When you think about development assistance with the greatest impact, what comes to mind? Likely a road connecting farmers to markets, or emerging technologies to detect or treat disease in low-resource settings. There is no question that these investments are critically important. However, the most consequential investments are those that enable the children born today to become active citizens as adults.

That’s because human capital – the aggregated health, skills, and knowledge of a population -- is the greatest driving force for national economic growth and stability [1].

Some 70% of a country’s wealth is attributed to human capital in high income countries, compared to just over 40% in low- and lower-middle income countries [1]. This finding reveals that the potential contribution of human capital to national wealth in poorer countries has been under-exploited, and indicates that targeting investments to maximize human capital could place countries and their populations on more equal footing.

A new tool to focus on investing in people

We now have a new tool to guide our thinking on how to target investments for human capital – and it is squarely focused on health and education outcomes. The Human Capital Index, recently launched by the World Bank, compares how countries fare relative to aggregated metrics spanning child survival, childhood stunting, as well as the quality of education that a child can expect to acquire by the age of 18.

This index reminds us that investments in health and education form two sides of the same coin; that is, investments in health and education are both needed throughout childhood and into adulthood to put populations on the path to greater economic productivity, competitiveness, and self-reliance.

The importance of health and education investments is not a new story in development. We know that the focus on the first 1000 days (conception to age two) is important. Instead, what is novel, is the recognition that child and adolescent development continues for approximately another 7000 days (until approximately age 21 years).

We now know that the timing of health and education interventions relative to critical development stages across the life course is a key factor in the effectiveness of these efforts [2].

To illustrate this point, let’s consider children ages 5 to 9 who are at greatest risk of not attending school due to infections and malnutrition. School-based deworming can reduce absenteeism by 25% [3] and school meals can increase attendance by 8% [4].

For these reasons, school-based health interventions are sometimes found to have a larger impact on access to schooling and learning than incentive- and instruction-based interventions [5].

Rebalancing investments in health and education for greatest impact

Presently global investment in both health and education is insufficient and inappropriately targeted to meaningfully improve human capital. Countries are largely directing health investments to children in younger ages, while conversely, education investments are targeted to older children [2].

What is apparent is that greater investment by the health sector for school-age children and adolescents would enhance education returns, through better learning and attendance, and create an enabling environment for vulnerable children to transition to secondary school.

Similarly, greater education investments targeted to early childhood education can foster soft skill development and school readiness and leverage better health outcomes from a better educated population. After all, children and adolescents need to be healthy and have the necessary educational foundation to enter, adapt and perform in the labor market when transitioning to adulthood.

Investments in human capital have strong returns throughout the crucial development phases during the first 8000 days - from child survival, to early child development, through school age and adolescence. The health and education sectors each have tangible and specific areas of investment that require greater attention to improve human capital outcomes. These include:

• The education sector’s current focus on early childhood development needs to be matched by a focus on early childhood education. Similarly, the focus on primary education should be supported by an equal focus on secondary education, including vocationally-focused curricula, which includes and goes beyond digital literacy.
• The health sector should sustain its investment in the first 1000 days, and at least double its investment during middle childhood and adolescence when children have their most important opportunity to attend school and learn.
• The education and health sectors should coordinate their efforts to maximize synergies; the timing of interventions relative to critical development stages matters.

The Human Capital Index comes at a pivotal point in our global economy. Technology is driving economic change at an unprecedented pace. Multisector programming and coordination can best position populations to respond to these challenges.

Greater investment in health and education across the first 8,000 days is an investment that will pay dividends as countries aim to sustainably address their most pressing development challenges.

Read the new report: Maximizing human capital by aligning investments in health and education

See our infographic: How to improve health and learning in school-age children

Note: The views expressed in this blog by the authors do not necessarily reflect the views of the US Agency for International Development (USAID) or the US Government. 

References

[1] Lange, Glenn-Marie; Wodon, Quentin; Carey, Kevin. 2018. The Changing Wealth of Nations 2018: Building a Sustainable Future. Washington, DC: World Bank. © World Bank. https://openknowledge.worldbank.org/handle/10986/29001 License: CC BY 3.0 IGO.

[2] Bundy DAP, de Silva N, Patton GC, Schultz L, Jamison DT. 2017a. Investment in child and adolescent health and development: key messages from Disease Control Priorities, 3rd Edition. The Lancet. http://dx.doi.org/10.1016/S0140-6736(17)32417-0

[3] Miguel E, Kremer M. Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities. Econometrica. 2004;72(1):159-217. doi: 10.1111/j.1468-0262.2004.00481.x.

[4] Drake L, Fernandes M, Aurino E, Kiamba J, Giyose B, Burbano C, et al. School Feeding Programs in Middle Childhood and Adolecence. In: Bundy DAP, de Silva N, Horton S, Jamison DT, Patton GC, editors. Disease Control Priorities, 3rd edition. 8. Washington DC: World Bank; 2017.

[5] Plaut D, Thomas M, Hill T, Worthington J, Fernandes M. Getting to Education Outcomes: Reviewing Evidence from Health and Education Interventions. In: Bundy D, de Silva N, Horton S, Jamison DT, Patton GC, editors. Disease Control Priorities, Third Edition (Volume 8): Child and Adolescent Health and Development. 2017. p. 307-24.