research paper on poverty and education in the philippines

Overview of Education in the Philippines

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• Lorraine Pe Symaco 3 &
• Marie Therese A. P. Bustos 4  

Part of the book series: Springer International Handbooks of Education ((SIHE))

The Philippines has embarked on significant education reforms for the past three decades to raise the quality of education at all levels and address inclusion and equity issues. The country’s AmBisyon Natin 2040 or the national vision for a prosperous and healthy society by 2040 is premised on education’s role in developing human capital through quality lifelong learning opportunities. Education governance is handled by three government agencies overseeing the broad education sector of the country. At the same time, regional initiatives relating to ASEAN commitments are also witnessed in the sector. However, despite the mentioned education reforms and initiatives, the education system remains beset by challenges. This chapter will give readers an overview of the education system of the Philippines through an account of its historical context and its main providers and programs. Key reforms and issues within the sector are also discussed.

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Useful Websites

Ambisyon Natin 2040 . http://2040.neda.gov.ph/

Commission on Higher Education (CHED) https://ched.gov.ph/

Department of Education (DepED). https://www.deped.gov.ph/

ECCD Council of the Philippines (ECCD Council). https://eccdcouncil.gov.ph/

National Council on Disability Affairs (NCDA). https://www.ncda.gov.ph/

Technical Education and Skills Development Authority (TESDA) https://www.tesda.gov.ph/

UNESCO Institute for Statistics Philippines profile. http://uis.unesco.org/en/country/ph?theme=education-and-literacy

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Symaco, L.P., Bustos, M.T.A.P. (2022). Overview of Education in the Philippines. In: Symaco, L.P., Hayden, M. (eds) International Handbook on Education in South East Asia. Springer International Handbooks of Education. Springer, Singapore. https://doi.org/10.1007/978-981-16-8136-3_1-1

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Global Study on Child Poverty and Disparities: the Case of the Philippines

In a country where poverty is prevalent, a significant number of children are likely to be illiterate, malnourished, and prone to abuse and physical violence. The Philippines is no different. Using known indicators on education, social protection, poverty, and health, this report summarizes the Filipino children's welfare and living conditions taking account the disparities in gender, income, and geographic location. This report shows that poverty incidence among children living in rural areas is more than twice that of children living in the urban areas. Looking at the regional patterns, some regions are consistently ranked as being 'worse off' compared to other regions. All these suggest wide disparities in poverty incidence across regions and between urban and rural areas. Chapter 2 of the report describes the many facets of deprivation that could either be severe or less severe. In 2006, 18.6 percent of children or 5.4 million children were deprived of at least one of the three dimensions of well-being covered by the study, namely, shelter, sanitation, and water. The report finds some remarkable improvements in the plight of the children based on recent data and indicator estimates. The five pillars of child well-being are examined more closely in Chapter 3. The first section deals with child nutrition and highlights the fact that malnutrition is one of the underlying causes of child mortality. The section on child health, meanwhile, analyzes trends and issues on infant mortality and child immunization. Compared to its close neighbors in Asia, the Philippines posted a drastic decline in immunization rates in 2003. The section on child protection, on the other hand, cites the Philippine government's efforts to protect the rights of families and children which began as early as 1935. Another section is devoted to education and highlights various basic education indicators and trends. It narrates how the 2007 level of elementary participation rate became at par with 1990 level, thus, requiring that the 25-year millennium development target be achieved in eight years. Disparities in education outcomes were also observed in different socioeconomic dimensions. In the section for social protection, policies and programs that aim to prevent, manage, and overcome the risks that confront the poor and vulnerable people were presented. The section also suggests critical areas that should be considered in assessing social safety net programs. In conclusion, the report proposes different strategies for action using the rights-based approach. Some specific recommendations include pursuing an effective population management program; stabilizing macroeconomic fundamentals; building up data and giving due consideration to regional disparities in aid of planning, and policy and program formulation; and allocating more financial and rational manpower resources for health, education, and child protection. As regards other government programs, the report finds that it is not sufficient that budget is allocated adequately. What is crucial is proper targeting and making sure that resources are given to that segment of population where interventions are needed the most. Moreover, research works should continue to look for reasons why gaps persist, to analyze the correlation between interventions and outcomes, and to examine the interrelated forces and relationship that would strengthen the pillars of child well-being. The report ends with a view on how the role and active participation of public institutions, private organizations, communities, and individuals must be upheld and coordinated to promote the welfare of the Filipino children.

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Breaking barriers: Education and poverty

FROM THE MARGINS

The economic downturn caused by the pandemic has pushed 18.1 percent of our population to live below the poverty line. Against this backdrop is a dim scenario for the ordinary Filipino: inflation accelerated to 6.4 percent in July from a three-year high of 6.1 percent in June. Our GDP growth slowed down at 7.4 percent in the second quarter as inflation hit us where it hurts the most: consumer spending. While unemployment rate remained at six percent in June, the number of jobless Filipinos increased to 2.99 million. More people joined the labor force, including those above 65 years old who had to look for jobs amid rising prices.

