Mayo grand rounds talk 2016

Mayo Grand Rounds Talk August 9, 2016

Thank you for inviting me to talk to you today about a topic that is near and dear to my heart.

I strongly believe that we need good and informed people to make a significant difference in the lives of children in this country — and I believe that our very best caregiver institutions should be in a lead role in making that difference.

We have learning gaps between groups of children in our schools today that are huge, damaging, and growing. Too many schools today have 70 to 80 percent of the students from our White and Asian American groups doing well on the basic tests of reading and mathematical ability in high school but those schools only have anywhere from 20 to 40 percent of the students from our American Indian, Hispanic, and African American groups performing at grade levels on those same tests.

We have huge learning gaps in our schools. Those learning gaps create lifelong problems and difficulties for the students with the lower scores.

We also have far too many people in prison in our country — and far too many of the people in prison today are from our minority groups as well. Our prison populations far exceed any other country.

We have seven times as many people in jail as Canada — and we have far more people in jail than any other country in the world.

Those two issues are related because far too many of the people in jail are from our minority groups. Hispanic Americans are

four times more likely to go to jail than White Americans and African Americans are six times more likely to go to jail.

We actually have more African American males in jail today than the total number of African American males who were enslaved at the beginning of the Civil War. An excellent report called The Sentencing Project was given to the United Nations a couple of years ago to show the disproportionate level of arrest, incarcerations, and sentences for our minority Americans. The Sentencing Project is cited in my Three Key Years book.

The link between those two issues is this. The children who do poorly on those learning tests tend to drop out of school.

Students who can’t read and students who don’t do well on the math tests tend to leave school before graduation.

The children who drop out of school tend to have a much higher likelihood of going to jail. That is true for children from every ethnic group.

For African American males, where 30 percent of the males in this country are currently spending at least some time in jail during their lifetime, roughly 5 percent of the high school graduates end up in jail. But more than 60 percent of the high school dropouts end up spending time in prison.

In fact, African American dropouts are more than 62 times more likely to go to jail than a white male in this country. That isn’t 62 percent more likely to go to jail. It isn’t six times more likely to go to jail. It is literally 62 times more likely to go to jail.

Those numbers are relevant to this Grand Rounds discussion at the Mayo Clinic because the path to prison for those dropouts is set for each child by age three. The factors that determine which

children will drop out of school are set for each child in the first three years of life. The single best determination factor for who will be in prison at age 18 is the number of words in their vocabulary by kindergarten.

Grim and powerful studies at Stanford and UCLA and Harvard and Berkeley and Columbia and the University of Washington and the University of Minnesota have shown that the kids who have fallen behind by age three never catch up.

Why is that true? The reason that is true is exactly why this is an appropriate topic for a medical grand rounds. The reasons why that is true are entirely biological. The reasons why those children who have fallen far behind by age three almost never catch up is based on what happens in a biological process in each brain for each child in those first three years.

Those learning gaps that cause us so much grief in so many settings are not the fault of the school systems. Schools work hard to help those children. We have known about those gaps for years and schools have been trying very hard to close them.

Good hearted and well-­‐meaning people have worked very hard in very intentional and very focused ways in many settings to close those gaps.

The Oakland School Systems — 10 years ago — looked at their current learning gaps.

They saw major gaps and they decided to do what they needed to do to end them. They put a great program in place. They created widely publicized very intentional and very focused programs that were aimed at ending those gaps for the Black boys in their system. They set up coaching and counseling and they set up direct one on one tutoring and teaching with highly

skilled and dedicated teachers for that group of boys. They provided emotional, cultural, and psychological support for that set of students. They hired a brilliant and even charismatic leader for that process.

When they started the process, 70 percent of the White boys in the school were at age level performance and only 40 percent of the African American males were at that level. A decade later — with the new Common Core sets of measurements — the White male numbers had dropped to 60 percent and the African American male numbers had dropped to 30 percent on reading scores and had dropped to only 20 percent on the math scores.

Why did that happen? Why did a decade of hard work result in bigger learning gaps?

The hard and clear reality is that you can’t close learning gaps at fifteen years — you have to close them at fifteen months.

The basic issues that need to be addressed to close those gaps are biological — not ethnic or racial or cultural.

Neuron connectivity is the key. The medical scientists in this room know those processes. Neurons connect in baby and infant brains. Neurons connect and those connections are reinforced and strengthened in the brains of very young children. The neuron connectivity processes that are most important to learning happen in the first three years of life for each child.

