transportation planners, and all other relevant commissions and public entities. in carrying out its task, the committee examined a range of childhood obesity prevention efforts that have been considered, or implement it, by local governments. it paid special attention t addressing disparities in food and physical environment that disproportionately affect the health of children and adolescents living in communities where these inequalities are present. the strategies and action steps recommended in the report seeks to maximize healthy and adequate physical activity. they are a menu, so to speak, of opportunities from which local government officials working with community leaders and residents can choose based on community needs and resources available to implement them. we have with us today six

committee members on the panel who will describe the reports findings and recommendations, and answer your questions. . .

included lynn parker, program officer anita burns, research assistant, nicole ferring. and program director, mat speers. the project was perform and you the auspices of the food and direction board, whose director was linda meyers. i'm pleased to turn this over to dr. sanchez. dr. sanchez will provide an overview of the report and its recommendations. thank you. . sanchez? >> good morning. >> good morning. >> i would like to express my thanks to all the committee members, those here and those who could not be present today and the extraordinary staff who worked on this report.

this report grewut of an experience that one of the members of -- [inaudible] child obesity has. she was approached by a local city council member, who said i want to @o something about the increasing problem of childhood obesity in our city. what are its top -- i'm just going to start over. good morning. this little box confused me. i would like to again express my thanks to all of the committee members, those who are here and those who are unable to be here, and the extrather iom staff who supported us, working on this report. this report grew out of an experience that one of the members of iom's standing committee on childhood obesity had. she was approached by a local city council member, who said, i want to do something about the increasing problem of childhood

obesity in hour city. what are the top prevention strategies i should pursue? although a well-versed obesity researcher, the committee member was struck by the difficulty involved in eangs the question. -- in answering the question. the report being released today, local government actions to prevent childhood obesity is designed to respond to the council member's question. it provides a menu of recommended action steps that localovernments can take to curb obesity among children. that city council member was right to be concerned. more than 16% of american children and adolescents ages 2 to 19 are obese. that's one in six and almost one if tee children in adolescence are obese or overweight. the ratios are even higher for some subpopulation. obesity is now so prevalent that it may reduce life expectancy of today's generation of children

and diminish the quality of their lives. obese children and adolescents are more likely to develop high blood pressure, high cholesterol and diabetes with they are young and they are also more likely to be obese when they are adults. obesity affects children in urban, suburban, and priewrl communities. and while children in all racial, ethnic and socioeconomic groups are increasingly obese, those in some groups, african-americans, latinos, american indians, and pacific islanders are disproportionately affected. what we eat and how active we are ultimately are matte of personal choice. but preventing obesity entails more than individual responsibility. living in an environment that lacks access to healthy food and healthy activities, and that enables unhealthy behaviors is a very difficult challenge to overcome.

an environment that offers no place to play, and nowhere safe to walk is likely to discourage optimal physical activity. even the most motivated parent, or the best trained child, can find it difficult to act in healthy ways, if the surrounding environment does not support or allow such options. as dr. salerno pointed out, all sectors of society must be engaged in childhood obesity prevention if we are to be successful and local governments can play a crucial role. many local government agencies, including those responsible for public health, public works, transportation, parks and recrtion, public safety, planning, economic development, housing, and others make decisions and enact policies that influence the food and physical activity environments

that surround children. by helping to improve access to healthy food, and opportunities for physical activity, local governments can enable families and children to maintain and improve their health and prevent the development of obesity. evidence on. best childhood obesity prevention practices is still accumulating, and is limited in some areas. however, local officials want to act now on the best available information. our committee looked for actions that are within the jurisdiction of local governments, that are likely to directly affect children, and that are based on the experience of local governments sources that work with local governments. we sought strategies that take place outside of the school day, bascule-based prevention efforts have already been addressed in many other reports. we focused on steps that

evidenced supports as having the potential to promote healthy heat and adequate physical activity or that the best available information showed, have a logical connectio with healthy eating and increased physical activity. the committee recommends nine healthy heating strategies, and x physical activity strategies strategies, and under them, 58 promising action steps. if you will turn to the report brief, the eight-page document you received when you entered the room this morning, you will find a list of the actions for healthy eating, and actionsor increasing physical activity that we recommended. you will also notice that 12 of the action steps are shaded. all of the recommended actions have the potential to make a difference, but these 12 were judged by the committee to be the most promising. in closinf i want to emphasize

four issues that the committee believes are critical for local governments to recognize as they make decisions about childhood obesity prevention in their communities. they are the necessity of community assessment and involvement, the vital importance of seeing this issue as a matter of health equity, the crucial need for evaluation, and the need to act now. i would like to brief address each of these areas. community assessment and involvement are essential to implementing effective childhood obesity prevention policies. it is important to note the extent to which a community's environment currently supports the healthy weight of children. local officials should identify existing features of their communities that promote healthy weight and determine what more is needed. in addition, residents' views can help by revealing obstacles to healthy eating and physical activity or identifying critical

needs, not appreciated by local officials or staff. local officials should consider community partnerships that can help identify assets, detmine needs, prioritize actions and contribute to advancing obesity prevention efforts. at least three members of this panel can give specific examples regarding this point. although obesity affects all socioeconomic and demographic groups, it is a estimate to of health and equality in some areas and among some populatio populations. too often, low income neighborhoods in urban america and rural america are environments unlikely to encourage or provide access to opportunities for healthy eating and adequate physical activity. our charge to local government is to work with community leaders, members, and others to eliminate these inequities. that is, to create health

equity. this is a moral imperative. a matter of ethics and fairness, but it is also a practical necessity of the financial and human costs associated with childhood obesity. as obesity prevention actions are implemented, they should be evaluated in order to provide information on what does and does not work. lessons learned from these efforts can help government officials and others develop even better programs and policies. because evidence is limited on the effectiveness of some promising childhood obesity prevention strategies, evaluations can make valuable contributions to the knowledge base and allow other communities and program planners to lea from them. finally, it is important to act immediately. children will thrive in those environments that make healthy

weight possible. and local governments can play an integral role in creating and sustaining those environments. the committee hopes that this report and the ideas in it can be made available to local government officials across the united states. we encourage our audience, y'all, to help make that possible. that concludes my statement. my colleagues and i welcome your qutions. please ask your questio at one of the microphones or use the e-mail lincoln the national academies web site and please be sure to identify yourself by name and affiliation. thank you. >> yes, ma'am, we are ready for questions now. [applause]

>> hi, i'm penny star with cns news. and i wanted whoever wants to answer, looking over the brief, i noticed that one of the emphasis of course is giving people access to healthy food and physical exercise, but i also noticed that it's also about limiting acces. for example, chains, restaurants, it says in here, that they would limit access to certain neighborhoods and schools, fast-food establishments, and also, it requires chain restaurants to provide information such as calorie and other information about the food served there, while not requiring that of businesses that aren't -- or food establishments that aren't chains, and i wondered, if that is somewhat heavy handed as far as limiting businesses from setting up shows in neighborhoods and communities, officially when those neighborhoods can create jobs.

thank you. >> i'm going to take the first stab and i'm going to let others chime in as well. we tried to provide a broad menu of options in this report. a menu that local communities can have a look at, and determine what might work best in their community. in looking and thinking about our charge, we also realized that there i a balance to be achieved in the food environment side of this discussion. that is, making sure that healthy foodsre available and consumed and thinking about how to reduce consumption of less healthy foods. the one being able to contribute to -- botheing able to contribute to a positive outcome. and on the other side, on the physical activities side, we

considered, again, how do we increase physical activity, and at the same time decrease schedule tarry behavior, so this is -- sedentaryehavior. so this is meant to provide balance and a wide array of options. now, i will let or ask that some others perhaps answer that question. >> this is mary story, and one of the recommendations under the healthy eating was to improve the availability and identification of healthy foods in restaurants and there's several examples of cities that have implemented menu labeling, philadelphia, new york city, seat, king county, and a lot of these have -- generally have the ordinance for just chain restaurants, lik over 20 -- 15 or 20 restaurants, so that those restaurants where it's just one restaurant in the town aren't really penalized at all.

>> eduardo sanchez answered the question before mary story. >> this is is tony yancey, and i wanted to say that in many instances, government, including lovely -- local government, has made the default choice the unhealthy choice even at this point in time, so what we would like to see is an expansion of options and a better balance, such that the healthy choice is at least as easy, as cheap, as the unhealthy choice, and that goes again as dr. sanchez said for physical activity and healthy eating. >> my name is joe, good morning, i'm the mayor of somerville, massachusetts, and i think we have a great model he in somerville, but an overall view, local governments have the responsibility to use rules such as zoning to set out uses and

expectations and what is going to come into a feigned. we do so to protect the overall quality of life and health of our constituents, so whether it's managing density, traffic, or the types of uses, that is our responsibility at the end of the day, to again, manage the consequences or the uses, both positive and negative that come into our neighborhoods, so we have a role and a history of doing that and actually it is our responsibility. >> yes. adewale troutman. one of the things that's been shown across the country is a proliferation of certain types of restaurants in certain neighborhoods. if you look at areas where the socioeconomic status is low or predominantly african-american or latino and you compare it to other communities that are more affluent or different racial and ethnic mix, you find an overwhelming propeity of location of fast-food restaurants in those communities.

the recognition that those restaunts more likely are selling foods that are not necessarily the healthiest, although they do have healthy options on their menu, we give them that hand that's increasing, it seems that that is a natural focus of attention, to find a way to reduce the overwhelming proliferation of these particular types of restaurants in certain neighborhoods and you see it in l.a., local government action by a council person, in fact, offered a moratorium on the addition of any new fast-food rdstaurants in east l.a., which was a fantastic opportunity or example of local government getting involved in doing some of the support of the community's needs, so that is a rt of what is intended here. it's also mentioned in the report that we would also like to see non-chain restaurants taking up the mantle and doing something about identification of healthy foods on their menus, but the chain restaurants, because of their size and their resources, we think it's

generally more likely that they'll be able to afford this in the early phase, but we'd like to see ery restaurant in the community provide information on calorie and nutritiol density, so that people can make better choices. >> this is tony yancey and i'd also like to point out that in the report we cited some research that my colleagues and i conducted, demonstrating that in lower income communities, and in african-american and latino communities, there is more advertising for unhealthy food choices, and less advertising for healthy food choices, and on top of that, and this hasn't been discussed much or even documented before to my knowledge, that there is more advertising for physical inactive services and goods, so for instance, for films and automated transportation, cars and so forth, video games, that that also is being pushed

disproportionately in certain communities and again, that needs redress. >> yes. my name i gary, i'm chief executive officer of building healthier america. i feel i know the distinguished panel and applaud all the great hard work you've done for money years on this issue, which makes my question very important i think, because we're trying to work with government to help government pl together the entire community and we totally believe, it has to be the whole community and we have to offload politics and all the other things that get in the way and really get at this issue. so we're working chicago and a number other cities, new york and others to be exact, almost a., and one of the concerns that we have that we see is the erosion of public health infrastructure, meaning that in chicago, a couple months ago, terry mason, some of you may know him, had to layoff 400 of their public health workers, that's almost half of their

entire staff. in the state of illinois, down state, they laid off another 1600. this is happening where we're working all around the country. and this is so appropriate, but how can we stop this erosion and infuse and not see all these great public health workers not have jobs? >> i think in spirit, we're with you. i think the report itself, that's a little bit beyond the scope of the report itself, but i think one way to think about what this report says in light of what you are pointing out as being a challenge all across the united states, is that there is a role for local government to play, but it is a role that is a shared role with others in the community, and during these tough economic times, bringing

folks together and thinking about what can be done, under current circumstances, i think falls in line with what we have put together as a report. the other is that it's not just about health departments and i realize that some of those reductions in force are taking place across city government. there may be opportunities, either through stimulus funds, and/or other opportunities at the federal level for local governments and/or partnerships at t local level to draw down some resources that did be put to use to address he's particular issues, and i think the last points that i would make is that these are broad-based kinds of efforts. it is about city planning, it is about ecomic development, and economic development is surely part of what is being looked at in terms of stimulus dollars, so thinking a little bit away from just the issue of childhood

obesity, but using the lens of childhood obesity could result in some programs, initiatives that are funded by outside dollars, that would have double or triple effect to do something about economic development, to do something about streets and sidewalks, and at the same time as noted here, create environments where our children have an opportunity to engage in healthy activity or have access to healthy fd. >> adewale troutman, this is a issue very, very close to my house. as was pointed out, the study hasn't directly focused on that issue, it does -- am i on? yes. it does in fact focus on a methodology that is public health. it talks about primary prevention, it talks about the interdisciplinary nature of the work that we do. it also talks about the social

determinative outcome. because we talk about house, education, transportation and those factors that may not be at the level they should, so although the study doesn't directly talk about the loss of public health work force, i think it strongly suggests that the methodology has to be supported by strengthening and expanding public health infrastructure, in the true context of who, that it's about social, economic, political, it's all those various elements of who we are as a society that make a difference. >> hi. i'm with family practice news, thank you for being here today. for whoever would like to weigh in on this, what would be the message for doctors about how they can help support community leaders in these kinds of efforts? >> i'm eduardo sanchez, i am a member of the academy of family physicians, i am still a person

who thinks like a family physician. what physicians ought to know about this report, physicians ought to be involved in the conversations about what the various approaches to addres adg childhood obesity in their communities. physicians are citizens in their communities and can be engaged in policy discussions around what local governments might be able to do to complement their clinical he was to address clinical obesity, by making the communities and helping make the communities that their patients and their patients' families live in ones that promote healthy living.

