so much on strict bottom line standards. again, i could be wrong on the details but that was my impression. more process standards examples. >> i think you need to read the activity as a subset of any enormous new movement to inform people and provide information about the types of plans. there is a lot of venture capital, a range of new companies that are trying to find ways to inform people about the different plans and inform people about the different providers within the plans and inform them when they are choosing a plan and inform them when they chose a physician. you will see a lot of efforts to improve the way the markets work. we are at the beginning of understanding how well all of those sort of new tools to they can advantage of an enormous

amount of big data, quality measurement stuff, and we don't know how well we can put that knowledge in the consumers that have other choices to make, how well they will be able to process the information and it will work through in the markets and i think organizations that have the creditability are important. but you will see a lot of stuff being done by different organizations to help improve the market. >> when people make comments like michael just did what runs through their mind and i cannot handle the information i am currently getting on my health care plan and how will have handle more? when you look at how the web works the people are going to win the race in this venture capital market place are the ones that create allegorrhythms

and give answers they trust. .001% of people will do double clicks on the web page and get on the passenger to analyze the data. most people will say will you give me a recommendation? like a google search. i will type and you say what you think is my match and within a minute or two in the future most people get the answers they want because there is an allegor rhythm that is running all of their data. it isn't going to be the consumer looking at the data it is going to be the intermedaries trying to solve it. and whoever gets the result like that and that is how the venture

capitalist are thinking about this. >> one thing that might have slipped by which is right the new information is often personal. it isn't which plan is better it is which plan is better for me. and that requires a lot of information. they are combining things in ways that would be useful to individuals and because it involves a lot of information and all information require value judgments it remains to be seen how successful they will be. but that is the vision they have. >> i am joyce with united page today with apologize because i am going to ask a provider related-question. there have been andotal reports about providers not finding out what network they are in or thinking they were in another and finding out otherwise.

i wonder if there are efforts being made in the model regs to make sure providers are adequately informed. >> so your question is more about providers not being informed than consumers buying a plan and figure out the provider is not there? >> right. >> i don't know that the model is going to spend a lot of time on that aspect. it is more going to be looking at it from the perspective of regulating the insurers and making sure they their plans they file with us are adequate and we are looking at it from that perspective rather than reaching out to providers and saying you may think you are in this one but you are not. that is probably not a step we would take. and that would be one of those

areas where it is just not going to be in our wheel house to be going that far. >> in any of the comments you received from providers did you hear about this? is this something they were talking about? >> that is not one that i have seen yet. >> first let me clarify what i said about providers wasn't implying i am a supporter of being unfair to them. i do believe the system needs to be fair to providers. but one way in which consumers get a lot of information is from their providers. if they are not well-informed about the networks or what is going on -- if they cannot figure where other providers are in the network it is hard to

make referrals in a way you would want. so it is important for the function of the market for providers to be informed, treated fairly and have the information consumers have because apart from being the most important part of the care delivery system they are also an important part of the information flow here. so just as consumers need to know which hospitals are in the networks, the providers need to know which hospital is in the network and the provider system is fragmented to avoid separati separation. so there are provider site issues that i believe require important attention for all of reasons. what i meant to imply before was at the end of the day we care about those at least because the

whole system and how everyone interacts is going to depend on the providers being treated fairly. in and out of itself the provider being in versus out isn't the ultimate goal. knowing who is in and out, being treated fairly in that process and not being dropped, those are important for providers and i think the regulators will take heed if we see abuse in that area and they should. >> i had to deal with hospital bills for one of my boys in the last couple years and the customer service in that industry is atrocious and that is because the system where everyone knows i am not making the choice of who my plan is, my employer is, so there is no accountability increasingly

through the private market place and the when the insurers respond to the individual on a retail level to sell the product rather than the employer on a wholesale level, customer service and other issues are going to get better. there is no other system in which the supply chain, the doctors and all of this that are part of the system, have as many conflicts with the ultimate payer in the system. claims processing and all of that has grown up in a way that is not customer-friendly and as we move to a retail-based system the winners are going to be the ones that figure out how to treat the individual right. >> i was going to add i think if you look at what makes health care potentially work better it is the ability for all components to be informed and

understand what is happening. and the consumer and the transparency and the provider has to be well-informed and they have to understand not just the networks but the complexity of the benefits designs that increase. it is important because the average patient is going to the average doctor these days saying what do i do with this co-insurance. what should i do? who is the better doctor for me to see? and historically patients trust their doctor more than anyone for health care and they continue to seek advice so we owe it to the system that the providers be as informed as possible. i think it is critical. >> from the provider perspective, a big challenge of developing these systems is how we inform the primary care

providers about quality and cost across the spectrum. if you are my patient and i am referring you, where is the best place, what systems practice resources and at a plan level that is difficult to measure. how do you defer around what is a good network in your specific area and do you get access to care the patient needs and how do you share that information with primary care, how does it get distributed. pcps are interested in their performance so how do we share what we collect back to the provider so they can make improvements. it is a complicated issue for us. >> jay? wait for the mike.

>> this is a question for professor. when you say we should be fair to the providers do you mean we should field them from economic distress and if that is what you mean why is that a good idea? >> i do not mean we should shield them from economic distress. i think we should limit the amount of fiscal coverage but as a general rule i don't think we need to not protect them from physical distress. i think we are trying to instill competition in the market here. and what i mean is you should be transparent in your dealing. you should not say you are in the network under these conditions and it turns out no, it was those conditions. or hold them to standards that they simply can't meet in a whole variety of ways.

at the end of the day, the provider -- and i believe in the market place being fair to providers is also a winning strategy because at the end of the day i believe the provider system, the hospitals, physicians and other health care providers, are the ultimate place in which consumers experience the system and they need to be able to function in a reasonable way. i think pressure through competition is something they will generate. i am mnot generally opposed to that but there are stories of people thinking they were in contracts but not being in or being told one thing or the other just broad general contract law dealing with folks and i think those are important. so that is what i mean when i say being fair to the providers. they need to know what they are getting into when they join a network and those conditions

should be upheld. i am a person who is flexible on what the criteria should be but once they are set you should know what you are getting into when you sign the contract. that is what i meant about being fair. and the providers shouldn't have some notion this is what the price of my services are and you just have to pay. i do believe there is going to be competition and it will lead to lower prices and i believe that is generally speaking a good thing. >> so we have been talking about providers and their level of knowledge as to what they are in, what they are not in, who is in. what about the consumers? so a recent report from mckinsey

based on an april consumer survey indicated that 26% of respondants indicated they had enrolled in an aca plan and were unaware of the network type they selected. almost twice that were aware of what kind of network they had selected. so there are questions about do consum consumers, one, know what they are signing up for when they sign up and two, once they are in, are they getting the updated information and the right information about who is in, who is not in, who they should go see, transparency -- so this is a broad question but can we talk about the consumer end. >> it is a broad question and michael put his finger on it earlier when talking about the

decision between buying the product and most consumers intend to stay healthy and buy down on products. that is the learning from the exchanges and that is what you predict people will do generally and then they have a different attitude if they do get sick. so the people most cynical about whether there is going to be a change in networks or whether consumers respond in the same way over the next couple years like in the '90s say is what we do in purchasing. wait until people need the care then they are going to say, well no one explained this well to me and i demand we will have the same response as we did with protection laws. it is hard to educate people but one is transparency. you have to have as much information as possible.

