The Shift: Voices of Prevention — A podcast by Prevent Child Abuse America

From Pain to Power: Dr. Nadine Burke Harris on Healing and Prevention

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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 Burke Harris tackles outdated narratives that keep systems from acting, calls out the dangers of letting fear override vision, and explains why every sector—from healthcare to business to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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you

SPEAKER_03:

This is The Shift, Voices of Prevention, a podcast from Prevent Child Abuse America, where we explore bold ideas, cultural change, and what it truly means to support children and families. Join us to change the narrative one conversation at a time.

SPEAKER_02:

Hello, and welcome to The Shift, Voices of Prevention, recording live from PCA America's 2025 National Conference in Portland, Oregon. I'm Luke Waldo. And I'm Nathan Fink. Today, our final day of the 2025 PCA America Conference, we're We're absolutely thrilled to be joined by Dr. Nadine Burke Harris, an award-winning physician, researcher, and former California Surgeon General who has transformed our understanding of the effects of adverse childhood experiences and toxic stress on long-term health. She pioneered efforts to treat toxic stress and has been a leader in promoting trauma-informed health policies. Dr. Burke Harris's TED Talk, How Childhood Trauma Affects Health Across a Lifetime, has been viewed more than 12 million times. Her book, The Deepest Well, Healing the Long-Term Effects of Childhood Adversity, was called Indispensable by the New York Times. Dr. Harris, welcome and thank you for joining the show.

SPEAKER_03:

Thank you so

SPEAKER_00:

much for having me.

SPEAKER_03:

So allow me a hot second to fanboy a little bit because your work has shown us a lot about prevention as more than just a health strategy. It's a life course strategy that can transform generations. And I've had the pleasure to read The Deepest Well, then reread The Deepest Well. And most recently, I've listened to it. But I wanted to thank you because that you voiced it was so powerful to hear you articulate your journey in your own words. So I really appreciated that and you sharing so much awareness and challenges and collective action. This is a layered question that wonders 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 any breakthroughs that rise to the surface that are more impactful for you personally versus professionally?

SPEAKER_00:

Ooh, wow. That's quite a question. Really insightful. So I think... And I have to say like right now, I just have to like come out and say like coming down from the morning plenary, I am like shaking. The women who spoke in the session about lived experience was so moving to me. And Just the power of the people in the room and the courage and to feel what happens when people really come together and to feel the energy and know that we can all go out and make a difference is really, it's touching me right now. And I think it really relates to your question because I didn't come to this work from a personal perspective. I came to this work very much from a professional perspective as a pediatrician serving a vulnerable community. And I guess I would say the irony is that Maybe it's not ironic. I guess there are mental health professionals who would be like, Nadine, it's kind of how it works. But certainly the greatest impact on me has been personal. As I was– I spent a lot of time kind of trying to– researching and trying to track down interventions for my patients to try to help them have better outcomes. And the more research I did and the more experts I worked with, I was like, oh, snap, I better apply that to my own life, both in terms of my own healing journey, right? Like, no surprise, probably a big part of the reason why I was drawn to the ACE science is because I've experienced a lot of ACEs myself. And although it's hilarious how that 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 out the answer. I think it more came in the way that probably a lot of the parents that I've cared for approach it, which is that because I've experienced a lot of 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 that you don't get services until you're symptomatic. That's not okay. I know you can be asymptomatic and still be struggling and still be at risk. And so for me, what's been really interesting as I've read all the research and evidence about safe, stable, and nurturing relationships, right? I had to let a few ex-boyfriends go. I was like, oh, this situation is actually, you know, actually harmful to my health, right? And I think that that led me to my husband, you know, as I, you know, I incorporated mindfulness as part of my own practice. And then I think one of the biggest things was in how I parent. And how I care for my kids, it was really important for me to break the intergenerational cycle in my household. Yeah,

SPEAKER_03:

I think, you know, in me asking that and kind of setting it up in that kind of dynamic or duality is I'm wrestling with this idea lately of tipping points, right? And it feels like, you know, as I'm kind of looking back on, you know, investigating my journey, there are these internal tipping points that pivot me toward action in a way that I can't explain. But then there's this tipping point towards collective action, right? And your journey, I see that there is these things that have happened repeatedly where you're overcoming challenges, which makes me want to ask you, has it allowed you to reflect on then how tipping points go from internal to external in a way?

