Skip to main content

Parenting with PACEs. PACEs science & stories. Trauma-informed change.

ACEs teach us why racism is a health equity Issue: Dr. Flojaune Cofer (Part One)


Dr. Flojaune Cofer and Ben Duncan, each from public health backgrounds that focus on health disparities, addressed ACEs in the context of health equity for  their panel entitledACEs, Race, and Health Equity: Understanding and Addressing the Role of Race and Racism in ACEs Exposure and Healing. Cofer and Duncan co-presented to a standing-room-only audience on day one of the 2018 ACEs Conference:  Action to Access co-hosted by ACEs Connection and the Center for Youth Wellness in San Francisco Oct.16-17.

Dr. Cofer (pictured above, left) is the state and research policy director for Public Health Advocates in California. Mr. Duncan (pictured above, right) is the chief diversity and equity officer for the Multnomah County Office of Diversity and Equity in Portland, Oregon. They framed the session by focusing on the historical policies and social issues that have shaped contemporary society. And they described how they were intentionally designed to create the outcomes we live with today. They also offered suggestions of what we can do organizationally (internally and externally), individually and in communities - collectively to make our systems more equitable.

This will be a two-post summary with the first highlighting Dr. Cofer’s presentation and the second focusing more on Ben Duncan’s.

Who Is Missing from the Original ACE study?

“The people in the original ACEs study are disproportionately white, employed, and insured, college educated and middle income,” said Cofer. Among those who were not well-represented in the original ACE study, she explained, include:  

  • African Americans
  • Latinos
  • Asian/Pacific Islanders
  • Native Americans
  • Immigrants
  • People on Medicaid
  • People who are uninsured
  • People experiencing homelessness
  • Children

“We have to think about who is missing,” said Dr. Cofer, emphasizing that in thinking about who’s not included does not in any way diminish the findings of the original ACE study. It  was groundbreaking, she explained, in showing how often trauma is the “unspoken risk factor” for poor health and lack of well-being. She explained how rates of certain health conditions, such as diabetes or stroke, for example, often viewed  “through this lens of nutrition and physical activity,” which is incomplete. “We’re often not thinking about childhood trauma, and how this plays out not just in children but in adult outcomes,” she said.

And she circled back to the issues at hand -- race and equity. “We have to think about who is missing,” and ask, “How does  (ACEs science) exactly fit in when talking about people who are not white, middle class, employed and insured? What do the adverse childhood experiences look like then?’

Community Trauma & Safety

Community Trauma

“Safety is a basic need,” said Dr. Cofer, and when we think about community trauma (see slide), we have to think about it in a wider context. “Our sense of safety is shaped by how we’re moving around in the world where there may be needles on the street, community violence, where one can be harassed or discriminated against.” And we cannot limit our idea about community to immediate surroundings: “What happens in the wider community --  on Facebook or in the news, where people-of-color are questioned or shot while in their own apartment or cars or homes!” said Cofer.

For ACEs research and surveys to be more relevant to diverse populations and reflective of how racism plays a role in people’s experiences, health, and well-being, considerations about juvenile justice  involvement, foster care involvement, deportation, homelessness, food insecurity, disproportionate school expulsions, suspensions and bullying should be considered, suggested  Cofer.

ACEs surveys and research should include community trauma and adversities not in the original ACEs study which also impact a child's health and safety, said Cofer.  

"We’re not doing a complete job if we’re not thinking about your race and ethnicity - how race and ethnicity might impact your feeling of safety,” for kids with or without ACEs in the home, she said.


Also, we must look at ourselves, especially if we are in the dominant culture, to understand what racism is and how it works and how implicit bias can impact our work and those we work with.

