How a surgeon general could help improve health care in California

Buried in the flurry of recent policy and leadership ideas from our new governor was a proposal to create a surgeon general for the state of California.

As a health foundation executive committed to improving health and wellness for vulnerable communities, I think it’s a terrific idea. A state surgeon general could be more than another figurehead in the morass of state government, using the position to push for a system that promotes health instead of managing sickness.

California is a unique state, with the world’s fifth largest economy and a larger population than Canada. We are home to genius in tech innovation, creative brilliance in the cinematic arts and 144 billionaires live here, more than in any other state. However, we also have the highest poverty rate, according to the US Census. While some California counties have among the longest life expectancies in the US, others are equivalent to Ecuador in this regard.

A state surgeon general could help tailor local solutions to some of the U.S. health care system’s biggest quandaries. The first person to fill the role should start with three objectives.

The first: Boost prevention. California has led the nation in crafting policies that encourage disease prevention, including comprehensive tobacco control, removing soda from schools and taxing it, improving student physical education and incorporating health in city and county general plans. But the health policy debate continues to be dominated by themes of costs and insurance coverage. We spend more than any other country in the world on health care yet we have poorer health outcomes.


The leading causes of death, disability and sickness -- including cancer, stroke, heart disease, diabetes and suicide -- are tied to environment and behavior. Treating these conditions costs hundreds of billions of dollars per year. Yet the data tell us that for every dollar spent on treatment, three cents or less is invested in community prevention.

We have proven we can’t spend our way to improved health. A California surgeon general could generate the drumbeat of prevention, refocusing health reform discussions around a longer-term vision.

Second: In addition to encouraging disease prevention, we should target community characteristics that contribute to poor health. When it comes to health, zip code matters more than genetic code. The quality of a neighborhood affects the quality of air, water and housing along with economic opportunity and the availability of healthy food and places to exercise.

Thanks to a Kaiser Permanente study more than a decade ago, we better understand the relationship between adversity in the lives of children and their health status decades later. The study found that the more emotional trauma a child sustains at a young age, the more likely he or she will be to smoke, abuse alcohol or drugs and be depressed or incarcerated years later.

Lifting up unhealthy neighborhoods and the children who live in them will require cooperation among leaders in education, business, criminal justice, land use and other sectors. A surgeon general could organize and align these efforts.

Finally, a California surgeon general could promote health equity. California continues to be plagued by savage disparities in health status. Communities of color (including Native American communities), rural, and LGBTQ communities remain at higher risk for poorer health status, and our state needs a “people’s doctor” accountable to and wholly invested in shaping strategic approaches to improving health for all, by focusing on populations suffering the most.

We are Californians. We don’t follow, we lead. Kudos to Gov. Gavin Newsom for executing on the idea of a state surgeon general. Prevention must take center-stage in future health policy discussions, and our state needs a champion whose day job and leadership focuses on nothing but that.

Dr. Robert K. Ross is the president and CEO of The California Endowment, a private foundation that works to improve the state of health in California. He can be contacted at