Public health for communities and children

The long-term health of communities and children are deeply connected.

City Health recently released its inaugural report rating cities on their ‘healthiness.’ We're pleased to note that high quality early childhood programs were included as an indicator of health. City Health explains it here:

“High-quality pre-K improves children’s school readiness and success: they enter school better prepared and are less likely to repeat a grade or be referred to special education. Long-term benefits include higher high-school graduation rates, lower rates of crime and teen pregnancy, higher lifetime earnings, and better health outcomes.”

Philadelphia scored a silver medal overall, and in high quality early childhood education programs, meeting all four critical benchmarks (related to teacher training, class size and ratio, site visits) and 8 of 10 overall benchmarks, but scoring low on enrollment.

There are an increasing number of research reports indicating that high quality early childhood programs can have a positive impact on health from the start, and on a range of life outcomes as children grow, including academic success, social-emotional well-being, and long-term health. A recent presentation by Bartik concludes that significant long-term outcomes can be shown for large-scale pre-K programs if they are high quality or specifically targeted to disadvantaged populations of children.

At the same time, early childhood education alone is not enough. A recent study shows that city living can make asthma worse for children, for example. Children’s success in kindergarten has been linked to food security, and long-term life outcomes can be influenced by factors ranging from family stability, and segregation, to specific parent engagement indicators. For example, Penn State researchers report that:

  • Promoting positive parenting practices and parent-child relationships can reduce behavioral problems.
  • Promoting home learning activities and effective teaching strategies can foster early learning.
  • Strengthening parent-teacher partnerships can boost academic and social-emotional skill development.
  • Emphasizing a child's physical health can aid healthy overall development.

Resilience can also be a factor for children challenged by ongoing toxic stress, which may be exacerbated by living in poverty, experiencing health issues, or being hungry. Strategies to build resilience are still being clarified, but it is clear that positive relationships with caring adults, along with opportunities for creative play, exercise, and mindfulness, can help. High quality preschool can be a factor in providing those opportunities.

Joan Lombardi, from The Center for the Study of Social Policy recently discussed a growing movement to “involve the whole community in efforts to help children and families learn and thrive.” This is based on a range of concepts, including: 

  • The ecological systems model that recognizes that children grow up in families, which are influenced by the communities around them and in turn by policies at all levels.
  • The movement towards collective impact, rather than focusing on impact from a single program.
  • The use of population-based data to drive towards results. 

Lombardi suggest a range of steps communities can take to strengthen and enhance the effectiveness of their efforts, including planning across sectors; developing strong connections and linkages among groups, and from families through the community; and developing integrated systems and dashboards to track the success of those efforts.

The Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation launched the 500 Cities Project in 2015, a useful source for current information on city indicators, “to provide city- and census tract-level small area estimates for chronic disease risk factors, health outcomes, and clinical preventive service use for the largest 500 cities in the United States.” The data for the largest cities in every state is included, to ensure all states are represented. 

Some data specifically related to Philadelphia changes over time are available here. The Pew Charitable Trusts has also released some case studies and infographics about how community development and health are related.

Last week NIEER described this report about cities offering universal preschool: “Child Care and Early Education Research Connections this week shared a Resource List providing a comprehensive list of city universal preschool initiative evaluations and research in the Research Connections collection. To count as universal, a city's program must aim to eventually provide universal access to publicly-funded preschool for all 4-year-olds using at least some city funds, even if it does not currently achieve universal access.”

The takeaway? It might take the whole city plus some high quality early childhood education to give every child the opportunity to succeed. Many elements that contribute to success are already in place in Philadelphia, and in other cities, which can provide examples of how to proceed.