and then you need brokers of information, in my view, to make it work. because you will never get the average consumer to understand all of this detail so you need skilled people to create the rhythms and data analysis tools that help people sort it out and put it in simple terms. people with health conditions will have electronic records and can run it through the system. we are in a world with a lot of data broker type people to help consumers. but all we know is people are choosing them on the front end. we don't know what happens when when the rubber meets the road. >> in wisconsin, we have thought seen an uptick in complaints about i brought this thing and thought i had the right thing

and then i had to go to this place and get the thing done. we are not hearing that yet. i think part of that is this is new to folks. this is the first time there has been a mandate to purchase health insurance. i think there is a percentage and i don't know if is a quarter like your data indicates. but a lot of folks said i have to buy health insurance and went out through the website and went through an agent or navigator and purchased it hoping they got what they needed. but you know, purchased it because it was the cheapest thing and they had to have something. there might be some of that. and to joel's point as this, and of course you had the problems last year and the open

enrollment that seemed to last forever, and hopefully things are more squared away this year and after a year of consumers purchasing health insurance through an exchange maybe they get better and asking questions and start hearing it isn't all the same. we need to better understand what benefits are available through that policy or how it is going to treat me if something should happen. i am optimistic that consumers ultimately will become more informed as they play a greater role in the decisions moving forward. >> i agree completely with that but even in that view there is going to be a subset of people that are not going to make good choices and that is true in every walk of life and every

dimension and certainly through in my family. i think part of the challenge for head and the regulations is try to try to figure out how we balance what, i think, is an obvious good and that is having consumers making responsibility with protection against consumers that are not going to do a good job. how do we manage a system in which we try to minimize the chance that someone ends up in a really bad situation? i think ted mentioned, joel mentioned, some of the fall back processes to make sure the worst case scenario isn't un unacceptable. how do you feel if 10% or 20% are making bad choices? it isn't going to be that most people are able to make the

perfect choice for them in anything and that is certainly going to be true in health care for something this complicated. so we have to minimize the downside if they don't make choices they want to live with and how they can learn and change overtime and do this in a way to not mess with the affordable and quality. i think consumers will have to learn to make more responsibility and that is easy to say while sitting here but i realize many will not. >> are you a fan of nudge theory? >> absolutely. the question is there is an enormous amount of work on how to help people make better choices. some involves more intervention in the market and framing than a standard free market economist might advocate. i believe in markets in a

variety of ways but in health care i think there is a lot of limitation to choice and a lot that can be learned in the way we structure choice. there is a lot of places we can help people make choices that are better for themselves and still give them the opportunity to do something different. there is a lot of examples showing markets don't work like the eco 1 models. to go into the this with an understanding and say competition works and people will choose will give us an outcome of having people in situations they don't like than i would be comfortable with. >> i don't want to change it into a broader health discussion but i want to remind you and folks that for a number of years

we are experimented or the was an allowance for medical savings accounts. health savings accounts. where individuals were in charnel charge of a good portion of their care and then you have a catastrophic plan. i think that idea really put consumers in charge and made them make better choices and caused them to perhaps be a little bit more curious about where the money was going because it was coming from their own pocket. let's not forget that is out there. but i agree there is a certain percentage of the population that is not going to have the information and it is up to the regulators to step in or promote

as much transparency and communication as we can to help people make better decisions. >> ted, in your state, how much are insurance commissioners really stepping in? we have andotal information, but can you give us a sense of how many of your colleagues in other states are already being active here? >> that is classified. we only talk about that in closed sessions. no, i am sure joel remembers this from his time in pennsylvania/oregon. commissioners and regulators in general do care about their markets. when they see disturbances or disruptions or things they have the authority to step in and do something about they will. and in this very issue of

networks and network adequacy, particularly, and not solely, but particularly in the rural states and i will call them the rectangular states, there are serious distances between you and anything. it is very specifically in those kinds of situation you cannot just have well you have to be within 60 miles. you have to go 60 miles to get a loaf of bread or a bag of flower to make the bread in some states. so commissioners will step in and they will have conversations with insurers saying this is not reasonable and let's work through these things. whether it is that situation or an urban situation where there may not be an essential community provider, very often

the commissioners will be talking directly with or through their lieutenants to carriers or providers to work these things out and get those market disruptions taken care of. this issue is very high up on many commissioner's list but from day-to-day over the years it is something that they deal with regularly. >> i would say if you want to look at states where you are seeing more aggressive action on behalf of the commissioners look at the three west coast states. washington, the commissioner struck out 3-4 programs from the exchange because they were too narrow in thor their networks. those plans did get in and the commissioner had to go back and figure out new regulations this year. the first set was rejected and then he settled on a

transparency strategy. it still isn't poplar and some of the consumers don't think there is number. in oregon, medicare advantage is there and they are talking about taking those standards in that state and there is an outcry from the insurers and in california you have david jones, the department of management care managed by a gi with a stake in this. so those are all people that are active in ted's committee, i think, and that is the other side to the prairie states where, you know, some of the same concepts are not well received. >> states are doing a lot more

besides this thing. and one of the issues is making sure the figure in to the broader areas of the state. >> let's wrap up. i will give each you have 30 seconds to tell you -- you have a bunch of reporters in the room. what is the biggest thing you think they ought to be looking for? it can be what you hope is going to happen or worried about happening, but what is the one thing you think everybody in the room should keep their eye on moving forward. >> i think we should be clear to tell the difference between value versus the other terminology. and we should not stand in the

way or create unnecessary burdens from a regulatory point of view that gets in the way of progress and innovation. >> my two things. 15 seconds each. remember the tradeoffs and don't get stuck on one aspect of the story but not the others. and understand that andotes wouldn't prove the rule bad things are going to happen no matter what and finding them means the system doesn't need to be redesigned >> i will second what you said. this is a hugely important issue. it is accelerating at a rate that we didn't anticipate and thus the working group that we work on on this very issue is taking comments and considerations and letters from

all parties to better address and better move forward with the better model for states to adopt and to implement. >> the issues are complex. there are tradeoffs. so it is an area where i hope we let the states be the laboratory of democries and experiment. and i would encourage the media to go into the different states and see what they are doing and i would be worried of a federal intervention that would limit the kind of experimentation i think we need to have on the issues. >> i think finding ways to report on quality and cost across the spectrum is key. and that is for physicians and patients so both sides have access. scombr >> great. this concludes our session.

i think the panelist and the reporters for joining us today. >> you are watching c-span 2 and the live coverage is continuing at the kennedy center in washington, d.c. it is more about africa and the big summit happening specifically improving the lives of women and girls in africa. featured speakers include the first lady, former president george w. bush and his wife, and also jill biden.

