ACEs in the Era of Inequality and AGEs

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ACEs in the Era of Inequality and AGEs

To reduce adverse childhood experiences and build healthy communities, we must address inequality in the context of adverse global experiences

Abstract

Adverse childhood experiences, or ACEs, affect a diversity of health outcomes from substance use to cardiovascular disease. We now understand some of the biologic pathways that translate this trauma into poor health, and exciting work to link this research with community improvement efforts forms the NEAR sciences: Neuroscience, Epigenetics, ACEs, and Resilience. A separate and substantial body of research has found wealth inequality to strongly and adversely affect a comparably wide range of health outcomes, including child well-being; it could be argued that inequality is upstream of ACEs. Finally, overwhelming evidence spanning the breadth of scientific inquiry shows how human activity threatens planetary health in what might be called “adverse global experiences,” or AGEs. We have a unique opportunity to make explicit the links between individual and global health. To improve the health of all we must address ACEs and AGEs and everything in between. Such a monumental task will only be achieved when we succeed in an even larger one—a sea change in our collective vision. Herein lies hope. That sea change may be so intrinsically appealing that its adoption may surprise us with its speed.

Introduction

“The health of the individual cannot be separated from the health of the family, the community and the world.” 
—the real Dr. Hunter Patch Adams

10 years into my medical career I took a 2-day training on the NEAR sciences: Neuroscience, Epigenetics, Adverse Childhood Experiences (ACEs), and Resilience. I’ve since shared this with audiences from physicians to teachers to parents struggling with their own ACEs. There is now tremendous hope around reducing ACEs and mitigating their effects through resilience research and interventions. Yet the data shows that childhood adversity is increasing.[1] Correspondingly, US mortality, already worse than in 35 other nations, has increased for 3 consecutive years, unprecedented in modern history.[2] Why is this happening?

The answer is complex. It carries us beyond the scope, as large a scope as it is...

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Posting #100

Okay so this is going to be my second blog in a month after not writing for over a year. As may have been obvious from the entry I just posted, I didn’t really know where I was going with it. That’s not unusual in and of itself. Often I’m not sure where an idea will take me. Mathematical concepts are an easy fallback and I found myself thinking about the idea of 6 degrees of separation, which is where the whole calculation about how much time it could potentially take to collect and share ideas from 7 billion people came from. Anyway you slice it, though, there wasn’t much said in that essay.

I just put the boys to bed after watching the 1953 version of Peter Pan with them. There was a fair amount of general sadness afterwards, nothing to do with Pan but rather with Mama not being present for bedtime. This was the first week back to school for both boys, so understandable there would be a little bit of angst.

Because of said angst, I delivered on my promise to tell an extra bedtime story after lights out. I asked if they wanted a giraffe story. Starting a couple of years ago I developed a whole Serengeti world replete with a four-member Giraffe family, Old Elephant and Baby Kale, Young Lion, Wise Baboon, Mama Hippo and Baby Amanzi (which means water in Zulu), and several others. I was tired and a giraffe story, like a blog about math, would have been an easy fallback. But Felix didn’t want a giraffe story. He wanted a story from when I was little boy.

Felix asked, wasn’t there a story about a mean teacher you had? I had to think about that and was drawing a blank, fortunately most of my grade school teachers were pretty kind, until he reminded me that I’d told them about a time when I was so afraid of our computer lab teacher in early grade school that I’d wet my pants rather than ask to use the bathroom. I can still remember that. I can still remember the surprise I felt at how much pee there was, still remember pretending to feel sick and going down to the principal’s office and asking for my mom and her coming to get me, and I can still remember my principle, Mr. Koopman, giving me the benefit of the doubt and commenting on how rainy and wet it was outside, that was obviously how I’d gotten so wet. Mr. Koopman was kind. That can make all the difference.

I didn’t, however, revisit that story, beyond acknowledging it. Instead I told them about third grade, when I really wanted to be an author, and the stories I used to write. I told them about my third grade teacher, Mrs. Johnson-Lamb, whose husband was a real life auctioneer. I figured it might make them laugh if I tried to imitate an auctioneer.

Then Felix asked, Dada why did you decide to become a doctor, instead of an author, if that was what you really wanted to be?

And I said that I became a doctor because I really wanted to help people, which is true, but that also some part of me still wants to be an author, and Sam asked which part, and I said my left knee and we laughed. And then I said that maybe I still will be an author someday, I’ll keep being a doctor but I’ll be an author too, because it’s possible to be more than one thing, like how you both want to be musician welders. Or welder musicians. I forget which and sometimes the order is very important, to my four- and six-year-old.

Maybe someday I will be an author. A doctor author, or an author doctor. Right now the order isn’t so important, to me as a forty-something-year-old. Can I be three things? A dad doctor author? Really, if I had to choose just one right now, that would be it. A dad.

September 2018

Next Tuesday will mark the 17th anniversary of 9/11.

In those 17 years the world has added more than a billion people. For Earth to reach its first one-billion-person mark (i.e., 1 billion people alive on the planet at one time) took, depending on when one defines humankind as a species, between 500,000 and 3 million years. In fact, it was only 10,000 years ago when Earth's total population was only 10 million. Twice this number now live in greater New York City.

If all 7.5 billion people alive today spoke aloud 100 words—as of this next dash, I’m writing 102—each taking 45 seconds to do so (it took me 46 seconds to read to that dash), then it would take one person 142 lifetimes of 75 years each to hear every spoken word.

If anger, such as that that led to 9/11, is grounded in fear, fear is grounded in misunderstanding, misunderstanding might be overcome through dialogue, and it is mathematically impossible for even one single person to hear just 100 words from every other person, we clearly have to find another route to peace. Fortunately there are attainable routes open to us. Let’s say every person alive met for an hour in groups of 10 people to come up with one best idea for peace and a representative to carry that idea forward, the following day the representatives met in groups of 10 to select the very best of the 10 ideas, and so on. Within 9 hours spread over 9 days, 100 “best of the best” ideas selected from the voices of all the world’s population could be identified.

Somewhere in between 9 hours and 142 lifetimes, then, might be the time required for humanity to better understand itself, stop fighting wars, and perhaps slow and reverse our growth rate to the point that we could live sustainably on our finite planet. If the last 17 years are any indication then we are on a timeline closer to the latter number. Let us hope—and, thankfully, there are indications of this—that our capacity for justice, compassion, and sustainability might accelerate in a matter akin to the acceleration of so many other trends. We are the ones we’ve been waiting for. The time is now.