We cannot afford to postpone investing in children until they become adults, nor can we wait until they reach school — a time when it may be too late to intervene
- Nobel laureate James J. Heckman

I am going to talk today about the importance of Early Child Development, or ECD, and, particularly, the urgency for comprehensive, integrated approaches to ECD that begin at the very earliest ages—0 to 3.

The Context for ECD
The significance of Early Child Development for all of human development is recognized increasingly in developed and developing countries. Dutch economist Jacques van der Gaag , in a recent World Bank publication wrote:

Well executed and well-targeted ECD programs are initiators of human development. They stimulate improvements in education, health, social capital, and equality that have both immediate and long-term benefits for the children participating in the programs. Investments in ECD programs are in many ways investments in the future of a nation.

Four points are relevant for our discussions today:

• First, the integration of new knowledge from the social sciences and the natural sciences makes it clear that early child development affects health, learning, and behavior throughout life.
• Second, young children are being reared today in societies that are undergoing marked social and economic changes and that need new public policies - in both developing and developed countries.
• Third, the gap between what we know about child development and what we do to promote high quality child development continues to be wide.
• Fourth, early child development has a greater effect on the health and well-being of a population than it does on just education alone (although the easiest way to measure the outcomes of ECD is through education).

The Science Behind ECD
What does science tell us?

It tells us that the development of the brain during a child's formative years is a pathway to lifelong physical and mental health, learning, and behavior. The evidence for these effects is solid. The early developmental stages, which begin at least at birth and perhaps even before — as evidence is beginning to show — set us on a trajectory that influences all of our later development as we grow into adolescence and adulthood.

What are the implications of this scientific understanding for ECD? Briefly, we now know that:

1. Human development depends on the interaction between nature and nurture. The new knowledge from neuroscience and genetics, which continues to advance exponentially, makes the debate about nature versus nurture obsolete.
2. Early care and nurturing have a decisive and long-lasting impact on how people develop, their ability to learn, and their capacity to regulate emotions.
3. With the plasticity of the brain, there are times when negative experiences or the absence of appropriate stimulation are more likely to have serious and sustained effects. Negative experiences, malnutrition, and exposure to drugs, environmental neurotoxins, and chronic stress can harm brain development.
4. Early interventions can improve the lives of vulnerable children, and the most deprived children can gain the most from these interventions. However, no magic bullet or one size of intervention meets all needs.

In addition, each child's experiences during the early years have a multiplier effect on the child's family and society. When a child is not well nurtured, he or she will tend to become disruptive, delinquent, and prone to criminal behavior. Another child, who is well nurtured, will tend to do better in school and will have a better chance to develop skills that he or she can use to contribute to society and compete in the global economy. By strengthening the growth and development of all young children, we strengthen our societies. What a good investment this is!

Now - when we focus on children, we need to address the whole child and all aspects of that child's development, for one aspect influences another. Appropriate nutrition, for example, encourages adequate growth, good health, and mental agility. One only has to look at the devastating effects of malnutrition in children to see how close these connections are.

Children in Brazil
Brazil has a long history of early childhood interventions, and its infrastructure of health, education, and social protection is well developed. Further, ECD programs are implemented by both private, non-governmental organizations (NGOs) and government agencies.

Yet, more than two-thirds of Brazil's children ages 0 to 6 do not attend early intervention programs. In 1997, about 27 percent of Brazil's 22 million children ages 0 to 6 were enrolled in daycare and preschool programs.

Who attended these programs? Mostly, it was children who were older, not younger; who lived in urban, not rural, areas; and who came from richer, not poorer, families. About 51 percent of 4-6 year olds, compared with 8 percent of 0-3 year olds, attended early interventions. Access to early interventions was lowest for children living in the Midwest, South, and North and in rural areas everywhere.

Analysis of survey data from households in Brazil shows that preschool attendance has a positive and significant impact on the average years of schooling that children ultimately attain. The analysis shows that one additional year of preschool increases the amount of schooling that children ultimately attain by 0.4 years. For children whose parents are illiterate, the gain in total schooling may be even greater — to more than half a year. Attendance in preschool also reduces the rate of grade repetition — a finding that is important for Brazil where rates of grade repetition are high.

One year of preschool indirectly adds 0.4 years to the total amount of schooling a child achieves and directly has an independent, positive effect by increasing the child's future earning capacity by 2 percent — this is the lowest estimated increase. The data indicate that the added earning capacity directly resulting from one year of preschool could be as high as 6 percent.