Some very important processes happen in the first three years for each child. WE need to understand those processes and those time frames. There are also some very important processes that happen in the first three MONTHS of life for each child that also need to be understood.

Those first three years are when the neuron connectivity process is influenced by the life experience of each child — and when the brains that are stimulated and exercised put in place and strengthen neuron connections that last for life. Those first three years are golden years for brain strength building for each child. Physical exercise builds strong muscles. Brain exercise builds strong brains.

We know what that exercise is for our brains.

Very basic interactions exercise the brain. Talking, reading, playing, interacting and even singing to the child strengthen the brain. When brains are exercised by trusted adults who are talking, reading, singing, playing, interacting and even counting with the child, neuron connections happen and are strengthened by the billions and those connections build stronger brains.

The children who do not get that exercise in those key years do not build or maintain those connections in their brains. Far too many children do not have adults talking to them, playing with them, and reading to them in those golden months and years.

The window of optimal opportunity is sadly relatively brief.

If children do not build and strengthen those brain connections by age four — some say by age three — the opportunity is gone and those children tend to never catch up.

The brains prune themselves of unused neuron connections at that point and the ability to create those connectivity pathways with ease shrinks immensely. For some areas of learning — like the ability to discern and learn languages — the shrinking of opportunity is severe for many people. Japanese children who don’t hear the sounds R or L before that point in their lives tend

to never be able to even hear those letters — much less use them.

You can still help children with various levels of brain strength and learning after that time frame — and there are clearly many key learning processes and wisdom and judgment development processes that happen for us all after that time frame — but the primary and golden opportunity to create core learning ability for each child is gone after those first years.

That is relevant to the topic I am addressing because those first three years are absolutely critical and key to any strategy we might use to actually close the learning gaps we have in so many schools in this country.

We can not close those gaps in our schools unless we help children from each group very directly in those first key years. If we do help the children, the results will have an immediate impact on our schools — because it will change the learning readiness levels for children entering kindergarten in just a couple of years. That ability to have more learning ready children in our kindergarten and our pre kindergarten programs is a much needed and very immediate return on any investment we make.

The health levels are also significantly better for the children who graduate from school in comparison to the children who drop out of school. Dropouts are, for example, roughly 70 percent more likely to become diabetics as adults.

Before talking about that point, I want to talk about the fact that we also now have much better information about the opportunities and problems that exist for each child not in the first three years — but in the first three months. Developmental

science has fairly recently gotten much better relative to giving us insight into those first months. We clearly need to focus our attention and our learning processes on those first weeks and months to provide maximum benefits for each child.

New and improving science is teaching us that the first 90 days are extremely important times for epigenetic processes for each child.

Emotional wiring — and a sense of environmental context — are created for each child by their direct experiences in the first 90 days after birth.

The brain wires itself differently based on the direct experiences for each child in those first days and weeks.

If a child is hungry — and is fed — and if the child is stressed — and is comforted, then the brain wires itself in one direction.

But if the child is hungry and is not fed — and if the child is stressed and is not comforted in those first 90 days — then the brain wires itself in a different direction.

Rhesus monkeys go through similar wiring processed based on their personal interactions with the world in those same first days and weeks of life. The monkeys who are not fed and comforted in those time frames have different brain wiring and different behavior patterns than the ones who are fed and comforted.

The impact is almost immediate. Several good research programs are focused on studying those differences in behavior patterns and responses in babies. The Center for the Developing Child at Harvard has done some great work.

Dr. Beatrice Beebe from Columbia University has done some wonderful work on those first weeks and months. Dr. Beebe explains that the children who do not get that support in those first weeks and months time frames end up with what her program labels, Presumptive Negativity.

Children with Presumptive Negativity at age three and age five and age fifteen assume that new situations are likely to be negative.

We have all seen Presumptive Negativity. It is not any easy path through life. Dr. Beebe and her team urge therapy in a family context for the children with interaction deficits in the first year of life. The resources to provide that much therapy to that many children clearly do not exist, so we need to move upstream in the process and do a different intervention — and we need to give parents and families and care sites the knowledge and support needed to put behaviors in place that create security for each child in those time frames.

Knowledge is power. Knowledge creates opportunity.

Knowledge also creates ethical accountability. The ethical position we are in with that knowledge needs to be recognized.

