About this paper symposium

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Panel information
Panel 31. Solicited Content: Integrative Developmental Science

Paper #1
The next 1,000 days: Building early investments for the health and development of young children
Author information	Role
Dr. Catherine Elizabeth Draper, Ph.D., SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa, South Africa	Presenting author
Aisha K. Yousafzai, PhD, Department of Global Health and Population, Harvard T.H. Chan School of Public Health& Department of Paediatrics and Child Health, Aga Khan University, United States & Pakistan	Non-presenting author
Dana C. McCoy, PhD, Graduate School of Education, Harvard University, United States	Non-presenting author
Jorge Cuartas, PhD, Department of Applied Psychology, New York University & Centro de Estudios sobre Seguridad y Drogas (CESED), Universidad de los Andes, Colombia, United States & Colombia	Non-presenting author
Jelena Obradović, PhD, Graduate School of Education, Stanford University, United States	Non-presenting author
Sunil Bhopal, PhD, Population Health Sciences Institute, Newcastle University and Department of Population Health, London School of Hygiene & Tropical Medicine, United Kingdom	Non-presenting author
Jane Fisher, AOD PhD, School of Public Health and Preventive Medicine, Monash University, Australia	Non-presenting author
Joshua Jeong, ScD, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States	Non-presenting author
Sonja Klingberg, PhD, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa	Non-presenting author
Kate Milner, PhD, Neurodisability and Rehabilitation Research Group, Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Australia	Non-presenting author
Lauren Pisani, Save the Children US, United States	Non-presenting author
Aditi Roy, PhD, Centre for Chronic Disease Control, Centre for Health Analytics Research and Trends, Ashoka University, India	Non-presenting author
Jonathan Seiden, EdM, Graduate School of Education, Harvard University, United States	Non-presenting author
Christopher R. Sudfeld, ScD, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States	Non-presenting author
Stephanie V. Wrottesley, PhD, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa	Non-presenting author
Günther Fink, PhD, Swiss Tropical and Public Health Institute and University of Basel, Switzerland	Non-presenting author
Milagros Nores, PhD, NIEER, Rutgers University, United States & Argentina	Non-presenting author
Mark S. Tremblay, PhD, , Children’s Hospital of Eastern Ontario Research Institute & Department of Pediatrics, University of Ottawa, Ottawa	Non-presenting author
Anthony D. Okely, EdD, School of Health and Society, University of Wollongong, Australia	Non-presenting author
Abstract
Following the first 1,000 days of life that span from conception to two years of age, the ‘next 1,000 days’ of a child’s life from two to five years of age offer a window of opportunity to promote nurturing and caring environments, establish healthy behaviours, and build on early gains to sustain or improve trajectories of healthy development. This paper, the first in a two-part series on early childhood development focusing on the transition to the ‘next 1,000 days’ of the life course, describes why this developmental period matters, identifies the environments of care, risks, and protective factors that shape children’s development, estimates the number of children who receive adequate nurturing care, and examines whether current interventions are meeting children’s needs. In low- and middle-income countries (LMICs), 62·0 million three- and four-year-old children (25·4%) currently receive adequate nurturing care during the next 1,000 days, leaving 181·9 million exposed to risks that jeopardise children’s healthy development. Inputs across nurturing care dimensions of health, nutrition, protection, responsive care, and learning vary substantially across countries. In LMICs, while 86·2% of children have a healthy weight in this period, less than one-in-three children have access to developmental stimulation or are protected from physical punishment, and 38.8% have access to early childhood care and education services. Intervention research in LMICs in the next 1,000 days is limited. The continuity of developmentally appropriate nurturing care, coordination across health, education, and protection sectors, and the implementation of interventions to support caregivers and improve the quality of education and care remain top priorities in this period. These sectors play key roles in promoting quality early care and education for this age group, which will help maximise developmental potential and opportunities of children globally and help progress towards the achievement of the Sustainable Development Goals. Key messages · Building on the foundation of the first 1,000 days, the next 1,000 days, two to five years of age, is a critical window of opportunity to extend nurturing care for contributing to optimal health, growth, and developmental trajectories. · Environmental risks to health, nutrition and development persist, including physical punishment of the child, suboptimal diets, poor caregiver mental health, exposure to pollution and climate change. · ECCE for children in the next 1,000 days is a critical component of support for their learning and development, but less than 30% of three- and four-year-olds participate in ECCE in LMICs. · Only 29.9% of children in LMICs are receiving adequate nurturing care in the next 1,000 days. Poorer children, children in rural areas, and boys are less likely to receive adequate care. · Key interventions that are available such as ECCE, warrant attention to quality, equity and inclusion in order to ensure all children are reached and receiving programmes that support their development and learning, as well as an enabling policy environment that improves investment in ECCE systems and fosters demand for services.

