Post on 18-Apr-2022
Measuring their impact on long-term health and the wider economy
Counting the Cost of Adverse Childhood
Experiences
Professor Mark A. BellisDirector of Policy and International Health
World Health Organization Collaborating Centre on Investment for Health and Well-being, Public Health Wales, United Kingdom
Email: m.a.bellis@bangor.ac.uk; Twitter @markabellis
How many people have suffered ACEs?
Bull World Health Organ 2014;92:641–655B; Bellis et al, 2014, 2016, 2018; Merrick et al, 2018
Physical abuse
18%average
AlbaniaNorth Macedonia7%41%
Romania
Turkey
Russian Federation
MontenegroSerbia
Ukraine15%19%
Moldova
16%Latvia
13%Lithuania
Poland
Czech Republic
20%18%
23%18%
11%
13%
15%
England
15%
6%
18%
24%
12%
12%
10%
4%
4%
ACEs measured
Physical abuse
Sexual abuse
Emotional abuse
Parental separation
Domestic violence
Household member:
Mental illness
Alcohol problem
Drug user
Incarcerated
Euro
18%
6%
10%
16%
13%
11%
16%
3%
5%
Wales
16%
7%
17%
25%
17%
18%
13%
6%
4%
USA
18%
12%
34%
28%
18%
17%
28%
8%
Eastern Europe 49% suffered at least one ACE, 6% 4+ ACEsEngland 48% suffered at least one ACE, 9% 4+ ACEsWales 50% suffered at least one ACE, 14% 4+ ACEsUSA 62% suffered at least one ACE, 16% 4+ ACEs
Child Maltreatment and other Adverse Childhood Experiences ACEs - The Life Course
Early Death
Social, Emotional and Learning Problems
Adopt Health Harming Behaviours and Crime
Disrupted Nervous, Hormonal and Immune Development
Child Maltreatment & other Adverse Childhood Experiences (ACEs)
Non Communicable Disease, Disability, Social Problems, Low Productivity
Life
Cou
rse
Death
Birth
Developed from Felitti et al. 1998Bellis 2016
£
WEIGHT & EXERCISE
1.4Physical inactivity
Obesity
1.22.1 1.5
PHYSICAL HEALTH
DiabetesHeart diseasePoor self-rated health
Cancer
Liver/digestive disease
Respiratory disease
2.2
2.3
2.8
3.0
3.7
MENTAL HEALTH
4.4
4.4
Anxiety
Low life satisfaction
Depression
Collaborative Global ACE Analysis with WHOSEXUAL HEALTH
3.6
3.7
4.2
5.9
Multiple sexual partners
Early sexual initiation
Teenage pregnancy
STIs
10.2
SUBSTANCE USE
2.22.8
5.6
5.8
SmokingHeavy alcohol use
Illicit drug use
Problem alcohol use
Problem drug use
7.58.1 30.1
VIOLENCE
Suicide attempt
Violenceperpetration
Victimisation
Hughes, Bellis, Hardcastle et al, 2017 Lancet Public Health
4+ACEsVs
No ACEs
Objectives•Aim• Create a life course measure of the main health-related costs of ACEs
Estimate Prevalence of ACEs
Calculate the proportion of common health conditions caused by ACEs
Convert health into Disability Adjusted Life Years
Convert DALYs to financial costs (Gross Domestic Product per person per Year)
(Bellis et al 2019; Lancet Public Health)
ACEsDALYS €Human
Capital Model
Population Attributable
Fraction
articles using unique samples on health topics included in Euro and NA
Full text obtained for 880 articles
4,387 unique references subjected to title/abstract review
9,156 references retrieved in searches
221 articles considered for inclusion
Study Selection
23(Bellis et al 2019; Lancet Public Health)
23.5% 1 ACE18.7% 2+ACEs
319 million individuals 15+ years with
1+ACE
23.4% 1 ACE35.0% 2+ACEs
172 million individuals 15+ years with at least 1 ACE
(Bellis et al 2019; Lancet Public Health)
ACEs
Increased risk of ill health outcomes by ACE Count
• Risks consistently higher as ACE counts increases• Similar increases
between continents• Smoking Euro NA• 1 ACE 29%↑ 23%↑• 2+ ACEs 82% ↑ 74%↑
• Some differences in risk • Cancer Euro NA• 1 ACE 8%↑ 10%↑• 2+ ACEs 58%↑ 25%↑
Population Attributable
Fraction
• Risk Factors• Harmful Alcohol Use• Illicit Drug Use• Smoking• Obesity
• Causes of Ill health• Anxiety• Depression• Cancer• Cardiovascular Disease• Diabetes• Respiratory Disease
DALYSDisability Adjusted Life YearsW
este
rn E
urop
e, B
oth
Sexe
s, A
ll A
ges,
201
7
Institute for Health metrics
Expected life years
RIP
Early Death
HUMAN CAPITAL MODEL- assign a monetary value to loss of health calculated as reduced or lost economic productivity.
