April 9, 2024

Youth mental health is the defining public health crisis of our time.

                                               -Vivek Murthy, US Surgeon General

There is a crucial need for more mental health care support in our country. Today, 157 million Americans live in areas with a shortage of mental health providers. (1) Limited provider capacity means that of the 46% of young adults who have diagnoses of substance abuse or mental illness, 55% of them receive no care. (2) And for historically underserved communities, including BIPOC and LGBTQ+ populations, finding a culturally sensitive provider can be even more challenging. (3)

I’m a doctor. A doctor’s toolbox includes medical education and training, a license to diagnose, and the ability to prescribe treatment. So, when a colleague suggested that unlicensed folks with lived experience might be as good or even better at meeting the needs of people who are struggling with mental health, you might think that I’d be skeptical.

As I looked at the literature on peer support, I realized that the model of connecting those who have lived through the same struggles has been helping people for decades outside of clinical settings. Communities for people who are mutually struggling with grief and addiction (4), for example, are trusted and commonplace. No one can better understand what it is like to lose a loved one or to hit rock bottom than someone who has been there, too. It’s why groups of people continue to gather week after week, year after year, in church basements and recreation centers, to support each other in ways that friends or doctors never could. It’s why people living...

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February 14, 2024

Food Security icon Food Security

It has been a challenging few years, learning to connect with patients while hiding my smile behind a facemask, in an environment where trust in the medical establishment has decreased and social media memes have become absolute truth. But screening for food insecurity has become a secret weapon for building rapport with my patients and fulfilling my calling as a pediatrician at a federally qualified health center serving an underserved community. When I walk into an exam room with a guide to healthy food resources in my hand, knowing that the family in front of me has limited access to food, I immediately connect with them on a personal level. We may not agree that today is the right day for their child to be vaccinated or that their child may benefit from weight loss, but we can unite on the fact that $7 for a dozen eggs is too expensive and $5 for a gallon of gas causes us to modify our spending habits. Our therapeutic alliance rests on the reality that so many people in our country are facing food insecurity, that our health center has recognized this and provided opportunities for me, their pediatrician, to address it.

Food insecurity is common. Nationally, 12.8% of families are food insecure. (1) Food insecurity may result in changes in eating habits, like consuming more calorie-dense and low nutritional value foods that tend to be more affordable and accessible. (2)(3) These habits can increase the likelihood of children developing chronic diseases like obesity. (4) Children also experience toxic stress associated with intense short-term and long-term food insecurity, even when their parents attempt to shield them from experiencing hunger. (4) This stress contributes to an increased risk...

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December 12, 2023

Health Food and Beverage icon Healthy Food and Beverage Standards

Jasmine, a first-generation immigrant from the Middle East, was one of the first patients I cared for when I transitioned from private practice to public health dentistry. She had only been in the States for a few years and was raising three children, including a 17-year-old son with developmental delays. She was computer savvy and her ability to navigate complex systems, including medical and dental care, was impressive. When I met Jasmine, it appeared that she had everything under control.

Yet, when she and her children stepped into my dental chair, I found signs of rampant decay and poor oral health. Despite their relatively uneventful medical histories, I noticed some underlying issues that needed attention.

Jasmine’s daughter appeared obese at only 14 years old. Jasmine had expressed that her daughter had been complaining about sporadic dizziness, which she attributed to pubertal changes. As a dentist, I recognized the interconnectedness between oral health and overall well-being. I took her blood pressure, which I was surprised to find was elevated and indicated early stage 1 hypertension.

This was a wake-up call for me. How many cases of childhood hypertension are going unnoticed? And more importantly, how many could be prevented if the underlying issues leading to childhood obesity and unhealthy eating were being addressed more proactively?

I spoke with Jasmine, and it soon became clear to me that her story was more than just a tale of dental struggles or deficient knowledge about healthy food and beverage choices. She understood that what goes in her mouth affects her overall health, but she also pointed out that eating healthy requires time, money, and access to...

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October 6, 2023

Structured Physical Activity icon Structured Physical Activity

Anthony is a 17-year-old young man who was brought to my clinic by his mother for behavioral concerns.

“He’s spending more and more time alone in his room”.

Anthony sits on the exam table with his shoulders slumped, eyes down, fidgeting with his hands.

“I don’t know why she brought me here. I’m fine.” he says.

He looks tired, so I ask about how he’s been sleeping. Before he can answer, his mother chimes in, “He stays up all night on his iPhone.” She shares that when she has tried to restrict his phone use, she later awakens to find him hiding in his bed under the sheets staring at the screen.

“It’s not that bad, some of my friends don’t go to bed until 2:00 in the morning!” he argues.

“Are you tired?” I ask him.

“Nah, I just drink a Red Bull and I’m fine.” he replies. His mom contends that he often sleeps in, is late for school, and he has also been falling asleep after school.

As his mom starts to tear up, he admits “I do feel bad because my mom keeps getting letters from school when I’m late and it’s stressing her out. I tried to cut back on using my phone at night, but I just can’t seem to stop. All my friends are texting and posting. I don’t want to be left out. I want to know what’s going on and that keeps me up.”

His mother shares that his teacher is concerned about his failing grades, poor concentration and how he constantly has his phone out during class. “What?” he interjects. “Everyone else is on their phones too! It’s not my fault that TikTok memes are more interesting than math!”

I notice that he has gained a lot of weight since our last appointment. He discloses that sometimes he just doesn’t have an appetite...

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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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