A recent report from the United Health Foundation reported on America’s Health Rankings stated that the “health of Americans has failed to improve for the fourth consecutive year. Key factors contributing to these results included unprecedented levels of obesity, increasing numbers of uninsured people and the persistence of risky health behaviors, particularly tobacco use.”
The Partnership for Prevention (Visit www.prevent.org.) recommended seven actions to prevent these problems. These actions include:
Enhance in-school physical education
Increase access to places for physical activity
Promote healthy foods in school
Increase access to healthy foods in the community
Make public places and workplaces smoke-free
Increase price of tobacco products
Ensure access to clinical prevention services
While I have no problem with these suggestions, I think they are missing a critical piece of reality, and that is why people participate in risky activities in the first place. If only the answer were simply to change behavior. But it isn’t that simple.
About five years ago, I discovered the ACE Study, some amazing research on the long term impacts of adverse childhood experiences (ACEs) on children as they grew up. The research was done on many thousands of people by Dr Vincent Felitti of Kaiser Permanente and Dr. Rob Anda of the CDC (Centers for Disease Control). The study identified a number of early experiences and determined whether the research subjects had experienced them. They then identified the frequency with which the subjects participated in high risk behaviors as adolescents and then whether they developed chronic illnesses as adults. To learn more about the ACE Study, I recommend that readers go to www.acestudy.org.and check it out.
So what’s an ACE? It is one or an accumulation of the following experiences prior to age 18:
Recurrent physical abuse
2. Recurrent emotional abuse
3. Contact sexual abuse
4. An alcohol and/or drug abuser in the household
5. An incarcerated household member
6. Someone who is chronically depressed, mentally ill,
institutionalized, or suicidal
7. Mother is treated violently
8. One or no parents
9. Emotional or physical neglect
The ACE study showed that such experiences changed the architecture of the brain and the more of these experiences a child had, the greater the likelihood that he or she would smoke, develop eating disorders, experience school failure, become delinquent, use alcohol and drugs and others. Further, such experiences increased the likelihood that they would develop many chronic diseases in adulthood, such as COPD (Cardiac Obstructive Pulmonary Disease), obesity and thus heart disease and diabetes, and many, as well as being more likely to have failed relationships, incarceration and to pass along these problems to their children. All of these results impact the health of our nation and increase the cost of health care.
All that said, it seems that the most important thing we can do to change the health of our nation is to invest in the prevention of child maltreatment and in assuring the well-being of our children. This requires a financial investment in prevention by promoting positive parenting, early home visiting, prenatal health, teen pregnancy, very early education in social and emotional development and other programs that will improve the outcomes for our children. Far too small a percentage of our money goes to improving child well being by promoting prevention programs for very early childhood and young parents. Let your policy makes know that if our children do better, they are less likely to develop, in the first place, the behaviors we are spending so much money trying to stop.
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