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Language as Health Predictor
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0:00
Transcriber: Xi He Reviewer: Peter Van de Ven
0:16
Thank you very much.
0:19
There is a profound predictor of health and wealth that can be determined by three years of age.
0:31
And that predictor is language. Language is the essence of what it means to be human. Now, animals may have noises or gestures that they can communicate with, I can assure you my cat can get me up out of the bed at five o'clock in the morning because he is hungry, but human beings are much more adept and much more facile at language. I can tell you that language in the Oxford Unabridged English Dictionary, there are 600,000 different words that American, that English people can know.
1:10
Lots of people spoke, speak more than one language. So the ability of humans is enormous, you never really and truly see a chimpanzee or a rhinoceros reading a book, but humans commonly read books, and we understand language. Babies come into this world acutely programmed to learn all these different words, to learn the essence of language, because language is what makes us human, and quite frankly, language is what makes us survive. There is a huge growth spurt,
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a huge increase in capacity in the brain by at least a third that occurs in the last part of pregnancy, right before babies come into this world. And I can tell you that babies are hard-wired to learn different languages.
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I can tell you that because the important thing about babies is not only that there is the capacity, but how we learn language is from our caretakers. That means mothers and babies have this unique experience. I can tell you from the maternal point of view that I experienced that in my own life. Now, I'm an obstetrician-gynecologist; I delivered lots and lots and lots of babies, but the experience of delivering somebody else's baby was completely different than my own pregnancy.
2:37
Now, I gotta tell you, I came to pregnancy, and I was already a doctor. I've known I wanted to be a doctor from age eight. I loved it. I was a really good surgeon. I wasn't really even sure I wanted children. And then, this pregnancy occurred - by choice - and all of a sudden, I was acutely aware of my unborn daughter. All of a sudden, this woman that had been interested in the outside world was only concentrated on my pregnant belly. I wasn't really interested in anything
3:15
more than ten feet away from me. The evidence of hard-wire is even more profound in babies. What you are looking at is the development of language, because language is the interaction between caretaker and baby. This experiment from the Harvard Child Development Center is about the importance of the hard-wire that is existing. This is called the "Still Face Experiment." What happened is the mothers are instructed to turn away and then turn back to the child and have a still face.
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Watch what happens to the baby. What you'll see happening is, first, she tries to engage. "Ah-ah," smiles, coos, points - that's to elicit a response. Points, then she coos, "Ah, ah, ah," "ma, ma, ma," and then she reaches out. This is important, this is hard-wired. And all of a sudden, she starts to get frustrated, nothing is catching attention, there is this screech, "Ahhhhh."
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She tries to comfort herself.
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And then she looks away, tries to disengage, makes one final, one more attempt to get her mother's attention.
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And then she dissolves into hopeless crying.
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It's hard-wired.
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The Still Face Experiments are clear indicators that this is hard-wired.
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So what's the importance? What's the long-term consequence of this kind of biologic stuff? Why is it important that a mother concentrates on her baby, or that a baby concentrates and demands the attention of its mother?
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The long-term effect of all this primitive stuff was done in some, I think, some kind of brilliant work by Hart and Risley. And they were experimenters who had been involved in the war on poverty. They'd been involved in the war on poverty, and they said, "You know, there's a problem here, because we are not really seeing, with these early educational interventions, although they are good, although there are some results, we are really not seeing what we wanted to see." So, they said,
5:50
"Can we look earlier? Is there something that is happening before these babies get to kindergarten, before these babies get to first grade? Is there something happening that is important?" Their work was an extreme, involved, deep observation of family life. They went into the homes of 42 families, and they had an intense observation of those families. They looked at those families an hour a month, every single month, from the time their children were seven months of age
6:26
until the end of the third year. And what they found, as by the title of my talk, was really not what they expected. First of all, the children were all well-cared-for. So it wasn't the changes in the children, the difference in the children had nothing to do with not having the physical needs met. Secondly, it was not about race, it was not about gender. And here's the key: it was not about money.
