August 14, 2025 • 30 mins
Live from PCA America’s 2025 National Conference in Portland, award-winning physician, researcher, and former California Surgeon General Dr. Nadine Burke Harris shares why prevention is both deeply personal and profoundly professional. Reflecting on her own healing journey, she reveals how the science of Adverse Childhood Experiences (ACEs) has not only shaped her groundbreaking public health leadership but also transformed how she parents and breaks intergenerational cycles of trauma.
Dr. Burke Harris tackles outdated narratives that keep systems from acting, calls out the dangers of letting fear override vision, and explains why every sector—from healthcare to business to education—has a stake in prevention.
“Our source of pain is also the source of our superpowers. When we come together strategically, play our part, and stay organized, we can make transformative change.” – Dr. Nadine Burke Harris
This episode is both an inspiring call to action and a practical roadmap: prioritize self-care, replace fear with courage, and harness our collective power to build a future where every child can thrive.
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UNKNOWN (00:01):
you
SPEAKER_03 (00:10):
This is The Shift, Voices of Prevention, a podcast
from Prevent Child AbuseAmerica, where we explore bold
ideas, cultural change, and whatit truly means to support
children and families.
Join us to change the narrativeone conversation at a time.
SPEAKER_02 (00:25):
Hello, and welcome to The Shift, Voices of
Prevention, recording live fromPCA America's 2025 National
Conference in Portland, Oregon.
I'm Luke Waldo.
And I'm Nathan Fink.
Today, our final day of the 2025PCA America Conference, we're
We're absolutely thrilled to bejoined by Dr.
Nadine Burke Harris, anaward-winning physician,
researcher, and formerCalifornia Surgeon General who
(00:48):
has transformed ourunderstanding of the effects of
adverse childhood experiencesand toxic stress on long-term
health.
She pioneered efforts to treattoxic stress and has been a
leader in promotingtrauma-informed health policies.
Dr.
Burke Harris's TED Talk, HowChildhood Trauma Affects Health
Across a Lifetime, has beenviewed more than 12 million
times.
Her book, The Deepest Well,Healing the Long-Term Effects of
(01:10):
Childhood Adversity, was calledIndispensable by the New York
Times.
Dr.
Harris, welcome and thank youfor joining the show.
SPEAKER_03 (01:17):
Thank you so
SPEAKER_00 (01:18):
much for having me.
SPEAKER_03 (01:19):
So allow me a hot second to fanboy a little bit
because your work has shown us alot about prevention as more
than just a health strategy.
It's a life course strategy thatcan transform generations.
And I've had the pleasure toread The Deepest Well, then
reread The Deepest Well.
And most recently, I've listenedto it.
But I wanted to thank youbecause that you voiced it was
(01:42):
so powerful to hear youarticulate your journey in your
own words.
So I really appreciated that andyou sharing so much awareness
and challenges and collectiveaction.
This is a layered question thatwonders a bit about you and you,
the professional.
So bear with me.
When you consider your journey,looking back on all that you've
been through, are there anybreakthroughs that rise to the
(02:03):
surface that are more impactfulfor you personally versus
professionally?
SPEAKER_00 (02:10):
Ooh, wow.
That's quite a question.
Really insightful.
So I think...
And I have to say like rightnow, I just have to like come
out and say like coming downfrom the morning plenary, I am
(02:31):
like shaking.
The women who spoke in thesession about lived experience
was so moving to me.
And Just the power of the peoplein the room and the courage and
(02:55):
to feel what happens when peoplereally come together and to feel
the energy and know that we canall go out and make a difference
is really, it's touching meright now.
And I think it really relates toyour question because I didn't
(03:16):
come to this work from apersonal perspective.
I came to this work very muchfrom a professional perspective
as a pediatrician serving avulnerable community.
And I guess I would say theirony is that Maybe it's not
(03:42):
ironic.
I guess there are mental healthprofessionals who would be like,
Nadine, it's kind of how itworks.
But certainly the greatestimpact on me has been personal.
As I was– I spent a lot of timekind of trying to– researching
(04:02):
and trying to track downinterventions for my patients to
try to help them have betteroutcomes.
And the more research I did andthe more experts I worked with,
I was like, oh, snap, I betterapply that to my own life, both
in terms of my own healingjourney, right?
(04:25):
Like, no surprise, probably abig part of the reason why I was
drawn to the ACE science isbecause I've experienced a lot
of ACEs myself.
And although it's hilarious howthat wasn't overt to me, right?
Like it wasn't like, hey, gosh,I've experienced a lot of these.
Let me go and try to find outthe answer.
I think it more came in the waythat probably a lot of the
(04:49):
parents that I've cared forapproach it, which is that
because I've experienced a lotof ACEs, when I see my patients
experiencing it, I'm just like,it's not okay with me to just
leave them there, right?
Like, sure, our system says thatyou don't get services until
(05:10):
you're symptomatic.
That's not okay.
I know you can be asymptomaticand still be struggling and
still be at risk.
And so for me, what's beenreally interesting as I've read
all the research and evidenceabout safe, stable, and
(05:30):
nurturing relationships, right?
I had to let a few ex-boyfriendsgo.
I was like, oh, this situationis actually, you know, actually
harmful to my health, right?
