ACEs: Growing awareness and creating community

The Michigan ACE Initiative: What we’ve learned so far

If you are reading this blog, you likely have awareness and, presumably interest, in Adverse Childhood Experience (ACE). The awareness of ACE is large and growing. Since our initiative began, I have met with many groups, individuals and held phone and email conversations and am impressed both by the multiple local initiatives underway that address early childhood development, child abuse and prevention as well as the potential that the Michigan ACE Initiative has to be a major catalyst for establishing and sustaining community interventions. Our underlying premise with the Michigan ACE Initiative is to facilitate this dynamic across Michigan. Our tools to seek and disseminate information from the Michigan ACE Initiative include the web siteFacebook page and YouTube channel.

While we will need to speak with one voice and a common interpretation of what ACE is and what it means for both children and their families, we will also need to be clear that each community will arrive at their approach differently.

I am pleasantly surprised regarding the knowledge that many who are involved in this effort bring to their profession, their volunteer efforts and their care of their children. I am also struck by the fact that once engaged in this effort, you cannot “walk away”—but struggle with the magnitude of the gap between awareness and next steps. That is our challenge.

As an aside, perhaps we are also struck by the total absence of any conversation regarding the impact of Adverse Childhood Experience, on “health care reform” that is consuming our state and national conversations. But perhaps that is a good thing, as we need to build this initiative community by community to reach a threshold for state involvement.  In many ways, this is a “cultural shift” that will take a generation to achieve—but the potential outcome is so huge, that we can’t miss this opportunity.  So, what is this outcome—and what is the relationship to health care?

Future outcomes are in front of us  

The magnitude of the impact of ACE is huge and the evidence supporting it is vast, impressive by any measure and growing—both epidemiological as well as more recent neurological studies, which we will explore in more detail in future blogs. The following illustration displays percentages of key conditions that are attributable to the presence of ACE in the population:

The original ACE research, that has been replicated across the country, including here in Michigan, clearly showed that ACEs are common and have a strong cumulative impact on the risk of common health and social problems. The calculation that is commonly used in public health studies is called Population Attributable Risk; this is displayed as a percentage on the above image and represents the percentage of a problem that is potentially preventable by reducing or eliminating ACEs.

The cumulative effects of ACEs reflect a powerful opportunity for prevention—no matter if you are working to prevent heart disease or cancer, end homelessness or hopelessness, improve business profitability or reduce interactions with law enforcement. Population Attributable Risk also provides the path forward, that signals that if we align our work around the common goal of preventing the accumulation of ACEs and moderating their effects, we will reduce all of these problems, and many others, all at once!

 The ACE Study is unique because it provides the potential to understand how multiple forms of childhood stressors can affect many important public health problems. Challenges to address population health, social determinants of health, disparities as well as the need to create integrated delivery systems are at the core of how ACE must be addressed in Michigan.  It is also clear that the solution for addressing ACE will require more involvement with non-traditional health care providers and organizations as this is not just a health care issue; it is an education performance issue, it is a law enforcement issue, and it is a work productivity issue.

Stay tuned for more

My next blog will suggest some public policy issues that we should explore as well as highlighting some of the Michigan ACE Initiative project status to date and continue to ask and answer; What if the largest public health discovery of our time is about the smallest of us?


The MAHP Foundation received funding from the Michigan Health Endowment Fund to support the Creating Healing Communities: A Statewide Initiative to Address Adverse Childhood Experiences (ACEs) in Michigan. Learn more here.