processes of medicare have increased access and participation by dentist. many have cooperation in working together and achieve greater gains in access. we are truly able for that help. education, care that is ongoing and said of episodic, and involves public, private partnerships, yielding the greatest results. each state medicaid program is different. and each state has different issues to solve. here are a few examples of reforms that demonstrate access. and i'm only going to highlight one due to time constraints. michigan's healthy kids dental is a partnership between the state dental associates and a commercial dental plan.

the streamlined administration and reimbursement is the same as the commercial plan. access for kids enrolled is approximately 70% for seven to 10-year-olds. in stark contrast where that children's dental program does not exist. efforts to expand the program are underway. there are many volunteer programs that ada and other dentists are involved in drug year. we recognize the volunteer programs are not an adequate health care system. due to their episodic nature. therefore in 2006, our give kids a smile efforts establish a great deal. the ada is increasingly involved in interprofessional activities because we realized the advantages of expanding the number of health professionals capable of assessing oral health and the importance of linking dental and medical. in an effort to reach kids

before they had the disease. there is increasing activity across the country in the area of utilization. due to the potential cost savings. one successful program, again, in michigan, is modeled after habitat for humanity. that does provide care free of charge, to low income individuals who perform community service. this has led to lower costs in the hospitals in the area and is a win win win for the community. it is prevention of the most effective level and has the greatest potential to yield the best results in improve oral health. the ada is proud to be a part of the partnership for healthy mouse and healthy lives. one other time, the national coalition that has resulted in this week and the ad council campaign with an oral health

message. you will begin to see the messages encouraging health. you might remember smokey bear and the crash test dummies. it really is exciting that it is an oral health message for the first time, and we are very excited to see the results. we are in the evaluation stage to create a community dental health coordinator. this new dental team member has a different approach, and it is modeled after community health workers. the goal of this is to break down many barriers and provide a link before to the patients in the dentists. it will help them navigate the system. in addition to helping them find the dental home, secure childcare and arrange transportation. they will also be able to provide a limited preventive services rather than focus on treating disease. the cbc is based on some of the ada's key principles of breaking down barriers to care.

maximizing existing system. in addition to the ada website, we are launching a website for the public, the url is healthy mallets.org. i would like to thank you for being a part of this panel and we look forward to working together healthy. >> thank you very much, monica. we are going to go now to julie sexual who is a manager for the children's dental campaign of the pew center where she focuses on workforce issues. as you have heard in the references by our speakers, it directs a really heavy amount of tension towards improving kids access to oral health services, we have issued several reports,

including a state-by-state evaluation of how well kids oral health needs are being met and we are very pleased to have julie representing a program with us today. >> thank you. as i have mentioned and you have heard repeatedly, dental care is the single greatest unmet health needs among children in the united states. five times more prevalent than asthma. a lot of times when we are talking about health care reform, we focus on medical and it is important. a research and advocacy efforts opus on for efficient cost effective strategies. one is ensuring that medicaid and the children's health insurance program is better for kids and providers to make sure that insurance translates into real care. the second is community water with fluoride and increasing sealants for kids who need it most and expanding the number of professionals who can provide high-quality dental care to

low-income kids. as i have mentioned, a lot of you might be familiar with her work. you might read tuesday reports that essentially are eight benchmarks to evaluate oral health aspects. if you haven't taken a look at where your state stands, i highly recommend it. these are the graves of our most recent report making coverage matter, which can find on our website. a lot of folks have effectively used these records as policy levers to increase oral health access in the state. earlier this year, the pew study released a report on preventable dental conditions. we examined a large sample of emergency room data collected by federal agency called the agency for health care research and quality. we then contacted the national number of emergency room visits identify the specific hospital codes for dental problems are considered to be preventable.

unfortunately, the state is not always available. also, some are not required to interpret were reported. so here is an example of our overall findings. you likely have a copy of this, so i highly recommend taking a look at it. what we found was preventable conditions the primary diagnosis and more than 800 30,000 visits to the hospital emergency room, nationwide in 2009. children accounted for nearly 50,000 of those e.r. visits and many other visits were made by medicare enrollees for the uninsured. states are paying a high price but a significant number of children who are seeking this type of care in the could've been prevented and treated more effectively. so it is really tragic -- this

scenario, the kind of care that folks are receiving, folks are going to the e.r. with a toothache, generally won't provide lasting relief. you usually don't have a dentist in the e.r. and their response is to either subscribe to pain medication or antibiotics, and this is not actually solving the problem. so what is the volunteer at the wrong time at the wrong place at the wrong time for desperate patient. the more than 800 and 30,000 visits to the emergency room represent the 16% increase from 2006. that is the bad news. the good news is that, in this is a real opportunity for states to save money, because these are totally preventable. we know that getting treated in the emergency room is much more costly than the care delivered in a dental office.

states are bearing a significant share of these expenses for medicaid and other public programs. i will give you two examples. in florida, dental related visits to the emergency room produced charges exceeding $80 million in 2010. about one out of three emergency trips were paid by medicaid. in washington state, dental problems were the leading reason for emergency room visits by people who were uninsured. here is another example from the report, taxpayers and consumers are paying a high price for this and in complete care that is delivered in the emergency room. so why is this happening? well, it boils down to access. the current system is not working for everyone. as is taken from the american dental association, and while it

uses the 2000 census data, roughly one third of americans lack access to care -- dental care in the united states. this is in line with what we are seeing. the logical thing is to look at the dental safety net for the dental safety net is at capacity. they are only able to treat 10% of the third of the population. so something else needs to happen. in addition, many people lack dental insurance. and even if that is not a problem for you, a lot of people have trouble finding a dentist and many people have to drive 20 to 30 mouse to access the dentist. more than 40 million americans have a shortage of dentists. so what can we do about it? >> well, as you heard, there is no silver bullet when you're talking about increasing access to care. it is a pretty complicated situation that requires multiple solutions, but a lot of states are taking a look at evaluating

the existing makeup of the dental workforce by talking about satellite providers. i don't know how many are new to the dental world, but when i first started, i thought valid for writers with one provider. but it is actually a larger umbrella. doctor monica tran-twos going tk about the advanced therapy program in minnesota. there are multiple models that we are talking about, including the advanced dental hygiene practitioner across the u.s. so it begs the question, why are we having this conversation now? well, in addition to research showing that this is a viable solution to increasing access to care, we can't afford not to. while it is clear that states are bearing the costs and the consequence of us not having

adequate access to care, in certain circumstances from the consequences can be much tighter. a lot of people who are not new but familiar with the tragedy of the maryland boy. this is continuing to happen in my home state of ohio. he recently had a dad, an unemployed dad who passed away a 27 years old because he did not have access to care. so this map is constantly changing. but it gives you an idea of which states are talking about workforce. the blue states showed states that have authorized providers and the green states represent states where the pew foundation is working, the american dental association is working, and states that have taken the initiative on their own. and i commend them for doing this. because it is not an easy

conversation to have, and i also appreciate the alliance and robert wood johnson foundation for making this what it is today. if you'd like to keep up with information on what we are doing, please feel free to sign up for our viewers. we are happy to share what we are doing monthly, and here is my contact information if you have additional questions after this briefing. thank you. >> thank you, julie. finally, we hear from christy fogarty, who is as do we describe, a licensed dental therapist. one of the first two people in the nation to receive this recognition. she started as a dental assistant and then became a licensed dental hygienist and last year she finished two years of training as an advanced dental therapist and received a master's degree is in oral health practitioner.

she works for children's dental services in minneapolis and some of you may have seen her featured in a recent pbs documentary on oral health. we are so grateful to have you here to tell us about your experience. >> thank you so much for having me here and allowing me to share the minnesota story and what we are doing. we have a real-life demonstration project going on right here. i was going to cover a few topics rather briefly and i'm going to talk a little bit about the therapy and talk better testing and training. tell you about where i work in the things that we do there in the demographics that have served. and then a little bit about the financial model that we are starting to see develop. i am also as is noted, a licensed dental hygienist and a licensed dental therapist. that dual licensure really serves me well for this community. and then talk a little bit about what is going on in the future and what we are looking up in

minnesota. talk a little bit about what a dental therapist says. the best comparison is like a nurse practitioner in medicine and dentistry. i can do just about any kind of fillings. i can do extractions of primary key, bbq, i can do stainless steel crowns, i can do like a root canal, to judy chu, and i can also do all kinds of space maintainers. in minnesota, there are actually two types of therapist. there are dental therapists and advanced dental therapist according to the legislation, dental therapist are required to to have a bachelors that many have a master for the university of minnesota is the only bid if you can dental therapy. the metropolitan school of his requiring me to work on your is

a full-time hygienist. we have the least amount of experience for searchers and we had one hygienist with the hygienist for 18 years. after i complete 2000 hours, which is a lot like residency, i will become an advanced dental therapist read they're trying to figure out what they're going to do in minnesota when i hit that number in november of this year. but i can get that licensure. the biggest difference between the two is the supervision. dental therapist have to be an indirect supervision. adenosine to be on the premises at all times. different types of procedures are being performed. once they become an advanced dental therapist, they can do general supervision. i can do anything within my scope of practice that i need done is to be upset with me.

that's a huge advantage, especially when it comes to talking about working with mobile equipment. we will see later that there's some people who traveled far distances to get access to dental care. if i can get to them and not have to have dentists in the same building as me, it will open up access to care significantly. one thing i do is let to make sure that people understand my dual licensure allows me to do a lot of things. dental therapists can do a simple cleaning for any kind of. awkward. i can do both. you get this population in the your chair, certainly want to do as much as you possibly can. it is not uncommon for me to do a stainless steel crown, clean their teeth, do sealants and the rest. for the training and testing we go through, i went for 27 months in a masters program. at metropolitan state. and my scope of practice, i am trained to the level of attendance. actually brought a book that talks about the 75 pages of codes but the dentist is license

to do. there are six and three we can do. as you can imagine, in 27 months, for the exact scope of practice, i am trained excellently and very highly, i am trained by dentist, side-by-side with dentists. the testing that we are getting is the same testing the dentist does. in fact, they don't know if it's a dentist ordered an advanced dental therapist that is taking the exam. after have received my licensure, i was able to get into a collaborative management practice agreement. currently where i work, i'm in collaboration with nine separate dentists. as a started out, there are different levels of supervision that they give me. by statute from the have to know what i'm doing and they have to be in the building. some of my work, most of them now just want to know what i'm doing. little bit about us.

lester we provide care to about 20,000 children. we are on track to do about 30,000. we work with mobile clinic. as you can see. we are a head start this program and about 200 sites statewide. we run about 300 sites. the vast majority of care is not done in our headquarters in minneapolis, but is done on-site in community centers, schools, and different types of permanent sites that we have established. you can see that we take anyone with any kind of insurance and we also have a fee scale. basically we turn away no one. children under the age of 21 and pregnant women. we also work a lot with children with special needs. i see a lot of children with autism, those who are wheelchair bound. the full spectrum. at our headquarters, we also can provide quiet rooms where we can

decrease the stimuli and really helped access those children who struggle, not only to get care, but they struggle to be cooperative with the care. we also do have those who surgeries and hospital care, honestly, i don't do that, and we have one to miss that comes in twice a month. since december 2001, i have seen about 900 patients. he can see the demographics they are red i always like to tell one little story. because it kind of brings home exactly why i do what i do and why i believe so much that we need work on access to care. when i first started doing chemotherapy, working in the clinic, a mother brought in the 2-year-old little boy. he had the saddest little face. and he was in so much pain. the mother said he had not slept all night. he had phoned the week before and bumped his front teeth. and she had spent the entire morning calling around to dental

offices, being told again and again that we don't take your public assistance insurance or if that we cannot see you. we were her last call before she was going to take her son to the emergency room. all of you have heard that it is not conclusive treatment. they gave the mother in a dramatic until the mother to find a dentist. she was tremendously grateful that our clinic was willing to see her son. once i got him in my chair, we determined that the tooth needed to be extracted. can you imagine a 2-year-old, a non-shamanic experience -- it was pretty awful for him. not to mention that he had not slept and was in pain. you can imagine how awful the situation is. the mother was so grateful that we were able to get the tooth out and get amount of pain, because i am a hygienist and all i think of is prevented care am i convinced the mother to please come in next week. get him in for a regular exam and make sure there's nothing else that's going on now that we have amount of pain. a week later i'm standing in the hallway and i see this little

