For human capital formation and a prosperous future, development and optimal health are crucial, from preconception to adulthood. The Nurturing Care Framework conceptualizes the influences that affect human capital occur during developmental periods, from preconception, through pregnancy, childhood, and adolescence (adapted to age 20). Other important considerations are stillbirths, mortality in children under 5 years of age, and deaths in children aged 5 to 19. It is estimated that in 2019, 8.6 million deaths occurred between 28 weeks of gestation and 20 years of age, being half of those occurring before 28 days of age, despite the global mortality rate in individuals under 20 years of age has declined since 2000. For human capital, the 1,000 days (from conception to 2 years) are especially influential. While overweight (from preschool through adolescence) increased in many regions of the world, there is a high prevalence of low birth weight in sub-Saharan Africa and especially in South Asia. Growth faltering (especially from birth to 2 years) is also a concern in most regions of the world. Analysis of cohort data shows that, in adulthood, nutritional outcomes are strongly determined by growth and early life trajectory. Educational opportunities in adolescents and older children, early childhood household resources, nutrition and health affect skills and knowledge growth. Adult intelligence quotients are better predicted by linear growth in the first 2 years of life than by increases in height in adolescents and older children. Learning-adjusted years of schooling are about 11 years in high-income countries, but only about 4 years for sub-Saharan African countries. Until adulthood, human capital depends on children and adolescents to survive, learning and thrive.

The complete paper is published in the LANCET