Health and development from preconception to 20 years of age and human capital

Optimal health and development from preconception to adulthood are critical for human flourishing and the formation of human capital. The Nurturing Care Framework, as adapted to age 20 years, conceptualizes the major influences during periods of development from pre-conception, through pregnancy, childhood and adolescence that affect human capital. In addition to mortality in children under five years of age, it is important to consider earlier (stillbirths) or later (from five to 20 years) loss of life. The global rate of mortality before 20 years has declined substantially since 2000, yet in 2019 an estimated 8·6 million deaths occurred between 28 weeks of gestation and 20 years of age, with over half, including stillbirths, occurring before 28 days of age. The 1,000 days from pre-conception to two years are especially influential for human capital. The prevalence of low birth weight is high in sub-Saharan Africa and even higher in South Asia. Growth faltering, especially from birth to two years of age, occurs in most world regions while overweight increases in many regions from the pre-primary school period through adolescence. Analyses of cohort data show that growth trajectories in early years of life are strong determinants of nutritional outcomes in adulthood.The accrual of knowledge and skills is affected by health, nutrition and home resources in early childhood and by educational opportunities. Linear growth in the first two years of life better predicts intelligence quotients among adults than increases in height in older children and adolescents. Learning-adjusted years of schooling range from about four years for sub-Saharan Africa to about 11 years in high-income countries. Human capital depends on children and adolescents surviving, thriving and learning until adulthood.