As a nation, it is critical to our collective future that we ensure that all children have the opportunity to achieve their full potential. Yet early adversity, toxic stress, and trauma are erecting lifelong barriers for many children, jeopardizing their healthy development, their ability to self-actualize, and their long-term well-being. The evidence is clear that adverse childhood experiences (ACEs) are widespread, and have dramatic, detrimental, and lasting effects on the health and wellbeing of children that can persist into adulthood.
While ACEs can affect children of all backgrounds, data shows that exposure to early adversity is not equally distributed in the U.S. ACEs are far more concentrated and prevalent in under-resourced communities struggling with poverty, economic hardship, or community or neighborhood violence, among other challenges. These experiences are often driven by deeply entrenched historic, systemic and institutional economic, racial, and ethnic inequities that increase the risk of poor health while limiting the resources available to families, neighborhoods, and communities that can promote or improve health.
New efforts to expand our understanding of health, to pay for and measure health care, and to develop linkages between physical, behavioral, and social services present new opportunities to prevent and mitigate ACEs. The health care system is well positioned to address ACEs given that it is a nearly universal system that touches almost all young children and families. The system also is becoming more attuned to addressing social determinants of health (SDOH). As health care systems transform to promote health, provide high-value care, improve outcomes, and reduce costs, equity-focused strategies to prevent and mitigate ACEs are critical to meeting these goals.
Progress in this work requires an intentional focus on addressing the broader social inequities that generate and intensify stressors and risk of exposure to early adversity. Improved outcomes for children will require both a willingness to take on hard, long-standing problems of structural inequality and a pragmatic set of tools that leverage the power of our health care system to address these problems. A commitment to understanding the root causes of early adversity, toxic stress, and trauma, and to developing strategies that can support children and families who experience compounding stressors, can improve systems and change community conditions so that all children and families can thrive.
This paper lays out a suite of the most important policies and strategies to leverage the health care system to address ACEs resulting from the combined effects of racial and other inequities and experiences of early adversity on health. It is intended to guide the work of national and state policymakers, state Medicaid agencies, health system leaders, and individual providers.
To read the full report, download the pdf here.