The three areas I'm going to deal with are population health, determinates of health; economic growth, very tangentially, and human development, which relate to the subject of learning.
The culture of the environment in which you grow up, and live and work, has an enormous influence on your coping skills and your competency. This not only has a direct bearing on learning, it has a direct bearing on your health and well being and, being one of the best measures of economic growth and prosperity, its effect on society is, in effect, the health and well being of the society.
I want to discuss the patterns that influence you at different stages and get you to think about the linkages between early events and late events.
If you miss out early on, does that create a handicap, which creates a problem for school systems and creates problems in adult life? If it does, what can you do about it? What do we know about these dynamics, between how the neurons in your head are wired which we know something about and the descriptive aspects of your own competence and coping skills and how did that tie back into it?
As a species, we have lived in a low density status for most of our existence. It wasn't until the agricultural revolution that we ceased being a tribal or troop kind of culture, like most of the other primates, and begin to move into our experiments in culture and civilization, if I may use that language to describe our experiments in creating large urban conglomerations, etc.
Let's look at the area of health.
When you examine the change in mortality in England and Wales from tuberculosis throughout the last century and most of this century, you discover there was a steep decline in deaths long before there was any effective medical or public health intervention, which came after the Second World War. The puzzle is: why did people stop dying from tuberculosis during that period? No one knows the answer.
If you track the changes in deaths in England and Wales during this period the one thing that is clear is the patterns of change coincide with the enhanced prosperity of England and Wales. Only about 25 per cent of the change can you directly attribute to public health measures. And very little of it can you attribute to medicine. So, prosperity has some effect on health.
But the other window you need to engage in thinking about, in terms of economics, some would argue, as would Lipsey, who heads our economics program is that we go through cycles of profound change in the way in which the societies produce the income or create their wealth. There have been three major periods in this experiment. We're in one now, according to Lipsey, which began in 1980 the information- technology period.
The question is, do we have enough wisdom today, if this, indeed, is the case, to handle this adjustment intelligently, taking into account the considerable population density we now have in contrast to earlier periods.
We do know that England and Wales have not done a very good job of bridging these changes. As indicated by Dahrendorf's lectures in 1982, England and Wales have not climbed as well economically, as measured by income per capita whatever that really means in contrast to a number of other countries. So, England is recognized as a country that has had trouble in this century keeping pace with the economic changes the economic growth and prosperity questions.
Has it had measurable effects on health?
One graphic example is the actual change in mortality. From 1931 to 1981, the radiant across social classes widened profoundly over this period, corresponding with what I would conclude their struggle economically. Remember that they introduced public financing of health care in 1948 and it was expected that would compress the gradient, but the gradient went the other way, which has been a great puzzle in the United Kingdom. Nevertheless, it tells you something powerful.
If we examine Sweden, we discover that the top social classes there do a lot better in terms of mortality rates than the top social classes in the U.K., but the dramatic thing is that the bottom social classes in Sweden actually have a lower mortality rate than the top social classes in the U.K.
Another way of looking at it is to examine life expectancy. In Japan, a study completed in 1986 indicates that they have soared past the life expectancy of three major English speaking cultures. If you think of that as a public health measure, what has gone on in Japan? It has nothing to do with the health care system.
There is an economic effect, which I think has a bearing, and that is the percentage of Japanese living in households with monthly expenditures less than 100,000 yen by year. Their prosperity dramatically, at all ages, affected the people and we think it has had a bearing on life their expectancy changes.
How do you explain prosperity in health, gradients, lack of disease specificity?
The simplest explanation is one that's been known for a long time and that is your coping skills; that, indeed, how well you handle what you do affects your host defence system. The mind-body dynamic is very real in terms of molecular interactions, indeed they're in continuous communication, and so, in effect, if you're not coping well with your task, you don't have the competency, you're at risk.
The link is that coping is your learning. We now know a fair amount about the wiring of neurons in your head. You have billions of them. The most plastic period of your brain is from conception to puberty. And that wiring is heavily dependent upon the quality of sensory stimulation that you receive when your brain is most plastic; visual, tactile, auditory, etc.
We think that most of those adult health risks are actually set in early childhood. Indeed, all of you have had your health risks probably set to some extent in early childhood.
One example of this is vision. The wiring of the neurons in the cortex in the upper layer of your brain, which has to occur to get the brain to see what the eye sees, is well worked out. You have to have sensory stimulation come in at the time the neurons in their development are receptive to turn the genetic machinery on to allow further visual stimuli to cause the neurons to wire up to let the brain see what the eye sees.
We think that is probably true for the whole of the cortex. We don't know for certain for humans and it probably has a bearing on behaviour and cognition, so that the issue is what we call the sensitive periods of the wiring of the human brain, the pathways that are involved and what happens if you miss a period.
In vision, it is known in animals if they miss the critical period and we're not sure if the other sectors are as critical you cannot rewire the brain to see. If a child is born with a lens defect and it is not corrected soon enough, the child in its teens will never have normal vision. So we know, at least in the eye wiring story that there's a real issue. It probably holds true for other domains and we'll know more about that in 10 years.
Let's look at this in the context of learning. How does how you're handled early in life affect you?
A Jamaican study split children at birth into two groups: a risk group and a normal group. One group got nothing, another got enhanced nourishment, another got stimulation and another one got both. It's the most dramatic study I know on the human primate showing the enormous power of both stimulation and nourishment affecting cognitive capacity.
Some studies suggest that if you have a higher education, your risks of coronary heart disease, cancer and accidents are less, than if you have less education. It fits back into the coping skills question.
We have a problem in Canada. In Quebec, Richard Tremblay, who is part of the human development program, actually looked at anti-social behaviour and violence in the Quebec school system. What he has found is that overall in the province it's six per cent. In Montreal, it's about 12 per cent and in the core area of Montreal it's about 26 per cent.
They did an intervention study showing that if you actually intervene on these kids in kindergarten, you can actually change the outcome, which is Premier McKenna's point. So in human development, we have a few simple things to think about: understanding the stages in development and their linkages to later events.
Do not expect the service system to cope with the problems that are rooted in early childhood problems. Don't expect institutional systems to be able to easily correct disabilities; don't expect teachers to be able to handle some of these problems; it's an enormous demand on a teacher to handle something that's very complicated, which requires exceptional resources to do it. Don't blame the school systems.
This brings us back to the economic issue. If you can't create the wealth creating society, you can't fund the other sectors. And if we are going through, indeed, a profound transition, we have to maintain a stable social environment with diminished resources.
As Lipsey has pointed out, we're moving from a period in Western English cultures to a challenge between laissez-faire capitalism, which does not concern itself with the society, to a form of capitalism that has be structured in its concern with the society...a new kind of capitalism.
You can maintain a stable social environment, which creates a quality environment for human development to building a learning society if you understand the points that Premier McKenna presented last night and some of the points I'm giving you today. But, it cannot be done just by institutions. It has to be done by the community as a whole. It requires all of us to become partners in handling the complex issues that are involved in this.