30 percent of the drugs used in this country are used off label. i doctor decides we're going to use it for these even though it's not approved for that. why would we want information to be stifled? that's one of my big gripes with both drug companies and the fda you think we could share every study. x and now you can. limits the knowledge and the sharing practitioners in this country, whether it be a notice or a doctor, they don't know what's out there and they don't have the time to go to.>> i think on that note we will have to take it and leave it here. thank youto our panel, thank you doctor coburn . >> appreciate that. >> live now you're on c-span2, so the national public week forums from the public health association. >> we will also be hearing a keynote address why surgeon general jerome adams. the introductions are

underway right now by the director of the association. x there's an audience out there and in east hampton. so we're really glad that that's is with us here as well today. >> i have the honor this morningof introducing an old friend . a young man by the name of jerome adams. doctor adams is a board-certified anesthesiologist who served in the indiana state health commission from 2014 to 2017. he has a bachelor degree in biochemistry and physiology , from university of maryland baltimore county. i like that because my doctor was in dc as well. and that's the public health degree from university of california berkeley and isand the university of california . i doctor adams when both he and i served on the advisory committee for the fairbanks system of public health in

indiana. doctor adams when he first came to the health commission he was new to this. but he got got to work quickly. he had to roll up his sleeves because some of you may know that he had this where it was the worsthiv outbreak in the country. in middle america . in a population that people didn't think would be getting hiv. and it was also involved with the use of opioids and other drugs. so it was a very gated outbreak. but he works in a really profound manner, working with the, his then daughter. governor francis. the cdc, with the local health department and others to get their hands around the epidemic. so doctor adams, i want to thank you for the work you did on that because that was great. his motto as surgeon general

is better health for every partner can't think of anyone who really has a better place to bring our theme for health week and his model together as a single thought. so ladies and gentlemen, the 20th surgeon general of the united states, doctor jerome. [applause] >> thank you. i knew you were going to do that. you set me up. good afternoon, everyone. you all can do better than that, good afternoon, everyone. it is fabulous to be here today. i am excited for public health week. i was thinking about what i was going to save you all week long and hopefully i don't disappoint.we're

going to do questions and answers at the end make sure you have some good hard once and because everyone expects this, we're going to do some selfie but do that in front because after the q&a's, i don't know if you're going to like me much anymore. >> but let's make sure we get everyone in there, ready? public health week, one, two, three. all right, fantastic . all right, i want to speak and the doctor for having me here and doctor benjamin. it's been great to meet with folks who think like i think, we talk a lot about this and such on a little bit during my talk and i want. i don't like you here before, but thank you for being here and i had conversations with most of you all and i really hope you great discussion,

i'm looking forward to it. i know you all are going to learn a lot from these individuals because they represent very different points of view, all of them toward the same goal . i'm so glad to hear the theme of this national public health weekis changing our future together. strengthening relationships within communities , is the key to improving health and i commend you all for embracing the idea of better partnerships. >> as surgeon general, i want each and every one of you to know, i want you to know that i believe with every fiber of my being every american deserves to live a long and healthy life. >> unfortunately, we are falling short of that goal. and as many of you know, your public health activities, public health has declined for the united states for a second year in a row. police and i were talking about thekids earlier, she is

the mom of two 5 1/2-year-old twins .can you believe that? and she's got one more at home. i'm the parents of a 13, 12 and eight-year-old i left over at the white house for the easter egg roll so ihope they are causing any incidents over there at the moment . i'm unfortunately, both elise and i and several of you all in this room are part of the first generation of parents in the last half of the century right now, and tell their children they are going to outlive us. think about that. half a century in every generation has been able to look their kids in the eye and say you're going to live longer than me. right now we can't say that. as surgeon general, i determined not to accept that fate for my children or at least for any of our children. >> my vision is for a healthier and more equitable america, so it can only be achieved if we reframe the way we think about and we talk about health in this country. >> by now, most of you in the

room are familiar with the varying degrees of the hhs counties that doctor benjamin spoke of so i'm not going to belabor it . a town of 4000 people never had more than three hiv cases in a single year, now over 230 cases of hiv are related to injection drug use. the experiences i had lessons i learned during the hiv outbreak are exactly why i treasure the opportunity that has been given to me to be the surgeon general of the united states. i also invited to speak at largeconferences , similar to , bigger than the one i'm in today. but i feel i truly have the biggest impact when i can help facilitate local discussion. just as i say all politics are local, all health is local.

and i personally feel we can only meaningfully and sustainably change health when local partners come together and create local solutions. love you all like me to say this but the folks in dc are going to ride in on a white horse and save the day. there's a lot we can do from here in dc, there's a lot the federal government can do and must dobut we are only going to create that change , that meaningful sustainable change when on a local level. i want to share with you a little bit of personal story about me that you may not have heard, one of the challenging things when you're going out and getting multiple talks is sometimes people here you couple times and they get tired of the same old story so we thought of a different one to share this weekend but it drives home the point of partnership in public health week. i'm a physician as doctor benjamin mentioned and i'm proud of that but most americans think about health , they think about me in a white coat. they think about prescription medication, they think about

vital signs. but we in the public health community know the reality is health is so much more healthcare. health is critical but health is so much more than healthcare. a few of you may have heard me tell the story about my childhood as a chronic asthmatic . and the frequent hospitalization as a child. the interactions i had with the healthcare sector. my interest in making and influence my decision to become a physician. yet myexperiences in the hospital are not what i consider my first exposure to public health . i didn't grow up in a wealthy family by any means. we had four kids, that ballooned up at different times and varying amounts that i'll go into in a little bit but i obviously did not realize how poor we were back then but we weren't well-to-do, let me put it that way.

