Experts from various fields have sought to highlight the importance early childhood plays in our development. Children who are well cared for and stimulated before the age of six tend to grow up to have fewer health problems as adults, earn better professional opportunities, and require less government assistance. Based on these principles, a group formed by researchers from the United Nations Children’s Fund (UNICEF) and the Center for Metropolitan Studies (CEM), one of the Research, Innovation, and Dissemination Centers (RIDCs) funded by FAPESP, created a methodology to calculate how much the Brazilian government invests in this age group. Their main finding: in 2021, less than 1% of the federal budget was allocated to early childhood.
“Public policies aimed at the early years of life have a positive economic influence on the individual’s future. We need to stop seeing them as an expense and start understanding them as an investment,” says UNICEF’s Liliana Chopitea, head of the Working Group on Public Spending on Early Childhood at the Interinstitutional Committee of the Mixed Parliamentary Front for Early Childhood. Created in 2021, the working group is coordinated by UNICEF and involves 17 institutions, including government agencies, higher education and research institutes like CEM, and public organizations. According to Chopitea, Brazil’s 2021 federal budget designated just R$420 million exclusively to children aged six and under. The study also found that investment in early childhood that year corresponded to 0.41% of Brazil’s Gross Domestic Product (GDP) and 0.92% of the federal budget. It also showed that 94% of the amount invested in early childhood was assigned to the areas of health, social aid, and education. “Without a budget, there is no way to formulate and implement public policies. By creating a methodology to identify the amount allocated to early childhood, the idea is to encourage public authorities to increase investment in this group of the population,” emphasizes Chopitea. While highlighting the pioneering nature of the initiative, she stresses that previous methodologies, such as the Budget for Children and Adolescents, were developed for municipal spending and included other more general benefit payments. With the new approach, however, it is possible to identify how much federal programs benefit children under six specifically, excluding older children and adults.
Public policy expert Ursula Dias Peres of the University of São Paulo (USP) and CEM explains that for investments that encompass a range of age groups, the challenge was to establish indicators that would make it feasible to “correctly determine the amount spent on children through programs that do not only benefit them.” “Investment in childhood vaccination is direct, but in the case of housing programs, for example, we had to identify how many children are impacted,” she explains. At the end of 2022, UNICEF trained 50 Brazilian public officials, including from the education and health ministries, in how to use the new methodology.
Chopitea points out that some of Brazil’s legal frameworks for protecting children and adolescents are globally renowned. Article 227 of the 1988 Federal Constitution determines that children must be the priority when formulating public policies. In addition to the Child and Adolescent Statute (see Pesquisa FAPESP issue no. 296), Peres cites the Legal Framework for Early Childhood, a law passed in 2016 that establishes specific guarantees and guidelines for public policies aimed at children up to six years old. Among other benefits, the law was the basis for the formation of the Mixed Parliamentary Front for Early Childhood. “Through the efforts of this parliamentary front, early childhood was prioritized in the 2020 to 2023 Multi-Year Plans [PPAs],” she says, explaining that PPAs establish objectives that must be followed by federal, state, and municipal governments over a four-year period. Based on these plans, a presidential decree established the Transversal and Multisectoral Agenda for Early Childhood, which describes a set of government actions implemented through public policies. The country has also set specific goals for early childhood education as part of its National Education Plan (PNE) since 2014. Despite these legal structures, not all guarantees and guidelines are followed. According to the 2018 UNICEF report “Poverty in childhood and adolescence,” 39.7% of all children under five in Brazil suffer rights violations at some point.
Looking more broadly across Latin America, Chopitea, from UNICEF, explains that the composition of budgets for children is a complex issue. “Peru, for example, claims to spend 0.23% of its federal budget on early childhood, while Mexico spends 10%. However, each country includes different items in their calculations,” she points out. In addition to the complexities of comparing Brazil’s budget against the budgets of other countries, there are internal discrepancies between state and municipal investments, since every audit court in Brazil uses its own methodology to make these calculations. “We hope that this new methodology will pave the way for the creation of tools that allow states and municipalities to calculate investment more precisely and systematically,” says USP’s Peres. She explains that CEM is part of a working group set up to develop methodologies and budgets with a focus on gender and race. “The idea is to be able to monitor the amount invested in different groups over time, including women, Indigenous peoples, Black people, and others,” she says.
Maria Beatriz Martins Linhares, a psychologist from USP, explains that the first three years of life are especially sensitive in terms of human development. She therefore argues that governments need to prioritize funding for this age group. “Poverty, violence, and lack of affection during childhood impact the individual throughout life, including their neurological integrity and learning ability,” she emphasizes.
Pioneering studies in the field by American economist James Heckman, carried out in partnership with psychologists, statisticians, and neuroscientists, have shown that every dollar invested in early childhood generates an estimated return of seven dollars by the time a child reaches 20 years old. “The work by Heckman, who won the Nobel Prize in 2000, paved the way for other studies aiming to measure the impacts of childhood experiences on adult life,” explains Linhares.