>> please enjoy the day. [ applause ] >> life became harder. then my family started being int international. [inaudible video playing]

[inaudible video playing] >> she is more of this thing you cannot describe. she is this human that is left to look after the kids and work hard for them. and i think society loses more than we know if we are not educated or taught how to look

at themselves has human beings. i think it is changing that some need to see more women coming in. >> i want to do more. i want to have a husband. and kids. >> being independent and being able to make my decision doesn't make me less of a woman, but it makes me a woman who knows that i can take care of myself and i can make decisions to changing my country, district, community, family and the world. your family can say i want to be

this or that. and the girls are not allowed to apply for certain things but now she can work for things and is hard working. >> i was given work by a company that didn't care and it came from a very well-to-do background. and with trust may made me believe in myself. and i told myself i can do this. >> it is hard to look at woman and if you are a woman you should be cooking or washing your husband's shoclothes. >> show the world you can sue

sew, show the world you can knit, color and do something creative and we can add value to her and she know she posesses a special place in the world. africa is changing. >> there have been many women that are setting an example oh or acting like a role model to show anything can happen. >> this changes our lives because we have the whole nation, continent and world looking at them. this woman is asking how would it feel like to be ms. president? this young girl will say one day i am going to be her. what do i need to do? how do i need to stand?

if she has the opportunity to prove she can do it, she can. >> africa is changing. >> i am here and ready to give all i have. they are coming back down and influencing someone in their life. they have been here all along and that is looking at the brighter side. [inaudible video playing]

[ applause ] >> ladies and gentlemen, please welcome the first lady of the united states, ms. michele obama. [ applause ] >> good morning. good morning. good morning. thank you so much. thank you so much, everyone. well my name is michele obama and i am an african-american woman. [ applause ] >> on behalf of myself and my

husband it is truly a pleasure and honor to welcome you here to washington. we have so many leaders here with us today. we have president bush and ms. bush who are here today and i want to than them both and the bush institute for their passionate leadership on the issues we will be discussing today. i want to recognize dr. jill biden, my dear friend, when he is here as well. she has been a partner over the past five and a half years and i am thrilled she is here with us today. and of course most of all i want to thank all of you for joining us at this event. we have a fabulous program lined up for you today as you have heard. we will be discussing important issues, hearing from renowned experts and making really exciting announcements about new initiatives across africa. this is going to be a really big

day. this has been a day that has been a part of a big week that has been a big part of a big couple months actually. as you may know, the summit that your husbands are attending is the largest gathering of african leaders every >> hoshosted by an american president. and about six weeks ago, 500 young leaders from across africa arrived here in the united states to take part in the mandela fellowship for young african leaders. and these young men and woman are extraordinary. then of them are barely half my age -- i don't want to say that but they are young. they founded ngo's, starting their own businesses, risen to single levels in their government and as part of the fellowship they have undergone

academic courses and leadership training at universities across america. the passion and intelligence and dedication of the leaders inspired all of us in the united states who have had the pleasure of spending any time with them. i had the privilege of speaking with these fellows last week and i met with a group of them who share my interest in girl's education and two of the fellows from that meeting will be doing a presentation on their stories and ideas and i will not steal any of their thunder because they are remarkable but i can tell you that why we talked about a range of issues there was one thing we kept returning to. again and again, these young people emphasis how important is it to have support from leaders in their government. and this is the same message i hear often from the young american leaders i meet with.

these young people are working so hard in their communities. they are facing so many challenges and obsticals and they are looking to us for inspiration and looking for us to champion the issues they care about. and most of all they are looking to us for empower them to be part of the solution. and that means that we all are going to need to do everything in our power to bring the young people to table. we need to spend a lot of time with them. more time listening and i mean really listening to their voices, to their views, so week understand the challenges they are facing through their eyes. we need to learn from their experiences and expertise. you see they are developing all kind of new technology to

address problems that our generation isn't solving. whether it is an app for cervical cancer or cleaner energy. they are coming up with solutions we could never dream of. so the question is can we and the government learn from them and follow their lead? can we embrace their ideas and incorporate them into policies and strategy? in our work as first ladies, first spouses, can we find new ways to be more inclusive of these young people and show them that we truly value their voices? so many of you are already embracing the young leaders in your countries through your work whether it is improving girl's education or fighting cervical cancer or hiv or fighting

financial crisis. it is my hope we will rededicate ourselves to these efforts and commit to new efforts to lift up your young people. i hope you have a chance today to connect with each, learn from each other, and hopefully be inspired by each other. and with that it is my pleasure to begin a conversation with the first lady who has long been an inspiration to me. laura bush set a high bar for me during her time in the whitehouse and he has continued to do outstanding work around the world since she and her husband left washington. i consider her not just a role model but also a friend. and i am thrilled that our conversation today will be moderated by another woman i greatly respect and admire, our

friend cokey roberts. i will have them come out to the stage with that so we can have our conversation. thank you so much for joining us and enjoy the rest of your day. [ applause ] >> well, i am so excited that we get to do this again. >> we did this last summer. >> and thank you so much for that. it was a wonderful, wonderful experience for all of us to be there with you. so thank you for >> hoshosting it last year and this year. i remember as i recall when last year you were getting blow back about your bangs. >> that is over now. more important issues.

let's see what they say about this one. >> but you had bangs in the program. i remember. and since then your daughter has turned 16. >> yeah. >> i know but i have to tell you i am envious to have it happen in the whitehouse where you can keep an eye on her. >> we can share the experiences of the world and the pain and pleasure that knows with it. ... 1-202-347-2661

>> to raise wonderful young people through this experience, and we have had some terrific role models. jenna and barbara are just amazing young women who are doing extraordinary things not just in this country, but around the globe. and once again, they're setting a high bar. but the girls are doing great, i'm very proud of them. >> and you have a grand baby. a girl. >> that's right. we have our first grand baby. yeah, exactly. our darling -- [applause] our darling little mila. george and i are just da georgia over our baby. >> so how old is she now? >> she's 16 months. >> oh, she's doing real things. >> yeah, exactly. 16 months. she's doing great. >> so we just saw that very important video, and, mrs. obama, you spoke last week to the young african leaders,

and you were very strong in your statements about the need for educating girls and treating women and girls with dignity and equality. why did you choose to do that? >> well, so off what we find in -- so often what we find in our positions is that you can, you have to change attitudes before you can change behaviors. and one of the things i said to the young people that we can talk about the need for more resources as it comes, when it concerns girls' education, the need for school fees, the need to improve transportation, but the bottom line is that until men, leaders, women, this we value women -- until we value women and girls, we won't tackle those other problems. until we prioritize our girls and understand that they are as important in their education -- and their education is as important as the education of our sons, then we will have lots

of work to do. and i wanted to just implant that notion in the minds of these young leaders, because they have to approach their work with a whole new attitude. and one of the things i asked the young men is that you have to be intraspective and ask yourselves whether you truly believe that women can be your equal. and in sharing my story, just understanding the power of having men in my life who valued me and put me first and treated me with respect and didn't abuse me and didn't talk down to me, i want young men around the world to understand that they have a role to play alongside of women who are fighting for these rights. and i want our young men to understand this at an early age. [applause] >> mrs. bush, you've been working on this issue for a long time, particularly with women of afghanistan. are you still doing that? tell us about where -- >> yes, we're still working on that. after september 11th when the

spotlight turned to afghanistan and we in the united states looked at the way women in afghanistan were treated, many, many people -- women and men in the u.s -- were concerned. and that's when i first started working with women in afghanistan. and mrs. obama is right. in fact, one person said to me one time why are you working with women? it's men that have the problem. [laughter] and i think we do need the make sure worldwide that all humans are valued, the women and men are valued, that girls and boys are valued and that human life is valued. i think that's really the most important thing we can do, all of us can do, is try to increase that knowledge worldwide that every life is precious. >> and, of course, on this question, the question of girls' education and women's health and

