Is this biggest unaddressed public health issue, asks Catherine Calderwood

Many people will have spent time together with their families over the festive break – which has both positives and negatives. Estate agencies tell me that big decisions are made – engagements, divorces, new families created – and their work is increased as these life events occur.

Close contact also brings with it the spread of winter viruses and many have been unwell. We await the statistics of how NHS Scotland has coped over the holiday. This year the weather was kind and the circulating flu virus level low – the vaccine this year is a good match and I would encourage you to get it if you are eligible. There are some positives too. Our labour wards are always busiest in September with the new lives created at this time of year!

There has been an increased focus on the positives and negatives of family life in recent years with the realisation of the profound effects a combination of “major life events” as a child can have on the future.

These “adverse childhood experiences” or ACES can include emotional, physical and sexual abuse, emotional and physical neglect, as well as domestic violence, substance abuse, mental illness, parental separation/divorce and an incarcerated parent. Most believe these experiences are not common.

In reality, 67 per cent of the population have at least one ACE and some would argue that this is the biggest unaddressed public health issue of our time. Those with four or more ACES (an eighth of the population) seem to be most at risk from negative lasting effects on health and wellbeing with three times the levels of lung disease and smoking, two-and-a-half times the levels of depression, 11 times the levels of drug abuse, and 14 times the levels of suicide attempts. Yet this is barely acknowledged or talked about.

Our schools are becoming much more aware of the impact of ACES on children and teachers are taught how to enquire sensitively and how to intervene appropriately. Information and support is available through all our schools and NHS Health Scotland with a focus on supporting children and young people’s mental health.

The impact can be offset by safe, secure, responsive adult relationships that buffer the effects of stress and adversity and support the development of resilience, a key mechanism to make sense of and recover from threats and fear. Children need to be supported to be confident, to problem-solve for themselves, to know that there is someone there for them.

Unsurprisingly perhaps it takes many years before people will disclose their experiences. Many now advocate routine inquiry by our public services and training is available. Given that ACES are so common and this is not stigmatising, should this routine inquiry be built in to all of our healthcare interactions too?

Long-term harm is not inevitable. The impact of ACES can be mitigated, there is always hope, there are always opportunities for recovery in childhood, adolescence and adult life.

When I talk to groups of people about adverse experiences in childhood a hush descends, people listen intently, reflecting on their own experiences or those close to them. Discussions are never open but afterwards I am contacted by those wanting to share how helpful it is to feel that they are not alone, to tell me that they are considering seeking help.

As I say to the NHS staff I talk to – we cannot look after others unless we look after ourselves and our families first. l Catherine Calderwood is Scotland’s chief medical officer. Twitter: @Cathcalderwood1