For the past four decades, the mission of the Department of Health and Human Services, Healthy People Initiative, was to present overarching, science-based health goals for the upcoming decade. Healthy People was launched in 1990, with a focus at that time of decreasing infant and adult mortality as well as increasing independence among older adults (Green & Fielding 2011.)
Over time Healthy People has grown in scope and expanded its reach. Healthy People 2020 included the following Leading Health Indicators (LHI):
"Every decade, the Healthy People initiative develops a new set of science-based, 10-year national objectives with the goal of improving the health of all Americans - The development of Healthy People 2030 includes establishing a framework for the initiative—the vision, mission, foundational principles, plan of action, and overarching goals—and identifying new objectives." - retrieved from https://www.healthypeople.gov/...-Healthy-People-2030
Healthy People 2030 has an even more ambitious agenda, one that includes sixty-three pages of objectives. What is glaringly absent from the pages of objectives are goals related to addressing Adverse Childhood Experiences (ACEs), toxic stress, developmental trauma, and trauma-responsive practices. This is not only curious but also flies in the face of current science that has documented the impact of exposure to adversity in childhood affects long-term health outcomes. (Felitti, 2009)
"ACEs are adverse childhood experiences that harm children’s developing brains and lead to changing how they respond to stress and damaging their immune systems so profoundly that the effects show up decades later. ACEs cause much of our burden of chronic disease, most mental illness, and are at the root of most violence." More information can be found at: https://acestoohigh.com/aces-101/
From now until January 17, 2019, the U.S. Department of Health and Human Services is allowing people to register and make online public comments about the Healthy People 2030 objectives. The steps are simple and I want to thank Salud America for creating the following template to encourage public comment:
"Make a Public Comment on Healthy People 2030
The U.S. Department of Health and Human Services is allowing people to register and make online public comments on Healthy People 2030 objectives, one by one.
Here are the steps to submit an online public comment:
- Copy one model comment below related to childhood trauma and ACEs, then click on the topic area link to reach the public comment webpage for that topic.
- When you arrive on the topic webpage, scroll down and paste the model comment in the “comment section.” You can also select if you want your comment publicly viewable and if the comment is on behalf of your organization or your individual views.
- Hit “submit comment.”
Here are the topics and our model comments:
- Access to Health Services: Increase the capacity of the primary care and behavioral health workforce to deliver evidence-based, trauma-informed care.
- Access to Health Services: Explore the impact of trauma-informed accreditation on health care system performance and community health outcomes.
- Early and Middle Childhood: Increase the capacity of the child care, early education, and education workforce to provide trauma-informed support for students.
- Early and Middle Childhood: Explore the impact of trauma-informed accreditation on school attendance and performance.
- Educational and Community-Based Programs: Explore and expand the use and impact of trauma-informed certification entities that certify people that work with kids to be trauma-informed.
- Educational and Community-Based Programs: Explore the impact of trauma-informed accreditation on community-based organization performance and community health outcomes.
- Educational and Community-Based Programs: Increase the capacity of the higher education and workforce development to include accredited trauma-informed care training.
- Injury and Violence Prevention: Increase the capacity of the criminal justice workforce to provide evidence-based trauma-informed services.
- Injury and Violence Prevention: Reduce the number of children and youth exposed to adverse childhood experiences.
- Injury and Violence Prevention: Increase the number of children and youth exposed to adverse childhood experiences who are identified and receive evidence-based trauma-informed care services.
- Maternal, Infant, and Child Health: Increase the percentage of pregnant women who are screen for adverse childhood experiences.
- Maternal, Infant, and Child Health: Increase the proportion of physician office visits made by children, youth and pregnant women who have been exposed to ACEs that include evidence-based, trauma-informed counseling, education or referral.
- Public Health Infrastructure: Explore the impact of trauma-informed accreditation on health department performance and community health outcomes.
- Public Health Infrastructure: Increase the capacity of state public health agencies to monitor adverse childhood experiences.
- Social Determinants of Health: Increase the proportion of adults who perceive great risk associated with adverse childhood experiences." - (Merk, 2018)
Let's raise our collective voices and shine a spotlight on this obvious omission. The CDC has clearly embraced the study of ACEs, especially as it relates to violence prevention. Certainly, the Department of Health and Human Services must follow suit. Here is a link to the extensive ACEs information on the CDC website: https://www.cdc.gov/violenceprevention/acestudy/index.html
Please share this information and encourage your colleagues, and network to speak up to make ACEs its own topic in Healthy People 2030!
Felitti V. Adverse childhood experiences and adult health. Acad Pediatr. 2009;9:131-132.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14:245–258.
Green, Lawrence W., and Jonathan Fielding. “The U.S. Healthy People Initiative: Its Genesis and Its Sustainability.” Annual Review of Public Health, vol. 32, no. 1, 2011, pp. 451–470., doi:10.1146/annurev-publhealth-031210-101148.
Merck, Amanda. “Tell Gov't: Address Childhood Trauma in Healthy People 2030!” Salud America, 20 Dec. 2018, salud-america.org/tell-govt-address-childhood-trauma-in-healthy-people-2030.