Health Affairs: Informing Early Childhood Health Policy

Investing in the early years—by supporting good nutrition and responsive caregiving that enables those early connections with parents and caregivers—is one of the most important things that can be done to foster early brain development and raise healthy children.

Creating a healthy start is fundamental to the Robert Wood Johnson Foundation’s (RWJF) broader vision of building a national Culture of Health that provides everyone in America a fair and just opportunity for health and well-being. RWJF takes a comprehensive view of what it means to give all children a healthy start to life including advancing policies that support families and children from the start. A cluster of articles in a Foundation-supported issue of Health Affairs provides further evidence that food insecurity, housing instability, low income, and other factors have on early childhood development.

Research includes:

• “Loss of SNAP is Associated With Food Insecurity and Poor Health in Working Families With Young Children” by Stephanie Ettinger de Cuba of the Boston University School of Medicine, and coauthors.

Analyzing data from 2007–2015 for families with young children, researchers examined the extent to which reductions or cutoffs in SNAP benefits due to increases in household income lead to economic hardships. Researchers found that families whose SNAP benefits were abruptly reduced or cut off because their earned income had increased in the prior month were more likely to suffer hardships such as food or energy insecurity, unstable housing, or a lack of health or dental care.

In addition, children in families that faced sharp reductions or cutoffs in SNAP benefits were more likely to be in poor health or face food insecurity compared to children in families whose benefits remained consistent.

The researchers note that SNAP is crucial for children and families struggling to access affordable food, and policy modifications to mitigate the health impacts of changes in SNAP benefits as incomes increase may protect working families with young children from increased food insecurity, poor health, and lack of care.

• “Early Care and Education Workers' Wages” by Jennifer J. Otten of the University of Washington, and coauthors.
  

Many early care and education (ECE) workers earn low wages, experience poor mental health, and suffer high rates of food insecurity. Lower-wage workers often worked at centers that did not offer health insurance, paid sick leave, or parental or family leave. Despite receiving limited job benefits and experiencing mental health challenges and food insecurity, these ECE workers remain responsible for the care, well-being, and success of approximately 10 million children younger than age six.

The study authors suggest that policies and programs that raise ECE workers’ wages or mandate the provision of meals to both children and workers could enhance teacher health and quality of early childhood education.

Additional studies include:

• “The Nexus Between Neighborhood Violence, Perceptions of Danger, and Child Health: New Evidence from the 2016 NSCH” by Dylan B. Jackson with the University of Texas at San Antonio, and coauthors.
  
• “Moving Toward Flourishing for U.S. Children: Building Family Resilience and Connection Amidst Ongoing Adversity” by Christina D. Bethell with the Johns Hopkins Bloomberg School of Public Health, and coauthors.
  
• “Infants Born while Homeless: Health, Healthcare Utilization and Expenditures from Birth to Six” Robin E. Clark of the University of Massachusetts Medical School, and coauthors.
  
• “Twenty Years of School-Based Health Care Growth and Expansion” by Hayley E. Love with the School-Based Health Alliance, and coauthors.
  
• “From Undocumented to Liminally Legal: DACA Linked to Improved Health for Recipients and Their Children in the Short Term, but the Benefits Did Not Hold Up Over Time” by Caitlin Patler with the University of California Davis, and coauthors.