TEDMED 2014
Nadine Burke Harris: How childhood trauma affects health across a lifetime
Nadin Berk Haris (Nadine Burke Harris): Kako trauma u detinjstvu utiče na zdravlje tokom celog života
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Trauma iz detinjstva nije nešto što prosto prevaziđete dok odrastate. Pedijatar Nadin Berk Haris objašnjava kako ponavljajući stres zlostavljanja, zanemarivanja i roditelja koji se bore sa problemima mentalnog zdravlja ili bolestima zavisnosti ima stvarne, opipljive efekte na razvoj mozga. Ovo se odvija tokom celog života, do te mere da oni koji su doživeli visok nivo traume imaju trostruki rizik za bolesti srca i rak pluća. Ovo je strastveni apel za pedijatrijsku medicinu da se direktno suoči sa prevencijom i lečenjem traume.
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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Centar za kontrolu bolesti (CKB)
i "Kaizer Permanente"
i "Kaizer Permanente"
00:17
discovered an exposure
that dramatically increased the risk
that dramatically increased the risk
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su otkrili izlaganje
koje drastično povećava rizik
koje drastično 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 Sjedinjenim Državama.
u Sjedinjenim Državama.
00:27
In high doses, it affects
brain development,
brain development,
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U velikim dozama,
utiče na razvoj mozga,
utiče na razvoj mozga,
00:30
the immune system, hormonal systems,
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imuni sistem, hormonalne sisteme,
00:34
and even the way our DNA
is read and transcribed.
is read and transcribed.
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čak i na način na koji se DNK
čita i preslikava.
čita i preslikava.
00:38
Folks who are exposed in very high doses
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Ljudi koji su izloženi u velikim dozama
00:42
have triple the lifetime risk
of heart disease and lung cancer
of heart disease and lung cancer
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imaju trostruki rizik da obole
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 razliku od 20 godina
očekivane dužine života.
očekivane dužine života.
00:52
And yet, doctors today are not trained
in routine screening or treatment.
in routine screening or treatment.
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A ipak, doktori danas nisu obučeni
za rutinsku proveru ili tretman.
za rutinsku proveru ili tretman.
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 govorim
nije pesticid ili hemikalija.
nije pesticid ili hemikalija.
01:03
It's childhood trauma.
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To je trauma u detinjstvu.
01:07
Okay. What kind of trauma
am I talking about here?
am I talking about here?
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Okej. O kakvoj traumi 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 pričam o padanju na ispitu
niti izgubljenoj utakmici košarke.
niti izgubljenoj utakmici košarke.
01:14
I am talking about threats
that are so severe or pervasive
that are so severe or pervasive
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Govorim o opasnostima
koje su toliko ozbiljne ili prožimajuće
koje su toliko ozbiljne ili prožimajuće
01:18
that they literally get under our skin
and change our physiology:
and change our physiology:
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da nam se bukvalno uvuku pod kožu
i menjaju našu fiziologiju,
i menjaju našu fiziologiju,
01:23
things like abuse or neglect,
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kao što su zlostavljanje i zanemarivanje,
01:25
or growing up with a parent
who struggles with mental illness
who struggles with mental illness
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ili odrastanje sa roditeljem
koji se bori sa mentalnom bolešću
koji se bori sa mentalnom bolešću
01:29
or substance dependence.
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ili bolešću zavisnosti.
01:32
Now, for a long time,
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Dugo sam ove stvari sagledavala
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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onako kako sam bila obučena
da ih sagledavam,
da ih sagledavam,
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 problem mentalnog zdravlja -
upućuje se na službe za mentalno zdravlje.
upućuje se na službe 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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A 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 specijalizaciju,
01:53
I wanted to go someplace
where I felt really needed,
where I felt really needed,
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želela sam da odem negde gde
sam osećala da sam zaista potrebna,
sam osećala da sam zaista potrebna,
01:57
someplace where I could make a difference.