And I think that that led me tomy husband, you know, as I, you
(05:51):
know, I incorporated mindfulnessas part of my own practice.
And then I think one of thebiggest things was in how I
parent.
And how I care for my kids, itwas really important for me to
break the intergenerationalcycle in my household.
Yeah,
SPEAKER_03 (06:11):
I think, you know, in me asking that and kind of
setting it up in that kind ofdynamic or duality is I'm
wrestling with this idea latelyof tipping points, right?
And it feels like, you know, asI'm kind of looking back on, you
know, investigating my journey,there are these internal tipping
points that pivot me towardaction in a way that I can't
(06:33):
explain.
But then there's this tippingpoint towards collective action,
right?
And your journey, I see thatthere is these things that have
happened repeatedly where you'reovercoming challenges, which
makes me want to ask you, has itallowed you to reflect on then
how tipping points go frominternal to external in a way?
SPEAKER_00 (06:58):
You're just slaying me with these deep questions.
I think that you are 100% right.
So one of the things that youlearn when you're a child and
(07:20):
you're exposed to huge amountsof trauma and it persists is is
that if you raise your voice, itdoesn't do anything.
That you can see something thatis overtly wrong that is
happening, and if you speak up,it doesn't make a difference.
(07:46):
And in my adult life, it hasbeen very important for me to
rewrite that narrative, to say,you know what?
If I speak up, it does make adifference.
We can change outcomes forpeople.
And particularly that for thosewho don't have the ability to
(08:12):
speak up, I'm gonna elevatetheir voice.
Their voice does matter.
And I think that doing thatParticularly in a way that is
also bringing so much of myselfto it because I am a super
(08:36):
hardcore science nerd.
And so like, you know, scienceand data is my love language and
being able to represent the mostvulnerable, but not just
represent them.
When I...
like if I'm testifying beforeCongress or if I got to go
before state legislature orwhatever, man, I know every
(08:59):
single, every single data point.
I know my, my odds ratios.
I know my sources.
I know my, like all of thatstuff, because I am speaking for
those who have been over andover again had that experience
that if they speak up, itdoesn't make a difference.
(09:21):
And then that dynamic that youtalked about, it's a
self-fulfilling prophecy.
It's not a self-fulfillingprophecy.
It is something that creates thecircumstance because when people
are told over and over againthat if you speak up, it doesn't
make a difference, they learn tostop speaking up.
But when people have theexperience that when they speak
(09:46):
up, they are heard, their needsare met, then they are
emboldened and encouraged tospeak up.
And that is what creates atipping point.
When people say, oh gosh, sheheard me.
She heard me, they heard me,they elevated my voice, and now
things are different.
(10:06):
And that is what I, I hope thatthe current challenges that
we're in speaking, that we'reexperiencing in the world
doesn't extinguish that frompeople, right?
And as long as I have air in mylungs, I'm going to keep
(10:27):
speaking up on behalf ofvulnerable families and trying
to transform our systems.
SPEAKER_02 (10:33):
So we're going to continue to work from that last
thread.
And I want to revisit the someof what you said in the plenary
speech.
You've certainly changed how weconnect health to early life
experiences.
You've done an incredible andinspiring job of elevating the
ample research that we now havethat demonstrates that, that
(10:56):
proves that connection.
And yet, as you mentioned, withall the public health approaches
and education that you andothers have done, we continue to
see challenges to adoption andimplementation of comprehensive
approaches and solutions, as,again, you stated in your
(11:16):
keynote.
Too many still take an either-orapproach.
It's either primary preventionor it's early detection.
or it's evidence-basedintervention.
So where do you still seeoutdated narratives or these
kind of entrenched mental modelsholding us back from both
preventing adversity andreducing harm if adversity has
(11:40):
already happened?
SPEAKER_00 (11:41):
Ooh.
Do you want me to speaktruthfully?
Please.
All right, I might...
I don't want to get myself intotrouble, but I'm...
but I feel like I do have tospeak quite plainly on this.
Where I see it coming up is inone of the most unlikely places
(12:06):
that you would ever think of,which is that there is a small
contingency within the AmericanAcademy of Pediatrics that is
essentially kind of, I actuallywas on a webinar on Tuesday,
where it was over again and overagain from the American Academy
(12:27):
of Pediatrics, it was repeated,like, we don't know that
screening for ACEs isassociated, isn't associated
with harms, right?
Like, that was one of thetalking points.
Another thing that was mentionedwas, well, if clinicians aren't
trained, that, you know, theycould, again, they could do
harm.
(12:47):
And...
And...
It's really interesting becauseI feel like I experienced some
of that, like, we don't knowthat it doesn't do harm piece
when I was actually in the roleof state surgeon general.
And there was a small publichealth emergency, the COVID-19
pandemic.
(13:08):
And when we were getting readyto launch vaccines, there were a
lot of people that said, well,we don't know it doesn't do
harm.
And they say, OK, well, you'vedone, you know, and they looked
at the research around thesafety and efficacy and they
say, well, but that's only donein a certain number of people.
And but obviously there was, youknow, skepticism there.
And I think that when I hearthat.
(13:37):
I just say I find it reallyconcerning because as I shared
today, like when we actuallylook at the data and in
California, more than 2 millionindividuals have been screened
for ACEs, more than a third ofCalifornia's kids on Medicaid.
