The Health Curve

How Early Childhood Shapes Lifelong Health | Prof. Farah Qureshi (Johns Hopkins)

• Dr. Jason Arora • Season 1 • Episode 21

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What if the seeds of your lifelong health were planted before you could even form memories? Research shows that early childhood experiences profoundly influence adult health and disease risk - decades later.

In this episode of The Health Curve Podcast, host Dr. Jason Arora speaks with Professor Farah Qureshi of Johns Hopkins Bloomberg School of Public Health, an expert in child health development, to explore how our earliest years shape long-term wellbeing. Together, they discuss the biological, behavioral, and social pathways through which childhood experiences “get under the skin” to influence outcomes like cardiovascular health, mental health, and resilience decades later.

Whether you are a parent seeking to support your child or reflecting on your own early experiences, this episode will help you better understand how childhood shapes lifelong health—and why it’s never too late to change the curve.

Speaker 1:

Welcome to the HealthCurve podcast. I'm your host, jason Arora. Today we're exploring how the earliest chapters of life what we eat, feel and experience as young children can shape our lifelong risk of disease and early development. At Johns Hopkins University, whether you're raising children or unpacking your own lifelong health journey, this episode aims to shed light on how early life shapes health and what we can all do to change the curve, starting from the very beginning. Farah, thank you so much for joining. It's really great to have you here.

Speaker 2:

Thank you so much. I'm excited to be here and to discuss my research and all sorts of things with you.

Speaker 1:

Awesome and I feel like a lot of what we're going to discuss is very topical. Right now. There are a lot of challenges around the discussion on various social determinants of health and how things in childhood can influence health later in life, and I feel like there's still a lot out there that people don't understand, and that's really the purpose of this episode is to make that more accessible to people. So, just to start off, so you focus on childhood and adolescence and how variables during these time periods shape our long term health, especially when it comes to chronic diseases. Right? What first drew you to this question of early life and health?

Speaker 2:

That's a great question. So it's actually funny. My way into this line of work is a bit roundabout.

Speaker 2:

I came into public health knowing that I was really passionate about children and youth. I really wanted to serve kids in some capacity. And when I received my master's here from Hopkins actually in child health and development I was very much focused on youth mental health and I thought that youth mental health was going to be my line of work and it was going to be what I studied forever and actually I didn't think I was even going to do research. I thought I was going to go either work for an NGO or work for like a health organization and as an advocate or somebody who kind of helped shape policy around that. But when I returned to grad school I went to Harvard to get my PhD.

Speaker 2:

I, funny enough, was linked up with my then mentor, laura Kubzanski, and when I read her profile initially I was like why would they link me with this person?

Speaker 2:

Because I'm interested in children and youth and she does work in aging, and I was like clearly they got something wrong.

Speaker 2:

This is strange. But then I learned more about her work and her work really focuses on understanding the intersection between mental health and physical health, and how experiences and not only early in life I focus early in life, but her work really spans the life course how the things that we experience in society essentially get under the skin and shape our physical functioning over time. And so when I started my doctorate I really did think I'm still going to be focusing on mental health, but I ended up being exposed to this whole world of stress research and understanding how our mental health really sits at the interface between our experiences in society and our biology. And so that's really what led me to this space of understanding early life experiences through the lens of chronic disease and kind of thinking about how even our experiences well before any inkling of cardiovascular disease or cancer or any of these chronic diseases could even be on somebody's mind, how these experiences could accumulate over time early in life and set the stage for our health later on.

Speaker 1:

Fascinating. So for those new to this idea how do things like happiness, belonging or early life stress actually influence our health decades later? What's happening in the body from a biological perspective that connects early experience to adult disease?

Speaker 2:

So that's a big question. There's a lot of different theories and there's a lot of different work that has explored different pathways. I think the three main roots by which our experiences in society, our mental health and how we feel, both positive or negative, could impact our health is really through, either directly, by influencing our stress response systems in our bodies. So we have physiological systems that are hormonally regulated, that are influenced by our experiences of stress, and so, if you remember learning about the fight or flight system and what triggers these reactions in our bodies, they're actually adaptive. They're important parts of our survival as human beings. They need to be triggered in order to help us encounter difficult circumstances and continue to survive and to sustain life. But when we have these stress response systems triggered chronically and that could be as a result of experiencing depression, or it could be a result of experiencing poverty or violence or a whole range of negative exposures or on the flip side, maybe thinking about, you know, having a more positive outlook or having a better mental health, feeling a sense of happiness, belonging it could lead to less activation of these systems, and these systems, when chronically activated, basically accumulate wear and tear on the body, and so there's been a lot of work that has found that our stress response systems in our body, when chronically activated, can contribute to cardiovascular disease over time, and it is exactly through the system of kind of wear and tear, it's this constant load that we're experiencing. So that's kind of the on the biological side. That's one piece of what's happening, but there's another really important piece, which is that how we feel and the experiences that we have in society set the stage for the different behaviors that we engage in. So if somebody is depressed, they may be less likely to engage in a healthy lifestyle, they may be more likely to be physically inactive, to engage in a kind of poor health behaviors. If you think about smoking, substance use, et cetera. These are linked in many ways to the ways in which we feel and the experiences that we have, and so there's these behavioral pathways.