all that, we have so much data now that shows if you educate a girl, you save a country. so are you finding you're able to keep working on that? that's manager -- because one of the questions i got last year after you all finished talking and i stayed for a couple of days from these wonderful women is, you know, how do you keep it going? >> well, one of the things we've done, george and i have done, obviously, when you live in the white house you have a platform. but former first ladies and former presidents continue to have a platform and a convening power. and we've tried to do that with the first ladies' initiative that we started last summer with the first conference, and that is to bring together first ladies really from around the world. we started with african first ladies, but we're interested in engaging women from every, first ladies from every country to talk about the very unique platform that the spouses of

world leaders have to help the women in their countries, to make sure that everyone is paying attention to the education of boys and girls in their country. and that we're making sure that women have the opportunity to be involved in the economic life of their country. because only countries where all people are involved can be successful. when we look around the world and we see countries where half of the population is marginalized or left out, then we usually see countries that are failing. so it's important to keep talking about that. >> and it's important, as i said in my opening remarks, to make room for the next generation of leaders, because one of the things that the young people said to me, as i mentioned, is that they asked me to ask the first spouses to make room for them. because they're looking for a place at the table. and they specifically said that when you meet with the spouses

of our country, tell them that we want to help, that we want a voice and that we're looking to them. they're looking to all of us to provide that seat. and that's where that platform be that mrs. bush speaks of, why it's so important. because these young people, they believe that they get their inspiration from us. they're looking to us. they still don't quite know that they have the expertise and the skills already. they think we know more -- >> we actually do. [laughter] >> we do. we do. [laughter] we do. but, you know, when you listen to just the opening speakers, when you think about social media -- >> right. >> you know? i mean, just listening to the hashtags and the twitter accounts, i mean, that was a little nutty. [laughter] but it's how you continue the conversation. >> and globalize it. >> and globalize it. and young people are just more adept at that. >> right. >> and they can, you know, as i tease my kids, i tell them i want them to use instagram to

take a picture of something really important rather than their food, you know? [laughter] >> oh, come on. >> but young people can be a support to us. >> exactly. >> i mean, no one really cares what you had for lunch. [laughter] >> well, you both talked last year when we were having this conversation about shining a light on an issue. and that you, in this unique position, that you have the opportunity to shine the light. and at some point people stop looking at what you're wearing and see what you're aiming at. one of the questions i get all the time is how do you choose? how do you choose what issue to shine a light on? now, you knew when you came in that you wanted to do something about military families, but it was kind of inchoate, right? you expected to do something about early childhood education and cognition and, of course, september 11th changed all that. how do you put it together to decide exactly what you're going to do? >> well, i think you look at yourself and see what your

expertise is. when i came to the white house, i was, had been a librarian, i loved to read, i'd been a teacher, and so education and literacy were very, very obvious interests of mine. and expertise of mine. so that's what i started with. but then also you look at what appears, and there are ways you can take advantage of different things that happen to go in another way. i got a phone call, for instance, from the head of the national heart, lung and blood institute here in washington, and she said did you know that heart disease is the leading cause of death among american women? and i didn't know that. i just had assumed cancer was the leading cause of death among american women. but, so i knew if i didn't know know that heart disease was the leading cause of death, that many american women didn't know that either. and so i was presented with the opportunity the talk about the heart truth and to get the word out to american women that heart

disease was a leading cause of death so that they could start doing things. because heart disease is often preventable. but also, if you know that you might have a heart attack, it wouldn't just be your husband that had a heart attack, then you can rush to the hospital yourself and get the kind of treatment that you would demand for your husband but you might not realize you would need it yourself. so i think there are both ways. both look to your own expertise, and then just take advantage of other interests that come up and see if you can make a difference in your countries. >> also where you, where your passions lie because i found that i've been most effective when i am uniquely authentic. there's a sort of, there's a authenticity to what i say. so that means i have to really believe passionately in the causes that i take on.

and that lends itself to more power, more effectiveness, it just makes you a better advocate because this is something you care deeply about. this was true when it comes, came to the issue of educating our young people. i just started an initiative this year, reach higher. because one of the things i'm deeply passionate about is the role that education has to play in the lives of our young people. and my story is the story that i try to share with young people to motivate them, you know? there's nothing in my life that would indicate that i would be sitting here on this stage with a former first lady and one of the most renowned journalist and every first spouse in africa. [laughter] nothing in my life indicated that. [laughter] but my parents believed in the value of education even though they were not educated themselves. and they pushed my brother and i to do the best that we could do. so what i want young people in america to understand is that we are blessed in this country to

have public education, to have opportunities that many girls around the world are putting their lives at risk to achieve. so it's incumbent upon us here this america to take advantage of every opportunity, and young people have to own their education. i can do that because i believe it. it is my story. it is, you know, why i'm sitting here. and my hope is that i can start a national conversation about reigniting that hunger for education in our young people and using that to talk about the issues that our girls around the world are facing with 60 million girls today not in school. >> right. >> 30 million of those in sub-saharan africa. i want our young people across the globe to be talking about how do we fix that. so that's just an example. i'm clearly passionate about that. [laughter] >> but one of the things that we're going to do today in the various panels is how to,

essentially. and you all have done the how to. and part of that is interest of private-public partnerships, and all of your initiatives, it seems to me, that you've both done that, that you've brought in universities, companies, foundations, whatever combination of things works. can you talk about it, for instance, with helping america's youth? >> sure. helping america's youth was one of my initiatives, and i traveled around the country and had summits, actually, conferences in many parts of the universities with all of the youth-serving agencies, types of agencies from individual foundations that people had to individuals themselves. two men, for instance, who used sports to teach character building in seattle and worked with sports groups because they

knew they could attract boys, and then they attracted their mothers there -- [laughter] because their mothers would bring the boys to their sports practices, so they would talk about sportsmanship in a way that really talked about life. and the way that people can use all the characteristics of a good sport to also be a good person. but what they discovered then was that their mothers were in many cases single mothers. they didn't have a community really of their own. and so they started after the sports games, they would have barbecues. so the mothers could meet each other and be with each other and really they were out to help the boys but found out they helped the whole family with this one, one agency or one foundation that these two men started. and that's just one example. many, many others that were part of helping america's youth. >> and helping people get off of drugs or not get into drugs, not

get into -- >> that's right. >> and it seems to me in some ways you've built on that with let's move. i mean, it is, it is being preventatively healthy, you know? [laughter] all along. so talk to us a little bit about how you've put that together. >> for those of you who don't know, let's move is my initiative to end childhood obesity in a generation, and we have really relied greatly on public/private partnerships, was what we all -- because what we all have to understand is government has limits. limited resources, you know, limited base of power. people look to government and think that government can do everything, but many of the solutions that we're trying to achieve require the involvement of the nonprofit sector and the private sector. so we've really enlisted companies to market food differently to kids so that they are not marketing unhealthy products. we've enlisted sports

organizations to get kids up and moving, try to invest in more sports and communities that are underserved whether it's the u.s. tennis association or the nba or what have you. many of these private players have been very eager to step up and partner with us to achievement and this goal because we all -- to achieve this goal because we all have an interest in haecking sure that the next generation is as healthy as possible. we spend billions of dollars in covering obesity-related illnesses, and all of these illnesses are completely preventable with good diet, nutrition, exercise. so what we have said to many of our partners is that we all have an interest in this, and there's a way that we can all do well by doing good, you know? we can, companies can still be profitable by creating foods and educating parents and families

to help them make better choices about what they feed their kids. >> i must say with teenage daughters, though, it must be -- i would suspect that sometimes they say to you, let's move, mom. [laughter] >> yeah. you've been sitting at our dining room table, cokie. [laughter] yeah, well, you know, every teenager has a little smart aleck in 'em, it's true. [laughter] they, you know, but one of the things we've found in our household is that kids listen, you know? they take on these new messages each when we don't think they're paying attention. and that's one of the things that we try to tell parents, is that you don't know that they're listening, but i see how my children make different decisions about what they eat now as tames now that they have -- teenagerrings now that they have control because they have the information about how food affects their overall health and their ability to perform. but it's our job to empower parents and families to make the choices that are best for them.

