TEDMED 2014
Nadine Burke Harris: How childhood trauma affects health across a lifetime
Nadine Burke Harris: Utjecaj trauma iz djetinjstva na zdravlje tijekom cijelog života
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Trauma iz djetinjstva nije nešto što se jednostavno preraste. Pedijatrica Nadine Burke Harris objašnjava kako ponovljeni stres zlostavljanja, zanemarivanja i stresa zbog roditelja koji se bore s duševnim bolestima ili ovisnostima ima prave, opipljive posljedice na razvoj mozga. Razvija se tijekom cijelog života, a oni koji su iskusili visoke razine traume u djetinjstvu imaju triput veće rizike za obolijevanje od bolesti srca i raka pluća. Ovo je jedna strastvena molba da se pedijatrija hrabro pozabavi prevencijom i liječenjem trauma.
Nadine Burke Harris - Pediatrician
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma. Full bio
Nadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma. Full bio
Double-click the English transcript below to play the video.
00:12
In the mid-'90s,
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Sredinom devedesetih
00:14
the CDC and Kaiser Permanente
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CDC i Kaiser Permanente
00:17
discovered an exposure
that dramatically increased the risk
that dramatically increased the risk
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otkrili su izloženost
koja značajno povećava rizik
koja značajno povećava rizik
00:21
for seven out of 10 of the leading
causes of death in the United States.
causes of death in the United States.
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za sedam od deset
vodećih uzroka smrti u SAD-u.
vodećih uzroka smrti u SAD-u.
00:27
In high doses, it affects
brain development,
brain development,
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Visoke razine utječu na razvoj mozga,
00:30
the immune system, hormonal systems,
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imunološki i endokrini sustav,
00:34
and even the way our DNA
is read and transcribed.
is read and transcribed.
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pa čak i način na koji se
naš DNK čita i prepisuje.
naš DNK čita i prepisuje.
00:38
Folks who are exposed in very high doses
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Oni koji su izloženi visokim razinama
00:42
have triple the lifetime risk
of heart disease and lung cancer
of heart disease and lung cancer
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imaju triput veće šanse obolijevanja
od bolesti srca i raka pluća
od bolesti srca i raka pluća
00:46
and a 20-year difference
in life expectancy.
in life expectancy.
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i dvadeset godina kraći životni vijek,
00:52
And yet, doctors today are not trained
in routine screening or treatment.
in routine screening or treatment.
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no suvremeni doktori nisu dovoljno
obučeni za rutinske preglede i liječenja.
obučeni za rutinske preglede i liječenja.
00:58
Now, the exposure I'm talking about is
not a pesticide or a packaging chemical.
not a pesticide or a packaging chemical.
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Izloženost o kojoj ovdje govorim
nisu pesticidi ili kemikalije,
nisu pesticidi ili kemikalije,
01:03
It's childhood trauma.
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već se radi o traumama iz djetinjstva.
01:07
Okay. What kind of trauma
am I talking about here?
am I talking about here?
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A o kakvim traumama govorim?
01:09
I'm not talking about failing a test
or losing a basketball game.
or losing a basketball game.
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Ne mislim na jedinicu iz testa
ili poraz na košarkaškoj utakmici.
ili poraz na košarkaškoj utakmici.
01:14
I am talking about threats
that are so severe or pervasive
that are so severe or pervasive
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Mislim na prijetnje koje su
toliko ozbiljne ili sveobuhvatne
toliko ozbiljne ili sveobuhvatne
01:18
that they literally get under our skin
and change our physiology:
and change our physiology:
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da nam se doslovno zavuku
pod kožu i promijene nam psihu:
pod kožu i promijene nam psihu:
01:23
things like abuse or neglect,
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stvari poput zlostavljanja, zanemarivanja,
01:25
or growing up with a parent
who struggles with mental illness
who struggles with mental illness
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odrastanja s roditeljem
koji pati od duševne bolesti
koji pati od duševne bolesti
01:29
or substance dependence.
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ili koji je ovisnik.
01:32
Now, for a long time,
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E sad, dugo sam
01:33
I viewed these things in the way
I was trained to view them,
I was trained to view them,
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promatrala te stvari onako
kako su me učili da ih promatram,
kako su me učili da ih promatram,
01:36
either as a social problem --
refer to social services --
refer to social services --
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ili kao društveni problem
koji se tiče socijalnih službi -
koji se tiče socijalnih službi -
01:40
or as a mental health problem --
refer to mental health services.
refer to mental health services.
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ili kao duševni problem
koji se tiče službi za mentalno zdravlje.
koji se tiče službi za mentalno zdravlje.
01:46
And then something happened
to make me rethink my entire approach.
to make me rethink my entire approach.