SPEAKER_00:

You're just slaying me with these deep questions. I think that you are 100% right. So one of the things that you learn when you're a child and you're exposed to huge amounts of trauma and it persists is is that if you raise your voice, it doesn't do anything. That you can see something that is overtly wrong that is happening, and if you speak up, it doesn't make a difference. And in my adult life, it has been very important for me to rewrite that narrative, to say, you know what? If I speak up, it does make a difference. We can change outcomes for people. And particularly that for those who don't have the ability to speak up, I'm gonna elevate their voice. Their voice does matter. And I think that doing that Particularly in a way that is also bringing so much of myself to it because I am a super hardcore science nerd. And so like, you know, science and data is my love language and being able to represent the most vulnerable, but not just represent them. When I... like if I'm testifying before Congress or if I got to go before state legislature or whatever, man, I know every single, every single data point. I know my, my odds ratios. I know my sources. I know my, like all of that stuff, because I am speaking for those who have been over and over again had that experience that if they speak up, it doesn't make a difference. And then that dynamic that you talked about, it's a self-fulfilling prophecy. It's not a self-fulfilling prophecy. It is something that creates the circumstance because when people are told over and over again that if you speak up, it doesn't make a difference, they learn to stop speaking up. But when people have the experience that when they speak up, they are heard, their needs are met, then they are emboldened and encouraged to speak up. And that is what creates a tipping point. When people say, oh gosh, she heard me. She heard me, they heard me, they elevated my voice, and now things are different. And that is what I, I hope that the current challenges that we're in speaking, that we're experiencing in the world doesn't extinguish that from people, right? And as long as I have air in my lungs, I'm going to keep speaking up on behalf of vulnerable families and trying to transform our systems.

SPEAKER_02:

So we're going to continue to work from that last thread. And I want to revisit the some of what you said in the plenary speech. You've certainly changed how we connect health to early life experiences. You've done an incredible and inspiring job of elevating the ample research that we now have that demonstrates that, that proves that connection. And yet, as you mentioned, with all the public health approaches and education that you and others have done, we continue to see challenges to adoption and implementation of comprehensive approaches and solutions, as, again, you stated in your keynote. Too many still take an either-or approach. It's either primary prevention or it's early detection. or it's evidence-based intervention. So where do you still see outdated narratives or these kind of entrenched mental models holding us back from both preventing adversity and reducing harm if adversity has already happened?

SPEAKER_00:

Ooh. Do you want me to speak truthfully? Please. All right, I might... I don't want to get myself into trouble, but I'm... but I feel like I do have to speak quite plainly on this. Where I see it coming up is in one of the most unlikely places that you would ever think of, which is that there is a small contingency within the American Academy of Pediatrics that is essentially kind of, I actually was on a webinar on Tuesday, where it was over again and over again from the American Academy of Pediatrics, it was repeated, like, we don't know that screening for ACEs is associated, isn't associated with harms, right? Like, that was one of the talking points. Another thing that was mentioned was, well, if clinicians aren't trained, that, you know, they could, again, they could do harm. And... And... It's really interesting because I feel like I experienced some of that, like, we don't know that it doesn't do harm piece when I was actually in the role of state surgeon general. And there was a small public health emergency, the COVID-19 pandemic. And when we were getting ready to 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've done, you know, and they looked at the research around the safety and efficacy and they say, well, but that's only done in a certain number of people. And but obviously there was, you know, skepticism there. And I think that when I hear that. I just say I find it really concerning because as I shared today, like when we actually look at the data and in California, more than 2 million individuals have been screened for ACEs, more than a third of California's kids on Medicaid. What we see is that it's associated with increased referrals to services, increased actually getting access to services, improvement in quality of care, and improvement in actually in health outcomes when it's paired with these evidence-based interventions. And so for me, when I look at some of the resistance I think one of the things that the panelists, one of the panelists said today that, again, like, you're getting me so raw because I'm so floored by everything that has been, happened in this conference today. But one of the things that a panelist mentioned is that the opposite of vision is fear, right? And so I can understand if there's fear there, right? But then I think that there's this incredible opportunity for us to come together, even if there is fear and concerns around solutions, so we don't let that fear get in the way of families getting the access to the services that they need. So how might

SPEAKER_02:

we

SPEAKER_00:

shift

SPEAKER_02:

that narrative? How might we shift towards a narrative of... say courage, that can then overcome that fear.