but i was blessed to have supporting parents who cared for me throughout my childhood, just as a little over an hour ago from here in rural maryland. my parents raised me to work hard, be humble and care for those around me. last lesson is one that particularly stuck with me. that's blessed a little bit too much to my parents liking and i'll share that with you now. >> whenever i noticed that classmate was getting picked on, or a friend or a teammate who didn't have a parent to spend time with, or anyone to go home to, i invite them to come to my house. sometimes we stay for a meal, sometimes they stay the night, sometimes a stable wholeweekend . on more than one occasion a state several weeks and sometimes the whole summer. they were fully happy, energetic and vibrant people

that they could be and i saw how they would light up after a good meal. . after a time where with a loving and laughing space, safe place to stay. >> my parents would often joke and i shouldn't say this but they say the rooms are always collecting sprays and bringing them home and my family went as far as welcome my friend and now my brother stan been in and out of foster care system his whole life and we brought him into our home and adopted him. and in a much more formal letter.i didn't realize it at thetime , but this experience as a youth trying to create an environment where otherscould drive was really my first foray into public health . no, i wasn't involved in making drinking water saver or promoting a vaccination campaign by helping others have access to nutrition, helping them interact with positive role models and a safe place to stay, my family and i were addressing the social determinants of health

and good meal prevents and increases overall health. also it's an increase of business at school. it increases resilience to the eight, we know for committeechildren, especially children of color are safe . having faith and increase cognitive and social functioning and allow the people to grow . now, i hear that story with you for two main reasons and there's a lot you can do but there are two main reasons i share that story. >> first, is a multifaceted approach that we as a public health community should be engaging in to better health. and to afford health equity for all americans. >> ,and perhaps more noteworthy, i did as a child and i did it as part of a family was barely above the poverty level ourselves . so yes, we need more funding.

we're not going to deny, you'll never hear me say is a public health advocate we don't need more funding. and yes, we need medical expertise, we need health expertise, we need to be grounded in the sciences. the surgeon general, youwill never hear me say that we don't need more expertise , you don't need or studies, that we don't need more science. but we can have a tremendous impact, we focus less on what we don't have and more on better engaging partners. engaging everyone to realize the potential already existing in every single community in our country. >> you know, when i was held commissioner of indiana, i would go out to the communities and would get excited about the health commissioner and what happens now and i'm surgeon general, you group to get around the table and everyone wants to meet you all the answers.

one of the things that sticks with me the most is i would go into those communities there be group senior disabled. and this person saying here and this person would be working on an issue and that person sitting in the seat next to them would be working on issue and it be in the same community and they would realize how many people in a very community were also all committed to and working towards the same goal. >>. >> what we need to change health already exists in our community, we just have to be better unleashing it. please don't misunderstand me because former pha president, doctor jones, he's a good friend of mine and she and i am a we have very vibrant discussions about the role of government and about health equity and the end of the day, i consistently tell her and i think she's finally agreeing with me that we believe in the same goals in the same ends.

i'm not saying there isn't a place for majorsystemic change . no matter how many you my family and i during our childhood, we could never change systemic oppression, institutional racism that affected my fears. it's too big hurdle for any one person, anyone family and in some cases even anyone community to tackle alone. i thought about better health through better partnerships there are so many different ways we can improve health we commit to working across sectors and engaging new partners. we had another discussion i thought many of us earlier. talk about better health and better partnerships, even when i look at the audience i see a few people nine their heads. everyone believes in partnering. it's a whole lot harder to do. i'm going to give you practical tips to being a better partner and forging better partnerships. number one, invite your table.

>> and go to their table. meet them where they are. >> necessarily think of. we had this discussion earlier, would've thought for a health issue you needed to invite the sheriff to come into town and be part of that discussion? that's what we had to do in scott county indiana. who would think that the first person you should call when you're dealing with a health issue is the local priest? that's usually at the end when everything else is exhausted question mark in scottcounty, that's what we had to do . to solve that hiv outbreak occurring in the community. so we got to again think about not additional partners and invite them to your table and go to their table. number two, tell them, show them that you care. here's a great saying, nobody cares what you know until they know that you care.

as a physician i got motivation. a motivational interviewing? >> there are patients with diabetes and i've often had that same cycle over and over again saying well, mister jones, you're diagnosed with diabetes. here's all the things that science says you need to do. to improve your diabetes. your prescription or your medicine, lose weight, exercise more. unfortunately, time and time again we see that it doesn't work. motivational interviewing is about asking mister jones what needs . instead of trying to push what i want on mister jones. asking him what he cares about and seeking areas of alignment so that we can get there. mister jones, you care about being able to visit your grandkids you care about able to walk or run that 5k with your daughter. you care about being able to make it to that softball game

or go on vacation. great. we want to get you there. we've got to get your diabetes under control and here are things we can do together to get you there. motivational interviewing. it is our responsibility as public health professionals to show communities we care about their needs rather than trying to ram a public health message down their throat. we talked about the hiv outbreak in scott county and there were a lot of folks who said doctor adams, why didn't you go down there and use your power to open up a service for them? if i'd gone down there and done that, the local sheriff would set up a perimeter around the service center and arrested people as they were coming in for going out. it doesn't matter what the signs said. he still have the legal authority to do that. if i tried to ram it down

their throats, there would've been local pastors talking about how the health commissioner came in from out of town and was the devil trying to push this on their community. we have to engage people where they are and show them that we care and i was in that community and i didn't say you need a service program, i came in and said you all have a problem, tell me how you feel we should solve this problem. tell me what your community needs and let's figure out how we can get there together. that's how we stop the transmission of hiv in that community . number three, last steps to better engaging partners, identify your target audience and address your messaging accordingly. i had a great conversation and a robert wood johnson prospective a few weeks ago and he and i shared being better communicators. we need to get much better at the science that is effective

health communication and that's not going to be open you all focus on but it's something that all public health advocates, particularly in the health realm need to talk about. how can we be more effective communicators. just like going to another country, effective communication starts with knowing what land you are in and what language they are speaking. anyonehere speak english as a second language , learn another language first? we've got two faults. when you go outside the united states and the americans come into town, what do they do? theyfind a person and start talking with them. theyexpect they're going to know english . and then when they don't know english, the americans , what do they do? they speak louder. they yell at them and expect that now they are going to understand what you are saying.