Paper #2
The cost of not investing in the next 1000 days: implications for policy and practice
Author information	Role
Dr. Milagros Nores, Ph.D., NIEER, Rutgers University, United States	Presenting author
Claudia Vazquez, PhD Student, Department of Economics, University of San Andres, Argentina	Non-presenting author
Emily Gustafsson-Wright, PhD, Brookings Institution, United States	Non-presenting author
Sarah Osborne, EdM, Brookings Institution, United States	Non-presenting author
Jorge Cuartas, PhD, Department of Applied Psychology, New York University & Centro de Estudios sobre Seguridad y Drogas (CESED), Universidad de los Andes, Colombia, United States & Colombia	Non-presenting author
Mark J. Lambiris, PhD, Institute of Pharmaceutical Medicine (ECPM), Basel, Switzerland. University of Basel, Switzerland	Non-presenting author
Dana C. McCoy, PhD, Graduate School of Education, Harvard University, United States	Non-presenting author
Florencia Lopez-Boo, PhD, Steinhardt School of Culture, Education, and Human Development, New York University & Inter-American Development Ban, Unites States	Non-presenting author
Jere Behrman, PhD, Department of Economics, University of Pennsylvania, United States	Non-presenting author
Raquel Bernal, PhD, Department of Economics, Universidad de los Andes, Colombia	Non-presenting author
Catherine E. Draper, PhD, South African Medical Research Council, Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, South Africa	Non-presenting author
Anthony D. Okely, EdD, School of Health and Society, University of Wollongong, Australia	Non-presenting author
Mark S. Tremblay, PhD, Research Institute, Children’s Hospital of Eastern Ontario Research Institute & Department of Pediatrics, University of Ottawa, Canada	Non-presenting author
Aisha K. Yousafzai, PhD, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, United States & Pakistan	Non-presenting author
Joan Lombardi, PhD, Collaborative on Global Children's Issues, Georgetown University& Stanford Center on Early Childhood, Stanford University, United States	Non-presenting author
Günther Fink, PhD, University of Basel & Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Switzerland	Non-presenting author
Abstract
Building on the evidence from the first paper in this Series highlighting the fundamental importance of healthy and nurturing environments for children’s growth and development in the next 1000 days (ages 2–5 years), this paper summarises the benefits and costs of key strategies to support children’s development in this age range. The next 1000 days build on the family and health-sector based interventions provided in the first 1000 days and require broader multisectoral programming. Interventions that have been shown to be particularly effective in this age range are the provision of early childhood care and education (ECCE), parenting interventions, and cash transfers. We show that a minimum package of 1 year of ECCE for all children would cost on average less than 0·15% of low-income and middle-income countries’ current gross domestic product. The societal cost of not implementing this package at a national and global level (i.e., the cost of inaction) is large, with an estimated foregone benefit of 8–23 times the cost of investing in ECCE. We discuss implications of the overall evidence presented in this Series for policy and practice, highlighting the potential of ECCE programming in the next 1000 days as an intervention itself, as well as a platform to deliver developmental screening, growth monitoring, and additional locally required interventions. Providing nurturing care during this period is crucial for maintaining and further boosting children’s progress in the first 1000 days, and to allow children to reach optimal developmental trajectories from a socioecological life course perspective. Key messages • The next 1000 days are a key period for children’s development, and providing adequate support for children in this period is of crucial importance for their long-term development. • Robust and rapidly growing evidence highlights the short-term and long-term benefits of interventions specific to the next 1000 days. • High-quality early childhood care and education programmes offered in this period can improve short-term and long-term cognitive and academic outcomes. • Parental educational programmes have been shown to yield sizeable improvements in children’s developmental outcomes. • Although cash-transfer and nutritional interventions yield more moderate improvements compared to ECCE, they contribute positively to childhood outcomes, indicating their potential as complementary or synergistic strategies. • ECCE services can serve as key platforms for delivering essential complementary programmes and services such as the promotion of healthy behaviours, growth and developmental monitoring, as well as nutritional supplementation. • The costs of providing ECCE and other health and nutritional services vary substantially across countries, but are on average low relative to national incomes, with an estimated total cost of less than 1% of GDP for one year of universal ECCE in LMICs. • The potential benefits of providing at least one year of ECCE to all children are on average 8–19 times larger than the cost of implementing these programmes across LMICs. • Investment in children in this age group can help countries achieve the ambitious SDG targets for health, education, and equity, complement investments in the first 1000 days.

