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From Womb to Tomb: The Influence of Early Childhood on Adult Health

From Womb to Tomb: The Influence of Early Childhood on Adult Health Program Transcript [MUSIC PLAYING] STEPHEN BEZRUCHKA: What do we do to foster good child rearing in the United States? When does society exercise responsibility for childhood? The only time the state legally intervenes is to make sure you have your vaccinations at age five to go to school. Before that, it's a free for all. By age five the die is cast, and getting your shots is not going to make up for a disadvantaged time in your mother's womb, or the struggles of the first five years of life. All of us have some of this early baggage to live with, and I'm not saying you should not do what you can to better your health. But I want you to recognize the importance of what happened before we were in a position to make individual choices. We have to structure early life and society for better health outcomes. ALI LIGHTFOOT: That's Stephen Bezruchka, and this is Alternative Radio. I'm Ali Lightfoot. This edition of AR features Stephen Bezruchka, From the Womb to the Tomb. The United States, the richest country in the world, currently ranks 27th in the health of its citizens, lagging behind not only most of the rich countries but a few poor ones as well. Fifty years ago the US was among the top five. What has happened in the past five decades to cause this decline? Bezruchka explains that an increasing stratification between the rich and the poor plays a major role. Life spans and infant mortality rates depend very much on the hierarchical structure of a society, and new research shows that half of what influences our health as adults is largely determined before the age of five. What can we learn from other countries whose citizens live longer and healthier lives? Stephen Bezruchka is a senior lecturer at the University of Washington, and works as an emergency room physician in Seattle. His particular areas of research are population health and societal hierarchy and its application to health. Stephen Bezruchka spoke in late April of 2005 in Vashon Island, Washington. STEPHEN BEZRUCHKA: Let me begin with a few assumptions: one is that you're here because you're interested in your health and that of your children, the second is that most of you assume that producing health in yourself or your children is something that one does today, and reaps the benefits tomorrow, or the next day, or certainly in the coming year. So I really appreciate your interest in health, but I want to challenge the second assumption, namely that we can strongly influence our health by what we do today, because that's not consistent with the evidence.

From Womb to Tomb: The Influence of Early Childhood on Adult Health

At least half of what influences our health as adults is determined by what happened to us when we were in the womb, and for the first few years of life thereafter. Our health is influenced by what happened to our mother when she was in her mother's womb, so maternal grandmothers are important for our health. Fathers and grandfathers have some impact, but actually not as much. It's only from considering such factors that we can come to understand why our health collectively as a nation is worse than that of people in about 25 other countries; pretty well all the other rich countries and a few poor ones as well. We're about as healthy as Cuba, the country we've been strangling for over 45 years. Although we have a country that espouses life, liberty, and the pursuit of happiness, in reality we end up with a short life, the illusion of liberty, and the pursuit of illness. What's wrong? I won't say anything that's speculative in the sense that leading scientists in our federal government don't say it in official respected publications. Last Friday in the New York Times Op-Ed page, for example, well-known economist and commentator Paul Krugman pointed out how much our health status is poor compared to other countries. But most of these concepts are not seriously discussed in schools or in the various media when health is talked about. What I think needs to be done for our country to regain its health standing in comparison to other countries, what medicine we need to take, what is that? I want to make two points. The first is that our health-- yours and mine, if we're from the United States, the world's richest and most powerful country-- has deteriorated profoundly over the last decades if we compare ourselves with other rich nations. Namely our health relative to them has declined. For the first time also since 1958, our infant mortality rate has risen. More infants are dying while we perpetuate the illusion of progress. Second point is that the cause of this health decline, the diagnosis, stems from changes in our own habits. But these aren't the individual health-related habits we've all come to learn about, but from changes in our habits as citizens, as a sovereign people of this country. We're abdicating our responsibility as citizens to govern ourselves, and are selling this right to the rich and powerful. This results in a bigger gap between the rich and poor, which I now identify as the root cause of our poor health. We've abrogated our sovereign rights to decide our own future. That is now in the hands of the rich and powerful, and our corporate elite who look after their own welfare very profitably, but not ours. The diagnosis is actually hopeful, because once we come to understand the cause and the reasons behind it, then the steps necessary to return to the road to health become apparent, but there's no quick fix. The time required for getting ourselves healthy again will take decades at least. The reason is that it is in the first few years of life where the medicine to make us healthy again has to work in order for we as adults to regain our health.

