Intended for healthcare professionals


Bucking the inequality gradient through early child development

BMJ 2010; 340 doi: (Published 11 February 2010) Cite this as: BMJ 2010;340:c468
  1. Clyde Hertzman, director1,
  2. Arjumand Siddiqi, assistant professor2,
  3. Emily Hertzman, research assistant1,
  4. Lori G Irwin, research associate1,
  5. Ziba Vaghri, research associate1,
  6. Tanja A J Houweling, researcher 3,
  7. Ruth Bell, senior research fellow4,
  8. Alfredo Tinajero, researcher 5,
  9. Michael Marmot, chair 6
  1. 1Human Early Learning Partnership, University of British Columbia, 440-2206 East Mall, Vancouver, Canada BC V6T 1Z3
  2. 2School of Public Health,University of North Carolina, Chapel Hill, USA
  3. 3UCL Centre for International Health and Development, Institute of Child Health, London
  4. 4Department of Epidemiology and Public Health, University College London
  5. 5Hincks-Dellcrest Centre, Toronto, Canada
  6. 6WHO Commission on the Social Determinants of Health, University College London
  1. Correspondence to: C Hertzman clyde.hertzman{at}

    A good start in life is the key to reducing health and social inequalities in society. Clyde Hertzman and colleagues argue that governments in rich and poor countries should be investing more in programmes to support early child development

    What happens to children in their early years is critical for their development throughout life.1 Healthy early childhood development, including the physical, social-emotional, and language-cognitive domains, influences obesity and stunting, mental health, heart disease, competence in literacy and numeracy, criminality, and economic participation.2 Investment in early childhood is thus a powerful strategy for social development in both rich and poor countries. The economic returns to a society over the life course are likely to more than repay the original investment, especially if they are reinforced in later childhood.3 4 5 We examine the challenges for resource rich and poor countries.

    Gradients in child development

    In every society, regardless of wealth, differences in socioeconomic position translate into inequalities in child development. Each step up the family social and economic ladder results in improved prospects for child development. Gradients in developmental outcomes result both from readily identifiable factors that are intimately connected to the child (such as the quality of time and care provided by parents and the physical conditions of the child’s surroundings) and from more distal factors (whether government policies provide families and communities with sufficient income and employment, healthcare resources, early childhood education, safe neighbourhoods, decent housing, etc). Gradients have been shown for infant and child mortality, low birth weight, injuries, dental caries, malnutrition, infectious diseases, and use of healthcare services.6 7 8 9 10 11 They are evident in every country in which they have been measured, rich or poor.12

    In the cognitive domain, gradients are found for school enrolment, mathematical and language achievement, and literacy.13 In …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription