The Impact of Social Determinants of Health On Early Childhood Development
Updated: May 4
In human beings, a child's development involves biological, emotional, and psychological changes between birth and the conclusion of adolescence. Early childhood is from conception to eight years of age (UNICEF, 2022). The earliest years of a person's existence are crucial to the child's life course and developmental trajectory. Early development is by the nurturing qualities of the environment - parents, caregivers, family, and community - where children are nurtured, live, and learn. The combination of biological and environmental factors determines how a child develops (Likhar et al., 2022). Early life circumstances and experiences, underlying social determinants of Health (SDH), impact early child development (ECD). The social determinants of Health (SDH) are the non-medical factors influencing health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the broader set of forces and systems shaping the needs of daily life. These forces and systems include economic policies, strategies, development agendas, social norms, and political procedures (WHO, 2023).
The SDH has an important influence on health inequities - the unfair and avoidable differences in health status seen within and between countries. In countries at all income levels, health and illness follow a social gradient: the lower the socioeconomic position, the worse the health. Social determinants of health, which can influence ECD and health equity in positive and negative ways, include characteristics of family environment, family income, parental mental health, education of parents, food insecurity and malnutrition, parent-child interactions, quality of child care, socio-cultural context, neighborhood, and built environment, biological factors, and genetic inheritance, child's educational opportunities or cognitive motivators, and exposure to violence among others (Healthy People, 2023; WHO, 2023).
Research shows that social determinants can be more important than health care or lifestyle choices in influencing health. For example, numerous studies suggest that SDH accounts for 30-55% of health outcomes (WHO, 2023). In addition, 7.6 million children under five worldwide die each year. More than 25 times that number – over 200 million children – survive but do not reach their full human potential in developing countries. As a result, their governments have an estimated 20 percent loss in adult productivity (WHO and UNICEF, 2012). Therefore, addressing SDH is fundamental for developing young children and reducing longstanding inequities, which requires action by all sectors and civil society.
ECD in the Nigerian Context
Childhood mortality remains a significant challenge in Nigeria. Nigeria is the second largest contributor to under-five mortality globally after India (UNICEF, 2023). Currently, there is little local evidence to guide policymakers in Nigeria to tailor appropriate social interventions to make the Sustainable Development Goal (SDG) targets of child survival (SDG-3), gender equality (SDG-5), and social inclusiveness (SDG-10) achievable by 2030 (UN, 2023). It is noteworthy that between and inside countries, there are considerable differences in the chance of survival, and this can be seen all over the world. In this regard, and as reflected in a report by the World Health Organization's Commission for Social Determinants of Health (2008), ECD has been emphasized, entitled "Closing the Gap in a Generation."
Implications and recommendations for policy
"Economists now argue, based on the available evidence, that investment in early childhood is the most powerful investment a country can make, with the returns over the life course many times the amount of the size of the original investment" (Human Early Partnership and Commission on Social Determinants of Health, 2007). Governments can make significant and sustained improvements in society by implementing policies that take cognizance of ECD while simultaneously fulfilling their obligations under the UN conventions on children's rights. A WHO report captioned 'Early Child Development: a powerful Equalizer" proposes ways in which government and civil society actors from local to international can work in concert with families to provide equitable access to nurturant solid environments for all children globally (Human Early Partnership and Commission on Social Determinants of Health, 2007). Recognizing the Impact of ECD on adult life, in some societies, inequities in ECD translate into vastly different life choices for children. In other communities, however, disparities in ECD reach a critical point where they threaten peace and sustainable development.
Given the above, Nigeria's current policies and programs could be more robust in addressing ECD. Fair promotion of economic, cultural, and social conditions of the society and consequently of the families can be beneficial in ECD and achieving the sustainable development of the community. During this context, our country is facing many challenges, such as increasing social harms, reducing social capital, lack of public awareness, growing socioeconomic inequities, reducing economic growth, economic instability, etc. this will provide conditions for the abuse and neglect of children or their unfair growth and development. Therefore, the government and relevant stakeholders should consider creating integration between policies and programs of different sectors, prioritizing children in the welfare umbrella, raising community awareness, and expanding services and support for families, especially in deprived communities.
Further studies on ECD in Nigeria should be conducted, including a survey of developmental disorders and delays in children and their relationship with social determinants of health. Finally, conducting an evaluation/review of progress in reducing inequalities in various aspects of ECD, assessing parents' knowledge, attitude, and practice about ECD in rural and urban areas, and examining the pilot implementation of ECD policy and its consequences will ultimately provide policy solutions.
Healthy People 2030 (2023). Social Determinants of Health. Available at https://health.gov/healthypeople/priority-areas/social-determinants-health Accessed 15 March 2023
Human Early Learning Partnership & Commission on Social Determinants of Health. (2007). Early child development: a powerful equalizer: final report for the World Health Organization's Commission on the Social Determinants of Health. / Prepared by Arjumand Siddiqi, Lori G. Irwin, and Dr. Clyde Hertzman. Vancouver: Human Early Learning Partnership. https://apps.who.int/iris/handle/10665/69729
Likhar A, Baghel P, Patil M. (2022). Early Childhood Development and Social Determinants. Cureus, 23;14(9): e29500. https://doi.org10.7759/cureus.29500
United Nations (2023). The 17 Goals. https://sdgs.un.org/goals
UNICEF (2022). Early Childhood Development Overview. Available at: https://data.unicef.org/topic/early-childhood-development/overview/ Accessed 15 March 2023
UNICEF (2023). Communication for Development. Available at https://www.unicef.org/nigeria/communication-development Accessed 15 March 2023
World Health Organization Commission for Social Determinants of Health (2008). Closing the Gap in a Generation. Available at: https://apps.who.int/iris/bitstream/handle/10665/43943/9789241563703_eng.pdf Accessed 15 March 2023
World Health Organization (2023). Social Determinants of Health. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
World Health Organization and UNICEF (2012). Care for Child Development. Available at: https://apps.who.int/iris/bitstream/handle/10665/75149/9789241548403_eng_Forward.pdf?sequence=19&isAllowed=y Accessed 15 March 2023