The next 1000 days: The call for early investment in child health and development

Early childhood education has long been recognised as the foundation for lifelong health and wellbeing. While much attention has been given to the first 1000 days of life (from conception to two years of age), recent research highlights the next 1000 days (from two to five years of age) as another crucial window of opportunity. Two recent Lancet papers provide an in-depth analysis of these two critical development periods, emphasising that continued investment in early childhood programmes is essential to support both individual wellbeing and broader societal progress.

The first paper explores why ages two to five are essential for growth and development, highlighting the importance of nurturing care, which includes health, nutrition, responsive caregiving, security, and early learning. The key findings include the following:

• Global disparities in nurturing care: Only 25.4% of children aged two to four years receive adequate nurturing care in low- and middle-income countries (LMICs), leaving over 180 million children at risk of developmental delays.
• Limited access to early learning: Less than 30% of children in LMICs attend structured early learning programmes, despite strong evidence of their benefits.
• Negative impacts of poverty and inadequate care: Factors such as poverty, a lack of stimulation, poor caregiver mental health, and exposure to physical punishment negatively impact child development.
• An overemphasis on the first 1000 days: Most programmes focus on early infancy, with limited research and interventions targeting ages two to five.

The paper emphasises that the next 1000 days provide a second chance to address missed opportunities from the first 1000 days and reinforce developmental foundations before children enter formal schooling. 

The second paper builds on the first paper to quantify the economic and social consequences of failing to invest in early childhood development. It highlights that investments in early childhood care and education (ECCE) and parenting programmes yield high returns, whereas inaction comes at a severe cost. Key insights from this second paper include the following:

• High economic returns: Every $1 spent on ECCE generates an estimated 8 to 19 times return in economic and social benefits and a less than 1% of GDP cost of providing one year of universal ECCE in LMICs. Despite this, many governments fail to allocate resources accordingly.
• Impact on child development: ECCE programmes significantly improve cognitive, social-emotional, and academic outcomes, while parenting interventions enhance language, behaviour, and emotional development. Cash transfers and nutrition programmes offer moderate but complementary benefits to child wellbeing.
• Persistent socioeconomic inequalities: Less than 20% of children in low-income countries attend pre-primary education, compared to over 80% of children in high-income countries. Socioeconomic inequalities in access to ECCE perpetuate cycles of poverty.
• Long-term consequences of inaction: Children without access to ECCE are at higher risk of poor school performance, lower earnings, and long-term health issues, with ECCE participation correlating with higher academic achievement and reduced risk of early school dropout. Countries that fail to invest in early learning may struggle to meet the Sustainable Development Goals related to education, health, and equity.

These two papers present a compelling argument that: (1) The next 1000 days are just as important as the first 1000 days, where, without continued nurturing care, early developmental gains can be lost; (2) Intervening at this stage is cost-effective, with the financial and social benefits of ECCE far outweighing the costs; and (3) Inaction has long-term consequences: without investment, millions of children will face developmental disadvantages that affect their education, long-term productivity, and health. Both papers call for urgent policy action to expand ECCE and strengthen multi-sectoral collaboration, to ensure all children receive the support they need to thrive.