How childhood trauma can affect mental and physical health into adulthood

Editor’s Note: This article is the first in a series exploring how research into adverse childhood experiences – or ACEs – is helping therapists, parents, educators and the medical community better understand the lasting effects of trauma on mental health.

For millions of children in the U.S., poverty, neglect or abuse is a reality of everyday life, though these struggles are often hidden from view.

Adult survivors often feel ashamed about and stigmatized for their childhood adversity. This makes it difficult to recognize that these events occur.

While it’s easier to turn away than to face these issues, we can no longer afford to do so. Stress, mental illness and substance abuse – all health outcomes linked to childhood trauma – occur in the U.S. today at very high rates.

In 1999, I joined the Centers for Disease Control and Prevention (CDC) as an early investigator on a study to examine how childhood trauma can impact health decades later. Little did I know that I was about to begin both a professional and personal journey that would forever change my understanding of medicine, public health and the human capacity to heal.

That seminal study provided insight into the lifelong health consequences of adverse childhood experiences (ACEs). It was the beginning of our understanding that these experiences can have negative effects on childhood development, leading to physical and mental health problems throughout life.

It brought to light the importance of preventing ACEs from ever occurring. It also drew attention to the healing and recovery needed to prevent these experiences from having an impact across generations.

The ACE Study

In the early 1990s, Vincent Felitti, a physician at Kaiser Permanente in San Diego, questioned why patients who successfully lost weight dropped out of a weight loss program. He could not make sense of it. He interviewed each patient individually and learned that the weight loss made patients feel vulnerable. A large proportion of the patients disclosed experiences of childhood sexual abuse. The weight protected them.

Felitti’s findings caught the interest of Dr. Robert Anda at the CDC. Together, they launched the CDC-Kaiser Adverse Childhood Experiences Study.

The ACE Study was one of the first and largest research efforts conducted to examine the impact of childhood trauma on health decades later.

From 1995 to 1997, more than 17,000 adult members of Kaiser Permanente in San Diego took part in the study. Researchers gathered information on their health and behaviors. Participants also answered questions about adverse childhood experiences, including physical, emotional and sexual abuse; physical and emotional neglect; and growing up in a home with divorced parents, domestic violence, substance abuse, or mentally ill or incarcerated household members.

One day, while reviewing the completed questionnaires, I came across several notes penned by the study participants, thanking us for asking these questions. One said, “I thought I would die never having told anyone about my childhood.” The messages were a true testament to the hidden nature of childhood adversities.

Key takeaways

The ACE Study offered groundbreaking insight into childhood trauma.

First, the ACE Study showed that childhood trauma is very common, even among white, highly educated adults with health care.

This was a novel finding, given that populations of low socioeconomic status and racial minorities are disproportionately represented in child welfare systems. For example, a large percentage of African-American and Native American children are seen in the child welfare system. The ACE Study helped us understand that childhood trauma cuts across multiple populations.

We learned that close to 30 percent of ACE study participants experienced physical abuse as a child. Fifteen percent experienced childhood emotional neglect.

A separate study showed that one in six men and one in four women reported childhood sexual abuse. Both men and women experienced similar risk for health outcomes like alcohol abuse and symptoms of depression.

Most importantly, we discovered that the 10 separate categories of abuse, neglect and related household stressors we assessed rarely occur as single events. For example, among adults who reported sexual abuse, 80 percent reported at least one additional ACE and 60 percent at least two. A large proportion of study participants, sixty-seven percent, reported at least one of the 10 ACEs.

It’s true that, during adolescence, youth tend to engage in risk-taking behaviors. Our research showed that childhood trauma increased the risk of alcohol use by age 14 and illicit drug use by age 15. Childhood trauma also contributed to the likelihood of adolescent pregnancies and adolescent suicide attempts.

But the story doesn’t end there. ACEs were also found to be associated with multiple adverse outcomes in adulthood, such as cardiovascular disease, liver disease, chronic obstructive pulmonary disease, suicide attempts, alcohol dependence, marital problems, intravenous drug use and many more.

If there is one common thread to many of the preventable diseases we face in the U.S., why are we not paying closer attention?

