human early learning partnership and health promotion
TRANSCRIPT
Population Health and Human Population Health and Human Development, 1987-2007Development, 1987-2007
Clyde HertzmanClyde Hertzman
Director, Human Early Learning Director, Human Early Learning PartnershipPartnership
Determinants of HealthDeterminants of Health
Life expectancy and income per capita Life expectancy and income per capita for selected countries and periodsfor selected countries and periods
30
40
50
60
70
80
00 5,0005,000 10,00010,000 15,000 15,000
LifeLifeExpectancyExpectancy(years)(years)
Income per capita (1991 international dollars)Income per capita (1991 international dollars)
Source: World Development Report, 1993Source: World Development Report, 1993
19901990
19601960
About 1930About 1930
About 1900About 1900
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..
..
..
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..
..
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Gradients in HealthGradients in Health
Index of InequalityIndex of Inequality
Hertzman, American Scientist, 2001, p 543Hertzman, American Scientist, 2001, p 543
U.K. Civil Service U.K. Civil Service Mortality - All CausesMortality - All Causes
CHD Mortality - UK Whitehall StudyCHD Mortality - UK Whitehall Study
A Developmental PerspectiveA Developmental Perspective
Infant MortalityInfant Mortality
0
2
4
6
8
10
12
14
16
18
20
1971 1976 1981 1986 1991 1996
Q1 - Richest
Q2
Q3
Q4
Q5 - Poorest
per 1,000
Mortality by Neighbourhood Income in Urban Canada, Wilkins R, Berthelot JM, Ng E, March 2001
Report: Raising Young Children, p 18, HRDC, 2003
Quantitative Literacy Scores for Youth Aged 16-25. Quantitative Literacy Scores for Youth Aged 16-25. International Adult Literacy Study, 1994International Adult Literacy Study, 1994
-1.5
-1
-0.5
0
0.5
1
1.5
6 7 8 9 10 11 12 13 14 15 16 17
Parents’ Level of EducationParents’ Level of Education
Eff
ect
Siz
eE
ffec
t S
ize
L
evel
1
L
evel
2
L
evel
3
Lev
el 4
Lev
el 1
Lev
el 2
Lev
el 3
L
evel
4
SwedenSweden
SwitzerlandSwitzerland
NetherlandsNetherlands
GermanyGermany
BelgiumBelgiumCanadaCanada
USAUSAPolandPolandIrelandIreland
N IrelandN Ireland G BritainG Britain
New ZealandNew Zealand
Organisation for Economic Co-operation and Development and Statistics Canada. (1995) Literacy, economy, and society: results of the first international adult literacy survey. OECD/Ministry of Industry Canada, p 151.
The Challenge of the GradientThe Challenge of the Gradient
• • ubiquitous in wealthy and majority world countriesubiquitous in wealthy and majority world countries
• • cuts across a wide range of disease processescuts across a wide range of disease processes
• • not explained by traditional risk factorsnot explained by traditional risk factors
• • replicates itself on new conditions as they emergereplicates itself on new conditions as they emerge
• • occurs among males and femalesoccurs among males and females
• • begins life as gradient in ‘developmental health’begins life as gradient in ‘developmental health’
• • gradients appear to ‘flatten up’gradients appear to ‘flatten up’
BirthBirth DeathDeathSocio-EconomicEnvironment
OR=1.87
Civil Society OR=2.05
Social
Network
OR=n.s.