>> you've gotten some blowback for it which -- >> surprising. blowback. [laughter] i don't know. [inaudible conversations] [laughter] >> that was just where i was headed. [laughter] it is, i know that, you know, you both get into these things, and you're doing them to, for the good of the country, and suddenly you get criticized for it, and it must just be such a shock in a way. i mean -- >> i was not that shocked. [laughter] remember, we had somebody that lived in the white house that we watched very closely that we loved -- [laughter] president bush and barbara bush. and so i was very aware when george ran for president that, you know, that you're always going to be characterized in a way that you aren't really. and so i don't think it was any big surprise to me. that doesn't make it any less hurtful.

but on the other hand, i think anyone who's in a leadership position of any sort knows that you're going to be criticized and a target, really, for criticism. >> that's absolutely true. and that's really the role of leadership, you know? it's not about amassing power, it's taking some of those hits in the, you know, and continuing to do the work each when it's -- even when it's painful and sometimes unappreciated. but that's why it's important for all of us to have a vision, you know, as first spouses. because if you have your vision and you know what you're passionate about and you know what direction you're going in, then all of the arrows and the spears and the criticisms, they just, they bounce off of you because you keep doing the work every day. >> they might pinch -- >> they might pinch a little bit, you know, you might get shot in the eye.

you just sort of go to the doctor, pad yourself up and get back in the game. >> i think that's an important message for people to hear, because it's hard to do what you all are doing. and you talked about it's not about amassing power. it's certainly not for those spouses, right? it's not being in that role. and the still you get the criticism. so it's important to say that you can live through it. [laughter] >> well, and everyone comes to these positions with different temperaments, you know? and, you know, i -- watching mrs. bush, you know, she has been able to traverse all of this with a level of grace from and kindness and compassion, you know? is -- just seeing how our transition worked, and we talked about this in tanzania. people are who they are. i said this in my convention speech about the president. being president doesn't change who you are, it reveals who you are, and that's true for first spouses as well. you come to this with a

temperament, you know? some people are shy and never want the limelight. other people are much more outgoing and it may be a bit more aggressive and able to withstand the heat of the spotlight that shines on us. but i think that all of us, we have to bring what is uniquely us to the table and work within that. and that's sometimes what, you know, people around the world don't understand. first spouses, we don't choose this position, we just happen to be in it. >> we're elected by one man. [laughter] >> right, right. >> and we can't be fired. >> we certainly hope not. [laughter] >> i guess we'll see, huh? [laughter] >> well, you know, one of the things that is unique is your voice as women, and you both talked about that last year. i went back and looked, you were both quite eloquent about how important it is for women to use your voices and your power.

and i think, mrs. obama, you said we're not complicated, but we're complex. laugh and i think that's a good way of putting it. but, again, mrs. bush, why is it important for women to, for women's voices in this particular position to be heard? >> for the first lady? well, i think it's important because the first lady has an opportunity really to talk about what is most interesting to her and what she thinks she can help, the ways she thinks she can help her country and the people in her country the best. i love to to quote lady bird johnson who said the first lady can has a podium, and she intended to use it, and she did. she was another texas first lady, and i admired her from a distance. i didn't know her then but got to know her later when george was governor and we live inside austin. lived in austin. but she really did, she used what she loved. and she happened to love the native flowers and the natural beauty of our country. and she made a huge difference.

the daffodils that you see blooming here along the george washington parkway were planted because of lady bird johnson. but, yes, she used education and civil rights. and she was a southern first lady, so it was very important for her to speak out about civil rights, and she did. she campaigned all across the south for the civil rights laws that were passed and signed during president johnson's administration. >> well, i, you know, once again i always go back to young people, you know? we meet, i know i do, we meet thousands of just wonderful young people in our countries and around the world, and, you know, to walk, to have a 7-year-old, a 12-year-old walk up to you or send you a letter and tell them thank you for what you do, i look up to you, you inspire me, you know? that reminds us all that whether we like it or not, we are role models. and as women, we have the young

girls in our worlds, in our countries, they're looking to us. they're looking to us for how we should be, how we should think, how to use our voices. and as a result, we have a responsibility to show them the way in whatever way we can. and that may be something as simple as embracing a child on the line and telling them that they're beautiful and that you're proud of them and that you know that they are important and they're valued. i think about that because every time i meet a child, i think who knows what's going on in her life? whether she's just bullied or whether she had a bad day at school or whether she lost a parent. that interaction that we have with that individual, with that child for that moment could change their life. so we can't waste this so the light. it is temporary. -- spotlight. it is temporary, and life is short, and change is needed. and women are smarter than men. [laughter] [applause]

>> that just goes without saying. [laughter] >> and the men can't complain because you're outnumbered today. [laughter] >> mrs. bush, you've talked about that before too, that it's a temporary spotlight. but you are now working hard to carry it on. and i think that sense of continuity is very important. so you have the george w. bush first ladies' initiative, tough global women's -- you have the global women's initiative, the women of afghanistan. you're keeping going. >> we are continuing to work, both george and i are, through the george bush institute which is in dallas now at the bush library and museum. and it gives both of us a chance to keep working on the issues that were the most important to us. pink ribbon, red ribbon is our global health initiative. many of you already know about that. we've launched in three countries in africa, and we're going to hear about some more in

a few minutes. but because pepfar was started while george was president, the president's emergency plan for aids relief, we wanted to be able to continue a global health initiative that builds on pepfar. and when we looked at the cancer numbers across africa and really across the world and saw that cervical cancer -- which is preventable -- is the leading cause of cancer death among african women, we figured out there was a way we could use the pepfar platform that's already established and add the testing and treatment for cervical and breast cancer to pepfar. and so that's our global health initiative. it's given us a way to keep building, and we have a number of terrific partners who are in the room. so thank you all to all the partners and thanks to the first ladies in the countries where we've already launched and where we're getting ready to to launch. >> i just thought that was such a smart initiative, because it

really does come wine so many -- combine so many elements that are just sensible, you know? which is another thing women are good at. but the fact is that you had the pepfar clinics, so the women were already coming in. but you needed, since breast cancer isn't caused by the same diseases, you needed to get somebody else in, so you got susan g. komen and the pharmaceutical companies in. >> that's right. >> and it's really now turned out to be a total women's health platform. >> it is, really, and it's partnering, obviously, with the u.s. government as well using the u.s. state department as our partner because we are using the pepfar platform to add. and the great news is that cervical cancer really can be treated. not when it's advanced, which is why it's so important that women come to be screened early on.