Mary Jane Pascua, a mother of three, knew how difficult life is when one comes from a poor family. Like many Filipinos, she believes that education is the best way to secure her children’s future. She wants all her children to finish college, so that they could have a better life.

Education and poverty

Poverty and education are inextricably linked. Not every person without an education lives in extreme poverty, but most adults living in poverty missed out on a basic education. Poor people stop going to school because they have to work, which leaves them without the literacy and numeracy skills needed to improve their situation. With little income and few options, their children are also more likely to leave school, perpetuating a cycle of poverty that spans generations. This is unfortunate, because the most important way that education affects poverty is that it can help to end it.

Education directly correlates with many solutions to poverty: economic growth, reduced income inequality, reduced infant and maternal deaths, reduced stunting, reduced vulnerability to HIV and AIDS, reduced violence at home and in society. For this reason, the fourth Sustainable Development Goal (SDG) of the UN 2030 Agenda relates to education: “ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.”

According to UNESCO, if all students in low-income countries had just basic reading skills, an estimated 171 million people could escape extreme poverty. If all adults completed secondary education, we could cut the global poverty rate by more than half.

Promoting access through microfinance

About 19.99 million Filipinos live below the poverty threshold. Meanwhile, the subsistence incidence or the proportion of those whose income is not enough to meet even just the basic food needs, was at 3.9 percent, equivalent to 1.04 million poor families. Not surprisingly, many poor Filipinos lack access to education, even with the welcome news that the Department of Education has surpassed its target of 28.6 million enrolled learners this school year.

The latest PSA figure on out-of-school youth (OSY) places them at 3.53 million in 2017. About 50 percent of OSYs belong to families whose incomes fall within the bottom 30 percent of the population. Financial concerns, or the high cost of education, was among the most common reasons given for not attending school.

I had been a microfinance practitioner for decades and have seen first-hand the truth of PSA’s findings: financial instability creates barriers to education and prevents children from attending school. These barriers include the costs of transportation, schoolbooks, and uniforms, as well as lost hours of child labor to support the family.

Poverty enticed Mary Jane to microfinance. In 2012, she joined a microfinance organization and took a loan to start a sari-sari store, which helped meet their daily needs. To support her children’s schooling, she also took out educational loans.

“My son became an electrical engineer with the help of microfinance,” she proudly says. It also supported her succeeding businesses: a tiklis manufacturing enterprise and the selling of LPG in their area. She says their lives improved because of these ventures, which now support the education of her two other children.

She appreciates the loans, savings and insurance that she can access through microfinance. “Even after all of my children complete their schooling, I will not leave this organization,” she professed.

As in Mary Jane’s case, microfinance enables poor families to afford schooling by providing income stability. Although few studies have analyzed the effect of microfinance on access to education, reports from the Philippines and Bangladesh support positive associations. Research from Uganda also suggests that participation in microfinance programs correlates with increased investment in children’s education.

Increased access to education can contribute to reducing poverty. The role of microfinance in promoting access to education is but a drop in the bucket. From my humble corner, I enjoin the government, the private sector and development partners to put more resources into this. As former US President Barack Obama once said: “The best anti-poverty program is a world-class education.”

(Dr. Jaime Aristotle B. Alip is a poverty eradication advocate. He is the founder of the Center for Agriculture and Rural Development Mutually-Reinforcing Institutions (CARD MRI), a group of 23 organizations that provide social development services to eight million economically-disadvantaged Filipinos and insure more than 27 million nationwide.)

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• Published: 26 May 2024

Effects of expanded adverse childhood experiences including school bullying, childhood poverty, and natural disasters on mental health in adulthood

• Natsu Sasaki 1 ,
• Kazuhiro Watanabe 2 ,
• Yoshiaki Kanamori 3 ,
• Takahiro Tabuchi 4 , 5 ,
• Takeo Fujiwara 6 &
• Daisuke Nishi 1  

Scientific Reports volume  14 , Article number:  12015 ( 2024 ) Cite this article

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The study aimed to examine the association of expanded adverse childhood experiences (ACEs) with psychological distress in adulthood. The data from nation-wide online cohort was used for analysis. Community dwelling adults in Japan were included. The ACEs was assessed by 15 items of ACE-J, including childhood poverty and school bullying. Severe psychological distress was determined as the score of Kessler 6 over 13. Multivariable logistic regression analysis was conducted, by using sample weighting. A total of 28,617 participants were analyzed. About 75% of Japanese people had one or more ACEs. The prevalence of those with ACEs over 4 was 14.7%. Those with ACEs over 4 showed adjusted odds ratio = 8.18 [95% CI 7.14–9.38] for severe psychological distress. The prevalence of childhood poverty was 29% for 50–64 year old participants and 40% of 65 or older participants. The impact of childhood poverty on psychological distress was less than other ACEs in these age cohorts. Bullying was experienced 21–27% in young generations, but 10% in 65 or older participants. However, the impact on psychological distress in adulthood was relatively high in all age groups. ACEs have impacted mental health for a long time. Future research and practice to reduce ACEs are encouraged.

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Introduction.

