An Ounce of Prevention is Worth a Pound of Cure

Two friends were standing by the banks of a river when they saw someone drifting by and yelling “help me, help me.” One friend said he could not swim. The other friend said he could swim and dove into the river and rescued the person.   Once he reached the shore another person came drifting down the river also asking to be saved. The friend dove in again and rescued this person. As soon as he reached the shore a third person drifted down the river begging to be saved. The friend dove in but said he was getting really tired and could not keep this up. The friend who could not swim said he would go up stream to find out who was pushing everyone in the river. That in a nutshell is the difference between treatment and prevention. We want to find out who is pushing everyone into the river.

We all know how critical child development is to one’s mental health, but there is evidence to show it is important for one’s physical health as well. This has been documented in the Adverse Childhood Experiences (ACE) study. Conducted by Kaiser Permanente and the Centers for Disease Control in the late 1990s, over 17,000 patients were interviewed and completed a set a 10 questions, which asked them about physical, sexual and emotional abuse or neglect, divorce or parental separation, substance abuse and mental illness in the family, and whether a member of their household went to prison. About 40% of the sample reported two or more ACEs and 12.5% experienced four or more.

The results of the study revealed that these early adverse experiences put people at greater risk for a substance use disorder, chronic obstructive pulmonary disease, depression, heart disease, liver disease, suicide attempts, poor work performance, intimate partner violence, unintended pregnancies, and poor academic performance.   There appeared to be a dose-response relationship between ACEs and negative health and well being across the life span: the more ACEs one had, the worse the outcome.

The ACE researchers developed a pyramid to suggest that adverse childhood experiences lead to disrupted neurodevelopment; impaired social, emotional and cognitive development; adoption of health-risk behaviors; disease, disability and social problems; and ultimately an early death. 

The good news is that these adverse childhood experiences and the subsequent negative outcomes can be prevented. Strategies to do this include: home visiting to pregnant women and families with newborns, parent training programs, intimate partner violence prevention training, social support for parents, parent support programs for teens and teen pregnancy prevention programs, mental health and substance use disorder treatment, high quality child care, and sufficient income support for lower income families.

To learn more about the ACE study just type in the words ACE study into any search engine or go to https://www.cdc.gov/violenceprevention/acestudy/ for an overview.

If you have any questions or comments, please don’t hesitate to contact me at ken@psychsem.com.