Salus Health Care Forum July 2, 2025

Bill B

Jack, so what are some of the ingredients of an integrated community?

Jack

Some of the ingredients that Alexander Layton talks about are community leadership, community participation, clubs, organizations, activities that include lots of different people. A structure that supports people all along the socioeconomic status. Those types of engagements that bring people together.

Bill B

It’s interesting to note that these are some of the same ingredients that de Tocqueville identified about early America. It’s very interesting that when he begins to talk about habits of the heart, which relate, Jack, to what you have mentioned.  More recently, Robert Bellah and his colleagues examined these same conditions.

Jeremy

Jack, you’d probably agree that these elements are often missing in the contemporary workplace. And I think healthcare is suffering profoundly from the absence of these elements. The well-being of health care workers is being damaged more now than at any point in history. We’re going through a very difficult time right now.

Jack

I rely on Alexander Layton to help me get through sort of the current morass that we’re in. Whether you’re a Trump fan or not a Trump fan, you can’t deny that there is an increased generalized stress in society. Even one more adverse event can tip you over into overt expression of mental, emotional, behavioral health. And so, whether you like Trump’s policies or not, there is this stress that’s toxic to us. And I think that for me is where we have to identify ways to mitigate that generalized stress that can align with or overcome.

Jeremy

I am reminded of the early days of positive psychology. It sounds like there’s a need for more positive sociology, which I assume is happening. The overemphasis on the negative is kind of what ACEs does, right? It points you to the pathology. I’m hearing from Craig and from your articles a little bit too, that kids aren’t important except for what childhood stress might give you when you’re an adult. So, we’re making this important because adults are getting sick and it’s costing Americans a lot of money. So, we should try and help the kids, but that’s going to be too difficult. So we’re just going to point out the problem, which I think was still a brilliant beginning.

Now, how do we shift that into what really works? This would seem like an opportunity for some really robust and interesting things to be done in the healthcare sector. Because a lot of us are primary care physicians and psychologists. And we’ve noticed that there’s an intersection happening. We’ve acknowledged and recognized that as physicians, we have less impact on the health of communities than we thought. That’s been a very humbling experience for us. I think we impacted by 20% through all of healthcare. Public health has a much greater impact, and social determinants of health have a much larger impact. So, I think the humility part has happened or the humbling part. So, where do we go from here? A shift is desperately needed because most clinicians are not that interested in learning stuff unless they know what to do about it. And I will say, even though ACEs have hit the radar, there’s a lot of avoidance behavior. It’s like, who am I going to ask these questions? Do I ask the parents or do I ask the kid? There is even a question about how to screen in a primary care setting. The screening can be rather intimidating. So, the uptake of screening for ACEs has not been robust. The talking about it has been robust, but not the implementation.