Q & A Janet M. Currie

Janet Currie studies the importance of fetal and early childhood development from an economics perspective, along with the cost effectiveness of interventions during these critical life stages. Her decades of work show how poverty and anti-poverty policies can affect the lifelong health and well-being of children. Her work contributes to the range of innovative solutions recognized previously by the Prize to improve learning, development and living conditions for children and youth globally.

What have been your largest contributions to the study of child/youth development?

I have been the leading contributor to a new research literature that focuses on the economics of childhood, showing that investing in children really does have a positive long-term impact at the societal level. For example, in a 1993 article, I showed that welfare payments under the U.S. Aid to Families with Dependent Children program, was an important factor in increasing birth weight among children born to mothers receiving the aid, with birth weight being an important indicator of child health and the risk of learning disabilities later in life. Then, using birth and death records as sources of data, I developed methods to identify how early childhood interventions including welfare payments, health insurance, and pollution prevention can reduce low birth weights, which in turn lowers the risk of developing diabetes, obesity, asthma and ADHD later in life.

How has your research been applied so far in the public sphere?

The Head Start program is a federal program in the United States that provides early childhood development, education and family support services to lower-income families with children ages 0 to 5. Prior to my work with Duncan Thomas of Duke University on this program, most research had focused only on test scores and suggested that Head Start kids ended up with the same test scores three years later as those who didn’t participate in the program, an observation referred to as “fade out.” I demonstrated that fade out was related to the quality of subsequent schooling, meaning that children who received poor quality education after Head Start saw the positive impact of the Head Start intervention on test scores disappear. More importantly, in the long term, regardless of effects on test scores, disadvantaged children who attended Head Start had a greater chance of completing high school and a lower chance of committing crimes. This work contributed to an explosion of interest in the expansion of early childhood education in the United States and other countries, including the United Kingdom.

My research with Jonathan Gruber of the Massachusetts Institute of Technology on the effects of expanding public health insurance for pregnant women and children in the 1990s has been influential, particularly during the run-up to the U.S. Affordable Care Act that was passed in 2010. This work provided the first evidence that public health insurance reduced infant and child mortality and improved child health. It inspired subsequent studies examining the longer-term effects of expanding public insurance, which have demonstrated that public health insurance for pregnant women and children is one of the most cost-effective social interventions when it comes to mitigating the impact of maternal poverty on child health, education, and future labor market performance.

You have led several studies looking at the impacts of even low levels of pollution on the health of pregnant women and newborns. Can you describe one of them?

In a 2011 study I worked on with Reed Walker of the University of California, Berkeley, we looked at babies born in New Jersey and Pennsylvania, focusing on mothers who lived near highway toll plazas before and after E-ZPass (an electronic toll collection system) began operating. We compared these mothers to mothers who lived a little farther from the toll plazas but along the same busy highways. Before E-ZPass, the mothers near the toll plazas were exposed to more pollution because cars idled while waiting to pay the tolls. E-ZPass greatly reduced pollution right around the toll plaza. Startlingly, the introduction of E-ZPass reduced the incidence of low birth weight and prematurity by more than 10% in the neighborhoods nearest the toll plazas.

Why have you decided to focus now on child and adolescent mental health and interventions?

According to the World Health Organization, one in seven children aged 10-19 suffers from a mental health disorder, but often these disorders are unrecognized and untreated. These children are at risk of school failure and dropout, future unemployment, substance abuse, and suicide. In fact, suicide is a leading cause of death in this age group. The COVID-19 pandemic has led to an increased recognition of the youth mental health crisis, as well as the burden it places on schools and educators, although the crisis predated the pandemic. One positive outcome of the pandemic may be that there is now less stigma associated with mental illness and more discussion of youth mental health and ways to address it, including through the school system. I aim to contribute to that discussion and to the destigmatization of mental illness through my research and through training the next generation of researchers.

With regard to child and adolescent mental health, where are there gaps in the current research, and how will you fill those gaps?

Adolescence is a critical period in development, and many mental health problems first manifest in adolescence. Receiving early, effective treatment is essential to help children reach their adult potential. I have been working since 2006 to document the extent of mental health disorders in children and adolescents, the short- and long-term consequences of these illnesses. Inappropriate treatments increase negative health outcomes and costs. One particular problem is that it is normal for adolescents to spend most of their time in school, yet most schools are ill-equipped to serve children with mental health needs.

What are some of your future research goals?

In the next five years, I will conduct research focusing on interventions designed to improve child mental health. I will try to understand why clinicians make inappropriate treatment decisions and examine the extent to which training, guidelines, or algorithmic decision-making tools can help to improve treatment and outcomes.

I also want to examine how changing the school environment can affect child mental health at the population level. I’ll look at the impact of school-based mental health providers and programs, as well as anti-bullying regulations and training. Another important question is how high-stakes testing affects mental health and whether there are ways to alleviate the burden.