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  • In the mid-'90s,


  • the CDC and Kaiser Permanente

    アメリカ疾病予防管理センターと カイザーパーマネンテは

  • discovered an exposure that dramatically increased the risk

    あるものに晒されるとアメリカでの トップ10死因のうち7つのリスクが

  • for seven out of 10 of the leading causes of death in the United States.


  • In high doses, it affects brain development,


  • the immune system, hormonal systems,

    免疫システム ホルモンシステム

  • and even the way our DNA is read and transcribed.

    そしてDNAの読み取りや 転写にも影響し

  • Folks who are exposed in very high doses


  • have triple the lifetime risk of heart disease and lung cancer

    心臓疾患や肺癌にかかるリスクが 生涯3倍にも高まり

  • and a 20-year difference in life expectancy.


  • And yet, doctors today are not trained in routine screening or treatment.

    しかし今日の医師はそれに対する一般的な スクリーニングや治療の訓練を受けていません

  • Now, the exposure I'm talking about is not a pesticide or a packaging chemical.

    今から私がお話しするその危険とは 殺虫剤や化学物質の事ではありません

  • It's childhood trauma.


  • Okay. What kind of trauma am I talking about here?

    さて どんなトラウマのことでしょうか

  • I'm not talking about failing a test or losing a basketball game.

    試験に落第したり バスケの試合に 負けたりすることについてではありません

  • I am talking about threats that are so severe or pervasive

    私がお話するのは 文字通り人を苛立たせ

  • that they literally get under our skin and change our physiology:

    私たちの生理機能を変えるような非常に 深刻であまねく広がっている

  • things like abuse or neglect,


  • or growing up with a parent who struggles with mental illness

    精神病に苦しんだり薬物依存の 親の下で育つといった

  • or substance dependence.


  • Now, for a long time,


  • I viewed these things in the way I was trained to view them,

    私は訓練された通りに 物事を見ていました

  • either as a social problem -- refer to social services --


  • or as a mental health problem -- refer to mental health services.

    精神衛生問題は精神病院に 委ねられるというようにです

  • And then something happened to make me rethink my entire approach.

    そしてその後 自分のアプローチ全体を 考え直す出来事が起こったのです

  • When I finished my residency,


  • I wanted to go someplace where I felt really needed,


  • someplace where I could make a difference.


  • So I came to work for California Pacific Medical Center,

    そこで私は北カリフォルニアで 最も優れた私立の病院である

  • one of the best private hospitals in Northern California,

    カリフォルニアパシフィック メディカルセンターで働き 同時に

  • and together, we opened a clinic in Bayview-Hunters Point,

    ベイビューハンターズポイントに 医院を開設することにしました

  • one of the poorest, most underserved neighborhoods in San Francisco.

    そこは サンフランシスコで 最も貧しく 医療サービスが十分でない地区の一つでした

  • Now, prior to that point,


  • there had been only one pediatrician in all of Bayview

    ベイビューに 小児科医は たった一人しかいませんでした

  • to serve more than 10,000 children,


  • so we hung a shingle, and we were able to provide top-quality care

    そこで私たちは大きな看板を掛け 支払能力にかかわらず

  • regardless of ability to pay.


  • It was so cool. We targeted the typical health disparities:

    とても上手く行きました 私たちは典型的な 健康格差をなくす事

  • access to care, immunization rates, asthma hospitalization rates,

    つまり受診率 ワクチン接種率 喘息の入院率を上げる事を目標にしました

  • and we hit all of our numbers.


  • We felt very proud of ourselves.

    私たちは自らをとても 誇らしく思っていました

  • But then I started noticing a disturbing trend.

    しかしその時 気がかりな傾向に 気づき始めました

  • A lot of kids were being referred to me for ADHD,

    多くの子供たちが 注意欠陥多動性障害 つまり

  • or Attention Deficit Hyperactivity Disorder,

    ADHDの事で 紹介を受けるようになったのです

  • but when I actually did a thorough history and physical,

    しかし実際 十分に病歴を調べ 十分に診察を行うと

  • what I found was that for most of my patients,


  • I couldn't make a diagnosis of ADHD.


