The Case for Naming Poverty an Adverse Childhood Experience

News | April 26, 2018


Adam Zolotor, MD, DrPH
Publisher, North Carolina Medical Journal

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Media Release


Morrisville, NC (April 26, 2018)

More than one in five North Carolina children experience poverty, which can lead to a higher likelihood of incarceration and exposure to violence later in life. Children who grow up without enough food or shelter are also less likely to be employed and less likely to have health insurance. All of which are reasons to consider poverty an adverse childhood experience (ACE), write Michelle Hughes and Whitney Tucker of NC Child in the current issue of the North Carolina Medical Journal.


“Poverty can really be seen as an epidemic-level issue,” said Tucker, “but it is never really tackled directly as a central problem that's affecting our kids.”


Research shows that growing up and living in poverty is a stressful experience for children, having a similar effect as other ACEs like divorce and substance abuse and mental illness in the home. ACEs can create an environment that is so consistently stressful, children's brains release chemicals like cortisol to help them cope with that stress, putting them in a perpetual state of hyper-vigilance. Unstable housing, not having enough to eat, and other symptoms of poverty can have similar effects, argue Tucker and Hughes.


“Kids get into survival mode and can't get out of it,” said Hughes. “Over time, this impacts the way the brain is wired and actually functions.”


NC Child, a statewide child advocacy organization, makes four recommendations for addressing poverty as an ACE. These include: Investing in quality early education, including high-quality child care for kids under the age of 5; strengthening and streamlining supports for families such as the Supplemental Nutrition Assistance Program (SNAP); enacting refundable tax credits such as the Earned Income Tax Credit for working families; and closing the Medicaid coverage gap for families who are ineligible but cannot afford private health insurance.


“North Carolina must begin to address child poverty as an ACE and a public health emergency,” write Hughes and Tucker. “Proven public policy tools exist...The state should make haste to employ them so that every child in North Carolina has a chance to reach their full potential.”


To read the full article, “Poverty as an Adverse Childhood Experience,” by Michelle Hughes and Whitney Tucker, as well as other NCMJ articles, visit



The North Carolina Medical Journal is a journal of health policy analysis and debate co-published by the North Carolina Institute of Medicine and The Duke Endowment. The NCMJ publishes six issues per year. To learn and read more, visit