Welcome to the first episode in our series: Unveiling Trauma's Impact: Navigating the Hidden Costs., uncovering the hidden costs of unaddressed trauma and delving into its far-reaching effects.
In our first episode, Ted Miller, a distinguished senior research scientist, unravels the extensive and often hidden economic and emotional toll of trauma. We examine the staggering $10.5 billion healthcare price tag associated with adverse childhood experiences (ACEs) in California for just a single year. We discussed the methodologies used to quantify the financial and human impact of trauma and gained perspective on the profound implications trauma has on health and society.
As we look at the potential for real-world change, Ted highlights the power of individual stories in shaping policy, and we conclude with a message of hope, recognizing that the courageous act of sharing one's own trauma can light a fire that contribute to societal movements and policy reforms.
Dr. Ted Miller is an internationally recognized health economist. He is a Principal Research Scientist at the Pacific Institute for Research and Evaluation with decades of experience analyzing the costs of societal ills. The Washington Post once called him a national oracle on the financial damage caused by substance abuse and injuries.
You can reach Ted via email at miller@pire.org or visit the PIRE website to learn more about his work.
Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.
Invite Manya to inspire and empower your teams + position your organization as a forward-thinking leader in fostering resilience and trauma sensitivity.
Welcome to the first episode in our series: Unveiling Trauma's Impact: Navigating the Hidden Costs., uncovering the hidden costs of unaddressed trauma and delving into its far-reaching effects.
In our first episode, Ted Miller, a distinguished senior research scientist, unravels the extensive and often hidden economic and emotional toll of trauma. We examine the staggering $10.5 billion healthcare price tag associated with adverse childhood experiences (ACEs) in California for just a single year. We discussed the methodologies used to quantify the financial and human impact of trauma and gained perspective on the profound implications trauma has on health and society.
As we look at the potential for real-world change, Ted highlights the power of individual stories in shaping policy, and we conclude with a message of hope, recognizing that the courageous act of sharing one's own trauma can light a fire that contribute to societal movements and policy reforms.
Dr. Ted Miller is an internationally recognized health economist. He is a Principal Research Scientist at the Pacific Institute for Research and Evaluation with decades of experience analyzing the costs of societal ills. The Washington Post once called him a national oracle on the financial damage caused by substance abuse and injuries.
You can reach Ted via email at miller@pire.org or visit the PIRE website to learn more about his work.
Go to https://betterhelp.com/resilience or click Notes on Resilience during sign up for 10% off your first month of therapy with my sponsor BetterHelp.
Invite Manya to inspire and empower your teams + position your organization as a forward-thinking leader in fostering resilience and trauma sensitivity.
It's important to have the numbers there and they help make the case, but it's also the people who can get up there and say this is what happened to me and it didn't need to happen, because we know these are things we could have done about it. Hello.
Manya Chylinski:
Welcome to Notes on Resilience. I'm your host, Manya Chylinski, and today is the first episode of our series Unveiling Trauma's Impact Navigating the Hidden Costs and my guest is Ted Miller. He's a senior research scientist at the Pacific Institute for Research and Evaluation and he is a leading expert on injury and violence incidents, the cost and consequences of trauma and substance abuse costs. He and I chatted because he wrote an article about the cost of adverse childhood experiences on adult health in California, and we talked today about the economic impact of trauma, the non-economic impact of trauma, and how we can take the really great information that economists create to help make real change in our society. I think you're really going to enjoy this episode. Hello Ted, I'm so excited that you and I are going to be having this conversation today. Thanks for being here. You're welcome. And before we dig into the topic at hand, the question I ask everybody to start with if you could have dinner with any historical figure, who would it be and why?
Dr. Ted Miller:
Shakespeare. First off, he speaks English. Yes. Second off, he's truly a fascinating storyteller. Yes, and eloquent. And third off, I could find out a piece of pseudonym.
Manya Chylinski:
Oh my gosh, because you would know who it really is. Wow, oh, I like that one. All right, if you figure out a way to make that happen, let me know. I want to hear the answers to those questions.