  • Most of the kids I was seeing had experienced such severe trauma

    私が診ていた子供たちは とても深刻なトラウマを体験していたので

  • that it felt like something else was going on.

    どういうわけか 何か重要な事を 見逃していたのです

  • Somehow I was missing something important.

    どういうわけか 何か重要な事を やり損なっていたのです

  • Now, before I did my residency, I did a master's degree in public health,

    私はレジデントの前に公衆衛生学で 修士課程を修めました

  • and one of the things that they teach you in public health school

    学校の公衆衛生学の授業で 教えられることの一つは次のような事です

  • is that if you're a doctor


  • and you see 100 kids that all drink from the same well,

    同じ井戸から水を飲む100人の 子どもたちを診るとします

  • and 98 of them develop diarrhea,


  • you can go ahead and write that prescription

    立て続けに 次から次へと

  • for dose after dose after dose of antibiotics,


  • or you can walk over and say, "What the hell is in this well?"

    しかし歩み寄ってこう言うこともできるのです 「一体この井戸の中になにがあるんだ?」

  • So I began reading everything that I could get my hands on


  • about how exposure to adversity

    如何に子供の脳と体に 影響するのかについて

  • affects the developing brains and bodies of children.

    書かれた物 全てを手に入れ 読み始めました

  • And then one day, my colleague walked into my office,

    そしてある日 同僚が診察室に入って来てこう言いました

  • and he said, "Dr. Burke, have you seen this?"

    「バーク先生 これ見ましたか?」

  • In his hand was a copy of a research study


  • called the Adverse Childhood Experiences Study.

    Adverse Childhood Experience (ACE,小児期逆境体験)Studyでした

  • That day changed my clinical practice and ultimately my career.

    その日から私の臨床実務と そして経歴さえも変わりました

  • The Adverse Childhood Experiences Study

    ACE Studyは

  • is something that everybody needs to know about.

    誰もががその内容について 知る必要があるものです

  • It was done by Dr. Vince Felitti at Kaiser and Dr. Bob Anda at the CDC,

    カイザーのビンス・フェリッティ博士と CDCのボブ・アンダ博士によってなされた研究です

  • and together, they asked 17,500 adults about their history of exposure


  • to what they called "adverse childhood experiences," or ACEs.


  • Those include physical, emotional, or sexual abuse;

    その中には 身体的 感情的なもの また性的虐待

  • physical or emotional neglect;

    身体的 精神的なネグレクト

  • parental mental illness, substance dependence, incarceration;

    親の精神疾患 薬物依存 投獄

  • parental separation or divorce;


  • or domestic violence.


  • For every yes, you would get a point on your ACE score.

    すべての「はい」の回答に対し ACEスコアに加点していきます

  • And then what they did


  • was they correlated these ACE scores against health outcomes.

    そのACEスコアを健康結果と 関連づけたのです

  • What they found was striking.


  • Two things:


  • Number one, ACEs are incredibly common.

    1つ目はACEが非常に 頻繁にあるという事

  • Sixty-seven percent of the population had at least one ACE,


  • and 12.6 percent, one in eight, had four or more ACEs.

    そして12.6% つまり8人に1人が4つ以上の ACEスコアがあるという事

  • The second thing that they found


  • was that there was a dose-response relationship


  • between ACEs and health outcomes:


  • the higher your ACE score, the worse your health outcomes.

    ACEスコアが高ければ高いほど 健康結果は悪いという事なのです

  • For a person with an ACE score of four or more,


  • their relative risk of chronic obstructive pulmonary disease


  • was two and a half times that of someone with an ACE score of zero.

    慢性閉塞性肺疾患(COPD)のリスクが あるのです

  • For hepatitis, it was also two and a half times.