Adverse childhood experiences (ACEs) are traumatic events that children and adolescents under 18 years of age have experienced 1 . People with a history of ACEs are at greater risk of deterioration in physical and mental health 2 , 3 , and ultimately premature mortality 4 , 5 . The cumulative effect of a diverse range of ACEs can impact health outcomes in adulthood and far beyond from life-course perspectives 6 , 7 . Studies increasingly establish evidence that ACEs leads to develop mental health issues, including depression, substance misuse, and suicide 8 , 9 , 10 , 11 . A World Health Organization (WHO) study revealed that ACEs were associated with all lifetime DSM–IV disorders worldwide 12 . These associations are explained by both neurobiological development and external factors 13 . For example, early life exposure to chronic stress causes greater activation of the hypothalamic-pituitary-adrena (HPA) axis, and high levels of inflammation, resulting in deficits of cognitive and affective functioning and increased allostatic load 14 , 15 . ACEs also lead to impaired social functioning, such as lack of social support 16 , 17 , 18 .

ACEs traditionally included childhood maltreatment and household dysfunction. For example, physical neglect, characterized by a caregiver's failure to provide for a child's basic physical needs. Recently, the concept has been expanded to include community-level and social factors, such as school bullying and economic hardship 19 , 20 , 21 , 22 , 23 . Furthermore, ACEs can differ by race, culture, and era 19 , 22 . An ACE scale for the Japanese context (ACE-J) has been developed to assess expanded ACEs reflecting the Japanese situation 7 and its potential benefit of use is to capture the influence of expanded and culturally familiar ACEs on outcomes. For example, Japan has a high prevalence of both school bullying victimization and natural disasters compared to other countries 24 , 25 . Childhood poverty is also considered an important factor as a root cause of ACEs from life-course perspective 26 . Although the relationship between the conventional ACEs and mental health issues in adulthood have been well investigated, the more recent potential constructs of ACEs should be further explored 27 .

Few studies have examined long-term effects of a wide range of ACEs in Asians. In Japan, the association of conventional ACEs with mental health was last reported in 2011 28 . A scoping review about different types of ACEs from articles (n = 1281) showed that less articles reported expanded ACEs (e.g., household financial hardship; 18%, victimization by peers; 10%, exposure to natural disasters; 2%) 23 . Besides, over 60% of the articles related to ACEs published from United States 23 . This disproportionate evidence motivates researchers to examine long-term impact mental health by expanded ACEs in various countries. The understanding of its association in ethnic groups of a particular culture can lead to the development and implementation of locally sensitive countermeasures 29 . Moreover, empirical evidence about the association of the expanded concept of ACEs on mental health would benefit specifically to evaluate the impacts of each ACE.

The aim of this study was thus to examine the association of expanded ACEs with mental health in adulthood in Japanese community sample. The impact of childhood poverty and school bullying on mental health was investigated, considering demographic indicators.

Research design

For this research, we utilized data from the Japan COVID-19 and Society Internet Survey (JACSIS), an ongoing nationwide online cohort study conducted in Japan 30 . JACSIS cohort study began in August 2020. The JACSIS included community-dwelling individuals aged 15–79 years. The baseline sample of JACSIS was collected in 2020, consisting of 28,000 participants. In 2022, a follow-up survey was conducted for the participants from 2020 survey or 2021 survey, and new participants were also invited. This resulted in a total of 32,000 participants in the 2022 survey. This study employed a cross-sectional design using the JACSIS 2022 data, which was collected in September 2022.

Participant recruitment

To recruit participants, we utilized email messages to request survey participation from a research panel maintained by Rakuten Insight, Inc. This private company have information about over 2.2 million individuals aged 15 to 79 years with diverse sociodemographic backgrounds, representing the national population across all 47 prefectures of Japan. We employed a simple random sampling method based on sex, age, and prefecture category in accordance with the official Japanese demographic composition as of October 1, 2019, to select potential participants. Those who agreed to participate were provided access to a designated website. Participants had the option to skip questions or discontinue the survey at any point.

Data quality management

To ensure the validity of the data, we excluded respondents who exhibited discrepancies or provided artificial/unnatural responses. Specifically, we used three question items to identify such responses: "Please choose the second from the bottom," "choosing positive in all of a set of questions for using drugs," and "choosing positive in all of a set of questions for having chronic diseases." A total of 3,370 respondents were found to have provided such responses and were subsequently excluded from the study.

Participants

Our study included community-dwelling individuals in Japan who were over 18 years old and had complete data. Participants who were under 18 years old were excluded (n = 13).

Measurement variables

Expanded adverse childhood experiences.

