Professor Clyde Hertzman ’€“ Early Child Development: A Powerful Equalizer

ABSTRACT: Professor Clyde Hertzman is a social epidemiologist with a distinguished scientific career, who has devoted the last 15 years to both study and action on arguably the most important determinant of lifelong health and function: early life.  He has published many papers demonstrating the close links between early life experiences, especially the social environment around and within the family, and the achievement of full human potential across socio-economic groups in modern society. Furthermore, he has consistently expounded the view that early life is, of all the determinants of health, by far the most amenable to policies and programs to reduce socio-economic inequalities in health, in any reasonable timeframe. Proven pre-primary child development programs can ’€œlevel the playing field of life’€ for a birth cohort within just a few years of initiation.
Over the last several years, Prof. Hertzman has established and directed the Human Early Learning Partnership at UBC in Vancouver, an applied research and knowledge transfer/exchange unit, funded from public sources.  It is dedicated to the population-level measurement, and prompt community feedback, of novel indicators of child developmental health ’€“ especially the Early Development Instrument (EDI), a twenty-minute fully validated questionnaire that assesses ’€œreadiness to learn,’€ which is now completed by kindergarten teachers in every British Columbia school every few years.  [This instrument has been clearly demonstrated to predict primary school achievement, and in turn ’€œlife success,’€ which correlates highly to lifelong health and function ’€“ it is therefore a sensitive indicator of social inequalities in health at the community level.]
The EDI results from all British Columbia’€™s far-flung communities are extensively analysed by HELP, using in particular data depiction methods accessible to lay persons. These data are then fed back promptly to local communities, including school boards, parents and teachers.  Part of the analysis allows these  takeholders to judge how their local children entering school that year are doing in developmental terms, compared to both previous birth cohorts in that setting, and same-aged cohorts of children in socio-economically matched settings across the province. Similar programs of population-wide measurement utilizing the EDI are in place in parts of Australia, and are being piloted in several other countries.
A key benefit to participating communities is the complete separation of these measurements from the contentious issue of school performance per se. Because these measures are taken when indergartners (typically five years of age in Canada) are only a few months into their first formal school experience, the results cannot be used to ’€œblame the schools for below-average performance.’€  Rather, the results are invaluable as resources, to local schools and communities, in advocating for additional resources to both improve future birth cohorts’€™ readiness to learn at school entry, via pre-primary child development programs of established effectiveness, and remedial instruction for those already in school.  The HELP program thus works to the advantage of the disadvantaged, at a local level, while also providing sensitive ’€“ and potentially promptly reversible ’€“ measures of human developmental health, at any level of aggregation in an entire population, that is relevant to program and policy decision-making.

Slides

Clyde Hertzman – Early Child Development: A Powerful Equalizer

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Watch: Measuring Health Inequalities. Talks by Rob Young (Oxford) & Frank Popham (St Andrews)

Talk 1: Rob Young, MRC Functional Genomics Unit, University of Oxford: What is the shape of the dose-response relationship between markers of socioeconomic status and health status indicators?

Abstract:
The association between socioeconomic status (SES) and health status has been extensively studied as a linear one, but this assumption of linearity is rarely tested. We have developed a novel technique based on spline theory which calls turning points, known as ’€˜knots’€™, within this linear relationship. Both the number and the position of these knots can be estimated using various standard regression models. The results of this modelling are summarised graphically and by two summary statistics ’€“ the Population Attributable Risk (PAR) and the Relative Index of Inequality (RII). We have used this approach to observe a significant increase in the strength of the positive association between the Scottish Index of Multiple Deprivation (SIMD) and the rate of hospital admissions due to alcohol misuse after reaching the bottom 10% of SIMD scores. When modelling a categorical variable such as education status we find that accounting for the population distribution can remove significant non-linearity even when analysing individual-level data. This new method improves the accuracy of traditional regression modelling while preserving much of its parsimony and, with the use of standard reporting statistics, its ease of interpretation.

Rob Young has just completed a six-month fellowship at the Scottish Collaboration for Public Health Research and Policy looking at non-linearity in the relationship between SES markers and health status indicators. This fellowship was a break at the end of the 3rd year of his DPhil based in the MRC Functional Genomics Unit, University of Oxford where he worked both computationally and experimentally on noncoding RNAs in the fruit-fly, Drosophila melanogaster.
Talk 2: Frank Popham, School of Geography and Geosciences, University of St Andrews: Comparing health inequalities in Scotland to elsewhere in Europe.

Abstract:
There is growing interest in how the extent of socio-economic inequalities in morbidity and mortality varies across countries. In Europe there have been a number of major comparative studies, the most recent of which covered data from the 1990s. However, Scotland has not been included in this work. So using data from the 1990s and 2000s the aim of the project was to replicate the most recent European work in Scotland. This talk will present the results.
Frank Popham is a research fellow in the School of Geography and Geosciences at the University of St Andrews. He has a social science background and his main research interests are health inequalities and population health.

Slides

John Frank & Sally Haw: Measuring and Monitoring Scotland’€™s Health Inequalities: New Approaches
Rob Young – hat is the shape of the relationship between socioeconomic status and health status?
Frank Popham – Comparing health inequalities in Scotland to elsewhere in Europe

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Latest Projects

December Bulletin 2018 (January 13, 2019)

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