Breaking the Cycle: How Tennessee’s Health Crises Relate to Adverse Childhood Experiences

By Rashmi Bharadwaj

November 6, 2020

Executive Summary

Tennessee has appeared in many health-related headlines, leading the country in opioid misuse and deaths, excess chronic disease burden, and loss of health coverage and access. In recent years, Tennessee’s poor health status has cost the state billions of dollars due to lost productivity and direct medical expenses. At the same time, adverse childhood experiences (ACEs) have been recognized as an alarming public health crisis, with the incidence of childhood trauma in Tennessee outpacing the rest of the country. While examining whether there are connections between the state’s healthcare issues and the prevalence of ACEs in Tennessee, the following observations emerged:

  • The increased burden of substance use disorders in Tennessee likely contributes to the rise in the number of ACEs individuals face in the state. Specifically, parental or personal opioid use counts as an ACE itself, and this has the potential to lead to further abuse, neglect, or household dysfunction.
  • As the number of ACEs individuals face increases, the risk for chronic illness multiplies. With Tennessee’s excess load of chronic diseases and ACEs, the toxic stress that results from childhood trauma appears to be a possible explanation of the state’s poor workforce health.
  • ACEs are cyclic and multigenerational issues that cannot be combated without adults and children having access to affordable preventive care and treatment. Tennessee has yet to expand Medicaid and has seen a large disenrollment of children from TennCare and CoverKids, making it difficult to address and mitigate ACEs.
  • The COVID-19 pandemic has exacerbated the occurrence of ACEs due to increased stress and instability, while limiting access to resources that families need to prevent and overcome trauma.

To address these serious issues, there should be more comprehensive screening for ACEs during primary care visits to halt generational transmission. Tennessee should also expand Medicaid to ensure low-income individuals at greater risk for these health crises have received proper care and screening. Lastly, ACEs education should be incorporated into grade school curriculum, so children are able to advocate for themselves if all other methods of detection and care fail. These efforts would help create a healthy future for all Tennesseans.



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