Senate Select Committee on Select Committee on Social Determinants of Health

Thank you.

Good morning, everyone. Thank you all so much for coming. You know, we are here today for a very important hearing of the Select Committee from the Senate, the Select Committee on the Social Determinants of Health. As Chair, it is my honor to welcome you, community members, educators, advocates, health professionals, and policymakers. A few housekeeping notes.

Please silence your cell phones and other electronic devices. We will be allowing for public comment in person only. There will not be remote public comment for this hearing, and each person offering public comment will be limited to a certain period of time. I'll let you know exactly what that time is. It's based on what time we finish.

We'll determine how much each person will have. And in order to facilitate the goal of our hearing from the public while maintaining order, we will not permit conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of legislative proceedings, disruptive behavior, or behavior that incites or threatens violence, including veiled threats will not be accepted.

We don't do that here in San Diego in Senate District 39, but we have to say this at the beginning and the materials and testimony from today's hearing will be made available after the hearing. I want to acknowledge—take a moment to acknowledge the elected officials who have joined us today.

First, starting in the audience, I see former Council Member Jack Hsu, who is here. And we also have on the panel with me today my fellow Senator, Steve Padilla. I will turn it over to you for a few words.

Thank you. Thank you very much, Madam Chair. Senator Dr. Weber is an amazing leader in our caucus on these topics, and I want to thank you, Chair, for your leadership in this space and for inviting me to participate on the Select Committee.

Certainly, as an ACE survivor myself, and having grown up in this region with all the complexities that contribute to our wellbeing, both physical, mental, emotional, and that, in turn, affects our pathways around education, self-understanding, and ultimately, success.

So, there's, you know, you don't need me to tell this distinguished group the multiple dimensions that are at play here and that we need to have a better understanding around so we can all contribute to good public policy.

And Senator Dr. Weber's been an amazing leader and even a mentor to many of us in the Senate on these issues. So, thank you. I'm looking forward to hearing from our distinguished panelists and speakers and a roll of our seats. So, thank you, Madam Chair.

Thank you. Thank you so much for being here this morning.

So, I want to take a few moments to discuss why this hearing matters and why the fact that I focus so much on social determinants of health, which I've done in my practice, but also since I've joined the Legislature, starting back from when I was in the Assembly.

So, here in California, we are so very proud of our advances in medicine and innovation, but we cannot ignore that children growing up just a few miles apart can face life expectancy differences of 10 years or more. Zip code remains a stronger predictor of health than your genetic code, and that is absolutely unacceptable.

Health is not created in our clinics or hospitals. It begins in the homes we live in, the schools our children attend, the air we breathe, the jobs we work, and the neighborhoods that we call home.

These social economic conditions—housing, food security, transportation, education, neighborhood safety—are powerful predictors of health outcomes, often more so than medical care itself. Here in San Diego, disparities are clear. Some neighborhoods enjoy access to safe parks, grocery stores, and nearby health care.

Others face unsafe streets, limited food access, and higher rates of asthma linked to housing or traffic exposure. We often talk about the difference between growing up south of 8 versus north of 8. Children growing up with housing instability, food insecurity, or trauma often carry those burdens into classrooms which adversely affect their academic outcomes.

Chronic absenteeism, lower reading scores, and reduced graduation rates are often rooted in these external conditions. I believe that health and education are inseparable. If we want children to succeed academically, we must address the socioeconomic conditions affecting their bodies and their minds.

This hearing today is designed to highlight both evidence and experiences from leaders and advocates working at the intersection of health and education.

The goal is to inform our understanding and shed light on what interventions show promise for improving outcomes for children and families, what barriers or challenges stand in the way of progress, and what steps we can realistically take to move from discussion to action.

We know as legislators and even here, just as community members, equity must remain at the center of our work. Communities of color, immigrant families, low-income neighborhoods, and rural regions often face the greatest burdens of unmet social needs.

For example, parent working two jobs facing long commutes on unreliable transit and still struggling to keep up with the rent. A child missing from school because of untreated asthma triggered by mold in an apartment or by poor air quality outside of their home.

These stories are repeated across our state and are rooted in long stand understanding policy decisions. Addressing inequities means listening to communities, considering their experiences, and ensuring policies reflect the needs of those most affected. Our work must be shaped by the reality of families and not by assumptions made in Sacramento.

Today, we have the benefit of hearing from an outstanding group of experts and community leaders who bring diverse perspectives on how social determinants of health impacts children and families. Dr. Rodney Hood, a physician and President and Chair of the Multicultural Health Foundation, will provide an overview of the social determinants of health.

Dr. Nadine Burke Harris, California's First Surgeon General, who was our Surgeon General from 2019 to 2022, will highlight the impact of adverse childhood experiences, also known as ACEs and trauma. Dr. Vickie Mays, UCLA Distinguished Professor of Psychology and Health Policy and Management, will speak to the health impacts for children.

Dr. Sud, Director of California's Children and Youth Behavioral Initiative, will share how the initiative is coordinating across state agencies, schools, and community partners to improve behavioral health outcomes for children and youth. From the Environmental Health Coalition, Program Manager, Maritza Garcia, will share community level work on environmental justice.

And finally, Dominique Donette, Director of Government Affairs at EdVoice, will share advocacy work focused on helping children overcome barriers to learning. I am looking forward to this hearing. We have some dynamic panelists, and I would also like to thank all of those who are attending today in person and who—and those who are watching via livestream.

And with that, we will begin our presentation today with our first two panelists. It is now my honor and my pleasure to introduce our first speaker, someone that everyone in San Diego should be aware of. Our first speaker is Dr. Rodney Hood. He is a physician and educator and recognized national leader on health equity.

He has lectured widely on health disparities, the historic role of race and genetics and health outcomes, and cultural competency in health care. Dr. Hood has testified before Congress, participated in the White House Health Forums, and is the past President and Chair of the National Medical Association.

He is a board-certified internist and UCSD Assistant Clinical Professor of Medicine and he will provide us at this point with a broad overview of social determinants of health. Dr. Hood.

Good morning, everybody. Good morning, everybody. I know I'm the first and actually, I've been giving this lecture a long time and sometimes too long, but I am going to refer to my notes, and I'm going to try and go through very quickly.

But I want to thank you for being here and I want to thank Dr. Weber for not only inviting me but for the work that she's doing.

So, social determinants of health, as defined by the CDC, are non-medical factors that influence health outcomes and these are conditions in places where people live, learn, work, worship, play, and age and they affect a wide range of health risks and quality of life outcomes. However, I believe it's more than that.

Most times folks talk about social economic status, where you live, education, job status, access to resources, and gender—critical. But nobody really talks much about the interplay of race, ethnicity, racism, bias, discrimination, and chronic toxic stress. There's a lot of data and science now.

The reason why they didn't talk about it is they didn't know how to measure it. They didn't know what it meant. Why are you calling me a racist? Well, because you live in a racist form. You may not be, but many of the policies have been. So, let's talk about the past.

And I'm going to go through this very quickly. And I think it's important because many barriers caused by the social determinants of health historically were intentional. Didn't just happen. These were intentional. What am I talking about? So, let's go back to the beginning. So, historically, in European white culture, they used to teach that blacks were not only—they weren't only discriminated against, they were dehumanized.

And they used to teach this in European science and medical schools and in the medical schools here in the United States where they said blacks were inferior, and here's the proof.

They looked at facial angles and stated that whites who had a facial angle closer to 90 degrees, therefore hierarchically they were superior, followed by blacks then apes. Okay? This was taught and this was believed. So, people keep talking about discrimination and dehumanization.

Yes, we've been discriminated against, but nobody, maybe with the exception of the Native American, has been dehumanized to that extent. And here are some of the culprits. We got Georges Leopold Cuvier, who was a French scientist who was father of paleontology.

He was a teacher of many American physicians who actually went over and studied with him and came back to Harvard and University of Pennsylvania, which was the first medical school, and taught many of these theories. And in case you're not familiar with Cuvier, he was the scientist in Europe that attracted this African female from South Africa, from the Koshan Tribe.

Her name was Sategia Baartman. They called her Hottentot Venus. And they dehumanized her. And when she died, he made a cast of her and had it in the Museum of Paris up until Nelson Mandela became President. He demanded the corpse come back.

So, centuries of dehumanization. He was trying to prove how inferior black folks were. And then we have Mr. Cartwright. He was a graduate of the University of Pennsylvania. He then went to Louisiana, where he became—his title was Professor of Diseases of the Negro in the Medical Department of the University of Louisiana. Black folks were a specialty.

And he wrote an article in Dubose Medical Journal and, and coined two terms: drapedomania, runaway madness. Slaves would run away, therefore they had to be crazy living in this wonderful slave environment. And another term, dysesthesia ethiopica. I love that term. And what he was saying—dysesthesia means ethiopic, meaning black. Dysesthesia meant they weren't as sensitive.

They could take the pain. And part of the treatment, if they continue to run away, was to whip them, as he said, to beat the devil out of them. One of the issues, even in today, where the health system still feels that black folks can take more pain and we get less pain medication.

And then, we got another individual, Samuel Morton. He taught at the University of Pennsylvania, taught the theory of craniotomy and phrenology, where they measured brain capacity—I call it one of the first European IQ tests—and said that blacks had smaller capacities and therefore were inferior. So, not only attacking us physically, but mentally.

And then, we have Dr. Joshua Knott, also a graduate of the University of Pennsylvania, one of the founders of the University of Alabama, who taught the theory, quote...where we weren't, we had a lot of medical problems, not because of our social conditions, but because we were inferior.

And then, of course, everybody knows Dr. Marion Sims, father of gynecology, women's health, who operated on mostly slaves without the use of anesthesia to the point of addiction.

This is a book by Dr. Harriet Washington. I just had the privilege of serving on a panel with her, who wrote the book called Medical Apartheid. And if you haven't read it, read it. It sums up a lot of dehumanization experimentations. Not just talking about the Tuskegee Experimentation, but multiple ones before then.

And she describes kind of the healthcare and experimentations that took place not only during slavery, but after slavery. So, what about the history? This is several hundred years of history. We started with "we the people," where, within the Constitution, we were labeled three fifths human beings. Again, they're dehumanizing us.

And then we went through slavery that I just discovered, and the type of treatment and healthcare that we got during slavery. And then we went to the Jim Crow era, where there was multiple terror. Not only lynchings, but there were dozens of communities.

Tulsa was one, Redwood was another, where blacks were becoming successful and black—whites—would burn down their towns and terrorize them. And so, it's discrimination, racism, over centuries. Now, you, you may not believe it, but that's got to have an effect on the population. So, here we are in the present.

And the reason why I put this up, there was a report by the Institute of Medicine that came out in 2002. It's now called the National Academy of Medicine. And the report was called Unequal Treatment Confronting Racial and Ethnic Health Disparities.

This is what began a lot of research in this area, because prior to that, in the 1980s, 1990s—I'm old, I've been around a while—I was then Chairman of the Board of National Medical Association, which is the black physicians in this country.

We just kept seeing these articles coming out where blacks were achieving fewer outcomes, being treated. And they kept saying, well, it must be because they're poor. Well, it must be because they're uneducated. So, this looked at dozens, if not hundreds, of studies and came to the conclusion that discrimination and racism in medicine is real.

This was the first study, and I bring it up because it was only the talk about politics. The National Medical Association advocated in Congress. Jesse Jackson Jr. Was the congressman, went to the Congressional Black Caucus and got this funded for about $900,000. And it was this study. So, I call it the National Medical Association Study.

And basically, this is just one study where in 1999, published in the New England Journal of Medicine, where these were actually actors that they filmed and asked thousands of physicians, what's the diagnosis and what would you do? Physicians are very trained. They got the diagnosis heart disease, but then they asked the question, what would you do?

They all gave the same history; all gave the same responses. For whatever reason, the intervention of cardiac catheterization was recommended much less for blacks, especially black females. Everybody's saying why? We didn't know about bias at that time. Well, some of us did. So, I'm going to talk about the social and biological science of social determinants of health.

Yes, zip code is more determinative of your health than your genetic code, but it's more complicated than that. We're talking about your environment, air, water pollution. We're talking about housing structures, how dense it is, how many folks live in the same area. Okay, we're talking about contamination and guess who lives in those environments more than other folks?

Then we're talking about your zip code that has poor access to quality education, healthy food, poor access to quality health care, and excessive exposure to violence with overexposure to the justice system. And then we have what I call the social code or your social status.

So, yes, zip code is important, but another independent factor is who you are, individually in this country, your level of economic achievement, your educational level, your quality of job, and yes, who you are. Race and ethnicity. And data and science will show that there are two groups mainly that have suffered chronically, that's the African Americans or blacks through slavery, and the Native Americans.

And this brings up racism, discriminatory policies such as redlining, as well as racial bias in health, education, justice, and financial systems. It's very holistic, so it wasn't just in the health system. And then a little bit about epigenetics.

Excessive epigenetics is the changes in gene expression, not actually a change in the gene, but the gene expression that's brought about by environmental stress is excessive, toxic stress that leads to infection and disease. And this is just a quick overview of what we mean by epigenetics.

