By Richard A. Aronson, MD, MPH
We embrace the following core values as the foundation to create humane worlds for children and families:
1. Honor the dignity of all children and families, and of their cultures.
2. Consider everyone an “expert” on their own experience.
3. Include women, youth, families, and communities as equal partners at all times.
4. Communicate with clear, non-jargon, non-acronym, and non-bureaucratic language.
5. Draw on peoples’ strengths, resilience, and resources.
6. Use data in an accurate way that is faithful to the art and science of public health.
7. Build public and political will for action.
8. Move from a paradigm of “eliminating disparities” to one of creating equity, regardless of race, ethnicity, income, gender, religion, geography, and nationality.
9. Recognize that behind every statistic and risk factor is a real human being with all the complexity, vulnerability, magnificence, and potential for good that is in each of us.
10. Stay relationship-centered. Encourage networks of social connectedness in promoting health and justice.
Thursday, August 21, 2008
Friday, August 15, 2008
Child Abuse as a Public Health Issue
By Richard A. Aronson, MD, MPH
In 1909, President Theodore Roosevelt articulated a governmental and societal responsibility for the health and safety of the nation's children. He stated that "each child represents a potential addition to the productive capacity...of the nation or, if allowed to suffer from neglect, a potential addition to the destructive forces of a community". Roosevelt made clear that society has a vested interest in seeing that all children do well. We all benefit when children grow up to become healthy, productive, and compassionate adults. The interests of society as a whole - indeed, its very security - depend on the welfare of our children, and ride on the extent to which we invest in children as our most precious resource. Roosevelt, in effect, was making the case, with which I strongly agree, that the prevention of child abuse and neglect, in all of its manifestations, is fundamentally a public health issue that should be front and center on our agenda as a nation and a world.
The stakes are high. A study conducted by Vincent J. Felitti and Robert Anda at Kaiser Permanente’s Department of Preventive Medicine revealed that “adverse childhood experiences are vastly more common than recognized or acknowledged, and [they] have a powerful relation to adult health a half-century later.” The child abuse categories of the Adverse Child Experiences (ACE) Study were: physical, emotional, and sexual abuse. Other ACE's included in the study were an alcohol and/or drug abuser in the household; an incarcerated household member; someone who has severe mental illness; mother treated violently; one or no parents; and emotional or physical neglect. The study revealed that a survivor of four or more of these adverse childhood experiences has a higher likelihood of smoking, chronic obstructive pulmonary disease, using intravenous drugs, and attempting suicide. Depression and obesity were also found more likely among individuals with exposure to childhood trauma.
This study’s findings highlight the public health urgency and challenge to prevent childhood trauma and, when it happens, to promote healing. We turn, for example, to Emmy Werner’s groundbreaking research on resilience. The Kauai Longitidunal Study followed 700 high risk children born in 1955 on the Hawaiian island of Kauai, addresses two fundamental questions: 1) What are the long-term effects of adverse perinatal and early child-rearing conditions on physical, cognitive, and psychosocial development in mid-life? 2) Which protective factors allow most individuals who are exposed to multiple childhood risk factors to do well in adulthood? The study followed a group of high risk children who had been exposed to chronic economic poverty, birth complications, parenntal psychopathology, and family discord as well as comparison groups.
The news from the study was, on one hand, good. A loving home environment makes all the difference. The long-term outcomes depended, increasingly, on the quality of the child-rearing environment and the emotional support provided by family members, friends, teachers, and adult mentors. One out of three who seemed headed for “disaster” didn’t turn out that way. These individuals, in addition to the quality of the child-rearing environment, had the following protective factors: 1) Charisma! They had an ability to be self-confident and attractive to other people. “Look, I’m worth something.” They took responsibility for themselves and others from an early age. 2) Self-efficacy: I can make things happen. I can make a difference. 3) At least one loving consistent adult. 4) Mentor: A teacher, coach, or other adult is extremely important. As Jacqueline kennedy Onassis once said, "If you bungle raising your children, nothing else in life matters very much".
On the other hand, the research by Werner and others highlights the urgency and necessity of putting our resources into programs and services that create humane worlds for children. We need to back up our words about investing in children with action and policy at all levels. All children benefit from humane resilience promoting systems in education, child care, health care, and parent support. Home visitation programs, when carried out under specific criteria, have been shown to prevent child abuse. Andd yet our society is lacking in its commitment to providing these and other services to all families.
Research on social support shows that a child needs someone who is absolutely crazy about him or her. But research also shows that youth and adults need that level of intimacy too. Thus, to prevent child abuse, for example, adults must have their own close relationships that encourage and support them to engage in safe parenting practices. Otherwise, a program to prevent child abuse is bound to fail.
The Humane Worlds Center provides consultation to communities, organizations, and others who seek to translate research, some of which I have reviewed above, into humane and culturally competent strategies to prevent child abuse.
