August 9, 2023

Structured Physical Activity icon Structured Physical Activity

I wear three hats in my professional life:

  1. I’m a pediatrician working primarily with under-resourced and historically marginalized patient populations.
  2. I’m a nature champion, promoting the health benefits of spending time outside in nature.
  3. I’m part of a leadership team that advocates for anti-racism, diversity, equity, inclusion, and justice in patient care.

For many who see my work from the outside, my hats all seem separate, but, for me, these three roles work synergistically to allow me to help my patients access significant and lasting health benefits.

Health Benefits of Nature
Numerous studies link spending time outside to experiencing better health outcomes including lower blood pressure and heart rate, better immune system function, lower levels of stress, and decreased risk of chronic diseases like diabetes and cardiovascular disease. Studies also demonstrate a link between nature exposure and improved cognitive function and development, brain activity, sleep, and mental health (including decreased risk of depression and anxiety).(1) But as many as 100 million people in the U.S. — 30 percent of the population — lack access to the benefits parks and green spaces provide.(2)

Inequities in Park Access
Many historically marginalized communities cannot access high-quality and safe parks and green spaces due to a combination of racial and economic disparities. This may mean that these resources do not exist near them, or, if they do, they may have damaged play equipment, be poorly maintained, or have criminal activity or other conditions that make the parks feel unsafe. A lack...

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June 6, 2023

Food Security icon Food Security

I recently celebrated with one of my patients as she met a major health goal: she maintained well-controlled blood sugar and blood pressure levels for a full year. In the eight years since our first visit, she struggled with consistent management of her diabetes, in large part due to challenges affording medications and nutritious food. In addition to caring for her two young children, she spent years as the primary supporter for her mother who suffered from complications from a severe stroke. Witnessing her mother’s decline in health only furthered this resilient young woman’s resolve to improve her own health, and I was excited to see her making progress towards this precious goal. 

Sadly, our shared joy was tempered by the harrowing realization that she might soon lose access to essential safety net services that buoyed the improvements in her health. We both knew that a significant part of her success was based on consistent Medi-Cal coverage and access to associated anti-hunger and anti-poverty support programs. The end of the federal COVID-19 Public Health Emergency (PHE) declaration on May 11, 2023, marked a reversal or regression of hundreds of federal and state legislative flexibilities that allowed for expansion of Medi-Cal services for the most vulnerable communities in California. 

Major Risks of the Great Unwinding of Medi-Cal Enrollments
For my patient and millions of other Californians who live at the margins of the social safety net, a critical piece of federal legislation prevented eligible patients from automatic disenrollment from Medi-Cal throughout the height of the COVID...

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April 3, 2023

Health Food and Beverage icon Healthy Food and Beverage Standards

While you might think there isn’t much overlap between the goals of a family medicine physician and a pediatric dentist, we have a shared understanding about the harmful effects of sugar-sweetened beverages (SSB) on the health of young children. We have both witnessed first-hand the increase in SSB-related poor health outcomes, especially during the COVID-19 pandemic. Our patients consumed higher than usual SSBs that coupled with experiencing a lack of access to physical activity, not surprisingly, increased the cases of obesity and/or dental caries in our practices.


When looking at BMI among San Diego school children, nearly 1 out of every 3 children were overweight or obese in the 2017-18 school year.1 In terms of their oral health, according to data from the Oral Health Assessment 2017-18, 27% of kindergartners and first graders already experienced tooth decay or restorations, and 21% had visible decay with 4% needing urgent dental services.2 These numbers were pre-pandemic and already shocking. Here are our personal experiences treating patients during the pandemic:...

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February 10, 2023

Food Security icon Food Security

It’s hard for me to believe that I have now been practicing medicine for twenty years. Every day has been a gift …It has been and continues to be an honor to be a part of my patients’ lives.

I serve patients in a community health center in Redwood City, where many struggle to manage their chronic diseases in the face of financial insecurity that often requires them to work multiple low-paying jobs. As their primary care provider, I thought my role was to educate and partner with my patients on their continued journey of well-being. I would draw simple diagrams explaining what high blood pressure and high blood sugar can do to the body. It took me nearly two decades of practicing medicine before I realized that many of my patients lacked access to the very foods I was advising them to eat.

