Jody Heymann

Investing in the foundation of sustainable development: pathways to scale up for early childhood development

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals.

Work and family divided across borders: the impact of parental migration on Mexican children in transnational families

Using new data collected in high emigration communities within Mexico, we explore the impact of partial family migration on children left behind in Mexico. Multivariate results suggest that households where respondents have a spouse who was a caregiver and who migrated to the USA are more likely to have at least one child with academic, behavioral, and emotional problems than non-migrant households. This finding supports efforts to decrease the need for families to cross borders either by decreasing the economic necessities for migration or by designing immigration policies aimed at decreasing the separation of families across borders and increasing family support after a caregivers departure to the USA. The end goal of these efforts and policies is to improve childrens health and well-being in communities with high levels of migration.

Breastfeeding policy: a globally comparative analysis.

OBJECTIVE To explore the extent to which national policies guaranteeing breastfeeding breaks to working women may facilitate breastfeeding. METHODS An analysis was conducted of the number of countries that guarantee breastfeeding breaks, the daily number of hours guaranteed, and the duration of guarantees. To obtain current, detailed information on national policies, original legislation as well as secondary sources on 182 of the 193 Member States of the United Nations were examined. Regression analyses were conducted to test the association between national policy and rates of exclusive breastfeeding while controlling for national income level, level of urbanization, female percentage of the labour force and female literacy rate. FINDINGS Breastfeeding breaks with pay are guaranteed in 130 countries (71%) and unpaid breaks are guaranteed in seven (4%). No policy on breastfeeding breaks exists in 45 countries (25%). In multivariate models, the guarantee of paid breastfeeding breaks for at least 6 months was associated with an increase of 8.86 percentage points in the rate of exclusive breastfeeding (P < 0.05). CONCLUSION A greater percentage of women practise exclusive breastfeeding in countries where laws guarantee breastfeeding breaks at work. If these findings are confirmed in longitudinal studies, health outcomes could be improved by passing legislation on breastfeeding breaks in countries that do not yet ensure the right to breastfeed.

The impact of migration on the well-being of transnational families: new data from sending communities in Mexico

We present results from a new study of the effects of migration to the USA on the well-being of transnational families in high emigration communities within Mexico. Our survey measured the well-being of family members in a variety of domains: economic, health, education, and child development for a representative sample drawn from high migration municipalities. Compared to those with no recent emigrants to the USA, Mexican households sending non-caregivers to the USA appear to gain economically without contributing to problems faced by children. However, when family caregivers migrate to the USA, the remaining members in Mexico struggle to meet the familys needs and children are more vulnerable to educational, emotional, and health problems. Children in households where a caregiver migrated were more likely to have frequent illnesses (10% vs. 3%, p<0.0001), chronic illness (7% vs. 3%, p=0.011), emotional problems (10% vs. 4%, p=0.006), and behavioral problems (17% vs. 10%, p=0.018) compared with children in households where the migrant was not a caregiver. Research, policy, and program implications of these findings are discussed.

How are we adapting to climate change? A global assessment

This paper applies a systematic approach to measuring adaptation actions being undertaken by 117 parties to the United Nations Framework Convention on Climate Change (UNFCCC) with the goal of establishing a baseline of global trends in adaptation. Data are systematically collected from National Communications prepared by Parties to the Convention and submitted periodically to the Secretariat. 4,104 discrete adaptation initiatives are identified and analyzed. Our findings indicate that while progress is being made on conducting impact and vulnerability assessments and adaptation research in nearly every country in the sample, translation of this knowledge into tangible adaptation initiatives is still limited. The largest number of reported adaptations falls under the category of infrastructure, technology, and innovation. Some types of vulnerability were more frequently reported across initiatives, including floods, drought, food and water safety and security, rainfall, infectious disease, and terrestrial ecosystem health. Notably, reporting on the inclusion of vulnerable sub-populations is low across all actions. Diffusion of adaptation across sectors remains underdeveloped, with the environment, water, and agricultural sectors emerging as the most active adaptors. Our analysis indicates that national communications provide a valuable source of information for global-scale adaptation tracking, but important gaps exist in the consistency of reporting that should be addressed, as these documents could greatly enhance efforts to monitor and evaluate adaptation progress.

