Evidence-Based Policymaking (with Julianne McCall)

In this episode, Co-Director of the California Initiative to Advance Precision Medicine Dr. Julianne McCall talks with a student from the UC Riverside School of Public Policy about scientific and evidence-based policymaking.

FEATURING Julianne McCall
February 16th, 2022



In this episode, Co-Director of the California Initiative to Advance Precision Medicine Dr. Julianne McCall talks with a student from the UC Riverside School of Public Policy about scientific and evidence-based policymaking.

About Julianne McCall:

Julianne McCall serves as Co-Director of the California Initiative to Advance Precision Medicine, housed within the California Governor's Office of Planning and Research. In that role, she oversees cross-sector health policy working groups and projects, research grantmaking, and state government interagency efforts, which include serving on Governor Newsom's COVID-19 Testing Task Force and as a writer of the forthcoming CA Surgeon General's Report on Adverse Childhood Experiences.

Learn more about Julianne McCall via

Podcast Highlights:

“We don't see the world objectively; that's why we have tools, censors, devices that are detecting phenomena at granular levels that we are completely blind to.”

-       Julianne McCall on the topic of human nature in research and policymaking

“The distribution of a finite resource that matters the most.”

-       Julianne McCall on the role and importance of funding in regards to research and solutions to problems. 

“A number of Americans and Californians have this lens within their faith communities, within a goodwill or golden rule framework, and ensuring fairness is top of mind for many folks.”

-       Julianne McCall on the topic of equity when it comes to solving real-world problems.


Julianne McCall (Co-Director of the California Initiative to Advance Precision Medicine)


Kevin Karami (UCR Public Policy Major, Dean’s Chief Ambassador)

Music by:

C Codaine

Commercial Links:

This is a production of the UCR School of Public Policy:

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  • Transcript

    Kevin Karami: Welcome to policy chats, the official podcast of the School of Public Policy at the University of California, Riverside. I'm your host, Kevin Karami. Join me and my classmates as we learn about potential policy solutions for today's biggest societal challenges. 


    Kevin Karami: Joining us today is Dr. Julianne McCall. I chatted with her about evidence-based policymaking. Dr. Julianne McCall serves as the co-director of the California initiative to advance precision medicine housed within the California Governor's Office of Planning and research. She's also an instructor for the science to policy program at the University of California Riverside, which is founded on the idea that scientists can and should play a critical role in Public Policy. Dr. Mccall, it is an honor to have you on today. 


    Dr. Julianne McCall: Thank you so much for having me Kevin it’s my honor to be here. 


    Kevin Karami: I'm really, really looking forward to this episode. But to get us started with our first question, I want to focus on you and your background. Your journey for research to policy. Your background is based on scientific research and that's where your focus was on. But there was a shift to policy and policy making and how science is critical and plays a critical role in policymaking. So can you describe your journey from research to policy and what were your motivations throughout this journey and what was your thought process? 


    Dr. Julianne McCall: Thank you so much for a kind first question. I like many people got into science to make a difference in the world. You can't help but be a person in society and see that there are so many challenges and new solutions needed. In my case, it was growing up with a kid sister who is developmentally disabled, requiring surgery after surgery. Non-stop revolving door of therapists and doctors. I got into research already as a 16-year-old shadowing a neurosurgeon at the Cleveland Clinic. Just wanting to learn more about that world and how research funnels into medical practice and surgical strategies and such. It was it was pretty early on I had my life's mission cut out for me. It's not something I would ever wish on my worst enemy to have a family situation that was so fraught, very in and out of the hospital regularly, but there's never been a single day of my life where I didn't I didn't know what my purpose was. I was fortunate after graduating with a PhD in neuroscience from Heidelberg University, to have gotten a fellowship with the California Council on Science and Technology, essentially like a National Academy of Sciences entity, but specific for California. They were in their eighth year of bringing PhD scientists across the stem fields into the California legislature. Providing that lens for policy analysis and research and the routines and you'll build processes. And I was hooked first day. I think my feet aching, I was smiling so much with the joy of feeling like I had found my people. And I know many of the alumni have similar, similar stories. Yes, I really take inspiration in terms of using the scientific training for policy application from the California senator Alex Padilla, former Secretary of State. He also trained as an engineer as an undergraduate and has a statement when people challenge him of why, Why is he wasting his engineering degree by going into policy? And he turns that around and he says, I got into engineering to solve complex problems. And that's exactly what I'm doing in the policy world. I like to think I'm following suit. 


