Childhood experiences lead to health disparities

The 17th Century poet John Milton once said that “The childhood shows the man, as morning shows the day.” The current issue of the Journal of the American Medical Association (JAMA) carries a report that finds that childhood shows the adult disease.

McEwen et al(1) explain that the negative childhood experiences of working-class youth and other disadvantaged people lead to adult disease. “Adverse childhood experience,” they note, “is one of the largest contributors to such chronic health problems as diabetes and obesity, psychiatric disorders, drug abuse — almost every major public health challenge we face.”

The authors discuss how the “toxic” stress of poverty, physical and emotional abuse, chronic neglect, and violence disrupts brain architecture and other organ systems, increasing the risk of chronic illnesses in adulthood. The endemic extreme poverty of the African-American community; the structural and institutionalized physical and emotional abuse of racial discrimination; the chronic neglect of African-American communities by city, state, and federal governments; and the rampant violence afflicting our communities all leave deep wounds in African-American youth. These wounds fester over the years, becoming manifest in the huge inequities in disease incidence and mortality that plague African Americans. Other oppressed groups face similar problems: Latinos, Asian-Americans, and women to name a few.

There is hope, however. As individual groups of disadvantaged peoples, we are “minorities.” However, together we are the majority. We need to band together and demand that the social inequities that underlie our ill health be eliminated. As I will continue to argue in this blog, eliminating social inequity will do far more to eliminate health inequities than any campaign aimed at individual health behaviors or physician practices.

1. Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention. JAMA 2009;301:2252-59.

Wednesday, June 3rd, 2009 at 14:16