One of the best things about my job is that there is always something new to learn. Since 1990, when I joined the Health Department as a newly minted public health nurse, there’s been an ongoing smorgasbord of ideas and information ranging from infectious disease to fiscal analysis for me to grab, consume, digest and use in my work.
Without a doubt, the most compelling and inspiring things I’ve learned are related to the science of hope. It’s compelling because it provides an innovative framework for understanding and addressing health disparities. It’s inspiring because, well … it’s about hope.
Health disparities are preventable differences in the level of health experienced by different groups of people, and they are a key focus of the public health lens. Since Public Health’s patient is the community, we are concerned with the health of all of its parts. You see, it’s not only the people with poorer health who are adversely affected by health disparities. They limit the overall gains possible in health for the entire community.
One of the oldest debates in modern psychology and medicine is about whether a person’s level of health is ultimately determined by “nature” (our genes and biology) or “nurture” (our environment, experiences and behaviors). It’s an important question, because the answer you land on determines what or how much you think can be done to improve health and reduce health disparities.
Both the “nature” and “nurture” arguments have holes in them. We know that many diseases “run” in families but there’s often a lack of predictability to it. We know that certain kinds of environmental exposure, such as tobacco smoke, are related to diseases like cancer, but not everyone who is exposed gets sick. So the answer to the nature vs. nurture debate is clearly “both” but how does that interaction occur? What is the mechanism?
In 1998, a landmark public health study designed to study the effectiveness of a weight loss program in a large health clinic inadvertently found a whole new set of answers to that question.
The study, now known as the “ACES” study, showed that adverse experiences in childhood were not only related with poor health behaviors (like smoking, or poor nutrition) but also directly related with poorer health — independent of those health behaviors. It implied that adverse experiences were themselves involved in the disease process.
In the two decades since, there’s been a confluence of information that, collectively, we refer to as NEAR science: neuroscience, epigenetics, ACES and resilience. It provides a framework in which to understand how our biology (“nature”) translates adverse experiences (“nurture”), especially in childhood, into health problems decades down the road. It also illuminates a critical relationship between health and hope.
Most importantly, it suggests that there are specific actions that individuals and communities can take to prevent trauma, mitigate harm, and foster resilience — which can help us decrease health disparities. It provides a recipe, backed by good science, for making hope.
I look forward to sharing more about the science of hope and how we can use it to improve community health when we talk again. In the meantime, I’d love to know – what gives you hope about improving our community’s health? You can write me at firstname.lastname@example.org.
Karolyn Holden, director of the Grays Harbor County Public Health and Social Services Department, can be reached at 360-532-8631 or email@example.com. The department’s website is HealthyGH.org.