Pay now . . .

or pay later. JAMA doesn't think you ought to be able to read the article, but here's the abstract of a review by Jack Shonkoff and colleagues of the ways in which injuries and indignities suffered by children are reflected in their health as adults. This is an extremely important, emerging area of knowledge, which goes a long way toward explaining the disparities in health we see according to race, ethnicity, and social status in societies throughout the world. It has profound implications for public policy, including the potential of enormous long-term benefits from making investments in children right now.

Among many key points:

• Cardiovascular disease in adults is associated with malnutrition in childhood


• Childhood psychological trauma is associated with adult coronary artery disease, pulmonary disease, alcoholims, depression, drug abuse, cancer, smoking, obesity . . .


• Psychological stress produces biological stress through neural and hormonal mechanisms, and chronic stress produces cumulative biological damage


• Poor living conditions in early childhood are associated with multiple diseases in adulthood


• Low birthweight is associated with metabolic syndrome and Type 2 diabetes


• The idea that acquired characteristics can be handed down to offspring is not entirely false after all: animal experiments show that the biological effects of early stress on an organism can affect how the next generation's genes are expressed. Of course, in the case of humans, we don't need genetic mechanisms to account for the transmittal of disadvantage across generations. Adults who are less healthy and have less adaptive coping responses are likely to find themselves in environments which are more stressful for their own children.

Many experimental interventions to improve the physical and social environment of young children have been shown to have lifelong benefits -- programs like head start, healthy start programs where nurses or trained community health workers visit young mothers at home, early intervention programs for kids with identified problems. But beyond offering special programs to kids in disadvantaged environments, we can and must provide everyone with safe neighborhoods, good education, employment, adequate income, and dignity and respect. Those are the resources they need to raise healthy children.

Two brief items: I have jury duty tomorrow, so depending on what happens, maybe no post.

Meanwhile, according to a publicist, for some reason Fran Drescher is involved in encouraging people to ask questions of their doctors. They sent me a widget and a link to a Facebook fan page which I can't really figure out the point of, but anyhow it all points to a web site maintained by the Agency for Healthcare Research and Quality, called "questions are the answer," and it's got the kinds of questions I wrote about yesterday plus a whole lot more. It looks pretty good to me so check it out.