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No onda se dogodilo nešto
zbog čega sam preispitala svoj pristup.
zbog čega sam preispitala svoj pristup.
01:51
When I finished my residency,
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Kada sam završila sa stažiranjem,
01:53
I wanted to go someplace
where I felt really needed,
where I felt really needed,
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htjela sam otići negdje
gdje sam mislila da sam zaista potrebna,
gdje sam mislila da sam zaista potrebna,
01:57
someplace where I could make a difference.
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negdje gdje bih mogla nešto promijeniti,
02:00
So I came to work for
California Pacific Medical Center,
California Pacific Medical Center,
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pa sam otišla raditi za CPMC,
02:03
one of the best private hospitals
in Northern California,
in Northern California,
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jednu od najboljih privatnih bolnica
u Sjevernoj Kaliforniji
u Sjevernoj Kaliforniji
02:07
and together, we opened a clinic
in Bayview-Hunters Point,
in Bayview-Hunters Point,
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i zajedno smo otvorili kliniku
u Bayview-Hunters Pontu,
u Bayview-Hunters Pontu,
02:12
one of the poorest, most underserved
neighborhoods in San Francisco.
neighborhoods in San Francisco.
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jednom od najsiromašnijih,
najzanemarenijih kvartova u San Francisku.
najzanemarenijih kvartova u San Francisku.
02:16
Now, prior to that point,
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Prije toga
02:18
there had been only
one pediatrician in all of Bayview
one pediatrician in all of Bayview
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postojao je samo jedan pedijatar
u cijelom Bayviewu
u cijelom Bayviewu
02:21
to serve more than 10,000 children,
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koji je bio zadužen
za više od 10 000 djece,
za više od 10 000 djece,
02:24
so we hung a shingle, and we were able
to provide top-quality care
to provide top-quality care
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pa smo postavili pločicu
i mogli smo pružiti kvalitetnu njegu
i mogli smo pružiti kvalitetnu njegu
02:29
regardless of ability to pay.
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bez obzira na sposobnost plaćanja.
02:31
It was so cool. We targeted
the typical health disparities:
the typical health disparities:
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Bilo je jako fora. Bavili smo se
tipičnim zdravstvenim nejednakostima:
tipičnim zdravstvenim nejednakostima:
02:35
access to care, immunization rates,
asthma hospitalization rates,
asthma hospitalization rates,
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pristup brizi, razine imunizacije,
razine hospitalizacije zbog astme
razine hospitalizacije zbog astme
02:40
and we hit all of our numbers.
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i postigli sve naše brojeve.
02:42
We felt very proud of ourselves.
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Bili smo jako ponosni na sebe,
02:45
But then I started noticing
a disturbing trend.
a disturbing trend.
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ali onda sam počela primjećivati
jedan uznemirujući trend.
jedan uznemirujući trend.
02:48
A lot of kids were being
referred to me for ADHD,
referred to me for ADHD,
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Mnogo mi je djece bilo poslano
zbog sumnje na ADHD,
zbog sumnje na ADHD,
02:52
or Attention Deficit
Hyperactivity Disorder,
Hyperactivity Disorder,
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odnosno poremećaja
hiperaktivnosti i deficita pažnje,
hiperaktivnosti i deficita pažnje,
02:55
but when I actually did
a thorough history and physical,
a thorough history and physical,
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ali nakon što sam obavila detaljan
pregled povijesti bolesti i sistematski,
pregled povijesti bolesti i sistematski,
03:00
what I found was that
for most of my patients,
for most of my patients,
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otkrila sam da većini pacijenata
03:03
I couldn't make a diagnosis of ADHD.
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ne mogu dijagosticirati ADHD.
03:07
Most of the kids I was seeing
had experienced such severe trauma
had experienced such severe trauma
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Većina djece koja su mi dolazila
doživjela su toliko teške traume
doživjela su toliko teške traume
03:13
that it felt like something else
was going on.
was going on.
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da se činilo kao da se nešto drugo događa.
03:16
Somehow I was missing something important.
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Nekako mi je promaklo nešto bitno.
03:21
Now, before I did my residency,
I did a master's degree in public health,
I did a master's degree in public health,
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Prije nego što sam odstažirala,
dobila sam diplomu za javno zdravstvo,
dobila sam diplomu za javno zdravstvo,
03:25
and one of the things that they teach you
in public health school
in public health school
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a jedna od stvari kojima te tamo nauče
03:28
is that if you're a doctor
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jest da ukoliko ste doktor
03:30
and you see 100 kids
that all drink from the same well,
that all drink from the same well,
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i vidite 100 djece
koja piju iz istog bunara,
koja piju iz istog bunara,
03:34
and 98 of them develop diarrhea,
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a 98 dobije proljev,
03:37
you can go ahead
and write that prescription
and write that prescription
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slobodno možete napisati
03:39
for dose after dose
after dose of antibiotics,
after dose of antibiotics,
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ispisati recepata
i recepata za antibiotike
i recepata za antibiotike
03:44
or you can walk over and say,
"What the hell is in this well?"