Addressing ACEs

In 2012, the American Academy of Pediatrics called for a focused effort to prevent and address childhood toxic stress.

The policy was informed by the ACE Study and research on the impact that childhood trauma has on brain development. Neuroimaging of people who have experienced ACEs shows changes in the structure and function of areas of the brain responsible for memory, learning, and emotions.

What’s more, many of the outcomes associated with ACEs among adult survivors – such as substance abuse and mental illness – may make it likelier that the next generation will experience ACEs as well.

But not all hope is lost. Research strongly suggests that humans have an innate capacity to adapt and positively transform, even after traumatic and stressful events. Most importantly, positive, supportive and healthful activities can contribute to positive well-being among adult survivors of childhood adversity. Change has to start with ourselves first, so we can provide children with the safety, support, love, and protection they need.

We must recognize – without judgment, but rather with compassion – that trauma is widespread, affecting children and adults across generations. We cannot afford to wait any longer to address trauma and break the cycle of childhood adversities.

Shanta R. Dube, Associate Professor, School of Public Health, Georgia State University

This article was originally published on The Conversation. Read the original article.

The polarising effects of #FeesMustFall are now pervasive in the academy, and probably beyond. Academics turn on each other, as do their schools and faculties.

Whole universities are pitted against one another – the “Wits option” vs the “UCT option”. Some academics are accused of being blindly supportive of “the innocent students” and parading their colours as the immaculate left; while others are seen as blindly securocrat, unreconstructed racists, or terminally bewildered.

So let’s (try to) agree on a modicum of common ground. Remarkably, there is a lot of it about. No-one can reasonably argue that universities are not underfunded. No-one can reasonably argue that the impact of underfunding has been transferred to fee increases, and that in turn, black (primarily African and coloured) students bear the burden. Given the failure of the post-apartheid economy to sufficiently redistribute wealth and the abject failure of trickle-down economics, “black debt” is a reality.

Let’s also accept that for many students, much of the academy is an alienating, overwhelmingly white, Eurocentric space and experience. Students arrive and are expected to meet imported norms, seminar room sarcasm, unknown customs, foreign authors, hard marking and plain hard slog of tertiary education, while being young and going through their own life transitions, and doing so in “othered” spaces, out of vernacular, and so on.

Let us also agree that virtually no university or further education college has genuinely grappled (institutionally, not at the level of the individual) with what it means to decolonise, beyond (at best) looking around quickly for some black/African authors. This is not true at school level, where many advances have been made – but these are islands in an ocean. Students swim in the ocean.

Let’s also accept the dangers of commodified knowledge and universities, and the fact that the system is slowly becoming a sausage machine for lawyers, accountants, MBAs and others deemed economically necessary for the economy. Those schools and faculties seen to add no “dollar value” are discriminated against locally and globally.

I say “let’s agree” because these issues have all been agreed to by both protesters and university management. There may be quibbles over the severity of this or that issue in this or that part of the sector, but the central issues are undisputed.

Divided we fall

So what divides us, and with such vehemence? For the immaculate left, it is ultimately a capitalist state that has no interest in the poor emerging from poverty; overlapping with black people in a society dominated by whiteliness; creating an unreconstructed racial capitalism that needs to be toppled. Students in this view lack agency, and are in every context victims of external forces. Every action is the response of victim to oppressor.

“Senior management” is seen to lead with security, follow up with more security, and have no interest in negotiation or compromise. Students just want a free, decolonised education in a transformed institution and are shot for daring to ask for it – and they remain innocent, brutalised “black bodies”.

For those who are not in this group, there is a basic commitment to teach, and to getting students to complete the academic year. They are disregarded as “liberals”, the ultimate South African insult. Security is regarded as a necessary evil – but since many academics have personally been assaulted and/or abused and/or disrupted, and many targeted for hiding students desperate to learn and/or shielding them from protesters, security seems a basic necessity. The pleas from students for support to finish the year have been incessant.