What we see is that it'sassociated with increased
(14:01):
referrals to services, increasedactually getting access to
services, improvement in qualityof care, and improvement in
actually in health outcomes whenit's paired with these
evidence-based interventions.
(14:23):
And so for me, when I look atsome of the resistance I think
one of the things that thepanelists, one of the panelists
said today that, again, like,you're getting me so raw because
I'm so floored by everythingthat has been, happened in this
(14:46):
conference today.
But one of the things that apanelist mentioned is that the
opposite of vision is fear,right?
And so I can understand ifthere's fear there, right?
But then I think that there'sthis incredible opportunity for
(15:07):
us to come together, even ifthere is fear and concerns
around solutions, so we don'tlet that fear get in the way of
families getting the access tothe services that they need.
So how might
SPEAKER_02 (15:23):
we
SPEAKER_00 (15:24):
shift
SPEAKER_02 (15:24):
that narrative?
How might we shift towards anarrative of...
say courage, that can thenovercome that fear.
SPEAKER_00 (15:33):
Yeah.
So there are a couple of piecesthat are really important.
Courage is not proceedingforward blindly no matter what.
Right.
And I think I definitely learneda lot about that in in my role
(15:55):
as a state surgeon generalduring the pandemic.
Even, for example, when we were,you know, my office was working
with the CDC and looking at thedata around vaccination, and
even when we were looking atincreased risk of myocarditis in
(16:18):
women with the COVID vaccine,right, and all of these
different things, and reallyevaluating You know, you
remember there was a time whereone of the vaccines, there was a
pause on it.
And so this is where I thinkinfrastructure is really
(16:40):
important.
When we are feeling, let me justsay like a great example is,
when you're a medical traineeand you start your first day of
residency, the first thing theygive you is a code card, right?
What to do if a patient goesinto cardiorespiratory arrest.
(17:01):
And it's like very simple andvery easy to understand and all
that kind of stuff.
And the idea is there is thatwhen something super stressful
is happening, right?
Or when you have this fullactivation, that it's really
helpful.
We do a lot better when we havea framework to fall back on.
And so- The CDC, when they were,you know, approving vaccines and
(17:23):
all this stuff, they actuallyhave a really good framework of
evaluating, you know, risk,doing a risk-benefit analysis,
right?
And so as we move forward withany kind of innovation in our
systems, especially inhealthcare, understanding that
(17:48):
there's a framework for us to beable to incorporate the best
available evidence, toconstantly monitor for adverse
events, which we do, and we'vebeen doing with our ACE
screening as well.
Rand just did an evaluation onthis and was looking at that
data.
And then to proceed forward withthe best available evidence and
(18:14):
at the same time, put into placethe systems and processes and
procedures to be able tomitigate against any potential
harm.
So there's never been ahealthcare intervention that was
associated with no harm ever,okay, right?
And that's not even theanticipation as we roll out a
(18:35):
screening.
The anticipation is that we havesystems to be vigilant, to
understand where are thereunintended consequences, how do
we mitigate against them, sothat the population can get the
benefit, right, while wemitigate the risks?
SPEAKER_03 (18:57):
This is not a question, which is a terrible
thing for an interview, but itkeeps making me think about the
code card, right?
Like the code card is arehearsed story you have told
yourself under certain duress.
SPEAKER_01 (19:13):
Yes.
SPEAKER_03 (19:13):
Right?
Yes.
And so you return to it.
But then as I'm kind ofwrestling with what you're
saying is, In the mental modelsthat we've had or systems that
we had, there are actuallystories that we've, they are
forms of stories that we havebeen telling ourselves
repeatedly, right?
So when we return to those underduress, we return to this
(19:38):
system, this story that has aframe around it that
incorporates those mentalmodels.
And so the code card, is anopportunity to tell ourselves a
new story.
SPEAKER_00 (19:51):
Correct.
And can I just add somethingonto that?
Let me tell you one of thesestories that we've been telling
ourselves.
One of the stories that we'vebeen telling ourselves as a
society is that talking abouttrauma and adversity does harm.
(20:13):
So people...
Trauma can happen.
It can be happening in a family.
It can be happening.
And particularly when it'shappening to a child, our
families, our systems and oursociety, this is like ballooned
out to our entire society.
It said.
(20:33):
Essentially, oh, no, no, no.
It's not the trauma that's theproblem.
It's the fact that you talkedabout it.
Right.
Because if we don't talk aboutit, we can keep we don't have to
do anything different.
Right.
But when you start talking aboutit, it makes everyone
uncomfortable.
Then it starts things get messyand it's your fault for saying
(20:56):
something.
SPEAKER_02 (20:58):
Right?
Yeah.
So at our Institute for Childand Family Wellbeing, when we
started to administer the ACEssurvey, we got a lot of
resistance from thepractitioners as well for
exactly what you've just framedup.
And so we added a finalquestion, which was, did asking
(21:19):
these questions cause youdistress or harm?
And through that study, as youpointed out, we discovered that
the vast majority of the peoplethat received the survey did not
feel that harm had been causedsimply because they were asked
the questions about theirchildhood and the adversity
they'd experienced.