2-year-old boy come around the corner. dirty air grin with the big missing tooth in the front. the mom comes up behind him and she says all he can remember is you or the lady took the pain away. this is why i do what i do and why i am so passionate about it. the mother was grateful for the care, the child needed to care. it could've gone so awful for this child. he is on the right path now. excuse me. let's talk about the finances. he put this up and one person raised their hand and said, okay, that's great. you save about $1200 on $10 a week. in collaboration, it reduced the number of demos that we need. it does not eliminate the need for dentist, but that's great.

but how do you get grant funding? how to get funding to pay her salary? how do you afford her remark. >> he was a little confused by the question because he had not put this site up yet. the sideshows that i produce more than the majority of the dentist office. there are two reasons for that. one is that i work in headquarters that is busy all the time. and two, have amazing collaborative dentist who really let me work hard and complete a lot of work. because i am not disturbed by an advanced dental therapist asking for my checks to be doing exams because i'm not quite licensed to do that yet, i won't be able to until i'm a therapist, i can get water in dentistry done, which can be very challenging industry. that helps a lot as well. my boss likes to say that this is actually a really unfair slide because it shows that you are the third-highest producer in the practice for the month of may. but the reality is you shouldn't be compared.

granted, probably with six most critical of the procedures that need to be done by this population. so it's a very important set of pages. but the dentist always have an advantage because it is far more expensive the procedures they could do. this is not the only month that i have been the third-highest producer it is the height of the sun. i generally sit in third, fourth or fifth every single month. i was the third-highest producer in the month of july. my production did not go up to $320 per hour. he said you really don't need need grant money. you need grant money. you just need to work them into your practice in a proper way. for the future, i am continuing working towards my hours and i expect to get it in november of this year. what do we didn't mention but she showed, minnesota has a

great day. we are actually a grade a. being the type of person i am, i'm hoping that once i become the first advanced dental therapist, that they will reconsider the grade. the other question that i get a lot that i think it's really important for people to know about is what has the acceptance by mike? and i thank god everyday for nurse practitioners. it becomes very easy to explain what i am licensed to do. and when your practice, i have one parent stay but i prefer my childhood dentist. acceptance rate is high and you remember you're talking the population that really need to dental care. and if so grateful to have the care. it is a very important message to get out there, this was one great tool. there is no silver bllet. we need a great big toolbox to solve access to dental care. and i think that what i am seeing is that dental care is that great wrench you can use

anytime it works. thank you. >> thank you very much, christy. we get to this part of the program, and you get a chance to ask our panelists what you want to get out of this conversation. you have the opportunity to ask questions whirly, and you can take out the green card in your packets, right question, folded up, and we will bring it forward. giving it a chance that person to respond to it. and i will invite doctor david krol to join in on the question. i wonder why we're getting started. i could ask doctor monica hebl about the give kids a smile program that you were talking about. and the effort that you described in 2006 to focus on

continuity of care and establishment of the dental home. how do you do that in a volunteer situation? >> training opportunities and best practices. the program -- we found ways to get dentist to accept the patient's ongoing -- it was a trainer, trainer kind of thing. dentists are pretty generous. they build that relationship, a lot of dentists are willing to take those kids on, once they get to know the families. >> a question for julie. i was looking at the map that you are displaying.

about the impact of the emergency department visits. and i wondered if there is much of a variation from state to state among the states that you were able to get data for. you have 800,000 of these visits per year. out of the total number of visits, something like 140 million. some of these percentages are just stunning in that context. >> again, we were only able to gather data from 24 dates. so it is not all 50 states. but i think the general takeaways is that people are utilizing emergency rooms because they don't have access. access to care. it is an issue. >> a question for lynn mouden

with the medicaid expansion. with the medicaid expansion coming, where the efforts to broaden provisions of dental benefits, especially for adults. what you see on the horizon? >> as we learned after the supreme court decision recently, we are still in the position where states can provide dental services for adults under medicaid or not that has not changed. obviously, we are still concerned that when there is an underserved area, a child has dental services until they are 21 and then we cut them loose. that doesn't mean that their dental problems or need for dental care has gone away. unfortunately, we are still in a position where it is up to the states individually to decide whether or not they are going to provide adult dental services under medicaid and with competing priorities and state budgets, it's going to continue to be a concern.

>> have there been any discussions about dental benefits in medicare? >> in my office, there have been those discussions. >> unfortunately, as i get within a couple of years of that magic number, it is amazing that when people turn 65 in this country, we apparently no longer care about their oral health. obviously i'm being a little for fun about that. we have meetings about seniors and their oral health. it is obviously a huge discussion for budget issues. and i can only hope that maybe medicare will catch up by the time i get there. >> a question for christy and maybe even julia. can you talk about the process a the minnesota went through to get this legislation passed? remapped -- the process is like making sausage.

you don't really want to see it, you just want the end process. it was a little bit like that. .. this is something we want to try. you want to expand the dental work force, and this is how we

want to do it, and what your support. it is not an easy conversation to have because you have a lot of different perspectives come into the table. it's important to take the time to understand where people are coming from, to respect what they're coming from, and try your best to build some sort of consensus so that it's not just a policy, but you have an infrastructure in place to sustain that new policy and you have a lasting change with respect to access. >> and setting that up, before the legislation was even presented, metropolitan state university already had an entire program approved by minnesota. so the education piece was already approved for the proper channels. as you @booktv seen as the legislation was passed i was sitting in of class from three to before it was signed. >> if i can just follow up on the general topic of how you get states to act, you folks did a wonderful evaluation of

children's dental of policies. and, as i understand, after the state of maryland really made major improvements. they don't show up on your map here with respect to sub respect to dental therapist. what kind of things to do and how they happened? >> specifically there might actually be able to talk a little bit about what they did. but i'd said that the focus more on -- let me just touch on the bench mark. the eight bids marks we used to great states are a focus on prevention and one is focused on work force and other on medicaid or reimbursement rates. so i said that maryland tackles more of the prevention and the reimbursement rates on access, not necessarily the work force.

others might be able to add to that. >> yes. >> okay. >> just a follow-up on the number of students, how many students are enrolled in the metropolitan state university program? what is the pipeline? out of things look going forward? >> sure. seven. we are very small in numbers. the second award is about halfway through. therefore. mike understanding from the university of minnesota, and please don't quote me because i did not go to school there, their first class, i believe, was nine and the second seven. so we are looking somewhere in the 20 number range in the next 12 months. up there working. >> other than minnesota can the practice in any other state, including alaska? >> no. rihanna licensed. minnesota is the only one that has dental therapy as part of the state budget.

it's actually a part of our dental practice act. an alaska it's a different situation speak more authoritatively then me, but i cannot practice in any other state. we have had several people move from other states to minnesota, including one of the first in a court from university of minnesota move from for a because she was seeing such problems with access to become a part of the solution in the she could not go back to florida, which i think is what she would have loved to have done. we can't practice in any other state right now. >> have a question. it's sort of grows out of the presentations as we heard them. it is directed. what is the american dental association's take on advanced

dental therapist like christie? are they providing appropriate care at the appropriate level? and how do you feel about minnesota becoming a model for other states? >> the ada believes that with the scarce resources available to improve access we believe a lot more can be done to fix the current delivery system. we have a demonstration projects all over the united states. just one. we know about a few of successful programs. we really believe that providers are there. we just need to fix the system around them. we caution against creating new

work force models that are allowed so before irreversible surgical procedures, especially about the scarce resources could be directed toward dentists providing care. it seems a little upside down to me to be having the sickest people being treated by the highest trained. i don't think that treating to year-old with the dental abscess is a simple extraction. in fact, in preparation for this event it just seems like i have been inundated with some really difficult extractions' temporary teeth, horace extraction i've had. as a moment came in with soft ball sized swelling. and the woman who buy tickets to the other was going to be as simple extraction and had a bleeding emergency. and so i was -- i think that --

we would like to see dentists be involved. and we think it can happen with a better system. all of us working together to make that happen instead of delivering the message and having it be a divisive issue. >> the 20 new schools in the pipeline. you look at the training. that's about six years of training. i just think that it takes a long time. i don't know that necessarily is going to be in immediate help when we needed. so we should find ways to make it so that we can involve all the people that are already members of the team and use them to their fullest capacity. we have hygienists' it cannot find jobs. we have dentists who are not as

right now. so in economic issue. and when you work in a subsidized system you can make things happen. we need to try and figure out how we can make the health care dollars work in the system that exists. >> yes. we have some folks standing at the microphones. we would ask them to keep their questions as brief as it possibly can and to identify themselves. >> are heard it was mentioned that medicaid pays 20 percent of the private pay rate. >> let me stop you right there because i was speaking for my personal experience practicing in misery almost 20 years ago. does not national data by any

means. >> my question is, how could medicaid as a federal agency allow states to pay so much less than the private insurance market or the private pay market the medicaid statute says that the medicaid program is supposed to ensure equal access, and that usually means paying a rate comparable to private pay. and so i'm surprised that states are allowed to pay less. i'm also curious what percentage of dentists choose not to take medicaid patients and why that is allowed also has a licensing issue. in other words, shouldn't states use their licensing authority to ensure that dentists are made -- making their services available

to the population within their area? >> are give those both the try because what you have actually asked about our to state issues. there is something called sufficiency in the medicaid program. access is to be basically equal to what is available in the private market. again, that is a state issue which is totally dependent on budget. the second thing you asked about his licensing. it very much a state issue, and whether any health care provider , be it dentist, physician, nurse, or otherwise, is required to take public assistance programs, there is a discussion. i don't think i'm allowed to have that. [inaudible] >> go ahead. >> executive director of the association positions for the underserved. thank you for a very informative

panel. he worked on this issue of world health for a number of years. this is the first topic that we actually brought together people across disciplines tillich and early childhood care prevention. my question is addressed to christie. what is the cost of the preparation for your advanced to the therapist? what are the opportunities for state or federal payment in the future? >> that's actually a really good question, and one that a little bit of a struggle and minnesota, the answer to the first question is education becomes an advanced. rumba the program which requires a half the bachelors in dental hygiene. so we're talking about six years of education versus eight, we do have an educated hedging work force right now that the step in 27 months and the producing enduring mark. so it's not another six years, but i just want to clarify that. just the dental therapy program, metropolitan state, about $70,000.

i know that she's was about $350,000 in debt. so it's not -- we are among the most expensive professionals to be trained. dentists and hygienists and therapists, and expensive proposition. the second answer to a question is, i was able to apply for some loan forgiveness. however, it's a national program, and i qualify because of lessons to adjust. dental therapist are not right now eligible for the program. so unless you're going through a program that starts in the foundation of hygiene you will be eligible for any statewide or national right now. >> do we know anything about the total cost of the program as opposed to the cost that the students are asked to bear? in either case, whether talking about to soar professionals.

