1. Population Health and Human Development, 1987-2007 Clyde Hertzman Director, Human Early Learning Partnership

2. Determinants of Health

3. Life expectancy and income per capita for selected countries and periods 0 5,000 10,000 15,000 Life Expectancy (years) Income per capita (1991 international dollars) Source: World Development Report, 1993 1990 1960 About 1930 About 1900 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. Gradients in Health

5. Index of Inequality Hertzman, American Scientist, 2001, p 543

6. U.K. Civil Service Mortality - All Causes

7. CHD Mortality - UK Whitehall Study

8. A Developmental Perspective

9. Infant Mortality per 1,000 Mortality by Neighbourhood Income in Urban Canada, Wilkins R, Berthelot JM, Ng E, March 2001

10. Report: Raising Young Children, p 18, HRDC, 2003

11. Quantitative Literacy Scores for Youth Aged 16-25. International Adult Literacy Study, 1994 Parents’ Level of Education Effect Size Level 1 Level 2 Level 3 Level 4 Sweden Switzerland Netherlands Germany Belgium Canada USA Poland Ireland N Ireland G Britain New Zealand Organisation for Economic Co-operation and Development and Statistics Canada. (1995) Literacy, economy, and society: results of the first international adult literacy survey. OECD/Ministry of Industry Canada, p 151.

12. The Challenge of the Gradient • ubiquitous in wealthy and majority world countries • cuts across a wide range of disease processes • not explained by traditional risk factors • replicates itself on new conditions as they emerge • occurs among males and females • begins life as gradient in ‘developmental health’ • gradients appear to ‘flatten up’

13. Contributions to Self-rated Health at Age 33, 1958 Birth Cohort Birth Death Socio-Economic Environment OR=1.87 Civil Society OR=2.05 Social Network OR=n.s. “ pathway/cumulative” factors: OR=6.15 “ latent” factors: OR=5.03 “ Intersecting” factors: OR=3.83

14. Health Problems Related to Early Life Coronary Heart Disease Non-insulin Dependent Diabetes Obesity Blood Pressure Aging and Memory Loss Mental Health (depression)

15. ‘ Sensitive periods’ in early brain development Binocular vision 0 1 2 3 7 6 5 4 High Low Years Habitual ways of responding Language Emotional control Symbol Peer social skills Relative quantity Central auditory system Sensitivity

16. Effects of Mothers’ Speech on Infant Vocabulary Source: Huttenlocher et al., 1991

17. 0 600 1200 12 16 20 24 28 32 36 High SES Middle SES Low SES Age - Months Literacy – Early Vocabulary Growth B. Hart & T. Risley, Meaningful Differences in Everyday Experiences of Young American Children , 1995 Cumulative Vocabulary

18. 03-089 Serotonin Gene and Depression Age 26 None Moderate Severe .30 .50 .70 A. Caspi, Science, 18 July 2003, Vol 301. Depression Risk LL SS SL S = Short Allele L = Long Allele Early Childhood Abuse

19. SES Differences in Prefrontal Cortex Activity

20. The Dynamic Epigenome and Modulation of Gene Expression

21. The ‘Meaney-Szyf Paradigm’ • critical periods of brain development • differential qualities of nurturance • epigenetic modification through methylation • lifelong change in HPA axis function • inter-generational transmission of nurturance

23. Percentage of Students Vulnerable on One or More scales of the EDI Based on Provincial cutoffs, Wave 1

24. Percentage of Students Vulnerable on One or More Scales of the EDI Based on Provincial cutoffs, Wave 2

25. Ever at risk Vulnerable

26. Average Score Emotional Maturity scale of the EDI, Cycle 1

28. Map 4.7.2: Vulnerability on Any EDI Scale and Socioeconomic Status in BC

29. Map 4.7.2-Highlight1: Vulnerability on Any EDI Scale and Socioeconomic Status in BC

30. Map 4.7.2-Highlight2: Vulnerability on Any EDI Scale and Socioeconomic Status in BC

31. Map 4.7.2-Highlight3: Vulnerability on Any EDI Scale and Socioeconomic Status in BC

32. Variation in SES-Vulnerability Linkage in British Columbia: SES-Typical and -Atypical Communities

35. Conceptual Diagram: Off- and On-Diagonal Groupings Group 2: Worse than expected (OFF) Group 1: Better than expected (OFF) Group 3: Left, regression line (ON) Group 4: Centre, regression line (ON) Group 5: Right, regression line (ON) Predicted vulnerability Actual vulnerability Let’s not forget Group 0: “other” n’hoods. J

36. Neighbourhoods Identified as Off- & On-Diagonal B

37. Cohorts of Interest    = focus of our current work 2007/2008 2006/2007 2005/2006 2004/2005 2003/2004 Wave 2: FSA (Gr. 4) 2002/2003 2000/2001 2003/2004 2001/2002 1999/2000 Wave 1: EDI (K)

38. EDI-to-FSA Data Linkage Rates 95% 94% 85% 96% 96% Kindergarten Grade 4 89% 87% Data Unavailable Data Unavailable Data Unavailable 5076 26502 3416 3411 4044 PEN Found 3172 +/- 3783 +/- FSA Score Found 27506 2002/2003 3643 2000/2001 5374 2003/2004 4008 2001/2002 4267 1999/2000 EDI

39. The EDI has Predictive Validity (but there’s more to it than that!) # of Vulnerabilities % Not ‘Successful’ = ‘Not Pass’ Numeracy 0 12.3 1 22.2 2-3 33.8 4-5 55.6 Reading 0 17.8 1 33.9 2-3 43.1 4-5 68.3 (EDI) (Grade 4)

40. Understanding C-to-B Ratios A D C B Let’s see how these deflections appear graphically… = “off diagonals” VULNERABLE NOT VULNERABLE EDI DID NOT PASSED FSA

41. A – Positive (Normal)

42. B – Negative Deflection

43. C – Positive Deflection

44. D- Negative (Normal)

45. Calculating C-to-B Ratios A B B C C D CBR= In essence, the CBR represents the ratio of positive to negative deflections D C VULNERABLE B A NOT VULNERABLE EDI NOT PASSED PASSED FSA Recall that… / ( + ) / ( + )

46. Vancouver Divergence: The development of children from higher vulnerability neighbourhoods, over time, falls behind that of children from lower vulnerability neighbourhoods.

47. Howe Sound Convergence: Children from higher vulnerability neighbourhoods tend to catch up, over time, with children from lower vulnerability neighbourhoods.