On top of the things James Brown said were great about “Living in America”, an additional one for me is the outsider’s perspective it gives on my own country. Interest in the UK is now fuelled by lockdown binges of Peaky Blinders on the one hand and Downton Abbey on the other. A confused American friend recently asked “So where do you come from on this British class thing?”
In his 1960s infamous and groundbreaking comedy sketch John Cleese ridiculed our class system. It feels like an awkward subject today as it did then. Many of us just wish class had retreated along with black and white TV, outside loos and coal sheds. So I reformulated the question in my head to the less awkward “which type of community did you grow up in?” After that pontification, my answer was : “poor, urban and multicultural”
I wrote about the poverty bit before, We were so far at the bottom of the ladder, we didn’t even make it onto the Cleese class sketch. I spent my formative years in inner city South Birmingham and North London. Without any fuss, we grew up with a diversity which was as influential as class in shaping our identity . Many of our school mates were only second or third generation British. Their grandparents had arrived in the migration waves that followed the second world war, forged ties across communities and faced down the duel struggle of poverty and racism.
There were rites of passage for all teenagers . First kiss, first football game…and in those days first smoke. But poor, urban kids like us had specific obsessions: Music, fashion and navigating trouble.
You could hear all types of music in our neighborhood, but Reggae was the main soundtrack and everyone wanted to be a DJ. In those days this was usually through a “sound system” with wobbly speakers piled on top of each other, booming out fresh imports from Kingston at neighbourhood parties. The average age of first buying a vinyl record would have been around 11 or 12.
Reggae and punk had been the most subversive music of the previous teenage generation . Back then, punk bands had no DJs to spin tunes between performances, so they hired reggae sound systems. The Punk and Rasta collaboration that followed was celebrated in Punky Reggae Party by Bob Marley and inspired a uniquely British, urban sound. It can be traced from the The Specials and the Beat and through to UK streetsoul collectives like Soul II Soul and Massive Attack and on to Amy Winehouse and even Stormzy. We loved Jamaican Reggae and US R& B, but we also had a sound that came from our own communities and reflected our experiences. It was political, but not ideological. It reflected our anxiety about violence and unemployment. The teenage toaster of the Beat, Ranking Roger sang of “Love and Unity”. Community and shared struggles above hatred and racism.
Despite our poverty, we were also irrationally obsessed with style. The precise geometry of where a trouser hem ended and a shoe began and the colour of the socks in between. The nurturing care of a pair of Brogues, High Tops or Nikes. The shame of being turned out in something below par. We were not peacockish. You just had to hit a certain standard and then you could go about your regular business.
The diversity affected the way we held ourselves and spoke. It was completely normal for someone of say Irish or Indian heritage to curse with a Yiddish word in a Jamaican patois accent….or the other way around. . We were poor, but our style and music was our source of dignity.
There was also a whole heap of trouble. It was not like The Wire. There were less crack dens and guns. Communities like ours could be vibrant and aspirational-with the music, Asian food, Irish pubs. But just beneath the surface, it seemed like an assault course of gangs, violence and drugs too. Joining a gang and dealing drugs were easy-access compared to healthier options. Poor kids like us did not go to university. Those with strong, united families tended to navigate better than those from broken or dysfunctional homes. For many , our futures hung by a thread. I was a proper tearaway, kicked out of multiple schools and in trouble with the law. I was eventually rescued by the influence and care of a wonderful teacher
It was a blessing to grow up with so much diversity. As Ezra Klein wrote in “Why We Are Polarised”: research shows how super-diversity with multiple identities and influences sets you up well for co-existence. Difference only becomes divisive and polarising when there are just two sides facing off across a single fault line. This is worse when bad politicians amplify identity above ideas and hate above hope. That type of politician is not faring so well in this pandemic. When difference is cut across multiple lines, it is a strength.
Covid 19 exposes the inequities of class and race, but it also shows how much we yearn for community, not tribe. As New York Times columnist David Brooks wrote”Community is based on mutual affection and tribalism on mutual hatred”. In this pandemic we are now united by our shared vulnerability and dependence on the same public systems and low pay delivery workers. Even our conservative Prime Minister acknowledged that our National Health Service is powered by love. Its workforce is radically diverse and disproportionately hails from similar streets to the ones I described above. Thats where I come from in the “British Class thing” . Here’s to Love and Unity.
Amidst the fear and uncertainty of the Covid19 lockdown in China, 26 year old Lele experienced something more terrifying than the virus itself. Her husband fashioned a weapon from a kitchen stool and beat her semi-conscious as she held her 11 month old baby in her arms. There was nowhere to go, no services to support, no possibility to flee. She had to spend several more weeks with her abuser before she could reach safety.