25% 34%18% 6%
28% 28%11% 12% 8% 19%
alcohol
illicit drug use
smoking
obesity
Anxiety
Depression
Cancer
Cardiovascular dis.
Diabetes
Respiratory dis.
$BillionsPer year
Fraction attributable to
ACEs
The Costs of ACEs across Europe
$143
$46
$165 $
40
$23
$29
$117
$185
$16
$47
Bellis, Hughes, Ford, Rodriguez, Sethi, Passmore, 2019 €Human
Capital Model
MINIMUM COST to Europe per Year $581 BILLON and combined with NORTH AMERICA $1.3 Trillion
HUMAN CAPITAL MODEL- assign a monetary value to loss of health calculated as reduced or lost economic productivity.
25% 34%18% 6%
28% 28%11% 12% 8% 19%
alcohol
illicit drug use
smoking
obesity
Anxiety
Depression
Cancer
Cardiovascular dis.
Diabetes
Respiratory dis.
$BillionsPer year
Fraction attributable to
ACEs
The Costs of ACEs across Europe
$143
$46
$165 $
40
$23
$29
$117
$185
$16
$47
Bellis, Hughes, Ford, Rodriguez, Sethi, Passmore, 2019 €Human
Capital Model
MINIMUM COST to Europe per Year $581 BILLON and combined with NORTH AMERICA $1.3 Trillion
• 2+ACEs account for around 3/4 of costs• Costs fall on • Whole population ($1,000 person per year– Euro & NA)• Health, Education, Crime, Social sectors
•Maltreatment, other ACEs and their Cost are preventable• INSPIRE and other cost-effective model
•At a Country level possible to• Measure more accurately how major health conditions and
care costs are related ACEs• Other costs (criminal) related to ACEs• Potential savings from investing in prevention of child
maltreatment and other adversity
OUTCOMES
Population Attributable Fractions England
10%
25%64%
Wales
0% 10% 20% 30% 40% 50% 60%
Alcohol use
Drug abuse
High BMI
Violence
Anxiety
Cancer
Heart Disease
Type 2 Diabetes
1 ACE 2-3 ACEs 4+ ACEs
Northern Ireland Gross Domestic Product –
2017 (2018 prices) - £26,014 per capita
Nor
ther
n Ir
elan
d,
Both
Sex
es, A
ll A
ges,
20
17
Annual Costs of ACEs in Northern Ireland
High BMI
22 million
Alcohol use
87 million
Drug use
129 million
Smoking
217 million
HEALTH RISKS
77 million
Depression
CAUSES OF ILL HEALTH
Violence
13 million
Type 2 diabetes
41 million
Anxiety
88 million
Other mental illness
209 million
Cancer
229 million
148 million
Respiratory disease
Heart disease
134 million
101 million
Stroke
Combined cost(excluding duplication)
£1.3 billion Per annum
Professor Mark A. BellisDirector of Policy & International Health, World Health Organization
Collaborating Centre on Investment for Health and Well-beingEmail - m.a.bellis@bangor.ac.uk, Twitter - @markabellis
Bellis, Hughes, Ford, Rodriguez, Sethi, Passmore; www.thelancet.com/public-
health Vol 4 October 2019
WHO Collaborating Centre