Presentation by Jack Shonkoff, M.D. given at the 2010 RWJF LFP Annual Meeting in St. Paul, MN. Research indicates that significant adversities in the early childhood years, such as from abuse or neglect and exposure to violence, can disrupt developing brain architecture and other organ systems and lead to higher rates of stress-related physical and mental health problems later in life. Science suggests that a range of early childhood policies and programs may hold the key to lifelong health promotion and disease prevention. Above and beyond improving a child’s readiness to succeed in school, we may be able to affect cardiovascular disease, hypertension, diabetes, depression, anxiety disorders, and substance abuse.

1. Closing the Gap Between What We
Know and What We Do
Reducing Toxic Stress to Protect the Health of
our Children and Communities
JACK P. SHONKOFF, M.D.
Julius B. Richmond FAMRI Professor of Child Health and Development
Professor of Pediatrics and Director, Center on the Developing Child
Harvard University

2. Multiple Sources of Knowledge Currently
Inform Practice in Poorly Connected Sectors
Science & Science &
Experience Experience
Health Education
Economic Human
Science &
Experience
Development Services Science &
Experience

3. An Integrated Science of Early Childhood
Development Could Drive More Productive
Investments Across Sectors
Health Education
SCIENCE OF
EARLY
CHILDHOOD
Human
Economic Services
Development

4. Significant Adversity Impairs Development
in the First Three Years
Developmental Delays
100%
Children with
80%
60%
40%
20%
1-2 3 4 5 6 7
Number of Risk Factors
Source: Barth, et al. (2008)

5. Risk Factors for Adult Depression are
Embedded in Adverse Childhood Experiences
5
4
Odds Ratio
3
2
1
0 1 2 3 4 5+
Adverse Experiences Source: Chapman et al, 2004

6. Risk Factors for Adult Heart Disease are
Embedded in Adverse Childhood Experiences
3.5
3
Odds Ratio
2.5
2
1.5
1
0.5
0 1 2 3 4 5,6 7,8
Adverse Experiences
Source: Dong, et al. (2004)

7. Early Life Experiences Are Built Into Our
Bodies (For Better or For Worse)

8. Three Levels of Stress Response

9. Significant Neglect Affects Brain Power

10. Profound Neglect
Impairs Physical Growth
Source: Johnson et al. (2000)

11. New Biological Evidence Links Maltreatment in
Childhood to Greater Risk of Adult Heart Disease
50%
Percent of adults
with biological 40%
marker for greater
risk of heart disease
(increased blood 30%
level of CRP)
20%
10%
Depression Maltreated Depression
(age 32) (as a child) (age 32) +
Maltreated
Source: Danese et al. (2008) (as a child)

12. Positive Childhood Experiences Lead to
a Higher Threshold for Activation of
Stress Response Systems
Early positive experiences
A balancing act
homeostasis
New homeostatic
set point

13. Adverse Childhood Experiences Lead to
a Lower Threshold for Activation of
Stress Response Systems
Early negative experiences
A balancing act
homeostasis
New homeostatic
set point

14. Science Can Inform an Integrated Approach
to Early Investment in Lifelong Health
Preconception
Prenatal
Policy & Biological Early
Caregiver & Foundations Childhood
Program Adaptations Health &
Community of Healthy
Levers for or Development
Capacities Development
Innovation Disruptions Across the Middle
Lifespan Childhood
Adolescence
Adulthood
Source: Center on the Developing Child (2010)

15. Healthy Development Can Be Assessed in
Multiple Ways
Outcomes in
Preconception
Lifelong Well-Being
Prenatal
Policy &
Caregiver & Foundations
Biology of Health-Related Early
Program
Community of Healthy
Health and Behaviors Childhood
Health &
Levers for Development Development
Capacities Development Educational
Innovation Across the Middle
Achievement &
Lifespan Childhood
Economic
Productivity
Adolescence
Physical &
Adulthood
Mental Health
Source: Center on the Developing Child (2010)

16. Early Experiences Are Built Into the Body
Through Complex Pathways
Biology of Health
and Development
Outcomes in
Cumulative Effects Lifelong Well-Being
Biological
Over Time
Policy & Foundations Health-Related
Caregiver & Adaptations
Program of Healthy Behaviors
Community or
Levers for Development
Capacities Gene- Physiological
Disruptions
Innovation Educational
Environment Adaptations & Achievement &
Interaction Disruptions Economic
Productivity
Biological
Embedding Physical &
During Sensitive Mental Health
Periods
Source: Center on the Developing Child (2010)

17. The Foundations of Healthy Development
Influence Biological Responses
Outcomes in
Foundations of Lifelong Well-Being
Healthy Development
Policy & Biological Health-Related
Caregiver & Foundations
Program Adaptations Behaviors
Community of Healthy
Levers for Stable, Responsive or
Capacities Development Educational
Innovation Relationships Disruptions
Achievement &
Safe, Supportive Economic
Environments Productivity
Appropriate Nutrition Physical &
Mental Health
Source: Center on the Developing Child (2010)

18. Caregiver and Community Capacities Affect
the Strength of the Foundations
Outcomes in
Caregiver and Lifelong Well-Being
Community Capacities
Policy & Biological Health-Related
Caregiver & Foundations Behaviors
Program Adaptations
Community of Healthy
Levers for Time and Commitment or Educational
Capacities Development
Innovation Disruptions Achievement &
Financial, Psychological,
and Institutional Resources Economic
Productivity
Skills and Knowledge
Physical &
Mental Health
Source: Center on the Developing Child (2010)

19. The Health Needs of Young Children Can Be
Addressed Across Multiple Sectors
Policy & Program Outcomes in
Levers for Innovation Lifelong Well-Being
Policy &
Public Health Caregiver & Biological Health-Related
Foundations Behaviors
Program Adaptations
Community
Child Care & Early Education of Healthy
Levers for or Educational
Capacities Development
Innovation
Child Protection & Disruptions Achievement &
Social Welfare Economic
Economic & Community Productivity
Development Physical &
Primary Health Care Mental Health
Private Sector Actions
Source: Center on the Developing Child (2010)

20. Rethinking the Core Focus of
Health Care for Children

21. Challenges Facing Health Promotion in
the Context of Health Care Reform
Recognize that efforts to expand health insurance
and reduce inequalities in access and treatment
within the medical care system do not address the
fundamental causes of disparities in health related
to social class, race, and ethnicity.
Leverage advances in neuroscience, molecular
biology, genomics, and the behavioral and social
sciences to enhance our capacity to promote health
and prevent disease, not just to treat illness.