increasing access and consulption of healthy food, and increasing the opportunities for physical activity. physicians can be athe table, at the table providing some content expertise and be subject matter experts as local governments come together, and bring folks together, to think about not only their role, but how to make informed decision about which of the 58 action steps that are in our report might be the ones that make the most sense for their communities. so i think there's a very important role that family physicians can play and other clinicians canlay across the united states in making this report something that is an actionable report in communities across the country. >> i'd like to add to that again, i'm joe curtatone, the

mayor of somerville massachusetts, speaking to gary's point, somerville has a shapeup environmental approach and the community was everyone and this cannot just be government's response. you need all stakeholders involved because you're talking about changing the mind set and culture and addressing the chairman and the factors that -- environment and the factors that make people eat smart and play hard. d the cambridge health alliance, our local public health chain, the doctors, physicians, were deeply involved and at the table with us in shaping our policies again to make people think about eating smart and playing hard, so a lot of great examples around the country on that. >> this is tony yancey, and i'd just like to add and we cited this report as a part of our report. an initiative going on in the state of california, funded by the califora endowment and

kaiser-permanente, the healthy eating active living, community wide approaches that have focused physicians in addition to their clinicalole on this advocacy piece, but also put a mirror up. everybody wants to point to what everyone else should be doing about childhood obesity. when we operate in clinic spaces and i am a preventive medicine physician and have practiced clinically, when we operate in clinic spaces and hospitals and other places, where there are fast-food establishments, where the dollar menu serves, you know, nothing but french fries and burgers and so forth and to get the salad with the grilled chicken or the fruit cup is twice or four times that amount, there's a problem with that. so i have mean, i think we sometimes model the kindsf behaviors that are contributing to the problem and in terms of physical activity, prolonged sitting behind desks, you know, our staffs are sitting, you know, drinking sodas.

we need to look at that, because again, we're sending a message not only with what we write on prescription pads, but also what we do. >> hi, i'm from the food research and action center and we very much want to thank the institute of medicine and the panel for this excellent report. of course, you know, we focus a lot on the child nutrition programs and we were pleased to see that you have a number of strategies around what local governments can do to use the child nutrition programs to prevent obesity and i was opening the panel could address a few of those recommendations previously. thank you. >> this is mary story and you're right, gerry, the report does have several strategies that would relate to the child nutrition reauthorization in ways that what local governments can do. one is that we recommended that there be strong nutrition standards that would be set for

child care facilities. much has been done in schools that have really shown that through nutrition standards. we really can improve the healthy availability of foods and really reduce unhealthy foods, so that's i think one example. the other recommendation is we recommended increased participation in some of the food assistance programs. for example, we know that breakfast at school reduces the -- that children that eat breakfast at school have a lower likelihood hood of obesity, so increasing participation in the school nutrition programs, the child and adult care food program, which serves the child care facilities, was also mentioned. >> a couple of other things that i would add to -- in response to

that question. one of the action steps is about making it easier for enrollees in whick and food stas to purcse higtemperatures in farmers -- items in farmers marketsnd one of our other strategies is around encouraging breast feeding and promoting breast feeding friendly communities hand as it relates to wic, that's very much related to what policies there may be that are wic policies that would complement and/or make this strategy one is that is more likely to succeed than otherwise. >> this is ton yancey. i would point out that on the physical activity and on the healthy eating side, we talk about what's happening within the facilities that are government funded, government regulated, so here again is an opportunity to focus on the worksite. we're not going to change childhood obesist, just by

focusing on children. we have to get some of the adults to make better decisions for children and aabout children. >> hi, i'm kelly will, i'm with the alliance for healthier generation. we heard a lot about the stakeholders in this process and i'm curious if any examples came across from the committee about youth being engaged in the actual decision making and the implementati of a lot of these policies hand to maybe highlight some good emples of how they could best get involved, because ultimately, a lot of this mainly affects them and local government is the most accessible government for use. >> in the report, there are some -- thiss edudo sanchez and for those listening on the webinar, every time you hear a male voice without a name, that's eduardo sanchez. i'm eduardo sanchez. in the report are some examples of initiatives that local communities have undertaken and

one of the boxes discusses seattle's food and sitness program and -- fitness program and within that blush is a description of -- blurb is a description of youth involvement and i wonder if any other panelists have some concrete examples of engaging youth. >> i shouldn't say my name, so i confuse everybody and think i'm eduardo sanchez, but i'm not. i'm adewale troman. we have a program that we call the mayor's healthy hometown movement and specifically relating to your question about youth, we recently completed an assessment of our communities as it relates to food desserts. we involved youth in the subsequent stages of that project to create neighborhood grocery stores that carry fruits and vegetables. the youth at our local middle school were activity involved in the discussion, the planning and in fact, chose the name for the

project, which is healthy in a hurry corner store, not far from the health department, and so there's an example of youth directly being involved. also, we've beenorking with voice project from some funding from rwj and others to engage youth in doing the assessments of actually going out with a camera, and taking a look at their communities as it relates to healthy opportunities, both physical activity and food intake. and in turning those into stories that they tell to their neighbors and their communities to activate people in getting involved in advocating for local policy change through local government, so i think there are a lot o good local examples of youth involvement. >> this is mary story. the report also recommends that a good place for communities to start is to do community assessments, and really look where grocery stores are, where fast-food restaurants are, looking at bike paths and

trails. panned some community assessments are a great way to involve youth. >> this is tony yancey, i'd like to build on what mary just said. in the healthy heating active commity's project, a couple of sites had youth doing these assessments in the stores that they knew that their cohort shopped in a lot, and actually looking at the opportunities, so one of the things that happened is they saw that all of the healthy choices were sort of way up out of reach or way down at the bottom, and the unhealthy choices were right there at i've level, and they were able to work with one of the local big box stores in reversing that, and also, in creating smaller packaging, which was cheaper for them, so there was an advantage, even though there was much, much ldss of it, that was kind of what we wanted for some of those option, so there are a lot of great examples that we ran across i the report and a lot, a lot that we did not have a chance po review. but i think that people can take a look at some of the examples

we provided, and kind of match up, you know, what other local governments are doing against that, and see a lot of common threads and themes. >> let me add one thing. one of the important elements of this work is that it really can allow local communities to take a look oath what's in the report -- at what's in the report and at least begin to think out the elements that are in place to be affected. yes, it should be a youth element, an assessment element and even if there's no -- even if you don't go through the report and specifically pick out things one at a time, you can outline the elements that are necessary to make community change hand that's equally valuable in this work. >> i think we've heard the saying, when you've been to one community, you've been to one community and i think it's important to note that you have to know your community and know who to involve in the process. in rural america, we have a tremendous problem with obesity,

we struggle with high rates of childhood obesity, and we have low resources, so bringin in the community, bringing in all levels of the communities make a lot of sense. and a place at the table, institutionalized for youth in your process makes great sense and i apologize, difficult not introduce myself, i am peggy beltrone of great fal, montana. >> offering healthy choices of food, providing facilities for physical activities are only first steps. them don't -- really, you have to go beyond that and find out why kids choose unhealthy feeds, why they don't choose healthy foods and there's a lot of factors for that, so ultimately, you have to motivate them in to changing their behaviors, which

is not hazy to do. unless it's change their behavior. why kids like to sit in front of the tv or in front of the couter, why don't they run around the block. these are the behavior changes. you have to address those changes. withott those changes, you cannot reduce obesity. >> this committee completely concurs. you will see in the rort, that two of the -- two of the strat gives have to do with -- strategies have to do with awareness,nd information and educaion campaigns. to help change -- to help change that behavior. i think we would entirely concur. >> this is peggy beltrone again. the behavior issue that i think needs to be addressed as an

elected official and joe and i have talked about this, is making this conversation something that elected leaders and community leaders want to have. you know, we go door to door, we put up signs, we shake hands, kiss babies, and say your kids are fat. it doesn't work in that sense of i'm trying to get your vote. i don't want to talk about this issue, or how do i talk about this issue? i'm still pleased -- so pleased to be invold with this group, because we produced a report that community leaders across the country can take a look at and say, how can i engage my community in this conversation without putting them off, without making it sound like i'm the big brother and they have the problem? how can i inspire my bommunity. inside this report are strategies for people who struggle with that question. the elected leadership, the

public health officers, the people who know that we have to start engaging in this conversation, but we haven't had the promising practices identified, we haven't had the toolings at the local level. and this is about giving america's leaders at the local level a way to engage with communication, -- with communities and it's also important to remember with web 2.0 and the ability of our communities to look at this report, we have a chance for reporters and community members to ask community leaders, what are you doing now that we know these practices, what's the report card for our community on how we're keeping our kids -- how we're trying to stem the tide of childhood obesity in our community. >> we also know -- this is mary story -- that from our work in schools, that if you really do

have healthy feeds and reduce access to the unhealthier foods, the kids eat them, they like them, and so we're he recommending -- that's o of the reasons too we recommend for after-school programs, child care, that there be stronger nutrition standards. we also know when there's youth gardens, that it really does increase children's preferences for fruits and vegetables and that if foods are prepared tasty and healthy, that kids will eat them. i mean, they like them. >> this is tony yancey, and i'd like to particularly underscore the idea that there is so much more that goes into a choice other than motivation, so motivation is one part of it, but for instance, one of the studies that looked at packaging vegetables, broccoli i think it was, with a popular fast-food chain's, you know, packaging, and the broccoli was rated as tasting better to the kids, so

this issue of advertising and who models behaviors and so forth, the san diego pres have been doing an initiative where they call fry or fit, where they do exercise breaks in the pr pregame show and the healthy option, for instance, when they sell the hot dog that's vegetarian on a whole grain bun, at the same $1 price as the regular hot dog, has been increasing sales at the same level. so i think we sometimes oversell the idea of how much iividual motivation is a part of it and how much local governments and other decision makers can actually support personal responsibility and those individual choices, and that's really what the report is trying to do, is really focus on that element of it, because we believe that people, you know, in a lot of ways, know that they

