Healthy Policies

By Helia Molina Milman

What role does child development play in your country’s policies? We have a great deal of knowledge and evidence about early childhood development, as well as lessons learned and systematized; nonetheless, the required levels of investment in children in Latin America and the Caribbean have still not been reached.

Last month, the World Health Organization’s (WHO) 8th Global Conference on Health Promotion was held in Helsinki, Finland. The first conference of this kind took place in 1986 in Ottawa, Canada, and it marked a sea change in public health worldwide. The Ottawa Charter for Health Promotion represents a new paradigm in health promotion because it establishes fundamental strategies such as the development of healthy public policies, the promotion of social and community participation, intersectoral work and the improvement of personal skills in order to make the best health decisions.

Between the first and the eighth conferences, a solid body of knowledge on social determinants of health has developed. The most recent conference emphasized a theme that has become more and more powerful: health in all policies. To the extent that there’s a greater awareness of the social determinants of health and a vision of health as a social construct, we must approach the topic of health using a multidisciplinary and intersectoral approach. The book “Health in All Policies” describes it well. Chapter 6, in particular, is devoted to children, and it addresses early childhood development from a results-oriented, equitable perspective.

The chapter was written by two Latin American and two Canadian authors, one of whom was Clyde Hertzman. As director of HELP and a researcher at the University of British Columbia, he served as a great leader in early childhood development at the global level and provided ample evidence of the effectiveness of interventions and innovative measurements of early childhood development. Dr. Hertzman died in early 2013 and so did not live to see the finished book. Therefore, I’d like to take this opportunity to recognize him both as a professional and as a human being, and to pay tribute to his tremendous contribution to the wellbeing of children in Canada and in many other parts of the world, mainly in developing countries.

In the book, early childhood development is approached from several perspectives. Successful experiences are described and comprehensive policies are discussed, as well as working models that focus on children’s rights. Early childhood development in all policies makes sense. Child development is multidimensional, not just as a result of the complexity of the processes occurring in the brain but also for the substantial influence that it has on the acquisition of biological, psychological and social skills. Critical periods represent a very brief window of opportunity. Children reach developmental milestones in several areas before their first one thousand days of life (beginning in the womb). This lends a sense of urgency to public policies focused on early childhood development.

In fairness, it should be noted that in recent years many countries in the region have placed children and early childhood development on their list of priorities. For this very reason, the challenge is to design and implement comprehensive policies that consider aspects such as cultural relevance, rights, and intersectoral cooperation. This moves even further up the agenda if we recognize the sectoral nature of the institutional culture in the countries within the region and that there is little in the way of complementarity and almost no synergy between the various interventions.

Helia Molina Milman, MD, MPH, is Professor of Public Health at Pontificia Universidad Católica de Chile (Pontifical Catholic University of Chile). She was Executive Secretary of the “Chile Crece Contigo” program from 2008 to 2010.