The Brain Architects Podcast: Connecting Health & Learning Part II: The Implications

Sally: Welcome to the Brain Architects, a podcast from the Center on the Developing Child at Harvard University. I’m your host, Sally Pfitzer. Our Center believes that advances in science can provide a powerful source of new ideas that can improve outcomes for children and families. We want to help you apply the science of early childhood development to your everyday interactions with children and take what you’re hearing from our experts and panels and apply it to your everyday work. Today, we’ll discuss how the science we shared in our previous episode, on the early years and lifelong health, can change the way we think about early childhood policy and practice, and what this shift means for policymakers, practitioners, and caregivers. So, I’d like to welcome back Dr. Jack Shonkoff, Professor of Child Health and Development and the Director of the Center on the Developing Child at Harvard University. Hi, Jack. Welcome back. Jack:Hey, Sally. Sally:  So we talked in the last episode about how the brain is connected to the rest of the body, and especially how the early years really matter when it comes to lifelong health. What does this science mean for policymakers, system leaders, or even caregivers? Jack: That’s a really important question, Sally. From the beginning of the early childhood field, it’s always been focused on early learning and improving children’s readiness to succeed in school. In the policy world, it’s in education policy, comes out of the education budget. For people who work in early childhood programs, and for parents, it’s about programs that encourage and provide rich learning opportunities for children to develop early literacy competencies. But the mindset shift here is that it’s not just about early learning in school—it’s about the foundations of physical and mental health. It’s not just about improving outcomes for greater economic productivity—better educational achievement. It’s also about decreasing the likelihood that you’ll develop heart disease or hypertension, or diabetes, or a wide range of the most common chronic illnesses in society. It’s not just a matter of return on investment—asking “So, how much more economically productive will the population be? How much will we save in incarceration?” It’s also how much will we save in the cost of health care. Sally: We’ve previously discussed the coronavirus pandemic, as well as the national reckoning regarding systemic racism, and the impact that this current climate has on children and families. Could you talk about how both of those issues are playing out in the context of policy and systems change? Jack:From a science point of view, disparities in health outcomes is not a new discovery. But from a public understanding point of view, the COVID-19 epidemic and its gross inequalities in exposure and in infection and in complications and in deaths has really put front and center the incredibly important impact of systemic racism and interpersonal discrimination as it affects health. We know that more people of color, particularly African Americans—but also Latino and Indigenous populations—have greater exposure to the infection because of working in jobs that cannot be done at home, more reliance on public transportation, tighter housing circumstances—all of which make it more difficult to be protected from exposure to the infection.  But what’s getting less attention is not just rates of exposure and infection, but also rates of complications. We do know that of those people who are infected, people with underlying medical conditions are more likely to be sicker, and in many cases, more likely to die from the infection. And those underlying conditions are not equally distributed across the population. And they are particularly a higher prevalence in populations of color and in people who have grown up in poverty. And here, what this new science is telling us is: this is not about adult exposure. These diseases have their roots early in childhood. They have their origins in excessive stress activation—excessive adversity—related to poverty, related to racism, related to exposure to violence, related to unstable housing, and related to food insecurity, all of which present tremendous burdens for families raising young children that increase the risk for excessive stress activation, which early on in life—doesn’t always affect—but can affect brain development, the development of the immune system, development of metabolic systems.  On the one hand, the impacts of racism belong on the list of a lot of other sources of stress for families. But on the other hand, there are burdens and hardships that are unique to experiencing racism that we have to start to come to grips with in a very different way.  If we don’t protect children from that, if we don’t provide the support for families to be able to help protect their children from the stresses in the environments in which they live, then what we see is over time, not only influences on early learning affecting readiness to succeed in school, but greater likelihood to have many of these chronic diseases later in life. And this is a rude awakening and an opportunity for the early childhood field to focus much more not just on early learning and school readiness, but to focus on the early origins of lifelong health problems, both physically and mentally. Sally: I completely agree with that Jack. And I’d also say that it’s so important that people at the policy and systems level work directly with families who are experiencing these stressors just to make sure they really understand their perspectives and their needs. And up next, Jack’s going to answer a question that’s been submitted by one of our listeners.  