As part of these new approaches, psychologist Carolina Ziebold of the Federal University of São Paulo (UNIFESP) participated in research led by David McDaid, from the London School of Economics and Political Science, which identified an association between mental health problems in childhood and a higher probability of failing school. “We used continuous data from a Brazilian cohort of disadvantaged youth to model the costs to the education system of untreated mental health problems,” she explains. Cohort studies compare a group of people exposed to a certain risk factor with another not exposed group over several years. Based on the value of the dollar when the research was carried out for the World Economic Forum by Ziebold and colleagues in 2019, the estimated cost to the government for an adolescent without mental health problems to repeat a school year was US$3,500. For adolescents who experienced chronic fear, anxiety, or other mental disorders during childhood, the amount varied between US$4,400 and US$6,300.
Another study, led by a team from the Federal University of Pelotas (UFPel) and published in The Lancet, analyzed the consequences of childhood poverty on health and individual development based on previous research carried out in 95 low- and middle-income countries (as per the World Bank’s classification). According to the United Nations (UN), people who live on less than US$1.25 a day are classified as poor. The study identified that poor children are two to three times more likely to die by age five. “We found that in most countries, the effects of poverty in the early years are persistent and generate major health and human development problems throughout a person’s lifetime,” explains UFPel epidemiologist Fernando Hartwig, one of the authors of the paper. The results also showed that children born into low-income families are at a higher risk of chronic malnutrition, developmental delays, low education, and teenage pregnancy than children from better-off families.
The researchers also assessed the long-term effects of childhood poverty in cohorts from five low- and middle-income countries, where individuals were followed from birth to adulthood. “Poverty during childhood continues to have an impact on health and development indicators three decades later,” emphasizes Hartwig. He explains that to carry out the comparative analyses, UFPel’s International Center for Equity in Health developed a methodology for standardizing data from the different countries involved in the study. “This process was a major challenge given the huge volume of data and the specific aspects of each country. It is especially challenging in low-income nations, where the information available is often poor-quality. The equity center performs the process on an ongoing basis, producing a comparable database that can be used for analyses like this one,” he says.
There are more than 32 million children and adolescents living in poverty in Brazil, according to a survey by the United Nations Children’s Fund (UNICEF) released in February. The figure corresponds to 63% of the population aged 18 and under, including children who experience multiple dimensions of poverty, from unsafe housing, insufficient family income, and child labor to a lack of access to education, food, water, and sanitation. To reverse the situation, UNICEF says public policies need to focus not only on children and adolescents, but also on their families and guardians. The survey, titled “The multiple dimensions of poverty in childhood and adolescence in Brazil,” was based on several official databases, such as the Continuous National Household Sample Survey (Continuous PNAD) and the Family Budget Survey (POF).
With the aim of monitoring childhood development, a cohort study to assess psychological, behavioral, biological, epigenetic, and other indicators in children aged six and under will be one of the first studies carried out by the Brazilian Center for Applied Research in Early Childhood (CPAPI). Created in 2021 by the Insper Education and Research Institute with funding from FAPESP, the center also involves seven other organizations and 18 researchers, most from USP. “With the results of research carried out at CPAPI, we want to encourage the formulation of public policies based on scientific evidence,” explains Insper economist Naércio Menezes, director of the center. He points out that Brazil does not know if children in the country are developing well, despite the existence of indicators such as the Primary Education Development Index (IDEB), which measures learning and yearly progression, and healthcare indicators related to infant mortality and disease. According to Menezes, Brazil is also unaware of the percentage of children with developmental delays.
Maria Beatriz Martins Linhares, a psychologist from USP who is also a researcher at CPAPI, highlights another study by the center that relates to the Child’s Handbook, a booklet designed by the federal government in 2005 that is used to record all healthcare information about Brazilian children until they are nine years old. “The handbook is underused. We are developing a methodology and a training program to help health professionals optimize its use, especially for monitoring child development,” she says. She points out that one of the challenges in formulating public policies for this age group is that they need to involve different areas and have to start before the children are born, including care for pregnant women, neonatal care, vaccination, and social aid as part of an integrated, transversal, and multisectoral agenda.
“The country urgently needs to develop policies that reduce inequality in early life and offer effective actions to lower the impact of negative childhood experiences,” argues the psychologist. Since 2020, she has been working together with USP psychologist Elisa Rachel Pisani Altafim, leading the implementation of a public program developed by the American Psychological Association to prevent violence against children in 24 municipalities in Ceará.
Projects
1. Center for Metropolitan Studies (CEM) (nº 13/07616-7); Grant Mechanism Research, Innovation, and Dissemination Centers (RIDCs); Principal Investigator Eduardo Cesar Leão Marques; Investment R$21,036,191.28.
2. Brazilian Center for Early Childhood Development (nº 19/12553-0); Grant Mechanism Research Grant ‒ Engineering Research Centers Program; Principal Investigator Naercio Aquino Menezes Filho; Investment R$3,820,170.21.
Scientific article
VICTORA, C. G. et al. Effects of early-life poverty on health and human capital in children and adolescents: Analyses of national surveys and birth cohort studies in LMICs. Optimising child and adolescent health and development – The Lancet. Vol. 399, no. 10,336. Apr. 2022.
Reports
Medição do Gasto Social com Primeira Infância para 2021. Grupo de Trabalho de Orçamento Público pela Primeira Infância. Comissão Interinstitucional da Frente Parlamentar Mista da Primeira Infância, 2022.
MCDAID, D. et al. An investment framework to build mental capital in young people. World Economic Forum. 2020.
