A 2017 report by the McKinsey Global Institute documented that companies with a “true long-term mindset” perform better on financial indicators than peer organizations with a more short-term focus. Companies such as Ford and Verizon have reinvigorated themselves by forestalling short-term worries to concentrate on long-term goals. In light of these lessons from the business world, those of us who care for children find our health care system’s myopic focus on short-term cost savings concerning. Health care systems focussignificant resources on programs for the top 5 percent of health care spenders (who are overwhelmingly adults with chronic conditions), while overlooking the needs of children. This spending pattern may cut costs quickly, but it ignores the fact that building the healthy adults of tomorrow requires investing in children (particularly young children) today. We advocate that Medicaid in all states include a quality metric related to school success—such as school readiness—thereby incentivizing health systems to collaborate with educational partners to promote population-based child well-being.
The First 1,000 Days—An Important Time To Promote Lifelong Health
With regard to child health, the US consistently ranks below other wealthy nations. Since the 1980s, the child mortality rate in the US has exceeded those of 19 developed nations—including Australia, Canada, Sweden, Switzerland, and the United Kingdom—despite higher per capita health spending. Children in the US also suffer from chronic conditions such as asthma and diabetes at higher rates than children living in most other highly developed nations.
Advances in neuroscience indicate that early childhood experiences influence both the foundational architecture and long-term functioning of the brain. A child’s experience with the physical, social, and emotional milieu is embedded biologically and influences health, behavior, and learning across the lifespan. Specifically, protective early experiences promote positive coping skills and good health, whereas insecure experiences can lead to maladaptive coping skills and poor health. Decades of research demonstrate that children deprived of a strong developmental foundation are more likely to experience negative health outcomes in adolescence (for example, pregnancy and substance abuse) and in adulthood (for example, obesity, coronary artery disease, and depression). Data concurrently demonstrate our ability to improve these outcomes for vulnerable children and to generate benefits to society that far exceed program costs. Nobel Laureate economist James Heckman documents that improving the experiences and environments of children ages 0–5 years provides a return on investment of up to 13 percent—translating to billions of dollars in net benefit to society.