What We Talk About When We Talk About Emotional Poverty

If you put your mask on and go for a socially distanced trawl through New York City’s bookshops, you will note the most in-demand book of the moment hails from Glasgow. Shuggie Bain by Glaswegian New Yorker Stuart Douglas just won the Booker Prize. Its’about a 1980s childhood derailed by poverty, exclusion and adversity, and recovery through love and resilience.

‘ Glasgow was losing its purpose’ pondered Shuggie’s father while surveying the working class communities fractured by pit and shipyard closures.

Glasgow has certainly found new purpose in its world-inspiring efforts to reduce violence and adverse childhood experiences (ACEs). The eminent public health thinker Sir Michael Marmot lauded Glasgow’s community-based violence reduction work for halving gang violence in the city. Sir Micheal described their approach as an example of ‘building resilient communities’. Martin Luther King used to describe community based work on violence and exclusion as striving for a ‘beloved community’. They are one and the same. Love is resilience.

It was a pleasure to join Sir Michael last week in an online public discussion on poverty and adverse childhood experiences (ACEs), hosted by the incredible Ace-Aware Scotland.

This pandemic has shone the light on poverty everywhere. Austerity and prior stagnation on child health coupled with growing inequality had made us more vulnerable to the shocks of Covid19. Globally the number of children in poverty is estimated to have already risen by 15% as a result of the pandemic. We know child poverty is a disaster for children and their families, but it is also bad for society. Tackling child poverty increases wealth and growth for everyone. When we don’t, the scars last a lifetime and can be passed from one generation to another.

I see three catastrophic burdens in childhood that can drive lifelong inequality: Income Poverty through a lack of the basic means to survive, thrive and reach one’s potential. Discrimination or Exclusion based on race, gender or disability for example. Emotional Poverty ( also known as ACEs ) the absence of the basic nurturing and protective parental relationships due to violence, neglect or dysfunctional parenting .

The three burdens often converge and exacerbate each other. But not always. Most middle class respondents to the first ever ACE survey in 1998 had experienced one ACE and 12. 5 % had four or more. We all know people raised in wealthy and loving families who suffer devastating social exclusion because of disability, race or gender. We also meet people from so-called ‘privileged elites’ whose lives have been ruined by devastating emotional neglect or sexual violence in childhood. All need our compassion and our policy advocacy must focus on protecting all children in all circumstances always.

Shuggie Bain was afflicted by income and emotional poverty as well as exclusion because of homophobia. In those days only income poverty had a widely recognized and understood public and policy narrative . Homophobia was endemic and entrenched, as immortalized in the anthem’s of Glasgow’s own Bronski Beat. In 1988 the Conservatives introduced legislation through section 28 of the Local Government Act against promotion of positive images of Lesbians and Gay Men. 23 years later the Scottish Conservatives had an openly Lesbian leader. Ruth Davidson was so talented she could even promote a positive image of the Conservative party…in Scotland! Along with other forms of exclusion, including on gender, race and disability, those 23 years saw a public narrative emerge with clear policy asks to address homophobia.

The narrative on poverty may have begun in the 18th and 19th century and on exclusion and discrimination in the 20th century. Some post-2016 soul searching has blamed the rise in populism on a post-industrial working class perception that the left had abandoned fighting poverty to fight exclusion. Thats another blog! But both struggles continue and perceived competition between them is bad for each other and for progress in general.

Our understanding of emotional poverty as a risk factor for lifelong inequality is a 21st century idea. It accompanies an explosion of new knowledge about how our brains develop, emotions work, decisions are made. It shows how healthy relationships are essential for wellbeing. This is powered through new evidence at the intersection of neuroscience, biology, psychology and sociology. It is a crucial part of the jigsaw puzzle with attachment theory, toxic stress and resilience that powers a much better understanding of child development.

This idea is so new, we don’t even have an agreed title yet. For most of us Adverse Childhood Experiences tell a story at a population level, as data sets on prevalence of ACEs and life outcomes. There have been around 30 ACE surveys in different parts of the world and across most US states. They all demonstrate remarkably similar results, though they are not yet nationally representative in the way data on childhood disease is, for example.

The ACEs methodology is often used by WHO, UNICEF, CDC and other major public health bodies. We use it with caution and humility in the knowledge that it is an emerging field of research. But there is now enough knowledge to act and call on governments to invest in the following strength-based population-wide interventions: 1)universal support for early parenting through home visits 2) reducing stress on the caregiver 3) resilient communities, including policing and schools that promote connection and belonging 4) breaking taboos and building a public narrative. These are all accelerators that can drive forward progress on multiple public health and social fields.

In the future we may have internationally comparable data sets for all countries. We can then measure progress in reducing ACEs and poor life outcomes against investments in strength-based policies on parenting and resilience. I have seen internationally comparable data leveraged for policy advocacy to reduce child mortality, disability exclusion and deinstitutionalization and to improve education outcomes. ACEs data used internationally at the population level could be as transformative as when expansion of immunisation, safe water access and improved nutrition dramatically reduced child mortality during the child survival revolution of the 1970s and 1980s.

While we must work to craft a clear narrative, we can also think about the type of conversation we want to have. Here are some initial thoughts:

1. Poverty and exclusion are system failures. We have a right to be angry and loud about these injustices. Transmission of emotional poverty or ACEs is different. It is when things go wrong in the home and relationships-often inter-generationally and unintentionally. It becomes a system failure when we don’t address it. We need a calm thoughtful conversation that doesn’t blame or create competing victimhoods.
2. We need to look out at any population and recognize that anyone can be in pain, often even without being aware of it. That everyone is at risk. This topic can be a trigger or a source of healing, or both at the same time. There is no ‘us and them’ as everyone’s life is touched in some way. If we have not had ACEs ourselves, our partners, neighbors or co-workers have. We need compassion.
3. You cannot have a conversation about emotional poverty or ACEs that is judgemental. The subject feeds into how people feel about their parents, themselves and their children. These are usually complex and deeply private feelings. The policy makers and parliamentarians who we want to legislate and invest in this sphere, are no different to anyone else in this respect.
4. Addressing ACEs does not detract from the struggle to end poverty and exclusion. Equally it doesn’t always need to take them into account. It is a different framework of analysis. It can also be used alongside child poverty and social exclusion research to advocate for a holistic advocacy agenda to child and human development. There is no competition between the three. Individuals and groups will be drawn to work on the one that is of most interest to them. We cannot talk about ACEs in an atmosphere of polarization or competition.

I write all of this with the humility of knowing it is a much less evolved sphere than say child survival or nutrition. Our knowledge is evolving. But from what I have seen thus far, we need to have a calm, compassionate, non-judgmental and inclusive policy narrative on emotional poverty and ACEs. Child psychologist Peter Fonagy highlighted that parents who become self-aware of the risks of transmitting inter-generational trauma are less likely to do so. With the right type of public narrative we can harness community wide self-awareness to bring an end to emotional poverty in the lives of children everywhere.