NORC at University of Chicago, Bethesda, Maryland 20814, USA.
Am J Prev Med. 2011 Jan;40(1 Suppl 1):S19-37. doi: 10.1016/j.amepre.2010.10.001.
The Robert Wood Johnson Foundation Commission to Build a Healthier America recommended that substantial resources be committed to ensure all children have high-quality developmental experiences through family support, child care, and early education. This article reviews and updates the evidence base informing that recommendation and explores federal and state policy challenges involved in implementing it.
Reviews of published research, analyses of federal child health data sets, consultation with early development and state and local program experts, and site visits were conducted between 2006 and 2009, with statistics and literature reviews updated through mid-2010.
The economic and social conditions of children's lives, especially in the early years, affect their health and development in childhood and across the life course. Forty percent of children in the U.S. live in families with incomes <200% of the federal poverty level and consequently are at higher risk of poor health and development. Recent advances in neuroscience and life course epidemiology reveal that these children are more likely to experience chronic or "toxic" stress resulting from frequent or sustained adverse experiences, increasing their lifetime risk of chronic disease. Intervening early in childhood by providing a safe, stable, nurturing, and stimulating environment can improve cognitive, emotional, and behavioral development and health outcomes in children--particularly socially and economically disadvantaged children--and both their health and social and economic well-being as adults.
Coordination of multiple programs and funding sources, along with higher standards of accountability for services, outcomes, and ongoing evaluation of effectiveness, are needed to ensure more effective state and local programs providing early developmental support. Federal leadership and funding are needed to ensure that children at high risk for multiple adverse exposures and their families receive attention and services as early as possible.
罗伯特·伍德·约翰逊基金会健康美国委员会建议投入大量资源，通过家庭支持、儿童保育和早期教育，确保所有儿童都有高质量的发展体验。本文回顾并更新了为该建议提供信息的证据基础，并探讨了实施该建议所涉及的联邦和州政策挑战。
2006 年至 2009 年间进行了对已发表研究的审查、对联邦儿童健康数据集的分析、与早期发展以及州和地方项目专家的磋商以及实地考察，并在 2010 年年中更新了统计数据和文献综述。
儿童生活的经济和社会条件，尤其是在早年，会影响他们在儿童期和整个生命过程中的健康和发育。美国有 40%的儿童生活在收入低于联邦贫困线 200%的家庭中，因此他们面临更高的健康和发育风险。神经科学和生命历程流行病学的最新进展表明，这些儿童更有可能经历慢性或“毒性”压力，这种压力源自频繁或持续的不利经历，增加了他们终生患慢性病的风险。通过在儿童早期提供安全、稳定、培养和激励的环境进行干预，可以改善儿童的认知、情感和行为发育以及健康结果，尤其是社会和经济处于不利地位的儿童，同时也能改善他们的健康以及社会和经济福祉。
需要协调多个项目和资金来源，并提高对服务、结果和对有效性的持续评估的问责制标准，以确保提供早期发展支持的州和地方计划更加有效。需要联邦领导和资金，以确保高风险儿童及其家庭尽早获得关注和服务，避免遭受多种不利影响。
