The first thousand days of life

The case for investment for successful childhood development

by Zac Hatzantonis and Nicholas Robinson

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Bringing evidence and economics together to solve problems faced by young Australians

There are many challenges faced by Australians of all ages, including our children. Some, for example, those with disability, those living in jobless homes and Aboriginal and Torres Strait Islander children, face additional, deep and persistent challenges. Our research tells us many of these obstacles will negatively impact the child for the rest of their lives and that investment is needed now to address this.

As such, there are many urgent calls upon government and the taxpayer. There are also many solutions being put forward as to how to help ensure more young Australians get the opportunities they need to reach their potential and live happy, productive lives.

On behalf of every community, government must therefore constantly struggle with the age-old problem of applying limited resources to unlimited problems and doing so via the most effective means.

Although this article reviews just two factors influencing childhood wellbeing, it will be the template for further work by our partnership and we hope, help inform the work of other organisations seeking to better the lives and prospects of Australia’s children.

The Strong Foundations: Getting it Right in the First Thousand Days Strong Foundations initiative is a collaboration between:

While early years experts have long been aware that this is an important developmental period, new research has started to uncover some of the mysteries surrounding the processes by which genes, experiences and environments interact to influence development at this time. These discoveries have increased experts’ views of the significance of this earliest period of development, and the need to reform policies, practices and systems in response to the evidence.

The Strong Foundations collaboration brings together extensive research, policy and practice expertise with each organisation providing unique skills and resources.

The report builds on the evidence base by presenting an economic analysis of improved early childhood outcomes for two scenarios which illustrate the potential benefits to society of investing in this crucial developmental period.

The first thousand days refers to the earliest stage of human development, from conception to the end of a child’s second year. This is a period of maximum developmental plasticity, when the foundations of optimum health, growth, and neurodevelopment across the lifespan are established.

While people have recognised the importance of childhood experiences on adult life for a long time, it is only recently that research has revealed the significance of this very early period. New research is rapidly advancing our understanding of the biological processes and environmental characteristics that shape development during this time and the significance of this period for future health, wellbeing, learning and development outcomes.

Despite this growing focus, the Australian public’s understanding of the significance of the first thousand days is limited, and the policy response to date has not been in line with the weight of the evidence. 

1 in 5 Australian children are considered developmentally vulnerable when they enter kindergarten

While there are many examples of policies, programs and initiatives focusing on early childhood, with more than one in five Australian children considered developmentally vulnerable when they enter kindergarten, it is clear there is still work to be done to give all Australian children the best possible start in life1. Targeting this earlier period of development the first thousand days may be more effective in influencing not only child development but lifelong outcomes.

The aim is to draw attention to the need to shift the dial in policies, programs and initiatives to target this earlier developmental phase. This report highlights that the timing of interventions is key to improving child outcomes. Two scenarios are presented that illustrate the impact that experiences during the first thousand days can have over a life-span and use economic modelling to illustrate the potential benefits to society of improving these outcomes.


The research

Using the evidence presented in the report The First Thousand Days – An Evidence Paper (see full report for more details), we identified approximately 50 outcomes to explore.

Through discussions with the Strong Foundations working group, supplemented by discussions with subject matter experts where appropriate, each outcome was assessed against key criteria to narrow the focus. Areas were concentrated on for which there is enough data to conduct analysis and create a credible model based on quantitative estimates, where new evidence can be provided to enhance our appreciation of the impact of this early period, and where changes in policies, programs and interventions could have a significant impact on improving life outcomes.

Using these selection criteria, antenatal care and housing stability were chosen as outcomes for modelling. The goal of modelling these outcomes is to demonstrate that improving access, quality, integration, and targeting of the service system for families and children could yield great benefits to individuals, families, communities, and the economy more broadly.

Antenatal care was chosen because it occurs during the very early period of development pre-birth and has the capacity to influence a wide range of highly influential factors at this time. Within this, the scenario of reducing the prevalence of smoking amongst pregnant women was modelled as a tangible example of the potential benefits of targeting this early period to affect change and the significant positive outcomes this could have for individuals and society.

Housing stability was investigated because it has an influence throughout the first thousand days and into early childhood.

It should be noted that there is a connection between parental stress caused by financial and housing instability and the benefits of access to quality services and a strong sense of community that stable, quality housing affords.

Importantly however, this is not to advocate for home ownership as the solution to improve outcomes but as a proxy to highlight the opportunity to provide greater stability for children within their first thousand days. Whether home ownership is beneficial over and above stable housing in the form of long term leasing, for example, merits further investigation.

As the government has not yet developed programs that could improve these outcomes, the economic modelling does not consider their costs as part of a cost benefit analysis. However, the results of the economic analysis are important to guide potential funding for these programs.


Key findings

These specific scenarios relate to broader themes and research about the impact of experiences in the first thousand days and highlight the potential impact that policies, programs and initiatives targeting this very early developmental stage could have. In particular, they underscore the important role antenatal care and strong community networks play in screening for risk factors and improving outcomes.

We explored the connections between the impact of antenatal smoking and housing instability on life outcomes through the flow on effects on health, education, criminality and economic participation.

A detailed explanation of how we arrived at the figures below and a breakdown of the costs is provided in the full report which you can find here.

Reducing the prevalence of smoking amongst pregnant women

There are many reasons mothers continue to smoke during pregnancy, and it is important to note that raising awareness of the risks is only one element in reducing the rates of antenatal smoking. Some mothers think smoking will help them control their weight during pregnancy or mean their baby is smaller and delivery is easier. While explaining that low birthweight carries risks for their child’s development may go some way towards countering those myths, for many smoking is heavily influenced by environmental factors.