    又肝炎にとって それは2.5倍の リスクになります

  • For depression, it was four and a half times.


  • For suicidality, it was 12 times.


  • A person with an ACE score of seven or more


  • had triple the lifetime risk of lung cancer


  • and three and a half times the risk of ischemic heart disease,


  • the number one killer in the United States of America.

    これは アメリカ合衆国での一番の死因です

  • Well, of course this makes sense.

    もちろん これは理屈どおりなのですが

  • Some people looked at this data and they said, "Come on.

    このデータを見てこう言う人もいるでしょう 「ちょっと待って

  • You have a rough childhood, you're more likely to drink and smoke

    生活の荒れた子供時代を送って 飲酒や喫煙をしがちだったのでしょう

  • and do all these things that are going to ruin your health.


  • This isn't science. This is just bad behavior."

    これは科学ではない   ただの悪習慣だ」と

  • It turns out this is exactly where the science comes in.


  • We now understand better than we ever have before

    私たちは 幼い頃 辛い体験に晒されると

  • how exposure to early adversity


  • affects the developing brains and bodies of children.


  • It affects areas like the nucleus accumbens,


  • the pleasure and reward center of the brain


  • that is implicated in substance dependence.

    脳の快楽や報酬を感じる部分を 司る領域に影響を与えます

  • It inhibits the prefrontal cortex,


  • which is necessary for impulse control and executive function,


  • a critical area for learning.

    学習にとって決定的な領域である 前頭皮質を抑制します

  • And on MRI scans,


  • we see measurable differences in the amygdala,

    恐怖に反応する部位である 扁桃体に

  • the brain's fear response center.


  • So there are real neurologic reasons


  • why folks exposed to high doses of adversity

    高いリスク行動に巻き込まれがち になるのかには

  • are more likely to engage in high-risk behavior,


  • and that's important to know.


  • But it turns out that even if you don't engage in any high-risk behavior,

    しかしたとえ高いリスク行動に 巻き込まれないとしても

  • you're still more likely to develop heart disease or cancer.


  • The reason for this has to do with the hypothalamicpituitaryadrenal axis,

    その理由は視床下部-下垂体-副腎系と 関係があります

  • the brain's and body's stress response system


  • that governs our fight-or-flight response.

    それは私たちの「戦うか逃げるか」の 反応を支配しています

  • How does it work?


  • Well, imagine you're walking in the forest and you see a bear.

    そうですね 森の中を歩き熊に 出会ったとしましょう

  • Immediately, your hypothalamus sends a signal to your pituitary,


  • which sends a signal to your adrenal gland that says,

    さらにそれは副腎に信号を送り こう伝えます

  • "Release stress hormones! Adrenaline! Cortisol!"

    「ストレスホルモンを出して下さい! アドレナリン!コーチゾル!」

  • And so your heart starts to pound,


  • Your pupils dilate, your airways open up,

    瞳孔は拡張し 気道は広がります

  • and you are ready to either fight that bear or run from the bear.

    そこで熊と戦うか逃げるかのどちらかの 準備が出来るのです

  • And that is wonderful


  • if you're in a forest and there's a bear.


  • (Laughter)

    (笑 )

  • But the problem is what happens when the bear comes home every night,

    しかし問題となるのは 毎晩 家で熊に会うと何が起こるかという事です

  • and this system is activated over and over and over again,

    このシステムは何度も何度も活性化され 適応して命を救う事から

  • and it goes from being adaptive, or life-saving,


  • to maladaptive, or health-damaging.


  • Children are especially sensitive to this repeated stress activation,

    子供は特にこの繰り返し続く ストレスの活性化に敏感です

  • because their brains and bodies are just developing.

    それは彼らの脳や体が正に 発達段階にあるからです

  • High doses of adversity not only affect brain structure and function,

    深刻な困難に晒されると脳の構造や 機能に影響があるだけでなく

  • they affect the developing immune system,


  • developing hormonal systems,


  • and even the way our DNA is read and transcribed.

