California Surgeon General: Opportunities for Equity

Within the first week of his tenure, Governor Newsom announced a number of health care actions, including an executive order to establish a California Surgeon General. We applaud the Governor’s decision to establish the position focused on a comprehensive approach to addressing health risks and challenges, including identifying social determinants of health and persistent inequities in the health of communities.


Today, CPEHN sent a letter to the Governor thanking him for his bold vision and outlining recommendations in order to make the most of this opportunity. We believe that the California Surgeon General can provide much needed leadership to eliminate inequities that have existed for far too long. While California has instituted components of this work across state government, including the Office of Health Equity, statewide vision and implementation is sorely needed. In order to actualize this vision, we recommend the following considerations for the California Surgeon General:

  • Provide authority for the California Surgeon General to work across state agencies and departments to identify the most pressing health disparities and implement cross-sectoral approaches.
  • Prioritize hiring a candidate with significant experience working with communities of color, LGBTQ communities, immigrants and persons with limited English capacity to future programs, initiatives, and investments are effective at eliminating the root causes of health inequities.
  • Collaborate with existing initiatives, including the Office of Health Equity in the California Department of Public Health and Health in All Policies Taskforce under the Strategic Growth Council, in order to maximum impact.
  • Provide for meaningful stakeholder input in the development of goals and activities of the California Surgeon General through the establishment of an advisory committee with consumer and community representation, drawing on the strength of our communities to effectuate real change.
  • Adequately fund and staff the California Surgeon General to be able to provide the infrastructure necessary for the importance of this work and include opportunities to fund community organizations to partner with and carry out the mission of the Office.

The Need for a Strong Focus on Health Equity

California is one of the most diverse states in the nation with a majority of its population, over 60 percent, comprising communities of color. The Latino community constitutes 38 percent of the state’s population while Asian Pacific Islanders and African Americans make up another 20 percent. Of the 14 million lives enrolled in Medi-Cal in California alone, an overwhelming majority of these individuals and families (80%) are from communities of color, with 30% speaking Spanish as a primary language. In addition, a majority of individuals enrolled in Covered California (66%) are from communities of color, with 10% speaking Spanish as a primary language. Shortly, the nation as a whole will see similar demographic shifts. By 2045, people of color will represent a majority of the nation’s population. Already 11 other states are at or close to a majority population of color.

California has been a leader in advancing health equity and expanding access to health care services under the Affordable Care Act. Yet we have a long way to go in living up to our promise of health for all. Persistent health disparities exist for communities of color, with no signs of decreasing without appropriate health system interventions that include a targeted focus on disparities reduction and elimination strategies. For example, in California Latinos and African Americans have twice the prevalence of type 2 diabetes and are twice as likely to die from the disease as non-Hispanic Whites.  The prevalence of current asthma among American Indians and Alaska Natives is three times greater than the state average. African Americans have exceptionally higher rates of asthma prevalence (40%), four times higher asthma emergency department visit and hospitalization rates, and two times higher asthma death rates than Whites in California. And, Black women and babies are far more likely to die that their counterparts.

In addition, mental health is a particularly pressing issue for communities that have faced historic trauma and discrimination and those who face current traumas related to immigration, community violence, and poverty. American Indians and Alaska Natives are 40% more likely than Whites to have experienced serious psychological distress during the past year, and though it is estimated that Asians and Pacific Islanders have a rate of serious mental illness similar to that of Whites, this overlooks important differences between Asian ethnic groups, with Native Hawaiian and Pacific Islander adults having the highest rate of depressive disorders among all racial groups.  

For these reasons, we are thrilled to see the Governor propose significant investments in initiatives that would reduce or eliminate longstanding health disparities, including screening both children and adults for exposure to trauma and rewarding health plans and providers for delivering better care. We stand ready to work with the Governor to implement these bold initiatives.