we do that far too often in public health. we expect they're going to speak our language and then when theydon't understand, we yell at them and call them names and expect that somehow that's going to help them around to where we are ? a couple ofpractical tools , two of my favorite publications, one is helen woodward the latin american nations area colin woodward is a cultural anthologist and what he did was break down the country into 11 distinct what he calls nations and he called them nations cause they are very different, folks don't realize how different the united states is. i told them i wouldn't tell any old stories , i'm going to tell stories but i know everyone in here heard this story i apologize tothose who have heard it . i was tasked with explaining to a bunch of people who are not from the united states, the united states state

health care system and i was given 10 minutes to do it. easy, easy. your what i said . >> you know, when you look at paris france and berlin germany, these are two cities and two completely different countries. they speak different languages and in the last right world war, they literally tried to load each other off the planet. either one had their way, they would not be a france or a germany right now. that's how different and distinct these countries are. but when you look at the top and most controversial health issues, public health issues, when you look at what's done, when you look at asset health care coverage, when you look at immigrant rights and contraception and abortion, when you look at drug policy and reduction, these two places, berlin germany and paris france that tried to

wipe each other off the planet are closer together than dallas texas and boston massachusetts. >> we truly are a country of different nations. i'm getting to the. they told me i got tostart wrapping up here . we're going to let the american nations, the other publication is robert wood johnson and we have a way to talk about the social determinants and what they did there was pull 4000 voters in the country and determine which phrases and which wordsresonated and which onesdidn't . and then they gave their practical tips . use phrases like opportunity, everyone should have the opportunity to live a long and healthy life . your neighborhood should be added to your house. it gives you practical solutions to speak the language that's going to resonate when you're in a different nation. that may be part of the same country. >> as i wrap up i'd be remiss

if i didn't see such a large audience about opioid attacks. >> today in america addiction is a public health crisis with an estimated 2.1 million people struggling with opioid addiction. that's more than the number of americans diagnosed with cancer every year but only one in five receive any treatment at all.they were losing every 12 minutes and from the time i've been on the state talking to you someone died from it opioid overdose, think about that. >> i see my role as surgeon general educate the american people about the severity of the epidemic, and how everyone can be part of the solution. all you can play a role in combating the opioid epidemic . that doesn't mean you haveto drop your other priorities and focus on opioids. it doesn't mean that all . i'm tired of telling folks we need to learn how to ride the wave.

with the opioid epidemic provides an opportunity to amplify your messaging. i was in tennessee about three weeks ago. who would've thought that tennessee in the middle of the bible belt would be leading the way in terms of talking about voluntary reversiblecontraception. certainly i wouldn't . but they are. they're providing voluntary contraception in prison to women and are doing it through the lens of the opioid epidemic because they notice they had some of the highest rates in the last syndrome in the entire country. they know this because they had the highest rates of taking children away from their mothers in the country, all related to the opioid epidemic that created a way for them to talk about reversible contraception. we know the communities most impacted by the opioid epidemic are also the same communities that i have high obesity rates, lowgraduation rates , that areaffected by age . there are opportunities that talk about so much more about what we want to talk about

through the lens of the opioid epidemic. and we also know that upstream interventions would mitigate not just opioid -related issues but all the issues that you care about. >> as i said to audiences, we've been trying for years, for decades to get people to pay attention not just to addiction, not just the mental health but to the social determinants that exist in all communities but especially communities of color. we've got a great opportunity now for folks who want to talk about that. i was a cabinetmeeting and you have ahead of the secretary of labor , the had of hud, agriculture, all these folks talking about social determinants of health . you have a great opportunity here and i have to say great and miss the tragedy but it's a unique opportunity to really push public health or the lens of the opioid epidemic if we're willing to ride that way. >> i want to close by stating

that every single one of you in this room, every single one of you and i talked to people who've been in public health for a while, but for that are in college right now, some of my fellow retrievers over there in college, every single one of you is a leader in your community , by the nature of you showing up today. thefact that you showed up means you are a leader and you have potential to influence other people. it means you have an opportunity , it also means you have a responsibility to lead by example. it's imperative all of us use our platform for maximum effect and with fervent leadership. >> a couple challenges to leave you with. challenge each and every one of you should think of at least one new partner you can invite to the table and whose table you can go to. whether it's the faith community, educational community, we have books here from the department of agriculture, from think of one new partner whose table you can go to andsit down. number two, i challenge you to stop .