We can’t ignore those issues now that we understand them.

Now that we have this knowledge about why so many children lead damaged lives, we now need to figure out the best and most effective ways of strengthening brains in those first three key years and we need to take intentional and useful steps to strengthen emotional security for infants in the first three months.

We need to begin by sharing that information. That information about the development process for our children is hugely important information and almost no one knows it. That lack of knowledge damages children and it makes life much more difficult for parents. Parents can’t make informed decisions about their own parenting processes without knowing what kinds of decisions and interactions with their child can add real value for their children

We have done a terrible job of teaching those realities to parents. Almost no parents know that those opportunities exist.

We have done a horrible job of teaching those realities to families and to communities.

We have not taught that information to the people who run our education system — and we have done a very weak job of even teaching it to our caregivers. Pediatricians have begun very recently to make reading and early brain development a priority in some settings, but even that activity by our pediatricians is not a priority for more practices and the information sharing about those developmental opportunities to parents is inconsistent at best.

That total lack of information sharing with all of those relevant and concerned parties is a massive public health failure. I personally believe it is the biggest single public health failure in our country today.

If we don’t transform that reality now, we should be deeply ashamed of ourselves for allowing so many children — children who are being born this very moment — to go down a path of difficulty, poor health, educational incapacity, incarceration, and functional failure because we did not use that information to

help each child in the time frames when each child could be helped by that information.

Children are being born every day, and many lives are being damaged because that information and that knowledge has not been shared.

We need our communities to all very clearly understand that information.

We need to make that information the core of a basic parenting paradigm for America.

We need to make that information key to the culture of parenting for every group and every community in America.

We need our caregivers to anchor that public health teaching process.

We need our obstetricians to be part of that teaching process.

Obstetricians are hugely credible to mothers — and the timing is perfect for the sharing of that information. We need OBs to teach that information to new mothers during the pregnancy so new mothers can plan ahead to do the right thing as soon as their baby is born.

We did a pilot in San Francisco a year ago where a couple of dozen low-­‐income mothers were told by their obstetrician in a community clinic about the value of reading and interacting with their child in the first year — and every single mother took that coaching to heart and was reading and talking intentionally to her child at the end of their first year. We need OBs and midwives to share that knowledge with each new mother.

We also need hospitals to be giving new mothers information about brain exercise as they leave the hospital, and we need pediatricians and our family practitioners and our pediatric nurses to be sharing that information with their patients in the first years and months of care for the patients.

We need all parents and all families to understand the value of talking and reading and playing and singing and interacting — and even counting — with their babies and children in those first months and years.

It does not take money to have a major positive impact on children. Talk is cheap. Talking is actually the single most effective brain exercise tool. Talking directly to a child and with a child is golden. We need to create a culture of compulsive and continuous talking by loving adults to children.

Some groups of parents do that now at almost compulsive levels — and those children have the test scores to show the results — but some cultures deliberately do not talk to their child until the child has indicated they are ready to talk by saying the first words. Those cultures that do not speak to the child until the child speaks first have some communities where there are major learning deficiencies by age three. All of those parents love their children. That parenting advice and interaction pattern has a completely unintended and unintentional negative impact on those children.

Some cultures tell their new mothers not to talk in public to their children using baby talk because “it makes the mother look stupid.”

Unintentional damage is done by those practices — and that unintentional damage happens in spite of the fact that all people

from all groups and all cultures love their children and all families and parents want their children to do well and thrive.

We need to communicate very clearly and persuasively to all parents that talking to babies and children is a wonderful and effective thing to do. Talking is good for the baby and it also feels good for the parent.

Many new mothers are insecure about their ability to do things that create value for their children. A number of Low-­‐income mothers say that they feel bad about their inability to provide more extensive support for their child. All of the mothers love their children. So we need all mothers to know that their own direct and loving talking to their baby and infant creates a huge and invaluable benefit to their child.

Reading also provides significant value to children at multiple levels. It is true that some mothers and some fathers can’t read themselves.

We need to teach every new parent that reading to their child in those first months and years is not as important as talking to their child — and every minute of talking builds millions and even billions of neuron connections for their child. We need all new Moms to know that she gives her child a huge gift that lasts for life when she talks directly to her child in those key months and years.

We need to give all new Moms and new Dads easy pathways to helping their child build both emotional strength and brain strength in ways that will feel wonderful for both the parent and child.

We need families to know that every loving interaction with their child is good.

