n DISCOURSE
year of 2014, by about 110,000-120,000
Medi-Cal beneficiaries. The ACA real-
ly, really threw gasoline on a fire we’d
already set. It was burning pretty hot
already because of all the unmet need
historically.
You’ve said before the ZIP code is more
predictive of death than the genetic
code. What does that mean?
There are some places in Sacramento
where the only fresh food is a lime. We
still have problems penetrating com-
munities with real food. We know there
are major concerns about air quality
around Sacramento. … We’re already
get t i ng h ig h rates of ast h ma, we’re
already seeing communities that are
impoverished, where there’s more vi-
olence, and all of those are predictive
of health outcomes. If you have social
determinants of health at the extremes
we have, that’s actually going to impact
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your well-being way more than whatev-
er you’re predetermined to have. When
you look at those studies nationally and
even internationally, we see the more
you move to a bourgeois, middle-class,
upper-middle-class environment, the
better the health outcomes become.
We def initely include a focus on
trauma-informed care. We understand
that early life abuse, neglect — could
be in the shape of not having access to
resources, food, etc. — have lasting con-
sequences on self-esteem, self-percep-
tion. Also (in terms of ) physical health,
we know there’s a correlation between
irritable bowel syndrome in adulthood
and a hostile environment in childhood,
which kind of makes sense. When you
think about sitting and eating at the ta-
ble with your family, if it’s violent that’s
a scary place to eat, so you (are) literally
metabolizing food in fear. So it doesn’t
surprise anyone that later in life that
whole digestive system is still inf lu-
enced. We try to take that into account.
We have cultural groups like Latina pa-
tients who will have physical pain symp-
toms that we know are manifestations
of depression, for example. Thirty-three
percent of adults walking through the
door are positive for mild to moderate
depression, and we know that in some
cultural groups it manifests in a physical
way. We literally will check for pain, if
there’s no obvious cause, it sometimes is
resolved with an antidepressant.
Tell me about the Women’s Health
program, which is offered at five lo-
cations throughout the region.
More than 50 percent of children being
born in California … are born to wom-
en from a low-income population. …
We want to make sure the prospective
mother is healthy and that she’s devel-
oping a healthy baby. These are clients
who have often had no access to care or