Nadine Burke Harris, MD, MPH, sees a young patient. Photo courtesy of the Center for Youth Wellness.

About a year ago, Nadine Burke Harris, MD, MPH, published her first book, The Deepest Well: Healing the Long-Term Effects of Childhood Adversity. The book chronicles her journey from San Francisco pediatrician to pioneer in the field of research on adverse childhood experiences (ACEs). On February 11, Burke Harris will take another momentous step on her career journey: She will be sworn in as California’s first-ever surgeon general.

Governor Gavin Newsom announced the appointment of Burke Harris on Martin Luther King, Jr. Day, describing her as a “pediatrician, entrepreneur, and nonprofit CEO” who has “dedicated her professional career to understanding the link between adverse childhood experiences and toxic stress in children, and the effect both have on future health outcomes.” As surgeon general, Burke Harris will “urge policymakers at every level of government and leaders across the state to consider the social determinants of health, especially for children.”

On the campaign trail, Newsom spoke often about the need to invest in early childhood education and health care, and he has worked quickly to propose early childhood investments in his initial acts as governor. During his inauguration speech he said, “California is our home. In our home, every child should be loved, fed, and safe. … We will support parents so they can give their kids the love and care they need, especially in those critical early years when so much development occurs.”

The Heart of the Issue

Burke Harris’ research has centered on the impact of trauma on children in early childhood. In 2008, she was working at the Bayview Child Health Center, treating children and adolescents who were growing up in one of San Francisco’s poorest neighborhoods. As she recounted a few years later to Paul Tough in The New Yorker, the clinic was making significant headway on health issues like asthma that are common among children in low-income households. Despite that, “I felt like we weren’t actually addressing the roots of the disparity,” she told Tough.

Then a colleague gave her a journal article about an ACE study conducted by Kaiser Permanente San Diego. The study of more than 17,000 Kaiser HMO members found that the higher an individual’s ACE score, the worse his or her health. There was a stunning range of negative health outcomes for which this correlation was found ­— likelihood of having an alcohol use disorder, of injecting drugs, of having diabetes, heart disease, or cancer ­— just to name a few. Lead author Vincent J. Felitti, MD, summarized, “The ACE study reveals a powerful relation between our emotional experiences as children and our adult emotional health, physical health, and major causes of mortality in the United States.”

The study was a revelation to Burke Harris and changed her approach to treating young patients in her clinic. In an interview with the Center for Youth Wellness, which she founded in 2013, she said, “When I first started my research into toxic stress, I had no idea that childhood adversity could change the way our DNA was read and transcribed. I never learned about that in medical school.” But she went on to pave the way for important local and national efforts to combat childhood trauma, leading the Bay Area Research Consortium on Toxic Stress and Health and serving as a member of the American Academy of Pediatrics’ National Advisory Board for Screening, among other appointments.

“We couldn’t be more proud of Nadine’s appointment as Surgeon General of California,” said Mary Pang, board chair of Center for Youth Wellness. “Nadine now takes the power of her voice and vision to Sacramento, working alongside policymakers to effect change and creating a healthier California for all of us.”

How California Is Caring for Those with Trauma

There is already some work underway at the state level to address childhood trauma. Former governor Jerry Brown signed two childhood trauma bills into law in late 2017. According to an ACEs Connection blog post, AB 340 “creates a statewide advisory body to review current screening protocols and make recommendations about how to improve trauma screening for children” in the Medi-Cal program. AB 1340 “requires the Medical Board of California to consider including in its continuing education requirements a course in integrating mental and physical health care in primary care settings, especially as it pertains to early identification of mental health issues and exposure to trauma in children and young adults and their appropriate care and treatment.”

Additionally, Medi-Cal has taken steps in recent years to focus on ACEs and trauma-informed care. For example, Medi-Cal’s Whole Person Care pilot program (PDF) in 26 counties coordinates health, behavioral health, and social services to improve vulnerable people’s health outcomes (CHCF is supporting the pilots’ Learning Collaborative). Some Whole Person Care pilots, including one in Marin County, use a trauma-informed approach to understand and address individuals’ complex needs.

Sandra R. Hernández, MD, president and CEO of the California Health Care Foundation, spoke at the Center for Youth Wellness’ 2018 ACEs Conference about the importance of health coverage for providing people who have experienced trauma with appropriate care. She praised Governor Newsom’s appointment of Burke Harris, saying, “Dr. Burke Harris is recognized nationally as a pioneer and advocate for understanding childhood trauma and building a foundation for lifelong health. I can’t imagine a better person for this role.”

Which issue do you think Dr. Burke Harris should tackle first as California surgeon general? Tweet at me with #EssentialCoverage or email me.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

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