In 1909, President Theodore Roosevelt articulated a governmental and societal responsibility for the health and safety of the nation's children. He stated that "each child represents a potential addition to the productive capacity...of the nation or, if allowed to suffer from neglect, a potential addition to the destructive forces of a community". Roosevelt made clear that society has a vested interest in seeing that all children do well. We all benefit when children grow up to become healthy, productive, and compassionate adults. The interests of society as a whole - indeed, its very security - depend on the welfare of our children, and ride on the extent to which we invest in children as our most precious resource. Roosevelt, in effect, was making the case, with which I strongly agree, that the prevention of child abuse and neglect, in all of its manifestations, is fundamentally a public health issue that should be front and center on our agenda as a nation and a world.
The stakes are high. A study conducted by Vincent J. Felitti and Robert Anda at Kaiser Permanente’s Department of Preventive Medicine revealed that “adverse childhood experiences are vastly more common than recognized or acknowledged, and [they] have a powerful relation to adult health a half-century later.” The child abuse categories of the Adverse Child Experiences (ACE) Study were: physical, emotional, and sexual abuse. Other ACE's included in the study were an alcohol and/or drug abuser in the household; an incarcerated household member; someone who has severe mental illness; mother treated violently; one or no parents; and emotional or physical neglect. The study revealed that a survivor of four or more of these adverse childhood experiences has a higher likelihood of smoking, chronic obstructive pulmonary disease, using intravenous drugs, and attempting suicide. Depression and obesity were also found more likely among individuals with exposure to childhood trauma.
This study’s findings highlight the public health urgency and challenge to prevent childhood trauma and, when it happens, to promote healing. We turn, for example, to Emmy Werner’s groundbreaking research on resilience. The Kauai Longitidunal Study followed 700 high risk children born in 1955 on the Hawaiian island of Kauai, addresses two fundamental questions: 1) What are the long-term effects of adverse perinatal and early child-rearing conditions on physical, cognitive, and psychosocial development in mid-life? 2) Which protective factors allow most individuals who are exposed to multiple childhood risk factors to do well in adulthood? The study followed a group of high risk children who had been exposed to chronic economic poverty, birth complications, parenntal psychopathology, and family discord as well as comparison groups.
The news from the study was, on one hand, good. A loving home environment makes all the difference. The long-term outcomes depended, increasingly, on the quality of the child-rearing environment and the emotional support provided by family members, friends, teachers, and adult mentors. One out of three who seemed headed for “disaster” didn’t turn out that way. These individuals, in addition to the quality of the child-rearing environment, had the following protective factors: 1) Charisma! They had an ability to be self-confident and attractive to other people. “Look, I’m worth something.” They took responsibility for themselves and others from an early age. 2) Self-efficacy: I can make things happen. I can make a difference. 3) At least one loving consistent adult. 4) Mentor: A teacher, coach, or other adult is extremely important. As Jacqueline kennedy Onassis once said, "If you bungle raising your children, nothing else in life matters very much".
On the other hand, the research by Werner and others highlights the urgency and necessity of putting our resources into programs and services that create humane worlds for children. We need to back up our words about investing in children with action and policy at all levels. All children benefit from humane resilience promoting systems in education, child care, health care, and parent support. Home visitation programs, when carried out under specific criteria, have been shown to prevent child abuse. Andd yet our society is lacking in its commitment to providing these and other services to all families.
Research on social support shows that a child needs someone who is absolutely crazy about him or her. But research also shows that youth and adults need that level of intimacy too. Thus, to prevent child abuse, for example, adults must have their own close relationships that encourage and support them to engage in safe parenting practices. Otherwise, a program to prevent child abuse is bound to fail.
The Humane Worlds Center provides consultation to communities, organizations, and others who seek to translate research, some of which I have reviewed above, into humane and culturally competent strategies to prevent child abuse.
Thursday, August 14, 2008
Hope, Resilience, and Health
By Richard A. Aronson, MD, MPH (For consultation, contact raronson@verizon.net or call 207 215 7317)
Growing into adulthood with a firmly rooted sense of hope is basic to the capacity of our species to feel healthy. To nurture hope in children is a central task of parenthood.
Human beings can live for roughly 8 to 12 weeks without food, 8 to 12 days without food and water, 6 to 8 minutes without oxygen. But without hope, a certain kind of spiritual death is immediate. And so it is that an inscription found on a cellar wall in Germany written by a Jew in hiding from the Nazis contained these words: “I believe in the sun even when it is not shining, I believe in love even when there is no one there, I believe through any trail there is always a way. And I believe in God when God is silent.”
So our challenge as a society and as public health leaders is to grow services that inspire hope in children. Instead of systems that pathologize, categorize, and lump people into a dizzying array of risks, diseases, and disorders, we need systems that honor children, families, communities, and cultures; celebrate their resilience, creativity, and capacity to heal; that does justice to research showing that a central determinant of health is the extent to which we feel connected to each other and to our communities. Relationships and civic engagement are to health what location is to real estate.
