Nadine Burke-Harris: ‘A strong community can reverse childhood trauma’ | Health

Dr. Nadine Burke-Harris, 49, vividly remembers a case that reshaped her understanding of medicine: a little girl with recurring asthma attacks she couldn’t figure out. “Could you describe your background? from home? Do you have pets or are there bugs around?” he asked the mother during a consultation. The answer was unexpected: “I don’t know, doctor. I just notice that she has a tantrum every time her dad hits the wall.”

This story is one of many that have marked Burke-Harris, one of the leading experts on how childhood trauma affects the mental and physical health of millions of adults. After completing a master’s in public health at Harvard and a medical residency at Stanford, Burke-Harris—California’s first female surgeon general—founded a clinic in one of San Francisco’s most neglected communities, Bayview Hunters Point. There, she focused her research on Adverse childhood experiences (ACE) – traumatic events such as parental abuse, neglect, and incarceration.

“This information changed the way I understood medicine,” she told a meeting organized by UNICEF during the first Global Ministerial Conference on ending violence against children. “We are facing a global public health crisis. The good news is that there are solutions that science has proven to work,” she said.

One of these solutions is fostering strong community networks. “A strong community can reverse childhood trauma,” she said. According to his studies, people exposed to four or more ACEs are twice as likely to develop cardiovascular disease and face increased risks of lung cancer and respiratory failure. Experiencing six or more can reduce life expectancy by 20 years.

“We look away because it directly challenges us, but the silence is part of the problem,” says Burke-Harris, a mother of four who admits her own studies have benefited her personally. “We can’t imagine a world where nothing bad happens, that’s impossible. It’s about building a community so that when something goes wrong, we look out for each other.”

Question. Approximately 90 million children have experienced episodes of sexual violence. Two out of three of them suffer violent punishment at home on a regular basis. In countries like Mexico, more than 26 million children are growing up without their father. Is childhood trauma a pandemic?

Response. As a public health geek, I would tell you that the term pandemic implies that the current situation is more significant than it was before. (Laugh). But I’m telling you it’s definitely global. The question is, is there an unusually high pre-norm prevalence? Unfortunately, we don’t know because there is no data. But certainly childhood trauma is a global public health crisis. No doubt.

Q You have calculated that the life expectancy of people who have been victims of at least six ACEs is 20 years shorter. How is this possible?

A. The reason why life expectancy is so low is because of the biological changes that result from these traumatic experiences: in the immune system, hormones, brain… This means that those who have been exposed to four or more ACEs have twice the more likely to suffer from cardiovascular diseases. Or those who have seven or more ACEs are 3.5 times more exposed. But what makes the difference is that these diseases appear at a much younger age because the individual has been exposed prolonged stress from a very young age. These people also tend to have multiple illnesses at the same time.

Q How responsible are we then for our own health?

A. Half of these diseases are associated with risky behaviors. If you’ve had four or more ACEs, you’re more likely to have problems with alcohol, smoking, or drug use. Any individual can learn about these studies and get ahead of them, but that only removes half the risk. There are other interventions: stable environments, nurturing relationships, mindfulness, nature walks, good nutrition, access to therapy… All of these help. The other part is government investment. There are a lot of people who think that childhood trauma is something that happens to individuals and that they alone have to go through it, and that’s unfair.

Q But not everyone can afford the solutions you mentioned…

A. Yeah… Some things like that meditation or mindfulness they are cheap.

Q Are ACEs random or influenced by race, gender, or social status?

A. The way these studies were originally conducted was very random. Dr. Vincent Felitti asked his patients how much they weighed when they had their first sexual encounter. One of them answered 18 kilograms. It was a girl and it was her father. This really surprised him, so he started asking more patients and noticed that sexual abuse is very common. And in this research, the majority were Caucasian, with higher education. But factors such as discrimination or being a victim of armed conflict also provoke toxic responses, even if they are not ACEs as such.

Q What role do communities play?

A. A strong community can reverse childhood trauma. It plays a fundamental role, but there needs to be a better understanding of what it can do; about the importance of stable relationships, of a child who feels loved, valued and understood. But there must also be access to psychological therapies, safe spaces for play…

Q Latin America is a region with a long history of violence. Dr. WHO’s Etienne Krug said in an interview with EL PAÍS that it had “normalized”. What are the risks of this?

A. I can also speak from experience. I lived the first five years of my life in Jamaica at a time when violence was a daily occurrence. And even there, safe spaces can be created for children by both community and family. This can help reduce the associated health risks.

Q You are a mother of four children. How has your research influenced your child-rearing?

A. It was a huge, huge help. I grew up in a home where my mother had untreated mental health issues and there was associated violence. I believe this information allowed me to break the cycle in my own family. I can’t explain how liberating it was. On the one hand, it allowed me to realize how important it is for me to be emotionally and physically well. There is nothing healthier for a child than a healthy caregiver. I say my husband and I have four children, but there are actually five. Between our third and fourth, we had one die. When I lost him, I was not well. I was in extreme pain, which really affected my ability to be a mother. I could barely get out of bed. The difference between the family I grew up in and my family now is that I was able to say, “I’m not okay.” And my brother and sister-in-law stayed with us. She took care of my kids while I got back on my feet. My kids knew I was sad, but they were fine because there was a network that looked after them. And my husband was able to take care of me. That is what this science has done. We cannot imagine a world where nothing bad happens to anyone, that is impossible. It’s about creating a community so that when something goes wrong, we look out for each other.

Q You talked about the enormous economic cost of looking the other way. But what happens to us as a society when we ignore this global crisis?

A. When we understand the intergenerational cycles – where someone who was a victim is much more likely to become a perpetrator – we see that the cost is immeasurable. It is a price we cannot afford.

Q In a very famous Ted talk, you said that maybe we don’t look at the problem in front of us precisely because it challenges us. what do you mean

A. Talking about childhood trauma is very painful for many of us. We associate it with shame and culturally we’ve learned to keep quiet when something upsets us. And that is part of the dynamic that perpetuates the problem. When we don’t call a spade a spade, nothing changes. When Vincent Felitti started doing his research, many asked him how he did it I’m talking about sexual abusebut when he spoke to the patients, they all thanked him. They said, “I thought I would die without telling anyone.” Silence is part of the problem.

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