Salus Health Care Forum July 2, 2025

The fourteenth Salus Health Care Forum was convened on July 2, 2025. In attendance were Mitch Applegate, William Bergquist, Jerome Fish, Bill Gillanders, Walt Mills, Mark Vukalcic, and Jack Westfall. A special guest was invited to participate in this forum: Craig McEwen, Daniel B. Fayerweather Professor of Political Economy and Sociology Emeritus at Bowdoin College.  The Trigger topic for this forum was provided by Dr. McEwen, who reported on the Adverse Childhood Experience Study that he helped to conduct. Results from this study have inform the way health care is provided and promoted in contemporary times. . .

Following is a narrative based on this Salus conversation:

Craig

My presentation today this about the Adverse Childhood Experiences Study, which I assume you know, but the wider audience may not, done in 1998 with adult Kaiser Permanente patients and discovered that childhood adversities self-reported by them were related to the frequency of a variety of adult health issues, ranging from heart disease, cancer, chronic lung disease, and to behavioral health issues like alcoholism and drug abuse.

They identified what are now 10 categories of adversities: sexual abuse, physical abuse, verbal abuse, physical and emotional neglect, and household dysfunction, divorce, spousal violence, imprisonment of an adult, mental illness, or substance abuse of a household member. And if you count each one of those 10 as a point, if an individual experienced them before the age of 16, you get an ACE score of 0 to 10. And that ACE score has been widely used and problematically used.

The ACE study itself didn’t recognize the biological mechanisms that are at work in translating adversity into health and behavioral issues. Indeed, the authors focused almost entirely on a linkage through health, behavioral health issues that they thought were psychologically compensating for adversity, smoking, overeating, drug and alcohol use. The link to toxic stress came at a parallel through the work of my brother and others reflected in the work of the MacArthur Network on SES and socioeconomic status and health between 1996 and 2008.