Surgeon General of California

Last updated
Surgeon General of
the State of California
Seal of California.svg
Seal of the State of California
Incumbent
Dr. Diana Ramos, MD
appointed August 25, 2022
Reports to Governor of California
Appointer Governor Gavin Newsom
FormationJanuary 7, 2019
First holder Dr. Nadine Burke Harris, MD
Salary$216,420
Dr Burke Harris, First Surgeon General of California Nadine Burke (38557973172) (cropped).jpg
Dr Burke Harris, First Surgeon General of California

The Surgeon General of California is the leading spokesperson on matters of public health within the State of California. The Surgeon General is one of only five State Surgeons General in the United States. The office was created on January 7, 2019, by Governor Gavin Newsom [1] and requires confirmation from the California State Senate. [2]

Contents

On August 25, 2022, Governor Gavin Newsom appointed Dr. Diana Ramos, MD as the current California Surgeon General. [3]

The first Surgeon General was Dr. Nadine Burke Harris, who served from February 11, 2019 to February 11, 2022. [4] [5]

The Surgeon General of California is one key component of the Governor's "California for All" agenda which includes a proposed $1.7 billion in funding for expanded early childhood education and early interventions.


Responsibilities

Top Priorities

Increasing Awareness of Toxic Stress and Adverse Childhood Experiences (ACES) [11]

Dr. Nadine Burke Harris has given many speeches and testimony to the impact of Toxic Stress on Children and how it impacts their future.

A PBS NewsHour opinion piece highlighted Nadine Burke Harris experience with Toxic Stress and how it is under-diagnosed in children.

A Washington Post video with Nadine Burke Harris explains Toxic Stress with powerful visuals and sound added to Dr. Burke Harris' explanation.

There are many websites and toolkits to better understand Toxic Stress and Adverse Childhood Experiences and their impact on health over a lifetime including ACES Too High, Harvard Center on the Developing Child,

Dr. Nadine Burke Harris has given multiple talks and had conversations [12] that have been made public and available to the public on Toxic Stress including a Ted Talk [13] that addresses Toxic Stress from a Public Health standpoint.

Trauma-informed care and Strengthening Resilience.

Necessary resources for medical, behavioral and educational professionals include resources to provide trauma-informed care. [14] Systems that work with children and their parents and extended families will need to create trauma-informed systems where the children and their families are supported by staff who are also supported while caring for survivors of trauma. [15]

A service system with a trauma-informed perspective is one in which agencies, programs, and service providers:

  1. Routinely screen for trauma exposure and related symptoms.
  2. Use evidence-based, culturally responsive assessment and treatment for traumatic stress and associated mental health symptoms.
  3. Make resources available to children, families, and providers on trauma exposure, its impact, and treatment.
  4. Engage in efforts to strengthen the resilience and protective factors of children and families impacted by and vulnerable to trauma.
  5. Address parent and caregiver trauma and its impact on the family system.
  6. Emphasize continuity of care and collaboration across child-service systems.
  7. Maintain an environment of care for staff that addresses, minimizes, and treats secondary traumatic stress, and that increases staff wellness.

These activities are rooted in an understanding that trauma-informed agencies, programs, and service providers:

  1. Build meaningful partnerships that create mutuality among children, families, caregivers, and professionals at an individual and organizational level.
  2. Address the intersections of trauma with culture, history, race, gender, location, and language, acknowledge the compounding impact of structural inequity, and are responsive to the unique needs of diverse communities.

Challenges of Children Traumatized by Systems

Children who come to the attention of the juvenile justice system [16] are a challenging and under-served population, with high rates of exposure to trauma.

Unaccompanied Migrant Children who may have Complex trauma [17] prior to encounters with systems like Border Patrol or the Foster Care system.

