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For years, research has shown that children who experience trauma such as abuse, neglect, and parental divorce, or who have an incarcerated parent are at higher risk for poor health outcomes, even into adulthood.

The more trauma a child experiences, called “Adverse Childhood Experiences” (ACEs), the worse their health. Kids with four or more ACEs before age 18 are twice as likely to develop heart disease or cancer. ACEs can also harm brain development and hormonal systems and immune systems, according to a landmark study from the mid-1990s by the Centers for Disease Control and health care giant Kaiser Permanente. The study showed that among 17,421 adults surveyed, 67% reported experiencing at least one ACE during childhood, while 12.6% had at least four ACEs. 

“Our response must go beyond the exam rooms”

Dr. Nadine Burke Harris, who recently wrote about the topic after seeing the impacts firsthand for years at her pediatric practice in San Francisco’s underserved Bayview-Hunters Point neighborhood, spoke at ����ֱ�� Nov. 6 about her book “The Deepest Well.”   

Burke Harris, now California’s Surgeon General, discussed with students and faculty her professional journey and urged them to join the fight against ACEs by raising public awareness through social media and writing and posting articles. Underserved communities, she said, are disproportionately affected by ACEs. She cited statistics indicating that 27.6% of families living in poverty are twice as likely to be struck by at least one ACE than families whose annual household income is at least $50,000.

“Put your voices out there,” said Burke Harris. “Our response must go beyond the exam rooms. As health care professionals, we are leaders in our communities and people will believe us. If you’re a leader in your child’s PTA, speak up and speak out. There isn’t anyone who has sat next to me on a plane who hasn’t learned about ACEs.”

ACEs are social determinants of health

Ché Abram, associate director of diversity in the Office of Diversity and Inclusion, called Burke Harris’ book a timely choice for SMU’s Community Reads project, a university-wide reading initiative that highlights the social determinants of health.

“Dr. Burke Harris is a role model who can guide students into becoming agents of change,” Abram said.

Burke Harris acknowledged that during the decade she has learned about and tried to bring attention to ACEs and their consequences, she has often felt she was hitting brick walls. Once, she met with a group of hospital CEOs who ended their discussion by asking her what she intended to do about this public health problem. 

Landmark initiative could lead to treatment

But help appears to be on the way.

Beginning in January, adults and children throughout California who are using Medi-Cal will undergo screening for ACEs, Burke Harris said. The state has budgeted $40.8 million to reimburse primary care providers for the screenings and another $50 million to train them in how to do it.

Burke Harris and her staff plan a statewide learning initiative so that health care professionals throughout the state can share best practices on how to treat ACEs in order to reduce their effect. For instance, healthy nutrition, regular physical exercise, ample sleep, frequent hugging of children, and nurturing relationships between primary caregivers and children have been shown to mitigate the potential harm of ACEs, she said.

“ACEs are not a destination,” she said. “With intervention, we can make a significant difference.”