How childhood trauma affects health across a lifetime
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0:01 - 0:02In the mid-'90s,
-
0:02 - 0:05the CDC and Kaiser Permanente
-
0:05 - 0:09discovered an exposure
that dramatically increased the risk -
0:09 - 0:14for seven out of 10 of the leading
causes of death in the United States. -
0:15 - 0:18In high doses, it affects
brain development, -
0:18 - 0:22the immune system, hormonal systems,
-
0:22 - 0:27and even the way our DNA
is read and transcribed. -
0:27 - 0:30Folks who are exposed in very high doses
-
0:30 - 0:34have triple the lifetime risk
of heart disease and lung cancer -
0:34 - 0:39and a 20-year difference
in life expectancy. -
0:40 - 0:46And yet, doctors today are not trained
in routine screening or treatment. -
0:46 - 0:52Now, the exposure I'm talking about is
not a pesticide or a packaging chemical. -
0:52 - 0:54It's childhood trauma.
-
0:55 - 0:58Okay. What kind of trauma
am I talking about here? -
0:58 - 1:02I'm not talking about failing a test
or losing a basketball game. -
1:02 - 1:07I am talking about threats
that are so severe or pervasive -
1:07 - 1:11that they literally get under our skin
and change our physiology: -
1:11 - 1:14things like abuse or neglect,
-
1:14 - 1:17or growing up with a parent
who struggles with mental illness -
1:17 - 1:19or substance dependence.
-
1:20 - 1:21Now, for a long time,
-
1:21 - 1:24I viewed these things in the way
I was trained to view them, -
1:24 - 1:29either as a social problem --
refer to social services -- -
1:29 - 1:33or as a mental health problem --
refer to mental health services. -
1:34 - 1:40And then something happened
to make me rethink my entire approach. -
1:40 - 1:42When I finished my residency,
-
1:42 - 1:45I wanted to go someplace
where I felt really needed, -
1:45 - 1:49someplace where I could make a difference.
-
1:49 - 1:52So I came to work for
California Pacific Medical Center, -
1:52 - 1:55one of the best private hospitals
in Northern California, -
1:55 - 2:00and together, we opened a clinic
in Bayview-Hunters Point, -
2:00 - 2:04one of the poorest, most underserved
neighborhoods in San Francisco. -
2:04 - 2:06Now, prior to that point,
-
2:06 - 2:09there had been only
one pediatrician in all of Bayview -
2:09 - 2:12to serve more than 10,000 children,
-
2:12 - 2:17so we hung a shingle, and we were able
to provide top-quality care -
2:17 - 2:19regardless of ability to pay.
-
2:19 - 2:23It was so cool. We targeted
the typical health disparities: -
2:23 - 2:28access to care, immunization rates,
asthma hospitalization rates, -
2:28 - 2:30and we hit all of our numbers.
-
2:30 - 2:33We felt very proud of ourselves.
-
2:33 - 2:37But then I started noticing
a disturbing trend. -
2:37 - 2:41A lot of kids were being
referred to me for ADHD, -
2:41 - 2:44or Attention Deficit
Hyperactivity Disorder, -
2:44 - 2:48but when I actually did
a thorough history and physical, -
2:48 - 2:52what I found was that
for most of my patients, -
2:52 - 2:55I couldn't make a diagnosis of ADHD.
-
2:55 - 3:01Most of the kids I was seeing
had experienced such severe trauma -
3:01 - 3:04that it felt like something else
was going on. -
3:04 - 3:08Somehow I was missing something important.
