Thank you very much. I really appreciate the opportunity to be here.
I really want to make one simple point here today. Canada's approach to child protection should begin by protecting children's brains in the first thousand days of life, starting from just before conception through to two or three years of age. That's really the fundamental point that I want to make.
Let me start by asking a counterfactual question. If your goal was to make sure that poor countries stayed poor, how would you do that?
One of the best ways would be to fail to protect the growing brains of children in the first thousand days of life, as I say, beginning just before conception through to two or three years of age. During that time, new evidence is showing that the brain is growing very rapidly with up to 1,000 new neural connections being formed each second. If children's rapidly growing young brains are not protected during this critical time, the consequences can really last a lifetime.
For example, a study from Guatemala showed that children who received a more balanced nutritional supplement prior to three years of age earn 46% more as adults. A study from Jamaica showed that children who received stimulation in those early years had lower rates, by two-thirds, of violent crime when they were teenagers. A study from Romania showed that children raised in orphanages had more than double the rate of psychiatric disorders than children without such a history.
Globally it's estimated that at least 200 million children fail to reach their full potential because of lack of attention to the early years.
What are the risks that affect children's brains in the early years? You can really think about them as falling into three categories. The first is biological, and that would include nutrition, lack of immunization, exposure to toxins, and also pre-term or premature birth. Second is enrichment and stimulation, which would include lack of responsive parenting with babies. Examples of responsive parenting are reading to children, singing, playing, and also maternal depression can lead to a lack of responsive parenting. Finally, conflict, maltreatment, and violence is another big category.
Often one sees an interplay among these risks especially in conflict zones. A young child's rapidly growing brain in utero—we're also talking here about the protection of pregnant women—and in the early years, needs to be protected from all these risks and from the toxic stress they bring to child development.
I've come to believe that this challenge of child development is actually one of the grandest challenges in international development. At Grand Challenges Canada we've launched an initiative to tackle the challenge of child development and that initiative is called “saving brains”.
Grand Challenges Canada is funded by the Government of Canada. It's dedicated to supporting bold ideas with big impact, so innovations in global health. We leverage additional resources from the not-for-profit, for-profit, and academic sectors to match greater than one-to-one the government funds.
We support innovators in low- and middle-income countries, and also in Canada. The bold ideas can be science and technology. They can be social innovations. They can be business innovations. We love to see these come together and integrate because we think that's important for sustainability and scale.
Zeroing down on the saving brains challenge, the challenge here is really to develop sustainable ways to promote and nurture healthy child and brain development in the first thousand days and to scale solutions so they can have a lasting impact on human capital in low resource settings.
Our vision is for you to actually imagine an exit strategy from poverty, a generation of children who become healthy, productive, and participating members of society. Saving brains has the potential to improve health education, increase income, and decrease violence.
The saving brains initiative is the largest and most diverse portfolio of innovations for early child development aimed at the developing world. We support 44 projects totalling $28 million.
Let me just give you a few concrete examples. One is kangaroo mother care. An estimated 15 million babies are born too soon or premature every year. That's more than one in 10 babies. Around a million children die due to complications of pre-term birth, but many survivors face a lifetime of disability including learning disabilities, visual and hearing problems. About 90% of these pre-term births occur in the developing world.
Kangaroo mother care is simple, a baby is held close to the mother for a period of time after birth. It's a simple innovation. It provides nutrition, warmth, and bonding. We know that it saves lives and that it's superior also to incubator care for brain development.
We have supported innovators in Colombia and their collaborators in Quebec to look at the long-term impact of kangaroo mother care on children's cognitive development through to adulthood, including school achievement, post-secondary education, and entry into the workforce.
One of the more exciting early results has been that kangaroo care can actually inhibit much of the delay in brain development that typically is experienced by premature babies. Evidence suggests that it can also enable them to develop motor function comparable to their full-term counterparts.
The second example I'd like to give you is an intervention to enhance the mother-infant relationship. This is in South Africa, where we support the University of Stellenbosch in examining the long-term impact of improved mother-baby relationships on cognitive functioning, social functioning, and emotional functioning. The original study showed how the coaching of mothers improved the relationships in an impoverished settlement outside Cape Town. In the follow-up study that we're supporting, the kids are now 13 years old. The study is measuring cognitive development, school attainment, and emotional and behavioural functioning.
The third example I want to give you is from Pakistan, where there's an intervention that combines early nutrition with stimulation in a disadvantaged population in rural Pakistan. In this case, we know that 88 million young children worldwide drop out before completing primary school education. At Aga Khan University, working with colleagues at Stanford and Harvard, they have combined an early childhood stimulation and nutrition package. They're now measuring how these early infant and toddler interventions affect school readiness and enrolment at four years of age to see if this helps regulate their behaviour and attention so that the children succeed when they begin school.
