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 opportunity for ECEC as a potential 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 of 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 determinant 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 (0-17).

  • Only 32.3% of children aged less than 3 years are in formal childcare - Latest figures (2020).

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 - ACE support 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.
 
Bulgarian 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 interventions on health action for children and youth at risk, among 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 - fostering collaboration

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

Other promising practices and interventions
What EU tools are out there?

EU tools that help implement Principle 11

There are EU policies and instruments 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.

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

More about the EPSR as a tool for regional and national action

The EPSR can be a strategic tool to shed light on national or subnational priorities on childcare and support to children. It could in turn highlight possible entry points for public health professionals within existing initiatives and resources created as a result of other EU instruments and encourage strategic linkages between public health and non-health stakeholders.

In view of the already overstretched capacities of the health sector, the EPSR could be an underpinning framework in promoting integrated approaches - giving public health elevated importance in the sectors which deal with the social determinants of health and embedding the public health agenda in different fora.

More about the EPSR as a tool for regional and national action
The EU Strategy on the Rights of the Child
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.
  • Invest in more effective violence prevention and protection measures; provide adequate support to vulnerable children who suffer violence.
  • Adopt legislation to ban corporal punishment in all settings.
  • Improve the functioning of child protection systems at national level.
  • Create a safe digital environment for children through effective and equal access to digital tools, digital and media literacy, accessible online educational tools.
  • Promote national strategies which move towards quality, family- and community-based care services.
The European Child Guarantee
Council Recommendation on High-quality Early Childhood Education and Care Systems
The European Care Strategy
Revision of the 2002 Barcelona Targets
Read about EU funding and contact points

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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