Blog Post
California’s first-ever Surgeon General, Dr. Nadine Burke Harris, spoke to the alumni of the California Health Care Foundation’s (CHCF) Health Care Leadership program.

How Adverse Childhood Experiences Shape Health Care: In Conversation with Dr. Nadine Burke Harris

October 23, 2020

By Sunita Mutha, MD, FACP

On September 24, the state of California’s first-ever Surgeon General, Dr. Nadine Burke Harris, spoke to the alumni of the California Health Care Foundation’s (CHCF) Health Care Leadership program about her frontline experience with trauma-informed care, including her focus on Adverse Childhood Experiences (ACEs). A highlight of the alumni meeting, Dr. Burke Harris’s keynote touched on central themes, including racism, health equity, and the critical need for leadership to achieve structural change uncovered by the COVID-19 pandemic.

Dr. Burke Harris opened by sharing what she described as a transformative moment following a discussion with several hospital CEOs to integrate ACEs screening into health care settings. On her way to the elevator, she was approached by a woman who had been serving coffee at the meeting. The woman shared that she’d listened to the conversation and suspected that she herself scored 10 out of 10 on the ACEs questionnaire. In candidly reflecting to Dr. Burke Harris that overhearing the conversation helped put her own struggles into context, she then noted, “I just want to tell you to keep doing what you’re doing.” This encouragement became the starting point for Dr. Burke Harris’s own leadership journey in overseeing a statewide focus on addressing ACEs through screening and integrating multidisciplinary approaches to support patients with ACEs. This story underscores the role of leadership as a driving force for changing systems, eliminating structural barriers, and ensuring progress toward better and more equitable health care.

Dr. Burke Harris also reflected on having been raised to view the world through a scientific lens and to understand the molecular mechanisms behind how things work. She applies this perspective to understanding how repeated exposures to adversity activate the body’s stress response and how chronic stress impacts our physiology, including brain structure and function as well as hormones, the immune system, and our DNA. In making the connection early on in her career that addressing ACEs require a public health approach, she wove together a picture of the need for cross-sector interventions to ensure that a wide range of professions — including educators, police, and health care workers — are trained in how to approach children impacted by ACEs and how this necessitates a different, multi-pronged response. 

“One of the things I find fascinating, often when we talk about ACEs, people think, ’How do we bring this compassionate care to how we do things?’” - Dr. Burke Harris

She offered examples of the ways in which health professionals can uniquely use their knowledge, privilege, and platforms to advocate for and drive change. Specifically, in response to a question about how public health leaders can help address systemic discrimination which has a “through line in contributing to ACEs,” she offered the following guidance:

  • Keep insisting on having this conversation and insisting on concrete changes.
  • Addressing racism as a public health threat must be front and center until we are able to change the outcomes.
  • Understand the mechanisms that contribute to systemic discrimination and identify how to counteract those negative elements.

Healthforce Center's program alumni are active partners in addressing ACEs and toxic stress in California, including leading health systems to screen, implementing trainings, and shaping policy that allows for sustainable ways to identify and direct resources. Throughout her talk, I was reminded of the African proverb: "If you want to go fast, go alone. If you want to go far, go together."

As an organization, Healthforce Center is committed to creating the health leaders of the future who are deeply invested in increasing communities’ access to better and more equitable care. Like Dr. Burke Harris, we turn to science and evidence to create effective trainings and to sustain networks that transform leaders’ capacity, skills, and ability to advocate for change.

 Watch the recording of Dr. Nadine Burke Harris speaking to CHCF Alumni leaders here.


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