Speaker 2:

Another one important one is sleep.

Speaker 2:

So if you are feeling good, you typically will find this restorative part of your life where you are sleeping and rebuilding and healing and all of that good stuff that happens when we get rest is going to be really efficient, whereas if you are encountering a lot of challenges or have experienced trauma, maybe that will disrupt your sleep, and that's a really important part of our health as well.

Speaker 2:

So we have this behavioral pathway, we have this biological pathway and then the third pathway, I think is a really important, interesting one. It kind of draws on this distinction between these positive and negative experiences we have, which is that if you encounter challenges in life it'll activate these systems. But there's also the possibility that when you have supports or buffers, or positive relationships or positive feelings, that could help you manage the negative impacts of stress more efficiently, and that could be both in terms of your behaviors and the ways in which you engage in society. But it also could happen at the molecular level too. It could modulate the extent to which your stress response system is essentially kind of firing off and it could mitigate some of that chronic wear and tear over time.

Speaker 1:

So, at a high level, there's the biology and your conditioning from an early age, how you are wired and how that is shaped over time, and then there are the behaviors that you learn from those around you, and then there's the combination of these two. That's what shapes an individual right? You've spoken a bit about how some things are helpful. There are these helpful adaptive responses. You know good stress things like resilience, et cetera, and this might be a difficult question to answer. Where is the line between what is useful to build that resilience in a young person versus this is going to cause trauma?

Speaker 2:

That is a tough one to answer because I think there's a lot of individual variability. I mean, you know, as a parent, I know as a parent, every child is different and so what could cross the threshold between being a very difficult circumstance versus being something that, oh, you know, might not be that big of a deal. It really depends on someone's constitution, like their personality, their makeup. But you know, there are some experiences that we know are objectively terrible. So abuse, neglect, we know that experiencing persistent mental health challenges, depression, anxiety, these are conditions and social experiences that we know. There's really no situation in which those are good for people, especially young people. Where it gets to be a little bit more fuzzy is kind of getting to the point that you were talking about in terms of like things that might be adaptive.

Speaker 2:

So if you think about dropping a kid off at school for the first time and I was a crier when I got dropped off at school the first time I remember just crying and crying, and it was weeks, weeks. My mom would drop me off and be like you're still crying, you've been going to school for weeks and I found that that transition was a tough one for me, but that's a normal life transition. That was stressful for me in the moment as a child life transition. That was stressful for me in the moment as a child. But that's a stress that I need to go through in order to develop that resilience, to develop that sense of competence and to be able to move on. And look at me, I went on, I just kept going to school for decades, and so I clearly needed to experience that to be able to develop the skills the coping skills, the emotional regulation skills to be able to manage these stressors.

Speaker 2:

But if it was a situation that involves a very dramatic experience in which there's harm to an individual or in which someone feels threatened or someone feels hurt, then I think that starts to move into a different space. And it's true that for some kids that threshold may be different. It may be that someone might perceive something as very upsetting that another child may not. But you know there's also this debate in the field about well, is it this objective experience that matters or is it how we feel? And so if the child feels distressed to the point of it being a really impactful thing that is hindering their ability to function, then that's something that matters, that's something that warrants some attention.

Speaker 1:

So I feel like I answered your question but didn't which is the social norms that we set for what is okay versus what's not, especially for young people, and there is currently a debate out there around are we wrapping people in cotton wool too much? Are people too easily offended? That sort of line of conversation versus, maybe generationally, a previous generation felt, oh no, this is important. It's important to tease each other because it's what builds resilience. Being in the field as a researcher, what's your take on what we know versus what we don't know about what actually influences health, and how do we separate that from what might just be an opinion or something political that people may feel?