On the left, you see the environment, what you eat, what you live, you exercise. And then on the right, it can result in with changes in gene expression. There's a lot of chemicals that interfere with your genes, interact with your cells, and can enhance disease. So, yes, place and race. This is San Diego.

This is some recent data that I got. In 2022, we're looking at the life expectancy. So, if you want to know about the whole issue of health disparities and social determinants of health, look at maternal health, infant mortality, and life expectancy. And this is looking at life expectancy just here in San Diego.

There's a range, the high range in the University area of 87.8 years and a low range of 75.6, a difference of 12.2 years, just in the County of San Diego. Now, in San Diego, they use region. So, that's just to show you.

And for those of you who are not familiar with San Diego, the higher income kind of live in the north and the lower income live in the south. Okay. And then on the east is kind of the rural, so the Middle South. Now, what's interesting is in the south, you see they have a pretty good life expectancy.

80. Why? A lot of Hispanics live down there. Okay. And whites. I'm not going to spend time doing that, but everybody always says we compare our outcomes to whites. We should really compare it to Asians and Hispanics. What about race? Asians have the highest life expectancy, 85.4 years. Hispanics next, followed by whites, followed by blacks.

What's missing from that is Native Americans. And when I look at the national statistics for Native Americans, they're either second, if not above second to Blacks as far as it's worse. So, those two populations keep coming up and everybody keeps saying, well, you know, we keep comparing ourselves to whites. Why are Asians and Hispanics doing better?

Don't have time. Stress. What do we mean by stress? I'm going to talk quickly about stress and the concept of allostasis. That is how we interact with the environment. Allostatic load, which is excess allostasis, is chronic insidious physiological stress causing wear and tear on the body organs called weathering and this leads to chronic disease.

And this is just showing the various interactions that cause stress. And I've come up with the term "racialized social determinants of health" to show how intentional in certain populations it is and that structural racism, and many times when you see this, they won't even have racism up there.

But I think it's probably more of a factor in the Black, Native American population than other populations. There are researchers in this area and one of my mentors is Dr. David Williams. He's now at Harvard. He's been researching in stress pathways caused by discrimination and how it affects health.

He wrote an article, that I'm quoting here, where he said negative emotional exposure generates psychological distress that adversely affects health such as depression and anxiety. Behavioral coping responses to manage these stresses leads to other issues, and psychological and behavioral responses to criminal chronic stress can lead to psychological system changes.

So, he has done a lot of research in this area, and he was one of the first to come up with tools to measure racism as a form of stress. And very quickly, you're going to hear a lot about ACEs. I took out a lot of my ACE slides, but it's very important. How did we get here?

Because on the left, I have racial social determinants of health, ACEs, beginning in life and then chronically through life. In the middle, I have PTSSD. I call it post traumatic slavery stress disorder. Okay. And I wrote an article on it. I'll show it to you later.

But basically, chronic toxic stress leads to primary stress mediators that are released and they affect the brain, that can affect behavior, that causes overeating, obesity, sleep problems, et cetera. And on the right, it can have a direct effect on our neurological system, our endocrine system, and cardiovascular system.

And then, if that's excessive, it can lead to diseases such as hypertension, myocardial...et cetera. And that can ultimately lead to the health consequences of what I—for black folks, PTSSD and ultimately, premature deaths. To me, significant contributor to the life expectancy.

And this is an article that was published in the Journal of Public Health looking at a study that showed, and I still don't have much time, so let me just say this study showed when they looked at measuring allostatic load, that blacks had higher allostatic load than whites.

And what was unique is that black women's allostatic load was higher than the male allostatic load. When you looked at whites and other ethnicities, the male's allostatic load was usually higher than the woman's, but in blacks, it was the female. And even when they looked at poor whites, the black's allostatic load was higher than poor whites.

Does this contribute to why we see black infant mortality and black maternal mortality at greater rates, no matter what the economic status is?

And this is just showing that on the left, maternal mortality is almost twice the average in the US and on the right, the infant mortality is almost twice what it is in the US. In summary, I say there are four stages to this stress level, and it includes one, ancestral trauma from slavery and Jim Crow, two, birthing trauma with high black maternal infant mortality, three, childhood trauma with ACEs, which you hear a lot about.

And the original study, Felitti, here in San Diego, if you look at that, it had a demographic of race and showed that Blacks had the highest ACE scores. And then we have adult trauma that we see with Blacks and Hispanics more in environmental toxic areas as well as Blacks having higher allostatic loads.

So, there's opportunity to correct consequences of these health disparities. Published in JAMA in 2023, "The Economic Burden of Racial, Ethnic, and Health Disparities, " it showed that in 2018 alone, these health disparities were costing our country an extra $451 billion. So, people say, if we're going to solve this problem, where are we going to get the money?

Investing in removing these structural barriers associated with the social determinants of health will result in improvement of these disparities and can be paid for with the cost savings. And this is just to let you know, this is just isn't in the United States. Similar studies and things have been done in Australia looking at the Aboriginal population.

They have similar statistics to black folks showing that they get sick, die earlier, and they started a campaign saying racism in medicine. And when we talk about racism, there are three types that I personally talk about. Personally mediated, structural, and internalized. And it's the structural internalized that's killing us, not when somebody calls us the N word.

It's the structures. We need to tear down those structures. And lastly, I want to thank you. This is an article that was just published two months ago in the journal, Racial and Ethnic Health Disparities, where I go off into more detail about PTSSD. Thank you.

Thank you so much, Dr. Hood, for that excellent presentation. I always love hearing you talk about social determinants of health and the history in this country and epigenetics and the impacts of stress on our bodies and on our families and on our communities. Our next speaker is going to be Dr. Nadine Burke Harris.

She made history as California's First Surgeon General, as I stated before, serving from 2019 to 2022. She is a nationally recognized pediatrician and founder of the Center for Youth Wellness. She will share her trailblazing work on how adverse childhood experiences and trauma can have lifelong impacts. Dr. Burke Harris, the floor is yours.

Thank you. And thank you, Senator, Dr. Weber, for inviting me to come and speak. And Senator Padilla, thank you so much. It's really my privilege to be able to share with you all this morning. And this work and this passion for me comes from my experience as a pediatrician.

I spent many years caring for kids in the Bayview Hunters Point neighborhood of San Francisco. And in that process and in getting to coming to serve this new neighborhood, I had many patients who were referred to me for concern of ADHD or Attention Deficit Hyperactivity Disorder.

And when I did my job as a pediatrician and did a thorough history and physical, what I found was that these challenges were most common in my patients who were experiencing stressful or traumatic events at home. And it turns out that it wasn't just their behavior, but overall, their health.

My patients with the most severe asthma, my patients with the most challenging diabetes, all of them were more likely to have experienced significant stressors and challenges at home. And that is really what led me into the research about how what we experience, how our experiences and environments get under our skin and change our biology.

And one of the most groundbreaking pieces of work in this field came from the landmark study, which was the Adverse Childhood Experiences Study, that looked at 10 particular categories of childhood adversity, including physical, emotional, or sexual abuse, physical or emotional neglect, or growing up in a household where parent experienced untreated mental illness, intimate partner violence, substance dependence, parental separation or divorce or incarceration.

And what they found from the study were two things that were really striking. The first is just how common these experiences are. So, 2/3 of folks had experienced experience at least one, and in the original study, 1 in 8 folks had experienced four or more.

Nationally, the CDC has now collected this data from all 50 states and found that still roughly about 2/3, but it's at the prevalence is around 1 in 6 Americans have experienced at least one adverse childhood experience. Here in California, 67% of California adults have experienced at least one ACE and 17.6% have experienced four or more.

And as you heard from Dr. Hood, the prevalence is greater in our communities of color, in our African American, Latinx, Native, and tribal communities, and also in our LGBTQ communities. So, just how common ACEs are was really the first big finding.

The second big finding that was really groundbreaking was that there was a dose response relationship between ACEs and physical, mental, and behavioral health outcomes.

So, when we, when we say dose response, we mean the more categories of ACEs a person experience, the greater their risk for high-risk drinking, early sexual initiation, teen pregnancy, and also teen paternity, substance use and dependence. Here we see ACEs and adverse school outcomes with repeating a grade, not completing homework, not caring about school.

And we see the same dose response relationship. In addition, we see ACEs and mental health outcomes that same dose response relationship. Recently, the CDC actually did an estimate of the impact of ACEs on the mental health of children and youth. So, many of the studies looked at the impact of ACEs on adult outcomes.

Recently, the CDC looked at the impact of ACEs on youth mental health. We know that 50% of mental health disorders are manifest by age 14. When the CDC calculated what they call the population attributable fraction of these health conditions and risk behaviors due to ACEs—and when we say population attributable fraction, what we mean is how much of this condition that we see out in the community is due to this risk factor.

So, for example, roughly 75% of lung cancer that we see out in the community is due to smoking. Right? That's the population attributable fraction.

Here I want to highlight a few things. So, among those under 18, roughly half of current alcohol use is attributable to ACEs. Roughly 84—84.3%—of current prescription opioid misuse. 80%—sorry, 65%—of persistent feelings of sadness or hopelessness is attributable to ACEs. 89.4% of suicide attempts in our youth attributable to ACEs, according to the CDC.

In addition, when we look at ACEs and homelessness, for example, we see that same dose response relationship, and then when we look at the 10 leading causes of death in the U.S., we see that same dose response relationship between adverse childhood experiences and the 10 leading causes—and nine out of the 10 of the leading causes of death.

And although Covid is number 10 in the most recent CDC data, although there's not an increased risk of the prevalence of ACEs, there's an increase—there is a dose response relationship between Covid and hospitalization—sorry, between ACEs and hospitalization due to Covid and death due to Covid.

And it's believed that that is due to increased risk of these other health conditions that can make an individual more vulnerable to Covid.

So, in addition to the increased risk of mental and behavioral health disorders, of serious medical disorders, we also see that ACEs are really strongly associated with health care expenditures. The Agency for Health Care Research and Quality published a study in 2024 estimating that 28.6% of adult Medicaid expenditures are excess expenditures due to ACEs. Right?

So, the cost is not just the human toll, but also the economic toll. So, not only do ACEs increase our health care expenditures, but we also see that ACEs increase the risk of Medicaid enrollments.

This data published by the CDC earlier this year in 2025 that show the ACEs increase the likelihood of Medicaid enrollment, housing assistance, and as you saw before, teenage birth, as well as felony charge.

We also understand that emerging data is showing that treatment of ACE associated health conditions can be more difficult in people who have ACEs than in people who don't. So, we see that ACEs increase the risk of depression.

Emerging data shows that individuals with depression, if they have ACEs, are less likely to respond to antidepressants and in this case, these are SSRIs, selective serotonin reuptake inhibitors, as compared to those without ACEs. Similarly, those with ACES were less likely to achieve remission of anxiety as compared to those without ACEs.

In addition, when we see treatment of substance use and dependence, right, here's the treatment efficacy of inpatient hospitalization for substance dependence, with no ACEs being here in the light blue and four or more ACEs being here in the dark orange, we see that same dose response relationship between impairment of treatment efficacy.

And so, it's really key, as a, as a, as a physician and a scientist, I have to say it's really key that we understand how this happens because when we understand how this happens, then we get insights into how to intervene and how to break this intergenerational cycle.

And what we now understand is that one of the key mechanisms has to do with the brain and body's biological stress response. So, it works a little something like this. Imagine you're walking in a forest, and you see this guy, right? What happens in our brains and bodies?

Our amygdala, which is our brain's fear response, sounds the alarm and activates our bodies to release stress hormones, including adrenaline and cortisol.

So, our hearts start to pound, our pupils dilate, we increase our blood pressure and our blood sugar so that we can send blood to our big muscles for running and jumping so we can get away from the bear, right? But if you were to think about it, fighting a bear wouldn't seem like a good idea, would it?

No, he's big. He's got teeth, he's got claws. And so that amygdala, the brain's fear response, actually sends projections to the prefrontal cortex, the part of the brain up here behind our forehead. And it's the part of the brain responsible for impulse control and executive function and judgment. And the amygdala turns that part way down.

Because the last thing you want if you're in a forest and there's a bear, is some impulse control getting in the way of survival, right? And so, instead, what it does is it turns up a part of the brain called the noradrenergic nucleus of the locus coeruleus.

Or as I like to call it, the part of the brain responsible for I don't know karate, but I do know...right? This is our within the brain stress response center and it gets us amped up. Now, the less obvious thing that happens when we activate our stress response is that it also activates our immune response.

Because if that bear gets his claws into you, you want your immune system to release inflammation so you can stabilize that wound to live long enough to either beat that bear or get away. This is brilliant. It was evolved over millennia to save our lives from a mortal threat.

But the problem is what happens when that bear comes home every night, and this biological system is activated by over and over and over and over again. And it goes from being...

Adaptive or life saving to maladaptive or health damaging. And what we know is that children are especially sensitive to the repeated activation of the biological stress response because their brains and bodies are just developing. So high doses of adversity in childhood affects the develop the developmental trajectory of children's brains.

They're developing hormonal systems, they're developing immune systems and even the way their DNA is read and transcribed, the epigenetics as you heard Dr. Hood talking about.