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negde gde mogu da ostvarim promenu.
02:00
So I came to work for
California Pacific Medical Center,
California Pacific Medical Center,
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Tako sam počela da radim
za medicinski centar Kalifornija Pacifik
za medicinski centar Kalifornija Pacifik
02:03
one of the best private hospitals
in Northern California,
in Northern California,
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jednu od najboljih privatnih bolnica
u severnoj Kaliforniji,
u severnoj 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 Bejvju-Hanters Pointu,
u Bejvju-Hanters Pointu,
02:12
one of the poorest, most underserved
neighborhoods in San Francisco.
neighborhoods in San Francisco.
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jednom od najsiromašnijih krajeva
u San Francisku.
u San Francisku.
02:16
Now, prior to that point,
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Pre toga, postojao je
samo jedan pedijatar u celome Bejvjuu
samo jedan pedijatar u celome Bejvjuu
02:18
there had been only
one pediatrician in all of Bayview
one pediatrician in all of Bayview
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koji je lečio više od 10 000 dece,
02:21
to serve more than 10,000 children,
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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 mi započeli ovaj posao
i mogli smo da pružimo vrhunsku negu
i mogli smo da pružimo vrhunsku negu
02:29
regardless of ability to pay.
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bez obzira na nečiju mogućnost da plati.
02:31
It was so cool. We targeted
the typical health disparities:
the typical health disparities:
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Bilo je baš kul. Bili smo usmereni
na tipične zdravstvene nejednakosti:
na tipične zdravstvene nejednakosti:
02:35
access to care, immunization rates,
asthma hospitalization rates,
asthma hospitalization rates,
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pristup nezi, stope vakcinisanosti,
stope hospitalizacije zbog astme,
stope hospitalizacije zbog astme,
02:40
and we hit all of our numbers.
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i postigli smo sve naše ciljeve.
02:42
We felt very proud of ourselves.
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Bili smo vrlo ponosni na sebe.
02:45
But then I started noticing
a disturbing trend.
a disturbing trend.
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Ali zatim sam počela da primećujem
uznemirujuću tendenciju.
uznemirujuću tendenciju.
02:48
A lot of kids were being
referred to me for ADHD,
referred to me for ADHD,
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Mnogo dece mi je bilo upućeno
zbog ADHD-a,
zbog ADHD-a,
02:52
or Attention Deficit
Hyperactivity Disorder,
Hyperactivity Disorder,
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poremećaja pažnje sa hiperaktivnošću,
02:55
but when I actually did
a thorough history and physical,
a thorough history and physical,
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ali kada sam pregledala njihove kartone
i obavila pregled,
i obavila pregled,
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 mojih pacijenata
03:03
I couldn't make a diagnosis of ADHD.
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nisam mogla da dijagnostikujem 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 dece koju sam primila
doživela je tako ozbiljnu traumu,
doživela je tako ozbiljnu traumu,
03:13
that it felt like something else
was going on.
was going on.
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da se sticao utisak
da se tu nešto drugo zbiva.
da se tu nešto drugo zbiva.
03:16
Somehow I was missing something important.
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Nekako mi je promicalo nešto važno.
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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Pre specijalizacije, stekla sam diplomu
mastera javnog zdravlja
mastera javnog zdravlja
03:25
and one of the things that they teach you
in public health school
in public health school
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i jedna od stvari kojima uče
u školi za javno zdravlje
u školi za javno zdravlje
03:28
is that if you're a doctor
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je da, ako 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 da stotinu dece
pije sa istog bunara,
pije sa istog bunara,
03:34
and 98 of them develop diarrhea,
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i 98 dobije proliv,
03:37
you can go ahead
and write that prescription
and write that prescription
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možete da im prepišete antibiotike
03:39
for dose after dose
after dose of antibiotics,
after dose of antibiotics,
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jednu dozu za drugom,
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 da priđete i pitate:
"Šta je to u ovom bunaru?"