    Kevin Karmi: Thank you for that. And actually, the California Science and Technology Institute we had an episode with Dr. Jun Bando previously at the end of last summer. It was an amazing episode. We had a great discussion. Like you mentioned, I think it's really important to emphasize that divide that you kind of alluded to that exists. You know, a lot of people might assume that you're on the research side, that you shouldn't have a say in policy and policy making. Its the opposite. These are some of the most, these are the experts. They know the ins and outs of climate change or about energy and all these different other important issues and topics that affect all of us. I guess with all that said, this kind of transitions perfectly into the next question. What is the importance of evidence-based policy making? Why should we care? Why is this something that we should all be interested in and invested in? 


    Dr. Julianne McCall: Really great question. So science is nothing if not humbling. I remember my first year of my PhD program. It's thought that I had detected a pattern in regrowing adult neurons after an injury. I was so convinced that the factor that I've added to the media in the cell culture dish was making the cells grow farther than, than, than the negative controls. So much that I even told my PI told my professor. He was thrilled and he said, We'll make sure you get the numbers and we'll look at how significant the effect is. And I stayed, I stayed all night, measuring, measuring those neurites, making sure that I was capturing every single neuron on the play to not miss a single one. And sure enough, it wasn't at all significant. It was it was barely a trend at all. So that's just one example of a larger facet of human nature that we don't see the world objectively. That's why we have tools. That's why we have sensors and devices that are detecting phenomena at granular levels that are completely, that we are completely blind to. In policy-making. The world is changing so fast, so fast. I feel like the same person I was five years ago. But the environment is not the same as it was five years ago. And without these detectors, without these sensors, without the data to backup, how things are changing. And the evidence-based projections that allow us to plan for the future are absolutely essential in all sectors, but certainly in policy where the impacts to the public. So potentially expansive. So yes, the world is dynamic. Climate change is accelerating by some projections. Here in Sacramento where I live and work. We had, we had the most rain in a single day just a couple of months ago. But we are still in a severe drought. It's mind-boggling and it's not just, it's not just environment, it's also our health, pandemic shown us that we are not, we are not impenetrable to the forces of nature when this tiny little lifeless virus evolves out of one vehicle or another, it some are our entire society comes to a halt. So we need that evidence-based policymaking machine to keep track of the trends and patterns happening in the real world. In order to not only keep up with the world in terms of policies that keep up with how the world is changing and how society is changing. But also to be able to plan for the future. And I'm extremely fortunate that the office that I work in, the Governor's Office of Planning and Research specializes in just that, the long-range planning and research to ensure that California has the tools available in Californians have the tools and resources available when they need them. 


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    Kevin Karami: Thank you for sharing.I think that you do a really good job of explaining exactly why it's important. But on that note, I think this kind of raises an obvious question. There is obviously a lot of research done on particular climate change and its effects. You even mentioned that there are studies that show that it's getting worse and accelerating. Scientists are saying that we don't have as much time as we might think we do. And then you also have, you know, with COVID vaccine, these topics and all this evidence. Sometimes so much you would think that people would be convinced that there's something going on. Yet there's a large sect of the population that doesn't believe in climate change or downplays its impact on the environment, on the planet. And the same with the vaccine. For the COVID vaccine. There are people who don't believe that the vaccine works or that is, it has a different purpose or whatnot. So when you have such a large number of people that You know, deny the evidence directly. As an expert, as a researcher, as a scientist, what is your response and what should you do? And then from, from the average person's perspective, what can we do when we see these people deny the experts and deny the evidence? Is there something that we can do? Is there a discussion that needs to be had? 


