Putting mental health, inequities of care atop the state’s health care ‘to-do’ list

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California Surgeon General Diana Ramos, MD, Puts Mental Health and Inequities of Care at the Top of Her Statewide To-Do List
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n August of this year California Governor Gavin Newsom named USC alumna Diana Ramos, MD, to the state’s surgeon general post. California is just one of five states that have their own surgeons general, which comes as no surprise to Ramos. “California leads the nation in health care,” she says.

The surgeon general is a proud double Trojan, first attending USC as an undergraduate, studying communications, then going to the Keck School of Medicine of USC to receive her medical degree. “It was a football game that got me hooked on USC,” she says. “Maybe that’s why I love football so much.”

We had a chance to sit down with her and ask her about her goals for improving the health of California’s citizens and addressing inequities in health care.

Q Governor Newsom has identified mental health as a priority for the state. Why is this so urgent?

A Mental health is one of the most pressing issues and one of the most prevalent. No one is immune. We need only look at our own data: 1 in 5 Americans will experience mental health issues in any given year. One in 6 children are experiencing mental health disorders. Fifty percent of us will have a mental health issue at some point in our lives. The opportunity lies in that 75 percent of mental illness starts by age 24. This is why the governor is pushing forward to identify and provide support for mental health issues.

People of color are disproportionately impacted by mental illness. Nationally, 37 percent of people of color will get help compared with 47 percent of the white population. We need to identify signs of illness early enough so we can hopefully change that trajectory. Mental health can also affect other health issues, such as diabetes and heart disease.

Q What strategies are you planning that can help with earlier identification?

A Our first priority is to help children and youth – up to age 25. We’re developing online training for teachers to recognize signs that students might display when they’ve had negative experiences such as abuse, neglect, discrimination, or poverty. Or signs that a child lacks food, or shelter, or witnesses domestic violence or drugs in the house.

Second, we are creating a public awareness campaign about adverse childhood experiences and how they might impact a child’s life. We see lots of opportunity to help turn this around.

Q How can mental health influence other societal issues?

A Mental health is that common denominator affecting all of us here in California and across the nation. If you look closely, there’s a lot of overlap – depressed and anxious people will often self-medicate with food, alcohol, and drugs. All of this builds to negative health outcomes such as diabetes, high blood pressure, heart disease, and gun violence. Many people who are committing gun violence have underlying mental health conditions. Many of the homeless have underlying mental health conditions. If we can provide assistance early, before conditions accelerate, then we can help change the health of the whole population.

Q How did your medical training and education at USC prepare you for the role of Surgeon General?

A USC has been foundational in helping me understand what health care should be. I was a communications and science major in my undergrad and learned the building blocks of what’s involved in communication – not just listening, it’s also organizational. In medical school at USC, in East Los Angeles, you are immersed in the heart of the inequities and disparities experienced by the patients. It’s an education. Knowing that patients were taking several buses to see you at the clinic builds in a humility as a physician. Some of my favorite patients came to me when I was at LAC+USC Medical Center. They take everyone. We had a whole ward for mental health initiatives.

And language was an important lesson. As a Hispanic physician, I felt lucky to be able to communicate in Spanish and hear patients’ gratitude that I could speak with them. In my role as adjunct faculty at LAC+USC, I remind students that we need to be grateful for our patients’ trust.

Q As an OB/GYN by training and practice, you have special insight into the needs around reproductive health care and health policy. What do you plan to tackle first?

A California is leading the nation in what the rest of the country needs to do to change. I don’t think folks realize all the opportunities we have here in California. There are so many programs that ensure women are healthy. Half of all births are covered by Medi-Cal. And one in three people in the state are covered by Medi-Cal.

That said, we are focusing on improving the perinatal outcome for maternal mortality in Black women. California has the lowest maternal mortality rate in the nation, but we still have work to do in the Black population. We need to ensure Black women are the healthiest they can be at the outset and then follow up with care postnatally. We’re already leading with access to the care; now we need to increase the awareness of what’s available and improve the quality of care provided.

In 2024, the state will start covering vasectomies. Few other states are doing that. We lead the nation.

Q You’ve had to give up practicing as an OB/GYN to take on this new role. What will you miss most?

A Direct patient care. I will still be faculty at LAC+USC, but I’ll miss making a difference in that one person’s life that’s right in front of me and being part of those happy birth day experiences. But now California is my one patient. I’m still asking people to reach out to me, to let me know what they need most.

Q What habits help give you the energy and focus you need as a physician and in this new role?

A Meditation every morning. I also try to walk every day and reserve some family time. But I make time for myself first so there’s enough of me to give to everyone else.

Q What three things do you most hope to accomplish as Surgeon General?

A I’d like to increase awareness of and access to the amazing resources we already have available in the state. I’d like to create innovative partnerships between private and public health. And I want to be a role model as a Hispanic woman for other Hispanic women to know they can make a difference and that you, as one person, can make an impact on the state of California.

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