Exploring the Foundations of Early Childhood Development: An Interview with Dr. Jack Shonkoff

ㅤ

HHPR Senior Editor Nyah Joudeh interviewed Dr. Jack Shonkoff, MD. Dr. Shonkoff is the Julius B. Richmond FAMRI Professor of Child Health and Development at the Harvard T.H. Chan School of Public Health and Harvard Graduate School of Education; Professor of Pediatrics at Harvard Medical School and Boston Children’s Hospital; Research Staff at Massachusetts General Hospital; and Director of the university-wide Center on the Developing Child at Harvard University. Dr. Shonkoff completed his undergraduate studies at Cornell University, medical education at New York University School of Medicine, pediatric training at Bronx Municipal Hospital Center and Albert Einstein College of Medicine, and fellowship in developmental pediatrics at Harvard Medical School and Boston Children’s Hospital. Prior to assuming his current position, he was the Samuel F. and Rose B. Gingold Professor of Human Development and Social Policy and Dean of The Heller School for Social Policy and Management at Brandeis University.

To ensure clarity, the interview below has been minimally edited.

Nyah Joudeh (NJ): Early childhood development and its connection with the social determinants of health is a very specific field. What inspired you to begin research and advocacy in this area?

Dr. Jack Shonkoff (JS): I started out as a pediatrician. I went to medical school, finished my residency and began working as a primary care pediatrician in a community health center in the South Bronx in New York, which is where I expected that I would spend my entire life. The rest of the paragraph should be pretty clear. When you work in a poor urban area, you learn pretty quickly that the major threats to children's health, beginning very early in life, are not solved in the doctor's office or in a hospital. I became very sensitized early in my career to the fact that where children live, where they're growing up, where their families are raising them have a huge impact on their physical and mental health as well as their early childhood development. That's how I got interested in the field from the beginning.

NJ: Moving from there, what inspired you to help establish the Center on the Developing Child in 2006?

JS: I had been doing a lot of work in the early childhood field, much of it originally in academic medicine, when I became seduced into the second phase of my career, as my focus shifted from clinical pediatrics to increasing involvement in social policy across sectors. After a decade of professional growth as Dean of The Heller School for Social Policy and Management at Brandeis University, I was recruited to create a new center focused on children that would not sit in any one School at Harvard but as an Interfaculty Initiative. This was an opportunity to draw on the intellectual resources of the University and the platform it provided to think about how we could generate, synthesize, and translate the underlying science of early childhood development to drive greater impact in policy and service delivery. It was an opportunity to mobilize rigorous, trusted, credible science to influence on-the-ground interventions to produce greater reductions in predictable disparities in health and developmental outcomes based on the context in which children were living.

NJ: With that, you've been described as a leader in the field of child development and toxic stress. May you tell us a little further about your day-to-day work at the Center on the Developing Child? How does it differ from your work at the JPB Research Network on Toxic Stress?

JS: The JPB Research Network on Toxic Stress and the National Scientific Council on the Developing Child are two initiatives that are based at the Center on the Developing Child. There's really no such thing as an average day for me at work. My activities begin with my leadership responsibilities for our Center. I'm actively involved in the early childhood field at large as a messenger and agenda influencer. I have teaching responsibilities here at the University. We’re engaged in a number of partnerships with carefully selected organizations and individuals across the early childhood ecosystem. All of that is designed to bring trusted science to the table, whether it be a policy or a service delivery table, also based on the fact that there's a huge amount of untapped science that isn't really being used or made actionable out in the field—but always with an appropriate amount of humbleness about the fact that science doesn't have all the answers.

I would describe in many ways what I do as a natural outgrowth of what a pediatrician should be into. Which is: How do you promote healthy development? How do you prevent impairments in learning and behavior and kind of long-term outcomes in physical and mental health? Although I'm not now and have not for a long time been involved in clinical work, I see what I'm doing as what the heart of pediatrics is all about: prevention, mitigation of the adverse effects of threats to healthy development, and appropriate interventions when needed for children whose development is going off track, helping to figure out how to prevent it from going off track, keep it on track, and get it back on track. That plays out in a different profile of activity every day, but that's what my work life is about.