    Dr. Julianne McCall: Really, really great point. The misinformation and disinformation that's running rampant through the US, keeps me up at night like it, like it does so many, so many of us. The fact that we can have a world of alternative facts when the evidence, like you said, you know, are, the evidence is so clear. National Institutes of Health, let me give you an example of National Institutes of Health in Bethesda, Maryland have acknowledged their blind spot in, in developing the vaccines, in distributing the vaccines. A blind spot in the behavioral implementation inside of the vaccine rollout and the vaccine disinformation they've committed in the future. It's not exactly helping right now as much as we would all hope. But in the future they would have greater investment in the implementation science is a relatively new field, at least in my world. I'm sure it's been around forever. You scientists tend to shout it from the rooftops and feel like nobody's listening for too long until, until we all start listening. But in terms of investing in implementation science, recognizing that human behavior is one of these factors, one of these variables that is as significant as whether the mutation causes the disease or the therapeutic agent relieves symptoms. Or you name the challenge implementation science of rollout, getting the right treatment, prevention, diagnostic measurement tools to the right people, to the right areas at the right time. This is almost the definition of precision medicine. We could do a better job of connecting our scientists with our communities. First off, this is a big theme that my program in particular, initiative to precision medicine, continues to champion. One story, one anecdote from graduate school as well. Where was I was in Columbus, Ohio Summer Program hosted by the National Institutes of Health on spinal cord injury surgical techniques. As part of the summer program, we had a speaker who herself had spinal cord injury. A scientist who had conducted this meta-analysis, thousands of patient surveys asking patients with spinal cord injury if they had a magic wand, among many other questions. But if they had a magic wand, one of their physiology what would they change first. She compared the responses of those surveys to the federal portfolio of research funding for spinal cord injury just to see how they would align or not. Unsurprising, unsurprisingly from an able-bodied person. The vast majority of federal funds were going to support motor and rehabilitation, motor and sensory rehabilitation research. We as a whole, we look at people with spinal cord injury and we say, boy, and I'm sure they wish they could walk. I'm sure they wish they could write a letter to their loved one, et cetera, et cetera. Compared to the thousands of surveys, survey responses, the vast majority of patients would have prioritized their bowel and bladder function rehabilitation because that's what was holding them back from, from having a more normal life, from feeling okay, leaving their apartments and not risking having an accident that would be terribly embarrassing. Or for some patients who can't detect when they need to release our waste products. Not having to worry all day long about getting septic shock from their own waste products in their own bodies. And so you cannot imagine a further disconnect from the research and what the patients actually wanted and needed. I think, you know, I don't ever want to blame the current misinformation landscape on any one player. It's way too complex for that. It's not just the people who are believing misinformation and these alternative facts. And it's not just the scientists. A lot of people say, well, scientists should do a better job of communicating. They should do a better job of this. Not all governments fault. There are so many programs I had personally know the person in the White House who is leading the vaccine rollout. He was originally. California Governor's COVID-19 testing task force co-chair. Just a brilliant, brilliant physician, leader in his own right. And so it's not just governments shortfalls, shortcomings. It will take all of us, it will really take all of us. I think from a scientific perspective, understanding that, that investment in implementation science and understanding the behavioral aspects of your long-term goals is, as I mentioned before, as essential as your negative controls is as essential as your understanding the molecular underpinnings of your disease area. 


    Kevin Karami: Thank you so much for answering a rather difficult question. I understand that can be very difficult. And I think that the way you brought up implementation science, and that's something I've never heard of. I think it's really interesting that there is an entire field on not just, it's not just the data and the evidence is there and obviously very important, but can be actually applied to the real-world is also equally as important because like you mentioned, what good is that research and what good is all the amazing things that these scientists and physicians and doctors are doing. If it can't be utilized to help real people in the real-world. That being said, I don't think misinformation is the only concern that exists when it comes to policy-making or evidence-based policymaking. Are there any other major issues that you think exist when it comes to implementing policy that is evidence-based and that is backed by research. And that is helpful for people, or do you think misinformation and disinformation are the only ones? Maybe you can rank them in terms of which ones you think are the most important to focus on. 