So I think, right, as you pointout, over time, we need to
(21:43):
reframe this narrative as thecode, you know, the code card,
right, that makes it very clearthat there are certain practices
that have become foundational toadvancing better care for our
communities so that those thatare capable of doing so can do
it with much more confidence.
(22:05):
So we're going to shift a bit tothe systemic and kind of
underlying root causes.
The analogy that when I firstfollowed your work that really
struck me was the seeing 100children coming with a similar
GI issue and not going back tothe well that they were all
(22:31):
drinking the same water from,right?
So we often talk about buildingindividual resilience because
America, and we do that throughbuffering, right, as you've
expressed.
But we also know that structuralinequities or, as some may call
it, adverse communityexperiences are often the root
(22:52):
of that adversity.
So how have you confronted thesystemic root causes that
exacerbate ACEs at a practicallevel?
SPEAKER_00 (23:02):
Yeah.
So, the more you just kind ofscrape under the surface and
start to look at how these oddsare set, right?
(23:22):
The more, the easier it is youto recognize the embedding of
some of these structuralinequities in our society?
I mean, I think that one of thethings that's really challenging
(23:44):
is a recognition that thosestructures are not accidental.
They didn't just turn out thatway, right?
And so I don't totally, I don'thave great answers as to how we
(24:13):
transform these structuralinequities other than number
one, to raise our voices, numbertwo, to, you know, science is my
love language, and to be able toshow to the powers that be the
(24:36):
tremendous cost to our societyin ways that might not, folks
might not immediately recognize,right?
but that needs to be paired witha desire for all of our
(24:57):
communities to be doing well andthriving.
SPEAKER_03 (25:02):
As you mentioned, listening to the panel, there's
so many people that have been inthese rooms.
This is the final day of athree-day conference of people
who are now going back at thismoment to their communities to
do the work.
Do you have any advice orguidance for them on taking what
they've heard and continuing ontheir journey themselves?
SPEAKER_00 (25:26):
Yes.
So I have a couple pieces ofadvice.
My number one advice is kind ofhow I concluded my talk, which
is that self-care is notselfish.
right?
That this work is long.
This work is, we're going to bedoing this work longer than any
one of our lifetimes.
(25:47):
And so it is so important forall of us to be well, especially
when we're supporting vulnerablefamilies.
I think that because there's noend to suffering in this world,
it's very easy for us to exhaustourselves.
And It's really important for usto be well in the work.
(26:12):
So that's my number, number,number one bit of advice.
And I take back my previousanswer, and I have an answer.
And I can't believe it.
I'm glad.
I can't believe I didn't saythis.
So let's talk strategy for asecond, because you're exactly
(26:32):
like, especially dealing withstructural inequities and those
kinds of things, right?
One of the things I love aboutusing the ACE data and the ACE
science is that someonedescribed it to me once as like,
it's almost like a RosettaStone.
We can look at the impact ofACEs on educational outcomes,
(26:52):
the impact of ACEs on justiceoutcomes, the impact of ACEs on
health outcomes.
There's all these differentplaces where we have actually
really robust data because ofthe amount of research that has
been done.
And, oh gosh, I love this somuch.
This is the work that we have todo.
We have to individually, right?
(27:15):
Each one of us, there's only somuch that we're gonna be able to
do.
And one of the things I like tosay a lot is that you don't have
to boil the ocean.
You just have to play yourposition.
What I love doing is helpinglots of different sectors
understand why they have a stakein addressing this issue.
(27:41):
And that has been successful inmy work on both sides of the
aisle, in red states, in bluestates.
If you're a healthcare provider,this is why this can happen.
is important for the work thatyou do.
If you are a policymaker, if youare a business leader, and this
(28:05):
is why understanding the impactof AIDS is actually important
for running your business,managing your workforce, all of
this kind of stuff.
And if you're a policymaker,let's say you want to spend less
money on Medicaid.
28.6% of current Medicaidexpenditures are excess
(28:27):
expenditures due to ACES, right?
So when we think about like, ifyour motivation is to reduce
costs, come with me, let's doearly detection, early
intervention, right?
And get better outcomes forfolks, right?
You can actually, we canactually reduce costs
(28:48):
expenditures without having tojust slash the roles and harm
people's health, okay?
That there is another way.
If you're interested ineducation, making sure that our
kids can learn, experiencingfour or more ACEs is associated
with 32 times greater riskLearning and behavior problems
(29:13):
for kids in school, right?
And so having lots of doorswhere folks can enter, but also
getting organized, right?
So this is where I'm in themiddle of writing.
I'm close to the beginning ofwriting my second book now, and
(29:34):
it's called Pain to Power.
And it's like our source of ourpain is also the source of our
superpowers.
The fact that ACEs impact allthese different sectors is huge.
It's a huge toll on our society.
The CDC estimates 14.1 trilliona year.
Right?
But it's also the source of oursuperpower because it means that
(29:57):
everyone's got a stake in this.
So when we come together and wedo it strategically and we're
organized and we each play ourdifferent part, we can make
transformative change.
Seems like a
SPEAKER_02 (30:10):
good place
SPEAKER_03 (30:11):
to
SPEAKER_02 (30:11):
stop.
It seems like the place to stop.
Well, Dr.
Burke Harris, thank you so muchfor sharing your time and your
experience and your expertisewith us today.