and then be treated. and then the vaccination programs with the hpv vaccination is important, and i think many african first ladies are trying now to manage these vaccination programs so that we really won't even have to worry about cervical cancer when these girls who are vaccinated grow up. >> do you think about that, mrs. obama? i know you're still right in the middle of it. >> i hope you're not thinking about that yet. [laughter] >> oh, no, not at all, not at all. >> but about how you can carry on some of these? and talk about some of your other initiatives, too, because you have done these private/public partnerships particularly around the military families. >> well, dr. biden and i, we started joining forces which is a nationwide effort to provide the support, respect to our men and women in uniform be and their families -- uniform and their families. we have worked with private companies to create jobs as these men and women transition

to civilian life, you know, working on making sure they get the education benefits, all the support that they should expect having put their lives on the line and their families' lives on hold. >> and the medical schools, you're working with medical schools. >> well, nurses are becoming trained to be able to identify and support men and women who may have post-traumatic stress disorder, educating the entire country on what ptsd means, trying to destigmatize it so that these men and women feel like they can seek help when they need it. all of that has been, you know, it is a passion for both jill and i. jill is a blue star mom, and she proudly says that. she has grandchildren who she's seen grow up while her son, beau, was deployed. so it's truly a passion for her. and for me, this is something

that i'm going to do long after we leave the white house, because these needs will always be there. and as i've been able to see through former first spouses and former first presidents that the platform is, it continues. and that's something that i would encourage all of you to think about as well is, you know, how do you sort of lay the foundation for the legacy that you want to create for yourselves? and i think as women, you know, we shouldn't be afraid to talk about our legacies, you know? what we want to leave behind in the work that we do. yes, there are so many important, symbolic responsibilities that we have in our roles, but there is nothing wrong with thinking about legacy and what we want to leave for the world. but that takes planning, it takes coordination, it takes partnerships, and i don't think that we should be afraid as women to have those conversations. >> right. >> it's too soon for me to do it

now. [laughter] but the time will come, and i will embrace that. because what i've seen from the bush family is that there is a level of freedom that also comes after you're out of the spotlight. it's a new spotlight. it's a different spotlight. but there are, you know, i think that there is more that you're able to do outside of office often times that you can do when you're in office. >> except you don't have the same -- i remember you saying at one point be, mrs. bush, you could pick up the phone and call a member of congress and get something done. >> exactly. [laughter] >> but i also just want to come back because we are at an african summit, and both of you have exhibited such a strong interest in africa. and i think you have very much helped to shine a spotlight on the continent and caused us all to learn a great deal more about the good news that's going on in africa. but i'm kind of wondering how you got there. i mean, mrs. bush, i know you were in 75 countries when you were in first lady, which is a

lot. but why africa? >> well, obviously, it started with pepfar. when george launched pepfar in 2003, remember what it was like. it was, people were dying every single day all across africa. it was a huge pandemic that was going to leave a continent of orphans if no one did anything about it. and so george saw that it was really important for the united states to be actively involved in helping in africa. it was so important for us as the wealthiest country in the world both because we could, but also because we should morally try to save as many lives as possible. so i went on that trip with george in 2003 when pepfar was launched, and our daughter barbara was with us as well. and she has really made her life choices because of that trip. she's now the head of global

health corp., she engages young people from every part of the -- >> she created it, right? >> she created global health corp., founded it, to engage young people to work in the health field. she has corporate fellows in africa and also here in the united states. but i think because of that first trip and because of pepfar, we just got a huge interest in africa and traveled there many times. and, of course, have traveled there many times since we've been home. we just had a wonderful trip this last march, a private trip. not a business trip, to ethiopia to visit the christian sites in ethiopia. so africa's become a very important continent to us partly because of that, because of pepfar, but just also because of our experiences there. >> well, and africa is an important continent to the rest of the world. its success is integral to

success, the success of this nation, the united states and the world. and it is an undervalued, underappreciated continent. so it is incumbent upon the world to have a better understanding of what africa has to offer. the importance of africa is very personal to me because as the president said last night in his toast, you know, africa's home for us, you know? his family is there. we have relatives there. we have visited the continent on several occasions. we have taken our daughters back to his grandfather's village, and they have seen a part of themselves. so the ip with this continent -- the partnership with this continent means a great deal to us. ask we've seen the power -- and

we've seen the power, the potential. to meet these young leaders and to see how hungry they are to take their countries to a new level, that kind of passion is infectious, and it's something that young people here should know and understand, you know? we want people from america to travel to africa to understand its languages and its different cultures and not to see it as a monolith and to truly see the investment opportunities which is one of the reasons why this summit has been so important, because it hasn't just been a conversation with world leaders, but some of the nation's most powerful businesses are here, some of the most prestigious nonprofits are here. that's why today's session is so important. because our success as a nation is directly tied to the success of africa. and it's -- now it is time for the united states as a whole to

embrace that reality. so we, this is the beginning of a lot of work that needs to be done. but it is, we are encouraged, and we are optimistic. >> well, i think this week has been very instruct i have for the whole -- instructive for the whole country. i really do, you know? it was wonderful to be in africa, but to have african leaders here in the united states is educating the country about what is, what is going on there. but i am going to, i am going to end where we began which is that as good as the news is coming out of much of africa, it won't be as good as it can be until we do more about the girls. >> uh-huh. >> that's right. >> and if you all wanted to the say a finishing word on that subject, and then we will conclude. >> well, let me just thank you, thank you very much. thank you, michelle, and thank you to president obama for hosting the african leaders'

summit here and thank you for inviting the bush institute to be a part of the first ladies' initiative. thank you for coming to our first ladies' conference last summer as well, and thanks to all the first ladies who have joined us. thank you for the great work you're already doing in your countries which we'll hear about in a few minutes, and thank you for all the good work you will do. thanks, cokie. >> well, again -- [applause] well, thank you, back at ya. [laughter] but, laura, no, absolutely. we are here today because of the example that was set in tanzania new the summit -- through the summit that the bush institute organized, and as my chief of staff stated, when this summit was being organized, we jumped at the chance to do something similar and to continue this conversation and to come together as first spouses and to continue to be inspired by each

other. what i would say just in closing is that we have to fight for our girls. there should never be a girl in this world who has to fear getting educated. that should be something that is intolerable to all of us. i can only think of my own girls, and i think we all have to see our daughters in these young girls. we want the best for our daughters. we want them to be start and empowered and loved. we want them to be healthy, we want them to be mentally sound. and if it's good enough for our girls, it's good enough for every single girl in the world. but it's going to take leadership like us, women like us speaking up in our countries and making sure that young girls are not summit to abuse and -- summit to abuse and that --

subject to abuse and that they are loved and valued. and until we do that, we will not solve these problems. investing in our women, the people who raise our children, the people who, you know, take care of families, they have to be healthy and whole. and that is the most important work that we do whether we talk about clean energy or economic empowerment. until we start to value women and girls, we will continue to struggle on this planet. but i have high hopes when i look around this room that we won't tolerate that, not anywhere on the planet. and if we continue to work together and continue to lift up our young people who are fighting for a better future, then i think we will see some progress on these issues. so i look forward to working with all of you in the years ahead. so thank you all, and i hope you enjoy the rest of the conference. cokie, thank you.

