Adverse Childhood Experiences (ACEs) are a pervasive public health crisis that significantly impact lifelong physical and mental health by altering physiological development, yet they remain largely unaddressed due to societal avoidance and lack of medical training.
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In the mid-'90s,
the CDC and Kaiser Permanente
discovered an exposure that dramatically increased the risk
for seven out of 10 of the leading causes of death in the United States.
In high doses, it affects brain development,
the immune system, hormonal systems,
and even the way our DNA is read and transcribed.
Folks who are exposed in very high doses
have triple the lifetime risk of heart disease and lung cancer
and a 20-year difference in life expectancy.
And yet, doctors today are not trained in routine screening or treatment.
Now, the exposure I'm talking about is not a pesticide or a packaging chemical.
It's childhood trauma.
Okay. What kind of trauma am I talking about here?
I'm not talking about failing a test or losing a basketball game.
I am talking about threats that are so severe or pervasive
that they literally get under our skin and change our physiology:
things like abuse or neglect,
or growing up with a parent who struggles with mental illness
or substance dependence.
Now, for a long time,
I viewed these things in the way I was trained to view them,
either as a social problem -- refer to social services --
or as a mental health problem -- refer to mental health services.
And then something happened to make me rethink my entire approach.
When I finished my residency,
I wanted to go someplace where I felt really needed,
someplace where I could make a difference.
So I came to work for California Pacific Medical Center,
one of the best private hospitals in Northern California,
and together, we opened a clinic in Bayview-Hunters Point,
one of the poorest, most underserved neighborhoods in San Francisco.
Now, prior to that point,
there had been only one pediatrician in all of Bayview
to serve more than 10,000 children,
so we hung a shingle, and we were able to provide top-quality care
regardless of ability to pay.
It was so cool. We targeted the typical health disparities:
access to care, immunization rates, asthma hospitalization rates,
and we hit all of our numbers.
We felt very proud of ourselves.
But then I started noticing a disturbing trend.
A lot of kids were being referred to me for ADHD,
or Attention Deficit Hyperactivity Disorder,
but when I actually did a thorough history and physical,
what I found was that for most of my patients,
I couldn't make a diagnosis of ADHD.
Most of the kids I was seeing had experienced such severe trauma
that it felt like something else was going on.
Somehow I was missing something important.
Now, before I did my residency, I did a master's degree in public health,
and one of the things that they teach you in public health school
is that if you're a doctor
and you see 100 kids that all drink from the same well,
and 98 of them develop diarrhea,
you can go ahead and write that prescription
for dose after dose after dose of antibiotics,
or you can walk over and say, "What the hell is in this well?"
So I began reading everything that I could get my hands on
about how exposure to adversity
affects the developing brains and bodies of children.
And then one day, my colleague walked into my office,
and he said, "Dr. Burke, have you seen this?"
In his hand was a copy of a research study
called the Adverse Childhood Experiences Study.
That day changed my clinical practice and ultimately my career.
The Adverse Childhood Experiences Study
is something that everybody needs to know about.
It was done by Dr. Vince Felitti at Kaiser and Dr. Bob Anda at the CDC,
and together, they asked 17,500 adults about their history of exposure
to what they called "adverse childhood experiences," or ACEs.
Those include physical, emotional, or sexual abuse;
Early adversity dramatically affects health across a lifetime.
Today, we are beginning to understand how to interrupt the progression
from early adversity to disease and early death,
and 30 years from now,
the child who has a high ACE score
and whose behavioral symptoms go unrecognized,
whose asthma management is not connected,
and who goes on to develop high blood pressure
and early heart disease or cancer
will be just as anomalous as a six-month mortality from HIV/AIDS.
People will look at that situation and say, "What the heck happened there?"
This is treatable.
This is beatable.
The single most important thing that we need today
is the courage to look this problem in the face
and say, this is real and this is all of us.
I believe that we are the movement.
Thank you.
(Applause)
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