85: Hidden Costs of Trauma (Part 1)—Understanding Economic and Societal Impact

Discover the hidden costs of trauma and why addressing them is not just a moral imperative but an economic necessity. 

In the first of a three-part series, recorded as a live webinar in May for Mental Health Awareness month, we uncover the prevalence of trauma and its far-reaching costs—not just financial, but impacting our communities on a deep level and offering an example of what is possible when we prioritize healing and resilience.

We start by discussing the $14.1 trillion annual economic burden of adverse childhood experiences (ACEs) and then move on to talking about the systemic barriers that perpetuate trauma, particularly in marginalized communities. Hear how historical and intergenerational trauma affect mental health, education, and the juvenile justice system, and why implicit biases and discriminatory policies still haunt people of color and women. 

Don't miss this insightful episode that underscores the urgent need for systemic change and the power of resilience in overcoming trauma.

Panelists:
* Martin Simms. Founder and Director of Performance Enhancement at The DOPE Coach Academy
* Ingrid Cockhren, CEO Cockhren Consulting
* Connie Iannetta, Founder, FosterStrong
* Jesse Kohler, Executive Director on loan for the Campaign for Trauma-Informed Policy and Practice (CTIPP)

Resources:

• Economic Burden of Health Conditions Associated With Adverse Childhood Experiences Among US Adults, JAMA Network

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.

Chapters

• 1:14 Hidden Costs of Childhood Trauma
• 13:35 Systems of Trauma and Healing
• 26:45 Navigating Trauma-Informed Leadership Strategies

Transcript

Jess Kohler: 1:15

And so the numbers that I'm going to share are directly related to adverse childhood experiences. But again, we do know that trauma spans beyond just those ACEs. But the population attributable risk around, say, cardiovascular disease is that more than one quarter of all cardiovascular disease is attributable to ACEs and that's the leading cause of death in the United States. Massive economic costs on our medical system, healthcare system. There's also nearly a quarter of cancer and asthma cases also attributable to adverse childhood experiences.

Manya Chylinski: 1:53

Hello and welcome to Notes on Resilience. I'm your host, manya Chylinski, and today we have part one of a three-part series unveiling trauma's hidden costs. This is from a webinar we did back in May with four special guests Martin Simms, founder and director of performance enhancement at the dope coach academy, Ingrid Cockhren, ceo of Cockhren Consulting, Connie Ianetta, founder of Foster Strong, and Jesse Kohler, executive director on loan for the Campaign for Trauma-informed Policy and Practice. And in this first episode we look at what are the costs of trauma, from the financial cost to the human cost. What does it mean for us individually and as a society? I think you're going to find this really eye-opening.

Manya Chylinski: 2:50

Well, a recent study showed that 63% of adults in the US have had adverse childhood experiences. In the US have had adverse childhood experiences and the economic burden of that related to this experience is $14.1 trillion annually. $183 billion of that is direct medical spending and $13.9 trillion is lost healthy life years. For the individuals who are dealing with this, that is $2.4 million per adult throughout their lifetime. And with our panelists today, we're going to look at these and the other costs of trauma on our society. We'll discuss how it's impacting society. What are the barriers to addressing these costs? How can we promote inclusivity about what are the most significant economic costs associated with unaddressed trauma and how do they impact us as individuals and as a society?