From Womb to Tomb: The Influence of Early Childhood on Adult Health

Three people stood alongside a river on a brisk afternoon. All of a sudden they heard a cry for help from a person caught in the river's fast-moving current, trying desperately to stay above the water. One of the people along the river bank started yelling at the drowning victim, what's wrong with you, don't you know how to swim? The second individual offered the desperate person discount coupons for swimming lessons. Fortunately, the third was a public health worker who jumped in the water and pulled the drowning person out. Over time more and more people came floating down the river in need of help. Researchers showed up and counted how many people made it part or all the way out of the river, and how many fell back in. They also collected other kinds of information about the risk-taking profiles of the people, their family backgrounds and educational levels. A few progressive individuals decided to head upstream to see what was causing so many people to fall into the river. More and more older folk came floating down river crying out for help, and it was not possible to pull them out despite everyone's best efforts. Quite a few were lost. It became very expensive to keep pulling victims out of the river. Some of those who were pulled out ended up back in the river. People soon realized that pulling casualties out of the river would never be sufficient to reduce the problem; too many kept falling in. Upstream they found younger citizens who were enticed into the river. The group found signs that read, "Go for it, just do it and come to river country." The signs said the river won't slow you down, and it doesn't get any better than this. All around were cleverly-constructed images that associated friends, success, sex, self-esteem, and the good life with the edge of the river and the rushing water. As these people looked around more, they discovered that children were particularly transfixed by all the colorful signs showing sexy men and women, sports stars, sophisticated people, and charismatic role models. They found a few warning signs, but generally the barriers to risky behaviors and the messages about caution were overwhelmed by the almost-magical inducements promoting swimming in the dangerous waters. The upstream group thought to make the environment safer to keep people out of the river, but it was tough and they met with a lot of resistance. The river marketers said that the irresponsible behavior of a few bad apples who did not know their own limitations when it comes to swimming should not be allowed to ruin the fun for everyone else. The real problem, they argued, was that people were just not responsible enough. If each individual would just be more careful, treat the river with more respect, and learn how to avoid the strong current, or how not to fall in, there'd be no problem. The marketers argued it was the responsibility of the family and the individual, not government or industry, to make sure the river was used wisely. Shouldn't families begin instilling better morals, and teach their children how to navigate the currents in the river? That

From Womb to Tomb: The Influence of Early Childhood on Adult Health

they should develop better family values, and institute swimming curricula for the schools? A few of the group painted over the billboards that were enticing people into the river. Others advocated for legislation requiring warning signs and counter-ads to be erected alongside the glamorous pictures. Still others brought attention to those who were erecting the signs in the first place, claiming that they must share the responsibility for the adverse consequences of their actions. The promoters turned to the government, claiming that the protesters were infringing on their freedom of speech. The public health workers countered that it is government's role to protect the vulnerable to the messages, particularly children. A few others realized there was still more territory upstream to be explored. Certainly exploitive marketing practices, misleading advertising, and the general lack of responsibility of various corporate interests were important, but younger people were coming down the river in greater numbers from further upstream. So this small group headed further up to the source, and found conditions that allowed large numbers of children to easily slide off the steep slope. They plunged on to flotation devices and slid in great masses into the river to drift downstream. The reason they slid was the steepness of the slope. It was the footholds and trying to push off those who were below them, since they felt that these people were destabilizing the slope. This was less steep than the address, to produce health. We must link what is observed downstream with these upstream conditions. To do so, we need to understand the upstream-downstream connection, and to cultivate and use your voice to make these conditions visible and meaningful. So upstream, we the people in the United States need to change the slope of the bank at the source to prevent people from falling into the river. Children are especially vulnerable. We must bring down the record gap between the rich and poor which prevents true democracy from working, causes ill health, and leads to early death. This is an unlikely prescription for a medical doctor to offer, one who continues to practice medicine in the emergency department, but it's what we must do if we follow evidence-based guidelines. Let me explain how I came to think about what makes a population healthy, because it's not what I was exposed to in medical school, or anywhere else for that matter. I began medical school at Stanford 35 years ago because after doing graduate work in mathematics at Harvard, I wanted to do something useful, and there was no question in my mind then that providing health care was the most important part producing health. When I began, there were some 14 countries that were healthier than the United States when we compared the average number of years lived by people in a country. This number, the life expectancy, is routinely

From Womb to Tomb: The Influence of Early Childhood on Adult Health

reported, and it's a good measure of health. Well after working as an emergency doctor for 15 years, I discovered that our health-- yours and mine, considered as a country-- had declined, so that by 1992, compared to the citizens in 21 other countries, we were worse off. Yes, we were living longer than our parents but compared to people in other rich countries, not that much longer. I hadn't expected the decline to continue when I was in medical school, as I came to the United States from Canada seeking the best and thinking the United States was Number One. Now it was clear the best was getting worse, I hadn't a clue why. The only thing I was sure of was that medical care had little to do with the health of populations. Sure, I could tell myself that I'd saved a life in the ER occasionally, but most of the time I found it hard to think that medical care had that much impact, despite the hype accorded it. So if you don't know something, you might reasonably consider going back to school. I went to public health school, Johns Hopkins, the biggest in the world, to find out what made a population healthy. What I learned there affirmed my belief that medical care had little to do with health, but as to what mattered to explain our health decline-- well, they didn't ask that question. I tried not to let schooling interfere with my education. So my discovery over the last 13 years has been incredibly exciting, profound, and challenging: exciting because there are real answers to this most basic of questions; profound because they go back to truths about our species and how we live; and challenging because although what needs to be done to produce health is so simple, it's difficult to get people acting on it. Here's what I learned. Our health in this country has declined compared to other countries and in absolute terms. There's no debate about this. The Institute of Medicine, a federally-funded agency that looks after health issues, in its 2003 publication "The Future of the Public's Health in the 21st Century," on page 20 writes, quote, "For years the life expectancies of both men and women in the United States have lagged behind those of their counterparts in most other industrialized nations," end of quote. So at some point we didn't lag behind. You'll find that in the late 1940s and early 1950s we were one of the healthiest countries in the world. Now in absolute terms, last year our National Bureau of Health Statistics reported that for the first time since 1958, our infant mortality rate, the proportion of babies born that die in their first year of life, has gone up. Our infant mortality rate is already the highest of all rich countries. So their report sounds a death knoll. The second concept, the diagnosis, is what determines health in a population is the nature of caring and sharing relationships in that population, I mean how well we care for and look after one another. Health is not produced by how well we look after ourselves. It's not what we do to make ourselves healthy as individuals, namely the usual do's and don'ts that I preach to my patients all the time: eat right, exercise, don't smoke, wear a condom, buckle your seat belt. There's