SPEAKER_00:

Yeah. So there are a couple of pieces that are really important. Courage is not proceeding forward blindly no matter what. Right. And I think I definitely learned a lot about that in in my role as a state surgeon general during the pandemic. Even, for example, when we were, you know, my office was working with the CDC and looking at the data around vaccination, and even when we were looking at increased risk of myocarditis in women with the COVID vaccine, right, and all of these different things, and really evaluating You know, you remember there was a time where one of the vaccines, there was a pause on it. And so this is where I think infrastructure is really important. When we are feeling, let me just say like a great example is, when you're a medical trainee and you start your first day of residency, the first thing they give you is a code card, right? What to do if a patient goes into cardiorespiratory arrest. And it's like very simple and very easy to understand and all that kind of stuff. And the idea is there is that when something super stressful is happening, right? Or when you have this full activation, that it's really helpful. We do a lot better when we have a framework to fall back on. And so- The CDC, when they were, you know, approving vaccines and all this stuff, they actually have a really good framework of evaluating, you know, risk, doing a risk-benefit analysis, right? And so as we move forward with any kind of innovation in our systems, especially in healthcare, understanding that there's a framework for us to be able to incorporate the best available evidence, to constantly monitor for adverse events, which we do, and we've been doing with our ACE screening as well. Rand just did an evaluation on this and was looking at that data. And then to proceed forward with the best available evidence and at the same time, put into place the systems and processes and procedures to be able to mitigate against any potential harm. So there's never been a healthcare intervention that was associated with no harm ever, okay, right? And that's not even the anticipation as we roll out a screening. The anticipation is that we have systems to be vigilant, to understand where are there unintended consequences, how do we mitigate against them, so that the population can get the benefit, right, while we mitigate the risks?

SPEAKER_03:

This is not a question, which is a terrible thing for an interview, but it keeps making me think about the code card, right? Like the code card is a rehearsed story you have told yourself under certain duress.

SPEAKER_01:

Yes.

SPEAKER_03:

Right? Yes. And so you return to it. But then as I'm kind of wrestling with what you're saying is, In the mental models that we've had or systems that we had, there are actually stories that we've, they are forms of stories that we have been telling ourselves repeatedly, right? So when we return to those under duress, we return to this system, this story that has a frame around it that incorporates those mental models. And so the code card, is an opportunity to tell ourselves a new story.

SPEAKER_00:

Correct. And can I just add something onto that? Let me tell you one of these stories that we've been telling ourselves. One of the stories that we've been telling ourselves as a society is that talking about trauma and adversity does harm. So people... Trauma can happen. It can be happening in a family. It can be happening. And particularly when it's happening to a child, our families, our systems and our society, this is like ballooned out to our entire society. It said. Essentially, oh, no, no, no. It's not the trauma that's the problem. It's the fact that you talked about it. Right. Because if we don't talk about it, we can keep we don't have to do anything different. Right. But when you start talking about it, it makes everyone uncomfortable. Then it starts things get messy and it's your fault for saying something.

SPEAKER_02:

Right? Yeah. So at our Institute for Child and Family Wellbeing, when we started to administer the ACEs survey, we got a lot of resistance from the practitioners as well for exactly what you've just framed up. And so we added a final question, which was, did asking these questions cause you distress or harm? And through that study, as you pointed out, we discovered that the vast majority of the people that received the survey did not feel that harm had been caused simply because they were asked the questions about their childhood and the adversity they'd experienced. So I think, right, as you point out, over time, we need to reframe this narrative as the code, you know, the code card, right, that makes it very clear that there are certain practices that have become foundational to advancing better care for our communities so that those that are capable of doing so can do it with much more confidence. So we're going to shift a bit to the systemic and kind of underlying root causes. The analogy that when I first followed your work that really struck me was the seeing 100 children coming with a similar GI issue and not going back to the well that they were all drinking the same water from, right? So we often talk about building individual resilience because America, and we do that through buffering, right, as you've expressed. But we also know that structural inequities or, as some may call it, adverse community experiences are often the root of that adversity. So how have you confronted the systemic root causes that exacerbate ACEs at a practical level?

