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Does poverty cause ACEs? Or do ACEs cause poverty?

 Street children, Jacob Riis photo, New York City, 1890

An article about a poverty simulation had me thinking about the belief that poverty causes ACEs. Dr. Vincent Felitti once said he thought ACEs cause poverty. Dave Ellis, a consultant and an ACEs master trainer in Minneapolis, said he thought poverty was a symptom of ACEs. 

 

The discussion about poverty usually focuses the spotlight on the individual. “Take a 19-year-old African-American single mother who dropped out of high school”….is often how people start the conversation. 

 

But the poverty simulator clearly shows that, once people live in poverty land, the systems that serve them collectively make a barrier — not a bridge — for them and their children to become economically healthy. 

 

The writer, simulating a 19-year-old single mom high school drop-out with a one-year-old child, was trying to find child care, housing and a job while living in a homeless shelter, then…

 

Upon returning to the shelter, I see a strongly worded notice from the state saying I needed to get to the family services agency immediately to re-certify my benefits, or risk losing them. So the next day I head there, Harvey, hungry and irritable, in tow, and find a long line. I must fill out a detailed form, and the counter closes just as I go to submit it. I’m told to come back the next day.

 

And that’s about when I realize I haven’t even budgeted time to shop for anything resembling healthy food for the family….I’m feeling a pit in my gut, the calling card of stress—increasingly anxious and irritable.

 

Summarizing, the author says: 

 

Bland's [Michelle Bland, manager of educational theatre at the Kaiser Foundation] first experience with the simulation was putting students through it who were studying nursing, criminal justice, or social services, to show them the day-to-day experiences of individuals living with low income.

 

He could also have said: “….to show them the disorganized, disjointed, and hope-sucking system we’ve created to serve poor people.” 

 

Economically poor adults tend to have high ACE scores. Traumatized as children, they were further traumatized by education, faith-based, healthcare, social service and juvenile justice systems that suspended, expelled, blamed, shamed, misdiagnosed, drugged, or further punished them to try to change their behavior. Hey! It didn’t....doesn’t...work. 

 

Our systems — whether they are populated by good-hearted people or not — corral a steady stream of children with high ACE scores into adult poverty (and/or healthcare and prisons). The systems that serve the adult poor continue the blame game. They tell the poor “It’s your fault!”, and make it as difficult as possible to climb out. 

 

So, do ACEs cause poverty? Or does poverty cause ACEs? Outside of natural disasters, systems exacerbate and cause poverty, which cause ACEs. Systems exacerbate and cause ACEs, which lead to poverty. We create those systems. As Louise Godbold, co-director of Echo Parenting & Education, says: Chicken or egg, no one’s getting out of the hen house the way it is now.  

 

(Besides changing our education, faith-based, healthcare, social service, and juvenile justice systems)…couldn’t we create a system for the economically poor like the one that Gilbert Gonzalez, the director of the Bexar County Mental Health Department, created for the mentally ill in San Antonio, TX? He brought together jails, hospitals, courts, police and mental health departments to create one integrated system that treats clients/patients with respect, that acknowledges their hard lives and the incredible strength it took to survive.

 

It regards them as valued customers and members of the community who deserve the services they need to become healthier. One good reason to do so is because our systems, in their collective ignorance — before we understood the consequences and biology of ACEs — didn’t provide those services when the adults, as children, (and their own parents) first cried out for help. 

 

ACEsConnection members, I really want to know what you think. On the right track? On the railroad spur heading for dead end? Or is there something creative like this happening in a community somewhere?

 

Please leave your comments below!

 

 

 

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Very interesting article! Caitlin O'Brien and I have been working on a report at the Scattergood Foundation to look at what trauma-informed public policy means, specifically focusing on public assistance programs offered by the City of Philadelphia. We designed a conceptual model to lay out the different elements at play to show how poverty interacts with toxic stress, ACEs, health, and public policies. Feel free to check out the model (view below) and we will share our report with the ACEs community once it is finalized.



If you would like to speak with Caitlin and I on our report, please email us at cobrien@scattergoodfoundation.org and sakins@scattergoodfoundation.org.

Last edited by Shoshana Akins

I lived in Mali for a year, some 20 years ago. I spoke with a Peace Corps volunteer who told me that the highest cause of death in Mali was traffic accidents. Well, perhaps for Peace Corps volunteers in Mali, but for the actual people there, the highest cause of death is poverty. I have seen it happen, where the parents cannot afford 1 dollar worth of available medication to stop a tooth infection from getting out of hand and killing the girl.

That is what this conversation reminds me of. Poverty is ACE. It is a crime. It is the biggest crime against humanity there is. Nothing grates so much against human dignity as poverty. That is not to say that many, many poor people don't act with dignity. Don't hear me wrong here. Please. But the structural violence of poverty is just that, violence.

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