the next time you're about to ask someone to do something you know is scientifically valid, and you know will improve individual community health, stop. just pause. stop for one second and have the courage to instead ask that person what their goals and desires are before you start talking about yours. show them you care before you try to show them what you know. and finally,i challenge you want to thinkabout how you can be a more effective communicator . at the end of the day, we know what to do . we're just playing lousy at getting people to do it. public health hasn't changed in the 20 years since i got my ndh. two more, be better, don't smoke, don't do drugs. all those less were there 20 years ago. where just plain lousy at communicating to people what we need them to do and it's because we don't recognize or we don't care that in many cases we are a foreign land

speaking a foreign language. my mother is better health through better partnership because no matter what area of public health you are passionate about, it's about forging better partnerships and being a better partner, good health is sure to follow. thank you aph a, thank you all of you for being here and to the folks joining us by webinar. thank you for bringing such a diverse groupof individuals together to collaborate with one another . and i hope each of you take the opportunity here today to find a new partner and get to know the person next to you and figure out how you might be able to helpthem and in turn they might be able to help you . it's been a pleasure to address all of you and my best wishes for a great public health week. thank you so much. [applause] did i run out of

time for questions or do they have time to grill me or what are we going to do? all right, a little bit of time for questions. anyone? in the back, yes ma'am. [inaudible] and tell us all who you are, too. >> is it on? i'm caroline revealed, i work for the public sector services but my background is in public health, louisiana department of health and also medicaid. the more i work in healthcare, the more the issue of helping health and security is coming to the forefront so you're talking about building better partnerships and i've worked on the local level in housing and healthcare and one of the roadblocks i think is the

funding and the lack of intersection of that funding at the federal level. can you talk about that a little bit and also maybe talk about what you're hearing from your house counterparts about what they need from us? >> wonderful, thank you so much and i'm going to step out here a little bit. one of the things i tell folks is we have another tremendous opportunity. no matter which side you're on or how you feel about individually , we have a position at the head of housing and urban development, i thought that doctor ben carson. he believes that housing should help. i told you all even two years ago that we had the opportunity to have a physician as the head of hud, you'd say that's fantastic that we aren't taking advantage of it. we aren't engaging hud on a

national and local level as public advocates to the degree that we could. doctor carson believes in it, we've got initiatives out there trying to promote housing and health but we need to help folks understand how to make that happen, how to create healthy housing because individuals just aren't familiar with that. when i was in indiana we had a situation where it was a hud housing complex and once upon a time someone thought it was a good idea to build a housing complex on top of an old lead facility. it we had engaged hud and they had engaged public health, we've done a better job of that then maybe we could have avoided some of these unfortunate situations so really taking advantage of that. the other thing, i thought about riding the wave of the opioid. we know the number one predictor two whether or not you're going to be successful

is having permanent housing. folks understand that. we have the opportunity to use the opioid epidemic to talkabout housing as a social determinants . we got to be at the table and also really engaging folks from a business point of view. one of the things i want to do is investigate the surgeon general's report on helping the economy because the number one thing that people vote on his job as an economy. the number two thing they vote on his safety and security. health is not even in the top five or top 10 but if we could help understand how we can create housing communities that are not just good for health but also for lifting up the community, lifting up prosperity, then we will better be able to engagepartners and not just ram it down their throats that you need to commit to healthier housing or pay for housing but that we can show you how we can create a community that millennial's want to move to .

everyone's talking about amazon and where they're going to take their headquarters. let's create a community where amazon says i want to come to that community because millennial's want to move there. there's streets, there's no food deserts, it's going to be a great place to bring in people and for them to be productive, for them to be prosperous but if we can do that in a back-and-forth we will be much more successful. if we can inject our public health inputs with a goal of increasing prosperity in addition to increasing housing, we can be humble coming in with a dose of humility, i think we can be successful so a great question and thank you for that. maybe time for one or two more. [inaudible] >> i'm wondering if the opioid epidemic, you talk about otheraddictions . >> elise wondered if the opioid epidemic was a good way totalk about other addictions and the short answer is absolutely . the opioid epidemic is not

the problem. it's the symptom. and it's a symptom of unrecognized and untreated mental health issues. my own brother is in maryland state prison hour from here because he had untreated mental health issues which he felt the need to medicate which caused him to steal $10,000 and get a prison sentence. even upstream from that, at adverse childhood experience, social determinants. there's a tremendous opportunity to talk about addiction to tobacco which we know these people, i talked to folks in one of the things i love hearing is their personal story about how they struggled with addiction and i can tell you tobacco is in so many of these. we know it can prime the rain for other addictions. opportunity to talk about alcohol. let's move upstream and talk about all the other things that can be a problem and stop playing laughable because what we can do with

this opioid epidemic is treated about and opioid epidemic. we will get our hands around it eventually and it will pop up somewhere else is something else further down the road if we don't get upstream so a great opportunity to talk about it and surgeon general, i do talk about it and i plan to talk about again not just opioids but addiction. not just addiction but mental health issues. not just mental health but have adverse childhood experiences. not just resilience but social determinants and health and not just social determinants but wellness that will ultimately lead to better outcomes across the board. there may be time for one more question. >> my name is benjamin brooks, and all of unaffiliated public health professional . i was wondering if you could talk about the role of public-private partnerships and if your office has any resources to support the development of those

partnerships. >> public-private partnerships are going to be huge. they already are increasing in prominence and prevalence but we need to begin think about how we can gauge those private entities. my report on health and the economy is not about me trying to tell businesses that they need to pick up my manual. it's about me going in and saying you engage in a healthy environment, is going to be easier to recruit you. you're going to have less absenteeism showing up at work and being less productive and have less workplace accidents. you're going to be more prosperous across the board. we've just got $6 million to respond to the opioid epidemic. it's more money than we've ever gotten to respond to opioids. you know the challenge is whatever we talk to folks

they continue to tell us it's going to cost so much more than that to be able to do what we want to do . we also know that we've got congress and an american people who believe in a certain size pie and that pie made it get bigger or smaller depending on who's in charge but at the end of the day it's still going to be a finite pie and there will never be enough of that pie coming from the federal government. we've got to figure out how we work harder and not just smarter, how we engage private partners, how we engage nontraditional partners and i'm working with the military. why? seven out of 10 people in the military are ineligible because they can't pass a physical, against me the educational requirements they had a criminal record. why don't we have dod and law enforcement and education and health all at the same table pulling their funding

together and all the private groups working each of those areas trying to figure out how we can work smarter the money that we have instead of going with our head out separately to congress over and over again and making the pie bigger because my peace isn't big enough. so absolutely i believe in public-private partnerships. man? [inaudible] >> i'm a student at george washington and i know a lotof students here going forward , what would be the number one piece of vice you would give us in public health? >> as a student she asked what would be some advice i would give you folks as they embark on their career. and this point i made earlier, i'll try to rephrase them. i would say we need to think beyond public health.

