In Part 4, we build on the analyses in Part 3 by presenting some strategic perspectives and describing specific initiatives, each of which focuses on the issue of constructing new social alignments to support child development. Although the focus of each is quite specific in terms of the population it serves or the problems it addresses, principles emerge which help understand the significance of the changing ecologies of child development and how we might begin to address them.
By focusing on the public health approach to adolescent mental health problems, Chapter 15 by Dan Offord, Helena Chmura Kraemer, Alan Kazdin, Peter Jensen, Richard Harrington, and Sam Gardner highlights the limitations, as well as the opportunities, for "compensatory strategies" in child development. It identifies the strategic problems created by the fact of high "relative" risks among relatively small segments of the population, compared with lower relative risk among broader segments of the population (which lead to higher "attributable" risks and, thus, greater public health impact overall). A strategy for sorting out the best mix of universal, targeted, and clinical interventions in a given community is a challenging task, and one which requires effective monitoring of outcomes at the community level.
Focusing on a coordinated community program to enhance child development in poor urban communities, Camil Bouchard illustrates in Chapter 16 the crucial connections between support for child development and promotion of community development. Taken together, chapters 16 and 17 illustrate ways that the notion of a learning society can be incorporated in the North American context.
In Chapter 17, Alan Pence describes efforts to support child development in Aboriginal communities. He deals with the inevitable tensions between expert-driven versus community-driven processes where the experts and the community do not share a common culture. A learning society will need to deal effectively with issues of diversity, and this treatment offers some important object lessons in that regard.
In Chapter 18, Daniel Keating returns to the initial question for this volume: How can modern societies best deal with the paradox of great capacity for generating wealth versus growing threats to developmental health? Drawing on the evidence described throughout the volume, he identifies three major themes which may help resolve the paradox, both conceptually and practically. First, given what we know about socioeconomic gradients and the innovation dynamic of economies in the emerging information age, we can usefully entertain a new conception of the "wealth of nations," one which is rooted in the developmental health of populations. Second, enhancing developmental health requires a deep understanding of the core dynamics of human development, from biology to society. Third, the prospects for societal adaptability, in a period of rapid change, depend upon the ability to become learning societies. Although we cannot draw a blueprint for designing a learning society, because it is a dynamic system, we can specify some key principles which may help to guide its construction.