Healthy People 2030 organizes the social determinants of health into 5 domains:

  1. Economic Stability
  2. Education Access and Quality
  3. Health Care Access and Quality
  4. Neighborhood and Built Environment
  5. Social and Community Context

Early Childhood Development and Education are key issues in the Education Access and Quality domain. 

Early childhood, particularly the first 5 years of life, impacts long–term social, cognitive, emotional, and physical development.12 Healthy development in early childhood helps prepare children for the educational experiences of kindergarten and beyond.3 Early childhood development and education opportunities are affected by various environmental and social factors, including:4, 5, 6, 7 

  • Early life stress
  • Socioeconomic status
  • Relationships with parents and caregivers
  • Access to early education programs

Early life stress and adverse events can have a lasting impact on the mental and physical health of children.3 Specifically, early life stress can contribute to developmental delays and poor health outcomes in the future.348, 9 Stressors such as physical abuse, family instability, unsafe neighborhoods, and poverty can cause children to have inadequate coping skills, difficulty regulating emotions, and reduced social functioning compared to other children their age.3, 4, 9

Additionally, exposure to environmental hazards, such as lead in the home, can negatively affect a child's health and cause cognitive developmental delays.3 Research shows that lead exposure disproportionally affects children from minorityi and low–income households and can adversely affect their readiness for school.3

The socioeconomic status of young children's families and communities also significantly affects their educational outcomes.6 Specifically, poverty has been shown to negatively influence the academic achievement of young children.6 Research shows that, in their later years, children from disadvantaged backgrounds are more likely to need special education, repeat grades, and drop out of high school.1 Children from communities with higher socioeconomic status and more resources experience safer and more supportive environments and better early education programs.1

Early childhood programs are a critical outlet for fostering the mental and physical development of young children.2 Some indicators of a high-quality early childhood development and education program include highly educated teachers, smaller classes, and lower child-staff ratios.710 High–quality early childhood programs can increase earning potential and encourage and support educational attainment.11

Early childhood development and education programs can also help reduce educational gaps.71213 For example, Head Start is a federally funded early childhood program that provides comprehensive services for children from low–income families.13 Head Start aims to improve health outcomes, increase learning and social skills, and close the gap in readiness to learn for children from low–income families and at risk children.13 Enrolling children in full–day kindergarten after the completion of preschool has also been shown to improve academic achievement.12

Furthermore, extended early childhood programs for children up to 3rd grade, also referred to as booster programs, can provide comprehensive educational, health, and social services to complement standard early childhood and kindergarten programs.1214 These programs help sustain and bolster early developmental and academic gains.1214 Characteristics of such programs include:12

  • Low student-teacher ratio
  • Focus on basic skills
  • Teacher training
  • Creation of school-parent liaisons
  • School meals
  • Provision of transportation to and from school
  • Night courses for parents
  • Health care services and referrals
  • Home visitation
  • Supportive social services

Quality education in elementary school is necessary to reinforce early childhood interventions and prevent their positive effects from fading over time.12 Research also shows that school quality has an impact on both the short– and long–term educational attainment of children, as well as on their health.715 For example, children who enroll in low–quality schools with limited health resources, safety concerns, and low teacher support are more likely to have poorer physical and mental health.15, 16, 17, 18

The developmental and educational opportunities that children have access to in their early years have a lasting impact on their health as adults.111920 The Carolina Abecedarian Project found that the children in the study who participated in a high–quality and comprehensive early childhood education program, including health care and nutritional components, were in better health than those who did not.19 The study found that, at age 21, the people who participated in the comprehensive early education program exhibited fewer risky health behaviors—for example, they were less likely to binge drink alcohol, smoke cigarettes, and use illegal drugs.19 This group also self–reported better health and had a lower number of deaths.19

Furthermore, by their mid–30s the children who participated in the comprehensive early childhood development and education program had a lower risk for heart disease and associated risk factors, including obesity, high blood pressure, elevated blood sugar, and high cholesterol.11 These studies show that quality early childhood development and education programs can play a key role in reducing risky health behaviors and preventing or delaying the onset of chronic disease in adulthood.1119

Early childhood development and education are key determinants of future health and well–being.12, 21 Addressing the disparities in access to early childhood development and education opportunities can greatly bolster young children’s future health outcomes.9, 12, 13, 19, 20, 22, 23, 24, 25, 26, 27, 28

Additional research is needed to increase the evidence base for what can successfully impact the effects of childhood development and education on health outcomes and disparities. This additional evidence will facilitate public health efforts to address early childhood development and education as social determinants of health.

Disclaimer: This summary of the literature on early childhood development and education as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges.


i The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.

ii Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.

 Karoly LA, Kilburn MR, Cannon JS. Early childhood interventions: proven results, future promise. Santa Monica (CA); Rand Corporation; 2005.

