Shifting focus - the need to prioritise an inclusive public health approach to trauma

Abstract Since 2017, the Welsh government has prioritised the development of a Public Health Approach to understanding the impact of Adverse Childhood Experiences. Taking the work of Bellis et al, and the population level research to understand the prevalence of ACEs, and associated risks (Bellis etc al, 2015), the ACE Hub Wales was established to coordinate a multi-agency, cross sector approach to preventing, tackling and mitigating the impact of adversity in childhood. The Hub developed its approach to advocate for more public awareness of the life course risks to health if the right support was not accessed or available to children, such as poor mental health and chronic conditions such as type 2 diabetes and heart disease in adulthood. From 2021 there has been a dramatic shift to attempting to understand the experiences, and unmet needs, of children and people who have come to Wales to seek sanctuary, migrant women who have no recourse to public funds, and people experiencing racism and discrimination. In 2021, the ACE Hub Wales co-produced a Wales national trauma-informed practice framework including a set of principles placing inclusion at the heart of the approach in Wales; shining a light on the need to have a cultural, intergenerational and gender-based understanding of adversity and trauma which links directly to, informs and supports the government’s ambitions to be a nation of sanctuary and to be anti racist by 2030. To continue to ignore the experiences of adversity and trauma by people of colour, and Gypsy, Roma and Traveller people; is to perpetuate the health inequity experienced in healthcare, and justice systems. Wales has committed to developing wisdom, not just knowledge, that means that a public health approach is inclusive of all of our communities in Wales. Key messages • The experiences of racialised ad minoritised communities from population studies of adversity and trauma is traumatizing. • Understanding the life course impact of adversity and trauma must include the experiences of racism and discrimination to be inclusive and trauma-informed.