Living in Tumultuous Times: Responding to the "Hidden" Public Health Crisis in the U.S.

Living in Tumultuous Times: Responding to the “Hidden” Public Health Crisis in the U.S.

We live in tumultuous times.  Although our minds might immediately take us to issues with North Korea, or ISIS, or the dysfunction in Washington D.C., these are not the primary focus of this article.  Washington’s dysfunction over the past couple decades is a contributing factor, yet the dynamics discussed here go far beyond our nation’s capital.

With the ongoing focus on the Affordable Care Act, health issues are at the forefront.  What is missing is a recognition of the deeper public health crisis facing our society.  The crisis is real, and in many ways it is undermining our society at its core.  It stems largely from pervasive stress and trauma in our society from a range of sources.

 What is the face of this crisis?

•  Suicide is the second leading cause of death in the U.S. for ages 10-24 (U.S. Centers for Disease Control (CDC)); suicide rates for girls and women have significantly increased in the past 15 years, with the largest increase among girls 10-14, which has tripled.

•  Often considered the “wealthiest country in the world,” one in three children live in poverty in the U.S. (this ranks 36^th out of 41 “wealthy” countries studies, UNICEF); in 2012 more than 24 million children were living in poverty in the U.S.!

• In a study of 27 “wealthy” countries (CDC), the U.S. had the highest rate of infant mortality, despite healthcare spending levels higher than any other country in the world.

• More American women are dying of pregnancy-related complications than in any other developed country in the world; only the U.S. rate of women who die associated with pregnancy has been rising! (NPR and ProPublica).

• Nearly 21 million Americans ages 12 and older had substance use issues in 2015 (SAMHSA); there are many reasons for substance abuse – but a direct link exists with childhood and other life trauma.

• 78 million Americans are obese with its associated health hazards; it is estimated that six million obese people have suffered physical, sexual and/or verbal abuse during their childhoods (CDC).

• One in 10 children are abused, mostly by a family member or someone they know; research shows that children who have been abused or exposed to family violence have changes in brain activity similar to that seen in combat veterans (Current Biology).

• A study of former foster youth aged 23 and 24 found more than half were unemployed, almost 25 percent had been homeless, more than 75 percent of young women had been pregnant, nearly 60 percent of young men had been convicted of a crime, and only 6 percent had a 2- or 4-year degree; 90-percent of children in foster care have experienced a traumatic event, with nearly half reporting exposure to four or more types of traumatic events (Stein et al., 2001).

• One in six Americans take some kind of psychiatric drug, mostly antidepressants (JAMA).

• More simplistic yet telling is that the number of fatalities involving enraged drivers (road rage) has increased nearly ten times since 2004 (NHTSA); incidents involving brandishing or firing a gun at another driver or passenger have more than doubled in just the last three years.

Although thankfully we could cite some improvements in public health and well being (such as the sharp decline in violent crime during the past 25 years), the trends identified tell us many people in the U.S. are living with a high level of stress, anger, fear and/or despair – and lives are being lost.  The indicators cited arguably reflect the pervasive impacts of trauma or imposition of trauma within our society.  And tragically, it is often family dysfunction and trauma which are the underlying causes --- this is the public health crisis that needs to be addressed.  Living in the wealthiest country in the world has not translated into better health, a sense of peace or contentment with life for many. 

Can a truly civil society fail to pay attention and respond to the challenges being faced by so many?  While our politicians hunker down in their ideological bunkers, our people – and our nation – pay the price, literally and figuratively.  The signs are already there.  It is not outlandish to suggest that the state of public health in the U.S. should be considered on equal terms with concerns about terrorism and other “threats” to our society and its people.  

While most national leaders seem to be asleep at the wheel, the rest of our society need not be.  Many states and local communities are taking action.  They are realizing it is foolish and callous to avoid our nation’s public health concerns, which clearly have long-term implications not only to individuals but to the health, economy and even the sustainability of our society as we know it, or perhaps more pointedly as we remember it. 

So how might we start to address this crisis?  We cannot afford to avoid the realities, yet realistically we cannot expect progress until we create a critical mass of concerned leaders.  First, we need to work past the white privilege mentality in Washington D.C. and the halls of government that has subjected many to second class citizenship status and resulting trauma.  Second, we need to push our society towards where it aspires – to be a place where a good education and opportunities are available to all, where we provide pathways to meaningful employment and where we mentor those seeking and striving to improve themselves, their community and society at large.  Third, recognizing excessive trauma is the source of many of our public health concerns, work to reduce trauma in families and incorporate trauma-informed principles into our government institutions, schools, businesses, justice systems and religious organizations.  Fourth, as recommended by Nobel Economics Laureate Dr. James Heckman, invest heavily in early childhood education and development, especially for low income families.  Finally, be courageous enough to recognize that love and compassion, not always discussed in the public square, form a foundation for helping struggling families, which are at the heart of our public health crisis. 

 We must not wait on Washington and other stagnant institutions, although we should push hard for change.  We need to start with what each of us can do in the communities where we live to make them bastions of trauma-informed practices and principles that lead to healing, wholeness and fresh opportunities.  This level of concern and action serves as the basis for a truly healthy, civil society.