-
3:10 - 3:13Now, before I did my residency,
I did a master's degree in public health, -
3:13 - 3:16and one of the things that they teach you
in public health school -
3:16 - 3:18is that if you're a doctor
-
3:18 - 3:22and you see 100 kids
that all drink from the same well, -
3:22 - 3:25and 98 of them develop diarrhea,
-
3:25 - 3:28you can go ahead
and write that prescription -
3:28 - 3:32for dose after dose
after dose of antibiotics, -
3:32 - 3:38or you can walk over and say,
"What the hell is in this well?" -
3:38 - 3:42So I began reading everything that
I could get my hands on -
3:42 - 3:44about how exposure to adversity
-
3:44 - 3:48affects the developing brains
and bodies of children. -
3:48 - 3:52And then one day,
my colleague walked into my office, -
3:52 - 3:56and he said, "Dr. Burke,
have you seen this?" -
3:57 - 4:01In his hand was a copy
of a research study -
4:01 - 4:04called the Adverse Childhood
Experiences Study. -
4:05 - 4:12That day changed my clinical practice
and ultimately my career. -
4:12 - 4:15The Adverse Childhood Experiences Study
-
4:15 - 4:18is something that everybody
needs to know about. -
4:18 - 4:23It was done by Dr. Vince Felitti at Kaiser
and Dr. Bob Anda at the CDC, -
4:23 - 4:31and together, they asked 17,500 adults
about their history of exposure -
4:31 - 4:36to what they called "adverse
childhood experiences," or ACEs. -
4:37 - 4:41Those include physical, emotional,
or sexual abuse; -
4:41 - 4:45physical or emotional neglect;
-
4:45 - 4:48parental mental illness,
substance dependence, incarceration; -
4:48 - 4:51parental separation or divorce;
-
4:51 - 4:53or domestic violence.
-
4:53 - 4:58For every yes, you would get
a point on your ACE score. -
4:58 - 4:59And then what they did
-
4:59 - 5:04was they correlated these ACE scores
against health outcomes. -
5:05 - 5:08What they found was striking.
-
5:08 - 5:09Two things:
-
5:09 - 5:13Number one, ACEs are incredibly common.
-
5:13 - 5:20Sixty-seven percent of the population
had at least one ACE, -
5:20 - 5:26and 12.6 percent, one in eight,
had four or more ACEs. -
5:27 - 5:29The second thing that they found
-
5:29 - 5:32was that there was
a dose-response relationship -
5:32 - 5:37between ACEs and health outcomes:
-
5:37 - 5:41the higher your ACE score,
the worse your health outcomes. -
5:41 - 5:44For a person with an ACE score
of four or more, -
5:44 - 5:48their relative risk of chronic
obstructive pulmonary disease -
5:48 - 5:52was two and a half times that
of someone with an ACE score of zero. -
5:53 - 5:56For hepatitis, it was also
two and a half times. -
5:56 - 6:00For depression, it was
four and a half times. -
6:00 - 6:03For suicidality, it was 12 times.
-
6:03 - 6:06A person with an ACE score
of seven or more -
6:06 - 6:11had triple the lifetime risk
of lung cancer -
6:11 - 6:15and three and a half times the risk
of ischemic heart disease, -
6:15 - 6:18the number one killer
in the United States of America. -
6:19 - 6:22Well, of course this makes sense.
-
6:22 - 6:27Some people looked at this data
and they said, "Come on. -
6:27 - 6:31You have a rough childhood,
you're more likely to drink and smoke -
6:31 - 6:34and do all these things
that are going to ruin your health. -
6:34 - 6:38This isn't science.
This is just bad behavior." -
6:38 - 6:44It turns out this is exactly
where the science comes in. -
6:44 - 6:48We now understand
better than we ever have before -
6:48 - 6:52how exposure to early adversity
-
6:52 - 6:55affects the developing brains
and bodies of children. -
6:55 - 6:58It affects areas like
the nucleus accumbens, -
6:58 - 7:00the pleasure and reward
center of the brain -
7:00 - 7:03that is implicated
in substance dependence. -
7:03 - 7:05It inhibits the prefrontal cortex,
-
7:05 - 7:09which is necessary for impulse control
and executive function, -
7:09 - 7:12a critical area for learning.
-
7:12 - 7:13And on MRI scans,
-
7:13 - 7:17we see measurable differences
in the amygdala, -
7:17 - 7:20the brain's fear response center.
-
7:20 - 7:24So there are real neurologic reasons
-
7:24 - 7:27why folks exposed
to high doses of adversity -
7:27 - 7:31are more likely to engage
in high-risk behavior, -
7:31 - 7:32and that's important to know.
-
7:32 - 7:38But it turns out that even if you don't
engage in any high-risk behavior, -
7:38 - 7:43you're still more likely
to develop heart disease or cancer. -
7:44 - 7:50The reason for this has to do with
the hypothalamic–pituitary–adrenal axis, -
7:50 - 7:54the brain's and body's
stress response system -
7:54 - 7:57that governs our fight-or-flight response.