And so this prolonged activation of our stress response systems in ways that disrupt the development of brain architecture and other organ systems and increases the risk for stress related disease and cognitive impairment is what scientists and doctors now refer to as the toxic stress response.

Now this slide is a very very busy slide that shows many of the systems that are impacted by the toxic stress response. And I will tell you that science and molecular mechanisms and data is my love language. But you all don't have to know this.

I put it up there just to say that advances in science and technology allow us now to more precisely what is understand what is happening in the developing brains and bodies of kids and our ability to measure.

The same way that the invention of the microscope allowed us to be able to see microbes and subsequently develop antibiotics, things like functional mri, genomics, transcriptomics, metabolomics, now allow us to be able to measure what is actually happening in the brains and bodies of individuals that have been impacted by adversity and to be able to understand how we can target interventions.

And one of the things that is a key factor that we understand now is that that all of these advances in science allow us to measure is that our social drivers of health can set the odds for exposures to ACEs and other risk factors for toxic stress.

Because we know that that dysregulated stress response and the neuroendocrine, immune and genetic regulatory disruption are not. Aces are not the only risk factors, right? Things like discrimination, experiencing the atrocities of war. Right. Severe poverty can also lead to prolonged activation of the biological stress response and neuroendocrine immune genetic regulatory disruption. And this is a depiction.

I sat on a committee for the National Academies of Sciences, Engineering and Medicine. And in the dark blue here we see our biological, psychological and socio behavioral development. Right? And we recognize that there are biological pathways that are develop over the lifetime.

But this biological pathway is shaped by family cohesion, by social connection, by caregiver well being and access to support healthy childhood development. These are in turn shaped by healthy living conditions, our health care system and early care and education all of these factors are shaped by structural inequities, socioeconomic and political drivers. Right.

So there is a strong and deep interconnection between these structural factors and the release of markers of inflammation, epigenetic regulation and development of the stress response in the body. But the good news is that aces are not destiny and that with early detection and evidence based intervention, we can transform outcomes.

And in fact we are transforming outcomes in the State of California.

So just as I showed you that very busy slide that showed so many of the biological systems that are disrupted by the toxic stress response, so also advances in science and technology allow us to measure what interventions and factors can mitigate and interrupt and potentially reverse the impact of the toxic stress response.

And we see things like high quality nurturing, caregiving is associated with normalization of the developmental trajectory of the white matter structures in children's brains. We see that responsive caregiving improves cortisol reactivity in children. Things like time in nature, mindfulness, healthy sleep, moderate exercise, all of these factors help to reduce stress hormones, reduce inflammation and enhance neuroplasticity.

So when I was in the state Surgeon General's office, my team put together this evidence based buffering interventions including supportive relationships, quality sleep, balanced nutrition, physical activity, mindfulness practices, access to nature and mental health care. And the data shows that these impacts actually make a difference.

So when we looked at a study that actually came from whales, looking at individuals with zero ACEs as compared to those with four more ACEs, no surprise, very similar to the data that I showed before that those with four more ACEs had increased risk of health harming behaviors and lower mental well being.

And then we saw what was the impact of those buffering factors. So this data demonstrates that even when individuals have experienced four more aces, when they receive high levels of these buffering factors, the re we can see up to a 59% reduction in health harming behaviors, lower mental well being and also medical outcomes.

They looked at things like headache, abdominal pain as well. So we can see a reduction in these adverse outcomes. So if advances in science and technology can help us identify who's at risk and also help us identify what interventions can actually intervene and mitigate that risk, then as we heard Dr.

Hood say, how do we align our structures to make sure that we get those that we can do systematically do early detection and early intervention?

Because that is actually what we saw from the National Academies that the preconception through early life periods are foundational for healthy development and that biologically a number of critical systems are developing and, and humans have high plasticity during those life stages.

And so in California we developed the ACEs Aware model to promote early detection and evidence based intervention to mitigate the health and societal impacts of ACES and toxic stress. We reimbursed our primary care providers for ACE screening. We required that they be trained on how to screen and how to respond with evidence based and trauma informed care.

And then critically we aligned eligibility for services based on risk rather than based on harm. Previously, in order to get access to wraparound services or specialty mental health, a child needed to have a mental health diagnosis.

Now in California, a child with four or more ACEs is eligible for services and I want to show you what that looks like. In California we've trained more than 49,000 health care providers on ACE screening and evidence based and trauma informed response.

More than four and a half million screenings have been conducted in more than two and a half individual Medicaid Members. We see that of the this work is happening all over the state and of those who are screened, roughly 7.5% of Medi Cal Members 0 to 20 have an ACE score of 4 or more.

And then this coordinated care to tie the ACE screening to access to Medicaid covered services. What we see is that from our LA County pilot we see this has dramatically increased eligibility for wraparound services. This is enhanced care management.

And we see eligibility based on substance use, depression, suicidal ideation, lack of adequate housing, foster care status, autism and ACE score four or more we see dramatically increased eligibility. But just because folks are eligible doesn't mean they're getting the services.

What we see because of the training of our providers we see both children and adults were dramatically more likely to be referred to services. And here we see social service referrals, we see that dose response relationship. This is a positive dose response relationship between ACE score and referral to services.

We also saw due to investments in infrastructure in the an investment that are ACES Aware Initiative that in the LA County pilot the time for a closed loop referral, the average time between the time someone was referred and actually received the services went from 120 days to 20 days due to investments in systems transformation to make sure that our clinics and communities are equipped to bring to make sure that families get access to services.

And in a telling fashion, when we see these are referrals to community based organizations that provide the buffering services that can help families address the impacts of ACEs and toxic stress. Here we see in the orange for families who had four more aces. Here we see in the green families with one to three aces.

The purple is zero aces and the blue is not screened. So our families with zero ACEs were more likely to be referred to appropriate community referrals than those who were not screened. So we can see the benefit for families. And then of course the most important piece which is improved healthcare outcomes.

And here we see youth who are referred to a mindfulness intervention, one of those evidence based intervention, this was a virtual mindfulness intervention. We saw a reduction in depression symptoms as measured by PHQ9 and reduction in anxiety symptoms as measured by GAD7.

And importantly, I'll just highlight that an evaluation from RAND showed that ACE screening was feasible, acceptable benefited patients and that after over 4 million screens there were no lasting adverse effects from the ACE screening.

One of the key, as I wrap up, I just want to highlight that this work was done, that ACE screening is just one part of a coordinated public health approach. And you're going to Hear More from Dr. Sud later on about other pieces of that coordinated public health approach.

But I want to highlight that in our educational spaces we launched the Safe Spaces training so that educators understand the their role in providing the daily doses of safe, stable and nurturing relationships and environments that are healing for kids.

Through First 5 California, there was a widespread public education campaign which showed 93% of parents intended to take action to manage toxic stress in themselves and their kids. 89% believed it was possible to help children heal. 88% believe that they can break the cycle of toxic stress. And there was almost a 21/2 times increase in knowledge.

Right. And we know that knowledge is power. Finally, the Live Beyond campaign developed for youth by youth to help break the cycle among our youth. And within our Corrections and Rehabilitations Department, we're also doing trauma informed systems transformation. So we can do this. We are doing this here in the State of California.

And I'm so grateful to Senator Dr. Weber for her partnership and leadership in these important issues. Thank you.

Thank you so much, Dr. Burke Harris, for sharing your expertise and helping us understand not only us here that are here today or that are watching, but really helping the state because you championed this when you were our Surgeon General and you continue to fight for this.

I remember you coming to my office about funding around this and so, you know, it is extremely important. And so I just really, really want to thank you for, for everything that you have done for our state and for our children.

I'm going to turn it over to Senator Padilla at this time and see if he has any questions for either Dr. Hood or Dr. Burke Harris.

Thank you, Chair. Both. Thank you. Both for your contributions and your leadership in this space. It's very informative and helpful. Obviously complex, I think with respect to your presentation, Dr.

Hood, first one of the most eye popping pieces of data that you highlighted and we talk about systemic bias even to some degree, you know, social and not malicious, but sometimes just ignorant and even subconscious that materializes in a way that adversely affects outcomes in terms of was the data you presented with respect to the bias seen in providers and Clinicians in terms of their interventions and response post diagnosis in a way that reflected that bias.

So one of the things, and it's related, and then to Dr. Burke Harris, you talk about the coordinated public health approach.

I'd be interested to know about your observations with respect to from a standards or licensing or training or institutional, for lack of a better word, because it's a complex process by which we license practitioners both here and nationally.

Is it a stand, you know, what are some of the observations about deficiencies operationally, systemically in our response, in the coordination insensitivities among practitioners, educators, all those integrated provider systems. Right. That have to play a role together in a coordinated fashion. There's always the funding that Dr. Weber referred to that that's perennial.

But I'm curious if there are other observations you might have about the work ahead in improving that. And the same would be to Dr. Hood with respect to increasing sensitivity, awareness and competency among providers and Clinicians in getting at that bias in treatment response that you referred to. So thank you.

Thank you for that question. First of all, the slide that I showed that was published in 1999 was really before people started talking about provider bias. Since then we've learned a lot. There are multiple studies now that looked at providers giving care to Hispanic patients, black patients and white patients. And let's talk about pain.

For whatever reason, they tended to give pain medications less to blacks and Hispanics. There was. And the reason why I like that study is it eliminated the issue of insurance and that type of thing. There was a study which we now have a test that we can actually measure somebody's bias. It's called the Harvard Implicit Bias Test.

It's been around for a while. And there was one study that looked at, I think by that time they had over a million folks had taken the implicit bias test. And if you're not familiar, it kind of lets you know, do you have a bias towards gays, towards blacks, towards women, et cetera.

And within that test there was a subset of physicians that they were able to look at and looked at the ethnicity of the physicians and found that physicians had one of the highest implicit biases against blacks, even higher than lawyers.

And when they looked at it by race and ethnicity, it was like Asians and whites had the highest implicit bias towards blacks, followed by Hispanics. And the ones with the least bias were the black physicians, especially the black females. They were almost zero.

More importantly, they then did studies to say, does that bias relate in how they treat? And they had other studies come out and say when these physicians treated patients of color, they tended to either over treat or under treat based upon their implicit bias.

So the higher your bias was towards blacks, the less you were able to give them that. So that brings us to can that change? And the answer is yes. There's evidence to suggest that physicians that had been gone through trauma informed care and cultural sensitivity tended to show some improvement.

The question is, we're not sure how long that lasts.

And in response to your question, your question was about licensure. But the. I will say that I think my response response is really focused on training, which is why Dr. Weber, appreciate your advocacy about the funding. Right.

Because so one of the big challenges is that, you know, I talked about the advances in technology and science that is enabling this understanding. I did my, my pediatric residency at Stanford. We did not learn about ACEs when I did my training.

And there are more and more clinicians who are learning about it now, but it's still, you know, I, I'm not that old. And so we have many, many physicians in practice who, who have not been trained on even the fundamentals of trauma informed care. Right.

Much less the impact of ACEs, the toxic stress response, how that may be showing up in their clinic. And you know, Dr. Hood and I were having a conversation just before the session started, and the reality is that, that the dysregulated stress response is being vastly undertreated in our healthcare system right now.

And the result of that is excess morbidity and mortality. And particularly when we look at, then again, the intersection between biology and social drivers of health. Right. And things like bias, whether that bias is in the health care system.

So just looking at the data showing that individuals of color are more likely to be exposed to ACEs and other risk factors for toxic stress, they're less likely to have, have access to things like green spaces, safe places to play, community supports where they're able to, or even, or even providers in their community to be able to provide culturally and linguistically concordant care.

Right. And so when you add those up, we see systematic differences in Morbidity and mortality. And that is where I see. Our responsibility is to shape our systems to be able to redress that. Right. And to. To support our. Our families, to systematically drive for better outcomes.

Thank you, Doctor.

If I can add to that, she gave a very informative talk on children. I'm an internist, and I still practice part time. And the population that I see are mostly adults. And all of them, when tested, have high ACE scores. Significant portion of my population is African American American.

Some of the data she showed were the resistance to SSRIs, antidepressants with those with high ACE scores. Now, I don't know that I have data to show this up, but I've been in practice a long time, 50 years, and I find that certain patients, especially with high ACE scores, are more resistant to certain medications.

When I went to school, we used to call it black hypertension versus African American. With hypertension, sometimes was much more difficult to treat. Found that they needed more medications to kind of treat. That's complicated by the fact that the history I showed blacks don't trust the health system. They don't want to take their medications.

They don't want to be compliant. They're trying more natural things, things. And I think the complex of ACEs and this chronic toxic stress makes them more resistant. And I actually had a friend, I'll just tell this one story, who was resistant to taking medications. He wound up having triple vessel bypass. He had hypertension, cholesterol, et cetera.

He wound up leaving, living in Cape Verde. He'd been there for about 67 years. And every time when I see him, man, I'm off my medications and my blood pressure is fine. I said, because you're not in America dealing with this toxic stress.

So I think many of us would be able to be off of medications if we weren't dealing with the toxic stress that we have to deal with in the United States. Thank you. Thank you, sir.

