Adverse childhood experiences (ACEs) is a term developed to define one of ten possible experiences that affect children as they are growing up that can lead to problems later in life. In the early stages of the PhD relatively little was known about how much ACEs cost society and how ACEs affect lifetime socioeconomic status and social mobility. Research published in 2020, however, estimated that ACEs cost the economy of England and Wales £48.2 billion.
This thesis is in two parts. The first part deals with testing a methodology for attributing lifetime health costs to the presence or absence of ACEs across five main diseases in terms of expenditure (Chapters 2-3). This thesis proposes a novel approach to achieve this aim which can be broadly defined as performing an extrapolation of the data that is available or a pro-rata approach to estimate the missing data. The second part (Chapters 4-5) of the thesis addresses the issue of whether ACEs are associated with a degree of lifetime social mobility defined by wealth in adulthood compared with wealth in childhood. Both parts of the thesis employ systematic informed reviews of current evidence (Chapters 2 and 5). In part 1, looking at attributable health costs, a population attributable fraction (PAF) methodology is used (Chapter 3). In part 2, social mobility is explored using part of the ACEs dataset (which is a large survey dataset conducted in Wales, England, Blackburn with Darwen and southern England between 2012 and 2015 (N=13,130) of the general public asking them to reflect on their ACEs). The areas used in the analytical chapter were a subset of this broader dataset and was confined to Wales and Southern England (N=7,429) as only these areas had the variable ‘wealth in childhood/adulthood’ used to calculate social mobility. The two parts of the thesis are connected. It is posited that an increase in investment to tackle ACEs, the amount of which is identified in the costing section, leads to an increase in social mobility and hence a commensurate increase in tax revenues for the government that could, if the government were so inclined, be invested back into society to deal with the outcomes associated with ACEs.
This thesis provides two novel findings. First, that it was possible to find lifetime attributable costs for mental health, cancer and circulatory disease but not the other two areas of musculoskeletal and genitourinary disease. This was because of a lack of information on odds ratios for ACE counts for musculoskeletal disease and a lack of data on odds ratios and costs for genitourinary disease. Secondly, with respect to social mobility, this thesis found a counter intuitive, but statistically significant outcome where increasing ACEs were associated with an increased likelihood of upward social mobility. This may be because access to health and social care increases as ACE counts increased. Another explanation may be that people become upwardly mobile despite ACEs by having access to a trusted adult and developing resilience. One way of preventing ACEs from being passed down the generations is through social mobility. The question will be asked if there are any enablers in terms of the promotion of resilience that aid social mobility in children who have experience of ACEs. This relationship is tested with the data in Chapter 5 and it is found that having a trusted adult is linked with upward social mobility given that the respondents have ACEs. That is children become upwardly mobile despite adversity given the help of a trusted adult.
The second finding also gave rise to a research dilemma. I could not reject the counterintuitive result because it was significant and could not rejoice over the intuitive result as it was not significant. Suffice to say that the knowledge base of this field of study has been expanded by this thesis.
In the final chapter, policy recommendations are offered based on the results of this thesis, around approaches to dealing with ACEs especially considering improving social mobility.
Developing access to a ‘trusted adult’ is seen as key in providing children with an element of resilience against the harmful effect of ACEs.
This thesis argues that if the role of trusted adults can be maintained and developed then this can protect children against the possibility of downward social mobility and even lead to upward social mobility. That is, children can ‘move on up’ despite having several ACEs, if given the right support with economic benefits both to themselves and the economy as a whole.