On the other side of the world in Greenland, the capital city banned alcohol sales to prevent growing child abuse during lockdown. In India the were 92,000 calls to a child abuse helpline in the first 11 days of lockdown. France experienced a 34% increase in abuse helpline calls by children and an even bigger increase in the number of peers and school mates calling on behalf of friends. . As closed schools and stay at home orders spread, so did the risk of abuse.This pattern played out across the world, in three ways:
The first is the way that lockdown piles pressure on households . Even the calmest, securely attached and ‘child development-aware’ parents are being tested by ‘pandemic-parenting’. Often they are working in uncertain jobs while teaching ‘cabin fever kids’ while adapting to loss of space and privacy. But most will not suddenly become abusive or neglectful. In more volatile families however, this stress can spill over into violence or exacerbate existing abuse patterns. The biggest beneficiaries of #StayAtHome are the serial abusers who practice coercive control and other forms of psychological aggression. the lockdown increase the likelihood of adverse childhood experiences.
Secondly, the means of reporting severe child abuse or neglect have been dramatically reduced. According to the US Department of Health & Human Services child protection interventions are initiated by reports from teachers, social workers or nurses. Social distancing measures have reduced reporting. From the 1980s onwards increased reporting of family violence was a major mark of success and progress in protecting the rights of women and children. Momentarily, reporting is in decline.
The third issue, is complex but equally serious. In normal circumstances less than 1 or 2 % of children are subject to interventions by social workers. Yet Adverse Childhood Experience (ACE) research across populations suggests between 15 and 20% of children are affected by chronic, multiple forms of abuse, neglect or dysfunctional parenting at home. This 15 to 20% of children are now in a state of isolation. Children have a biological imperative to have protective, soothing relationships with an adult and are simply not built to be isolated. When a positive relationship at home is absent, the child interprets it at risk. It over-activates their stress response system which wreaks havoc on all aspects of healthy development. Unaddressed it can lead to catastrophic health and wellbeing outcomes throughout life. But when the stress is buffered and soothed by a healthy relationship with a teacher, grandparent or friend and the child is made to feel they matter on an individual level-then the recovery can begin. Right now around the world, hundreds of millions of children have been cut off from those relationships.
This is deeply distressing. Accounts of childhood maltreatment often recall a despairing loneliness and unbearable slowness. Loneliness when the parent who should soothe the pain, is actually the source of that pain. Slowness during long pauses of waiting for a violent outburst or scarce moments of maybe feeling loved. The isolation of the pandemic amplifies this pain exponentially. It is malleable with no end in sight. Relationships with teachers, grandparents and friends were cut off suddenly with no date for restoration.
We need to act with urgency on all three issues. Governments and communities could appoint ministers or local leaders to coordinate child wellbeing during lockdown. A priority must be engagement with parents on managing stress, home schooling and positive discipline, tailored to lockdown conditions. Online and media platforms could be adapted to facilitate a conversation with families and disseminate pandemic-specific parenting tips, similar to the global UNICEF parenting hub. Social protection and housing support must be adapted to reduce the stress on vulnerable families. Behavioural insights and technology innovations should be used to understand how we can best support parents and protect children.
Expanded helplines and channels that enable neighbours and friends to report maltreatment anonymously need to be provided . Equally we need to encourage extended family and friends to maintain regular communication with children in lockdown with abusive or neglectful parents. One of the most moving stories of the pandemic so far is the upsurge in calls by friends of victims reporting maltreatment in France.
Innovation and adaptation could help teachers and social workers restore normal levels of communication with children, despite lockdown. If they are not giving lessons, can they call each child for five minutes? These measures need to be population-wide and not just targeted to 1-2% of children who are child protection cases.
Decades ago, it became normal to ensure every child was immunised against deadly disease with a vaccine. In the future we could hope for a world were every child is buffeted from trauma by a calm and predictable adult connection. A world in which we improve prospects for parenting in every family at the earliest possible stage and maltreatment is managed and prevented as a part of routine public health . All we can do now is demand protection for Lele, her baby and millions of abused children and women locked down, unreported and isolated around the world as part of our immediate and shared struggle to defeat Covid19
I am unbearable company during the Oscars. Like most US-based Brits I can’t help but do football stadium style cheering every time someone from the UK wins anything. Worse still I can’t watch films like Judy or Rocketman without analysing the”underlying messages” on insecure attachment. Nor can I enjoy The Joker, Harriet or Honeyland without giving a droning commentary on how toxic stress ruins lives. The invitations are drying up.
In case you are not clued up on the lingo: Insecure attachment is the term used to describe how poor early parental attachment undermines our ability to form healthy and nourishing relationships . Toxic stress is when prolonged childhood trauma chronically activates our stress response systems. Robust recent research now shows how people with either do worse in education, employment, physical and mental health and inter-personal relations throughout life.
From a rough estimate, about a quarter of 2020 Oscar nominee productions feature a story line with the following formula: Child trauma – healing/soothing relationships = train wreck adulthoods. Does the proliferation of these story lines in films mean our recognition of the link between early trauma and poor life outcomes ? It is not just happening in Hollywood. In the sober UK BBC Question Time a couple of weeks ago. Decorated former Police Chief Mike Barton told a studio audience that we can only reverse the London drug and crime problem if we address adverse childhood experiences (ACEs). Research in the USA shows how media coverage on the theme has dramatically increased in recent years.
