The world’s best scientists have recently confirmed that greater investments are needed to promote children’s ‘cognitive capital’. Cognitive capital refers to the economic benefits resulting from investing in the evolving brains of children. Nobel Laureate James Heckman says that early investments yield the greatest returns: a dollar spent during prenatal and early childhood yields 7% to 10% more than investments at older ages. During the first years of life, one thousand brain cells connect every second. These connections define a child’s capacity to learn and regulate impulses and emotions. They influence the ability to solve problems and relate to others. To capitalize on these investments we need to secure nutrition, healthcare as well as safe and loving families for all children. This requires ensuring universal access to education, healthcare, sanitation and nutrition as well as freedom from poverty and fear for every child.
The reverse is also true. Adverse conditions are harmful to brain development and cognitive performance. Chronic neglect - such as that experienced by children in institutional care - has been shown to be highly disruptive to the brain architecture. This places lifelong limits on the development of skills that are necessary to succeed in school and adulthood.
This week, with the support of UNICEF, 29 governments from across the region gathered in Malaysia to share efforts to promote children’s cognitive capital. Indonesia was invited to share its experience in implementing the world’s largest national health insurance scheme (‘JKN’). Launched in 2014, the JKN already covers nearly two thirds of the country’s 255 million people. For many families healthcare is now affordable. As described by Deputy Minister Subandi of Bappenas, the head of the delegation, Indonesia’s goal is to cover the entire population by 2019, which would help to reduce child mortality, a critical target of the Sustainable Development Goals (SDG).
Still, there are challenges. Roughly 90 million people are not yet enrolled, mostly from the informal sector. This includes some of the country’s most vulnerable children. At 1.5% of GDP and just 5% of the national budget, Indonesia spends less on health than its neighbours. Out-of-pocket spending is still too high, creating financial hardship for families. Furthermore, chronic disease care for the elderly has led to billion dollar deficits in the system. Additional resources and prioritizing investments in children will both be essential for maximizing returns in cognitive capital.
The meeting urged governments in the region to accelerate efSforts to invest in universal health care and social protection for all children. To improve service coverage and reduce costs to families, countries should allocate at least 3-5% of their GDP to public health spending. Social protection efforts should be unconditionally linked to social service access. High level leadership must also be mobilised to prevent violence before it starts. Laws and policies must be enforced to end all forms of violence, and services must be made available to all victims.
Biology is not destiny. Policymakers in the region face vital choices for future economic growth and prosperity of their countries. Investments in children, particularly in the earliest years, generate long-term intergenerational effects on development and yield dividends that can finally eradicate inequality and deprivation. With nearly half of the world’s children living in Asia and the Pacific, consensus amongst policymakers in this region to act now for children will make all the difference.
