PSYC23H3 Lecture Notes - Lecture 1: Childhood Obesity, Cardiovascular Disease, Asthma

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28 Jun 2015
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PSYC23 Reading 1: Adverse Childhood Experience
When developing biological systems are strengthened by positive early experiences, healthy children are
more likely to grow into healthy adults.
Sound health also provides a foundation for the construction of sturdy brain architecture and the associated
achievement of a broad range of abilities and learning capacities.
Health
is more than merely the absence of disease—it is an evolving human resource that helps children and
adults adapt to the challenges of everyday life, resist infections, cope with adversity, feel a sense of
personal well-being, and interact with their surroundings in ways that promote successful development.
Nations with the most positive indicators of population health, such as longer life expectancy and lower
infant mortality, typically have higher levels of wealth and lower levels of income inequality.
In short, children’s health is a nation’s wealth, as a sound body and mind enhance the capacity of children
to develop a wide range of competencies that are necessary to become contributing members of a
successful society.
Adverse events or experiences that occur early in childhood can have lifelong consequences for both
physical and mental well-being.
developmental and biological disruptions during the prenatal period and earliest years of life may result in
weakened physiological responses (e.g., in the immune system), vulnerabilities to later impairments in
health (e.g., elevated blood pressure), and altered brain architecture (e.g., impaired neural circuits).
-For example, exposure of expectant mothers to highly stressful environments can influence the birth
weight of their babies, and lower birth weight has been linked to substantially increased risk for obesity,
diabetes, and cardiovascular disease later in life.
Traumatic experiences during childhood, such as physical abuse or the adversities that accumulate for
children reared in deep and persistent poverty, are also capable of disturbing the neurobiological systems
that guide physiological and behavioral responses to stress, potentially for the remainder of an individual’s
life.
Altering these regulatory mechanisms (e.g., setting the stress response system on a “short fuse”) can
permanently increase the risks of acute and chronic disease, and even a shortened life span, by undermining
the normally adaptive response of the body to the challenges and stressors of everyday life.
These alterations to developing biological systems can lead to greater susceptibility to a wide range of
illnesses well into the adult years, even in the absence of any conscious memory of early trauma.
poor health early in life also imposes significant societal costs that are borne by those who remain healthy.
For example, when large numbers of children become ill because they did not receive their immunizations,
the entire population becomes vulnerable to epidemics of infectious diseases.
Similarly, the consequences of adversity and poor health in childhood can lead to higher rates of chronic
diseases in adults, such as diabetes, hypertension, cardiovascular disease, and various forms of cancer, as
well as depression, anxiety disorders, addictions, and other mental health impairments.
These conditions affect all of society by reducing the productivity of the workforce and increasing the
incidence of disability, the demand on medical facilities, and the costs of medical care.
Thus, a focus on health promotion in the early childhood period—where an extensive body of evidence
supports the promise of effective prevention programs that can change the trajectory of children’s lives—
can help reduce the social and economic burdens of illness, not only in childhood but also throughout the
adult years.
*This connection b/w early life experiences and the health of a nation underscores the importance of
strategic investments in the care and protection of pregnant women, infants, and young children, and it
suggests that most current attempts to prevent adult disease and create a healthier workforce may be
starting too late.
Reconceptualising the Health Dimension of Early Childhood Policy:
significant progress in lifelong health promotion and disease prevention could be achieved by reducing the
burden of significant adversity on young children
this progress could be accelerated through science-based enhancements in a wide range of policy
domains, including child care and early education, child welfare, public assistance and employment
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programs for low-income parents, housing policies, and community development initiatives, to name just a
few.
a broader perspective on health promotion and disease prevention is guided by the following three
overarching concepts:
(1) Experiences are built into our bodies (for better or for worse) and significant adversity early in life can
produce physiological disruptions or embedded biological “memories” that persist far into adulthood and
lead to lifelong impairments in both physical and mental health.
(2) Genes and experiences interact to determine an individual’s vulnerability to early adversity and, for
children experiencing severe adversity, environmental influences appear to be at least if not more powerful
than genetic predispositions in their impact on the odds of having chronic health problems later in life.
(3) Health promotion and disease prevention policies focused on adults would be more effective if
evidence-based investments were also made to strengthen the foundations of health and mitigate the
adverse impacts of toxic stress in the prenatal and early childhood periods.
The biology of health is defined by advances in science that explain how experiences and environmental
influences “get under the skin” and interact with genetic predispositions, which then result in various
combinations of physiological adaptation and disruption that affect lifelong outcomes in learning, behavior,
and both physical and mental well-being.
