Proceed with Caution: Framing Early Childhood Development as a Health Issue

Science shows that positive experiences during early childhood support lifelong health and wellbeing, and that unbuffered stress and adversity can affect developing biological systems in ways that increase the likelihood of chronic illness and poor health throughout life.

Based on this science, the early childhood field is expanding its messaging to emphasize how early experiences not only shape learning but also lay the foundations for lifelong health.

Communicating about this connection seems especially important in a rapidly changing political landscape where funding and public support for all kinds of policy issues seems to hang in the balance. This health framing appears helpful in increasing the salience of early childhood, building new constituencies, and advocating for a broader set of policies and solutions to support children and families.

But new research from the FrameWorks Institute is suggesting that connecting early childhood and health is not as straightforward as we might think and has the potential to backfire.

The early childhood field was careful and employed a test-and-learn approach as it began translating the science of early brain development and framing the implications of this science for early learning. Our research suggests that it’s important to be just as careful in thinking through the challenges and opportunities of framing development as a health issue.

Research on the mindsets that shape how people think about health can help guide the field as it takes on and begins to mobilize this new frame.

Framing early childhood as a health issue

Since summer of 2020, the Culture Change Project has been tracking mindsets that shape how people in the United States think about health. As part of this, we are using surveys to track the strength of two distinct mindsets:

1. Health individualism: The belief that a person’s health is primarily a result of individual choices and behaviors.

2. What surrounds us, shapes us: The understanding that health is strongly influenced by social and environmental factors.

We have found that individualistic thinking about health remains high and may even be growing more dominant. This seems surprising. We began fielding the tracking survey at the beginning of the pandemic and hypothesized that, because of a public health crisis that affected everyone and where impacts were largely outside of the realm of individual choice and will, people would grow less individualistic and more contextual in their ways of thinking about of health. This has not been the case.

Americans’ highly individualistic way of understanding health gives us pause about framing early childhood as a health issue. Might making this connection recruit individualistic understandings and bring them to the topic of early childhood development, where such understandings have been shown to depress demand for efforts to increase supports to families and communities?

Additional findings suggest that it’s not an issue of whether to frame development as a health issue but of how this connection is made.

We have evidence that explaining how differences in people’s environment of experiences help explain health differences between groups, activates what-surrounds-us-shapes-us thinking and helps counterbalance the individualistic mindset, leading to support for policies aligned with a social determinants perspective. For example, when people hear an explanation that health disparities between racial groups are in part due differential access to and quality of health care services, they see health through a lens that balances contextual and individual influences.

What does this mean for early childhood?

These findings suggest that without careful framing, discussions of early childhood and health are likely to activate individualistic thinking and dampen support for the kinds of policies and solutions the field is working to advance. For example, if individualistic thinking is primed, support for the child tax credit will diminish as people see child health and wellbeing as the narrow responsibility of parents and their effort and choices. Without careful framing, connecting health and early childhood may very well lead people to see early childhood as an individual/parental rather than a social responsibility, reducing support for the use of public funds to help more young children and families thrive.

At the same time, these findings suggest that advocates need not avoid talking about the health implications of early childhood development. Our work is showing that there is a way to have this conversation that increases understanding of inequities and builds support for the policies that would address them.

Advocates can emphasize the ways that different groups of people experience different environmental risks and opportunities that affect development in ways that can have health impacts on children and families now and into the future. This brings health into the early childhood conversation and helps people appreciate the importance of environments and the power of policy to shape them.

A strategy for framing the health impacts of early childhood development

We are still learning about how to most effectively frame the health dimensions of early childhood, but there are things we do know that can help communicators now as they navigate the complex and fraught mindsets that people use to think and make decisions about health.

• Provide examples that show how contexts create differences in experiences in early childhood and how this can result in health disparities. Advance stories that demonstrate how unfair distribution of risks and opportunities associated with place and context can shape children’s health outcomes. Emphasizing that these differences stem from structural inequities rather than individual choices can help avoid cuing the health individualism mindset.
• Communicate the science of plasticity to make it clear that context can be a source of positive experiences and health outcomes, even when negative experiences have occurred. The idea that biological systems remain open and sensitive to context can be used to ward off the idea that damage done is damage done. If we are not careful when talking about the experience of risk and adversity, we can inadvertently communicate that children who are exposed to early adversity are doomed to a life of poor health outcomes. The scientific concept of plasticity holds that systems remain open to the effect of experiences and environments and thus that positive experiences can improve outcomes.
• Talk now and later. It’s important when talking about the health implications of early childhood to avoid the tendency to talk only about later or long-term effects. Explain how early experiences influence health for young children right here and now. The effects of development need to be framed as happening now and later.
• Make health more than just negative outcomes. Be clear that while experiences of risk and adversity in early childhood can have negative health outcomes, positive early childhood experiences and opportunities support positive health. While connections between risk and compromised health are an essential part of the story, it’s important to communicate that contexts can facilitate positive experiences, which result in positive health outcomes. The sensitivity of early childhood as a developmental period breaks both ways—it means we need to reduce experiences of stress to limit negative health outcomes, and it means that providing positive opportunities can create healthy children and adults.