Gov. Tina Kotek appointed Dr. Sejal Hathi interim director at Oregon Health Authority. To learn more about her, watch the above video and read the interview below. Dr. Hathi’s confirmation hearing with the Legislature is scheduled for Feb. 6, with a vote scheduled in the days following the hearing.
Q: How does your background as a physician shape the way you think about this role?
To best answer this question, I should go a bit further back and mention my childhood. When I was 15, I was diagnosed with a mental illness, namely anorexia nervosa. It was extremely hard on me and my family.
For months, my parents and I denied my diagnosis. But eventually I began to realize that society has created a culture in which thousands of people, and especially young women, fall prey to eating disorders, depression and other psychosocial illnesses because we do not understand our intrinsic worth. And, therefore, we cannot possibly reach outside of ourselves to imagine and create a better world.
Against this backdrop, my physicians – from my pediatrician to my endocrinologist, OBGYN, and psychiatrist – were transformative. They gave me back my dignity and helped me begin the path to recovery.
Today, I strive to do the same for others, by caring for people as a doctor and by fostering health systems that empower all people to reach their full potential – by building trust, dismantling inequities, and espousing and embodying a more holistic definition of “health.” It’s with this lens and perspective that I approach our work today in Oregon. And when I talk about the importance of supporting, empowering and listening to those with lived experience, this personal journey is a major part of what motivates me.
Q: You were born in the United States to parents who moved here from Africa. How has their immigrant experience shaped your world view and your approach to the work you do?
My dad fled his birth country at the age of 17. Many of his earliest years in America were suspended in a delicate balance between two selves: past and future, Swahili- and English-speaker, refugee and citizen.
But where others may have broken, my father built a bridge. He channeled his struggles into the pursuit of engineering, the Silicon Valley dream, and eventually into supporting my mom start her own immigration law practice.
Three decades later, I tread a similar path. But the worlds I have sought to bridge have been more intentional: patient, doctor; organizer, policymaker; activist, clinician. Witnessing my parents’ journeys has given me a conviction in giving back more than we take, and in reclaiming our hardships as vessels for our potential.
These values – service, and the courage to “re-baptize our hardships as our strengths,” to echo one philosopher – fundamentally shape what it means to be an American, and to pursue the American dream.
This is the heritage that my parents gave me, which later compelled me to channel my struggle with anorexia into a movement for female empowerment, and ultimately to join the Biden-Harris administration.
This is the same spirit I hope to bring to my work at OHA.
Q: The COVID-19 pandemic effectively upturned life in this country. What were you doing, professionally, when COVID hit? How has the pandemic affected your outlook on medicine and public health?
I was a practicing doctor throughout the COVID-19 pandemic and was seeing patients in the hospital when the World Health Organization declared the global pandemic.
Initially, we had only a few patients. But slowly, and then quite abruptly, the hospital filled with patients suffering from inflammation, shortness of breath and full-on organ failure.
During those first several months, I was working in the ICU six to seven days a week, 16 to 20 hours a day, taking care of patients who had been sequestered from their families and stripped of their identities. And it was hard.
But what was hardest for me was calling family for whom my nightly update was their sole connection to their loved ones. This was before visitors were allowed into the wards and, in those early months, even before we’d set up iPads to beam family faces into ICU rooms. Families were desperate for information, yet too often we had too little.
Medical school doesn’t prepare you to look into the eyes of someone fighting for their lives in isolation or to transmit the love and caring of family members who can’t be there.
One of the silver linings of the pandemic is that it seems to have awoken a realization among many physicians that the policy decisions we make in this country – from minimum wage to insurance coverage to paid leave – exert medical effects just as profound and as enduring as any we might make within our hospital walls.
This awakening has encouraged more physicians to engage civically – to embrace our own agency, and to look up, speak up, and step up. Thankfully, I believe that mindset has outlived the pandemic.
In terms of how the COVID-19 pandemic has shaped the way I view public health – it drove home how we as a society have been fixated on biomedical interventions over social services and proven public health tools.
Disease will only become a pandemic if you layer on housing insecurity, food insecurity, income inequality and lack of political power. Yet, I fear that we’re continuing to glorify biomedical marvels over further investments in public health.
One of the lessons I hope we learn is how to effectively bridge the public health sector to our care delivery system and our community-based organizations. Because that disconnect was at the heart of many of our most preventable problems during the pandemic.
Q: You spent a couple of years working in the Biden-Harris administration as a senior public health advisor. Can you tell us about your work there? What lessons do you carry into your role leading a state health agency?
I served as a senior advisor on the Domestic Policy Council, which is responsible for formulating, driving and overseeing the President’s health agenda.
It was a lot of fun because I got to work with a variety of committed and passionate public servants who helped us achieve consensus around conflicting ideological values and deliver positive results for the American people.