Speaker 2:

I think that my general experience in public health and in doing this research is that a lot of what we hear, sometimes even within the field, is often people's perceptions. It's often their biases, their attitudes, their cultural norms that they kind of bring to the forefront. And so this debate about you know what's good for kids, what's bad for kids? I don't think there is a clear answer. We can't necessarily turn to the literature and say these types of experiences contribute to these terrible outcomes and these positive experiences contribute to these great things. Everything is very gray, and so I think what we're experiencing now in terms of how we're engaging with young people and I think part of this is a generational divide we're seeing the cultural values of one generation butt up against the cultural values of another generation, and I think we're trying to find some deeper explanation for how, oh, it's going to set kids off the rails or it's not going to set kids off the rails. So I think that's one piece of it that I would say is important to acknowledge and kind of set aside. Another piece of it does relate to real challenges that kids are encountering. So it's not the same world that it was 20 years ago, 30 years ago, 40 years ago. So when we were teenagers, we did not have the entire world in our pocket. We did not have all of our friends texting us and engaging with us, people that we've never met, engaging with us through the internet, through social media. It's just a different world, and so I think that many of the challenges that we're seeing around mental health and some of the issues that young people are dealing with every day are really the result of our changing world.

Speaker 2:

Again, in terms of saying, well, what is it good for kids? Is it bad for kids? Are kids too thin skinned? Do they need to develop thicker skin? I think that kind of misses the point of just kind of understanding. We can't put the toothpaste back in the tube. The world is different than it was before, and so I think the next question is well, how do we help kids develop the skills that they need to succeed and to thrive in this changing world? And so you know I've done a lot of reading of the psychologist. Lisa DeMora has talked a lot about how, when engaging with young people, there is this general cultural attitude that we should just all be happy, and that's not. Actually. The goal in life is not just to be happy. The goal is to be able to encounter whatever experiences that you have in life and to be able to manage those experiences in a healthy way.

Speaker 2:

And so there are some instances in which you will not be happy, and that's okay, and being able to kind of sit with that and know, okay, how do I respond to this experience and how do I engage with this experience, knowing that it's challenging. And so I think part of that again is related to the cultural shifts that we've seen. Part of it's related to the way social media and technology has kind of come into the world and shaken up kids' lives, and kids are exposed to a lot more information than they were before. And so I think if we take a step back and think about what's the best way to help young people develop the skills they need to succeed in any circumstance, I think that's kind of a more useful way to see this question than trying to figure out whether they're too thin skinned or need to be tougher. That makes sense.

Speaker 1:

That's a really interesting way to put it, in that the world is changing and therefore the way we train and condition and support our youth needs to change with the changing world. Just to take us back on track, how early can this sort of thing begin? In childhood? We hear that it can start in the womb the things that a fetus can hear, you know or it starts as soon as someone's born. What does the research tell us?

Speaker 2:

So the research tells us that early matters but, as with everything in science, it depends and so it's not so clear cut. I think that oftentimes people read the work you alluded to in terms of some of the work that's looked at prenatal effects and that's looked at very early life effects, and kind of interpreted this as saying you know, kids can be set off the track very early, and once that's done, it's done, and I'd say that nothing about child development is that deterministic, other than maybe exposure to certain teratogens which are things that could influence the development of the fetus in the womb and lead to maybe congenital defects. That's one thing, but when we're talking about child development, generally speaking, you don't have so many of those situations where there is this definitive outcome that's set in stone immediately. What we typically see are sensitive periods, which means kind of periods in life when there's a lot of changing physiologically, socially, psychologically in kids' lives, and that could be a time in which certain experiences could have a greater influence on outcomes. So when we think about early life, as in infancy, the first years of life, toddlerhood, these years are really important because kids are rapidly growing, they're rapidly developing and they're rapidly changing, and so this is a time when positive or negative experiences can be very influential. It's also a time when kids are entirely dependent on their parents, on their environments, on the caregivers that are taking care of them. So the experiences that parents are having or caregivers are having, the social environments, are really influential because there's less agency that a kid has to kind of control their outcomes. As kids grow, these experiences and the things that are influential to them will change too. So as kids get older and transition to childhood, adolescence, their social environments become more influential. They start to have more of a life outside of the home. So these experiences that may be happening in school, with peer groups et cetera, have a greater influence because that's where young people are spending more of their time. So I think that you know.

