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AB-887 Office of Health Equity: Surgeon General.(2019-2020)

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Date Published: 03/28/2019 09:00 PM
AB887:v98#DOCUMENT

Corrected  April 01, 2019
Amended  IN  Assembly  March 28, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 887


Introduced by Assembly Member Kalra

February 20, 2019


An act relating to state government. to amend Section 131019.5 of the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


AB 887, as amended, Kalra. State government. Office of Health Equity: Surgeon General.
Existing law requires the State Department of Public Health to establish an Office of Health Equity for the purpose of aligning state resources, decisionmaking, and programs to accomplish specified goals, including, among other things, to advise and assist other state departments in their mission to increase access to, and the quality of, culturally and linguistically competent health and mental health care and services and to improve the health status of all populations and places, with a priority on eliminating health and mental health disparities and inequities.
This bill would also require the office to advise and assist other state departments in their mission to increase the general well-being of all Californians, and would require the office to work toward eliminating adverse childhood experiences. The bill would require the office to advise the Governor on a comprehensive approach to addressing health risks and challenges as effectively and early as possible.
Existing law requires the Governor or the State Public Health Officer to appoint a Deputy Director of the Office of Health Equity, subject to the confirmation of the Senate. Existing law requires the deputy director to report to the State Public Health Officer and to work closely with the Director of Health Care Services to ensure compliance with the requirements of the office’s strategic plans, policies, and implementation activities.
By executive order, the Governor established the position of Surgeon General, as a public entity within the Governor’s direct executive authority, to advise the Governor on a comprehensive approach to addressing health risks and challenges as effectively and as early as possible. The executive order prescribes the qualifications of the Surgeon General and sets forth specified duties of the Surgeon General.
This bill would codify provisions of the executive order to require the Governor to appoint a Surgeon General. The bill would prescribe the qualifications of the Surgeon General consistent with the executive order. Under the bill, the Surgeon General would oversee the office and would serve a 4-year term to run concurrently with the term of the Governor. The bill would make the appointment subject to confirmation by the Senate, beginning January 2023. The bill would require the Surgeon General to report to the Governor and to work closely with the State Public Health Officer and the Director of Health Care Services to ensure compliance with the requirements of the office’s strategic plans, policies, and implementation activities. The bill would eliminate the position of Deputy Director of the Office of Health Equity, and would, instead, require the Governor to appoint a deputy director to report to the Surgeon General and to work closely with the State Public Health Officer and the Director of Health Care Services to ensure compliance with the requirements of the office’s strategic plans, policies, and implementation activities.

Existing law establishes the State Department of Public Health within the California Health and Human Services Agency, and requires the appointment of a State Public Health Officer to serve as the director of the State Department of Public Health.

This bill would state the intent of the Legislature to subsequently establish the office of state Surgeon General.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 131019.5 of the Health and Safety Code is amended to read:

