Closing the Gap Between What We
      Know and What We Do
Reducing Toxic Stress to Protect the Health of
       our Childr...
Multiple Sources of Knowledge Currently
Inform Practice in Poorly Connected Sectors


   Science &                        ...
An Integrated Science of Early Childhood
Development Could Drive More Productive
       Investments Across Sectors



    ...
Significant Adversity Impairs Development
            in the First Three Years
Developmental Delays


                    ...
Risk Factors for Adult Depression are
Embedded in Adverse Childhood Experiences

             5


             4
Odds Rati...
Risk Factors for Adult Heart Disease are
Embedded in Adverse Childhood Experiences
              3.5

               3
 Od...
Early Life Experiences Are Built Into Our
    Bodies (For Better or For Worse)
Three Levels of Stress Response
Significant Neglect Affects Brain Power
Profound Neglect
Impairs Physical Growth




                          Source: Johnson et al. (2000)
New Biological Evidence Links Maltreatment in
  Childhood to Greater Risk of Adult Heart Disease

                        ...
Positive Childhood Experiences Lead to
  a Higher Threshold for Activation of
        Stress Response Systems


          ...
Adverse Childhood Experiences Lead to
  a Lower Threshold for Activation of
       Stress Response Systems



            ...
Science Can Inform an Integrated Approach
   to Early Investment in Lifelong Health


                                    ...
Healthy Development Can Be Assessed in
             Multiple Ways


                                                      ...
Early Experiences Are Built Into the Body
       Through Complex Pathways

                                  Biology of He...
The Foundations of Healthy Development
     Influence Biological Responses


                                             ...
Caregiver and Community Capacities Affect
     the Strength of the Foundations


                                         ...
The Health Needs of Young Children Can Be
    Addressed Across Multiple Sectors


   Policy & Program                     ...
Rethinking the Core Focus of
  Health Care for Children
Challenges Facing Health Promotion in
 the Context of Health Care Reform

Recognize that efforts to expand health insuranc...
Reducing Toxic Stress to Protect the Health of our Children
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Reducing Toxic Stress to Protect the Health of our Children

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Presentation by Jack Shonkoff, M.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN.

Research indicates that significant adversities in the early childhood years, such as from abuse or neglect and exposure to violence, can disrupt developing brain architecture and other organ systems and lead to higher rates of stress-related physical and mental health problems later in life.

Science suggests that a range of early childhood policies and programs may hold the key to lifelong health promotion and disease prevention. Above and beyond improving a child’s readiness to succeed in school, we may be able to affect cardiovascular disease, hypertension, diabetes, depression, anxiety disorders, and substance abuse.

Published in: Health & Medicine, Education
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Reducing Toxic Stress to Protect the Health of our Children