Speaker 2:

To answer your question about how early are these effects observed, we do see that from the literature there are associations with health outcomes later, and so if we look at experiences as early as, you know, the first years of life, we do see associations with outcomes even decades later. So there's been work that's looked at positive mental health in early childhood. I've done some work in that area and we found that kids around age five kids who had higher levels of behavioral challenges were more likely to have dysregulated cardiovascular functioning. So, thinking about a variety of different health indicators like cholesterol, blood pressure et cetera, they had higher levels of these things by adolescence. So we're starting to see these patterns emerge, but that doesn't mean that they're set on a certain path, because there's all of these different points in development where you can intervene and when experiences can modulate the effects over time.

Speaker 1:

So that's very early in that these variables during childhood can start showing up in adolescence. Now you've studied both sides of the coin, right. You've studied the negative effects of things like poverty and discrimination and family adversity, but also the protective power of positive emotions and support. Your work also highlights how feeling loved, having optimism around you, being made to feel like you matter, are also powerfully protective. So how does the positive side of the coin work exactly?

Speaker 1:

Because you know, I think a lot of people might be listening to this and thinking I can understand how the negative stuff would potentially cause problems for someone later in life based on putting them under too much stress, conditioning them the wrong way so that they may overreact to things and not deal with difficult situations appropriately. They have an overactive nervous system, if you want to simplify it. Situations appropriately. You know they have an overactive nervous system, if you want to simplify it. And there are also behavioral things that you know people may learn, and then things that may affect them more directly. What's going on on the positive side of the coin? How do these things nurture people as they grow?

Speaker 2:

I love this question because I think it really speaks to the heart of my research agenda. So I did start off in the space of understanding how negative experiences shape outcomes over the life course. I think part of it is because of like you allude to. It's a bit more intuitive. You can understand how these negative experiences could predispose a whole range of poor outcomes over time. But I think what led me to understanding and to studying the positive side of the coin is really what I heard from young people themselves when I was working in Baltimore, which is that from the medical field, the public health field, they felt like all they heard was what was going wrong in their life and what they were doing wrong and why they needed to stop engaging in XYZ behavior. And what they didn't hear and what they didn't see were the things that were really powerfully protective in their life, that were going well, the things that they wanted to see elevated. And so I think that that's kind of what brought me to this space of understanding. You know, not just what could set kids on the wrong path, but what strengths do they have within themselves, within their communities, within their families, that we could be leveraging, that we could be building up to help them survive and help them support better health over time. So, in terms of the specific question that you asked, though, how does it work potentially differently? In some ways it's kind of the flip side, so you can think about how maybe positive experiences, rather than leading to chronic activation of these systems in your body or leading to poorer behaviors, they actually may downregulate some of these systems. So that's one side of it, but I think almost a more interesting way to think of this, too, is that the positive things in our life may also promote positive biological and positive behavioral processes, some of which we know and some of which we don't. So, on the biological side, there's been some indication that things like positive psychological well-being, like a sense of happiness, optimism, other dimensions that are distinctly different from just not feeling bad so this is really getting at really truly feeling good or feeling optimistic we see protective associations with biomarkers that are related to restorative functions in our body. So, if you think of HDL high-density lipoprotein cholesterol the jargony way or the medical way of just saying the good cholesterol, the good cholesterol in our body, clears out the bad cholesterol, and it's an important part of our cardiovascular system, and so we actually see associations with these positive indicators of health In terms of other biological markers, because we typically study bad things and how bad things contribute to bad processes. We actually there's a lot we don't know, and so there's been some interest in understanding. You know, maybe antioxidant function, if you think about also immune function, so like, obviously our immune system serves a protective role. So these are processes that protect us and promote better health over time. So there's some indication that these positive factors can promote more healthy functioning.

Speaker 2:

When we think about the behaviors, as we mentioned before, there's obviously behaviors that contribute to poor health over time, and then there's restorative behavior. So I mentioned sleep earlier. Sleep is an important one that's getting a lot of attention in the literature and understanding what are the intersections between different aspects of our lives and our ability to get the sleep that will really help us support better health over time. And so those are kind of, I think, some of what we've already elaborated on, but potentially the more interesting piece is what we've been speaking about a little bit in terms of this protective function in the face of adversity. So we're all going to encounter adversity in our life and all kids, especially as you're growing up will encounter difficult circumstances, but these positive resources typically give you the coping skills and the social support networks that you need to encounter these challenging circumstances with resilience and to not have it really set the course of life in a different direction.

