Editor’s Note: Dr. Nadine Burke Harris is the Surgeon General of California. She is a physician, researcher and an advocate on the issues of childhood trauma. The opinions expressed in this commentary are her own. View more opinions on CNN.
Now that the Pfizer vaccines have been authorized for emergency use in children ages 5 to 11, I, like so many parents across the US, am breathing a sigh of relief that my little ones can finally be protected against Covid-19. We still have a lot of work to do to ensure we emerge from this pandemic as soon as possible, but as a pediatrician and the Surgeon General of California, I recognize that reining in the virus can’t be the end of the story.
If we’re going to truly heal from the impacts of Covid-19, we need to once again let medicine lead our decision making and recognize the role that trauma caused by the pandemic and other cumulative stressors plays in both personal and public health — particularly when experienced during childhood.
In their recent deliberations, the US Centers for Disease Control and Prevention rightly noted that the Covid-19 pandemic has led to an increase in adverse childhood experiences (ACEs), or potentially traumatic events that are linked to health problems, and an increased risk for many of the leading causes of death in the US. Unfortunately, most medical professionals have yet to incorporate this powerful research into how we administer care for both children and adults. In fact, too many doctors that I’ve spoken to still think ACEs are social problems that don’t directly impact health or require medical interventions.
It’s high time we change that. The research is clear and if we don’t address the long-term effects of ACEs, I’m afraid our country will be battling the lingering consequences of Covid-19 for decades to come.
ACEs refer to 10 categories of adversities or traumatic events experienced by the age of 18, such as parental mental illness, witnessing domestic violence or growing up in a home where substance abuse is present. Exposure to these stressors in childhood, without the buffers in place to cope, leads to a prolonged activation of the body’s stress response. This is known as the toxic stress response and it is particularly harmful to a child’s brain, immune, and hormonal development.
The effects of toxic stress can persist through every stage of our lives. The more ACEs an individual experiences, the more likely that person will develop acute and chronic diseases, such as asthma, cardiovascular disease or depression, both in childhood and adulthood. According to a study published in the American Journal of Preventive Medicine in 2009, those with six or more ACEs are expected to live shorter lives – 19 years shorter on average than people without any ACEs.
ACEs have been on the rise during the pandemic, as have other risk factors for toxic stress that can hurt long-term physical and mental health — like having a relative die, which tens of thousands of children have experienced because of Covid-19. And while the pandemic itself is not one of the traditional ACE criteria, it’s likely that it can lead to toxic stress. For much of the pandemic we have been cut off from the day-to-day supports and social interactions we need to turn off the body’s stress response. So, it’s not surprising that the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association recently declared a national emergency for child and adolescent mental health due to the enormous adversity and disruption they’ve experienced as a result of the pandemic.
People raised in homes where adversity is already present are especially at risk. Communities of color were already more likely to experience ACEs but now they’ve borne the brunt of Covid-19 infections and deaths – as well as economic hardships during the pandemic. This could lead to even higher rates of health conditions, such as cardiovascular disease.
The sharp uptick in ACEs due to Covid-19 will likely lead to a massive wave of after-effects that will threaten not only our health care system, but our economy and our education and criminal justice systems too. A study published in early 2020 estimated the annual cost of ACEs in California from just eight health conditions and risk factors to be $10.5 billion, with another $102 billion lost to disease burden, which estimates the cost of premature death and years of productive life lost to disability. And children with four or more ACEs have significantly reduced likelihood of high school graduation and are 3.1 times more likely to get arrested as a juvenile compared to their peers with no ACEs, according to a 2016 study published in the journal, Pediatrics. These are all pre-pandemic numbers. We still don’t know how harmful ACEs caused or compounded by Covid-19 will be.
But we do know that with the right infrastructure in place ACE prevention, screening, and treatment can prevent individual suffering, as well as persistent societal challenges, before they ever take root. Toxic stress is treatable when ACEs are identified early and managed with high quality interventions. So we need a coordinated, cross-sector approach that gives health providers the right training and support to effectively and equitably address ACEs.
Here in California, we’re making great progress building our own ACEs infrastructure that I hope the rest of the nation can learn from. As Surgeon General, I developed a report to serve as a blueprint for how communities can scale ACE interventions. In January 2020, California launched the ACE Aware initiative and, since then, 20,000+ health providers have been trained to screen for ACEs and treat toxic stress with evidence-based interventions. And now, with the recent passage of the ACEs Equity Act, more Californians will have insurance coverage for high-quality ACE screening – a crucial step forward for our state’s public health.
And that’s only the beginning.
This year’s California state budget is putting more than $4 billion over five years into transforming youth behavioral health — a once-in-a-generation investment in health care, education, public safety and the other parts of our society that suffer because we aren’t treating people for toxic stress. It’s the kind of systems-wide policymaking we need at the state and federal level to chip away at the intersecting and multifaceted impacts of ACEs. As our nation works to build back better from one of the greatest collective traumas of our time, government leaders must similarly take a trauma-responsive approach to policymaking.
This country will never fully move forward, and never fully heal, if we don’t learn the lessons of this pandemic and let medicine lead. I like to say that Adverse Childhood Experiences don’t have to dictate a person’s destiny. Now is the time to address the root of the challenges before us and ensure a different destiny for ourselves, our children, and our country.