We assessed Adverse Childhood Experiences (ACEs) using the Adverse Childhood Experiences Japanese version (ACE-J) questionnaire 7 . The ACE-J questionnaire was developed to measure individuals' exposure to various adversities during their childhood in Japan. For example, incarcerated household member was excluded, reflecting Japanese culture. Each category of adversity was represented by a single item, except for parental loss, which included both parental death and divorce or separation. In addition to the CDC-Kaiser ACE questionnaire 1 , the ACE-J included, childhood poverty, overcontrol, school bullying, hospitalization due to chronic disease, and exposure to life-threatening natural disasters. The ACE-J questionnaire consisted of a total of 15 items (parental death, parental divorce, mental illness in the household, substance abuse in the household, mother treated violently, physical abuse, physical neglect, emotional abuse, emotional neglect, childhood poverty, overcontrol [“I always felt suffocated because my parents did not respect my opinion”], school bullying, sexual abuse, hospitalization due to chronic disease, natural disaster), and participants were asked whether they had experienced each adversity before the age of 18. The response options were "Yes" or "No." One item related to emotional neglect was a reversed question, specifically assessing whether participants felt loved by their parents. To calculate the total number of ACEs experienced, the score of the reversed item was reversed, and the summed score of all ACE items was used. The ACE-J questionnaire was not validated in publication.

Psychological distress

Psychological distress refers to a broad range of emotional and psychological symptoms or experiences that can cause discomfort, suffering, or impairment in daily functioning.　Psychological distress was measured by The Kessler Psychological Distress Scale (K6), which has been widely used and is preferred for screening for any DSM-IV mood or anxiety disorder. K6 includes six items that measure the frequency of psychological distress symptoms experienced by participants over the past 30 days 31 . Participants provide responses on a scale ranging from 0 (none of the time) to 4 (all the time). Previous studies have reported satisfactory internal reliability and validity for Japanese version of K6, showing that performance in areas under receiver operating characteristic curves (AUCs) was 0.94 detecting DSM-IV mood and anxiety disorders 32 . K6 scores over 13 are regarded as a serious mental distress 31 , 33 , 34 . Prevalence of people with over 13 scores of K6 was reported 4% in Japan 35 .

Demographic characteristics

The sociodemographic characteristics of the participants were assessed, including age, sex, educational attainment (categorized as less than high school, vocational/college, undergraduate, graduate or over), marital status (categorized as married, single/divorced), household income (categorized as < 3 million yen, 3–5 million yen, 5–8 million yen, 8–10 million yen, over 10 million yen, or no response/unknown), and working status (categorized as paid work, no paid work, or students).

Statistical analyses

First, the descriptive statistics were estimated. These included the prevalence of ACEs and severe psychological distress and the coexistence of the ACEs. To address a potential sampling bias due to the internet survey, a propensity score for participation in the internet survey was calculated. We utilized a demographic distribution of a national paper-based survey, the Comprehensive Survey of Living Conditions of People on Health and Welfare (CSLCPHW). Using sex and age group stratifications (sex × age groups = 14 strata), we calculated the propensity score separately for each stratum. The mean of the score was group-mean centered and was set to 1.0 within each stratum. Residential area, marital status, education, home-ownership (household), self-rated health and smoking status, which were available both CSLCPHW and JACSIS, were used for the model to calculate the propensity scores. The inversed propensity score was used as the sampling weight for the calculation of the prevalence of the ACEs and psychological distress. The difference in the prevalence of ACEs among stratified categories (sex and age groups) was tested using a chi-square test. Also, the summed number of ACEs was tested using a t-test in sex and one-way analysis of variance (ANOVA) in age category. The coexistence of the ACEs was presented as a matrix.

For the main analysis, the associations of ACEs with severe psychological distress were assessed by using logistic regression analysis, adjusted by age, sex, marital status household income, work, and educational attainment. The sampling bias was also adjusted by the inversed propensity score. Additionally, the subgroup analyses were conducted stratified by sex and age categories. The statistical significance for all analyses in this study is set at 0.05 (two-tailed), and 95% CIs were calculated. SPSS 28.0 (IBM Corp., Armonk, NY, USA) Japanese version was used.

Ethics approval and consent to participate

The study was reviewed and approved by the Research Ethics Committee of Graduate School of Medicine/Faculty of Medicine, The University of Tokyo (no. 2020336NI-(3)) and by the Research Ethics Committee of the Osaka International Cancer Institute (no. 20084). All methods were carried out in accordance with the Declaration of Helsinki.

Informed consent

Online informed consent was obtained from all participants with full disclosure and explanation of the purpose and procedures of this study. The panelists had the option to not respond to any part of the questionnaire and the option to discontinue participation in the survey at any point.

A total of 28,617 community dwelling people was included in the analysis. The participants’ characteristics are presented in Table 1 . The mean age was 48 years old (standard deviation [SD] = 17.1). Majority demographics included those who were married (62%), with undergraduate level of educational attainment (46%), and with paid work (65%).

The sample weighted prevalence of expanded ACEs is presented in Table 2 . The overall prevalence of expanded ACEs was varied from lowest (physical neglect = 3.2%) to highest (emotional neglect = 38.5%). The mean of summed number of ACEs was 1.75 (SD = 1.94). The histogram of the summed number of ACEs is presented in Supplementary Fig.  1 . The prevalence of those with ACEs over 4 was 14.7%. The prevalence of childhood poverty and school bullying was 26.3% and 20.8%, respectively.