Thank you. I have so many questions, but I know I don't have time to get to all of them, but what you just said is actually, Dr. Hood, a good segue into what? I wanted to briefly ask you about stress and the life expectancy.

And so I know you mentioned that we didn't have time to get into the difference between, you know, the life expectancy for Asians versus Hispanics versus black Americans.

But my question is, do we see that difference based on the time that we've been here in this country and the amount of stress that has occurred over generations, or is it something else?

Excellent question. And yes, that's a significant part of it. If you look at the populations that, that have had the chronic toxic stress, African Americans and Native Americans, they have the worst health outcomes, and that's because of the chronicity. The other issue is culture.

If you look at Hispanics and Asians, they've been able in America to maintain some of their own cultural identity, their language, some of their customs. And we notice as immigrants come to this country, Hispanics, Asians, and they acculturate, their health gets worse. So the more you're able to, I often say American culture is bad for your health.

And somehow or another we need to learn that cultural differences are not necessarily unpatriotic. Cultural differences can be healthy when you understand them.

Yeah, that's what I was thinking. And you know, a lot of, as has been pointed out earlier, a lot of the stress that has been placed on African Americans and Native Americans throughout generations are things that have been done by policies and legislation that has been passed in this state and in this country.

And so looking at some of the current policies, legislation, mandates, Executive orders that are coming out of this current Administration, I'm wondering what you would hypothesize or think would be the outcome on these current communities that are experiencing like Ayes raids and the trauma that they are experiencing, the adults, the children, and how that may impact their epigenetics in the near future.

Yeah, I believe I show statistics where Hispanics, Mexican Americans, life expectancy is longer. I think what they're going through now, it's going to long term show a decrease because they're being terrorized.

I'm sorry if I used that word, but you saw me talk about doing Jim Crow when, when blacks were being lynched, when communities were being burned, they were terrorizing the black community. And that certainly increased their toxic stress.

So what's happening today in the Hispanic and other people of color community is, I have to believe, is severely increasing their stress. The aces. And long term is going to have some negative health outcomes.

Thank you for, for that. And Dr. Burke Harris, I was just loving your slides. One in particular I'm gonna have to show to Governor Newsom because he loved to veto my bill on social determinants of health screening and adults because he said, we're already doing ACEs. I said, well, that's not for adults really usually.

But you know, it's interesting because as people who are trained in the medical system, we think about diagnosis and we think about pharmacologic treatments. And I think one of the things that stood out so much to me in your slides. And also what Dr.

Hood noted from his practical experience is that the medication that we give don't necessarily work the same or as well in patients that have chronic stress or high A scores, and that in those particular patients, we need to think outside of the box and do things like mindfulness, increasing exercise, increasing exposure to open green spaces.

And so that got me to thinking about how, from a legislative standpoint, can we better translate the science around aces into policies that reduce some of these inequities that we see.

...in kids.

Yeah. I, so, I think that there are a couple of pieces. One of—one key takeaway from the slide around the treatment efficacy is this recognition that we need to treat the condition if it's depression or substance use disorder, and we also need to treat the underlying dysregulated stress response and use evidence-based treatments for both.

I do believe that there's a role for pharmacotherapy in the treatment of the dysregulated stress response. So, I'm going to put that in there.

But when we're talking about how do we align our policies with the science, one of the key pieces is making sure that we have access to, number one, as I mentioned, the early detection evidence-based intervention, and that is—and that we are investing in ensuring that family—individuals and families—can receive that on a regular basis.

Not only that, but also ensuring that we are, that we're integrating that into our practice. I would say the one additional piece that that goes along with that is really thinking about also how are we—you know, oftentimes in medicine, we talk about treating to effect, right?

So, we actually have to—and one of the things that's in the ACEs aware training is to evaluate, okay, so we have supported this family with wraparound services. We've connected them or given them access to evidence-based interventions. And how are we doing on outcomes?

And when we are getting to equity in outcomes, when we are getting to improved outcomes and dramatic reduction in morbidity and mortality, that's when we'll know that we are achieving the goal. And so that's—I think that's critical.

Well, thank you. Thank you both so much. If we can give our first panelists a round of applause. We will now move into our second panel which will focus specifically on how social determinants of health impact children's physical and mental health.

This panel brings together leaders in research, state program,s and community advocacy to help us understand the conditions shaping children's health and wellbeing. Our first panelist is Dr. Vickie Mays.

She's a distinguished Professor of Psychology and Health Policy and Management, UC Presidential Chair in Health Equity and Mental Health, and Director of the UCLA Bright Center for Science Research and Policy. Her work focuses on the health status and health behaviors of racial and ethnic minority groups.

Today, Dr. Mays will discuss the impacts of social determinants of health on overall health outcomes for children. We are also joined by Dr. Sud, Director of California's Children and Youth Behavioral Initiative—Health Initiative.

The Initiative serves as a coordinator and unifier across multiple state agencies, schools, and community partners to strengthen prevention, expand early intervention, promote behavioral health screenings, and improve access to care.

Today, Director Sud will share how California's Children and Youth Behavioral Initiative—Health Initiative—is approaching social determinants of health and the actions underway to mitigate and address these challenges for children and youth.

We also welcome Maritza Garcia, Program Manager with the Environmental Health Coalition, who will share community level perspectives on how environmental health issues, such as air quality and housing conditions, affect children and families and the work that is being done locally to confront safety these inequities.

And our last speaker on the panel will be Dominique Donette, Director of Governmental Affairs at EdVoice. She will share how EdVoice is working to advance policies and strategies to remove barriers to learning and improve educational equity for all California's children. We will begin with Dr. Vickie Mays. Dr. Mays, thank you for being here today, and the floor is yours.

Thank you, Senator Dr. Weber. I just want to applaud you for having a hearing on social determinants of health because as you'll see from my talk, I think it's one of the most important things that we can focus on.

My colleagues have set me up so well, so I have slides, like my allostatic load, that I'm just going to zip through. My slides are pretty dense because I wanted to make sure of what I left for you, of the research. But what you're going to get from me is my policy side.

So, I, you know, hope that will be helpful.

Let me start by saying that I hope that when everyone walks out of here that what you will really begin to think about is that when you see a child that's obese, when you see a child that gets put out of school because they're acting up, when you see a child that you're trying to wonder why in the world do they have cardiovascular risk factors so high, that you do not just focus on what that child should do, they didn't walk enough, they didn't eat enough, et cetera, but that you really begin to think about other parts.

So, I'm hoping that, you know, the presentation that I do will lift some of the burden off of our healthcare providers because we think that that's where everything is.

Dr. Nadine Burke Harris was on it near her end slides where she talked about there are many aspects and I'm hoping with some of the policy stuff that I'm going to talk about that I can actually shore that up.

So, when we begin to think about social determinants of health, in terms of health and mental health, one of the great things about research is that we are starting to learn what specific social determinants of health interventions are associated with the ability to change people's health and mental health.

So, the researchers are doing a great job in the sense of allowing us to see actually, what—is it education, is it economics, is it living in a particular type of neighborhood? So, it's part of what I'm going to talk about today.

But the other thing before we get there is I need to remind you that the other place that research has helped us is to see the relationship between health and mental health.

So, we're beginning to see for, you know, in the primary care setting, that interventions that address mental health allow the actual health care to be more beneficial. So, we can't forget that what social determinants of health do is they impact your brain, the way in which, for example, these connections happen.

It's your executive functioning in terms of your ability to make decisions. We see kids and we go, well, that was pretty dumb. And you see us fussing at them about their impulses and things that they've done.

Stop fussing at them and start thinking about what happened in the structure that you live in that also causes you to not have good judgment. So, connect that up with these health outcomes that we're trying to change, and I think we'll be much better off.

So, just remember that in terms of, as we think about kids, ability, you know, and they seem to be lacking, particularly in terms of why did this kid get put out of school? The kid got put out of school because of all the things that weren't there in their neighborhood, the parental neglect and things like that.

So, let me move on because I don't want to be here to preach today. This is why we have to keep NIH going in terms of funding. This is one of the largest studies that's been done, and we all call it the ABCD study. It is done in 21 states. It has over 10,000 participants.

It has a significant number of racial and ethnic minorities in the studies. So, we were able to see the results in terms of black children and others. What they did in this study was they were able to actually specify and grow group certain social determinants of health.

And then, you could see the outcome in terms of health and mental health in terms of the kids. I'm not going to spend a whole lot of time telling you the affluence one, because some of us either live it, strive it, or we watch it on TV, et cetera.

So, those are the, you know, kind of low structural stigma. You know, they're the communities where, you know, kids walk home, they don't worry about safety and all that kind of stuff. Not where a lot of our kids live that have some of the worst problems.

The second environment that they talked about is called the high stigma environment. And in this environment, what you saw is, and thank you, Rodney, for, you know, Dr. Hood, for talking about implicit bias and discrimination because in the high stigma areas, it really was about that towards women, towards sexual orientation and gender identity groups.

You also saw here things like the environment is poor, you know, low college enrollment, but you also saw things like pollutants, you know, heat exposure, ozone. So, you're living in a community in which there was a lot of board and care type facilities, you know, nursing homes, military barracks.

So, what you have is those are like contained groups. They're not out there mixing with the community. They're very regulated in terms of how they are. And then there's a lot of kind of discrimination there. Third group, now group 3 and 4, is where we really begin to understand what happens in terms of children and our communities, because this is where blacks and Latinos, in particular, cluster much more in these kind of environments.

So, when we talk about this high social economic deprivation, big sociological term, but important to just talk about it as economic deprivation.

So, this is an area in which what you're likely to see is that, you know, we have family income that's low, we have people without jobs, the homes, you know, you have low value in terms of your homes, unemployment. You have a high population of people who are disabled. So, you begin to see a lack of opportunity.

You begin to see places in which the deprivation has a lot to do with the fact that income doesn't give you access to good foods, good schools, good opportunities to raise yourself up, and you're being surrounded by others that also are kind of in that same bucket.

Here you also see children experience the greatest amount of racism and discrimination. You also see that towards the immigrants that live here. And it also is an area where there's lead exposure.

So, for those of you, I mean, the physicians in the room probably know this, you know, lead exposure is a significant impact on the brain in terms of children. Where's the lead coming from? Often in terms of the dirt, often in terms of, you know, the walls and all these other places kids put to—ingest it.

We have a lead problem, if you don't realize that, from the wildfires. So, the black community, that impact—that was impacted in Altadena—the recent study that came out showed that there are high amounts of lead.

If people went back looking through things, not fully masked, we're going to see a problem, you know, in terms of the that community. So, I'm just putting you on alert. What did we see here? The worst mental health is in economic deprivation. Blacks and Hispanics here, more so than Asians, were impacted in this community.

The children here had the highest level of internalizing. Internalizing is like when I, you know, I feel depressed, I don't talk about it. Externalizing is when I'm acted out and getting drug into the teacher's office and getting kicked out of school.

Social mental health problems, their cognitive performance. Again, we think, you know, can't you talk any better than that? And can't you—understand what's impacting a person's ability to be able to think, act and be reasoned in context, less likely to exercise, have sleep disturbance. Fourth one, high crime, drug sales.

You know, this is a place where lower education—here you see that there's more crime, drugs. You know, there's a lot of density. I don't know about where you are, but for instance, in LA County, other places, you will see three families living in a home. It's that kind of density.

And here it was for the Latino children that were overrepresented in those communities. Economic deprivation is something we have to seriously think about. How does this come? What you begin to see is the neighborhoods that are economically disadvantaged have problems in terms of psychological distress, depression, anxiety, serious mental disorders.

And those are all the things that make it difficult for people to take their medication, follow instructions, and be healthy. We also have the inequality. It's, you know, the haves and the have nots. The problems we have among haves and have nots are, you know, such that you don't have resources.

Your health could be better, but you don't have the resources. In economically impoverished neighborhoods and schools, what you will see is social networks are not strong enough. We don't have social capital and cohesion. We have chaos. We have fragmented relationships.

We have children that don't have the ability to have those role models that we need them to have in order to be able to, you know, grow up to do the kinds of things that they have the capacity to do.

I'm going to skip this slide, but just say very quickly that on the left side are all these social determinants of health, and on the right side, what you see is when there's concentration of poverty and violence, what you see is coronary heart disease. Ooh, my M is left out in inflammatory disorders and cognitive impairment.

Here's where I want to spend my time as a policy person, and that is to talking about what can we do. I think one of the most important things is to prioritize economic interventions. I happen to sit on Treasurer Ma's Baby Bonds Committee.

And there we have looked at, and we also have a study that was funded at Stanford that we're working on, in which what we show are things like what it means to be able to give people income, and they choose to use it.

You don't legislate how they use it, but you'd be surprised that it is often used well. There are a lot of experiments about that California has done about its guaranteed income programs. The pilots are working. We just need to move those pilots into some kind of, you know, systematic distribution program.

You know, and we're not the only ones doing these pilots, but we have done them best. That's the one thing about California, I will biasly say.