Perfection is not needed.

Constant interaction is needed.

Talking is the single most important interaction for each child.

Talking directly to a child is an interactive way is pure gold for both brain development and emotional development and emotional security for a child.

Books are also very good and very useful for helping children.

Books teach children the link between symbols and meaning.

Books also create a secure and loving interaction with an adult.

Books are a bit like breast-­‐feeding in having several levels of benefits for children.

The children who are read to more often are more learning ready when they get to kindergarten and school.

Higher income homes tend to read far more often to their children. There are also some low-­‐income homes that read extensively to their children — and the benefit to those children in those low-­‐income homes that read is clear — but on average, higher income families read more often and read more books for their children.

The average higher income home has 12 books per child. Over half of the Medicaid homes do not have a single book.

Children love to be read to. Parents and other adults can bond in very supportive ways with children through reading. We need to

encourage reading for all families, and we need to do what needs to be done to make books available to low-­‐income families who can’t afford them.

Counting is also important. Children learn a lot when parents and other adults count with them. That does not always happen.

In some communities, the learning gaps on numeracy skills are even greater than the reading gaps.

In Oakland — where only roughly 30 percent of the minority children can read at grade level — fewer than 20 percent of the children have grade level mathematics skills.

Those skills can be built by counting and they can be built by playing basic and simple numbers games with each child. Simply saying — how many apples are in that bowl? — can help build those skills. We need to teach all parents that those kinds of basic counting and arithmetic interactions with their very young children have huge value for the children. We need to model those behaviors, and we need both families and day care settings to offer basic counting interactions.

From a purely medical perspective — in addition to working on the various learning levels for each child — we need to be very focused on helping children avoid the damages that can result from toxic stress. Too many children suffer from toxic stress syndrome. The Harvard Center for the Developing Child and the child development program at UC Davis led by Dr Ross Thompson have done some remarkable work in those areas.

Toxic stress is exploding as a problem for children in America as well.

When children are either under stress — or when they are significantly isolated — negative neurochemicals build up in

their brains and those chemicals can create damage at multiple levels that can last for life.

The children with toxic stress syndrome often have major behavior problems. They tend to have significant health problems and they tend to be suspended from school for both behavior and substance abuse. They tend to have higher rates of drug use and alcoholism and higher rates of pregnancy.

Some good research tells us that a daily buffering experience with a trusted adult can significantly reduce the toxic stress damage for a child-­‐and work done at USC Davis tells us that the buffering from positive experiences can have positive impact with as few as 30 minutes per day of positive interaction.

The Harvard Center for the Developing Child and the program led by Dr. Ross Thompson at UC Davis have done some very good work on those toxic stress issues as well. The good news is that the things that we need to do in families and settings to improve both emotional security and learning abilities for children also work very directly to mitigate toxic stress. We don’t need a separate program. We just need to do the right things for our children in those key areas — and we now know what those right things are.

So now that we know all of those medical and developmental problems and opportunities for our children — what should we do about them?

Now that we know that children in those key months and years need those basic interactions, what do we do to help children have better lives?

We need to use the tools we have available to change lives. We know that there are some basic tools that work to make lives better for babies and children in all settings. To succeed in those efforts, we need to make this body of precious knowledge a major public health campaign — with advertising, books, brochures, news stories, direct teaching materials, and a wide and continuously improving range of internet based interactive and social media tools to communicate this information with a high level of immediacy and credibility to parents and families in America.

We are trying to do that through the Commission I chair in California. The television ads you saw that opened my talk today are from that campaign. The First Five Commission for Children and Families is running ads right now to get that message out.

First Five also has an interactive website and social media links that teach this information to parents and families.

The television ads are running in a couple of languages.

We also have an extensive radio ad campaign, and the radio ads are running in a dozen different languages. The radio ads are done as reader ads, with the announcer reading a script from First Five rather than just pushing a button and playing a pre recorded message from First Five.

We do the reader ads on the stations that use other languages because we want the people who are doing the ads to understand exactly what we are trying to do to help children from their group. We want all of those media folks to understand the science and the opportunities at a very basic level — so we have them read the ads out loud from our scripts.

We then encourage the radio announcers to tell their own story at the end of each ad — to add content from their own family or their own life. Many do exactly that and it is extremely useful when that happens. Some of those stories are extremely powerful and they are highly credible, given the source.

