**7. ACEs and implications on international health security**

The challenges of chronic disease are evident and encountered not merely by the individual and their support system, but by the healthcare system. The increase in incidence of chronic disease increases direct and indirect healthcare costs that have significant implications on the economy and the ensuing measures to address this problem. It is apparent that adverse childhood experiences (ACEs) considerably contribute to the development of chronic disease as an adult through a higher likelihood of engaging in high-risk, health-harming behaviors, characteristically used as maladaptive coping mechanisms to contest traumatic experiences. It is approximated that 1 billion children, ages 2–17, are anticipated to have encountered an adverse childhood experience as previously described [17]. ACEs are avertible by creating safe and stable childhood settings that encourage less health-harming behaviors used as a strategy to cope with suicidal behavior, substance abuse, etc. [18]. Additionally, stable settings support academic achievement and the possibility to overcome poverty, recognized as a contributor to instances of ACE and perchance an ACE itself.

International health surveillance and initiatives that promote preventative measures on a practitioner level are paramount to address this destructive trend [19]. Said initiatives are beginning to appear in an attempt to address the important implications ACEs have on chronic disease as an adult. Primary and secondary prevention is essential in creating a nonviolent and encouraging environment for children. This includes a surveillance system that is comprehensive, cooperative and effective in identifying vulnerable individuals like a Behavioral Risk Factor Surveillance System (BRFSS). This system provides statistics on ACEs throughout a child's early years. Irrespective of the specific survey utilized, it is important to include trauma-informed practices that possess the empathy essential by primary care practitioners to initiate critical conversations and promote appropriate childhood practices, especially in children that have previously encountered an ACE [20]. It is imperative that individuals that are affected by ACEs be medically managed by clinicians accustomed to their particular health risks and resource for intervention. Initiatives like supplementary feeding programs and targeted food distribution may be initiated in regions where a demonstrated burden of food insecurity including micronutrient deficiency or acute malnutrition is present [21]. In conflict zones, disease prevention including vaccination campaigns, civil protection authorities including legal aid and academic training would be crucial in addressing the detriment of displacement. Tertiary prevention via rehabilitation programs that assist in diminishing high-risk, health-harming behaviors that propagate chronic disease like smoking cessation. Individuals with mental illness like depression, PTSD, etc. need access to appropriate psychiatric management. By enacting these preventative and promotional strategies on a state and national level, it is reasonable to reverse forthcoming projections pertaining to the negative implications of chronic disease on the patient population and healthcare system as an entity.

#### **8. Conclusion**

Unfortunately, ACEs are acknowledged to be prevalent and pervasive in society. Slightly under 50% of individuals under the age of 18 admit to an exposure to at

**177**

*The Relationship of Adulthood Chronic Disease and Adverse Childhood Experiences (ACEs)…*

least 1 ACE. An increase in odds ratio for maladaptive, high-risk behavior and morbidities increased as ACE scores increased to 4 or more. Therefore, a strong dose-response relationship exists pertaining to the number of ACEs encountered and the likelihood that health-harming behavior contributes to premature death in individuals diagnosed as having a chronic disease, particularly maladaptive coping mechanisms such as substance abuse and suicidality. Additionally, exposures to ACEs in itself predisposes individuals to chronic disease in their adulthood through proposed mechanisms like the Biological Embedding of Childhood Adversity Model and the negative determents of chronic inflammation described as allosteric load [22]. Because of the prevalence and immense impact ACEs have on patient populations and international health including the censorious concepts like conflict, displacement and food insecurity, it is important to implement appropriate intervention and prevention to diminish the prevalence of ACEs in high-risk patient

*DOI: http://dx.doi.org/10.5772/intechopen.93520*

populations.

**Author details**

Easton, PA, USA

, Christine Marchionni1

\*Address all correspondence to: bankim.bhatt@sluhn.org

provided the original work is properly cited.

and Bankim Bhatt2

1 Department of Psychiatry, St. Luke's University Health Network, Easton, PA, USA

2 Division of Endocrinology and Metabolism, St Luke's University Health Network,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

\*

Jordan Holter1

*The Relationship of Adulthood Chronic Disease and Adverse Childhood Experiences (ACEs)… DOI: http://dx.doi.org/10.5772/intechopen.93520*

least 1 ACE. An increase in odds ratio for maladaptive, high-risk behavior and morbidities increased as ACE scores increased to 4 or more. Therefore, a strong dose-response relationship exists pertaining to the number of ACEs encountered and the likelihood that health-harming behavior contributes to premature death in individuals diagnosed as having a chronic disease, particularly maladaptive coping mechanisms such as substance abuse and suicidality. Additionally, exposures to ACEs in itself predisposes individuals to chronic disease in their adulthood through proposed mechanisms like the Biological Embedding of Childhood Adversity Model and the negative determents of chronic inflammation described as allosteric load [22]. Because of the prevalence and immense impact ACEs have on patient populations and international health including the censorious concepts like conflict, displacement and food insecurity, it is important to implement appropriate intervention and prevention to diminish the prevalence of ACEs in high-risk patient populations.
