Developmental Health and the Wealth of Nations: Social, Biological and Educational Dynamics

The book Developmental Health and the Wealth of Nations arises from the work of the Population Health Program of the Canadian Institute of Advance Research and its founding president, Dr. Fraser Mustard. The twenty-seven contributors from throughout Canada, the United Kingdom and the United States piece together a set of observations, hypotheses and implications that tie the social well-being and economic wealth of societies to the developmental health of children with an emphasis on the mental and emotional well-being. As a result, this book places a very high social and political priority on ensuring the optimal development of our children and youth. This is probably not news to child and adolescent psychiatrists but what matters here is the public stating of the priority and the science to back it up. The authors introduce modernity’s paradox in which we now live in societies generating unprecedented and record wealth yet create a degree of social stress such that even children and families living in apparently secure economic settings are developing difficulties which may undermine the very talents needed to continue with successful wealth production. Although historians can point to statements throughout recorded time about the degeneration of children and youth, the authors are not as dismissive, noting that there is much more scientific evidence of social change now than ever. The book helps to describe the science and choices between blissful reassurance and grave social concern. Part I of the volume examines the growing recognition of a strong association between the health of a population and the size of the social distance between members of the population. This is “the gradient effect.” Societies with sharp social and economic difference (a steep gradient) among individuals in the population have an overall level of health and well-being that is lower than in societies where these differences are less pronounced. This gradient holds for a wide variety of physical (life expectancy, cardiovascular disease), cognitive (intelligence testing), school (school attainment), emotional (depression, anxiety), behavioral (anti-social, aggressive) and mental health outcomes. The term ‘developmental health’ describes this full range of developmental outcomes. Part II examines the possible pathways mediating the effects from steep social gradients to individual health. Three processes with supporting evidence are proposed. The first derives from the observations of neural development and the way in which it takes place in the growing infant to match the environment to which it is exposed. This process is called neural sculpting. The second process, neuroendocrine development, incorporates the development of the endocrine system as it is affected by the experiences of the early infant and child (e.g. trauma and corticosterone release). The third process is psychoneuroimmunology. Early development can affect overall resistance to disease throughout life and to degenerative disorders at the end of life. In addition to these mediating processes, evidence is reviewed that there are sensitive periods in early life for the development of affect regulation, attention regulation and social regulation. Overall these processes are affected by many of the differing characteristics of the socio-economic gradient and constitute the ‘biological embedding’ of the environmental experience into the developing child. The steeper the socio-economic gradients, the more the characteristics of the various levels affect individual growth differentially and, for the most part, detrimentally for those on the lower ends. Parts III and IV shift from the effects of society on the individual’s growth and development to the characteristics of a society that could function in a manner to optimize the developmental health of its citizens. This would be a ‘learning society’ capable of organizing and acting on behalf of human development. An examination of the human developmental conceptual framework created earlier in the book naturally leads to implications for social organization and functioning to support this learning society. As the authors note, we need to “grasp the core dynamics of the system and move it toward greater prosperity and developmental health - which, we suspect, may become fundamentally the same in the not too distant future.” Part IV leads off with Dr. Dan Offord’s work on “Lowering the Burden of Suffering” with clinical, targeted and universal approaches. This is followed by examples of programs that lower aggressive behaviors and improve school readiness and academic attainment in school. Lisbeth Schorr’s book ‘Within Our Reach” would make an ideal follow up to this book as it presents a wide range of evaluated programs, which are effective during various developmental stages and enhance the mental, emotional, behavioural and physical health of children and youth. As an edited book the writing styles do vary. However, Keating and Hertzman should be congratulated for ensuring that some similarity for format is followed and that this includes clear well written summaries for each chapter and each part. The science can be a bit difficult in some of the chapters but the message of the book comes through loud and clear. If we do not look after the developing health of our children, we will sacrifice the economic wealth of our nation. This is even more crucial with our shift to knowledge based economies, and paradoxically, potentially aided by this knowledge because we can now collect and evaluate the status of our children more accurately than ever. This can set the stage for a learning society in which we must provide the incentives not just for economic activity but for healthy human development. These incentives will need to drive healthier development as powerfully as profits drive economic activity. While this is not a book that will leave the child psychiatrist with improved clinical knowledge or skills, it is a book that reaffirms the work of child psychiatry. Child development and its affiliated studies is at the cutting edge creating and maintaining a healthy society. This book may not belong on the desk of every child psychiatrist but does belong on the desk of every political decision maker. They are the ones who must set the policies that can enhance child development, shift the socio-economic gradients and build the wealth of the nation. Child psychiatrists who use this book will bring its knowledge to a wider public and enhance the role of child psychiatry in advocacy for children.

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