    Dr. Julianne McCall: Oh boy, I could talk to you forever, Kevin, about this topic alone. I was really inspired by, I think it was a 2016 report by the Commission on evidence-based policymaking. It's Commission was convened under the Obama administration with bipartisan backing from Senator Patty Murray and then Representative Paul Ryan. I believe it made the point that the report and the countless recommendations made the point that we need government to work better with researchers, be able to link datasets in a way that still confidential, that is still secure and still maintains the integrity of people's data privacy. We need real-time information and we need it to be in combination. We have, I mean, how many thousands of databases exist out there, just in the public sector alone. But the data are in different formats. You're lacking the opportunity for interoperability, a term that I hear at least ten times every day. These days. You are lacking the infrastructure. Getting more and more data in this era of big data, more and more costly to secure them and store them, store the data in a way that can be maintained sufficiently. It's also, it also requires a culture change in government. And President Biden just released for public comment actually might be already a month ago. A learning agenda for how you inspire agency leaders at the federal level to look at trends and shortcomings and identify areas for quantitative measurement to ensure that the decisions at the federal agencies are aligned with the intentions of the policies in place. It's tough. It's a significant culture change. I wonder if you're not familiar, there's, there's an organization called the Copenhagen, Copenhagen Consensus. I want to say it has the engagement of i don't know, almost ten Nobel Laureates in economics. And one of the many projects they do is looking at all of the challenges in the world. Basically costing out how expensive it would take to address certain challenges. For example, malaria or blindness due to cataracts or malnutrition. And found that they can cure malaria for some amount of money. They can cure blindness from cataracts or some amount of money they can treat or cure other conditions. For some amount of money and the policymakers, I want to say it was a UN meeting, went up to the founder and president of the Copenhagen Consensus and said, You know, I really don't like that. My priority, my priority area was ranked 20th, you know, in your list of priorities. But I respect the method. Policymakers they have their own They they bring their own lives to the policy-making machine. When you tell them something that is not in agreement with what they have announced publicly over and over and over again is the number one priority. It takes some diplomacy to make sure that that is that's a point that's agreed upon that they understand the methods underlying that it's not just one person or one organization versus another organization or person, that there's actually some data underlying that. They understand how the data were collected and analyzed. I could keep talking. The State of California is undergoing a transformation that are under the Newsome administration to use data far more effectively. I can speak best about the Health and Human Services set area of government. The Department of Health Care Services, for example, is the administrator of California's Medicaid program. That is the public insurance, public health insurance for low-income Californians. Its supports, I want to say around 12 or 13 million Californians. It's a ginormous program. They conducted. This is best. This is what I'm sharing with you as best practices. They conduct, they invested some money to conduct pilot projects in reorienting their focus toward the social determinants of health. If you're unfamiliar, social determinants of health include your housing conditions, your access to transportation, access to nutrition, nutritional foods, education level, income level, environmental exposures, right? If you live in a polluted area, for example. The social determinants of health are vastly more predictive of your current health status than your genetic code. To the tune of one to seven. So 85% of your health can be predicted with some significant regularity just by the social determinants of health compared to 15% from your genetics. So I am just like in awe of how quickly they've been moving. They created this program called Cal-Aim, which seeks to bring in more information reflective of the social determinants of health in order to better provide supports and services to Californians with the public insurance plan. If you're unfamiliar, there's a brilliant TED Talk by a physician named Rishi Manchanda. He is a leader of what's being called the upstreamist movement. If you're familiar with the stream analogy, if you see people drowning in a river or a stream, without question, you jump in and you're saving lives. You're pulling them out of the river before waterfall or somebody like this. But if your many people, you have at least one person run upstream to figure out what is causing people to fall into the river or a stream in the first place. This Dr. Rishi Manchanda, is one of the leaders trying to shed light on not only the social determinants of health that I listed before, but also the impacts that long-lasting impacts of racism and adverse childhood experiences and other forms of discrimination that have the capacity to embed themselves in our biology and impact our physiology for the long term. 


