Reach Out and Read

A grand debate in child development is “Nature or Nurture?” Do children turn out a certain way because of some fixed, inherent genetic trait, or because of learned behaviors and the influences around them? This is not limited solely to behavior and personality, and moves even into discussions about phenomena such as medication allergies, where the connection to genetics is frankly tenuous.

The pendulum of societal discussion on this subject swings back and forth over time. I’d say that over the past few decades, it’s definitively moved back from a “nature,” largely genetically determined mindset, to a “nurture” perspective. This is well-supported by science, and this rebalancing is actually in line with the evidence that it’s really not either-or, it’s each influencing the other.

While we can’t change our genes (let’s leave high-tech gene editing out of the discussion, please), the conditions we experience cause our biology to turn genes “on or off,” tailoring what’s expressed to help cope with the environment. So, for example, environments filled with chronic, unbuffered stressors — what we call “toxic stress” — turn off genes designed for long-term learning and growth in favor of genes supporting immediate survival and safety.

We’ve known about this for some time now, and it was well articulated several years ago in a 2012 American Academy of Pediatrics policy statement. The next edition of that statement was published this past summer and masterfully took us from the problem — how toxic stress explains how deep societal problems spring from a shared biology but disparate experiences and opportunities — to a solution: relational health.

What is relational health? It’s the capacities of individuals, families and communities to build strong, stable, nurturing relationships for people so that they can take on life’s challenges. It’s the science of how we look at relationships, which are the single largest factor determining how children will flourish and thrive in the long term.

If flourishing and thriving children is our goal, this has enormous implications for what we can “do.” On the micro level, how do we coach, model, reinforce, and advise parents so that they are comfortable, competent, capable, and confident in doing the job of being the good parents they want to be? (Fundamentally, this is what we do in the Reach Out and Read early literacy program I am heavily involved with. You might think we’re a book giveaway, but we’re secretly a parenting support program.)

Moving up a level, what are the programs we might offer at a community level? Home visiting, high-quality and accessible early childhood education, jobs paying a living wage, parks and other green spaces — these all affect relational health deeply. And at the societal level, what are the policies that make a difference? Paid family leave, child care subsidies and child tax credits are state- and national-level concepts that are relational in nature.

The answer, I think, is very clear: While nature and nurture are indeed engaged in an interactive, ongoing duet with one another, the reality is that we, as a society, have the opportunity — nay, responsibility — to deeply and profoundly decide what that “nurture” looks like, through the advice we give, the programs we set up and the policies we enact. And if there was ever a time in which we recognize precisely how much environments matter, it’s amidst the single largest disruption to our global psychosocial environment seen in decades, this pandemic. What better time to renew that focus?

Some personal news: The end of last year marks the end of my first semester in a new professional role. While I remain in the Department of Pediatrics at the University of Wisconsin School of Medicine and Public Health, I now have a joint appointment as a Clinical Associate Professor of Human Development and Family Studies at the UW-Madison School of Human Ecology. Thinking about how the environments in which people live and thrive on a broad societal level is what human ecology is all about. And after reading what I wrote above, I think you might understand why it matters to me to add to my professional life that broad-based, human-centered way of looking at the world. I look forward to what we can all build together.

Dr. Dipesh Navsaria, MPH, MSLIS, MD, FAAP, is an associate professor of pediatrics and a clinical associate professor of human development and family studies at the University of Wisconsin-Madison. He also holds master’s degrees in public health and children’s librarianship. Engaged in general pediatrics, early literacy, medical education and advocacy, he covers a variety of topics related to the health and well-being of children and families.

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