: Impact of Injury Prevention Age period when interventions take place Age period with continuing positive impacts of intervention

15. 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

16. Lifespan: Impact of Interventions for Mental Health Disorders Age period when interventions take place Age period with continuing positive impacts of intervention

17. 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…

18. 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

19. 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

20. 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