04/15/2014 05:04 pm ET Updated Jun 15, 2014

If Babies Could Smoke

It's easy to forget that the deck is stacked against millions of children in distressed communities across this country. Living with everyday violence, poor nutrition, inadequate housing and income instability (to name just a few) can affect a child's ability to learn and achieve academic success. Fortunately the renewed push for universal preschool is reminding the public that early education is essential to cognitive development and can mitigate the effects of poverty on success in high school and beyond.

But do policy-makers know that living in toxic conditions has lifelong implications for health? The Carolina Abecedarian Project, which has followed two groups of babies since 1972, shows that poor children who had quality early education are far healthier today than their peers who received none. The CDC's Adverse Childhood Experiences Study ties early adversity to adult onset of chronic disease along with mental illness and concomitant social problems.

The latest research on brain development and immunology suggests that violence and trauma affect the architecture of the brain. Chronic stress -- unlike the "healthy" stress associated with a playoff game or a final exam -- is an attack on a child's developing mind.

This is a public health crisis. It's also preventable. What are we going to do about it?

The anti-smoking movement may offer some clues. I grew up haunted by those little kids playing dress-up in the American Cancer Society PSA ("Children love to imitate their parents. Children learn by imitating their parents. Do you smoke cigarettes?"). Meanwhile my mother chain-smoked Salems. Did she want me to die? Did she even know that her smoking could turn me into a smoker, then a cancer victim, then a corpse?

For my mother's generation, smoking was an addiction made popular by seductive actresses and rugged cowboys. Thanks in part to public health campaigns like the one that scared the wits out of me, educated people began to drop the habit. In recent years the smoking rate for affluent adults has fallen 27 percent, but among the poor it has declined just 15 percent. Smoking is the leading cause of preventable death in the U.S., so it's not surprising that a "smoking gap" correlates with inequality in health outcomes between rich and poor.

Here's the problem: Now that so many middle class people have stopped smoking, they don't seem concerned about the prevalence of smoking in distressed communities. It's easy to dismiss poor people as willfully ignorant, self-indulgent or morally compromised. So if they end up with cancer, heart disease or emphysema, the thinking goes, they kind of brought it on themselves. Have we come to believe that widening disparities in health, like income, are inevitable?

But what if babies smoked? That awful image just may be the wake-up call the public needs.

They would learn that though babies don't smoke, many young children in low-income communities do experience toxic hardship. Who knew that childhood adversity results in sharply higher rates of high blood pressure, obesity, heart disease, chronic obstructive pulmonary disease (COPD), depression and cancer?

Dr. Nadine Burke Harris, founder and CEO of the Center for Youth Wellness in San Francisco, is a powerful spokesperson on the effects of adverse childhood experiences. Her work illustrates how childhood trauma (e.g. violence at home or in the community; having a parent with mental illness or substance dependence) affects the structure of the developing brain. In turn, behavior and school performance are compromised and organic diseases like asthma, obesity, and heart disease are more likely.

We know how to keep cigarettes away from babies. We know that violence and trauma cause the same levels of pain and suffering in children experienced by soldiers returning from active duty in Iraq and Afghanistan. We know how costly it is to treat those health conditions.

When we talk about the importance of early education versus the tragic consequences of going without, let's talk about the brain and the body. When we list the probable outcomes of poor education (dropping out of high school, early pregnancy, drug abuse, jail) let's not forget the litany of diseases that are caused not by genetics but by neglecting young minds. Either way you look at it, we're breaking hearts, but at least we're not letting babies smoke (at least not yet).