Jess Kohler: 4:11

$14 trillion is a pretty substantial number, right, that is massive, and so when we break that down, I think that, manu, when we were talking, you were asking about what are the hidden costs? Right, and I know that Connie's going to build on this, but I think that what's important is that, when we know where to look, these costs really aren't hidden. They're just the root causes of what we view as symptoms and can observe and see on the top, and so I want to share that. Before the $14.1 trillion number came out, there was another number back in, like 2017 or 2018, maybe 2019. It was definitely pre-COVID and everything pre-COVID feels like just a different lifetime in some ways, and so I forget the exact year, but it said that the cost of ACEs annually was $748 billion, and we knew that that was a conservative estimate, so $14 trillion feels a lot better. It looked at three adverse childhood experiences specifically, and that number looked at four health outcomes across the lifespan, and I think that, while I am going to talk about the economics, what's really important is that we don't lose the humanity in where these dollars come from, and these are real lives. So much greater at the time. That was larger than the Department of Defense budget for the entire year in the United States by about $10 billion. We at CTIP did independent research looking at population attributable risk data that showed that at least 650,000 lives are lost each year because of ACEs and you can find that resource on our website. I'm happy to put that in the chat when I'm done speaking, just to show kind of how we calculated that using some CDC data and population attributable risk data. But there is a real human cost to all of this. That has strong ripple effects that are really important to show.

Jess Kohler: 6:25

And one other thing before I dive into the numbers is that I'm going to be talking about ACEs adverse childhood experiences which are a powerful public health tool. Because it is finite, it is measurable when we look at the original ACEs, but we know that trauma is so much greater than just ACEs. Even the four realms of ACEs, trauma becomes infinitely complex, which makes it difficult to measure. And that's where the ACEs data becomes very powerful at a public health level. Because it's finite, we can measure the impact, and so the numbers that I'm going to share are directly related to adverse childhood experiences. But again, we do know that trauma spans beyond just those ACEs but the population.

Jess Kohler: 7:11

Attributable risk around, say, cardiovascular disease, is that more than one quarter of all cardiovascular disease is attributable to ACEs and that's the leading cause of death in the United States. Massive economic costs on our medical system, healthcare system. There's also nearly a quarter of cancer and asthma cases also attributable to adverse childhood experiences. We also know that there's a high correlation with substance misuse 78% of IV drug use, when we think about the opioid epidemic, is correlated or attributable to ACEs. 65% of alcoholism, 36.7% of current smoking, has been found to be attributable to ACEs. So when we think about the $14 trillion cost that is in that JAMA article, it piles up because of the very real human impacts and the way that systems then have to navigate.

Jess Kohler: 8:10

From a healthcare perspective, from a child welfare and child and family support system perspective, from a justice system perspective or carceral system perspective, from an education perspective, we see these costs piling up and what we know is that from the work of the Family Policy Council in Washington state I don't know if everybody here has read the self-healing communities model, which is a Robert Wood Johnson Foundation report that shows the impact of reducing ACE prevalence and coming through a systemic, trauma-informed approach, and they measured the economic benefits of these approaches and they created $1.1 billion in cost avoidance.

Jess Kohler: 8:55

That was measured for the state, which was a greater than 35x return on investment. And I'm going to let this be the last thing that I say because, connie, I think that it feeds well into what you're going to share here on this similar line of questioning. But we know that if that program or systemic change had lasted for more than 17 years and we got to the 20, 25, 30-year mark when we saw kids who were born into this program becoming parents of their own, we would have reduced the transmission of intergenerational trauma. And while a 35x return on investment is just magnificently huge when we block that intergenerational transmission of trauma, we can imagine the ways in which that cost avoidance becomes exponentially greater generation after generation, until there's some plateau where the world and our systems look so incredibly different that we are able to navigate in different ways. And so that's yeah, um, yeah. That's, I think, what I wanted to share at first about the costs and the hidden costs that I see thank you so much, jesse.

Manya Chylinski: 10:06

That really sets us on the footing of why this is so important. And, connie, we'd love to hear from you specifically thinking about that generational trauma.

Connie Ianetta: 10:16

Thank you. Wow, those numbers are incredible. So whereas Jesse focused more on the economic cost, I want to focus more on the human cost. I mentioned that I have foster care history. I'm actually a third generation former foster youth. I then went on to do kinship times three through two different sides of my family, taking in children, two of which are adopted. One was reunified.