In a Q&A Dr. Burke Harris was asked, "Gov. Newsom has made funding early education one of his highest priorities. How do you plan on incorporating trauma-informed teaching into the overall effort?". In response she answered, "We’re understanding more than we ever had before the role of experience and environment in early childhood in shaping lifelong health outcomes. That is the data and research we are seeing across the board. So, when you look at something that is such a huge public health issue then we must recognize that to implement public health solutions we need to be engaging across sectors. So, in our educational system, in our health system, in our justice system — across the board — we need to have broad-scale and coordinated efforts to address the impact of early adversity on health and development. Healthcare and early education go hand-in-hand." [18]

Trauma as a Toxin or Public Health Problem [19]

"Imagine identifying a toxin so potent it could rewire a child’s brain and erode his immune system. A substance that, in high doses, tripled the risk of heart disease and lung cancer and reduced life expectancy by 20 years. And then realizing that tens of millions of American children had been exposed. Nadine Burke Harris, is a leading voice in a movement trying to transform our understanding of how the traumatic experiences that affect children, can trigger serious physical and mental illness, and looking at it using epidemiology, like John Snow did in 1800s London.

Decades of research that has found that children who endure sustained stresses in their day-to-day lives undergo biochemical changes to their brains and bodies that can dramatically increase their risk of developing serious health problems, including heart disease, lung cancer, asthma, and depression." [19]

History

The Surgeon General of California was first created with the signing of Executive Order N-02-19 [20] —one of the first acts taken by Governor Gavin Newsom on his first day in office—on January 7, 2019.

Governor Newsom appointed Dr. Nadine Burke Harris as California's first-ever surgeon general. She held office from February 11, 2019 until her resignation February 11, 2022, citing a desire for more time for her family and her personal wellness. [21]

On August 25, 2022, Governor Gavin Newsom appointed Dr. Diana Ramos, MD as Surgeon General.

List of Surgeons General of California

#NameServicePrior offices
1 Dr. Nadine Burke Harris February 11, 2019 – February 11, 2022none
2 Dr. Diana Ramos September 1, 2022 – PresentCalifornia Department of Public Health- Assistant Deputy Director of Chronic Disease Prevention


Related Research Articles

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

<span class="mw-page-title-main">Social determinants of health</span> Economic and social conditions that influence differences in health status

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

Dominic Cappello is a strategist, writer, designer, and educator. He is the creator of the Ten Talks book series published by Hyperion in 2000 and 2001. Ten Talks received national attention when Oprah Winfrey created a show around the book on sex and character in October 2000, featuring parents who had used the books' approaches to family communication.

Childhood trauma is often described as serious adverse childhood experiences (ACEs). Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse, witnessing abuse of a sibling or parent, or having a mentally ill parent. These events have profound psychological, physiological, and sociological impacts and can have negative, lasting effects on health and well-being such as unsocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Similarly, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Early childhood is a critical period in a child's life that includes ages from birth to five years old. Psychological stress is an inevitable part of life. Human beings can experience stress from an early age. Although stress is a factor for the average human being, it can be a positive or negative molding aspect in a young child's life.

<span class="mw-page-title-main">Transgenerational trauma</span> Psychological trauma

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary mode of transmission is the shared family environment of the infant causing psychological, behavioral and social changes in the individual.

<span class="mw-page-title-main">National Child Traumatic Stress Network</span> US organization to support traumatized children

The National Child Traumatic Stress Network (NCTSN) is an American organization whose "mission is to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States". According to its website, the NCTSN "offers training, support, and resources to providers who work with children and families exposed to a wide range of traumatic experiences, including physical and sexual abuse; domestic, school, and community violence; natural disasters, terrorism, or military family challenges; and life-threatening injury and illness."

<span class="mw-page-title-main">Nadine Burke Harris</span> Pediatrician and first Surgeon General of California

Nadine Burke Harris is a Canadian-American pediatrician who was the Surgeon General of California between 2019 and 2022; she is the first person appointed to that position. She is known for linking adverse childhood experiences and toxic stress with harmful effects to health later in life. Hailed as a pioneer in the treatment of toxic stress, she is an advisory council member for the Clinton Foundation's "Too Small to Fail" campaign, and the founder and former chief executive officer of the Center for Youth Wellness. Her work was also featured in Paul Tough's book How Children Succeed.

Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious illness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. The effects of this trauma can be experienced very differently depending on factors such as how long the trauma was, how severe and even the age of the child when it occurred. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.