>> if we can get those will make sure we post them on our website. >> i'm a reporter for you today. my question is rather basic, and i apologize if people must know the answer, but like to know why there are a shortage of dentists, the factors affecting that. >> there is a distribution of dentists. burro areas and the urban areas, economically you can't sustain practice in those areas. and so we need to find ways with loan forgiveness to get done this to be able to practice their so that they can sustain. we just had a pediatric dentist

that had to a sell his practice to hospital system because he couldn't compete. not of federally subsidized health center and does not give the subsidization from the government. could not keep dentists employed . there would leave and go somewhere else. so i think that is where i was talking about, the system that we had, we have the capacity. baby boomers are retiring like they were before the economy down turned. profession of their hygienists, already on the ground. utilize on to the full effect. even dental assistants. so we think the capacity is just where they're located. >> i've also, i would reiterate as debt that i used to my presentation that 40 million americans currently live in an area where they don't have

access to a dentist. their research shows that is the fact. it is a possible solution. does make economic sense. you really sort of war in 2010. producing an economic model that showed that adding that dental therapy, real data. at the time it was a terrific economic model. living proof that it's actually does not affect the bottom line. >> overall reason is because we believe it increases access to care. >> i. karen freelancer. the american dental hygienists association. thank you to the alliance role

in his precinct. i just want to respond to something. seemed tech come into question, safety and efficacy of this irreversible procedure provided. while it may be new in the united states, more than 50 other countries for nearly a century have used dentists to deliver these irreversible procedures. a rigorous research demonstrates that non dentists can deliver safely and effectively irreversible procedures. i have never seen a study that shows anything contrary. i don't know if you know if there are some studies to share with us. >> i guess my response would be dead whether we have received

joe or anybody, unless we did people navigated to those places and teach them what they need to access on darn prevention to stay healthy and that they need to brush and floss their own teeth, it doesn't -- it almost doesn't matter. >> i completely agree. oral health literacy needs to be improved. you know, i think -- and they really do know when a patient needs to be referred to a dentist. i don't think anybody wants to supplant the distant to the dentist. because there aren't enough way to supplement the care that is provided. >> thank you. >> love. organizing the session.

i would like to change the direction of the discussion just a little bit. who gets to hold the drill to fill a hole the we could have prevented? et think this is really so unfortunate. we know, and this has been stated by at least three of the speakers. we know how to present. that is basically the disease we're talking about. when act appropriately we can prevent tooth decay for the most part. we are focusing on who is going to hold the deal. why are we sharing more of affirmation about the general public, especially people with low health literacy. they don't even know that this disease can be prevented. we have stated in maryland that demonstrates clearly that low income, low educated prevents

tooth decay. never heard. fluoride has been around and used for almost 75 years. it we have not shared that information. it seems to me where we should focus is on trying to educate health care providers because they don't necessarily know the correct information either as well as the general public. on the slide, once led would have said more campaigns are about. several million into that as i recall. toothbrushing two times a day for two minutes to prevent tooth decay. now, there is no evidence that brushing two times a day for two minutes will prevent tooth decay. you have to put fluoride on a toothbrush.

and yet the word is even used in any of the documents that are on line or available for the general public. this would be a make -- major step ahead if you even use that word. thank you. >> the ada was part of that huge coalition. the group that does that add council really does a lot of research and focus groups. we had to take on a step back a little bit and take our hats to try to control that massive and just then that they knew what they were doing in the market erode. this was through their focus group research that this was an appropriate message to get what we're talking about. so i agree, you know, that seems like he is going to work. they do a big part of this

campaign to measure the result. so if it doesn't get results it will continue to happen. it could be tweaked. the group, the marketing firm that does is the same one that to the messages of the little baby. he gets straight. and so they put out some effective campaigns. i'm hopeful that this is the first up and that we can get to the point they're talking about. >> a couple of people talked about prevention, but fluoridation and sealant. where is that in the national policy since? is it covered by any of the medicaid programs? the type of insurance companies,

cover that service. >> obviously medicate is very supportive. oral health, we also obviously covered the region of fluoride treatments. fluoride varnish provided by physicians and nurses. whether there is a national program, community water fluoridation, or a house which is providing considerable amounts of funding to various state programs to support water fluoridation. am always very thankful to the private foundations that have also help support community water fluoridation across the country.

>> one of our areas of focus because we know that 74 million folks on the private water system to not have access to community water fluoridation. we are working to create a national home base. i always did mixed up. i like my teeth. provides a tool kit for folks who are interested in fighting at their robotic tensor increasing fluoridation in their water. it's a turkey habit. somewhat effective in creating fear. science. and you kind of is people the way. find the right balance of communicating in education but also providing tactics of the people can effectively keep their water fluoridated or get their water fluoridated is a challenge.

>> did i just add to my job to around. i recognize what you're saying, and i agree with that. this is a major problem. all of the body of water that is available, including in here. most people are not drinking tap water. a large part of it is because they don't. so major educational campaign about water fluoridation and get it from the tap. does it really help to have tap water into the water fluoridation. >> we mentioned the focus on issues at a state level. is there a national moral health plan or a national strategy for

oral health? are there opportunities for groups like coalitions like the u.s. national moral health alliance or other organizations to help push a national or of the tennant? >> out jump right in. the world health coordinating committee made up of representatives from various federal agencies in discussion now about what could be called a plan that we tend to not use that word because there have been too many plans. whether it's called a strategy all whenever. different federal agencies to work together in a combined effort to improve oral health and access to world of care. beyond that the goals. our fourth iteration of healthy people plan. we continue to see oral health as a major focus in healthy people 2020.

we would obviously want everybody that is represented in this room and anybody else wanting to take this seriously. not just by in the sky. things this series that can be done to of raise partnerships, federal, state, and local. >> a couple of follow-up questions. it's based on as my previous question on why dental care is not readily available in certain low-income areas. i guess the question is, does that mean that dental care is too expensive for most people? and then the question is why. if we do have more dental therapist as part of the solution, from what i understand it can only address and a few, not the full spectrum of dental care. and so the low income person in these more advanced care, the still going to be very expensive you pays for that?

out of the get access for more advanced gear? connect to that is the second question, the affordable care act doing to address dental care? what kind of solution is there for low-income people to have access to the full range, not just a small piece that dental therapist can provide. i understand it is an important part. and trying to get the bigger picture. how do we get care to everybody? the full spectrum of care. >> of take a small piece of that. the affordable care act, we did have the essential health benefits that need to be covered under the various insurance entities, whether it's the exchanges or private pay insurance. it would be the basic package that includes dental benefits. >> another small stab at it. that think that is what

prevention is so important. because this is a disease that does not have to happen. and so while there are people out there that need some expensive care, if we can change the perception in home care and attitude in get people to the go for prevented visits an ongoing care we can get them for their oral health care. and then dentists have always been in an industry where there are out of pocket costs. it has been treated kind of as an expression area and come. tough on private practice because people can put off going to the dentist or the actor. the advantage of that is that there is transparency in the cost of oral health care as opposed to madison weather is in a lot of transparency, and that is an advantage in blunting the we don't think of as being translated to the medical world.

and so it is a complicated issue again, that is why so many people need to put their heads together to figure out how we're going to do this and how we're going to find it fairly and effectively in make sure that the most appropriate person is treating. >> one last thing about the affordable care act, and appropriates 11 billion for community health centers over a five-year time frame. that's something specific that the affordable care act as. >> the demonstrations. included in the dca. but they are subject to appropriations. authorized. and none -- by the way, we are getting toward the end of our time with you. i would ask that as you listen to the exchanges, questions and

answers, the evaluation form, make that the blue evaluation form. fill it out so that we can try to respond to the different kinds of topics and speakers and formats. can someone explain the difference between a dental therapist with different types of dental therapist which are limited to a state that expanded function dental assistants we seem to have some similar works go, but are widely used and accepted by dentists and dental organizations? >> take a little bit of a step that. nationwide dental assistants, the hygienist's, difference codes of practice. they can allow certain types of

procedures to be done. for example, prior to being a dental therapist was what's called a restorative expanded dental hygienist. a dentist can go and an assist to for filling in i can come in and do it. what that does is allow the dental tin to work more efficiently. hopefully open up access to get into care. that is what it was designed for. there are those types of allowances. not all states allow it. not all states require less measure. another thing that i absolutely amazed at the other collaborative practice to the allegis -- digest which means that there are times i actually just work as a hygienist. i may go into a school. a complete dental sealants, to a cleaning. i can to x-rays and things of that nature. those are all under the collaborative practice agreement. that is allowed in the state of minnesota. so that is what they're talking

about. some state to state variants which is a great way to do it because the state is best to knowing what its needs are. >> basically the difference is the cutting. the dental assistant does not cut. >> come back to the question of rights and compensation and a couple of questions that arose. one is, looking at the slide that we displayed showing you the third ranking producer and a practice. what -- are there any private insurance members in that list? >> we do have a small amount of private patients. some patients just really

enjoyed our clinic because it's a great environment for kids. oppose addition to where they live. we also have a number of people who go in and out of the public and private system depending on employment and things like that, but the vast majority that i see are on some type of public assistance program or a sliding pay scale. we all the way down to zero. >> and what percentage, that is probably too precise question. hal able are you to respond to the level of need for folks in a vulnerable populations without any coverage at all workers to mitigate? >> you mean, in my scope of practice. >> no, i mean in terms of the number of minnesota and sue are in need of those kinds of services. >> i probably could not give you a percentage number of minnesotand sue are in what i can tell you, we have 300. we go all over minnesota. at 16 miles north of my home,

school for the deaf and blind. people who go all the way up. the layout. that is probably about 500 miles the can go up and go under 22 exams, to the intimidating. it is not ideal. though we tried to be consistent in getting there at least once a year so the people he don't have access to that community have something. it's more of a safety net. we do have parental in duluth and st. paul. so we have one spot in northern minnesota, one in central. the southern part of the state. does that help answer your question a little bit? >> we try and get to the people. the biggest obstacles to my getting to the dentist. >> somewhere 47 million people. kind of an agency. >> right. >> what about the national

health service group? the federal forces that flow from it. i suppose it's more a question. umass to -- i mean, you mentioned your connection with your colleagues. >> i apparently set too much. [laughter] i, frankly, know very little. i do know that those are available. low rate payment available to those that are willing to underserved areas. help. i also know that there are wycherley hundreds of national health service corps sites still looking for oral health providers. >> that vacancy number is much lower than it was before the economic downturn. the recession to many people

involved. one of the things that happens with that program is you don't find out if you get loan forgiveness until after the fact because they come and put it in the hopper and supplement. the spit out the forgiveness. then also, you take that amount and you would have a dentist providing the services. if you took the write-off for the medicaid program is basically a wash. and so, we always see we need meaningful loan forgiveness programs to make a difference. >> well, i think what we have just demonstrated today, if nothing else, is that this is a multi faceted area of inquiry, opportunities and challenges abound. i think what you prove today is how rich a description of both the challenges and some

potential options for dealing with those challenges. my colleagues for allowing us to get into a topic we don't get into often enough. i want to thank you for showing up on a beautiful august day in sticking with this discussion. i want to ask you to join me in thanking our panel for an incredibly useful in basic discussion of a very complicated topic. [applause] >> in ten days was double to go coverage of the republican and democratic conventions live on c-span, you're from receipt. next the conference of mayors less of the possible effect on

cities from automatic defense budget cuts, different industry officials talk about the role in preventing terrorism and the alliance for health reform issues a report on access to dental care. >> the republican national convention meets in tampa, florida and ten days. first republican harbor and the committee will draft a platform for the delegates to approve. live coverage of the platform committee meetings beginning monday at 1:30 p.m. eastern time you can watch it on the c-span and c-span.org. >> the training program. >> this sunday on c-span q&a "washington post" columnist talks about his various jobs as a journalist and my views on extravagant u.s. spending overseas, and his criticism for the defense department. >> bill the formula.