"What the hell is in this well?"
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ili možete doći i zapitati:
"Što nije u redu s ovim bunarom?"
"Što nije u redu s ovim bunarom?"
03:50
So I began reading everything that
I could get my hands on
I could get my hands on
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Počela sam čitati sve što sam stigla
03:53
about how exposure to adversity
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o tome kako izloženost nedaćama
03:56
affects the developing brains
and bodies of children.
and bodies of children.
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utječe na razvoj mozga i tijela u djece.
03:59
And then one day,
my colleague walked into my office,
my colleague walked into my office,
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Jednog dana kolega mi je došao u ured
04:03
and he said, "Dr. Burke,
have you seen this?"
have you seen this?"
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i rekao: "Dr. Burke,
jeste li vidjeli ovo?"
jeste li vidjeli ovo?"
04:09
In his hand was a copy
of a research study
of a research study
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U ruci je držao kopiju istraživanja
04:13
called the Adverse Childhood
Experiences Study.
Experiences Study.
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pod nazivom: "Studija
o nepovoljnim iskustvima u djetinjstvu."
o nepovoljnim iskustvima u djetinjstvu."
04:16
That day changed my clinical practice
and ultimately my career.
and ultimately my career.
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Taj mi je dan promijenio
i kliničku praksu, a i karijeru.
i kliničku praksu, a i karijeru.
04:24
The Adverse Childhood Experiences Study
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To je istraživanje
04:26
is something that everybody
needs to know about.
needs to know about.
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nešto s čime svatko treba biti upoznat.
04:30
It was done by Dr. Vince Felitti at Kaiser
and Dr. Bob Anda at the CDC,
and Dr. Bob Anda at the CDC,
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Proveo ga je Dr. Vince Felitti
na Kaiseru i Dr. Bob Anda na CDC-u.
na Kaiseru i Dr. Bob Anda na CDC-u.
04:35
and together, they asked 17,500 adults
about their history of exposure
about their history of exposure
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Zajedno su ispitali 17 500 odraslih
o njihovoj povijesti izloženosti
o njihovoj povijesti izloženosti
04:43
to what they called "adverse
childhood experiences," or ACEs.
childhood experiences," or ACEs.
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nečemu što su nazvali "nepovoljna
iskustva u djetinjstvu", tj. ACE.
iskustva u djetinjstvu", tj. ACE.
04:49
Those include physical, emotional,
or sexual abuse;
or sexual abuse;
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Ta iskustva uključuju fizičko,
emocionalno i seksualno zlostavljanje;
emocionalno i seksualno zlostavljanje;
04:53
physical or emotional neglect;
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fizičko ili emocionalno zanemarivanje;
04:56
parental mental illness,
substance dependence, incarceration;
substance dependence, incarceration;
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duševna bolest roditelja,
ovisnost, zatvorski staž;
ovisnost, zatvorski staž;
05:00
parental separation or divorce;
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odvajanje roditelja ili razvod;
05:02
or domestic violence.
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nasilje u obitelji.
05:05
For every yes, you would get
a point on your ACE score.
a point on your ACE score.
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Za svako "da", dobijete
bod na ACE-testu.
bod na ACE-testu.
05:09
And then what they did
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Zatim su
05:11
was they correlated these ACE scores
against health outcomes.
against health outcomes.
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usporedili ACE-rezultate
i zdravstvene ishode.
i zdravstvene ishode.
05:17
What they found was striking.
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Saznanja su bila zapanjujuća.
05:19
Two things:
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Dvije stvari.
05:21
Number one, ACEs are incredibly common.
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Prvo, ACE-ovi su jako uobičajeni.
05:25
Sixty-seven percent of the population
had at least one ACE,
had at least one ACE,
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Čak 67% populacije
imalo je barem jedan ACE,
imalo je barem jedan ACE,
05:32
and 12.6 percent, one in eight,
had four or more ACEs.
had four or more ACEs.
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a 12,6%, svaki osmi ispitanik,
imao je 6 ili više ACE-ova.
imao je 6 ili više ACE-ova.
05:38
The second thing that they found
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Drugo -
05:41
was that there was
a dose-response relationship
a dose-response relationship
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postoji odnos doza - odgovor
05:44
between ACEs and health outcomes:
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između ACE-ova i ishoda zdravlja:
05:49
the higher your ACE score,
the worse your health outcomes.
the worse your health outcomes.
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što je ACE-rezultat viši,
to su gori ishodi zdravlja.
to su gori ishodi zdravlja.