Race-based traumatic stress is the traumatic response to stress following a racial encounter. Robert T. Carter's (2007) theory of race-based traumatic stress implies that there are individuals of color who experience racial discrimination as traumatic, and often generate responses similar to post-traumatic stress. Race-based traumatic stress combines theories of stress, trauma and race-based discrimination to describe a particular response to negative racial encounters.

Adverse childhood experiences (ACEs) include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The categories are verbal abuse, physical abuse, contact sexual abuse, a battered mother/father, household substance abuse, household mental illness, incarcerated household members, and parental separation or divorce. The experiences chosen were based upon prior research that has shown to them to have significant negative health or social implications, and for which substantial efforts are being made in the public and private sector to reduce their frequency of occurrence. Scientific evidence is mounting that such adverse childhood experiences (ACEs) have a profound long-term effect on health. Research shows that exposure to abuse and to serious forms of family dysfunction in the childhood family environment are likely to activate the stress response, thus potentially disrupting the developing nervous, immune, and metabolic systems of children. ACEs are associated with lifelong physical and mental health problems that emerge in adolescence and persist into adulthood, including cardiovascular disease, chronic obstructive pulmonary disease, autoimmune diseases, substance abuse, and depression.

Religious trauma syndrome (RTS) is classified as a set of symptoms, ranging in severity, experienced by those who have participated in or left behind authoritarian, dogmatic, and controlling religious groups and belief systems. It is not present in the Diagnostic and Statistical Manual (DSM-5) or the ICD-10 as a diagnosable condition, but is included in Other Conditions that May Be a Focus of Clinical Attention. Symptoms include cognitive, affective, functional, and social/cultural issues as well as developmental delays.

Adverse childhood experiences (ACEs) are identified as serious and traumatizing experiences, such as abuse, neglect, exposure to violence, substance use, and other harmful events or situations that occur within a child's household or environment. Unfortunately, exposure to ACEs within the child's community is all too common in low-income households and neighborhoods, with close to 43% of children in the United States (U.S.) living in low-income families. ACEs were first identified by the Centers for Disease Control and Prevention (CDC) and Kaiser Permanente's Adverse Childhood Experiences Study conducted from 1995 to 1997, where ACEs were examined and correlated with later-life well-being. With one in four children experiencing or witnessing a potentially traumatic event, children who grow up in an unsafe environment are at risk for developing adverse health outcomes, affecting brain development, immune systems, and regulatory systems.

Hispanic immigrants living in the United States have been found to have higher levels of exposure to trauma and lower mental health service utilization than the general population. Those who met the criteria for asylum and experience trauma before migrating are vulnerable to post-traumatic stress disorder (PTSD) symptoms. Higher levels of trauma-related symptoms are associated with increased post-migration living difficulties. Despite the need for mental health services for Hispanic immigrants living in the United States, cultural and structural barriers make accessing treatment challenging.

Diana Ramos is an American obstetrician and gynecologist who was appointed to serve as the Surgeon General of California by Governor Gavin Newsom.

Trauma-informed care (TIC) or Trauma-and violence-informed care (TVIC), is a framework for relating to and helping people who have experienced negative consequences after exposure to dangerous experiences. There is no one single TIC framework, or model, and some go by slightly different names, including Trauma- and violence-Informed Care (TVIC). They incorporate a number of perspectives, principles and skills. TIC frameworks can be applied in many contexts including medicine, mental health, law, education, architecture, addiction, gender, culture, and interpersonal relationships. They can be applied by individuals and organizations.

Trauma-informed approaches in education (TIE) are educational techniques that acknowledge the prevalence of adverse childhood experiences and other traumas on students and attempt to mitigate the widespread impact of such trauma. By adopting trauma-informed principles, educational organizations aim to create a supportive environment that facilitates learning and promotes the emotional well-being of students. Trauma-informed education is referred to with varying terminology.

