Many serious health conditions are associated with childhood trauma, and medical schools and health care systems need to do much more to recognize that connection and devise effective treatment, said Nancy Hardt, M.D., the latest speaker in the Dean’s Visiting Professor Series.
Hardt, a University of Florida emerita professor of pathology and obstetrics and gynecology, spoke April 27 at the UMKC School of Medicine on “Adverse Childhood Experiences: The Most Important Public Health Topic Missing from Our Curricula.”
Adverse Childhood Experiences — ACES for short — include sexual and physical abuse, growing up in poverty, divorce, alcoholism and other drug addictions, and crime and neighborhood violence. Hardt drew on research indicating the scope of their connection with disparities in health, including findings that:
— Suffering six or more childhood trauma incidents cuts 20 years off life expectancy.
— More than 14 percent of adults in one study had suffered four or more adverse childhood experiences.
— Of people who have suffered five or more adverse events, 90 percent have some sort of developmental delay.
— Each adverse childhood experience increased the rate of everything from asthma and anxiety to heart disease, stroke and diabetes. ACES also correlated with poverty and unemployment, which further increase the likelihood of serious health problems and difficulty in getting them treated.
Hardt cited the work of Michael Marmot, who wrote “The Health Gap” and said, after studying developed countries around the world, that the United States “had a lot of nerve” allowing one-fourth of its children to grow up in poverty. Marmot also did research among British government workers and found that all up and down the pay scale, more money correlated with better health.
Many social service agencies are trying to address ACES and head off the costly health problems they cause, Hardt said. But medical care has lagged behind, she said, in part because medical schools don’t teach prospective doctors about these connections.
She told of one doctor, Vincent Felitti, whose research established a connection between childhood sexual abuse and obesity later in life. He initially was puzzled about why some patients in a weight loss study couldn’t keep off lost weight — until he learned that adults who had been sexually abused often felt safer, less a target, when excess weight made them unattractive.
“He said, ‘I’ve been a doctor for 25, 30 years, and I never knew that. Why didn’t they teach me this in medical school?’ ” Hardt said.
Felitti then met Rob Anda, a Centers for Disease Control researcher who thought childhood trauma correlated with hypertension in adults. Felitti and Anda then did a large study showing the many health problems linked to ACES.
The good news, Hardt said, is that rsearch also has shown that the effects of traumatic experiences often can be reversed with the right treatments and interventions.
An abused or neglected person’s resilience can be aided by everything from mindfulness practices, meditation and yoga to getting sufficient sleep, nutrition, exercise and daily pleasurable experiences, she said.
Researchers and caregivers also are learning more about what to try, she said. For example, in some cases it has been found that traumatized children who cannot attach to adults can connect with younger children and help them, too.
Hardt said it also was important for medical schools and centers to practice care for their own people, so that students and caregivers weren’t themselves stressed or traumatized and thus less able to provide care that’s responsive to trauma. And it’s important for the medical profession to realize and address the secondary trauma that caregivers can suffer.
Hardt noted further that there’s a sound business case for such treatment and interventions, given the large number of serious later-in-life problems that can be prevented or mitigated.
Good treatment requires a team effort, she said, and that provides opportunities for medical schools to work ACES information and experience into their curriculum. Medical students, for example, could provide the sort of staff help that’s always need by community partners treating traumatized youth.
The Kansas City area already is “rockin’ and rollin’” in this area, Hardt said. The Head Start-Trauma Smart program of Saint Luke’s Crittenton Children’s Center is just one example of an area program doing good work, she said.
“I’ve never seen a place with more opportunity to make this happen,” she said.