-
7:57 - 7:59How does it work?
-
7:59 - 8:03Well, imagine you're walking
in the forest and you see a bear. -
8:03 - 8:07Immediately, your hypothalamus
sends a signal to your pituitary, -
8:07 - 8:10which sends a signal
to your adrenal gland that says, -
8:10 - 8:13"Release stress hormones!
Adrenaline! Cortisol!" -
8:13 - 8:16And so your heart starts to pound,
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8:16 - 8:18Your pupils dilate, your airways open up,
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8:18 - 8:24and you are ready to either
fight that bear or run from the bear. -
8:24 - 8:27And that is wonderful
-
8:27 - 8:30if you're in a forest
and there's a bear. -
8:30 - 8:33(Laughter)
-
8:33 - 8:38But the problem is what happens
when the bear comes home every night, -
8:38 - 8:44and this system is activated
over and over and over again, -
8:44 - 8:48and it goes from being
adaptive, or life-saving, -
8:48 - 8:53to maladaptive, or health-damaging.
-
8:53 - 8:58Children are especially sensitive
to this repeated stress activation, -
8:58 - 9:01because their brains and bodies
are just developing. -
9:02 - 9:08High doses of adversity not only affect
brain structure and function, -
9:08 - 9:11they affect the developing immune system,
-
9:11 - 9:14developing hormonal systems,
-
9:14 - 9:19and even the way our DNA
is read and transcribed. -
9:20 - 9:25So for me, this information
threw my old training out the window, -
9:25 - 9:29because when we understand
the mechanism of a disease, -
9:29 - 9:34when we know not only
which pathways are disrupted, but how, -
9:34 - 9:38then as doctors, it is our job
to use this science -
9:38 - 9:41for prevention and treatment.
-
9:41 - 9:43That's what we do.
-
9:43 - 9:47So in San Francisco, we created
the Center for Youth Wellness -
9:47 - 9:52to prevent, screen and heal the impacts
of ACEs and toxic stress. -
9:52 - 9:57We started simply with routine screening
of every one of our kids -
9:57 - 9:58at their regular physical,
-
9:58 - 10:03because I know that if my patient
has an ACE score of 4, -
10:03 - 10:08she's two and a half times as likely
to develop hepatitis or COPD, -
10:08 - 10:10she's four and half times as likely
to become depressed, -
10:10 - 10:15and she's 12 times as likely
to attempt to take her own life -
10:15 - 10:17as my patient with zero ACEs.
-
10:17 - 10:20I know that when she's in my exam room.
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10:20 - 10:23For our patients who do screen positive,
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10:23 - 10:28we have a multidisciplinary treatment team
that works to reduce the dose of adversity -
10:28 - 10:34and treat symptoms using best practices,
including home visits, care coordination, -
10:34 - 10:38mental health care, nutrition,
-
10:38 - 10:43holistic interventions, and yes,
medication when necessary. -
10:43 - 10:47But we also educate parents
about the impacts of ACEs and toxic stress -
10:47 - 10:53the same way you would for covering
electrical outlets, or lead poisoning, -
10:53 - 10:57and we tailor the care
of our asthmatics and our diabetics -
10:57 - 11:01in a way that recognizes that they may
need more aggressive treatment, -
11:01 - 11:06given the changes to their hormonal
and immune systems. -
11:06 - 11:10So the other thing that happens
when you understand this science -
11:10 - 11:13is that you want to shout it
from the rooftops, -
11:13 - 11:17because this isn't just an issue
for kids in Bayview. -
11:17 - 11:21I figured the minute
that everybody else heard about this, -
11:21 - 11:24it would be routine screening,
multi-disciplinary treatment teams, -
11:24 - 11:29and it would be a race to the most
effective clinical treatment protocols. -
11:29 - 11:33Yeah. That did not happen.
-
11:33 - 11:36And that was a huge learning for me.
-
11:36 - 11:41What I had thought of as simply
best clinical practice -
11:41 - 11:44I now understand to be a movement.