[inaudible] the interest. >> more with columnist sunday night at 8:00 p.m. on c-spanhis q&a. >> at this meeting of the u.s. conference of mayors defensepote industry executives and government officials discussed the potential effects ofsp automatic pentagon spending cute from sequestration.an hour an the u.s. conference of mayors of this year's meeting in orlando. this is an hour-and-a-half.

>> good morning, everyone. apologize for being a little overime. i think the one thing that we know, especially given the subject matter here this morning , anticipation of a special is that everyone here has safe, secure, and nonviolent. we are here this morning toive h discuss. this is of forum on effective approaches tto reducing violence in cities all across america. the panel, and introducing thesi members shortly. but this particular panelays of discussion is about discussingio the unique and effective ways of addressing what i personallysshu believe this one of the most serious problems facing citieso

all across the united states america. that, of course, is unfortunately the issue ofi violence.the certainly many of you already know that violence is a top priority for me personally talking a little bit more aboutd that tomorrow.p but as mayor of philadelphia ano the vice-president, the u.s. conference of mayors, ay d particular focus on the issue in my city in cities all across the united states. a little bit of a picture of aee country. in 2010 there are 13,000 murder victims across the united state pe america. on average 16 young people between the ages of ten and 24 a murder.le. 86 percent of them are males. 50 percent total homicide

victims, 85 percent of those victims. 16 percent of black men under the age of 24. it is clear that unfortunately we are watching an entire generation of african-american males slowly retire, watching the next generation our children grow up with without male rolewo models.n, watching our communities crumbled and the the weight ofll incarceration contracts, and most of all violence. we are watching. of course, many are asking theai question what are we doing.nfer at the national level in addition to my work at the u.s.a conference of mayors i have been working with many people to establish.

this is a diverse coalition tt demands. working in partnership with angk variety of stickle the organization's among the men. i want to encourage all, and now we talked about this tomorrow, to join us in this effort.ties speak about cities united is o trying to do or expects to do in the weeks and years to come.ng o several cities, what is often referred to as the cease-fires model. that is what we're going to discuss in this particular forum.publicealth the unique interdisciplinary public health approach to preventing violence. this began in chicago and several other cities including baltimore, new orleans, and philadelphia.d 's b the subject of rigorous h

evaluation and has been demonstrated to show that it isn working. in philadelphia cease-fire is one of our goals in the overall strategy to reduce violence. working with local partners for federal grants to expand modelse and and and strategy. very grateful with thess foundation for sponsoring this form making it possible for mayors all across the country tf learn about cease-fire in how is operates. all of you go home with disinformation.ities and about a cease-fire and havec works in cities across america.c the conference of mayors looks forward to continuing to workrom with the foundation to provide information.n our ty's m mayors and others.ride this issue and others affecting our city's most vulnerable. so talk a little bit. have with us this morning cease-fire founder and executive

director. has led to the application of a public health, screen violencesd as an infectious disease.of physicians and epidemiologists, a professor of epidemiology in the university of illinois at chicago. describe the cease-fire model for us.odiend bmo we're also here. cee city has the longest running application. outside.yo now, the conference of mayors, the vice chair. gains in use development in our criminal and social justice committee. following year, the universityof of washington.pub let's maintain an affiliation. the school of public health,

participating in their recentas completed evaluation of baltimore cease-fire applicatioe the results of that evaluation. then we will hear from new orleans mayor. the most recent efforts to implement the cease-fire model. providing the perspective thatis the city is not yet implemented the cease-fire model. this testing cease-fire applicability [laughter] and her city and how it relates to the efforts -- that is not something i usually say in philadelphia. [laughter] but how her efforts are already underway to reduce violence. finally, jane love, team director of the vulnerable populations portfolio at the robert woods johnson foundation. she will discuss the foundation's effort to provide information to mayors in cities across the country about cease-fire and assist them in implementing this model.

i will ask our panelist to be brief and that always happens at the u.s. conference of mayors and any paddle that i have been on a i have always ignored that request and we expect the same to be true this morning. we certainly do want to leave the bed of them time for q&a at the end. therefore, mayor slutkin you're up. >> speak and everybody here may? good morning. how is everyone? thank you mayor nutter and everybody for coming. i'm going to talk today about the cease-fire health model, public health model. the theory behind it and how it works and the results and also kind of the way ahead. the way that i would like to start is by thinking about this problem in the context of other problems in the history of --

obstructed our process and this is a painting. the reason i bring it up which of course we now know is an infectious disease centuries ago, we were stuck with a situation where people were dying in neighborhoods. people did not want to go in those neighborhoods. the people themselves were blamed, and we frequently have solutions like a dungeon. the reason that we went to solutions such as this is because we did know but was going on and the reason we didn't know what was going on is because there were invisible processes going on which we had not scientifically gotten there to figure it out. in this case it was a microorganism inside of a flea inside of a rat. who knew? arsons now with respect to the problem of violence is that we have not, or maybe we are now just beginning to understand the invisible brain processes that are going on underneath us that

allow us now to move on to better scientific positioning in developing a more scientific approach to the possibility of putting this problem behind us. in the essence of that we are still working with the same type of solution. however if we begin to look at this now in a scientific way in this particular city we begin to look at these maps and say wait a second, here we see geographic clustering of space. this is absolutely typical of the epidemic process. likewise if we look at graphs of violence over time we see not linear ways but curvilinear ways or waves on top of ways typical also of infections are epidemic processes. one of reasons why criminologists and economists and others have difficulty saying well, violence went up or

down because of this or that is because they are looking for linear responses. when this is a more transmissible type of process. then of course we all know that violence begets violence but what does that really mean? what it means is there is transmissibility that being exposed to violence as a young person or even further on as a victim or even observing it, you are more likely to do violence. not everything is transmissible. tb leads to tb and the flu leads to the flu. diabetes does not lead to more diabetes. being exposed to someone with a stroke is not mean that you are more likely to have a stroke. this is a transmissible infectious process so if we proceed and speak about this now, think about violence as a scientific issue an order to develop a scientific approach. we would not only be looking at is epidemiology but also behavior. what else could it be?

so it left me wondering where do behaviors come from? does anybody want to no? where do behaviors come from in the first place? it turns out a lot of behaviors are model. the majority of models -- haters are model. this is called social learning. what is going on in the brain is not thinking about it but unconscious mirror neurons circuits that cause us to do what we observe to a certain extent. what keeps behaviors in place as it turns out is what other people think or what we think other people think, will be what we call social expectation. these kids may not have bought about it but they know what is expected of them, to fight. gets expected of you to not smoke today, these are social expectations of others and they are scientific pathways in the brain that allow this. the need to belong. dopamine pathways that are

powerful as being used for food and are also used for social belongings. social isolation shows up as pain in the brain. it's important to belong. than we have this escalation capability of violence which has to do with dysregulation of the emotion or the limbic system and hypervigilance and all this. so if you put these together what you get is infectivity of behavior following escalation, epidemic process, but there's there is good news biscuits -- because we know how to reverse epidemics and there is only praying things you need to do to reverse epidemics. one, intro transmission. secondly find who is likely to transmit and then provide what is needed and in this case a need for change and then shift the underlying norms. this is called public health and this is called world health reverses epidemics especially contagious epidemics such as this.

so to interrupt transmission you need to find someone who can detect and interrupt the process. will use violence in directors for the stage of the system. the second is you have to find who else is a likely person to do violence which we can do in the neighborhoods for certain epidemiologic and other characteristics in that -- and begin to applied behavioral change with them and laughed for, underlying social norms that drive the whole thing so that it's very acceptable to violence and becomes less acceptable. this is what it looks like on the street. interruption, which of course has two steps, detection from sources of information in the community, sources of information elsewhere including in the hospital. they are trained in how to persuade and interrupt.

changing the thinking is the job of the cease-fire outreach workers. and then changing the underlying norms through a number of methods that the community managers put into place including responses to ever shooting using multiple messengers. the clergy has a role. the public education campaign and so on. if you put this into play, shootings over time come you see a rapid reduction and then when the program got doubled even further drops and the or added. this was the community that went from over 30 shootings and killings to three. we have two communities that have gone from 220 and one from over 426. an average 45% drop. eight more communities, three sets of controls. before-and-after hotspot mapping, shootings before and

after. these are the results of the study, a set of four studies really at the department of justice supported. seven years aboard, tenure-based findings. these are not one-year results. this is not before and after. this is not self-reported. this is an independent evaluation independently funded department of justice study. gang network analysis, five of the neighborhoods had 100% reduction in retaliation. the baltimore work will be described, but besides the significant results there was a spread of the behavior change shown in a relationship between interruption and homicide reduction. this is the program that was in the film, the interrupter's for those of you who have seen it. this theory has been explored by "the new york times magazine" and the cover story. the other contagion is urban violence at virus and the world edition of the economists call this the approach that will come to prominence.

recently at the institute of medicine we reviewed the literature and the research confirming the theoretical basis of this work. so we are now working in about 15 cities around the country including some of these on the panel. we are working in five other countries because the state department and the pentagon and others are interested in this in particular in latin america and elsewhere. so in summary this is a scientific approach. it comes that this problem from a different angle. law enforcement does what it does and this comes at a different angle of the same time so it's synergistic. this behavior change and validated not only by research studies but by very detailed independent studies and it allows us to begin to think about this problem differently than punishment. this is a intentionally medieval script into a new way of thinking about this as an acquired behavior where we need

to do different sets of actions. the advantage of this is a safer neighborhood, newer angle using an effective approach, adding to law enforcement and i want to highlight changing the norms which is the long-term solution that we want in our neighborhoods. these are our challenges. the biggest challenge is sticking with the model. if you do the model the way it is, it works. if you are doing something else or saying you are, good luck. if we can help in these ways and myself and candace payne who was with me and josh grant woods will help on the adaptation of the model, assessing whether your city is the right place and you have the right hotspots. on changing norms, the hostile intervention which i didn't have time to talk about really and educating our adversary on this approach. these are -- and you also have

information in your seats. thank you very much. [applause] >> dr. slutkin thank you very much. we are now going to hear from stephanie rollins blake. >> good morning and thank you. i've like to thank you mayors and mayor nutter for convening this form on a critical topic in after hearing dr. slutkin, let's just go right into question-and-answer. so given its unique approach and demonstrated effectiveness baltimore implemented the cease-fire chicago model back and -- sorry, 2007. it is overseen as you should be based on the model by the city's health department and an plummeted by a community-based organization in a police post with a high level of violence. a role of the local health

department in combating any public health issues such as aids, heart disease or cancer is to identify and interventions and work with the committee to implement them with fidelity and monitor the effectiveness. as such the city's health department has adopted the same approach to combat violence by creating the youth violence prevention under the safe streets baltimore program. the health department is responsible for managing a vigorous defender and site selection process as well as providing technical assistance and intense monitoring to ensure the adherence to the cease-fire model. additionally the health department implements a citywide public education campaign and develops plans for expansion as well as sustainability. the program currently operates in two of the most violent neighborhoods with two additional neighborhoods to be launched over the next year. eligible areas are predominantly in the top 25% of communities in

areas with the highest rates of violence and implementing organizations have a history of proven success with the targeted areas. when funding becomes available community-based organizations within the eligible areas are encouraged to apply through aarp process. critical for new site selection, excuse me criteria for new site selection includes a demonstrated understanding of the cease-fire chicago model, the organization's capacity to implement the program, the reputation and credibility within the targeted area and experience in providing services to the targeted population. sends dr. whitehill will present the findings of the independent evaluations i'm not going to go into the specifics of the program however i would like to briefly discuss what we believe attributed to our successful results. first come first-come as first msn evidence-based program it's essential that the program is implemented to the model.