    さらにDNAの読み取り 転写のされ方まで影響を受けます

  • So for me, this information threw my old training out the window,

    この情報を得て 私は臨床研修で受けた 知識を捨ててしまいました

  • because when we understand the mechanism of a disease,


  • when we know not only which pathways are disrupted, but how,


  • then as doctors, it is our job to use this science

    医師として 予防や治療の為に 科学を使う事が

  • for prevention and treatment.


  • That's what we do.


  • So in San Francisco, we created the Center for Youth Wellness

    そこでサンフランシスコに The Center for Youth Wellness を設立しました

  • to prevent, screen and heal the impacts of ACEs and toxic stress.

    ACEと有害なストレスの影響を 予防し検査し治療する為です

  • We started simply with routine screening of every one of our kids

    私たちは 子供たち皆の 一般的なスクリーニング検査を

  • at their regular physical,


  • because I know that if my patient has an ACE score of 4,


  • she's two and a half times as likely to develop hepatitis or COPD,

    ACEがゼロの患者の2.5倍肝炎や COPDに罹りやすく

  • she's four and half times as likely to become depressed,


  • and she's 12 times as likely to attempt to take her own life

    ゼロの患者の12倍自殺を試みる 傾向があると

  • as my patient with zero ACEs.


  • I know that when she's in my exam room.

    そんな患者を私の診察室で診て それが分かりました

  • For our patients who do screen positive,


  • we have a multidisciplinary treatment team that works to reduce the dose of adversity

    困難を減らす事に努める 多職種から成る治療チームを編成しています

  • and treat symptoms using best practices, including home visits, care coordination,

    そこでは 家庭訪問 治療の調整 精神衛生 栄養などの総合的介入で

  • mental health care, nutrition,

    必要ならば薬剤も投与し 心と体の両面から症状を治療し

  • holistic interventions, and yes, medication when necessary.

    トラウマに身を晒するのを 軽減する活動をしています

  • But we also educate parents about the impacts of ACEs and toxic stress

    親が電気のコンセントに カバーをしたり 鉛中毒に注意したりするように

  • the same way you would for covering electrical outlets, or lead poisoning,

    私たちは親に対してもACEと 有害なストレスの影響について教えました

  • and we tailor the care of our asthmatics and our diabetics


  • in a way that recognizes that they may need more aggressive treatment,

    すでにホルモンと免疫システムに 大きな変化を与えているので

  • given the changes to their hormonal and immune systems.

    より積極的な治療が必要であると認識した 治療計画を作りました

  • So the other thing that happens when you understand this science


  • is that you want to shout it from the rooftops,


  • because this isn't just an issue for kids in Bayview.

    それは単なるベイビューの子供たちの 問題ではないからです

  • I figured the minute that everybody else heard about this,


  • it would be routine screening, multi-disciplinary treatment teams,

    すぐに一般的スクリーニング 多職種混成治療チームができて

  • and it would be a race to the most effective clinical treatment protocols.

    最も効果的な治療方針を即刻開始 になるだろうと思ったのですが

  • Yeah. That did not happen.


  • And that was a huge learning for me.

    それは私にとって 大きな学びでした

  • What I had thought of as simply best clinical practice

    はじめ私が単に最良の臨床治療だと 思っていたものは

  • I now understand to be a movement.


  • In the words of Dr. Robert Block,


  • the former President of the American Academy of Pediatrics,


  • "Adverse childhood experiences


  • are the single greatest unaddressed public health threat


  • facing our nation today."


  • And for a lot of people, that's a terrifying prospect.

    そして多くの人々にとって それは恐ろしい可能性です

  • The scope and scale of the problem seems so large that it feels overwhelming

    問題の範囲や規模が非常に大きいので どうやってアプローチするか考えると

  • to think about how we might approach it.