I have brought the same passion for outcomes-driven processes and evidence-based decision-making to my state roles, most recently in New Jersey and now in Oregon. I’m hopeful that this experience and the relationships I’ve built at the federal level – with colleagues across the U.S. Department of Health and Human Services and within the White House – can accelerate our priorities as a state and agency.
Q: You have said that ever since you were young, you’ve been “obsessed with fixing what is broken.” What are your initial thoughts on the challenges facing Oregon and how we can fix them?
I really appreciate this question. While some may want to imply that we are “broken,” my first several days in Oregon have proven to me that we are resilient. We are strong. And this agency is full of committed public servants who are dedicated to breaking down barriers and strengthening health and well-being for all Oregonians.
Over the next few months, I will visit every major region of the state to learn from people who are already tackling our state’s challenges – and the people and communities most harmed by health inequities. I’ll be meeting with local leaders, non-profit partners, health care providers and hospital staff, local public health officials, coordinated care organization representatives and other folks who understand the needs of their communities.
The priorities I set and the strategies we adopt must and will be informed by these conversations.
Still, many of the issues facing Oregon are crystal clear, and you won’t be surprised to hear that I view our challenges similarly to my boss, Governor Tina Kotek. I would highlight three issues for the purpose of this conversation.
The first is health inequity – that is, inequity perpetuated by both historical and contemporary structures of oppression including racism, sexism, ableism and classism, and how all of those forces overlap.
When we think about achieving our 2030 goal of eliminating health inequity, we really need to think hard about how to dismantle those structures – then articulate clear metrics and benchmarks for progress. This includes evaluating the financial incentives of our care delivery system to ensure that they promote those investments that upend disparities and keep communities healthy.
The second issue is our behavioral health crisis.
Our country and our state are engulfed by an unprecedented behavioral health pandemic – with a full third of Americans reporting symptoms of clinical anxiety and depression—a 200% increase from pre-pandemic rates. Opioid-related deaths have increased over that same period. And in more than 40 states, emergency department visits for mental illness have surged as people struggle without the community-based infrastructure to support them.
That problem is even worse in Oregon. Mental illness is a force multiplier for so many of our broader societal issues – from food and housing insecurity to job insecurity.
So, addressing this behavioral health pandemic has to be at the center of our conversation about how to make our state healthy. That means focusing not just on access to care, which remains imperative, but also on the upstream drivers of mental illness – in other words, investing in prevention and early intervention just as much as we do in treatment and in rehabilitation. It means building a social infrastructure that helps protect and promote optimal behavioral health.
Doing this work will require us to build partnerships and work in collaboration with the entirety of state government and with our community-based partners.
The third issue is the fragmentation between our public health and care delivery systems.
In Oregon, as in many other states, public health has been chronically underfunded and understaffed, and insufficiently coordinated with our health and social services sectors. These cracks were splayed wide open during the pandemic.
At the same time, Oregon has been reeling under the weight of an overburdened health care system with neither the beds nor the workforce to meet patient demand.
We have the lowest number of hospital beds per capita. We produce among the fewest nursing school graduates per capita. It’s essential that we make long term investments in cultivating the health care workforce that we need – including traditional health workers and clinicians who come from, or share, lived experience with the communities they serve, especially in rural areas.
Q: OHA is committed to achieving health equity in Oregon by 2030. What does that mean to you? What gives you hope we can reach that goal?
To me, that goal means every person in every community can fulfill their full potential and their highest level of health, no matter their race, class, creed, other identities or circumstances.
But beyond that, I think it’s a practice. Equity is an approach and an attitude whereby we explicitly value and center the people and the communities that we seek to serve.
What gives me hope is that Oregon is already miles ahead of other states in building authentic relationships with community partners to identify community-led solutions to health inequities.
That started many years ago and gained further momentum when Oregon was intentional in adopting a shared definition for health equity and its core components.
We are also working to establish diverse and accountable internal leadership, hiring and elevating people of diverse backgrounds and with lived experience of the challenges we are trying to solve.
We still have a lot of work to do. First and foremost, we must craft a robust, measurable and outcomes-driven plan for achieving our 2030 equity goal. But we have all the right tools and the will to do so.
Q: Finally, how are you finding Oregon so far? What are you looking forward to exploring most?
Oregon is such a gorgeous state. Already, my husband and I have formed mini traditions – cafes we visit each weekend, a fitness spot, a new favorite bookstore. The team here at OHA has gifted me a book of the state’s best hiking trails, as well as passes to Oregon State Parks, which I can’t wait to use later this spring.
I am also looking forward to exploring the intersection of Oregon’s natural beauty with its commitment to environmental justice and sustainability. That legacy aligns closely with our priorities around public health, and I’m keen to see how that integration plays out.
Finally, we are gearing up for our regional listening tour, where I’m eager to hear Oregonians’ stories and their ideas for how we can move forward productively on our core challenges. It’s important to me to be able to visit every region of the state during my first few months, so the team has been hard at work planning this since even before my arrival. I’m looking forward to the dialogue.