We are moving into what could be a golden age for both health systems and healthcare.
We will have electronic information on every patient. That data, funneled through artificial intelligence, care algorithms and connected caregivers, can significantly enhance and improve diagnosis, treatment plans, care coordination, and an extremely wide range of settings for receiving care.
We have learned much more how DNA and RNA coding works and we can use those tools for both better diagnosis and more targeted, effective treatments. When the next pandemic hits, we should be able to respond much more quickly. We also should be able to use blood markers to anticipate and do very early diagnosis on cancer, and we should be able to build chronic disease plans that fit each patient individually.
The links between scientific code-based biology and care are strengthening—and we need to make them even stronger by taking advantage of the knowledge of epigenetic impacts. Some of the learning here, and the interventions that follow from them, will have to wait for future science. But we already know plenty, and society must step up to use that knowledge if we are to truly reach the golden age for systems of care.
We now know that the first 100 days after a child is born influence which sets of epigenetic programs for emotional context are activated in each child.
We also now know that the children whose brains are exercised in first three years of life build billions and even trillions of neuron connections, and that lacking that stimulus the brain begins to purge itself of unused connections at age 4.
We know that the children who have missed that magnificent and golden neuron linking opportunity cannot make those links later.
That isn’t fair. It also isn’t equitable.
We have massive racial and ethnic inequities happening today for too many of those children—and we need to work together to stop it.
Books might seem cliche, but they are often ignored early on to the detriment of us all on a massive scale.
Reading books to a developing child creates billions of connected neurons. Children in homes in America with no books tend to have fewer than 5,000 words spoken to them in the first years before kindergarten. Meanwhile, children who are read to even once a day hear more than 200,000 spoken words by age 5.
Over half of births in America this year will be in our Medicaid population—and the huge, painful, dysfunctional, unacceptable and ethically unforgivable inequity is that more than half of those Medicaid homes do not have a single book. Low-income families too often need to spend all their money on food, housing and on clothing.
That’s just plain wrong. Medicaid should be providing supportive and engaging books to every child. Those books should include numbers and counting games and number-related stories, because another sad truth is that our math literacy is abysmal. In Milwaukee, for example, only 16% of the children do adequate math at 15 years old.
We are not going to change the hugely inequitable earning gaps and the painful wealth gaps we have in this country today if children in the low end of that gap can’t count or read when they finish school.
Why have I kept using “we” as I write this? Because it’s a healthcare issue.
Data on adverse childhood experiences shows us that patients with four or more ACEs are 60% more likely to get cancer as adults. They are also twice as likely to have a heart attack, three times more likely to have lung diseases and 12 times more likely to attempt suicide as an adult.
That’s not 12% more likely—it’s 12 times more likely.
That’s Kaiser Permanente data, so the patients who were studied were all in the same care system with the same doctors and the same patterns of care and the same neighborhoods and the same basic economic status—and the patients with four or more ACEs are still 60% more likely to get cancer as an adult.
That’s also clearly the epigenetic impact of stress on our physiology in our early years and we need to factor that information into our care plans and into our life plans for every patient.
We also have more people in prison than any country on the planet. We disproportionately imprison minority Americans. Sixty percent of Black males in this country in their 30s who dropped out of high school are in prison today. Ten percent of Black males in their 30s who graduated from high school are in jail as well. That’s a horrible and painful number—but 10 is lower than 60.
We know with over 60% accuracy by age 4 which people are on that track—and we need to do the right things to help every child and we need to get books into every home and support other interventions to change those trajectories.
We need to understand the issues and impact of racism and prejudice and discrimination and we also need to work with those epigenetic opportunities to help all of our children get that neuron connectivity support in those key time frames to give us a chance for future success as a nation.
It will be our own fault if we screw it up because we know what needs to be done and it’s in our hands.