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    Kevin Karami: Thank you so much Dr. McCall for such an extensive answer to again, another very difficult question. from someone who doesn't have that background in science and research. I think one of the misinformation and disinformation with that area is usually the most common issue that we see. But you just you just explained a plethora of other issues that most people might not even know exist. One of the ones I think that was most interesting was the way scientists and researchers or people from that sector have to interact with people in government. That diplomacy is can be really difficult. At times. I immediately thought of when we were talking about. When Mark Zuckerberg was called in and the questions that he was asked, where sometimes so made you think that these are leaders and it just made you question their expertise. And obviously the expectation isn't for them to be the expert on social media and data and all that. But it does make you think about how well, how invested, not only them but their teams. And it really makes you question the role they played. But then the other issue is you also mentioned obviously the cost and money is always going to be a factor in this area. But then also the, It's something that I also didn't know about was the data management and data storage issue. You talked about how the age of people say Where the age of information and data is the most useful, the most useful asset for so many companies and it's becoming more and more and more and more important. And companies are utilizing it for somebody's purposes. And so that's just to name a few of the issues that you mentioned. And so the fact that all of these problems insists unknowingly for the public, is kind of concerning. Most people, like I said, probably assume that the biggest issue is just misinformation. People don't want to accept that climate change is real or whatnot. But then all these other factors exist. I think that made me a followed by half to that is, I'm gonna use climate change as an example, but you could use other examples too. Even if we do have, we have the evidence seems overwhelming evidence of it existing. We have, let's say we have government officials and people in power that believe it exists and that wanted to do something about it. But then the issue of money always comes up. From your perspective. How is that specific problem? What is the way we address that issue? Even if we have people that want to cause, want to have positive change, want to promote greener energy, want more solar panels or wind turbines or other, other amazing ideas. Hey, you know, when, when money is the issue and the issue isn't  Everything else we talked about? What is the approach we need to take? Also, have these approaches ever been utilized by governments? Maybe, maybe not by the US maybe, by foreign governments? 


    Dr. Julianne McCall: Yeah, there's a lot in that question. I loved that they California's fourth Climate Assessment that came out a few years ago, was broken up by region. Acknowledging that California is not a monolith. In fact, it's a vibrant, diverse set of communities, each with their own unique flavor and culture. Understanding that all of these policies that are coming from a state-level tend to have baked into them and adaptability to certain circumstances, whether its geographic or otherwise. The regionalization. And that's something that I can give you some credit with UC Riverside, the science to Policy Center at UCR is an absolute leader in thinking in this way. They've connected with Palm Desert Center. They've coordinated a report on solar net meter, net metering and looking at the re-greening, the rewilding of golf courses. These are issues that impact people in Riverside and the adjacent communities. And that's what it takes. It takes the local scientists with local communities and community organizations and local policymakers to actually make that change happen. Because people in Sacramento, it's hard for them to understand exactly what that's like. They have thousands of other problems and priorities that they're constantly dealing with. That localism, that regionalization of science, policy, guidance and support are critical, I think, for moving forward in an evidence-based way. When it comes to data, You mentioned that your data is driving so much of society. It's not, it doesn't stop at data, data informed information. You can think of two data points that are not yet connected and the information is something like this dot is blue and this dot is green. Once you have several more dots to be able to connect them is some kind of insight like, oh, maybe there's a pattern here. But let's stop after insight is knowledge. How are they connected? How does one lead to the next, to the next? And then from knowledge you have wisdom, right? The ability to anticipate, project, and truly understand the underlying mechanisms of that trend. I've got myself off track. What was your main question? 


    Kevin Karmi: Yeah, no worries. The main question was on the issue of money. Even when we have a situation where people in power want to address these issues. And I use climate change and an example but its not the only example, we have people who want to address these issues. What, when, when money becomes the main problem, what is the solution? What are potential passes solutions, and also, have they ever been utilized at a local, state, or national level? 


