Laying the Foundation for a Healthy Life
A healthy beginning sets the stage for health and well-being for a person’s entire life. These indicators represent important dimensions of children’s health and well-being from infancy through the teenage years. As a society, we can work together to ensure all our children have the opportunity to thrive and reach their full potential.
Goal Highlights
Healthy Beginnings Indicators
California’s infant mortality rate is one of the lowest in the nation.1
Infant mortality is an important indicator of the overall health of the population. The infant mortality rate is a highly sensitive measure of population health because there is an association between the causes of infant mortality and other factors that influence the health status of entire populations such as economic development, general living conditions, social well-being, rates of illness, quality and access to medical care, public health practices, and quality of the environment.
California has one of the lowest mortality infant rates in the nation. However, significant disparities persist, with respect to race and ethnicity, geography, and other socio-demographic characteristics. Reducing infant deaths is complex, requiring wide-ranging approaches and cross-sector collaborations.
This indicator tracks the number of deaths in infants under one year of age per 1,000 live births.
Safe Births. Healthy Parents and Babies.
Although most pregnant individuals can have vaginal births, surgical delivery (cesarean section, or C-section) is an appropriate method when vaginal delivery carries risk for the fetus and/or the pregnant individual. Cesarean delivery is a major abdominal surgery with short- and long-term risks and consequences, such as surgical complications, admission of the infant to neonatal intensive care, longer recovery period, increased health risk for future pregnancies and births, and high medical costs. There is strong clinical evidence that many pregnant Californians undergo procedures such as C-sections, repeat C-sections, and labor inductions that may not be medically necessary.1
Deliveries that result in first-time, full-term (37 or more weeks gestation), one fetus (singleton), headfirst (vertex) live births are considered low-risk. Among these, cesarean deliveries may pose avoidable risks of significant short- and long-term maternal health complications or death that can compound with subsequent cesarean deliveries.2
This indicator tracks the low-risk cesarean birth rate, in an effort to reduce the rates of medically unnecessary cesarean deliveries.
Breastfeeding helps build the foundation for a healthy life, providing benefits for infants and breastfeeding parents
Although most newborns breastfeed (or receive breast milk) during their first day of life, few are exclusively breastfeeding at six months old. Breast milk contains nutrients, antibodies, and other essential ingredients that protect infants from infections and promote brain development and digestive health. Over the life course, those who were breastfed have reduced risks of ear infections, asthma, childhood obesity, and type 2 diabetes. Breastfeeding parents have reduced recovery time after delivery and, over the life course, lower risks of ovarian and breast cancer, high blood pressure, and type 2 diabetes.
The American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months, with continued breastfeeding for at least two years or beyond, balanced with the introduction of foods. Exclusive breastfeeding consists of only breast milk, without any additional food or liquids, not even water.1,2
This indicator tracks exclusive breastfeeding at 3 months postpartum.
Vaccines: defense against infectious diseases1
One of public health’s greatest accomplishments is the development of vaccines. Vaccinations help keep children from getting certain dangerous preventable diseases, while also greatly decreasing the spread of diseases among children. California continues to work to improve the uptake of child vaccinations, however false information and fears surrounding the long-term effect and dangers of vaccinations represent major barriers. Despite recent challenges including public protests, progress continues to be made through collaboration between parents, childcare providers, medical providers, and other key stakeholders.
This indicator tracks the percentage of children (by birth year) who have received the recommended combination vaccinations by 35 Months.
Adverse childhood experiences have a lasting, harmful effect on health and wellbeing.1
Adverse Childhood Experiences (ACEs) affect nearly two million children in California across socioeconomic lines, putting them at risk for health, behavioral, and learning problems.2 ACEs are traumatic childhood experiences – which include abuse, neglect, and being exposed to violence, mental illness, divorce, substance abuse, or criminal activity in the home – that often leave people more vulnerable to environments and behaviors that can lead to poor health. The more ACEs an individual has experienced, the higher their risk climbs.3
The National Survey of Children’s Health (NSCH) tracks the percent of California children who have experienced ACEs. It uses a set of questions on family, economic, and community adversity to ask parents about current adverse experiences to which their children have been exposed. This population-based survey measures adversity among California children by asking parents about the trauma their children have experienced while they are still children, compared to methods that ask adults to recall their childhood experiences, such as adult retrospective data from the California Behavioral Risk Factor Surveillance System (BRFSS).2,4
Reducing child maltreatment is a public health goal1
Neglect, physical, sexual, and emotional abuse, and intentional violation of custody agreements are types of child maltreatment. Experiencing child maltreatment can lead to poor physical and mental health throughout life.1 During childhood, children who experienced maltreatment are more likely to exhibit anxious, depressed, withdrawn, and aggressive behaviors,2 and poor emotional, social, and school functioning.3 As they reach adolescence and adulthood, individuals who experienced maltreatment during childhood are more likely to report having poor mental health, problematic substance use behaviors,4 and chronic conditions such as asthma, diabetes, and chronic pain.5
An allegation of child maltreatment is a suspected case of child abuse that is reported to Child Protective Services (CPS). A substantiated allegation is an investigated case of suspected child abuse where investigators decided that maltreatment took place.
This indicator tracks the number of substantiated allegations of child maltreatment per 1,000 children.
Early developmental and educational opportunities impact later educational performance.1
Overall school readiness refers to how prepared a child is to succeed in school cognitively, socially, and emotionally. Since young children’s early experiences influence brain development that can set the stage for future development and success in school and life, tracking readiness can be representative for many other non-health determinants.2
Although there is currently no indicator to measure levels of overall school readiness, this has been identified as an opportunity for further data development to monitor this priority area of attention.
Early learning sets the foundation for success1
Studies have consistently demonstrated that people with high literacy levels are more likely to experience positive health outcomes, have greater health information fluency, and practice health-promoting behaviors.2
Students with limited reading abilities have a harder time keeping up across multiple subjects (including math, science, and other languages), and those who fall behind in the early grades often stay behind. Educational attainment is associated with better quality of life and longer life expectancy, and students who have fallen behind by the end of 3rd grade are less likely to finish high school or attend college. Thus, early intervention is critical for children who struggle with reading to promote health over their life course.1,3,4,5,6
This indicator tracks the percentage of 3rd grade students who read at or above the proficient level standards.
Emotional and mental well-being are integral to overall health
Physical health and mental health are closely related. This indicator measures the percent of students in 7th, 9th, and 11th grade that have constant feelings of sadness or hopelessness, with the aim of reducing their frequency. Supporting positive mental health for young people is one critical element preparing them for healthy lives.2
Learn More » about Decreasing Frequency of Sad or Hopeless Feelings in Youth
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