During the Covid-19 pandemic, our clinic decided to screen everyone for food insecurity. We found that close to 20 percent of patients who came through our doors worried about having enough food to eat. When we delved deeper, we found that even more did not have access to the nutritious foods that we often instructed them to eat. I’ll never forget when my patient, whom I had known for 8 years, told me that he felt ashamed to admit that he did not have enough food for himself and his family. I was disappointed that I did not think to ask and understand what his circumstances were. I missed what was right in front of me. Despite having the theoretical understanding that nutrition is so foundational to health and wellness, I was not doing enough to identify and address one of the root causes of chronic disease that many of my patients faced. I became passionate about finding strategies to address food...

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December 12, 2022

I spent several years working as a family medicine physician in Los Angeles. Many of my patients were Spanish-speaking and low-income individuals, a large portion of whom suffered from obesity, diabetes, and other chronic conditions. I found that simply advising patients to “eat a healthy diet and exercise” did not lead to improved health measures. By embracing a holistic approach, I was able to find the root cause of my patients’ health problems. Many of my patients lived in neighborhoods without a nearby grocery store to buy fresh fruit and vegetables and did not understand how to read nutrition labels. Over a series of clinic appointments, I would work closely with my patients to find ways to address barriers to healthy eating and exercise. My clinical experiences inspired me to go beyond the clinic walls to find ways to address the social determinants of health that were contributing to my patients’ poor health outcomes.

When the COVID-19 pandemic began in 2020, I made the decision to move to my hometown area in Central California. As a public health trained physician, I wanted to give back to the region where I was raised and assist with local programs aimed at mitigating the impact of COVID-19 on vulnerable communities. I began working with the Fresno County Department of Public Health (FCDPH) and helped coordinate the department’s efforts to protect farmworkers against COVID-19 by making COVID-19 tests and vaccines more accessible in the rural areas of the county. As the daughter of Mexican immigrant farmworkers, I know firsthand the challenges that many farmworkers face when accessing health care. My parents were monolingual Spanish speakers and due to their language barrier, they had...

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October 11, 2022

Structured Physical Activity icon Structured Physical Activity

Kaleah was a cheery 11-year-old who loved spending time with her family, but when I first met her in the clinic during her annual check-up, she was depressed and suffering from childhood obesity.

I learned that Kaleah’s 17-year-old brother, who she idolized, and was a standout player on his high school baseball team, had recently suffered a stroke. He was in therapy relearning how to walk and talk. When the doctors explained to Kaleah and her parents that the stroke was probably connected to her brother’s diet and weight, Kaleah became doubly concerned.

At home there always seemed to be a pot of frijoles with carne on the stove and fresh, homemade tortillas. Kaleah’s Abuela loved to spoil them with soda and encouraged them to drink tall glasses of orange juice or ‘liquado,’ which was rich with whole milk. Kaleah wondered if this could have caused her brother’s stroke and wanted to help improve her family’s health.

I connected Kaleah to free nutrition and healthy lifestyle classes offered by Santa Cruz County’s migrant education program. Kaleah was a sponge! She not only attended every class, but she began researching how to read nutrition labels. She made it her mission to work on eating healthy, buying healthy food and getting regular exercise…not just for herself, but for her whole family, and especially for her recovering brother. In addition, I connected Kaleah and her family to the ParkRx program of Santa Cruz County with Friends of County Parks. The ParkRx program promotes equitable access to parks and outdoor spaces as a way to improve the...

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Throughout the pandemic, Americans have celebrated farm workers for keeping food on the table in the toughest of times. Yet, we conveniently forget about their sacrifice as those same workers toil in the heat without access to preventative dental care. As a private practice dentist in Ventura County, a major agricultural center, who offers my services at low or no-cost to farm workers and their families, I’ve seen first-hand the detrimental effects of this lack of access to basic dental care.


Let me tell you about the father of a young patient of mine, Juan, who works in nearby fields. Juan left Mexico to make a better life for himself and his family. When Juan brought one of his six children in for a dental checkup, I noticed Juan himself looked unwell. He told me that he had a painful toothache. I offered to examine him, but he hesitated because he was afraid of the cost. I assured him that I could provide an exam at no cost and he hesitantly agreed. I was shocked to see how severely damaged his teeth were. He explained that he’s never had any dental care. He also shared that when he came to the U.S., he quickly adopted a diet that consisted of fast food, candy, soda, and sports drinks. Sadly, I...