From Womb to Tomb: The Influence of Early Childhood on Adult Health

nothing wrong with following that individual advice, it isn't wrong. But that advice is not important when it comes to our health. Why do I say that? Well take the healthiest country in the world by any measure, Japan. Twice as many men smoke in Japan as in the United States. Japan smokes the most of all rich countries, and yet it is the healthiest. I'm not saying that the reason Japan is the healthiest country in the world is because all the men smoke. If I made that statement you'd be wise to discount everything else I say. But what that observation tells me is that although smoking is bad for you, compared to other things it's not that bad. There are worse things we do for our health than smoke cigarettes. What are those; not caring for and sharing with each other. Now I'm a scientist. I started out as a mathematician, where everything proceeds in logical faction from a few axioms or basic concepts. So you should demand proof from me for anything I say. I do this in my courses at the School of Public Health and Community Medicine at the University of Washington, and students in their course evaluations are always amazed at how logically the arguments proceed. Even then, they find these concepts hard to believe because they've not been brought up to think that way. If we define our health as a country by the average number of years lived, the life expectancy, and if caring and sharing produces health, how can we measure caring and sharing and relate it to health? Now the science on this subject is amazingly diverse and consistent in its findings. There are measurements of social capital, of extent of friendships, of income distribution, of political participation, of gender equality, of racism, of environmental quality, of child welfare, of numbers of prisoners-- we house a quarter of the world's prisoners, by the way-- of access to medical care, and many others. If we care for and share with each other, then there won't be such a big gap in incomes, or differences in political power, or numbers of prisoners, or women being treated unfairly, or children living in poverty. A UNICEF report released last month shows our commanding lead in having the most poor children of all rich countries. In all of these, there are strong associations of these measures with health outcomes. Notice that I said associations, and critics will say association doesn't imply causation. They're right. How can we infer causation from association? The federal agencies have spelled out the criteria to use, beginning in 1964 with the surgeon general's report linking smoking and health. I won't trouble you with that academic exercise. Suffice it to say that the association between caring and sharing behaviors in a society and its health is causative. Societies that care for and share with each other are healthier than societies that don't. You may say what I'm talking about are death rates. You don't care how long you live, you just want to be happy, even if you don't live to a ripe old age. What I say also applies to quality of life measures such as happiness, and it will not surprise

From Womb to Tomb: The Influence of Early Childhood on Adult Health

you to learn that our happiness as a nation has been declining. So a measure of caring and sharing is income distribution, namely how do we decide what to pay various people in society for the work they do. There are many different statistics for income distribution used by economists and sociologists, and again, I won't bore you with the arcane details of these and instead take a simple concept, namely how much more the boss makes compared to an average worker. I use mainstream data sources such as the New York Times, Business Week, or Newsweek because I've had experience with getting articles published there, and with the fact-checking process. Before they allow you to get something in print, they verify your numbers and the sources. In January 25, 2004, the New York Times reported in the front business page that the boss in the United States makes 531 times what an average worker makes. The boss makes in half a day what you and I make in a whole year. If you've looked at almost any newspaper in the last decade, you've seen many reports about how the income gap is skyrocketing in this country over the last few decades. Now Business Week reported that the gap was only 42:1 in 1980. Now in the same issue of the New York Times they mentioned that in Japan, the world's healthiest country, the boss only makes 10 times what an average worker makes. As a measure of caring and sharing, during Japan's economic crisis in the late 1990s, bosses and managers took pay cuts rather than laying off workers. You can't imagine that happening here, and it won't take place and unless we the people make it happen. So more egalitarian societies are healthier societies. The feds state this pretty bluntly. In the Institute of Medicine's "Future of the Public's Health in the 21st Century" I mentioned earlier, on page 59, they write, quote, "More egalitarian societies, i.e. those with a less deep differential between the richest and the poorest, have better average health," end of quote. This is pretty clear to me, and this document was written during the current administration. Perhaps we should have a warning on our paychecks, along the lines of, your pay compared to the boss is bad for everyone's health in the US. Notice that I said your pay is bad for everyone's health. Don't let me get away with such a pronouncement, for this is a profound statement in which lies our salvation. There are now several studies demonstrating that the rich may be adversely impacted by inequality. In other words, the rich have worse health than if they were less rich in a smaller-gap society. While those who are poor will always have poorer health, it is becoming apparent that the rich are more harmed by inequality from living in high-gap states in the United States. The rich would have healthier lives if they weren't so rich in a smaller-gap society. So part of our job is making the rich aware of this, not an easy task, but a doable one. So we no longer care for and share with each other, and therein lies the reason for our poor health status as citizens of the United States. Now at what point in the human life span from womb to tomb does caring and sharing matter most?

