Early Brain Development: A Keystone for Health Equity

March 27, 2018|11:46 a.m.| Community Health and Prevention Team

Healthy early childhood brain development is critical to achieving important social, behavioral, and educational milestones. State and territorial health departments, federal agencies, and other national partner organizations are increasingly taking steps to support healthy brain development at the earliest stages of life. Public health leaders can implement and support the development and use of evidence-based best practices in programs and policies to promote optimal early childhood brain development for all.

Research shows that brain development occurs most rapidly during the years before children start going to school. From the prenatal period to school age—and especially during the first three years of life—the neurological processes of early brain development are influenced by nurturing, interactive relationships with caregivers. Early screening for developmental disabilities, delays, and other conditions is also vital to optimizing every child’s early brain development, along with ensuring timely diagnosis and treatment.

Early brain development has direct implications for health equity and creating optimal health for all. Some parents struggle to provide the interaction and care that their infants need for reasons ranging from needing to work multiple jobs to a lack of awareness of the importance of this crucial period. Disparities in access to care and living conditions across socioeconomic and racial groups also play a role. For example, some children may not receive recommended health screenings and other services as early as they could if they had regular preventive care.

Most notably, researchers have found that a “word gap” correlated with socioeconomic status: Children in more affluent homes hear 30 million more words than children in families of lesser means by the time they reach school age. ASTHO is working with several national and federal partners to address this disparity and improve early childhood brain development.

At CDC, the National Center on Birth Defects and Developmental Disabilities created the “Learn the Signs. Act Early.” program that emphasizes the need for early screening and services for children with autism and other developmental disabilities. The program is comprised of three main components: research and evaluation, a health education campaign, and an Act Early Initiative. The research and evaluation projects are geared toward improving early intervention for children with autism and other developmental disabilities, with a specific focus on addressing health disparities. The program’s long-running health education campaign helps parents and professionals identify developmental concerns early. Finally, the Act Early Initiative has fostered collaboration among state and territorial early childhood programs, with the goal of improving screening and referral to early intervention services.

Healthy early brain development is also a priority for the American Academy of Pediatrics (AAP). The organization’s priorities include supporting public health approaches to toxic stress. AAP has a number of resources on the issue to improve how early brain and childhood development is understood by pediatric healthcare professionals. AAP’s policy statements and technical reports highlight how appropriate medical care can support early brain development by mitigating the effects of toxic stress, for example, and by building the resilience of children and their families at the population level to reduce health disparities.

At the state level, public health departments have also taken concrete steps to promote healthy early brain development for all children and infants. In Delaware, the state’s division of public health oversees the Early Childhood Program, which focuses on early brain development and understanding the impact of adverse childhood experiences (ACEs) and toxic stress among children under three and their families. The program’s activities include training healthcare and childcare providers and home visiting professionals on reducing toxic stress; screening for ACEs at Federally Qualified Health Centers, and creating skill-building resources for parents on minimizing toxic stress in their children’s lives. To date, the program has provided ACEs training to more than 50 early child care providers, provided ACEs screening to more than 200 families, and provided domestic violence training to almost 150 early child care providers. The program is federally funded as part of HRSA’s Maternal and Child Health Bureau’s Early Childhood Comprehensive Systems Grant, which has also been awarded to nine other state agencies.

Georgia’s Talk With Me Baby program is a nationally-recognized initiative to educate caregivers on the importance of talking with their babies every day to build the supportive, interactive, and nurturing relationships that facilitate language acquisition and support healthy early brain development to ultimately address the word gap. The Georgia Department of Public Health leads the development and implementation of this program in collaboration with five other organizations. The program emphasizes “language nutrition,” centering on how caregivers can interact with children to support their language acquisition and brain development before they reach school age. This model acknowledges the major influence caregivers have on children, given their constant interaction from the earliest developmental stages, and recognizes that caregivers need support from other professionals, like doctors, nurses, social workers, nutritionists, and early learning professionals, to keep kids healthy and promote optimal brain development.

These programs and policies all take evidence-based approaches to improving early brain development, from before birth through kindergarten. This emphasis on early language acquisition is critical because the factors driving the word gap begin long before school entry, making this early period foundational in achieving health equity. ASTHO’s work on early brain development in the coming months will build on these interventions and policies to help public health leaders become more active in this area, ensuring all children can be successful in both learning and life.


Doug KershnerDoug Kershner, Senior Analyst, Maternal and Child Health, is responsible for ASTHO’s work to support healthy early childhood brain development. This work includes identifying collaborative opportunities with ASTHO’s other maternal and child health (MCH) projects and creating targeted technical assistance for states and territories, and working with experts to develop evidence-based recommendations through written documents, webinars, and other media.