UCSF 2020 Chancellor’s Health Policy Lecture Series Summary

By Sonia Ghandi, UCSF GRACE Initiative, February 26, 2020

UCSF Philip R. Lee Institute for Health Policy Studies held its annual Chancellor’s Health Policy Lecture Series on February 13^th, 2020. This Lecture Series was established in 2006 with the aim to highlight the important role and impact of health policy on the UCSF community by brining outstanding health policy leaders to the UCSF campus. This year’s lecture was given by Nadine Bruke Harris, MD, MPH, FAAP, on applying the science of toxic stress to transform outcomes in California. Dr. Bruke Harris is California’s first-ever Surgeon General, the leading spokesperson on recognizing childhood trauma. 

An introduction to the lecture was given by Director of UCSF Institute for Health Policy Studies, Claire Brindis, DrPH, and Chancellor Sam Hawgood, MBBS. Both Dr. Brindis and Dr. Hawgood acknowledged each other’s leadership, support, and contributions towards the importance of health policy. Dr. Hawgood pledged to Dr. Bruke Harris that UCSF will do everything it can “to make her tenure as the first Surgeon General, a roaring success.”

First, Dr. Bruke Harris gave a background to her role as the California’s Surgeon General. She mentioned that together with Governor Newsom, three key priorities of health equity, early childhood, and adverse childhood experiences (ACEs) and toxic stress were identified for this role. Through a historical investment of Governor Newsom, more than $160 million over three years was allocated to routine screening in primary care and provider training as well as $9 million was allocated to a California initiative to advance precision medicine to address ACEs’ health impacts through research projects.

She then acknowledged the original ACE study conducted by CDC-Kaiser Permanente published in 1998 that defined ten traditional ACE criteria that fall under three general types of abuse, neglect, and household dysfunction. She pointed out that while the actual ACEs go beyond these traditional criteria and the fact that the study was conducted on a community of 70% college-educated Caucasians, the study has highlighted two powerful points about ACEs. One being how incredibly common ACEs are that affect all communities and another being the dose-response association that exists between number of ACEs experienced and the relative risk of negative health outcomes. She further mentioned that while the acute stress response also known as fight-or-flight response has evolved in humans as a life-saving or adaptive physiological mechanism, it becomes maladaptive and health damaging in children who experience stress repeatedly. Consequently, high doses of adversity in children could lead to changes in their developing brain’s structure and function, developing immune and hormonal systems, and even their DNA epigenetics modifications. Such long-term changes to the developing critical body systems is now known as the toxic stress response.

Dr. Bruke Harris and her team summarized around 20,000 studies in the literature that helped them to pinpoint six easy steps that all can implement at home as interventions to buffer the toxic stress response, namely: sleep, exercise, nutrition, mindfulness, mental health, and healthy relationships. These interventions have been associated with reduction in the levels of stress hormones and inflammation, enhancement in neuroplasticity and epigenetic regulation. “We see that our body is wired to have these healing and protective mechanisms. This is powerful! We have the power to transform outcomes for the next generation,” Dr. Bruke Harris said and stated that her main goal as California’s Surgeon General is “to cut ACEs and toxic stress in half in one generation in California.”

For lecture closing remarks, Dr. Bruke Harris went over current and future work of her Office in the Department of Health Care Services as well as her Initiative called ACEs Aware which was deployed to be able to address ACEs and toxic stress across health providers. ACEs Aware website contains provider trainings, screening tools with de-identified and identified versions, screening clinical workflows for care providers to refer to, ACEs and toxic stress risk assessment algorithms to understand patients’ level of risk, and treatment planning, all of which are tailored towards pediatrics and adults separately. ACEs Aware implementation is done though a phased approached in which phase 1 is minimum requirements for reimbursement that contains a 2-hour online training and CME and MOC credits, phase 2 is provider engagement and training through partnering with organizations, and phase 3 is a state-wide Learning and Quality Improvement (LQI) Collaborative that has been launched and led by Dr. Edward Machtinger at UCSF.

At the end, Dr. Nadine Bruke Harris said, “I believe that in 20 years from now, I hope to be back here having this conversation that just as we’ve seen this reduction in cigarette daily use, maternal mortality, and HIV mortality, so I will be showing you a slide yet to be developed, on  the dramatic drop in adverse childhood experiences and toxic stress in the State of California.”

To watch the full lecture video as well as to read a UCSF article on the lecture, Statewide Learning and Quality Collaborative, and changes to the School of Medicine Curriculum, Click Here.

For more content on the topic, watch Dr. Brindis’ interview with Dr. Bruke Harris published on February 14^th, 2020, Click Here.