NJ: How fitting for a pediatrician, nevertheless. We've been talking about a lot of current work. To go back a bit, From Neurons to Neighborhoods: the Science of Early Childhood Development which you helped produce in 2000, was a landmark report. Why did you feel personally compelled to help author this report? How has the field and your point of view shifted since then?

JS: That's a wonderful question because that report was at the time for me just a dream of a project to be involved with. A few years before that, I was appointed Chair of the Board on Children, Youth and Families at the National Academy of Sciences and the Institute of Medicine [now the National Academy of Sciences, Engineering, and Medicine]. At one of our early meetings, we went around the room, and each of us was asked to describe a project that we would like to initiate under the auspices of the Board, and I put my dream on the table. I noted that the early childhood field, as an ecosystem of different services delivered through different sectors, was fragmented into healthcare, childcare, social services, and early education, among others. Having participated actively in a number of those systems, it was clear to me that there really was one underlying science of early childhood development that needed to be unified.

Each of these systems had its own knowledge base. People in the health care system learned about health, and people in childcare and early education learned about early learning. I put on the table the idea of a blue-ribbon committee to create an integrated report that would bring them all together under one roof. Then, we had to find the funding. This is a good lesson for everybody early in your career: if you have a good idea and it doesn't take off quickly don't give up. It took us five years to get the funding to go ahead. We worked over two years and generated From Neurons to Neighborhoods: The Science of Early Childhood Development. We weren’t the only ones to do that, but this report had the imprimatur of the National Academies, and so it had gravitas.

This report was written for policymakers, but it had a tremendous effect in the way it empowered people who were working on-the-ground in the early childhood field, including childcare providers, early educators, and home visitors). Many felt that this report gave more luster to their work, which was often trivialized by such comments as: “oh, you're such a wonderful person; you're so warm; you’re doing all these wonderful things for families with young children.” For them, the message was that they’re not just doing good. Now, there was hard science behind the services which empowered underpaid, on-the-ground providers. That inspired the creation of the National Scientific Council on the Developing Child to educate the public, particularly policymakers and civic leaders, about the increasing evidence that early experiences literally shape the architecture of the developing brain. That began the part of my career that has brought me to where I am right now: understanding the power of trusted, credible science as a way to change the public conversation about the importance of the early childhood period.

Twenty years ago, in many states across the United States, public leaders felt that early childhood was a private family responsibility, not something that the government should be involved in. There were understandable, legitimate reasons for people to feel that this way, but what the science began to help many people understand is that we all have an interest as a society in optimizing a level playing field of opportunity for all children, regardless of where they live and regardless of their race, ethnicity, or their family’s economic circumstances. The legacy of From Neurons to Neighborhoods was the power of changing the public conversation and helping people understand that what happens in the early years of life can have long-term impacts.

NJ: Does anything strike you as a place where your point of view might have shifted since then or where your intentions are?

JS: I really appreciate that question because earlier this year we posted a call to action and identified what we are now calling the science of ECD (early childhood development) 2.0, in contrast to the legacy of From Neurons to Neighborhoods.What we put out on the table as ECD 2.0 is new knowledge that has been accumulated over the last 20 years. It doesn’t replace the “old” science of ECD 1.0; it expands it. For example: yes, ECD 2.0 is still very much about brain development, but it's also about the development of other biological systems, like the immune and metabolic systems, which are all connected to the brain. Yes, ECD 2.0 is still very much about the importance of enriched experiences, particularly for early learning, but it's also about protecting the developing brain and other biological systems from the disruptive effects of toxic stress. It's still very much about the critical importance of responsive adult-child relationships, which are the active ingredient of how the environment affects early development, but it's also about the broader society in which families are raising young children.

This is what's been most energizing for me, continuing to do this work: the fact that science is always moving. Although the theme of science-informed, early childhood policy and practice is not a new idea, the science of early childhood development has advanced dramatically. As science moves, so does public understanding need to move. As the science becomes more sophisticated, it becomes even more important that it be actionable for connecting to lived experiences. All of these roads lead back to the core vision for our Center from the time we began 16 years ago— leveraging science and driving change on the ground. Since the science has moved a great deal, it's both the same story and a new story about what our organization is all about.

