Early Relational Health: Building Foundations for Child, Family, and Community Well-Being (2025)
Chapter: 1 Introduction
1
Introduction
Early relational health, or the dynamic process of mutual, meaningful, and affirming moments of connection in the youngest relationships, is foundational in shaping lifelong physical, behavioral, and mental health. These early relational experiences, expressed through varied cultural pathways, serve as a key ingredient of early learning and well-being. They shape brain architecture; regulate stress physiology; and scaffold emotional, behavioral, cognitive, and physical development. Early relational health also can buffer the impacts of adversity and build resilience (Bethell, Gombojav, & Whitaker, 2019; Esposito et al., 2017; Felitti et al., 1998; Garner et al., 2021; Hambrick et al., 2019; Morris et al., 2017; Oh et al., 2018; Sege & Harper Browne, 2017; Stein et al., 2013; Traub & Boynton-Jarrett, 2017). Importantly, the development of early relational health cannot be separated from the broader health of families and communities. Though poor early relational health does not prohibit the possibility for health, well-being, and flourishing across the lifespan, early relational health plays a powerful role in promoting lifelong well-being.
Communities, families, and caregivers across cultures and backgrounds have long understood the importance of connection and relationships for human development. Researchers, clinicians, and practitioners in disciplines across the developmental, educational, health, and social sciences have focused on these early relationships as a seminal source of wellness and flourishing.1 Rooted in long-standing family and community perspectives and
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1 Flourishing is a concept that originated in Aristotle’s discussions of what it means to “do and live well,” and it is embraced in social science and other literatures (see, e.g., Keyes, 2002,
scientific understandings, the concept of early relational health has been introduced more recently as a framework and orientation. It recognizes that children’s flourishing reflects the collective commitment of families, communities, and society; and when relational challenges emerge, they present opportunities for community- and society-wide relational supports, healing, and recovery.
This report spotlights many streams of knowledge related to human and child development, infant and early childhood mental health, early childhood physical health, education, learning, cultural anthropology, and neurodevelopment under the encompassing framework of early relational health. Its purpose is to highlight the contexts and conditions that advance early relational health and to offer guidance for integrating early relational health into research, practice, and policies to support the health and wellbeing of young children, families, and communities.
STUDY SCOPE AND METHODS
In response to a request from the Centers for Disease Control and Prevention, the National Academies of Sciences, Engineering, and Medicine’s Board on Children, Youth, and Families convened an expert ad hoc committee to examine early relational health determinants of future health and well-being for infants, children, and families. The committee was to focus on future directions for research, policy, and practice to advance early relational health within health care, childcare, education, and other community settings.
The committee was tasked with carrying out this study and producing this consensus report on a rapid timeline. It included individuals with expertise in the areas of child development, pediatrics, infant and early childhood mental health, child and family policy, neuroscience, psychology, parenting, and cultural research. See Box 1-1 for the full Statement of Task.
Study Scope
Early relational health is an umbrella term encompassing a myriad of constructs all sharing the goal of describing the relationship between infants and toddlers and their parents, caregivers, families, and community members (Dumitriu, 2024); see Box 1-2 and Chapter 2. In 2021, the American
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p. 210). According to VanderWeele (2017), “Human well-being or flourishing consists in a much broader range of states and outcomes, certainly including mental and physical health, but also encompassing happiness and life satisfaction, meaning and purpose, character and virtue, and close social relationships” (p. 8148). VanderWeele (2017) also noted the importance of sufficient stability and financial resources for flourishing to continue (p. 8149).
BOX 1-1
Statement of Task
The National Academies of Sciences, Engineering, and Medicine will convene an ad hoc committee of experts to conduct a consensus study on early relational health. The committee will make recommendations on future directions for research, policy, and practices and recommend strategies and actions to translate basic and applied research findings to advance early relational health across health care, childcare, education, and other community settings. In conducting its work, the committee will examine clinical, program, and research trends related to this paradigm shift that focus on early relational health for infant, child, and family wellbeing.