thank you as well. [applause] >> thank you, both. thank you both so much for the work you're doing, first of all, for coming together. i keep saying you set such a good example for the men. [laughter] but also for allowing me to participate in this conversation. thank you very, very much. [applause] [inaudible conversations] >> ladies and gentlemen, please now welcome pink ribbon, red ribbon ambassador strive masaiwa. [applause]

[inaudible conversations] >> good morning. thank you. your excellencies, distinguished guests, my name is strive. thank you for joining us this morning. i'm an african businessman. i founded a company called econet wireless.

i'm delighted to introduce the video that shows the treatment of a disease that is taking the lives of women of our deponent. continent. led by the george w. bush institute, the u.s. government through the president's emergency plan for aids relief, pepfar, susan g. komen and the joint united nations program on hiv/aids along with 15 other members, pink ribbon, red rib bob is the -- ribbon is the leading public/private partnership to combat cervical and breast cancer on the con innocent. as many of you know, cervical and breast cancer are the primary causes of cancer deaths among women in sub-saharan africa. pink ribbon, red ribbon is changing that by helping to harness the collective efforts of government leaders, first

ladies and the health workers to confront the challenge head on and to provide the hope of a bright future for women. i am an african father and father of five daughters. my grandmother -- [applause] is 106 years old. and she is alive, and my mother is alive. [applause] thank you so much. let us watch, and god bless you all. ♪ ♪ ♪ ♪

♪ ♪ ♪ ♪ ♪ ♪ ♪ ♪ ..

these people can get very good help. >> we know that worldwide -- they come into contact with

women. that's why the whole of the sub-saharan region has put together program for prevention, detection and treatment. a number of african countries have partnered with pink ribbon. >> when i was growing up, lots of women and men, including myself, had no idea of the silent killer. it is a sexually transmitted disease. a woman gets it from a man who has be hiv virus probably after 10, 15 years is when a woman starts to notice the symptoms. that is why the screening pro graham is very, very important for us. to get to a level where we can

treat. ♪ ♪ ♪ >> in africa, the notion to go to a doctor is, you've got to be really sick to look for medical health in africa. and so we first have to bridge the barrier within the women themselves.

>> we start with the pre-hiv/aids testing, and then we offer consultation. the ladies do a screening. we actively treated on site. when we find -- we actually do a referral so they can actually get treatment. >> yesterday, there was this announcement, that there will be some assistance.

you cannot do everything ourselves. >> we need to preserve the health of our women. >> pink ribbon is coming to the aid of our country. there are many people that do the work we do, but we feel privileged what we're doing here. we have the support we need to continue to coordinate care. >> the young generation, their varied in age.

i am now with the grandchildren that are very young. >> ladies and gentlemen, the 43rd president of the united states, george w. bush. [applause] >> thank you. it's an honor to be with you. i note that this is called the first spouses event. [laughter] not the first ladies event.

because there are few men in the audience is wise our more famous and popular than they are. i'm one. and rightly so. and i suspect president obama would say the same thing. and so to both michelle and laura, i think you very much for the great example and dignity you brought to the office of first lady. i want to thank the african first spouses who have joined us, some of whom i got to know when i was president, it is great to see friends again. i also want to give a shout out to our dear daughter, barbara. not me thanks instance me to come back to washington. [laughter] the first lady summit of course is one. the other is to be able to dine with our dear daughter who is a fabulous young woman making a big difference on global health around the world. i love you, baby. [applause] it was an honor to see dr. biden

again. i'm pleased to see sharia blair. please give your whole family my best. he is retired like i am. margaret spellings who was secretary of education when i was president, today i does job at the bush institute. and give get our members of cons here, thank you for coming. if not, why not? [laughter] i also want to thank lisa carty to thank lisa guardian and ambassador deb burks, the co-chairs of pink ribbon red ribbon. i thank you for your exceptional work. on behalf of african women. i appreciate our founding partners, michael, thank you. appreciate you being here. and judy, the president and ceo of ccj komen. i've got a little more time on my hands these days -- susan g. komen. surprisingly some painting, but

that doesn't cause me not to have enthusiasm for the future. and as a father of two wonderful girls, and now a grandfather of the world's smartest granddaughter. [laughter] i'm more concerned about the future, not less. through the bush institute, laura and i are engaged in issues that define our time in the white house. and throughout many of our institutes priorities and proposals is woven one theme, the success of any nation is impossible without a political participation, the economic empowerment, the education and health of women. a decade ago the health emergency for women, and for everyone, was an uncontrolled aids pandemic in parts of africa. some of you probably have the families stories of tragedy and loss.

but together we witness one of the brighter chapters in the human story. a combination of global resources and local courage has demonstrated two points. disease can be defeated, and people living with aids refused to be defeated. they are holding jobs, raising crops, starting small businesses, raising children and country being each day to africa's success. the american commitment to the fight against global aids has reached across the political divisions, and to administrations. thanks to up far, the global fund and the rising commitments and resources of african governments, more than 9 million men, women and children are on aids treatment in sub sahara africa. [applause] a generation on the verge of being lost has been found.

life expectancy is up, health care systems have grown stronger, many more people in their most productive years from the '20s to the '40s are contributing to africa's economic growth. and many of the first ladies, first spouses, have led efforts to end mother to childhood transmission or the first and necessary step creating an aids-free generation. we started the battle against aids with a broad response and there was no alternative. but a great need and hope at this stage of the fight is to focus our efforts and resources. better data, better treatment options and better prevention approaches allow health officials to reach and help the highest risk regions and groups. applied with clear goals and accountability this saturation approach presents an amazing opportunity. the beginning of the end of

aids. it also requires something from the rest of us. it is impossible to direct health where it is needed most when any group is targeted for legal discrimination and stigma. compassion and tolerance are important medicines. one group that requires particular -- [applause] one group that requires particular attention is women and girls. we know the young women are particularly lovable hiv/aids. because they are particularly lovable to poverty and violence. and women with hiv are four to five times more likely to develop cervical cancer because the bodies of reduced ability to fight infection such as -- this fatal link between hiv and cervical cancer can be broken. it is our job to break it. taken together focal -- cervical

breast cancer of the number one killer of women in africa. diseases still surrounded by stigma and ignorance. the suffering spreads across generations. when a mother dies young, children are less likely to be of the and educated and more likely to die young as well. one of the best ways to help jonah is help the mothers live to raise them. a few years ago the bush institute launched pink ribbon red ribbon which as lord discovers a public-private partnerships, partnership that combats women's council with the -- has withstood commitment to people living with aids should not be dying from preventable and treatable diseases. by bringing together a broad partnership of government, corporations, foundations and multilateral organizations, we set out to raise awareness, screen high-risk populations, provide hp the vaccinations and treat those with lesions are simple low-cost methods.