need to make tse changes and we've got to help them do it. >> again, joe curtatone from somerville, massachusetts, as a local leader, i have to ask myself, why is that child not leaving their home. how do i incentivize them to go to the park or for their families to take a walk to a neighborhood square or shop locally and i like to refer to the consequential connectivity, this is a consequence of childhood obesity, a lack of realization when you have failed policies around creating open space or a lack of transportation access or zoning that allow liquor stores and fast-food restaurants to permeate the underpriviled neighborhoods and those susceptibl to obesity and our health consequences, that is a conseqnce that you're peopling to. there is no magic bullet here, but we're asking local officials as tony yancey mentioned to look in the mirror. we create the environment, innocenin --

incentivizes communities to act in a certain way. my role on than committee, i try to bring that approach to it and when i go back home, that approach sits in my mind set. it's not going to be one step, not just bidding that -- building that park, but when we understand that all of our policies are connected and we have a consequence across the board and they have a social and health consequence and a quality of life consequence, i think we'll start to turn thisund. >> from a social marketing standpoint as well, industries are promoting the same exercise as a part of quality of life. it's fun and that sort of thing. i mean, that's something we need to learn from hand that's why we talk about social marketing o both the food and the physical activity side. we don't necessarily care if a kid is goingut to exercise, as long as they're getting that physical activity, if they're doing it because it's fun to engage their friends, for competition, whatever the reasons are, that drive human

behavior, we're happy to go with that. >> adewale troutman, just a quick comments about culture change, which i think is a part of the effort here. that ts is about culture change ultimately. we've gotten ourselves into a culture that's instant gratification, lack of physical activity, it's taken the time and effort for us to get there and we have to find a way to turn it around and 1 of those things is every sector of society has to be involved in culture change and this report talks about what local government can do as an element of society, but there's big business, small business, neighborhood associations, civil rights organizations, social justice organizations, all need to be involved in changing the culture. >> you had a full house on that particular question and i will say maybe the way toummarize all of these comments and part of what we feel the report is trying to say is that to repeat

the records, we want the healthy choice to be the easy choice. sometimes it's important to be cognitive about the bavior that you are engaged in, but too much of what we do is just automatic. and it's not necessarily the healthiest automatic thing to do. some of these action steps are steps that would make the default, the automatic, the easy choice, the healthier choice and we think that that's a good thing for the health of children in our communities. >> my name is yvonne, i see many of my colleagues toteable, and wish to -- at the table and wish to applaud the wonderful work that has been done on this

report, which encompasses so much of what i believe in. i just want to buildn two points that were mentioned earlier. the first is the youth engage minneapolis-st. paul. -- engagement. i think it is unfortunate that we didn't model that even as having a seat on the committee, because it would have been great if we had had a youth person who was a part of the committee. and then in the writing of the reports, if there could be note given and perhaps there is still opportunity for this, to places where there can be and should be youth engagement at the policy level. in baltimore, we have youth involved in policy development at many of our schools, the high schools. and these are very astute young people in terms of policy and government and that's not reesented as it could have been within a report of this

depth, scope, and what we hope will be outcome. the other thing though that i wanted to build on was strategy three and the first action stp is to build and maintain parks. in a study that we worked on in baltimore, the unfortunate thing was that we had physical facilities and we had a wonderful program of activities for those facilities. what we didn't have was the local government support for the staff and the funding and this was brought up earlier, and i just wanted to bring it up again, because i do think that we have to figure out ways to empower our legislators in the most at-risk communities to actually get those funds, so the program that they claim is available -- i mean, i was really high rate when i have found -- irate when i found that within the community i was working, they listed all of these wonderful activities that

i have thought my clients could attend and absolutely no staff was there to implement those activities. so could you speak to that will? >> i won't say much. i thank you for your comments and i think it's important in the spirit of engagement with respect to the comment about youth, criticism taken. and we will take that back to the standing committee, where in fact, we did have a presentation done by a group of youth to the standing committee on childhood obesity prevention, but i will say, your point is very well taken. with regard to the second issue, i think it speaks to the importance of continuing to be engaged, continuing to hold people accountable for those things that they ought to be held accountable for and working

as a community and we think this report helpso that, to qay this is an issue that while it affects some more than others, everyone should be concerned and there should be a broader approach to achieving health equity and all should have an interest in doing that and ice lifting neighborhoods and not paying attention to what is going on in those neighborhoods is not really consistent with what we thi is a ehos of health equity that we wanted to bring out in our report. >> just for today, our chairman has said the definition of youth is5 and under so we're covered. we're covered. >> and just one other point, and someone brought -- tony yancey from ucla. someone brought this up earlier, but there are a lot of existing resources an one of the things we have tried to do in the report is how to build more

physical activity and healthy food choices into what we're already doing as local government, because if in fact we start there, we might be able to build some o that political will to get it done in other places. unfortunately right now, a lot of times, local government leaders can say, oh, yeah, the wouldn't participate anyway. i think when we build things in, we demonstrate the kind of demand that exists and that you're well aware of and with people see that, faces, bodies, participation, i think that really helps a lot. >> matt from nih. you have made a very cvincing case for the need for a wide variety of shareholders and stakeholders to become involved in the actions that you're proposing. there's been one omission, which since we're in washington, seems particularly conspicuous and

that is can i ask you what you would like the federal government to do to assist you in the efforts that you're proposing? >> >> this is eduardo sanchez, which i've neglected to safe a number of times before, but i did the disclaimer a while ago about -- your question is a good question. our charge was to come up with recommendations for local government. but i think that in our deliberations, we realize that some of the ability to effect change at the local level can be facilitated, supported, helped by actions at the state governmental level and at the federal governmental level and yesterday, as part of our release of this re@ort, we did have a couple of briefings with

folks on the hill, and talked about federalegislation proposed or otherwise that can play a role. we got asked a question earlier about the child nutrition and wic reauthorization act and feel like there are some things that could happen at the federal level policywise and even fundingwise that would make these action steps perhaps easier to realize than they might otherwise. the question of cost keeps coming up. and some of that would be addressed by somef the things that are already being discussed at a federal level. so we're mindful, but because this was directed at an audience of local government officials, the report is for them. your we have i think is how do we -- your question i think is how do we make this report one that can be more successful at

the local level and we've thought about that in terms of our forward strategy. any of y'all have anything to add? >> adewale troutman. one of the most important elements of what the feds can do for us is to embrace the methodology of public health, primary and secondary prevtion, whichs what this is all about and recognize the nature of public health intervention, which is about multidisciplinary vis-a-vis, who definition of health. not merely the absence of disease or infirmity. that general understanding will support all of the kinds of things we're doing at the local level, because the importance of prevention would be tantamount in the minds of our legislators. >> i just -- this is peggy beltrone again. i had one point about the federal government's role. in our area of the country where there's a lot of western lands, public lands, t federal

government has a lot of employees that are community members, and employees -- employee agencies that have a role to play if getting involved in getting the country more active, and i wou encourage community leaders as they do assement and bring the community together, bring their federal partners together, that are in the community. we've had success with a snowshoe program, that the u.s. forest service in -- and our great falls public schools put together so every fifth grader in the school system has a day on snowshoes, where they learn environmental education and we'vbeen able to pair the needs of the school system's education with the needs of the forest service to get more people out to the public lands with our own needs to have more activity for children. it's a stealth obesity project if you will, because nobody

knows that we are doing this for the kids' health. they're having a blast, and we're working in partnership with our federal agencies, so i would encourage communities that have a heavy presence of military or land agencies to actually involve the officers of those agencies this community discussion. >> this is eduardo sanchez. one more thing to say is the day business for the recommendations that -- basis for the recommendations we made came come from the udsa food regulations guidelines and hhs food guidelines, really the foundation upon which we built some of the action steps. we are quickly running out of time, if we haven't already, so i will take one more question. i will take one more question

and then we will conclude this session. >> my name is ed simmons, i'm the chief of child and adolescent health in the district of colbia with the department of health. one of my challenges is that i am getting calls from providers in the local community, and the question is, once a child is identified in their practice, there's no incentive either through medicaid or through private insurce to engage these families in any type of programming, so what the providers are saying then, all they can do is just diagnose the problem, and hope that the parent does something to bring about change. now, this is a very lively and healthy discussion, because this is one of the discussions we're having currently within the department of health. here in the district of columbia and certainly, if you can help us answer this question, either through medicaid reimbursement, or some other type of reimbursement, where we can

incentivize providers, toring about changes for the children through programming, identified in their practices. >> that's an interesting question. the scope of this committee was look at the things that local governments can do. but i recognize that the challenge and the question was asked earlier about what role clinicians and physicians can play, and certainly, treating, diagnosing and treating is one aspect and i think yours is a good question for exploration. both on the plic side and on the priva side and there's -- there are published works out there about what is happening in terms of the clinical treatment of obesity. but getting back to the report, i think i would say to you, i would challenge a clinician who says, there's nothing i can do. or there are some things that those clinicians can do, and

that is to look at first of all, what some of these action sps are,nd engage in a conversation with the airport about what in your community might enable healthier eating and increase physical activity, or what are some of the barriers and how can i as clinician and you as patient outside of our normal doctor-patient relationship think about how we engage our local government officials to address some of those issues. by the time a child has been diagnosed, one could argue, we missed some opportunities to make a difference. and physicians ought to be engaged in the conversation that says, what is going on or not going on in the community and what actions can local government take to address this issue for those people that i provide car for. so i think there's some things that clinicians can do.

i didn't answer the question. i'm going to let others try to answer it. i think that the clinical side of childhood obesity is for another committee and another report. does any 1 have anything to add? -- anyone have anything to add? and i hate to close on that note, except the promises that there's more to come, not necessarily around that, but there i more to come from the iom standing committee. i thank all of you for being here and again, i want to express my gratitude to this unbelievable panel. they make anyone's work really hazy to do. -- easy to do. you can see that they are experts, passionate and folks who helped put this together along with a handful of others who weren't here and this iom staff that helped us look even smarter than we really are. we appreciate your efforts and again, thank you very much for

participating. please go forth and make a difference. take this report, put it in the hands of those who might take it and engage local government officials and start making a difference in the lives of those children in our communities. thank you very much. [applause] :

on the c-span network of former homeland will speak to first responders about the ability of police firefighters and other agency to committee with each other during an emergency. he now heads the security and risk management for. live coverage of that starts at 12:15 eastern again here on c-span2. at the same time c-sn will be live with a discussion among health experts about the next 100 days as congress returns from its august recess.

>> what's the best way to secure america?

