George Halvorson retired as president and CEO of Kaiser Permanente more than three years ago, but the 70-year-old is staying busy in his golden years: He's writing a book on early childhood development called "Three Key Years," chairing the First 5 California Commission, which is tied to those same issues in the Golden State where he lives, and launching a small institute that's attempting to tackle issues of racism and intergroup conflict. We recently spent a few minutes exploring why the first three years of a child's life are so critical, and how those early years are related to violence and chronic disease.
Could you tell us about this concept of the first ‘three key years’?
HALVORSON: When you look at African-American males who drop out of high school in our country today, 60 percent end up in jail. And we can predict with 80 percent accuracy by age 3 which path each student is on — whether he or she will dropout of school or graduate, because the first three years of life are when brains develop and are exercised in every child. The children who are doing well at 3 continue to do well, and those who are falling behind by 3 tend never to catch up. It's biological. The brain literally changes its organizational process at 4 and starts pruning out anything that wasn't developed before 4. The learning gaps in our schools are massive and they're not closing because you can't close learning gaps at 15 years. For instance, when you look at places like Milwaukee, which has massive unemployment and major incarceration problems, only 15 percent of the African-American children in the school system can read. This is a problem that we can't solve until we go upstream and deal with the issues of development for all the children.
Why does this warrant health care CEOs’ attention?
HALVORSON: This is particularly relevant to leaders in the health care field. We know that brain development occurs in the first three years of life when it gets exercise and learning abilities are developed, but the first three months of life are epigenetically important. The brain develops itself down a different pathway. We are genetically wired to identify what kind of environment we are in and then to structure the brain to fit the environment. And so, in those first weeks and months, if a child is hungry and is fed and if a child is stressed and is comforted, the brain wires itself in one direction. But if he or she is hungry and not fed and stressed and not comforted, the brain literally wires itself differently and you are able to tell the difference in the brain wiring at 100 days. That 100-day period is extremely predictive of where kids are going to be at 3 and 5 years. Parents need to know this. A lot of people are looking at the differences in children based on economic status, but it's a biological, behavioral process. So, the poor kids who have someone feeding them and interacting with them do well, and the well-to-do kids who don't have this care do badly. But the pattern shows that wealthier families interact differently with their kids. One reason is that the average working mother reads to her children from birth through kindergarten about 1,500 hours per child; the average working mother on Medicaid only reads 30 hours. Half the births in America this year will be to mothers on Medicaid. So, we're going down a pathway where we really need to go upstream. So, what I'm working on is communicating this information through books, lectures, talks, ads and the internet because every parent who understands this changes the life trajectory for a child.
If the evidence is so strong, why not make a bigger push?
HALVORSON: Caregivers in this country are well-intentioned but are unaware of the science. However, the American Academy of Pediatrics is now encouraging reading and there's a lot of early development activity going on in the pediatrics world. But outside of that, nobody knows it, including community leaders and faith leaders. What they don't know they can't teach. The Catholic Church of California just agreed to endorse the talk-read-sing agenda for their parishioners, but they didn't know this until relatively recently. When we explained it, they looked at it and said, 'Wow, this is powerful, useful, important information and we need to share it.' We also know that there's a high suicide rate in the military among those who have post-traumatic stress syndrome. But we could probably cut the number of military suicides in half had we gone upstream and helped them as children during their first three years. All the pieces of this fabric are connected, and once you understand that, it's stunningly powerful.
How can poor brain development in those first years lead to incarceration and gang involvement?
HALVORSON: Overwhelmingly, gang members and those committing violent crimes are people who dropped out of school. One out of three African-American males in this country will end up in prison. And more than 60 percent of the people in our prisons regardless of ethnic and racial group, can't read. Of African-American males in their 30s who have dropped out of high school, 60 percent are in jail today. So, you're six times more likely to go to jail if you drop out of school. And we know, with 80 percent accuracy by age 3, whether or not you will drop out of school. That's powerful, powerful connectivity. They're not getting the right exposure in those first three years. Let's look at Chicago, for example: 91 percent of gang members in Chicago are high school dropouts. What we have to do is create programs that help all kids in the first three months and in the first three years, so they don't go down the path of a school dropout. I've been a hospital CEO for three decades. Once you know what causes a person to take the wrong pathway, you feel compelled to act on this information because we now know how important the first three years of life are to a child's future.
How does this affect health outcomes later in life?
HALVORSON: The children who go down the path of dropping out of school, the children who are not going to do well, they're falling behind by age 3. When they're far behind at kindergarten, they don't catch up and then they end up dropping out of school. Those children are significantly more likely to have heart attacks or asthma. They're three times as likely to end up with strokes and about five times more likely to be depressed. They are significantly more likely to use drugs and girls are more likely to become pregnant at an early age. We could cut the number of people who are depressed by more than half if we helped all the kids across the country before age 3. We did some work with the nurse-family partnership in Los Angeles and we coached mothers half a dozen times about this information. It was direct coaching from a nurse to a mother about this information and was during those first years. For the group that did not get coaching, 14 percent were reported for abuse or neglect. For those who received coaching, only 4 percent were reported for abuse or neglect. That 10 percent difference represents the kids who are headed down a path to being four times more likely to have asthma.
How are you spreading the word?
HALVORSON: We have two themes: "Surround Sound" and "Trusted Messengers." We're talking with trusted messengers — people that the mothers and fathers and families trust — to get the message through to each family. In California, First 5 is running an extensive ad campaign on other-language radio stations.
A goal at First 5 is to flip the 90 percent of Medicaid mothers number in the other direction. How are you doing?
HALVORSON: Definitely, yes. We have all kinds of feedback from parents confirming that this is working. I distribute a handout that explains five things you should do with a newborn child, and I pass it out in restaurants. At a restaurant in Sausalito [Calif.] recently, I went up to a mother with a tiny child and a couple of other people at the table. I handed the mother one of my handouts and said, 'You're really having a great interaction with [your infant] and I don't want to interfere, but you might enjoy this information because it's fun stuff.' The mother looked at it and said, 'I know this. I heard the ads.' So, we're getting through.
THE HALVORSON FILE
Who has been the biggest influence on your career, particularly with respect to early childhood?
HALVORSON: I'd say Dr. Vincent Filetti, who did the original research into adverse childhood experiences, and Dr. Patricia Kuhl, who did some spectacular work and a wonderful TED talk on brain development in the first months. But Dr. Filetti is a superstar and genius who uncovered the ACE connection.
Do you have any hobbies? How do you stay busy in retirement?
HALVORSON: I love to fly fish. I do catch and release with barbless hooks, but I will fly fish for hours.
Where do you call home now?
HALVORSON: Sausalito, Calif., but in Minnesota about 30 or 40 percent of the time. I have grandkids and family there and that's my old stomping grounds, and we still have a house there.
How many grandchildren do you have?
HALVORSON: I have five grandkids. I have five sons. Of those, there are a couple professors, a couple lawyers and a consultant. So my children are all doing intellectually challenging things. My eldest grandchild just graduated from high school and the youngest is in first grade and doing some really interesting things with electronic music. Magnificent, beautiful children.