05:53
For a person with an ACE score
of four or more,
of four or more,
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Osoba s ACE-rezultatom
od četiri pa naviše
od četiri pa naviše
05:56
their relative risk of chronic
obstructive pulmonary disease
obstructive pulmonary disease
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ima veći relativni rizik
od kroničnih respiratornih poremećaja
od kroničnih respiratornih poremećaja
06:00
was two and a half times that
of someone with an ACE score of zero.
of someone with an ACE score of zero.
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dva i pol puta veći od nekoga
s ACE-rezultatom od nula.
s ACE-rezultatom od nula.
06:05
For hepatitis, it was also
two and a half times.
two and a half times.
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Za hepatitis također dva i pol puta.
06:08
For depression, it was
four and a half times.
four and a half times.
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Za depresiju četiri i pol puta.
06:11
For suicidality, it was 12 times.
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Za sklonost samoubojstvu dvanaest puta.
06:15
A person with an ACE score
of seven or more
of seven or more
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Osoba s ACE-rezultatom od sedam pa naviše
06:18
had triple the lifetime risk
of lung cancer
of lung cancer
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ima triput veće rizike
za obolijevanje od raka pluća
za obolijevanje od raka pluća
06:23
and three and a half times the risk
of ischemic heart disease,
of ischemic heart disease,
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i tri i pol puta za obolijevanje
od ishemičke bolesti srca,
od ishemičke bolesti srca,
06:27
the number one killer
in the United States of America.
in the United States of America.
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vodećeg uzroka smrti u SAD-u.
06:31
Well, of course this makes sense.
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Naravno, to ima smisla.
06:34
Some people looked at this data
and they said, "Come on.
and they said, "Come on.
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Neki su proučili
te rezultate i rekli: "Ma daj!
te rezultate i rekli: "Ma daj!
06:38
You have a rough childhood,
you're more likely to drink and smoke
you're more likely to drink and smoke
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Imao si teško djetinjstvo,
pa si skloniji pušenju i opijanju,
pa si skloniji pušenju i opijanju,
06:43
and do all these things
that are going to ruin your health.
that are going to ruin your health.
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a sve će ti te stvari
uništiti zdravlje.
uništiti zdravlje.
06:46
This isn't science.
This is just bad behavior."
This is just bad behavior."
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To nije znanost,
to je samo loše ponašanje."
to je samo loše ponašanje."
06:50
It turns out this is exactly
where the science comes in.
where the science comes in.
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Ispada da znanost
upravo tu uskače.
upravo tu uskače.
06:55
We now understand
better than we ever have before
better than we ever have before
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Sad bolje nego ikad razumijemo
07:00
how exposure to early adversity
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kako izloženost ranim nedaćama
07:03
affects the developing brains
and bodies of children.
and bodies of children.
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utječe na razvoj
mozga i tijela u djece.
mozga i tijela u djece.
07:06
It affects areas like
the nucleus accumbens,
the nucleus accumbens,
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Utječe na područja poput
nucleus accumbensa,
nucleus accumbensa,
07:09
the pleasure and reward
center of the brain
center of the brain
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centra u mozgu zaduženog
za užitak i nagradu
za užitak i nagradu
07:12
that is implicated
in substance dependence.
in substance dependence.
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koji je zahvaćen u ovisnostima.
07:14
It inhibits the prefrontal cortex,
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On onemogućuje prednju koru mozga
07:17
which is necessary for impulse control
and executive function,
and executive function,
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koja je nužna za kontroliranje
impulsa te izvršnu funkciju,
impulsa te izvršnu funkciju,
07:21
a critical area for learning.
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ključno područje za učenje.
07:23
And on MRI scans,
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Na MR-skeniranju
07:25
we see measurable differences
in the amygdala,
in the amygdala,
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vidljive su mjerljive razlike u amigdali,
07:29
the brain's fear response center.
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centru u mozgu zaduženog
za reakciju na strah.
za reakciju na strah.
07:32
So there are real neurologic reasons
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Pravi neurološki razlozi objašnjavaju
07:35
why folks exposed
to high doses of adversity
to high doses of adversity
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zašto su oni koji su izloženi
visokim razinama nedaća
visokim razinama nedaća
07:39
are more likely to engage
in high-risk behavior,
in high-risk behavior,
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skloniji visokorizičnim
oblicima ponašanja,
oblicima ponašanja,
07:42
and that's important to know.
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a to je važno znati.
07:44
But it turns out that even if you don't
engage in any high-risk behavior,
engage in any high-risk behavior,
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No, čak i ako se ne uključite
u visokorizična ponašanja,
u visokorizična ponašanja,
07:50
you're still more likely
to develop heart disease or cancer.
to develop heart disease or cancer.