we need to think about how public health needs in to the priorities of the voters. the private entities of the corporations, of the law enforcement community, of the educational community and show them how we could help them achieve their goal. focus on communication, we don't want to spend the next 20 years of your life working on an issue with your blinders on. and then re-frustrated and say i didn't really make a difference and still talking about the same thing. we canmake a meaningful change if we become more effective communicators, better partners and if we become servant leaders and walked in asking how we can serve others instead of expecting that because we've got the moral high ground and the science then everyone is

going to listen to us . more practical tips, i really think it's more specific to the younger folks, take advantage of opportunity that come your way. i did a study at howard university in actuarial science, a window that is? it's the science of figuring out risk and it was all about math and i love math but ordinarily, you think that has nothing to do with public health and i've met tremendous people, gain some valuable skill sets. as long as you're increasing your net worth, learning something, it's a worthwhile endeavor. so continue to take advantage of those opportunities that come your way and continue to grow, continued network, that's something i told him. time. i had the privilege of being able to be at the side of the vice president the last four or five years. it's an opportunity the white house earlier this morning around the president and sit down with me and casual setting and say i have a chance to talk to president

from, this is what i'd say. then they get next to me in front of president from and. [laughter] when we talk about an elevator speech, that's 30 seconds. you got 20 seconds, what do you want to communicate about what you're interested in, what you're doing about who you are in an efficient manner to make the most use of your opportunity. it goes back to effective communication. i would say, maybe one more before they give you the yes ma'am. >>. >> amelia roberts with graduating from lsu. i did get to work on aging and public health. in public health i find we can just focus a lot on young people, children, teenagers and young mothers but we can to neglect people who adversely have already gone through life. there's a feeling there's nothing left we can do for them but as most of them know our population is rapidly aging so i want to get what you think public health and

usually address that. >> that's a wonderful question. think public health to do more and there's another opportunity you have, someone who has worked in healthcare, everyone is shaking their boots about the baby boomers getting to the point where many of them are going to be retiring and leaving the workforce and they're going to be on medicare, drawing social security. there's an opportunity to bring to the table and talk about what we're doing to take care of individuals across the section. we silo things out again, we got to break down the silos and bring partners to the table. we can talk about aces, adverse experiences. the first sign of that is resilience. one of the things that having a positive adult influence, i was talking with ivanka and

one of the challenges with youth sports as we can't find enough coaches. parents are working, we've got single-parent households. trying to utilize the aging population out there to become coaches, to engage and help the kids, it's going to help them but it's also going to be figuring out places where there's overlap, where our missions aligned and not just saying how do we help the aging in our society but how can webetter utilize the aging in our society as part of an overall mission and once we get them engaged, they will help us across the board. there's a great opportunity but i can't believe nobody asked me about guns. i'm disappointed in you all. i'm disappointed . no, but what i would say before i leave is another kit for young folks. travel as much as you can. as much as you can because i've experienced 11 american nations, just coincidentally by traveling around the country and seeing how different things are. i just went to school in baltimore, and where the

person next to me done, it was a direct threat to my life because it was going to come through the wall and hit me if gun discharged so in that sense, all public health is local just like all politics are local, in that local environments, guns were a public health care. my father-in-law who i just saw on an airplane this morning lived on a farm. and sat on his back porch and watched coyotes run across his backyard. not having a gun is a threat to his livelihood because that's how he defends himself and his livelihood . in that local environments, he sees someone wanting to take away his gun threatening his livelihood and ultimately his life. so we need to understand that we as leaders need to foster these local conversations so that we can again have harder

policies across the board. we also need to make sure we are doing when we talk about public-private partnerships, we need more research we can say we need more certainty and intelligence what policies work, what policies don't and when and where they were policies work in some places but may not work and another and a great example of that is a friend service program and our fulton la and san francisco wanted to tell me to run a program in early indiana. i go to new york city where there's a syringe service program and anywhere else, and i can guarantee you can take the average person in new york city and they couldn't tell you where there's a service program was because not something experienced in their everyday life even though they got more ranges than anywhere. go to sac county indiana, you can go to middle school and every kid can tell you where there syringe service program is we need to make sure we are leading local conversations , coming up with local solutions and public health advocates, public health

researchers, we need to make sure we're evaluating these programs in a way that allows us to then go to different communities and say this will work in your community or this won't work because i've seen it work. when i was inindiana, they didn't care what they were doing in boston . they cared what was going on in ohio. in illinois, in communities that were like their communities. but to bring it back to the conversation about guns and about everything else, we need to make sure we're facilitating those local conversations that we don't go in with our own biases and expects because we believe something is right or because we thought it work in one community that's got to be the way things are going to happen in another community because what's going to happen is that community will push back, they're not going

