• Rebecca Bryan

ACEs Cost the US $748 Billion -- Annually.

How do you begin to add up the cost of childhood adversity? Especially the cumulative impact of growing up in toxic, chronic stress, and knowing - without a shadow of a doubt now - that ACEs cast a shadow on the body-mind across the entire lifespan? Well, thank God for public health researchers, that's all I have to say.

Mark Bellis, Karen Hughes and colleagues have added to their formidable scholarship by publishing a systematic review and meta-analysis that calculates the annual cost of ACEs. Using a human capital approach, they were able to parse out the amount of risk for chronic disease directly attributable to ACEs, and estimated their impact on disability-adjusted life years (DALYs), both in Europe and in North America. "We estimated that the annual costs from the effect of ACEs on the health outcomes measured were US$581 billion in Europe (equivalent to 2.67% of gross domestic product) and $748 billion in North America (equivalent to 3.55% of the gross domestic product)." That's a pretty penny. Especially when you realize - at least in theory - it's preventable.

"Millions of adults across Europe and North America live with a legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or $105 billion." Risks - and costs - are especially high for illicit drug use (think of the opioid crisis) and for ill health due to mental illness: 30% of anxiety cases and 40% of depression cases in North America are attributed to ACEs. We have evidence-based approaches to preventing ACEs as well as moderating the effects of them. Is healthcare funding going to shift to support this, now that we know the cost? Here's the evidence that I'm aware of: United Way, at least in the Philadelphia region, is only funding organization initiatives that can demonstrate a trauma-informed approach. And Aetna Medicaid is developing a 6 level model of trauma-informed practice. Many states have also passed ACEs-informed legislation and adopted ACEs-informed policies.

This research reinforces what experts in the industry have been saying - ACEs are the non-infectious equivalent of the germ theory. Bellis and colleagues write, "Our results suggest that many conditions commonly seen in adults by health professionals are rooted in childhood. Trauma-informed care can ensure such individuals receive support to address underlying drivers of health-harming behaviors..." Or, as I like to say, if you understand the trauma, you understand the behavior. It's simple, it's powerful, and it's true.