Our shared narratives should never be deterministic about the pathway from childhood trauma to adult dysfunction. Sometimes those with high childhood adversity flourish. But the most recent evidence suggests those with higher levels of trauma are much more likely to have poorer life outcomes. As Mike Barton may concur, they are the ones most likely to be targeted by criminals, groomers and radicalisers alike. As the US Centre for Disease Control has shown, they are also do much worse on almost every health and wellbeing indicator. The costs are huge and quantifiable. The UK Based Overseas Development Institute modestly estimated that violence against children alone (excluding the devastating global costs of child neglect) cost 8% of GDP. Conversely Nobel Prize winning economist James Heckman argues that if we invest in prevention in the very beginning of childhood-the return on investment through life is up to 13-fold.
Film scripts don’t always end with trauma. They can also inspire us with recovery and resilience. Gus van Sant’s Good Will Hunting had nine Oscar nominations and won two and is one of America’s most popular films. It is perhaps the most compelling cinematic representation of how a young adult overcomes debilitating childhood trauma through connection with an empathetic witness . When the film was made, recovery through connection was only a common sense proposition. Now that proposition is firmly backed up by science base. Human connection and a sense of belonging in family, school or community provides a buffer against toxic stress. It calms the stress response system and helps rebuild the attachment model. It enables the child to build the resilience to navigate future shocks and see a lifeline to a better future. We call this science of resilience.
The opposite of Good Will Hunting’s story of recovery is the inter-generational emotional neglect suffered and transmitted by Elton John’s father in RocketMan. Deep in middle age he sings: “I can’t love, shot full of holes, I don’t feel nothing, I just feel cold“. At the extreme end of this spectrum is the character played by Joachim Pheonix in The Joker. Severe childhood trauma with no empathetic witness on the path to adulthood is costly for the individual, their family and society as a whole.
Film and literature critics often tell us that fine writing gives a tangible narrative to feelings the viewer or reader has, but could never put into words. The research shows that between 50 and 80% of any given population have experienced one ACE and between 10 and 20% have experienced 4 or more. Everyone, everywhere is affected by childhood adversity. We don’t talk about it easily. We could assume it has been taboo for most of human history. But if we are not affected by it directly, our spouse, neighbour or colleague is. It is often manifested in their decisions and behaviour. It’s why we identify so much with these stories. It’s one of the reasons Good Will Hunting is held in such affection and why so much of our popular culture alludes to this theme. This is our story. Our broken childhoods and our struggle to overcome them are a central theme of human existence and spirit. But a marginal theme within our national and international conversations. Could that be changing?
From an advocacy perspective I hope so. More public openness to the theme could drive the political will and public demand needed. A good public policy start would be investment in 3 things. Trauma prevention though early parent outreach and support. Recovery and resilience through trauma-informed communities and schools. Open and taboo-busting public discussion on adverse childhood experiences. These interventions could close the costly gap between what we know and the policies we do. Imagine how much trouble could have been prevented if Gotham City had had better childhood policies. In Pinner and Philadelphia too.
And that brings us back to Elton and his Oscar nominated recovery anthem: “Find the wind to fill my sails, Rise above the broken rails, Unbound by any ties that break or bend, I’m gonna love me again” How rich our world would be with an opportunity for everyone to rise above those broken rails.
Its progress we rarely acknowledge. Today across the world, in savannah and steppe and in city and village, most children will go to school. A few decades ago, this was a pipe dream. Access to education is a hard-fought human right which makes our world a better place. It is an accelerator for every other form of progress in any society. For example, half of the global reduction in child mortality over the past 20 years is attributable to the first generation of mothers in many poor countries receiving an education. A third of the world’s poorest girls continue to be out of school with huge societal costs. In total, 9% of the world’s children still don’t go to school. By 2030 we must achieve the goal of basic access to universal education.
Now the global discourse is expanding from access to quality and relevance of what children learn. From this lens, global education is in a learning crisis. 53% of children in low and middle income countries cannot read a basic text by the time they are 10. This is a benchmark described by the World Bank as learning poverty. Education spending has increased in many low and middle countries. Yet it is not directed towards the poorest children who need it the most. In low income countries, almost half of education budgets go to the wealthiest 10%. Against a background of fast-paced technological change in the labour market, poorer children will be left behind.
We now know that brain development is most prolific before the age of 5. Primary and secondary school are hugely important, but not the most impactful institutions for social, emotional and cognitive development of the child. The family in infancy and then pre-school from 3-6 years of age yield the most influence on learning and life outcomes. Yet, the poorest families have little guidance on early stimulation and brain development. Research has shown that 3 year olds from families on welfare hear around 600 words an hour. Those from professional families hear over 2000. This gap in language acquisition is an indicator of huge inequality even before the child enters pre-school.
Such early disparity could most obviously be addressed by a pre-school education starting at 3, as the child’s brain continues to develop rapidly. But in many countries most poor children just do not go to pre-school. The gap in pre-school access between the wealthiest 20% and poorest 20% is vast. The OECD Pisa survey shows that much later at 15 you can see the outcome of this early inequality. 15 year olds who attended pre-school are on average between one and two years ahead in maths science and language. Together, these early disparities drive an intergenerational cycle of poverty. This harms the individual child, exacerbates inequity and undermines economic and social development.