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June 6, 2022

My patient, Nina, is a delightful little girl, but when I first met her at age two, she was a child in extreme pain -- unable to sleep through the night, play or even eat proper meals because of dental cavities. For months, her parents tried numbing her teeth with a gel and weren’t sure if they should take Nina to her pediatrician or a dentist. Unfortunately, when they finally did go to a dentist, he lacked experience working with very young children and did not recommend treatment. Nina suffered rapid progression of her tooth decay.

The combination of their prior poor dental experiences, their lack of understanding about dental health, limited income, and fear of submitting their daughter to risky general anesthesia, led Nina’s parents to further delay her treatment. The problem could no longer be ignored when Nina woke up with a swollen face and had to be rushed in for a traumatizing emergency tooth extraction. Fortunately, Nina ended up receiving the care she needed, but her fear of dentists is now well ingrained, and her parents face substantial medical bills.

Sadly, Nina’s story is not as rare as one might think. According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 21% of children aged 2 to 5 years had dental caries in their baby teeth. (1) Many parents may not be aware that dental health starts this early. If there’s a silver-lining to this story, it’s that Nina’s parents aren’t about to let the same thing happen to Nina’s younger brother. I now see both of their children for regular preventative checkups. They’ve made it a point to share their story with their friends and family about the importance of bringing children as young as one...

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April 13, 2022

Health Food and Beverage icon Healthy Food and Beverage Standards

COVID-19 and COVID-19-related illness is, unfortunately, the disease that has swept across the entire world for the past two years. News outlets have devoted nearly 24/7 hour coverage to the minute-by-minute developments of this pandemic. Simultaneously, while these tragic events are unfolding – we continue to see cases of heart attacks, obesity, cancer, and cavities. 

Cavities?! Okay, okay - I get it – most people wouldn’t put that on the same list as life-threatening diseases like cancer…but maybe they should. Your mouth is connected to the rest of your body. So, what happens to your oral health can have far-reaching ramifications for systemic health and productivity. Even California state representative Tony Cárdenas, D-Calif.(1) has gone on record to state that “oral health illness results in tens of millions of lost workdays each year.” One should take this statistic seriously, because even if you don’t, the bacteria on calculus will. Some of the most prevalent bacteria in your mouth can bind with platelets, small cells in the blood. Once this occurs, normal blood flow can be interrupted leading to blockages in arteries and a higher risk of cardiac events.(2) Given roughly 50 percent of individuals over age 30 have some form of gum disease and heart disease is one of the leading causes of death in America – we must take oral health seriously.

Bacterium from your gums has a secondary target as well - your mind! An infection in your gums can kill off brain cells, leading to memory loss and dementia. To this end, a study published in 2020 showed that participants with gum inflammation were nine times more likely to score lower on cognitive tests.(3) Also, it is important to consider...

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February 7, 2022

Health Food and Beverage icon Healthy Food and Beverage Standards

Childhood obesity in the U.S. is on the rise… again!

Numbers reported by the Centers for Disease Control and Prevention prior to the pandemic (2017-2018) showed hard-earned efforts to reverse the growing trend of childhood obesity had worked. However, throughout the pandemic, as children spent more time on screens, less on the playing field and snacked their way through classes, those efforts have been undermined. Today, one in five adolescents are obese (overweight or obese) and obesity numbers following the onset of COVID-19 have risen 2 percent according to the CDC. Tragically, the impact is being felt disproportionately among low-income children and communities of color.

As a Pasadena mother and clinician working in family medicine, I see childhood obesity far too often in my patients, and the impact is staggering. The health risks of childhood obesity include diabetes, heart disease, hypertension, high cholesterol which in turn can translate into risks for complications of stroke, heart attack and kidney failure. Beyond the physical toll, childhood obesity can have an impact on a child’s self-esteem, socialization and can ultimately impact their ability to reach their full potential. What’s more, childhood obesity takes a tremendous toll on our healthcare system, especially given the fact that it often continues into adulthood causing future health complications.

While America was making headway in addressing this issue, the COVID-19 pandemic has laid bare many of our society’s social failures, including our inability to create equitable policies, systems and environments that ensure all children have the opportunity to live healthy lives.

The virus has highlighted...

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