The other thing is to think about our housing, because if we can disrupt neighborhood housing patterns by incentivizing them to be mixed, one of the things in the study that I showed you is when kids live in mixed neighborhood in terms of income, even if they're poor, they do better both in terms of their health and their mental health. Third policy thing that I'm going to talk about, now, I'm not a lawyer, I don't like suing everybody.

But, you know, State of California has begun to think about suing some of the health plans when they don't have parity in terms of mental health services. So, we need to think about making sure that child mental health services are available, because I'm a tell you, as one that is the Chair of the UC Health Care Task Force, I know what goes on in our health plans and the health plans throughout the State of California.

This is some of the most tragic things to deal with is when somebody's trying to find services for their kid and they can't get them for weeks.

And then, the other thing is, and this, this goes against some of the federal policies that are being advocated, and that is a requirement of early mental health screening services and treatment based on the number of social determinant conditions, such as economic deprivation.

You could switch this and also use the ACEs, but sometimes we don't always have the ACEs in the school setting. We can get this data, but I would say if we had the ACEs data, I would say, use that to actually allow the determination for when it is you should be doing screenings.

I'm going to stop here because I know my time's up already.

Thank you. Thank you so much, Dr. Mays. Next, we will hear from Dr. Sud, Director of California's Children and Youth Behavioral Health Initiative. Dr. Sud, please proceed.

Thank you so much. It's a pleasure to be with you all. I'll start by noting that I'm joined today by a very special young woman. Katie Kersnick is hyperlocal. She is a SDSU student who serves as one of the ambassadors of the programs that I'll be talking about.

So, later on, I'll be passing to Katie to continue the conversation. But it's a pleasure to be with you all today. As was mentioned, my name is Sohil Sud. I serve as Director of California's Children and you Behavioral Health Initiative. I'm a practicing pediatrician and a proud dad of two kids in California public schools.

And this Initiative is a $4 billion-plus effort to really do what those words on the screen say, to transform the way California serves and supports its children, youth, and families, particularly in the areas of mental health and substance use. And what I'm proud to say, particularly in this context, is that the approach is multi-pronged, right?

So, part of the effort is really addressing some of the wrongs and lacks of access to service that we know exist within the formal healthcare sector. Right? We need a bigger workforce, we need more access to different services, we need a better built primary care workforce, as Dr. Burke Harris was just mentioning as well.

But we also need to meet people where their lives play out. And this is where our lives are lived, right? In homes, in colleges, in schools, in communities, and in the digital space as well. Everywhere I go I ask the question, raise your hands if you do not have a smartphone on you right now.

And in general, that's the answer that I get, right? So, we live in this hybrid world, and this framework is very much in line with the themes and the topics today, right?

And so, focusing—today I'll be focusing much more probably on the education, the social and community context, and the healthcare access pieces as we talk about social determinants.

And just to underscore a little bit on the education side, health and education, I think, for far too long, have been separate entities and if we bring them together, it is such a virtuous side cycle, right?

The better people are from a mental health wellbeing standpoint, the more they engage in school, there's data to show the more they show up in school.

And the more they show up in school, the more they attend school, the more they graduate from school, the better their lives are. Evidence-based, in terms of longevity, in terms of substance use, in terms of many, many health outcomes.

So, I'm really pleased we are trying to bring these worlds together in a more sustainable fashion going forward. Instead of talking about this at a very high level about what we're doing, I thought I'd break it down to this beautiful community in this place here and what's actually happening in San Diego as we speak.

So, on this slide are all of the funded partners that the Children and Youth Behavioral Health Initiative is working with in San Diego County to scale and build up some of the services that are provided here.

These slides are available for reference and so, you know, certainly won't be talking about all of them, but just to highlight a few of them in certain spaces.

In the healthcare space, I will say as a pediatric hospitalist, as someone who's taken care of kids, I have seen them in the hallway on a psychiatric hold for having an issue related to harm and said, you have to wait until we can find a place for you to go, right.

And so, happy to say in San Diego, working with the San Diego Center for Children as one of many, many partners throughout the state to increase access to residential treatment services and day treatment services as well.

The other two, I'll point out on that side are the next two bullet points, is expanding training programs to have more psychiatrists, to have more social workers in this community, including on this campus, actually, because as we know, the data is pretty strong that where you train is often where you stay, maybe not exactly in that community, but in that region.

So, that combined with loan repayment programs and scholarships and other ways to build up that workforce are some of the activities that are happening here in the healthcare space. I'm going to talk a lot more about education as a—as the slides go on—but in the homes and community space, I'll highlight a few things.

One is, as has been mentioned—maybe I'll say it from my own perspective, parenting is hard and it's not something we're born with, and we learn, right? We often learn it through our communities and our culture. And as Dr. Burke Harris and Dr. Hood have mentioned, sometimes our upbringings aren't always the best.

And so, there are evidence points, parenting programs that exist, positive parenting program, effective black parenting program, another one that's called Motherhood and Fatherhood is Sacred, that specifically works in tribal communities, that we are working to scale and build up throughout the state, including here in San Diego, as well as we know stigma is nuanced and it's cultural, right.

So, we are partnering with, what is that, the fourth bullet down, the Indian Health Council, the San Diego Refugees Communities Coalition, San Isidro Health Youth Campaign Board, and the Institute for Public Strategies to provide information to youth in your community, by your community, by with culture and with language really at the forefront of the approaches that is occurring within that.

So, this is the scale of the effort specific to San Diego, but the scale of change in this county includes some of the statewide supports that also improve and hopefully support everybody, no matter where you live. And to go—if you're ever curious and want to look this up yourself, again, you can use the slide deck.

But this is a single website where you can search by county, by organization, by award type to learn more about what's happening here. Because my fear actually is that all of these live as separate bullet points on a PowerPoint slide. They really need to be integrated and aligned.

And so, let's all work together to see how we can make that happen. I'm going to spend the next few moments kind of double clicking and going a little bit deeper into certain aspects of the program and then pass over to Katie.

So, to expand on some of the themes that Dr. Burke Harris mentioned, we are working with educators to teach them the biology of stress. Very much in line with ACEs and adversity in childhood and understanding what that's like.

Both that you can have positive stress, you can have tolerable stress, and you can have toxic stress and how that manifests in your students in different ways, right. Some internalize, some externalize their behaviors, and educators, and really everyone that works with youth, needs to learn this.

And so, this is a two-hour online course that is available for free for anybody, really heavily promoted in education spaces, but anybody that works with you can take this. And so far to date, happy to say that 12,000 individuals have engaged in this course in one form or another to date.

Another component of really understanding ACEs and spreading the word about it is in addition to training providers, in addition to training educators and those that work with schools, we also have to lift up an understanding among the youth themselves. And this is the campaign that Dr. Burke Harris was referencing called Live Beyond.

And that's what the youth wanted the key message to be. It's very much that ACEs exist and we need to learn about them, but they are not our destiny. We can live beyond them.

And highlighting some of the campaign materials here for folks to take a look at that really, we worked with Native youth that very much in line with Dr. Hood was mentioning about the disparate impacts we see in various communities, in particular in tribal youth and black youth, to make this relevant to them and to lift up their stories and their supports as well. So, livebeyondca.org is a place where you can learn more.

To date, I'm very happy to say, in terms of how we can measure engagement with a campaign, there have been more than 1 billion impressions, which means people are looking at what's out there and sharing, sharing it and clicking on it and, you know, passing it to their friends and neighbors.

And so, the word is getting out there, and really, the key on this is that it's stories of California youth sharing their lived experience and sharing what they're doing to get better. Moving to a few other aspects of the initiative. So, as has been mentioned, we need a workforce that better understands that culture and concordance matter.

And California has stood up a new profession in the state called a Certified Wellness Coach. And you can go to this website to learn more. But essentially the concept behind it is right now, our workforce, to be a behavioral health specialist, to be someone who works in that field, you really need to be quite far along the education spectrum, right?

You need a master's degree to be a social worker, you need a license, you need to have a doctorate in medicine or psychology to be able to work with these workforces.

So, we've said let's make junior people eligible to work in this space as well. So, this is an entry level position. You can have an associate's degree or a bachelor's degree, have some relevant experience.

And then, we've worked with the Federal Government to ordain them as a health care provider so they can get reimbursed for their services and really, you know, appreciate the value of what they bring to the table already.

And that is an approach to not only increase the workforce, but to have people who look like you, who come from your communities, work with you. A little bit—I'll spend a little bit of time on a non-specialist provider. So, access to care for specialists is incredibly hard in many places throughout the state.

There are counties where there are zero child psychiatrists, but access to primary care is a little bit better. And so, how can we work with our primary care workforce to really build them up?

As a General Pediatrician myself, sometimes I don't know whether this is anxiety or ADHD, and sometimes maybe I forgot to do an ACE screen, right? I can call that number now and speak to a specialist who can coach me and educate me about what I can do better to keep that patient in my midst.

And so, through this platform, more than 3,000 primary care providers in the state are engaging and providing and working with child psychiatrists and others to receive consultation. And what we've learned is more than half the time they're able to keep their patient, as opposed to referring them out and waiting longer to be seen.

In schools. You just mentioned the importance of mental health screening in schools. Schools are doing a lot of work in mental health. They are providing these services and they are bringing in their community partners as well to do this work. The challenge is paying for it. Right.

And so what California has done, first in the nation to do so is to say these are healthcare services and so the healthcare industry should pay for it. Right.

And link these services to all insurance products, essentially that the state has any regulatory power over and said that schools can pick and provide the network of providers and the types of behavioral health services that they offer and submit claims to health insurance plans which are required to pay for it. It's complicated. It's hard work.

It's getting off the ground. And because there are thousands of school districts and dozens of health plans, there's a third party in the mix to help streamline that process. So to date, what I can share is that more than $1.3 million of new funds have reached schools.

Through this effort, 38 school districts, LEA stands for Local education agencies, have received funds payment from these plans and 30 health plans have provided those payments, resulting in more than 20,000 services being reimbursed to date.

We have a long way to go here and I'm happy to say in San Diego, what is it, 60 school districts or so have participated in this to some degree or fashion and are onboarding onto this system and learning more as we all go collectively move forward.

I'm going to skip ahead to make sure we have time for Katie here. And so what I want to close on is we have a number of free accessible online platforms for folks to get care and for folks to connect with professionals. You were mentioning the challenges in access.

Dr. Mayes was and this is a Saluna is one of those platforms for ages 13 to 25 where you can drop in and connect with a professional with a wait time of five minutes as opposed to five weeks. Right. It can start your journey into receiving some care.

And I'll pass to Katie to talk a little bit more about that experience.

Hi everyone, my name is Katie Kersnick and I'm a youth ambassador with Saluna as well as a current college senior at San Diego State University studying business marketing. After college, I hope to build my own companies as well as become a manager in the hospitality industry.

In my free time, I love to surf, spend time with my family and friends, do photography and travel. Some other things I like include Star Wars, Pirates of the Caravan, Lego Jurassic park and playing Minecraft with my boyfriend.

Mental health is a challenge that many people face across all ages, quietly, daily and often without the support they truly need. As someone who lives with OCD and autism, I know what it feels like to need help, but not always know where or how to reach out.

This is why I believe technology, specifically a digital mental health platform like Saluna can be a part of the solution. In person, therapy and school counselors are essential and I believe they absolutely should remain available to all students. But sometimes these options are not accessible in the moment when someone needs help.

Whether it's due to stigma, cost issues, anxiety of speaking face to face as I have experienced myself or not having available transportation methods. Having another way to get help can make all the difference from firsthand experience with mental health and having a younger sister that struggled with mental health issues.

We had experienced at times some of these reasons of lack of accessibility when it came to getting help for our mental health. This is why I believe it would be so crucial to have a platform like Saluna.

Not only is it available and accessible to all youth but but unlike other digital spaces, it removes any potential negative experiences by providing a pre moderated safe space. When I was 13 years old, I experienced a serious life changing rock climbing injury that triggered obsessive and anxious thoughts that I did not know how to manage.

At the same time, my younger sister struggled with substance abuse and depression and unfortunately, despite the restrictions our parents put on social media, I noticed that she got influenced by the wrong crowd.

There are moments in both of our circumstances where we felt alone, unsure who to turn to and not always ready to talk to our parents or teachers. Looking back, I wish we had access to something like Saluna.

If my sister had access to a digital mental health platform like Saluna, she would have had more tools to navigate her internal and external struggles.

For example, I feel like she could have used the journaling feature when she was feeling peer pressure from students at school, or she could have used the community forum to confide in another peer who is more positive and support her of her situation.

I feel like having someone outside of the family like a coach could have allowed her to confide in someone without feeling judged or embarrassed to get help. Like with my sister's situation, I think many youth want to feel more in control and and having Saluna could provide them with the resources to do this.

With tools like Saluna, we are not replacing mental health support services, we are expanding it. For myself personally, even just knowing there was a judgment free space for me to turn to day or night could have helped me learn strategies for communicating better and feeling less isolated as I navigated my journey from teenage years to adulthood.

For instance, I struggled communicating and verbalizing with my parents at times when I was overly emotional and often misinterpreted their words. It would have been helpful for me to get over those exact situations with a coach to have someone help me understand what they were trying to say.