Creating and Using New Data Sources to Analyze the Relationship Between Social Policy and Global Health: The Case of Maternal Leave

Objectives. Operating at a societal level, public policy is often one of our best approaches to addressing social determinants of health (SDH). Yet, limited data availability has constrained past research on how national social policy choices affect health outcomes. We developed a new data infrastructure to illustrate how globally comparative data on labor policy might be used to examine the impact of social policy on health. Methods. We used multivariate ordinary least squares regression models to examine the relationship between the duration of paid maternal leave and neonatal, infant, and child mortality rates in 141 countries when controlling for overall resources available to meet basic needs measured by per capita gross domestic product, total and government health expenditures, female literacy, and basic health care and public health provision. Results. An increase of 10 full-time-equivalent weeks of paid maternal leave was associated with a 10% lower neonatal and infant mortality rate (p≤0.001) and a 9% lower rate of mortality in children younger than 5 years of age (p≤0.001). Paid maternal leave is associated with significantly lower neonatal, infant, and child mortality in non-Organisation for Economic Co-operation and Development (OECD) countries and OECD countries. Conclusions. This preliminary study, using newly available worldwide policy data, demonstrates the potential strength of using globally comparative data to examine SDH. Further data development to make multilevel modeling of the impact of labor conditions possible and to broaden which social policies can be examined is a critical next step.

An Uneven Burden: Social Disparities in Adult Caregiving Responsibilities, Working Conditions, and Caregiver Outcomes

Using data from a large, nationally representative U.S. survey, the authors examine differences in adult caregiving responsibilities, working conditions, and caregiver outcomes by gender, ethnicity, immigration status, and educational attainment. Women, Hispanics, and first-generation immigrant caregivers are more likely to have worse working conditions including an unsupportive culture at work, less schedule flexibility, and less access to paid vacation leave. Women and first-generation immigrant caregivers are more likely to report caregiving contributing to poor job outcomes including quitting work, retiring early, or reducing hours involuntarily. Caregivers with less than a college degree experience both worse working conditions including lack of access to paid sick days and worse job outcomes including having lost wages or a job. Women, second-generation immigrants, and those with a high school diploma or less are more likely to report that their caregiving responsibilities interfere with their quality of life including negative impacts on their ability to spend time with friends. Research and policy implications are discussed.

Economic conditions and health behaviours during the ‘Great Recession’

Background The adoption of healthier behaviours has been hypothesised as a mechanism to explain empirical findings of population health improvements during some economic downturns. Methods We estimated the effect of the local unemployment rate on health behaviours using pooled annual surveys from the 2003–2010 Behavioral Risk Factor Surveillance Surveys, as well as population-based telephone surveys of the US adult general population. Analyses were based on approximately 1 million respondents aged 25 years or older living in 90 Metropolitan Statistical Areas and Metropolitan Divisions (MMSAs). The primary exposure was the quarterly MMSA-specific unemployment rate. Outcomes included alcohol consumption, smoking status, attempts to quit smoking, body mass index, overweight/obesity and past-month physical activity or exercise. Results The average unemployment rate across MMSAs increased from a low of 4.5% in 2007 to a high of 9.3% in 2010. In multivariable models accounting for individual-level sociodemographic characteristics and MMSA and quarter fixed effects, a one percentage-point increase in the unemployment rate was associated with 0.15 (95% CI −0.31 to 0.01) fewer drinks consumed in the past month and a 0.14 (95% CI −0.28 to 0.00) percentage-point decrease in the prevalence of past-month heavy drinking; these effects were driven primarily by men. Changes in the unemployment rate were not consistently associated with other health behaviours. Although individual-level unemployment status was associated with higher levels of alcohol consumption, smoking and obesity, the MMSA-level effects of the recession were largely invariant across employment groups. Conclusions Our results do not support the hypothesis that health behaviours mediate the effects of local-area economic conditions on mortality.

Life in institutional care: the voices of children in a residential facility in Botswana

Abstract As a result of the HIV/AIDS pandemic, there are now more than 12 million orphans in sub-Saharan Africa. The majority of these children have been absorbed into their extended families. A minority of AIDS orphans and other vulnerable children are living in residential care facilities. Although concerns have been raised regarding the care received in such facilities, very little is known about childrens perspectives on their own experiences residing in these institutions. As part of an ongoing initiative to better understand the impact of HIV/AIDS in Southern Africa and what can be done to address needs, one-on-one interviews were conducted with the children and youth residents, and graduates of a residential care facility in Botswana. The children report on the importance of having uninterrupted access to food, shelter and schooling and a sense of belonging. However, they also reveal a profound ambivalence towards their paid caregivers, and the other children residents. They describe being separated from siblings, missing their families and feeling disconnected from the community at large. Their narratives offer insight into ways in which we can better meet their complex needs. Policy implications are discussed.

Adaptation to climate change in the Ontario public health sector

BackgroundClimate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario – Canada’s most populous province – include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials.MethodsFifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention.ResultsResults indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%), severe weather (68%) and poor air-quality (57%). Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies.ConclusionsThis study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into policies and programs, while higher levels of government must improve efforts to support local adaptation and provide the capacity through which local adaptation can succeed.