having staff separate from the site level individuals as we do it health department to monitor model parents and provide technical assistance has been critical to our success. we piloted the adaptation of the model with the modified staffing plan to two adjacent police post, one who determined the model didn't quite have the same level of effectiveness we reverted to the standard model on the police post. second evaluation identifying conflict mediations were key to the reduction in violent incidents and specifically significant reductions in homicide -- and we had as many conflict mediations per month as significant reduction. having the right outreach staff with the right skills is the most critical elements to conducting high-risk conflict mediation and it's essential to the initiative.

finally, and i know this is a challenging time for mayors all over the country when it comes to funding. i will share some cost information related to the program. baltimore has the distinction of operating the longest running cease-fire replication and since the program's inception we have never needed to spend operates -- suspend operations because of lack of funding. we attribute the program, the sick says that to being housed within an agency that has the capacity to obtain funding from a broad range of sources, federal and state grants as well as foundation, support and individual donations. and the help of dr. slutkin. danno cost of implementing and monitoring safe streets in baltimore was $500,000 per site. that compares to the cost of both financial and emotional shooting incidents so the cease-fire model has saved many many lives in baltimore and last

year we were down to the lowest homicide rate since 1977. and i'm pleased with the results and hope to be able to spread it in more areas. thank you. >> thank you, mayor. [applause] ms. whitehill you are next. [inaudible] i am jennifer whitehill -- okay. is that better? i am here on behalf of my colleague at johns hopkins and the together completed the independent scientific evaluation of baltimore safe streets program. i'm really grateful to be here today to discuss their findings

with all of the. what we found in a nutshell is that safe streets had great success in reducing serious violence in the neighborhoods where was implemented with the most fidelity to the cease-fire model. our study focused on the four neighborhoods were safe streets operated between 2007 in and 2010. these neighborhoods appear on the map in green. the first safe streets site was in the calgary park and later that baltimore side was expanded to two other neighborhoods, elwood park and madison. there was another site in south baltimore and a neighbor called cherry hill. the yellow areas are the other neighborhoods that were also in the top 25% for homicides in shootings. that is what we used as a comparison group for a study. we also looked at the neighborhoods before the safe streets neighbor is to see if there was a spillover and the results to those neighboring areas. at that is what you see on that map in blue. to measure the effect of the

program on gun violence we obtain from the baltimore city police department through each neighborhood we measured changes in homicides in the name -- might not be low shootings before and after the program is implemented. we compare that difference to the same time period and the similar high violence neighborhoods and we made the same comparison for the border neighborhoods. we wanted to be sure that the results could be attributed to safe streets and not something else away control for for the basement level of violence in the neighborhoods using variations, drug arrest, weapon arrests and also special policing activities that were focused at the same time on reducing violent crime. this table shows will be found in terms of the percent change of homicides and nonfatal shootings relative to the comparison neighborhoods. the asterisk indicates the results that were statistically significant part of the clearest results when the cherry hill neighborhood. after safe streets was implemented there that neighborhood had a 66% decrease

in homicides in a 34% decrease in non-fatal shootings. it appears as some of those positive effects spilled over to the adjacent communities. things are a little bit more complicated in east baltimore. initially they might calgary park neighborhood saw excellent results with those three sites did share a management team and by the time the program got going in that neighborhood it happened that a very long-running gang shoot arrested the same month the program got started and that was before the outreach workers that dr. slutkin was describing had an opportunity to get in the community and influence things so an additional complication was that some of the staff resources from mcelderry park were directed away from that situation but we did find that mcelderry had a 63% reduction in homicides during the month when the staff was not occupy it and a in a whole other area. so in elwood park we did not see

reduction in homicides but there was a 34% rate action and nonfatal shootings. for those results for gun violence are the primary outcome for our if i wish we want to see the program did indeed change the social norms about using gun violence to settle a dispute. we wanted to test the theory behind the program so we undertook an anonymous thestreet survey street survey of young men and mcelderry park and the similar neighborhood that didn't get the program. our survey, on our survey the young men indicated how likely they would be to use a gun in different scenarios that are considered common sparks for gun incidents and we found that in mcelderry park in the safe streets neighborhood, the young men were four times more like you to express little or no support for using a gun after we controlled control for other factors. so overall we found that this model can be replicated effectively and can lead to very

impressive reductions in shootings but it's important that the model be implemented with high fidelity. there was also evidence towards that these change social norms about violence so that is the short and sweet evaluation and i would be happy to take any questions later. [applause] >> thank you jennifer. next up is mayor mitch landrieu. >> thank you for your leadership on this issue. i have enjoyed working with you on cities united. i want to just say a couple of things. we tend to get in these meetings and the language gets a bad antiseptic so i'm going to change that for a moment if you don't mind. ..

>> not the last time i checked was around 10% and 12%. run the numbers a little bit, and you had to ask yourself what it means. what is means is young black men

are being slaughtered on the streets of america. that's what that means. a now, some people think that's too harsh, so let me prove my point to you. my city, the city of new orleans, for example, has about 360,000 people. y we had 199 murders last year which puts our per capita murder rate ten times the national average. we have the worst problem as it relates to murder. incidentally, violent crime, we're the 80th. there is a distinction between violence and murder. from a public health perspective, we have to see it that way, but statistics in new orleans are similar to those in philadelphia, new york, chicago, baltimore, everywhere elsewhere in certain neighbors and our cities, you have young men killed at sometimes 100 times the rate of the national i average. now, this is a national epidemic, and it's not okay, and wet. have to state that, and the

lives are important, and we have to do something to stop the carnage on the streets of o america. there is a school in new orleans where there were five young men that coincidentally went to the school, were killed ould tell, be . been struggling about is what makes people stand up, what makes people stop. and so on going to say two things that might upset you. that's why we're here to do. first of all, mayor mike has said the number of different times, the ku. >> klan killed 200 african-american man on the streets of america their ordeal to pay .

the world stop moving. i mean, the sun would stop shining. all the sudden we would not be talking. we would have a serious talk. the other day my wife was listening to tom joyner. and there was an african-american female columnist on talking about a report that she read from evidently a caucasian border who blocks for russell simmons. that will test your head up a little bit. he was talking about chicago. this guy who was a caucasian said it 53 when people got shot in chicago over the weekend the president was stop what he's doing, call at the national guard. so basically what you have is a little disconnect. if you don't pay attention we're not going to pay attention. so it all gets down to it's not my fault. so here's the other thing that we all have to get our hands

around. not everybody is to blame. we are all responsible. if we focus on problem, analyze it the right way i think we can solve the problem. if it's something that we don't think is a major problem, a national epidemic, important, priority, and don't put the resources, time, organization behind trying to understand it. in the city of new orleans, for example, ten times the national, we went back and looked at it. of course people say, you're not doing a good enough job. there something wrong with your police chief, something wrong about the way you come near. i agree with that. so we went back and looked at the data. we found was we went back as far as we could. 1979 to 1980. ronald reagan, jimmy carter, larry bird, alice cooper, way back when in the day we have had

an average of 241 murders every year on and on and on. some years got better. some got worse. when you went back and look at the average was tells you this is a very deeply rooted problem that can only be dealt with from seeing it as a public health epidemic. so the cease-fire model is built on an idea that is exactly right. it is one of many, many tools that we have to love to get to the problem. unless we recognize it is deeply rooted in a lot of very serious things may not going to get. the doctor used the word transmissible, and i want to tell you a brief story. i'll stay within my time. last week in the city of new orleans there was a birthday party for nine year old boy taking place. thirty seconds from city hall and a residential neighborhood. three young men were driving down the street and saw somebody they have been looking for on

this porch. they got out of their car. one of them took an ak-47 and spread the neighborhood. when he finished spring the neighborhood rihanna allen who was five, the cousin of the nine year-old to have heard gets blown out on the porch, the nine year-old got clubs here. a bullet traveled three blocks down the road and hit a mother of three young boys in the head and killed her instantly. now, we -- as you can imagine, a very dramatic event for everybody that saw that, that went through that, entire family the funeral was held and then we had in new orleans will recall a repass. everybody comes back to the house. we are sitting down. we have these things called metro ground. just having some with the family . walking toward me were two people that have recognized.

as i walked up to him i recognized him. this man was the father of a young african-american boys who had witnessed the death of a two year-old three months earlier whose name was key era homes to get gunned down in the courtyard of the place where she lived for 20 other kids were. and then the lady next to him says, you don't remember me do you. no, remind me. i'm jeremy's mother. the 2-year-old it had been shot months before it got caught in the drive by. these two people talk about transmissible, work together. the son of the young african american new. so this'll boy himself saw and knew three people who were five for youngbear that cut killed.

now, the transmission and complexity of that over a long time is something that we ought to all stop and say, we have to find a way to get into that and to stop that. we will not be able to do this, by the way, if the nation is not called to purpose on this issue. i do not want to hear from congress that they don't have enough money to do this. the new york times reported last week, if it was accurate, that the united states of america spend $8 billion nation building in standing up police departments in iraq in afghanistan. that may very well have been unnecessary expenditure, but it is hard for me to believe and to understand as the mayor of a major american city that if the point of that is to secure our homeland by helping their security forces be secured that we can find a way to bring that money full circle and partnership with federal, state and local government so we don't

have to rely on wonderful people like that of robert johnson foundation to do for the people of america will we should do ourselves. the good part about this is if we identify it, call the mission to purpose, and say it is important to save the lives of young african-americans, we can. we know it is fixable, but it takes time to resources, money. i'm proud to tell you that we have cease-fire. it's a great model. the model works with you guys in baltimore and philadelphia. and what has gone on in chicago, really bright light spirit is one of many things, but we have to start with saying it is a national epidemic that we will not tolerate and do everything we can to fix. thank you very much. >> now you know why he's my partner. >> thank you very much.

