The truth is that the effects of child abuse are long-lasting, not just on its victims but on the health system’s bottom line

Rebecca Reeve


Churches have begun to acknowledge how they ”failed” abused children. Scouts NSW recently told the Royal Commission into Institutional Responses to Child Sexual Abuse it, too, had ”failed” young boys. But such admissions are insufficient if society’s largest institution, government, fails to invest fully in child protection.

At a time when governments are increasingly driven by fiscal restraint, it is important that public spending decisions around complex issues such as child protection consider not just the short-term effects but also the longer-term costs and benefits – in the case of child abuse, for both the victims and society as a whole.

Research published in the journal Economic Record and conducted by Dr Kees van Gool and myself at the Centre for Health Economics Research and Evaluation shows that in addition to the human cost of child abuse there are lasting health effects for victims and therefore substantial and very long-term costs for the health system.

We used the Australian Bureau of Statistics’ National Survey of Mental Health and Well-being to measure the effect of childhood physical abuse, sexual abuse and ”combined” physical and sexual abuse on long-term health problems and self-harming behaviour into adulthood.


The results indicate that, after controlling for other factors, Australian adults abused in childhood suffer from more physical and mental health problems and have higher annual healthcare costs than adults who were not abused.

While the effects differ by gender and abuse type, the findings show that adults with a history of abuse are more likely to experience drug and alcohol problems and to have attempted suicide.

In all cases the outcomes are worst for victims of combined physical and sexual abuse.

We found that the average annual healthcare costs of people who had been sexually abused as children were more than double those of the people who had not been abused. For those who had been both sexually and physically abused, annual healthcare costs as adults were six times higher.

The study also found the probability that a woman would attempt suicide rose from 1.2 per cent within the general community to 17.5 per cent among women who had suffered combined physical and sexual child abuse.

Among men, the probability of drug abuse rose from 7.5 per cent generally to 25.8 per cent for those who had suffered combined abuse.

The probability of alcohol abuse increased from 6.6 per cent for women who had not been abused to 17.9 per cent for women who had suffered combined abuse. For men, the probability rose from 32.1 per cent to 49.8 per cent.

The effects of abuse persist throughout a victim’s lifetime, our research indicates.

There are also long-term societal consequences because of the effects that self-harming behaviour has on a victim’s friends and family.

That means child abuse is a serious economic as well as social problem because of the implications for healthcare budgets, with these costs borne not just by the individual but by the broader community.

Therefore it is imperative that governments consider the persistent health and well-being effects of child abuse when they evaluate the costs and benefits of interventions aimed at its prevention.

Our research calls for further reforms in the co-ordination of health and social services to treat victims appropriately and to minimise the long-term physical and mental harms caused by abuse.

Ultimately, the question is not how much child protection we can afford, but how much child protection we can afford not to provide.

Dr Rebecca Reeve is a health economist and research fellow at the Centre for Health Economics Research and Evaluation.

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