Connie Ianetta: 10:41

So trauma is something that's trickled through my family tree for generations. So for me, I've seen firsthand that unadjusted trauma, especially within families and communities, it perpetuates these generational cycles of pain. It affects mental health relationships, socioeconomic opportunities. It manifests itself in increased healthcare expenses, decreased productivity, career stuff, and it puts a heavy strain on social services. So for me, what kind of paved the way of me entering into advocacy? At first it was survival and then I started really digging into how do we stop this cycle of trauma and struggle in my family and everything.

Connie Ianetta: 11:26

So my experience with generational trauma kind of underscores how unresolved issues are inherited. Generational trauma kind of underscores how unresolved issues are inherited and they're perpetuating these societal disparities and inhibiting healing and growth. So one thing I've noticed is to touch on the ACEs. For me and most of my family we can check all the boxes, if not most of them. So something that I've always kind of been curious about is what makes us the exception to the rule, those of us who've always kind of been curious about, is what makes us the exception to the rule, those of us who are still kind of moving forward, putting one foot in front of the other. So, as Martin touched on earlier in his introduction, dr Bruce Perry is someone that I really admire and his books are incredible. But later on I'll kind of dig more into his shift in mindset. As far as you know, what happened to you and everything, Thank you for sharing.

Manya Chylinski: 12:18

Connie, appreciate that and this one. We'll start with you, martin. How do intersecting factors like race, gender, socioeconomic status compound the impact of trauma, and what kind of initiatives can we be thinking about to promote inclusivity and address these particular challenges?

Martin Simms: 12:41

Probably start with the way Black women are treated in childbirth. So if I start there and we look at the discrepancies of the amount of women who died during childbirth as far as African-Americans are concerned and the trauma surrounding that, I guess that is probably the best example. And then there's a lot of other things outside of that. But when we talk about that, you're talking about two generations at once. We're talking about birth trauma, we're talking about a lot of things that go on in there and that's based on how the medical establishment deems Black women when they say that they're in pain or when they express some type of discomfort, and the thought process is that they're not in as much pain or they can deal with more pain than their white counterparts or other racist counterparts. And there's very, very deep, there's very deep implications to that which result in childbirth or death during childbirth for either the child or mother. But I think that's a small microcosm in the overall dealing of trauma in the first place when it deals with our race, being how we're looked at in the psychology spaces, how we're looked at in different spaces on top of the trauma that we've gone through as a people here in this country to get to the country and all of those things that are involved with that. So the barriers are great, but I think if we start in those spaces to recognize that, that's where the discrepancies are and start to understand what those awarenesses or what the implicit biases are within the societies and being able to address those.

Martin Simms: 14:26

First and foremost because while I'm talking about childbirth, that also shows up in the juvenile justice system. That also shows up in the juvenile justice system. That also shows up in the kindergarten classes when you're determining whether a child has a ADHD or whether they have some type of learning disability which sets up and it might sound something small in kindergarten and third grade level. But then that goes into juvenile justice system, that goes into lifelong imprisonment and in this whole school to prison pipeline. There's no mental health, anything in that space. There's just behavior control and things of that nature.

Martin Simms: 15:03

And so those are the barriers, that that's exactly what we're up against, completely in the back of the minds of the system that were created to perpetuate what they've been perpetuating so far, and so if we know that that's like the monster to have to deal with, then that's what we're actually operating on not just awareness, but also the cognitive and implicit biases that were present when these systems were put together in the first place.

Manya Chylinski: 15:28

Ingrid, I'm curious your thoughts on this as well, sort of those intersecting factors and adding to what Martin said about how that compounds the impact of trauma.

