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Injury Center

Public Health Leadership Initiative

Millions of children are abused or neglected every year. Research indicates those experiences have an impact lasting long after childhood and may contribute to some of the nation’s worst health problems.

The Public Health Leadership (PHL) Initiative believes public health agencies can make great strides in preventing child maltreatment. From 2010-2013, the PHL Initiative worked with national and state public health leaders to better understand successes and challenges of public health efforts to address child maltreatment.  Information from this work is shared in the tools and resources below.

PHL Initiative Resources

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Understanding Child Maltreatment

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Recent Research

  • The Cost of Child Abuse and Neglect
    The financial costs of child abuse and neglect for victims and society are substantial. A CDC study, The Economic Burden of Child Maltreatment in the United States and Implications for Prevention found the total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion.
    Published in Child Abuse and Neglect, The International Journal, the study looked at confirmed child maltreatment cases—1,740 fatal and 579,000 non-fatal—for a 12-month period. Findings show each death due to child maltreatment had a lifetime cost of about $1.3 million, almost all of it in money that the child would have earned over a lifetime if he or she had lived. The lifetime cost for each victim of child maltreatment who lived was $210,012.  This estimate is comparable to other costly health conditions such as stroke with a lifetime cost per person, estimated at $159,846 or to type 2 diabetes, estimated between $181,000 and $253,000.

  • The Foundations of Lifelong Health Are Built in Early Childhood
    A vital and productive society with a prosperous and sustainable future is built on a foundation of healthy child development. Health in the earliest years—beginning with the future mother’s well-being before she becomes pregnant—lays the groundwork for a lifetime of vitality. When developing biological systems are strengthened by positive early experiences, children are more likely to thrive and grow up to be healthy adults. Sound health also provides a foundation for the construction of sturdy brain architecture and the achievement of a broad range of skills and learning capacities. 
    The Foundations of Lifelong Health Are Built in Early Childhood, a report co-authored by the National Scientific Council on the Developing Child and the National Forum on Early Childhood Policy and Programs, presents a framework for understanding how policies and communities affect the biological underpinnings of lifelong health. The report was funded, in part, by CDC, and now a new 7-minute video explains the framework and its relevance to policy decisions.

  • Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a Framework for Health Promotion and Disease Prevention
    In a CDC-funded paper, Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention, authors Jack P. Shonkoff, M.D, W. Thomas Boyce, M.D., and Bruce S. McEwen, Ph.D., discuss how the origins of many adult diseases can be traced to negative experiences early in life. The authors suggest confronting the causes of adversity before and shortly after birth may be a promising way to improve adult health and reduce premature deaths.
  • Safe, Stable, and Nurturing Relationships May Shield Children Against Poor Health Later in Life
    Early childhood exposure to adversities such as child abuse or neglect are associated with increased risk of lifetime physical and mental health consequences. A recent CDC commentary in the Journal of the American Medical Association suggests that progress in preventing the nation’s worst health problems – such as obesity, diabetes, and heart disease – can be made by investing in programs that promote raising infants and young children in healthy, safe, stable, and nurturing surroundings.
    In Creating a Healthier Future Through Early Interventions for Children, the authors suggest investments in programs that are effective in promoting these important aspects of children’s surroundings can reduce exposure to adverse events, counter adverse experiences in childhood when they do occur, and promote optimal development.

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Additional Resources

  • Adverse Childhood Experiences (ACE) Study
    The Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted on the links between childhood maltreatment and later-life health and well-being.
  • Adverse Childhood Experiences (ACE) Infographic
    This interactive infographic highlights ACEs, their impact, and what can be done to prevent them.
  • Essentials for Childhood
    Safe, stable and nurturing relationships and environments are essential to prevent child maltreatment and to assure children reach their full potential. The Essentials for Childhood Framework  proposes evidence-based strategies communities can consider to promote relationships and environments that help children grow up to be healthy and productive citizens so that they, in turn, can build stronger and safer families and communities for their children.
  • Child Maltreatment Uniform Definitions [PDF 4MB]
    The purpose of the child maltreatment uniform definitions and recommended data elements is to present a definition of child maltreatment, its associated terms, and recommended data elements for voluntary use by individuals and organizations in the public health community.
  • Doris Duke Charitable Foundation
    The PHL Initiative is supported in part by the Doris Duke Charitable Foundation. The mission of the Foundation is to improve the quality of people’s lives through grants supporting the performing arts, environmental conservation, medical research and the prevention of child maltreatment, and through preservation of the cultural and environmental legacy of Doris Duke’s properties.
  • Maternal, Infant, and Early Childhood Home Visiting
    Maternal, Infant, and Early Childhood Home Visiting supports pregnant women and families and helps parents of children from birth to age 5 tap the resources and develop the skills they need to raise children who are physically, socially and emotionally healthy and ready to learn.
  • Pediatric Abusive Head Trauma—Definitions [PDF 8.69MB]
    This publication was developed to improve the quality and consistency of data on abusive head trauma in children. It provides a definition of abusive head trauma and presents recommended data elements for use by individuals and organizations.
  • Triple P Study
    The U.S. Triple P System Trial, funded by CDC, found lower rates of substantiated abuse cases, child out-of-home placements, and reductions in hospitalizations and emergency room visits for child injuries in nine study counties in South Carolina where parenting interventions were implemented.
  • Triple P-Positive Parenting Program®
    The Triple P-Positive Parenting Program® is a multi-level, parenting and family support strategy. Triple P aims to prevent behavioral, emotional and developmental problems in children by enhancing the knowledge, skills and confidence of parents.

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