SPSSI at the United Nations
Toxic Stress Levels as Barriers to Fulfilling Children’s
Rights to Health
Corann Okorodudu, Professor Emerita of Psychology & Africana Studies, & SPSSI NGO Representative at the United Nations
In Resolution 19/37 adopted on March 23, 2012, the Human Rights Council decided to focus its next full-day meeting in 2013 on the right of children to enjoy the highest attainable standards of health and invited the Office of the High Commissioner for Human Rights (OHCHR) to prepare a report on this issue. OHCHR requested various stakeholders, including governments, UN agencies, and civil society organizations to provide input for the report, focusing on children’s main health challenges, barriers to the implementation of children’s right to health, and examples of good practice. This column is based on a paper that I developed and submitted on October 1, 2012 to OHCHR on behalf of the NGO Committee on Children’s Rights and the Psychology Coalition at UN Headquarters in New York City.
Today across the world children are being exposed to high levels of stress from various (and frequently multiple) debilitating conditions including: poverty resulting in chronic hunger, malnutrition, and preventable diseases; disparities in their access to physical and mental health care; disparities in their access to and attainment of primary and secondary levels of formal education; abuse and exploitation, including trafficking and sexual exploitation; violence against children in the family, the community, and in armed conflict; hazardous and injurious child labor; harmful traditional practices like early marriages and genital cutting of girls; loss of parental or family care due to death of parents during war, natural disasters, diseases like HIV/AIDS, and separation during migration.
While certain levels of stress are necessary for survival, according to the Academy of American Pediatrics, children experience toxic levels of stress from “strong, frequent or prolonged activation of the body’s stress response systems in the absence of the buffering of a supportive, adult relationship (Shonkoff & Garner, 2012).” Children experience stressors as traumatic and toxic depending on their developmental stage; their previous life experiences and developmental capacities; the intensity, duration, and number of stressors to which they are exposed at the same time; and their access to family or other caring adults who have the capacities and resources to respond effectively to children’s needs (Gunnar, Herrera, & Hostinar, 2009).
Effects of Toxic Levels of Stress. The adverse relationship between stress and children’s development has long been established by psychological research (Garmezy & Rutter, 1983; McLoyd, 1990), but the physiological mechanisms underlying this relationship have only recently begun to be uncovered by scientific studies. When stressors like persistent hunger and poverty threaten a child, hormones are released and distributed throughout the child’s body. Severe and persistent exposure to stress hormones can disrupt the connection of brain circuits and result in the development of a smaller brain. Brain circuits are particularly vulnerable when they are developing during infancy and early childhood, causing children to develop a low threshold for stress, thereby becoming overly reactive emotionally to stressors in later childhood (Gunnar, Herrere & Hostinar, 2009; Shonkoff & Garner, 2012; Teicher, Anderson & Polcan, 2012). Research has demonstrated further that high levels of stress hormones, including cortisol, result in suppression of the immune response, leaving the child vulnerable to infections and chronic health problems (Shonkoff & Garner, 2012). Persistently high cortisol levels can damage the hippocampus (14), a brain area responsible for learning and memory, resulting in childhood cognitive deficits (American Psychological Association, 2012).
Scientific findings also suggest that, in the absence of sensitive, attentive and resourceful adult support, there are long-term consequences of exposure to toxic stress and that adverse childhood experiences may have mental and physical health consequences that last into adulthood (Middlebrooks & Audage, 2008; Shonkoff & Garner, 2012; Szalavitz, 2012). These include: increased risk of cardiovascular disease, depression, anxiety, suicide attempts, substance abuse, and post-traumatic stress disorder (Gunnar, Herrere & Hostinar, 2009). It is therefore imperative that, as a world community, we advocate with governments for the prevention and amelioration of toxic stress by establishing healthy and safe environmental conditions for children, families, and their communities.
Children’s Rights to Physical and Mental Health and Well Being. The Convention on the Rights of the Child (CRC) is the most widely accepted human rights standard, having been ratified by most nations of the world, except the United States, Somalia, and South Sudan. The CRC provides for the protection and fulfillment of the broad range of economic, civil, political, and cultural rights, including children’s rights to survival, security, development and participation (Convention on the Rights of the Child, 1989). It calls for governments that have ratified it to “recognize the right of every child to benefit from social security (Article 26)” and “a standard of living adequate for the child’s physical, mental, spiritual, moral and social development (Article 27).” These rights apply to all children without discrimination of any kind, regardless of the child or the child’s “parents or legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status (Article 2).” The preamble to the Convention recognizes that “in all countries in the world, there are children living in exceptionally difficult (stressful) conditions and that such children need special consideration. For example, special articles cover refugees and migrants (Article 22), children who are physically and mentally challenged (Article 23), children living under traditional practices injurious to their health (Article 24), under trafficking (Optional Protocol to the CRC on the Sale of Children, Child Prostitution and Child Pornography, 2002), and under armed conflict (Optional Protocol to the CRC on the Involvement of Children in Armed Conflict, 2002).