And thank you for the many yearsof both curiosity and research
about our experience as humanbeings.
(30:32):
It's certainly made me a betterperson and professional, and it
has made our world and society abetter place to
SPEAKER_03 (30:39):
live.
Thank you.
Thank you.
And you can invite UpstreamSolutions into your feed by
subscribing to The Shift Voicesof Prevention today.
Join us to create an ecosystemwhere children and families live
purposeful and happy lives withhope for the future.
you
SPEAKER_03 (00:10):
This is The Shift, Voices of Prevention, a podcast
from Prevent Child AbuseAmerica, where we explore bold
ideas, cultural change, and whatit truly means to support
children and families.
Join us to change the narrativeone conversation at a time.
SPEAKER_02 (00:25):
Hello, and welcome to The Shift, Voices of
Prevention, recording live fromPCA America's 2025 National
Conference in Portland, Oregon.
I'm Luke Waldo.
And I'm Nathan Fink.
Today, our final day of the 2025PCA America Conference, we're
We're absolutely thrilled to bejoined by Dr.
Nadine Burke Harris, anaward-winning physician,
researcher, and formerCalifornia Surgeon General who
(00:48):
has transformed ourunderstanding of the effects of
adverse childhood experiencesand toxic stress on long-term
health.
She pioneered efforts to treattoxic stress and has been a
leader in promotingtrauma-informed health policies.
Dr.
Burke Harris's TED Talk, HowChildhood Trauma Affects Health
Across a Lifetime, has beenviewed more than 12 million
times.
Her book, The Deepest Well,Healing the Long-Term Effects of
(01:10):
Childhood Adversity, was calledIndispensable by the New York
Times.
Dr.
Harris, welcome and thank youfor joining the show.
SPEAKER_03 (01:17):
Thank you so
SPEAKER_00 (01:18):
much for having me.
SPEAKER_03 (01:19):
So allow me a hot second to fanboy a little bit
because your work has shown us alot about prevention as more
than just a health strategy.
It's a life course strategy thatcan transform generations.
And I've had the pleasure toread The Deepest Well, then
reread The Deepest Well.
And most recently, I've listenedto it.
But I wanted to thank youbecause that you voiced it was
(01:42):
so powerful to hear youarticulate your journey in your
own words.
So I really appreciated that andyou sharing so much awareness
and challenges and collectiveaction.
This is a layered question thatwonders a bit about you and you,
the professional.
So bear with me.
When you consider your journey,looking back on all that you've
been through, are there anybreakthroughs that rise to the
(02:03):
surface that are more impactfulfor you personally versus
professionally?
SPEAKER_00 (02:10):
Ooh, wow.
That's quite a question.
Really insightful.
So I think...
And I have to say like rightnow, I just have to like come
out and say like coming downfrom the morning plenary, I am
(02:31):
like shaking.
The women who spoke in thesession about lived experience
was so moving to me.
And Just the power of the peoplein the room and the courage and
(02:55):
to feel what happens when peoplereally come together and to feel
the energy and know that we canall go out and make a difference
is really, it's touching meright now.
And I think it really relates toyour question because I didn't
(03:16):
come to this work from apersonal perspective.
I came to this work very muchfrom a professional perspective
as a pediatrician serving avulnerable community.
And I guess I would say theirony is that Maybe it's not
(03:42):
ironic.
I guess there are mental healthprofessionals who would be like,
Nadine, it's kind of how itworks.
But certainly the greatestimpact on me has been personal.
As I was– I spent a lot of timekind of trying to– researching
(04:02):
and trying to track downinterventions for my patients to
try to help them have betteroutcomes.
And the more research I did andthe more experts I worked with,
I was like, oh, snap, I betterapply that to my own life, both
in terms of my own healingjourney, right?
(04:25):
Like, no surprise, probably abig part of the reason why I was
drawn to the ACE science isbecause I've experienced a lot
of ACEs myself.
And although it's hilarious howthat wasn't overt to me, right?
Like it wasn't like, hey, gosh,I've experienced a lot of these.
Let me go and try to find outthe answer.
I think it more came in the waythat probably a lot of the
(04:49):
parents that I've cared forapproach it, which is that
because I've experienced a lotof ACEs, when I see my patients
experiencing it, I'm just like,it's not okay with me to just
leave them there, right?
Like, sure, our system says thatyou don't get services until
(05:10):
you're symptomatic.
That's not okay.
I know you can be asymptomaticand still be struggling and
still be at risk.
And so for me, what's beenreally interesting as I've read
all the research and evidenceabout safe, stable, and
(05:30):
nurturing relationships, right?
I had to let a few ex-boyfriendsgo.
I was like, oh, this situationis actually, you know, actually
harmful to my health, right?
And I think that that led me tomy husband, you know, as I, you
(05:51):
know, I incorporated mindfulnessas part of my own practice.
And then I think one of thebiggest things was in how I
parent.
And how I care for my kids, itwas really important for me to
break the intergenerationalcycle in my household.
Yeah,
SPEAKER_03 (06:11):
I think, you know, in me asking that and kind of
setting it up in that kind ofdynamic or duality is I'm
wrestling with this idea latelyof tipping points, right?