These findings call for us to rethink current, adult focused approaches to health promotion and disease
prevention by incorporating an understanding of the early childhood origins of lifelong illness and
disability.
The foundations of health refer to three domains of influence that establish a context within which the
early roots of physical and mental well-being are either nourished or disrupted:
(1) A stable and responsive environment of relationships.
This domain underscores the extent to which young children need consistent, nurturing, and protective
interactions with adults that enhance their learning and behavioral self-regulation as well as help them
develop adaptive capacities that promote well-regulated stress response systems.
(2) Safe and supportive physical, chemical, and built environments.
highlights the importance of physical and emotional spaces that are free from toxins and fear, allow active
exploration without significant risk of harm, and provide supports for families raising young children.
(3) Sound and appropriate nutrition.
emphasizes the foundational importance of health-promoting food intake, beginning with the future
mother’s preconception nutritional status and continuing into the early years of the young child’s growth
and development.
Caregiver and community capacities to promote health and prevent disease and disability refer to the
ability of family members, early childhood program staff, and the social capital provided through
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neighborhoods, voluntary associations, and the parents’ workplaces to play a major supportive role in
strengthening the foundations of child health.
These capacities can be grouped into three categories: (1) time and commitment; (2) financial,
psychological, and institutional resources; and (3) skills and knowledge.
Public and private sector policies and programs strengthen the foundations of health through their
ability to enhance the capacities of caregivers and communities in the multiple settings in which children
develop.
Relevant policies include both legislative and administrative actions that affect systems responsible for
public health, child care and early education, child welfare, early intervention, family economic stability
(including employment support for parents and public assistance), community development, housing, and
primary health care, among others.
It is also important to underscore the role that private-sector practices as well as government-sponsored
programs can play in strengthening the capacities of families to raise healthy and competent children.
-Workplace policies related to parental leave, flexible working hours, and time off to care for a sick child or
attend a parent-teacher conference are a few examples.
*The goal is to catalyze informed investments and creative innovations that build on a shared
scientific base to achieve significantly improved outcomes for children and society above and beyond
the impacts of existing efforts.
Limitations of this framework : focused on current circumstances and opportunities in the United States.
Understanding the Biology of Health in the Early Years of Life:
Early childhood is a time of rapid development in the brain and many of the body’s biological systems that
are critical to sound health.
When these systems are being constructed early in life, a child’s experiences and environments have
powerful influences on both their immediate development and subsequent functioning.
-These effects may appear early and be magnified later as children grow into adolescence and adulthood.
Some have compared a child’s evolving health status in the early years to the launching of a rocket, as
small disruptions that occur shortly after take-off can have very large effects on its ultimate trajectory.
*Thus, “getting things right” and establishing strong biological systems in early childhood can help to
avoid costly and less effective attempts to “fix” problems as they emerge later in life.
Physiological adaptations or disruptions in early development:
An extensive body of scientific evidence now shows that many of the most common chronic diseases in
adults—such as hypertension, diabetes, cardiovascular disease, and stroke—are linked to processes and
experiences occurring decades before, in some cases as early as prenatally.3,7
ex. longitudinal studies have demonstrated that lung disease in adulthood is commonly associated with a
history of respiratory illness in childhood, particularly among premature infants and young children
exposed to tobacco smoke.8
- Chronic, life-threatening cardiovascular disease in adulthood can also be linked to nutritional deficits and
growth impairments occurring as early as the prenatal period.
Early experiences or exposures can affect adult health in two ways—by the chronic wear and tear of
repeated damage over time or by the biological embedding of specific physiological disruptions during
sensitive developmental periods.
If a physiological maladaptation occurs in response to cumulative exposure to adverse social and/or
physical conditions, then an ensuing chronic disease can be seen as the consequence of repeated encounters
with psychologically or physically toxic environments.
When damaging exposures occur during sensitive periods in the early development of specific biological
processes, the resulting disruptions can become biologically embedded and subsequent adult diseases
appear as the latent (or delayed) outcomes of early environmental assaults.
-In either case, science shows that there can be a lag of many years, even decades, before early harm is
expressed in the form of overt disease.
Cumulative Exposures to Adverse Childhood Experiences:
An extensive and growing body of research demonstrates multiple linkages between childhood adversity
and health impairments in the adult years.
The Adverse Childhood Experiences (ACE) Study, for example, documents strong associations among
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