Even many well-resourced primary and secondary education systems in wealthy countries struggle to keep pace in a changing world. Education reform is never a progression from one static position to another. It is an evolution constantly informed by two streams of change. The first is the changing labour markets and civic culture Education should prepare citizens contribute and gain from progress and prosperity. The second is our growing knowledge of brain development and how children learn. Systems creak and move slowly, and despite the amazing dedication of most teachers, schools are behind the curve on both counts.
All research shows the one thing that drives good education outcomes is the performance of teachers. Yet stakeholders including unions, parents and parliamentarians often focus on structural issues like class size or teaching hours rather than teaching itself. Children learn from teachers they love and who inspire a passion for their curiosity. The 20% of children affected by multiple traumas at home cannot learn at all unless the teacher provides a sense of safety, calm and belonging.
Most countries do not have a system to recruit high calibre teachers, keep them motivated and developing in step with a changing world. Many spend less than 1 % of their education budgets on in-service development. They are teaching for a moving target. A glance at todays vacancy pages shows jobs that did not exist when I started school millions of years ago. Teachers should be preparing children for jobs that don’t exist yet, and for working lives with much greater change than we have known before. Teachers need to shift from teaching kids stuff to teaching them how to think and create stuff. Children also need to learn how to learn and to be inspired to keep learning throughout the life course. For good citizenship they need media literacy too. Many countries are not adequately making these obvious changes happen. Pink Floyd railed against authoritarian teachers in the 70s. Today the threat is “authority-less” teachers with kids checking their smart phones in class to see if what the teacher is saying is up to date.
No public service institution can keep up with the pace of start-ups and tech. No country can address the learning crisis without engagement of the private sector. No private sector can flourish without a properly equipped workforce. Each needs each other, yet there is so little collaboration between them.
Both our evolving knowledge of adolescent brain development and of the labour market lead us to the same conclusion. The most relevant and rewarding way for a teenager to learn is through collaboration with peers in developing a creative solution to a problem. Yet most classrooms do not and cannot practice this.
Rutger Bremen questioned the mantra about educating children to find their place in the labour market of tomorrow. Instead he argued we should educate children to create the kind of labour market and society we would like them to live in. School informs character development, whether we intend it to or not. Inclusive moral and civic learning is a prerequisite for individual and societal flourishing. The UK-based Jubilee Centre has developed a framework for teaching integrity, respect, neighbourliness alongside core performance and intellectual competencies. The framework is being adopted in UK schools, and adapted oversees.
To address the global learning crisis we need to make sure that children are ready for three big transitions. The first is school readiness at 5 or 6. This requires narrowing the gap in early learning. All parents should receive knowledge of early stimulation through pre-existing primary health networks, at the same time they learn about vaccines and nutrition. We should pursue universal access to pre-school for 3-6 year olds as we have pursued access to primary and secondary education. Governments should invest at least 10% of their education budgets in early learning. They should also end the huge wealth disparity in pre-school attendance.
The second transition is at age 10. We need to eradicate learning poverty by ensuring that all children can read a basic text at 10. More than anything else, this will depend on the quality of teaching. We need behavioural science innovations to keep teachers motivated and systems where teaching practice can be informed by the evolving science of learning. Schools need to be trauma-informed so children affected by family or humanitarian trauma can be soothed, feel safe and make the important connections required to enable learning. Inclusion and gender-responsive school systems are also essential to end learning poverty.
The third transition is at 16 or 18 to work, training or higher education. This is about the relevance of education to both the labour marker and citizenship. We need a global commitment for teaching competencies, collaboration and character in an age of AI and fast-paced technological change..The public sector cannot achieve this alone and needs innovative financing and constructive technical collaboration with the private sector. As has happened in Finland, the teaching workforce needs to become an agile community of practice. This would enable it to adjust and develop teaching based on what it sees in the classroom and in the outside world. Creativity and collaboration needs to be at the heart of teaching.
Wherever we are, in addressing the learning crisis, our aspirations must be high. On the one hand we should work toward a world in which our children and then their children have a quality of life that is better than the one we had. On the other to ensure that they shape a society that is even fairer, kinder and a better place to live. Only a radical rethink of global education will help us get there. We owe our children nothing less.
I wouldn’t need a large abacus to count the number of times my experience as someone raised in care of the state has been well represented in a film. But one fleeting moment in Robert Altman’s 2001 murder mystery Gosford Park, an elegant pre-cursor to Dowton Abbey, nailed it.
During a large and free-flowing dinner table conversation about family, Mr Stockbridge (played by Clive Owen) stunned fellow diners when he answered a question with a simple “because I grew up in an orphanage“. The ensuing silence told more of our story than any scripted dialogue ever could.
Anyone from state care who had to describe their background because of a routine question about childhood in a polite conversation knows that silence. Until very recently and in middle age I still grimaced when such discussions arose at the diplomatic functions I attend with my job. If I am honest about it, at different stages of my life I have felt intrinsic shame, stigma and especially guilt for the discomfort it may cause to others and this has often fed into a deep, internal narrative that I am not really good enough to be here . But I also felt compelled never to hide who I am or where I come from. Being from state care is as important for my identity as being a Belgan or being a Hindu may be to someone else. It is where I spent my formative years, it is what shaped me and I want to be a good role model for kids in care today. It is at my core . I just would rather not talk about it.