Returning to class

What is at fault with all these views is the assumption that if protesters win enough compromises – such as sector-wide agreement on free, quality, decolonised education and the need to plan, design and cost it so that it can be an implementable reality not a slogan (being self-evidently not swiftly realised) – they will return to class. And they will do so as victors. We know that the vast majority of non-protesters also want to be back in class - and a great many are there already. But this core assumption is wrong.

It is increasingly difficult to retreat from the notion that this is an incipient insurrection. While some protesters are undoubtedly idealistic and brave fighters for free quality education, the movement of 2015 has been colonised by political parties and anarchist movements in 2016. A movement without prominent leaders of 2015 has become leaderless in 2016.

Acts of bravery and camaraderie in 2015 have become acts of racist abuse and thuggish violence in 2016. Burning has replaced marching; destruction of university infrastructure is a key goal. This is no longer #FeesMustFall as we knew it – it has become #StateMustFall.

Universities are being used for testing the potential for broader insurrection –- if you can bring down universities you can bring down cities, if you can bring down cities, you can collapse and take control of the state. No compromise will get the core protesters back into class, or satisfy their academic or political mentors, because their goal is so much larger: state capture. It has allegedly been done once under democracy, so why not again?

Who is to blame?

Politics hates a vacuum, more than nature. The ruling African National Congress (ANC) is morally compromised on every front. Seemingly all courts in the land are packed with lawyers attempting to stop good governance and allow uninterrupted bingeing at the trough. The brazen moves to cover various political derrieres are breathtaking – but create space for any other party to claim the moral high ground.

In 1976 during the Soweto youth uprising, protesting students were given political education by mainly the Black Consciousness Movement. Those students went into exile got their education from the liberation movement organisations, the ANC and the Pan-Africanist Congress (PAC). Whether they were Africanist – closer to the PAC – or Charterist – aligned with the ANC – they were taught about the democratic state that had to be built and the principles on which it was to be built. Who now provides political education for protesting students?

The ANC is utterly compromised and cannot claim the moral authority to “lead”. The Democratic Alliance and ANC student wings, DASO and Sasco respectively, were loud in proclaiming their various Student Representative Council victories earlier in the year but have vanished from the scene. The prominence of Economic Freedom Fighters leaders – at national and student level – may or may not be relevant. So too the various incarnations of Black First Land First, pan-Africanist student movements and others. We are reduced to using student leaders of the 1980s as mediators, still on the faulty assumption that protesters want to return to class. They don’t. They are far more ambitious than that.

We have to call the bluff of those who keep moving the goalposts. Universities have agreed to free, quality, decolonised education in a transformed institution. Exam dates have been changed. Exam content is being modified to accommodate lost classes. But then the demands shift – we want this fully legislated now, or we won’t return to class. Or, we want amnesty for students suspended after due process regardless of what they did. Or, we want students arrested by police released. And so on and so on. These are patently not demands that the academy has the legal mandate to meet, even if we assume it had the will so to do.

If we do not call this for what it is, we face the danger of realising apartheid architect Hendrik Verwoerd’s dream – the man who advised us:

There is no place for [the Bantu] in the European community above the level of certain forms of labour … What is the use of teaching the Bantu child mathematics when it cannot use it in practice? That is quite absurd.

If, as seems likely, for the second year in a row, university students in South Africa are going to complete only part of their annual curriculum, and will be examined on only part of their curriculum, the result is that every subsequent year is divided between “catching up” on what was missed and squeezing a year of teaching into less time – we face the danger of ensuring that no student will receive even a quality colonised education (an oxymoron for some, of course). We are not educating our students to compete locally or globally. We are crippling them. They are being sacrificed for the few who see state capture as tantalisingly close.

David Everatt, Head of Wits School of Governance, University of the Witwatersrand

This article was originally published on The Conversation. Read the original article.

South Africans have a sweet tooth so shouldn't say no to a sugar tax

Debates on a proposed tax for sugar sweetened beverages in South Africa have reached fever pitch with the local food and beverage industry squaring up against the proposed sugary drinks tax expected to be implemented in April 2017. Professor Karen Hofman and Aviva Tugendhaft provide a few facts.

What difference has a sugar tax made in other countries?

