Article7 Renee Boynton Jarrett_smallweb

Renée Boynton-Jarrett, MD, ScD

Americans are fond of saying that our children are our nation’s most valuable resource. But if our actions are the measure, do we really mean it?

Mounting research evidence from neuroscience, public health, economics and social science all supports a simple conclusion: investing in early childhood, through affordable early childcare and enrichment opportunities, pays dividends in child development, well-being and health trajectory. Certainly, if you asked people what they thought about making high-quality, affordable early childhood care available for everyone—not mandating it, but simply making it available—few, if any, would say they oppose it.

Yet, we know that not all children have an opportunity to experience high-quality early childcare—and this is the case because we have chosen not to support universal access.

Scientific research supports the long-term value of enriching and nurturing environments for child health and development. We know that creating the conditions children need for a strong start is the best chance for making them healthy, productive adults. We also know how to create, scale and support these social and educational programs and make them accessible. Why, then, aren’t we committed to ensuring these opportunities?

Our political discussions about early childhood tend to center on parents’ choices and responsibilities. We expect parents to make good decisions for their young children. But wouldn’t a tighter safety net of opportunities and support make good decisions easier, and make parents less likely to stumble in their efforts?

We need a new conversation, one that places what is optimal for children at the center.

That’s what The Raising of America, a new five-part documentary series, is trying to do. I’m proud to be a part of the film, which probes how conditions faced by young children and their families form the foundation for future success—both in school and in life.

In examining the prolific data about the positive effects of quality early care on health, The Raising of America brings to light the consequences of our failure to provide adequate support for parents raising young children.

Our Experiences Shape Our Biology

In recent years, we’ve seen a gradual shift in the way we view health. Medical professionals are now looking at health outcomes through the lens of social determinants. What we’ve learned is that health is profoundly influenced by factors outside the healthcare system.

Study after study has shown that our experiences—positive as well as negative—influence the ways our biological systems operate. Chronic exposure to adverse experiences takes a toll on the body’s stress response system and can disrupt its ability to maintain an internal balance. As a consequence, your blood pressure may regularly run higher. Your concentration might be impaired.

We also know that children’s social and emotional development is foundational to how they learn. Children who live in environments with a lot of concentrated disadvantage and in high- stress home environments are most likely to have adverse childhood experiences, or ACEs. A higher prevalence of ACEs can affect their emotional regulation, which in turn can impair optimal learning. A child who has difficulty regulating his or her emotions is not likely to be able to stay in the classroom and learn.

We’ve come to understand that where you live matters to your health. In a neighborhood that suffers from chronic poverty—such as a lower ratio of caregivers to kids, low employment, unsafe housing, community violence and physical decay—the odds are stacked against optimal health and development.

Dropping the Ball

Yet with all of this knowledge, we still haven’t bridged the gap between data and practice.

Quality early care is prohibitively expensive for many middle-class families, and out of reach for families at the lowest rungs of the income ladder. The United States is the only wealthy nation that doesn’t guarantee paid parental leave. Many mothers, as a result, return to work earlier than desired and within two weeks of giving birth because they can’t afford to stay at home.

Worse yet, we’re seeing in some states that the vouchers and subsidies designed to help lower- income parents pay for child care disappear when their incomes reach a certain threshold. Parents who are already spending a lot on child care literally can’t afford to accept a raise. Many believe they’re being punished for achieving professional success.

Moreover, childcare providers are among the lowest-paid professionals in America. Not surprisingly, there is a lot of turnover. We’re content to entrust our children’s wellbeing to caregivers who are underpaid, undertrained and overworked.

Failing to consider how heavily these factors weigh in child wellbeing constitutes more than negligence. Rather, it is actively causing harm.

The Choice We’ve Made

It strikes me that as a society we have accepted that the challenges parents face are all “just part of raising a child.” That the stress of trying to balance time and cost goes against what’s best for our kids is now the norm. That it’s not imperative to offer all children the opportunity to experience the high-quality early care they need to succeed may also now be the norm.

I’d like to think that things are the way they are due to neglect, rather than intention. What if just for a moment we all envisioned what it means to consider “health in all policies”? Adopting this new framework may help us understand that policies that support safe neighborhoods promote not only crime reduction but also physical and mental health and educational success.

I would love to give working parents a sense that they are not alone in their experience, that there are countless others like them who want to be great parents but are struggling to give their children what they need. That in itself can be powerful and may even galvanize positive action.

But families can’t do it alone. It’s my hope that the larger conversation we’re launching— through ongoing research and The Raising of America—will prompt a closer look at how we can develop an opportunity agenda for our nation’s children, and steer a course that puts children front and center.

I hope this is the moment when society says, “It doesn’t have to be this way. We can change the opportunities experienced in early childhood for all children. Let’s get started.”

Renée Boynton-Jarrett, MD, ScD, is a Boston Medical Center pediatrician and researcher. She is founding director of Vital Village, a network of residents and agencies committed to maximizing child, family and community well-being.

The “Signature Hour” of The Raising of America can be viewed online from November 9 through November 30 at