6% of UK 18 year olds from state care go to university compared to around 27% of the general population. When I was 18 ( a very long time ago) it felt more like 0%. We were from a minority that was more likely than any other to end up in prison, a gang, trafficked, addicted or die early and very very unlikely to go to university. Unlike other marginalised minorities, we had no underpinning culture, flags or narrative to carry a sense of pride in our identity. I am so proud of the 6% of 18 year olds from care who end up in university today. It is mainly a testimony to their own resilience and brilliance, but also the fact that the system has been somewhat reformed in the past couple of decades. The odds are still stacked against them, they make it through anyway.
Like many of my generation, I left a children’s home aged 16 with a €200 leaving care allowance, a modest bag of life possessions and a complete absence of any form of love or belonging at all.
I have never complained about where I come from. This was the way my life was, it was normal to me. Coming from the bottom 1% of a society where identity was shaped by class and family, and then trying to advance though university & career etc often left me feeling unsteady on my feet and like an outsider or an imposter. I still feel like an outsider today to be honest, but I wouldn’t want to go back and change anything.
There are also things I am proud of. Because I had no parental support at all, I woke up at 4 am on weekends, when the other students were coming back from parties, and ran market stalls in Camden Town, I drove a mini-cab around London late at night and did shifts in an old peoples home and a college kitchen to pay my way through university. I really believed that a university education would help me escape the legacy of my childhood and I would do anything to reach that goal. I remember going to my first day of university, buying my own pens and books with money I had earned and not quite believing that I was lucky enough to be there. I was surrounded by people who seemed to take it all for granted. How much luckier I was then them, that this could feel like such a blessing in my life. I still feel blessed and privileged today.
But then there is love. In state care, one often grows up with this internalised sense of being unloveable, not even by one’s parents. Biologically all children are programmed to seek loving protection and nurture from parents, when it is absent they interpret it as danger. Adults from care backgrounds often have low self esteem, insecure attachment, post-traumatic stress and over-active fight or flight systems. This has a profound impact on your identity and sense of self.
You can strive to be a success on the outside as a young care leaver, but inside there are all these jagged edges and broken parts that, if you are aware of them, you would like to put together again. But because you are trying to escape extreme poverty and have an absence of support networks, you are just thinking about survival. Profound emotional insecurity can be a barrier to the relationships that the research now tells us are the single most most important determinants of both healing from trauma and building the resilience to overcome barriers and get on in life. Often the strategy the subconscious gives us is to separate the left and the right side of the brain-to run on the gas of the cognitive: job and education and forget the oil of love, emotion and belonging. But just like a car, you will break down in the end.
Nobody politically can articulate this. The main political discourses in our society don’t do emotional. They only do economic and power.
The left often argues that a care leaver is a victim of discrimination and poverty. But as Nimco Ali wrote recently about race & gender & being a refugee “The left wants to frame my life experience via the prism of helplessness and victimhood. I am meant to be consumed by all that has happened to me — to long for all that I have lost and wait to be rescued, but I have always refused to do that“. For me, it has taken me most of my adult life to feel really comfortable talking about being from care. But I can be shut down in a moment if someone tries to frame my narrative as a victim, and that often comes from the left.
Economic models from the right make life difficult for already marginalised care leavers. I know this from the rock face because I left care during Thatcherism. And then they argue that if an individual care leaver (actually a tiny fraction) can progress through hard work, then anyone can. But evidently they cannot and do not because the impact of trauma and neglect is very individual and complex and based upon the interaction of experience, resilience & biology. In 2019, policy makers should really know this, we shouldn’t have to explain it. And anyway, as Colin Powell once said, “how can you ask someone to pull themselves up by the bootstraps when they don’t have boots“. Care leavers badly need support networks.
Discrimination, poverty and hard work are high stakes challenges for any care leaver, but the main issue remains love, or the lack of it. There is a broader need for a politics that can talk about love, wellbeing, trauma, violence and hope. The social and emotional drivers of all of our behaviour and decisions. And this makes democratic sense because care leavers are not alone.
Until recently there was a common public perception that childhood trauma, neglect & violence were marginal issues addressed through the care, social work and juvenile justice systems dealing with maybe 1 or 2 % of a given child population. But the World Health Organisation and other bodies have undertaken surveys in multiple countries on general populations which reveal that on average, around 60% of adults in family settings were affected be one serious adverse childhood experience (ACEs) and around 15% by 4 or more. The 15% with 4 or more ACEs, like care leavers are much more likely to have really bad life outcomes in health, crime, education and all aspects of wellbeing. In psychology research, 42% of adults across countries are said to have insecure attachment due to absence or inconsistency of parental love in the first two years of life. Insecure attachment severely affects their ability to have quality relationships. The common perception about the marginality of trauma must have ran counter to people’s lived experience and their ability to articulate it. That is now changing.
I was raised in care of the state. I am neither proud of it or ashamed of it. But I would like to live in a world where future care leavers don’t suffer long silences & superficial victim or bootstraps narratives. Where investments are made to ensure those from public care & others affected by adversity everywhere-can reconnect, build and heal free from shame and public stigma. This would be socially just, fiscally prudent and frankly just plain easier and better for the whole of society.
