Donald Bundy

Child and Adolescent Health and Development: Realizing Neglected Potential

It seems that society and the common legal definition have got it about right: it takes some 21 years for a human being to reach adulthood. The evidence shows a particular need to invest in the crucial development period from conception to age two (the first 1,000 days) and also during critical phases over the next 7,000 days. Just as babies are not merely small people—they need special and different types of care from the rest of us— so growing children and adolescents are not merely short adults; they, too, have critical phases of development that need specific interventions. Ensuring that life’s journey begins right is essential, but it is now clear that we also need support to guide our development up to our 21st birthday if everyone is to have the opportunity to realize their potential. Our thesis is that research and action on child health and development should evolve from a narrow emphasis on the first 1,000 days to holistic concern over the first 8,000 days; from an age-siloed approach to an approach that embraces the needs across the life cycle. To begin researching and encouraging action, this volume, Child and Adolescent Health and Development, explores the health and development needs of the 5 to 21 year age group and presents evidence for a package of investments to address priority health needs, expanding on other recent work in this area, such as the Lancet Commission on Adolescent Health and Wellbeing (Patton, Sawyer, and others 2016). Given new evidence on the strong connection between a child’s education and health, we argue that modest investments in the health of this age group are essential to attain the maximum benefit from investments in schooling for this age group, such as those proposed by the recent International Commission on Financing Global Education Opportunity (2016). This volume shares contributors to both commissions and complements an earlier volume, Reproductive, Maternal, Newborn, and Child Health, which focuses on health in the group of children under age 5 years. There is a surprising lack of consistency in the language used to describe the phases of childhood, perhaps reflecting the historically narrow focus on the early years. The neglect of children ages 5 to 9 years in particular is reflected in the absence of a commonly reflected name for this age group. Figure 1.1 illustrates the nomenclature used in this volume, which we have sought to align with the definitions and use outlined in the 2016 Lancet Commission on Adolescent Health and Wellbeing. The editors of this volume built upon the commission’s definitions to include additional terms that are relevant to the broader age range considered here, including middle childhood to reflect the age range between 5 and 9 years. The editors also refer to children and adolescents between ages 5 and 14 years as “school-age,” since in lowand lower-middleincome countries these are the majority of children in

The School as a Platform for Addressing Health in Middle Childhood and Adolescence

Health and nutrition programs targeted at school-age children are among the most ubiquitous of all public health programs worldwide. Since the inclusion of school health and nutrition (SHN) in the launch of the call for Education for All (EFA) in 2000, it has been difficult to find a country that is not attempting at some level to provide SHN services (Sarr and others 2017). It is estimated that more than 368 million schoolchildren are provided with school meals every day (World Food Programme 2016), and according to the World Health Organization (WHO) statistics (WHO 2015), 416 million school-age children were dewormed in 2015, which equals 63.2 percent of the target population of children in endemic areas; see chapter 29 in this volume (Ahuja and others 2017). These largely public efforts are variable in quality, and coverage is greatest in the richer countries, but the scale indicates public recognition of the willingness to invest in middle childhood and adolescence. Health status affects cognitive ability, educational attainment, quality of life, and the ability to contribute to society. Some of the most common health conditions of childhood have consequences for education. SHN interventions can support vulnerable children throughout key stages of their development in middle childhood and adolescence. A set of priority school-based interventions, selected on the basis of cost-effectiveness, benefit-cost analysis, and rate of return, is described in chapter 25 in this volume (Fernandes and Aurino 2017). Schools are a cost-effective platform for providing simple, safe, and effective health interventions to school-age children and adolescents (Horton and others 2017). Many of the health conditions that are most prevalent among poor students have important effects on education— causing absenteeism, leading to grade repetition or dropout, and adversely affecting student achievement—and yet are easily preventable or treatable. With gains in enrollment achieved by the Millennium Development Goals, SHN interventions are important cross-sectoral collaborations between Ministries of Health and Education to promote health, cognition, and physical growth across the life course. The education system is particularly well situated to promoting health among children and adolescents in poor communities without effective health systems who otherwise might not receive health interventions. There are typically more schools than health facilities in all income settings, and rural and poor areas are significantly more likely to have schools than health centers. The economies of scale, coupled with the efficiencies of using existing infrastructure and the potential to administer additional interventions through the same delivery mechanism, make SHN interventions

100 Years of Mass Deworming Programmes: A Policy Perspective From the World Bank's Disease Control Priorities Analyses

For more than 100 years, countries have used mass drug administration as a public health response to soil-transmitted helminth infection. The series of analyses published as Disease Control Priorities is the World Banks vehicle for exploring the cost-effectiveness and value for money of public health interventions. The first edition was published in 1993 as a technical supplement to the World Banks World Development Report Investing in Health where deworming was used as an illustrative example of value for money in treating diseases with relatively low morbidity but high prevalence. Over the second (2006) and now third (2017) editions deworming has been an increasingly persuasive example to use for this argument. The latest analyses recognize the negative impact of intestinal worm infection on human capital in poor communities and document a continuing decline in worm infection as a result of the combination of high levels of mass treatment and ongoing economic development trends in poor communities.