Musical interlude Sally: And we’re back! For this segment, we asked audience members who listened to the podcast to send in any questions they may have for Jack. Today’s question involves the role of significant stress on our abilities to use core life skills—the skills that help us manage information, make decisions, and plan ahead to make healthier long-term choices or avoid impulsive risks, reduce stress, and ultimately improve health. Today’s question comes from a listener named Abbi Wright. Abbi: My name is Abbi Wright, and I’m a first-year graduate student at Oklahoma State University studying speech language pathology. And my question for Dr. Shonkoff is: how does strengthening core life skills in children affect lifelong health? How can we strengthen those skills in families that are especially vulnerable because of immigration status or racism? Jack: So that’s a really important question, Abbi. Let me try to answer in the following way. Building core skills is part of a strong foundation of resilience that will help you deal with stresses and engage in more health promoting behavior over your life course and further decrease the risk for disease. For young children, strengthening those skills helps to build coping capacities. That helps bring the stress response down so that when these systems are developing very early on, they’re not being disrupted. One of the things that we are beginning to understand in a much clearer way is that reducing excessive stress activation in the early childhood period helps to protect all these developing biological systems that not only affect learning, but also affect physical and mental health.  Part of the way that we reduce stress activation in young children is by the adults who care for them to provide a sense of safety and security and buffer children from the stresses that are present in the lives of their caregivers. Families are experiencing significant stress. The pressures are greater to be able to provide that sense of safety for children—help them build their own coping skills. We know that some groups are particularly at risk, not for their ability to be good parents, but for the level of threat and hardship and burden that is imposed on families because of structural inequities in our society. Systemic racism is one obvious example. Immigrant families in the United States right now are another good example of families who are dealing with more than the usual amount of stress because even for immigrants whose legal status is not in question, there is an atmosphere of anxiety and threat and concern about the discrimination experienced by many immigrant families. So, the basic biology is the same regardless of your life circumstances. The level of threat—the level of hardship—varies based less on parents’ abilities to help build skills in their children, but more in terms of how much of an external burden of hardship and threat is imposed on families in their everyday lives raising their young children. Sally: Thanks, Jack. And thank you, Abbi, for that thought provoking question. Up next, our panel will talk more about the implications of this new science for people across the early childhood field.  Musical interlude  Sally:  So, on today’s podcast, we have with us Dr. Aaliyah Samuel. She’s the Executive Vice President of Government Affairs and Partnerships at Northwest Evaluation Association, and a Senior Fellow at the Center on the Developing Child. Thanks for being here today, Aaliyah. Aaliyah: Thanks so much, Sally, for having me. I’m really looking forward to the conversation today. Sally: Also joining us on today’s podcast, we have Cindy Mann, partner at Manatt Health and former Deputy Administrator at the Centers for Medicare and Medicaid Services, and former Director of the Center for Medicaid and CHIP services. Hi, Cindy, great to have you with us. Cindy: It’s a pleasure. Thanks so much for including me. Sally: And also, on today’s podcast, we have Jane Witowski. State Director of Help Me Grow South Carolina. Thanks for joining us, Jane. Jane:  Thanks so much. I’m happy to join the group today for this very important conversation. Sally: My first question is for you, Aaliyah. Could you discuss the policy silos in state and federal government? What mindsets have shaped the current policy landscape? Aaliyah: I will say one of the fundamental challenges is really the cross and inter-agency communication. It’s just really important both at the federal level and as well as the state and local level, that we get individuals that represent multiple systems to come to the table and have conversations. That is how we can start to really think about how to blend and braid funding to ensure that we get the maximum number of families—children—getting access to these programs. We have seen the evolution over really the last I would say five to 10 years, where it has moved from early childhood being a woman’s issue to a workforce issue and a non-partisan issue. When I was Director at the National Governors Association of the Education Division, we watched the 2018 gubernatorial campaigns very closely. And of the 36 governors that were running at the time, there was not one that did not make a reference to early childhood and its importance to some degree. So, I can say that early childhood and this issue around childcare, families, our youngest citizens, is truly a non-partisan issue, which I think is important to underscore because it creates a recognition that it doesn’t matter what side of the aisle you’re on, this is an important issue. I think too as we talk about some of the mindsets or even the current policy landscape, I will say, one of the things COVID has really done is exposed the inequities that were hidden in plain sight. We can’t ignore the data, we can’t ignore the disparities, we can’t ignore the communities and individuals and families that have been hit the hardest, and who have historically been hit the hardest, and will also have the most challenges recovering from the pandemic and all that’s come with it. I think, ultimately, what is really lacking is the voice of those who are impacted the most. I heard a quote once, that I really do believe, which says, don’t do anything for us without us. I think as we start to really think about reshaping the policy landscape to address some of these inequities, we need to make sure that there is diversity at the table of decision makers, but also those who will be impacted the most, and making sure that we’re underscoring their voices.  