Public Policy Update - September 2016

Submitted by Jeanie Holt, Public Policy Committee Co-Chair

As the Public Policy Committee works to update our Child Health and Safety Policy Statement, we have been talking about the public health impacts of Adverse Childhood Experiences. Karen Welford (Children's Trust and member of NHPHA's Public Policy Committee) and Dr. Kelley White wrote the following article to help us better understand the research on this important topic.

Adverse Childhood Experiences: A Public Health Perspective
Submitted By Karen Welford, BSN MSPA and Kelley White, MD

The whole-life perspective taken by the Adverse Childhood Experiences (ACE) study uncovers the effect of childhood stressors on a person’s health and social well-being throughout life beyond childhood. The study, an ongoing collaboration between the Centers for Disease Control (CDC) and Kaiser Permanente, measures a variety of adverse childhood experiences and their effect on the public health.

Begun in 1994, the study included over 17,000 adults surveyed by the Kaiser HMO in San Diego, California. The survey asked questions on 10 adverse childhood experiences: physical, psychological, and sexual abuse; emotional Publication1and physical neglect; alcoholism or drug use in the home; loss of a biological parent when under 18 years of age; depression or mental illness in the home; seeing a mother treated violently; and having an imprisoned household member. People who had these experiences as children were defined as having had “adverse childhood experiences” (ACEs)

Three important findings are revealed by this research. First, adverse childhood experiences are very common and often remain unrecognized. Second, they are powerful predictors of adult social function, well-being, health risks, disease and premature death. And third, the combination of these first two findings make adverse childhood experiences “the leading determinant of the health, social well-being, and economy of the nation". (1)

The prevalence of traumatic life experiences in childhood and adolescence is far higher than had been previously conceived. Only 33% of the survey participants had an ACE score of 0, while one in six adults acknowledged 4 or more adverse childhood experiences, having an ACE score of 4 or more.

The broad public-health perspective of the ACE study led to the recognition of a wide array of impacts on health behavior, disease-risk factors, and health outcomes such as obesity, inactivity, smoking, alcoholism, use of illicit drugs, depression, autoimmune disease, liver disease and premature death. The ACE score captures the cumulative negative impact on social, emotional, and cognitive development; and other impairments in the function of brain and body systems. As the number of adverse childhood experiences increases, the risk of developing significant health problems increases in a strong and graded fashion. More adverse childhood experiences mean more risk of negative outcomes. Dr. Robert Anda concludes that understanding this causal connection will help us make progress in preventing and recovering from these problems. (2)

The American Public Health Association Child Health Policy for the United States acknowledges: “Access to medical services is necessary but not sufficient to support children’s health and healthy development; attention also must be paid to the larger context of families’ lives and to the intergenerational effects of health status and economic resources. (3)

Evidence presented by the ACE Study indicates that adverse childhood experiences are major risk factors for illness, disability, death, and poor quality of life. This has important implications for those addressing public health in New Hampshire. Early-childhood and family support and strengthening programs, such as Family Resource Centers, continue to learn more about the long and short-term outcomes of adverse childhood experiences and to develop policies and programs addressing the prevention of these traumatic experiences for the children of our state. New Hampshire is beginning to understand that PREVENTION MATTERS.

[1] Anda, R, Felitti,V. “The Lifelong Effects of Adverse Childhood Experiences” Chadwick’s Child Maltreatment Encyclopedic Volume 2, STM Learning Inc.

[2] Anda, R. “The Adverse Childhood Experiences Study: Child Abuse and Public Health,”  Prevent Child Abuse America,

[3] American Public Health Association Child Health Policy for the United States

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