The Brazilian researchers who conducted the study estimate that one year of primary school increases future income by approximately 11 percent. (Other researchers estimate the increase at 10 to 30 percent.) [Using that equation] the additional 0.4 years of schooling would thus translate to an indirect increase of 5 percent in added earning capacity. By combining this indirect effect with the direct increase of 2 percent, we see that just 1 year of preschool ultimately results in a 7 percent increase in potential added income later. These findings are for children whose parents have 4 years of education. For children whose parents are illiterate, the potential added income rises to 12 percent.

ECD and Literacy
Brazil has a special challenge to improve overall literacy, as well as access to ECD services. Literacy capability is a useful measure of brain development, and ECD programs foster literacy. An assessment of literacy conducted by the Organization for Economic Cooperation and Development (OECD) and Statistics Canada showed that 42 percent of Canadian youth functions at literacy levels 1 and 2 (low on the OECD scale) and about 22 percent functions at levels 4 and 5 (high levels). However, for Brazil, as the figure shows, 83 percent of the [entire] population functions at low literacy levels, that is, below levels 2 (levels 1 to 2).

To participate fully in the knowledge-based economies of today, a country's population should function at literacy levels four and five. Evidence shows that educational systems cannot foster this level of literacy unless they include strong ECD programs. One study in the United States which assessed the performance of 8th-grade students showed that the characteristics of children (readiness to learn in kindergarten) and of their household (mother's education) had much larger effects on their test scores than did classroom variables (child-staff ratio).

Rethinking ECD and Human Development
The brain is not a blank slate when a child enters school for the first time. Many brain functions, which include social and antisocial behaviors, have already been set by the totality of children's experiences during their early years. Because ECD affects physical and mental health, as well as learning and behavior, in adult life, we need to create a more integrated ministry for public policy in this area — perhaps a Ministry of Human Development.

The participation at this conference exemplifies the type of integration needed, and perhaps this conference can serve as the beginning of greater integration for human development. Today, all of the state secretaries in Rio Grande do Sul are participating — the State Secretary of Health, State Secretary of Education, State Secretary of Culture, State Secretary of Work Citizenship, and State Secretary of Social Assistance. Together, all of you have come together to focus on young children as Brazil's priority for the 21st century.

Integration and Cooperation
ECD must be approached in an integrated way—with cooperation at all levels of society (that is, parents, families, communities, and national institutions) and among all sectors, social and otherwise. Major sectors that have a special role in children's early development include nutrition and play-based learning, health, and social protection. But, other sectors also can contribute — for example, agriculture (for food contributions), finance (for funding support), government (for policy), labor and welfare (for training), and information (for public advocacy).

Within a state such as Rio Grande do Sul, or within a nation, all ministries concerned with the totality of children's development must work together to achieve interventions that are comprehensive and integrated. Just as one aspect of a child's development influences another aspect — to greater effect — so, too, can one intervention (for example, in nutrition) influence another intervention (for example, in education) to assure the benefit of each intervention and to reap the added benefit of the combined interventions.

The common adage is correct — the whole is more than the sum of the parts. To realize — and to maximize — their effects, ECD strategies and programs must aim to reach the whole child and to address each child's complex of needs — physical, mental, social, health, nutrition, protection, etc. No single sector can do this alone _ I especially want to emphasize this point.

For young children ages 0-3, the role of the State Secretary of Health is particularly important and critical. From the perspective of health, the State Secretary of Health can take the lead in ECD — to integrate the diverse aspects of ECD (childcare, health, nutrition, education, and stimulation); to create a dynamic for improving the quality of human development, particularly for young children ages 0-3; and to collaboratively engage colleagues in other sectors to design new policies and effective programs that will enhance ECD for the benefit of all children in the country.

I recently attended the 11th Asian Pediatrics Congress and, while there, I learned that the Government of Singapore is doing exactly this — approaching child development in an integrated and coordinated way. The Ministry of Health has a Department of Child Development that is coordinating all government programs focused on young children. The programs include not only health and nutrition interventions, but also relate to other aspects of child development, such as mental, social, and emotional health and cognitive development. The department coordinates with other sectors, such as education, and links to communities and families.

Effective ECD Programs
What are the key features of effective (that is, successful and sustainable) ECD programs? The examples of programs presented at this conference contribute to our understanding of effective programs and suggest key features. An effective ECD program is:

• Integrated within a comprehensive package of social and educational services (as in Cuba)
• Culturally relevant and tailored to children and families (as in Chile, Mexico)
• Active in involving parents and communities (as in Cuba, Mexico)
• Supported by local, regional, and national institutions (as in Cuba)
• Strengthened by intersectoral collaboration (as in Cuba)
• Giving more to those who have less (as in the U.S.A.)
• Setting national standards of quality and licensing criteria (as in the U.S.A.).