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još ste uvijek skloniji obolijevanju
od bolesti srca ili od raka.
od bolesti srca ili od raka.
07:56
The reason for this has to do with
the hypothalamic–pituitary–adrenal axis,
the hypothalamic–pituitary–adrenal axis,
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Razlog za to ima veze s hipotalamusom,
hipofizom i nadbubrežnom žlijezdom,
hipofizom i nadbubrežnom žlijezdom,
08:02
the brain's and body's
stress response system
stress response system
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sustavom reakcije na stres mozga i tijela
08:05
that governs our fight-or-flight response.
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što upravlja reakcijama
za borbu ili bijeg.
za borbu ili bijeg.
08:09
How does it work?
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Kako funkcionira?
08:11
Well, imagine you're walking
in the forest and you see a bear.
in the forest and you see a bear.
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Zamislite da šetate šumom
i ugledate medvjeda.
i ugledate medvjeda.
08:15
Immediately, your hypothalamus
sends a signal to your pituitary,
sends a signal to your pituitary,
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Hipotalamus odmah šalje signal hipofizi
08:19
which sends a signal
to your adrenal gland that says,
to your adrenal gland that says,
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koja šalje signal nadbubrežnoj žlijezdi:
08:22
"Release stress hormones!
Adrenaline! Cortisol!"
Adrenaline! Cortisol!"
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"Pusti hormone stresa!
Adrenalin! Kortizol!"
Adrenalin! Kortizol!"
08:25
And so your heart starts to pound,
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Srce vam počne lupati,
08:28
Your pupils dilate, your airways open up,
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zjenice se prošire,
zračni putevi otvore
zračni putevi otvore
08:30
and you are ready to either
fight that bear or run from the bear.
fight that bear or run from the bear.
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i spremni ste ili na borbu
s medom ili na bijeg od njega.
s medom ili na bijeg od njega.
08:36
And that is wonderful
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To je super
08:38
if you're in a forest
and there's a bear.
and there's a bear.
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ako ste u šumi i naletite na medu.
08:42
(Laughter)
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(Smijeh)
08:45
But the problem is what happens
when the bear comes home every night,
when the bear comes home every night,
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No problem nastaje
kad medo dolazi kući svake noći,
kad medo dolazi kući svake noći,
08:50
and this system is activated
over and over and over again,
over and over and over again,
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a ovaj se sustav iznova i iznova aktivira
08:56
and it goes from being
adaptive, or life-saving,
adaptive, or life-saving,
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te od prilagodbenog sustava
ili sustava za spašavanje života
ili sustava za spašavanje života
09:00
to maladaptive, or health-damaging.
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preraste u maladaptivni sustav
ili sustav koji ugrožava zdravlje.
ili sustav koji ugrožava zdravlje.
09:04
Children are especially sensitive
to this repeated stress activation,
to this repeated stress activation,
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Djeca su posebno osjetljiva
na ovakvu ponovljenu aktivaciju stresa
na ovakvu ponovljenu aktivaciju stresa
09:10
because their brains and bodies
are just developing.
are just developing.
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jer im se mozak
i tijelo još uvijek razvijaju.
i tijelo još uvijek razvijaju.
09:14
High doses of adversity not only affect
brain structure and function,
brain structure and function,
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Visoke razine nedaća ne utječu samo
na strukturu i funkcioniranje mozga
na strukturu i funkcioniranje mozga
09:20
they affect the developing immune system,
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već i na razvoj imunološkog
09:23
developing hormonal systems,
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i endokrinog sustava,
09:26
and even the way our DNA
is read and transcribed.
is read and transcribed.
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pa čak na način na koji se
naš DNK čita i prepisuje.
naš DNK čita i prepisuje.
09:32
So for me, this information
threw my old training out the window,
threw my old training out the window,
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Ovi podatci za mene potpuno su
obezvrijedili moje dotadašnje znanje
obezvrijedili moje dotadašnje znanje
09:37
because when we understand
the mechanism of a disease,
the mechanism of a disease,
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jer kad razumijemo mehanizam bolesti,
09:41
when we know not only
which pathways are disrupted, but how,
which pathways are disrupted, but how,
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kad znamo ne samo
koji su putevi zapriječeni već i kako,
koji su putevi zapriječeni već i kako,
09:45
then as doctors, it is our job
to use this science
to use this science
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onda smo kao doktori
dužni iskoristiti tu znanost
dužni iskoristiti tu znanost
09:50
for prevention and treatment.
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za prevenciju i liječenje.
09:53
That's what we do.
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To je naš posao.
09:54
So in San Francisco, we created
the Center for Youth Wellness
the Center for Youth Wellness
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U San Francisku otvorili smo
Centar za zdravlje mladih
Centar za zdravlje mladih
09:58
to prevent, screen and heal the impacts
of ACEs and toxic stress.
of ACEs and toxic stress.
