It is a regular complaint among European policy makers and practitioners that too much attention is given to US prevention and early intervention initiatives.

After all, child development is broadly consistent across the world. Poverty, inequality and other risks to children’s physical and emotional health may be greater in economically developing nations, but the children are much the same. So why should we persist in looking in only one direction for answers?

There are some good reasons: the US has led the way in service design and rigorous evaluation, if not in applying the accumulated evidence to universally available prevention services.

Because North America has been so much the destination and the melting-pot of less affluent, fugitive populations, it has been well-placed to investigate children’s ability to recover from massive disadvantage. Measuring the impact on growth of a US diet on children previously raised in South America is a good example.

But that isn’t to say that as much can’t be learned from prevention initiatives conceived and applied in the developing world. Stuart Shanker, Director of the Milton and Ethel Harris Research Initiative at York University, Toronto is a pioneer in this area – and his latest starting point is Cuba.

The reputation of Cuban early child development programs is well established. In the late 1990s UNESCO studies estimated the benefits in terms of language and math scores to be in the region of two standard deviations, compared even to the best performing Latin American countries.

Cuba’s approach to school readiness has focused on comprehensive birth counseling, nutrition programs and pediatric services. The impact has not been limited to educational achievement. Since the revolution in 1959 there has been a steep decline in infant mortality and significant improvements in birth weight and anthropometric measures – height for example – all of which reliably indicate improved physical heath at the population level.

One of the first initiatives was to set up early years centers called Circulos Infantils, which succeeded in creating a supply of pediatricians and other health professionals for pre-schoolers by training working mothers. The initiative also gave them the skill to maximize every child’s potential and to detect signs of early developmental delay.

By the mid 1980s a national program, Educa a tu Hijo, was introduced which now reaches nearly all children. Cuban evaluations indicate significant contributions to emotional health and behavior.

The Canadian team are planning epidemiological and longitudinal studies of Cuban children to estimate the long-term impact of the programs. Since the provision is universal, the researchers also intend to evaluate the introduction of Educa a tu Hijo in Brazil, Colombia, Chile, Ecuador and Mexico. Their work will also extend to comparisons with Canadian children.

The obstacles to evaluation are considerable. Many western policy makers will question the reliability of data emerging from Cuba. Taking proper account of the unusual Cuban context will also be problematic. The country is poor but social capital and cohesion are reported to be high. Parent literacy rates and the weight of investment in learning also exceed comparative contexts. Estimating the impact on outcome may be hindered by the fact that everybody receives the service: where to turn for a control group?

But there is much to learn from the research experience. In the west “universal” means everybody who wants to use a service. What is the result when everybody must use it? And might a Communist regime do better at achieving program fidelity? How much variation is likely to be detected across a country where so much rides on enforced notions of egalitarianism?

Reference
UNESCO International Comparative Study of Language, Mathematics, and Associated Factors in Third and Fourth Grades (1995–2000)