Let me emphasize that we're not primarily talking about IQ here. We're talking about the ability of the child later to regulate themselves—the soft skills that lead to success in business, the regulation that leads to the avoidance of criminality, and of course cutting down on depression and non-communicable disease.
How does this fit into our more general approach in international development? Well, last week I had the honour to attend the high-level summit on maternal, neonatal, and child health convened by the Prime Minister and attended by global leaders. One clear message that came out of the summit was this. The same simple innovations in maternal health, in newborn care—I gave you the example of kangaroo care—in nutrition—I gave you the example of the nutrition program in Pakistan—and in immunization that save lives also save brains and help children reach their full potential. This is the double dividend of Canada's commitment to maternal, newborn, and child health.
Let me give you a couple of concrete examples of what I'm talking about. In our saving lives at birth portfolio, which we do with partners USAID, Gates foundation, Norway, and UK aid, we have a project that's distributing chlorhexidine in an innovative way. Chlorhexidine is a common component of mouthwash. It's being distributed through lady health workers to pregnant mothers in Nepal.
Here is the actual tube from Nepal that's being distributed. This little tube costs about 20¢ per tube. It deals with one of the main causes of newborn death—I'm sure my friend Patricia Erb, from Save the Children, will talk about their focus on newborns—which is infection that enters through the baby's umbilical cord. This is almost like a Polysporin that you put on the umbilical cord.
The point I want to make is that the focus on this simple, inexpensive newborn intervention—by the way, for every 200 of these tubes that you distribute, it's estimated that you save one newborn life—not only saves lives but likely also saves brains.
Let me give you a second example. The second example is from Cambodia. It's this fish. You might have seen this fish around in the newspapers in the last couple of weeks.
A young graduate student from the University of Guelph went to Cambodia and noticed the problem of iron deficiency anemia. This is a problem that affects two billion to three billion people in the world and causes billions of dollars of lost income. Children are listless. Women go into pregnancy with lower blood counts, so if they do hemorrhage around the time of birth, they're more likely to die.
We noticed the problem of iron deficiency anemia, and we wanted to do something about it. A young Canadian graduate student—the supervisor, by the way, was the president of the University of Guelph—started by putting an iron ingot into the cooking pots, but nobody wanted to use it because it was so ugly. He went back into Cambodian folklore, found a legend of this little fish, a lucky fish with a little smile on it, and manufactured these things in the form of the fish. Each one costs $5 and lasts five years, and now this is the Cambodian equivalent of selling like hot cakes.
They have a social enterprise that they've started in Cambodia. Grand Challenges Canada supports them in part with a grant, but part of that is actually a loan, so it's bringing a type of business discipline to their social enterprise as well as tackling the problem of iron deficiency anemia. Again, this is an intervention that not only saves lives, but also saves brains. There's a double dividend here in terms of the life-saving potential of Canada's approach to maternal, neonatal, and child health.
In summary, I fully see the types of interventions you're looking at here: early forced marriage, human trafficking, the protection of children, and so on. These are extremely important areas. However, what I want to focus on in this presentation, to complement the other things you'll be hearing, is that what makes the most sense is to start a focus on child protection by protecting the brain in early childhood. It is where the child is the most vulnerable, where the return on investment will be the highest, and it enables all of those other investments. For example, if you're more ready to go to school, you're less likely to drop out of school and you'll do better in school.
I'm arguing that Canada's approach to child protection should start just before the time of conception, with adolescent girls, and follow through to protecting the child's brain in utero, protecting pregnant women, and protecting that child's brain in the first few years of life. There's emerging evidence that this is a critical moment to intervene. It's the same issue in conflict situations, where conflict, nutrition, stress, etc., all come together, essentially to create a lost generation during this critical period. This is the time that the brain is most vulnerable. This is the time that protecting it can have the greatest impact, and it is the best time to intervene so that children can reach their full potential.
I'd be glad later in the questions, or on another occasion, to talk about some of the other innovations we have, in terms of teenage girls and how we're protecting them, mental health issues, and so on.
I wanted to provide one focused message because I thought this was one thing you might not hear in such a focused way from others. The saving brains initiative, again, supported by the Government of Canada, is a flagship initiative internationally. It's now recognized internationally, with Canada as the leader. The point I want to make is that it doesn't defocus us, because the very same approaches we're taking in women's and children's health, save lives, save brains, and provide this double dividend.
Thank you very much. I look forward to the other presentations and to the discussion period.