This begged the question – were there other areas of poor health in adulthood or social outcomes where the people affected had largely been victims of childhood adversity?
What followed in the mid-90s was a longitudinal Adverse Childhood Experiences Study, of more than 17,000-mostly middle-aged and middle-class West-coasters in the US, through a collaboration of Kaiser Permanente clinics and the Centre for Disease Control in Atlanta.
Firstly, the findings revealed the shocking and heart-breaking prevalence of 10 classified types of Adverse Childhood Experiences which were broken down into three areas:
1) Abuse: Sexual, physical, emotional;
2) Neglect: Failure to meet basic physical needs, leaving a child uncared for, or unloved;
3) Household dysfunction: Witnessing, addiction, crime, parent-to-parent violence, mental illness etc.
Respondents were given an “Ace Score” of 1 to 10. Two-thirds of respondents had experienced at least one ACE and 12% of respondents had an Ace Score of 4 or more.
20% had been victims of child sex abuse – a number almost identical to the much later Council of Europe estimate that 1 in 5 European children suffer from sexual violence.
The statistics on all forms of violence also broadly correlate with prevalence levels that can be seen from the global UNICEF report on violence against children: Hidden in Plain Sight.
If researchers were knocked sideways by the shockingly high levels of prevalence, including in middle- and high-income households, they were also astounded to find an almost “dose-response” correlation with high adversity and poor life outcomes, in health, education, addiction and crime throughout the lifecycle.
According to a leading ACE researcher and public health practitioner, Dr Nadine Burke Harris, in California somebody who had experienced 7 of 10 forms of childhood adversity has a 20-year shorter life-expectancy than someone who has experienced none.
It took a different type of research, from the field of neurobiology, to explain why high childhood adversity converted to poor outcomes in adulthood – through the impact of what the Harvard University Centre for the Developing Child has termed ‘Toxic Stress’upon the physical and brain development of children.
As devastating as all of this is, we now have the knowledge and the science to build a global effort to reduce the impact of childhood adversity and violence against children. If we can reduce the dose of adversity and toxic stress we are not only fulfilling our human rights obligation to protect children, but also potentially ensuring long-term reductions in poor public health, low productivity, high crime etc.
UNICEF works throughout the CEE/CIS region in Regional Knowledge Leadership areas to help governments to simultaneously do three things:
1) Build violence prevention mechanisms, from pre-natal visits and throughout a child’s life cycle;
2) Provide interlocking services of child protection, health, education and justice that will protect the child victim of adversity and help him or her recover; and
3) Break the public taboo on childhood adversity which prevails in almost all of the countries in our region.
In Montenegro in late 2013 we had the first national discussion on child sex abuse as part of a national survey on violence against children in parliament. Services are being strengthened, reporting seems to be on the increase and there is more public discussion. But we are mindful that this is just the beginning.