I feel like I would have been able to take what I learned in that session to reapply back to that conversation with my parents and have less of a communication barrier.

This is why it's so important for young people to have access to a digital mental health service like Saluna to drive early intervention prevention and resilience with Saluna, California is showing us the message that it is okay to ask for help and that help does not always have to look one specific way.

Many mental health challenges as the ones my sister and I faced, especially cannot wait for appointments. Life does not follow office schedules or school hours. This is why it's important to have options like Saluna that are readily accessible on any device. With the Internet, Saluna isn't just fancy technology or another simple app.

Instead, it's a platform that provides accessible support services in real time, for free and for real people like us. Saluna could help change lives. Thank you.

Thank you so much for sharing your story, Katie. I'll close just by noting to date, more than 360,000 children, youth and families are engaging with Saluna and Bright Life Kids, 30,000 of which are in San Diego County and more than half statewide are persons of color and more than half statewide.

This is their first time accessing any type of formal mental health support. So certainly more work to be done on all aspects of increasing ways to receive support, be that online, in person, in your homes, in schools and communities, or through yourself. So thank you.

Thank you so much. Director Next we will hear from Maritza Garcia, Program Manager with the Environmental Health Coalition. Ms. Garcia, the floor is yours.

Thank you so much. I am so honored to be here and be able to share my experience. And thank you so much, Senator Dr. Weber for giving me the space to be able to speak on this. So my name is Marita Garcia. I work with the Environmental Health Coalition. I am a policy advocate and a program manager.

And we are a binational organization working in some some of the most underserved and overlooked communities. Three here in San Diego and one Colonia, Chilpancingo and Tijuana. We actively work to fight against environmental racism and I'll talk a little Bit more about how we categorize that.

So it really is the disproportionate impact of environmental hazards on people of color because of systemic racism. So these are policies and practices that result in people of color, lower income communities, really being overburdened and exposed to greater environmental hazards. And the way we combat that is by actively fighting for environmental justice.

We believe that it's the right of all people and communities to live, work and play in a clean and safe environment. It shouldn't be determined by where you live to live in a healthy environment. And so this is our direct response to environmental racism.

We often use this tool, it's called calenviros Screen, which is an online tool that helps to kind of give a visual representation on how environmental racism is shown in the State of California. So they use pollution burden indicators like ozone, particulate, diesel matter, proximity to traffic, both personal and freight traffic, lead risks and things of that nature.

But it also focuses on population characteristics. So your race, your income, the type of health that your community experiences, the amount of hospital visits that you have, asthma rates, education, and even housing. And sorry, as you can see, you know, the really big red orange in the middle is the San Fernando Valley, the factory backbone of California.

And you can obviously see how much they are burdened compared to the rest of our state. I did want to kind of emphasize a couple of more communities just to really see this trend that you see throughout the state.

So on the left you have the Los Angeles area, where downtown and the port communities like the Port of Long beach are actively being disproportionately affected. In the middle you have the San Francisco Bay Area, where Oakland and other portside communities also have these high burdens. And then on the right you have the San Diego area.

And these are the communities that we mainly focus in. Logan Heights, Barrio Logan, where I'm from, West National City, another portside community, City Heights, which has really heavy traffic, pollution, all being in the really high reds, the really bright oranges, and, you know, obviously overburdened by this racist. And why are we so disproportionately affected?

Like I said, it is systemic racism. These are policies that have been put in place over generations to actively allow for this to happen.

In the 1960s, you saw a lot of disinvestment where communities were getting redlined, they were not being given the proper funding to be able to advance their education, their housing, and simultaneously you saw a lot of white flights.

So then you have these communities that are mainly lower income, people of color, people that are more affluent, going to other places where they did have these opportunities to grow and to get more financial stability and really invest in their own communities.

Then you have these racist practices like the Federal highway act where it allowed for the freeways to be placed in these communities that were already getting disinvested. Further. Sorry words, further displacing community Members.

You know, thousands of homes being torn down to be able to create a system for people to get to and from different cities more easily. And lastly you have rezoning. Where communities like Logan Heights and Barrio Logan were once all neighborhood zoning.

Only houses can be there being rezoned to industry, allowing for these polluters to come in and be our next door neighbors. Really affecting the health because it's right in our backyard. And so this is how you see it. These are a couple pictures of my community.

So on the left you have, we're neighbors to the port and their practices allow for these heavy diesel trucks to actively come in. Thousands of trucks daily going right down our community. Someone mentioned, you know, not having that many green spaces. And it's true. We have maybe two parks in our whole community.

Most kids play in the street. And not only is it obviously not safe because there's cars coming down now you have the added unsafety of these big rigs coming down, you know, spewing pollution.

We have multiple freeways, the Coronado Bridge there that is actively, you know, increasing the amount of truck pollution and car pollution because during rush hour there's, you know, thousands of cars there. Then you also have the incompatible land use where again we have industry being our next door neighbors.

So this is actually a picture of a biodiesel company that's right across the street from single family homes. Right across the street. And in this. Where's the little pointer things at this? There it is. This building over here is a senior housing facility, affordable housing.

So most of these people that live here, it's the only place that they can afford living and they have to be burdened by this. Recently we had a campaign to try to actually close down this facility because for so long they've been open for about 15 years.

And the smell to just really repurpose that, the repurposed cooking oil to be able to make biodiesel fuel.

It was so nauseous that people had to really think am I going to kind of suffocate in my home from the heat because we don't have proper ventilation, especially during the summertime or am I going to open it to try to get Some fresh air. But really it's so nauseating that I'm now feeling sick.

I have my eyes burning, I have a headache. Constantly. People are embarrassed to have family and friends over for parties, for any kind of get together to be able to, because they don't want to expose them to this. And so these are the things that we're constantly having to fight against.

And you see that in the health impacts like Dr. Weber mentioned. We are the 99th percentile of most impacted communities, 95th percentile for cancer risk. Nationwide our life expectancy is 10 years Shorter than everyone else. Just for the zip code that we live in, we have three times as much asthma related ER visits than the county average.

Sometimes it's not just asthma, it's other respiratory issues. And so these health impacts obviously affect us personally, but then it also affects our social dynamic. Families are having to now take time off to be able to care for their sick ones, which then increases the amount of medical bills. It decreases the amount of income that you have.

A lot of these families are lower income and so they're working two to three jobs just to be able to pay the bills. And now they're not able to even work as much and you know, their bills back up. That brings a lot of mental stress.

It creates this survival mode where you're actively always trying to just get by to the next day so you don't get to enjoy your life really. You're not able to, you know, go on a vacation, be able to just spend time with your family because you're actively trying to catch up to make ends meet in kids.

Because of the amount of health issues that you get, you get a high absentee rate. So this is a list of 15 different schools in the San Diego Unified School District. Seven of these are in the 92113 zip code, which is Logan Heights and Barrio Logan.

This high absenteeism is students that miss 10% or more of instructional days in a year. So not only are they missing out on their education, they're also now missing out on more opportunities for social interaction with their peers, with other adults.

Sometimes, you know, schools are the only safe spaces that they have in their day to day life. And now they're not even able to really have that. And you know, then we talk about like Dr. Mays was saying, you know, lead safety. A lot of these homes in our communities are from the 70s or older.

Lead based paint is very, was very common during that time. And it's not financially feasible to always be able to actively, you know, mitigate these lead disparities, it's hard to be able to repaint. And why is it so important? Because, you know, it affects our brains, it affects our kidneys, our livers, our blood, reproductive system.

So in young children, they're four to five times more likely to absorb these issues. And it shows in their development, they become more aggressive, less tolerable to, you know, being able to just kind of brush it off their shoulders. And this violence really transfers into how they act in day to day life.

Something that might be a minuscule inconvenience to one person ends up being this really big issue in their mind because they're not able to process the, these negative things. In adults, you get heart disease, you have higher cases of stroke. In pregnant women, there's a lot of different damages to your organs.

And then also the baby that's being formed inside is more likely to have these developmental issues in the future. And this comes from again, all of these different sources. But the number one cause is the ingesting it. So in the lead paint, kids, as you know, put everything in their mouth, they're constantly playing in the dirt.

And if there's high exposures to lead in those areas that they touch, they're more likely to be exposed. And unfortunately, lead is a silent disease. There's no, there really isn't that many symptoms that will show you that your child has lead poisoning.

So it makes it very, very difficult to not only detect, but then to be able to help mitigate and fight against. And so, you know, I said a lot of negative things, but fortunately for our, especially in our community, we're really resilient and we actively fight to try to better it.

We know that unfortunately we don't get as much outside help. And it's up to us to be able to use our people power to be able to fight against this. And that's what our organization does. We help to not only educate, but really give the tools so that community Members can fight against it.

Like I mentioned, I'm from Logan Heights. The reason why I am able to be in spaces like this is because I partnered with an organization like the Environmental Health Coalition who gave me these tools. I was a very angry child. For once. I found out all of the negative things that I grew up in.

My classroom in elementary school, had a nurse that was personally put with a student and, and I thought that was normal. I thought that every school in all of the county had these nurses in these classrooms because there was always someone that needed that.

I thought it was normal that a lot of friends in recess couldn't run around and play because of their respiratory issues. And it wasn't until I got to high school, when I talked about my childhood to other students from other parts of the communities that they looked at me so crazy like wait, that's how you lived?

And I was like, wait, that's not how it's supposed to be. And so I was really angry for a long time because I, you know, didn't. I felt powerless. And EHC really helped to bring these tools to talk about it and to educate us in different ways to be able to actively fight against it.

And so one thing that the Environmental Health Coalition really worked for was the child's right to lead safe housing ordinance. So in 2008 this was passed in the City of San Diego that really brought five key requirements to prevent lead poisoning.

This included stricter lead safe work practices for renovators, property owners needing to correct lead hazards in pre1979 housing, property owners having to make these reconstructions when there was vacancies and they wanted to, you know, re bring more rentals, having more education out there in home improvement and water pressure equipment rental stores and then having childcare facilities required to obtain proof of blood lead testing at enrollment to really minimize the amount of expo, not only exposure but having that requirement so that parents did have to go and lead test and they can find these issues in their children early on to be able to rectify it in 2018.

This is just a photo of, you know, having a lot of people that fought for it be able to celebrate a 10 year anniversary.

And currently the City of San Diego was awarded $15 million to pay out a payout from paint manufacturers accused of knowingly adding toxic lead in their paint after knowing that these destructive health consequences were, were known and what it does to families and to children.

And so we're using this money to be able to remove the lead paint from local homes. Although these programs are out there, they're not always as accessible to community Members or community Members don't necessarily trust them. And so that's where EHC comes in. We are a trusted organization in the community.

We've been working for over 40 years in these types of communities, communities. And so we have these relationships with community Members to be able to actively fight for, you know, for improving our health. And what EHC does is they go out, they talk about these, about this program, they help residents fill out these applications.

And because we're so trusted, it's something that's a little bit more certain that it's going to get to the finish line. So qualified homes get tested for lead. They do it in different ways.

You know, the paint, the soil, they get window and door replacements, they get relocated during this time to be able to actually get this, all of this work done in a safe way so they're not more exposed and just going quickly. These are the eligibility requirements.

So in the city, you must be in the City of San Diego having a house built prior to the 1960s or house built prior to 79 with children that are younger than 6 years old that live there or visit frequently. So you don't even have to have a six year old in the home.

As long as you have someone that's frequently coming to visit, you qualify. Have housing build property prior to the 79 with residents childless that less than 18 years of age that already have lead in their blood that have been tested with above 5 micrograms per deciliter based on the owner. And the owner is low and moderate income.

But that's not necessarily the only requirement. If you are low income, you get these services for free. If you have a little bit higher income, you, you only pay a portion of the thing, which really is beneficial because, you know, low income is yes, very dominant in our community. But not everyone is low income.

And sometimes these community Members that are a little bit higher income don't always get these services. And they're still really expensive services. We also have other programs like the PEAR program, the Portside Air Quality Improvement Relief.

So a couple of years ago, we had a really bad navy ship fire that lasted for a couple of days in the port of San Diego. And because of that, we were awarded a really big settlement that allowed for us to pay for air purifiers and air monitors in the community.

And we were able to disperse them to about 500 families. That allowed you to not only purify the air inside of your home, but really also see the air quality quality outside. So you were able to choose if your kid was going to go outside and play, if you were going to want your window open or closed.

These are different ways to be able to fight against what's happening in our community. And I'm going to go even quicker. Because I know I have no more time. So another thing, like I said, zoning is really unfortunate in our community because we have industry right next door. So in 20202021 we were able.

Barrio Logan was able to update their community plan that created like a buffer zone. So there's going to be this mitigated area space where industry can't be your next door neighbor anymore. Now it's going to be commercial space that doesn't bring polluters.

That really helps to at least kind of separate the polluting air from industry to our residents. And that is all. Sorry I went really fast at the. End, but.

Thank you. Thank you so much, Ms. Garcia, for your presentation. It really shows the power of community and, you know, even though it shouldn't be those that are most infected impacted having to do this work, it just shows the power that you have when you do get involved. So thank you so very much.