For sexual difference, the mean of the summed number of ACEs was larger for females (1.85 vs 1.65; p < 0.001). Sexual abuse was particularly experienced more in female populations (6.9% vs 1.8%). For age difference, the mean of the summed number of ACEs was highest in age 35–49 years old (1.87 [SD 2.03]). Those over 65 years old showed lowest score of ACEs (1.55 [SD 1.73]). Among those over 65 years old, the prevalence of parental death (21%) and childhood poverty (40%) were higher than other age category (p < 0.001), and parental divorce (7%) was lower (p < 0.001).

Table 3 shows the prevalence of severe psychological distress (K6 ≥ 13), which was adjusted for weighed scores. The overall prevalence was 10.4%. The prevalence of severe psychological distress increased as the number of ACEs increased. The highest prevalence of high distress was observed in those with ACEs over 4 in ages 18–34 years old (40.7%). In the group with the same number of ACEs, younger groups showed significantly high prevalence of severe distress compared to older groups (p < 0.001). The significant group difference of sex was not shown in the group with 2 or more ACEs.

The result of the associations of ACEs with severe psychological distress is presented in Table 4 , using a logistic regression analysis. Almost all individual ACEs, except parental death, were significantly associated with high distress in adulthood in adjusted model (odds ratio ranging from 1.23 to 4.01). The adjusted odds ratio of school bullying, hospitalization due to chronic disease, and natural disaster was 3.04, 2.67, and 2.66; respectively. The odds of high distress increased as the number of ACEs increased; those with ACEs over 4 showed adjusted OR = 8.18 [95% CI: 7.14–9.38].

The result of logistic regression analysis which was stratified by sex and age category is shown in Table 5 . Adjusted odds ratio was rather higher in male than female in physical neglect and sexual abuse (aOR = 4.68 [3.68–5.94], aOR = 4.05 [3.06–5.36]; respectively). In age category, physical abuse and physical neglect were highly impacted on the prevalence of high distress among those over 65 years old (aOR = 5.60 [2.87–10.93], aOR = 6.27 [3.41–11.55]; respectively), compared to other age group. However, parental death, parental divorce, and childhood poverty showed lower odds among those over 65 years old and 50–64 years old, compare to 18–34 years old and 35–49 years old.

Supplementary table 1 shows the relationship between ACEs, which was adjusted for weighted scores. We found high comorbidity of ACEs; for example, those who experienced physical abuse also experienced emotional abuse (75%), overcontrol (68%), and emotional neglect (65%).

This study presented the high prevalence of expanded ACEs in Japan and its strong impact on mental health in adulthood. The mean of summed number of ACEs as measured by expanded ACEs scoring customized for Japanese people was 1.75. The prevalence of those with ACEs over 4 was 14.7% and they significantly showed high odds on severe psychological distress in adulthood, compared to those with none ACE (aOR = 8.18 [95% CI 7.14–9.38]). Childhood poverty showed lower odds among those over 65 years old and 50–64 years old compared to other ACEs. Bullying relatively showed higher odds among all age categories, with some difference of prevalence across age category.

About 75% of participants had one or more ACEs in this study. Reports of worldwide prevalence of ACEs are lower, including 62% in U.S. 36 and 47% in Europe 37 , by measuring 11 items of ACEs in both studies. A systematic review of a ACE-related study with a large sample reported that a pooled prevalence of individuals with one ACE was 23.5% in Europe and 23.4% in North America, and those with two or more was 18.7% in Europe and 35.0% in North America 38 . However, in expanded ACE study (The Philadelphia Urban ACE Study), a prevalence of 83.2% had at least one ACE and 37.3% experienced four or more ACEs, measured by 14 items with additional stresses including bullying 39 . These studies support our findings of prevalence of expanded ACEs.

Among 15 of the expanded ACEs, emotional neglect, childhood poverty, and bullying showed highest prevalence (39%, 26%, and 21%, respectively). A previous study from 2002–2004 using Japanese data reported that parental death (12%), parental divorce (11%), family violence (10%), and physical abuse (8%) were the most prevalent, but neglect was reported less (2%) 28 . The prevalence of emotional neglect in this present study (26%) may be over reported. When compared to recent studies, the prevalence of psychological neglect was 11.6% 40 . One possible reason was that emotional neglect in our study was measured by an inverse item (i.e., “I felt loved by my parents.”). Reversed items in surveys sometimes cause measurement problems due to misresponses 41 . Since this data was obtained online, the misresponse or careless answer may be more likely to occur compared to in-person interviews. However, based on the finding that there is a significant positive association between the presence of emotional neglect and severe psychological distress, it is possible that emotional neglect is this prevalent in Japan. Possible factors contributing to a high prevalence of emotional neglect might include Japan's traditionally reserved emotional culture (e.g., less expression of positive feelings 42 ), insufficient emotional support due to parental employment and household issues, as well as inadequate systems for early detection and protection, potentially resulting in an elevated prevalence rate. The expected level of “loved” for Japanese may be higher than the standard family relationship.