Our research showed us that the two most influential and credible sources of information for minority mothers was their pediatrician and their own language radio talk show hosts. We are working directly with both of those credible sources to teach this information to the people in each group. A key part of our message is that every language works to build baby brains. In too many dual language families, the families have chosen to speak only to their babies in English. That is well intentioned, but it often results in many fewer words being spoken to those children. We need many words spoken and all languages meet that need.

The ads seem to be having a positive impact. For our very first run of television ads, a year ago, we had the results studied by the University of Chicago. They measured the reach of the ads and the impact of the ads. Their research showed that we reached over half of our target market with people who could remember the ads with unaided recollection — and their surveys told us that 72 percent of the mothers who remembered the ads said they changed their parenting behavior in some way as a result of the ads.

The University researchers were stunned at those results. They had measured a number of public service campaigns. They told us that a 10 percent recognition level was a major success for most campaigns and they told us that getting more than 10

percent of people to change behavior with a public service campaign was unheard of.

We had a 50 percent recognition rate and we had more than 70 percent as an influencer for change.

Why did that happen? Were they truly great ads?

They were good ads. But they worked at that very high level because all mothers love their children and mothers love their children so much that they responded to the fact that our ads gave them easy to use ways to show that love and provide a direct benefit and gift to their child.

One of the basic mantras for continuous improvement in any health care setting is to Make The Right Thing Easy to Do. That is a basic tenet of the health improvement agenda at Kaiser Permanente. When you make the right thing easy to do, it is much more likely to get done.

That process involves figuring out the right thing, and then it involves figuring out how to make it easy to do. My health care process improvement books use that thought process and strategy. We need to follow that same process here. We need to figure out the right thing for children and then we need to make it easy to do.

The ads had that positive impact in part because they made the right thing easy to do. Another study showed that when low-­‐ income mothers were both coached about the value of reading to their children and were given a supply of free books to read, the number of readers grew by a factor of seven for that group.

That study is cited in my Three Key Years book.

So as we look at tools that work, we clearly need to start by getting more information about these opportunities to all families and parents — and we can do some of that teaching and communicating through ads. We also need to build additional ways of teaching that information to families and parents.

We know that when we do not teach that information to parents, they do not know it. This is not common knowledge.

That key science that sits at the heart of the work done at Columbia and Harvard and Stanford and UC Davis and the University of Chicago and the University of Minnesota is not getting to any parents.

The brilliant work done by Dr. James Heckman — Nobel Prize Laureate in Economics at the University of Chicago — on the massive positive economic return that results from investing in the first three years of life for our children — is not known by parents in this country today. Dr. Heckman has a quote on the back cover of my Three Key Years book. Almost no parents anywhere have read his work.

We checked that out. More than 90 percent of the Medicaid mothers we talked to in California did not know that they could strengthen their child’s intelligence levels by exercising their child’s brain.

Our goal at First Five is to flip that 90 percent over — so that next year in California, 90 percent of the parents who give birth in California will know they can strengthen their child’s brain by exercising the brain.

To achieve that goal, we have a two-­‐part program that we call Surround Sound and Trusted Messengers. We are working hard at multiple levels to create surround sound for parents and families about these issues and we are working hard to share that information through a wide range of trusted messengers.

We want to share that information through caregivers, community leaders, social media, faith leaders, educators, and several levels of very clear advertising.

We need social media to be a key part of that tool kit, and we need people to hear about those brain development opportunities for their children from people they trust.

We are experimenting with using the WIC program to teach those messages to Medicaid Mothers in Los Angeles. The WIC program reaches more than 80 percent of the Medicaid Mother in America, so it is a great tool to use to get that information in a credible and systematic way to mothers who really need the information.

WIC usually teaches nutrition. WIC provides financial assistance for the purchase of food for low-­‐income mothers. Hubert Humphrey, a Minnesota ICON, was the original sponsor and creator of WIC for our country. Coming from an agricultural state, he anchored WIC in buying healthy food for the low-­‐ income mothers of America.

In the First Five WIC pilot in Los Angeles, the results are being studied…but the first indicators are that there was a 37 percent reduction in the learning gap levels for dual language Medicaid children in just one year based on the WIC counselors encouraging reading to the children and providing some books to the children on their visits to the WIC centers.

The Nurse Family Partnership program has even bigger positive consequences for children. That is a national program that serves far too few children. The Nurse Family Partnership program is a wonderful and beautifully targeted program that has trained nurses going into homes and coaching low-­‐income mothers on parenting several times a year for each home.