to care what you know because they don't know that you care. so thank you so much for the opportunity to address you all and i look forward to working with each and every one of you. you're the army. i just get to stand here in the nice uniform and talk, but you are the ones who go out there and do it and i'mso thankful you're here today. i think for the opportunity to be your surgeon general and i hope we all get a chance to talk even more in the future. so thank you george and thank you tothe panel for being patient with me . >> . >> is going to be great, is going to be a wonderful panel and i hope all of you pay close attention to this because i'm looking forward to it? >>. >>. >> another round of applause for the surgeon general. >> thank you. that's a stimulating speech. it's a wonderful panel so i get to introduce the moderator. this is doctor jill, she is

the president of the american public health association. the professor of public health practice and research in the carly has distinguished chair of public health, college of public health in georgia. he also serves as cochair of the department of community help a girl in education and department of health policy and management. the host a masters in social work and mph from the university of california berkeley and abpa from the johns hopkinsuniversity. he's had over 33 years experience as a clinician and community advocate and public health practitioner , our president , in the american public health association, doctor,gil. >> . >>. [applause] >> thank you very much doctor b. thank you to our surgeon general. again, i want to thank everyone for attendingand you all who are listening , i want to thank you for coming

to our panel today. i have the distinguished pleasure of introducing the phenomenal panel that you had to hear about. as i get started i want to give you a little background on each of the panelists, starting with at the far end here, i want to doctor wendy ellis and she is the milton scholar of health policy at the milton, milken institute school of public health and department of health policy and management.ms. ellis the project director of building community resilience, collaborating at the milken institute of public health at the george washington university. this program is a space program in that building community infrastructure to promote resilience in the cities and communities. prior to joining george washington university she served as manager of policy at the morris pop town hall and practiced in washington dc.

in 2017 ms. ellis was selected for the george fellowship for the motion of childhoodwell-being and also in the summer . miss nothing old and mph from university of washington school of public health and aba from seattle university. >> our next panelists is janet motel swear. >> swear is director of prevention services in the associate director of health education services at george pound university. she has an adjunct faculty and member in the georgetown women's and gender studies department where she teaches a class on gender violence. >> missed some your service program advisor for on the advisory board for the rate of use national network and

has full facilitated edc university consortium. she also participated as a member of the dc salt response team and the dc also victims rights on the task force. her bf in education and an a in accounting psychology are from the university of nebraska lincoln and she's a licensed professional counselor in the district of columbia. our next panelists is sissy hernandez cassio, director of health equity, families usa. and where she leaves the organization's efforts to advance health equity and reduce racial and ethnic disparity. she serves on the addressing disparities panel for the patient centered outcomes institute. and the robert wood johnson foundation strategies advisory committee. >> missed hernandez has her baby from wilson school of public health, and international affairs and a degree from your university

school of law where she was a civil rights fellow. and our last panelist is miss elise sabina elise is the national program director for foundation responsible for directing foundations national and international program supporting the federal foundation building health communities including four cities and healthy counties challenge. prior to this position she served as a program officer and managed portfolios of international grants in the digital health and integrated healthcare with a focus on ordination and quality. she has four authored a number of articles and review journals including the general public health, predictive medicine and archived internal medicine. she's a 2012 fellow and in the grantmakers and health insurance institute for emergingleaders . and she earned her masters

from the university of north carolina chapel hill and the university of rochester. we are going to do with our panel is we're going to start off in a general question. the panelists have 34 minutes to answer the question. our first question is this. for the second year in a row, in the united states is dropping. so can you speak briefly about your work and its impact on community health to how we can turn this time on this trend. >> i, okay. so my work as doctor bussard described his building community resilience collaboratives at george washington university. what we have the heart of our is addressing adverse policy experiences in the context of adverse community environments .

the rest of us in this room understand community environments social determinants but unfortunately when we go and we see two other sectors, they don't necessarily understand what we're talking about. they certainly understand lack of economic mobility, theimpacts of unaffordable housing , the fact that we have inequities, systemic inequities and so when we really try the center of our work, really understanding how does inequities, that can be a focus on our system as opposed to just having done so well in public health with regard to personal intervention, changing our behavior because it's no good to change behaviors and send people back to the same system to our work really highlights the fact that there is no surprise that we have declining life expectancies in our country because we have growing disparities in inequities in health outcomes and income, neighborhood disparities so these are signs of, we're not

in a system, where in public health not necessarily talk about dynamic systems modeling but it's so key to us understanding the context in which our work is being delivered. so understanding from dynamic systems modeling's that our systems are designed for the outcomes we see so if we see declining life expectancies, you have to ask why are our systems designed for such an outcome?is not going to be about changing individual behaviors, is working at systems level so we can reengineer just as you would expect an iphone assembly line to suddenly put out an android. it has to be deliberate in its design because so many of our social policies have this inequality over the course of more than 200 years, absolutely, eventually you're going to have so many people that are held back and inequalities going beyond just racial disparities in the opioid question is an excellent example.

but that is the real example of why we have a growing lowering life expectancy in this country so it's not just about other people or those people. it's really truly about all of us and i think that one metric, the decline in life expectancy is a great example of that. that's why our work is really looking at not just working upon communities but bringing communities to the table. at the same time the community can affect all the changes happening in our systems level so making sure we are setting a table that has community voice but also those system operators understanding theimpact of their work and the system designs that we can get truly to address these inequities . >> you very much. >> good afternoon. so i work at georgetown

university where i undersea the prevention program. we also incorporate and include the personal violence of all times so stalking, harassment, working with survivors but also doing prevention work . in the beginning i like to take a moment to kind of highlight a couple of things that i think have already been said for the conversation earlier but my background, i've been doing this work on advocacy and activism or 18 years. my background is not in public health but i think this is a critical and important example of what it means to be inclusive when one of our load because we look at how violence impacts community health and outcomes . it's a natural connection. so i have an article that i was reading recently about

radical feminism coexists asa public health issue. the short answer is yes, it can. but really it's only been in the past 18 years , probably the past 5 to 10 years that i've done this work that we been engaged in doing prevention work and using public health models to further that conversation. it's been operating in silos in some ways and in setting the groundwork and just grassroots organizing that was needed. but now we're at a space where we can say the model of public health iswhat makes sense for us to think about doing ourprevention work , not just saying we need responses for survivors in our communities , but also talking about how do we get to the place where we are preventing the violence before it occurs and how are we setting the tone for the and spreading the message around?