    Dr. Julianne McCall: Thank you. I appreciate it. I'm getting us back on track. Yes.Money is the universal currency literally in policymaking. When you have 39 million constituents, they have 39 million times a 100 problems. The distribution, the distribution of a finite resource that matters the most. And I think this is something that scientists and engineers would be wise to incorporate into their understanding as well. That it's not just presenting a good idea. It's presenting a solution that considers the different lenses of a policymaker, that includes the economic lens. You might have the greatest, most sophisticated solution in the world. But if it costs a billion dollars for one household, to give a ridiculous example, it's just not feasible, That's never going to be scalable. There are other, there are other lenses. Let me see if I can remember all five of them. There's this brilliant book. I wish I had the author's name top of my mind. Understanding environmental policy where the author professor lays out five lenses. One is the economic lens, the other is the political lens. Recognizing that politicians, they are always aware of their status with their constituents and their chances for re-election. I'm also just the nature of policymaking. There's not it's not just a legislative process, It's also a judicial process. You can challenge a law in court to change an interpretation. Then of course, you have your executive actions like an executive order coming from the executive executive branch without legislative oversight? Well, there is oversight, but you know what I mean? There's also the scientific lens. How well-founded a solution is? Also the technology lens. Do we have the capacity to implement this policy idea? If, again, in the lab, if you're able to reduce pollution in a fume hood. Well, great. But it's not like we can put the entire atmosphere inside of a fume hood. We need to really think of the technological implications. And then the last one is a moral lens. A number of Americans and Californians have this lens within their faith communities, within a goodwill framework, a golden rule framework, and ensuring that fairness is also top of mind for many folks. The scientific lens is just one of those five lenses that a policymaker is constantly juggling. Also wanted to mention, right? So in terms of climate change, so a lot of the research, a lot of the research in climate change and elsewhere is not always leading to policy recommendations that are feasible. Which is difficult for a policymaker to receive, digest, and translate into real-world policy. I can give, I can give an example from the health world, at least. If you have $5 million for Parkinson's patients, people with Parkinson's often have a real stunted gate. They can't move very fluidly. And it's neurodegenerative. You could invest $5 million in research to better understand if there's maybe a potential experimental therapy that would reduce the symptoms of Parkinson's. Or you could spend $5 million building ramps up to every public building in a certain region of California. There is no research telling you what is the best investment. Those are the policy decisions where the research is lacking and could be bridged. There are some examples, like for climate change. The UC Institute for Transportation Studies has built itself up to be like a rapid response team of scientists and engineers for the legislature when they do have questions about transportation policy, regarding climate change or otherwise, for them to pose questions like I just gave an example of. And have the scientists gathered whatever science. And evidence is readily available to better inform that decision-making process. I'll say one more thing about climate change. It's not just not just an environmental disaster. It's appending social disaster as well. And so my office, Governor's Office of Planning and Research, once again, is investing millions, hundreds of millions of dollars into affordable housing within communities that are resilient. Boosting the resilience when you have your social cohesion. When you have people who are housed rather than unhoused, when you have people who are not breathing in pollution, right? They are more capable of orienting their focus and resources toward more using recyclables and being more considerate of which light bulbs they buy at the store. When you have as many people as you do in California living in poverty and violent neighborhoods. In some, in some communities. There's no way you can expect them to think about the environment when they're thinking about their own safety. I know that was in Switzerland. They were playing around with an idea of a universal basic income specifically to address climate change. Because it is exactly the reasons I just laid out when they knew that, when their citizens were concerned about you know economic strain, they were not thinking about whether they're reusing their bags or you're taking the train instead of their car. And sum, all the other life choices that we individuals can, can have an impact with 


    Kevin Karami: Thank you so much. And I think that you made at the end was really, really powerful. That climate change isn't just about the environmental issues, but the social problems that cause it. It's not just the pollution at how the pollution effects the people living in a specific neighborhood. It's not just a forest being cut down as how that impacts a community and how the people that are directly impacted and what the response is. You mentioned affordable housing and so many other examples. I think that's a really important point to also remember. You've been talked about earlier about how many different lenses that we have to look at. These issues are so complex that sometimes it becomes difficult and we get this kind of tunnel vision. We focus on one aspect. We forget about the other ones. We will focus on the economic and we forgot the research and the political we focus on the research that we forget about. Well, how is it going to be implemented as feasible? There's so many factors to consider that it goes back to a point you made earlier about community and that this isn't something that one person or even one group can consult. These issues are so complex and it really takes people with different backgrounds and different expertise, different ideas to kind of come together to solve. As we approach the end of our discussion, I do want to ask you a question on a topic that we haven't really touched on, but haven't asked or discussed directly. And that's the social barriers or the barriers that exist in our society in terms of medicine and health equity. So we kind of briefly mentioned this, but maybe we can dive a little bit deeper. How can we achieve equity in medicine and health throughout society? What kinds of barriers exist? The bain ones that we need to be focusing on to overcome to maybe reach a point where at least the majority of people have access to some form of affordable medicine. 


