Dr. Nadine Burke Harris has been on a mission to raise awareness about the impact toxic stress and trauma can have on children. About seven years ago, the UC Davis School of Medicine-trained pediatrician founded the Center for Youth Wellness, which advocates for screening and early intervention to head off adverse childhood experiences. She now has a much bigger megaphone, having been named California’s first surgeon general last month. Harris, the author of The Deepest Well: Healing the Long-term Effects of Childhood Adversity, spoke with Modern Healthcare population health reporter Steven Ross Johnson about her new role as the state’s top health advocate and how she hopes to use her platform to make California a model for addressing adverse childhood experiences and their health impact. The following is an edited transcript.
MH: What do you see as the primary duties of the surgeon general since you are the first one ever in California?
Harris: I get to shape the role a little bit, but the role is really to be a medical adviser to the government and administration, a health strategist and also a public health advocate and I’m looking forward to doing all of those things.
MH: How do you see your role fitting in with the state’s current public health infrastructure?
Harris: I’ll be working in partnership with the secretary of Health and Human Services and other leaders within the state’s public health infrastructure. I have to say, that’s actually one of the things I’m most looking forward to—working with really smart, amazing colleagues in an administration where the governor and the administration are very focused on prevention and helping every child have a healthy start.
MH: Do you see yourself as the state’s head advocate for prevention and wellness and for addressing social determinants of the health?
Harris: That’s the job. I think that the job of the surgeon general is really to be the leading spokesperson for health and particularly, for this administration, one of the reasons the governor selected me was really because of the focus on social determinants and a healthy start for every child and really looking at some of the root causes of health inequities in our state. I really see myself leading on those issues.
MH: Is the creation of this office related to the recent shift in focus within the healthcare industry toward trying to address social determinants and promoting prevention and wellness?
Harris: Absolutely. More and more, both the medical and scientific communities, as well as the public at large, are looking to promote the advancing science of what we understand about some of the root causes and the social determinants of the health threat that we are seeing.
I really see the creation of this role—particularly when Gov. Gavin Newsom announced its creation on day one after he was sworn in—specifically to talk about addressing health inequities and addressing adverse childhood experiences as part of the focus of the administration. We are seeing the result of greater and greater recognition of this as a core issue, as a root-cause issue, and making investments and trying to move forward with solutions.
MH: In your book, you talk in great detail about how you took into consideration the role that adverse childhood experiences played among patients you saw within your pediatric practice. What were some of the biggest lessons you learned from that?
Harris: No. 1, it’s really about how we incorporate the science of adverse childhood experiences and toxic stress into advancing practice. My own experience was that early detection and early intervention help improve outcomes. As we move toward broader adoption of screening across the state, many clinicians ask, “How will that be received? How will my patient experience it? Will they be comfortable with a screening?”
In my experience, both as a pediatrician and also in the role of leading the national practice community for ACE screening, it has been so welcomed by my patients. When I hear feedback from clinicians all around the country, there hasn’t been a single clinician who said, “Oh, no, I tried screenings, but I’m going to go back.”
Certainly there are places where there are challenges and difficulties, but widely what we see is that clinicians report, “Wow, this has improved the quality of the care that I am providing. It has improved the efficiency and effectiveness of the care that we are providing.” The clinicians I talk to, all of them say, “We will never go back to not screening.” That’s been a big piece.
MH: Are there approaches toward trying to address those issues within adults who have had those kinds of experiences?
Harris: Absolutely. This is one of the things I talk about in my book based on a lot of the research around how the consequences of childhood adversity affect physiology throughout a lifetime. A lot of this research has been done in adults, so what we see, for example, are studies looking at the impact of mindfulness or meditation in reducing inflammation and improving cardiovascular performance. In addition, when we look at the effects of regular exercise and enhancing your plasticity and reducing stress hormones, again, most of those studies have been done in the adult population.
As a result, what we see is that the same things that work with kids—sleep, exercise, nutrition, mindfulness, mental health and healthy relationships—those tools are the same tools that we can be using in the adult population. But the critical key is recognizing what the issue is in the first place.
They say that a proper diagnosis is half the cure, right? It’s helping folks understand that because of what happened to them in their childhood, their stress response may be a bit overactive. The tools they can use, including the ones I just mentioned, are targeted at reducing stress hormones, reducing inflammation, enhancing your plasticity and directly countering the biological effect of the toxic stress response.
