Californians have experienced an alarming epidemic of adverse childhood experiences. Between 2011 and 2017, 60 percent of Californians reported experiencing at least one type of childhood adversity; about 16 percent experienced four or more. People who experience four or more ACEs are 1.5 times as likely to have heart disease, 1.9 times as likely to have a stroke, and 3.2 times as likely to have asthma as people who have experienced no ACEs. (For more information about ACEs and ACEs science, go to ACEs Science 101.)
That’s why California Governor Gavin Newsom included $45 million in the state's 2019-2020 budget to screen Medi-Cal recipients for ACEs, and why California Surgeon General Dr. Nadine Burke Harris, who leads the screening effort, has pledged to reduce the burden of ACEs by 50% in a generation.
But a new succinct, 12-page report, "Beyond Screening: Achieving California's Bold Goal of Reducing Exposure to Childhood Trauma," developed by the California Funders Workgroup on Prevention and Equity, cautions that "Without addressing systemic, community-wide factors that fuel toxic stress and trauma, ACEs would more likely occur. Systemic racism, a hostile climate for immigrants, displacement, economic inequity, and unequal access to health-promoting resources like parks and public transit all contribute. Without addressing these underlying causes, we will not dramatically reduce ACEs in California."
The report was written by Juliet Sims and Manal Aboelata at the Prevention Institute in Oakland, CA, and published this month. Members of the California Funders Workgroup on Prevention and Equity include Blue Shield of California Foundation, the Sierra Health Foundation, The California Endowment, St. Joseph Community Partnership Fund, The California Wellness Foundation, and WellBeing Trust.
"As California embarks on its campaign to reduce adverse childhood experiences and the health and mental health conditions that can result from them," the authors write, "it is important that our approach include elements that reduce adverse community experiences and build community resilience." (We at ACEs Connection add a third realm: adverse environmental experiences, such as a pandemic.)
The report advises multi-sector changes in four broad areas to take pressure off the healthcare system from being solely responsible for addressing ACEs. These comprise:
- Strengthen economic supports to families, including maximizing statewide participation in the California Earned Income Tax credit and strengthening the state's paid family leave program;
- Promote social norms that protect against violence and adversity, including establishing a state-level office to coordinate community-based solutions to end cycles of violence and to consolidate funding for violence prevention; and strengthening and expanding investments in youth diversion programs;
- Foster access to housing and health-promoting community development, including developing family-friendly housing developments with childcare and outdoor playgrounds; and repealing legal mechanisms that maintain exclusionary housing practices based on race and income;
- Ensure a strong start for children and youth in educational settings, including creating a coordinated early childhood system of care that includes access to affordable childcare and education programs; and embracing the community schools model.
"Through engagement and partnership with multiple agencies, sectors, and communities," the report notes, "California can build momentum for change that ensures that communities, philanthropy, healthcare, and local and state governments align toward the shared vision of a healthy, safe, and equitable California for all children and families."
A PDF of the report is attached.