““pathway/cumulative” pathway/cumulative” factors: OR=6.15factors: OR=6.15
Contributions to Self-rated Health at Age 33, Contributions to Self-rated Health at Age 33, 1958 Birth Cohort1958 Birth Cohort
““latent” factors: latent” factors: OR=5.03OR=5.03
““Intersecting” factors: Intersecting” factors: OR=3.83OR=3.83
Health Problems Related to Early Life
Coronary Heart Disease
Non-insulin Dependent Diabetes
Obesity
Blood Pressure
Aging and Memory Loss
Mental Health (depression)
‘‘Sensitive periods’ in early Sensitive periods’ in early brain developmentbrain development
Binocular vision
0 1 2 3 7654
High
Low
Years
Habitual ways of respondingLanguage
Emotional controlSymbol
Peer social skillsRelative quantity
Central auditory system
Effects of Mothers’ Speech on Infant VocabularyEffects of Mothers’ Speech on Infant Vocabulary
Source: Huttenlocher et al., 1991Source: Huttenlocher et al., 1991
0
600
1200
12 16 20 24 28 32 36
High SES
Middle SES
Low SES
Age - Months
Literacy – Early Vocabulary Growth
B. Hart & T. Risley, Meaningful Differences in Everyday Experiences of Young American Children, 1995
Cum
ulat
ive
Voc
abul
ary
03-08903-089
Serotonin Gene and DepressionAge 26
None Moderate Severe
.30
.50
.70
A. Caspi, Science, 18 July 2003, Vol 301.
Depression Risk
LL
SS
SL
S = Short Allele L = Long Allele
Early Childhood Abuse
SES Differences in Prefrontal Cortex SES Differences in Prefrontal Cortex ActivityActivity
The Dynamic Epigenome andThe Dynamic Epigenome andModulation of Gene ExpressionModulation of Gene Expression
The ‘Meaney-Szyf Paradigm’The ‘Meaney-Szyf Paradigm’
• • critical periods of brain developmentcritical periods of brain development
• • differential qualities of nurturancedifferential qualities of nurturance
• • epigenetic modification through methylationepigenetic modification through methylation
• • lifelong change in HPA axis functionlifelong change in HPA axis function
• • inter-generational transmission of nurturanceinter-generational transmission of nurturance
Kindergarten: Kindergarten: Early Development Instrument (EDI)Early Development Instrument (EDI)
1.1. 5 domains:5 domains:
Physical health and well beingPhysical health and well being Social knowledge and competenceSocial knowledge and competence
Emotional health and maturityEmotional health and maturity Language and cognitive developmentLanguage and cognitive development Communication skills and general Communication skills and general
knowledgeknowledge“Developmental Readiness”
Percentage of Students Vulnerable on One or More scales of the Percentage of Students Vulnerable on One or More scales of the EDI EDI
Based on Provincial cutoffs, Based on Provincial cutoffs, WaveWave 1 1
Percentage of Students Vulnerable on One or More Percentage of Students Vulnerable on One or More Scales of the EDI Scales of the EDI Based on Provincial cutoffs, Based on Provincial cutoffs, Wave 2Wave 2
Ever at risk Ever at risk VulnerableVulnerable
Average Score Average Score Emotional Maturity scale of the EDI, Emotional Maturity scale of the EDI, Cycle 1Cycle 1
Proportion of Variation in EDI Vulnerability across 470 Neighbourhoods ‘Explained’ by SES
• physical health and well-being -- 31%• social competence -- 24%
• emotional maturity -- 22%
• language and cognitive development -- 27%
• communication skills and general knowledge -- 46%
• one or more vulnerability -- 43%
Map 4.7.2: Vulnerability on Any EDI Map 4.7.2: Vulnerability on Any EDI Scale and Socioeconomic Status in BCScale and Socioeconomic Status in BC
Map 4.7.2-Highlight1: Vulnerability on Map 4.7.2-Highlight1: Vulnerability on Any EDI Scale and Socioeconomic Status Any EDI Scale and Socioeconomic Status
in BCin BC