All 15 of the individual ACEs showed the negative impact on mental health, after adjusting covariates. Physical neglect and physical abuse showed highly negative associations (aOR = 4.01, 3.65; respectively). This result was partially consistent with the previous Japanese WHO survey data, which showed parental mental illness and physical abuse strongly affected the onset of mood disorder 28 . With a few exceptions 43 , few paper suggested that physical neglect had a significant impact on mental health; but we should note that those with physical neglect has high comorbidity of ACEs (e.g., childhood poverty, emotional abuse/neglect) in this study. Many studies suggested that emotional abuse and neglect had great impacts on mental health 44 , 45 , 46 , 47 . Such comorbidity might strengthen the impact of physical neglect. Consistent with Tzouvara and colleagues (2023), this study demonstrated that all ACEs can negatively impact mental health, and ACEs can manifest differently in different populations 27 .

In this study, school bullying impacted on deteriorated mental health in adulthood among all age categories, although the prevalence of experience was lower in older generations. School bullying have serious and lasting negative impacts on mental health, including depression 48 , 49 , 50 , 51 , anxiety 48 , 50 , 51 , 52 , 53 , post traumatic stress disorder (PTSD) 54 , and risk of suicide 51 , 52 . Japan has a higher prevalence of school bullying compared to most other countries (i.e., Japan 22% vs OECD countries 19%) 55 . This study showed that the prevalence was low in elderly population. The possible reasons for this low prevalence may less awareness, different school dynamics (societal norms), and supportive community functions in old Japanese 56 . A previous study indicated the widely varied exposure to bullying across countries 57 , even in one country, the prevalence may vary from generation to generation. To reduce the prevalence, evidence-based practice is needed to be implemented at school 58 .

Natural disasters as one of ACEs was overall experienced 3.5% and impacted on severe psychological distress in adulthood, except those 65 or older. The findings were in line with the previous studies, demonstrating that when experiencing natural disaster, such as earthquake, heavy rain/snowfall, flood, heatwaves, storm, and/or tsunami, can cause short-term and long-term deterioration in mental health 59 , 60 , 61 , 62 . The worldwide climate is rapidly changing and we face the increased risk of natural disaster. Assessing the psychological impact that the experience of natural disaster(s) causes may become increasingly important in the near future, in addition to the effort to avoid children from being exposed such traumatic events.

Childhood poverty was experienced more in older age (40% in 65 or older; 17% in 18–34-year-old group), but the negative impact on mental health was less among the elderly population. This result was in line with a previous study showing that accumulative exposure of the economic hardship impacted mental health, but that negative association was attenuated if they experienced upwards mobility 63 . Many of elderly population in this study experienced childhood poverty, but financial difficulty might not persist and change positively. Even so, we should not ignore the importance of childhood poverty for mental health in adulthood, as significant effects have also been found in older adults. A possible mechanism of the link between childhood poverty and mental health are presented; persistent poverty-related challenging tasks 64 , disengagement coping strategy 65 , diminished spatial short-term memory, and helplessness behaviors 66 . Poverty is not only one of the critical social determinants of health 67 , but also an adversity that should primarily be addressed during childhood, when it has significant implications for neurodevelopment, social development, and behavior. The findings of the present study posed the need to ensure that poverty does not persist among the young generation, who suffered economically in childhood.

Overall, this study showed the cumulative negative impacts of expanded ACEs on psychological distress in Japanese adults, as well as individual adversities. A previous study suggested that a 10% reduction in ACE prevalence could equate to annual savings of 3 million DALYs or $105 billion 38 . Primary prevention, or preventing children from having ACEs is urgent action for public mental health. In addition, childhood maltreatment has consistently been shown to be associated with poor treatment outcome after psycho- or pharmaco-therapy in depression 68 . Trauma-informed care can be one of the important approaches to be implemented for tertiary prevention.

Limitations

This study has several limitations. First, generalizability of the findings was limited because this was an online cohort study. Although we adopted sample weighting to adjust the bias and examined the prevalence with large number of participants, we should note that the present result may possibly be different from the real data of community dwelling people in Japan. Participants of online survey have access to the internet and motivation to answer the questionnaire with small reward. It is possible that participants with certain demographic characteristics and traits are likely to participate. Second, a recall bias in terms of measuring ACEs was not avoided. Older participants answered less ACEs may underestimate the impact. Third, the definition of school bullying may also vary between younger and older generations. The authors should note that the outcome of this study was obtained self-report questionnaire and it could cause self-reporting bias. Fourth, there are possibly unconsidered/unmeasured confounding factors. Many factors which can impact on mental health during or after COVID-19 have been presented, but not all factors can be comprehensively considered in the analytic model of this study. Fifth, the number of respondents excluded from the analysis due to inappropriate answer was relatively high. It may be possible that this procedure exclude participants with certain response tendencies. Sixth, although K6 has been shown the relationship with clinical outcome and diagnosis, further study which utilize other clinical assessment may need to be conducted in the future. Seventh, the specific age of having adversity is not clear in this study, although the timing may be important in some ACEs. Future research is needed to consider such detailed information and to examine precise mechanism of the associations of ACEs on health.

Research, policy, and practical implications

Prospective longitudinal study with information about expanded ACEs and clinical diagnosis of mental health disease may be beneficial to suggest the exact impact of ACEs on mental health. Specifically, it is essential to further investigate modifiable childhood factors within the home and school environments to develop effective prevention measures for ACEs through public health policies.