From Womb to Tomb: The Influence of Early Childhood on Adult Health

The next point is also substantiated in federal documents. The time when caring and sharing matters most for our health as adults is the condition of our being from the time we're a gleam in our parents' eyes until the age of four or five. In order to have the healthiest adult life, the conditions in early life especially when you're in your mother's womb and for the first few years of life outside, are the critical ones for our health as adults. This is fantastic information because it tells us where we must act to produce health. Epistemology is a fancy word for how we come to know things. How do doctors come to know what they know about health? Well in medical school I was taught physiology, how the body works, and my daughter was taught the same thing this year in grade 10. On what basis do we know how the body works? Well from references in my student physiology book, I found the studies were mostly done on dogs. At Stanford Medical School back in the early 1970s, where they perfected heart transplants, much experimenting was done on dogs. Now the animal rights people got upset about this, and to them I suggest that they join the human rights people in drawing attention to the experimenting going on on humans in this country and in the world at large, where we are creating so much experimental poverty to see how it affects our health. In 50 years time people will look back upon this era and be horrified at what we did, just as today we're aghast at the Tuskegee Experiments that took place only 40 to 50 years ago, where we didn't treat African-Americans with syphilis because we wanted to study progression of the disease. So what we know about how human bodies work comes from various animal studies. The results are then evaluated to see if they explain the common findings in humans. Some animal studies don't appear to transfer to human beings, but many, many do. It allows me to decide how to investigate illness as a doctor, and how to prescribe treatment. If you're hemorrhaging and we replace your fluids, you survive-- something we learned from bleeding dogs. The results of such animal experiments are routinely accepted. There are others that are overlooked for strange reasons. Many of the overlooked studies look on various behaviors rather than physiologic parameters such as blood pressure or glucose levels. One example that I learned from Michael Meaney at McGill University concerns mother rats. Studies on rats show that mothers who lick and groom their pups, their babies, will have those pups lick and groom their babies when they become mothers. For mothers who don't lick and groom their pups, when those pups grow up and have their own babies, they don't lick and groom them. If the pups are isolated from licking and grooming mothers and not licked and groomed, then when they become mothers they don't lick and groom their pups, and vice versa. Pups from non-licking and grooming mothers who are licked and groomed by other rat mothers will lick and groom their babies when they become mothers. So nurturing behaviors appear to be transmitted in non-genetic means. Epigenetics describes how this happens, but it's not widely taught in schools. This example

From Womb to Tomb: The Influence of Early Childhood on Adult Health

points out the importance of what happens soon after birth, and how that affects subsequent generations. Now the biology behind this has two facets. One relates to the stress that you and I experience and its hormonal manifestations. The other relates to what happens in the brain, which is also related to the stress of society. We have a physiologic system that responds to imminent danger by fighting or fleeing, the so-called fight or flight response. It's mediated by cortisol and adrenaline produced in the adrenal gland. These substances ready your body to succeed in escaping the danger, they save your life. But produce these chemicals most of the time when you're stuck in traffic or mad at the boss or worrying about paying bills, they turn out to be responsible for half of the diseases of modern society, from diabetes to high blood pressure to heart attacks. I'm impressed with studies on pregnant sheep and their offspring demonstrating the importance of stress in the womb. I'm not sure why sheep are such a good animal to study, but you've all heard of Dolly, the first cloned animal, who was a sheep. Studies show that the fetal lamb secretes cortisol in response to stress, whether it is getting inadequate nutrition or not enough oxygen, or whether the placenta is behaving badly and allowing mother's cortisol from her own stress to reach the fetal lamb. So the fetal lamb has to deal with its own cortisol production from being stressed as well as the mother's, and its own cells are sickened by both. With too much cortisol, Hamlet might say, "We are more susceptible to the thousand heartaches and natural shocks the flesh is heir to, and the lamb more quickly achieves the sleep of death." Well this same endangerment occurs in humans. There is a vast scientific literature supporting the concept that what matters for health are conditions early in life, especially those associated with stress. What happens between generations? Well Irv Emanuel, a colleague of mine at the University of Washington, studied the importance of these early factors, and he'd been interested in health outcomes that depend on our mothers and grandmothers, and he showed the importance of the maternal grandmother on our health. To paraphrase Wordsworth, the daughter is the mother of the woman. To understand what impacts the woman, we have to look before her mother to her grandmother's situation. So by creating good conditions for your daughter, she will beget healthy grandchildren. So it will take generations. Another component to the stress response has not been prominently featured in high school or medical school curriculums; namely the tend and befriend, or calm and connection response, mediated by another hormone, oxytocin, produced in the brain. The only thing I ever learned about oxytocin as a doctor was that it expelled stuff. It expelled uterine contents when I wanted to induce labor, or it expelled breast milk. It turns out to have a vast repertoire of other actions. I wonder if the reason it has been overlooked is it tends to be more active in

