A Trauma-Informed Approach Provides Framework for Achieving Health Equity
We have known for years that health equity is possible only through eliminating racism, but we have yet to realize this imperative. The 2021 Future of Nursing Report1 and the Future of Nursing: Campaign for Action2 (an initiative of AARP Foundation, AARP and the Robert Wood Johnson Foundation), the Josiah Macy Jr. Foundation,3 and the American Association of Colleges of Nursing,4 provided key recommendations for health care, including dismantling racism and discrimination. Creating a culture free of racism and focused on equity requires individual and structural changes, and a trauma-informed (TI) approach provides a framework for these changes.
Trauma-informed approaches in health care emerged after the publication of the seminal Adverse Childhood Experiences study (ACEs)5 in 1998. This study highlighted the relationship between experiences of childhood trauma (due to abuse, neglect, and violence), debilitating mental and physical health conditions in adulthood, and early death. The Philadelphia ACEs study in 2013 expanded on the original ACEs by assessing household and community-level exposures to trauma such as witnessing violence, experiencing racism, and living in unsafe neighborhoods, in a diverse and urban sample.6 This landmark study provided evidence of the intersection of race, gender, poverty, and community and the effects of trauma on subsequent risky behavior and poor health outcomes. These studies and evidence from neuroscience research have elucidated the impact of trauma, adversity, and stress on the brain. Understanding changes in the brain as a result of trauma is critical when considering the utilization of services and systems in health care or education, which has often been traumatizing or re-traumatizing, especially for individuals from historically and systemically excluded groups. A TI program, system, or organization realizes the impact of trauma, recognizes signs and symptoms of trauma within oneself and others, responds by making changes to policies, procedures, and practices, and actively resists re-traumatization.7