“…….seeking but a moment’s rest among the long-forgotten haunts of childhood, and the resorts of yesterday; and dimly finding fear and horror everywhere….”  –Charles Dickens Martin Chuzzlewit London,1843
Everyone knows poverty drives inequity. Here in Montenegro one of the ways we address this is by supporting dramatic expansion of pre-school education for the poorest 3-6year olds, who are currently 10 times less likely to attend which ensures worse life prospects and an inter-generational cycle of poverty.
But is childhood adversity: violence, neglect and dysfunctional parenting, also a driver of inequity?
152 years passed between Dicken’s writing Martin Chuzzlewit and the discovery of a neurobiological explanation of how and why broken childhoods haunt and destroy adult lives-even into old age.
The Adverse Childhood Experience (ACE) study, launched in 1995, continues to demonstrate in many countries huge inequity between adults who were affected by high levels of child abuse, neglect or dysfunctional parenting, and those who were not. High childhood adversity leads to markedly worse outcomes in health, education, employment and crime. It is much more prevalent than we thought and occurs across wealth quintiles.
In addition to being one of the world’s finest novelists, Charles Dickens also gave an authentic voice to those whose childhoods had been pulled apart by the desolate loneliness and crushing injustice of childhood adversity and inequity as he had experienced first-hand himself . As with Dickens, the passion of many UNICEF staff to tackle childhood inequity stems from our own childhood memories and in my case the experience of growing up in loveless institutional children’s homes has always been a major driver of my work.
At any given time across the region of CEE/CIS we have a million children in state care, a fact that will place them on a lifelong path of inequity.They come into state care because of childhood adversity or because they are abandoned, mainly into large-scale children’s homes. A placement in a children’s home is a secondary trauma for any child. It does not provide healthy attachment with an adult and this is particularly catastrophic for children under 5 when brain development is most active and dependent on consistent interaction with an adult.
Comparative brains scans as well as measurements of development-inhibiting cortisol levels between those in institutional care and those in strong families reveal a neurobiological inequity that will eventually translate into long term economic and social inequity.
A children’s home is a place where a child lives in a state of neglect – unequal not just in terms of poverty, but in terms of love, affection and attention. This is why 21 countries in our region have joined forces with the UN Human Rights Commission and UNICEF to eradicate placement of children under 3 in large scale institutions. In Montenegro there will be a complete end to placement of under 3s in state care by 2017. There is a similar campaign in Latin America where around 240,000 children live in state care.
The right to family life is being secured through stronger social work systems, which can keep families together, and promotion of fostering and other family based alternatives for children who cannot be cared for in the biological family. This has already yielded a 40% decrease in the number of children in institutional care in the past five years in Montenegro.
Children in state care are just the tip of the childhood adversity iceberg, the overwhelming majority of childhood adversity is suffered by children in families. We are thus working with health, education, justice and social work sectors to build systems which protect children and promote better parenting through pregnancy until adulthood. We work with government and women’s groups to break the taboo on childhood adversity-learning the lessons from similar efforts in the UK and Scandinavia a couple of decades ago. I recently did a TedX talk on this & was inundated with messages from Montenegrin adults who had been affected by childhood adversity and many had never told anybody. We launched the first study on child abuse in the parliament recently and next year we will launch and measure the impact of a public campaign on childhood violence and adversity. The aim is to reduce the space in which adversity is unreportable and invisible or even acceptable.
But how can we close the equity gap for adolescents whose lives have already been plagued by adversity?
Neuroscience may have taught us the bad news that when childhood adversity collides with adolescent brain development-it can put children on a lifelong negative trajectory : inequity, gangs, violence, but it has also taught us that the character and decision making skills required to prevent such a trajectory can be learnt thoughout childhood: grit, optimism, integrity and self-control for example . In collaboration with the Government, Birmingham University and ING, we are working with youngsters who have experienced high levels of adversity to teach these characteristics. We hope that this will help them to make better decisions , get back on track and close the equity gap between them and children from more stable backgrounds.
As international civil servants it is easier to talk about poverty than it is to talk about love. When we talk about adverse childhood experiences we are talking about love, a lack of love, or children being violated by those who should love them. We need to find ways of talking about childhood adversity as a major driver of inequity-despite the discomfort.
I would never want to lose sense of who I am and where I come from. Every month I join a group of young people who grew up in children’s homes in Montenegro and help them draw out their own potential to build better material and emotional future. I see my own reflection in their eyes and hope they will have a better tomorrow.
 Dickens, C. The Life and Adventures of Martin Chuzzlewit (1843), Chap. 25
 Tomalain C. Charles Dickens A Life 2011 Viking
Benjamin Perks is the UNICEF Representative in Montenegro
Parenting, education & environment in childhood drive wellbeing in adulthood everywhere. Adverse Childhood Experiences (ACEs) including 1o different types of neglect, violence and dysfunctional parenting in the home during childhood, harm the economic, social & democratic development of any society.
Recently global development collaboration efforts have expanded beyond the visible challenges of disease, hunger & illiteracy to also tackle the less visible emotional, social & psychological barriers to human development. The current UN sustainable development goals call for an end to all forms of violence in the lives of children everywhere by 2030.