The committee will address the following questions:
- What is the link between early relational health and long-term health and wellbeing?
- What is the impact of early relational health on addressing a range of challenges at the multiple levels of behavior, biology, epigenetics, neurodevelopment, and communities, for addressing the needs of all children?
- What are the multiple roots of early relational health that are critical to understand, incorporate and address in public health initiatives?
- What is the evidence from family engagement and place-based initiatives in communities that can guide new family support and systems to further advance early relational health?
- What are best practices to advance early relational health and community resilience through community-level early childhood systems change across sectors, such as health and mental health systems, public health systems, family support programs, and early care and education systems?
- What federal and state policies and programs can support and advance early relational health?
The committee will organize and host a public workshop focused on these questions. Based primarily on workshop presentations and discussions, supplemented by additional literature review as appropriate, the committee will develop a short report with recommendations to advance early relational health across child health care and communities. It will articulate research opportunities to galvanize research and policy activities to uplift and strengthen families and communities.
Academy of Pediatrics (AAP) adopted a policy statement reorienting pediatric care toward the promotion of early relational health (AAP et al., 2021). It defined early relational health as stable and nurturing relationships early in life (Garner et al., 2021). The AAP’s definition has since been endorsed by the Canadian Pediatric Society (Williams, 2023) and by the Paul Ramsay Foundation’s early relational health research roundtable in Australia
BOX 1-2
Early Relational Health as an Encompassing Concept
Early relational health encompasses diverse theoretical constructs with varied origin, focus, measurement, time lens, and scope. However, these constructs ultimately converge in their shared objective of describing distinct facets of early relationships.
Early relational health focuses on the overall quality of the relationship, including joy, shared activities, shared meaning, and emotional well-being. Its scope includes safety, trust, mutual enjoyment, coregulation, and support for developmental needs. Early relational health is often measured through broad relationship assessments (e.g., PICCOLO,a NCAST,b parent–child interaction scales) and encompasses infancy but also toddlerhood and preschool. It seeks to understand both everyday moments (e.g., feeding, reading aloud, going for a walk, or telling stories) and challenges to capture the full relational climate.
Attachment is a related concept that focuses on the bond between the infant and primary caregiver (Ainsworth et al., 1978; Bowlby, 1969). It generally posits the caregivers’ (usually the mothers’) sensitivity and responsivity to a child’s needs, which influence the child’s attachment style and development of internal working models (Bretherton, 1992). These models, in turn, influence later social-emotional health across the life course (Cassidy & Shaver, 2016). Though early relational health focuses on positive, nurturing, and reciprocal relationships as foundational for health and well-being, the concept is broader than attachment; it also looks at the overall quality of various caregiver relationships in early life (parent–child, family, and community) and the contexts that support them. Its focus is on mutuality and synchrony and goes beyond the child’s internal sense of security. Furthermore, early relational health also considers the social drivers of health with a focus on promotion and prevention (building relational health in families, communities, and society). As early theory has continued to evolve into more complex constructs over time, both concepts converge in their focus on relationships and mutual interactions, their impact on development, and the importance of sensitive and synchronous caretaking.
Infant and early childhood mental health and early relational health are similar terms that share a core focus on the emotional well-being and connection between a baby or young child and the important people in their life. Though there can be differences in the application of these terms, the importance of healthy relationships and the context of family, community, and culture to infants, young children, and their families is at the center of both (Nurture Connection & ZERO TO THREE, n.d.).
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a PICCOLO stands for Parenting Interactions with Children: Checklist of Observations Linked to Outcomes.
b NCAST stands for Nursing Child Assessment Satellite Training.
(Coffin et al., 2022). Other groups have suggested variations to the AAP’s definition. According to the Burke Foundation, early relational health is an emerging vision that organizes the science and practice of human relationships during the early years of life and derives from moment-to-moment interactions between parents and caregivers with infants and toddlers (Li & Ramirez, 2023).
