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The principles of Nurturing Care promote human capital and mitigate adversities from preconception through adolescence
  1. Maureen M Black1,2,
  2. Jere R Behrman3,4,
  3. Bernadette Daelmans5,
  4. Elizabeth L Prado6,
  5. Linda Richter7,
  6. Mark Tomlinson8,9,
  7. Angela C B Trude1,
  8. Donald Wertlieb10,
  9. Alice J Wuermli11,
  10. Hirokazu Yoshikawa11
  1. 1Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2RTI International, Research Triangle Park, North Carolina, USA
  3. 3Department of Economics, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, USA
  4. 4Population Studies Center, University of Pennsylvania School of Arts and Sciences, Philadelphia, Pennsylvania, USA
  5. 5Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
  6. 6Nutrition, University of California Davis, Davis, California, USA
  7. 7Centre of Wxcellence in Human Development, University of the Witwatersrand, Johannesburg, Soutn Africa
  8. 8Global Health, Stellenbosch University, Cape Town, South Africa
  9. 9School of Nursing and Midwifery, Queens University, Belfast, UK
  10. 10Eliot-Pearson Department of Child Study and Human Development, Tufts University, Medford, Massachusetts, USA
  11. 11Global TIES for Children, New York University, New York, New York, USA
  1. Correspondence to Dr Maureen M Black; mblack{at}


A comprehensive evidence-based framework is needed to guide policies and programmes that enable children and adolescents to accrue the human capital required to meet the Sustainable Development Goals (SDGs). This paper proposes a comprehensive, multisectoral, multilevel life-course conceptualisation of human capital development by building on the Nurturing Care Framework (NCF), originally developed for the foundational period of growth and development through the age 3 years. Nurturing care (NC) comprises stable environments that promote children’s health and nutrition, protect from threats, and provide opportunities for learning and responsive, emotionally supportive and developmentally enriching relationships. NC is fostered by families, communities, services, national policies and beyond. The principles apply across the life course, endorse equity and human rights, and promote long-term human capital. This paper presents an evidence-based argument for the extension of the NCF from preconception through adolescence (0–20 years), organised into six developmental periods: preconception/prenatal, newborn/birth, infancy/toddlerhood, preschool, middle childhood and adolescence. The proposed framework advances human capital within each developmental period by promoting resilience and adaptive developmental trajectories while mitigating negative consequences of adversities.

Attaining the SDGs depends on strengthening human capital formation, extending throughout childhood and adolescence and supported by NC. Embedded in enabling laws, policies and services, the dynamic NCF components can mitigate adversities, enhance resilience and promote the well-being of marginalised groups. The life-course extension of the NCF is strategically positioned to enhance human capital, to attain the SDGs and to ensure that children or adolescents are not left behind in reaching their developmental potential.

  • child health

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  • Handling editor Seye Abimbola

  • Contributors MMB conceived the manuscript and organised the preparation. JRB, BD, ELP, LR, MT, ACBT, DW, AJW and HY contributed equally. All authors researched and wrote sections, contributed to the interpretation, reviewed and revised sections of the manuscript and approved the final version.

  • Funding The study was supported by a grant from The Bill and Melinda Gates Foundation (OPP 1148933). Individual funding was received from the National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK107761) (MMB and ACBT), the National Institute of Child Health and Development (R21 HD097576) (JRB), NYU Abu Dhabi Research Institute (HY and AW); the Wellcome Trust (077210/Z/05/Z) (LR), the University of the Witwatersrand, the South African Medical Research Council (LR).

  • Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.