Early childhood development-global action is overdue.

In 2007, The Lancet declared that early childhood development was a global challenge of the greatest urgency. 4 years later, we have made progress, but still have far to go in making early childhood development the global priority it must be. The importance of early childhood development remains profound. As the accompanying papers in The Lancet show so clearly, the prenatal and postnatal periods are the most critical time in a child’s development, laying the foundation for physical, emotional, and intellectual wellbeing. Dietary defi ciencies, inadequate feeding practices, chronic infections, and low levels of stimulation during this period jeopardise a child’s chance to reach his or her full potential and increase the risk that poor health and poverty will follow that child into adulthood. Exposure to multiple deprivations increases these terrible consequences. Not surprisingly, children in the most disadvantaged quintiles of their societies are at the greatest risk of being deprived during this crucial early period. As the Lancet papers show, interventions directed at the poorest children can provide enormous returns on investment. For example, home and community-based parenting and family support programmes signifi cantly benefi t the youngest children by promoting physical, cognitive, and emotional development, especially when they are integrated with other health, nutrition, and childprotection interventions. For children aged 3–6 years, organised early childhood learning centres not only improve school readiness but also school attainment. In turn, children who remain—and succeed—in school are more likely to earn higher incomes as adults, and to provide better nutrition, health care, stimulation, and educational opportunities to their own children. Furthermore, early childhood development interventions have a substantial impact on children aff ected by violence, disability, and developmental delays. That is why it is so alarming that the poorest and most vulnerable children who are most likely to benefi t from early childhood development programmes are also least likely to have access to them. According to the World Bank, the Organisation for Economic Co-operation and Development countries spend an estimated 1·6% of their gross domestic product (GDP) on family services and preschool for children aged 0–6 years, and 0·43% of GDP on preschools alone. By comparison, low-income countries such as Nepal, Kenya, and Tajikistan spend just 0·1% of GDP on preschools, while Nicaragua and Senegal spend less than 0·02%. Neglect of young children most in need is an outrage—and a huge strategic mistake. Focusing on reaching these children is not only the right thing to do, it is a highly cost-eff ective investment that countries can and must make for their long-term growth. To cite just one example raised in the Lancet papers, increasing preschool enrolment rates to 25% could yield an estimated US$10·6 billion through higher educational achievement, while a 50% increase could generate $33·7 billion. Such investments in centre-based early childhood development yield even greater dividends when they are coupled with community-based nutrition and parenting programmes. The two Lancet papers present new evidence on the causes and consequences of developmental inequities in early childhood—and the exceptional opportunity we have to redress them. We must not ignore this evidence. Instead, we must act on it, working together to make safe and supportive early childhood development a reality for the world’s poorest and most vulnerable children. Increased investment is needed in quality parenting programmes and organised early learning centres for the most disadvantaged children. These services should also be better integrated into existing community-based programmes across a broad range Published Online September 23, 2011 DOI:10.1016/S01406736(11)61450-5