Provider Spotlight

Dr. Nadine Burke Harris and Dr. Ray Bignall on Exposure to Racism and Discrimination as Risk Factors for Toxic Stress

In April 2021, ACEs Aware hosted the first in a series of webinars that explore research demonstrating how exposure to racism and other forms of discrimination can serve as risk factors for the toxic stress response and lead to ACE-Associated Health Conditions. Below are key takeaways from part one of the series.

Dr. Nadine Burke Harris, California Surgeon General, on how racism and discrimination act as risk factors for toxic stress:

ACEs are very common across income, geographic, racial, and ethnic boundaries. ACEs affect all communities, and about two thirds of us have experienced at least one ACE.

Racism and other forms of discrimination weren’t part of the original ACE study, which is why we don’t include them in determining the ACE score during screening. However, research tells us that exposure to racism and discrimination act as risk factors for the development of the toxic stress response in a variety of ways.

  1. Racism and the resulting systemic inequities, such as disproportionate incarceration rates among people of color, have created conditions that lead to ACEs. CDC data demonstrate that communities of color carry a higher burden of ACEs and are at greater risk of ACE-Associated Health Conditions.
  2. Low-income communities and communities of color are disproportionately located in environments that have fewer resources for buffering supports, such as access to fresh and healthy foods, recreational facilities, green spaces, and health care resources.
  3. Exposure to racism can act as a direct and chronic stressor. Exposure to racism and discrimination can lead to a prolonged activation of the body’s biological stress response and disrupt the normal functioning of neuro-endocrine, immune, metabolic and genetic regulatory systems. In other words, exposure to racism can lead directly to the development of the toxic stress response.

A key takeaway from the ACEs Aware work is that toxic stress is a health condition that is amenable to treatment. Clinicians and clinical team members are strongly encouraged to consider utilizing the evidence-based strategies presented through ACEs Aware to mitigate toxic stress in your patients who have been exposed to racism or discrimination.

In addition, the larger, more systemic issues require systemic solutions. Therefore, a public health approach requires us to implement systems to eliminate racism and discrimination.

I want to provide my commitment that the ACEs Aware Initiative will continue to address racism and discrimination as critical public health issues that have negative effects on the health and well-being of children and adults.

Dr. Ray Bignall, pediatric nephrologist from Nationwide Children’s Hospital in Ohio, on how social drivers like neighborhood segregation, income inequality, and policing impact ACEs:

The resurgence of the movement for black lives that we have all experienced within recent years forces us to acknowledge an incontrovertible fact that undergirds any honest conversation that we have about health disparities. Racism is the most significant and pervasive cultural paradigm in the United States of America.

At its core, racism works in tandem with systems of inequality that permeate nearly every aspect of American life. Today, a growing body of literature appreciates the impact of social drivers like systemic racism and inequality on the likelihood of experiencing ACEs.

Neighborhood segregation is the greatest driver of inequality that we see in America today and is one of the most vivid examples of structural racism in the 20th century. With devastatingly surgical precision, the federal government’s homeowner’s loan corporation historically used color-coded maps to indicate which neighborhoods were worthy of federal investment. Communities that were historically “redlined” remain disproportionately impoverished today.

When it comes to income, several structural barriers prevent Black communities from building wealth here in the United States, including wage inequality and significantly higher unemployment rates among communities of color.

We certainly can’t talk about systemic inequality in America without also talking about policing. The truth is unmistakable — not all communities in the United States are policed the same and not all Americans feel served and protected. A growing body of literature explores the impact of police violence, policing practices, and mass incarceration on the health and well-being of children. I encourage you to familiarize yourself with research from luminaries like Dr. Jacob Bor in Boston and Dr. Nia Heard-Garris in Chicago, who take a scholarly lens to this problem.

Dr. Bignall on steps providers can take to engage and advocate solutions to support their patients at greater risk of ACEs due to systemic inequality, racism, and discrimination:

First and foremost, providers should be willing to exercise empathy and extra effort on behalf of children and families at greatest risk due to ACEs and systemic inequality. As a pediatric nephrologist, in order to take the best care of my patients, it’s my responsibility to take care of more than just their kidneys. I also need to think about their mental health, their family’s ability to weather the financial circumstances that surround their kidney health, and the lived environment that could be contributing to their illness.

Secondly, we should screen for ACEs and social determinants of health in our child health encounters. This sounds simple, but it can be challenging in health systems both large and small without proper support. Many institutions today have thankfully started to incorporate screening into their normal processes and electronic health records.

It’s also crucially important that we have a plan for what to do when patients test positive for these screens. We must support primary prevention strategies through public health policy. I would encourage you to take a look at the Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health, in which the Office of the Surgeon General describes some of the primary prevention strategies that can be championed by all of us through public health policy. Advocacy is in our lane, and that includes things like paid family, leave high quality education for all children, and access to health care – and not just for kids, but for their parents and caregivers as well.

We should also be comfortable integrating psychologists and mental health providers into physical health settings. They can be immeasurably valuable in both primary and sub-specialty care settings and can be trained to teach patients coping strategies and mindfulness techniques to help improve mental health and well-being when facing adversity in their daily life.

Finally, building robust longitudinal and authentic community partnerships is key. We must resist the urge to colonize marginalized and minoritized populations, especially those experiencing the burden of health disparities and ACEs. Rather than trying to lord solutions over communities, we should be investing in grassroots partnerships, money, time, and energy, allowing communities to develop their own solutions that we can support through those mechanisms to improve the conditions and lived experiences of children and families who live there.

Watch the full webinar below. For more information, visit the ACEs Aware Health Equity page.

Take the Survey

We would like to hear from you!

Take our Survey