From Womb to Tomb: The Influence of Early Childhood on Adult Health

women, and it's men that do the studies. Men produce just as much of it as women, but testosterone inhibits its actions, while estrogen promotes it. So faced with an emergency, what does woman do? She takes care of others, tends to her child instead of abandoning it to the attacker or threat. Now oxytocin is also a neurotransmitter in the brain, and it's released during sex, massage, gossipping, trusting, and many other conditions that are good for us. There's likely much more of this chemical around in more caring and sharing societies, and it might be a factor in the licking and grooming of rat pups. While I can quote studies that demonstrate higher cortisol levels in less caring and sharing human societies, we don't yet have these population studies with oxytocin. So the lower down you are in society's pecking order, the lower your income, status, wealth, job rank, education level, skin color, accent, the more cortisol you produce. As the sheep experiments show, being a poor pregnant mom under stress, more of your cortisol gets into your baby, and so the baby is not born on third base. It often doesn't even get to first base. It stumbles as it leaves the plate after a bunt. Science is clear, we're not all born equal. Those from more disadvantaged early life situations are already slated to be less healthy at birth, and to become sick later. This is evident from their having low birth weights and being born prematurely, which are both highly correlated with adult disease. All this happens before birth. What about after? Well, the Institute of Medicine's treatise "From Neurons to Neighborhoods: the Science of Early Childhood Development" talks about brain plasticity, namely the forming and forming of neuronal connections in early life based on social and environmental influences. Soon after birth, the visual cortex, the part of the brain that processes visual images, is busy being sculpted. The most important reason is what British psychiatrist John Bowlby termed secure attachment to a familiar face that allows the infant to venture forth from a secure base to explore the world, knowing the face will be there she crawls back. Eye contact is really important here, and we are the only primate species with whites in our eyes, so the infant can know whether or not the attachment figure is there or not. ALI LIGHTFOOT: You're listening to Stephen Bezruchka, From the Womb to the Tomb. This is Alternative Radio. You can get copies of this program by calling toll free, 1-800-444-1977, or you can go to our website, alternativeradio.org. Stay tuned at the end for complete details on ordering. STEPHEN BEZRUCHKA: The report "From Neurons to Neighborhoods" point out that children who are not securely attached to a caregiver in early life have higher cortisol levels. As adults, such individuals are more likely to have worse mental health and depression, which is related to mental health, to depression in the mother, and associated with cortisol. Around the first year of life it's the auditory cortex, which is busy processing sound and developing language skills.

From Womb to Tomb: The Influence of Early Childhood on Adult Health

The range of vocabulary and content is vital for later success at school and avoiding behavioral problems later in life. If all you hear are cease and desist orders-- "Stop that, shut up, don't do that"-- you won't do as well as an adult than if you were exposed to an engaging, diverse vocabulary. So creating a nourishing early language environment is very important for adult health. Now the frontal lobes of the brain are very plastic from around age two until teenage-hood. The frontal lobes are our social organ-- playing, sharing, looking out for one another, and understanding social clues is what this period of development is all about. We have cohort studies which follow children from birth into adulthood, and these studies demonstrate the profound importance of the early childhood conditions on brain development, success at school, and adult health. To quote the feds in "From Neurons to Neighborhoods," quote, "Of all aspects of children's early environment, the family socioeconomic status is most powerfully associated with children's cognitive skills when they enter school. The influence of socioeconomic status during early childhood years appears stronger than SES in later years. It's the steepness of the slope upstream at the source that matters most." They go on to write, quote, "Children in single parent families are at greater risk for poor developmental outcomes." As well they point out that, quote, "Stress resulting from marked threats to physical or psychological well-being can have dramatic effects on health and development." And they go on, quote, "Psychosocial risks that affect maternal behavior include poverty, family violence, and maternal depression. Supportive and nurturing caregiving can help protect offspring from these adverse outcomes," end of quote. So why is this important for us in the United States? I said that our health is worse than that of the other rich countries, and for the first time since 1958 our infant mortality rate, a very sensitive indicator of our health as a society, is rising. That's very troubling. French demographer Emmanuel Todd noticed such a rise in the infant mortality rate in Russia in the early 1970s, and he wrote a book in 1976, titled La Chutte Finale, in which he predicted the collapse of the Soviet Union for just those reasons. Now our CIA, the Central Intelligence Agency, monitors infant mortality rates in parts of the world to see where the next trouble spot will be. So I hope our new intelligence director, John Negroponte, is kept informed of our infant mortality rate rise and our decline as a society. If early childhood is this important, what do we do to foster good child-rearing in the United States? When does society exercise responsibility for childhood? The only time the state legally intervenes is to make sure you have your vaccinations at age five to go to school. Before that, it's a free for all. By age five the die is cast, and getting your shots is not going to make up for a disadvantaged time in your mother's womb or the struggles of the first five years of life. All of us have some of this early baggage to live with, and I'm not saying you should not do what you can to better your health. I want you to listen to the advice I give you if

