A 2020 report on Health Equity in England: The Marmot Review 10 Years On notes that a central criticism of the ACEs approach is the "lack of contextualisation of the role of poverty and the social determinants of health. A systematic review of the relationship between childhood socioeconomic position and ACEs found that much of the ACEs literature and policy documents fail to adequately consider social and economic position. Instead, the literature and subsequent policies have individualised problems and solutions, and ignored the role of poverty and the social determinants of health.”
The Report recommends that in order to reduce “inequalities in health, prevent the transmission of disadvantage and inequality across generations and improve the quality of life of children, young people and adults,“ it is necessary to undertake comprehensive whole-systems approaches that take effective and sustained action on the causes, prevalence and impacts of ACEs and impacts of deprivation across all of children’s frontline service. Reducing ACEs necessitates reducing the number of families in poverty and proportionately increasing income among those at the lower end of the social gradient, particularly for lone mothers, through family benefits or the tax system, for example. The Scottish government, which has supported the ACEs approach in the past, recently stated the importance of understanding the impact of child poverty in relation to preventing and addressing ACEs. Family support services, particularly during the earliest years, are another important intervention.” See (https://www.health.org.uk/publ...5EAAYASAAEgJ1W_D_BwE )
A review of over 1300 empirical study of ACEs published yesterday in Children and Youth Service Review reinforces the conclusions of the Health Equity Report. "Adverse Childhood Experiences: A Scoping Review of Measures and Methods" highlights three points:
- This scoping review summarizes ACEs research between 1999 and 2019.
- More attention is paid to ACEs’ effects than to causes, inequities, or interventions.
- We suggest incorporating ACEs into broader frameworks of determinants of health.
This article concludes that the “dominant narrative about ACEs [in this research] started with ACEs as the ‘villains’ who begin a story of decline and ended with ‘victims’ who have behavioral and/or emotional problems. Studies overwhelmingly examined the downstream effects of ACEs rather than upstream causes or preventive interventions. That is, only 6.6% of articles proposed protective factors that went beyond the individual or family level; and researchers’ recommendations favored amelioration of ACEs after they occur, with only 20% of articles mentioning primordial or primary prevention.
"This disproportionate focus on downstream determinants after ACEs have already occurred limits the impact of this research in terms of potential cost-benefit, social justice, and mitigation of health inequities. We recommend that future ACEs research be incorporated into broader, strengths-based and action-oriented frameworks focused on social determinants of health and health inequities; link ACEs to their putative causes as a bridge to primordial/primary prevention; address obstacles to this shift toward upstream causes of ACEs; and communicate findings and recommendations more effectively."
______________________________
“Adverse Childhood Experiences: A Scoping Review of Measures and Methods” by Canan Karatekin. Susan M. Mason, Amy Riegelman, Caitlin Bakker, Shanda Hunt, Bria Gresham, Frederique Corcoran, Andrew Barnes
Comments (3)