From The Poverty Clinic by Paul Tough in the March 21st New Yorker:
(ACE stands for “adverse childhood event” which could be sexual abuse, growing up in a household with an alcoholic or drug user, emotional neglect, etc.)
[The researchers] started with the assumption that ACEs led to chronic illness through behaviors like smoking, heavy drinking, and overeating, which would produce increased rates of lung cancer, liver disease, diabetes and heart disease. The problem with this theory was that ACEs had a profound negative effect on adult health even when those behaviors weren’t evident. The researchers looked at patients with ACE scores of 7 or higher who didn’t smoke, didn’t drink to excess, and weren’t overweight, and found that their risk of heart disease (the most common cause of death in the United States) was three hundred and sixty per cent higher than it was for patients with a score of 0. Somehow, the traumatic experiences of childhood were having a deleterious effect on their later health, through a pathway that had nothing to do with bad behavior.
…the ACE data “have given us reason to reconsider the very structure of primary care medical practice in America.” And it’s true that, if the data is accurate, it poses a significant challenge to the way that we diagnose and treat many diseases. For example, the American medical system spends billion of dollars each year measuring and trying to lower people’s cholesterol, because we know that having a cholesterol reading above two hundred and forty milligrams per decilitre doubles your chances of heart disease. But, according to the Kaiser study, so does having four or more ACEs. So if we trust the data, and we want to prevent heart attacks, it makes as much sense to try and reduce ACEs, or counter their effects as it does to try and lower cholesterol.