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It wasn't determined by the number of toys that could be purchased by the parent. It wasn't determined by the neighborhood they lived in. It wasn't determined by the size of the house they lived in. It was determined by the interaction of the parents with the child. And the interaction that they saw after three years of observation was that there were 30 million more words that those families that were identified as professional families, 30 million more words that those families,
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those mamas and daddies, said to their children than the children in poverty.
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The reality is, for those families in poverty, those parents were only saying about 600 words an hour. For the professional families, it was over 2000 words an hour. Because the professional families were having constant talking with their baby. "Oh, your diaper needs to be changed. Oh, bless your heart, I'll take care of that." "Oh, look at those toes. Aren't those toes wonderful! Oh, and look at that belly button. That is the cutest thing I've ever seen. You are my beloved child."
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Thirty million more words. That's important because neurological development of the brain, actual physical development of the brain, depends on words. Each time a word is said, it shoots up the neuron, it stimulates the neuron. And when that word is repeated, that same path is stimulated again, and it'd get stronger and stronger and stronger, and it branches out so there's capability of learning. And if those words are not repeated, the opposite occurs. Those neurons shrink and die
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and go away. The scientific word is pruning. But what it means is, it decreases the ability to learn. Now I've got to tell you one more thing, it's not just hearing the words. Because babies put in front of televisions, it's like the Still Face Experiment, they don't learn. They don't learn, because it is the interaction. And children who are deaf can learn language. "Thank you," in sign language is language, it is symbols that mean something. It's language. So it's not the hearing,
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but it's the interaction that is most important. And it is enormously important. This is a graph of the effect of those 30 million different words on these children. At the end of the three years, those babies that were born to welfare parents knew 500 words, while those babies in the "professional" families knew over a thousand words. It makes a difference.
10:13
This whole process is language nutrition. And what it means is that language is absolutely important for the development of the brain. Language is absolutely the basis from which all human learning occurs. If you think about it, what language nutrition really is, is the development of neurons, the development of the brain, is absolutely, biologically dependent on language, which leads directly to the ability to read, which leads directly to graduation from high school,
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which leads directly to college education,
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or high school education.
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The importance of learning to read, the importance of this language nutrition, is that there were profound effects that they observed that were long-term. It wasn't just short-term, it was long-term. They looked at these same children five years later, and they found that they could tell that the gap had increased between those children. It'd gone from 500 to 1000 words to the ability to pass standardized tests at third grade.
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And why is that benchmark so important? Third grade is important in the whole part of human learning because up to third grade you learn to read. After third grade, you read to learn. If you cannot read on level by third grade, you can't read the text, so you can't keep up. You may never catch up. For those children who are not reading on level by third grade,
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they are four times more likely not to be able to graduate from high school. And remember this language nutrition model? If they can't read, they don't graduate from high school, and that leads directly to a problem with success in the society. If you are really behind in reading, there's a six times greater chance that you won't graduate from high school.
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Now, the problem in Georgia is
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that 70 percent of Georgia's children do not read on third grade level. 70 percent.
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That has profound implications for the state and profound implications for the individuals that are involved. There is this ranking called "American's National Health Rankings."
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And in those health rankings, there are two clusters that keep me up at night. Two clusters that, as a state health officer, I worry about. One cluster is about infant mortality, and prematurity, and all that.
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And we have made some progress there; that's a talk for another day. The other cluster where they were at the very bottom of the pack, where we are at the lowest tenth of the country, has to do with this whole business about literacy at third grace. We have high numbers of children in poverty, high numbers of failure to graduate from high school, high numbers of income disparity, lack of health insurance, underemployment, unemployment. All of this caused
13:50
by our lack of ability to read on level at third grade.
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Also, as a state health officer, I can tell you, that is unacceptable. It is unexpectable, especially since I know it's not the neighborhood, it's not the income, it's not the genetics,
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it's the exposure to language,
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the early exposure to language. So we are involved in a public-private partnership called "Talk with me baby."
