02/05/2020
“Social determinants of health” are buzzwords floating in nearly every circle of public health these days. And they should be, as there is mounting evidence that environmental exposure shapes human disease. In 1998, the Centers for Disease Control released its landmark study on adverse childhood events (ACE), drawing links between childhood stressors, disease, social concerns and risk of early death.
The ACE study has been emphasized in trauma-informed work in the mental health sector, yet it was conducted on individuals who were predominantly White and middle-class. No similarly scaled study has ever been conducted with African-American youth or adults.
The one study I found on low-income urban youth included just 119 participants, of multiple races (compared to 17,000 in the ACE research) (Wade et al, 2014). That’s problematic. Any person who has ever worked with predominately African-American populations, especially low-income people, know that our lives are full of adverse events—whether experienced at home, in the community or within institutions. We need to look at these determinants of African-American mental health if we are to support recovery, healing and hope.
Last year, when I first learned about the ACE study, I decided to take the 10-question survey that was used by its researchers. I easily scored 9 out of 10 possible points. I was born in rural South Carolina in the late 1970s. My biological parents and my stepfather all had direct experiences with Jim Crow segregation laws, Klan violence and domestic violence, before I was born. I was raised by highly traumatized people to begin with. When we moved to the South Bronx in 1982, it was literally on fire. Divestment, the proliferation of drugs and “White Flight” caused the Bronx to collapse into urban decay. Our city-owned apartment was dilapidated, infested with vermin. We lived on less than $10K a year. Though my mother came here to escape racism, my K-8 schools were both segregated and under-funded. The violence I experienced and witnessed began early. When my family refused to let dealers sell drugs in our building, they attempted to kill us. I was just five years old. We had to pass the bullet holes they left in the door and outside walls every day. Community shootings occurred so frequently that all the kids in my neighborhood were trained to hit the floor as soon as we heard gunshots to avoid stray bullets. I witnessed significant numbers of people succumb to the crack-cocaine and HIV epidemics, including relatives. Intravenous drug use was so commonplace, it was difficult not to step on needles when walking down the street. Even worse, I suffered sexual assaults by multiple perpetrators before the age of 18.