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kako bismo spriječili, uočili i zaliječili
utjecaje ACE-a i toksičnog stresa.
utjecaje ACE-a i toksičnog stresa.
10:04
We started simply with routine screening
of every one of our kids
of every one of our kids
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Počeli smo s rutinskim pregledima
svakog djeteta
svakog djeteta
10:09
at their regular physical,
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na redovnim sistematskim
10:10
because I know that if my patient
has an ACE score of 4,
has an ACE score of 4,
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jer znam da ukoliko moja pacijentica
ima ACE-rezultat od 4 i naviše,
ima ACE-rezultat od 4 i naviše,
10:15
she's two and a half times as likely
to develop hepatitis or COPD,
to develop hepatitis or COPD,
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dva i pol puta je sklonija obolijevanju
od hepatitisa ili kroničnih bolesti,
od hepatitisa ili kroničnih bolesti,
10:19
she's four and half times as likely
to become depressed,
to become depressed,
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četiri i pol puta je sklonija depresiji
10:22
and she's 12 times as likely
to attempt to take her own life
to attempt to take her own life
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i dvanaest puta sklonija
pokušati oduzeti vlastiti život
pokušati oduzeti vlastiti život
10:26
as my patient with zero ACEs.
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u usporedbi s pacijentima s rezultatom 0.
10:29
I know that when she's in my exam room.
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Znam to dok se nalazi u mojoj ordinaciji.
10:32
For our patients who do screen positive,
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Za pacijente koji ostvare
pozitivan rezultat
pozitivan rezultat
10:35
we have a multidisciplinary treatment team
that works to reduce the dose of adversity
that works to reduce the dose of adversity
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imamo tim multidisciplinarnog tretmana
koji pokušava smanjiti razinu nedaća
koji pokušava smanjiti razinu nedaća
10:40
and treat symptoms using best practices,
including home visits, care coordination,
including home visits, care coordination,
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i liječiti simptome koristeći se najboljim
postupcima poput kućnih posjeta, njege,
postupcima poput kućnih posjeta, njege,
10:46
mental health care, nutrition,
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brige za duševno zdravlje, prehrane,
10:50
holistic interventions, and yes,
medication when necessary.
medication when necessary.
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holističkih zahvata,
pa i lijekova kada je to potrebno.
pa i lijekova kada je to potrebno.
10:54
But we also educate parents
about the impacts of ACEs and toxic stress
about the impacts of ACEs and toxic stress
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Također educiramo roditelje
o učincima ACE-a i toksičnog stresa
o učincima ACE-a i toksičnog stresa
10:59
the same way you would for covering
electrical outlets, or lead poisoning,
electrical outlets, or lead poisoning,
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onako kako ih educiramo o prekrivanju
utičnica ili trovanju živom,
utičnica ili trovanju živom,
11:05
and we tailor the care
of our asthmatics and our diabetics
of our asthmatics and our diabetics
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a brigu o astmatičarima
i dijabetičarima oblikujemo
i dijabetičarima oblikujemo
11:09
in a way that recognizes that they may
need more aggressive treatment,
need more aggressive treatment,
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na način koji ukazuje na to
da će im možda trebati agresivniji tretman
da će im možda trebati agresivniji tretman
11:13
given the changes to their hormonal
and immune systems.
and immune systems.
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imajući u vidu njihov
endokrini i imunološki sustav.
endokrini i imunološki sustav.
11:17
So the other thing that happens
when you understand this science
when you understand this science
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Kad shvatite tu znanost,
11:22
is that you want to shout it
from the rooftops,
from the rooftops,
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poželite o njoj vikati na sav glas
11:25
because this isn't just an issue
for kids in Bayview.
for kids in Bayview.
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jer to nije problem samo djece u Bayviewu.
11:29
I figured the minute
that everybody else heard about this,
that everybody else heard about this,
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Pretpostavila sam
da će čim svi čuju za to,
da će čim svi čuju za to,
11:33
it would be routine screening,
multi-disciplinary treatment teams,
multi-disciplinary treatment teams,
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uslijediti rutinski pregledi,
multidisciplinarni timovi za tretiranje
multidisciplinarni timovi za tretiranje
11:36
and it would be a race to the most
effective clinical treatment protocols.
effective clinical treatment protocols.
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te da će se utrkivati do najuspješnijih
protokola kliničkih tretmana.
protokola kliničkih tretmana.
11:41
Yeah. That did not happen.
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Aha, to se nije dogodilo.
11:45
And that was a huge learning for me.
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Puno sam naučila iz toga.
11:48
What I had thought of as simply
best clinical practice
best clinical practice
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Ono što sam smatrala
najboljom kliničkom praksom
najboljom kliničkom praksom
11:53
I now understand to be a movement.
