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Child Care: A Key to Community Health and Well-Being?

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"Children are the world's most valuable resource and its best hope for the future."

- John F. Kennedy

What was a President's lofty belief 50 years ago is now a scientifically-based reality. In recent years, research has increasingly pointed to the importance of the first years of life in setting the trajectory for lifelong well-being. This research has various threads, from "brain science" to "developmental origins of health and disease," but weaves a common lesson for public policy: the first five years of life are the most important for affecting lifetime cognitive, emotional, and physical well-being. Our best hope for the future is to adopt practices and policies that recognize this reality.

The good news is that, across the country and globally, many efforts are not only recognizing this reality but addressing it. The national movement to increase availability of preschool programs is one such effort. Community-based programs to help parents acquire and use the varied skills needed for the challenging role of parenting are another.

However, as laudable as preschool parent and support programs are, they do not address a growing reality of American childhood that represents a key opportunity to improve children's lives: child care.

The Child Care Setting as a Lever for Change

Across the U.S., almost 11 million children younger than age 5 are in some type of child care arrangement, spending an average of 36 hours a week there. In Vermont, where I live, more than 70% of children 0 to 5 years of age are in a child care setting outside their home. Yet, efforts to improve child health and development have only rarely recognized this reality of children's lives and even more rarely taken advantage of it.

What would the impact be on children's lives and our shared future if child care were made more accessible, more affordable, and of higher quality? What if the child care provider, who interacts with a child for hundreds, if not thousands, of hours every year was given support and training in optimizing child development? What if that provider, building on the frequent contact and high level of trust enjoyed with parents, was given the tools to recognize and find community-based help for parents dealing with addiction, underemployment, or other life stresses? What if we used the child care setting, where children spend so much of their waking lives, as a key venue to improve both child nutrition and nutrition education? What if we evaluated all this, while we were doing it, to develop a robust evidence base as to how best to use the child care platform to improve children's well-being?

In Vermont, a number of individuals and organizations have started to address such questions, in a coordinated effort to elevate the arc of children's lives. But, there is much more to do.

Invest Early, Invest Wisely

President Kennedy was right: Children are the world's most valuable resource and its best hope for the future. As a society, we need to increase our investments of time and energy in the first years of life. This is the right thing to do, but also a savvy investment in our future. But, as with any investment, we need to invest wisely, not blindly. We need to accumulate evidence as to what works, and in which contexts.

So, just as it is important that evidence inform efforts to use child care to improve children's lives, it is important that these efforts generate rigorous evidence as to what does, and does not, work. In future posts, I hope to report both about what Vermont is doing in this area and what evidence it might provide to inform the work of others.