Data availability

The data used in this study are not available in a public repository because they contain personally identifiable or potentially sensitive patient information. Based on the regulations for ethical guidelines in Japan, the Research Ethics Committee of the Osaka International Cancer Institute has imposed restrictions on the dissemination of the data collected in this study. All data enquiries should be addressed to the person responsible for data management, Dr. Takahiro Tabuchi, at the following e-mail address: [email protected].

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Acknowledgements

We thank all study respondents and lab members for their sincere support.

This work was funded by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grants [Grant Number 17H03589;19K10671;19K10446;18H03107; 18H03062;20H00040; 21H04856; 21H03203], the JSPS Grant-in-Aid for Young Scientists [Grant Number 19K19439], Research Support Program to Apply the Wisdom of the University to tackle COVID-19 Related Emergency Problems, University of Tsukuba, and a Health Labour Sciences Research Grant [Grant Number 19FA1005;19FG2001;22FA2001; 22FA1010].

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Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan

Natsu Sasaki & Daisuke Nishi

Department of Public Health, Kitasato University School of Medicine, Sagamihara, Japan

Kazuhiro Watanabe

Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

Yoshiaki Kanamori

Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan

Takahiro Tabuchi

The Tokyo Foundation for Policy Research, Tokyo, Japan

Department of Public Health, Tokyo Medical and Dental University, Tokyo, Japan

Takeo Fujiwara

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Author D.N. was in charge of this study, supervising the process, and providing his expert opinion on the subject. Authors N.S., T.T., and D.N. organized the study design. The questionnaire was created through discussions with collaborators outside of this work. N.S. analyzed the data. N.S. wrote the first draft of the manuscript, and T.T., T.F., Y.K., and K.W. revised the manuscript critically. K.W. and Y.K. supported the data analysis. All authors approved the final version of the manuscript. The sponsors played no role in the design of the study; in collecting the data or managing the study; in data analysis; in the interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

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Correspondence to Daisuke Nishi .

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Sasaki, N., Watanabe, K., Kanamori, Y. et al. Effects of expanded adverse childhood experiences including school bullying, childhood poverty, and natural disasters on mental health in adulthood. Sci Rep 14 , 12015 (2024). https://doi.org/10.1038/s41598-024-62634-7

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DOI : https://doi.org/10.1038/s41598-024-62634-7

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Access to Education, Health Services, Economic Opportunities Key to Improving Welfare of Indigenous Peoples in the Philippines

More data, speedier processing of legal land rights needed to benefit vulnerable populations.

Manila, May 27, 2024 – Increasing Indigenous Peoples’ access to water and sanitation, education, health services, and economic opportunities, while still preserving their cultural identities, could significantly improve their living standards, a World Bank report released today says.

More data and speedier processing of legal land titles would further benefit Indigenous Peoples, who share collective ancestral ties to the lands and natural resources where they live, or from which they have been displaced, the report , No Story, No Data: Indigenous Peoples in the Philippines , says.

Approximately 9.4 million people identified as indigenous live in the Philippines, about 8.7% of the population, according to census data, and many live in geographically disadvantaged areas. Enhancing the development of these regions through improved connectivity and other interventions can accelerate poverty reduction within these communities. In addition, more ethnicity-disaggregated data to clearly identify Indigenous Peoples and other ethnic minorities could improve poverty reduction strategies and the targeting of social programs, the report says.

"Understanding the interplay of ethnicity, gender, and geography is crucial to comprehending the challenges faced by Indigenous Peoples, which are closely linked to the conditions within their geographic locations," said World Bank Country Director for Brunei, Malaysia, the Philippines, and Thailand Ndiamé Diop . "It is apparent that Indigenous Peoples are at a disadvantage in several critical aspects of well-being, including education, labor, access to productive opportunities, and gender equality, compared to non-Indigenous Peoples."

The Indigenous Peoples Survey conducted in 2023 reveals that approximately 59% of Indigenous Peoples perceive themselves as “poor,” compared to 52% of people who do not identify as indigenous. Almost half of them think that education, health, access to clean water, and social assistance are the most pressing concerns that the government needs to address to improve their welfare.

Approximately 51% of Indigenous Peoples consider themselves "food poor," higher than the 45% reported by non-Indigenous Peoples. Both groups experience hunger, with around 37% of Indigenous Peoples and 36% of non-Indigenous Peoples reporting instances of hunger in the past three months.

Compared to non-Indigenous populations, Indigenous Peoples also lag in educational metrics: smaller percentages advance beyond primary school, complete high school, or attain post-secondary education. Those with only primary education often find employment in agriculture or self-employment.

Despite these challenges, almost 90% of Indigenous Peoples said they are proud of their identity, and more than 70% have a strong sense of belonging to the country.

Continuing to strengthen and protect the legal recognition of the rights of Indigenous Peoples to their ancestral domains is a further avenue for improving their welfare.