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sada smatram pokretom.
11:57
In the words of Dr. Robert Block,
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Riječima dr. Roberta Blocka,
11:59
the former President
of the American Academy of Pediatrics,
of the American Academy of Pediatrics,
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bivšeg predsjednika
Američke pedijatrijske akademije,
Američke pedijatrijske akademije,
12:03
"Adverse childhood experiences
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"Nepovoljna iskustva u djetinjstvu
12:06
are the single greatest
unaddressed public health threat
unaddressed public health threat
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jedan su od najvećih zanemarenih
prijetnji javnom zdravstvu
prijetnji javnom zdravstvu
12:11
facing our nation today."
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naše nacije."
12:13
And for a lot of people,
that's a terrifying prospect.
that's a terrifying prospect.
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Mnoge ljude to zaprepašćuje.
12:18
The scope and scale of the problem
seems so large that it feels overwhelming
seems so large that it feels overwhelming
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5805
Domet i težina problema
čine se toliko veliki da je previše
čine se toliko veliki da je previše
12:24
to think about how we might approach it.
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čak i razmišljati o tome
kako se s njim suočiti,
kako se s njim suočiti,
12:26
But for me, that's actually
where the hopes lies,
where the hopes lies,
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ali meni baš ta činjenica daje nadu
12:31
because when we have the right framework,
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jer kad imamo pravi okvir,
12:33
when we recognize this to be
a public health crisis,
a public health crisis,
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kada ovo prepoznamo
kao zdravstvenu krizu,
kao zdravstvenu krizu,
12:38
then we can begin to use the right
tool kit to come up with solutions.
tool kit to come up with solutions.
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tek ćemo onda početi koristiti
pravu opremu da dođemo do pravih rješenja.
pravu opremu da dođemo do pravih rješenja.
12:43
From tobacco to lead poisoning
to HIV/AIDS,
to HIV/AIDS,
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Od nikotina, trovanja živom,
pa sve do HIV-a/AIDS-a
pa sve do HIV-a/AIDS-a
12:47
the United States actually has
quite a strong track record
quite a strong track record
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SAD ima dobar učinak
12:52
with addressing public health problems,
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2904
po pitanju bavljenja
zdravstvenim pitanjima,
zdravstvenim pitanjima,
12:55
but replicating those successes
with ACEs and toxic stress
with ACEs and toxic stress
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ali ponavljanje tih uspjeha
s ACE-ovima i toksičnim stresom
s ACE-ovima i toksičnim stresom
13:01
is going to take determination
and commitment,
and commitment,
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zahtijevat će odlučnost i predanost,
13:05
and when I look at what
our nation's response has been so far,
our nation's response has been so far,
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a kada pogledam kako se
dosad prema tome odnosila naša nacija,
dosad prema tome odnosila naša nacija,
13:09
I wonder,
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pitam se,
13:11
why haven't we taken this more seriously?
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zašto to nismo ozbiljnije shvatili?
13:15
You know, at first I thought
that we marginalized the issue
that we marginalized the issue
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U početku sam mislila
da smo marginalizirali problem
da smo marginalizirali problem
13:19
because it doesn't apply to us.
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jer nas se ne tiče.
13:21
That's an issue for those kids
in those neighborhoods.
in those neighborhoods.
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Tiče se one djece u onim kvartovima,
13:24
Which is weird, because the data
doesn't bear that out.
doesn't bear that out.
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što je čudno jer podatci to ne pokazuju.
13:28
The original ACEs study
was done in a population
was done in a population
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4133
Originalno ACE-istraživanje
obavljeno je na populaciji
obavljeno je na populaciji
13:32
that was 70 percent Caucasian,
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od 70% bijelaca,
13:35
70 percent college-educated.
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70% fakultetski obrazovanih ljudi,
13:38
But then, the more I talked to folks,
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ali što više razgovaram s ljudima,
13:42
I'm beginning to think that maybe
I had it completely backwards.
I had it completely backwards.
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to više počinjem misliti
da sam sve krivo shvatila.
da sam sve krivo shvatila.
13:47
If I were to ask
how many people in this room
how many people in this room
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Da pitam koliko je ljudi u ovoj prostoriji
13:53
grew up with a family member
who suffered from mental illness,
who suffered from mental illness,
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odraslo uz člana obitelji koji je
bolovao od duševne bolesti,
bolovao od duševne bolesti,
13:57
I bet a few hands would go up.
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kladim se da bi nekoliko podiglo ruke.
14:00
And then if I were to ask how many folks
had a parent who maybe drank too much,
had a parent who maybe drank too much,
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5701
A da vas pitam koliko vas je
imalo roditelja koji je pio
imalo roditelja koji je pio
14:05
or who really believed that
if you spare the rod, you spoil the child,
if you spare the rod, you spoil the child,
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ili koji su vjerovali da je
"batina u raju izrasla",
"batina u raju izrasla",
14:11
I bet a few more hands would go up.
