The littlest among us are key to our biggest health problems


Editor’s note: During his eight-week internship with the World Health Organization (WHO) this summer, third-year DMU osteopathic medical student and M.P.H. candidate Brian Ferguson was immersed in a gigantic global challenge, the impact of poor-quality child development. Despite the weighty implications of this worldwide woe, Ferguson found the experience to be invigorating, career-affirming and even inspiring.

Before enrolling at DMU, Ferguson was an astrophysics data and research analyst for the Space Telescope Science Institute, which operates the science program for the NASA Hubble telescope. A member of the U.S. Air Force and competitive gymnast on the trampoline, he eventually decided to begin a career in medicine where he could work more closely with people and contribute to improving their health outcomes. Ferguson is one of 14 DMU students who, since 2009, have held summer internships at the WHO and at the Pan American Health Organization (PAHO), WHO’s regional office for the Americas.

At the WHO, I worked in an area called early childhood development (ECD), advocating for funding and writing national and international project proposals to address this issue.
The problem of poor early child growth and development is enormous and increasing. Some 219 million children worldwide under the age of five years are estimated to be at extreme risk of impaired physical growth as well as cognitive and social/emotional development.

The stimulation of a child, both socially and cognitively by caretakers (mothers/fathers), is directly linked with the growth and early psychosocial development of children; both growth and this early psychosocial development are predictors of competence in literacy and mathematical ability and, later, school achievement.1-5 This has profound implications for the economic and social development of any country where there are children actively raised in vulnerable households, especially with little parental education and poverty.6

A child’s chance to reach his or her full developmental potential can be jeopardized by dietary deficiencies, inadequate feeding practices, chronic infections, poor bonding and attachment and low levels of stimulation by the mother. This is most true during first 1,000 days of life (the 270 days of pregnancy plus the first two years of life after birth). During the first two years of life (following birth), the maximums in potential growth in various cognitive areas exclusively occur, including sensory (seeing/hearing), language/speech and higher cognitive functions.

In other words, growth takes place in brain structure and function at the highest lifetime rate during the most early time of life. If certain stimulation and affection needs of the child are not met, this sets in effect negative lifetime trajectories for the child that are very difficult and costly to reverse. The longest-running evaluation on investment in early childhood development has found a return of 17 dollars to every dollar invested.7 Just some of these costly negative effects are poorer capacity in terms of education and earnings, poorer health and longevity (especially related to chronic disease), and poorer personal and social adjustment and coping throughout life, leading to higher incarceration rates.

Exposure to multiple deprivations (common in poverty-stricken developing countries) increases these terrible consequences of poor early childhood development. Thus, there is an absolute requirement for policy-based intervention to alleviate as much of the risk as possible for these vulnerable children.

Exposure to multiple deprivations early in life increases the terrible consequences of poor early childhood development (ECD). On the brighter side, ECD programs have demonstrated drastic improvements in survival, growth, health and development of vulnerable children. The challenge is getting more regions and nations to implement these programs.

On the brighter side, early childhood development programs have demonstrated drastic improvements in survival, growth, health and development of vulnerable children. According to the WHO, among all the social determinants of health, early childhood development is the easiest for societies’ economic leaders to understand, because improved ECD not only means better health, but it also is directly related to a more productive labor force, reduced criminal justice costs and reductions in other strains on the social safety net.

The main goal of the project I worked on was to effect a reduction of neglectful treatment of children, and therefore an end to the intergenerational transmission of poverty.
I worked most closely with the Geneva Foundation for Medical Education and Research and the world headquarters of the WHO in Geneva, Switzerland, to tackle this task of seeking early childhood development priority. My project included research into current and previously effective interventions, their components and how to recapture and extend proven results. I was fortunate to collaborate with experts in the field including the previous 25-year WHO focal person for worldwide ECD, Dr. Meena Cabral de Mello, as well as experts from the World Bank, Harvard University and Boston Medical University. With the assistance of these world ECD advisers, I authored dual project proposals to Swiss National Funds and the Bernard van Leer Foundation for an initiative for building capacity in early childhood development, especially for Brazil and Peru.

The main tasks of these two projects included the creation of a professional quality and universally appealing video targeted at country-level stakeholders, policy makers and advocates to entice investment in ECD, comprehensive maternal-child health programs and a reduction of violence against children. This audio-visual project encompassed expert testimony on the scientific and social foundation of ECD, with multiple language translations and electronic media adaptations. An informational handbook and a second longer video were also an essential part, created to assist with the training process of ECD and to highlight specific caregiver interactions of previously effective interventions for the development of ECD staff, communicators and teachers.

Working at the WHO, I was immersed in an environment of focused people motivated to bring about change on a world scale. These individuals are not hesitant to target tasks and problems much bigger than their personal scope of practice, or even that of the entire organization.

The WHO also places great importance on cultural sensitivity. Working at the organization taught me to carefully examine the cultural situation in which patients live, before haphazardly dictating health-based guidelines. It showed me that for many nations, lack of resources (including Internet access even at health advisory and high government levels) makes dissemination of current medical recommendations very difficult. This necessitates careful consideration of the effectiveness of health guidelines, as most are written for Western and first-world countries.

My biggest take-aways from my time at WHO are as follows:

  • Continual personal research into medical care is paramount to an effective practice of medicine, while new research and guidelines are continually developed.
  • I will always consider the cultural traditions of those who come into my future practice and understand their implicit importance in their lives and the difficulty in changing those traditions.
  • No problem is too big to tackle for a few passionate people who work well together as a team.
  • The level of adversity that some people experience is far beyond anything that I could have experienced or seen, goes deeper than I can conceive, and significantly affects disease, health and life outlook in a way that is extremely important to consider.

In my professional aspirations, I am now more interested in becoming a true patient advocate—whether I am assisting with an intervention in a single patient or a country of patients. Sensitivity to life experience of those who are targeted by the intervention, I have learned, is paramount to making that intervention a success and beneficial in their lives.

This experience has reaffirmed my initial understanding of humanitarian medicine: I firmly believe we are given a gift in the chance to become physicians and achieve a very special and influential place that can, if we desire, alleviate the suffering of many. We can act by helping to prevent illness, promote overall wellness and, in our capacity as human beings, to relate to the life-situation and comfort the distress of those within our scope of practice, both locally and globally.

  1. Grantham-McGregor, S., Developmental potential in the first 5 years for children in developing countries. The Lancet, 2007. 369 (9555): p. 60-70.
  2. Walker, S.P., Effects of early childhood psychosocial stimulation and nutritional supplementation on cognition and education in growth-stunted Jamaican children: prospective cohort study. The Lancet, 2005. 366(9499): p. 1804-7.
  3. Victora, M.D., Victora, C.G., and Barros, F.C.: Cross-cultural differences in developmental rates: a comparison between British and Brazilian children. Child Care Health Development, 1990. 16(3): p. 151-64.
  4. Bhargava, A., Modeling the effects of health status and the educational infrastructure on the cognitive development of Tanzanian school children. American Journal of Human Biology, 2005. 17(3): p. 280-92.
  5. World Health Organization: Early child development: a powerful equalizer. WHO, Editor. 2007: Geneva.
  6. Naudeau, S., Investing in Young Children: An Early Childhood Development Guide for Policy Dialogue and Project Preparation. 2011, World Bank: New York.
  7. Schweinhart, L.J., Montie, J., Xiang, Z., Barnett, W.S., Belfield, C.R., and Nores, M.: Lifetime effects: The HighScope Perry Preschool study through age 40. Monographs of the HighScope Educational Research Foundation, 14, 2005. Ypsilanti, MI: HighScope Press.
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