The good news is that antenatal smoking is one of the few preventable factors associated with low birthweight and other adverse pregnancy outcomes, and the message is getting across. A higher proportion of women stop smoking during pregnancy than at any other time in their lives.

While reducing the prevalence of smoking amongst pregnant women has been modelled in this instance to show how a modifiable change that affects this very early period could benefit individuals, and society as a whole, we could have chosen a number of factors. They all link to broader themes about the role of antenatal care to identify risks and address them, and the importance of environmental factors and community support to ensure the optimal development in the first thousand days to support lifelong health, wellbeing and opportunity.

Improving housing stability

Stable housing enables expectant parents to experience better, connected antenatal care as well as a stronger sense of community overall. Experiencing social support during pregnancy reduces the likelihood of maternal stress, depression and risk taking behaviours during and after pregnancy.6

Supports that provide stability for families during pregnancy and the early years could alleviate stress, offer the stability needed to build strong social support networks, and enable parents to benefit from a more connected experience of antenatal care.

Although this report focuses on home ownership for the purposes of the modelling, there are a number of issues relating to housing that have an impact on child development during the first thousand days and lifelong outcomes.

Housing instability and financial instability can be a big cause of parental stress, which is known to have a negative impact on foetal development and young children, and the impact is often greater for young children than for older children. Unstable housing arrangements can often be linked to poor housing conditions, which are also known to have an impact on the health and wellbeing of the mother and child.

On the other hand, supporting housing stability for expectant parents and families with young children brings a number of benefits, including alleviating parental stress, helping to build a stronger sense of community and belonging, supporting a more connected experience of antenatal care, and the development of stronger relationships with care providers.

We acknowledge that governments are currently working to improve early childhood outcomes; therefore, we present suggestions for how we can improve on policies, programs and initiatives to do what we are doing now, but better.


Conclusion

How to improve antenatal care and housing stability in the future

These findings provide an opportunity to think differently about how policymakers approach the first thousand days. As the report shows, there are a number of highly influential factors in a child’s development out of sight of government and community services. Nonetheless, our understanding of these is improving rapidly thanks to new research focusing on the first thousand days.

Nutrition and education factors are prominent in parents’ minds, but other elements such as the environment, and levels of parental stress (particularly for the mother) can also have notable impacts. These can result from housing and financial insecurity, job strain and relationship difficulties.

There are a number of steps that can be taken to improve outcomes by targeting the first thousand days. In terms of policies, programs and initiatives, the focus could be on improving information and education, improving services and supports provided to families during this period, and improving the environment families and children live in.

The purpose of this report is not to advocate for a specific area for intervention but to provide economic analysis as a guide for potential future funding for programs.

While this report focuses on only 2 aspects of the first 100 days, there are many other factors that impact early childhood outcomes.

Suggestions for key areas where changes could be made include:

  1. Better identification of important risk factors to enable earlier intervention to give children the best possible start in life. This is particularly relevant for those most vulnerable.
  2. In addition to the current focus on education and communicating health messages, better guidance and support to address challenges caused by the circumstances and environment the parents are living in.
  3. A more connected pathway for parents through the antenatal, perinatal and postnatal periods, providing seamless support.

These are the top 10 factors that were scored by the consortium. There are therefore some other key factors that should be considered for research in future:

For more detailed information on the findings and the specific recommendations see the full report here.


References

Project partners

PricewaterhouseCoopers Consulting (Australia) (PwC)
PwC Consulting is part of Australia’s largest professional services firm, PricewaterhouseCoopers Australia. We bring the power of a global network of firms to help Australian businesses, not-for-profit organisations and governments assess their performance and improve the way they work.

Australian Research Alliance for Children and Youth (ARACY)
The Australian Research Alliance for Children and Youth (ARACY) is a research and results focused, apolitical organisation. It works with government, researchers and those providing services to children and their families. ARACY’s aim is to help children achieve a better life by focusing on heading off problems before they arise.

Bupa Australia
Bupa in Australia and New Zealand are part of the Bupa Group, a leading international healthcare organisation that draws upon our international knowledge and expertise to provide health and care services.

Bupa Health Foundation
The Bupa Health Foundation is one of the leading charitable foundations dedicated to health in Australia. It is committed to improving the health of the Australian community and ensuring the sustainability of affordable healthcare.

Centre for Community Child Health at the Murdoch Children’s Research Institute (MCRI)
The Centre for Community Child Health at the Murdoch Children’s Research Institute (MCRI) is an international leader in early childhood development. The Centre works with families, communities and governments to advance equitable health and developmental outcomes for all children, using evidence to understand and address the myriad of factors that influence children’s development. The Centre develops innovative solutions that make a measurable difference to children and families.


1 Australian Early Development Census. (2016). Findings from the AEDC.
2 Moore, T.G., Arefadib, N., Deery, A., & West, S. (2017). The First Thousand Days: An Evidence Paper. Parkville, Victoria; Centre for Community Child Health, Murdoch Children’s Research Institute, p.2
3 National Collaborating Centre for Women’s and Children’s Health. (2008). Antenatal care: Routine care for the healthy pregnant woman.
4 Australian Institute of Health and Welfare. (2018). Mothers and babies 2016 – in brief.
5 Australian Institute of Health and Welfare. (2018), National Core Maternity Indicators. 
6 Goldfeld S, Villanueva K, Lee JL, Robinson R, Moriarty A, Peel D, Tanton R, Giles-Corti B, Woolcock G, Brinkman S, Katz I. (2017). Foundational Community Factors (FCFs) for Early Childhood Development: A report on the Kids in Communities Study.

Contact us

Zac Hatzantonis

Partner, PwC Australia

Tel: +61 (3) 8603 5210

Nicholas Robinson

Manager, PwC Australia

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