i am fired up and ready to go. well done. i just want to share a few things with you from our experience in fresno. as was mentioned, we are not implementing the ceasefire program that has been presented this morning in its entirety, but there are elements that we have been able to incorporate actually from all law enforcement perspective. of talk about that in a moment. i want to say that i am very compelled by the other elements that we are missing in fresno and very eager to see how we can rate those pieces. i am extremely encouraged by what i see happening in our community. people standing up and saying enough is enough. interestingly it is coming from moms and dads and grandparents. we have an organization in our community called the fresno st. that was brought together by seven african-american pastors who knew each other. this gets to the point of the

epidemic. a particular family event, one of the pastors lost his grandson in an incident of violence. a similar situation as to that which the mayor described in a family gathering, rival gang members came upon the gathering and this past his grandson was lost. they were gathered for the funeral, the family was there grieving going through all the normal processes. they realize that there were running out of some ice and some help. so they sent to other grand kids down the street to the neighborhood store to get a few items of aggression store. and as both children were walking to the core stores one of them was gunned down as a result of gang violence and unintentional crossfire. some needless said this series f

events sparked really what has become a community of revolution and transformation with many of the african american grandfathers' coming together saying, we cannot lose anymore. i had a mom and my office not long ago whose son was going through the criminal justice process and was involved in gang activity. she relate to me that all of the moms or friends. this particular rival gang situation, she could name all of these kids' moms and said, now our sons are killing each other. so i certainly share the passion that uc from these other terrific leaders and communities and understanding addressing this. what has been going on in fresno from a law enforcement perspective. this is an important element and i appreciate that it is not the

focus and the system solution, but nonetheless it is extremely important that our law enforcement agencies are working in coordination with one another. not being a strategically deployed as they can be in an era of diminishing resources. we have to fix that problem. so we have been working with david kennedy out of the boston area cease-fire. we have begun to the line every level of law enforcement to target the ten percenters, those who are 10 percent of the people who are committing 90 percent of the violent acts in fresno. really, probably, many of the have heard this, but the signature feature of this particular program is the call-in where you invitees ten percenters to come in, usually held at churches and they hear

from law enforcement at the local, state, federal level, but they also hear from former gang members, reformed gang members, trauma nurse or in the are dark and a spectrum of people who all send the same message which is violence must not. and it, the combined message, you have to stop. you know you will be locked away for many, many years. if you choose to stop there are a range of resources available to get you out of the lifestyle you're in now. after the law enforcement panel there is the record of service providers to come in and be with the individuals and connect them with services in an attempt to help them begin the process of exiting the gang activity they are involved in. so far they have been doing this for the last two years. 315 people called and. of those only five have recommitted of federal or violent act. so there has been a tremendous impact on at least sort of

jarring people's attention. we have seen a tremendous reduction in violence. what i am inspired by this morning is the idea of raising up the interrupters. honestly i think this probably sounds like the hardest thing to implement, and i'm curious to hear from others on the panel how you go about finding people who can be effective in that capacity. what we experienced is that those suits -- it's difficult to find those with the credibility needed to relieve fill that function. those who are willing to almost upon admitting they're willing to do it become, you know, it's difficult to get the credibility that they need. i'm anxious to learn more about that peace and see that added in. i am also really curious about working with hospitals and finding out -- that is so clearly the right spot to intervene. you know, we typically have police officers all over the

place. anticipation of retaliatory acts. we don't necessarily have the community response that goes along with that. i'm anxious to learn more about that. thank you. >> thank you. and we will hear from now jane. >> thank you very much. i want to thank both the mayor you have heard our of implementing the ceasefire chicago model. your new insight that reminds us that there are many different pathways year that we need to take to come together and solve this problem. so i just want to put forward the importance of using effective solutions to solve this problem of gun violence in american cities. now, you might wonder why the

largest health care foundation in the united states really devoted all of you who are in pr offensive probably heard, brought to you by the robert wood johnson foundation, designed to improve health and health care for all americans. so you might wonder why we have an interest in reducing gun violence. that will be a fair question. we regard violence as a pressing public-health issue that strikes at the heart of the community and well-being of individuals, families, and whole communities. and ed disproportionately affect on low income communities and vulnerable populations. as you heard from everyone here, young men of our city, these are areas where the foundation has always placed a very special emphasis. so it goes without saying that gun violence, the toll of gun

violence is very clear commander should not get ourselves about this happening just in one neighborhood, one city or four neighborhoods in a city. doesn't affect any of the rest of us. believe me, what happens to people in cities across america, rural communities across america, suburbs across america affects all of us, and we need to remember that whether we like to burn not we are all very deeply interconnected. clearly you have heard from gary and from others about the contagion of violence. we know from other work that we are doing around behavior and neuroscience and the evidence that is rapidly emerging around brains and brain science that this is an important issue. and it is no exaggeration to say that gun violence is an epidemic and one shooting leads to another.

i assume that nothing commands your attention more than and needless homicide as the lead story in your morning paper when you go to read it weather on line or you actually still get the paper. it is also clear, and this is where the neuroscience comes in, that the physical and mental toll that takes place for people is not just among those two are directly affected were involved in acts of violence. in these neighborhoods and the mayor provided an excellent example, many examples of where people have been exposed to violence and how the chronic instability in the neighborhoods affect people's lives, and we know that when a child is exposed to violence that it has a very long lasting impact on their lives. and this is what in the parlance of the sciences called toxic

stress. this toxic stress can wire or rewire a young child's brain such that they are far less likely to have healthy relationships, succeed in school, or be physically and emotionally healthy. and that creates greater risk for disease and disadvantaged. so the evidence is for how and why to present the epidemic of violence borne out by silence. so it is an approach. a public approach that seeks to interrupt the spread of violence, much in the same way as carey described we seek to interrupt the spread of infectious diseases. so at the risk of being redundant the foundation supports the cease-fire model to combat gun violence because it works. that was our hypothesis ten years ago when we began our invest in addition, and since then the foundation has committed nearly $10 million to develop, test, and spread the model and tell the stories the

you're hearing today began to develop for them a business plan and strengthen the organizational capacity for replication. provide the technical assistance that is available to all of you across the country to help replicate this model. and we know that the technical assistance is bearing fruit because of the visions of mayors like those who are with us today . people, these mayors and others are open to different solutions, one set would sometimes have to be explained to a skeptical public. the opportunity in a community, it is a cost train through lost wages to the depressed housing values, low jobs creating investment and exceptionally high use of police and emergency

room services. if you can stem the violence it opens the door to strengthening communities, to making unhealthy , and it strengthens them in ways that are fundamental to this health and vitality, investment and schools, businesses, jobs, housing, and someone. while we have committed significant amounts to the cease-fire model, the reality is that any philanthropic resource to tackle such a vast problem are entirely insufficient and it is unrealistic to think that we will support this work indefinitely. so other partners, including u.s. mayors, need to come on board based on the evidence and the track record and help spread a novel model that works. we can do this together. we don't want to wait any longer. we cannot afford to watch any longer. the payoff is enormous.

if you have fewer shootings and killings to revitalize neighborhoods in a fundamentally healthier future for the people and communities you leave his division and it certainly is the goal. thank you very much. [applause] >> what a great, great panel. we want to thank all of our panelists for their presentations on this very important topic. we want to open the floor to the mayor's. a really brief note, certainly to recognize the work, we have in philadelphia shown that there is a movie called the interrupters. about two hours. a little less than two hours. we have had a number of showings it is very powerful, compelling, but also some very clearly tells

a story about what is really going on on the streets. it was made in chicago, but quite frankly it could -- you could watch the movie, close your eyes and you could be in any city in the as its american. we have shown in the number of times and planned to show it during the course of next school year in a variety of places all across the city of philadelphia. so with that, if there are questions, comments, concerns, just raise your hands. >> a quick question, and i appreciate this model. we were talking. this model makes sense. we have seen it work in a lot of different instances, as he talked about earlier. if someone lit a cigarette in this room would freak out.

we have changed the norm. one of the things they have stir with personally and professionally, some of this violent behavior in our streets, the psychological long-term psychological damage that has been done, particularly with african-american males. that is being played out by this violence. the question is how we begin to reverse that. once you get beyond making this non example warm and allow bill cosby for bringing that to bear on the latest incident be dealt with in baltimore the question i want to know is the next step? there is something psychological challenging when african-american boyer and the man can point again at a boy that looks like them and say it's okay to pose for granted to life.

>> i will tell you, give you another statistic that will schedule a little bit. at least in new orleans 88 percent of young men actually know each other. >> we can add to that. not only do they more often times than not know each other, but on any given week on a monday you could have a person who is a perpetrator engage in some criminal activity. by friday that same person is a victim. most of the folks involved in criminal activity, violent crime in the 70 to 80 percent of range for both have previous criminal records, multiple arrests and are all what we would call in the game.

so the overall majority of violent crime in most cities in america is committed by a relatively small group of people who are all to see each other around. when there are perks, the next victim, and in many instances some have been shot multiple times. through the windows of science and medicine this survive in this circumstance. so you get a sense sometimes that this criminal activity is going on. it's not random. these folks on of each other. this week is about something that happened two weeks ago with somebody else. brother, cousin, nephew, friend. whatever the case may be. they're all just chasing each other around. >> let me just remind anyone cannot if he could raise your hand, we will be here after the session. i will be here all day today.

if i could connect with anyone here. in the context i want to really remind everyone, the business of transmissible has really correctly last on to and not a metaphor in more. i mean, the science of this is really solid. that is what the institute of medicine workshop really landed on. it really is infectious and we have fundamentally misdiagnosed this problem. this is a very important and essential concept that we have been mistreating because we have misdiagnosed it. we need the son in the effort of course, but my original diagnosis which was people did not care enough, there wasn't enough money in it, not the

whole thing. it's really that we have really not been applying the right approaches. it feels good blocked. malaria was blocked forever. loudobbs@foxbusiness.com

>> which we know more about than 10-15 years ago. actually, we need to know this. it's not consequences. they are not worried about the consequences. they are wiredded not to care. go out into the world and prepare because they are supposed to protect things and do things and save the world. what they care about is what their friends think. that's the way we are evolutionarily wired. furthermore, they need risk. they need risks to be normal, to feel normal. that's the normal way, not even

the disregular so the way that we see this in terms of using the since for interrupting this is that this is really free stuff, and in order to reduce the trauma, we have to -- in order to reduce the effects of the trauma, one, we have to begin to reduce the trauma that's happening which means that we have to reduce the shootings as fast as we can which is what the interruption part does. point one, we got to interrupt the situation, and it's not just the long term method, but this method gets result when you use the model in the first 6-12 months, and point two, shift north. it's done sequentially, and then we have to slitly begin to put into place some kind of treatment.

professionalized health care for people repeated by traumatized, and we're treating with the workers themself on how to help others manage. there's methods for that that we've talked about, but there are new interventions that we need to bring to scale, but we're really not being honest if we're just treating the trauma, not causing the problem and the other aggressive stuff going on. >> i just want to say one word about the trauma for the mayor of denver. there is a physician in philadelphia named john rich who also is a public health doctor who is working very hard on the issues of trauma op young men, and i would encourage you to

take a look at his work. it's focused a lot on trauma informed care so how do you prevent the killing from happening, how do you begin to engage with the young men around these deep issues of trauma? i would also say that from the philanthropic community now, there is a huge surge interest and a lot of activity happening around the needs of addressing young men of color in this country. we are focusing on middle and high school young men of color. there are my colleagues at numerous foundations and cities across the country looking at this along the developmental spectrum, and it really has to not only deal with the terrible issue of violence, but it also really needs to go back and why removing kids in school, why not

create pathways for success, and barriers and issues here. we're focused on the issue of violence, and it is big and powerful. we also have to remember that the solutions lie upstream with the business community, all of us have a stake in making the lives of our young people, whether they are young men of color or young women better, and so we have to think about in this situation as gary talks about as in big intersecting circles and work within the communities to gather up all of the organizations that are in one way or another coming at this problem from different points of view. >> just a couple of interruption, immediate

interpretation, like stop the shooting right now. don't care what's going on, where you came from, where you're going, stop the shooting. that's interruption. transmission, when you -- she said when you get upstream on this thing, bring it home. a little girl's father was killed, and it's the same place we buried a 16-year-old boy killed thee months earlier. two days after, there was a free lunch program in the same church where, by the way, a lot of us have a lot of usd on the table in the summer because we have no place to feed the kids so we partnered up and they were in eating, and we are a table, i don't know, 22 5-year-olds, and i couldn't help but look at them and say where are you going to be? the kids who know each other, killing each other, all in the

game, one of the great danger, and i hear this from everybody is, hey, i can't touch that. that's not me. those are thugs killing thugs. they were not always thugs. one day, they were that 5-year-old at that table in a church eating a free lunch going through a recreation program. on the issue of interruption, if we don't change what we do now and interrupt, what happens between 5-16 for the young men? they do the same thing. what's the upstream or downstream conditions that have to be changed so we do you want produce the same outcome that we have now. now, cease fire is like, you know, putting a plug in the dike, like, doing more than that, but right now, it's taking the kids there already and saying stop what you're doing. we have to get way down and way early and change the condition so we don't have that problem for those same kids ten years from now. >> two quick questions. mayor henderson from f. myers,

florida. is the power point available? question two, in our city, we're having challenges with our witnesses getting a -- >> getting what? witnesses getting what? >> lockjaw. >> i understand. >> go to silence, lockjaw. that's a crude term, story. you get it. >> yeah, yeah. >> could you help us how you deal with this in your cities? appreciate that, thank you. >> sure. you know, there's been this, well, on the figure question, i'm sure that they would make this powerpoint available to everyone. in philadelphia, we certainly combat, don't call it lockjaw, but referred to as no snitching,

and then witness intimidation, and we've had a couple bad situations, but in many instances, you know, folks, again, folks in many instances, all in the same neighborhood, everybody knows everybody, there's family, friends, friends. of friends, associates, all the rest that goes with it, and, you know, some of the issues then, somebody else, folks in the neighborhood know who did what. there's no bigamist ri -- big mystery here. all the folks talk. they couldn't keep their mouths shut if their lives depended on it, but they will not call the police because they don't want to deal with the system or the man whatever it may be. we deal with this ourselves. we're back to that.