From Womb to Tomb: The Influence of Early Childhood on Adult Health

you see me in the ER, because I think it still matters, but I want you to recognize the importance of what happened before we were in a position to make individual choices. We have to structure early life and society for better health outcomes. We have the highest teen birth rates of all rich countries, twice the rate in the next closest country, and that gap is increasing despite a slight decline in our teen birth rates. The gap between the rich and the poor is related to teens giving birth. Where there's a bigger gap, more will have children. We also have studies demonstrating that when teens are reared by a single parent, usually by a poor mom; they'll initiate sexual activity earlier, get pregnant sooner, than if they're in a two-parent family. The reason is clear-- life is precarious, you won't live that long, so begin your family earlier, even though will be a tough life. This is usually not a conscious decision, but one made subliminally to adapt to the environment. Studies demonstrate that being raised in a single-parent family is not only harmful for the parent's health, but also bad for the child. Children raised by a single parent not only have more sickness, illicit drug and alcohol problems, and suicide attempts, but a greater chance of dying than children raised in a two- parent family. Now any parent can attest to how difficult it is to raise a child these days. It's harder to do alone. I could go on and on presenting depressing statistics about how unhealthy we are compared to people in other rich countries and some poor ones as well, but I think it's time to think of solutions. The cause of our poor health is that we've given up our sovereignty to decide what is best for you and I in this country. We've been led to believe that as individuals we can achieve any level of health or prosperity we want. We just have to pull up our bootstraps. Problem is, many of us no longer have bootstraps. We gave those away to the rich and powerful some time ago. We have to take back our collective bootstraps. Where are we going to find them? Well, let's look in some other countries that are healthier than we are to see how their bootstraps work to pull people up. Let's take Sweden, the second-healthiest country in the world. Sweden is a very diverse country, with over 10% of the people living there being born outside of Sweden, comparable to the US rate. Swedes pay high income taxes and have a wealth tax to supply funds for social purposes. It's a decision they make, namely recognizing that everyone does better when everyone does better, and they understand the importance of early childhood. In Sweden, you have to take a year's maternity or paternity leave at full pay. You can't get out of it. After the first year, you can take an additional year at 80% pay. After that, if you return to work, then your child is placed in a government-run free daycare. What's the requirement to work in a Swedish daycare? You have to have a master's degree in play. The daycare experience is all about learning to play with others. So such conditions give your child the chance to develop secure attachment, to be exposed to a rich vocabulary, and socialize with peers. It doesn't guarantee it will happen, but it makes it more

From Womb to Tomb: The Influence of Early Childhood on Adult Health

likely, and the fact that child and adult mortality in Sweden is so low compared to the US, I think attests that it works. Notice I said nothing so far about the role of health and medical care in producing health, despite the fact that I work as a doctor in emergency rooms. There are no data that support health care as it is done in the United States, at least as having a positive impact on our health. The reasons why are a whole other talk, but I mention it here just so you don't think I forgot an important piece. Health and health care sound synonymous, but they're not. Medical care is invested in disease, and our abilities to discover disease are so sophisticated now that I can say with certainty to all of you in this room, "If you think you're healthy, you haven't had enough tests yet." We can find disease in anybody, but I'm talking about health. Now respected sources such as the Oxford Textbook of Public Health and others back me up on this seemingly unintuitive concept. I'm not suggesting you don't receive medical care when you need it, but don't look to health care to make a population healthy. So let me move on and ask, "How are we going to produce a caring and sharing society in the United States and get back on the road to health." Well we can begin by overturning pretty well all the recent legislation that gives everything to the rich, and we are to be satisfied with what trickles down from them. Greed isn't good for our health. We have to make the choice between greed and good if we want health. If we don't, then we can continue to have ever-less so the rich always have more. Maybe you don't want the rich to have worse health because of this. Remember, I said "It is not only your health that 's impacted by inequality but that of the rich as well." Tax cuts for the rich and rich corporations are not good for our health. Back in 1940, United States corporations paid 40% of the federal tax bill. By 1960 it was 26%, by 1990 13%, and in 2000 only 7%. From 1996 to 2000, during a period of strong economic growth in this country, 60% of US corporations paid no federal income tax, according to the General Accounting Office. The feds said that. In 2003 Time Warner, for example, made $4,224,000,000 in profits, and paid no tax. We can change that, for we the people, as I said, make the laws in this country. The intent to permanently repeal the estate tax is another example of legislation that we should not allow, because it will be bad for health if enacted. President Franklin Delano Roosevelt said that both inherited power and inherited wealth were inconsistent with the guiding principles of this nation. Our highest personal income tax rates used to be 91% when we were one of the healthiest countries in the world. Now they are 35%, and our relative health decline mirrors the drop in tax rates for the rich.

