early childhood health promotion and its life-course consequences bernard guyer md mph johns hopkins...

Early childhood health promotion and its life-course consequences

Bernard Guyer MD MPHJohns Hopkins Bloomberg School of

Public Health

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Univ. Minnesota & Federal Reserve Bank,Minneapolis MN, October 14-15, 2010

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

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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.

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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

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2009

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

Life Stage of Intervention Adult Impact

Level of intervention

Preconception/ pregnancy

Infant/child Adolescent Adult

Individual

Family/houshold

Local/community

National/state policies

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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

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Lifespan: Tobacco Impact and Prevention

Level of Intervention

Lifespan Stage Intervention and ImpactImpact of Early

Intervention

Preconception/ Pregnancy

Infant / Childhood Adolescence Adulthood

Individual Smoking cessation therapy 1

Smoking cessation therapy 2

Smoking cessation therapy with partner support 3

Smoking cessation therapy targeting relapse 4

Family Smoking cessation for adults living with children 5

Local / Community / Workplace / School

Media campaigns 6

Bans / restrictions in workplace and public 7

Community mobilization 8

National / State Price increases 9

Enforcement of age ban on sales 10

Age period when interventions take placeAge period with continuing positive impacts of intervention

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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

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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

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Lifespan: Obesity Impact and Prevention



Intervention



Individual Observational Studies 1

Observational Studies 2

Family Preschool Education 3

Parent Education 4

Local / Community / Workplace / School Teacher curriculum 5

National / State


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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

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Lifespan: Impact of Injury Prevention



Intervention



Individual Gun safety education 1

Family Home visits 2

Prenatal home visitation 3

Education against the use of baby walkers 4


Community education combined with incentives distribution for safety 5

Smoke detector distribution

National / State Changes in baby walker safety standards 6

Child passenger safety laws 7


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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

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Intervention



Individual Child-focused training 1

Parent support programs: Healthy Steps 2

Parent-focused training programs; Triple P 3 ,4,5

Family Parent- and child-focused training programs 6


School-based: Fast Track 7

National / State New Hope 8

Lifespan: Impact of Interventions for Mental Health Disorders


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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

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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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early childhood health promotion and its life-course consequences bernard guyer md mph johns hopkins...

Documents

health health problems

parental smoking

absence of disease health

tobacco impact

maternal smoking

family smoking cessation

early childhood need

tobacco exposure