Written by Violet Noe, Lindsey Miller, and Janet Viveiros

Violet Noe is a Student Assistant with Healthy Eating Research. Lindsey Miller, MPH, is Senior Research Analyst with Healthy Eating Research. Janet Viveiros, MPP, is Senior Program and Policy Analyst with Nemours Children’s Health.

In 2022, Nemours Children’s Health and Healthy Eating Research presented the “Healthy Kids, Healthy Future: Advancing Equity in Early Childhood” webinar series. Through four webinars, this series explored how to leverage early care and education settings to achieve equitable health outcomes by highlighting opportunities and advances in: Policy, Research, Philanthropy, and Innovation.

Early care and education (ECE) is an important setting for promoting equitable health outcomes in early childhood by utilizing best practices in healthy eating and physical activity and participating in child nutrition programs that promote food security. The COVID-19 pandemic exacerbated equity and food security challenges, however, there are opportunities to take the lessons learned during the public health emergency to better serve young children and families.

Here we highlight key takeaways from each of the four webinars. More information on the series can be found here: https://healthykidshealthyfuture.org/featured-success-stories/healthy-kids-healthy-future-advancing-equity-in-early-childhood-webinar-series/

Policy Opportunities

Effective food security and child nutrition policies are critical to advancing health equity and the ECE sector can play an important role in helping families access nutrition assistance programs. Expanding program eligibility, increasing benefits, and streamlining enrollment processes can make the programs more accessible and impactful.

• Extend and make permanent the federal nutrition program flexibilities and increases in benefits enacted during the COVID-19 emergency. During the height of the pandemic, waivers issued for federal nutrition programs resulted in expanded program access, more dollars going to participating families, and more equitable access to benefits. Making these changes permanent could improve food security and access to healthy foods for young children and families over the long term.
• Simplify enrollment processes and improve communication of program impacts. Reducing the paperwork required for ECE programs to enroll in federal nutrition programs and streamlining enrollment processes for programs with similar eligibility requirements can make it easier for families to learn about and access a variety of programs and services. Additionally, pairing high-quality program evaluation and surveillance data with personal stories is important to making the research more relatable and impactful for policymakers.

Research Findings

There is a growing body of literature measuring the positive impact of nutrition programs and other obesity prevention interventions in early childhood and the important pathway ECE programs can provide for delivering these interventions.

• Policy and environmental interventions in ECE settings have the strongest evidence of obesity prevention. Research has found that programs that support ECE systems to improve and adopt best practices and policies encouraging healthy eating and physical activity are the most effective in reducing weight for young children and improving practices in ECE programs. Examples of these effective programs include the National Early Care and Education Learning Collaborative (ECELC), Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC), and Child and Adult Care Food Program (CACFP).
• High quality ECE programs promote positive child health outcomes, but require resources to support optimal implementation. Emerging research demonstrates that enrollment in high quality ECE programs such as Head Start and Early Head Start is associated with improved weight trajectories for children, including reduced obesity risk into adulthood. However, many ECE programs, especially those in under-resourced communities, need follow-up support and guidance through technical assistance or coaching to adopt best practices in healthy eating and physical activity. Many states do not currently have sufficient resources available to support ECE programs in these efforts. Without these resources, equity gaps can persist.

Role of Philanthropy

Philanthropic efforts to advance equity in early childhood are now largely focused on structural drivers of health inequity for young children. This places greater attention on policies and systems that support economic security and center lived expertise in decision making. 

• Financial investments in early child care and education have evolved from focusing on childhood obesity prevention to focusing on enhancing access to nutrition programs and economic supports for families. In the 2010s, philanthropic organizations began investing in evidence building, implementation, and policy advocacy for interventions to support early childhood health through obesity prevention. In recent years, philanthropic organizations are increasingly focused on structural drivers of health inequity for young children, such as structural racism and its impacts on systems critical to early childhood health including social support systems, the food system, and access to health care. Examples of current funding priorities include demonstrating the impact of expanded benefits of federal nutrition programs and federal child tax credits on food insecurity and child poverty.
• Philanthropic organizations are working to center community members with lived expertise to drive local decision making. Many philanthropic organizations are pursuing “trust-based philanthropy” as an approach to support communities. This approach focuses on developing relationships with communities and providing capacity-building support to community-based organizations by deploying people-centered, non-stigmatizing general operating grants and unrestricted funds. This support enables community-based organizations to take on more leadership and integrate lived expertise in processes for determining the solutions best tailored to a community’s assets and needs. Philanthropic organizations are also increasingly focused on using inclusive, people-centered language and centering community members with lived expertise to drive local decision making.

Innovation Advances

The challenges the COVID-19 pandemic posed to families with children and ECE providers necessitated innovative community action and policy change. The inequitable impacts of the pandemic highlighted the need to structure programs to effectively reach families and ECE providers and elevate their voice in decision making. 

• ECE stakeholders adopted innovative approaches to help families facing increased financial pressures and social isolation at the height of the COVID-19 pandemic. These approaches included delivering healthy food boxes and recipes for healthy meals to families and ECE providers, resulting in self-reported increases in healthy food consumption by young children, and hosting virtual Family Café meetings to build social networks and supports while parents, caregivers, and ECE providers were experiencing social isolation and intense stress.
• Layered approaches and shifting power to people in the community are necessary for integrating equity in ECE programs and systems. The Healthy Kids, Healthy Future Technical Assistance Program (HKHF TAP) provides Equity, Diversity, and Inclusion (EDI) training & technical assistance to enhance state stakeholder capacity to apply an EDI lens to their work and helps states restructure their ECE quality rankings systems to acknowledge ECE programs demonstrating positive change. Additionally, the Healthy Early Coalition has shifted power to people in the community by restructuring their decision-making board from a board dominated by state agency representatives to a board consisting of community members.

Moving Forward

There are many opportunities and advances in policy, research, philanthropy, and innovation that can be leveraged to advance child health equity and promote food security in ECE settings. Research demonstrates that expanding access to federal nutrition programs and high quality ECE programs are effective strategies for improving food security and healthy food access for young children and families. Policies, philanthropic support, and innovative approaches that enable equitable participation in federal nutrition programs and adoption of best practices in healthy eating and physical activity in these programs are crucial to achieving equitable health outcomes for young children and families.

See the webinar recordings and the webinar synopses here.