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Poverty Is Making Kids Sick
Chris A. Smith | Photo: Robyn Twomey | September 30, 2013
Or so argues Nadine Burke Harris. And the rest of the medical establishment—not to mention Hillary Clinton—is beginning to listen.
It’s a busy afternoon at the Bayview Child Health Center, and Nadine Burke Harris has barely touched her lunch. The 38-year-old pediatrician has been in an exam room for close to an hour with a new patient, a teenage girl who recently suffered a devastating trauma. (Due to patient confidentiality, Burke Harris can’t be more specific.) The Bayview is one of the city’s poorest and most violent neighborhoods, with the third-highest poverty rate and the second-highest homicide rate in San Francisco. The neighborhood’s dysfunction, Burke Harris discovers, has marked the teenager in numerous ways.
A previous doctor diagnosed the girl with attention-deficit-hyperactivity disorder and sent her on way, but Burke Harris disagrees—she believes the problem goes deeper. She questions the girl and her mother closely about their lives. Then she lays out a long-term treatment plan: a battery of evaluations, sessions with the clinic's in-house psychologist, mindfulness and breathing exercises, yoga for mother and daughter to do together. The teenager smiles as she says goodbye.
After the girl leaves, Burke Harris sinks into her office chair. A child’s drawing of a rainbow hangs on the wall; stacks of plastic-wrapped toy cars share desk space with dosage manuals. She sighs deeply, “That was intense.”
In case it isn’t yet clear, Burke Harris, who founded this community clinic in 2007 (it is affiliated with California Pacific Medical Center), is no average pediatrician. She’s a rock-star doctor who has been profiled in the New Yorker and on This American Life, and has earned the respect of both the medical establishment and the public health elite. She was also recently tapped as a spokesperson for the child advocacy organization Too Small to Fail, former secretary of state Hillary Clinton’s first post-Washington initiative.
And this month, Burke Harris’s team moves into a state-of-the-art facility on Third Street in the Bayview. Built with help from local philanthropies like Tipping Point Community (the antipoverty foundation run by Levi’s heir Daniel Lurie), the new building boasts twice as many exam rooms, plus expanded space for therapy sessions, parenting classes, and community meetings. It also houses Burke Harris’s Center for Youth Wellness, which conducts research on childhood trauma. Lurie, who in one night raised $4 million for the new facility, says, “There should be a center like this in every major city in the country.”
Burke Harris is, at this point, synonymous with a new kind of pediatrics, informed by a growing body of research showing that when kids are exposed to undue stress in their homes or neighborhoods, they are more likely to suffer from chronic health problems like heart disease, cancer, depression, and drug addiction later in life. “Being exposed to trauma is really bad for your system,” she says, “and we as a medical community really need to start coming up with solutions.” For Burke Harris, the solution is to confront “toxic stress” before it can do lasting damage. And she has made it her mission to convince the medical world to follow her lead. As Martha Davis, executive director of the Institute for Safe Families, a Philadelphia nonprofit dedicated to improving childhood health, puts it, “Nadine’s creating a whole new medical model.”
Burke Harris’s original goals were far more modest. Born in Canada to Jamaican parents and reared in Palo Alto, she always knew that she wanted to be a pediatrician. After earning an MD from UC Davis and a master’s in public health from Harvard, she set up shop in the Bayview. In the clinic’s early days, she wrote scrips and gave immunizations like any good pediatrician. Soon, though, she began to suspect that the ills of her young patients had roots in the endemic problems of the Bayview—poverty, unemployment, gang warfare, domestic violence, unstable families. And none of those could be fixed by a 15-minute doctor’s visit. “It was just like, ‘Holy moly, we’re not even touching this stuff.’”
Burke Harris felt stuck. Pediatricians treat kids, not societal problems. Then, in what has now become public health lore, a colleague sent her a study conducted by Kaiser Permanente in 1995. It, along with many that came after it, confirmed what Burke Harris already knew, if abstractly: People with what doctors call adverse childhood experiences (ACEs)—nine categories of trauma that include parental neglect and abuse, the incarceration of a relative, and divorce—are significantly more likely to report serious health problems.
The science, though not yet fully understood, works like this: The bodies and minds of children can be rewired by toxic stress. Traumatized kids have trouble learning and are more likely to engage in high-risk behaviors like fighting, drug use, or unprotected sex. Trauma also activates the “fight or flight” response—useful in limited doses, Burke Harris notes, but damaging to the immune system over the long term and a frequent precursor of chronic disease. “It’s good if you’re trying to outrun a bear,” she says, “but what happens if the bear comes home every night?” Burke Harris’s approach is to excavate her patients’ hidden histories of trauma, then prescribe measures proven to relieve anxiety: breathing exercises, play therapy, and the like.
It may take decades to overhaul the system, but advocates are confident that it will happen. Trauma, as the original Kaiser study found, is universal. “This impacts folks in the deepest poverty, but it also impacts everyone else,” says Ann O’Leary, who runs the children and families program for the San Francisco nonprofit Next Generation, Clinton’s partner in Too Small to Fail.
Back in her office, recalling the mother-daughter visit, Burke Harris notes that some patients wouldn’t have agreed to the regimen she prescribed. As she talks, her eyes fill with tears. “To see families who are willing to take that on, to say yes to doing things differently,” she says, her voice cracking. “And it works. It works. You can break the cycle, you know?”
Originally published in the October issue of San Francisco