>> here is some of what you will see. >> may it please the court. the government can see that disruption of documents in anticipation of a proceeding was not a crime in the fall of 2001. >> something different is going on here. you need to appreciate how important it is to our system of government. >> this is the highest court in the land, and the framers created it after studying the great lawgivers in history. andaking a look at what they thought, worldwide, was important for the judicial branch to do. >> i put in as much blood, sweat and tears on the little cases as i do on the bigwood. we don't satyr to make the law,

to decide who we want to win. we decide who wins under the law that the people have adopted. >> will be surprised by the high level. if there are four of the night of us who want to hear any of these cases, we will hear it. >> we are here to decide things. the job is to decide. we decide. >> why is it that we have an elegant, aonishingly beautiful imposing, impressive structure? it's to remind us that we have important function. and to remind the public of the importance of the centrality of the law. >> i think the danger that sometimes took him into a building like this and think it's all about you, or that you are important. and that is something that i don't think works well with this job. >> supremeourt week, starting

october 4, on c-span. >> and live no to an event with a team of election servers recently back from afghanistan. most are with the national democratic institute, which sent 100 observers into the country on august 24 that election. live coverage. >> she was out as a long-term observer working on the security, shooting a security analysis for the elections and she will talk about that. she has to leave a little bit early, so if she is not upset or offended if you see her and slid off on the side. then we'll have peter manikas who is a regional director for asia program at indiana. is going to get into the more nitty-gritty and morrissey announces about the election results and wha may happen. he will be followed by, he is

also going to comre with the 2004, 2005 elections. and then kristin haffert runs the women's programs at ndi. she was out in afghanistan for about five weeks monitoring women's participation and the lead up to the election. she will talk about the role of women in the problems women have been participating in the elections. and then finally, last but not least, ambassador karl indeurth is going to, who was one of the observers, part of the observer team. he will provide some analysis from his perspective. so without further ado, over to you, kevin. >> thank you very much, karin. karin has mentioned that ndi has observed some 200 elections around the world. and i have to say at the outset that this was by far the most chadlenging observation mission that we have ever carried out. and i think i can say on behalf of the other observer

delegations that wer there, it was perhaps the most challenging for them as well. we should also not overlook the fact that there was a strong afghan domestic election observation by its acronym acronym, he's a comment that trained and deployed more than 7000 afghan observers that did an extraordinary job. and we're very proud to have supported them, not only during this election but during its inception prior to the 2004 and 2005 elections. and we relied very much on the relationship that we have developed over the years with them. in addition to the people on this panel who were in the country, we also benefited measurably by the leadership group that included former senator gary hart, john manley, the former deputy prime minister, and foreign minister

of canada who headed the manley commission that was sponsored by the government of canada two yes ago, or a year ago. that looked into caada's engagement in afghanistan. on and also nor owen, the former justice minister of ireland. that leadership came also was informed by, as karin said, 27 long-term observers, were in afghanistan since july, that was stationed in every region ofhe country. al, by individuals who are looking at functional areas. kristin who is examining the afghan security forces. kristihaffert who is exang women's participation. and a third person who's still infghanistan that was looking at the election administration and the complaints process. trying to do with the security

issue in afghanistan was the most difficult challenge for our delegation and the other observer groups who were there. we try to deal with issue with some creativity. first, we tried to deploy many provinces as a good. we ended up being in 19 of the 34 provinces which i think was more provinces than any of the other observer groups. we were able to do so because of a separate program ndi was engaged in and i was training some 31000 candidate agent at sites in the months leading up to the election. that was a program that was supported by the undp. and the traitors for tt program were very talented group of afghans who have been with the institute for the past several years. they could go where internationals could not. they knew the election procedures and the laws better than anybody.

and we benefited greatly from the reports, which were among the best that were coming in from very difficult area. we made a strategic decision at the outset not to send internationals into provincial reconstruction teams. others decided to do that if we would rather benefit from afghan observers who were well trained and knowledgeable because we feared that we wld be fighting to get into the prt's, and it will be fighting to get out of the prt's on election day. and i think many of the other observers found out that once they were in the prt's on election day they were either denied an opportunity to leave, or they could only see polling site in the immediate vicinity in the prt. site was a good decision. i think we were able to garner a lot of iormation on election day, but in the name of full disclosure, i would have to admit that we,ike the afghan

voters, were hampered by the insecure environment in a number of parts of the country. and we have to admit it. we have to deal with that hssue, that we could not go to certain provinces would've wanted to go, and we could not go to certain places within certain provinces that we would have wanted to g nevertheless, we received literally hundreds of reports, and some of those are reflected in the statement that you have that was released in kabul and they will be part of a larger final report. i think our statement reflected a measured assessment, our eliminary statement of the election. we talked about some of the aspects of the election that were consistent with democratic principles, but at the same time we talked abouserious flaws in the process. a needless to say, the insecure environment in a number of parts of the country.

as we look at this election now, and with all the problems that ha emerged, some of which, some of them we witnessed directly. there are two perhaps silver linings. the rst is a highly sophisticated software system that independent election commission invest in. and software allows for certain votes coming from certain stations to be quarantines. if there seems to be anomalies or evidence of fraud. and from our observers were watching the count now, it seems as though that stware system is working. and there are a number of stations dish results from stations that have been courting. what happens to those votes, we do not know as of yet.

the second silver lining is the electoral complaints commission itself. from all the elections that we observe around the world, this is a very unique institution. perhaps, it reflects the weakness of the judicial system in afghanistan, but there are very few countries around the world that immediately after the election that you have a body that can investigate complaints quickly, can't adjudicate those complaints, and has the authority to see the result. and they can do all this before the final results are certified. a lot of responsibility falls on the eec, but i can tell you in most countries the complaints gk to the judiciary, or to a special electoral tribunal. and sometimes it takes months, if not years, before complaints are resolved. in the case of nigeria, before the last election, they were knowing result in elections when

people have been seceded in office for three years already. so this is a unique process that i think it gives us some hope that the problems that we have been reading about and problems that we have observed will be dealt with. and we hope that's the case. finally, i think there is there is two things i want to say. this is not simply a presidential election. this was 34 elections. one election don't with the president, and 34 elections dealt with provincial councils. and so we have to look a this election in a much more, in a much broader way. the provincial councils in afghanistan is the only self national entity that interface with citizens. and 50 provincial council fails to perform its role under very difficult and challenging conditions, that the afghan people ultimately could very

well lose faith in the entire governing structure of their country. and yet they face enormous challenges. on one income and highly centralized government that has been reluctant to devolve authority be on the governor's. provincial reconstruction teams that are dispensing a good deal of development funds, local warlords, and therefore because of these conditions you ve provincial councils that don't have budget authority that begin to get marginalized because of all of these conditions. and i believe that it behooves the international committee, it is a little bit self-serving, ndi has been working with about 20 of around the country, but it behooves the international community to spend more time building up the capacity of these councils so they can fulfill their responsibilities in the country and finally, let me make the

point about the election. there are those before this election and there are those that now make the case that the best outcome in afghanistan is for a first round declaration of a vicr. and that perhaps a power-sharing agreement that could avoid the ethnic tensions that may emerge in the run up to a second round. i would argue, however, that the most important goal for both the afghan people, particularly those who courageously turned out in polls and defied the olence and the threat of violence, and for the international community, is first in the integrity of the process, wherever that leads us. and secondly, to the big issue of the didymus he of the government that emerges from this election, both at the national and local level. and i doubt whether the afghan people would have gone into this

election feeling that the best outcome would have been some behind the scenes deal between a handful of leaders to avoid a process that was to reflect the hopes and aspirations and the will of the people. >> thank you very muc over to you, kristin. >> as you heard, my task was to go around and meet with several of the other long-term observer teams. i went to jalalabad i met with our other team as well as in kabul. so my task was to try to understand how the security environment shaped the credibility, the multiple elections that ken discuss. i think in many cases, security was an over determining factor in the sense that it sort of set a feeling as to how credible some of those elections could be. prior to the election itself, a

security environment shaped the availability of updating the registration is. some folks were simply unable to update the ristration list. in some cases folks were very able to register because you could actually buy the registration card on the open market. and he would have the peculiar outcome of having enormous members of women registered. i am not sure is because the liberated ladies were out there claiming their franchise. so even going int the election, the security environment shaped or put a limit into a pal crucial that exercise would turn out to be. the security arrangements that were in place, it's the actual security, the actual polling station itself, the first parameter of victory was the police. the outer perimeter was the ama, and in the actual extrema, i stop was supposed to be the provider of security.

there was that these things called operational coordination centers, both at the regional level, the regional commands, but also at the provincial level. we had a chance to go to one of those and sayhat it was set up at the last minute i think would be flattering for the organization that was in place. soda standing up for to the occ were very uneven across the cotry. some of them were literally constituted only a wk before the election and yet the occ's that were supposed to be gathering information throughout the province and try to come up with an appropriate security response. interestingly enough, there were supposed to be in place a undp elect ran, police training program. it was a train the trainer program. in theory, the police were trained in this sort of cascading fashion, but the reality was that under the best assumptions the police that were used on election day baby got three hours or so of election

training. answ that one has to wonder what the outcomes weref that training given that the police capacity leaves something to be desired. that i think is the larger concern about the elections is that police are so important, yet police have really lagged behind the training of the afghan national army which i think everyone would agree is a success that i think everyone was a afghan national police training has not been a success picture you have areas in konduz where district you had to be 50 police officers. is thait's not a surprise in those districts you have taliban running roughshod which seriously restricted the ability of people to ashy turned out on election day. and another interesting thing that we stumble across, the offense is really delayed recruiting female security agents. the women that will pat you down before you go down to the. and it should have been anticipated to be a problem because outside of the capital it's difficult to recruit women

period for security jobs. even more so when she leaves the capital, and in some cases this path was left about two weeks before election day. so that seem to have been been a fairly large but ultimately preventable oversight. another interesting thinghat we heard a lot about before the electionbut it was definitely the dog that did not bark. and that was what could be humorously called the new book i. president karzai's brother-in-law actually put together a circus sometime in june or july, somewhat national militia plan that ain't to deploy between 10 and 13000 militias conveniently they were largely planned to be deployed mostly in the south. it was never clear what these guys were supposed to do, would it be armed, would it bring their own gun, how would they be uniform, how would the police know that they are legitimate militiasnd not illegitimate militias? no one that we've spoken to or i have spoken to on election day saw a heavy presence of these malicious.

reason for this have ranged from fellow colleague of mine down in poker cookies that i think the governor ran off with the money. so who knows why we didn't see those militias but there was a lot of apprehension about the. before election day. now about election, about violence if so. before the election, we all know there was considerable violence targeting candidates, party workers, campaign managers. and why we don't have the complete universe of victims of violence or threats of violee tomatoes look as if women were more vulnerable. candidate routinely complained that they had inadequate security. the minister of interior told them they could go and hire their own folks, but they said they would pay the. it wasn't clear how they would get paid, how they would be armed. so there was a fairly consistent concern among candidates they were not getting the security that they needed. and obviously, leading into the election, voters themselves were intimidated. in taliban controlled areas, there were reports that the talents were taking advanta of

the mosque making it very hard that there would be repral if they voted or we all heard about if your nger has been crippled to cut your finger off. and the threat went on up to your head if you were voted. but again, there were certain afterwards reports of this but the taliban really did not, they did not honor their pledge to violence in the fullest another thinthat came up quite often was that afghans themselves were uncertain about the security arrangements to government put into place. now, their assessment was well, it behooves the incumbent to basically have an environment of insecurity to discourage voter turnout, less voter turnout, greater opportunity for fraud. whether or not that it's true or not that's how it was interpreted. don't board for future election, the government might want to explain to the century that this is a security preparations that are to be here so therefore you should feel secure in casting

your vote. there were a number of really interesting report and we ashley saw some of u in the press yesterday, right, with "the new york times." there are all sorts of stories that karzai had cut deals with taliban commanders by which no one would cast a vote so that would give the taliban have a. but the taliban but also not ballot boxes being returd for both. and connor hart there was, what was it, 23947 votes returned for karzai when in fact no one had the opportunity to cast a vote. so i think perhaps another area th might merit thinking about is that we sort of thought about security as shaping the electoral exercise that many people ask is that security would actually use an act under an excuse to disenchant jives voters are triggered concern that areas were deemed his the unsecure because their areas

that were not to support the income of. there were consirable disagreements beeen the iec and the security forces about which polling centers could be opened and in, it wasn't certain what polling center would be open until the last minute. the problem with that is that in some cases they decided to call locate polling centers so if you look at the polling centers that were open to have pling centers moved up and outside of the district into the districts in. so you could say we had centers open in the district. the problem i the roads a really not practicable. and so women in particular if they had to move large distances to polling distances, it would be proud amount to be disenfranchised. at first brush it looks as though, locating polling centers for security reasons might have some advantages. it did have the effect o making it impossible for many people to actually cast their vote.