From Womb to Tomb: The Influence of Early Childhood on Adult Health

We live amongst a few Hood Robins that take from the poor and give to the rich. We can have a maximum wage, just as we prescribed for Japan when we wrote their constitution in 1946. At that time the maximum wage in Japan was set at JPY 65,000. Today the boss in Japan makes 10 times what an average worker makes, as I said, and ours makes 531 times. Last year in the US, the highest- paid wage for CEOs, that is Chief Ego Officers, was $110 million, and in some recent years it's been almost seven times that. Pay for the boss in the last decade has tripled while corporate profits have only doubled, and worker pay went up only 49%, and inflation ate up most of that. So the average worker's dying for a living. President Roosevelt, a Democrat, put forth legislation in 1942 to create a maximum wage for the United States of $25,000 a year. We could go back to that kind of regulation since we almost had a maximum wage then. President Nixon, a Republican, proposed a negative income tax in his Family Assistance Plan of 1969. He said there would be a guaranteed income for every family with children. Newspaper support was 95% in favor. The plan passed the House of Representatives and languished in the Senate, where Nixon became embroiled in Watergate, and it was never passed. We could revisit that legislation. Enacting it would certainly help cope with the large numbers of homeless children that were not present back in Nixon's time even. So the medicine we need to produce, health is one we used to consider taking in the past, or took in the past, so we could compound it again in our political pharmacy. A trickle-down politics is no better than trickle-down economics. We must see that we the people are the source of power. We are our population health doctors, and we need to take that power back. We can only do it by becoming aware of what makes a population healthy, and taking steps to produce health in ourselves. We don't need more research on this. Asking for more research is a way of subverting political action. If the goal is becoming healthy, we know all we need to know. The material I presented can be considered a new paradigm for looking at health, and our history is replete with scientific revolutions. And something that commonly occurs with revolutions is what can be termed a professionalization of the old paradigm. Now as a medical doctor, I find doctors are the most resistant group in this country when it comes to trying to produce health. We love the old treating disease model, for that creates immense profits. So we're very resistant to the ideas I've described. M-Deities don't want to think of changing our disease perspective because we're comfortable with it, even though we die much younger than we should, at least compared to people in 25 other countries. Our health in this country is so far behind others that if we eradicated heart disease-- our leading cause of death, kills almost half the people in this country-- we still wouldn't be the healthiest country in the world. And there's no M-Deity out there that could contemplate winning the war on heart disease as a possibility, but that shows how much our health has declined. US used to be one of the healthiest

From Womb to Tomb: The Influence of Early Childhood on Adult Health

countries in the world back when we cared and shared. We can go back to those values of caring and sharing. We need to discard greed in favor of good. Now I've talked about our health as people whether in the womb as children, as adults, or getting nearer to the tomb. Now benefits extend far beyond our species to the physical environment. Studies show that where the gap between the rich and the poor is smaller, the rape of the physical environment is less. Equity and good ecology are almost synonymous. Now you may say I'm espousing a one size fits all perspective and if the goal is a sustainable planet, caring and sharing works. If the goal is wealth-creation and all of us dying young, then we just need to continue making the rich richer. Now some of you will say these ideas are all nonsense. How do we come to know things in our travels from womb to tomb? In the past we used to ask our parents, talk with teachers, ask our friends what do you think? These days we Google, and in 0.21 seconds we're presented with 1,254,902 hits for just about anything. I find this incredibly underwhelming as a way of learning. We get too much information, and our brain shuts down as we don't want cognitive dissonance, and we go back to business as usual. I'm proposing to you here tonight that if the health of your children is important, if the health of your unborn grandchildren is important to you, that you must become familiar with these ideas. Don't take my word for it, find out for yourself if they're true. The illiterate of the 21st century will not be those who can't read and write, but those who cannot learn, un-learn, and relearn. So verify the statements from the Institute of Medicine's various reports, which are available for free on the web, then delve into other scientific literature. Go to our Population Health Forum's website, which has a diverse source of materials. Now it may take you a while to become convinced, just as it did me. You can then teach what you've chosen to learn. Get other people thinking about this question. Band together to organize, and change the rules in this country that determine who gets what share of the pie. Inequality hurts everyone, including the rich, and it's time to redress that. But the rich and powerful won't give up easily, and they will try to subvert you. So as citizens we need to look at existing policies in this country and new ones proposed to see what they do to the gap between the rich and the poor. If they increase it, then we can expect worse health outcomes. If they decrease it, then we can count on a longer time between womb and tomb. We can only influence policies, existing and forthcoming, by working together to understand their health effects, and to help others recognize this. Now such organizing begins in our communities. The way to fight organized money is with organized people. Now recently a group of us met with our local congressman to get his take on the forthcoming CAFTA, or Central American Free Trade Act, which like NAFTA demonstrated, promises to be bad for our health because it allows the rich to

