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Earlier this month, California’s Surgeon General Nadine Burke Harris launched an ambitious campaign to reduce adverse childhood experiences, which can cause lifelong health problems. With more than 60 percent of Californians saying they were exposed to a traumatic childhood event, adverse childhood experiences are at crisis levels in the state. The ACEs Aware campaign will train and pay health care providers to screen Medi-Cal recipients for adverse childhood experiences, known as ACEs.

This investment in screenings is a first step for the surgeon general, who is also a pediatrician, in achieving her visionary goal to reduce adverse childhood experiences by 50 percent in a generation.

Those exposed to ACEs have increased “risks of injury; sexually transmitted infections, including HIV; mental health problems; maternal and child health problems; teen pregnancy; involvement in sex trafficking; a wide range of chronic diseases; and the leading causes of death such as cancer, diabetes, heart disease, and suicide,” according to a new report from the U.S. Centers for Disease Control and Prevention.

Rachel A. Davis

Reducing ACEs will improve health and wellbeing across the state. And, to fully achieve the surgeon general’s laudable goal, we must also focus on what gives rise to ACEs in the first place. Addressing adverse community experiences, which disproportionately burden communities of color and people with low incomes, must be an essential part of our strategy.

In California, adverse community experiences are the result of underinvestment and disenfranchisement in too many neighborhoods, which have brought about severe poverty, food insecurity, displacement from housing or homelessness, community violence, and deteriorated community conditions, oftentimes rooted in racism or anti-immigrant bias.

Adverse community experiences result in trauma at a community level. Traumatized communities experience a breakdown in connection and trust, which gives rise to hopelessness and contributes to decrease in civic engagement.

Adverse community experiences and the trauma they create make ACEs more likely to occur. They increase conditions that make ACEs more probable, such as community violence and limited access to economic opportunities. For example, in a community that hasn’t benefited from business and government investments, community residents may be out of work, have to travel far distances to work or juggle multiple jobs, which makes life stressful for parents and may lead to adversity within the household.

Howard Pinderhughes

Community trauma also negatively affects conditions that are protective against the impact of ACEs, like social supports. Social supports, like neighbors looking out for each other, can help children and youth cope with adverse experiences, so they are less likely to result in toxic stress.

Meanwhile, community trauma is also a barrier to putting effective improvement strategies into place, because communities with high rates of trauma are less able to participate in efforts to advocate for improved community conditions like good jobs, affordable housing, quality schools and access to healthy food.

We learned about the significance of community trauma while working with more than 20 U.S. cities that wanted to develop comprehensive violence prevention initiatives through a project called UNITY, or Urban Networks to Increase Thriving Youth.

Many cities that participated in the UNITY Network saw violence decrease, but they also found that community-level trauma was functioning as a barrier to successfully implementing health-promoting strategies. High levels of trauma were contributing to a diminished sense of agency and efficacy in communities. This also led to a break down of the community’s social networks, social relationships and positive social norms—all of which could otherwise help protect the community from violence and trauma.

After talking with public health and violence prevention practitioners, community leaders and non-profits across the country, we published the Adverse Community Experiences and Resilience framework (ACE|R) and began working with communities in California, as well as others nationwide, to put the approach into practice.

The framework offers strategies to address and prevent community trauma and foster resilience. Since its release in 2016, it’s been integrated into community efforts to address ACEs, mental health problems, suicide, the opioid epidemic and community and domestic violence, among others.

Integrating an Adverse Community Experiences and Resilience approach into California’s new ACEs Awareness campaign could take a variety of forms. As children are being screened, we could also educate policymakers about the relationship between ACEs and adverse community experiences. We could support communities in putting healing-centered strategies in place to reduce adverse experiences in neighborhoods across the state.

Burke Harris has broken new ground by recognizing the fundamental impact of trauma on children’s health and mental health. Let’s all take action to ensure that alongside screening, we also take steps to improve the communities where children play and learn, so that we can reduce ACEs by 50 percent in a generation.

Rachel A. Davis is the executive director of the national nonprofit Prevention Institute, headquartered in Oakland. Howard Pinderhughes, vice president of the Prevention Institute board of directors, is chair and professor of the UC San Francisco Department of Social and Behavioral Sciences.