Building on these definitions, the committee outlined a broad framework to orient its report. Early relational health, although not a new concept, emphasizes early relationships as a foundational aspect of the developmental process that shapes future health and well-being. It is an ongoing, dynamic state that evolves with iterative contextual, cultural, and social experiences. From preconception onward, early relational health can be conceptualized as emerging within the ecological network of relationships surrounding infants and young children, co-constructed by caregivers, families, communities, and cultures (Condon, 2024; Frosch et al., 2021; Li & Ramirez, 2023). Early relational health is the state and practice of nurturing, safe, and responsive relationships that build emotional security, trust, mutual delight, and grounding through connection.
The concept looks at the overall quality of nurturing and responsive caregiving in the youngest relationships (Charlot-Swilley et al., 2024). It encompasses a dynamic process of mutual interactions or connections among people (e.g., parents and young children and their families), places (e.g., cities, farms, and parks), cultural communities (e.g., faith-based groups to neighborhoods), and society, with systems such as childcare and education. These moments of connection can occur in any contexts where children spend time, such as in families, in care settings, and in communities. They may include shared activities such as reading aloud, storytelling, play, or interacting with nature.
The committee’s understanding of early relational health emphasizes that all relationships are shaped by the cultural contexts in which they occur. Therefore, early relational health is viewed through a cultural lens that shapes how families perceive infants and informs the various observations of multiple family–infant interactions across distinct cultural communities (Bornstein, 1991; Harwood et al., 1995; Keller, 2007; Rogoff, 2003; van Ijzendoorn & Sagi-Schwartz, 2008; Wesner et al., 2025). In this regard, early relational health is understood and achieved through a range of cultural pathways in the early years. These early relationships shape lifelong health, learning, and well-being for both children and caregivers, and are foundational for flourishing families and communities.
The committee also recognizes that there is a sensitive period early in life when the biological systems that are necessary to support early
relational health develop; see Chapter 2. Given this early window of opportunity to support the development of relational health, this report focuses on early childhood systems that engage young children, ages 0−5, and their families.
The committee chose to emphasize a strengths-based approach to early relational health in its report. Such a perspective seeks to ensure opportunities for positive development, mitigate the effects of current adversities, and cultivate the adaptive capacities necessary to cope with future stressors (Brody et al., 2016; Flouri et al., 2015). This approach fosters resilience by supporting strong relationships as well as leveraging them to address current challenges and equip individuals, families, and communities with the tools needed to flourish amid future adversities. This contrasts with the toxic stress model that is problem focused, highlighting the adverse biological effects that emerge when emotional and social buffering systems are insufficient or absent. The term toxic stress refers to a spectrum of biological responses—encompassing molecular, cellular, and behavioral changes—that result from prolonged or intense adversity in the absence of mitigating social-emotional buffers and protective relationships (Shonkoff et al., 2012). The impact of such stress-related adaptations may be perceived as either health promoting or maladaptive depending on the context in which they occur and how adaptations are processed. The committee notes, however, that much of the existing research base has been framed as risk related; thus, some of the literature reviewed in this report reflects that lens. However, moving forward, research will need to be more cognizant in understanding and promoting family and community strengths and resilience; see Chapter 6.
Resilience, a term used widely in both research and practice, is “a set of social and emotional skills that allow children to adapt to future adversity in a healthy manner” (Garner et al., 2021, p. 11). Some scholars have argued that using this term can unintentionally shift focus away from the system-level factors that contribute to adversity, placing the burden of adaptation and recovery on individuals rather than emphasizing the system-level conditions needed for flourishing (McLean et al., 2024). From the committee’s perspective, early relational health offers a pathway toward the scalable promotion of health at the individual, family, community, and society levels to build resilience.
Given the committee’s charge and timeline, this report briefly summarizes key themes from the available knowledge on early relational health. It relies heavily on recent metanalyses and other scoping reviews, as appropriate, but it is not exhaustive. Furthermore, the committee outlined policy and practice opportunities across multiple ecological levels and sectors that together may advance early relational health. Many of these opportunities center on the public health and health sectors as these systems almost
universally reach young children and their families and have potential for supporting early relational health and connectedness for young children, families, and communities. While actionable areas are identified, they are not exhaustive. Additional efforts and opportunities are highlighted across other child-serving and early childhood systems, including but not limited to the domains of early care and education, child welfare, and family support.