"Šta je to u ovom bunaru?"
03:50
So I began reading everything that
I could get my hands on
I could get my hands on
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Tako sam počela da čitam
sve čega sam dokopala
sve čega sam dokopala
03:53
about how exposure to adversity
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o tome kako izloženost
nepovoljnim uslovima
nepovoljnim uslovima
03:56
affects the developing brains
and bodies of children.
and bodies of children.
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utiče na mozak u razvoju i tela dece.
03:59
And then one day,
my colleague walked into my office,
my colleague walked into my office,
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Onda jednog dana,
kolega je ušao u moju kancelariju,
kolega je ušao u moju kancelariju,
04:03
and he said, "Dr. Burke,
have you seen this?"
have you seen this?"
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i rekao je: "Doktorka Burk,
jeste li videli ovo?"
jeste li videli ovo?"
04:09
In his hand was a copy
of a research study
of a research study
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U ruci je imao kopiju istraživanja
04:13
called the Adverse Childhood
Experiences Study.
Experiences Study.
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nazvanog Studija nepovoljnih iskustava
u detinjstvu.
u detinjstvu.
04:16
That day changed my clinical practice
and ultimately my career.
and ultimately my career.
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Taj dan je promenio moju kliničku praksu
i naposletku i moju karijeru.
i naposletku i moju karijeru.
04:24
The Adverse Childhood Experiences Study
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Studija nepovoljnih iskustava u detinjstvu
04:26
is something that everybody
needs to know about.
needs to know about.
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je nešto što svi treba da znaju.
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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Obavili su je Dr Vins Feliti na Kajzeru
i Dr Bob Anda u CKB-u
i Dr Bob Anda u CKB-u
04:35
and together, they asked 17,500 adults
about their history of exposure
about their history of exposure
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i zajednički su pitali 17 500 odraslih
za njihovu istoriju izloženosti
za njihovu istoriju izloženosti
04:43
to what they called "adverse
childhood experiences," or ACEs.
childhood experiences," or ACEs.
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onome što su nazvali "nepovoljna iskustva
u detinjstvu" ili NID.
u detinjstvu" ili NID.
04:49
Those include physical, emotional,
or sexual abuse;
or sexual abuse;
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Oni uključuju fizičko, emocionalno
i seksualno zlostavljanje;
i seksualno zlostavljanje;
04:53
physical or emotional neglect;
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fizičko i emocionalno zanemarivanje;
roditeljsku mentalnu bolest,
bolest zavisnosti, smeštanje u zatvor;
bolest zavisnosti, smeštanje u zatvor;
04:56
parental mental illness,
substance dependence, incarceration;
substance dependence, incarceration;
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05:00
parental separation or divorce;
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razdvojenost roditelja ili razvod;
05:02
or domestic violence.
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ili nasilje u porodici.
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 se dobija poen na NID skali.
05:09
And then what they did
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A zatim su korelirali te NID rezultate
sa zdravstvenim posledicama.
sa zdravstvenim posledicama.
05:11
was they correlated these ACE scores
against health outcomes.
against health outcomes.
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05:17
What they found was striking.
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Ono što su otkrili je zapanjujuće.
05:19
Two things:
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Dve stvari:
05:21
Number one, ACEs are incredibly common.
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Prvo, NID su neverovatno česta.
05:25
Sixty-seven percent of the population
had at least one ACE,
had at least one ACE,
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67 posto populacije
je imalo bar jedno NID,
je imalo bar jedno NID,
05:32
and 12.6 percent, one in eight,
had four or more ACEs.
had four or more ACEs.
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i 12,6 posto, jedan od osam,
imalo je četiri ili više NID.
imalo je četiri ili više NID.