Katherine Ortega Courtney is an American psychologist and author who co-developed the 100% Community model, a theoretical framework designed to guide the state and local work of preventing two interrelated public health and education challenges: adverse childhood experiences (ACEs) and adverse social determinants of health (SDH). As bureau chief of New Mexico's Child Protective Services Research, Assessment, and Data Bureau and developer of a data-scholars program for child welfare managers across the nation, she saw firsthand child welfare's lack of capacity to implement a data-driven strategy to prevent maltreatment by ensuring families had access to the vital services of medical care, mental health care, food security programs, and safe housing.

<span class="mw-page-title-main">Cristina Pearse</span> Womens trauma recovery advocate

Cristina Pearse is a Pacific Islander and US-based complex post-traumatic stress disorder survivor and women's trauma recovery advocate, living in Boulder, Colorado, United States.

References

  1. "Gov. Newsom Appoints California's First-Ever Surgeon General". NBC 4 Southern California. January 21, 2019. Retrieved 31 January 2019.
  2. "Codes Display Text". leginfo.legislature.ca.gov. Retrieved 2022-08-26.
  3. "Governor Newsom Appoints Dr. Diana Ramos as California Surgeon General". California Governor. 2022-08-25. Retrieved 2024-09-19.
  4. Leslie (January 30, 2019). "Black Woman Appointed California's First-Ever Surgeon General". The Chicago Crusader. Retrieved 31 January 2019.
  5. "Dr. Nadine Burke Harris Officially Sworn in as California's First Surgeon General". BOTWC. Retrieved 2019-03-25.
  6. Newson, Gavin (2019-01-07). "EXECUTIVE DEPARTMENT STATE OF CALIFORNIA EXECUTIVE ORDER N-02-19" (PDF). Governor of California. Retrieved 2019-08-20.
  7. Chandler, Michael A. (October 6, 2016). "This doctor pioneered a way to treat stress in children, a startling source of future disease". The Washington Post.
  8. 1 2 Adolescence, Committee On; Pediatrics, Council on Community; Health, Section on Adolescent; Dougé, Jacqueline; Dooley, Danielle G.; Trent, Maria (2019-08-01). "The Impact of Racism on Child and Adolescent Health". Pediatrics. 144 (2): e20191765. doi: 10.1542/peds.2019-1765 . ISSN   0031-4005. PMID   31358665.
  9. "ACEs Pioneer Nadine Burke Harris Named California's First-Ever Surgeon General". The Chronicle of Social Change. 2019-01-23. Retrieved 2019-08-21.
  10. "Bill Text - AB-340 Early and Periodic Screening, Diagnosis, and Treatment Program: trauma screening". leginfo.legislature.ca.gov. Retrieved 2019-08-21.
  11. "Adverse Childhood Experiences (ACEs)". www.cdc.gov. 2019-04-23. Retrieved 2019-08-21.
  12. A Conversation with California's First Surgeon General Nadine Burke Harris , retrieved 2019-11-07
  13. How childhood trauma affects health across a lifetime | Nadine Burke Harris , retrieved 2019-11-07
  14. Peterson, Sarah (2018-02-28). "Trauma-Informed Care". The National Child Traumatic Stress Network. Retrieved 2019-08-21.
  15. Peterson, Sarah (2018-01-30). "Creating Trauma-Informed Systems". The National Child Traumatic Stress Network. Retrieved 2019-08-21.
  16. Peterson, Sarah (2018-01-30). "Justice". The National Child Traumatic Stress Network. Retrieved 2019-08-21.
  17. Peterson, Sarah (2018-01-25). "Complex Trauma". The National Child Traumatic Stress Network. Retrieved 2019-08-21.
  18. Washburn, David. "Q&A: California's first-ever surgeon general on her plans to tackle toxic stress in children". EdSource. Retrieved 2019-08-21.
  19. 1 2 Healthline, Anna Maria Barry-Jester, California (2019-03-04). "California Has an Innovative Plan to Deal With Childhood Trauma". Vice. Retrieved 2019-08-21.{{cite web}}: CS1 maint: multiple names: authors list (link)
  20. Order N-02-19
  21. "California's first surgeon general, Dr. Nadine Burke Harris, resigns". Los Angeles Times. 2022-02-02. Retrieved 2022-08-26.