Health Equity

All Californians deserve the opportunity to reach their full potential

doctor handing a piece of paper

“Through ACEs Aware, we can realize a more just and equitable reality where we can truly prevent and provide healing from childhood adversity for all Californians.”

- Former California Surgeon General Dr. Nadine Burke Harris

While ACEs impact all communities, we know that some populations are affected disproportionately.

The original ACE study was conducted among a population that was largely White, middle class, college-educated, and privately insured. [ 1 ] [ 2 ] Subsequent studies have found a higher prevalence of ACEs among individuals who are racially marginalized (Black, Latinx, Native American, or multi-racial), experience a failing education system in their communities, lack access to quality health care, are pulled into the justice or child welfare systems, or are disregarded or harmed because of their gender and/or sexual identity. [ 3 ] [ 4 ] It is clear that vulnerable and systematically overlooked communities bear the brunt of each new crisis – from COVID-19 to climate change – and that these communities deserve a much more effective set of buffering systems and supports.

To transform the negative outcomes associated with ACEs, California is leading the way in improving the lives of our most vulnerable residents by investing in a cross-sector framework for preventing, screening for, and treating ACEs and toxic stress. These are key components of our overarching efforts to advance equity, improve health and well-being, reduce homelessness and other adversities, and move toward person-centered, value-based care.

It is important to recognize exposure to racism and discrimination as risk factors for toxic stress and acknowledge the long-term impact on health. We must also understand that historical racism can affect how patients relate to health care clinical teams, as well as other organizations in the community. With this awareness, we can better promote integrated efforts to heal.

Watch the ACEs Aware Health Equity webinar below to better understand how exposure to racism and discrimination are risk factors for toxic stress and how clinicians can use this knowledge to improve health and well-being for all patients. 

1: Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine 1998; 14: 245–58.
2: Dube SR, Felitti VJ, Dong M, Giles WH, Anda RF. The impact of adverse childhood experiences on health problems: evidence from four birth cohorts dating back to 1900. Preventive Medicine 2003; 37: 268–77.
3: Miller GE, Chen E, Parker KJ. Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a model of behavioral and biological mechanisms. Psychological Bulletin 2011; 137: 959–97.
4: Liu SR, Kia‐Keating M, Nylund‐Gibson K, Barnett ML. Co‐Occurring Youth Profiles of Adverse Childhood Experiences and Protective Factors: Associations with Health, Resilience, and Racial Disparities. American Journal of Community Psychology 2019; published online Sept 6. DOI:10.1002/ajcp.12387.