A public health perspective on poverty and Adverse Childhood Experiences (ACEs)

Our latest guest blog looks at poverty and Adverse Childhood Experiences (ACEs) from the perspective of public health. Katy Hetherington, Organisational Lead for Child and Adolescent Public Health at NHS Health Scotland, calls for action across all sectors to ensure families' life circumstances give them opportunities to thrive.

Our experiences in childhood can profoundly affect us, and particularly our health, in later life. As a society, we need to understand how important these experiences can be for everyone’s health and wellbeing, so that we can all give our children and young people the best opportunity to prosper.

While overall health has improved in Scotland, health inequalities persist.* This results in unfair and avoidable differences in health, social and cognitive development between the wealthiest and poorest children in society. Poverty is a hugely important factor in considering these differences and studies on Adverse Childhood Experiences (ACEs) add to our understanding of health and wellbeing. The public health landscape is changing in Scotland. We now have an opportunity to ensure that action to prevent and respond to ACEs are a key part of our response to the public health challenges of today and we welcome their recognition in the recent Public Health Priorities.

The Adverse Childhood Experiences (ACEs) research highlights the risk and impact of exposure to traumatic events in childhood on subsequent physical and mental health. At NHS Health Scotland, we advocate for a public health approach to tackling ACEs – that means focusing on reducing poverty and inequalities, upholding children’s rights and creating the conditions for them to do well. Taking a public health approach involves action across all sectors to prevent ACEs; no one sector, community or individual can do this alone.

The responsibility for action

In the course of raising awareness about ACEs, there is a risk of putting too much responsibility for action on individuals. This can draw our attention away from the hugely important social, economic and political factors that shape and influence the circumstances in which we live. We must consider the external factors which can place additional pressure and stress on parents which then affect children’s lives. Not having enough money to fully participate in society is central to this debate. So, how we frame the discourse on ACEs, both to the public and to a professional audience, is incredibly important. This is particularly true for ensuring that any stigma around ACEs is not made worse. This is where a public health focus, in its recognition of all the things in life that we need for good health and wellbeing, can come into its own. In taking such an approach, we can locate the problem where it really lies – not in the individual, but in their life circumstances.

Although ACEs are found across the whole population, children growing up in poorer areas are at greater risk than others. The precise reason for this is still unclear, though it is the subject of a review of evidence that we will publish later this year.

What we do know is that the ability of households to buffer the effects of ACEs is influenced by the financial resources available to them. We also know that UK welfare reform is making the situation worse by pushing more people into poverty. Tackling poverty requires taking action on the its main drivers: income from work and earnings, income from social security and costs of living and this approach underpins Every Child, Every Chance, the Scottish Government’s Child Poverty Delivery Plan.

What Scotland needs

Tackling ACEs needs a policy environment that recognises the impact of childhood adversity across the life course. We also need a Scottish workforce that understands the psychological impact of early adversity and trauma – this means one that looks beyond the 10 questions in the original ACEs study. And lastly, we need to look at the wider social and environmental context of a person’s life, with services that give families the support they need, mitigating the impact of adversity and recognising the central role of relationships. This, together with knowledge across society about the impact of poverty and childhood adversity on children and families now and throughout their lives, can all contribute to achieving Scotland’s ambition as a country where everybody has the opportunity to thrive.

By improving our knowledge about the links between our early experiences and later health and wellbeing, we can design and deliver better services to prevent childhood adversity. That surely must be at the heart of our collective effort to improve Scotland’s health.


*Taken from ScotPHO (2018) Scottish Burden of Disease Study 2016