Speaker 2:

So I think understanding these protective functions, whether they're operating directly or whether they're operating to kind of help us manage some of the challenges that we encounter, are really important parts of our understanding of the science, but they're also grossly understudied, so we just don't know as much about the good stuff that contributes to better outcomes. There's a lot of anecdotal, cultural expectations, values that we kind of assume, but in terms of figuring out what's the secret sauce, there's a lot that still needs to be understood. But what I can say, though, is that, in general, in childhood, feeling loved, feeling supported, feeling that you are cared for and protected that seems to matter the most.

Speaker 1:

If you were to design a system in society that you feel just based on what you've seen in the literature, what you've researched, what you've heard anecdotally, given that you have this lens and framework of what is more likely to work versus what's not, how would you design a system that nurtures health from a young age?

Speaker 2:

I think, first and foremost, it really comes down to the structures in society that support families and support parents, and so how far back you go, you could really. You could be talking about even before you even remotely are thinking about having a child, like what systems are in place to allow people to have autonomy over their reproductive decisions and determine their own fate in terms of whether they want to have a child or not, and in what circumstances will that play out? Will they have the resources that they need to go through pregnancy and to have that be a kind of protective and beneficial experience for both mom and baby and the whole family, whoever is involved in it? I think that you could go as far back as there, but if we're talking about when a kid is here, I think there's.

Speaker 2:

Here in the United States, we have an abysmal social safety net system for parents.

Speaker 2:

We don't have guaranteed paid family leave after people have children.

Speaker 2:

We often see that parents, like birthing people, are returning to work while they're still managing the recovery, their physical recovery, while they're still managing learning how to take care of a baby, while they're still managing intense sleep deprivation.

Speaker 2:

All of these things set the stage both for poor health for the person who gave birth to the child and for the family, but also for the child who's coming of age in an environment that's just inherently challenging, and so I think ensuring that our society supports parents you can think about the cost of childcare as being a really important piece of that as well these are structural supports that have major impacts on the lives of children and families and, by extension, will also have impacts on this nurturing environment that we're able to cultivate based on the kind of children and families, but and, by extension, will also have impacts on this nurturing environment that we're able to cultivate based on the kind of bandwidth and the ability that parents have to support their child.

Speaker 2:

So I think it really starts from this higher level place, and then you know, when it comes down to what people need to do to support children, I think parents know a whole lot about what they need to do to love and care for their child. I think, more often than not, it is the broader societal constraints that make it challenging for them to actually do what they know inside and what they feel is best for their child.

Speaker 1:

So, to summarize this part of the conversation, what would you advise parents in particular to think about when it comes to early childhood influences for long-term health?

Speaker 2:

I would hate for parents to leave this conversation thinking, oh my God, I've screwed up my kid because I haven't done X, y, z. I don't think that that is at all the takeaway here. I think it actually is quite simple what matters most for kids is to have a loving and supportive caregiver in their life. In fact, that is the consistent finding across a wide range of research that shows that having at least one supportive, caring, loving adult in a child's life can make a huge, huge difference and is associated with a whole range of positive outcomes over time. A key takeaway there, I think what families and what parents really have entirely in their control is that piece of it right Is the ability to be loving, be available and be supportive of your child A lot of the other challenges that we face in society.

Speaker 2:

As I mentioned before, there's a lot of structural barriers to being able to do that well, and I think recognizing that we don't live in a perfect world is also important, and so you know we can be coming together to try to advocate and support and call for a more supportive environment for parents and caregivers. I think that's one piece of it, and I think another piece of it is also ensuring that parents and caregivers are able to care for themselves, because if your ability to love and support your child is the single most important thing for your child, that's pretty strongly tied to your ability to love and care for yourself too. So I think oftentimes parents give and give and give and forget that their ability to support their child is really really closely tied to their own well-being as well. So I think I would say that that would be my main takeaway for folks.

Speaker 1:

And this impacts all aspects of family life, right? So when you have a child, the first most important thing is your child. If it's two of you, you both focus on your child. The second thing is then your self-preservation how do I get more sleep, how do I eat, how do I keep my sanity, or whatever it is and then the thing that falls to the wayside is actually the two of you and nurturing that relationship. This is multifactorial. It will impact the child's long-term health positively or negatively. It will impact the individual's health and it will impact the couple and their marriage and the overall family structure, right?

