Capturing data on the mental health and well-being of children can provide valuable insights into the impact of child maltreatment and other ACEs. Child maltreatment can have a profound negative impact on mental health and well-being of children and throughout the life-course (4,72,73). Twenty-six countries (53%) reported in the survey that they have regular monitoring on child mental well-being, commonly using a school-based survey.
10–14 5–9
1–4
< 1 year
Source: WHO Regional Office for Europe (55).
Assault hospital admissions, per 1 000 Croatia Czechia Denmark Finland Lithuania Malta Serbia Slovenia Switzerland
0.0 0.1 0.2 0.3 0.4 0.5 0.6 0.7
Age-specific hospital admission rates for assaults on children in selected European countries
Fig. 7.
National survey Subnational survey None Data not available
Countries that reported survey data on child maltreatment
Fig. 8. CHAPTER 3. OBJECTIVE 1: ARE COUNTRIES MAKING CHILD MALTREATMENT MORE VISIBLE BY MEASURING IT?
Surveys of ACEs have been undertaken in young people (18–25 years) in higher education in 13 countries, including Albania, Czechia (57,58), Latvia, Lithuania, Montenegro (59,60), Poland (61), Romania (60,62), the Republic of Moldova (63), the Russian Federation (64), Serbia (65), the former Yugoslav Republic of Macedonia (60,66), Turkey (67) and Ukraine (68). These surveys were conducted with support from the WHO Regional Office for Europe, and multisectoral policy dialogues were held to disseminate results and recommend next steps for preventive action.
Results demonstrate that the prevalence of child maltreatment and other adversities in childhood is
high. Half of respondents (48.5%) across all 13 countries reported at least one ACE, with 6.3% reporting four or more. ACEs reported included physical, emotional and sexual abuse, neglect, and witnessing intimate-partner violence and a household member with alcohol misuse, drug abuse, mental illness and/or incarceration.
Strong associations with health-harming behaviours were found, which inevitably leads to poor individual health outcomes and has negative societal impacts.
These surveys have been used to underscore the policy advantage of ensuring violence-free, nurturing and caring childhoods (60,69). Similar surveys have been conducted in other countries, including Sweden (70) and the United Kingdom (60,71).
Box 2. Surveys of ACEs in Europe
EUROPEAN STATUS REPORT ON PREVENTING CHILD MALTREATMEN
National data have been powerful advocacy tools to drive multi-agency action to prevent and respond to ACEs in United Kingdom (Wales). Data on the extent and impact of ACEs in Wales to advocate for the multi-agency action required to prevent and respond to them using evidence-based approaches were lacking prior to 2015. Public Health Wales then undertook a national ACE study among the general adult population. This found that 47% of adults surveyed had experienced at least one ACE, and 14% had suffered four (71). The more ACEs people had suffered, the more likely they were to engage in health-harming and antisocial behaviours, develop chronic health conditions and require health treatment. The survey also demonstrated the gains to health and well-being that could be made if ACEs were prevented (71). The findings were widely disseminated alongside information explaining how ACEs affect
behaviour and health. An animated film based on the data was also produced to support awareness-raising.
This work generated significant multi-agency attention and drove changes to health and social policy in Wales, supporting a shift towards investment in prevention of ACEs and better support for vulnerable children. The Welsh Government prioritized support for families to reduce ACEs and committed to developing ACE-informed public services, including building childhood resilience in their national strategy. An ACE hub was established to share learning and knowledge across the country and ACE-informed practice is emerging among health, social care, education and justice sectors. A second national ACE survey was undertaken in 2017, identifying the value of childhood community resilience assets in reducing the extent of poor childhood health (34).
Box 3. Garnering multi-agency commitment to prevent ACEs in United Kingdom (Wales) using national data
The ACE study in the former Yugoslav Republic of Macedonia found that one in five (21%) of university and high-school students had been exposed to physical abuse, 30% to psychological neglect, 11%
to psychological abuse, and 13% to sexual abuse in childhood. Approximately two in three participants (65%) had been exposed to an ACE, with 35%
experiencing multiple ACEs (66).
Evidence on the scope of the problem and three awareness-raising campaigns helped set the national policy and legal landscape for child maltreatment prevention actions.
The national action plan for prevention and combating child abuse and neglect, adopted in 2013, addressed child maltreatment, strategically in the country for the first time. Other linked policies for reducing poverty and social exclusion, improving children’s rights, tackling children on the streets, and prevention and protection of sexual abuse and paedophilia, also reflected the importance of child maltreatment prevention.
The WHO Training Education Advancing Collaboration in Health, Violence and Injury Prevention (TEACH VIP) modular training curriculum on violence prevention and control has been introduced to address capacity-building needs. Around 2390 general practitioners, emergency medicine doctors, paediatricians, gynaecologists, psychiatrists and nurses completed training between 2010 and 2012. Sixty university professors from faculties of medicine, psychology, social work, gender studies, pedagogy, law and the police academy became trainers of trainers on TEACH VIP workshops between 2009 and 2010.
Despite the enormous progress made in child maltreatment prevention and safety promotion, further strategic efforts are needed in the years ahead to reduce violence using evidence-based preventive programmes and reinforce the legal and policy framework. Clear budget allocations from all relevant ministries and more defined indicators for reducing child mortality and burden of child maltreatment will be addressed in an upcoming national action plan on preventing ACEs.
Box 4. Preventing child maltreatment in the former Yugoslav Republic of Macedonia
© WHO/MALIN B
4. Objective 2: have countries
developed national action
plans to coordinate action to
reduce child maltreatment?
EUROPEAN STATUS REPORT ON PREVENTING CHILD MALTREATMEN