Study Methods
The committee held five meetings and conducted additional deliberations by electronic communications during the course of the study. To support its information-gathering process, the committee solicited perspectives from a variety of interested parties, including the study’s sponsors; academics and researchers; and organizations representing parents, families, and communities, as well as federal and state government leaders. Interested parties were asked to provide guidance on advancing early relational health, including existing and emerging best practices; current opportunities to advance local, state, and federal policies that can support early relational health; and suggested directions for future research to advance early relational health and next-generation flourishing. Such perspectives were gathered through presentations or written memos and were used to supplement the committee’s expertise.2
Information-Gathering Themes
The information-gathering process revealed some common themes, which served as important context for the committee’s deliberations and are
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2 The following individuals or organizations provided information to the committee: Alan L. Mendelsohn, Anne Seery, and Meredith Ansell, New York University Grossman School of Medicine; the American Academy of Pediatrics; Annie Davis Schoch, Katy Falletta, Rebecca Vivrette, and Sarah Crowne, Child Trends; Christina Bethell, Johns Hopkins Bloomberg School of Public Health; Claudia M. Gold, Hello Its Me Project; Craig Olsson, Jacqui Macdonald, Tracy Evans-Whipp, Juli Coffin, and Stephen Zubrick, Australian Early Relational Health Living Evidence Institute, SEED Centre for Lifespan Research; Division of Home Visiting and Early Childhood Systems, Maternal and Child Health Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; Dorothy T. Richardson, University of Massachusetts Chan Medical School; Jeffrey Linkenbach and Carla Ritz, The Montana Institute; Junlei Li, Harvard Graduate School of Education; Joe Waters and Elise Anderson, Capita; Misty Boyd, Chickasaw Nation Department of Health, Division of Public Health; Nikki Shearman, Reach Out and Read, Inc.; Tyson Barker, Institute for Child Success; Nim Tottenham, Columbia University; Rob Grunewald, Rob Grunewald Consulting LLC; Walter Gilliam, Yale School of Medicine and ZERO TO THREE; Kay Johnson, Johnson Consulting Group; Alex Briscoe, The Public Works Alliance; Nathan T. Chomilo, Medicaid & MinnesotaCare, Minnesota Department of Human Services; and Elizabeth Groginsky, New Mexico Early Childhood Education and Care Department.
reflected in its conclusions when justified by the evidence reviewed. Salient themes presented by authors and speakers include the following:
- Both the science of human development and the importance of relationships are irrefutable. Research across the fields of child development, child health, child psychology, mental health, early education, neurodevelopment, family studies, and the social sciences affirms a foundational role for early relationships in human development and meaningful experiences. The convergence of these many streams of knowledge underscores the need to translate what is already known about early relational health into effective policies and practices.
- Supporting the well-being of caregivers can create conditions for early relational health. Young children cannot thrive if their caregivers are struggling. Accordingly, policies supporting paid family leave, health care coverage (including Medicaid expansion and extended coverage for pregnant women to 12 months postpartum), doula access, mental health payment parity, and community-based parent support are all examples of policy opportunities to create the conditions in which early relational health can flourish. In addition, efforts to address social drivers of health benefit early relational health.
- Relational approaches grounded in family, community, and cultural perspectives offer community-based pathways to flourishing. Cultural continuity, narratives, extended kinship networks, and relational worldviews align with early relational health principles (Boyd, 2025). Nature-based learning and Indigenous frameworks of kinship with land offer relational models for fostering early relational health for some ethnic and cultural heritage groups. These models may be underleveraged in conventional early relational health approaches but may offer important learning for health in other communities.
