Dr. Nadine Burke Harris is California’s first surgeon general. She was appointed to the newly minted position by Gov. Gavin Newsom last month to address health equity across the state.
Dr. Burke Harris’ appointment made history, as California is just the fifth state to create a surgeon general’s office, after Pennsylvania, Michigan, Florida and Arkansas.
Much of Dr. Burke Harris’ work before her appointment has been focused on the ways that childhood trauma affects a person’s health throughout their lifetime, which she has called "single greatest unaddressed public health threat facing our nation today.” She delivered a TED talk in September 2014 about this, which has been viewed more than 4.9 million times.
She actually met Newsom during his time as mayor of San Francisco while she was working in Bayview-Hunters Point, a medically underserved neighborhood of the city. She was appointed as surgeon general after emailing Newsom during his campaign asking him to pay attention to the issue of childhood trauma if elected.
She says that she hopes to release a surgeon general’s report on adverse childhood experiences and toxic stress in the state of California in the next year and a half.
Dr. Burke Harris joined Insight Tuesday to talk about her newly created office and her plans to address healthcare issues in underserved communities across California. Here are some of the highlights.
On Gov. Newsom’s expectations for her new role
When we had our conversation, the governor was really focused on a couple of things. Number one, addressing the unacceptable level of health disparities across our state. And the governor was also really supportive of deepening and expanding the work around childhood trauma, early childhood health and also these issues of how we address the ways that early adversity manifests in affecting health throughout the life course. It was a super fun conversation. It was really about you know what can we do in the state of California to help make our residents healthier.
On what Kaiser Permanente and the CDC’s pioneering 1998 study of childhood trauma found
What they found were two things that were really striking. One was that adverse childhood experiences were incredibly common. Two-thirds of individuals in this study had experienced at least one adverse childhood experience, or ACE, and one in eight folks had experienced four or more. And keep in mind this wasn't the inner city. This wasn't a low income population. This was Kaiser San Diego. 70% Caucasian, 70% college educated. It really recognized that this was much more common than many people previously anticipated or believed.
The other piece was that that the higher the number of ACEs, the greater the risk for not just the things that you would expect, like mental health issues like depression and also behavioral issues like substance dependence and other issues like that, but dramatically increased risk for heart disease, stroke, cancer, chronic lung disease, liver disease, even Alzheimer's.
On moving beyond her medical training to study childhood trauma
When I trained, we didn't learn anything about the adverse childhood experiences study or about the biological mechanisms of toxic stress. And so if a teacher was referring a child for ADHD or we were seeing a child who was having severe asthma or something else, I was taught to prescribe that inhaler medication or to prescribe the ADHD medication or perhaps refer them to a mental health provider if it seemed like it was necessary. And I never learned in my training, if I actually want to improve the health of my patients, I have to address the underlying problem, the root cause, which is the exposure to adversity. And so that is really what I've spent the last decade of my professional career is not only developing clinical protocols and advancing the science and doing the research but also raising awareness.
On how toxic stress affects Californians
It's big. When we think about the fact that two-thirds of our population, so here in California 61.7% of Californians have experienced at least one adverse childhood experience. And 16.7% of Californians have experienced four or more adverse childhood experiences and that 16.7% of Californians are at more than double the risk for heart disease. More than two and a half times the risk for stroke, triple the risk for chronic lung disease. We now understand that early adversity is a root cause of our some of our biggest chronic disease issues and our biggest drivers of healthcare costs.
And not just health care costs. When you look at the the proportion of for example the kids in special ed who have experienced adverse childhood experiences or individuals in our justice system or individuals who are experiencing mental health and substance dependence issue. For someone with four or more adverse childhood experiences, they're 10 times as likely to be an I.V. drug user as someone with zero adverse childhood experiences. The ramifications are everywhere in our society. And we have this incredible opportunity now that we understand the drivers and the science behind it, to raise awareness, do early detection and early intervention and we can change those outcomes.
On her priorities as surgeon general
As a surgeon general, I feel like a big part of my job is not just to remind folks of the things that we know that they'd need to do to stay healthy, but also to help folks understand what is the public health crisis that they didn't know existed.
I'm very much focused on tackling a couple of issues. I don't have any intention to boil the ocean but I'm really going to be focused on child health and well-being, particularly focus on adverse childhood experiences, developmental screening and a lot of the early foundations for health. Also, the science of toxic stress. You heard me say that we see double the risk for heart disease, two and a half times the risk for stroke. But the science behind that, understanding how any physician or clinician in California should perhaps be treating their patients differently if they have an ACE score of eight versus if they have an ACE score of zero. That science has a tremendous way to go and that's not just a child health issue. Most of the manifestations that we see in terms of chronic disease really show up in adulthood. My other really key focus is going to be on health equity. We are the fifth largest economy in the world and yet we still have unacceptable levels of inequities in health outcomes when we look at for example maternal mortality. We see that African American mothers are dying at a rate that is greater than four times that of Caucasian mothers in the state of California today. That's unacceptable. So really pushing on these issues of child well-being, toxic stress and health inequities are really the areas that it will be my focus.
This interview has been edited for brevity and clarity. Click the “play” button to listen to the entire interview.