131019.5.
 (a) For purposes of this section, the following definitions shall apply:
(1) “Determinants of equity” means social, economic, geographic, political, and physical environmental conditions that lead to the creation of a fair and just society.
(2) “Health equity” means efforts to ensure that all people have full and equal access to opportunities that enable them to lead healthy lives.
(3) “Health and mental health disparities” means differences in health and mental health status among distinct segments of the population, including differences that occur by gender, age, race or ethnicity, sexual orientation, gender identity, education or income, disability or functional impairment, or geographic location, or the combination of any of these factors.
(4) “Health and mental health inequities” means disparities in health or mental health, or the factors that shape health, that are systemic and avoidable and, therefore, considered unjust or unfair.
(5) “Vulnerable communities” include, but are not limited to, women, racial or ethnic groups, low-income individuals and families, individuals who are incarcerated and those who have been incarcerated, individuals with disabilities, individuals with mental health conditions, children, youth and young adults, seniors, immigrants and refugees, individuals who are limited-English proficient (LEP), and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQQ) communities, or combinations of these populations.
(6) “Vulnerable places” means places or communities with inequities in the social, economic, educational, or physical environment or environmental health and that have insufficient resources or capacity to protect and promote the health and well-being of their residents.
(b) The State Department of Public Health shall establish an Office of Health Equity for the purposes of aligning state resources, decisionmaking, and programs to accomplish all of the following:
(1) Achieve the highest level of health and mental health for all people, with special attention focused on those who have experienced socioeconomic disadvantage and historical injustice, including, but not limited to, vulnerable communities and culturally, linguistically, and geographically isolated communities.
(2) Work collaboratively with the Health in All Policies Task Force to promote work to prevent injury and illness through improved social and environmental factors that promote health and mental health.
(3) Advise and assist other state departments in their mission to increase access to, and the quality of, culturally and linguistically competent and trauma-informed health and mental health care and services. services, and to assist and advise other state departments in their mission to increase the general well-being of all Californians.
(4) Improve the health status of all populations and places, with a priority on eliminating health and mental health disparities and inequities. inequities, and adverse childhood experiences.
(5) Achieve any other priorities deemed necessary by the Surgeon General.
(c) The duties of the Office of Health Equity shall include all of the following:
(1) Conducting policy analysis and developing strategic policies and plans regarding specific issues affecting vulnerable communities and vulnerable places to increase positive health and mental health outcomes for vulnerable communities and decrease health and mental health disparities and inequities. The policies and plans shall also include strategies to address social and environmental inequities and improve health and mental health. The office shall assist other departments in their missions to increase access to services and supports and improve quality of care for vulnerable communities.
(2) Establishing a comprehensive, cross-sectoral strategic plan to eliminate health and mental health disparities and inequities. The strategies and recommendations developed shall take into account the needs of vulnerable communities to ensure strategies are developed throughout the state to eliminate health and mental health disparities and inequities. This plan shall be developed in collaboration with the Health in All Policies Task Force. This plan shall establish goals and benchmarks for specific strategies in order to measure and track disparities and the effectiveness of these strategies. This plan shall be updated periodically, but not less than every two years, to keep abreast of data trends, best practices, promising practices, and to more effectively focus and direct necessary resources to mitigate and eliminate disparities and inequities. This plan shall be included in the report required under paragraph (1) of subdivision (d). The Office of Health Equity shall seek input from the public on the plan through an inclusive public stakeholder process.
(3) Building upon and informing the work of the Health in All Policies Task Force in working with state agencies and departments to consider health in appropriate and relevant aspects of public policy development to ensure the implementation of goals and objectives that close the gap in health status. The Office of Health Equity shall work collaboratively with the Health in All Policies Task Force to assist state agencies and departments in developing policies, systems, programs, and environmental change strategies that have population health impacts in all of the following ways, within the resources made available:
(A) Develop intervention programs with targeted approaches to address health and mental health inequities and disparities.
(B) Prioritize building cross-sectoral partnerships within and across departments and agencies to change policies and practices to advance health equity.
(C) Work with the advisory committee established pursuant to subdivision (f) and through stakeholder meetings to provide a forum to identify and address the complexities of health and mental health inequities and disparities and the need for multiple, interrelated, and multisectoral strategies.
(D) Provide technical assistance to state and local agencies and departments with regard to building organizational capacity, staff training, and facilitating communication to facilitate strategies to reduce health and mental health disparities.
(E) Highlight and share evidence-based, evidence-informed, and community-based practices for reducing health and mental health disparities and inequities.
(F) Work with local public health departments, county mental health or behavioral health departments, local social services, and mental health agencies, and other local agencies that address key health determinants, including, but not limited to, housing, transportation, planning, education, parks, and economic development. The Office of Health Equity shall seek to link local efforts with statewide efforts.
(4) Consult with community-based organizations and local governmental agencies to ensure that community perspectives and input are included in policies and any strategic plans, recommendations, and implementation activities.
(5) Assist in coordinating projects funded by the state that pertain to increasing the health and mental health status of vulnerable communities.
(6) Provide consultation and technical assistance to state departments and other state and local agencies charged with providing or purchasing state-funded health and mental health care, in their respective missions to identify, analyze, and report disparities and to identify strategies to address health and mental health disparities.
(7) Provide information and assistance to state and local departments in coordinating projects within and across state departments that improve the effectiveness of public health and mental health services to vulnerable communities and that address community environments to promote health. This information shall identify unnecessary duplication of services.
(8) Communicate and disseminate information within the department and with other state departments to assist in developing strategies to improve the health and mental health status of persons in vulnerable communities and to share strategies that address the social and environmental determinants of health.
(9) Provide consultation and assistance to public and private entities that are attempting to create innovative responses to improve the health and mental health status of vulnerable communities.
