title: The Affordable Care Act, science, and childhood adversity: a call for pediatric nurses and physicians to lead.
abstract: The Patient Protection and Affordable Care Act aims to increase access to many who were previously uninsured, to increase the quality of health care, and to decrease costs. Accountable Care Organizations are a manifestation of these new health care reforms. A proactive approach focused on primary prevention to address modifiable determinants of health holds the promise of a healthier population while being cost-effective. Exposure to toxic stress in childhood places many children on a trajectory for poor immediate and long-term health outcomes. A lifecourse approach to disease prevention offers opportunities at every age and stage to build resilience, which buffers and protects children from the effects of adversity and toxic stress. The American Academy of Pediatrics, recognizing that many adult diseases are rooted in experiences in early childhood, has proposed an ecobiodevelopmental framework that expands the role of pediatricians and embraces a preventive lifecourse approach to health and well-being. Exposure to adversity and toxic stress in childhood is a serious public health problem. A new kind of leadership is required to address these issues. Pediatric nurses and physicians are trusted healers and in a position to seek solutions skillfully and intentionally.
authors.affiliation: Children's Mercy Hospitals and Clinics, Emergency and Urgent Care Services, Kansas City, Missouri 64108, USA. domalley@cmh.edu
authors.forename: Donna M
authors.initials: DM
authors.lastname: Oʼmalley
mesh_terms: D000328:Adult; D002648:Child; D002675:Child, Preschool; D004781:Environmental Exposure / Q000517:prevention & control*; D015386:Hazardous Substances; D006801:Humans; D007857:Leadership; D024802:Nurse's Role; D058991:Patient Protection and Affordable Care Act / Q000458:organization & administration*; D010372:Pediatrics / Q000458:organization & administration*; D010819:Physician's Role; D011322:Primary Prevention / Q000458:organization & administration*; D011634:Public Health / Q000592:standards*; D014481:United States
chemical_list: D015386:Hazardous Substances