The Five Whys

The Five Whys

Stephanie Harrison

Stephanie Harrison, CEO, Wisconsin Primary Health Care Association. Executive Member Wisconsin Partners

In health care, we recognize the vital importance of early childhood education on long-term health and well-being. As we seek to eliminate health disparities and ensure that everyone in Wisconsin achieves their highest health potential, we must pay attention to brain development in our infants and toddlers if we are going to create long-lasting change in the health of the population.

One strategy is to include early childhood education in our quality improvement processes. For example, one of the tools we use is “The Five Whys” – a technique from the Six Sigma framework. When facing a systemic problem, asking “why” five different times assists in getting to the root cause.

Here’s an example of the technique:

1. Why is our county doing so poorly in the County Health Rankings?

Because a high percentage of people are living in poverty.

2. Why are a high percentage of people living in poverty?

Because the high school graduation rate is low and young people can’t access living-wage jobs that fit the education they have.

3. Why is the high school graduation rate low?

Because a significant number of students need remedial education services and struggle with  emotional and social difficulties that make completing school difficult.

4.Why do a significant number of students need remedial education and struggle with  emotional and social difficulties?

Because they did not get a firm foundation in these skills between infancy and age five  –  when their brains are undergoing the most significant development.

5. Why didn’t they get a firm foundation in these skills in their early education?

Because their families couldn’t afford high-quality early education.

The connection of health status to early childhood
The UW Population Health Institute  has shown that much of our health is actually about our behaviors and social and economic factors, like education and employment. As we ask why even more, we can trace things like poor health, smoking, substance abuse, graduation from high school, and employment back to the foundations for language, vocabulary, and socialization that are built in early childhood. In fact, the Center on the Developing Child at Harvard University notes that disparities start to show up around 18 months of age.  This is particularly evident in vocabulary. In response, many community health centers in Wisconsin participate in the Reach Out and Read program as a way of getting health care providers to urge parents to read regularly to their kids – thereby providing a more language-rich environment for their children.

If we are serious about making our state a healthier place, we need to pay more attention to the education that our children are receiving at home and at childcare centers in their earliest days and years.

By Stephanie Harrison, CEO, Wisconsin Primary Health Care Association. Executive Member Wisconsin Partners