- Social connections influence early relational health. Early relational health is influenced by a constellation of relationships, within both formal and informal systems. Examples include relationships involving early care and education systems, educators, coaches, and other significant adult relationships in the community; family members’ workplaces; digital environments; and the norms and values embedded in national policy, among others.
- Relational health requires advancing system-level supports. Scalable, evidence-based models (e.g., HealthySteps, Reach Out and Read, PlayReadVIP, evidence-based home visiting [Nurse-Family Partnership, Healthy Families America, Parents as Teachers, etc.],
- Attachment and Biobehavioral Catch-up, Family Connects) are available, but they require supportive financing, data infrastructure, professional development pipelines, cross-sector leadership and coordination, and consideration and adaptation for the cultural and contextual settings in which they are implemented.
- Relationship-centered measurement and accountability are essential. Existing pediatric health, public health, and early care and education metrics often fall short with respect to relational quality. Additional tools are needed to provide validated, culturally informed pathways to assessing and strengthening early relational health at a system level.
- Early relational health is a public good with intergenerational returns. Investing in early relational health through early childhood systems yields returns for both individual children and their families and society (e.g., increased school readiness, reduced health expenditures, stronger workforce participation). Benefits often accrue over decades and across generations (see, e.g., García et al., 2020; Reynolds-Salmon et al., 2024).
GENERATIONAL AND CULTURAL ROOTS OF THE EARLY RELATIONAL HEALTH FRAMEWORK
The committee took a broad view of the roots of early relational health as encompassing knowledge from a variety of scientific disciplines and lived experiences across cultures and perspectives in response to its Statement of Task. In so doing, the committee was inspired by the Māori metaphor of a braided river for bringing together diverse worldviews and research paradigms (Martel et al., 2022). The committee was also inspired by Indigenous perspectives within the United States and globally that understand relationships as the foundation for thriving children, families, and communities (Cajete, 2017; Day et al., 2014; Red Horse, 1997; Ullrich, 2019). The African philosophy of Ubuntu (Mathabane, 2018; Ramose, 1999), for example, offers a relational perspective on well-being grounded in the African proverb, “I am because we are.” Ubuntu recognizes that children’s flourishing reflects a collective investment of families and communities, and, when relational challenges emerge, communities can provide relational support, repair, healing, and strengthening support systems. Value systems such as educación and being acomedida/o in many Mexican, Central American, and South American communities offer another example where interrelationships and mutual responsibility across generations and integration in community life are emphasized (Alcalá et al., 2018; Coppens et al., 2014; López-Fraire et al., 2024; Rogoff & Coppens, 2024).
BOX 1-3
Indigenous Worldviews on Early Relational Health
The committee highlighted collective practices expressed in various cultures globally as vital and enduring sources of relational wisdom. These approaches place children in broad kinship networks and with community and spiritual connections starting at birth (Ball, 2019; Blackstock, 2019). They offer transformative insights that revitalize and expand dominant frameworks for understanding early relational health.
Indigenous perspectives on relational health emphasize communal caregiving, relational continuity, and kinship networks (Armstrong et al., 2022; Institute for Integrative Science and Health, n.d.; Muir et al., 2023). Children are understood to form attachments through relationships with extended family, elders, and community members. This relational ontology often includes not only communal and kinship relationships but also relationships with the natural world; past and future generations; ancestors and descendants; and, in many Indigenous cultures, the spiritual realm (Bang & Medin, 2010; Meixi, 2022; Super & Harkness, 1986; Ullrich, 2019; Wesner et al., 2025). From this interconnected perspective, a child’s well-being is inseparable from the collective networks in which that child is embedded and forms the basis for emotional security and intergenerational transmission of cultural knowledge and identity. For example, the Cherokee concept of Gadugi emphasizes harmonious, helpful relations among community members of all ages (Cherokee Nation of Oklahoma, n.d.) while the Lakota concept of tiospaye emphasizes the importance of extended family in teaching children how to live according to their tribe’s values and in providing a sense of self and belonging (Pickrell, 2001).