so very quickly, in doing this work as a practitioner there's some things that we know are correlated. not every survivor will experience them but higher incidence of eating disorders, higher incidence of ptsd, self-medicating with alcohol or drugs. my office sits in a space where we are seeing other practitioners who work around other substance abuse issues. >> ..

z so very quickly, i think part of turning the tide in that space that we really see as practitioners in the area is starting the conversation earlier. colleges are doing a great job right now of getting into the spaces that they need to be and the conversations with the enhancement of title mind over the past 5 to 7 years, more universities and campuses have really been able to bulk their programming, prevention, mandatory conversations with students. again, i will talk about this more later. but often by the time we get students that are 18, they have experience violence. how are we having conversations about bullying in schools and one to have next frontiers for us in turning the tide and being able to start addressing the issue at its core in terms of

impact of public health overall. >> thank you very much, and thank you both. it's the speaker looking one, the one that says speaker. >> that one, okay, first of all, thank you very much for inviting me to this discussion, it's excited to be part of public health organization especially coming families usa that's focused on getting coverage for everyone. we believe that every person in the united states deserves the opportunity to have the highest possible and the possible quality health care available to them. so i want to -- with regards to what's happened in the last two years of life expectancy, it's important to break it down because things aren't necessarily as bad as they sound

overall. that's the problem with averages, it clouds what's happening to specific communities and really interesting that there was so much media attention to this statistic and then when they started digging into exactly what the cd data was, you know, the only group that actually was white women, that in itself -- especially if you're looking at the reasons, the cause of death being what some have called diseases of despair, accidents, suicide, cirrhosis from drinking and those kinds of things, it becomes apparent that there's a huge problem, a connection i think here that we see with what -- jen was talking about and what happened in communities particularly in -- in communities that on top of these dynamics, women are also more

likely to suffer problems from having downturn in the economy an unemployment and so forth than men. i think that's really important for us to call out just as it is important to call out the fact that life expectancy for all hispanics and black men actually increased. so there's something that's being -- that we are doing right somewhere and for, you know, black women and white men, it kind of stayed leveled. i don't want to make it sound like we are nit-picking on things, it's important if we think about what's happening in communities to understand exactly what is the burden of health, of negative health outcomes that different communities are sharing, now, putting that aside, you know, we are seeing disparities, racial disparities reducing, but we are also seeing that african americans still have a much

despite these -- these changes and trends among white people, african american rate much lower life expectancy, et cetera, so one of the things that we do at families usa is we understand that coverage is -- it's in our dna, we have been doing that forever. you need to have health insurance in the country because it was designed for this, we can have over debates about whether universal health care, you can put that aside, in this country having insurance whether it's government insurance or private insurance is kind of the entry way into being able to get the health care that you need and that includes health care like the mental health and stuff used in all of those treatments and preventive services that are so necessary to stay healthy but we also understand that that's barely the tip of the iceberg. health doesn't happen inside a doctor's office or inside the clinic or the hospital, health

happens in communities and part of what we are shifting to right now is figuring out how do we change the way health care is paid for so that things that are valuable to individuals in particular communities are supported, right, building, there's a lot -- health care is the biggest sector of the economy, right, there's a lot of resources there that probably could be better invested in things like housing or in community health workers, we have been working a lot with community health workers because they can speak that language, they are natives to that country and can make connections, what we are figuring out right now is we can use what's in the health care system right now in terms of funding in much better ways then a public health perspective that you all understand prevention and promotion and we know it's going to work better and that where a lot of

communities are struggling is where they can't connect to the health care system that really has so much -- so many resources in it and not necessarily resources to provide the best care at the right time, so we need to -- >> thank you. >> we need to adjust that. >> thank you, thank you very much. >> really good points. yeah, so i think if we unpack that life expect and at the foundation we use that statement as a foundation of what we do. it's really about building healthy communities and touches on what you guys are saying, what we do is support local organizations and local partnerships to address underlying social, we talked

about this today, two of initial initiatives are cultivating grant programs which is accepting applications for that, i had to put a plug for that and ask local organizations and partnerships to look outside of the traditional health care space and address at least one of five domains to focus on social determinance and community safety, environmental exposures, social and economic factors and -- and healthy behaviors, and what we are seeing with these programs it's really exciting, reminds me of what dr. adams is saying about motivational interviewing at the community level, the programs have produced really exciting and innovative home-grown solutions because they are focusing on what the communities feel are really important to them, so we said, you know, you guys work on the social

determinance, broad domains, but what's important to you and let's work on that together. and we are seeing examples of success, some of our -- spotlight award winners in our challenge, in danville, virginia putting effective policies to decrease obesity epidemic or sewer to improve water quality in their communities so i think that really turning the tide on the life expectancy issue, it's going to take leadership, it's going to take leadership that have committed to addressing health equity and social determine that are at local level and that's where we need to put resources. >> thank you very much, reminder for the audience out here and outside, please if you will have a chance for a few questions at the end of our panel, please

