Periodic Reporting for period 3 - DEVORHBIOSHIP (The Developmental Origins of Health: Biology, Shocks, Investments, and Policies)
Periodo di rendicontazione: 2022-04-01 al 2023-09-30
The main objective of DEVORHBIOSHIP is to shed light on key unknowns about the developmental origins of inequalities in health, such as the role of biological mechanisms and of behavioural responses, and the interplay of genetic and environmental factors – within frontier econometric models of human capital, combined with novel methodological developments. Developing more cost-effective approaches to promote good health across the lifecourse is crucial in today’s societies where governments are spending increasing shares of the public health budgets in health care, mostly of a curative (rather than preventive) nature. The overall project is structured in five research themes (RT). Their objectives are: to analyse the (possibly adverse) impacts of in-utero medical/lifestyle interventions and both universal and targeted public health programmes for under 5s (RT1 and RT2); to understand the mechanisms trough which pre- and post-natal shocks (including COVID-19, RT3 and RT5) affect child development, and the mediating role of behavioural responses; to combine genes, shocks, investments and policies into a novel unified lifecourse model of health production (RT4) to estimate the long-term impacts of early life investments.
Significant progress has been made since the beginning of the project, with eight papers published in both high-rank economic outlets (e.g. Journal of Public Economics) and top non-economic journals (e.g. Lancet); two chapters published in an economic handbook and an interdisciplinary book; three policy briefs/opinion pieces published in relation to the impacts of COVID-19 on the early years; and several other papers submitted or in progress.
Some of the main results achieved to date – just to mention only the published papers - are as follows. I have contributed to a paradigm shift in the timing of interventions by showing (in a major Lancet paper with an interdisciplinary group of top co-authors) the key importance of preconception health in human development; and shown that early home visiting programme can have long-lasting impacts via a variety of mechanisms, including improvements in mother-child interactions (RT2). I have shown that large-scale integrated early interventions can improve children’s health (prevent hospitalizations) in the longer term, and so reduce inequalities, even in the presence of universal health coverage (RT2). I have uncovered the importance of diet composition and quality (in addition to simple caloric intake) as driver of adolescent obesity after prenatal exposure to poor nutrition (RT3). I have shown for the first time that inequality in socio-emotional development in children has significantly increased across cohorts born thirty years apart in the UK (RT4). I have computed for the first time the significant lifecycle costs of child maltreatment in UK (RT4), using a newly developed methodology within an incidence-based approach. I have also uncovered the wide and unequal effects of COVID-19 and of repeated cuts to the public health budget on the health visiting workforce composition, the delivery of public health and health care services, and parental investments and child development in the UK (RT5).
All the research findings have been widely disseminated in academic and policy and practitioners settings alike, and also among the general public. Many of them have received wider dissemination, and not only mentioned in the main press outlets, but also used for submitting evidence to Parliamentary committees – reaching significant impacts. I have also received multiple awards and recognitions for this research.
Some of the main results achieved to date – just to mention only the published papers - are as follows. I have contributed to a paradigm shift in the timing of interventions by showing (in a major Lancet paper with an interdisciplinary group of top co-authors) the key importance of preconception health in human development; and shown that early home visiting programme can have long-lasting impacts via a variety of mechanisms, including improvements in mother-child interactions (RT2). I have shown that large-scale integrated early interventions can improve children’s health (prevent hospitalizations) in the longer term, and so reduce inequalities, even in the presence of universal health coverage (RT2). I have uncovered the importance of diet composition and quality (in addition to simple caloric intake) as driver of adolescent obesity after prenatal exposure to poor nutrition (RT3). I have shown for the first time that inequality in socio-emotional development in children has significantly increased across cohorts born thirty years apart in the UK (RT4). I have computed for the first time the significant lifecycle costs of child maltreatment in UK (RT4), using a newly developed methodology within an incidence-based approach. I have also uncovered the wide and unequal effects of COVID-19 and of repeated cuts to the public health budget on the health visiting workforce composition, the delivery of public health and health care services, and parental investments and child development in the UK (RT5).
All the research findings have been widely disseminated in academic and policy and practitioners settings alike, and also among the general public. Many of them have received wider dissemination, and not only mentioned in the main press outlets, but also used for submitting evidence to Parliamentary committees – reaching significant impacts. I have also received multiple awards and recognitions for this research.
The state of the art has been advanced in several dimensions. In addition to what mentioned above in relation to published papers, work in progress shows the importance of examining also measures of fetal development and an extended set of birth measure (beyond birth weight) to proper understand causes and consequences of early life health, including the impacts of exposure to shocks; the importance of examining non-health outcomes over extended follow-up periods to properly evaluate early medical interventions and account for potential adverse effects, in addition to quantifying benefits; the key role played by the quality of the workforce delivering early interventions to understand heterogeneity in their impacts, and the difficulty of measuring it; the moderating role of genetic endowments in explaining heterogeneity in the impacts of early interventions; and new methodologies to compute the long-term costs of adverse early environments (such as child maltreatment) and shocks (such as COVID-19).
Expected results until the end of the project include: a better understanding of the mechanisms through which home visiting programmes work, also based on alternative data sources (e.g. unstructured text data); novel methodologies to understand the multiplicity of the dimensions of child development and to flexibly model the lifecycle production of health, and the role of genes in these processes; and novel methods to more comprehensively account for the lifecourse costs and benefits of early interventions.
Expected results until the end of the project include: a better understanding of the mechanisms through which home visiting programmes work, also based on alternative data sources (e.g. unstructured text data); novel methodologies to understand the multiplicity of the dimensions of child development and to flexibly model the lifecycle production of health, and the role of genes in these processes; and novel methods to more comprehensively account for the lifecourse costs and benefits of early interventions.