    Dr. Julianne McCall: The perpetuation of inequities and exacerbations of health disparities, especially from things like the COVID-19 pandemic and climate change. These are the topics that hit all of us so hard, especially in the policy world and in community organizations, that drive us to work around the clock sometimes in order to address them. Such a complex scenario, it's not just a matter of changing one thing, of course. When we look upstream though, like I mentioned before, when let me get, let me give an example. I think the Surgeon General of California, California's first ever Surgeon General, Dr. Nadine Burke Harris concludes her three years as Surgeon General today. In fact, February 11th, 2022. And she has been the ultimate champion of shedding light on adverse childhood experiences, otherwise known as ACEs and toxic stress. The impact of childhood trauma. We wrote a whole report on this. Surgeon General's Report of California came out in December 2020. It is publicly available for download. It understands that different sectors will have different approaches to prevention. Prevention of aces, prevention of disease and disorders prevention. You name the social or health condition. We read thousands of articles, we read thousands of research to boil down into terms for a general audience, how one would approach the prevention of adverse childhood experiences. For those, if you're unfamiliar aces not only causes your mental health challenges throughout the lifetime, you if you have an exposed to four or more different categories of abuse, neglect, or other household challenges, you're about 30 times more likely to be diagnosed with depression sometime in your life. But what is less known is the physical health impacts. If you've been exposed to four or more ACEs before the age of 18, you are about 11 times more likely to develop Alzheimer's disease in your lifetime. You are two to three times more likely to have a cardiovascular event like a stroke, you are two to three times more likely to be diagnosed with certain types of cancer. And it's not just because of the riskier behaviors that result from childhood trauma. It's also the impacts the trauma had on your organs, not just your brain, but your digestive system, your immune system. People with aces tend to have infections at higher rates. This is magnificent problem. There's been a really elegant studies at Johns Hopkins and elsewhere on positive childhood experiences. So instead of aces, it's PCE. Showing that when you have a really close protective relationship with an adult who's not your parents. When you have a feeling of belonging in school, when you feel safe in your neighborhood, when you can connect with your neighbor in a significant way. When you have these kind of protected and buffering factors. It has the potential to outweigh the negative outcomes of a background with childhood trauma. It is just magnificent how powerful these positive childhood experiences can be for one's physiology and long-term health. In terms of the original question of how do we get to equity and reduce the barriers? From a research point of view, you need to be aware of the real-world. You need to think outside the lab and actually connect with the people that you are purporting to serve through your science. You need to understand everything they're going through. The most vulnerable Californians don't speak English, then you know that English curriculum that you developed for healthcare workers or community health workers is not going to be helpful. You need to go the extra step and translate that curriculum. That's for the researchers, for general public getting engaged in some of these advocacy organizations that speak for and amplify the issues that are challenging the most vulnerable and underserved areas and communities of California. Speak up for them. Write a letter to the editor of your local newspaper to ensure that those priorities are amplified. Because oftentimes, it's not like they can't speak for themselves. But when you are living on such low-income and going from job to job, three shifts in a row or something like this. The last thing on your mind is writing a letter to the editor or joining a community advocacy organization to travel to Sacramento to talk to policymakers. It will take all of us researchers definitely have a role to play. Universities like UC Riverside and it's science to policy program. Giving that policy lens to stem trained PhD scientists and engineers is absolutely crucial to give them that big picture understanding of how the world works, where the gaps are, how we can address those gaps, and how we can bring change to society. 


    Kevin Karami: Thank you so much, Dr. McCall for wrapping it up in a perfect way. And also on a positive note, we talked a lot about the issues that existed, difficulties in some of these things seem like they can't get resolved. But I think that is equally as important, actually, maybe even more important to emphasize that there are ways to solving. There are people and organizations. You've mentioned science and policy obviously, and there are other ones out there as well that are working to train scientists to be more aware of the policy aspect. And it's not just about that too. There are other factors to it as well. I'm making sure that people, people in power, the people that we elect in these positions of power. I'll also have that lens, the back of their minds when they're making a decision. When it comes to where to allocate money or whatnot, anything like that. So thank you so much. Dr. McCall for joining us, I had an amazing time discussing with you the importance of evidence-based policy-making in the world that science and research plays. In policy, It's such an important topic. Again, it's a topic that was important before COVID, but COVID has made it even more important than ever. And so thank you so much again, Dr. McCall it was an honor to have you on the podcast today. 


    Dr. Julianne McCall: The pleasure is all mine, Kevin, thank you again for the invitation. 

    Kevin Karami: This Podcast is a production of the UC Riverside School of Public Policy. Our theme music was produced by CCodeine. I'm Kevin Karami. Till next time.