Health Policy$ense

An Economic Analysis of Childhood Exposure to Crime and Violence

Wasted Funds and Broken Dreams

The impact of childhood exposure to crime and violence is pervasive and longstanding. It might be tempting to assume that the economic losses, spread over a lifetime and across the country, cannot be calculated. But that’s just what LDI Associate Fellow Michal Gilad and co-author Abraham Gutman have done in a new working paper that attempts to calculate the consequences of such childhood exposure. The total? An annual cost to the country of $458 billion—greater than the entire share of the federal budget devoted to children in 2018—or a lifetime cost of $193,413 per child.


Michal Gilad recently received her SJD from Penn Law and is an LDI Associate Fellow.

We’ll look at their estimates in more detail in just a moment. But the broader message is that the cost of neglecting the consequences of direct and indirect exposure to crime and violence is likely much greater than the cost of investing in interventions to help children recover from their experiences.

This issue crosses socioeconomic, racial, and geographic boundaries. Children witness violence at school, in the neighborhood, or even in the “safety” of their own home. Children may also be affected indirectly when parents fall victims to crime, or when a parent is incarcerated. The unique developmental, social, and cultural characteristics of children make them particularly vulnerable to the negative forces of crime. The authors estimate that 64% of children living in the U.S. will be affected by some form of crime or violence by age 18, as shown in Table 1. This includes direct victimization, witnessing family or community violence, and living through parental incarceration. Boys more frequently experience direct victimization, while girls are more frequently exposed to family violence.

Table 1: Percentage of Population Exposed to Crime or Violence by Age 18

A large body of evidence confirms that childhood exposure to crime and violence is associated with a wide array of adverse outcomes. The observed harms range from increased involvement with the criminal justice system and heightened risk for substance use, to poor educational achievements, higher rates of unemployment and homelessness, and reduced  economic well-being.  Exposure is also strongly linked with physical and mental health conditions, such as cancer, lung, heart, liver and skeletal diseases, sexually transmitted diseases and diabetes, anxiety, depression, PTSD and increased risk for suicide attempts.

Despite the severity of the consequences, and the devastating effect it has on millions of children nationwide, little is done on the policy level to heal the open wounds. Most children harmed by crime do not receive any services to facilitate recovery from trauma. At present, there are no effective mechanisms in place to identify affected children and refer them to vital services. Although resources and services for affected children exist in most states, access is obstructed by a myriad of bureaucratic hurdles and systemic design flaws.

The ramifications of this ongoing neglect go beyond compromising the well-being of individual children, and have a spillover effect on society. With millions of children across the nation untreated, and at heightened risk for acute health problems, substance use, criminal behavior, and repeat victimization, community safety is inevitably compromised. These negative outcomes  carry hefty costs that are shouldered by society as a whole, and unnecessarily burden public resources. The authors call this the Comprehensive Childhood Crime (Triple-C) Impact problem.

Using a cost-of-illness, “bottom up” approach, the authors designed an economic model to estimate the full cost of the Triple-C Impact on individuals and to society. The model, based on a cohort of children born in 2002, accounts for the prevalence of exposure, the risk of an adverse outcome attributable to the exposure, and the cost of the outcomes in adulthood, in 2017 dollars. Applying a conservative valuation, they found total annual costs to society of more than $458 billion, or a lifetime cost of $194,413 per each affected individual (Table 2).

Table 2: Total Annual and Lifetime Costs Per Person Exposed

Ultimately, this analysis sets the foundations for an evidence-based argument for the economic benefits of investing in timely identification, referral, and interventions that will facilitate recovery of affected children. These policies, such as the universal trauma screening currently proposed by the California Surgeon General, Dr. Nadine Burke Harris, may not only improve children’s well-being, but may also be cost-saving in the long run.

The full paper can be found here.