What has a higher impact on our Health? Using medications or having the basic needs?

Our healthcare system is broken. Our nation is in “sickcare” mode. The typical entry point into medical care is in the ER or the urgent care clinic, when something is wrong. The clinician’s office visit allows only enough time to go through medications and cursorily address complaints. Oftentimes, the very source of a health problem is put aside for later – which never comes – or thrown out, rather than being addressed directly.

When I was training, one of my attendings didn’t want to hear anything about social history when we presented the patients. On one side, it seemed superfluous to the problem and slowed the presentation down, but, on the other hand, social factors and behaviors completely interact with our health. Within this information lies often the source of the risk factors to an illness.

If you wanted to know how much a person is at risk for health issues, you need only broach the topic of childhood trauma – which undermines the basic needs of safety and shelter:

When 17,000 members from an HMO in SoCal were asked to fill out a survey on trauma or adverse childhood experiences (ACEs), two-thirds of participants reported at least one ACE; one in five reported three or more Aces. A dose-response of ACEs was seen with regards to health outcomes – depression, alcohol abuse, COPD, liver disease, risk of partner violence, heart disease.

A nice website link for details of the ACE and how the study relates to chronic diseases.

Likely, what is at play are changes in our brains in the setting of trauma that predispose us to future unhealthy behaviors. The changes likely have to do with neurotransmitter or endocrine signaling, e.g. cortisol produced in adrenal gland regulated by hypothalamus-pituitary-adrenal axis. This is a signal for “fight or flight”. I have written a few earlier blogs that can go into more detail about this. Trauma primes the brain for behavioral loops, including an increased sensitivity for cocaine and an “addictive personality”. Developing obesity has been strongly correlated with trauma as well.

What are we to do? 
We are not doomed like Sisyphus to repeat the behaviors that lead to the same harmful consequences. We are not victims but survivors. The brain can modify its function to lead to new behaviors. The brain can change and reorganize its connections from the inside – the concept of neuroplasticity – without the need for lifelong medications or therapy. Stemming from this is mindfulness and living in the “now” rather than being anchored down by our past experiences.

Basic needs like shelter, safety, food, water and clothing are the strongest health determinants. We must ensure that we and our sphere of influence, loved ones, friends and family are getting those needs met .. Starting with ourselves first.

In the hospital, we often must face the dilemma of providing medical care to a person without a social support web or resilience / coping skills. A person who is homeless is admitted for an abscess in the setting of intramuscular injections “muscling” and is found to have a chronic health problem, like diabetes or hypertension. We are eager to treat the diabetes or the hypertension with any of the treatment options available and check that off the list. The likelihood of her filling the prescription – zero. How do we address the most difficult situation about her healthcare, no shelter, no social support and no resilience mechanism (beaten down from drug abuse and prior trauma)? The basic needs are like the base of a house of cards — without a stable base, all the cards fall.

When those basic needs are addressed and a person is in a stable social system free of abuse and trauma, a person can then press onward on the path toward wellness. Our fear of safety diminishes and we can then focus on development — rather than flight or flight. We can then develop a bridge to others through love, gratitude and creativity.

I leave you with this message on Wednesday:

Let the light of your creativity shine for all to see, breaking free from any shame, guilt or trauma that you suffered. It may just be the first step to finding wellness in your life.

Reading:
Relationship of Childhood Abuse and Household Dysfunction to Many Leading Causes of Death. Am Journ Prev Med. 1998. 14:245-258.