Map 4.7.2-Highlight2: Vulnerability on Map 4.7.2-Highlight2: Vulnerability on Any EDI Scale and Socioeconomic Status Any EDI Scale and Socioeconomic Status
in BCin BC
Map 4.7.2-Highlight3: Vulnerability on Map 4.7.2-Highlight3: Vulnerability on Any EDI Scale and Socioeconomic Status Any EDI Scale and Socioeconomic Status
in BCin BC
Variation in SES-Vulnerability Linkage in British Variation in SES-Vulnerability Linkage in British Columbia:Columbia:
SES-Typical and -Atypical CommunitiesSES-Typical and -Atypical Communities
Defining Off-/On-DiagonalityDefining Off-/On-Diagonality
• Better than expected:Better than expected:– Low SES Low SES / / Low EDI vulnerability Low EDI vulnerability (Group 1)(Group 1)
• Worse than expected: Worse than expected: – High SES High SES // High EDI vulnerability High EDI vulnerability (Group 2)(Group 2)
• As expected: As expected: – High SES High SES // Low EDI vulnerability Low EDI vulnerability (Group 3)(Group 3)– Medium SES Medium SES / / Medium EDI vulnerability Medium EDI vulnerability (Group 4)(Group 4)– Low SES Low SES / / High EDI vulnerability High EDI vulnerability (Group 5)(Group 5)
Off-Diagonal:
On-Diagonal:
J
SES Data SourcesSES Data Sources
• EDI Wave 0/1 (1999/2000, 2000/1, 2001/2, 2002/3, 2003/4)
• 2001 Census
• Child Care Data (1999 to 2003)
• 1998 Taxfiler Data
• EDI Wave 2 (2004/5, 2005/6, 2006/7)
• 2001 Census
• Child Care Data (1999 to 2003)
• 1998 Taxfiler Data
• Change from 1998 to 2004 in Taxfiler Data
Year EDI became a systemic
program in BC
B
Conceptual Diagram: Conceptual Diagram: Off- and On-Diagonal GroupingsOff- and On-Diagonal Groupings
Group 2:
Worse than expected
(OFF)
Group 1:
Better th
an expected
(OFF)
Group 3:
Left, regression lin
e
(ON)
Group 4:
Centre, re
gression line
(ON)
Group 5:
Right, regression lin
e
(ON)
Predicted vulnerability
Act
ua
l vu
lne
rab
ility
Let’s not forget
Group 0: “other”
n’hoods.
J
NeighbourhoodsNeighbourhoods Identified as Identified as Off- & On-DiagonalOff- & On-Diagonal
B
Cohorts of InterestCohorts of Interest
2007/2008
2006/2007
2005/2006
2004/2005
2003/2004
Wave 2:
FSA (Gr. 4)
2002/2003
2000/2001
2003/2004
2001/2002
1999/2000
Wave 1:
EDI (K)
= focus of our current
work
EDI-to-FSA Data Linkage RatesEDI-to-FSA Data Linkage Rates
5076
26502
3416
3411
4044
PEN Found
3172 +/-
3783 +/-
FSA Score Found
275062002/2003
36432000/2001
53742003/2004
40082001/2002
4267 1999/2000
EDI
95%
94%
85%
96%
96%
Kindergarten Grade 4
89%
87%
Data Unavailable
Data Unavailable
Data Unavailable
The EDI has Predictive Validity (but there’s more The EDI has Predictive Validity (but there’s more to it than that!)to it than that!)
# of Vulnerabilities % Not ‘Successful’ = ‘Not Pass’
Numeracy
0 12.31 22.22-3 33.84-5 55.6
Reading0 17.81 33.92-3 43.14-5 68.3
(EDI) (Grade 4)
Understanding C-to-B RatiosUnderstanding C-to-B Ratios
VULNERABLE
NOT VULNERABLE
EDI
DID NOTPASSED
FSALet’s see how these deflections appear graphically…
= “off diagonals”
A – Positive (Normal)A – Positive (Normal)
B – Negative DeflectionB – Negative Deflection
C – Positive DeflectionC – Positive Deflection
D- Negative (Normal)D- Negative (Normal)
Calculating C-to-B RatiosCalculating C-to-B Ratios
DCVULNERABLE
BANOT VULNERABLEEDI
NOT PASSEDPASSED
FSARecall that…
/ ( + ) / ( + )
CBR=
In essence, the CBR represents the ratio of positive to negative
deflections
VancouverVancouver
Divergence: The development of children from higher vulnerability neighbourhoods, over time, falls behind that of children from lower vulnerability neighbourhoods.
Howe SoundHowe Sound
Convergence: Children from higher vulnerability neighbourhoods tend to catch up, over time, with children from lower vulnerability neighbourhoods.