Principle 11

Childcare and support to children

"Children have the right to affordable early childhood education and care of good quality. Children have the right to protection from poverty. Children from disadvantaged backgrounds have the right to specific measures to enhance equal opportunities."

- Principle 11 of the European Pillar of Social Rights

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Childcare and support to children as determinants of health

The time between birth and compulsory primary school age is the most formative period of children's lives, impacting lifelong learning, social integration, health and wellbeing, development, and potential employability.

Childcare and services as determinants of health

Early childhood education and care (ECEC) are key health determinants. They play a significant role in reducing risky health behaviours, increasing health literacy and efficacy of self-care, and preventing chronic diseases in adulthood. Childcare can offer a health-enabling environment in which all children can benefit from healthy diets, physical activity, and psychosocial and cognitive support to set them well for life.

While in principle access to childcare may be universal, practice paints a different picture. The high cost of ECEC can generate inequalities in access. As a result, children from disadvantaged backgrounds and from families with lower socioeconomic status are less likely to attend, and when they do, the services they attend are of poorer quality.

These inequalities lead to lost potential for ECEC as an equaliser of opportunities. This, in turn, affects learning and health outcomes in subsequent years and across the life course. For example, research shows large cognitive benefits of formal childcare leading to a potential for higher earnings in adulthood, and in the US, the increase in yearly GDP due to universal pre-school attendance is estimated to be 0.16-0.44%. Indeed, the economic return on investment in ECEC is higher than that of any other time during childhood and adolescence.

Over 18 million children in the EU have grown up in poverty or social exclusion. Providing conditions which enable affordable ECEC and break the intergenerational cycle of poverty and social exclusion are essential to positive health outcomes across the life course.

Childcare and services as determinants of health
About principle 11

What does the EPSR Action Plan say?

The EPSR Action Plan sets out three key goals for EU Member States:

  • Education and care must be accessible and affordable to all young children in line with the Council Recommendation on High Quality Early Childhood Education and Care Systems (2019).

  • The number of people at risk of poverty or social exclusion should be reduced by at least 15 million by 2030, where at least 5 million should be children.

  • The provision of formal early childhood education and care should be increased to ensure that at least 78% of the population aged 20 to 64 is in employment by 2030.

Where are we now?
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Where are we now?

The Social Scoreboard measures progress on the principles of the EPSR. Linked to the principle of childcare and support to children, the Scoreboard outlines that in the EU:

  • There is a 24.2% at-risk-of-poverty rate or exclusion for children aged less than 18.

  • Only 39.3% of children aged less than 3 years are in formal childcare.

*Latest figures - 2024

What are public health actors doing?
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What are public health actors doing?

The following actions taken by public health actors at (sub)national level can support the implementation of EPSR principle 11.

Click on a country to learn about initiatives taking place.

Adverse childhood experience (ACE) support hub

The Adverse Childhood Experiences Hub, established in 2017, is funded by the Welsh Government and hosted by Public Health Wales. The hub aims to transform public services, organisations, and communities to become aware of ACEs and to be trauma informed in practice, breaking the inter-generational cycle of ACEs, adversity, and trauma across the life course.

The ACE Hub has worked with a range of sectors, including housing, policing and criminal justice, youth work services and sport.  From the outset, one of the priorities has been to support the development of a Whole School Approach to Mental Health and Wellbeing, and to ensure that every school in Wales is ACE aware, inclusive and can confidently respond to trauma, helping children to flourish and have the best start in life.

This inclusive approach has garnered impressive results, including increased pupil attendance and less exclusions and has also been adapted for use in pre-school settings. In efforts to transfer the educational system, the Hub has also produced a Trauma and ACE (TrACE) Informed Organisational Toolkit to encourage organisational self-assessment, identification of existing good practice and action plans around areas for strengthening.

More information

Wales - The ACE Childhood Experiences Hub

Bulgaria - Improving maternal and child health and early childhood development in vulnerable groups

The Bulgarian National Center of Public Health and Analysis (NCPHA) - through its dedicated Department on Child and Youth Health - is actively involved in actions which improve maternal and child health, particularly among vulnerable groups.

Have a look at the examples below for more information.

  • The "Nurse Family Partnership - Bulgaria" project
    The "Nurse Family Partnership - Bulgaria" project - a home visiting program for pregnant women and children up to 2 years of age from vulnerable groups (mainly the Roma community and families living in poverty). The NCPHA is involved in the programme's adaptation and implementation within the health system, as a service to these targeted groups. The programme is further explained in the videos linked [available in English and Bulgarian.]
  • The We Care Project
    The We Care Project aims to improve maternal and child health within vulnerable groups with a focus on Roma communities. It brings together eleven organisations in their efforts for system changes at national level in health policies with direct impact on the child's development from pregnancy until the age of 3. Experts from the NCPHA are involved in the project's advocacy initiatives, and in ensuring access to prenatal care, medicines, healthy nutrition and parental services. More information is available here.
  • The Center for Maternal and Child Health project
    The Center for Maternal and Child Health project is an innovative care model for pregnant women, also providing support to families in raising newborns and children up to age of 3 years. For the implementation of the project, a Memorandum of Understanding was signed between UNICEF, the Bulgarian Ministry of Labour and Social Policy, the Ministry of Health and others, involving the participation of multiple stakeholders.
Bulgaria - The Department on Child and Youth Health

Portugal - Fostering cross-sectoral collaboration in disease prevention

In 2019, the Portuguese National Health Service developed an integrated model for interpersonal violence prevention, implemented through the National Program for the Prevention of Violence in the Lifecycle within the Directorate-General for Health. It included health-related actions for children and youth at risk, amongst others.