05:38
The second thing that they found
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Druga stvar koju su otkrili
05:41
was that there was
a dose-response relationship
a dose-response relationship
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je da postoji odnos doze i reakcije
05:44
between ACEs and health outcomes:
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između NID i zdravstvenih posledica:
05:49
the higher your ACE score,
the worse your health outcomes.
the worse your health outcomes.
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što je viši vaš NID rezultat,
gore su vam zdravstvene posledice.
gore su vam zdravstvene posledice.
05:53
For a person with an ACE score
of four or more,
of four or more,
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Za osobu sa NID rezultatom
od četiri ili više,
od četiri ili više,
05:56
their relative risk of chronic
obstructive pulmonary disease
obstructive pulmonary disease
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rizik od hronične opstruktivne
plućne bolesti
plućne bolesti
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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je dva i po puta veći u odnosu na nekog
sa NID rezultatom od nula.
sa NID 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, rizik je takođe
dva i po puta veći.
dva i po puta veći.
06:08
For depression, it was
four and a half times.
four and a half times.
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Za depresiju, četiri i po puta.
06:11
For suicidality, it was 12 times.
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Za sklonost samoubistvu, 12 puta.
06:15
A person with an ACE score
of seven or more
of seven or more
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Osoba sa NID rezultatom od sedam ili više
06:18
had triple the lifetime risk
of lung cancer
of lung cancer
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ima trostruku šansu da dobije rak 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 po puta veći rizik
od ishemijske bolesti srca,
od ishemijske bolesti srca,
06:27
the number one killer
in the United States of America.
in the United States of America.
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ubice broj jedan u Sjedinjenim Državama.
06:31
Well, of course this makes sense.
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Naravno da ovo 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 ljudi su pogledali ove podatke
i rekli: "Ma dajte.
i rekli: "Ma dajte.
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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Kad imate teško detinjstvo,
verovatnije je da ćete da pijete i pušite
verovatnije je da ćete da pijete i pušite
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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i radite sve te stvari
koje će vam uništiti zdravlje.
koje će vam uništiti zdravlje.
06:46
This isn't science.
This is just bad behavior."
This is just bad behavior."
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To nije nauka. 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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Ispostavilo se da upravo tu
nauka dolazi do izražaja.
nauka dolazi do izražaja.
06:55
We now understand
better than we ever have before
better than we ever have before
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Sada razumemo bolje nego ikada pre
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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utiče na mozak u razvoju i tela dece.
07:06
It affects areas like
the nucleus accumbens,
the nucleus accumbens,
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Deluje na oblasti
kao što je nukleus akumbens,
kao što je nukleus akumbens,
07:09
the pleasure and reward
center of the brain
center of the brain
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centar mozga
za zadovoljstvo i nagrađivanje
za zadovoljstvo i nagrađivanje
07:12
that is implicated
in substance dependence.
in substance dependence.
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koji je uključen kod bolesti zavisnosti.
07:14
It inhibits the prefrontal cortex,
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On inhibira prefrontalni korteks,
07:17
which is necessary for impulse control
and executive function,
and executive function,
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koji je neophodan za kontrolu impulsa
i izvršnu funkciju,
i izvršnu funkciju,
07:21
a critical area for learning.
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ključna oblast za učenje.
07:23
And on MRI scans,
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I na MRI skeniranju
07:25
we see measurable differences
in the amygdala,
in the amygdala,
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vidimo merljive razlike u amigdali,
07:29
the brain's fear response center.
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centru mozga za reakciju straha.
07:32
So there are real neurologic reasons
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Dakle postoje stvarni neurološki razlozi
07:35
why folks exposed
to high doses of adversity
to high doses of adversity
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zašto su ljudi izloženi
brojnim nepovoljnim okolnostima
brojnim nepovoljnim okolnostima
07:39
are more likely to engage
in high-risk behavior,
in high-risk behavior,
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skloniji visoko rizičnom ponašanju,
07:42
and that's important to know.