Understanding Racism

“The new racism is to deny racism exists,” Dr Cofer said, which she said, is due in part because some believe only blatant racism, which she called, “Disney racism,” racism, she explained that is so obvious, unfair, and wrong that “even a 3-year old can pick up on it.” She said, many people are unaware that racism can take other forms, which she broke down as follows:

4 levels of racism:

  1. Personally-mediated racism (the blatantly wrong “Disney racism”)
  2. Cultural racism (Which group characteristics are valued? Who do we see as valuable or not valuable in the wider society? Noticing how some communities and culture are treated and regarded vs. how others communities and cultures are treated and regarded). 
  3. Internalized racism (when we believe the things, mostly negative, that have been said about our own group)
  4. Institutionalized racism (formal and informal policies and practices that perpetuate inequity, such as discriminatory practices and policies and structures). An example of institutionalized racism is the disproportionate marijuana-associated arrests of people of color, which Cofer said had  “nothing to do with marijuana use patterns.” For example, when arrested for marijuana some people-of-color went to prison and some were charged with felonies. However, even those who were not incarcerated or convicted, faced hardships or challenges with immigration, housing, employment, the child welfare system as a result of that institutionalized racism. Cofer explained that, “This is a type of community trauma we can’t ignore.”

“We have to think about community and historical trauma arising from systems and do it while recognizing how race and bias can be baked into our understanding of ACEs,” she said.

That’s something that also shows up as implicit bias.

Implicit bias, she said, shows up in  “attitudes and stereotypes that affect how we understand the world” and  are, often unconscious. For example, she said, split-second decisions that are biased against a particular group are reflective of the family and society in which we are raised.

Why is implicit bias so important? Because, explained Cofer, it’s not random, and often results in decisions that  “favor the dominant group.” Because implicit bias may differ from our stated beliefs, explained Cofer, we might not realize that it is  influencing us or shaping who and what we recognize, respond and work to remedy.

To make the point, Cofer compared two different headlines, one published after Tamir Rice, age 12, who lived in Cleveland, OH and was playing alone with toy gun when killed by two police officers, and another after Stephen Paddock,who was 64 years old when he murdered 57 people and injured hundreds others who were attending a concert in Las Vegas, NV.

One headline read:

Tamir riceOne headline read:

stephen paddock

“So what are the questions we ask,” said Dr. Flo when a black child (Rice) is killed? With Tamir Rice, “we asked about his parents,” even though “his parents were not the ones who killed him. He was playing alone in a park and killed by a police officer. “The relevant question is did the police officer grow up around violence” as opposed to how Tamir Rice grew up,”But that’s not the question we asked,” she said, which raises other questions such as, “Who is being portrayed this way and why?"

She said, “when a white man (Paddock) kills people we try desperately to try to find their humanity.... What ties them to us. When a child dies, who happens to be black also, we are looking for ways he deserved to die or was on his way to die anyway and that it’s almost good riddance to this kid we don’t have to worry about growing up and robbing you.” She asked us to ponder both headlines and consider bias, and the impact of it, as we read the news.

In addition to how differently people of color are portrayed compared with white people, she also suggested we keep another issue front and center in our movement work. “I want to point out that the ‘who is missing’ question is an important one to ask in all the work we’re doing,” Cofer said. “Every time in a room thinking about policy, strategy, even at the planning phase, It is important to point out who is not in the room, because if you do not do that, you’re setting up yourself to have some potentially major blind spots in the way in which you work”

She encouraged us all to look at ourselves, and our own organizations first before setting out to do work in other communities or organizations. “If you can't get it right within your staff, it's unlikely you're doing it in the work,” she said. The good news she pointed to is that, “When we talk about institutional racism, every one of you work in institutions,” and so change can be made by us as we make change in ourselves and our own organizations and institutions.

In Part Two, Ben Duncan shares tools, resources and stories to help individuals, organization and systems to be intentional about addressing racial equity.

Special thanks to Donielle Prince, Laurie Udesky, and Dana Brown. Donielle organized this amazing panel, helped keep racial equity top priority at the national conference, and wrote the introductions to both blog posts about this session. Laurie Udesky, who was busy writing throughout the conference and after, also helped others by editing lots of blog posts. Dana Brown, is always kind, generous, and brilliant. She helped monitor this large session, along with CYW staff, which enabled me to take a lot of notes.


Images (3)
  • Community Trauma
  • Tamir rice
  • stephen paddock

Add Comment

Comments (0)

Copyright © 2023, PACEsConnection. All rights reserved.
Link copied to your clipboard.