Ingrid Cockhren: 15:39

Yeah, I think we tend to look at trauma from an individual standpoint as a collective, so we tend to think about the individual ways in which we can cope and the individual traumatic experiences like ACEs. But to me and my work just in general, how I was introduced to this work in the first place, is through historical trauma, which is like when Constance was talking about intergenerational trauma. It's the same thing, but it applies to specific cultural groups and so when it comes to race, gender and all the other ways we like to separate ourselves in this country, it's probably the most impactful of all the ACEs and trauma in general, because it's so pervasive. It impacts all of us. Even our white counterparts are impacted by this, because it's also perpetuated through policies. We've had policies put in place to intentionally impact people of color, to intentionally impact women, and as we create policies that are damaging to some of us, they're damaging to all of us and so the ripple effect there is huge. But if we look just with race and how it has really warped our understanding of our reality and how we see ourselves and how we see others, implications there for the cost of the trauma in that space is immeasurable. There is no dollar amount that I can put on that, because obviously it's tied to kind of the sector specific things that we were talking about and the numbers that Jesse gave us. But we also have there kind of the sector specific things that we were talking about and the numbers that Jesse gave us. But we also have there kind of the unlocked human potential, all the ways in which we do not get what we need from our human populace because people are being oppressed and subjugated, so cures for diseases, technological advances get to see because our system is created to impact the prosperity of certain groups and essentially cutting off our nose to spite our face as a country.

Ingrid Cockhren: 17:39

And this is traumatic in many ways. But one of the ways that kind of Martin touched on is parenting and being a mother. You know, part of the birth trauma is just the understanding that you're having a child who is of color in this country. That causes a lot of stress and anxiety in general the thought that I'm going to have to talk to my child about what it means to be, whatever race that they are, and all the things that come along with that, that I'm going to have to be there to go to this process of racial socialization and let them know that because of their skin color or the shape of their eyes or their hair or all the different ways that we believe race is a real thing, that that's going to have impact on them. This process ensures that we will continue to have like kind of two Americas. That because not everyone is going through this racial socialization process. It also impacts individuals' perception of themselves. It impacts their academic performance.

Ingrid Cockhren: 18:38

Think about social determinants of health and all the different ways that we kind of highlight the impact of institutional racism.

Ingrid Cockhren: 18:46

We leave off historical trauma as a driver. So even if we had a magic wand and we were able to set all of our systems right and we had all perfect policies, we would still have to deal with the psychological impact of the past that is so pervasive in our country because we have to, as parents, racially socialize our children to prepare them to deal with a racist society. And this is ongoing and even through generations we still have these issues and that's because we're not addressing historical trauma. And the reason why we're not doing that is because it requires the healing practices that we would not want to engage in as a country, so Indigenous practices, being embedded within the way that we operate, and no one wants to do that, because the belief is that Indigenous practices are somehow uncivilized or savage or demonic. Right, and there's this stigma in our society around them. We also can't uphold white supremacy and colonialism if we push for Indigenous practices as healing modalities and this keeps us stuck in a space where we're not able to effectively solve our problems.

Manya Chylinski: 19:55

Thank you, martin and Ingrid. I appreciate the conversation of what is keeping us stuck, like you just ended with Ingrid, and we're looking at things from implicit bias to policy to just no political will for making those kind of changes. So I appreciate you bringing that up, ingrid. Some critics argue that the current focus on trauma-informed care actually perpetuates the mentality of a victim mentality or prevents people from taking responsibility for their individual actions. And how do you respond to that kind of criticism and how can we make sure that trauma-informed approaches actually empower people?

Ingrid Cockhren: 20:38

Yeah, I think that this is. There's so many different ways that this view is kind of a cop-out and lacking in accountability and so, yes, we have to think about kind of this social ecological model. We have individual actions and we can engage in coping, we can go to counseling, but I've worked with families within institutions, I've worked with families that are in crisis, I've worked with families in the foster care and juvenile justice system and there is no clear understanding within those systems of how actually the human body works. So I'm in crisis and now I'm expected to fill out forms and go to meetings and somehow get to the meeting with no transportation and all these systemic barriers that are in place. So I would say that when we're talking about oppressive systems, what does individual resilience mean? I am putting too much emphasis on the ability of individuals and families to deal with structural issues and then I blame them and say, well, it's because then we get into victim blaming.

