Guest post by Christine Deyss, Executive Director, Prevent Child Abuse New York
As our country and state struggle to find health care solutions, we must recognize that preventing child maltreatment is a necessary element in containing health costs. When President Obama addressed Congress and the American people on September 9, he outlined three goals of a comprehensive health care plan: provide more security and stability to those who have health insurance; provide insurance to those who don’t; slow the growth of health care costs for our families, our businesses, and our government. Health care costs throughout our lifetimes are inextricably linked to childhood experiences. Children who are abused, neglected, live with violence and family dysfunction, become adults who suffer chronic and life-threatening diseases.
The Adverse Childhood Experiences (ACE) Study makes this clear. Perhaps the largest scientific research study of its kind, it examines the relationship between multiple categories of childhood trauma and health and behavioral outcomes later in life, among more than 17,000 middle-class adults.The major finding is "a strong graded relationship between the breadth of exposure to abuse or household dysfunction during childhood and multiple risk factors for several of the leading causes of death in adults"—heart disease, cancer, stroke, diabetes, chronic lung disease, skeletal fractures, and liver disease, as well as depression, alcoholism and drug abuse, and severe obesity.1
Why is this? Dr. Vincent Felliti's description of the origin of the ACE Study explains: "The Adverse Childhood Experiences Study is an outgrowth of observations made in the mid-1980s in a Kaiser-Permanente obesity program that had a high dropout rate. Accidentally and to our surprise, we learned from detailed life interviews of 286 such individuals that childhood sexual abuse was remarkably common and, if present, always antedated the onset of their obesity. No one previously had sought this kind of medical information from them but many patients spoke of their conscious awareness of an association between abuse and obesity … The counter-intuitive aspect was that, for many people, obesity was not their problem; it was their protective solution to problems that previously had never been acknowledged to anyone."2
The same is true for other health-risk behaviors. Smoking, alcohol and illegal drugs can provide relief, albeit temporary, from emotional and psychological pain and depression. A health behavior problem can be a personal solution, a coping device, for those who have been abused and neglected as children. Clearly, the ACE Study and related studies that have since been undertaken by other researchers across the country, have profound implications for health care policies. We can contain and reduce costs by preventing disease. Part of that endeavor is to prevent child abuse and neglect and other adverse childhood experiences.
Wisely, national efforts to reform health care have begun to address prevention as a public health concern. All of the draft plans include provisions for evidence-based home visiting services during the prenatal and early childhood years. These programs offer immediate health benefits: improved birth outcomes, decreased infant mortality, and increased access to primary care and needed medical treatment. They also provide long-term health benefits, helping assure children's future health and productivity by reducing abusive and neglectful parenting. Prevent Child Abuse New York helped assure home visiting is part of comprehensive health care planning, working with colleagues from Healthy Families New York, Prevent Child Abuse America, and other national home visiting programs. We also have joined an effort spearheaded by SUNY Albany School of Social Work to apply Adverse Childhood Experiences research to improving prevention and treatment policies and practice.
An ACES research briefing from the Schuyler Center for Analysis and Advocacy
may be downloaded at
http://www.scaany.org/resources/publications.php1 Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, Volume 14, Number 4. Vincent J. Felitti, MD, FACP, Robert F. Anda, MD, MS, Dale Nordenberg, MD, David F. Williamson, MS, PhD, Alison M. Spitz, MS, MPH, Valerie Edwards, BA, Mary P. Koss, PhD, James S. Marks, MD, MPH
2 Vincent J. Felitti, MD, The Relationship of Adverse Childhood Experiences to Adult Health: Turning gold into lead. English translation of: Felitti VJ. Belastungen in der Kindheit und Gesundheit im Erwachsenenalter: die Verwandlung von Gold in Blei. Z psychsom Med Psychother 2002; 48(4)