Three questions about the California Surgeon General

With the announcement last month of Dr. Nadine Burke Harris as California’s first ever Surgeon General, Governor Newsom demonstrated again his prioritization of health care as the state moves forward. But the appointment also creates some important questions as to what the position will do and how it will integrate with the existing state health infrastructure. Here are three questions we’ll be watching to answer as the position take shape in the weeks to come.

 

1.  What will the Surgeon General do?

For the federal government, the Surgeon General serves as the head of the Public Health Service Corps, a uniformed division of the Department of Health and Human Services tasked with responding to health emergencies and addressing system health problems in the country and world. The U.S. Surgeon General also services as the “Nation’s Doctor,” a visible and public leader promoting health information and initiatives – remember C. Everett Coop and smoking?

However, California has an existing Director of Public Health that heads an army of doctors, nurses, scientists, researchers, public health professionals and staff addressing and promoting public health. With Dr. Burke Harris’s background in pioneering research on Adverse Childhood Experiences (ACES), she is uniquely poised to address childhood trauma, but will she address other pressing issues in the state like health care cost, opioid and substance use treatment, and meaningful access to care for marginalized populations?

2.  How will the Surgeon General position interact with the Department of Public Health?

As mentioned above, the California Department of Public Health has a well-established Director, leadership, and structure. Announced at the same time as the new Deputy Secretary of Early Childhood Development, we will be watching to see if Dr. Burke Harris will focus on directing more attention to upstream prevention to address future health outcomes, or whether it will she will serve as a figure head for the state across multiple health issues.

In addition, we wonder where this position will be seated? Is the Surgeon General a member of the Governor’s staff, or the Department of Public Health, or some other department? Will she have a budget, department, and staff, or will she be more of a media touchstone?

3.  What does the position really mean for the future of California health care?

Though an exciting and novel addition to state government, we wonder if the Surgeon General position really represents a new direction in prioritizing health care in California. While her qualifications are stellar, will the position truly enable Dr. Burke Harris to make actionable change in the system or will the lack of structural definition hamper her impact?

 

Only three other states currently have a surgeon general, Arkansas, Pennsylvania, and Florida, while Michigan eliminated its position in 2010. The National Academy for State Health Policy listed several advantages to the position in a 2016 white paper, including opportunities to direct cross-sector population health improvements, leadership not bound by administrative duties, and the presence of an independent medical advisor to weigh in on important emerging health concerns.  We will have to wait and watch what shape the position takes here in California.