  1. 1. Closing the Gap Between What We Know and What We Do Reducing Toxic Stress to Protect the Health of our Children and Communities JACK P. SHONKOFF, M.D. Julius B. Richmond FAMRI Professor of Child Health and Development Professor of Pediatrics and Director, Center on the Developing Child Harvard University
  2. 2. Multiple Sources of Knowledge Currently Inform Practice in Poorly Connected Sectors Science & Science & Experience Experience Health Education Economic Human Science & Experience Development Services Science & Experience
  3. 3. An Integrated Science of Early Childhood Development Could Drive More Productive Investments Across Sectors Health Education SCIENCE OF EARLY CHILDHOOD Human Economic Services Development
  4. 4. Significant Adversity Impairs Development in the First Three Years Developmental Delays 100% Children with 80% 60% 40% 20% 1-2 3 4 5 6 7 Number of Risk Factors Source: Barth, et al. (2008)
  5. 5. Risk Factors for Adult Depression are Embedded in Adverse Childhood Experiences 5 4 Odds Ratio 3 2 1 0 1 2 3 4 5+ Adverse Experiences Source: Chapman et al, 2004
  6. 6. Risk Factors for Adult Heart Disease are Embedded in Adverse Childhood Experiences 3.5 3 Odds Ratio 2.5 2 1.5 1 0.5 0 1 2 3 4 5,6 7,8 Adverse Experiences Source: Dong, et al. (2004)
  7. 7. Early Life Experiences Are Built Into Our Bodies (For Better or For Worse)
  8. 8. Three Levels of Stress Response
  9. 9. Significant Neglect Affects Brain Power
  10. 10. Profound Neglect Impairs Physical Growth Source: Johnson et al. (2000)
  11. 11. New Biological Evidence Links Maltreatment in Childhood to Greater Risk of Adult Heart Disease 50% Percent of adults with biological 40% marker for greater risk of heart disease (increased blood 30% level of CRP) 20% 10% Depression Maltreated Depression (age 32) (as a child) (age 32) + Maltreated Source: Danese et al. (2008) (as a child)
  12. 12. Positive Childhood Experiences Lead to a Higher Threshold for Activation of Stress Response Systems Early positive experiences A balancing act homeostasis New homeostatic set point
  13. 13. Adverse Childhood Experiences Lead to a Lower Threshold for Activation of Stress Response Systems Early negative experiences A balancing act homeostasis New homeostatic set point
  14. 14. Science Can Inform an Integrated Approach to Early Investment in Lifelong Health Preconception Prenatal Policy & Biological Early Caregiver & Foundations Childhood Program Adaptations Health & Community of Healthy Levers for or Development Capacities Development Innovation Disruptions Across the Middle Lifespan Childhood Adolescence Adulthood Source: Center on the Developing Child (2010)
  15. 15. Healthy Development Can Be Assessed in Multiple Ways Outcomes in Preconception Lifelong Well-Being Prenatal Policy & Caregiver & Foundations Biology of Health-Related Early Program Community of Healthy Health and Behaviors Childhood Health & Levers for Development Development Capacities Development Educational Innovation Across the Middle Achievement & Lifespan Childhood Economic Productivity Adolescence Physical & Adulthood Mental Health Source: Center on the Developing Child (2010)
  16. 16. Early Experiences Are Built Into the Body Through Complex Pathways Biology of Health and Development Outcomes in Cumulative Effects Lifelong Well-Being Biological Over Time Policy & Foundations Health-Related Caregiver & Adaptations Program of Healthy Behaviors Community or Levers for Development Capacities Gene- Physiological Disruptions Innovation Educational Environment Adaptations & Achievement & Interaction Disruptions Economic Productivity Biological Embedding Physical & During Sensitive Mental Health Periods Source: Center on the Developing Child (2010)
  17. 17. The Foundations of Healthy Development Influence Biological Responses Outcomes in Foundations of Lifelong Well-Being Healthy Development Policy & Biological Health-Related Caregiver & Foundations Program Adaptations Behaviors Community of Healthy Levers for Stable, Responsive or Capacities Development Educational Innovation Relationships Disruptions Achievement & Safe, Supportive Economic Environments Productivity Appropriate Nutrition Physical & Mental Health Source: Center on the Developing Child (2010)
  18. 18. Caregiver and Community Capacities Affect the Strength of the Foundations Outcomes in Caregiver and Lifelong Well-Being Community Capacities Policy & Biological Health-Related Caregiver & Foundations Behaviors Program Adaptations Community of Healthy Levers for Time and Commitment or Educational Capacities Development Innovation Disruptions Achievement & Financial, Psychological, and Institutional Resources Economic Productivity Skills and Knowledge Physical & Mental Health Source: Center on the Developing Child (2010)
  19. 19. The Health Needs of Young Children Can Be Addressed Across Multiple Sectors Policy & Program Outcomes in Levers for Innovation Lifelong Well-Being Policy & Public Health Caregiver & Biological Health-Related Foundations Behaviors Program Adaptations Community Child Care & Early Education of Healthy Levers for or Educational Capacities Development Innovation Child Protection & Disruptions Achievement & Social Welfare Economic Economic & Community Productivity Development Physical & Primary Health Care Mental Health Private Sector Actions Source: Center on the Developing Child (2010)
  20. 20. Rethinking the Core Focus of Health Care for Children
  21. 21. Challenges Facing Health Promotion in the Context of Health Care Reform Recognize that efforts to expand health insurance and reduce inequalities in access and treatment within the medical care system do not address the fundamental causes of disparities in health related to social class, race, and ethnicity. Leverage advances in neuroscience, molecular biology, genomics, and the behavioral and social sciences to enhance our capacity to promote health and prevent disease, not just to treat illness.

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