Newsweek - 06.03.2020

NEWSWEEK.COM 25

HEALTH

the forefront of a growing movement that aims to transform the

way the medical profession handles childhood adversity. Child-

hood stress can be as toxic and detrimental to the development

of the brain and body as eating lead paint chips off the wall or

drinking it in the water—and should be screened for and dealt

with in similar ways, in Burke Harris’ view. As California’s first

Surgeon General, a newly created position, she is focusing on

getting lawmakers and the public to act.

Earlier this year, thanks in part to her advocacy, California

allocated more than $105 million to promote screening for “Ad-

verse Childhood Experiences” (ACEs)—10 family stressors, first

identified in the late 1990s, that can elicit a “toxic stress response,”

a biological cascade driven by the stress hormone cortisol that is

linked to a wide range of health problems later in life.

In recent years, epidemiologists, neuroscientists and molecular

biologists have produced evidence that early childhood experiences,

if sufficiently traumatic, can flip biological switches that can pro-

foundly affect the architecture of the developing brain and long-

term physical and emotional health. These “epigenetic” changes—

molecular-level processes that turn genes on and off—not only make

some people more likely to self-medicate using nicotine, drugs or

alcohol and render them more susceptible to suicide and mental

illness later in life. They can impair immune system function and

predispose us to deadly diseases including heart diseases, cancer,

dementia and many others, decades later. Not only does childhood

stress harm the children themselves, but the effects may also be

passed down to future generations.

A groundswell of support has arisen in the world of public

health in favor of treating childhood adversity as a public health

crisis that requires intervention—a crisis that seems to run in fam-

ilies and repeat itself in trans-generational cycles. At last count, at

least 25 states and the District of Columbia had passed statutes

or resolutions that refer to Adverse Childhood Experiences. Since

2011, more than 60 state statutes aimed at ACEs or intervening

to mitigate their effects have been enacted into law, according

ACEs Connection, a website devoted to tracking the phenomenon

and providing resources. California’s effort is among the most ag-

gressive. The state has set aside $50 million for next year to train

doctors to provide screening, and $45

million to begin reimbursing doctors in

the state’s MediCal program for doing

so ($29 for each screening). If it proves

effective, other states may soon follow.

“The social determinants of health are

to the 21st century, what infectious dis-

ease was to the 20th century,” says Burke

Harris. She rose to national prominence

after writing a 2018 book on the subject,

embarking on a national book tour and

“What I was seeing

was incredibly,

INCREDIBLY HIGH RATES

of kids who were

experiencing adversity

and then having

REALLY SIGNIFICANT

health outcomes.”

ơ

FOLLOW THE STRESS

None of her mentors at

medical school suggested

that childhood stress

could cause seemingly

unrelated physical

illnesses. But what Nadine

Burke Harris saw in the

clinic alarmed her and sent

her searching for answers.

Far left: A children’s home

in Bucharest, Romania.

Left: Burke Harris.