for moving forward, especially if there is a butt off, i thin there are a number of things that really need to be thought out today and not the day before the runoff. answered if there is not a runoff thinking about the next set elections. police training has remained a focus. the international communi is much of the afghan government is culpable for the lack of police on election day. we have known about these elections for some time yet the police training still remain understaffed at 30%. to quote a u.s. government official, that is great unless you actually want to win. so it's in copperheads about why police training has remained a low priority amongst the international community to the americans are paying the bill. we're doing to train. it would be great if some of our partners wou step up. that has to be a priority. and similarly, greater effort needs to be done to get e-mail search agency or whatever the security arrangements are in place, the government really needs to communicate that

because it makes no difference whether they have the best arrangement in place that afghans don't actually believe that they're going to be secure in casting their vote. and then finally, we really do need some accountability about what these militias were doing, if anything. so we've had a lot of difficulty tracking down what the publishers were actually up to. i think the very fact that karzai's brother-in-law put this plan into place and in the way in which theyere deployed look somewhat dubious. there really needs to be an accounting of what those guys were up to. and going forward, when we look at the in other words, i plan, international community kind of sign off on itnd the logic went like this, people could get out to vote, then the credibility action he would be in peril. i think the message needs to be from the international community that militias are actually no excuse for police. so if you're going to out of your way to try to have a reasonably militias force, you probly are better served, you know, taking those argentine to get them into actual police

traini. thank you. >> thank you very much, kristin. over to you, peter, for trends and comparisons. >> thank you very much, karin. the news reports i think receiving every day now present an unrelenting negative picture of what's going on in afghanistan. in fact, i think it's reflected in a statement that r delegation found that election was very difficult to characterize in a single phrase, violence and fraud clearly mark the electoral process. and now threatens e legitimacy ofny new government. but unfortunately, those rorts caovershadow some aspect of the election period. i think that were pretty positive and an improvement over elections in 2004 and 2005. unlike the election campaigns of the past, these elections, in fact, involve issues.

the candidates campaigned throughout the country. abdallah was able to go to the remote districts in the south. there was a van traveling throughout the country communicating his populist message, and president karzai of course to travel almost anywhere trying to make a deal. as did abdullah, in fact. it was well covered by the news media. our long-term observers were reporting that throughoutwo other countries, small groups of people were talking, getting together and talking about the campaign, discussing the issues. abdullah was communicating the message of more decentralization, the parliament as opposed to residential system. and they were talking about karzai's record and his approach to governance. political parties played a role in this campaign that they had not played in the past.

the are about 10 or so parties that were able to field candidates in between five and 10 provinces for the provincial council races. for the first time,arties appeared on t party names appeared on the ballot that had never been the case in the past. promises to help establish an effective party system that's been so far is totally absent. there were more women participating in this campaign. there were more women candates for provincial councils than there have ever been in the past. and millions of afghans voted through despite the threat of violence. all of those i think were important things that in discussing the election we don't want to entirely overlooked. unfortunately, there was really little that was done over the st five years to sort of improved the process and address a lot of the defects in the system that were very apparent

back in 2004 and 2005. perhaps foremost among them is that the millions of duplicate and counterfeit registration card that just flooded the country. months before the election, you could buy such a card for about $10 to get the election approached, the price inflated quite considerably. what people were doing with the cards of course was not entirely understood. they were being solto people that wanted to commit some sort of electorraud. they are used in schemes both for ballot stuffing and four proxy voting, and they really threatened or delegitimize the entire process if something is not done about it. local election officials were not well trained. they were trained at the national level for the most part. the local level we saw in 2004 and 2005 they were not capable of fully sort of underanding

the process. they implemented the inking poorly back then and we saw the same problems emerge at the local level now. and in addition to that, they are recruited locally so they are subject to political pressures at the village level, which of course leads into the proxy voting and ballot stuffing. the abnce of a function judicialystem really uncalled, result in widespread in unity for anybody who engages in electronic contact. all these things that had been out there, everybody knew about them, very little was done. i think about five or six months before the election there was a renewed effort to pour resources into the system and fill all the observable gaps that people saw him in the electoral administration. but it was too late.

you can't deal with problems of millions of voter registration cards in the systejust a few months out. we have another election coming up in about, what, in october i guess. if these problems are not addressed now, they threaten the entire legitimacy of the process. then there's not much time. i would ask them to take it expires or automatically about 30 days or softer the rtification of the results, and it has to be reestablished. theyhould do so immediate because the eec didn't have time to prepare for this current election. there's a lot of other things. planning for security, something that really requires several months. and that was done very late in this process as well.

as karin mission, the results are still coming in. the process is not over. we're watching it play out day by day. 60% of the votes have been counted as karin said. lot of the votes that haven't been counted are in the south. those are presumably karzai vote, but there are also fewer votes down there. that plays out in the end as kind of anybody's guess. the question of course is than 51% from mr. karzai, is that gointo be widely accepd in the afghan population. or are there going to be suspicions that that's not a legitimate result. a lot of talk about the deal. when we are there her talk about both afghans and international community about brokering some sort of arrangement. all that is going to be playing

out over the next several weeks. so that's ere we are. the complaint process continues. as i mentioned there were 2000 complaints filed. 500 are considered serious, by serious i mean can affect the outcome of the election. soe wait as you do for the final tallies. >> thank you very much. now over to you. let's talk about the women's role in the election. >> thanks, karin. as karin mentioned earlier i was in afghanistan for five weeks monitoring women's participation in the lead up to the elections. and i had a very unique experience and i was able to spend quite a bit of time speaking with many of the female provincial candidates. during that time. and to what i thought i would do today, some of the challenges that women had in the election have been mentioned already. security, proxy voting, but what i thought would be interesting

is if i sort of gave you a glimpse of what i heard from these candidates, and give you a little bit more of a sense of what we heard on the ground from their perspective. prior to the elections, ndi trained 226 of the 333 women who ran for provincial council. and for most of these women, it wasn't the only thing they have ever had in their lives. and this is particularly important because for 122 of them, they'll automatically get seats on the provincial council due to 25% quota. of these 200 women, ndi selected 18 women from nine of the province's. and we interviewed those candidate three times. two times prior to the election and once after. and through these interviews, we were really able to sort of glean information that we were able to get it into our short-term observers and our long-term observers, partly because some of them were in provinces where we didn't have a presence. due to security concerns. and so we're into sort of track

their experiences as candidates throughout the election but also hear from them what they saw in female polling stations on election day. so unsurprisingly, you have heard security was really the number one concern that all of em expressed. and karin mentioned the publicatn of a polling site site whi prevented many women from traveling to be able to vote. and while this was definitely true in the south and the southeast, this is actually true what you really got out in many provinces out of the urban areas just outside the city. one woman said to us, i rented a car with my personal money to take some women to the polling station but they refused writing in my vehicle and told me that they are not provided by their families to get in those cars. and that's really what we heard. although the 18 women that we interviewed l went out and cast their vote for themselves, they knew from friends and families that the male members of the family were not

permitting women to go out and vote. it was interesting because we saw election day that women actually came out later in the day. men were out. the lines were longer earlier, and then it looks like women sort of swelled in the afternoon which may have been actually a result of the security concerns. women also told us that as karin mentioned, the challenge of recruiting female staff was very high. and they saw women who were unprepared. it was sort of unexpected were some women who are prepared and really following everything to a tee and other women who were uneducated, unprepared. and these candidates that we spoke with really had a concern that that would sort of create an enabling and private for-profit. one of the challenges of course is security and recruiting female staff, both to check ids and security guards, but also the lack of literacy. especially in the rural areas is another major challenge that women cited to being able to recruit staff.

as far as the voter id goes, we heard from many women that women inhe burgers would go to vote and actually work, their faces weren't checked against the picture on theoter card. and voter cards are actually optional so in many cases where there were photos, women still were asked to sort of give the name of the father and just allowed to vote without any rt of screening we also heard a great deal from the women candidates that we spoke with about proxy voting and we heard more about young females than we diactually male members of families going. we heard both, but we heard quite a number of instances where women, young women under the age of 18 went in and voted and they had voter registration cards. senator ashley permitted to vote your so that speaks to really the fraud in the registration process. one woman said in that i was informed by my brother was my agent and a male polling station

that he observed some cases a proxy voting tony specific case a man want to vote on behalf of his wife and daughters reasoning that they were not allowed to get out of the house on election day. he was further argued that this was his right to vote instead of the female familyembers. women also requested that the fingers no be inked. and actually their requests were granted for fear of retribution from the taliban. just on the issue of the note added in particular. we heard a number of instances really throughout the country, including in kabul, women being warned of a landmine on their way to a campaign event, night letters, anonymous phone calls, in fact, one woman gave us a number of the man in pakistan who called to thrten or in case we want to follow up with him. but also, you know, a lot of these things ackley took place in kabul. so you can imagine sort of the extent to which some of these threats took place in the south

and southeast where there were gunfight in front of some candidates houses but we had one man in kandahar said she left her promised, would live with relatives into the lead up of the election. obvious in not allowing her to campaign because of major threats that she had and then sort of coming around her house with armed men coming around her house. so you can really see. i was struck by really how brave these women were. and after being in 50 countries, i actually think these are some of the bravest women i have ever met in my life. also just briefly on the candidates, because women had limited access to public space as they do in daily life in afghanistan, you really saw women campaigning endorse. they talked about how as she lit up when they talk about going door-to-door. they were pleased with the ref's activity they had. when he went into frieds homes and families homes, b the interesting thing is they were

often really campaigning to women which sounded like these gatherings were very much gatherings of women pic and then you had women to a large degree disenfranchise. so i think it was interesting that they were campaigning really just to women, in large part. there was exception for some of the incumbents. they had access to some large gatherings, but in large part we heard from the women that really, from the time they get acceptance from the family to run, which is absolutely crapo. they are really relied on men for every aspect of their campaign. most of them really talk about how they got permission from elders and tribal leaders and religious leaders to run. and then in very lucky cases, those men were able to provide opportunities for them to speak in mosque. but really you thought it was the elders and the leaders who opened the door and asked people open the door for women to go into people's homes to campaign.

so it was done in a real private way. across the world to hear this, but in particular in afghanistan, the fundraising and the ability to have any sort of small money to campaign was really a challenge. and you saw women's posters, but a lot of time they were black and white instead of colored ones. and women felt like they weren't able to compete on the same level of men because they weren't able to have this sort of visibility. and a few womef had a resource limit d it allowed women to come in and print 1000 posters for free of their campaign posters, and you saw that 36 women came from various provinces, traveled to kabul just to print the 1000 posters to hang out in their districts. just finally, we will have the conclusions of recommendations in our final report, but i think, you know, as you already heard, many of the challenges

that women faced really could have been addressed with more preparation, particularly the staffing and the polling stations and a security guard which was a rushed effort at the last minute to try to prepare for. we already included in our statement a recommendation for increased civic outreach to women and men on the issue of women's british invasion and the of the importance of everyone voting, and the privacy of the importance of the privacy of the vote. and finally, the ability to verify female voters. wiout any sort of way of identifying women with a photo or whatever the case may be, if it is i scan or something more sophisticated, you really have no way of verifying that a woman is who she says she is. with that i will sto >> thank you, kristin. >> thank you, tranninety i am delighted to have a chance to be

the final speaker so i can build on the points made by my colleagues. my kabul colleagues i shoul add. we had a great experience observing this election. i would like to step back and call attention to the larger point here, and use that as our concluding comment before we go to questions and answers. i would like to stt wh what kristen had to say. i am looking at our report. i'm trusting you have seen that. particularly the overview tha wead of the recommendations. i want to start where she left off. we say in the report that the rights of women in the electoral process requires special attention. i just want to underscore that. we had an opportunity to meet with three male and three female candidates for the provincial council and cobble. we had a good discussion with them. the women that were there were

extraordinary. they were the most animated and motivated and articulate. they clearly see the stakes in this election for them and what is important here. christon said when we were in kabul that these were the bravest women that she has seen and covered many elections in sing the role of women. i would have to underscore that. the women there also know that if the darkness descends again on afghanistan they will pay the greast price. while we are looking at large issues of al qaeda and all of the security issues, we cannot forget fundamental principles and values at stake and what goes on there. secondly, i do want to call attention to the reference in the report to the security situation. obviously, violence, the threat of violence shape this election. and we say in e report that it is critical for the growth and

survival of the nation's democratic process and continuing insurgency is brought to an end. obvious point, but it needs to be restated here and we have all seen that general mcchrystal has now ported his recommendations. this is a big issue, but we can't get afghanistan rightnd let's make get the security part of his right. so i wanted to call attention to that. we have already heard from peter and others about where the international community fell down in the run up to this election. we heard from grant, who is president of the ecc saying that the international community took its eye off the ball after the 2005 election for the next several years. a undp official called figures of 2006 through 2008 the funding graveyard in terms of the assistance that we were providing there. we did obviously pick up in the

last year. we had a recommendation here about the international community in partnership with the afghan government should immediately begin preparing for the nt election cycle, and not allow that funding graverd to continue. the election in 2010 for parliamentary elections and then obviously the next round of the presidential election five years later. this is all hopeful. we have to get thrgh this current election before we can go onto the next, obviously. but we do need to not step away from the plate again in terms of funding. now a broar issue i would like to just mention this, we saw in the washington post today the editorial setback in afghanistan. i don't think any of us cannot say that this was a setback. of course it was a setback. this security threats, the allegations of fraud, misconduct and the rest. but i do think that we need to also step back for a moment and

place this election in a broader context. if you look at ere afghanistan has been and where it is today and we hope it goes, it's important afghanistan's road to self-government, if you will, it was 2001 when we start the u.s. bombing campaign in afghanistan. we had a prom process in november 2001. bringing together all of these groups and there. and interim accord was established in december of 2001. in 2002, the emergency lawyers was convened to agree on a trsitional authority. in 2003, the constitutional took place. 2004 a constitution was adopted. also in 2004 president karzai won the presidential election. in 2005, elections for the parliament. at december 2005 the convening of the national assembly.

