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The Early Years: A Path to Wellness or a Path to Illness

November 20, 2013

A catastrophe on the scale of the Philippines typhoon focuses critical attention on the susceptibility of poor and vulnerable populations to natural disasters. Yet, it is no less important to remember that poor and vulnerable populations, particularly children, are susceptible to shocks and health risks on a regular basis wherever they live.

Photo courtesy of Heinrock

Photo courtesy of Heinrock

In the late 1990s, Vincent Felitti and Robert Anda conducted a landmark study that examined the effects of adverse childhood experiences (ACEs)—including abuse, neglect, domestic violence, and family dysfunction—and found a persuasive connection between the level of adversity faced and the incidence of many health and social problems. The first article from the Adverse Childhood Experiences (ACE) Study was published in AJPM in 1998. It struck a deep chord and has been one of the most cited papers and requested full-text articles from the Journal in the past 15 years.

More recent articles by the authors include: Building a Framework for Global Surveillance of the Public Health Implications of Adverse Childhood Experiences (2010), and Adverse Childhood Experiences and the Risk of Premature Mortality (2009).

There is now a collective body of evidence suggesting that childhood traumatic stressors (“toxic stress” is the term used at the Center on the Developing Child at Harvard University) represent a common pathway to a variety of long-term behavioral, health, and social problems. There is growing acceptance that childhood abuse and other adverse childhood experiences are overlapping risk factors for long-term adult health problems and that the accumulation of these adverse experiences increases the risk of poor adult health.

Social determinants such as neighborhood economic distress and disadvantage, housing inadequacy, low social capital, poverty, low parental education, and lack of social support are all associated with child maltreatment. Community adversity alone exerts a persistent influence through a sequence of adverse social, behavioral, and psychological experiences (a chain of insults) that in turn contribute to adverse health outcomes.

Extensive biological and developmental research also shows that significant neglect—the ongoing disruption or significant absence of caregiver responsiveness—can cause more harm to a young child’s development than overt physical abuse. The consequences include subsequent cognitive delays, impairments in executive functioning, and disruptions of the body’s stress response.

And traumatic experiences in early life can not only leave emotional scars and developmental impairment, they appear to leave a genetic mark as well. Children who are physically abused and bullied tend to have shorter telomeres—structures at the tips of chromosomes whose shrinkage has been linked to aging and disease. Researchers have found associations between stress and accelerated telomere loss, and shortened telomeres correlate with several health problems, including diabetes, dementia, and fatigue. The findings are suggestive, but much more work needs to be done.

That children need to be protected is unarguable, but how to do so is open to debate. Britain and the United States are taking very different paths, a topic that I will explore in the next blog.

— Michael Lytton, AJPM Blog Editor

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