  • But for me, that's actually where the hopes lies,

    しかし私にとっては 実際そこには 希望があるのです

  • because when we have the right framework,

    それは 私たちが正しい取り組みをし

  • when we recognize this to be a public health crisis,


  • then we can begin to use the right tool kit to come up with solutions.

    その時 私たちは解決法を見出す 正しい手段を使い始めることが出来るのです

  • From tobacco to lead poisoning to HIV/AIDS,

    煙草から 鉛中毒や HIV/AIDSに至るまで

  • the United States actually has quite a strong track record

    合衆国には実際 公衆衛生の問題に 取り組んだ

  • with addressing public health problems,


  • but replicating those successes with ACEs and toxic stress

    ACEと有害ストレスに関して 同様の成功を収めるられるかどうかについては

  • is going to take determination and commitment,


  • and when I look at what our nation's response has been so far,


  • I wonder,


  • why haven't we taken this more seriously?

    何故私たちはこれをもっと真剣に 受け止めなかったのでしょうか?

  • You know, at first I thought that we marginalized the issue

    最初 私たちはその問題を主流から 外したと思っていました

  • because it doesn't apply to us.


  • That's an issue for those kids in those neighborhoods.

    それはあの近隣の あの子供たちの問題です

  • Which is weird, because the data doesn't bear that out.

    妙なことにデータは その事実を裏付けてはいないのです

  • The original ACEs study was done in a population

    オリジナルのACEの研究は 次の住民の間で行われました

  • that was 70 percent Caucasian,


  • 70 percent college-educated.


  • But then, the more I talked to folks,

    しかしその時 皆と話をすればする程

  • I'm beginning to think that maybe I had it completely backwards.

    ますます私はそれを逆に考えていると 思い始めました

  • If I were to ask how many people in this room

    もし ここに居る人に

  • grew up with a family member who suffered from mental illness,

    精神病に苦しむ家族と共に育ったかと 尋ねられたら

  • I bet a few hands would go up.


  • And then if I were to ask how many folks had a parent who maybe drank too much,


  • or who really believed that if you spare the rod, you spoil the child,

    鞭を惜しむと子供をだめにすると 本気で信じている親だったかとすれば

  • I bet a few more hands would go up.


  • Even in this room, this is an issue that touches many of us,

    この部屋の中でさえ この事は 私たちの内の多くに影響を与えています

  • and I am beginning to believe that we marginalize the issue

    私は この問題が過小評価されているのは

  • because it does apply to us.

    自分たちのことだからなのだと 思うようになりました

  • Maybe it's easier to see in other zip codes

    他の地区のことであれば 簡単に分かるのかもしれません

  • because we don't want to look at it.


  • We'd rather be sick.


  • Fortunately, scientific advances and, frankly, economic realities

    幸運にも科学の進歩と 卒直に言って経済的な事実が

  • make that option less viable every day.


  • The science is clear:


  • Early adversity dramatically affects health across a lifetime.

    幼い頃のトラウマは生涯に渡って 健康に影響を与えます

  • Today, we are beginning to understand how to interrupt the progression

    今日私たちは 幼い頃の不幸な出来事が 病気や早逝に繋がるのを

  • from early adversity to disease and early death,


  • and 30 years from now,


  • the child who has a high ACE score


  • and whose behavioral symptoms go unrecognized,

    その行動に関する症状が 認識されないままの子供

  • whose asthma management is not connected,

    喘息の管理がACEに 結び付けられていない子供が

  • and who goes on to develop high blood pressure


  • and early heart disease or cancer


  • will be just as anomalous as a six-month mortality from HIV/AIDS.

    HIV/AIDS の患者が6ヶ月で死ぬことと 同じくらい異例なものになるでしょう

  • People will look at that situation and say, "What the heck happened there?"

    人々はこの状況を見てこう言うでしょう 「ここでは一体何が起きたの?」

  • This is treatable.


  • This is beatable.


  • The single most important thing that we need today


  • is