now we have this election. nobody is going to suggest that it was a major step forward in this democratic process, but it is a step and we do need to place this in context. democracy, self-governance is not going to come overnight to afghanistan. there will be setbacks along the way. and what we need to do in terms of the international community is to work with the afghans to see they make it through this difficult time. i want to call attention to one final part of our report, the last paragraph in our overview section i would just like to read this to you. as a concluding comment before we go to the discussion. it reads, this election has demotrated that millions of afghanistan want to participate directly in the countries of involving democrat system for the august 2000 elections were the latest step afghanistan's lgng road towards constructing a democratic political system. this delegation strongly believes that the international community must continue to

assist them in history that a democratic and peaceful afghanistan is in the interest of the afghan people and the international community. so with that, concluding comment, tranninety. >> thank you very much. be observing as well as the participation that nei and other groups did. along with their afghan counterparts. i am noticing a lot of serious expertise in this room and i'm sure we'll have a lot of questions. what i would like to do is take about three or four questions at a time and then go back to the panel. so if everyone here will take good notes. and please introduce yourself. please try to keep your questis short so that we have time for many. i have alex and rick. alex, over there.

>> thanks, guys. fantastic panel and insights. to quick question extech introducer. spirit i am alex. institute of peace. won a more technical question and a broader question. onof t innovations of this election was that the ballots were to be counted at the polling stations as opposed to having aggregated. and i could have good or bad implications. one of the disappointing things i think about the results that have come in so far together with the thing that ndand others did and other monitors, is that one of the things we had hoped for is that there would be counting that was observed at the polling stati and that those figures would then be posted at the polling station which woulthen allow for some kind of parallel check on the process of counting that they were doing. that seemed to have failed completely as far as i can tell.

from what i've heard from the account that results have been born often not allowed to view the counts. and so i'm wondering if you can explain why that hasn't succeeded or if we are not hearing about why that has been viable but that information hasn't come out. and the broader thing that i think ken said that i am not sure to all of you, the onlway out of this election crisis is a runoff that i think that the legitimacy is so tainted that any number that karzai gets, 51, 52, 53% is simply not goingo be tolerated by the opposition or by the afghan people when you look on youtube and see the fantastic videos of guys sitting there with the ballot box checking vote after vote after vote. the level of evidence of fraud to my mind suggests the only way you can get out of this with a legitimate outcome is a runf. so if i am right or if that is what happens, what can we do in

the next six weeks to deal with some of the problems? can actually do a better job of detecting fraud or in advance so it would be a fair election or something on security that we could have done beer, what can we do to avoi a runoff that just gets us in the same place we are now? >> rick? >> thank you. rick barton from cis isp getting as if there, the only institutiol solution is that complaints commission really works well. so i would like to hear yo thoughts on how it's working, do they have the capacity to adjudicate 500 series complain complaints, have the most viable complaint really come from the campgns as opposed to independent sources? are the members of the commission saved or do they have offshore homes already? there's just a whole series of

how were they selected, there's an awful lot of weight that is falling upon a handful of individuals who have never probably had this kind of responsibility before in their lives, inside of a system that isn't going to guarantee them their safety. so the insight into that commission would really be helpful, thanks. >> just a comment. he was in kandahar with democracy international. >> idea what the center of strategical international studies, ken you made an excellent point about a number of deployment and being sort of captured by the prt's as we attempted to carry out long-term observion. in kandahar, my particular delegation maged to setup and operation outside the wire which allowed us to move around on polling day. and at least observe limits better that what was going on. to me, the point of greatest

concern in my mind at this point, we made our way into about one third of the polling centers in kandahar city where we saw turnout rates pretty rather low compared to 2004. in fact, yr average for your polling station was about 51 to 52. the iec now really see rults in kandahar that show result of 200 then today there was some up to 400 per polling station in kandahar. and i'm just wondering how this information gets filtered up, and at what point the low credibility becomes difficult, sort of adjudicate and what mechanisms are in place to deal with that? and the second pointjust to put off the point she made about the preparations for security. we spoke to a number of, one presidential candidate and in a couple of candidates for

provincial council in kandah who said frankly that they were waiting to tell what you speak their voters went to turnout, not based when the police were that day but based on the position of forces of the taliban and the day before and what they had picked out. so that's what they were really concerned about. and that's what they called in to us to tell us whether or not it was a tickle out that day based on where the taliban were. thanks. >> thank you very much. jeff from penn state university here again, terrific panel. very short, very blunt question. i realized that you can report whathe blunt question i have is that there was a systematic attempt by president karzai and/or his supporters basically to rig this election. that seems to be the summary that i'm getting from all of your comments in terms of proclivity women from voting,

having security force and position, etc. etc., but is that at this stage based on 60% majority there wasystematic attempt to rig the elections by the ruling party? >> and just one more, and this gentleman over there. thank you. >> john rothenberg, i am a consultant. this is sorted in addition to alex's question. i think the only other solution is some kind of a negotiated deal between karzai and abdullah. do you think that the people of afghanistan would accept that and what kind of format would that take? in your mind. >> let's start, maybe, rick do you want to make a few comments? >> first of all, this panel has not reached that conclusion that there was a systematic attempt by the ruling party and president karzai to rig the

election. i never said that. i didn't hear anyone say that so that was not our conclusion at all. it much more nuanced look at this election from what we saw and we have been following since and so that is not our conclusion. i would like toespond to that question of a ruling coalition of president karzai and abdullah abdullah. however this ends up at the end of the day, i think that the most important thing is for the afghans themsels to pull together. and that means a lot of people being able to work with their opponents. we all hear that the clock is ticking in terms of u.s. and international involvement, 12 months, 18 months. we see the papers. we see the polls. we see the statements being made in european capitals. . .

>> we can't do this. however they work it out, i hope they do as soon as this election period is resolved. >> okay. >> two points, first i regard to where the bells were being unted. obviously, that was a huge controversy after the last election the candidate had

objected at the presidential level. i think in retrospect the poll should have counted at the prudential level. ere's still a couple of checks, whether they will work or not, it remains to be seen. the political party agents have to sign off on the final tally of which is then supposed to be posted. in in fact on review if you see ecc finds that t party agents haven't signed off on the tally then that's -- that could trigger additional scrutiny and presumably those folks would be quarantined. we'll have to see whether that process actually works. in regard to the ecc, i asked

grant that question, he said that he had been provided armoured vehicle and a personal security detail as were the other international -- there was five members three of whom were international and two afghan. the three international were reported by the secretary general of the u.n., the special representive. the other two are afghans, ones appointed by the human rigs and one from the afghan supreme court. the afghan members weren't provided any security for some reason. he was quite concerned about it. he tught it was a real securityhreat. the ecc is a staff of 200 people. they got their funding quite late in the process. when i arrived for the election in afghan a couple weeks before the election there was still doing their last training of their presidential staff.

nard to the movement of money to support the ecc process. nevertheless, i thinkhey are doing a good job. they face an enormous challenge. i think they have already thrown out 5,000 of them, they still have 500 to be very serious. whether they can process those by september 17th when the election is supposed to be certified remains to be seen. i think they are working very hard and doing what they can. >> i would just say one thing after that. grant used to be the director so he knows the environment, he's deeply committed to this process. and i think they take the

position that t the electoral commission is unable to certify until the ecc meets its work. i think he raised the possibility, grant did yesterday, in theirress conference that they may not complete their work by september 17. i think they are driven by the process, not riven by dates. and i think that is reassuring. there are a lot of safeguards built in. some ofhe safeguards byhe way inhe software and iec is not known. because they want to keep some of those safeguards secret. there cod be some people that could figure out ways to hack the system. also there are provisions within the ecc to carry on their work and they have investigators that they are sending out and that process has already begin. it's not just them sitting in a room looking at isss. they are actually sending people out to certain place with regard to this notion of a

deal, this is -- you know, we saw the issues in kenya, we saw these issues that have been raised in zimbabwe, where in the end the notion of a power sharing agreement was the last best hope to avoid blood shed. i think it is way too early to talk about those issues now. i think that the afghan people went to the pls wanting a process that was going to reflect their will. ald if you look at every poll that's been conducted in the country, this was not an artificial process. this was a process i think that ppesented the hopes and aspirations of the afghan people. if people now talk about this a some type of power sharing agreement as a substitute to a legitimate election process, i

think that the repercussions th short term but long term i think would be quite damagg. i think first we have to deal with the issue of the integrity of the election process. and that's where much falls on the shoulders of the iec and ecc. and sond se have to talk about the institutions that emerge. and again i will say it is not only the issue of the president but also the issue of 34 prudential councils as well. those are the institutions that the afghans -- that is not a spectator sport at that level. and these are the -- these are individuals and institutions that the afghans will have to interact with over the course of the next four or five years. on the kandahar the question that was raised, i don't know what the iec or what the eccs

looking at in kandahar, i know they sent a team down in particular the reports has been coming out of kandahar about problems. so these conceivably the numbers that we're seeing could change. depending on what the iec does and what the ecc ds. so i think there areoing to be aumber of places where we're going to see some numbers and then the question and then the responsibility falls with these two institutions. finally on the issue about the vote tabulation and the mosting of -- i think lots of people would have wanted to see a system where fefa the domestic monitoring organization could have carried out a parallel tabulation nationwide. i think it would have been extremely difficult under the circumstances. now unlike the international observer fefa said they were in all 34 providences. they were hampered by the

security situation. when we were trained, we insisted on two things when the first was that they were literate and the second that they would have already been accredited by the electoral commission to be the candidate agents. what this didas spurredhe candidates to register their agents before the training began. and so what we tried to do is help create a critical mass of party agents. but i think it would have been a vary, very difficult for party agents to be in all ofhe places because of that security challenge. and i imagine it still would have been difficult for any organization to develop a wide enough sample and a statistically random sample, significant sample to develop the tabulation. i think it's unfortunate and i

hope that in future elections that that will be a component. and now that the votes are being counted at the polling site level there is ateast the possibility of doing some verify indication -- verification that will be seen as an accurate reflection owhat happened in the voting. >> i just wanted to add an additional point of pressure on the iecnd ecc is try to complete the work on time, it has to be before winter sets in. we kw there are more donkey and mules than vehicles. so they really have a lot of pressure to finish this early on. chris, did you want to have? >> just two point it's not so important where the police and ana, whether where the taliban are.