Public-private partnerships in which government plays primarily a funding, regulatory, and supportive role—while the private and NGO sector delivers ECD services-is an effective strategy for ECD. The partnerships created here in Brazil under the leadership and vision of Dr. Osmar Terra may be an example for other countries. I want to emphasize that, contrary to what we have been used to with the government serving as both provider and funder of ECD services, government can, instead, strengthen its funding and regulating role while encouraging the private sector to provide ECD services.

New Zealand uses this approach for its early childcare and education (ECE) efforts. Its strategies include fostering self-managed institutions by decentralizing ECE to the institutional level and holding individuals accountable; creating choices for parents and students; and targeting children and families who are most in need, to ensure equity. In New Zealand, the government's role is facilitative (that is, it finances the childcare) and regulatory, while the "doing," or providing, of services is handled by the private and NGO sector.

A government fund for ECE "follows" each child to whichever service the parent chooses to use_it may be private or public and may be provided in the home as home-based care or in play centers, childcare centers, or kindergartens. The government provides "seed funds" to organizations that develop services which are funded by grants and fees based on a per-child capitation formula; loans to students who want to train as ECD teachers; and income support to poor families to pay ECD fees. The Government of New Zealand also sets standards, develops curricula, licenses services, and audits and reviews programs.

Partnerships that support networked ECD programs linked to the primary education system are especially effective for communities. The model of linking a network of ECD and parenting centers to the primary education system can be found in Canada, Cuba, and the U.S.A. In Cuba, for example, preschool is not compulsory, but it is an initial link and part of a nationwide system of education. Comprehensive programs target children ages 0 to 5, and about 98 percent of these children are enrolled in these programs. Services include both formal daycare centers and non-formal programs. Parents' participation is engaged through the message "Educate your child" starting from within families and communities and subsequently linking to enrollment of 5- to 6-year-old children in preschool preparatory programs.

The attention given to children in Cuba begins before birth, at pregnancy. In each neighborhood, pregnant women receive a special allocation of milk and staple foods, and parenting programs are available for mothers and families. As soon as children are born and until they enter primary school, they benefit from an array of childcare and ECD services. All of the services involve parents and communities (the non-formal sector) and health and education institutions (the formal sector). Also, the services are intergenerational — for example, a literacy program for parents is linked with development strategies for their children.

Programs that are organized from the bottom-up (rather than the top-down) are effective and sustainable — when there is an appropriate infrastructure. A national network of ECD programs, viewed from the bottom-up, often consists of thousands of micro-projects (or units), each providing services to 15 or 20 children in any one center. Each of these micro-units is labor intensive and depends heavily on parents. Groups of 10 to 20 micro-units form what is called neighborhood clusters. These clusters depend on parents' associations _ for example, to contract for services from health care providers and NGOs. The clusters link with city-wide support systems _ to procure and distribute food, train caretakers, and advocate publicly for ECD. City-wide networks tap into regional institutions, and these networks contribute to, and are affected by, national policies and funding for ECD.

To enhance the likelihood of success and sustainability, ECD programs also need to be "owned" by the community. Local ownership by parents and families across the community gives staying power to ECD interventions, which are broad, comprising childcare, health, nutrition, education, and stimulation, and involve many different local, regional, and national institutions to assure their financial, management, and implementation support. One effective strategy to support ECD programs locally is to obtain matching funds and in-kind contributions from parents, the community, and local or regional organizations, such as foundations and NGOs.

In Conclusion
The research evidence on early child development is abundant and still increasing. This research shows how the early social, emotional, and physical life of young children affects their future growth and potential. For all children, the ages of 0 to 3 are critical moments — science tells us this — but they are especially critical for poor and disadvantaged children. To make sure that today's children of poor families are not tomorrow's parents of poor children, each country must strive to give all children a fair and equal chance at the "game of life."

Increasing the odds for all children is what ECD interventions are all about — they enable children to enter the game with a fair chance to win because they give children the equipment and training they need in order to win. For children who are malnourished and have never had a book read to them, the playing field is certainly not level when they enter primary school at age 6, and they will have little chance to succeed. ECD programs help to level that playing field for these children — and for all children — so that the competition is fair.

To quote Nobel laureate James J. Heckman: "We cannot afford to postpone investing in children until they become adults, nor can we wait until they reach school — a time when it may be too late to intervene."