NJ: That was a very beautiful way to say it, and I'm happy you brought up your new report because I was going to bring up Re-envisioning Early Childhood Policy and Practice in a World of Striking Inequality and Uncertainty: New Science + More Diverse Forces = Greater Impact (your January 2022 report). You describe an urgent need to leverage the advances in science with on the ground experience and a richer diversity of voices to re-envision the field. How do you practically see this playing out? More specifically, what do you foresee the biggest challenge being?

JS: Oh my goodness, the challenges are immense right? Because many of the most compelling challenges are not new and the answers at 10,000 feet haven't changed, but the devil is in the details, right? Think about this, for starters: social class differences, intergenerational poverty, systemic racism, cultural racism, interpersonal discrimination, all these deeply embedded inequities that are major threats to development in the early years are not new discoveries. Social determinants of health were first suspected a few hundred years ago, when people noticed that people who grew up facing poverty and adversity had more health problems and a shorter life. What is most compelling about where we are right now is that we’ve talked about these same things over and over again, and we desperately need new ideas about what to do differently.

Right now, we’re talking about the fact that a lot of the infrastructure in the field was severely disrupted during the pandemic, and many childcare centers went out of business. As providers looked for other jobs, more people started talking about the need to not simply rebuild but build something better that will be more effective than what we had before.

We also need more diverse voices at the table. We need new science that hasn't been as well known. We need the perspectives of parents raising young children representing a wide diversity of cultural contexts and facing a variety of deeply embedded, structural inequities. Although it's hard to think about this in the current political environment, we need to bring together a diversity of political perspectives. Putting all those things together, our Center believes that the time is ripe to make new science more accessible, but also to recognize the tremendous sense of uncertainty right now—not about whether there's going to be a different kind of world in which we live but what is that world going to look like?

NJ: Your expertise and passion shows. Taking into account the new awareness and the broader ecological view of child development that the pandemic has shown, as well as the new research you mentioned that's coming out every day, if you could say something directly to the readers or anyone at home, what would it be?

JS: The one thing that I think is really important for everyone to understand is why I’m saying that the early childhood period is so important. I'm not saying that it's the only important time of life, but the reason I'm saying it's so important can be looked at through three lenses.

The first lens is a very simple one. It's our moral responsibility for assuring that all children have a fair chance at a healthy, successful life from the beginning. For all religions and cultural traditions around the world, I can't think of any that wouldn't resonate with this simple concept.

Just moral responsibility is not enough for some people, so the second lens that we must consider is that public policies that protect the health and development of all young children are also a wise financial investment. If you're a person who says, “Well, how many dollars am I going to get back for every dollar I invest?” we can say that if we don't invest wisely now, we will all pay a high price later. These two lenses have driven the early childhood field.

The current state of science, the current state of political contentiousness, and the current state of appreciation for the wide variety of circumstances in which families are raising young children now call for a third lens, which is what our Center is dedicated to addressing and what I hope will be an important part of the way people think about the early childhood field going forward. We have a tremendous amount of relevant yet untapped scientific knowledge that is not being used and could help produce better outcomes. At the same time, we have an equally important imperative to bring to that same table the diversity of lived experiences of families raising young children and the equally varied experiences of people who are responsible for making decisions about limited resources to support policies and service delivery systems.

We're not starting from the beginning, rather with the best of what we know. What have we learned from decades of investment in a variety of policies and programs? How can we launch a new era in early childhood policy and practice that takes us to a higher level of impact? The problems are incredibly challenging. A lot of people look at issues related to deeply embedded inequalities related to racism and intergenerational poverty and say, “oh this is so complicated. It's too hard.” Of course it is! But I would fiercely argue that this is the opposite of hopeless. Yes, it's very difficult. Yes, it's challenging, but we have so much new knowledge. We have a wide diversity of lived experiences that must have a seat at that table. That makes this an incredibly exciting time to be focusing on what we could do differently.

We can build on successes we've achieved today to reduce disparities in early opportunities and life outcomes that are not inevitable and that should not be tolerated any longer.