And it feels like, you know, asI'm kind of looking back on, you
know, investigating my journey,there are these internal tipping
points that pivot me towardaction in a way that I can't
(06:33):
explain.
But then there's this tippingpoint towards collective action,
right?
And your journey, I see thatthere is these things that have
happened repeatedly where you'reovercoming challenges, which
makes me want to ask you, has itallowed you to reflect on then
how tipping points go frominternal to external in a way?
SPEAKER_00 (06:58):
You're just slaying me with these deep questions.
I think that you are 100% right.
So one of the things that youlearn when you're a child and
(07:20):
you're exposed to huge amountsof trauma and it persists is is
that if you raise your voice, itdoesn't do anything.
That you can see something thatis overtly wrong that is
happening, and if you speak up,it doesn't make a difference.
(07:46):
And in my adult life, it hasbeen very important for me to
rewrite that narrative, to say,you know what?
If I speak up, it does make adifference.
We can change outcomes forpeople.
And particularly that for thosewho don't have the ability to
(08:12):
speak up, I'm gonna elevatetheir voice.
Their voice does matter.
And I think that doing thatParticularly in a way that is
also bringing so much of myselfto it because I am a super
(08:36):
hardcore science nerd.
And so like, you know, scienceand data is my love language and
being able to represent the mostvulnerable, but not just
represent them.
When I...
like if I'm testifying beforeCongress or if I got to go
before state legislature orwhatever, man, I know every
(08:59):
single, every single data point.
I know my, my odds ratios.
I know my sources.
I know my, like all of thatstuff, because I am speaking for
those who have been over andover again had that experience
that if they speak up, itdoesn't make a difference.
(09:21):
And then that dynamic that youtalked about, it's a
self-fulfilling prophecy.
It's not a self-fulfillingprophecy.
It is something that creates thecircumstance because when people
are told over and over againthat if you speak up, it doesn't
make a difference, they learn tostop speaking up.
But when people have theexperience that when they speak
(09:46):
up, they are heard, their needsare met, then they are
emboldened and encouraged tospeak up.
And that is what creates atipping point.
When people say, oh gosh, sheheard me.
She heard me, they heard me,they elevated my voice, and now
things are different.
(10:06):
And that is what I, I hope thatthe current challenges that
we're in speaking, that we'reexperiencing in the world
doesn't extinguish that frompeople, right?
And as long as I have air in mylungs, I'm going to keep
(10:27):
speaking up on behalf ofvulnerable families and trying
to transform our systems.
SPEAKER_02 (10:33):
So we're going to continue to work from that last
thread.
And I want to revisit the someof what you said in the plenary
speech.
You've certainly changed how weconnect health to early life
experiences.
You've done an incredible andinspiring job of elevating the
ample research that we now havethat demonstrates that, that
(10:56):
proves that connection.
And yet, as you mentioned, withall the public health approaches
and education that you andothers have done, we continue to
see challenges to adoption andimplementation of comprehensive
approaches and solutions, as,again, you stated in your
(11:16):
keynote.
Too many still take an either-orapproach.
It's either primary preventionor it's early detection.
or it's evidence-basedintervention.
So where do you still seeoutdated narratives or these
kind of entrenched mental modelsholding us back from both
preventing adversity andreducing harm if adversity has
(11:40):
already happened?
SPEAKER_00 (11:41):
Ooh.
Do you want me to speaktruthfully?
Please.
All right, I might...
I don't want to get myself intotrouble, but I'm...
but I feel like I do have tospeak quite plainly on this.
Where I see it coming up is inone of the most unlikely places
(12:06):
that you would ever think of,which is that there is a small
contingency within the AmericanAcademy of Pediatrics that is
essentially kind of, I actuallywas on a webinar on Tuesday,
where it was over again and overagain from the American Academy
(12:27):
of Pediatrics, it was repeated,like, we don't know that
screening for ACEs isassociated, isn't associated
with harms, right?
Like, that was one of thetalking points.
Another thing that was mentionedwas, well, if clinicians aren't
trained, that, you know, theycould, again, they could do
harm.
(12:47):
And...
And...
It's really interesting becauseI feel like I experienced some
of that, like, we don't knowthat it doesn't do harm piece
when I was actually in the roleof state surgeon general.
And there was a small publichealth emergency, the COVID-19
pandemic.
(13:08):
And when we were getting readyto launch vaccines, there were a
lot of people that said, well,we don't know it doesn't do
harm.
And they say, OK, well, you'vedone, you know, and they looked
at the research around thesafety and efficacy and they
say, well, but that's only donein a certain number of people.
And but obviously there was, youknow, skepticism there.
And I think that when I hearthat.
(13:37):
I just say I find it reallyconcerning because as I shared
today, like when we actuallylook at the data and in
California, more than 2 millionindividuals have been screened
for ACEs, more than a third ofCalifornia's kids on Medicaid.
What we see is that it'sassociated with increased
(14:01):
referrals to services, increasedactually getting access to
services, improvement in qualityof care, and improvement in
actually in health outcomes whenit's paired with these
evidence-based interventions.
(14:23):
And so for me, when I look atsome of the resistance I think
one of the things that thepanelists, one of the panelists
said today that, again, like,you're getting me so raw because
I'm so floored by everythingthat has been, happened in this
(14:46):
conference today.