The results of those programs have been significant reductions for the learning gaps for the children whose mothers receive that coaching. I heard a presentation early last week in Sacramento at a childcare summit about the Nurse Family Partnership in Los Angeles about the results for a program there. For the families that had six or more visits during the prior year, the number of families that ended up with a child abuse or mistreatment problem dropped from 14 percent of the families to only 4 percent.

Dropping from 14 percent to 4 percent is not only a good result for right now for many children, it also has massive down stream positive consequences for those families and children.

The visits help hugely. More than 90 percent of the families that had those visits changed parenting practices in positive ways.

More than 70 percent of those families reported higher levels of comfort and affection for their child. Parents loved getting that support, and it helped parents feel less helpless and overwhelmed in their ability to care for their child.

Those are wonderful programs — and we need to make them available for many more children.

Early Head Start Programs in a number of communities have also had significant success in closing learning gaps.

Standard Head Start programs do very good things for many children — but they do not tend to close learning gaps. Multiple studies have shown that result. Four years old is too late to make a major dent in learning gaps.

Pre kindergarten programs also do very good things for their children — but those programs also do not close those learning gaps.

Early Head Start begins earlier for each child, and those programs do have a good track record in closing those gaps.

The American Enterprise Institute looked at a dozen preschool intervention and support programs in various settings this year — and they only found significant learning gap success in the couple of programs that focused on the first years of life.

We clearly need to focus on creating both a culture of parenting that helps children in those key years and on the support systems that actually provide support to families and children in those time frames. We need to do that as a nation.

Instead of thinking about our national education policy as a K to 12 agenda — as it is usually addressed — we need a national and local education policies based on B to C — Birth to College.

We are beginning to hold B to C summits at First Five in California — and the Superintendent of Schools for the state — Tom Torlekson — in entirely on board with that agenda and has directed his planning teams to think of the future in those terms.

As part of that B to C agenda for the nation, we need to look at the day cares of America as being functional and important parts of the education process. We need to make day cares more

affordable — and we need to make day cares more effective and successful in helping children with those issues.

More than half of the day cares for the low-­‐income families do not have a single book. We need books in all settings. We need to teach the rudiments of basic brain science to all day care workers, and we need to require and encourage both toys and appropriate interactions with children in all settings.

We need all parents to be sufficiently informed of the opportunities that exist to steer their day care settings to the right interactions with their children. Informed parents can make a big difference in the day care realities and interactions for their children. Knowledge is power.

We also need extensive book availability programs in all of our settings and communities.

We need low-­‐income mothers and fathers and families to have books available.

Even for the families where the parents can’t read, the books can be used to tell stories — and other people in those settings who can read can do the reading for the children.

The first year is absolutely crucial for the brain strength building for each child — and talking to the child directly in loving ways is the key interaction that strengthens brains in that time frame.

Babies and children in those first years benefit significantly from “serve and return” interactions with trusted adults — with direct interactions that let the baby know that he or she is heard and is being responded to.

Baby talk is really important to that process. The work done by Dr. Patricia Kuhl and her team at the University of Washington is brilliant relative to those issues. Dr Beatrice Beebe at Columbia University has also done some stunning work on those issues.

The Center for the Developing Child at Harvard has done some spectacular work on the serve and return interactions.

All of those programs need to be understood and used by our public health and educational leaders as foundations for our child development agenda for our country. We need to teach the values of those interactions to all relevant people — and we need to make those knowledge a key part of the parenting paradigm for America.

We need to include our news media in the understanding of that paradigm. We neeed the reporters who cover those issues for the print media and the electronic media to understand the learning gaps and to understand the kinds of brain development processes that can close those gaps — because we want the media to be asking informed questions about how well those processes are going.

We also need our scriptwriters for our television shows and movies to understand those issues and we need those writers to work those themes into our popular culture through those communication pathways.

That work is also being done. We have had a number of meetings as child development activists with scriptwriters to help them understand how much good they can do by building this information into their Scripts. Too Small to Fail has taken the lead role on that work. They have done a great job leading that effort.

Orange is the New Black just had a couple of shows where the new mother going to jail did a talk and read and sing lecture to the father of her child. She then criticized him for not following up.

Jane the Virgin just had a great teaching piece on the need to talk constantly to her baby to build brain strength.

