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PACEs Champion Flojaune Cofer drives public health policies to prevent ACEs in California


Dr. Flojaune Cofer is an epidemiologist who wants to improve health and prevent trauma, racism, and inequity in communities throughout California. That’s a big charter, but since 2019, as senior director of policy for Public Health Advocates, she’s making progress with a team focused on public health prevention and restorative justice initiatives. Those initiatives include My Brother’s Keeper, for boys and men of color, and All Children Thrive, which works with 20 cities to prevent youth trauma and foster child well-being.

Cofer learned about the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study) in 2004 while in graduate school at the University of Michigan School of Public Health, where she earned a doctorate in epidemiology. The conclusions drawn from the data in the study made her aware that “we needed to think from an intergenerational level, if we really want to disrupt the cycle of trauma.”

Her first reaction to the seminal ACE Study? “This makes sense. It gave me the language, data, and framework for talking about my own experiences. It also provided the framework for describing the patterns we’re seeing now so that we can help children.”

Cofer’s interest in public health started when her father died of congestive heart failure when she was 11 years old. She said that “people like me started to lose grandparents, uncles, other family earlier.” Her father smoked Newport cigarettes, which were deliberately marketed to African Americans, and she and her mother had asthma.

“Over time, I became interested in public health because I wanted to understand the patterns I was seeing and what could be done to disrupt them,” she explains.

Cofer earned a bachelor’s in chemistry at Spelman College, followed by an MPH in Epidemiology at the University of Michigan in 2006 before going on at Michigan to earn her PhD in epidemiology in 2010. While doing graduate work, starting in 2008, and up until 2019, she has spent summers working with youth in a settlement outside of Durban, South Africa, for TRG International. Over the years, she learned the Zulu language, which includes three different click sounds for the letters Z, X, and Q, and is spoken by 12 million people.

Her first policy job after graduate school was with the California Department of Public Health, as a contractor with UCSF, promoting the health of women of reproductive age by helping communities implement new legislation regarding protections for women’s health. Among its achievements, its recommendations for reproductive health, including free birth control, were included in the preventive services for women that were enacted in 2012 as part of the Affordable Health Care Act.

In her work with Public Health Advocates (PHA), which she joined in 2017, she furthers the agency’s goals to bring a public health lens to pressing problems by helping communities pass laws, reform systems, and establish norms that foster justice, equity, and health. Founded in 1999, the organization has accomplished many firsts in the nation, such as the first to sponsor legislation addressing childhood obesity by banning sugary drinks in all public schools along with junk food by 2005, to encourage funding the CDC’s Diabetes Prevention Program in Medicaid, and developing the proposal to make Sacramento the first city in the nation to redefine public safety to include youth-focused prevention

This year, All Children Thrive, a PHA initiative that was initially funded by the state in 2018, received an additional $25 million in state funding for the next five years to prevent ACEs and foster individual and community healing and resilience. The campaign is a partnership with UCLA and brings together community members with city staff and elected officials to create policies to address conditions underlying childhood trauma.

For All Children Thrive, says Cofer, “ACEs is at the root of what we do. Every city has a coach, and we do the onboarding, talking about the importance of ACEs. We help the coach and teams frame the issues to better understand the science of trauma, racism, and structural disparities in historical and political context.

“Most people want to default to programs because society is structured to be reactive. Prevention, on the other hand, involves changing the structure of how we do things.”

She points to the example of the medical profession—a field she originally wanted to enter, but then realized she could only help one person at a time and only after they got sick: “Public health asks: How do we keep you from getting sick in the first place?”

“What would it look life if children had safe environments, were engaged in how cities were structured, and lived in affordable housing?” she asks. The prevention approach to public health reframes issues to identify root causes and develop policies that support families and help them lead happy lives.

In its third year, more work needs to be done before expanding the All Children Thrive model nationally. Already, a few similar models are in place with PHA partner UCLA in Cincinnati, Philadelphia, and other cities throughout the U.S.

Cofer does admit that as for public health initiatives, “California often is ahead of other US states. But we look terrible when we compare ourselves to other industrialized nations.”

If anyone can be integral to disrupting the patterns that lead to bad health outcomes, childhood trauma, racism, and inequity, it’s Flojaune Cofer.

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