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i 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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Ali ispostavilo se da čak i ako
ne ispoljavate visoko rizično ponašanje,
ne ispoljavate visoko rizično ponašanje,
07:50
you're still more likely
to develop heart disease or cancer.
to develop heart disease or cancer.
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još uvek imate veću šansu
za nastanak bolesti srca ili rak.
za nastanak bolesti srca ili rak.
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 tome ima veze sa
hipotalamičko-hipofizno-adrenalnom osom,
hipotalamičko-hipofizno-adrenalnom osom,
08:02
the brain's and body's
stress response system
stress response system
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moždanim i telesnim sistemom
za reagovanje na stres
za reagovanje na stres
08:05
that governs our fight-or-flight response.
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koji upravlja našim odgovorom
"bori se ili beži".
"bori se ili beži".
08:09
How does it work?
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Kako to funkcioniše?
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 vidite medveda.
i vidite medveda.
08:15
Immediately, your hypothalamus
sends a signal to your pituitary,
sends a signal to your pituitary,
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Istog trenutka, vaš hipotalamus
šalje signal hipofizi,
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 žlezdi koja kaže:
nadbubrežnoj žlezdi koja kaže:
08:22
"Release stress hormones!
Adrenaline! Cortisol!"
Adrenaline! Cortisol!"
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"Otpustite hormone stresa!
Adrenalin! Kortizol!"
Adrenalin! Kortizol!"
08:25
And so your heart starts to pound,
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Tako vaše srce počinje da lupa,
08:28
Your pupils dilate, your airways open up,
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vaše zenice se šire,
disajni putevi se otvaraju,
disajni putevi se otvaraju,
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 da se borite sa medvedom
ili da bežite od njega.
ili da bežite od njega.
08:36
And that is wonderful
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I to je sjajno
08:38
if you're in a forest
and there's a bear.
and there's a bear.
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kada ste u šumi i tu je medved.
08:42
(Laughter)
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(Smeh)
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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Ali problem je šta se desi
kada medved dolazi kući svake noći,
kada medved 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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i ovaj sistem se aktivira
iznova i iznova i iznova,
iznova i iznova i iznova,
08:56
and it goes from being
adaptive, or life-saving,
adaptive, or life-saving,
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i pretvara se od adaptivnog
ili spasonosnog
ili spasonosnog
09:00
to maladaptive, or health-damaging.
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u maladaptivni ili štetan po zdravlje.
09:04
Children are especially sensitive
to this repeated stress activation,
to this repeated stress activation,
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Deca su naročito osetljiva
na tu ponavljanu aktivaciju stresa,
na tu ponavljanu aktivaciju stresa,
09:10
because their brains and bodies
are just developing.
are just developing.
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jer se njihov mozak i telo tek razvijaju.
09:14
High doses of adversity not only affect
brain structure and function,
brain structure and function,
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Mnogo nepovoljnih okolnosti ne samo
da utiče na strukturu i funkciju mozga,
da utiče na strukturu i funkciju mozga,
09:20
they affect the developing immune system,
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utiču na imuni sistem u razvoju,
09:23
developing hormonal systems,
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hormonalne sisteme u razvoju,
09:26
and even the way our DNA
is read and transcribed.
is read and transcribed.
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čak i na način na koji se DNK
čita i preslikava.
čita i preslikava.
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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Za mene je ovaj podatak
odbacio moju staru obuku,
odbacio moju staru obuku,
09:37
because when we understand
the mechanism of a disease,
the mechanism of a disease,
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jer kada razumemo 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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kada znamo ne samo koji putevi
su prekinuti, već i kako,
su prekinuti, 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 je nama kao doktorima zadatak
da koristimo nauku
da koristimo nauku
09:50
for prevention and treatment.
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radi prevencije i tretmana.
09:53
That's what we do.
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To je ono što mi radimo.
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 smo osnovali
Centar za dobrobit mladih
Centar za dobrobit mladih
09:58
to prevent, screen and heal the impacts
of ACEs and toxic stress.
of ACEs and toxic stress.