we have to cool that down immediately. often, literally starting at the hospital where the one who got shot, and the boys show up, okay, we going to get -- all kinds of language, not appropriate for the u.s. conference of mayors or c-span. >> or c-span. >> so, i mean, you really do have to chill that out immediately whether it's at the hospital, in thed neighbor, and all of the other components that go with it, and so that's where boots on the ground make a difference, and having people in the neighborhood who are prepared to stand up and step up, and that's what it's about. we do have, in many instances folks stepping forward. in philadelphia, we put our -- couple months ago, 100 most wanted folks up on the city's

cable access channel and city's website, and within two weeks, 21 of the folks were either arrested, turned themselves in, or we got information on where they were. people really do want -- everybody wants a safe community ultimately. you have folks out there who are not, you know, engaged in the common amores we maybe, but we have to provide them an opportunity, and in some instances, sam thing the young people use, social media, texting, tip hotlines, anonymous opportunities to give information to get the stuff out so we can do our job, but i think the no snitching attitude is a major challenge in many, many places, but we have to give people a sense of hope in that they're protected and not subject to retaliation themselves. >> okay, thank you. >> sure, yeah. >> right here. >> yes, sir. then come right down here.

there's a microphone for you. >> morning. i'm wayne hall, mayor of hempstead, new york. just a couple questions. on wednesday, i'm to meet with the national county da to try to implement cease fire, and what i want to know is how do you determine interruptions? how do you screen them for that? >> sorry, what? >> figure out who to interrupt -- >> people who work with you on the cease fire. >> in baltimore, it's people who, as mayor, wold -- would say have been in the game. choosing the right individuals. that's something -- that is out of my lane. you know, i know the work of it. i can explain it. i don't speak -- i wouldn't be speaking with any credibility. they need people to have been

where they've been. that is the benefit of that is when you get that right person, you're able to get the results. the challenge is making sure that person's out of the game. >> right. completely. >> i want to answer this because there's so many mayors here. our experience, and in watching cities try to do this on their own, is that ordinarily, it's not so exactly likely that people are going to be selecting the right people op their own. we are -- we have a lot of experience in helping in this, and there's criteria for this, and there's research to be done in the neighborhood on this because you need to determine, that's what we talked about with the assessment, what is actually going on in this neighborhood right now? are there five groups or three groups? a bunch of cliques?

random stuff? what's going on here. who do we need to hire to interact with the various groups or cliques or whatever? who knows them? then point by point by point, we have to go through an actual systematic process of determining who has that roladex and who has both his or her feet on this side of the line now, but not a toenail over there? and they are hungry to do the work. >> right. >> and they can do the work and so on so there's a whole -- and then they're not random. five interrupters in city w. no, it's a part of a control disease system supervised with monitoring and support and training. there's a whole training program i didn't get into for interrupters, for outreach workers to do persuasion, do behavior change, do norm change. we're seeing people like hiring

interrupters. it just means -- okay, hire a chest surgeon. no. they need to be the right person and properly trained. >> we should get in touch with june? >> yeah. [laughter] >> that ends up being the bottom line. >> a few other mayors back there. >> okay. >> good morning, i'm from the city of west palm botch mayor. talk to us about the implementation process, where to start, how long it takes, and, you know, a little more specifics about that. >> why don't we get mayor rollins some time. >> i think it's in the presentation. it was really a blue print for the way we handled it. first, identify the areas. we do this all of the time with our city step process. we identify where we have neighborhoods that have historic violence, historically been violence. identify those, you know,

intense dots on the map, and after you do that, then you have to make sure that in those areas and one of the areas that we first talked about, i mean there was a lot of violence, but also strong community groups there that wanted different so you have to -- you have to have all of those things. you have to have, you know, the unfortunate part, the violence, and then you have to have that community group able to do something and wants to do something in the fight with you, and then you can layer on the work of identifying the potential interrupters, and, you know, i would encourage anyone that is interested to learn from the mistakes of other cities which is, you know, you can't -- it's not something you can -- you can't take the powerpoint and do it. you need to work with a group to make sure that you are sticking to the model. the same way we were talking about a public health issue, the

same way you can't listen to a lecture from a doctor and diagnose people. you have to work with the professionals that develop the program to get results you want, and it's only through, you know, strict adherence to the model that we're getting the results, and you have to figure out in your city how you can get that strict adherence. you know, because we try different ways, and then, you know, it's the work with the health department as the lead in the cease fire, safe street, you know, that was able to make sure we are sticking with the model. >> we're going to -- i'm going to take a couple questions. we're a little over our time, but this is obviously a very serious discussion, and then i know there's other activities going on. take a little point of privilege. i want to follow-up on something that mayor mitchell andrew referenced, and he and i and a number of other mayors looking

at this from a national perspective, and so i know a lot of folks are taking notes. you mite want to take this down. now, on september 11th, 2001 in new york, washington, and in a field in pennsylvania, 2977 people were killed. horrific attack on the united states of america, and it's been an incredible response to that. last year, there were 5 # 15 # homicides in new york city. 63 in boston. 108 in washington, d.c.. 19 # 6 in obama. 324 in philadelphia. 298 in los angeles. 199 in new orleans. 433 in chicago. 87 in atlanta. 344 in detroit. 91 in newark. 198 in houston. 147 in memphis. the top five cities in the united states of america plus

eight others. don't bother doing the math. it was 2981 in 13 cities last year. even though crime has generally been going down, if you want to know how many people in those 13 cities total were killed over the last ten years, of course, multiply by ten. now, what happened as a result of 9/11? we created -- government created a cabinet level position, the secretary of homeland security. unless you are from orlando, every one of you had an experience with the tsa, transportation security administration, almost had to take your clothes off to get an airplane. that's fine. everybody's safe. as long as you don't miss your flight, it's cool. i sat in a speech inial has tee with -- tailtallahassee with mayor john

marks. the tsa, the transportation security administration, in the united states of america, on our streets, what we need is the wasa. this is the walking around security administration. [laughter] we need to be as safe in our cities on our streets as we want to be flying anywhere in the united states or around the world. we changed security procedures for how you fly in the world as a result of that horrific incident on one day in the united states of america. yet, last year, in 13 cities, more people were killed than were killed on one day in that horrific attack. i want to be safe flying. i want to be safe walking. that's what we need to focus on. next question. >> amen to that. yes, sir? >> scott eisenhower.

i appreciate your thoughts on the issue and on the program. my question for you is with a bit of a statement ahead of that. unfortunately, for all of us violence crime is not just a big city issue, but an every city issue. >> absolutely. >> for communities of less than 50,000, can this program work? >> we are working with some smaller communities including communities in illinois. >> i mean, we -- it works best when there is a serious problem, and that's when it is most effective and should be used. >> yeah. last question. yes, ma'am? >> good morning, i'm from gary, indiana, and i know my team was talking with your team, and there's a lot of similarities, and i've been involved with the

drug court, and there's similarities in terms of changing the norm and other aspects of the cease fire movement. my question is in terms of your colleagues and the medical field, a lot of the movement in the drug analysis in terms of drug treatment -- drug addiction as a disease came as a result of the medical world. is that -- are you having that same success among your colleagues, among the physicians to look at violence as a public health issue? because i think that the more of them that do, the more success we'll have in this area, and then my other question is how involved is the faith community in terms of getting involved in the cease fire initiatives that are underway? i heard in fresno they actually started your program, but how involved is the faith community in terms of what's happening

with cease fire safe street? >> i'll just take the first part of this one. i'm glad you're here, and we hope to be working with you and hope to be and aware of the programs there. the health community needs to be much more involved. the health directors, public health departments need to begin to step up. they have not known, i think, until this model that there was a place for them on the serious violence. in other words, by convention they've left that to others who are, you know, controlling the resources in this issue, but they have been involved in work related to younger children and school bullying and thingses like that. there is a place for them now, and we need the health directors and the health departments of your cities to begin to step up as baltimore has to again to and

others to take a very active role here because not only is there a place for them, but the face of this issue needs to change to a health matter so that the more, in a way, positive, helpful, supportive, effective treatments can be applied or at least added to what else is there. >> [inaudible] >> yeah. it's been really a key component of what we've been doing in fresno, and we've got networks of churches throughout the city that organized themselves to kind of cover each geography of the city with various faith-based organizations. we have groups as well as different, you know, different deno , -- denominations and religions coming together. we have a street team doing

community prevention and outreach work for us. our police department initiated a partnership in the really historically most dangerous part of the city in southwest fresno. we got 50 different faith based non-profits that meet every week with the police department and stage a range of programs and activities and outreach year round starting in southwest fresno, and now they are moving to southeast and central fresno, and, you know, they are very small churches. it doesn't have to be megachurchs deciding this is the main focus. these are most churches that are small. as they come together, they are very, very impactful, and they have the relationships needed with the grandmas and grandpas and the guardians and others involved in the lives of the people we're trying to impact. >> i am forgetting the serious signal -- [laughter] this has been a most engaging conversation.

i want to thank the panelists, and i also want to mention to the mayors and others that it is important to have boots on the grounds, but as mayors, we have to continue to advocate for and push for support from our federal partners, our good friend, shannon, in the back from the cops office, the cops program, important, all across the united states of america, and so certainly see her and make sure that we have our voices heard as mayors and community leaders with regard to law enforcement, but our police departments as good as any of them are cannot be and will not be the only answer to the particular challenge. it is a community based problem and community based solutions, and the answers from gary and jennifer and others are, again, on the front lines of making america the safe place in our

cities and the safe places to be. let's give our panelists a big round of applause. [applause] >> thank you.