Manya Chylinski:
Well, ted, as you know, we are here today to talk about the hidden costs of trauma and you are episode one. You are helping lay the foundation for the further episodes in this series and in the context of this discussion. Hidden costs can be financial, like increased health care costs or lost productivity, but it's also things like opportunity costs or societal burdens or long-term consequences that somehow we're not always accounting for. And, ted, you are an economist and I found you because of your article. The adult health burden and costs in California during 2013 associated with prior adverse childhood experiences, and that number just was shocking to me. In the report, you said $10.5 billion in excess personal health care costs, just for California and just for the year 2013. Take it away.
Dr. Ted Miller:
What does that mean? So what we did was we looked at studies that are out that you can do that. Look at the health conditions that people have who have no adverse childhood experiences, one, two and so on, and a lot of the literature groups them and the worst is four plus the more aces you have, the more likely you are have a series of different health conditions. And if you look at the literature actually you find that it's not even just health conditions, it's self-reported disability, it's injuries, premature mortality, mental health, especially depression, maternal health, infectious disease, chronic disease, risk behaviors like substance abuse, disorders, smoking, obesity. And we have studies for the health conditions.
Dr. Ted Miller:
So we know that in California, depression, asthma, copd which is sort of respiratory stuff arthritis and cardiovascular disease were all elevated in their data and we could see it there. And we went to studies that had here's what the medical costs are. We went to other studies that said here's what the quality of life loss is from those conditions and we used a framework where quality of life encompassed work loss as well, so that we could just look at those two categories. Now one of the challenges there is putting a dollar value on that quality of life loss.
Manya Chylinski:
Right, that's what I'm wondering about. How do you put that number to it?
Dr. Ted Miller:
I've been doing that since the 1980s. What we do is we look at what people pay for small changes in their chance of being killed or injured, or we do surveys that ask them what they would pay to reduce their chance of death in specific situations. For example, do you slow down in a bad wind and rainstorm when you're driving, and how much higher do you think your risk of death would be if you didn't slow down?
Manya Chylinski:
Oh, wow, okay.
Dr. Ted Miller:
Or as more and more, as the price of smoke alarms came down and more and more people bought them, we could look at how much they were spending and get a picture across the population how much more of the population bought smoke alarms as the price of that safety came down. Wow.
Manya Chylinski:
There's some interesting nuances in the way that you're looking at this data that I never imagined.
Dr. Ted Miller:
Most of the studies that are done started out by taking known economics about how much people earn Okay, and studies of this and projecting how much people earn, and they added in the risk of dying or being injured on the job and they were able to say this is how much extra people get in their wages for risky work.
Dr. Ted Miller:
Wow Okay, I always wondered how you could put a dollar figure on a life or a quality of life Right, and what we do is we then split that because we know how much their lifetime earnings would be. We take that off and what's left is the value of the quality of life, net of earnings. We divide by the number of life years to get the value of life here.
Manya Chylinski:
So that's averaged out over the population that you're looking at.
Dr. Ted Miller:
That's right and currently most federal agencies are using a number just over 10 million between 10 and 11 million dollars for life.
Manya Chylinski:
Is the value of one human life in the US? Yes, and that's basically lifetime earnings of if you had a job and you worked, it's mostly quality of life.
Dr. Ted Miller:
Lifetime earnings are about a million and a half, something like that. Okay, the value of lifetime household work the best is the value of lost quality of life and pain and suffering.
Manya Chylinski:
Wow. So, ted, you are sitting at your desk and you're looking at these numbers that we've put to the value of a human life. What does that feel like? To be thinking about people from that perspective?
Dr. Ted Miller:
Well, what it felt like when I first started doing it was very frustrating because the federal government was just valuing people's lives based on what they earned. Okay, especially in the Department of Transportation, the Environmental Protection Agency and Department of Labor were using higher values that included quality of life. Oh, okay, because the government wasn't, and I felt like the victims were being cheated because the government was really understating what a lot of injuries cost. And I did a lot of what's called systematic review where I laid out all the studies and we finally got it in the feds to change it. What changed it was a table I did that showed what the values were at different federal agencies. The lawyers took one look and said our agency is being disadvantaged and changed it, whereas the analysts have been very hesitant to put a dollar value on quality of life. Traditionally they hadn't.
Manya Chylinski:
Yeah, thank you for doing that work and helping us get a fuller picture of how important our individual lives are. And I imagine it also is hard for me as a non-economist. It's hard to think of putting a dollar value on my life and what I'm worth. I think it's difficult to think of a life in that way because that's not how I approach my life, right? Yeah?