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da bismo predupredili, pregledali
i zalečili uticaje NID i toksičnog stresa.
i zalečili uticaje NID 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 prosto rutinskim pregledom
svakog našeg deteta
svakog našeg deteta
na njihovom redovnom sistematskom,
10:09
at their regular physical,
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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 ako moj pacijent
ima NID rezultat od 4,
ima NID rezultat od 4,
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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ima dva i po puta veću šansu
da dobije hepatitis ili HOPB,
da dobije hepatitis ili HOPB,
10:19
she's four and half times as likely
to become depressed,
to become depressed,
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četiri i po puta veću šansu
da postane depresivan,
da postane depresivan,
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 12 puta veću šansu da pokuša
da oduzme sebi život
da oduzme sebi život
10:26
as my patient with zero ACEs.
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u odnosu na pacijenta sa nula NID.
10:29
I know that when she's in my exam room.
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To znam kada se nalazi
u mojoj sobi za preglede.
u mojoj sobi za preglede.
10:32
For our patients who do screen positive,
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Za naše pacijente koji se pokažu
kao pozitivni na pregledu,
kao pozitivni na pregledu,
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 multidisciplinarni tim za tretman
koji radi na smanjenju nepovoljnosti
koji radi na smanjenju nepovoljnosti
10:40
and treat symptoms using best practices,
including home visits, care coordination,
including home visits, care coordination,
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i leči simptome koristeći
najbolju praksu, uključujući kućne posete,
najbolju praksu, uključujući kućne posete,
koordinaciju nege,
negu mentalnog zdravlja, ishranu,
negu mentalnog zdravlja, ishranu,
10:46
mental health care, nutrition,
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holističke intervencije, i da,
primenu lekova kada je to neophodno.
primenu lekova kada je to neophodno.
10:50
holistic interventions, and yes,
medication when necessary.
medication when necessary.
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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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Ali takođe edukujemo roditelje
o uticaju NID i toksičnog stresa
o uticaju NID 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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na isti način na koji bismo to činili
kada se radi o pokrivanju utičnica
ili trovanju olovom
ili trovanju olovom
11:05
and we tailor the care
of our asthmatics and our diabetics
of our asthmatics and our diabetics
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i oblikujemo negu
za naše astmatičare i dijabetičare
za naše astmatičare i dijabetičare
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 prepoznaje da im je možda
potreban agresivniji tretman,
potreban agresivniji tretman,
11:13
given the changes to their hormonal
and immune systems.
and immune systems.
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uzevši u obzir njihov
hormonalni i imuni sistem.
hormonalni i imuni sistem.
11:17
So the other thing that happens
when you understand this science
when you understand this science
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Druga stvar koja se desi
kada razumete ovu nauku
kada razumete ovu nauku
jeste to da želite da je razglasite
na sva zvona,
na sva zvona,
11:22
is that you want to shout it
from the rooftops,
from the rooftops,
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11:25
because this isn't just an issue
for kids in Bayview.
for kids in Bayview.
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jer to nije samo problem dece u Bejvjuu.
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 onog trenutka
kada svi ostali čuju za ovo,
kada svi ostali čuju za ovo,
11:33
it would be routine screening,
multi-disciplinary treatment teams,
multi-disciplinary treatment teams,
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to će biti rutinski pregled,
timsko multidisciplinarno lečenje,
timsko multidisciplinarno lečenje,
11:36
and it would be a race to the most
effective clinical treatment protocols.
effective clinical treatment protocols.
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da će se takmičiti ko će imati
najefikasnije kliničke protokole lečenja.
najefikasnije kliničke protokole lečenja.
11:41
Yeah. That did not happen.
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Kako da ne. To se nije dogodilo.
11:45
And that was a huge learning for me.
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To je bila velika stvar koju sam naučila.
