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A Critique of the Adverse Childhood Experiences Framework in Epidemiology and Public Health: Uses and Misuses

Published online by Cambridge University Press:  03 April 2019

Michelle Kelly-Irving  and
Cyrille Delpierre
Michelle Kelly-Irving*
Affiliation:
Equity research team, LEASP, Inserm, Iferiss, Université Toulouse III Paul Sabatier, France E-mail: michelle.kelly@inserm.fr
Cyrille Delpierre
Affiliation:
Equity research team, LEASP, Inserm, Iferiss, Université Toulouse III Paul Sabatier, France E-mail: cyrille.delpierre@inserm.fr
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Abstract

Adverse childhood experiences (ACEs) have emerged as a major research theme. They make reference to an array of potentially harmful exposures occurring from birth to eighteen years of age and may be involved in the construction of health inequalities over the lifecourse. As with many simplified concepts, ACEs present limitations. They include diverse types of exposures, are often considered cumulatively, can be identified using prospective and retrospective approaches, and their multidimensional nature may lead to greater measurement error. From a public health perspective, ACEs are useful for describing the need to act upon complex social environments to prevent health inequalities at a population level. As the ACEs concept becomes popular in the context of policy interventions, concerns have emerged. As a probabilistic and population-level tool, it is not adapted to diagnose individual-level vulnerabilities, an approach which could ultimately exacerbate inequalities. Here, we present a critique of the ACEs framework, discussing its strengths and limits.

Keywords

Adverse childhood experienceshealth inequalitiesepidemiologypublic healthpolicy

Information

Type
Themed Section: Adverse Childhood Experiences (ACES) – Implications and Challenges
Information
Social Policy and Society , Volume 18 , Issue 3 , July 2019 , pp. 445 - 456
Copyright
© Cambridge University Press 2019 

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