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Lancet. 2017 Jan 7;389(10064):103-118. doi: 10.1016/S0140-6736(16)31698-1. Epub 2016 Oct 4.

Investing in the foundation of sustainable development: pathways to scale up for early childhood development.

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DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa. Electronic address:
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
Bernard van Leer Foundation, Washington, DC, USA.
UCLA Fielding School of Public Health and WORLD Policy Analysis Center, University of California Los Angeles, CA, USA.
Inter-American Development Bank, Washington, DC, USA.
Departments of Economics and Sociology, University of Pennsylvania, Philadelphia, PA, USA.
Division of Global Health Equity, Brigham & Women's Hospital, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
Consultant in International Health and Child Development, New York, NY, USA.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA.
Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
Center for Global Child Health, Hospital for Sick Children, Toronto, Canada; Centre of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
Haas School of Business and the School of Public Health, University of California Berkeley, CA, USA.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.


Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

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