As we struggle through the fifth year of recession, facing budget cuts, austerity and now the sequester, it may be a good time to re-evaluate our national priorities. Last year, the Reach Out and Read program that distributes books to low-income children from 6 months to 5 years lost its federal grant and this year the Head Start program is being cut back. These cuts will be borne by our most vulnerable citizens.

These cuts come at a time when there is a growing mountain of evidence that the seeds for our health are sown in the first years of life. Dr. Neal Halfon at UCLA and others have compiled this evidence into a Life Course Health Development model that shows many of the determinants of health and disease are programmed in the first years of life. Fascinating evidence, like the Fetal Origins of Adult Disease epidemiology, have shown how relative fetal malnutrition and low birth weight lead to adult hypertension, coronary artery disease and diabetes. Other studies have shown how early stress is linked to adult depression. And early poverty has been shown to be one of the greatest determinants to later diminished health. This points to a model of health as a integrated developmental progression with sensitive and vulnerable periods, not just cumulative risk. These periods represent opportunities for early intervention that can improve the health of the whole life-span. Risk factors such as poor nutrition, poverty, and less cognitively stimulating environments push the health trajectory downward, while protective factors such as parental bonding, good nutrition and full access to health care push the trajectory upward.

James Heckman, a Nobel Prize winning economist from the University of Chicago, has shown how early intervention benefits everyone. He states that investment in early education for disadvantaged children from birth to age 5 helps reduce the achievement gap, reduce the need for special education, increase the likelihood of healthier lifestyles, lower the crime rate, and reduce overall social costs. In fact, every dollar invested in high-quality early childhood education produces a 7 to 10 percent per annum return on investment.

This data should have a large impact on our health policy and budget priorities. We should invest "upstream" in our children to achieve a healthy future rather than arguing about doing "too much, too late" at the end of life. These early years are a time of incredible brain growth, neural plasticity, when the neuro-endocrine-immune pathways are being programmed for the rest of life. Integrated social investments in the first years of life could optimize this period. Many countries around the world have already put this research into practice to optimize their future like the Sure Start program in the United Kingdom aimed at 0-3 year olds.

At a time when most American families are facing austerity and 60 percent of the federal discretionary budget goes to military spending, we would be wise to heed the words of Dwight D. Eisenhower in 1953. "Every gun that is made, every warship launched, every missile fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed. This world in arms in not spending money alone. It is spending the sweat of its laborers, the genius of its scientists, the hopes of its children."

The health of our children is the true wealth of our future. Although health care reform and financing has been divisive and contentious we can all agree on giving our children the best start. Now we have more evidence to confirm William Wordsworth words that "the child is father of the man." Let us invest wisely.

Dr. John F. Irwin, Baltimore

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