Consistent with psychological theory (Bronfenbrenner, 1986), the preamble and other articles of the CRC recognize that the family is the natural environment for the growth and well-being of its members, particularly children. As such the family is to be given the necessary protection and assistance to assume its responsibilities, so that the child may grow up in an atmosphere of “happiness, love, and understanding” (Convention on the Rights of the Child, 1989).
Barriers in Implementing Children’s Rights to Health. Although the CRC is the most widely ratified human rights treaty, governments in all regions of the world have not carried out their commitments to implementing its principles by investing in childhood, particularly early childhood, as the foundation for healthy human development. A recent study of child well-being in 28 countries in the Organization for Economic Cooperation and Development found that only 24% of childhood expenditures were allocated to the period from birth to age 5, while 36 % was spent on children age 6-11, and 41% from age 12 to 17 years. While the investment in early childhood is comparatively low in these countries, it is significantly lower in sub-Saharan Africa, which also has the highest poverty rate for children in the world (Shonkoff, Richter, van der Gaag & Bhutta, 2012).
In most countries of the world, including the developed regions, many children and their families continue to live in poverty reflected in stark disparities in employment in decent jobs, education, physical health, mental health, and access to quality health care and social services. Especially in developing countries, transportation to the nearest medical facility is often at a distance. There is an even greater scarcity of quality and affordable mental health care, therefore children often do not receive care. Families are often not literate in the language of health care facilities further reducing the accessibility of healthcare and adherence to treatments. Many communities do not have access to trained medical and mental health staff. Moreover, staff that may be available lack multicultural competencies and sensitivity, making it difficult for providers to work with the range of diverse families in the best interest of their children.
Recommendations Offered to OHCHR to Promote, Protect, and Fulfill Children’s Right to Quality Physical Health, Mental Health and Psychosocial Well-being
American Psychological Association. (2012). Effects of poverty, hunger and homelessness on children and youth. www.apa.org/pi/families/poverty.
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development. Developmental Psychology, 22(6), 723-742.
Center on the Developing Child, Harvard University. (2012). Toxic stress: The facts. http://developing child.harvard.edu.
Convention on the Rights of the Child (1989). New York, NY: United Nations Children’s Fund.
Garmezy, N. & Rutter, M. (1983). Stress, coping and development in children. Baltimore, MD: John Hopkins University Press.
Gunnar, M.R., Herrera, A., & Hostinar, C.E. (2009). Stress and early brain development. Encyclopedia on Early Childhood Development. www.childencyclopedia.com/documents/
McLoyd, V.C. (1990) The importance of economic hardship on families and children. Child Development, 61(2), 311-346.
Middlebrooks, J.S. & Audage, N.C. (2008). The effects of childhood stress on Health across the lifespan. Atlanta, GA: Center for Disease Control and Prevention.
Optional Protocol to the CRC on the Involvement of Children in Armed Conflict. (2002). New York, NY: United Nations Children’s Fund.
Optional Protocol to the CRC on the Sale of Children, Child Prostitution and Child Pornography. (2002). New York, NY: United Nations Children’s Fund.
Szalavitz, M. (2012). How child abuse primes the brain for future mental illness. http://healthland.time.com.
Shonkoff, J., & Garner, A. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129(1), e232-e246.
Shonkoff, J., Richter, L., van der Gaag, J. & Bhutta, Z.A. (2012). An integrated scientific framework for child survival and early childhood development. Pediatrics, 129(2), 1-13.
Teicher, M.H., Anderson, C.M., & Polcan, A. (2012). Child maltreatment in association with reduced volume in the hippocampal subfields CA3, dentate gyrus, and subiculum. Published online, February 13, 2012. www.pras.org/content/109/9/E563.
The Urban Child Institute. (2012). Stress has lasting effect on child’s development. www.urbanchildinstitute.org.
Nabudere, H., Asiimwe, D., & Mijumbi, R. (2011). Task shifting in maternal and child healthcare: an evidence brief for Uganda. International Journal Of Technology Assessment In Health Care, 27(2), 173-179.
Valen, M., Narayan, S., & Wedeking, L. (2012). An innovative approach to diabetes education for a Hispanic population utilizing community health workers. Journal of Cultural Diversity, 19(1), 10-17.