But one of the things that apanelist mentioned is that the
opposite of vision is fear,right?
And so I can understand ifthere's fear there, right?
But then I think that there'sthis incredible opportunity for
(15:07):
us to come together, even ifthere is fear and concerns
around solutions, so we don'tlet that fear get in the way of
families getting the access tothe services that they need.
So how might
SPEAKER_02 (15:23):
we
SPEAKER_00 (15:24):
shift
SPEAKER_02 (15:24):
that narrative?
How might we shift towards anarrative of...
say courage, that can thenovercome that fear.
SPEAKER_00 (15:33):
Yeah.
So there are a couple of piecesthat are really important.
Courage is not proceedingforward blindly no matter what.
Right.
And I think I definitely learneda lot about that in in my role
(15:55):
as a state surgeon generalduring the pandemic.
Even, for example, when we were,you know, my office was working
with the CDC and looking at thedata around vaccination, and
even when we were looking atincreased risk of myocarditis in
(16:18):
women with the COVID vaccine,right, and all of these
different things, and reallyevaluating You know, you
remember there was a time whereone of the vaccines, there was a
pause on it.
And so this is where I thinkinfrastructure is really
(16:40):
important.
When we are feeling, let me justsay like a great example is,
when you're a medical traineeand you start your first day of
residency, the first thing theygive you is a code card, right?
What to do if a patient goesinto cardiorespiratory arrest.
(17:01):
And it's like very simple andvery easy to understand and all
that kind of stuff.
And the idea is there is thatwhen something super stressful
is happening, right?
Or when you have this fullactivation, that it's really
helpful.
We do a lot better when we havea framework to fall back on.
And so- The CDC, when they were,you know, approving vaccines and
(17:23):
all this stuff, they actuallyhave a really good framework of
evaluating, you know, risk,doing a risk-benefit analysis,
right?
And so as we move forward withany kind of innovation in our
systems, especially inhealthcare, understanding that
(17:48):
there's a framework for us to beable to incorporate the best
available evidence, toconstantly monitor for adverse
events, which we do, and we'vebeen doing with our ACE
screening as well.
Rand just did an evaluation onthis and was looking at that
data.
And then to proceed forward withthe best available evidence and
(18:14):
at the same time, put into placethe systems and processes and
procedures to be able tomitigate against any potential
harm.
So there's never been ahealthcare intervention that was
associated with no harm ever,okay, right?
And that's not even theanticipation as we roll out a
(18:35):
screening.
The anticipation is that we havesystems to be vigilant, to
understand where are thereunintended consequences, how do
we mitigate against them, sothat the population can get the
benefit, right, while wemitigate the risks?
SPEAKER_03 (18:57):
This is not a question, which is a terrible
thing for an interview, but itkeeps making me think about the
code card, right?
Like the code card is arehearsed story you have told
yourself under certain duress.
SPEAKER_01 (19:13):
Yes.
SPEAKER_03 (19:13):
Right?
Yes.
And so you return to it.
But then as I'm kind ofwrestling with what you're
saying is, In the mental modelsthat we've had or systems that
we had, there are actuallystories that we've, they are
forms of stories that we havebeen telling ourselves
repeatedly, right?
So when we return to those underduress, we return to this
(19:38):
system, this story that has aframe around it that
incorporates those mentalmodels.
And so the code card, is anopportunity to tell ourselves a
new story.
SPEAKER_00 (19:51):
Correct.
And can I just add somethingonto that?
Let me tell you one of thesestories that we've been telling
ourselves.
One of the stories that we'vebeen telling ourselves as a
society is that talking abouttrauma and adversity does harm.
(20:13):
So people...
Trauma can happen.
It can be happening in a family.
It can be happening.
And particularly when it'shappening to a child, our
families, our systems and oursociety, this is like ballooned
out to our entire society.
It said.
(20:33):
Essentially, oh, no, no, no.
It's not the trauma that's theproblem.
It's the fact that you talkedabout it.
Right.
Because if we don't talk aboutit, we can keep we don't have to
do anything different.
Right.
But when you start talking aboutit, it makes everyone
uncomfortable.
Then it starts things get messyand it's your fault for saying
(20:56):
something.
SPEAKER_02 (20:58):
Right?
Yeah.
So at our Institute for Childand Family Wellbeing, when we
started to administer the ACEssurvey, we got a lot of
resistance from thepractitioners as well for
exactly what you've just framedup.
And so we added a finalquestion, which was, did asking
(21:19):
these questions cause youdistress or harm?
And through that study, as youpointed out, we discovered that
the vast majority of the peoplethat received the survey did not
feel that harm had been causedsimply because they were asked
the questions about theirchildhood and the adversity
they'd experienced.
So I think, right, as you pointout, over time, we need to
(21:43):
reframe this narrative as thecode, you know, the code card,
right, that makes it very clearthat there are certain practices
that have become foundational toadvancing better care for our
communities so that those thatare capable of doing so can do
it with much more confidence.
(22:05):
So we're going to shift a bit tothe systemic and kind of
underlying root causes.
The analogy that when I firstfollowed your work that really
struck me was the seeing 100children coming with a similar
GI issue and not going back tothe well that they were all
(22:31):
drinking the same water from,right?