11:48
What I had thought of as simply
best clinical practice
best clinical practice
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Ono što sam smatrala jednostavno
najboljom kliničkom praksom
najboljom kliničkom praksom
11:53
I now understand to be a movement.
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sada shvatam da je pokret.
11:57
In the words of Dr. Robert Block,
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Rečima Dr. Roberta Bloka,
11:59
the former President
of the American Academy of Pediatrics,
of the American Academy of Pediatrics,
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bivšeg predsednika
Američke akademije pedijatara:
Američke akademije pedijatara:
12:03
"Adverse childhood experiences
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"Nepovoljna iskustva u detinjstvu
12:06
are the single greatest
unaddressed public health threat
unaddressed public health threat
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su najveća nerazmotrena opasnost
po javno zdravlje
po javno zdravlje
12:11
facing our nation today."
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sa kojom se naša zemlja danas suočava."
12:13
And for a lot of people,
that's a terrifying prospect.
that's a terrifying prospect.
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Za mnoge, ovo su užasavajući izgledi.
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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Obim i razmere problema deluju
tako veliko da se čini nesavladivo
tako veliko da se čini nesavladivo
12:24
to think about how we might approach it.
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razmišljati o tome kako da mu pristupimo.
12:26
But for me, that's actually
where the hopes lies,
where the hopes lies,
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Ali za mene, upravo tu leži nada,
12:31
because when we have the right framework,
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jer kada imamo pravi okvir,
12:33
when we recognize this to be
a public health crisis,
a public health crisis,
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kada prepoznamo da je ovo
kriza u javnom zdravlju,
kriza u javnom zdravlju,
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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tada možemo početi da koristimo
pravi alat da dođemo do rešenja.
pravi alat da dođemo do rešenja.
12:43
From tobacco to lead poisoning
to HIV/AIDS,
to HIV/AIDS,
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Od duvana i trovanja olovom do side,
12:47
the United States actually has
quite a strong track record
quite a strong track record
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5013
Sjedinjene Države zapravo imaju
prilično jake rezultate
prilično jake rezultate
12:52
with addressing public health problems,
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u rešavanju problema javnog zdravlja,
12:55
but replicating those successes
with ACEs and toxic stress
with ACEs and toxic stress
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ali za ponavljanje tih uspeha
sa NID i toksičnim stresom
sa NID i toksičnim stresom
13:01
is going to take determination
and commitment,
and commitment,
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biće potrebna odlučnost i posvećenost,
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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i kada pogledam na to kakav je odgovor
naše zemlje bio do sada,
naše zemlje bio do sada,
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 ovo nismo uzeli ozbiljnije?
13:15
You know, at first I thought
that we marginalized the issue
that we marginalized the issue
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Znate, prvo sam pomislila
da smo marginalizovali ovaj problem
da smo marginalizovali ovaj problem
13:19
because it doesn't apply to us.
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jer se ne odnosi na nas.
13:21
That's an issue for those kids
in those neighborhoods.
in those neighborhoods.
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To je problem one tamo dece
u onim tamo krajevima.
u onim tamo krajevima.
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 podaci to ne pokazuju.
13:28
The original ACEs study
was done in a population
was done in a population
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Izvorno NID istraživanje
je obavljeno u populaciji
je obavljeno u populaciji
13:32
that was 70 percent Caucasian,
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koja je bila 70 posto bele rase.
13:35
70 percent college-educated.
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70 posto fakultetski obrazovanih.
13:38
But then, the more I talked to folks,
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Ali onda, što sam više pričala sa ljudima,
13:42
I'm beginning to think that maybe
I had it completely backwards.
I had it completely backwards.
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počela sam da pomišljam
da sam možda sve naopako shvatila.
da sam možda sve naopako shvatila.
