Dr. Georges Benjamin, the executive director of the American Public Health Association, addressed a captive audience of health professionals and community members who know the toll that stress and trauma take on health at Washington University School of Medicine’s 2017 Homer G. Phillips Lecture on October 27.
Emergency medicine can’t solve it, Benjamin said – but comprehensive primary health care will.
“Most of what keeps us from dying prematurely does not occur in a doctor’s office,” said Benjamin, who worked for many years in emergency medicine. He also previously served as secretary of health in Maryland, where he oversaw the expansion and improvement of the state’s Medicaid program.
Having health insurance is everything, he said.
“The first question, no matter where I want to refer somebody at 3 o’clock in the morning, is, ‘What is their insurance status?’” he said. “It determines everything that happens before that.”
Benjamin’s remarks relied heavily upon results of the landmark ACEs study, which examined adverse childhood experiences (ACEs) and their negative effect on health outcomes. ACEs are traumatic events, including physical, sexual and emotional abuse; physical or emotional neglect; experiencing or witnessing intimate partner violence; substance abuse in the household; mental illness in the household; parental separation or divorce; and incarceration of a loved one.
“What kills people is a little bit of high blood pressure, a little bit of elevated blood sugar, a little bit of schizophrenia, a little bit of obesity, a little bit of physical inactivity,” Benjamin said. “I can’t fix that in the emergency department.”
According to the newest national data released in October, 47.8 percent of children under the age of 18 in Missouri have encountered at least one ACE. Nationally, over 46 percent of U. S. youth – 34 million children under age 18 – have experienced at least one ACE and more than 20 percent have experienced at least two.
Those findings, released by the Robert Wood Johnson Foundation, come from the 2016 National Survey of Children’s Health data analyzed by the Child and Adolescent Health Measurement Initiative at Johns Hopkins Bloomberg School of Public Health.
ACEs can have a serious, long-term impact on a child’s health and well-being by contributing to high levels of toxic stress that derail healthy physical, social, emotional and cognitive development. ACEs increase the risk for behaviors that lead to negative health outcomes, such as smoking, alcoholism, and depression. The study reported that 33 percent of U.S. children with two or more ACEs have a chronic health condition that involves a special health care need, compared to 13.6 percent of children without ACEs.
“I don’t care how many visits you come into the emergency department, I’m not going to be able to treat somebody with chronic lung disease, with a little bit of congestive heart failure,” he said. “It only gets fixed with comprehensive primary care.”
Benjamin said universal health coverage, not single-payer coverage is what is needed in the U.S.
“Universal coverage is essential to having a resilient community and fundamental to my view that health care is a fundamental human right,” Benjamin said. “I remind you that every industrialized nation on the planet except the United States of America has universal coverage. Most of it is private sector, although it’s publicly funded.”
A single-payer system refers to having one entity, like the government’s Medicare for ages 65 and older or the Veterans Administration for military and their dependents, to pay health care claims.
Benjamin also talked about environmental factors that take a toll on health – including where trash and toxic waste is dumped (in or near poor neighborhoods), the lack of good infrastructure, transportation issues, pollution, climate change, poverty, income inequality, housing, phone and WIFI access, and homelessness.
“You really can’t get a job when you’re spending your whole day trying to figure out where you’re going to sleep the next night,” he said.
He said broadband deserts pose a different problem – for children who need to do their homework and do not have computers or access to WIFI or broadband at home.
“More and more of these kids are being asked to do their homework online, and so we have kids riding around on school buses, trying to catch the hotspots before they go home to get their homework done,” Benjamin said. “They download it, sitting outside wherever they can get a hotspot – coffee shop, grocery store or some restaurant. They might get shooed away, but they go there so they can do their homework.”
Following his remarks, Benjamin was honored for this work in public health.
The organization Alive and Well STL also was honored for its work to create a trauma-informed community. Alive and Well is a community-wide effort to reduce the impact of stress and trauma on health and well-being in the St. Louis area. Since its founding by the St. Louis Regional Health Commission, Alive and Well has grown into a separate organization.
The award was accepted by Alive and Well co-chairs Fred Rottnek, M.D. (Saint Louis University) and Joe Yancey (Places for People), both of whom are commissioners of the St. Louis Regional Health Commission.
“The Homer G. Phillips legacy sort of defines our mission and how we want to move forward,” Jennifer Brinkmann, president of Alive and Well STL, told The American. “The award will be a north star for us as we continue as our own organization working to improve health, well-being and promoting equity across the region.”
She said Benjamin’s comments on underlying causes of poor health outcomes in the nation’s communities were on target.
“When we talk about building resilient communities in the face of trauma, I think he hit spot-on that we have to deal with these root-cause issues, whether that’s limited access to food, or poor housing, lack of good education, a neighborhood or lack of a feeling of safety,” Brinkmann said.
“We know that these are the issues that create trauma and toxic stress and can ultimately lead to poor health, so organizing as communities to respond to these issues is of critical importance when we think of addressing trauma and toxic stress.”
The annual series is sponsored by the Office of Diversity Programs at Washington University School of Medicine, under the leadership of Will Ross, M.D. associate dean for diversity, Washington University School of Medicine.