Anderson LM, Shinn C, Fullilove MT, Scrimshaw SC, Fielding JE, Normand J; Task Force on Community Preventive Services. The effectiveness of early childhood development programs: a systematic review. Am J Prev Med. 2003;24(3):32-46.

Currie J. Health disparities and gaps in school readiness. Future Child. 2005;15(1):117–38.

Center on the Developing Child. The foundations of lifelong health are built in early childhood [Internet]. Cambridge (MA): Harvard University; 2010 [cited 2018 Feb 20]. Available from:

Evans GW, Kim P. Childhood poverty, chronic stress, self‐regulation, and coping. Child Dev Perspect. 2013;7(1):43–48.

Arnold DH, Doctoroff GL. The early education of socioeconomically disadvantaged children. Ann Rev Psychol. 2003;54(1):517–45.

 Magnuson KA, Waldfogel J. Early childhood care and education: effects on ethnic and racial gaps in school readiness. Future Child. 2005;15(1):169–96.

Shonkoff JP, Phillips DA, editors. From neurons to neighborhoods: the science of early childhood development. Washington: National Academy Press; 2000.

Noble KG, McCandliss BD, Farah MJ. Socioeconomic gradients predict individual differences in neurocognitive abilities. Dev Sci. 2007 Jul;10(4):464–80.

NICHD Early Child Care Research Network. Child-care structure→ process→ outcome: direct and indirect effects of child-care quality on young children's development. Psychol Sci. 2002 May;13(3):199–206.

Campbell F, Conti G, Heckman JJ, Moon SH, Pinto R, Pungello E, et al. Early childhood investments substantially boost adult health. Science. 2014;343(6178):1478–85.

Hahn RA, Rammohan V, Truman BI, Milstein B, Johnson RL, Muntañer C, et al. Effects of full-day kindergarten on the long-term health prospects of children in low-income and racial/ethnic-minority populations: a community guide systematic review. Am J Prev Med. 2014;46(3):312–23.

Advisory committee on Head Start research and evaluation: final report [Internet]. Washington: U.S. Department of Health and Human Services; 2012 Aug [cited 2018 Feb 20]. Available from:

Reynolds AJ, Magnuson KA, Ou SR. Preschool-to-third grade programs and practices: a review of research. Child Youth Serv Rev. 2010;32(8):1121–31.

Huang KY, Cheng S, Theise R. School contexts as social determinants of child health: Current practices and implications for future public health practice. Public Health Rep. 2013;128(Suppl 3):21–28.

Muennig P, Woolf SH. Health and economic benefits of reducing the number of students per classroom in US primary schools. Am J Public Health. 2007;97(11):2020–27.

 Pianta RC, La Paro KM, Payne C, Cox MJ, Bradley R. The relation of kindergarten classroom environment to teacher, family, and school characteristics and child outcomes. Elem Sch J. 2002;102(3):225–38.

Crosnoe R. Double disadvantage or signs of resilience? the elementary school contexts of children from Mexican immigrant families. Am Educ Res J. 2005;42(2):269–303.

Muennig P, Robertson D, Johnson G, Campbell F, Pungello EP, Neidell M. The effect of an early education program on adult health: the Carolina Abecedarian Project randomized controlled trial. Am J Public Health. 2011;101(3):512–16.

Pianta RC, Barnett WS, Burchinal M, Thornburg KR. The effects of preschool education: what we know, how public policy is or is not aligned with the evidence base, and what we need to know. Psychol Sci Public Interest. 2009 Aug;10(2):49–88.

Maggi S, Irwin LJ, Siddiqi A, Hertzman C. The social determinants of early child development: an overview. J Paediatr Child Health. 2010;46(11): 627–35. doi:10.1111/j.1440-1754.2010.01817.x

Abbott-Shim M, Lambert R, McCarty F. A comparison of school readiness outcomes for children randomly assigned to a Head Start program and the program's wait list. J Educ Stud Placed Risk. 2003;8(2):191–214.

Ludwig J, Miller DL. Does Head Start improve children's life chances? evidence from a regression discontinuity design. Q J Econ. 2007;122(1):159–208.

Currie J. Early childhood education programs. J Econ Perspect. 2001;15(2):213–38.

Knudsen EI, Heckman JJ, Cameron JL, Shonkoff JP. Economic, neurobiological, and behavioral perspectives on building America’s future workforce. Proc National Acad Sci U S A. 2006 Jul 5;103(27):10155–10162.

Hart B, Risley TR. Meaningful differences in the everyday experience of young American children. Baltimore (MD): Paul H Brookes Publishing Company; 1995.

Gormley Jr WT, Gayer T, Phillips D, Dawson B. The effects of universal pre-K on cognitive development. Dev Psychol. 2005 Nov;41(6):872–84.

Beddington J, Cooper CL, Field J, Goswami U, Huppert FA, Jenkins R, et al. The mental wealth of nations. Nature. 2008;455(7216):1057–60

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