Neal Halfon on Managing Health Care Costs by Focusing on Trajectories Shaped in Childhood

Neal Halfon, director of the UCLA Center for Healthier Children, Families and Communities, and a contributor to our recent book, Formative Experiences: The Interaction of Caregiving, Culture, and Developmental Psychobiology (Cambridge, 2010)  has a new opinion piece in US News & World Report on health care costs that argues against “short-term economic fixes” for (in particular) “costly chronic conditions.”

He argues that:

Individual and population health follow a trajectory. More and more research is clearly showing that early health influences are critical, and that lifelong health trajectories are initiated and programmed in utero, and formulated during the early years—right through adolescence. While the impact of poverty and other social adversity on the health trajectories of young children is well documented, it is not only the poorest children that are at greatest risk for lifelong health problems. Many low income and middle class families are also squeezed by lower wages, higher costs of living, and a lack of adequate education and support services that their children need to arrive at school healthy and ready to learn. Several decades of research shows that children who are deprived of the developmental scaffolding that guarantees a healthy trajectory are more likely to experience school failure, teen pregnancy, criminality, and substance abuse during the second decade; obesity, elevated blood pressure, and depression by the third and fourth decade; coronary artery disease, diabetes, and renal disease by the fifth and sixth decades; and premature aging and memory loss in old age.

His solution is a health care system that focuses on prevention of chronic health conditions in children by “optimizing health and development pathways in the early years,” rather than on the detection of disabilities in the young and disease in the old.

If we are going to really shift the cost curve into a lower trajectory, we need to shift the health curve in to a higher trajectory. The most leveraged and cost effective way to do that is to focus on the time in life when health trajectories are being formed, developed, and launched.

In his chapter (co-authored with biological anthropologist Emily S. Barrett and physician-psychologist Alice Kuo), he likens children to “canaries in the coal mine” in the sense that “children often serve to reflect changes in society, especially those that cause alterations in their health and development.”

This entry was posted in culture, brain, development, and mental health by Constance A. Cummings. Bookmark the permalink.

About Constance A. Cummings

Constance A. Cummings, PhD, is Project Director of the non-profit Foundation for Psychocultural Research, which supports and advances interdisciplinary research and scholarship at the intersection of brain, mind, culture, and mental health and illness. She is co-editor (with Carol Worthman, Paul Plotsky, and Dan Schechter) of Formative Experiences: The Interaction of Caregiving, Culture, and Developmental Psychobiology (Cambridge University Press, 2010) and (with Laurence Kirmayer and Rob Lemelson) the forthcoming Re-Visioning Psychiatry: Cultural Phenomenology, Critical Neuroscience, and Global Mental Health (Cambridge, 2015). She received her doctorate in theoretical linguistics from New York University.

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