So we often talk about buildingindividual resilience because
America, and we do that throughbuffering, right, as you've
expressed.
But we also know that structuralinequities or, as some may call
it, adverse communityexperiences are often the root
(22:52):
of that adversity.
So how have you confronted thesystemic root causes that
exacerbate ACEs at a practicallevel?
SPEAKER_00 (23:02):
Yeah.
So, the more you just kind ofscrape under the surface and
start to look at how these oddsare set, right?
(23:22):
The more, the easier it is youto recognize the embedding of
some of these structuralinequities in our society?
I mean, I think that one of thethings that's really challenging
(23:44):
is a recognition that thosestructures are not accidental.
They didn't just turn out thatway, right?
And so I don't totally, I don'thave great answers as to how we
(24:13):
transform these structuralinequities other than number
one, to raise our voices, numbertwo, to, you know, science is my
love language, and to be able toshow to the powers that be the
(24:36):
tremendous cost to our societyin ways that might not, folks
might not immediately recognize,right?
but that needs to be paired witha desire for all of our
(24:57):
communities to be doing well andthriving.
SPEAKER_03 (25:02):
As you mentioned, listening to the panel, there's
so many people that have been inthese rooms.
This is the final day of athree-day conference of people
who are now going back at thismoment to their communities to
do the work.
Do you have any advice orguidance for them on taking what
they've heard and continuing ontheir journey themselves?
SPEAKER_00 (25:26):
Yes.
So I have a couple pieces ofadvice.
My number one advice is kind ofhow I concluded my talk, which
is that self-care is notselfish.
right?
That this work is long.
This work is, we're going to bedoing this work longer than any
one of our lifetimes.
(25:47):
And so it is so important forall of us to be well, especially
when we're supporting vulnerablefamilies.
I think that because there's noend to suffering in this world,
it's very easy for us to exhaustourselves.
And It's really important for usto be well in the work.
(26:12):
So that's my number, number,number one bit of advice.
And I take back my previousanswer, and I have an answer.
And I can't believe it.
I'm glad.
I can't believe I didn't saythis.
So let's talk strategy for asecond, because you're exactly
(26:32):
like, especially dealing withstructural inequities and those
kinds of things, right?
One of the things I love aboutusing the ACE data and the ACE
science is that someonedescribed it to me once as like,
it's almost like a RosettaStone.
We can look at the impact ofACEs on educational outcomes,
(26:52):
the impact of ACEs on justiceoutcomes, the impact of ACEs on
health outcomes.
There's all these differentplaces where we have actually
really robust data because ofthe amount of research that has
been done.
And, oh gosh, I love this somuch.
This is the work that we have todo.
We have to individually, right?
(27:15):
Each one of us, there's only somuch that we're gonna be able to
do.
And one of the things I like tosay a lot is that you don't have
to boil the ocean.
You just have to play yourposition.
What I love doing is helpinglots of different sectors
understand why they have a stakein addressing this issue.
(27:41):
And that has been successful inmy work on both sides of the
aisle, in red states, in bluestates.
If you're a healthcare provider,this is why this can happen.
is important for the work thatyou do.
If you are a policymaker, if youare a business leader, and this
(28:05):
is why understanding the impactof AIDS is actually important
for running your business,managing your workforce, all of
this kind of stuff.
And if you're a policymaker,let's say you want to spend less
money on Medicaid.
28.6% of current Medicaidexpenditures are excess
(28:27):
expenditures due to ACES, right?
So when we think about like, ifyour motivation is to reduce
costs, come with me, let's doearly detection, early
intervention, right?
And get better outcomes forfolks, right?
You can actually, we canactually reduce costs
(28:48):
expenditures without having tojust slash the roles and harm
people's health, okay?
That there is another way.
If you're interested ineducation, making sure that our
kids can learn, experiencingfour or more ACEs is associated
with 32 times greater riskLearning and behavior problems
(29:13):
for kids in school, right?
And so having lots of doorswhere folks can enter, but also
getting organized, right?
So this is where I'm in themiddle of writing.
I'm close to the beginning ofwriting my second book now, and
(29:34):
it's called Pain to Power.
And it's like our source of ourpain is also the source of our
superpowers.
The fact that ACEs impact allthese different sectors is huge.
It's a huge toll on our society.
The CDC estimates 14.1 trilliona year.
Right?
But it's also the source of oursuperpower because it means that
(29:57):
everyone's got a stake in this.
So when we come together and wedo it strategically and we're
organized and we each play ourdifferent part, we can make
transformative change.
Seems like a
SPEAKER_02 (30:10):
good place
SPEAKER_03 (30:11):
to
SPEAKER_02 (30:11):
stop.
It seems like the place to stop.
Well, Dr.
Burke Harris, thank you so muchfor sharing your time and your
experience and your expertisewith us today.
And thank you for the many yearsof both curiosity and research
about our experience as humanbeings.
(30:32):
It's certainly made me a betterperson and professional, and it
has made our world and society abetter place to
SPEAKER_03 (30:39):
live.
Thank you.
Thank you.
And you can invite UpstreamSolutions into your feed by
subscribing to The Shift Voicesof Prevention today.
Join us to create an ecosystemwhere children and families live
purposeful and happy lives withhope for the future.
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