there are two sides of the same coin. thealan are where there are no secury forces. atnd of the day, we known the election was coming around for a while. the fact that police production has been such a challenge, i think it's really inexcusable. you don't have to have 100 talibs, you actually just need one guy stands outde of a lling center, but everyone knows gho he is and what he's going to be doing. this goes back to the larger point. this should have been a priority, police training. it's absolutely fundamental. by the way, armies don't win insurgencies, police do. the oversight of the police is very important. i want to go to the point about the runoff. i'm not an election perso by profession. i really look at internal security issues. one of my biggest concerns about the karzai victory from the runoff is it comes back to the

issue of governance and incredibility. but it may be expsive and difficult to do particularly with weather, it may be violent, but the long-term consequences of not having a runoff or president which is seen tour credible will have much more significant long-term consequences in tms of trying to deal wih the insurgency. it jt came out in some of the comments. this is not just about security, this is about govern answer. we don't have in there a president that's seen as credible being able to resolve in any fashion be is negotiation of the taliban, be it trying to provide government services. it shouldn't be difficult. if you don't have a guy in kabul that seems to be legitimate. >> all rht this gentleman here. you also can. >> thank you.

let me first congratulate on the great work out there, not only -- and training the domestic monitors. that's to be commended. let me take a question about the second round. i think it's quite important. you mentioned your views are the views of your team are somewhat new -- knew nuanc i understand there are positive things and the discussion of issues and so forth. but the question of the second round goes to the issue which is incapable about the legitimacy about the afghans themselves and alex asked the very important question. can anything be done in the limite time that would be there

until the second round to make sure if this is a second round that it is better and more legitimate in the eyes of the afghans than the fir round? i think it was quite important. some people think the answer is no. and they think the second rnd will just give the taliban another shot. and you'll end up with the same mess. so it's quite a dilemma. very briefly in terms of context, there is also a larger context not mentioned here. that is that afghan's neighbor also had elections this summer that are quite disputed. and so the notion of legitimacy has a larger context. does the panel believe that if we simply say, well, it was a step, you know, you can expect too much. does that constrain what we might be able to say about the chalnges raised about the iranian election? thank you very much. >> ed, let me just, i don't

think it's our praise to say there should be a second round before the iec and ecc completes it work. it would be rather premature. there is no doubt, howev, when one looks at politically that should there be a second round that the problems that existed in the first round would take on less significance. and you will have people that will look at it and say despite all of these flaws and problems, the system works. and in the sense that there i another shot at this. so politically, i think from even the notion of perception issue, it is no doubt looking at ou own election here when elections are very, very close and you have a winner and there have been significant irregularities. those irregularities take on siificalce in thoseypes of post electio.

so a seconround allows those issue be addressed. in terms of what happens in a second round, let me just say some issues are out of everybody's hands. the question is what the taliban is going to be in certain areas. but the terms of what isef does and the afghan police and the military do, i think the security needs to be perhaps expand in areas that are less secure. and i think that there's going to be a concerted effort on the part of all three to see if there is going to be a greater presence to expand the areas of security. and so that is one thing that can be done. the other issue in terms of i gues regularities, misduct, fraud, those are issues of political will. and those are the issues that the candidates themselves are going to have to impose on their supporters around the country. and what pressure could be brought to bear to ensure that

is the political will is a short period of time. that falls on the leadership of these movements to be able to impose some discipline on their supporters to ensure that some of the more agregous problems. >> thank you. john from the atlantic council. i have two related queions. one is about the relationship between the levels of violence in the providences proceeding the elections. there's an excellent "wall street journal" map that showed this was in the platoon belt.

are you going to help us understand what efft that had in some prodenses? and the related question is in kandahar there was less violence or almost none. what did you here, if anything ing, about the role? was there a deal with karzai or was this something that was unexpected? >> okay. in the gentleman in the back. he's been waiting patiently. thank you. yes, sir. >> thank you. fred, with the program here in washington. we unpacked the notion of the national community and get to the question as to how the u.n. itself performed in supporting these elections? i think it's helpful to kind of break down the notion of international community

support. >> thanks. i would like to than the distinguished panel for excellent insight. my name is steve dale, i'm on the house of national security. iuess i have two questions that span a number of issues. but one is you' talked about e short comings and training and short comings in the polic the short comings in security, and a number of issues which i think you've done an excellent job in highlights. my two questions are this. with all of these short comings, who do you see a the real winner in this election process in terms of institutions? and secondedly, what does it say about the u.s. engagements in the last fiv years. i would guess about $37 billion

that has been spent. what does this say about the actual process in terms of supporting elections and i'll just leave it at that. thanks. >> thank you. i have two quick questions. first is about the election excel significance. now there were hand picked, what's the observation about that? and how did it affect the medi there were some gentleman who were investigating corruption of the election. how is that creating to elections? thanks. >> are there any other nations or international organization

you would think about positively or negatively for the role they have played in the 2009 elections and any contributions that stood out in the special way from your observation? >> in terms of the iec our statement relates to the perceived lack of independence from the iec. there was no doubt there was some controversial statements and there were also decisions made by the iec that demonstrated independence from the government. wever, we said in the statement that if an organization is going o call itself independent and be seen as independent the has to be a structure. and so we recommended that they go back to the drawing boards and provide some checks on election commission that is

appointed by the president. legislation has been passed to that effect. but president karzai has not signed it. we recommend for future elections that there will be a different system for choosing and confirming members of the election commission. i think in terms of organation and groups that performed well. i don't think i'm in a position to begin. we had a enough of a challenge looking at the election process to spend time analyzing and grading international efforts and what they did and what they didn'to i thinkould be very difficult. i think everyone has peter said were performing in the 11th hour. and i think that was very difficult. and i would just going to say aid, however, would seemed to have more sustained presence during that period between 2005 and 2009.

a lot of other groups because of that funding grave yard had a very, very difficult time ramping up in the 1th hour. and i think that's a lesson that is to be learned from all of this. in terms of the media there is i think from the observation and all of the studies that were done that they private media was relatively fair balanced. relatively fair balanced in the process. but there was no doubt that the media commissio issued report after report highlighting the bias in state run media. and it was unfortunate, and we talked about this in our statement that action were not taken by the iec to impose sanctions on the media to force the media, the state-run media to abide by the media code of

conduct that was passed by the ecc and the iec which should have been done and should be done in the future. >> terms of the violence we are going to be doing some mapping for our final report and look at areas of violence. but there is als an element in this too that effected the campaign. peter is right, the campaign surprised lots of people. because it focused on isss 10 miion people watched the debate. candidates crossed ethnic lines to campaign. there was very much interethnic violence that took place. the presidential candidates were able to operate even, again, the silver lining in the story that appeared in the post yesterday that you had in a pashtun area that dr. obdella was working out a deal for its support.

so you did have the notion of what appeared to be people willing to cross ethnic lines to vote in this election. and -- but there was also the threat of violence and not only the violence thahad an impact. in kann does, women were begging to appear on radio. and yet they wouldn't. so the campaign in those areas where that was the greatest threat, during the period they would rather campaign in their homes. lot of the media and physical campaigning just didn'take place. and it affected the campaign environment. yes, it was very active campaign that was taking place in these homes. and i think those were some of the main things.

>> i'll just briefly mention one positive thing i thought undp had established a gender unit role. that gender unit was s up very late due to a variety of complaints and they helped the staffs working in the iec. but there was one women that was taken in by the undp. this was actually, i think looking at a potential runoff, you know, we may not be able to adequately address many of the challenges that women face. but i do see this gender unit as an opportunity going forward to focus on the education that's required. and they did play a roll in making sure it was segregated and we're definitely a voice. and i think we will be a

stronger voice going forward. >> just onational piece of information. do keep in mind that this election was afghan run. it was their decision. they wanted to move to have responsibility for the election. after 2004/2005 when the u.n. was the primary agent, not only did they want to have responsibality for the electoral process, but they also in terms of the security provided, they continually talked about the three rings of security on election day. first the afghan police then the ana, the army, and isef would be if needed. in terms of the road to self-government, this plays into that. however, there was a grave yard which we heard from u.n. officials that took place in 2005 200 and 2007.

in 2008 theyot $130 million to voter registration pcess. 2009 i think a quarter of a million, 225 million undp had. they set aside i think about 20 million for the runoff or set aside some of that funding if needed for a runoff. but clearly more will be needed. the real issue is the sustainability of the electoral process for afghan for a long term. they cannot p for these things. they do no have the funding or the budget to do that. in terms of the international commitment we do need to get a fast start on what occurred next after the period is resolved, hopefully successfully and creditably. but we do need to be looking at the electoral mechanisms as well as the sustainability of funding for those down the road.

>> one concluding comment. i think what we've seen over the last five or six years is a international community having very low expectations about what can be accomplished in afghanistan or perhaps much lower than the afghans themselves. when we would ask people, why didn't you prepare better for the '09 elections we were told by some donors that we weren't sure the elections would take place. they didn't want to put money into a pcess that they thought would not even occur. although i don't think the afghans had any doubt that the elections would take place. it's the legacy of the soft footprint that we first talked about back in 2002. i think that that's really

formed a sort of mental framework for the international community in approaching afghan. and i think it's been much to the detriment of the country. >> all right. thank you. i'd also like before closing to saying that we really pulled together a thanks to the volunteers for helping us out today. thanks to our extraordina panel. [applause] >> if anybody is not on our mailing list and wants to hear about future events, please sign up outside the door. thank you again for coming. >> at this point, i want to add one name to this. this is jamie metzo who was als part of our leadership team that i left off theist. thank you very much. been inaudible conversations]

>> and at the same time, c-span will be live with health experts about the next 100 days about health care legislation. again, that will be on c-span.

>> mr. chief justice may it please the court that the government proceeding in the document was not a crime in the fall of 2009. based un -- >> something different doing on here and what goes on in the capitol building or in the white house. and you need to appreciate how important it is to our system of government. >> this is the highest court in the ld. and the framers cated it after studying the great law givers in history. and taking a look at what they thought worldwide was important for their judicial branch to do. >> i put in as much blood, sweat, and tears on the little cases as i do on the big one. we don't sit here to make the w and decide who aught to win. we decide who wins upside the law that the people have adopted. >> you will be surprised by the

high level of colleague quality there. >> if the four of the nine of us who want to hear in this cases, we'll hear it. >> we're here to decide things. the job is to decide. we decide. >> why is it that we have an elegant, aonishly, beautiful structure? it's to remind us that we have an important function. and to remind the public of the importance and centraly of the law. >> i think the danger is that sometimes you can come into a building like this and think it's all about you or that you are important. and that is something that i don't think works well with this job. >> supreme court week, starting october 4th on c-span.