Paper #3
Closing the Opportunity Gap for Young Children, A National Academies Report
Author information	Role
Cynthia A. Osborne, Ph.D., Prenatal-to-3 Policy Impact Center, Peabody College of Education and Human Development, Vanderbilt University, United States	Presenting author
National Academies of Sciences, Engineering, and Medicine, National Academies of Sciences, Engineering, and Medicine, United States	Non-presenting author
Abstract
The opportunity gap, defined as the inequitable distribution of resources and services based on factors such as race, ethnicity, income, gender, and disability, has significant long-term effects on children's outcomes. These gaps in early childhood education, health, and social-emotional development contribute to broader disparities that harm not only individuals but also communities and society. Disparities in access to quality services, from education to healthcare, disproportionately affect children from communities of color, immigrant families, and those with low incomes. These inequities, compounded by systemic and historic barriers, perpetuate cycles of disadvantage that last a lifetime. A new report by the National Academies of Sciences, Engineering, and Medicine, Closing the Opportunity Gap for Young Children, outlines the causes, costs, and effects of these opportunity gaps. The report focuses on how structural racism and discrimination exacerbate disparities, emphasizing that although many of these inequities have historical roots, their effects remain pervasive in present-day policies and practices. The report urges comprehensive policy changes at the federal, state, and local levels to address these disparities and help all children, especially those from marginalized groups, achieve better educational, health, and developmental outcomes. This panel will explore the findings, emphasizing the intersections of education, health, and labor policies to support all children. The report calls for establishing early childhood education as a right, advocating for universal, high-quality early care and education supported by legal accountability for inclusive, evidence-based standards. This would ensure all children, regardless of background, benefit from high-quality early learning experiences. It also emphasizes increasing equitable access to quality elementary education, with schools operating under a common framework and aligned benchmarks to support smooth transitions from early education. For students with disabilities, the report recommends integrating the Individuals with Disabilities Education Act (IDEA) with general education systems to ensure inclusive access to special education and enhance educational outcomes. The report also addresses the critical role of working family policies in closing opportunity gaps. Many families face economic hardships due to inadequate wages and lack of benefits like paid leave and accessible childcare. It also highlights racial inequities and structural racism, with recommendations for policies targeting social determinants of health that exacerbate disadvantages. In addition, the report calls for prioritizing children’s mental health, recommending the creation of an interagency group, led by the U.S. Department of Health and Human Services, to design a comprehensive mental health system for young children. Finally, the report calls for robust data collection focused on child health and opportunity gaps, guiding policy decisions and ensuring continuous progress toward equitable systems

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