Making the Case: “Dollars and Lives: The Economics of Healthy Children” by Dr. Phaedra Corso

Author’s note: Healthy children lead to healthy adults. And healthy adults are more productive and drive a healthy economy. Because the nation cannot sustain its productivity potential if it has a large number of unhealthy adults, ensuring the physical and emotional well-being of our children through the prevention of child abuse and neglect must be one of this country’s top priorities. The immediate, short-term economic impacts of child maltreatment are clear. They include the cost of healthcare services for acute injuries, the utilization of social and protective services to investigate and treat abused children, and the money spent on the legal and criminal justice systems involved. Perhaps the greatest economic impact of child maltreatment on society, however, is the unhealthy adults that are produced as a consequence.

The Cost to Society of Adults who were Childhood Victims of Abuse and Neglect

Research has revealed the impact on society of unhealthy adults who were exposed to childhood abuse.

First, adult survivors of child maltreatment are more likely to have decreased health-related quality of life¹ as shown by considerable evidence of higher levels of chronic and mental health diseases relative to non-abused adults². There is evidence of a strong correlation between childhood exposure to abuse and adult obesity, cardiovascular disease, and adverse lifestyle behaviors such as alcohol and tobacco use. The economic implications of these and other adult chronic and mental health conditions being associated with abuse are very serious, resulting in excess utilization of our healthcare system. Research done by³ Dr. Amy Bonomi at Ohio State University reveals that the annual healthcare costs for adult women reporting physical abuse during childhood were 22% higher than costs for women reporting no abuse during childhood. If one considers this excess cost, which is about $500, and multiplies it times the number of adult women in the US (about 110 million) and the prevalence of self-reported physical abuse from this study and others, ranging from 19 to 34 percent, then the excess healthcare costs associated with childhood physical abuse for women in the US is between $10.4 and $18.7 billion per year. Add to this the excess medical expenditures for men, which could be higher because their prevalence of self-reported physical abuse is higher⁴ and the excess medical expenditures for other types of abuse (sexual, emotional), and the economic impact on our healthcare system is even greater. When adult survivors have access to employer-based health insurance, these excess expenditures are borne by the employer and the survivor in terms of out-ofpocket expenditures and health insurance premiums. In cases where adult survivors do not have access to private health insurance, these excess expenditures are paid by society through tax dollars that support publicly-funded health insurance, primarily Medicaid and Medicare, or by cost shifting that results from uncompensated care delivered in hospital settings.

The Impact on the Labor Force

Higher levels of chronic and mental health conditions among adults who were victims of childhood abuse and neglect may also affect the labor supply through lower productivity. Good health, while vital for individual wellbeing, also plays a large role in employee productivity. When adult survivors of child abuse and neglect suffer from long-term effects of chronic and mental health conditions, the results are increased number of sick days and increased number of days at work marked by low productivity. Some studies have noted that productivity losses for chronic diseases can be up to 4 times higher than the costs of the associated medical expenditures⁵. This means that in addition to the direct medical expenditures estimated above, female survivors of childhood physical abuse cost the economy an additional $40 to $75 billion in lost productivity each year.

The Impact on Long Term Economic Growth

These estimates, exclusive of the impact on productivity losses for men and for other types of abuse, are just the tip of the iceberg in terms of real consequences for long-term sustainable economic growth. Hard to quantify productivity impacts of chronic diseases associated with adult survivors of abuse include: unwanted job changes, impediments to job promotion opportunities, and lack of proper educational attainment to obtain the desired job or to maintain one’s job through ongoing continuing education and training. Most importantly, lifetime productivity losses associated with premature mortality resulting from child maltreatment make these estimates even greater.

The Adult Legacy of Childhood Abuse and Neglect

Finally, childhood exposure to abuse and neglect has been linked, both anecdotally and scientifically, to a lifetime trajectory of violence perpetration and victimization,⁶ non-violent criminal activity⁷, and increased utilization of social and welfare services. This means there is less money available for the criminal and legal justice systems, including police, prosecution, courts, probation, prison, and legal aid; and social welfare services, such as social security disability benefits. Beyond the economic impact associated with the actual survivor, it is also important to consider the influence on society and the family. For example, if child maltreatment has long-term impacts on the adult survivor’s social functioning, coping skills, and relationship potentials, then one should also assume that there are negative spillover effects on the quality of life, physical and emotional well-being, and productivity potential for those in the survivor’s sphere of influence. While not easy to quantify, these spillover economic impacts of child abuse and neglect may be no less important than those specific to the individual victim. The costs to individuals and to society of childhood abuse and neglect are enormous. The savings through prevention in lives and dollars should be an important public policy objective.

Endnotes

1. (Corso paper; Edwards paper),
2. (Felitti, and other papers),
3. Bonomi et al. found that,
4. (Briere and Elliott, 2003)
5. (Loeppke et al., 2007)
6. (Fang papers)
7. (Widom, NIJ cites)
8. R Loeppke et al., “Health and Productivity as a Business Strategy,” Journal of Occupational and Environmental