Dr. Ted Miller:
You do make all those decisions about doing unsafe things, right, we all do unsafe things. I mean it's dangerous to get out of bed you might trip and break your neck but it's dangerous to just stay in bed, right? So you have to take risks in life.
Manya Chylinski:
Right, we do. Before we hit the record button. You and I were also talking about another number. You were talking about when someone is murdered. That then results in I think the number you said was one and a half to two and a half people going into therapy. That's right. So that is another cost to just to look at a murder of a loved one as a trauma. In addition to the financial costs that we've been looking at, there's this other cost now that's affected the quality of life of this person's loved ones and the amount of therapy that they do, and it may traumatize them and impact their life going forward.
Dr. Ted Miller:
Yes, and what you see is that post-traumatic stress disorder, ptsd, is common, it's very real and it's very costly. Laura Winston, the Children's Hospital of Pennsylvania, did a study one time where she talked to parents whose children had been injured in motor vehicle crash and they got a phone call from some authority saying your child has been in a road crash and they transported to the hospital. There were some of those people whose kids had turned out to be just fine by the time they got to the ED, but who were reliving that experience and stuck in it. When you look at something like some of the mass shootings, the people who didn't get shot can still be stuck in that moment and have severe mental health problems because of it.
Manya Chylinski:
Absolutely.
Dr. Ted Miller:
When the Veterans Administration we did a study in 2008 for the Veterans Administration I was part of, and when they looked at all the different categories of injury that they compensated, it turned out that, no matter what the percent disability was, the most costly was post-traumatic stress disorder in terms of quality of life loss?
Manya Chylinski:
Yes, and I can understand that myself, having had post-traumatic stress disorder, I have my own perspective on it, but it definitely negatively impacted the quality of my life and I have read lots of things about it and I'm not spending a lot of time thinking of how it is continuing to affect my life and my potential lifespan. I'm not wanting to go there.
Dr. Ted Miller:
Let's take another step from there. So people who, because of their ACEs or their injury or their mass trauma or disaster or whatever, may have PTSD, may have severe depression, may have anxiety, may have other mental health disorders those disorders all affect your employability as well as your lifespan and that in turn affects your food security, your housing security, your ability to form good relationships and maintain them, your chance of being divorced. So that's a whole nother set, of course, costs that ripple down.
Manya Chylinski:
Yes, and I so appreciate you bringing those up, like food insecurity and loss of your job. These are things that I feel like this is my own perspective, but I feel like when we're you know when something happens, so you know, after the bombing, the thought isn't all of these downstream effects and how can we help sort of stem the tide by taking care of people in the immediate aftermath. And we need to be thinking about this is the impact on society if we don't take steps to take care of these people. You're on the research side, you're on the economic side. You're not the policy guy, you're not the person who takes your research and says we're going to turn this into a policy. But what do you think are the barriers to taking this really good information that you and other researchers have done to show the impact of trauma and actually make real changes?
Dr. Ted Miller:
Policy processes move slowly and usually what moves them is the champion. It's important to have the numbers there and they help make the case, but it's also the people who can get up there and say this is what happened to me and it didn't need to happen, because we know these are things we could have done about it and we need to not let that happen to other people. Right, and I always tell people when I've done work that has the quality of life in it, that if they're going to go testify, for example, in a hostile place, that the standard bearer of the numbers should be a victim or a survivor or someone who lost the loved one, because anybody who is sufficiently empathetic to get elected is never going to ask the victim. Well, how do you know that your child was worth $10 million? And the head of the department of health may well get asked that.
Manya Chylinski:
Right, because the department of health is just a number, it's a data point, but for the victim or the survivor or the family member, it's personal and I would imagine you'd have to be very brave to ask someone like that one of those questions.
Dr. Ted Miller:
Yeah, the other problem that you hit is that we don't know enough about how to deal with PTSD. There have been some recent breakthroughs, I believe, but it's still not a disease that we have a real good handle on.
Manya Chylinski:
Right, ted. One of my arguments is, if we can validate people's experiences and get in there early and say what you're experiencing is normal, then we can help some more people tap into their own networks and their own resiliency and maybe reduce the number of people who get these post-traumatic stress disorder, acute depression all of these downstream, so that we can minimize these costs and lift us up as a society.
Dr. Ted Miller:
Yeah, and with the ACEs it appears that what's really important is to give those kids a good, strong support of the adult or two in their lives, young and when they're experiencing the ACEs.