Ellen, on the Ellen show, had a piece on that subject with a couple of new mothers.

Dr. Oz just did a segment on that issue and he passed out my new Three Key Years book to the members of his studio audience. Dr Oz asked his viewers to contribute books to the WIC program for low-­‐income mothers and he generated nearly 45,000 books as the result of his request.

So we are beginning to get a tiny bit of traction. But it is far from enough. We need to get this information out to every caregiver in America.

We need all obstetricians and midwives to share this information with pregnant women.

We need family doctors, pediatricians, and nurses who work with kids and families to know this information and make it available in easy to use ways for their patients.

We need all hospitals to make sure that this information gets included in the take home material for each new baby — and we need to encourage early talking and reading in the same way many hospitals not encourage breast feeding.

New studies, by the way, link those two topics. An excellent study just done by Brigham and Womans Hospital of 180 pre-­‐ term babies found that children who were fed more breast milk in the first 28 days of life had higher IQs at age seven. T

That article was published Friday, July 29 of this year, in the Journal of Pediatrics.

My own favorite study on that topic was published in The Lancet in March of last year.

The Lancet study followed 3,500 new babies for 30 years.

Literally 30 years. That study showed that the children with longer periods of breastfeeding had distinct socioeconomic advantages 30 years later.

They looked at a total of 6,000 infants who were born in Brazil.

They controlled in the study for ten social and biological variables…including family income for parents at birth.

That study showed a four point higher IQ level for the breastfed babies — and nearly 30 percent higher monthly income levels for the breast fed babies at age 30. The breast fed babies apparently were more likely to be employed and more likely to get raises when they became employed.

That study probably has a number of challenges, but it does make sense that it might be possible that the babies who were breast fed had more direct interactions with their mother in ways that stimulated intelligence and created personalities grounded in emotional security and not what the team at Columbia calls Presumptive Negativity.

Whether or not those factors are relevant to those children — we do know that we need to create a culture of continuous learning and a culture of support for parents who want to help their children thrive in those first weeks, months and years. We need to support parental leave programs — and we need to teach parents who take parental leave the very best things to do in that time to create security and learning readiness levels for their children.

In California — with strong support from First Five — the state just enacted the most extensive parental leave program in the country. The people who run that program for the state are working directly with First Five to get the right information at the right time to the parents who take advantage of that program.

We need to do that work because the learning gaps in our schools are huge and getting worse. The consequences of not closing those gaps will be dire. Damage will be done to those children, and society will be damaged as people fail, become incarcerated, and become very angry with the people who are not failing.

What we have done to close those gaps up to now has failed.

Really well meaning people and very well intentioned educators and community leaders have failed to close those gaps. So we have far too many people in gangs or in jail.

The people who drop out of school also have significant health problems. The famous Adverse Childhood Experience research done by the Institute of Health and Kaiser Permanente researchers have shown the major adverse health consequences of having adverse childhood experiences.

Simply dropping out of school has the result of people being 70 percent more likely to be diabetic and 60 percent more likely to have heart failure. The dropouts have significantly higher rates of asthma — and they are more than twice as likely to have a stroke.

For all groups, dropping out of school results from a pathway that begins before the age of three and has multiple levels of economic, health, and functional consequences that damage people for life.

We need to change the trajectories for those lives by helping children in those first key years.

We need Early Head Start.

We need fully funded Nurse Family Partnerships.

We need WIC coaching every Medicaid mother.

We need trusted messengers — faith leaders and community leaders and family members — who teach every mother and every father and every family the glory and joy and the huge benefit of interacting in loving and effective ways with each child.

We really cannot afford the path we are on. Right now, working mothers are reading to their children between birth and kindergarten about 1,500 hours. Medicaid mothers are reading to their children, on average, under 30 hours. About 30 percent of Medicaid moms do read to their children, but half of the Medicaid homes do not have a single book.

This year, 50 percent of all of the births in this country will be to Medicaid moms.

If we do not change the learning trajectories for many children, the consequences will be dire.

All of the mothers love their children. Fathers and families love children. Everyone wants their children to succeed. Lets take advantage of that support for children by providing really good support for children.

You, as the Mayo Clinic, can take a lead role in that effort. You were just rated number one again in the country as a care system. Well done. Best care in the country in multiple categories. No one is more credible than the team of caregivers in this room.

Please figure out ways of using that credibility to help these kids.

Be well.

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