Sally: Yeah, that’s such a great point, and leads into my next question for you, Cindy. Can you speak about the policies affecting prenatal to three? Cindy: Let me just start by underscoring a point, which is that the country is moving in this direction. I’m seeing all across the country, movements in pediatric practice, in health care, in Medicaid programs, in state government, in local communities along these paths. So, I really do think these are all achievable. Everybody has to have access to health care coverage. Start there. That is not the case now. And while children are more likely to be covered than other groups, the rate of insurance for children has been dropping in the last couple of years. And mostly, they’ve been dropped off in Medicaid and not picked up elsewhere, and there’s a lot of different reasons for that. There’s also groups of children who because of their immigration status are just not eligible for coverage. Also, one of the I think really important tenets of good pediatric practice is to make sure that parents’ needs are met as well. We also have a number of states that have not extended Medicaid to low-income parents, and that really disenfranchises the family in terms of being able to access the kind of care that families need to make kids strong and healthy. Some of the other policy issues that need to happen are, is to really begin to integrate behavioral health and physical health. Those two worlds have lived often in very separate silos. That’s not how kids live, that’s not how families live. We need attention to the social and economic needs of families as a very integrated way of addressing those issues in the practice of the provision of health care coverage. A real focus on equity throughout all of the policies that we’re moving forward. As Aaliyah said, there’s no secret to the fact that we have significant structural racism and disparities based on race, and COVID has laid bare and put that, again, in our face, and we need to do something about it. And it really does take a very intentional focus on trying to address disparities to deal with it. We also have a financing issue. So much of the recent investments around social determinants—help with homelessness, help with hunger—have been driven by this perception of a return on investment to the healthcare sector. Well, that mostly leaves kids out, because while there is a market return on investment if you invest in young children’s health care, that return doesn’t always happen in a very short period of time, and that return also sometimes happens to other parts of our system. To our education system, to our juvenile justice system, to our child welfare system. So, we need a way of really having cross-sector collaboration in the design and in the financing of the full range of services for kids. Sally: And Jane, I’m wondering if you could speak to us from the healthcare and community service perspective, how do the families you work with feel about the policies in early childhood? Is there a sense that change is needed? Jane:  Sure. I would characterize the mindset as hopeful and encouraged. And what I’ve experienced is a real desire to work together across sector, and was pleased to hear Cindy bring that up as one of her last points in that cross-sector collaboration how necessary it is. And I’ve seen that at the local level and at the state level. However, it’s accompanied by a real frustration about how to go about it. There’s still a lot of confusion, and also barriers. When providers are faced with funding restrictions, staff capacity, regulatory mandates, and still this mindset of needing to stay in your lane. One of the reasons that I’m hopeful is the Help Me Grow system, which 20 years ago was seen as an innovation and an opportunity to bring together those service providers with the common goal of meeting family’s needs. And so, I’ve seen how it can allow service providers to break down those barriers, and to help make connections that are really meaningful for families. Aaliyah: Sally, can I just chime in here? Jane, when you said the flexibility, particularly in the regulations and staff capacity that is so spot on. I do a lot of advocacy work both at the federal and state level. One of the things we are advocating hard on is allowing for flexibility in the regulation so that at the community level, the funds can be used in the way that best fits the community needs. We fundamentally have to take a step back and stop being so prescriptive on what we think communities need, and create the funding structure to then package it to a community to make the changes and provide the supports that they need. And also, it’s ironic when you mentioned the innovation piece or staff capacity. It’s so hard to be innovative when you’re pumping out reports, when you’re seeing families one after another. And so, we have to think about how do we create the place and space for innovation to happen. And that takes time, that takes time to plan, it takes time to collaborate across systems. We can’t keep expecting do what you’re doing with no additional funds or support, and then be innovative on top of that. It just doesn’t happen that way. And you can have the most well-intended people who have the passion and the ideas to innovate, but if they don’t have the capacity it’s not going to happen.  