Connecting the brain to the rest of the body

The extreme challenges of 2020 have laid bare longstanding inequities that affect the lives of millions of children and families, as well as the health of our nation. Fully addressing these deeply embedded inequities and the inter-generational trauma of systemic racism will require a transformative change at a societal level.

More robust early childhood policies and programs must be part of this change because significant adversity in the lives of young children can disrupt the development of the brain and other biological systems. And these disruptions can have lifelong consequences that will undermine young children’s opportunities to achieve their full potential.

When children experience a sense of danger or threat, their stress response is triggered. Multiple biological systems (e.g., neural, immune, cardiometabolic) spring into action, like a team of skilled athletes, each with a specialized capability that complements the others and all of which are dedicated to a common goal. If this activation of stress response systems is brief and intermittent, followed by a return to balance, it leads to healthy adaptations that build resilience.  

But children developing under conditions of ongoing, significant stress may develop physiological responses and coping behaviors that are attuned to these immediate harsh conditions, at the long-term expense of both physical and mental well-being and effective learning.  The team, in other words, begins to break down under the cumulative burden of stress. 

This understanding must stimulate a new conversation about early childhood investment in a post-pandemic world. Drawing on the rapidly growing science of adversity and resilience—including continuing advances in brain research — this conversation can inform more effective strategies for protecting all developing organs and systems.

By intervening early, we can prevent the physiological disruptions that lead to problems in early learning, social-emotional development, and both physical and mental health — preventable problems that cost the U.S. more than $600 billion in direct health care expenditures annually (above and beyond their indirect costs, such as lost productivity). 

To begin this conversation, we must understand two fundamental concepts from 21st-century science:

• All biological systems interact with each other and adapt to the contexts in which a child is developing—for better or for worse.

• Early experiences and exposures during the prenatal period and first 2-3 years after birth are likely to have as much or greater influence on later health as on school achievement.

The policy implications are clear — supporting expectant mothers during pregnancy and families with young children will build a strong foundation for lifelong health as much as for school readiness. Childcare and early education affect both health and learning. Social services and home visiting for families affect both health and learning. 

Family income supports affect both health and learning. Health care, which also affects both health and learning, currently constitutes the most substantially funded infrastructure focused on young children in the United States. New models of primary care practice that focus explicitly on the effects of early adversity on whole child development must be a fully integrated part of the early childhood ecosystem, not an adjacent, loosely connected sector.

The dramatic variation in COVID-19 impacts around the world has demonstrated the strengths and weaknesses of different public health responses, medical care systems, and the availability of broader population-level supports.

Countries that fared the best implemented strong action plans based on cutting-edge scientific knowledge from trusted sources; every nation continues to confront the complex challenges of making important decisions in the face of incomplete data.

Scientific knowledge alone cannot prevent or reduce the lifelong consequences of excessive adversity in the early childhood period. But science-informed insights combined with the lived experiences of families and communities, the expertise of service providers, and a diversity of political perspectives among policymakers and civic leaders can catalyze fresh thinking and more effective action.

The time has arrived for a mindset shift for the early childhood field as part of a broader movement for social change. The brain is indeed connected to the rest of the body, but health and education are separated in the policy. An integrated approach to confronting the inter-related origins of disparities in each offers a compelling path forward to greater impact at scale for both.

Jack P. Shonkoff, M.D., is the director at the Center on the Developing Child at Harvard University.