SPEAKER_00:

Yeah. So, the more you just kind of scrape under the surface and start to look at how these odds are set, right? The more, the easier it is you to recognize the embedding of some of these structural inequities in our society? I mean, I think that one of the things that's really challenging is a recognition that those structures are not accidental. They didn't just turn out that way, right? And so I don't totally, I don't have great answers as to how we transform these structural inequities other than number one, to raise our voices, number two, to, you know, science is my love language, and to be able to show to the powers that be the tremendous cost to our society in ways that might not, folks might not immediately recognize, right? but that needs to be paired with a desire for all of our communities to be doing well and thriving.

SPEAKER_03:

As you mentioned, listening to the panel, there's so many people that have been in these rooms. This is the final day of a three-day conference of people who are now going back at this moment to their communities to do the work. Do you have any advice or guidance for them on taking what they've heard and continuing on their journey themselves?

SPEAKER_00:

Yes. So I have a couple pieces of advice. My number one advice is kind of how I concluded my talk, which is that self-care is not selfish. right? That this work is long. This work is, we're going to be doing this work longer than any one of our lifetimes. And so it is so important for all of us to be well, especially when we're supporting vulnerable families. I think that because there's no end to suffering in this world, it's very easy for us to exhaust ourselves. And It's really important for us to be well in the work. So that's my number, number, number one bit of advice. And I take back my previous answer, and I have an answer. And I can't believe it. I'm glad. I can't believe I didn't say this. So let's talk strategy for a second, because you're exactly like, especially dealing with structural inequities and those kinds of things, right? One of the things I love about using the ACE data and the ACE science is that someone described it to me once as like, it's almost like a Rosetta Stone. We can look at the impact of ACEs on educational outcomes, the impact of ACEs on justice outcomes, the impact of ACEs on health outcomes. There's all these different places where we have actually really robust data because of the amount of research that has been done. And, oh gosh, I love this so much. This is the work that we have to do. We have to individually, right? Each one of us, there's only so much that we're gonna be able to do. And one of the things I like to say a lot is that you don't have to boil the ocean. You just have to play your position. What I love doing is helping lots of different sectors understand why they have a stake in addressing this issue. And that has been successful in my work on both sides of the aisle, in red states, in blue states. If you're a healthcare provider, this is why this can happen. is important for the work that you do. If you are a policymaker, if you are a business leader, and this is why understanding the impact of 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 Medicaid expenditures are excess expenditures due to ACES, right? So when we think about like, if your motivation is to reduce costs, come with me, let's do early detection, early intervention, right? And get better outcomes for folks, right? You can actually, we can actually reduce costs expenditures without having to just slash the roles and harm people's health, okay? That there is another way. If you're interested in education, making sure that our kids can learn, experiencing four or more ACEs is associated with 32 times greater risk Learning and behavior problems for kids in school, right? And so having lots of doors where folks can enter, but also getting organized, right? So this is where I'm in the middle of writing. I'm close to the beginning of writing my second book now, and it's called Pain to Power. And it's like our source of our pain is also the source of our superpowers. The fact that ACEs impact all these different sectors is huge. It's a huge toll on our society. The CDC estimates 14.1 trillion a year. Right? But it's also the source of our superpower because it means that everyone's got a stake in this. So when we come together and we do it strategically and we're organized and we each play our different part, we can make transformative change. Seems like a

SPEAKER_02:

good place

SPEAKER_03:

to

SPEAKER_02:

stop. It seems like the place to stop. Well, Dr. Burke Harris, thank you so much for sharing your time and your experience and your expertise with us today. And thank you for the many years of both curiosity and research about our experience as human beings. It's certainly made me a better person and professional, and it has made our world and society a better place to

SPEAKER_03:

live. Thank you. Thank you. And you can invite Upstream Solutions into your feed by subscribing to The Shift Voices of Prevention today. Join us to create an ecosystem where children and families live purposeful and happy lives with hope for the future.