Cindy: I’d love to jump in on this part of the conversation as well. Another important point is to build the infrastructure in the community to be able to help connect people—health care sector—to community-based organizations and other resources. You can’t expect that a pediatrician is going to figure out where to send their families if they’re homeless or if they’re hungry. Or maybe you can send them, but you can’t necessarily do the follow up that’s needed to make sure that those needs get met. So, increasingly different communities are coming up with and states coming up with integrator organizations. They can be Accountable Communities of Health, is what Washington state calls them. North Carolina is planning to set up lead entities to help coordinate community-based organizations in certain regions and connect them to the healthcare sector. So, we absolutely can’t do this just on the fly. We’ve got to create systems—systems of financing and systems of working together—that are adequately funded so that this can work. And let me just also underscore a point made before that I neglected to raise, which I so firmly believe in the importance of families being not only at the table, but really in leadership to really figure out what those priorities are, and whether the system is working well, and whether the system is not working well. So, both at the policy table, and then as real time monitors of how well the system is working for kids. Sally: How can policies change to address the stressors inflicted by poverty, community violence, and racism?  Aaliyah:  First, we have to acknowledge that they exist. That has to be step one. The stressors, the impacts of racism, bias, violence. What is real to someone who exists and has to exist in those communities, versus those who only have a perception based off of what their realities are, what their community is. It creates that disconnect. And the realities of families at all levels are different, and we have to acknowledge that. We can’t turn a blind eye, we can’t say, well, I’ve never seen it, so, I don’t think that that’s true. I will say—I’ll give a personal example. I have two sons, but my youngest son has some really significant health care needs. I didn’t understand the challenges of being a mom with a child with special healthcare needs until I had one. I was an educator, I have a master’s degree in special education. But it’s very different when it’s your child and you’re trying to navigate the education system, the health care system, and advocate for your child who is struggling. There’s two parts. One, policymakers have to be more intentional in bringing in the voices of the people most proximate to these issues. And really include their voices, not just into the considerations, but into the actual decision making. I also think from the community aspect, we really have to hone in and recognize that policymakers work for us. They work for us. And it is okay as a community to stand up and require our policymakers to not only adhere to their campaign promises or challenges within the community, but recognizing that in their role, it is their fundamental obligation to hear from the constituents. And so, whether that is writing a letter, whether it’s writing an email, whether it’s having a phone call, all of those small actions at a community and individual level do matter. The more active we are at the local level and really elevating our voices and the needs, it makes policymakers pay attention. We have to recognize that not addressing racism, stress, poverty, has a multi-generational effect. It doesn’t only affect the adults right now, but it affects the children and even the children’s children. And so, if we really want to start breaking these cycles of poverty and racism, we have to start addressing them now. And so, I think holistically, it’s just time to take a step back and think about how do we really ensure access to these support programs, to health care, and what that means so that we can really start to address and see the changes around improving wealth outcomes for families, health outcomes for families, and really educational outcomes as well. Sally:  To follow up on that, I have a pretty big question for this panel, which is, what does an ideal future look like from your perspective in this cross-policy system space? Cindy: That is a big question. So, let’s imagine a world where first of all, everybody has a source of payment for their healthcare needs. That seems to be basic, it’s true in most westernized countries, it is not true in the United States. So, let’s start with that. And then, let’s go to the narrow world of healthcare, and let’s break down those lanes—those silos. I think it was Jane that mentioned everybody’s in their lane and it’s hard to break out. Well, children and families, they don’t live in lanes. They live in the community, they live in their homes, they live in their real life, and we need to meet them where they are. So, let’s start with having an integrated healthcare delivery system where we treat the whole family and the whole child. And then, let’s go beyond the healthcare system. Let’s look at all of the agencies and departments and entities that are really in very close regular contact with kids, and think about how they can work together with the healthcare sector. That’s schools, that’s child care, that’s the juvenile justice system, that’s parks and recreation. What do we need to keep kids and families healthy? So, beginning to work together. And then working—as I mentioned before—with community-based organizations, who really do have a lot of expertise on how to address homelessness and hunger. They may not have all the resources they need for sure, but they need to be working together in concert both to deliver the services and to have everybody advocate for more resources to the extent that more resources are needed.  