Adverse Childhood Experiences (ACEs) are much more prevalent than policy makers previously imagined and are distributed within a similar range across continents, classes and races. They include emotional, physical or sexual abuse, emotional or physical neglect & chaos at home including domestic violence, mental health, addiction & crime .
There are ACE or similar Violence Against Children (VAC) surveys from at least 33 countries and 32 US States. These included the UK,, Canada, China, Russia, Brazil, Poland and countries in Africaand Asia.
Looking at the data from 11 European, 12 African, 6 Asian, the US, Brazil and Canada (the 1st, 2ndand 5thmost populous countries of the Americas) and the Solomon Islands, the first thing that is striking is the similarity in prevalence of ACEs. On average about 60% of adult populations have experienced 1 ACE. Some countries such as Brazil and Russia are closer to 80% and some such as the Wales and Serbia are closer to 50%. But almost all countries fall somewhere between 50 and 80%, most hovering around the 60% mark, Similarly the prevalence of 4 or more ACEs is on average around 15%, though some countries have less than 10% such as the Czech Republic and some have more than 20% such as Vietnam.
This is a relatively new form of research and relying on subjective responses to a questionnaire. ACE research in the US shows little difference in prevalence of 1 ACE in social class or ethnic groups. However, a link between prevalence and poverty is clear when it comes to 4 or more ACEs.
When we think about violence against children in the family often the first policy intervention we think of is a targeted social work response. But lets think again. . In a country like Wales, the prevalence rate for 1 ACE is 50%, the prevalence rate for 4 ACEs is 14%, yet the total number of children who are subject to targeted social work intervention for example on a register or in care, it is 1%. To achieve the UN global target to end violence-we need to massively expand universal efforts through prevention & mitigation through health, education and policing working alongside social work.
There is no one reading this blog whose life is not affected by ACEs in some way. ACEs don’t just affect individuals, they affect societies
We know this because where ACE studies have been undertaken they always show a dose response correlation between the number of ACEs you have experienced and poor outcomes in almost every single wellbeing indicator in health, education, crime violence, mental health, addiction and much much more. throughout the entire life cycle
Perhaps the starkest illustration of the inter-generational transmission of violence, criminality and addiction is in the graph below from a 2015 study from Public Health Wales in collaboration with Liverpool John Moores University highlighted a high correlation between adults who experiences four or more ACEs and negative life outcomes:
Compared with people with no ACEs, those with 4+ ACEs are:
4 times more likely to be a high-risk drinker
6 times more likely to have had or caused unintended teenage pregnancy
6 times more likely to smoke e-cigarettes or tobacco
6 times more likely to have had sex under the age of 16 years
11 times more likely to have smoked cannabis
14 times more likely to have been a victim of violence over the last 12 months
15 times more likely to have committed violence against another person in the last 12 months
16 times more likely to have used crack cocaine or heroin
20 times more likely to have been incarcerated at any point in their lifetime
The Wales data also show a much higher likelihood of becoming a victim of violence if you have higher ACEs. Recent work in England has revealed that grooming gangs have a tendency to go after young women with low self-esteem and what psychologists call “ambivalent attachment” as an outcome of inconsistent, neglectful and chaotic parenting in childhood.
The Welsh data is similar to what we see across societies globally. Health departments across US states reveal a similar dose-response correlation between higher aces and worse outcomes in health, wellbeing and decision making with regard to 40 different indicators. The indicators include health outcomes but also behaviours related to addiction, criminality, mental health and unemployment.
Research from China shows a similarly graded link between ACEs and likelihood of alcohol abuse.While ACE studies from Malawi and the Solomon Islands showed a similar graded link between risky behaviours, such as multiple sexual partners and high ACE scores.
Psychiatric evaluations of 1000 detainees at Cook County Juvenile Detention facility in Illinois revealed that 84% of offenders had experienced two or more ACEs and that the majority of offenders had experienced 6 forms of childhood trauma. In a recent study in North Macedonia on ISIS recruitment all teachers, without exception, cited lack of parental care as a major factor for driving children toward radical extremism.
Amongst children in school, if we take ACE data from WHO across Eastern and Central Europe and OECD data from the Pisa study, there is evidence of a correlation between higher than average ACEs and higher rates of school violence. Coupled with the data from Wales showing a link between high ACEs and criminal and violent behaviour, this adds to a growing body of research showing the clear link between family and societal violence and criminal behaviour.
The American Academy of Paediatrics (AAP) suggest that periods of prolonged stress without respite in the home result in “toxic stress” or chronic activation of the stress response system. Research shows that it is not just violence and chaos that creates toxic stress but also emotional coldness from the parent. This is because children are biologically programmed to seek strong bonds and attachments from birth for love and stimulation, but also for protection. As a species we are extremely dependent on parents for protection in early childhood. When the emotional attachment is absent, children see it is a threat and it activates the stress response system. This was also a finding of the prior research on attachment in psychology which revealed that while neglected children often stop showing outward signs of emotional need, their heart rate and cortisol levels are high 
Toxic stress derails normal development of all major systems of the fragile and evolving body and brain of the child. The impact affects the neurological, cardiovascular, immune and endocrinology systems and the way that genes are expressed. One of the impacts of toxic stress is that the body and brained is flooded with the stress hormone cortisol. Research showed that children who had been adopted in Canada but had spent their first year in a state of extreme neglect in children’s homes eastern Europe had much higher levels of cortisol than those who had been adopted earlier or who lived with their biological parents. This despite the fact that the high-cortisol children had spent most of their life in a secure adopted family.