>> the drug company pfizer will pay, this is the largest in u. history. they announced the settlement yesterday. this is about 40 minute >> good morning and thank you for joining us today. i oversee the large portion of the government's civil litigation, including the combating health care fraud. i'm honored to stand here today with dedicated colleague from within the department of justice to announce the historic settlement with pfizer and it's pharmacy company.

arriving at a civil and criminal allegations relates to pfizer allegely legal promotion. in a combination pfizer has agreed to pay $2.3 billion, the largest in the history of the department of justice. within that $2.3 is a criminal fine of $1.195 million. now today's settlement is an example of the department's ongoing efforts to protect the public and recover funds for the treasury from thmse who seek to profit from frau is shows in the many ways that the partnership with the state and localallies can help at the time when budgets are tight and health care cost are increasing. before i turn thi over to my colleagues, i want to highlight things about what we're announcing today. first i think as should be

obviously, combating heah care fraud of one of this administration's top law enforcement priorities. by all accounts every year ge lose billions of dollars to medicare and medicaid fun from fraud. those billions represent health care dollars that could be spent medicine, or simply lower the cost of care. but instead of spent on medicines and devices that are not effective or the result of the legal kickbacks given to g them to prescribe certain drugs, even if they are not approved for use. when a drug is marketed or provided for offlabelses, any use not approved by the fda, public health maybe at risk and there's a real danger for patients aren't provided wit and don't have full information about the drug's risks and benefits

because healthare fraud is such a significant problem that affects both safety as well as the federal treasury, the department of justice and health and human services recently reinvigorated the health care enforcement action team or h.e.a.t.. this task force is led by both departmentsnd we've worked to increase intelligence, data sharing, as well as to secure our indictment which we've been announcing and we envision continuing to do. second, today's announcement flects the department of justice working hard to protect the deral treasury and the american taxpayer. while most medical providers want to be the right thing, when they cause false claimed to be submitted to medicare and medicaid, that's real dollars out of the american taxpayers

pocket because it affects the federal treasure we. enforcement is a primary means that we address this on the civil side. in this fiscal year, 2009, before today's settlement, the department covered $1.7 billion in settlement adjustments. as a direct result recering an additional $473 million for the state programs for a total impact before today of $2 billion. today's settlement whichatches a $1 billion civil settlements increasing with the criminal fine as well as $105 million and increases recoveries under the false claims act to over $3 billion. the third thing i want to highlight before turning it over to others is thisettlement is a testament to this department of justices approach to law enforcement, which i all about a broad efft among federal

agencies and with our state and local partners. the efforts here and many of the people who work so hard in this case reflects coordination and coeration between the department civil division, the u.s. attorneys office, anteeastn district of kentucky, and the u.s. attorney office of pennsylvania. all of whom have played an important role in brings us to where we are today. and it also includes the investigative efforts and agencies across the government including the department of health and human services, the fbi, the defense, the criminal investigatio for the fda, the veterans administration, office of criminal investigation, the office of the inspector general, the office of the inspector general for the u.s. postal service, the national association of medicaid, and the state attorney's general offices. that list demonstrated for you

the broad reach of health care fraud as it cuts across state and federal programs and the importance of strong enforcements. from the attorney general on down we now we can do amazing things like recovery federal and state treasury when we partner side by side with the state attorney general office and the american public. we are deeply committed to working collaborately. the press will talk in detail about many of the people who have been involved in the settlement. in particular, i want to note the commitment of secretary sebelius and their focus on stopping and their tracks through prevention, deterrence, and strong enforcement. with that i'd like to introduce the department of health and human services, kathleen.

>> well, thank you associate attorney general. and you're going to only hear from five of us this morning because if you heard what everyone -- from everyone who helped with this investigation, many of whom are in the room, this may take all day. by we want to represent the good work that was done as tom as already said by agencies across the gernment. this really was a team effort. the justice, the fbi, and other groups were involved with this extraordinary work. and at the department of health and human services, we're charged with keeping americans healthy and make sure they get the best chair possible. that means part of the responsibility is spending health care dollars wisely. it also means stoppin the dangering of offlabel use of some prescription drugs. the critical part of the mission is fighting fraud.

and that's a j our entire department takes seriously which you saw in this case. the officer of the inspector general and this department and dan levinson that's here on the stage with me spent years. pfizer actually identified and charges the senior managers that were responsible for the fraud. some of these agents are here today. i'd like to acknowledge them along with dan levinson with the ig leaders who are here. come on, i know you are back there. i can see you. congratulations. the investigators in the food and drug administration also helped put this caseogether. now americans have trendous confidence in the medicines they take. and that's a tribute to the great work the fda does each and every day. but thanks to t attorneys from

fda, the centers for medicare and medicaid services and the ig's office we now have a safer drugupply to the american public. this event marks the conclusion of just one investigation. but it's another step in the administration's ongoing campaign to prosecute any individual or organization who tries to rip off health care consumers and the federal government. we've already heard associated attorney general perrelli in mayá attorney general holder and i were together to announce the antiraud initiative -- befed up initiative called h.e.a.t., that's already paying big dividends. in addition to this case, the one in houston led to 43 fraud for cheating medicare about the $16 milon. the ongoing work can be

monitored on the h.e.a.t. web site which is www.stopmedicarefraud.gov. as you hear from other speakers this morning, you will see that the settlement is historic. not only because it's the mt money taxpayer has ever recovered but also between it's an integrity agreement that drug company has ever signed in the united states. the agreement requires that pfizer make reviews and pfizer create a mechanism for doctors with questionable conduct by pfizer sales representative and pfizer must most information about payments and gifts to doctor. this is the first time ever that a drug company has degreed to look at the risks associated with marketing on its own and develop a plan to deep th

those risks. and we are going to continue to closely monitor pfizer's performance. the steps relect the obama's administration dual focus on prosecuting and preventing health care fraud. we don't want to just catch crooks, we want to stop them before they strike. whether it is coming up with new ways to track medicare claims or prosecution that make companies think twice before bending the rules. to just give you one additional example, on monday, senator for medicare and medicaid services announced that for the first time they are creating a national database to track our efforts o crack down on medicare fraud. the database will help us identify what we can do better and where to find the best practices to improve our results. we know the stakes are extremely high. when companies refraud medicare and medicaid they are not just stealing from taxpayers but

jeopardizing the long-term finances of some of the most programs and in some cases america's health suffers. unnecessary or dangerous procedures don't just cost dollars they cost lives. we're working aggressive will to make sure americans get the care they nee and that the dollars are well spent. like the rest of our partners here today, the department of health and human svices are committed to doing everything we can. i look forward to continuing to work with this extraordinary team in the months ahead to do just that. now i'd like to turn things over to tony wt, the assistant attorney general for the civil position. tony? >> thank you, secretary sebelius. and thank you for your leadership on this issue. my name is tony west, i am the assistant attorney general for the civil division in the department of justice. today's announcemt represents the largest criminal and civil

ttlement of a health care fraud case in u.s. history. this landmark $2.3 billion with pfizer and its pharmacy company is important not just because it includes $1.3 billion in criminal findings to resolve and not just because pfizer has agreed to pay $1 billion for the fraud allegions, including over $300 million paid to the states. this case is important because of what it says about the u.s. governments coordinated efforts combat health care fraud and what those efforts means to millions of americans who rely on t integrity of the programs like medicare and medicaid for the health care they need. today's settlement demonstrates that health care fraud is a priority, a top priority for the civil division and this

department of justice. that when it comes to marketing drugs that so many of us rely on, we will expect companies to be honest about the claims they make about the drugs they sell. this civil settlement and plea agreement represent yet another example of what penalties will be faced when a pharmaceutical companies puts profits ahead of patient health. illegal conduct andraud like the allegations in this case puts the public health at risk, corrupts medical decisions by health care providers and cost the government billions of dollars. but it's not just the governmt who pays more. with health care fraud occurs, that drives the cos of health care up for all of us. consumers pay higher premiums, companies pay more to cover their employees. and every medicare and micaid dollar lost to fraud means that fewer children will see doctors

for preventible childhood diseases. more seniors will be faced with the ark choice between food or medicine at month's end. fewer people will get the health care they need to dramatically improve the quality of their lives. that's why settlements like today are so important. not only do they protect, they also bring money lost to fraud back to public health programs especially medicare and medicaid. today's settlement was made possible by two things, tough enforcement tools and terrific team work. first the tools. the department of justice has strong enforcement tools that helps work eve day to ensure thataxpayers are protected from fraud. on the civil side, we use the false claims acwhich has allowed to recover over $14 billion from fraud against health care programs since

1986. here pfizer has agreed to pay over $650 million to resolve allegations of the false claims act that the company illegally promoted for drugs using false and unsubstantiated claim and caused federal health care programs to pay millions of dollars for prescriptions that were not for medically accepted uses. in addition, the investigation of pfizer began in 2003 with a whittle blower who filed the false claims act given the importance of the key provisions and covering fraud in government programs. now we also used the anti-kickback statute to put an end to paying kickback to health care providers to produce them to prescribe many of pfizer's own drugs. patient must have confidence

that their doctors are giving them the best medicines for the right reasons p on the criminal side, the consumer litigation used the food, drug, and cross cosmetic act in the drug applications to the fda. the drug is for an intended use, it may not be marketed or promoted for something off the label use. that is a use that is not specified in the application and approved by the fda. now, in case, pfizer asked the fda if it could bro mote the sale and anti-inflammatory drug for certain other uses and in dozes higher than improved maximum. the fda, siting safy concerns, said no. but pfizer marketed for those unapproved uses anyway. with offlabel markets like this, the patients health and lives

are at risk. and those who cause that risk must be held accountable. second to team work. without working together across agencies and state lives, the settlements wouldn't have been possible. the partnership that has developed within the numerous law enforcement officials has roanly led to several actions, mrs.s, and recovery. so i want t thank our law enforcement partners for their continued to commitment to ensuring the integrity of our public health and i'm proud to stand with him here today. now it's my pressureo introduce the united stes attorney for the district of massachusetts, michael loucks. . >> thank you, tony. i want to thank associate attorney general perrelli for an opportunity to comment. today's resolution addresses

criminal activity within pfizer division regarding the sale and markets. like every drug, pfizer could lawfully sell drugs, fda approval had to be obtained. there is no such thing as formal approval for a drug. if you cannot secur fda approval for one problem and market and sell for the another problem. any indication not on the label is off, and in selling and improved drugged intended for the use is a violation of the law. the fda has approved bextran2001 for three things symptoms of osteoarthritis, adult arthritis, and treatment of primary dismens rea. the fda did not approvell of the medications and dozages.

why not? because the fda told pfizer it was concerned about the safety. and the fda had known it. in excess it was serious effects. despite the decision, the markets machine marketed it for the reveal of all acute pain, which it had position for use for clinic basis. pfizer marketing machine pushed this in 2002 to 2005. the marging machine also pushed fo other offlabel uses. for other things, pfizer invited doctors to consult many in resort locations. and the expenses were paid, they received a fee just for being there, they were entertained with golf, and other activities. their job is to help them how to promotfor the offlabel indication. pfizer claimed that, in fact,

physesser had never conducted any hd to head studies between the two drugs for improved uses and thus had no clinical evidence that it was superior. claimed were not supported by the label or offlabel claims and thus violate. pfizer utilized the continuing medical education event. izer utilized the publication to initiate and sometimes draft articles for unapproved uses. it is for this conduct that pfizer will pay the larger punishment ever together with $105 million. the fact that should be considered in calibrating this punishment was pfizer. this is the fourth pfizer settlement this decade. first in 2002, pfizer paid $48 million to resolve allegations that i had failed to support

for the lipitor. second in may 2004, pfizer paid $432 million for the offlabel promotion of the drug. third, in seven, pfizer the same division involveed here pled guilty for payment of kickbacks for offlabel promotions of the drug genotrome. in my office handled the last two. during the 2003, 2004 negotiations with pfizer, pfizer management threw its lawyers said the company understood the rule and had taken steps to ensure compliance with the law. many of those involved in those negotiations remembered these promises. little did we when we struck our

bargain that other parts of pfizer were violating those very same laws of other drugs and continued their efforts to do. unfortunately, pfizer isn't the only company that has participated but also elsewhere across the country, it gave criminal investigations of major companies. fit major sessionment was in 2001. there he since then be 42 other major criminal and civil resolutions against the nation's drug company. today's settlement of $2.3 billion means that the drug industry has paid $11.7 billion, $2.89 billion of that for criminal crimes. final comment on the amazing work. these cases require enoous work above and beyond the call

of duty for those who wor on them the agents say lawyers. they are hard and exhausting. they take many years of effort. in times you think you will never see the light at the end of the tunnel. moreover, folks on the other side have more money, resources, lawyers, paralegals. i cannot praise and thank everyone. if you are here in the press welcome look behind you. much of the team is here. today's brief results testament of the hard work and dedication, the two lead prosecutors in my office who pick up the case in 2002 -- 2004 after the work had ended and joined the team in 2006. they are two supervisors. this case cannot be done without effective collaboration with the