I recently had the great fortune to attend the conference on the Intersection Between Community and Health in Charleston, that was co-sponsored by the Federal Reserves of Richmond and Cleveland. 

It was a great meeting.

There were many highlights - talks on obesity in children (limit sugar intake); important thoughts on aging in place; elderly care; and a great initial talk about dramtaticaly different health outcomes in the same community.

However, the talk that affected me the most was the one by Mike Brumage, Commissioner of Health for Kanawha and Putnam counties. 

He talked about Adverse Childhood Events (ACE) and the relationship to ACE testing and suicide, shorter life, drug abuse, obesity, cancer, heart disease and a litany of other health outcomes. 

For folks not familiar with ACE testing, there is a great review on National Public Broadcasting. 

It is a short questionnaire given to children under 18 that investigates three areas: Trauma, Neglect, Family Dysfunction. 

A score of 4 is associated with a 12x risk of suicide. A score of 6 increases the risk of a shorter lifespan (up to 20 years).

Dr. Brumage performed a small volunteer-based study of West Virginia residents using the needle exchange program, who are at high risk for abuse behavior. These people had very high ACE scores. 

Interestingly, J.D. Vance, the author of "Hillbilly Elegy," had an ACE score of 6. 

This score predicted poor health and a short life for him. In contrast to this prediction, he is in good health.

What creates the buffer?  What creates resilience in health and in life?

It seems that positive relationships and connections do this. Connections that build love, safety, abundance mentality and hope. These positive connections build resilience.

How about negative connections that induce fear, scarcity mindset, and hopelessness. 

They create more vulnerability. 

I am convinced that with the dissipation of jobs (provide more social interactions and connections), low density population (less connections) and the breakdown of family structure and community (because of drugs, educational gap and loss of jobs), then close community relationships that were sustaining, now may promote more vulnerability.

These concepts are attractive given that successful strategies for improvement of health metrics or addiction rely on positive community connections from healthcare workers, social workers, community navigators or sponsors.

Maybe that is a key answer to the vexing health problems of West Virginia and the United States.

That may explain that states spending more on healthcare generally have worse metrics. It is not the technical nor physician access that matters most.

It is a strong and positive connections to community, family and friends. 

They build resilience and support health, even in the presence of adversity. 

Thus, the best medicine is caring, love, safety, purpose and hope.