This National Program was created to reinforce prevention, diagnosis, and intervention mechanisms in interpersonal violence, with special attention to persons in situations of increased vulnerability, especially in early ages. Close collaboration is fostered among health professionals, police, child protection services, educational and judicial and social protection systems.

The National Health Institute Doutor Ricardo Jorge (INSA), a public organisation of the Ministry of Health, carries out research on the health needs of children and works closely with other governmental institutions to provide such information to decision-makers.

Addressing nutrition and childhood obesity through community involvement
An example of this is the participation of the Food and Nutrition Department in the MUN-SI Programme, which coordinates municipality action, the academia and researchers from the National Institute of Health Doutor Ricardo Jorge, and the institutional support of Health and Education and Science Ministries. It is a child health promotion program that aims to reduce the prevalence of pre-obesity and childhood obesity in Portugal through community involvement. The main aim is to address and tackle childhood malnutrition in Portugal through a set of activities in which local environments can mobilize the community to adopt healthy lifestyles, also in line with the Portuguese National Health Plan on obesity prevention.

The programme is further explained in this video (in Portuguese).

Portugal - Collaboration on disease prevention

France - Health promoting strategies and preventative interventions

  • Under the new health inequalities program, France's National Public Health Agency (SpF) advocates the reduction of health inequities from early childhood. In partnership with UNICEF, SPF focuses on the inclusion health equity from early childhood is accounted in public policies, particularly with respect to air quality and mental health.
  • SpF is also developing a health promotion strategy to address the need for psychosocial skills among children, young people and adults in educational settings. This action is part of an inter-ministerial strategy.
  • SpF developed a health promotion strategy around the first 1000 days of childhood to address the need for adapted interventions which account for different socioemotional environments that may impact children and their families, upholding the principle of proportionate universalism.

Other preventative interventions are aimed at families with psychosocial vulnerability factors. For example, the Panjo programme, organises home visits during pregnancy and the first year of the child, and the French adaptation of the Family and Parenting Support Program aims to strengthen parenting skills and develop older children's (6-11 year olds) psychosocial skills.

France - Strategies and preventative interventions

Other promising practices and interventions

  • Schools4Health, an EU-funded project, ran between 2023 and 2026 and aimed to introduce, strengthen, and sustain the adoption of a health promoting schools approach. Health promoting schools integrate health and wellbeing into all of its policies and culture, creating healthy settings for living, learning and working. 
  • The DRIVERS project (EU-funded, 2012-2015) focused on improving health equity through policy and practice, including early childhood development.
  • The Right Start to a Healthy Life (GRADIENT), an EU-funded project that ran between 2009 and 2012, focused on levelling up the health gradient among children, young people and families in the EU.
  • CHAIN, the Centre for Health Equity Analysis, has extensively studied the links between education and health using data from the Global Burden of Disease study. It found that every year of education reduces inequality with 2%. The findings have been summarised in fact sheets on the associations between parental education and child mortality and one's own education and mortality rates.
Other promising practices and interventions
What EU tools are out there?

EU tools that help implement Principle 11

There is a range of other policies and instruments at the EU level that can help relevant actors in the field, including public health, to work together to achieve EPSR Principle 11 on Childcare and Support to Children. 

Since the launch of the new EU priority agenda 2024-2029, EU action has increasingly emphasised integrated child protection, stronger monitoring and accountability, and a safer digital environment for children. 

More information about the EU institutions and programmes is available on EuroHealthNet's Health Inequalities Portal.

Read about EU funding and contact points
The EU Strategy on the Rights of the Child The European Child Guarantee Early childhood education and care systems The European Care Strategy WHO/Europe Strategy for Child and Adolescent Health and Well-being 2026–2030 Combatting violence against women and domestic violence Protecting minors under the Digital Service Act
The EU Strategy on the Rights of the Child

The EU Strategy on the Rights of the Child invites Member States to:

  • Prioritise children in national mental health strategies and build networks to support their mental wellbeing including through stronger links with the EU’s comprehensive approach to mental health.
  • Invest in more effective violence prevention and protection measures; provide adequate support to vulnerable children who suffer violence and strengthen integrated child protection systems across sectors (health, education, social services and justice).
  • Adopt legislation to ban corporal punishment in all settings.
  • Improve the functioning of child protection systems at the national level and reinforce governance, coordination and professional capacity for child protection.
  • Create a safe digital environment for children through effective and equal access to digital tools, digital and media literacy, accessible online educational tools and strengthened online safety measures, including implementation of EU rules on online platforms and the protection of minors.
  • Promote national strategies which move towards quality, family- and community-based care services.
The European Child Guarantee
Early childhood education and care systems
The European Care Strategy
WHO/Europe Strategy for Child and Adolescent Health and Well-being 2026–2030
Combatting violence against women and domestic violence
Protecting minors under the Digital Service Act

Available resources

For more supportive policy instruments on the topic, consult our other flashcards:

Available EU funding

Available EU funding

Contact points for further assistance

Contact points for further assistance

Technical resources

Technical resources
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Have your say

Would you like to share promising policies or practices carried out by your public health institute, which support the implementation of this EPSR principle?

Feel free to reach out to our EuroHealthNet colleague Silvia Ganzerla.

What's next?

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EuroHealthNet is the Partnership of public health agencies and organisations building a healthier future for all by addressing the determinants of health and reducing inequalities. Our focus is on preventing disease and promoting good health by looking within and beyond the health system.

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