(10) Seek additional resources, including in-kind assistance, federal funding, and foundation support.
(11) Advise the Governor on a comprehensive approach to addressing health risks and challenges as effectively and early as possible.
(d) In identifying and developing recommendations for strategic plans, the Office of Health Equity shall, at a minimum, do all of the following:
(1) Conduct demographic analyses on health and mental health disparities and inequities. The report shall include, to the extent feasible, an analysis of the underlying conditions that contribute to health and well-being. The first report shall be due July 1, 2014. This information shall be updated periodically, but not less than every two years, and made available through public dissemination, including posting on the department’s Internet Web site. internet website. The report shall be developed using primary and secondary sources of demographic information available to the office, including the work and data collected by the Health in All Policies Task Force. Primary sources of demographic information shall be collected contingent on the receipt of state, federal, or private funds for this purpose.
(2) Based on the availability of data, including valid data made available from secondary sources, the report described in paragraph (1) shall address the following key factors as they relate to health and mental health disparities and inequities:
(A) Income security such as living wage, earned income tax credit, and paid leave.
(B) Food security and nutrition such as food stamp eligibility and enrollment, assessments of food access, and rates of access to unhealthy food and beverages.
(C) Child development, education, and literacy rates, including opportunities for early childhood development and parenting support, rates of graduation compared to dropout rates, college attainment, and adult literacy.
(D) Housing, including access to affordable, safe, and healthy housing, housing near parks and with access to healthy foods, and housing that incorporates universal design and visitability features.
(E) Environmental quality, including exposure to toxins in the air, water, and soil.
(F) Accessible built environments that promote health and safety, including mixed-used land, active transportation such as improved pedestrian, bicycle, and automobile safety, parks and green space, and healthy school siting.
(G) Health care, including accessible disease management programs, access to affordable, quality health and behavioral health care, assessment of the health care workforce, and workforce diversity.
(H) Prevention efforts, including community-based education and availability of preventive services.
(I) Assessing ongoing discrimination and minority stressors against individuals and groups in vulnerable communities based upon race, gender, gender identity, gender expression, ethnicity, marital status, language, sexual orientation, disability, and other factors, such as discrimination that is based upon bias and negative attitudes of health professionals and providers.
(J) Neighborhood safety and collective efficacy, including rates of violence, increases or decreases in community cohesion, and collaborative efforts to improve the health and well-being of the community.
(K) The efforts of the Health in All Policies Task Force, including monitoring and identifying efforts to include health and equity in all sectors.
(L) Culturally appropriate and competent services and training in all sectors, including training to eliminate bias, discrimination, and mistreatment of persons in vulnerable communities.
(M) Linguistically appropriate and competent services and training in all sectors, including the availability of information in alternative formats such as large font, braille, and American Sign Language.
(N) Accessible, affordable, and appropriate mental health services.
(3) Consult regularly with representatives of vulnerable communities, including diverse racial, ethnic, cultural, religious, and LGBTQQ communities, women’s health advocates, mental health advocates, health and mental health providers, community-based organizations and advocates, academic institutions, local public health departments, local government entities, and low-income and vulnerable consumers.
(4) Consult regularly with the advisory committee established by subdivision (f) for input and updates on the policy recommendations, strategic plans, and status of cross-sectoral work.
(e) The Office of Health Equity shall be organized as follows:
(1) A Deputy Director shall be appointed by the Governor or the State Public Health Officer, and is subject to confirmation by the Senate. (A) The Governor shall appoint a Surgeon General, as a public entity within the Governor’s direct executive authority, to oversee the Office of Health Equity. The Surgeon General shall serve a four-year term, to run concurrently with the term of the Governor. Beginning January 1, 2023, the appointment shall be subject to confirmation by the Senate. The Surgeon General may be appointed to consecutive terms. The salary for the Deputy Director Surgeon General shall be fixed in accordance with state law.
(B) The Surgeon General shall report to the Governor and shall work closely with the State Public Health Officer and the Director of Health Care Services to ensure compliance with the requirements of the office’s strategic plans, policies, and implementation activities.
(C) The Surgeon General shall be a key spokesperson on public health issues throughout the state by providing Californians with the best medical and scientific evidence on current health issues through public health reports and other tools of public communication.
(D) The Surgeon General shall have the following qualifications:
(i) Be licensed as a physician to practice medicine in this state.
(ii) Possess exceptional communication skills across multiple platforms, including scientific and community forums, policymaking venues, and traditional and digital media outlets.
(iii) Be a recognized thought leader in addressing the root causes of health disparities.
(iv) Have a demonstrated commitment to increasing the power and voice of individuals who are disproportionately experiencing the ill effects of the social determinants of health.
(2) (A) A deputy director shall be appointed by the Governor based on a recommendation by the Surgeon General. The salary for the deputy director shall be fixed in accordance with state law.

(2)

(B) The Deputy Director of the Office of Health Equity deputy director shall report to the State Public Health Officer Surgeon General and shall work closely with the State Public Health Officer and the Director of Health Care Services to ensure compliance with the requirements of the office’s strategic plans, policies, and implementation activities.
(f) The Office of Health Equity shall establish an advisory committee to advance the goals of the office and to actively participate in decisionmaking. The advisory committee shall be composed of representatives from applicable state agencies and departments, local health departments, community-based organizations working to advance health and mental health equity, vulnerable communities, and stakeholder communities that represent the diverse demographics of the state. The chair of the advisory committee shall be a representative from a nonstate entity. The advisory committee shall be established by no later than October 1, 2013, and shall meet, at a minimum, on a quarterly basis. Subcommittees of this advisory committee may be formed as determined by the chair.
(g) An interagency agreement shall be established between the State Department of Public Health and the State Department of Health Care Services to outline the process by which the departments will jointly work to advance the mission of the Office of Health Equity, including responsibilities, scope of work, and necessary resources.

SECTION 1.

It is the intent of the Legislature to subsequently amend this measure to include provisions that would establish the office of state Surgeon General.

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CORRECTIONS:
Heading—Line 1.
Digest—Page 1.
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