Improving the Built Environment Prevents ACEs and Creates Safer Communities 

January 26, 2024 | Caitlin Langhorne, Meghan Auer

Child's hands holding paper dolls resting inside an adults hands, palms face upAdverse childhood experiences (ACEs) are potentially traumatic events in childhood, including experiences of violence, abuse, or neglect. ACEs can also come from a child's environment (e.g., living in a household with substance use or mental health problems and witnessing violence in the home or community), which plays a role in their well-being, development, and overall safety.

When working to address and prevent ACEs, it's important to consider a child's built environment, or the physical surroundings in which they live. Built environment impacts a family's access to school, healthcare, grocery stores, parks, sidewalks, and bicycle/walking paths, which, in turn, directly impacts a child and their family's level of physical activity and health outcomes.

In addition, unkept infrastructures (e.g., condemned buildings), land use, and zoning can influence the community's sense of safety, lead to misbehavior and crime, and ultimately encourage continued acceptance of disorder. The level of disorder in the community can shape the quality of a child's surrounding environment and increase the likelihood of ACEs.

Jurisdictions can address these challenges and prevent ACEs by working with communities to create safe, stable, and nurturing environments. Effective interventions include improving abandoned areas, creating green spaces, and developing healthy community infrastructure.

State Success Stories: Enhancing Built Environments

Vermont's Technical Assistance Pilot

The Vermont Department of Health has encouraged healthy communities by supporting small towns in developing a Technical Assistance Pilot that advances equity and inclusion through placemaking, building public spaces, and increasing outdoor recreation spaces (e.g., walking trails).

This pilot enabled communities access to subject matter experts—such as communication specialists, landscape architects, and health equity professionals—to increase access to community spaces, transportation, and food. These serve as essential protective factors for preventing ACEs and improving overall health among children and families.

Tennessee's Office of Primary Prevention

The Tennessee Department of Health has created the Office of Primary Prevention to "help Tennessee communities build a culture of health through livable and nurturing places and spaces so that all residents can reach full potential."

The office awarded Healthy Built Environments grants across Tennessee to improve the built environments and overall quality of life for all Tennesseans. To further support this work, the Tennessee Department of Health hired seven regional positions, known as Healthy Development Coordinators, to promote the Healthy Built Environments across the state and engage in cross-sector collaboration to address the social and environmental determinants of health in their region.

In part, these grants helped strengthen the built environment for families by increasing public accessibility to green spaces, playgrounds, and spaces that promote social connection and support.

Integrating Built Environment Strategies into ACEs Prevention

By supporting communities and neighborhoods, health agencies can increase and maintain the health, safety, and well-being of their entire state. As health agencies integrate built environment considerations into ACEs prevention, they should consider:

  • Coordinating closely with local health departments to guide innovative decision-making and ignite positive change.
  • Partnering with state (e.g., Department of Transportation and Department of Interior) and community-driven/grassroots organizations that focus on the built environment as well as health equity.
  • Incorporating the intersection of health equity, built environment, and ACEs into state health improvement plans and/or needs assessments.
  • Implementing the Justice40 Initiative, which is dedicated to addressing disadvantaged communities through environmental improvements at the state level through legislation, listening to the community, and using the Climate and Economic Justice Screening Tool to guide funding communities.

Special thanks to Clint Grant, Director of Healthy Community Design at ASTHO, for his contributions to this blog.