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

Dr. Nadine Burke-Harris, 49, vividly recalls a case that reshaped her understanding of medicine: a little girl with recurring asthma flare-ups that she couldn’t figure out. “Could you describe your home environment? Do you have pets or are there cockroaches around?” she asked the mother during a consultation. The reply was unexpected: “I don’t know, doctor. I just notice that she has flare-ups every time her dad punches the wall.”

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

“That information changed the way I understood medicine,” she said at 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 her studies, individuals exposed to four or more ACEs are twice as likely to develop cardiovascular disease and face heightened risks of lung cancer and respiratory failure. Experiencing six or more can reduce life expectancy by 20 years.

“We look the other way because it directly challenges us, but silence is part of the problem,” says Burke-Harris, a mother of four children who admits that her own studies have benefited her personally. “We cannot imagine a world in which nothing bad happens, that is impossible. It is about forging a community so that, when something goes wrong, we take care of each other.”

Question. Around 90 million children have suffered episodes of sexual violence. Two out of three of them suffer violent punishments at home on a routine basis. In countries like Mexico, more than 26 million children grow up without their fathers. Are childhood traumas a pandemic?

Answer. Being a public health nerd, I would tell you that the term pandemic implies that the current situation is more significant than it was before. (Laughs). But I will tell you that it is certainly global. The question is, is there an unusually high pre-norm prevalence? Unfortunately, we don’t know because there’s no data. But certainly, childhood trauma is a global public health crisis. Without a 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 life expectancy is so low is because of the biological changes that result from these traumatic experiences: in the immune system, hormones, the brain... This means that those who were exposed to four or more ACEs are twice as 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 to prolonged stress from a very young age. These people also tend to have several simultaneous diseases.

Q. How responsible are we then for our own health?

A. Half of these diseases are associated with risky behavior. If you had four or more ACEs, you're more likely to have alcohol problems, smoke or use drugs. Each 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, walking in nature, good nutrition, access to therapy... All of that helps. The other part is government investment. There are a lot of people who think of childhood trauma as something that happens to individuals and that they alone have to work through it, and that's unfair.

Q. But not everyone can afford the solutions you have mentioned...

A. Yes… Some things like meditation or mindfulness are inexpensive.

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

A. The way these studies were initially 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 kilos. She was a girl and it was her father. This surprised him a lot, so he started asking more patients and noticed that sexual abuse was very common. And in this research, the majority were Caucasian people, with higher education. But factors such as discrimination or being a victim of an 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 greater understanding of what it can do; about the importance of stable relationships, of a child feeling loved, valued and understood. But there also needs to be access to psychological therapies, safe spaces to play…

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

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

Q. You are a mother of four children. How has raising your children shaped your research?

A. It’s been a huge, huge help. I grew up in a home where my mother had untreated mental health issues and there was related violence. I think this information has allowed me to break the cycle in my own family. I can’t explain how liberating it has been. On the one hand, it has allowed me to realize how important it is for me to be emotionally and physically well. There’s nothing healthier for a child than a healthy caregiver. I say my husband and I have four children, but it’s actually five. Between our third and fourth, we had one who passed away. When we lost him, I wasn’t well. I was in extreme grief, 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 children while I got back on my feet. My children knew I was sad, but they were fine because there was a network that looked after them. And my husband was able to look after me. This is what this science did. We cannot imagine a world in which nothing bad happens to anyone, that is impossible. It is about forging a community so that when something goes wrong, we look after each other.

Q. You have spoken about the enormous economic cost of looking the other way. But what happens to us as a society when we do not give importance to this global crisis?

A. When we understand the intergenerational cycles — where someone who has been a victim is significantly more likely to become a perpetrator — we see that the cost is immeasurable. It’s a price we cannot afford.

Q. In a very famous Ted talk, you said that perhaps we don’t look at the problem head on 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 have learned to keep quiet when something upsets us. And that is part of the dynamic that perpetuates the problem. When we don’t call things by their name, nothing changes. When Vincent Felitti first started doing his research, many people asked him how he could talk about sexual abuse, but when he spoke to 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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