"For Indigenous Peoples, land is a fundamental aspect of their identity, culture, and subsistence. Protecting Indigenous Peoples’ land rights is therefore a crucial step in addressing poverty and conflict in the country," said World Bank Senior Social Development Specialist Carlos Perez-Brito .

While Certificates of Ancestral Domain Titles – formal recognition of the rights of Indigenous Peoples to their ancestral domains – have been approved for approximately 20.5% of the country’s total land area, processing has been slow. Overlapping and conflicting land management mandates and scarce resources have held the process back.

Data gaps also pose obstacles to understanding the complexity and diversity of Indigenous Peoples populations in the Philippines. The report recommends establishing standardized guidelines for Indigenous Peoples data collection, incorporating Indigenous Peoples indicators in national surveys, and including ethnicity variables in government statistics, among other actions.

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Everything You Should Know About Poverty in the Philippines

The Extent of Poverty in the Philippines

Poverty in the Philippines declined to 22.4% in 2023 , down 1.3% from the same period in 2021. However, despite this decrease, the current state of poverty and inequality is startling. The poverty incidence was 22.4% in the first semester of 2023, affecting approximately 25.24 million Filipinos. The poverty incidence refers to the proportion of Filipinos whose per capita income is insufficient to meet their basic needs. On average, a family of five needs at least PhP 13,797 monthly to cover their basic needs, according to the Philippine News Agency. Additionally, the subsistence incidence or the proportion of Filipinos whose income is insufficient to buy basic food needs stood at 8.7%, meaning approximately 9.79 million Filipinos are unable to fulfil basic food needs.

These statistics demonstrate the extent of poverty in the Philippines and provoke the question of why the Philippines continues to struggle from poverty despite its growing economy. The Philippines struggles with a huge disparity in wealth equality. According to the World Bank, the Philippines holds one of the highest Gini Coefficients in the East Asian and Pacific region, sitting at 40.7% as of 2021 . This means that, despite economic improvements, those most susceptible to poverty may not see the benefits of economic growth.

The Affected Population

Poverty affects the unemployed and underemployed and those who lack education most in the Philippines as they are unable to find opportunities or jobs which pay a sufficient wage. Environmental instability is also an issue, in regions most vulnerable to natural disasters schools have to shut down, disrupting education. In April 2024, hundreds of schools in the Philippines had to close due to extreme heat, an issue which annually rising global temperatures will exacerbate.

The World Bank estimates that 60% of the land in the Philippines is vulnerable to multiple natural hazards. This causes severe damage to homes and transport infrastructure, interrupting business and education and costing billions to repair. This has been an issue in Mindanao recently, where flooding caused more than 411,000 people to flee .

The State of the Economy

Despite the pessimism surrounding poverty in the Philippines, there is reason for optimism . The Philippine economy grew by 5.5% in 2023, making it one of the best-performing economies in Asia, according to the Philippine News Agency, but high inflation has offset the benefits of income growth on poverty reduction. To overcome inflation, growth must remain consistently high. Currently, economic growth for 2024-2025 could be at an average of 5.8% if growth in the domestic market is achieved. The World Bank expects this domestic market to grow due to the thriving tourism sector and the information technology-business process outsourcing industry. This indicates a bright future for the Philippine economy. For the poorest Filipinos to benefit from the projected growth in 2024, income gains from economic growth must be guided towards reducing inequality.

Positive Progress in Poverty Alleviation

The reduced poverty rate from 2021 to 2023 is a move in the right direction. The government achieved this through initiatives such as the fuel subsidy and the one-time rice allowance, according to the Philippine News Agency. However, greater income equality must still be strived for if President Marcos wants to reach his goal of a single-digit poverty rate by 2028 . The Philippine Development Plan of 2023-2028 is one initiative which can help achieve this goal. This plan aims to bring economic and social transformation by reinvigorating job creation and accelerating poverty reduction. It aims to be the mechanism of implementation of the Sustainable Development Goals (SDGs) and includes programmes to improve education and to upskill the workforce. If The Philippines achieves this plan, it can make further poverty reductions by addressing the key areas where inequality thrives.

To relieve the problem of environmental instability, the government is building new infrastructure under The Metro Manila Flood Management Project . This benefits the Metropolitan Manila area but fails to help other areas susceptible to flooding. This only furthers the issue of inequality, benefiting the city of Manila instead of reaching more deprived areas. More deprived areas struggle to recover from natural hazards, weakening their ability to become more prosperous and resistant to annually occurring hazards. Last year, Bulacan was placed under a state of calamity due to the damage that typhoons and subsequent flooding caused .

Looking Ahead

Despite projected economic growth and current initiatives being in place to address poverty, there remains a significant proportion of Filipinos who are vulnerable to poverty. While there is room for improvement, the country has great potential to reduce poverty further. The progress made in 2023 and the current economic growth projections are a testament to this. The persistence of inequality requires greater attention from the government in addressing areas of education and environmental relief. Initiatives to help those most vulnerable to poverty must be used to ensure more people can benefit from the coming economic growth. In this way, the Philippines can continue to progress in reducing poverty.

– Lauren Alkhalil

Lauren is based in London, UK and focuses on Good News and Technology for The Borgen Project

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