From early infancy, children are oriented toward cultural-collective participation. The African-centered worldview Ubuntu teaches that children develop their identity through connections with others; it is grounded in the principle, “I am because we are.” According to this philosophy, children develop their self-identity through relationships with family members, community members, and their ancestors. From birth, Ubuntu-informed parenting practices focus on community health above personal needs because caregivers consider emotional regulation, social competence, and moral development as responsibilities shared by the entire community instead of belonging to parents alone. The African diasporic cultural principle of Sankofa, which means “go back and get it,” emphasizes the need for intergenerational learning and ancestral wisdom when raising children. Through Sankofa, communities build on historical knowledge and cultural memories (Appiah-Adjei, 2016).
The Native American Seven Generations principle requires decision-makers to assess their choices by considering their effects across seven future generations and preserving the wisdom of seven past generations (Clarkson et al., 1992; Udah et al., 2025). Similarly, an African proverb states, “We don’t inherit the land from our ancestors; we borrow it from our children,” encouraging choices that prioritize the well-being of future generations.
The Lakou system in Haiti demonstrates an enduring practice of mutual caregiving together, with shared responsibilities, interdependence, and group accountability. This system features multigenerational households that share landownership; children receive care from both elders and extended kin members and neighbors (Edmond et al., 2007). Children in the Lakou system experience relational practices that teach them about reciprocity, elder respect, and spiritual-social belonging. This intergenerational system establishes various levels of protection and assistance through age-based distribution of caregiving duties, which decreases single-caregiver stress and maintains cultural traditions by passing down traditional knowledge directly. In the Lakou system, early relational health exists within a communal-relational-ecological framework that positions child well-being as inseparable from collective well-being. Both Lakou and Sankofa demonstrate the importance of continuous relationships between generations by providing strong frameworks for studying early development through group-based rather than individually oriented perspectives.
These collective-centered approaches to early relational health are evident across cultures worldwide. For example, the Mi’kmaq people of Eastern Canada practice traditional parenting through community-based caregiving and land-connected practices that reflect their collective values of consensus, group harmony, and interdependence (Ball, 2019). Similarly, the whānau system in New Zealand Māori communities demonstrates collective responsibility because children are members of the entire whānau family, instead of just belonging to their parents (Herewini, 2018; Te Kahui Mana Ririki, 2011). Traditional Māori parenting practices focus on shared responsibility and mutual support to raise children within love, hospitality, and kinship connections (Jenkins et al., 2024; Kiro, 2011). In Kenya, the Giriama practice early community integration through their kahoho kuhuma madzi system, which allows toddlers to retrieve water, thus demonstrating their early involvement in community duties (Lancy, 2018).
These culturally rooted caregiving systems place infants within kinship networks and reciprocity systems while orienting them socially and physically toward their communities from birth. This emphasis on community engagement is visible in early developmental practices across various groups. For example, among the Runa people of Ecuador, children are carried facing outward toward the world rather than inward toward the caregiver, symbolizing their orientation toward community rather than individual attachment (Lancy, 2018). Mexican Mayan children demonstrate greater attention to their surroundings and other people’s actions compared with European-American children, a difference attributed to their early integration into community life and expectation to participate actively in social interactions (Rogoff, 2003; Rogoff et al., 2015). This encouragement to turn toward the community begins well before children can speak or contribute to household tasks.
In many Indigenous cultures, children’s development depends heavily on elders who provide cultural wisdom, emotional backing, and moral direction. These cultures often recognize elders’ essential role in supporting children’s spiritual, cultural, and social development (Greenwood & de Leeuw, 2012).
These perspectives, and those further illustrated in Box 1-3, reinforced the committee’s understanding that the development of early relational health cannot be separated from the health of the community and relational ecosystem3 in which children grow. This orientation supports early relational health by creating conditions where children experience themselves as valued members of caring communities and relational networks that extend beyond the dyad or nuclear family, fostering the security, belonging, and sense of self needed for development. It is important to note that although there are important differences among Indigenous communities in the United States and globally, there are also some principles that are often held in common. Furthermore, the peoples of the United States, and most countries worldwide, include people whose ancestry and cultural history came from Indigenous communities in other parts of the world. The diasporic communities in the United States and globally maintain many of the values and practices of the communities of their ancestors, at the same time that they often become fluent in the ways of life of their new location.