13:47
If I were to ask
how many people in this room
how many people in this room
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Kada bih pitala
koliko je ljudi u ovoj prostoriji
koliko je ljudi u ovoj prostoriji
odraslo sa članom porodice
koji je patio od mentalne bolesti,
koji je patio od mentalne bolesti,
13:53
grew up with a family member
who suffered from mental illness,
who suffered from mental illness,
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13:57
I bet a few hands would go up.
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2466
kladim se da bi se nekoliko ruku podiglo.
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 ako bih pitala koliko je vas
imalo roditelja koji je možda previše pio,
imalo roditelja koji je možda previše 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 je zaista verovao
da je batina iz raja izašla,
da je batina iz raja izašla,
14:11
I bet a few more hands would go up.
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kladim se da bi se još nekoliko
ruku podiglo.
ruku podiglo.
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 pitanje
koje se tiče mnogih od nas,
koje 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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pa počinjem da verujem
da marginalizujemo problem
da marginalizujemo problem
14:22
because it does apply to us.
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2596
jer se odnosi na nas.
14:25
Maybe it's easier to see
in other zip codes
in other zip codes
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Možda ga je lakše videti sa udaljenosti
14:28
because we don't want to look at it.
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jer ne želimo da ga sagledamo.
14:31
We'd rather be sick.
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2078
Radije bismo bolovali.
14:34
Fortunately, scientific advances
and, frankly, economic realities
and, frankly, economic realities
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Srećom, napredak nauke i,
iskreno govoreći, ekonomska stvarnost
iskreno govoreći, ekonomska stvarnost
14:40
make that option less viable every day.
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svakim danom čine tu opciju
manje održivom.
manje održivom.
14:45
The science is clear:
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1587
Nauka je jasna:
14:48
Early adversity dramatically affects
health across a lifetime.
health across a lifetime.
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875991
4949
rane nepovoljne okolnosti drastično utiču
na zdravlje tokom života.
na zdravlje tokom života.
14:54
Today, we are beginning to understand
how to interrupt the progression
how to interrupt the progression
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Danas počinjemo da razumemo
kako da prekinemo širenje niza
kako da prekinemo širenje niza
14:58
from early adversity
to disease and early death,
to disease and early death,
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4301
od ranih nepogodnosti
do bolesti i preuranjene smrti,
do bolesti i preuranjene smrti,
15:03
and 30 years from now,
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2525
i za 30 godina,
15:05
the child who has a high ACE score
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2508
dete koje ima visok NID rezultat
15:08
and whose behavioral symptoms
go unrecognized,
go unrecognized,
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i čiji simptomi u ponašanju
nisu prepoznati,
nisu prepoznati,
15:11
whose asthma management
is not connected,
is not connected,
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2700
čija kontrola astme je nepovezana,
15:13
and who goes on to develop
high blood pressure
high blood pressure
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i koje razvije visok krvni pritisak
15:17
and early heart disease or cancer
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2844
i rano srčano oboljenje ili rak
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
biće podjednako neuobičajeno
kao šestomesečna smrtnost od side.
kao šestomesečna smrtnost od side.
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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4485
Ljudi će videti tu situaciju i reći:
"Šta se, dođavola, ovde dogodilo?"
"Šta se, dođavola, ovde dogodilo?"
15:30
This is treatable.
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2287
Ovo je moguće lečiti.
15:32
This is beatable.
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Ovo je moguće pobediti.
15:35
The single most important thing
that we need today
that we need today
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Najvažnija stvar
koja nam je potrebna danas
koja nam je potrebna danas
15:39
is the courage to look
this problem in the face
this problem in the face
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jeste hrabrost da gledamo
ovom problemu u lice
ovom problemu u lice
15:43
and say, this is real
and this is all of us.
and this is all of us.
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5072
i kažemo, ovo je stvarno i ovo smo svi mi.
15:48
I believe that we are the movement.
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4737
Ja verujem da smo mi pokret.
15:53
Thank you.
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Hvala.
15:54
(Applause)
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(Aplauz)
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