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And this is to solve this problem that we have here in Georgia. This is a public-private partnership. It involves United Way, it involves The Anne E. Casey Foundation, it involves Public Health, it involves the Department of Early Child Care and Learning. But all of it is the same; all of it is to change the paradigm. For example, The Marcus Foundation, which is one of our partners, they are involved in developing the tools to teach healthcare providers,
14:57
to teach nurses, hospitals, and doctors how to tell their patients about this, the importance of early learning, and also how to tell their patients how to do it. In public health, we are going directly to the mamas, because in public health, we have an interesting little program called WIC. WIC is the Women, Infant and Child Nutrition Program. Now, WIC is different from a regular food stamp program. In WIC, you don't just get a little plastic card
15:30
and go to the grocery store and do whatever you want. In WIC, you have to come to see us, every three months to see a nutritionist. And you can only purchase certain foods with your WIC card.
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We see this as a unique opportunity to take food nutrition, which is so important for our citizens of this state, and talk to them about language nutrition. And there are a lot of people in WIC, 50 to 60 percent of Georgia's babies qualify and are in WIC. 50 to 60 percent. And all those low-risk mothers. And WIC is everywhere, there are 159 counties in Georgia, and we have 159 or more WIC offices in Georgia. We have a WIC office capable of reaching these people, every single place in Georgia.
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There is not a single place in Georgia that you can't get to a WIC office.
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We hired the Marcus Foundation to come up with some videos, and these videos will be played in the WIC clinics. And they'll tell these young mothers, these young needy mothers, these poverty mothers that we're going back to the original studies, about the importance of food nutrition. They'll tell these mothers how to do it, because it is not just straight forward, "Oh, talk to your baby and you'll be fine." There are subtleties that you need to know, and these videos are designed to do that.
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It'll tell them such things as a baby is born recognizing its mother's voice, therefore when you start talking to your baby, it's when your baby is still in the womb. So this program is designed to get to all these mothers. So far, what we have done is, we want to know what works. I believe it'll work, but what we want to know is, does it really work? So we have evaluated the average number of words that the children in our WIC clinic know. And we are going to start the videos,
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and we are going to couple it with the reinforcement - remember those every-three-month visits for pregnant women and children? We are going to reinforce that with the nutrition saying to them, "Food nutrition is important, but language nutrition may be even more important for your baby." And when that mama goes home from the WIC clinic, she's going to be taking a book. I really think that ...
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this will change the dynamics here in Georgia. I know for a fact that it is all about language. The most important concept is the development of language.
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I know that the Office of the Budget for the House of Representatives recently did a study, and they looked at the evaluation of the war on poverty that was started back in the '60s, and according to our budget office, we've spent five trillion dollars on it.
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And here's what's happened to the poverty rate. In 1965, when it started, the poverty rate was 17.3. In 2012, after five trillion dollars, it is 15. That's not much progress. I present to you, I think the problem is we didn't look for the answer to the problem early enough, and we didn't - we weren't including language. We have to include language. Language is the very basis of solving the problem of poverty.
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Life expectancy at the time of Christ was 20 to 30 years.
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Life expectancy for human beings a thousand years later was 20 to 30 years.
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Today, you people sitting out there,
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your life expectancy is 80 years or more. You survive birth, you survive learning to drive as a teenager, and you have a great chance of living to 80 or more.
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That expected change in life expectancy is not because of bypass surgery or CAT scans. Bypass surgery and CAT scans are great; they may add a year or two. But those transformational changes are from more basic, primary, primitive public health initiatives. Those changes in life expectancy are from clean water, and an effective sewer, and vaccinations, and the developement of antibiotics.
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I can tell you that in 1900, the things that were killing us, the three killers of human beings in 1900, was pneumonia, TB, and diarrhea.
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And I can also tell you that the things I mentioned - clean water, sewers, vaccinations, antibiotics - those are responsible for the expected change in life expectancy.
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I can also say to you that I believe that we are on the precipice of the next transformational change in public health. That transformational change, I truly believe, is the deep understanding of the importance of language development, and the determination that we have absolutely universal, effective, early language development.
21:36
My message to you as a state health officer of Georgia today is really simple, but I think it is important. And my message to you is: talk with your baby. Thank you. (Applause)
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