July 12, 2017; New York Times
A New York Times article from last week describes how severe ongoing stress can affect a child’s brain. The article focuses on the treatment of children for whom the toxic stress of day-to-day survival results in learning disabilities, behavioral abnormalities, and possibly metabolic and immunological impairments.
Mounting research on potential biological dangers of toxic stress is prompting a new public health approach to identifying and treating the effects of poverty, neglect, abuse and other adversity. While some in the medical community dispute that research, pediatricians, mental health specialists, educators and community leaders are increasingly adopting what is called “trauma-informed” care.
Clearly, the focus of the Times piece is on medical efforts to diagnose and treat these young victims. One hopes, however, that a public health approach to toxic stress might also examine and treat the root causes of the problem. Waiting for children to be damaged by poisonous environments and then providing them with remediation treatments seems remarkably similar to the strategy used to address lead poisoning for the past several decades.
Toxic stress is not a new diagnosis. A 2013 op-ed from the NYT “Opinionator” blog roundup column identifies the role of the parent in creating a safe environment for the child and spotlights the work of Child First, a program pioneered in Shelton, Connecticut, that focuses on improving parenting skills. Alas, asking families to build stable homes for at-risk children is unrealistic when those families are overwhelmed by the challenges of toxic neighborhoods. Lack of community supports like affordable and reliable daycare, living-wage jobs, and safe housing can quickly defeat the most carefully prepared parents.
A brand new study reported in Science Daily shows that since the Great Recession, a higher percentage of children are living in economically impacted neighborhoods—the kind that generate toxic stress. One of the study authors, Rachel Kimbro, expresses the hope that “the research will shed light on the impact of neighborhoods on academic success and will allow educators and policymakers to design interventions to help underperforming students.” It’s another example of remedial treatment instead of prevention.
In each of these reports, the challenge is seen to be developing new ways to diagnose and treat children who suffer from toxic stress. Much less attention is given to prevention. While the Times article acknowledges the sociogenic roots of toxic stress, the social interventions recommended are modest and post-diagnostic. The article cites a 2016 study that urged “pediatricians to routinely screen families for poverty and to help those affected find food pantries, homeless shelters and other resources.” One has to ask, how’s that treatment working?
While there’s a growing movement among medical professionals to prescribe real social treatments, the pace of change is glacial and the threat of healthcare “reform” is ever-present. Social activists working in non-medical, nonprofit settings must poke, prod, cajole, and shame the medical establishment to “prescribe housing.” The moment calls for social activism among housing providers, social service providers, and advocates for the poor. The evidence of the connection between location and toxic stress could not be clearer. It is the political will to end social and economic inequality that is lacking.
Scattered examples of collaboration among housing advocates and medical professionals are promising, but the collaborations are still dominated by medicine’s treatment model and medical providers capital investment interests. Politico this week offers a profile of efforts by the Cleveland Clinic to transform its neighborhood by supporting a new transportation corridor through its inner city neighborhood and new business development on the periphery of the medical campus. Meanwhile, their low-income neighbors are suffering from lead poisoning and toxic stress at alarming levels.
Here’s what we know can make a difference: universal rental assistance and universal legal representation in eviction court. Think of it as the Matthew Desmond prescription. For seasoning, add in source-of-income protections for tenants with federal assistance, and home search supports for geographic mobility. None is perfect, but even modest changes in the household housing supports can make a profound difference. The time to start is now.—Spencer Wells