Authored By Rick Murdock, Michigan ACE Initiative Grant Coordinator

The categories of Adverse Childhood Experiences include: Abuse, neglect and household dysfunction and the impact that ACEs have on future health conditions and behaviors. Similarly, many also are aware of the need for public policy to focus more on social determinates to provide positive health outcomes.

For those needing a brief context of social determinants—they are generally defined as the conditions in which people are born, grow, live and work—and they play a key role in determining a population’s health. There are five major categories: Economic stability, education status, social and community context, health and health care and neighborhood and environment.

We know that poverty limits access to healthy foods and that safe neighborhoods and that more education is a predictor of better health. We also know that differences in health are striking in communities with poor “social determinants” such as unstable housing, low income, unsafe neighborhoods or substandard education. According to Healthy People 2020, by applying what we know about social determinants of health, we can not only improve individual and population health but also advance health equity. This will also increase the likelihood of fewer instances of adverse childhood experiences.

The Michigan ACE Initiative has taken a strong position on public policy regarding reducing adverse childhood experiences.  Importantly for this discussion, one of the key recommendations is to “shore up” the safety net. This is due to the recognition that public spending on such areas as safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins all reduce adverse childhood experiences.

The discussion of ACEs and social determinants has now taken an additional and timely perspective courtesy of the Citizens Research Council of Michigan and their recent report: “An Ounce of Prevention: What Public Health Means for Michigan”.

The Citizens Research Council report shares that public health is a central and yet broadly misunderstood function of government that focuses on prevention of disease and injury, and management of environmental factors (physical and social) that affect health. The report noted improvement may be needed for Michigan’s system of public health service delivery that is currently fragmented between multiple state departments. Like the approach recommend by the Michigan ACE Initiative, the Citizens Research Council propose that a “Health in All Policies” approach be adopted statewide so that every government policy (from schools to roads to criminal justice) includes assessment of associated health risks and/or benefits.

The public must develop a deeper understanding of public health, assume greater individual responsibility for personal and community health, and hold public leaders accountable for failures to protect the public’s health. Health underpins every individual’s ability to pursue their own happiness and to make productive contributions to their community.  Michigan faces numerous health challenges and large numbers of people continue to experience notable health disparities.  Greater attention to public health will work to deconstruct physical and social barriers to healthy, productive lives, and to safeguard the health and wellbeing of all citizens on this pair of pleasant peninsulas

While Michigan needs greater investment in public health—it should be clear that investment also means greater philosophical buy in. Each of Michigan’s departments, agencies, and local governments should prioritize safeguarding the public health and adopt a “Health in All Policies” philosophy and approach to governance. To that recommendation, I would add, “Amen”.

The Michigan Association of Health Plans and MAHP Foundation started the Michigan ACE Initiative in recognition that we cannot continue to pay the bill for health care expenditures without bankrupting our not only our wallets, but the public resources. We know the research on ACEs is very clear:  Reduce ACEs and you will reduce substantial future payments in health care. The public health challenge raised by Citizens Research Council is similar: Michigan cannot afford to continue to spend massive amounts on health insurance policies and costly medical interventions while failing to invest in population-level health promotion and disease prevention, or, more generally, in social well-being.

Our failure to invest in social determinants of health; our failure to invest in public health; and our failure to prevent adverse childhood experiences have consequences. Not only do we spend more than $70 billion dollars on health in Michigan—we do so without measurably improving health outcomes.  More Michiganders smoke and/or are obese than the national average.  Michigan has a higher rate of infant mortality and its residents have a shorter life expectancy at birth than the U.S. average.

Michigan pays a price for not prioritizing an approach to reduce adverse childhood experiences, to address the social determinants of health and for disinvesting in funding public health.

To continue to support the status quo will condemn future generations to poor health outcomes and higher health care cost. The incoming new Administration and Legislature can make a difference that will be felt for generations to come.