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PACEs in Early Childhood

Shonkoff: Re-Envisioning, Not Just Just Rebuilding: Looking Ahead to a Post-COVID-19 World


It’s truly been a year like no other since we issued a statement in March 2020 about the COVID-19 pandemic that was rapidly sweeping around the world. Our primary aim for that statement was to honor first responders, health care workers, and front-line service providers—especially those supporting young children and their families. A year later, that tribute needs to be redoubled and tripled. The enormous efforts that have been made on behalf of others are awe-inspiring.

We also made two predictions a year ago, and each is still undeniably true. First, we noted that the impacts of this rapidly changing situation would not be evenly distributed. Sadly, this all-too-evident projection has come to pass. Disparities in rates of infection, harshness of symptoms, deaths, vaccine distribution, job losses, hunger, and evictions have been well documented—with people of color and other marginalized communities carrying disproportionally higher burdens. Second, we noted the importance of acting on credible scientific knowledge while recognizing that science by itself rarely has all the answers. Over this past year, the devastating toll of the pandemic has underscored the critical importance of connecting what science is telling us to the lived experiences of people and communities. Unfortunately, we have also seen the consequences of failing to make that connection.

One year ago, we vowed that “we will get through the ordeal that lies ahead”—but we did not envision its full scope, duration, and cumulative effects. The death toll has been staggering. The economic impacts and disruptions of the social interactions that are so fundamental to our wellness as human beings have been monumental. Yet scientists producing highly effective vaccines in record-breaking time, and responsible citizens supporting each other through vigilant protective measures, are bringing us closer to a point where the end of this nightmare is in sight.

Now, a year later, early childhood policies and services are at a critical inflection point—and the need to build a stronger ecosystem has never been more compelling. Longstanding concerns about fragile infrastructure and chronic funding constraints have been laid bare. While we rightfully celebrate inspiring examples of ingenuity under pressure, we cannot ignore that some segments of the ecosystem (especially childcare) may be particularly difficult to restore. Few disagree with the call for a different path forward, but the nature of that path remains to be determined.

The science of early childhood development (and its underlying biology) continues to advance, and tenuous “systems” that were in place to support families before the pandemic began need to be rethought, not just rebuilt. Early childhood policy must be about the foundations of both lifelong health and readiness to succeed in school. The reconstruction of a more robust ecosystem that forges stronger connections at the community level among primary health care (both physical and mental), early care and education, social services, child welfare, and financial supports is essential. Making sure that all policies and services are guided by the best available knowledge (both scientific and pragmatic)—and evaluated rigorously to determine what works for whom in which contexts—are necessary prerequisites for achieving greater impact at scale.

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