Start Early to Build a Healthy Future

The research linking early learning and health

Start Early to Build a Healthy Future

Research continues to affirm how critical are the first five years in a child’s life. And when it comes to giving him or her a chance to learn, grow and lead a long, healthy and productive life, the importance of a strong start cannot be emphasized enough.

This publication analyzes the latest research on the ways that early experiences, both beneficial and stressful, can have strong impacts on the health of the developing child, and offers research, policy and practice recommendations for supporting children’s lifelong health through high-quality early childhood education.


Foundations of Health: Essential for a Bright and Healthy Future
Leading researchers from the Center on the Developing Child at Harvard University and the Women and Children’s Health Policy Center at Johns Hopkins University have collaboratively identified four foundations of health that buffer young children against adverse childhood experiences, allowing their bodies and brains to develop without the lasting effects of toxic stress. These four foundations that all children need to thrive are:

  • stable and responsive relationships
  • safe and secure environments
  • nutrition
  • health-promoting behaviors

Stable and responsive relationships: According to a report by the Robert Wood Johnson Foundation, “while much emphasis has been placed on the foundational importance of the early years for later success in school and the workplace … an environment of supportive relationships is also the key to lifelong physical and mental health.” Secure attachments with caregivers affect young children’s ability to form relationships and regulate emotions. Stable, responsive relationships support young children’s social-emotional health, helping them develop skills such as trust, compassion, cooperation and self-soothing. And according to a literature review by researchers from Johns Hopkins, stable and responsive relationships help build up children’s neuroendocrine, stress regulatory, inflammatory, and immune systems.

Safe and secure environments: As young children grow, their exposure to different environments expands—from the prenatal environment to the home, school, community and beyond. The safety and security of their environments at every level have strong implications for their health throughout their lives. The need for safe and secure environments begins prenatally—for instance, children whose mothers smoke tobacco or live in very stressful environments during pregnancy are more likely to be born with low birth weight, a significant risk for chronic diseases such as coronary heart disease, hypertension and diabetes.

Nutrition: A healthy diet fuels learning, growth and development and staves off obesity and disease. Nutritional interventions for young children have been shown to promote growth and development across every domain. Undernourishment in early life, on the other hand, has been associated with higher risks for hypertension, insulin resistance and heart disease, and may play a key role in the development of osteoporosis, autoimmune diseases, diabetes and cancer. And childhood obesity raises children’s risks of developing heart disease, high blood pressure, cancer and asthma.

Health-promoting behaviors: Early learning about behaviors that promote health helps young children establish routines that lead to healthier choices throughout life. At this stage, young children are developing the ability to create causal theories about how things happen, as evidenced by their perpetual question, “Why?” Studies show that 2- and 3-year-olds can develop causal explanations of health, including an understanding that illness is caused by invisible germs and that, “He needs more to eat because he is growing long arms.” Caregivers can help young children develop healthy behaviors by engaging their curiosity and budding independence, providing them with healthy choices and explaining why healthy behaviors are important.

Recommendations for Early Education and Health Care Policy, Practice and Research
In the context of a changing health care landscape that places increasing emphasis on disease prevention and health promotion—on keeping people healthy and thereby reducing the need for costly treatments later in life—early childhood programs have an opportunity to play a larger part. We call for increased investment in high-quality early education and family-support programs, as well as for greater coordination and integration across systems that touch the lives of vulnerable young children and their families. Here we offer five policy, practice, funding and research recommendations to bring us closer to achieving our vision of a healthy start for all.

  • Direct health resources to the youngest and most vulnerable children from the prenatal period to age five. Ensure that young children and their families, particularly those facing poverty and other stressors, have access to comprehensive, high-quality early childhood education, home visiting, and health care services.
  • Implement effective and evidence-based practices that meet young children’s comprehensive needs in both early education and health care settings.
  • Invest in systems to support high-quality and effective services in early childhood and health care settings.
  • Build cross-sector collaboration to support young children in achieving good health and address children’s interrelated health and developmental needs.
  • Embark on research and evaluation that further explores and defines the link between early learning and health.

These recommendations put forth a vision for a comprehensive approach to disease prevention and health promotion that takes into consideration the health and developmental needs of the “whole child.” A whole-child perspective acknowledges that a child’s supportive and enriching experiences in homes and early education classrooms are as integral to a child’s lifelong health as care received in pediatricians’ offices in reducing young children’s risks of toxic stress, disease, injury, preventable disability and premature death and giving every child a fair chance at health. By holistically supporting young children in the critical first years, high-quality early childhood programs with an intentional focus on health have the potential to change the course of children’s lives. They have a powerful role to play in narrowing the health gap and elevating children’s chances at a healthy future from the very start.


The Ounce works to ensure that public policies and funding are in place to give vulnerable children access to voluntary, high-quality early childhood programs.

The Ounce Illinois policy team pursues policy changes that promote and support healthy child development, which includes physical and oral health, healthy social and emotional development, auditory and visual development and the nutritional and wellness needs of young children and pregnant women. Broadly speaking, the Illinois policy team works to promote and implement systems and legislative changes that improve access to preventative services and health care, and address social determinants of health disparities in order to achieve greater health equity.

The Ounce national policy team builds on the experiences and lessons of the Illinois policy and advocacy work, and partners closely with state leaders across the country to help them integrate health across early childhood systems and strengthen connections between the early childhood and health systems. And the First Five Years Fund mobilizes nationwide support for early education programs, citing the research evidence on early education’s beneficial effects on health as well as economic well-being and academic achievement.

Educare is a comprehensive early education program for children 6 weeks to 5 years old and their families living in poverty. Since 2003, the Ounce has partnered with the Buffett Early Childhood Fund, as well as other philanthropies, to replicate the Educare model across the country. Each Educare school collaborates with healthcare providers to promote children’s healthy development and school readiness. Four Educare schools include on-site or neighboring health clinics, and two Educare schools are linked to elementary schools with school-based health clinics.

With our community-based partners, the Ounce offers home visiting to nearly 1,900 families throughout Illinois and a unique doula program to about 700 expectant mothers per year. These home visitors help promote healthy child development and ensure families are connected to medical, dental and mental health services. They also support parents to model healthy behaviors for their children, such as hygiene, healthy eating and physical activity.

Because research demonstrates the powerful potential of early education programs to promote children’s health, the Ounce research team urges the early education field to assess health outcomes. The Educare Learning Network research & evaluation committee, in its recent National Research Agenda for Early Education, echoes this imperative. Here are some examples of ways that these research values are being put into practice: the ongoing Educare Randomized Controlled Trial and the Doula Home Visiting Randomized Controlled Trial measure myriad health outcomes; and two studies of Educare by embedded local evaluation partners have explored the relationship of adverse childhood experiences to various childhood outcomes, with a focus on social-emotional and behavioral health.

The Ounce Institute is the recognized training provider for all home visitors in Healthy Families, Parents Too Soon and Parents as Teachers programs in Illinois. Findings from the Adverse Childhood Experiences Study on the powerful impacts of traumatic early experiences on young children’s lifelong health have been integrated into home visitor trainings. What’s more, the Ounce Institute has held training events exclusively focused on trauma, and in Chicago, a pilot project in home visiting programs managed by Ounce staff has a special focus on trauma-informed work. As a result, trauma-informed best practices have been incorporated into home visiting programs across the state. And now, after nearly 30 years of training home visitors in-person, the Ounce is about to launch professional development courses online to bring evidence-based practices such as these to home visitors and supervisors across the country.