We need to have a very intentional equity lens as we go about these collaborations in the delivery of services and the thinking about where the financing should be prioritized. And we need to have all of this with the construct of families in the lead. And particularly, communities of color, given the health disparities. I’ve had the occasion of working with community-based organizations that are led by the community, and I’m taken by Aaliyah’s reference. I never learned more about the system as when I’m talking to parents of kids with special health care needs. They are so expert not just on what their kid needs, but on what works and what doesn’t in the health care system. So, if you’re really wondering how to get smart on all of this, sit down with some families that have really been trying to navigate the struggle, whether it’s because they’re homeless and they’re trying to get care for their kids, or whether their kid has special health care needs. They are the experts and they really need to guide us as we go forward. Sally: I really love this thread and I feel like it’s been followed through our entire conversation today. Really just making sure you have the right voices at the table—not for them to just for react to something that’s already been created, but to be there to actually create these things, and I think that’s extremely important. And Jane, I’m wondering if you could talk a bit more from your perspective about how these silos that everyone’s been referring to throughout the conversation truly impact families and communities. Jane: I would like to tell you the story about a family we worked with, a lower income family who identified themselves as Latino. Dad worked in construction, mom was home with four children. The older children were in school. And she had reached out to Help Me Grow because she had some real concerns about her youngest child—lack of language skills primarily, but also some behavior issues, which may have been associated with those communication challenges. The family lives in a rural part of our state, which while services are available in a nearby city, transportation is not available. And the mom and the child were connected with our early intervention to have an evaluation. But when we did some follow up with them, we understood they missed the appointment. Why? Because the car that they were using broke down, and the family had no money to get the car fixed. So, the story could have ended right there with the child in need, a frustrated parent, and a frustrated service provider not truly understanding what was going on. But it didn’t thank goodness, and I think that shows the resiliency that this mom had in understanding that she really had a child who had some needs and she wanted to get help for her child. And a care coordinator at Help Me Grow, who really understood the social and environmental challenges that that family was facing, and who came up with some innovative solutions to make sure that the child and the mom could get to the appointment. So, we ended up with a child who was evaluated and qualified and is still receiving early intervention services. And I just feel like that’s an example of how we can work together in a coordinated fashion to have a positive impact on outcomes for children. Imagine a community where children and families could access services without any restrictions. A community where every individual member shared a common goal of improving outcomes for all children, and where programs and resources and services that families might need, such as the health care, early learning experiences, healthy nutrition, would work together as a coordinated system. I do see one challenge, and I’d love to hear some thoughts that Cindy might have around this, is that historically, child health care providers haven’t been viewed as full participants in this community network. And yet, ironically, they are the very first service providers for children, and really continue to see the majority of children on a regular basis throughout their earliest years. And so, I think one of our goals should also be to intentionally embed child healthcare practitioners seamlessly into this network of community providers. Think about this provider network as an electrical power grid. So, when the grid is really functioning well, there’s this reliable flow of resources, and families can access them and plug in whenever it is that they need to. Help to keep children healthy and really provide opportunities for them to be successful, and for their families to be well. There’s work to be done on building and maintaining such a strong grid because it’s complex and it often requires some work to untangle pieces of the grid so that there is a guarantee that we won’t experiences any outages. But I think that that is an opportunity for us, if you think about how we can provide access to multiple resources and have a reliable flow of resources for families so that we can have some influence on that lifelong healthy trajectory that we want children to begin with. Aaliyah: Sally, if I could just build on that. Jane, I so see the same future and community that you just outlined. That is the world that I not only want to exist in, but I want for my sons as well. For those who would say, well, you know what, I don’t have kids, why should this matter? And for people who respond in that way or have that question, my response is, we are all connected in some way, shape, or form. None of us exists in isolation. We all have a mother, a brother, a sister, an aunt, a cousin, a coworker, somebody that we care about. And our communities are all interconnected. We have to think about not only the health and well-being and safety for those in our immediate concentric circles, but thinking about how those concentric circles are nestled within others. And if we don’t really think about the support of all, that as a whole, as a community, as a state, as a nation, we are not going to be able to succeed. Cindy: I want to jump in too at Jane’s invitation to talk a little bit about the issue she raised, which is our children’s health care providers not really given the resources and the voice that is commensurate with the importance of the work that they do. We really do need to build the mechanisms to hear from