Jan 31, 2020
by Gary Pace M.D.
Chronic illness, mental health problems, substance abuse, and homelessness seem to be spinning out of control. Sometimes there seems to be a multi-generational component to these issues. It seems almost like some kids have the deck stacked against them even before they are born.
We are starting to understand some of what is going on here, and it helps guide some potential responses to the problem. None of this is short term, though.
The intractable nature of some of these problems can be staggering. How is it that people continue to make choices that hurt themselves and their families?
National research in recent years clearly shows that health disparities correlate with economic disparities. The studies demonstrate that there can be up to a 20 year longer average lifespan in neighborhoods with higher socioeconomic status compared with nearby areas that are poorer, after controlling for other lifestyle factors.
We are also learning that Adverse Childhood Experiences (or ACEs) such as living in under-resourced neighborhoods, frequently moving, having parents with emotional or substance abuse problems, and experiencing food insecurity, can cause something called ‘toxic stress’ (extended or prolonged stress). Toxic stress from childhood trauma can change brain development and affect such things as attention, decision-making, learning, and response to problems.
Children growing up with toxic stress may have particular difficulty with forming healthy and stable relationships. This may all lead to erratic work histories as adults and ongoing struggles with finances, jobs, and depression throughout life. These effects can also be passed on to their own children.
While it is easy to see how ACEs can lead to Mental Health and relationship issues, and even to substance abuse to numb out the pain, it is also clear that regular health outcomes can also be affected. Many chronic illnesses are much more likely in people with higher numbers of childhood ACEs.
Dr. Nadine Burke-Harris, the new California Surgeon General, has made this a focus of her work. You can see her on a TED talk that explores the topic:https://www.ted.com/speakers/nadine_burke_harris_1.
We all know how hard it is to help someone who is very sick, in jail, deeply involved in drugs, or having a mental health crisis. Understandably, acute care is where most of the health resources go. Yet, a gentler and more cost-effective approach is to try to prevent these outcomes before the behaviors get firmly entrenched.
Sure, it would be great to decrease the trauma that the children are exposed to, but I’m not sure we have the power to cure that problem. The research does show some promising things that can be done, though—basically providing programs that support the folks who are the most vulnerable. By giving some support before the behavior and brain changes are firmly established, the long-term trajectory can be changed in a good way.
Teaching parenting skills and providing some support for young parents can help prevent outbursts from frustration, which decreases the toxic stress for the kids. Ensuring food security and housing stability helps. Also, it seems that having any stable adult that bonds with a child during the early years can help protect them from the worse effects of the traumas, even if their parents are inconsistent. So, pre-school, mentoring classes, after-school activities, church programs, etc. will all go a long way towards softening the wounds that these children carry with them.
We have come a long way towards understanding some of the contributing factors for chronic substance abuse, mental health, and physical problems. Early childhood insecurity and trauma seem to be an important link to these long-range, multi-generational problems.
We are also gaining some understanding of solutions. Early childhood and family support programs have been shown to mitigate the impacts of trauma on young children, and can produce long-term improvements for people. Many of the Health leaders in the County are working to expand and strengthen the preventive programs that are already in place. It will take a few years to see the results, but we all feel that the next generation is our biggest resource and deserves the best chance they can have.
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