Dr. Ted Miller:
That's easy to do when the ACEs didn't result from continuing problems in the home. It's difficult to do when the home is unstable, when your mother or your father has an alcohol or drug use disorder, when they're not functional and when that household is there for an up functional. But it's important to remember that people want to be good parents. Even that person with all that problems wants to be a good parent Right. Our job is to find ways to help them do that and to put another stable point in that child's life. Besides that as well, right, and we do have programs that can help them the nurse family partnership and some of the other home visitation programs for newborn infants and their mothers. And also we have schools and we have preschools and through those institutions we could set up routine screening phrases and supports for the kids who scream positive. And with the opioid settlements in some states we're pushing to try to see some of that happen.
Manya Chylinski:
Oh, great, excellent, ted, you are doing such great work at figuring out the cost to society, you and your colleagues who are doing this kind of research. What can an individual or an organization take away from your research? That's really gonna help move the needle.
Dr. Ted Miller:
The costs of this are far higher than the cost will be to fix it because it's so pervasive for so many people. 63% of Americans have had adverse childhood experiences. 22% have had four or more adverse childhood experiences. That means that 22% of people are very prone to things like severe depression and anxiety because of what happened to mischildren. Breaking the cycle of child abuse is part of what we need, because ACEs include child abuse. We don't do nearly enough for maltreated children in this country. We don't have enough willingness to talk about what's happened to them, and that's particularly true of sexually assaulted children. Huge quality of life loss with sexual assault, particularly for children. Huge numbers of children sexually assaulted and we don't talk about it. We don't do things about it. It needs more champions.
Manya Chylinski:
We do, we do, but you're right, these topics are difficult and I think they're difficult to hear about, they're difficult to think about and certainly to talk about, and I think that is one of the underlying challenges and why we need more advocates and people sharing their story, because we need people to force others to listen to how important this information is.
Dr. Ted Miller:
Yeah, the other thing that it makes is needing some mass movements. Like I was talking about the importance of the individual victim, but then if we look at history, we'd say, mad, yes, those upset individual victims got together into an organization.
Manya Chylinski:
Yes.
Dr. Ted Miller:
So we're enough of them, then, to have political clout.
Manya Chylinski:
And I think every one of these conditions that we have talked about, there are enough people. If we could find each other. There are enough people to make a real movement behind. I think the challenge is, especially when you're dealing with trauma is not everybody wants to talk about their trauma or be upfront about it for all sorts of reasons. So we'll just need to find some ways that we can all find each other then, ted, thank you for that.
Dr. Ted Miller:
But it's also striking that we've done more about sexual assault and prison in terms of both tracking how common it is and doing something about it than about sexual assault in the home.
Manya Chylinski:
Yeah, that's a shame, especially as the things you were talking about for kids. If we can address those aces early, we can give back quality of life.
Dr. Ted Miller:
Yes, it's longevity. It's how many years you're gonna live and whether you're gonna get cancer and whether you're gonna get heart disease and all sorts of things.
Manya Chylinski:
I know, I know. Well, we are getting close to the end of our time. What's one thought you'd like to leave our listeners with?
Dr. Ted Miller:
That trauma isn't just an acute condition. It affects, for many, many of the victims, their entire life and many aspects of their life. We economists are brave, we can stick our necks out, we can put a dollar value on that, but we can never fully capture it.
Manya Chylinski:
Ted, thank you so much for talking with me today and sharing with me and our listeners this really important work that you do. And thank you for the work that you do because it is part of making real change for trauma victims and I, for one, appreciate that greatly.
Dr. Ted Miller:
Thank you for running this series, Manya.
Manya Chylinski:
Thanks to our listeners. Look forward to episode number two soon. Thank you for listening. I hope you got as much out of this conversation as I did, so if you'd like to learn more about me, Manya Chylinski, I work with organizations to help understand how to create environments where people can thrive after difficult life experiences, and I do this through talks and consulting. I'm a survivor of mass violence and I use my experience to help leaders learn about resiliency, compassion and trauma-sensitive leadership to build strategies to enable teams to thrive and be engaged amidst difficulty and turmoil. If this is something you wanna learn more about, visit my website, www. manyachylinski. com, or email me at manya@manyachylinski. com, or stop by my social media on LinkedIn and Twitter. Thanks so much.
