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Adverse childhood experiences and lifelong health

Nature Medicine volume 29, pages 1639–1648 (2023)Cite this article

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Abstract

With the advent of the sustainable development goals, the field of global child health has shifted its focus from reducing mortality to improving health, nutrition and development outcomes — often measured as human capital. A growing knowledge of the biology of development and neuroscience has highlighted the importance of adverse environmental exposures, collectively termed adverse childhood experiences (ACEs) on health outcomes. ACEs are associated with short-term, medium-term and long-term negative consequences for health and development and their effects may be multiplicative, especially during critical periods of sensitivity and developmental plasticity. Some of these effects are compounded by emerging global threats such as climate change, conflict and population displacement. In this Review, we discuss the key mechanisms linking ACEs to health outcomes and consider promising strategies to prevent and mitigate their effects, highlighting evidence from programs in low-income and middle-income countries. Finally, we emphasize the need for early recognition of ACEs and delivery of packages of interventions spanning key sectors such as health, education, women’s empowerment and social protection.

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Fig. 1: Adverse childhood experiences and opportunities for intervention across the life course.
Fig. 2: Mechanisms by which adverse childhood experiences impact neurodevelopment and health outcomes.

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Acknowledgements

The authors are grateful to T. Vaivada for support in drawing Fig. 1, and to A. Ali for assistance in manuscript formatting. No funding was secured for this work.

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Authors and Affiliations

  1. Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada

    Zulfiqar A. Bhutta

  2. Institute for Global Health & Development, The Aga Khan University, South Central Asia, East Africa, United Kingdom, and Karachi, Pakistan

    Zulfiqar A. Bhutta

  3. Child Development Group, Sangath, Goa, India

    Supriya Bhavnani

  4. Boston College School of Social Work, Chestnut Hill, MA, USA

    Theresa S. Betancourt

  5. Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa

    Mark Tomlinson

  6. School of Nursing and Midwifery, Queens University, Belfast, UK

    Mark Tomlinson

  7. Department of Global Health and Population, Harvard Chan School of Public Health, Boston, MA, USA

    Vikram Patel

  8. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Vikram Patel

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Bhutta, Z.A., Bhavnani, S., Betancourt, T.S. et al. Adverse childhood experiences and lifelong health. Nat Med 29, 1639–1648 (2023). https://doi.org/10.1038/s41591-023-02426-0

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