One statistic that frequently comes up in public health research circles is the kind that ought to be featured on the front page of all of the nation’s major newspapers. The estimated yearly economic cost of adverse childhood experiences in North America alone is close to $748 billion. The largest portion of that is carried by the United States. However, it is completely avoided in the majority of policy discussions concerning workforce decline, healthcare spending, and productivity.
Growing up in homes characterized by substance abuse, mental illness, or incarceration, as well as exposure to domestic violence, emotional, physical, and sexual abuse, are examples of adverse childhood experiences, or ACEs. These are not peripheral circumstances. People with four or more ACEs had a four- to twelve-fold higher risk of alcoholism, drug abuse, depression, and suicide attempts, according to research based on more than 17,000 patients in a California HMO. It is not a marginal result. Millions of American lives are characterized by this pattern.
A 2019 meta-analysis that was published in The Lancet Public Health attempted to quantify the damage in monetary terms using data from 23 high-quality studies and more than a million individuals in North America and Europe. It’s hard to sit with the numbers. ACE-related illicit drug abuse costs North America about $168 billion a year. An additional $73 billion is added by alcohol abuse. The cost of cigarette smoking is $160 billion. Lung disease, cardiovascular disease, obesity, and mental illness are all correlated, in quantifiable percentages, with what happened to individuals prior to the age of eighteen.
The compounding effect makes this more difficult to ignore. Researchers are still trying to fully understand how having two or more ACEs multiplies the risk rather than just doubling it. People who have had multiple adverse events account for 82% of all ACE-related costs in North America. It’s not a coincidence. It begins in childhood bedrooms and kitchen tables rather than in hospital waiting rooms or unemployment lines, and it is a feedback loop.
Particularly in policy circles, there is a temptation to view these as issues of personal shortcomings. In addition to being erroneous, that framing is costly. According to the data, even a 10% decrease in the frequency of multiple ACEs would result in annual savings of about $105 billion for both North America and Europe. Speculative optimism is not what that is. Any serious fiscal conservative should find that return on investment appealing, but the discussion hardly ever goes in that direction.
It’s important to take a step back and think about how this truly appears outside of the spreadsheets. When a child grows up in a home where one of the parents is addicted, they are not just absorbing emotional suffering on their own. In a very quantifiable way, that child is accruing future expenses in the form of healthcare, lost income, involvement with the criminal justice system, and generational poverty. When they move away from home, the trauma doesn’t stay. They bring it into every relationship, every job, and every trip to the doctor.
According to the Lancet analysis’s researchers, the combined annual cost of ACEs in North America and Europe is $1.33 trillion. It’s difficult to fully comprehend that number. Given how many downstream effects—such as decreased civic engagement, impaired group decision-making, and diminished creativity in the workforce—are practically impossible to measure, it’s possible that even this significantly understates the issue.
It’s becoming more and more obvious that treating ACEs as a social service problem rather than an economic one has allowed the crisis to spread largely unchecked. Early intervention, mental health services, parental support, and prevention programs are not considered charitable expenditures. They appear to be the most sensible investments a society could make, according to the data. Whether there is the political will to treat them that way is the question. The majority of the time, the answer has been no.