EARLY RELATIONAL HEALTH: BENEFITS TO SOCIETY
The Surgeon General’s 2023 report declaring an epidemic of loneliness and a similar 2020 report from the National Academies, Social Isolation and Loneliness in Older Adults, both underscore that social connection is a fundamental human need with measurable impacts across health, education, and economic outcomes (NASEM, 2020; U.S. Department of Health and Human Services, Office of the Surgeon General, 2023). They also emphasize that social disconnection is not just an individual problem but a societal one, shaped by structural and cultural factors, including the autonomy mindset, technology, declining community participation, and shifting demographics. The COVID-19 pandemic intensified these forces, further isolating individuals and weakening social bonds across generations. The ubiquity of digital environments is also reshaping human connection and, in many cases, disrupting relational development (Haidt, 2024).
What is often underemphasized, however, is that one of the drivers of relational health in adulthood is childhood experiences of early relational health. These early experiences shape the developing brain and stress response systems in ways that influence how individuals relate to others, form
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3 Relational ecosystem refers to a system where the components are defined by their interconnected relationships rather than individual properties, emphasizing mutual influence and interdependence within a defined boundary.
attachments, and navigate emotional landscapes throughout life. The early sensitive period for development of relational processes (see, for example, Shonkoff, 2016) suggests that there is an urgency to promoting early relational health for every child, family, and community, so that children—and by extension, the adults they will become—can flourish.
NASEM (2024a) argues that
ensuring that every child is healthy, ready to learn, and on their optimal trajectory to adulthood is imperative for the nation. This imperative arises from the inherent value of child health, their future health as adults, parent and societal health, and intergenerational health. (pp. 38–39)
That report described the multigenerational antecedents of child growth and development and the impact of child health and well-being on other generations:
- It is a national value and moral imperative to give all children a healthy start in life. The future depends on nurturing young minds and bodies.
- Child health and wellbeing support the nation’s tax base, workforce, economic prosperity, and sustain a high standard of living. The current young adult workforce does not meet national economic and security needs.
- Children who are sick prevent parents from working, playing, resting, and being their full selves. Parent health, happiness, and productivity depend on child health and wellbeing.
- Child health is the foundation for adult health. Most adult health problems, including heart disease, diabetes, and mental health, have origins in childhood, and the most effective prevention starts early in life.
- Scientific and technologic advancement point to the promise of earlier identification and prevention of disease to improve societal health (e.g., genomics, artificial intelligence prediction). Identification, prevention, and health promotion in the preconception, prenatal, childhood, and adolescent stages pay off. (NASEM, 2024a, pp. 39–45)
In this context, the committee for this study emphasizes that promoting early relational health can shape lifelong health. Early relational health benefits young children directly and is foundational for individual wellbeing. It also has the potential to support positive educational outcomes and kindergarten readiness, workforce readiness, community safety, and health, thus benefiting national strength, economic stability, and societal cohesion. That said, there is still much more to learn about early relational health and life course health, well-being, and societal contributions (see Chapter 6).
ORGANIZATION OF THE REPORT
This report is organized into six chapters. Following this introduction, Chapter 2 summarizes what is known about the link between early relational health and long-term health and well-being (Statement of Task questions 1 and 2). Chapter 3 describes the many influences on early relational health at the individual, relational, and systems levels (Statement of Task question 3). Next, Chapter 4 reviews promising approaches for applying the research on early relational health, emphasizing findings about the key role of family leadership in supporting early relational health (Statement of Task questions 4 and 5). Chapter 5 outlines policy and practice opportunities for advancing early relational health (Statement of Task questions 5 and 6). Finally, Chapter 6 outlines an agenda for future research. The appendix contains biographical sketches of the committee members and staff.
