Letter from Dr. Robert Anda

I always knew there was suffering in the world.

As a physician with a career in preventive medicine and epidemiology. I saw that we could treat lung cancer or heart disease or diabetes, but that it was difficult to persuade people to change their behavior. I had the sense that I was looking at the wrong end of the horse. I decided to investigate the emotional origins of health-related behaviors and disease.

With the first publication from the Adverse Childhood Experiences (ACE) study, published in 1998, we looked broadly at 10 categories of childhood adversity, including abuse, neglect and family dysfunction. We asked about emotional, physical and sexual abuse, growing up in a home where there was substance abuse, having a family member who was in prison or who had a mental illness, and having parents who were separated or divorced.

Today I believe that adverse childhood experiences and the wide-ranging health and social problems they generate are our Nation’s leading public health problem—bar none.  ACEs are highly predictive of many of our Nation’s worst health and social problems. The good news, however, is that what is predictive is preventable.  The Community Resilience Cookbook is a wonderful compilation of the basic science and early experience of a variety of communities that have created their own innovative responses to this problem. The stories reflect many common themes, as well as unique examples of emerging successful approaches.

The ACE Study and related findings from surveys and studies across the country are generating a movement that, coupled with the concept of being “trauma-informed,” is spreading rapidly. However, my personal belief—based upon my experience with public health approaches to preventing and treating problems such as cardiovascular disease and cancer that I participated in at the Centers for Disease Control and Prevention (CDC)– is that any approach to a major public health problem must necessarily include broad-based public education.  In fact, an informed public is often the major driving force for change.

You will learn that ACEs are common–in fact the number of people affected by ACEs outnumbers those who have not been affected by ACEs.   Our country cannot generate enough funding for services and systems to adequately address this problem.  I have seen people, however, who begin to understand how ACEs have affected their lives be empowered to take responsibility and change their lives, the lives of their children and families, and become a force for change and resilience in their communities. I believe that this is where the greatest power of healing and resilience resides. As you read the stories in the Community Resilience Cookbook you will find this common theme among them.

This movement is new and there are many communities across the country that it has not reached. The Cookbook provides examples for them that may catalyze awareness and then participation. The stories can accelerate the pace to build a trauma informed nation – a nation where the average person works in synergy with the systems, service providers, policy makers, and legislators to create sustainable changes that reduce the intergenerational transmission of ACEs by helping those affected by them to heal—or even to transcend their effects. However, without broad support and engagement of people affected by ACEs, the growth and sustainability of the types of changes described in the Cookbook are in jeopardy.

While there is obviously no step-by-step recipe or exact protocol to be followed to activate this movement, the intent of the cookbook theme is to generate hope and a call to action using the examples it contains.

We are rapidly learning from a wide range of communities, about how they are understanding and applying the science of ACEs, to come up with creative and collaborative ideas and responses. While we continue to learn and work, let the darkness and breadth of the adversities that our families and children face, continue to motivate us to action. We can take hope in the creative and emerging movement of prevention and healing that the stories in the Community Resilience Cookbook represent.

 Rob Anda, MD, MS
Co-Principal Investigator and Co-Founder
Adverse Childhood Experiences (ACE) Study
and Co-Founder ACE Interface