Speaker 2:

Absolutely, and you know, in the jargony way we call this really a life course approach to understanding child development. It's not just a single child's experience. A child is nested within their family environment and that family environment can influence the child and the child influences the family environment. And that family environment can influence the child and the child influences the family environment. So these are all operating simultaneously and interacting with each other, and so it is very, very hard to do all of these things at once. And I think, again, being kind to yourself and recognizing that, like we can't do it all, but just remembering that you know these things matter, these aspects of our lives do matter, and so caring for yourself matters for your kid as much as caring for your kid matters for your kid. And it's tough. I have a three-year-old so I know how tough it is but I think being kind and forgiving and just recognizing what's important is a big part of ensuring that your child has what they need to succeed in life.

Speaker 1:

We'll get back to this conversation in just a moment, but if you're finding this episode helpful. Here's a quick ask Take a second to follow or subscribe to the Healthcare Podcast wherever you're listening, and if someone else in your life would benefit from this episode or any of the others you've heard, please send it that way. All right, let's get back to it. Please send it that way. All right, let's get back to it. So just to shift the conversation on so even if we get these things as right as we can when a child is young to positively influence their long-term health, how do structural barriers get in the way later, and what are some of the things you've seen in your research that show, quite obviously, that these structural barriers can be even more influential than things that we might do when a child is young in terms of their biology, in terms of behaviors?

Speaker 2:

That's a great question, you know, especially when thinking about these positive factors that we know play an important role in health, if we think about positive parenting practices, if we think about positive mental health and all of these different dimensions of our lives that serve a protective function over time. The research has not actually interrogated this question particularly well in terms of you know, how do these protective factors maybe function differently in the face of broader structural adversities, or even among diverse groups that may encounter different challenges in society. I think there's a number of working theories, one of which is that these protective factors are beneficial for everyone, but it may be the case, as I would expect, that certain groups have more access to them. So you have more capacity to receive mental health care, to take care of your own mental health, to be a loving and supportive parent, because you're not working two jobs and you have a living wage and you have a job that was able to give you paid family leave. So some folks are more easily able to access these health assets what we call than others, and so, on one hand, these structural barriers play a role in determining who is able to acquire this good stuff that you need to support better health. Another theory that has also been explored and substantiated among some populations is that these protective factors are beneficial for everyone, but they I guess, in theory.

Speaker 2:

But some groups may have less resources to translate these health assets to better health. So, spoken more plainly, what I mean is if we think about like positive psychological well-being somebody who feels really well, feels happy, optimistic, they have a positive outlook. This is generally believed to be really health promoting over time. However, if you are in a pretty good mental state but you don't have the ability to translate that good mental state to being able to exercise outside because you live in a neighborhood where it's not safe, or you're not able to access a gym, or maybe you don't have the financial resources to eat healthy and actually the only thing you can do is eat fast food or eat processed foods, then, no matter how good you feel, you're not going to be able to will yourself into better health.

Speaker 2:

Because what we typically see is that these positive mental health variables help us develop these resources, these coping resources, to engage in what can be sometimes challenging health behaviors, like maintaining a healthy diet is challenging, maintaining physical activity is challenging. So feeling good is an important part of ensuring that we can do that. But if you don't have the resources that you need to be able to act on it, then you may not actually see that this positive mental well-being is translating to better physical health. And so I think this also speaks to some of the challenges around this work, in which sometimes people see it and think well, you just need to be happier, and if you're just happier, that'll help you beat cancer, that'll help you overcome this challenge, that'll help you prevent chronic disease. It's not that simple, so there are a whole wide range of barriers that can make it really challenging to translate these things that are objectively good. Having a positive mental health state is objectively good, but it may not necessarily translate to better health in every circumstance.

Speaker 1:

I have come across research that states that if you have Black teens who have had strong emotional or social assets in childhood, they will still face worse long-term health outcomes than white teens who didn't have those assets. Is that true and can you talk a little bit about?

Speaker 2:

that. So the first thing, a little bit about that he called skin-deep resilience, which basically was this phenomenon where he mostly studied. I think in the study he was focusing on Black youth who were living in the South in a rural area, and he found that young people who were characterized by what you would think of as a very positive like having these positive health assets, they were in good mental health condition, seemed to not have been bogged down by serious mental health challenges, they seemed to have a supporting environment, et cetera. We saw that they had better mental health, but they didn't necessarily have better physical health, so there's a greater risk of diabetes and a whole range of different outcomes over time. And so I think that would suggest that, even in the face of having these protective factors, if you're encountering broader structural barriers in society, that these structural barriers can have potentially a more impactful role in driving health.