There are many cities and countries that have instituted a sugar tax. These include Mexico, France, Hungary, Chile, Columbia, Brazil, 23 states in the US and the cities of Philadelphia and Berkeley.

The introduction of a sugar tax in Mexico in 2014 resulted in a marked difference in consumption patterns. The country is one of the highest consumers of sugary beverages and has one of the highest obesity rates globally. More than one in three adults were classified as obese.

After the introduction of a 10% tax, the purchase of sugary beverages fell by 12% in the first year. Studies have also shown that since the tax was implemented people have switched to drinking water.

New evidence released in Berkeley in the US this year shows that after a sugar tax was introduced in the city sales of sugar sweetened beverages fell by as much as 20% in some areas.

What is important to note is that the introduction of a sugar tax always triggers a much greater level of awareness about why sugar, particularly liquid sugar, is especially harmful.

Why should there be a sugary beverage tax in South Africa?

It is well established that taxes are the most effective of several ways to reduce the consumption of sugary beverages. This is because taxes reach the entire population and are easily implemented.

South Africa needs one. The country has a massive and growing obesity epidemic. Obesity related lifestyle diseases now rival HIV/AIDS and TB in terms of their impact. About 40% of women and 11% of men suffer from obesity in the country. And 25% of teenage girls in rural South Africa are overweight or obese.

Across the country, research from the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group shows that chronic diseases result in one death every hour. Obesity not only shortens a person’s lifespan, it also affects their quality of life. It leads to lifestyle diseases that result in strokes, blindness, amputations and kidney failure.

This health burden is linked to South Africans' daily sugar consumption. According to the World Health Organisation, people should not consume more than six teaspoons of sugar a day. Most 330ml fizzy sugary beverages contain nine teaspoons of sugar while fruit juices have 10. These sugary drinks have no nutritional value, don’t satisfy hunger and are particularly harmful to the body in liquid form.

An average teenager in Soweto consumes double the recommended daily limit through sugar sweetened beverages.

Business says jobs will be lost. South Africa’s Health Minister says the consumption of sugar sweetened beverages is having a huge impact on the health system. Who is right?

The cost of sugar consumption to health care and to companies should not be underestimated.

Severe obesity has been linked to a 23% increase in health care costs.

But the impact on companies must also be viewed through loss of productivity and absenteeism. Projections indicate that obesity will reduce South Africa’s gross domestic product by 7% by 2030. Based on experience with the successful tobacco tax in SA, money spent on cigarettes were spent in other sectors, thus saving lives.

Without any interventions the situation is likely to get worse. Our research shows that there will be an additional 1.2 million obese people in the next few years if nothing is done. Of these, almost 300 000 will be obese due to consuming sugar sweetened beverages.

It must also be remembered that job loss figures quoted by companies are based on industry commissioned studies which are not peer-reviewed. An evaluation of the impact in Mexico shows no job losses.

The fightback against initiatives to curb sugar consumption has been very aggressive. Reports show that in the US alone between 2009 and 2014 beverage companies spent US $100 million to sway public and political opinion from initiatives to curb sugar consumption.

Aren’t there better ways to do this, like banning advertising?

There are several other initiatives that can and should take place. Taxing sugar is by far the best prevention focused initiative and is the first of several steps. Food advertising regulations are the next best way to curb the consumption of sugar sweetened beverages, alongside front of pack labelling and work site and school based interventions.

In South Africa there is a voluntary marketing pledge under which the food and beverage industry has promised not to advertise unhealthy products to children under the age of 12. But this is ignored. A recent study in Soweto, considered one of the biggest urban settlements in Africa, showed billboards advertising sugar sweetened beverages close to schools in the area.

Taxing sugar sweetened beverages should be done in conjunction with awareness initiatives as well as mandatory advertising regulations and front of pack labelling.

Karen Hofman, Program Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, University of the Witwatersrand and Aviva Tugendhaft, Deputy Director, PRICELESS SA, Wits/MRC Agincourt Rural Health Transitions Unit, Wits School of Public Health, University of the Witwatersrand

This article was originally published on The Conversation. Read the original article.