-
11:45 - 11:47In the words of Dr. Robert Block,
-
11:47 - 11:51the former President
of the American Academy of Pediatrics, -
11:51 - 11:54"Adverse childhood experiences
-
11:54 - 11:59are the single greatest
unaddressed public health threat -
11:59 - 12:01facing our nation today."
-
12:01 - 12:06And for a lot of people,
that's a terrifying prospect. -
12:06 - 12:12The scope and scale of the problem
seems so large that it feels overwhelming -
12:12 - 12:14to think about how we might approach it.
-
12:14 - 12:19But for me, that's actually
where the hopes lies, -
12:19 - 12:22because when we have the right framework,
-
12:22 - 12:27when we recognize this to be
a public health crisis, -
12:27 - 12:32then we can begin to use the right
tool kit to come up with solutions. -
12:32 - 12:36From tobacco to lead poisoning
to HIV/AIDS, -
12:36 - 12:41the United States actually has
quite a strong track record -
12:41 - 12:43with addressing public health problems,
-
12:43 - 12:49but replicating those successes
with ACEs and toxic stress -
12:49 - 12:54is going to take determination
and commitment, -
12:54 - 12:58and when I look at what
our nation's response has been so far, -
12:58 - 12:59I wonder,
-
12:59 - 13:03why haven't we taken this more seriously?
-
13:03 - 13:07You know, at first I thought
that we marginalized the issue -
13:07 - 13:09because it doesn't apply to us.
-
13:09 - 13:12That's an issue for those kids
in those neighborhoods. -
13:12 - 13:16Which is weird, because the data
doesn't bear that out. -
13:16 - 13:21The original ACEs study
was done in a population -
13:21 - 13:23that was 70 percent Caucasian,
-
13:23 - 13:2670 percent college-educated.
-
13:26 - 13:30But then, the more I talked to folks,
-
13:30 - 13:34I'm beginning to think that maybe
I had it completely backwards. -
13:35 - 13:41If I were to ask
how many people in this room -
13:41 - 13:45grew up with a family member
who suffered from mental illness, -
13:46 - 13:48I bet a few hands would go up.
-
13:48 - 13:54And then if I were to ask how many folks
had a parent who maybe drank too much, -
13:54 - 13:58or who really believed that
if you spare the rod, you spoil the child, -
13:59 - 14:02I bet a few more hands would go up.
-
14:02 - 14:07Even in this room, this is an issue
that touches many of us, -
14:07 - 14:11and I am beginning to believe
that we marginalize the issue -
14:11 - 14:13because it does apply to us.
-
14:13 - 14:16Maybe it's easier to see
in other zip codes -
14:16 - 14:19because we don't want to look at it.
-
14:19 - 14:21We'd rather be sick.
-
14:22 - 14:28Fortunately, scientific advances
and, frankly, economic realities -
14:28 - 14:32make that option less viable every day.
-
14:34 - 14:35The science is clear:
-
14:36 - 14:41Early adversity dramatically affects
health across a lifetime. -
14:42 - 14:47Today, we are beginning to understand
how to interrupt the progression -
14:47 - 14:51from early adversity
to disease and early death, -
14:51 - 14:53and 30 years from now,
-
14:53 - 14:56the child who has a high ACE score
-
14:56 - 14:59and whose behavioral symptoms
go unrecognized, -
14:59 - 15:02whose asthma management
is not connected, -
15:02 - 15:05and who goes on to develop
high blood pressure -
15:05 - 15:08and early heart disease or cancer
-
15:08 - 15:13will be just as anomalous
as a six-month mortality from HIV/AIDS. -
15:13 - 15:17People will look at that situation
and say, "What the heck happened there?" -
15:18 - 15:21This is treatable.
-
15:21 - 15:24This is beatable.
-
15:24 - 15:28The single most important thing
that we need today -
15:28 - 15:31is the courage to look
this problem in the face -
15:31 - 15:36and say, this is real
and this is all of us. -
15:36 - 15:41I believe that we are the movement.
-
15:41 - 15:42Thank you.
-
15:42 - 15:46(Applause)
- Title:
- How childhood trauma affects health across a lifetime
- Speaker:
- Nadine Burke Harris
- Description:
-
Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 15:59
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast approved English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime | ||
Morton Bast edited English subtitles for How childhood trauma affects health across a lifetime |