Toxic stress also over-activates the amygdala region of the brain and the human fight or flight response and de-activates the executive function, impulse control and learning capacity of the brain. Children with high ACEs are likely to have problems with concentration, self-soothing and remaining calm and concentrated in the classroom. They are also likely to over-estimate the presence of danger and therefore are more prone to over react and make poor choices in the face of challenges such as perceived “disrespect” from peers or even adults.
This is particularly true during adolescent brain development-when personality and values begin to take shape and underpin individual identity, but also when there is a mismatch between mature impulse response and immature impulse control systems. All of this leads to poorer education outcomes and higher likelihood of
The UK Police are increasingly using ACEs to understand and prevent criminal behaviour such as drugs trafficking across country lines or urban knife crime.It is widely assessed that criminal gangs or violent radical organisations on the one hand, and organised groomers and human-traffickers on the other-prey on young people from high ACE backgrounds. Knowing that there is a neurobiological pathway for high propensity for being a perpetrator or victim of violent crime has led to new levels of collaboration across police, health, social work and education sectors.
Some of the solutions to child trauma, adversity & violence are now known
The first is primary prevention. Nursing visiting where the nurse can demonstrate secure attachment behaviours and positive parenting strategies can halt intergenerational transmission at the moment when the relationship and the parenting style if being formed. The importance of the parent practising the behaviours with the support and guidance of the nurse is crucial. Often for new parents with high ACEs , for example for young women from state care backgrounds, having children in a supportive environment is the breakthrough which enables the parent to strengthen their attachment capability, self-soothe and overcome their own high ACEs background. This is important because the first step to preventing intergenerational transmission of ACEs is ensuring that the parent is okay, calm and without anxiety Through longitudinal studies in Jamaica and the United States, Nobel prize winning economist Professor James Heckman demonstrated improved productivity, more health-seeking behaviour and reduced criminality amongst young adults who had received home visits decades earlier as babies yielded up to a $ 17 return for every public dollar invested, and that this was the biggest return on public investment that any government can make.  This correlates with research done by the Overseas Development Institute which conservatively suggests that 8% of global GDP is lost through the long term costs of violence against children.
The World Bank, UNICEF & WHO now cite the Heckman research to advocate for governments to create fiscal space for investment in perinatal care, parenting and also pre-school for three to six year olds. The pre-school component is also important in combatting ACEs because the absence of stimulation and presence of toxic stress at home in early childhood derails language acquisition and other key learning and concentration attributes which cannot be caught up later and further diminish the prospects of progressing through school thus exacerbating the negative impact of ACEs on human flourishing. Universal pre-school is crucial to mitigate the long-term impacts of ACEs.
The second policy intervention is building resilience. Studies from child survivors of the holocaust to present-day conflicts and ACE-based research has pinpointed resilience as the main antidote to toxic stress or chronic trauma. Resilience in childhood is about having “development assets which mitigate the impact of toxic on the brain and body. While the 2015 Welsh study had a dose response correlation between ACEs and poor life outcomes, it also had a dose response correlation of children with ACEs “bouncing back” from trauma if development assets were in place.
There are many environmental factors, a lot of research of childhood survivors from the holocaust for example pinpoints ability to form and maintain relationships as a key determinant. Having at least one positive relationship is perhaps the one determinant of resilience across all research. Other key aspects of resilience are things like belonging, purpose and a capacity to self-soothe. It has often been noted that children in state care or other high ACE situations are more likely to do better in life if they engage in sports. There are generations of bar stool pundits who have suggested that this is because such young people have had a chance to “channel their aggression positively” however through the research on resilience we probably now know that the positive correlation with sports and overcoming adversity is rather about positive relationships, belonging and purpose. Another myth that the resilience research bursts is the concept of the resilient individual overcoming adversity through sheer, individual perseverance. In reality where resilience occurs, it is normally because of relationships, not the rugged individual operating by themselves.
A good policy target for governments wishing to promote human flourishing would be to ensure that every child has at least one positive relationship with an adult in their lives. Sometimes this may need to be a teacher, a sports coach or social worker if the family is not able to provide such a relationship. The approach of trauma informed schools in which children are able to regulate, relate & reason…in order words calm down the stress response system, have a deep connection with a teacher and then begin to learn…are increasing being mainstreamed in education sector reform.
For the first time in history, the sustainable development goals provide policy space to make parenting, resilience and violence prevention systems available globally by 2030. To maximise this opportunity, we need to build a global movement that can harness this knowledge into action everywhere and create common understanding across societies whilst maintaining the flexibility to graft these interventions on to local cultures and value systems. Through this approach we can create a world in which all children can have the optimum opportunity to grow free from trauma and thrive in societies which flourish.