A Public Health Approach to Childhood Adversity Carly Grant and Ruairi O’Brien Public mental health team, NHS Health Scotland @NHSHS_MH @NHS_HS The national Health Board working to reduce health inequalities and improve population health in Scotland. Find public health research, evidence, evaluations and resources. For practitioners and policy makers, Community Planning and Health and Social Care Partnerships, and other public service staff. ACEs – Public Health Approach We are advocating for a public health approach to ACEs - Work on ACEs fits well with what public health is all about: Public health is defined as “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” (Acheson, 1988; WHO).

ACEs Animation Seminal ACEs study considered 10 ACEs. Carried out mid 1990s in southern California. Start findings – clear relationship between ACEs and physical and emotional health across the life course. Many ACE studies carried out since. No specific Scottish data however evidenced from English and welsh populations show similar trends to American study. Unlike England and Wales, Scotland hasn’t undertaken ACE survey looking at prevalence of the 10 most commonly measured ACEs – looking at Scottish Health Survey Bullying / Poverty / Bereavement

Polishing the diamonds “The evidence of impact of adverse childhood experiences is compelling, as is the case for action from a moral and financial perspective at an individual level and to prevent the repeated cycle of intergenerational transmission.”

The Scottish ACEs Hub Formed as a result of the above report the Scottish ACEs Hub is a multidisciplinary group which is helping to shape actions we can take and support work to engage with a wide range of sectors. It shows the collaborative nature of this work and that together we are developing areas of work. e.g. Chief Commander in Ayrshire Police is the rep for Police Scotland but has made a commitment that Ayrshire Police will be a ‘trauma-informed’ police force.

Public health priorities Priority 2 A Scotland where we flourish in our early years Priority 3 A Scotland where we have good mental wellbeing “We want Scotland to be a place where everybody thrives. We want to reset how Scotland thinks about wellbeing and health. Wellbeing cannot be created and sustained by the NHS alone”. Published 14th June 2018 6 Priorities

Changing a mind-set… What's happened to you?

Fundamental causes – health inequalities The fundamental causes of health inequalities are an unequal distribution in society of Income - money received by individuals or groups over a specific time period. Wealth  - the value of an individual or group’s money and/or material assets that have built up over time. Accumulated wealth may provide extra income from interest, rents or share dividends. Power - a complex concept which includes the ability or capacity to do, or not to do, something and control, force or influence through a variety of means.   They are fundamental because they are the basis from which health inequality is formed.  The fundamental causes influence the distribution of wider environmental influences on health and access to services and wider society. This in turn shapes people's individual experiences and results in health inequalities. Context of perinatal mental health? Perinatal MH does not discriminate, however what about the impact of health inequalities in perinatal period and the impact these may have on an individuals experience. How does this shape and impact on how they are doing in the perinatal period? What are our responses? Do our services meet needs?

A public health approach to perinatal mental health… A complete redesign of RSB! – significant increase in volume and content of MH across the perinatal period. If mental health is one of the identified ACEs and we know the impact of not treating MH difficulties in the perinatal period should we invest more at this stage? Joining up the dots! Dads and partners – ?Routine enquiry?

Questions Reflections Feedback