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kladim se da bi još nekoliko podiglo ruke.
14:14
Even in this room, this is an issue
that touches many of us,
that touches many of us,
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Čak i u ovoj prostoriji, to je problem
koji se tiče mnogih od nas
koji se tiče mnogih od nas
14:19
and I am beginning to believe
that we marginalize the issue
that we marginalize the issue
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i počinjem vjerovati
da marginaliziramo taj problem
da marginaliziramo taj problem
14:22
because it does apply to us.
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2596
jer nas se tiče.
14:25
Maybe it's easier to see
in other zip codes
in other zip codes
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Možda ga je lakše uočiti drugdje
14:28
because we don't want to look at it.
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jer mi sami ne želimo gledati u njega.
14:31
We'd rather be sick.
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Radije bismo bili bolesni.
14:34
Fortunately, scientific advances
and, frankly, economic realities
and, frankly, economic realities
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Srećom, napredak znanosti
i gospodarske realnosti
i gospodarske realnosti
14:40
make that option less viable every day.
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tu mogućnost čine sve manje održivom.
14:45
The science is clear:
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1587
Znanost je jasna;
14:48
Early adversity dramatically affects
health across a lifetime.
health across a lifetime.
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4949
rane nedaće znatno utječu
na cjeloživotno zdravlje.
na cjeloživotno zdravlje.
14:54
Today, we are beginning to understand
how to interrupt the progression
how to interrupt the progression
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Tek sad počinjemo shvaćati
kako omesti napredak
kako omesti napredak
14:58
from early adversity
to disease and early death,
to disease and early death,
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4301
od rane nedaće do bolesti
i preuranjene smrti,
i preuranjene smrti,
15:03
and 30 years from now,
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2525
a za trideset godina,
15:05
the child who has a high ACE score
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to dijete s visokim ACE-rezultatom,
15:08
and whose behavioral symptoms
go unrecognized,
go unrecognized,
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čiji se bihevioralni simptomi
ne primijete,
ne primijete,
15:11
whose asthma management
is not connected,
is not connected,
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2700
čije se liječenje astme ne povezuje
15:13
and who goes on to develop
high blood pressure
high blood pressure
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i koji oboli od visokog tlaka,
15:17
and early heart disease or cancer
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2844
preuranjene bolesti srca ili raka
15:20
will be just as anomalous
as a six-month mortality from HIV/AIDS.
as a six-month mortality from HIV/AIDS.
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5144
bit će jednako anomalan kao i
šestomjesečna smrtnost od HIV-a/AIDS-a.
šestomjesečna smrtnost od HIV-a/AIDS-a.
15:25
People will look at that situation
and say, "What the heck happened there?"
and say, "What the heck happened there?"
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Ljudi promotre situaciju i zapitaju se:
"Što se to ovdje događa?"
"Što se to ovdje događa?"
15:30
This is treatable.
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2287
To se može liječiti,
15:32
This is beatable.
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2772
može se pobijediti.
15:35
The single most important thing
that we need today
that we need today
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Najvažnija stvar koja nam je
u današnje vrijeme potrebna
u današnje vrijeme potrebna
15:39
is the courage to look
this problem in the face
this problem in the face
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jest hrabrost da se suočimo s problemom
15:43
and say, this is real
and this is all of us.
and this is all of us.
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i kažemo da je stvaran
i da se tiče svih nas.
i da se tiče svih nas.
15:48
I believe that we are the movement.
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Vjerujem da smo mi taj pokret.
15:53
Thank you.
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Hvala vam.
15:54
(Applause)
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(Pljesak)
ABOUT THE SPEAKER
Nadine Burke Harris - PediatricianNadine Burke Harris’ healthcare practice focuses on a little-understood, yet very common factor in childhood that can profoundly impact adult-onset disease: trauma.
Why you should listen
Pediatrician Nadine Burke Harris noticed a disturbing trend as she treated children in an underserved neighborhood in San Francisco: that many of the kids who came to see her had experienced childhood trauma. She began studying how childhood exposure to adverse events affects brain development, as well as a person’s health as an adult.
Understanding this powerful correlation, Burke Harris became the founder and CEO of the Center for Youth Wellness, an initiative at the California Pacific Medical Center Bayview Child Health Center that seeks to create a clinical model that recognizes and effectively treats toxic stress in children. Her work pushes the health establishment to reexamine its relationship to social risk factors, and advocates for medical interventions to counteract the damaging impact of stress. Her goal: to change the standard of pediatric practice, across demographics.
Nadine Burke Harris | Speaker | TED.com