those pediatric providers, to support those pediatric providers, and to bring the families, again, into the discussion and into the dialogue. We’ve got the future of the nation and children in our hands, and we’re being very short-sighted by not devoting the kind of resources that’s needed. Now, there are a lot of advances in this area. We’re really seeing some additional investments put into those practices. Extra dollars to help with care coordination. Extra dollars to make sure there’s family navigators, child navigators, to really help families make their way through the health care system, but also beyond the health care system. If they need to apply for SNAP, if they need to have assistance in terms of housing subsidies. So, the design is not a mystery. Help Me Grow has that design, other pediatric practice innovations have that design. We need to value it and to put our resources in it. Aaliyah: When you mentioned the care coordination, that was the game changer for us with our youngest son. Between the age of nine months and three, he had over eight specialists in two different states. And I was a working mom, I had a four-year-old, and I was trying to consistently figure out which specialist, track medications, give the referral. I mean, it was a true nightmare. And finally, at the age of three, we finally got a care coordinator who managed all five of the primary specialists that my son was seeing at the time. That was when I could finally take a step back and breathe because I had someone helping me navigate this complex health system. Cindy: Thank you for sharing that. We need to really have a much more family-centered system of care management, where the alliance of that care manager is to the child and the family, not to a particular institution, not to a hospital or a rehab center or a specialty practice. But I am here for the child, I am here for the family. We also need to not just put all the burden on the families, we also need people in power positions to align with those families’ voices, and to say, yes, it is time to put a different balance in our investments in this country. And that’s healthcare sector leaders, that’s business leaders as well really stepping up to the plate and saying we’ve got to do things differently. Many, many years ago, I was working with a pediatric clinic in Boston Medical Center. And they were seeing a system—a lot of no shows as they call them, in terms of people not coming for their appointments. And they did a survey. They reached out and asked their patients, what’s going on in your lives? Why aren’t you able to make appointments? In a non-judgmental way, really trying to find out what was happening. And of course, not surprisingly, the two issues were, I didn’t have childcare and I didn’t have transportation. I was desperately trying to come into the appointment. It was really high priority, it’s not that it wasn’t a priority for families, but they had very concrete barriers of lack of transportation and lack of childcare. And then the institution said, fine, we’ll develop some shuttle buses. And they developed their own system of transportation. It couldn’t solve everybody’s problem, it wasn’t perfect, but it was a really important step forward in the community. And they also set up childcare in the clinic so that a mom could come and bring her other children and not worry that they weren’t going to be attended to or that they would be bored or otherwise get into trouble. And so, it really became a family center.  So, it really goes to the point of listening on a one-on-one basis to the family, and also soliciting their advice and respecting that they very much want to be full partners in the system, and mostly care so much about the well-being of their children. Instead, entities have imposed copayments, saying, well, people don’t appreciate care unless they pay money. Well, that will be a barrier to care. So, listen to what people want and construct your policies accordingly. Jane: As a service provider, we have to be not just engaging parents, but really listening to parents. And include them in the work we do, the plans that we make. Too many times, I think parent engagement is looked at sort of as a have to, check the box, we do it. But, that’s not enough.  So, I would definitely put that out there as an opportunity and sort of a mandate, a challenge to all of us who are not truly in a meaningful way, including that voice at the table. Aaliyah: I think the only thing I would say is as we continue to move towards equitable outcomes, we have to really understand that moving towards equitable outcomes is not going to confirm equity. There are two different things. By trying to make sure everyone has access, that doesn’t mean we’ll get the outcomes that we need. There are some that are resting back and kind of sitting back and saying, well, they could access that program if they wanted to. But if we don’t really unpack it, like the perfect example that Cindy just gave, then we’re not going to get to the outcomes that we’re really trying to drive towards. Sally: Thank you all so much for joining us. I really enjoyed this conversation, and especially, the different perspectives that you each brought to the table. When we come back, Dr. Shonkoff and I will be discussing another common misconception about early childhood development and lifelong health. Musical Interlude Sally: I’m joined again by Dr. Jack Shonkoff, who’s going to help clear up another myth that exists in the early child development field. So Jack, we’ve talked a lot about how interactions between genes and environment shape human development and lifelong health. And yet, when some people talk about adult diseases, the conversation can turn to being about whether the disease that person has or this person has is a result of genetics or if it’s a result of their lifestyle choices. Jack: The reason why that’s a myth is that it’s basically telling us that if you develop a chronic