Q&A: Newly-appointed Surgeon General Diana Ramos, MD, discusses youth behavioral health, reproductive health, and health equity

Diana Ramos, MD, was appointed as California’s second-ever Surgeon General by Gov. Gavin Newsom in August. Ramos has served as Public Health Administrator at the California Department of Public Health’s (CDPH) Center for Healthy Communities since 2021, and was a Public Health Medical Officer at CDPH from 2017 to 2021. Ramos also served as the Director of Reproductive Health at the Los Angeles County Department of Public Health’s Maternal, Child, and Adolescent Health Division from 2005 to 2017.

In this Q&A, Ramos discusses her plan to expand services for youth behavioral health and reproductive health in her new role, as well as her intention to make health equity the epicenter of her work as Surgeon General.

 

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State of Reform: What are your priorities for the role? What key issues will you be advocating for?

Diana Ramos, MD: “There are two priorities that I’m going to be focusing on. The first one is mental health, and the second one is reproductive health. In caring for patients continuously over the years, I have seen an increase in anxiety and depression across all ages. Here in California, we have seen that young people are facing higher rates of anxiety, depression, other mental health issues—in particular in our children of color, LGBTQ+ [children], as well as lower income [children] … 

So it’s not that the issue is new because we know that before the pandemic, there were mental health challenges and the data was at about 1 in 5 kids were having some type of mental or emotional developmental behavior disorder. Unfortunately, we have seen these numbers increase since COVID. 

Mental health disrupts not only the lives of children, we have to remember that children grow up to be adults, and it just builds a negative trajectory for all of our society. So, it’s really important for us to address it. With adults, many times, we self-medicate when we have anxiety, when we feel depressed, when there is a lot of stress and we don’t know how to manage that. That’s when substance abuse comes in. When we use food as medicine, now we’re talking about obesity. And many times we don’t get the mental health support that we need, and that contributes to some of the homeless situation.

But what is really exciting for me is the fact that here in California, we have invested in improving mental health, and the governor has budgeted over $4.7 billion in children and youth behavioral health improvement programs. This really complements the monies that were initially started back in 2007 from the Mental Health Service Act in California. 

So it’s not like California is saying we’re just going to start [investing in this]. No, we’ve [been investing] in this, but now we’re stepping up to the plate and really expanding more of that coverage. In particular, for the Hispanic population, it’s important to realize that nearly 1 in 5 Hispanic high school students, about 20%, seriously considered suicide, and nearly half about reported persistent feelings of sadness or hopelessness in 2021. Unfortunately, kids don’t always know where to go for help, and that is where we’re going to be really promoting and helping roll out the Children and Youth Behavioral Health Initiative.

There’s a lot of great work that is happening, and I see myself as being that connector to services that are there, as well as to the state and community as a whole. Culturally, it may be taboo sometimes to say that there are mental health issues. 

I know in the Latino community, we don’t say that there’s depression. We say that we’re nervous. We use euphemisms, and so I think if we start to educate folks that mental health really is a disorder that can be supported with medication and counseling, and if we change that perception. I think we’re going to be helping really all of California and the rest of the country in terms of the trajectory that we’re all going.

The other area I’m looking forward to focusing on is reproductive health. As an OBGYN, this is what I know how to do very well, not only as a physician, but as a public health leader. When I was in Los Angeles County as director for reproductive health, our team developed programs to decrease maternal mortality, as well as improve the health of people wanting to get pregnant. 

It’s important to realize that I’m defining reproductive health as the health of people from adolescence to menopause, and it’s just going to be an awesome opportunity because right now, in California, we have so many programs that are already supporting women and men before they become pregnant and are wanting to start a family. 

In California, we’ve also expanded the 1-year Medi-Cal coverage for new parents to help address any medical problems that were diagnosed during pregnancy, like high blood pressure, diabetes, depression, hobbies or medical problems that can really impact the rest of your life. Obviously, with reproductive health issues, California is a leader in helping patients decide if they want to continue a pregnancy or not. So I’m happy to be the leader, having had that boots on the ground experience at the public health level and the direct one-on-one patient level to really [expand] the reproductive health opportunities here.”

SOR: From your perspective, what are the biggest public health challenges facing the state right now?

DR: “There are many challenges facing us here in California. The good thing is that there’s a lot of work that’s being done across the state. But I think [behavioral and reproductive health] are some of the biggest opportunities for improvement. Navigating that mental health crisis is really important because we know there are many underlying issues that were there already before the pandemic, and the pandemic just exacerbated all of these issues. According to Governor Newsom, there are over 284,000 children youth in California that are currently experiencing major depression and 66% of those with depression do not receive treatment. Suicide rates for children aged 10 to 18 increased about 20% from 2019 during 2020. We were all on lockdown, and we all had that shared experience. Everyone has different resiliency, and we’re all coming out of it in different ways. The other really important thing to realize is that about 35% of Hispanic adults with mental illness receive treatment each year compared to the US national average of 46%. So we have some work to do.

The other challenge that I see here in California is just trying to identify what our new normal is going to be, and by that I mean the pandemic was disruptive. It really disrupted all of our health system, even our annual visits. We know that well-child visits, annual physical exams, and annual preventive care has been delayed, and I know that many of the health care systems are backed up with appointment availability. So just trying to get all of us back to that healthy new norm.”

SOR: How will you work to promote health equity through leading the state’s public health response?

DR: “In California, we lead with equity. I am a clear example of Governor Newsom’s commitment to equity. I am Hispanic and the first in my family to go to college to become a doctor and a public health leader. In a state as diverse as California, it’s important to have leaders who understand the challenges and issues that all of us face, no matter what our background, culture, or ethnicity is. 

As a Native Mexican American speaker, I understand the culture of those here in California. We represent 40% of all Californians, and I understand that diversity and equity is ingrained in everything I do, and I don’t take it for granted. I really want to elevate the voices of all because by elevating the voices of all, we really elevate the health outcomes for the entire state. 

I know that data is really what drives action, so I am excited to work with our public and private data partners so that we can identify not only the opportunities and measure our successes, but really use that as a driving force to let us know that we’re making a difference in equity and in outcomes. So we need to consider that every community is different. Every community knows what is right for them. Those were some of the key lessons I learned working in public health at LA County and at the state level.

I just want folks to communicate with me. If there’s anything that I’ve learned in my medical career, taking care of patients in public health and even in business in my MBA program, it is that Californians are who are going to tell us what we’re doing right and wrong. So we need to listen to what the issues are. I am the one that is really being the voice for the local experience, and so I really encourage folks to let us know when we are doing something well and when we can do something better. 

I am really looking forward to serving and being that voice for the Latino community because many times the information is not related to everyone, and so this is an opportunity to share information and to elevate everyone’s voices so that we can improve the health of California and [be] the model for the rest of the country.”

This interview was edited for clarity and length.