Paul Simms
Guest Commentary
San Diego – For the past twenty-eight years, the San Diego Black Health Associates, Inc. (SDBHA) has been working to address the health status gap which African Americans face. For nearly every major chronic disease, Blacks suffer the highest mortality levels, the highest hospitalization rates and the most frequent visits to the emergency room of any ethnic group in the United States. Our organization has engaged in consumer education, conducted workshops, held screening sessions, and provided guidance for healthier choices and promoted health through prevention. Our “Fifteen Health Commandments” reflect counsel to our communities about the importance of making the right choices.
Dr. Vincent Felitti was Medical Director of the Department of Preventive Medicine at Kaiser Permanente in San Diego for more than 16 years. During his tenure, patients who were seeking to lose weight adopted the Kaiser plan for fasting. This medically controlled denial of solid foods was directed in such a way that many persons lost significant amounts of weight. It was soon discovered that a large number of these patients dropped out of their program because the images they were protecting and the events which they had hidden were surfacing as a result of the weight loss. Come to find out, in some cases, the extra weight was protective of other events – events which happened years earlier.
Speaking at a program on Innovations in Patient Empowerment sponsored by Claremont Graduate University, Dr. Felitti described research conducted in a mail survey with 17,000 middle class patients, all of whom were Kaiser beneficiaries. African Americans represented 10% of the participants in the study. He asked the patients several questions about traumatic events which may have happened to them as children. Incredibly, over 70% of people receiving the survey responded, and these patients gave permission to connect the responses they gave to the survey to their medical records. The questions asked the consumer s inquired about whether they had been abused as a child.
This abuse could have been physical, psychological, emotional or sexual. The survey also inquired whether any adult person in their household was a problem drinker, whether they ever used drugs, whether they were mentally ill or whether a person in the household attempted suicide. Finally, the survey asked whether a member of the household had gone to prison.
Surprisingly, nearly 50% remembered at least one Adverse Childhood Experience (ACE). The research team included representatives from the Center for Disease Control and Prevention (CDC), and together, their coined the term the “Ace Score”.
Several physicians at the conference sitting near the author of this story grumbled at Dr. Felitti’s assertions about the abuse as a child. One felt that he would not inquire about such acts of abuse by parents or anyone so many years ago, because he would not want to “stir up” a can of worms with such an inquiry. Another physician expressed dismay that within his practice, there were only a certain number of minutes to see each patient. Asking questions about adverse childhood experiences would consume more time than he felt was available. A third physician was opposed to the inquiry by primary care physicians, many of whom had little training in psychiatry.
Dr. Jeffrey Brenner is the Founder of the Camden Coalition of Healthcare Providers and Medical Director of the Urban Institute at Cooper University Healthcare. Earlier this year, Dr. Brenner wrote a “blog” (January 29, 2014) that stated:
“For nearly 15 years, we’ve had the secret to delivering better care at lower cost in America. The information has sat hidden away in the medical literature, and barely mentioned among physicians. It’s a remarkable story of bias. The neglect of this information by the medical community tells you a lot about our failings as a profession and the poor training we receive. It is also a powerful commentary on the values of our society and the biases built into our society’s view of health and healthcare”
Incredibly, the ACE score predicted healthcare utilization, healthcare spending, obesity, substance abuse, smoking, alcoholism, and prevalence of poorly controlled chronic diseases better than anything the health care industry has ever found. Dr. Brenner noted:
“The terrible things that sometimes happen to children can cause a lifetime of health impacts. This is true for even for middle class patients. However, poverty magnifies the potential to have higher ACE score and possibly exacerbates any trauma that have occurred”
This past weekend, Clovis Honore, President of SDBHA and I made a presentation to the Men’s Group at Bethel AME Church. Nearly 25 African American men listened while we discussed the importance of making the right health choices, why it is important to monitor one’s blood pressure and why Covered California was important to African Americans for access to health care. For the first time, the ACE Score was also discussed and a pilot survey was conducted.
Information about ACE was also discussed at the retreat sponsored by the Village of Promise, a group of advocates working to provide support and resilience to children whose parents have been incarcerated.
We may be wrong but we are impressed with the findings of Dr. Felittl. He has agreed to guide our explorations into a community conversation about ACE and abuse, neglect, parenting and changing our environments for African Americans (and others). We are interested in improving the future of our children and the mindfulness of ACE may be an answer. Remember, there is no one coming to help us, but us.