Our last speaker will be Dominique Dunnett. She's Director of Government affairs for Ed Voice, who will now share how Ed Voice is advancing policies and strategies that remove barriers to learning and promote educational equity for all children. Ms. Dunnett, please proceed.

Thank you, Senator. Dr. Weber Pearson, we really appreciate the invitation to be here. In particular your statement on the ways in which education and health are inseparable.

I've learned so much just being here on this panel listening to you all, and we thank you for your work because we really do believe we have to work together to get this done for kids. This meaning giving children the opportunity to have great lives. Excuse me. As I mentioned, I'm Dominique Danae.

I work on behalf of Ed Voice and Ed Voice Institute. Today, I'm here with my Ed Voice Institute hat on. That is our sister organization where we think through podcast policies.

I'm going to start my presentation on my own story because it really connects the bridge between health and education and sort of what led me to being an advocate in this space today. So my life was a unique one, as many people's are. I was a child who was in foster care.

I moved quite a bit, but I also experienced some in school challenges. Excuse me. So I was undiagnosed. I had dyscalculia, and so I moved through math classes unable to participate in learning. I was also undiagnosed having adhd. And so I was told that I could not and would not learn.

And so obviously that had an impact on my mental health. I then found a space in the black church that really supported me in my understanding of collective organizing and, and of being in community with people to get things done.

It was in that space that I understood that it was going to take a lot more than just one person to do something. And so that really planted the seed for me being a student advocate. I went on to become the first in my family to graduate from high school.

I then obtained a full ride scholarship to UC Berkeley and then a master's from Harvard. This is all a student who was told that I could not learn. Today I lead government affairs at Edvoice and I really believe in systems change. Excuse me, it's dry in here. Speaking about the air.

So I really believe in systems change and I understand that when we think about education, it's not that children can't learn, it's that much of what has been flagged already. It's thinking about the conditions that are set for them and really supporting them in that journey. And so I know for me what made the difference.

It was mentorship, extracurriculars and scholarships, all made possible by my public school education. So at Edvoice, we're really, as I said, thinking about in school policies that impact children, particularly in low income communities with the goal of allowing them to have opportunity filled lives.

So we believe public education is the foundation for a thriving, healthy and more equitable future. We really, and when we say opportunity filled life, we think about that as different than, you know, we hear the term achievement gaps. We really think about opportunity gaps. We think that's more inclusive and holistic.

We know that education is an investment in our future. It, it fuels economic growth, it reduces crime and it allows for better health outcomes. And we absolutely know that education is the social determinant of health and it's not talked about enough. So California currently has a reading crisis.

So I think this slide is really important to think about. Again, many of the themes that have been raised. But truly understanding what happens when a student has access to resources and doesn't. You see here on the slide that children from low income communities are disproportionately impacted by the reading crisis.

Currently in the State of California, 3 in 10 students are reading at grade level. That is, I don't even have a word for it. That's the silent pause for you all. It is a crisis. It demands urgent action and everyone should be concerned in thinking about this.

In particular, if you look at the rates for low income black students, low income Latino students and students with disabilities and English learners, those rates are even lower. We know that this impacts when we talk about opportunity filled lives, reading and the ability to be literate. In this country and in this state, it's absolutely critical to participate.

Participate at any level of a good life. So as I mentioned, the connections between health and education, they are in lockstep. We know that students who struggle to read are two to five times more likely to experience multiple health conditions that have already been flagged. But I'll just go through them.

So what I like about my presentation in close closing on education is my argument has already been made. This feels like a really good just like cherry on top because you all have already flagged so much of what I was going to talk about.

But as far as the specific health conditions, we know that children who struggle to read are two to five times more likely to experience anxiety, depression and other social, emotional and mental health conditions. We know that they're more likely to experience suicidal ideation and dropping out of school.

We know that they are more likely to be incarcerated and overrepresented in unhoused populations. And they are four times more likely to not graduate high school. That's a typo. So as I mentioned we've already called out a lot of this so I won't stop stay here for too long.

But I do think it's important to really emphasize thinking about economic stability. So what does that mean? Education improve improves employment prospects and earnings. We see now entry level employment opportunities are requiring four year degrees, people being paid at the lowest levels, requiring college level education.

It is absolutely imperative and critical that we we be thinking about what that means for the future of this country and the state and why we are so focused at Edvoice on reading as a foundation.

When we think about health behaviors, we know that early education influences lifelong habits and so really thinking about high quality childhood education programs and what that means for high risk behaviors later on in life and other health conditions such as obesity and hypertension.

And then also anyone in the room who's ever had to advocate for themselves in the health system, you know, the difficulty that you could experience just having to make a phone call or to advocate for services or to make an appointment. This all comes down to reading and accessibility and then finally psychosocial skills.

So we know that education builds problem solving and self efficacy which later down the line can help people manage stress, the aces that they encountered which has already been called out, etc. So we really also think about school based and non school based opportunities for children and sort of the levers that impact those experiences.

So for school based we think about access to pre K class, class size, access to supplemental supports. So things like what I had mentorship, extracurricular activities. We think about public funding or public school funding structures, we think about access to screenings for learning difficulties and access to qualified teachers for non school based.

Much of this again has already been said, so this is just highlighting it but food and housing insecurity, what does that mean for a child who's coming to school hungry, thirsty, who hasn't slept because of moving place to place or space to space? Intellectual disabilities ACEs and lack of adequate mental and physical health care.

When we think about advocacy at Edvoice, we're really focused on the school base, but we really appreciate and focus on partnering with people like your organization, others who are outside of the school and really thinking about the whole child. And that's why we really believe in coalition building and partnership.

Because this work can't be done in a silo. We know that limited literacy affects everyone. California has one of the highest rates of adult illiteracy in the nation at 28%. That's more than a quarter. And so again, just pausing to really take in what that means.

So that means that there are people who cannot participate fully in day to day life because of the inability to read.

And so when we talk about needing to move with pace for this issue, that's why we focused on this as our number one policy priority at this time because we understand the direct implication on limited literacy across every element of, of life.

We know that in particular, people who, excuse me, have lived in poverty are going to be further disenfranchised if we don't get them reading. And so as I mentioned a bit about our work at Edvoice and Edvoice Institute, we are sister organizations. Ed Voice Institute really thinks about policies and Edvoice really thinks about direct advocacy and action.

And so, so this is a little bit about our model, but really we think about it from different lenses. And so with grassroots and grass tops work, we're really thinking about inside to outside and side to side, so pushing in from all sides, so developing evidence based policy solutions.

Earlier we heard a lot from Dr. Burke Harris, we've heard from Dr. Mays, we've heard from everyone about what does evidence based means. And so, so we really look to the evidence and the science and the data to help us move forward policy solutions. We then really focus on building a diverse coalition of advocates.

And so as I mentioned, we're not just thinking about what happens for a child in the school, we're also thinking what happens outside of the school. And so because we have such, you know, such great aspirations for changing the educational landscape in the state, we know it's not possible to work alone.

We absolutely believe in working in coalition. And there are many who are on the ground who are already doing this work in addition to states who have already implemented change and so we look to them as partners.

We then identify and educate Members of the Legislature to educate them, but also seek partnership and ask for their leadership and guidance. And we know that advocacy can take time, it can take years for not only a piece of legislation to get passed, but also for it to be implemented with Fidelity and at the highest level.

And many of you all know that in this room. And so a quick case study on literacy. As I've mentioned multiple times, we are starting with reading because we truly understand what that means for students in this state. And so just quickly, we've talked about what Ed Voice Institute does on the policy side.

So we built a coalition on literacy. We worked with experts. We looked to superintendents in the state who had best practices, particularly county offices of education. We leveraged their expertise. We then built out a policy brief and we educated people.

And so we used this document to go to people in the community and also to Members to say, hey, we're not just asking for your support here or a vote or anything else related to that.

We really want you to understand what is happening for students and how you can be thinking about this for the future and how this connects to everything else. And then for Ed Voice, as I mentioned, we worked together in partnership. We've had some great wins.

We got K2 Universal screening for reading difficulties passed and we also had a budget allocation of, of $200 million for teacher training on evidence based reading instruction. And so we have a lot of exciting things in the pipeline and I hope that we can continue the conversation on how that looks in the future.

So a quick note on our agenda. Excuse me. As I mentioned, when thinking about the ways in which education and health are interlinked, this is how Edvoice is approaching the work. As I mentioned, we started with effective early education, really focusing on the reading aspect. Next we're going to be focusing on teacher workforce.

We understand currently there is a teacher shortage in the state and not only is there a teacher shortage, so it's not just the recruitment aspect, but it's also the retention and it's also ensuring that teachers are qualified. Are they credentialed? Are they prepared with materials? Are they trained on them? Are they trained on those materials?

Are those materials evidence based? Really thinking about that because that truly teachers and a high quality teacher in a classroom is the number one school based factor for student achievement. And so that is when I say critical importance, I know that I've said that about reading, but that's the next one that's critically important.

I want to call your attention to the last two pillars on this page. Adequate and equitable funding and accountability, continual learning and collaboration. Because we understand that there are certain foundational conditions that need to be set in order for this policy agenda to move forward and for it to be implemented.

I would say that there's a third one that hopefully we can work with you all in this room on, but that's ensuring that health needs are met for students. Because we understand that in order for any of this to happen, a child needs to be healthy. We understand that this is going to take time.

But that leads me to my last slide which is we have to work together so we truly understand that health and education are interconnected and an unhealthy child has limited educational opportunity and an uneducated child has limited opportunity to to be healthy.

And so when we say that things are these issues are interconnected, there is a vision for possibility here. We believe that, as I mentioned, it's working together. It's continuing conversations like these. It's continuing to learn about the work that our colleagues are doing and it's really staying focused on, as mentioned, evidence based policies and solutions.

And so we thank you for your again, your leadership, Dr. Weber, Pearson and everyone else in the room. Thank you.

Well, I want to thank Ed Voice Institute and Ed Voice for all of your advocacy up and down the state, all of your education, not only for the community but for the Members of the Legislature.

And I remember very early in the state legislative session you all giving a presentation to the California Legislative Black Caucus of which I currently chair and the issue of evidence based instructional materials.

The research around that was so dramatic that I immediately had to support those efforts and am very, very proud of what the Governor will hopefully sign very soon because that will be really a game changer for our students here in California and was proud to learn about those efforts through you all and very proud to co author it and I'm hoping that the Governor will sign it very soon.

So at this point we are going to open it up to public comment. I'm to going or questions. You all may come to the mic right here and as people are coming up you will have one minute per person for your question or comment.

I did want to acknowledge that we introduced some of the electeds earlier but I did see Mr. Cody Peterson, he is on the San Miguel Unified School Board come through. I saw Allison Snow who there she mayor, who's mayor of the City of Lemon Grove come through. I know we talked a lot about education.

We also talked about some things within the City of Lemon Grove. And while we are having people come and stand, just one very quick question for each of you to answer, because this is always an issue, and I know, Director, this was an issue as well this year with budget and funding for your program.

But with state revenues projected to decline and even deeper cuts coming from the Federal Administration, where should California prioritize limited funding, whether in prevention, community health, or environmental protections, to make the greatest impact on children's health outcomes?

I'll start and really say that with children, I think it's on prevention, but prevention that changes systems. Not the kid itself, but the systems.

Completely agree with Dr. Mays on that. I would add to that.

I think through this initiative, which in large part has been designed and is currently deep in the implementation phase, there are some nice on ramps into some work that is burgeoning and nascent, namely the Behavioral Health Services act, which has a heavy focus on prevention and early intervention work that is underway.

And some of the work, it's called BH Connect, which focuses on many aspects of interconnecting the healthcare system. On that front.

Yeah, in our field, I feel that that educational aspect of being able to really get these programs to the community Members that need it the most, and by that, I mean that funding for positions like mine that bridge that gap where these programs are available, but maybe not as known to community Members or even accessible in a way where they trust it.

So really funding to be able to have us go out and educate our community Members and really advocate for these programs to be that they're viable and that they really are going to help is one of the most important.

I think. As I mentioned, we know that children are inherently born brilliant. It's not that they can't learn. It's just ensuring that the teachers in front of them are trained.

And so just continuing to think about existing monies and how those are allocated and ensuring that, you know, the people who are working with our children have the tools that they need to do their jobs best.

Thank you so much. Okay, we will now turn it over to public comment or question. If you have a comment or question, please limit it to just one minute. And if you have a question, please just ask it of one of the panelists. Thank you.

Good morning, Chair and Members. My name is Samantha Schwimmer, and I'm here on behalf of the California Pan Ethnic Health Network, or CPEN. Thank you so much, Senator Dr. Weber Pearson, for holding this hearing on such an important issue. As we've discussed today, we know that health outcomes do not begin or end in the Doctor's office.

Unfortunately, the Federal Government's actions through HR1 threaten to place an undue burden on California's families and risk reversing much of the progress our state has made in addressing these upstream drivers of health. This includes critical steps California has taken to integrate social determinants of health into health policy and to reduce health inequities.

At CPEN, we remain committed to working alongside lawmakers and partners across the state to confront these new challenges and continue advancing policies that improve health outcomes and promote equity for all of our communities. Thank you.