From Womb to Tomb: The Influence of Early Childhood on Adult Health

take even further advantage of the poor. The politician felt that unless we can turn out large numbers of people, such as Martin Luther King used to do, to support the defeat of the legislation which hurts everyone, the likelihood of it passing are high. This is the challenge ahead. So to summarize, I pointed out that we as citizens in the United States are less healthy than people in all the other rich countries, and a few poor ones as well. Fifty years ago we were one of the healthiest countries in the world. But as we've lost interest in governing ourselves and allowed those with wealth and power to further concentrate their wealth and power, our health compared to other nations has declined. All of us, rich, poor, and vanishing middle class alike, pay the ultimate price for living in the richest, most powerful country in world history. We live less happy lives and die much younger than we need to. If we accept it's better for the rich to have everything and for them as well as us to be so unhealthy, then all is well and we can continue hanging on to the steep slope at the source. But we could decide that we actually desire a long life, shared liberty, and happiness rather than just its pursuit. Then we have to work hard to gain back our sovereign rights to determine our well-being. Now we cherish our democracy, or at least we talk about it, but mostly we follow Benjamin's Law: when all is said and done, more is said than done. We're not aware of how much work it takes to have a democracy. It means much more than voting once every four years. Even then we have the lowest voting turnouts of all countries. Plato said 3000 years ago for a democracy to function, the richest person should be no more than four times as wealthy as the poorest. Today it's close to a trillion to one, or a million million to one, far from Plato's 4:1. So we don't have a functioning democracy in this country, or at least one where we the people do much work in deciding who benefits from the policies that are enacted in the United States. Democracy is not what we have, democracy is what we do. We feel we're too busy to work in a democratic process. It takes too much time to understand the issues and to work together. If we take time for democracy though, we'll more than make up for it with added years of productive, enjoyable life. What a fantastic investment in ourselves, our children, and our grandchildren. So if well-being is important to you, we have to work to improve our health for the rest of our lives. There's no quick fix, no way to check a box on a form and send it in, and all will be well. Each of us must inventory our skills, interest, and energy, and act in concert with those. If you do what you enjoy doing, and you can continue doing for a long time that addresses the big picture of health, then it will make a difference to this country. Now personally I try to develop curricula for middle and high schools, so that our young people will learn the need to make group decisions for our health. They need to see that being healthy is not an individual matter, but something that a

From Womb to Tomb: The Influence of Early Childhood on Adult Health

society decides. And for the young here tonight, ask your teachers about these ideas. I also write for audiences from the homeless to academics, and teach at college level. Now it's difficult to make a living in this country espousing economic justice, so keep your day job. After tonight I want each of you to extend a hand to three others on the steep slippery neoliberal, or slope of trickle-down economics, and tell them what you've learned tonight, and how it affects our health. You may never know what results come from your actions, but if you do nothing, there will be no results. So one person working alone won't help that much. We need solidarity, sharing our efforts with one another. If you give me a fish, you've fed me for a day. If you teach me to fish, you've fed me until the river is contaminated or the shoreline seized for development. But if you teach me to organize, then whatever the challenge, I can join together with my peers, and we will fashion our own solution. If we organize, then the upstream source of the problem will vanish, and people won't be sliding into the river, and we'll all enjoy a much healthier and longer time between womb and tomb. Thank you. ALI LIGHTFOOT: That was Steven Bezruchka, From the Womb to the Tomb. Since Dr. Bezruchka gave this presentation, the new 2005 health figures were released from the UN. The United States has declined further, and now ranks 29th. This program was produced by Alternative Radio, an unembedded award- winning weekly series based in Boulder, Colorado. Since its inception in 1986, AR is independent and supported solely by listeners just like you. AR features such diverse voices as Arundhati Roy, Noam Chomsky, and Bill Moyers. A Bezruchka two-pack is available that includes this program and the previous one titled Health and Wealth. Just ask for the Bezruchka two-pack. To access our vast catalog, visit our website at alternativeradio.org. Again, that web address is alternativeradio.org. To place a credit card order for the complete one-hour program you just heard, Stephen Bezruchka, From the Womb to the Tomb, call us toll-free at 1-800-444- 1977. Again, that toll-free number is 1-800-444-1977. You can also order online from our web site, alternativeradio.org. Or you can send us a check. CDs and tapes are $15 plus $1 for postage. Printed transcripts are $9 even. Please specify which format you'd like. Our address is AR, PO Box 551, Boulder, CO, 80306. David Barsamian is AR's director. I'm Ali Lightfoot. Thank you for listening. We go out with Odetta singing "Two Little Fishes and Five Loaves of Bread."

From Womb to Tomb: The Influence of Early Childhood on Adult Health

[MUSIC PLAYING] A crowd of people went out in the desert to listen to what the Good Lord said. They done listened and heard the Good Lord's words, then they got hungry and had to be fed. Only two little fishes and five loaves of bread. The Lord's disciples began to get worried. He didn't even have to scratch his head. But what could they do, because each one knew there was a big crowd that had to be fed with only two little fishes and five loaves of bread. The Good Lord stood up and told his disciples to bring him the loaves of bread instead, bring the fishes by and let him try a little idea he had in his head; about the two little fishes and five loaves of bread. He broke the bread up, and also the fishes, and then his disciple went ahead. But the more they passed around, the more they found, with lots left over when all had been fed, on only two little fishes and five loaves of bread. Hear what I said, if we all help one another, then the world will be fed, only two little fishes, five loaves of bread.