Childhood trauma can leave scars that last long after the experiences themselves have ended. Its effects can reach into adult life, increasing the risk of mental illness, physical health problems and other difficulties.
Our latest research estimates that the health effects associated with adverse childhood experiences cost the equivalent of £7.8 billion in Wales and £115.6 billion in England in 2023. These figures represent 8.4% of Wales’s gross domestic product (GDP) and 5% of England’s.
These are not bills paid directly by governments. Instead, they put a monetary value on the burden of illness and premature death associated with childhood adversity, showing the scale of its potential effects on society.
Adverse childhood experiences are traumatic or highly stressful events. They include physical, verbal and sexual abuse, as well as experiences such as domestic violence, parental separation, or living with a family member who has mental health problems, misuses alcohol or drugs, or has been in prison.
Around half of adults in England and Wales report at least one such experience. About one in ten report four or more.
Research has consistently linked childhood adversity to poorer health and wellbeing in adulthood. People exposed to several types of adversity face greater risks of mental illness, chronic physical conditions and health-harming behaviour, like smoking and harmful alcohol use. Childhood adversity has also been linked to poorer education and employment outcomes and a greater likelihood of involvement in violence.
These consequences can increase demand for healthcare and other public services. Understanding the costs helps to show the scale of the problem and the potential benefits of investing in prevention.
Counting the costs
We combined data from 10 studies conducted across England and Wales between 2012 and 2024. These studies interviewed adults about their childhood experiences and their health as adults. In total, we analysed data from 28,449 adults.
We examined seven causes of ill health, including mental illness, cancer, heart disease and stroke, alongside four health risks: smoking, high alcohol use, drug use and high body mass index. We explored links between childhood adversity and these outcomes, then used data from the global burden of disease study to estimate how much illness and premature death across the population could be associated with it.
Finally, we assigned a monetary value to these health effects using a government estimate of society’s willingness to pay to reduce ill health and premature death.
Drug use and violence showed some of the strongest links with childhood adversity. Our estimates suggest it was associated with around 60% of drug use in Wales and 57% in England. It was also associated with almost half of all violence: 49% in Wales and 46% in England.
However, the largest estimated financial costs came from mental illness and smoking. This is because these affect more people and account for a greater share of ill health overall.
In Wales, the estimated costs associated with childhood adversity were £1.8 billion for mental illness and £1.8 billion for smoking. In England, the figures were £37.8 billion and £22.7 billion respectively.
We also calculated regional estimates for England for the first time. These ranged from £6.3 billion in the north east to £18 billion in the south east.
Why prevention matters
Our findings strengthen the case for preventing childhood adversity and supporting children and families who experience it. Reducing exposure to trauma could help improve health across people’s lives, while potentially reducing the wider costs associated with illness and premature death.
There are several ways to help prevent childhood adversity. These include supporting parents, building life skills, challenging harmful social norms and addressing the social conditions that put families under pressure.
Awareness and action to address childhood adversity has increased across the UK. Evidence suggests that some adverse childhood experiences may be declining. But others such as verbal abuse and household mental illness have been less addressed and may even be increasing.
People affected by trauma also need effective support. Trauma-informed approaches, which recognise how past experiences can shape people’s needs and behaviour, are one way to improve that support. For example, the Trauma-informed Wales Framework sets out an approach to understanding and responding to trauma across society.
There are important limits to our findings. The estimates put a monetary value on health effects, including the value society places on reducing the risk of illness and premature death. They are not a direct measure of public spending or money that could automatically be saved through prevention. The study also identifies associations between childhood adversity and health outcomes, rather than proving that adversity caused every case.
Some vulnerable groups, including people in prison, were not represented in the surveys, despite being more likely to have experienced childhood adversity. Our estimates may therefore understate the true scale of the problem.
Even with these limitations, the findings highlight the potential scale of the health and economic burden associated with childhood adversity. Preventing trauma and providing better support for those affected could bring benefits that extend well beyond childhood.