Well, this is still morning. Good morning. I am so proud and happy to have Senator Dr. Weber Pierson as my Senator and to have Alex Padilla here as well. The Cal environmental screening map that was shown really shows this is happening here in our districts here. But unfortunately, structurally maybe the state is not doing the right thing.

Unfortunately. SB 34 was passed which gave South Coast Air District inability to deal with indirect sources of air pollution from coming to a greater source which was transportation sector in the South Coast Air District. That affects us here in San Diego because that limits what we can do here to some degree in the future at least.

The sentiment is not there. There is legislation that's coming up. SB 684 which is titled Make Polluters Pay and develops a super Fund which will provide equity and funding to undo some of the damage done by the fuel producers. The polluters themselves, they have lots of money.

We should get some of that money and to Fund some of the remediation that is called for in our community. Thank you so much for putting this repeatedly putting this on the agenda and inviting the people that you had here at this hearing. I learned a lot. This information needs to get out.

It doesn't get out enough and we need to push it in our community. But I want the community to push for legislation because our legislators unfortunately have not been doing their job. Pollution continues. The blue line, which will help us so much.

I'm sorry, the purple line will help us so much here is not on the agenda for our local transportation system. Thank you.

I love the comment from Marisa earlier that she was angry. There's a lot of people and our students are coming through and figuring out that they live in disinvested communities. They're figuring out that this everything's not equal and that's not a lesson we want to teach our children.

So I'm happy for this opportunity to have the Senate hearing here. Thank you for bringing it to our community. Thank you for inviting the community to come forward, making it possible to have access to these types of hearings. And thank you for listening to these voices.

Because we have historically been disinvested, we're looking for opportunities to help our children. I will say that they mentioned the new online access to be able to communicate with therapists in our community. Our kids are still suffering after Covid. They are so sick of being online.

My kid, we try to get her therapy, the only options online were online. And so we are really struggling to find qualified individuals who are willing to meet with our children. Where our children Are thank you for pushing for that.

Thank you for hearing their call and thank you listening to their cries and hopefully nobody else will grow up angry in our community space. Thank you.

Hello, I am Purita Javier, Filipino American with existing medical condition and victim of ceramics kill toxicity next door since 1997. The hazardous business was located, contracted, and operated since 1984 in a neighborhood dedicated and residential zone community.

We formally reported the health and safety concern with police, fire hazards, city code, informant, and other law local authority Mayor Gloria, city attorney, council Members. But for four years of engagement nothing has been done.

Sorry my love, I am the husband also a victim of this. I'm sorry, but I have to express our body language. Cancer develops and genetic theory proposes it is induced by radiation. It is induced by viruses or toxins like what we are suffering now. For four years, nobody listens.

From the leadership of the core City of San Diego, including the air pollution which was governed by Ms. Chancellor. Where is he now? He knows our situation. They know what is going on in Tijuana River Valley. If just for comparison, ma'am, we are sick and dying and the only solution is to produce 10,000 air purifier.

I don't think that is a medical procedure. There must be an accompanying cure, medication, etc, etc to strengthen the victims. Ma'am, they were dead, but they have not declared it. Now we are going into death which is inevitable if you won't help us. Ma'am.

Instead of me given the medal, I am now restrained twice successively effective the 16th of September and the hearing will be October 6th and October 14th. I'm sorry, ma'am. Thank you.

Thank you for sharing that. It's really hard to follow a very emotional comment. I'm Crystal Sine. I'm the Chief Health Equity Officer and a Professor of Medicine at UC San Diego Health.

I'm an internal medicine Doctor and I just wanted to say that, you know, health system as of June, January of 2024 have to screen all of our adult patients who come into the for social drivers of health. That was a great piece of legislation from Centers for Medicare and Medicaid.

The challenge is that there's no requirement that you then address those needs. Obviously, from an ethical standpoint, we make referrals, our social workers make referrals. But that is contingent on what's available in the community and the resources that those community organizations have in order to be able to address those needs.

So I'm wanting to highlight this one as an opportunity and a way that we really have to strengthen what's available in the communities and there are still gaps, like as an academic at UCSD, which I think UCSD Health is still the safety net for San Diego. We have to have lawyers, we need other people.

There are health harming legal needs. We don't have embedded legal assistance. There are lots of gaps still. And I hope that we can find better ways to connect our health system with our social services. And even when we make those referrals, we need closed loops.

As physicians, we need to know that patient that I referred to get a need met, actually got that need met. Otherwise everybody just kind of, the patients don't want to give the information and the doctors don't want to even bother screening because we know we can't help or we don't know if we did help.

So I hope that we can get some better integration around the connection between health and social systems.

Thank you so much for that comment. That was a part of my legislation that the Governor vetoed twice. So we will talk.

All right, thank you everyone. Thank you all for being here. Thank you Senator Weber Pearson for having this Select Committee. So my name is Samantha Williams. I'm a family nurse practitioner, also the CEO of Gyra Providers. I'm here with a proposal to just put it out there.

It's unfortunately fallen on deaf ears, even though I have certain seats at the table. And so while implicit bias training and some of the other interventions that were mentioned today, when put in place are helpful, they are not enough. We cannot continue to rely on training alone to repair structural harm.

Bias training, implicit bias training does not restructure systems, it does not change access, and it does not guarantee accountability. Black residents make up less than 5% of San Diego's County's population and are scattered across healthcare systems like Sharp, Scripps, UCSC, Kaiser FQHCs, et cetera.

This fragmentation, combined with the absence of racially aligned providers makes culturally responsive and coordinated care nearly impossible. We need medical providers that are designated to serve the needs of specific populations, not just in outreach, but as embedded clinical specialists. Almost finished in clinical environments.

When, when we notice an increase in adverse outcomes like catheter associated infections or hospital acquired conditions, we respond immediately with evidence based policies and system wide interventions to reduce harm. And yet, when it comes to the PERS, well documented harm caused by systemic racism and implicit bias in healthcare.

We've known about these outcomes for decades, over a century in fact, and still we're not seeing the results that we want. So my rhetorical question is why is harm reduction policy automatic and infection control, but optional when it comes to the harm that we see racially if we can align policy to correct catheter use.

Okay, I'll send it later. Thank you, guys.

Hello, my name is Rahmu Abdi. I'm the Director of organizing a campaign with pana, the Partnership for Advancement of New Americans. So our African refugee community, many people. Do not trust healthcare system. The reason is clear because cultural barrier, language barrier as well making unsafe and unfair for them to go and seek doctors.

When they have to go to the Doctor, they take their kids with them to translate it. Imagine a 15 year old finding out her mother is diagnosed with stage four cancer and she have to tell them.

So as this Committee, what can you do or allocate any funding to have professional translator and also a material that translated in different languages for those applicant communities. Thank you.

Thank you. If you follow up with my office, they can let you know about some of the things that we have done as far as improving language access barriers for all languages here.

Good morning, my name is Lindsey Wade. I'm with the Hospital Association of San Diego and Imperial Counties. I just want to start by saying thank you. Thank you for holding this hearing here in San Diego. Thank you so much to the panelists and your expertise and Dr.

Hood to have you hear and your voice and your expertise for so long in our community and still pushing the barriers and I'm still learning every time you present. It's really wonderful. And it's also an incredible experience to be here with so many of our own partners that we work with.

We just completed our 2025 community health needs assessment and after hearing from the experts today, you can really comfortably say that once again our community got it right.

It's really clear when you go out to the street, when you go to experts, when you have surveys, we heard the same things that you were sharing today, which is the whole community is under debilitating, ongoing chronic stress and it's taking a toll on all of our house and our ability to care for ourselves and our community.

And so deeply appreciate the additional research that we learned today and just want to make sure that we're available here from our perspective perspective to support any efforts locally. So thank you again.

My name is Giselle Maywe and I am retired. But I have been volunteering in my community. I have enriched background in the medical field, healthcare and also in the special education. And also I raised a son that he was diagnosed autism, serial handicap in those days was the term and today it's a computer science.

Very intelligent with a deep thinking, analytical. Well. My recommendation to this I want to say thank you for the invitation to be part of these enrichable experiences as part of my community.

And I want to say that thank you for all the expositors and I would like to see to include more of this and I would like to see like the program, all of us and color. I don't know if you are familiar about that program. That program. They are. Okay, well I would like to say that program.

Thank you.

Thank you for your leadership chair and Members of the Committee, thank you for the opportunity to speak. My name is James Carter. I work at the intersection of health and education systems. We can remediate our way out of downstream problems. Kids thrive when families are economically stable and when schools are equipped to meet whole child needs.

If we invest upstream, we reduce ER visits, truancy and remediation cost. We grow healthier, more empowered communities. I'm here to advocate to Fund school based mental health professionals and school based health centers and implement trauma informed practices state, statewide. This is how we can vision.

This is how we can catch vision hearing immunization, anxiety and asthma before they become absences or ER visits. I'm also here to elevate the need for accountability and equity. Tie funding to clear child centered metrics. Reductions in child poverty and food insecurity. Improved attendance and kindergarten readiness. Increased access to mental health and primary care progress.

Closing racial and rural gaps. Budgets are values. Budgets are values. Let's Fund the conditions that every child needs to learn, grow and belong like we would want for our own children. Our cousins, our nieces, our nephews, our neighbors. Thank you for your leadership.

Hi, my name is Nancy, I represent a couple of organizations in the intersection of homelessness and and foster youth. We are Cal AIM providers and so really loved all the dialogue around like the whole person, whole child approach today.

Wanted to ask a question, kind of going with Dr. Mays when you mentioned the baby bonds idea and what was the other wording, the guaranteed income kind of programs.

So I, I'm from Michigan originally and Dr. Mona Hannah who was the physician that found the lead poisoning in the Flint water has started an initiative called RFKids that kind of links philanthropy with TAMP, like repurposing TAMP dollars kind of going along that baby bonds idea and I was just curious if there's anything happening in this Legislature or ideas around making something available.

So the idea is just like no strings attached cash for pregnant moms and money throughout that first couple years of that baby's birth or livelihood. So wondering if there's anything happening there.

We should be very. We should be very proud of California because we're actually leading the way. There's two different. And you'll find this more in the treasurer's office. So the notion of baby bonds, the Bill that was passed was, which I'm on that Committee that's doing the work.

What it does is it says that any child under the age of 18 whose parents died, for example, of COVID Not just parents, but caretakers, et cetera. There is a Fund, but budget has, you know, impacted that there is a Fund. And when they reach the age of 18, there will be monies.

And those monies are to help them get started in life the way that a parent would be helping a child to get started. It is also for foster children. If you've been in foster care more than 18 months, you will also qualify for that program. Again, we have budget constraints.

But the other thing that California has piloted is this notion of a guaranteed income where women in particular were selected based on, you know, whether they have kids, poverty rates, et cetera, and were given 1000 bucks a month.

People at first were going to be outraged because they said they're going to drink it up, they're going to do drugs. These women with this money ended up becoming entrepreneurs. They took care. First thing they did, took care of their bills, took care of building things. And many of the women started their own businesses. So we piloted.

We need to make it work. But we just hit a snag because of, you know, the budget. But I say keep advocating for California to follow through on this innovation.

Yeah, thank you for that. And, you know, you are correct. The issue is being able to implement this from a budgetary standpoint statewide. But if you look, there have been various grant programs, whether it's things that have started or pilot programs that have started at the state or even individual cities have done this on their own.

And so, you know, it may be something that here in San Diego residents lobby the City Council about or the Board of Supervisors to start a program here, here in San Diego, because we do have tighter budget constraints.

But I always say that the more data that we have, the better it is to be able to use to say, this is why we need to do it on a statewide level. Thank you.

Can I ask a follow up question related to that?

We are out of time. Out of time. No worries. Thank you. But I do want to close by thanking everyone who came to provide public comment.

We appreciate all of you taking the time to share your perspectives with the Committee and our presenters, I want to thank so much our panelists, our community partners, you know, Senator Padilla, who came for participating and supporting today. You all did an amazing job.

You have provided such a wealth of information for me, my community, but also for the state, as this is being live streamed as well. You know, I feel like we haven't always gone in the right direction in terms of policies from the state, locally, or from the nation.

We often try to look at things as if they are in silos without really truly understanding that everything is connected and the foundation of that is often one's health. You cannot get an education, you cannot get jobs.

You cannot grow and develop into a happy and productive Member of your community or of this society as a whole if your health is at risk. And unfortunately, health, as we have pointed out by many of the presenters, has a lot to do with where you live, where you work, where you play.

And as a Legislator, we must change that. And as residents of California, you must be very strong in your advocacy for us to change it.

Because regardless of where you live, you know, we live in a country and in a state that has billions of dollars, and yet, because we have not invested in that equitably, we are at the bottom of health outcomes, we are at the bottom of educational outcomes.

We are not where we should be as a whole because we have not looked out for each other equitably. So whether you live in Barrio Logan, National City, Southeast San Diego, La Jolla, all of this should be issues that we all champion so that we all rise. Otherwise, we will all continue to fall.

And with that, I thank you all so much and hope that you enjoy the rest of your day. Thank you.

I wanted to tell you that.