Salus Health Care Forum July 2, 2025

Bill G

There is a closely related question, as we talk about the stress being related to families. Is there any evidence about what sort of families work best either in aggregate or individually? Individually, is there a traditional two-sex mother-father, gay families, racial mix of the families? What does the research say about what type of family you come from? If the family is intact, are there differences among the types of families in which you experience early childhood development?

Craig

I don’t know of evidence about the wide variety of family structures. The fact that divorce is included in the ACE measure suggests that divided families matter, but a major way they matter is that single mothers have lower income, and that economic insecurity is a powerful factor. So, I think the factors that make households economically secure to parent earners doing well with child care compared to a single parent with no child care working in a job with uncertain and changing hours is clearly different.

And one of the psychologists/neuroscientists at Dartmouth has introduced the notion of family chaos as a crucial factor in adversity. When child care is uncertain, where a kid stays, changes from moment to moment. Schedules are fractured. That is productive of toxic stress. So, household structure matters. I don’t think whether it’s a gay family or Black families or Latino families matters. What matters is the structure of the family and their resources.

Walt

A couple of things. One is that we’re talking about the 1970s and 1980s. The mind-body connection was not at all recognized. It was actually disputed. And you were weird if you actually talked about spiritual aspects to health, let alone emotional or psychological aspects. Now, it’s good for us to appreciate how far the collective consciousness in healthcare has proceeded. I walk in a room and if I mention the word meditation, the response is, yeah, I tried it. Oh, I know that. Oh, I have this app. Oh, look at this. You know, it’s not weird. It’s almost a norm to a degree.

The same thing with ACEs. It was a breakthrough to actually document that something, in this case, epidemiologically. The mind-body-spirit, all those connections, how would something that happens to me when I’m two years old relate at all to what’s going on when I’m 45 having premature heart disease? Wait a minute. Where’s the science of that? We have a long ways to go to understand the psychoneuroimmunology, et cetera, et cetera, for all these connections, but it’s very exciting to see we haven’t gone back.

It’s not that ACEs have been disputed or disproved at all. They’re just emerging as we continue to have more elegant ways of understanding it. And I’m really curious where AI is going to take us with this because there’s a lot of pieces to connect those dots going forward. The fact that allostatic load is a nuanced term, I’d be really curious how that relates to what we’ve already been discussing because when I saw it in ACGME requirements, what, Jeremy, 21, something like that, when it popped in there, you don’t see educators, you don’t see people talking about it.

You don’t see it really in studies. You don’t see it in our dialogue or training. So I’m just wondering where that’s going. Is that going to go away or is it something that is just early and in 10 years, it’s going to be something that’s really informing how we go to a higher level as a healthcare system and training ourselves and conducting ourselves.