disease as an adult, particularly the most common chronic diseases like heart disease and hypertension, diabetes, addictions, depression, that it’s either genetic or it’s because you are not living a healthy lifestyle. And that kind of setup is a really important myth to burst. Because what we do know is that all health outcomes are a mix of differences in genetic predispositions, and whether we’re living health promoting or health disrupting lifestyles. Not to say that it doesn’t matter how well you exercise or how well you eat. It’s also not true to say that there’s no genetic contribution to the greater risk to have a particular health impairment. Very, very few, and none of these common chronic conditions are primarily genetically determined. And many of these conditions that are found to be associated with not very healthy lifestyles, you don’t exercise, you eat poorly, you’re overweight, your blood pressure’s up and you have a heart attack, people can look at that and say, well, yeah, that’s your own fault because of the way you live. What we’re missing is that the relatively higher risk or protection against these diseases starts very early in life. It starts prenatally and the first few years after birth. And that’s why it is so important that we try to protect children from excessive adversity, and why we want to help bring down excessive stress activation because it affects these developing systems very early in life, when they are relatively immature, that can have an effect on the greater likelihood of good health or the greater likelihood of being at risk for many common diseases. Musical Interlude Sally: And we’re back with Dr. Jack Shonkoff to wrap up today’s episode. Jack, we’ve talked a lot about changes that need to happen at the policy level, the systems level, and even the program level. What would you say to parents or caregivers who are hearing this information and thinking, well, I can’t wait for these changes to happen, I need to help my child now. Why should this new science make our listeners more hopeful that these changes can occur, and what can we be doing in the meantime? Jack: Let me answer first by saying that not being hopeful is never an alternative. Ever. If we’re talking about the health and wellbeing of young children, both our own children, if we’re looking at it from a family perspective, or all of our own children, if we’re looking at it from a community or societal perspective, there’s no room for hopelessness.  I think the most important message for parents about this new mindset is that all of the things that you have been doing right to provide an environment for your young child that promotes early learning, healthy social and emotional development, and prepares your child to come to school ready to succeed, you don’t have to do anything differently to build a strong foundation for your child’s physical and mental health. A lot of attention has been directed in the early childhood field to the importance of responsive relationships, the need for serve and return interaction between young children and the adults who care for them. The importance of buffering children from stresses in the lives of families who work really hard to help build their children’s ability to be able to adapt to the stresses of everyday life. The importance of building skills to help to deal with stresses and hardships. The importance of building resilience that then transforms into being able to cope with adversity and to learn effectively and do well in school. That same resilience, those same kinds of coping skills, not only protect the developing brain, they protect the developing immune system. They protect developing metabolic systems. All of the wonderful things that parents do for their children. It used to be done in the service of early learning without even thinking about you doing the same thing to protect your child’s health now and in the future. The reason to be more hopeful about this is that we have a very strong science-based explanation for why what happens early in life influences all of the things that make for a healthy, productive, successful, engaged population for society. It’s very hopeful to think that if that science message gets out with the credibility that it deserves, that a broader part of the population will understand what a terrible missed opportunity is to not invest very early in the lives of children whose families are facing significant adversity and to understand that we will all benefit at the end of the day. Doesn’t mean that there isn’t a lot of hard work to be done at the policy level, a lot of hard work to be done at the service delivery level. A lot of hard work to be done to help families with young children across the population to be empowered, to advocate for what families need to kind of raise healthy and competent children. All of that to me presents a lot of hope. It doesn’t underestimate the struggle to change policies, but we have more information and knowledge to work with. Sally: Absolutely. There’s clearly a lot of work that needs to be done. But hearing your perspective as well as the voices of our panelists earlier in the call definitely makes me feel optimistic that change is possible. I’d like to once again thank our guests, Cindy Mann, Dr. Aaliyah Samuel, Jane Witowski, and Dr. Jack Shonkoff. And thanks to Abbi Wright for your question. I’m your host, Sally Pfitzer, and we’ll see you next time. The Brain Architects is a product of the Center on the Developing Child at Harvard University. You can find us at developingchild.harvard.edu, where we’ll post any resources that were discussed in this episode. We’re also on Twitter @Harvardcenter, Facebook at Center Developing Child, Instagram @developingchildharvard, and LinkedIn Center on the Developing Child at Harvard University. Brandi Thomas and Charley Gibney are our producers. Bridgette Cyr is our audio editor. Our music is Brain Power by Mela from freemusicarchive.org.