>> senior executives from the nation's largest defense contractors took part in the forum in colorado last month. representatives from boeing and lockheed martin discuss private sector's role in u.s. homeland security. the aspen institute holds the security forum annually in colorado focusing on issues ranging from counterterrorism to cybersecurity. this portion is an hour. >> earlier panels have often made the point about how important it is that both the public and private sectors come together to work against the challenges related to security.

i have the great pleasure of introducing a terrific panel of defense and security related business representatives. before i do that, i'd like to thank walter for including target in this aspen security forum, and i'd also like to answer a question that phil put to me last night which was why in the heck is target here? [laughter] phil didn't say heck.ir that's a fair question. after all, we sell all of that y cool stuff for your household co and your family, the stuff you really didn't know you neededre. until you came into the store.ot we don't sell defense productsnd or security services. now, a little earlier, my friend and colleague, brad, god a staro on the answer commenting on our private-public partnerships with law enforcement for the purpose of addressing terrorism and other threats to the community. that's a good start at an answer t

. against terrorism or ct path to improved tort security. the results, businesses take more responsibility to secure our cargo against terrorism and the government can then provide more efficient and timely customs inspections. everybody wins except the bad guys. but the better answer goes back to brad's point, that there is nothing more important in protecting our more than 365,000 team members and other members of the public. that is a critical part of the target mission and that is why we employ talented security professionals like brad and his team and then share so much of

their time and talent with the community. unfortunately, the recent violence in aurora the mines -- reminds us once again of the importance of this mission. i'm sad to say that one of our key members was killed and two of them critically injured and that senseless tragedy. for all of the survivors are discussion today feels especially timely and relevant and meaningful. we have target are truly honored to be part of the security forum. thank you, walter. and now to talk about how the private sector is continuing to innovate in the security space, please join me in welcoming our panel is. we with us. buswell president and ceo of morpho detection, thomas grumbly vice president of several government programs in washington operations of lockheed-martin.

john harris to second president of subby technical services company, roger krone at knowing and wesley rhodes deputy chief technology officer, ibm federal. and the moderator of the panel, national security correspondent for "the wall street journal," adam and his. please join me in welcoming adam and our other panelists. [applause] >> thank you very much. when it comes to, as you well no, over the last 10 years has been tremendous intimation that is change the way homeland security has done and how warfighters conduct their efforts in afghanistan where you have drones that are sapping militants and you have tremendous surveillance technology that is used to charge the soil to see if there has been any disturbances that could point to ieds.

the men who are up here do for the cia and dod what q did for james bond. they develop the gadgets that made this possible. given the trends that we have seen in the wars in iraq and afghanistan i thought we would start with an issue of big data, which is the cnn afghanistan and iraq initially as general petraeus was collecting -- they could collect, intercept sms's and all this information that pass passed by phone and from that able to pinpoint the location of militants. it has become so sophisticated by the end of the campaign in iraq that if they militants tossed his phone taste on a pattern of phonecalls, they were able to trace likely where that's militant, was now using

and pick up his or her trail. in afghanistan in the last few years, this is the same technology that is being used in ways that is mind-blowing. it's to the point where in a pillage they would collect data on the price of potatoes, you know the traffic flows in a community in addition to sms and he brings out altogether and you are getting close to what is referred to as the holy grail of being able to almost predict what's going to happen next so these are the ultimate correlation tools. so all of these companies here out of hand in this, and i thought we would start off by maybe discussing what you guys are doing in this arena and what the trends are so i don't know who wants to start. >> you are looking down here so i guess i will start. what are the trends? you all heard the term big data.

big data is going to get bigger and bigger and bigger. one of the values of big data is it allows us to ingest or receive this vast amount of detailed records, vast amount. and i think one of the biggest benefits that we get out of big data analysis is that ability to predict, that ability to understand the world around us but also allows us to eliminate the process we have been using all this time. we can't measure a prc until he find out something that we can measure and we draw a correlation or a relationship to the things that we can't measure and then that is the way that we guide and understand how things are going. can't measure nutrition so i look at other indications of nutrition, height and weight and so forth but what big data does is allows us to understand the world and its complexities, understand exactly how it really

is. so that necessitates a lot of technology to receive, to sort, to understand, to correlate. a lot of statistics though that makes our nation safer and also enables us to do it at a much lower cost. >> roger i was hoping to ask you what is possible? in the last -- i remember going out to afghanistan two years ago and there was a lot of skepticism about the now being able to crunch all this and actually spit out results with tells you there is a higher chance of insurgent activity in this one area. what is the last quantum leap forward in the last few years? >> i was thinking about that and i really think a good proxy is this is our third year the security forum here at aspen and kind of reflect on what the audience was doing two years ago versus frankly and i will admit it, what i have been doing for the last two days. so, i have in order of magnitude

more compute power at my place. i am multitasking. i am out on apps so we moved the data closer to the tactical edge. the equipment that i have two years ago, three years ago, i probably had an early version of a blackberry and today they could have an ipad or an iphone filled with apps and maybe one of the most remarkable things is, so there is a speaker appear that makes the comment that somebody has picked that up either streaming or in the audience, has posted it on a blog, and it is put on politico and we are over there at the table reading the quote of the speaker within maybe 30 seconds after the statement is actually made. so we have significantly reduce what we call latency which is the relevancy at how fast we can take the data that is collected,

turned again to information and then push it out to the tactical edge where the user is. think of us all as being users. they can then create an action based upon that intelligence and do something to provide security. >> how does this work in the field? like you know, with all the collection that is going on, is it an algorithm that is used to determine what's going to happen for white might happen in an area and how is this information synthesized in a way that is usable to a warfighter out in the field? speak you want me to answer that or do you want john to? >> there are a number of algorithms and lots of decision trees and all of those things are done in microseconds. it allows people to get kind of that real-time data and information to make informed decisions at the local level. i think is roger mentioned, it's really no different for example then our ability or for example

amazons ability to make predictions around what your next purchase is going to be. what google thinks you are going to want to look at the next time you go on line. so while we are doing is taking that same kind of approach with respect to data analysis, predictions, inputs, decision trees and give people information that is usable and then the next element is really then parsing that information out to the edge and pushing it to the edge so that any number of people can use it in an effective and timely manner, to make informed decisions about whatever mission they might have. >> yeah, i am from lockheed-martin, the large -- world's largest security corp. and i wanted to take a little bit different of the attack and to say most of you most of whom are customers in many respects,

we do what you want us to do both with the taxpayers money as well as with their own research and development where we spend nearly a billion dollars a year of our own funds. we are the people who do the can and you are the people who do this should. what happens with this big data issue is that our ability to process data, driven by the incredible increases in computing power that writer alluded to, we are going to create more and more issues for those of you who are in the audience that are decision-makers about how much information do you need? how far up the curve do you need to be for surveillance purposes, for kinetic purposes. we are very familiar with delivering kinetic energy at the right spot, but we recognize that as the big data problem gets bigger, some of the issues that we are talking about yesterday are actually run

around like for example general alexander, of under what circumstances can you use all the data that you have? we will become greater and greater. said the intersection between technology and policy will become closer and closer but fundamentally, we are the people -- you tell us what you want and we tried them make it for you. >> in a place like afghanistan and iraqi don't have any constraints like a petri dish. you are experimenting with your systems, right? >> it's not true that we don't have -- as my colleagues would say there are plenty of rules of engagement. there are plenty of opportunities to you know two things technologically that we can do but that we don't do because you know our military or our partners in the partner

governments don't want to. but yeah it is an opportunity and we have in fact is i'm sure we will talk about, developed the things with the right kind of modifications to make them less costly can be used here on that homeland security process process as well. >> we don't make the policy decisions but i think one of the core responsibilities in the role of industries to take the time to listen to the customer's challenge is an figure out how could we possibly answer that question? and it might be within the confines of the companies here. it might be within the confines of of small business who has a great idea and a different approach or perspective to solving problems and it might be outside the defense marketplace like in a commercial marketplace so our challenge and our charter is really to figure out how to solve the problem and ours is not to make determinations with respect to policy. ours is figuring out the possibility of what could you

possibly do given the challenges you have? >> one thing to note, it used to be in times past the federal government was unique. we did all kinds of technology unique to their problems and we still do that but not near to the degree that we did before. now you have multinational corporations, large reparations, global corporations that have got the same amount of security problems. they have got the same strengths. they have got the same worries, problems and the amount of data that they need to deal with is also very massive so one thing you see is that the amount of technology that we create to then handle the problems that our commercial customers are asking us about directly relates to federal. some of the things we do in federal directly relate to the same problems. may be different data, and perhaps different algorithms for the same problems we have an commercial. i think a good indicator that

his target being here. if jim alexander were here he might be very proud of that because they think that begins to show more and more that public/private relationship. >> so what we are doing in afghanistan compared to what amazon is doing in terms of telling me what book i'm going to buy next. are they pretty much comparable? i assume and i would think that it would have -- amazon does not have drones and they don't have, at least not yet and they don't have those capabilities. >> you can certainly do a laser like focus on customer needs. >> i don't know about the drum thing. [laughter] [inaudible] >> i do think, i guess i differ a little bit in these perspective. i think the federal environment is still different. the kinds of rule sets that govern the federal environment and the kind of challenges that some of our colleagues and even

those in the audience halfway or, when they asked us to do something or when they want to pull the trigger it has to be writer people died. that is a different kind of a problem, not from a data analysis perspective but i think in terms of how you organize the data, how you deliver it to your customers whether they be defense customers are homeland security or treasury. there is still a difference in that and i think there is no shame in recognizing it. >> roger, how close do you think we are to this holy grail of literally being able to take this information in a place like afghanistan where you don't have as many constraints and produce results, actionable results being able to predict finding the needle in the haystack, preventing an attack based on what you're collecting? >> i think david sanger when he was a pair talking about the holy grail being predictive

analytics. the monty python movie the holy grail was something you always seek but basically never achieve. we are much better than we have been. we have terrific software tools. of that haystack, we can now analyze a larger percentage of the haystack. this coming together of moore's law and metcalfe's law has allowed us to attack what used to be rules of physics and generate information on the data that we never could before. the ideas to think about kind of the evolution and the intel world to go back to the cuban missile crisis. we were determined that there was something there but that is about it. we didn't have a lot of information about where it came from and what the intentions were. [inaudible] so we have moved beyond that because we now can measure over time. became look at trends. we can start to draw --

i think the last panel talks about a ship. there is a ship somewhere where it's not supposed to be. that is valuable but if you knew where it was yesterday and you knew where it was two weeks ago and oh by the way if you have access and you knew who the skipper was in the ownership waa and figure out there's an llc based in the cayman islands and now you can start to build a picture. from that picture we are talking about analyst support. we provide software capabilities to the analyst said the analyst can now spend less time searching the data. we use machines for that. and more time doing what they do well which is the human mind to recognize and synthesize and understand the intentions of that rogue ship that is someplace where it is not supposed to be or a piece of data, a change in pattern on a road near fallujah that wasn't

there yesterday. we are so much better now than we were say the beginning of the iraq war but there is still a lot of work to do. both big companies and little companies are continuing to develop capability so we can do this in an automatic way. >> it i was going to shift now maybe to discuss the innovation to have seen in the war zones where you know the looser controls on this and then you try to bring it home to the u.s. either homeland security or for that matter you know border security specifically at the airport and you know there are all these constraints, government puts all these rules about what data can be shared and what can't be shared. you have prices here that you don't have. i thought maybe brad could -- >> i think my company is a little bit different than the rest of these just because you have not heard of my company but we make the explosive detection

systems that was talked about this morning. both for the checked baggage and for the explosives and narcotics tracing equipment that does the secondary type of screening. it occurred to me the discussion this morning and we won't go into the policy discussions because we set up several times. we are about what can we do and not what should we do and tom is right that the nexus between those is going to become closer and closer in that you know, charlie allen sort of chuckled over the date metric advantage discussion but fundamentally what is our semester get manitoba the terrorist? it's her ability to collect and analyze tremendous amounts of data and taking that data to interdict when they need to and part of the interdiction can be screening went to have identified as high-risk people and talkiab