Speaker 2:

Interestingly, I don't think it's every health asset's created equal and that all of these pathways are functioning the same for everyone across the board. And work that I've done using national data from the National Longitudinal Study of Adolescent Health, we looked at a wide range of positive mental health assets. So we looked at optimism and happiness and self-esteem some of the stuff that you typically think of but we also looked at feeling loved and having a sense of belonging and we found that Black youth had the highest levels of these protective factors and actually, among kids who had the highest levels of these assets, the disparities in cardiovascular risk later in life were reduced. So there was actually not a huge difference in the physical health of Black youth with high levels of assets and white youth with high levels of assets.

Speaker 2:

So that's not to say that one approach is right and one approach is wrong. I think we looked at a different range of positive resources, but I think that what we found in our study that's promising, suggests that these factors could actually play a role in helping us combat some of these disparities. I don't think it means put all of our eggs into the basket of just making sure that every kid feels loved, because there's broader structural barriers that are hindering it, as you've alluded to. But I think if we are able to identify ways that we can bridge these structural supports with these more tangible individual level interventions that help young people in their day-to-day lives, you can potentially have very transformative effects on health at the population level.

Speaker 1:

So if we take an example of a variable like racism and we think about young black men in the US, how does this play out for that particular population group and what are the kinds of things that if we have young black men listening right now, what can they do to help themselves through these structural barriers?

Speaker 2:

Well, I will say I'm probably the last person in the world to speak to young Black men about their experiences, given that I am not a member of that group. But I will say what we see in the literature can feel bleak sometimes, that there are these broader structural forms of racism that are just kind of insidiously getting under the skin and shaping folks' health outcomes over time. It can feel very overwhelming, it can feel almost like we don't have a whole lot of power in our own health outcomes over time, and I think that can feel very overwhelming, I would imagine. But I think that what's useful to remember and to hold on to is that there are positive resources within our communities, within ourselves, strengths that we have that we can be leveraging to help ourselves and our communities combat these barriers. I guess what I want to say is that there are strengths within individuals and communities that we can be enhancing and supporting to give our communities a better fighting chance to overcome these challenges, and so I think our number one priority has to be to really dismantle these systems that perpetuate these health disparities.

Speaker 2:

But there are also a lot of opportunities that we have within our communities, whether it's within our schools or within our faith, whether it's within our schools or within our faith-based organizations or within our community organizations, to support folks, and these actions that we take matter. They have an important impact on health over time. So, absent of you know a magical switch that can just kind of remove structural racism from our lives, I think we have to remember that supporting each other is a really important part of combating many of these challenges. So many people say I mean I think it matters in terms of shaping who has access to these things or not, but the thing that's the conundrum is that Black youth typically have high levels of these resources, but they also typically have the worst outcomes. And so what's happening in between? I think it really comes down to like you already alluded to in our prior conversation the structural barriers.

Speaker 1:

Okay. So if we think about adults who are maybe looking back at their lives and looking back at their childhoods and feeling, oh man, I did go through some things that were probably very bad for my long-term health emotionally, mentally, even physically, Am I messed up for life. What would you say to those people?

Speaker 2:

I would say no, you're not messed up for life. I feel like there's a lot of compelling evidence that changing health behaviors, for example, even late in life, can have dramatic impacts on our wellbeing, so for I focus on cardiovascular disease. There's work on smoking that says if you quit smoking, even if it's after a decade of smoking, your health can return to a pretty good state, and so quitting at any time matters, and so I think the same thing applies to mental health, like you could go your whole life and not have the mental health supports you need, but that doesn't mean that you're just done. There's still opportunities to change the trajectory of our health and our well-being, and so I think now we live in this amazing time where there are so many more resources, there are more providers to get care through, there's more opportunities to learn through the Internet, through social media, there's people to talk to. In general, as a culture and as a society, we're much more open to discussing these things, and I think there are so many opportunities for us to grow, and that that can have very important impacts on the rest of our lives from here on out, because it's not just one and done.

Speaker 2:

So I think that, thinking about the ways in which you can support your well-being now and understand where you've been is probably the best path forward, I think. Again, I think showing grace to yourselves is probably the most important thing. So when I think back on aspects of my childhood, or with older folks in my life, thinking back on the things that they've experienced, it helps you understand why things may be the way they are, but it doesn't mean that it's just set in stone to be that way forever. I think it helps us adapt and it helps us determine how we want to move forward, and I think, when it comes to mental health and cardiovascular health, there are many intervention points that we could leverage to improve outcomes for folks.

