California’s new surgeon general made Sacramento the first stop on her statewide listening tour, and after Tuesday’s event, Dr. Nadine Burke Harris told The Bee that capital residents are powerfully grappling with the long-term impact childhood trauma has on their families and neighborhoods.
Burke Harris said many of the 100 Sacramento-area residents she met with asked her to find ways to bring training, resources and support to families, educators, nonprofits and other community-based organizations, so they can better deal with the toxic stress that affects physical and neuro-development starting in childhood.
To study the impact of traumatic childhood events, the U.S. Centers for Disease Control and Prevention and Kaiser Permanente asked 17,000 people, from 1995 to 97, to share their childhood experiences and their current behavioral and physical health status. They found there are about 10 different categories of adverse experiences that can lead to long-term dysfunction. Burke Harris said they include physical, emotional and sexual abuse; physical and emotional neglect; or growing up in a household where parents were mentally ill, substance-dependent, incarcerated; or living in a family where there was parental separation, divorce or domestic violence.
Many people – as many as two-thirds of adults in the study – will go through at least one of those experiences, Burke Harris said, but one in eight will have had to find ways to cope with four or more. That coping process, she said, may lead children to develop an overactive stress response, triggering hormones and physical reactions that shouldn’t commonly have residence in the body.
When people consider the impact of this kind of toxic stress, Burke Harris said, they typically talk about the behavioral and mental health impact, and they don’t commonly or intuitively think to look at the physical impact of it. In addition to mental and behavioral health, things like heart disease, chronic lung disease, cancer, stroke and diabetes all may have roots in a child’s attempt to overcome numerous adversities.
Look, for example, at the incidence of asthma among children who have four or more adverse childhood experiences. They are twice as likely to develop the chronic lung condition as children who experience no adverse reactions, Burke Harris said.
What can be done?
This is why physicians and the health care community at large are talking about addressing social determinants of health, Burke Harris said. When people talk about things like access to safe and affordable housing, she said, that is germane to the conversation about reducing toxic stress for California’s children because it shapes whether a child will grow up in a stable, secure environment.
Burke Harris said she’s concerned, though, because she can tell from Tuesday’s session and other interactions with state residents that people feel overwhelmed when it comes to making a dent in solving this problem. Everyone doesn’t have to solve everything, she said. Rather, they can work on their part of it.
“It’s critically important that the state of California is taking this on as a public health issue,” Burke Harris said, “and when we each are leaning in and taking on this issue in our own sector, then everyone doesn’t have to do everything. ... It’s going to feel overwhelming if everyone feels as thought they have to invent a separate wheel, and this is what I heard today, rather than having all of us be part of a system that is working in coordination.”
This is also a two-generation challenge, Burke Harris said.
“Adverse childhood experiences reliably and consistently are handed down from one generation to the next,” she said, “so in order for us to interrupt this inter-generational transmission of childhood adversity, we have to address caregivers’ history of adverse childhood experiences.”
This means caregivers must have access to mental health services or lessons in how to ensure healthy relationships for themselves, along with services shown to help improve health outcomes in their kids, Burke Harris said.
Improving the well-being of children can take a number of different interventions, Burke Harris said:
It could be meditation or, in the case of the child with asthma, medication.
Nutrition and therapy have to be available.
And kids will benefit from expanding exercise programs and safe, open green spaces. This year, local agencies can apply for $255 million in state funds to create new parks and introduce new recreation opportunities specifically in California’s low-income communities. California State Parks is taking applications through Aug. 1.
“We’re seeing research that’s coming back now that’s telling us that safe, open green spaces, especially paired with exercise, can not only improve health but it can improve mental health as well,” Burke Harris said
Burke Harris also hopes to see primary-care clinician screening for adverse childhood experiences, both in children and in adults all around California, one day, and she hopes legislators will approve the governor’s proposed funding for screenings for adverse childhood experiences among Medi-Cal beneficiaries. State regulators developed protocols for those screenings as part of Assembly Bill 340, so families can get early access to a network of services that can help them overcome toxic stress.
Burke Harris, California’s first-ever surgeon general, has had years of experience in treating children suffering with toxic stress at the Center for Youth Wellness that she founded in San Francisco in 2007, and she’s written a book on the topic, “The Deepest Well: Healing the Long-Term Effects of Childhood Adversity.”