“An ounce of prevention is worth a pound of cure”
- Benjamin Franklin
There is a public health fable that runs like this: If, as a doctor, you see 98 kinds out of 100 coming to you with diarrhoea after drinking water from a well, what should you do? On the one hand, you can write prescription after prescription for antibiotics. Or you can walk over and inspect what is in the well that is making all of these kids sick. Another anecdote asks: When is the best time to intervene in a child’s life? The answer: 100 years ago. When is the second-best time? Now.
Early development, parenting and health
It is only in recent decades that the size of the problem of developmentally damaged people has begun to be recognised, writes Vincent Felitti, author of the ACE study. It has become evident that traumatic experiences during childhood and adolescence are far more common that is usually recognised. Early traumatic experience is linked with outcomes later in life that are of concern to public health and the social fabric. Early adverse experiences have a large impact on neuroregulatory systems mediating illness as well as social behaviour. When it comes to illness and disease, we often focus our attention on tertiary consequences far downstream while primary causes are protected by time, taboo and social convention. The ‘hidden epidemic’ of early life trauma is not just a problem for mental health fields and medicine but for all of society. There is a need to create interventions for primary prevention of many physical and mental illnesses. Felitti argues that parenting skills is likely to be a core feature of primary prevention in the future of medicine and psychiatry. The influence of childhood experience, as outlined by Freud, including often unrecognised traumatic experience, is as powerful as Freud and other early pioneers described it. Chronic life stress in early development is generally underappreciated as an etiological mechanism underlying many biomedical illnesses.
Supporting early child development is a prominent goal among practitioners and policymakers. Large studies that link early adversity to a large number of negative outcomes and concerns about young children’s exposure to ‘toxic stress’ are adding urgency to the need to invest in this area. Backed by attachment research, supportive parenting is being seen as a crucial buffer that protects young brains against toxic stressors. Several attachment intervention programmes have been demonstrated to have positive effects. Attachment interventions are increasingly moving to community-based implementation potentially allowing these programmes to play a role in the provision of social services to families.
Violence is a big problem in society and the best intervention is to prevent developmental aggression in very early childhood from turning into antisocial personality disorders. Early care-giving qualities is a major contributor to outcomes and the longer a developmental pathway is pursued the harder it is to change. Maternal mental well-being and social circumstances impact a child’s well-being and development. Supportive and sensitive parenting is one of the best predictors of positive outcomes for children.
Investing in child development is the foundation for improved health, economic and social outcomes. Not getting the early years ‘right’ is linked with violence, depression, transmission of non-communicable diseases, lower wages and negative impact on gross domestic product. Unless early development is addressed effectively countries will be locked into poverty and sustainable development will not be achieved.
Interpersonal violence, especially violence experienced by children, is the largest single, preventable cause of mental illness. Early childhood violence is the equivalent for mental health to smoking for physical health. This indicates that it is important to make it a key focus of therapeutic intervention. There is a large amount of evidence that show the success of interventions that start in pregnancy and continue after birth.