Speaker 1:

And we look at both the research and the anecdotal evidence and we see and I look at my own health journey as well from childhood and it's pretty consistent. I think that we see if you are to change things at any time, it's going to have a dramatic impact, and so that's one of the points of this podcast, of course, is to help people do that themselves where our systems may be failing them. And so, whether it comes to your emotional health, just being able to unpack what you've been through, understand it, understand how it's impacted you that gives you a framework moving forward so that you can approach different scenarios in a more healthy way from an emotional perspective and also from a mental health perspective, if you start to think about how you make decisions based on that emotional framework. If you think about your physical health, I mean there were periods during my childhood where, even though I got mom's good cooking, I still ate a lot of junk food and then did lots and lots of sports as I grew older and now I'm a yoga instructor, and these things have all required me just to understand a little bit better about the positive things I had been doing, the negative things and then just having a way to move forward from that moment.

Speaker 1:

So let's talk about schools now, because of course, children spend a lot of time in school growing up. They spend more time in school than they do at home in many circumstances. You've recently started to look at school environments and social health and how those environments impact the long-term health of people Things like kindness and connection and trust in school communities. If we wanted to redesign schools to support lifelong health, which I'm a big advocate for, where would we start?

Speaker 2:

There's so many places to start. I think part of the reason why I've started to move into the space of looking at schools is because they're kind of the prime outlet to reach a huge amount of people and to have a very dramatic impact over time, considering how early in life they're starting to engage with young people. So I think there's a lot of different ways we can be thinking about school environments as in and of themselves. So I'm thinking not even just the types of programs. So when I was a kid, there was like Jump, rope for Heart and all these physical activity programs in schools. I'm not even talking about those necessarily, I mean just your experience in school and how you were treated in school. I think there are ways that we could redesign or help move schools into a healthier place, particularly around school discipline, how we engage with behavioral challenges with young people, whether we are approaching those challenges from the perspective of providing mental health care as opposed to punitive approaches that take kids out of school. And so we know that school environments are a really, really important beneficial source of health promotion for young people, both in terms of their ability to naturally connect young people to opportunities and education, but also the support that kids receive. So if we're creating environments that are more carceral or where kids don't feel safe, or where kids feel like they are under greater scrutiny I mean bullying fits into this too If there's a culture of bullying, of fighting, of a lack of support, these things can have long-term impacts on kids. And so if we're able to think about how to cultivate school environments that are community-based, that are focused on cultivating kindness, cultivating care for each other, supporting team-based environments, helping young people engage with each other in positive ways and also encountering what are the many, many challenges that teachers and school staff have to encounter when it comes to young people, from a place that is, as I said before, less carceral and more focused on child development, I think that will only be beneficial for lifelong health. And so some of the initial work that we've been doing, looking at things like how kids feel in school, their sense of connection, the resources that they have available to them, we see pretty robust associations with mental health over time, and we also see pretty robust associations with cardiovascular outcomes, and so one area also that I think I've started to move into and thinking a lot more about is these opportunities within schools to kind of feed two birds with one hand, so to speak. I don't like saying kill two birds with one stone anymore, but if we are able to support programming that helps cultivate and promote positive mental well-being while also supporting physical health, you are really doing just that, and so a natural response to that is youth sports. Youth sports are a hugely important way to develop confidence, to develop cooperation, to be kind, creative. You have so many opportunities to develop these mental health resources and other resources that you need to succeed, and you also are developing habits to engage in a healthy lifestyle over time.

Speaker 2:

Increasingly, we see in the United States, youth sports are just inaccessible for many families. They are often like PE classes is cut out of school experiences. If people want to get their kid into a sports team, they have to pay tons of money, they have to be starting when the kid's really young, and this wasn't always the case and it isn't the case in other parts of the world, and so I think that this movement that we've seen towards increasing privatization of youth sports and taking it out of the school environment is harmful to kids, quite frankly, and I think that that's something that I would love to see us have more investment in and, again speaking, to leveraging the strengths within young people in their communities. This is something kids love. Kids love sports, they love team sports and these are things that, if we listen to young people and what they actually want, what they actually care about, you end up moving into a direction that helps us create the environments that we want to support.

Speaker 1:

Awesome. Professor Farah Qureshi, thank you so much for joining us. This was a very, very full conversation. We spoke about a lot of things that I'm sure our listeners will get a lot of value out of it. So thank you so much.

Speaker 2:

Thank you so much too. This was a great conversation, and I hope to maybe be back someday and chat with you about, you know, more stuff in the work that I'm doing.