The long-term benefits for disadvantaged children who attend high-quality early years programmes have long been known to include better qualifications, higher adult earnings and lower involvement in crime. But a groundbreaking study shows how the positive outcomes can extend to physical health – including lower levels of obesity and reduced risks of heart disease.
Research published in the American journal Science uses data gathered from men and women in their mid-30s involved, throughout their lives, in the longitudinal evaluation of an early years intervention known as the Carolina Abecedarian Project (ABC). Born between 1972 and 1977, they were randomly allocated to take part in a preschool programme of full-day childcare promoting language development, emotional regulation and reasoning skills, or to a non-participating control group.
The original sample of 111 children from 109 disadvantaged families was recruited on the basis of characteristics such as parental education, family income, and sibling’s educational performance. In addition to their nursery and learning support, programme participants also received healthcare checkups and screening, and a nutritional intervention consisting of two meals a day and a snack.
On reaching elementary school, the study children in each group were subdivided at random to receive additional home-school learning support, intended to improve their math and reading skills, or be part of a control group. The children’s progress continued to be monitored when they were 12, 15, 21 and 30. The results have identified lasting gains for participants in the early years programme in their academic attainment, cognitive skills and employment compared with the control group.
However, for the latest follow-up investigation, researchers included personal health questions, including a survey of cardiovascular and metabolic risk factors. Interviewees also underwent a physical examination by a doctor and provided blood samples for analysis.
The results showed that individuals who had been part of the first-stage, preschool programme were enjoying better physical health than the control group. There were also strong indications that their future health was also likely to be better.
Both men and women in this group scored significantly better on measurements assessing their risk of experiencing coronary heart disease during the next ten years. Female participants were also less likely to be rated abdominally obese than the control group, although differences were only marginally significant.
The results for male participants were particularly striking, revealing significantly lower levels of hypertension (high blood pressure) and obesity combined with hypertension. None of the men from the experimental group exhibited a cluster of conditions associated with an elevated risk of heart disease, stroke and diabetes (“metabolic syndrome”), unlike one in four of the control group. Male participants, at age 30, were more likely, in the American context, to be covered by health insurance and to have sought professional healthcare when sick.
An obvious difficulty in drawing generalisable conclusions from the Abecedarian data is the small number of interviewees. The latest follow-up study involved only 72 members of the original, first stage sample (no evidence was found of any treatment effects attributable to the second stage). However, the researchers specify advanced statistical techniques that they used to test and improve the validity of their findings and an imbalanced reduction in survey participants (the worst attrition was among men in the control group).
Citing morbidity, mortality and health economics data, they conclude that the benefits flowing from the health improvements they observed are likely to be substantial and wide-ranging. For example, obesity is associated with higher absenteeism and lower productivity in the labor market as well as lower life expectancy. Hypertension and diabetes carry similar implications.
Even so, precise explanations as to how an early years intervention produced encouraging health outcomes more than 30 years later remain speculative. The ABC Project implemented a bundle of different components, making it hard to know which produced the positive results. Nevertheless, a statistical analysis carried out by the researchers suggests the programme’s influence during infancy contributes an important indication. As much as half the programme’s effect on hypertension and obesity was found to be related to children’s body mass index measured when they were just a year old.
Despite unanswered questions concerning causation, this study suggests that investments in early childhood programmes can achieve substantial, long-term effects on their health as well as their economic and social wellbeing. From a public policy perspective, they hold genuine promise as a means of reducing adult healthcare costs.
Campbell, F., Conti, G., Heckman, J. J., Moon, S. H., Pinto, R., Pungello, E., & Pan, Y. (2014). Early Childhood Investments Substantially Boost Adult Health. Science, 343(6178), 1478-1485.Return to Features