Such connections represent a deep well of protection from stresses and adversity, including traumatic adverse childhood experiences (See the ACE Study). The key questions for public health leaders to address are: How can we create humane environments, i.e. worlds, that make it natural for such bonds to form? How can we design systems to inspire, from childhood on, deep civic and community engagement? Our responses to these questions, and how new public health leaders are equipped to face them, will have a profound impact on the worlds that future generations experience. Humane Worlds Center is here right now to guide communities, organizations, and young people in that quest.
- From a Presentation given by Dr. Aronson at the Amherst College Class of 1969 Alumni Reunion, May 2004
Growing into adulthood with a firmly rooted sense of hope is basic to the capacity of our species to feel healthy. To nurture hope in children is a central task of parenthood.
Human beings can live for roughly 8 to 12 weeks without food, 8 to 12 days without food and water, 6 to 8 minutes without oxygen. But without hope, a certain kind of spiritual death is immediate. And so it is that an inscription found on a cellar wall in Germany written by a Jew in hiding from the Nazis contained these words: “I believe in the sun even when it is not shining, I believe in love even when there is no one there, I believe through any trail there is always a way. And I believe in God when God is silent.”
So our challenge as a society and as public health leaders is to grow services that inspire hope in children. Instead of systems that pathologize, categorize, and lump people into a dizzying array of risks, diseases, and disorders, we need systems that honor children, families, communities, and cultures; celebrate their resilience, creativity, and capacity to heal; that does justice to research showing that a central determinant of health is the extent to which we feel connected to each other and to our communities. Relationships and civic engagement are to health what location is to real estate.
Such connections represent a deep well of protection from stresses and adversity, including traumatic adverse childhood experiences (See the ACE Study). The key questions for public health leaders to address are: How can we create humane environments, i.e. worlds, that make it natural for such bonds to form? How can we design systems to inspire, from childhood on, deep civic and community engagement? Our responses to these questions, and how new public health leaders are equipped to face them, will have a profound impact on the worlds that future generations experience. Humane Worlds Center is here right now to guide communities, organizations, and young people in that quest.
- From a Presentation given by Dr. Aronson at the Amherst College Class of 1969 Alumni Reunion, May 2004
Wednesday, August 13, 2008
Humane Worlds Center Services Provided
By Richard A. Aronson, MD, MPH
The Humane Worlds Center specializes in:
1. Synthesizing research that will have a significant impact on maternal and child health practice over the next 50 years: A) Social determinants of health. B) Adverse Childhood Experiences (ACE) Study. C) Resilience. D) Life Course Perspective. E) Brain development. F) Chronic stress from racial discrimination and other inequality. G) Conditions for productive dialogue.
2. Translating this research into humane MCH and public health practice and leadership.
3. Integrating cultural understanding and respect into MCH and public health as key strategy to end disparities.
4. Changing the language of public health to better reflect our ideals and purpose.
5. Bringing multiple stakeholders together to untangle complex public health challenges and take collaborative action to solve them.
6. Inspiring a new generation of leaders in public health and service.
We offer the following services:
1. Consultation to individuals, communities, and organizations to build capacity in the above. Includes A) Giving presentations and workshops. B) Organizing forums. C) Writing papers and grants.
2. Teaching, mentoring, and leadership. Includes A) Individual and group mentoring of college and graduate students exploring public health and service. B) Classroom instruction. C) Internships to give experience and build capacity of young people for public health leadership and service.
3. Organization and facilitation of interactive meetings with broad stakeholder participation to unite diverse parties and spark action to create public health equity.
Please contact me if you're interested:
raronson@verizon.net
207 215 7317 Cell
207 622 8822 Office
The Humane Worlds Center specializes in:
1. Synthesizing research that will have a significant impact on maternal and child health practice over the next 50 years: A) Social determinants of health. B) Adverse Childhood Experiences (ACE) Study. C) Resilience. D) Life Course Perspective. E) Brain development. F) Chronic stress from racial discrimination and other inequality. G) Conditions for productive dialogue.
2. Translating this research into humane MCH and public health practice and leadership.
3. Integrating cultural understanding and respect into MCH and public health as key strategy to end disparities.
4. Changing the language of public health to better reflect our ideals and purpose.
5. Bringing multiple stakeholders together to untangle complex public health challenges and take collaborative action to solve them.
6. Inspiring a new generation of leaders in public health and service.
We offer the following services:
1. Consultation to individuals, communities, and organizations to build capacity in the above. Includes A) Giving presentations and workshops. B) Organizing forums. C) Writing papers and grants.
2. Teaching, mentoring, and leadership. Includes A) Individual and group mentoring of college and graduate students exploring public health and service. B) Classroom instruction. C) Internships to give experience and build capacity of young people for public health leadership and service.
3. Organization and facilitation of interactive meetings with broad stakeholder participation to unite diverse parties and spark action to create public health equity.
Please contact me if you're interested:
raronson@verizon.net
207 215 7317 Cell
207 622 8822 Office
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