Population Approaches to Promoting Relational Health From Early Life.

In this paper we provide an integrative synthesis of eight systematic reviews that compromise our systematic review series entitled ‘Population Perspectives on Nurturing Relational Health from Early Life’. We reflect on what we know, what we don’t know, and what we need to know to better safeguard the interpersonal world of the child. Our review series brings forth evidence addressing a fundamental question: How do we create the basis for optimal development of relational skills that enable humans to establish trust, regulate their emotions, engage in exploratory behaviour, communicate effectively, apply introspection, and be more self-efficacious in meeting opportunities and challenges. The collaborating authors provide a unique opportunity to view the current status of this evidence across the bioecology of early human development. They find that our current view of relational health is limited. Much of the extant evidence is concentrated in the microsystem of early life, and it is overly focussed on the mother-infant dyad. Intergenerational findings from longitudinal cohorts point to additional influences on early relational health prior to conception extending back into the life histories of parents; however, these data remain exceptionally rare. There are also immense gaps in cross-cultural applications and extensions that measure, describe and inform the developmental model of relational health along with a glaring and urgent gap in the impacts of the digital social ecology on relational health. Pleasingly, evaluated interventions to promote and influence relational health exist and some are being implemented at scale. However, the outcomes of implementation are almost an after-thought in evaluation designs. We conclude by reflecting on the challenges faced by researchers, governments, policy makers, and agencies in moving relational interventions to scale, and particularly the challenges posed to their onward sustainability, in place, and more universally.