GRACE Initiative (part 1): discovering the science of childhood adversities


Picture yourself in a massive San Francisco hotel ballroom, surrounded by a thousand health professionals with a shared passion for changing the landscape of health using a seemingly unlikely lever: reducing adverse childhood experiences (ACEs). You haven’t read much about ACEs, but what you are learning is revelatory. You hear that childhood traumatic events drastically affect the human mind and body – not just immediately after the traumatic event, but into and through adulthood. You learn that prolonged toxic stress (being in a “fight-or-flight” response for months or years) induces hormonal and neurological deregulation that can precipitate serious health conditions such as depression, hypertension, diabetes, and even cancer.

Much as you may have pondered the root causes of each of these individually, you are magnetized by the evidence that a defined set of early-life experiences effectively paves the way for this host of chronic conditions. You immediately think of patients you’ve seen in the corridors of your local hospital, people struggling on your city streets, and the cashier at your local market whose health is always in peril. You ask, “Do they share a similar history?”

You are already astonished to learn this, but that is not the end of it. The speakers explain that some of these adversities are disproportionately more prevalent in certain communities. In fact, as close as the other side of town, in the Bay View neighborhood of San Francisco. As the presentation continues, you learn that ACEs are not just the problem of economically disadvantaged or less educated families, but that they affect people across the socioeconomic spectrum. More importantly, you learn that a child with just one of those adversities, for example a child whose parent is in prison, is at higher risk of experiencing other adversities, such as being emotionally neglected. And, sadly, as the number of those adversities a child accumulates, so does their risk for certain diseases. As an epidemiologist, you would know this concept well: a dose-response relationship.

This story happened about a year ago, when the you in the story was me. As an ACEsConnection reader, you already know more about ACEs than I did at the time and you may be thinking I was an accidental attendee – perhaps a driver for the keynote speaker or a passerby on my way to lunch. Contrary to these understandable assumptions, I am a medical epidemiologist.

Studying the links between a disease and its risk factors is nothing new to me. After completing my medical training in 1999 in Tehran, Iran, I eagerly undertook two more public health degrees in the US: a master’s in public health from UC Davis in 2002 and a doctorate in public health from UC Berkeley in 2009. Since then, I have worked as a researcher and health educator at UCSF, focusing on complex issues such as drug use and HIV co-epidemics and translating scientific literature to inform health policies and decision making on a variety of diseases. In short, I have plenty of credentials and experience. And yet, despite twenty years in the field, it was possible for someone like me to overlook one of the most important chapters of health sciences: children’s mental health.

You may think that I should have known better since it has been over 20 years since the advent of the Landmark ACE study. Well, sadly, I am not alone in this. There are many other health researchers on our campus and other places who have yet to discover and act on the significance of ACEs. For example, in the Institute for Global Health Sciences, where many of my colleagues have made unprecedented efforts to improve health of mothers and newborns and flight devastating diseases such as HIV, malaria, and tuberculosis in developing countries, little if any conversation has been around the effects of childhood adversities on health. Is this because ACEs are not as common in those communities? Or perhaps because they are not as severely impacting those communities? The answer to both questions is obvious: no and no. In fact and on the contrary, due to the socioeconomic and cultural context of many communities in developing countries, not only are ACEs more prevalent, but there are also fewer financial and human resources are available to remedy the impact.

Thanks to the overall improvement in economic growth, education, immunization, and other public health interventions, great progress has been made in improving life expectancy and reducing mortality worldwide. While we are far from being done with the global fight against HIV, TB, and malaria epidemics, we are also facing an unprecedented set of challenges such as climate change, mass migrations, and gun violence that unequally impact certain vulnerable groups, in particular children.

Dealing with traumatic effects of climate change, immigration, and war does not lend itself to our existing compartmentalized, disease-specific healthcare systems. The last time I checked, we did not have the Department of Climate Change in our hospitals. We need to take a fresh look to discover solutions that are effective, cheap, easy to scale-up, and culturally appropriate across geographies. Looking closely into the science of ACEs and translating that science into actionable policies and programs may create the opportunity for a breakthrough in addressing such imperiling issues.

To turn the page for myself, other health researchers who are unfamiliar with this field, and millions of children impacted by ACEs globally, I started learning about the field of ACEs and created partnerships among like-minded individuals at UCSF. I also formed an initiative, Globally Reduce Adverse Childhood Experiences (GRACE)

In my next post, I will share what I have discovered about how the UCSF community is contributing to ACEs-related work and how the GRACE initiative builds on exciting collective efforts to contribute to the well-being of children globally.

By Mohsen Malekinejad, MD, DrPH 

Editorial Contribution by Erin Barker, MLIS

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