Health and development from preconception to 20 years of age and human capital

Abstract

Optimal health and development from preconception to adulthood are crucial for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualises the major influences during periods of development from preconception, through pregnancy, childhood, and adolescence that affect human capital. In addition to mortality in children younger than 5 years, stillbirths and deaths in 5-19-year-olds are important to consider. The global rate of mortality in individuals younger than 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with more than half of deaths, including stillbirths, occurring before 28 days of age. The 1000 days from conception to 2 years of age are especially influential for human capital. The prevalence of low birthweight is high in sub-Saharan Africa and even higher in south Asia. Growth faltering, especially from birth to 2 years, occurs in most world regions, whereas overweight increases in many regions from the preprimary school period through adolescence. Analyses of cohort data show that growth trajectories in early years of life are strong determinants of nutritional outcomes in adulthood. The accrual of knowledge and skills is affected by health, nutrition, and home resources in early childhood and by educational opportunities in older children and adolescents. Linear growth in the first 2 years of life better predicts intelligence quotients in adults than increases in height in older children and adolescents. Learning-adjusted years of schooling range from about 4 years in sub-Saharan Africa to about 11 years in high-income countries. Human capital depends on children and adolescents surviving, thriving, and learning until adulthood.

Figure 1

The Nurturing Care Framework from preconception to adolescence Adapted from Black and colleagues.

Figure 2

Regional mortality rates and age-specific proportion of deaths from 28 weeks of gestation to 19 years in 2019 Data from UN Inter-agency Group for Child Mortality Estimation., , Data to reproduce this figure available in table 1 and the appendix (pp 4, 6). Fragile states are represented by broken colours and identified according to the World Bank definition. *High-income countries are listed in the appendix (pp 9–10).

Figure 3

Mean length or height and body-mass index for females and males from birth to 19 years by world region Mean length or height for 0–59-month-old females (A), 5–19-year-old females (B), 0–59-month-old males (C), and 5–19-year-old males (D), and mean body-mass index 0–59-month-old females (E), 5–19-year-old females (F), 0–59-month-old males (G), and 5–19-year-old males (H). Data sources were Demographic and Health Survey, Multiple Indicator Cluster Survey, and the Non-Communicable Disease Risk Factor Collaboration. *High-income countries are listed in the appendix (pp 9–10).

Figure 4

Learning-adjusted years of schooling by world region Adapted from Filmer and colleagues. *High-income countries are listed in the appendix (pp 9–10).