we work to let the shadow of stigma from the cancers that target women. our goal is not to build a bureaucracy but to build a broad shared practical commitment. and we took the pepfar approach as a model. we work to show, and i did it can work to increase capacity and to bring it to scale. in the three countries were pink ribbon red ribbon started work, we are seeing results. more than 100,000 women have thus far been screened for cervical and breast cancer. [applause] first lady has been a champion fighting against the false rumors about the hpv vaccine, something needs to be done here in america as well. [applause]

the first lady of tanzania has been a great advocate and led the mobilization for mass screenings. first spouses -- [applause] first spouses are leading the way and all of us thank you. for doing really what you should be doing. [laughter] lower and i've seen the outcome first and last two summers we spent time in -- i was in charge of painting. she was in charge of going over the spots i've missed. [laughter] she had a lot of work cut out. in my defense, i was beginning to study the impressionist movement. [laughter] whenever we want an example of kindness and hospitality we always think about the zambian people. [applause]

besides dancing with women here's what i remember most. [laughter] by the way, it was a forgettable dancing. the women were nervous at first, nervous to be screened. but then they became joyous. joyous to know that people cared about them. joyous to know that the government wanted them to be healthy. so far in 2013 the zambian partners, the people of zambia have screened 43,000 women for cervical cancer. about a third of those tested positive for pre-cancers or cancerous cervical cells. in other words, the screening was a matter of survival. i know the process can be seen as intimidating, but it's truly a source of life and hope. and by the way, for the first ladies, if you are worried about your husband political future, taking care of women is good

politics. [applause] >> many sure the work and credit of pink ribbon red ribbon at it want to thank organizing members, pepfar, susan g. komen, for demonstrate a moral commitment for human dignity that unites our country. i deeply appreciate our generous corporate and foundation members, many of whom are here, for the consistent dedication to women and girls in africa. it's also a partnership with the countries in which we operate. these programs survive and thrive with local leaders take ownership and commit their resources as we've seen intend to me, zambia and botswana. our goal is to great working models proven partnerships that additional countries over time to expand and incorporate into their own national plans. it's always been my approach to development, partnership not

paternalism. so i'm pleased to announce today that pink ribbon red ribbon is expanded to include two additional partner countries, namibia and ethiopia. [applause] i am a particularly grateful to glasco smithkline compressed so myers squib foundation, ge, iaea and the american cancer society for the willingness to work in those two countries are providing education, vaccination screening and treatment. today we're going to announce as will a distinct group of advocates called pink ribbon red ribbon ambassadors who will help us all take this message come important message across the continent of africa. bethlehem gertrude pesce i would say the last and i'm confident i would mispronounce of them. [laughter] are here today. you just met -- an awesome guy. we are thrilled that the our ambassadors but the truth of them it is the first ladies

ought to be ambassadors as well. the first spouses have a chance to impact the future of your country in remarkable ways. you can check in national politics. you can help build political will. you can save the women from cancer. you are uniquely positioned, it is one of the problems we have. people died of stigma. too many people not being treated because of some false rumors, and the first ladies, while stigma may seem like an unbridgeable wall, you've got to realize that truly made of glass. and through your leadership they can be broken by being outspoken and by being honest and by being compassionate for the sake of mothers and grandmothers. it doesn't take a lot to get me to lead dallas. i'm it doesn't take much, it takes me a lot to lead dallas. this conference surely is one

reason why i came. it's awesome. this is great come and we thank the white house. i think the bush institute and their team for helping prepare this important conference. i'm not going to invite the first lady of ethiopia, first lady of namibia to come and join on the stage. god bless you all. [applause] [applause] >> excellencies, fellow first ladies, distinguished guests,

all observers. let me have the very outset thank you on behalf of government and the people of namibia to express my profound gratitude for pink ribbon red ribbon for choosing ethiopia as a new country of engagement. the studies and reports indicate that cancer in all its forms is a critical topic health problem. cancers are found to be leading cancers among women. these cancers are common causes of morbidity and mortality in ethiopia, too. however, -- stomach cancer and other communicable diseases have not been adequately addressed in ethiopia in the past. take into account the ever

increasing battle against come ethiopia's taken a number of issues that aim at preventing and controlling cancer prevention and control of cancer is included in the health strategy. [inaudible] there are 25 health assistance providing screening and treatment for precancerous lesions. a very cost effective method. we have a committee that is composed of government and institutions and ngos and varies development partners to support the ongoing initiatives and to enhance prevention, detection, services and how to care. together with the ministry of health and these committees, reach out --

[inaudible] for women's cancer in ethiopia. efforts are also underway to improve access to catch achievement and care packages. our government plans to publish five regional centers for cancer treatment by 2016. we will be working hard to revive effective services, we also need to work for the prevention of cancer because it's the most cost-effective and sustainable way of reducing the national cancer battle in the long term. cost effective services must be made available through access to information and education at the primary health care little. [inaudible] effective cancer prevention at the national level against with

the national council control plan. we have to work hard alongside health care providers to make sure that anyone who needs cancer care and access it completing the necessary medications are managing the disease. that are so many challenges in ethiopia. one of the challenges is a low level of awareness. [inaudible] last but not least, it's my earnest hope and, indeed, the expectation of all women who are

suffering from cervical and breast cancer in ethiopia, we will work in partnership with the government and all stakeholders to increase cancer prevention including hiv, hbv vaccination, screenings and stigma. breast cancer education and early care seeking but our women, like never before. building the platforms. i want to assure you that your intervention and results will look for us partnering with you. thank you. [applause] >> ladies and gentlemen, the first lady of namibia, her excellency.

[applause] >> your excellencies, ladies and gentlemen, i am honored to be part of investing in our future as the u.s.-africa leaders summit, and i'm delighted that my country, the republic of many be a, will be one of the next two countries -- namibia. in committing to our future, the theme of this summit is a noble goal that all community must embrace -- humanity must embrace. implementing this goal must be

protecting all women. we are here today to witness a commitment, a commitment to the future of wealth, the 104,000 in care, a commitment to cervical cancer free namibia. a cervical cancer is a growing health problem in our country. and ranks as the second most frequently diagnoses among women. breast cancer is number one. every year, 172 namibia women have cervical cancer, and half of them die from the disease.

losing one woman is cause for concern, but in our countries, with our small populations, the impact is particularly devastating. i experienced this firsthand while caring for namibia women and their families over many years. these statistics are playing out daily in our cities and towns, and families all across our country. and because of the special vulnerability of women and girls hiv come and because women with hiv are so much more vulnerable to developing cervical cancer than their hiv-negative peers,

the problem is even more pressing. the good news is that cervical cancer is an avoidable disease. and we can stop the disease through effective screening and programs. i'm so grateful for the commitment of pink ribbon red ribbon partners. thanks to the work with our government and local ngos, 90 be a doctors and nurses already received training and are saving our women. -- namibia doctors. in fact, the last week of july this new -- 15 of them tested

positive for pre-cancerous lesions. 11 of these were treated the same day, and 4 -- treatment. these women, these are women, if left unscreened, might have developed cancer. women who benefited from this treatment were able to know their health of data and -- with hope for the future. i am encouraged that our government permitted pashtun is committed to women's health, and particularly in preventing cervical cancer, which includes the introduction of vaccination of young girls against the hpv

virus that causes the disease. we are aware that we need to do this, and they are ready and able. cervical and breast and prostate cancer, i saw our country's readiness to tackle these issues head on. we have successfully brought together leaders from around the world, from 20-22nd of july to discuss how to in cervical cancer by 2015. [applause] i believe that net maybe you can be a role model in this fight against cervical cancer. we have been successful in