Ingrid Cockhren: 21:47

I also think it's interesting this outlook of trauma at least in my work, which is on the collective scale, kind of this big picture, systemic issues like racism and sexism and our capitalist system, when people say things like oh, it's a victim mentality. Some people are victims of this system. They're actual victims. It's not by chance or there are actual, clear trends in our history. We have policies. All of these things have been encoded. We have the quotes of our forefathers and conquerors. These are not made up. There are groups of us who are victims of this society and any time we have harm has been perpetuated. Then there's an expectation that there's retribution, that there's reparations, there's go to the process of redemption and healing.

Ingrid Cockhren: 22:42

Again, that we are not on board with doing, and so I don't. Typically, in general, resilience is murky, but then, on top of that, I don't know that we can talk about individual resilience in the face of systemic issues. But when we're talking about victim mentality and what people can own, I will say that we can own our own healing. We may not be able to be as effective within this oppressive system as individuals, but we can own our own healing. So that's where that individual practice comes into place, that I can get behind, the way that we can practice mindfulness or just engage in whatever individual healing practices are needed for ourselves. But just to be very clear, we are doing that and it's a band-aid, not a solution.

Manya Chylinski: 23:35

Thank you so much for that and, connie, I'm curious your thoughts on this question as well, about this victim mentality, and how do you respond to that criticism?

Connie Ianetta: 23:46

It's really important to kind of acknowledge that trauma-informed care doesn't absolve people from responsibility. It's supposed to kind of help them understand a lot of their actions and help people working with them understand through, like a lens, past experiences. So for me it's kind of a double-edged sword. I mean my family, we're gritty, we are so we believe in like pushing forward. But we also the professional background that I have, pushes back on the whole pull yourself up by your bootstraps thing. So my family, everybody's like. You know we're headstrong, we're stubborn, we're just people don't cry so much or anything like that. You power through, you keep going. But I've had to find a healthy balance with that because I think in our family that actually was really damaging us. That was a trauma response. You know that hyper anxiety, the perfectionist mentality and stuff like that. I mean that harmed us for many generations. So now it's about finding a healthy balance.

Connie Ianetta: 24:44

I will say since probably when I was 18 and I aged out of foster care and struggled a lot and I got really involved in youth advocacy and later the alumni advocacy, there was a struggle in many conversations among a lot of the peer support groups about accountability because a lot of people would lean on. Well, I've been through trauma, so I didn't carry out this task that I said I would do. So I feel like there has to be some level of owning your history and owning your responsibilities. And having that expectation of accountability does not mean you lack empathy or that you're not being trauma informed, because trauma history is not the full picture, though it's a large part. So there's a really popular quote that I love to share with the masses If you never heal what hurt you, you'll bleed on people who didn't cut you. So if you think about it like the example that we discuss a lot in the youth and alumni groups and everything is okay, so experienced trauma. You have a task to complete. You're not completing that task. This is a struggle for you. What about the person that the task then gets passed to, or it falls on in your absence and stuff.

Connie Ianetta: 26:00

So we actually have taken a more trauma informed approach, especially with Foster Strong. You know we're another alumni led group of individuals with lived experience, both personally and professionally. So we always have like a plan B for circumstances, like if someone is supposed to do something for an event. Life happened, people have had relatives pass away, they've had things trigger them and stuff, and we always kind of have a plan be in place and we also have our way of supporting each other and just open dialogue. So I think that's really important. But I don't believe in embracing the victim mentality and this has come up a lot in conversations but I don't believe that we should just ask people to push on and power through. So I think it's all about finding a healthy balance between the two.

Manya Chylinski: 26:45

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 want to learn more about, visit my website, www. manyachylinski. com, or email me at manya at manyachylinski, or stop by my social media on LinkedIn and Twitter. Thanks so much.