think about what you want to ask to everyone. so our next big question and this is a general question for the panel and y'all can chime in any order you feel comfortable, we look -- we in public health are looking to achieve our healthiest nation in 2030, which means for us making a concerted effort to tackle social determinance of health and moving upstream to focus on prevention which is something you brought up, the focus that you had on prevention, targeted prevention that the intent mash what we are trying to accomplish, at the system's level but as well as the ground level and recognize that these diverse outcomes are critical. so for the panel, from what your perspective is, what do you think is important as we are

moving forward to achieve this healthiest nation and what do you see as priorities that you had your chance and you could put together your priorities, 1 to 2 because we don't have a huge amount of time is what would be your priorities to achieve this outcome and anybody can start? >> okay, i will go ahead, today is the first day of mphw and i believe that behavioral health was the theme, i will lead with mental health matters and, yes, my work is steep in the adverse childhood experiences but we know that these average childhood experience have a longitude impact on development as well as outcomes across the life span and by taking that lens, the trauma lens, you automatically become multigenerational and thinking about what you're looking at because you're not just going to address the child's exposures but you to think about that in the context of their family as well as within their community because there's community level

traumas that we need to prevent, so i would think that, you know, putting that at the forefront, you're going to get to all of these other chronic diseases that we have discussed add nauseam in public health and really begin to think about it from a prevention standpoint and i would also say that because we are looking at what are universal because if you're steep in the cdc data you understand that ace is public american issue but we also recognize that there's a differential outcome for individuals, so, yes, more than -- more americans have to aces in the last recent wave of data but we also know that depending upon what type of community you're in and what type of supports you're in the outcomes are different.

that begins to speaking to the value of addressing social determinance and working from a prevention aspect of that is the important of cross sector collaboration, we all heard about public health 3.0. i really think that this is the opportunity for us to think about how do we as leaders bring together these other sectors and really think about ourselves as conveners, yes, we hold a lot of data, that's our central roll, we -- role, data are powerful but also data that comes from other sectors as well as the community itself. a lot of the qualitative data that we seem to overlook is very, i think, telling. if i had to say two priorities, taking more of a trauma lens to really understand the impact and really appreciate the impact of adversities across the life span and secondly being that truly

enacting and putting in action the public health 3.0 model so that we are the conveners bringing together multiple sectors and truly collaborating to build a more resilient community. >> okay, thank you, ms. ellis, anybody else? >> i can be very brief, sorry, because actually one of mine -- one is the trauma informed lens being so critical. with the work specifically that i do, the movement has been very reactive because it's needed to be in building movements, but in order to grow and to change, there needs to be a proactive lens, so how are we not just talking about how do identify, for example, problematic relationships or abusive relationships but how are we providing models for healthy relationships, language for consent, those are piece that is need to start early and often because it's often been lost in the conversation to think about thousand react to something, the other piece as mental health

practitioner is removing stigma, so not having one model of mental health and one model of providing that support but really engaging and going into spaces and understanding what community needs are to be able to provide support for better outcomes after adverse events. >> thank you very much. >> i'm going to say something boring, which is we need to make sure that everybody in the country has health insurance because you won't be able to access the counseling or necessarily the preventive care or anything unless you have that ticket, that golden ticket of having health insurance, but we also have to remember that health insurance, insurance car is like a cell phone, only as good as the network it's on and for a lot of communities it's not providing what we need, not just because the network isn't good but because the correct appropriate services are not culturally competent, so that

leads me to two number which is really -- their estimates one of third in health care spending is wasted, it's wasteful or duplicative and we know that entire communities weren't getting enough of health care at the right time and ended up having real bad outcomes afterwards, complications and so forth. we need to figure out, take an opportunity of changing the way we peaf for health care to make sure what is taking a really deep pocket, health care system funding and finding ways to divert and push it into the needs of communities. the evidence is fantastic on that and you're investing in the community and in job in community when it's been right that has all sorts of, you know, spill other effects but also because they are like a little key where you can divert some of the money from the hospital system or community center and push it into someone's home if

what they need is an air cleaner for asthmatic child. at the end of the day it's about resources and resources are not an accident, right, they are -- the systems are designed to get the outcomes they have and what's been happening is in the community that are under-resourced, we need to figure out how we use resources and divert them in the community that need them the most. >> okay, thank you. any comment? >> briefly. it's really about pushing the message that health care is local and starting at community level and addressing the issues but really creating these healthy community agendas and valving the leadership to create those healthy community agendas and this book has already started, it's starting at local

level, it's up to us to shine the spotlight on it and to push it out there and as a public health care workforce we can do that, as a foundation we are trying to do that, so i think from where we sit, that's a critical piece, you know, improving the nation's health, showing folks what are the best practices that are out there and how can rereplicate those in similar communities across the nation. >> okay, so we still have a few minutes on the question so i will ask the panelist to just react, one minute, if you will and ask you to do something that we try to avoid in public health which is a solution for complex problems, i'm going to ask you to provide in a minute a specific and concrete as you possibly could to address this question, what -- what do we need, what can we do in a specific way to look to have some of the outcomes? >> so i guess i'm cheating, i believe that if we get to a

place where every single person who wants to have a partner from their community like a community health worker or a peer navigator or a community health representative or promotora, whatever flavor you need, able to help you navigate not just the health care system but the system that is you live in so that you can make a better life for yourself that, i think, is going to be central to make sure that there is this ability, that there is agency for individuals to help -- whether you're a young mom, whether you're just getting out of prison or incarceration, whether you have chronic disease, whether you're dealing with addictions, whatever reason, you should be able to have somebody who understands your language, understanding your culture and understands healthy context and if we had that funded and integrated into a health care system we would be so many miles

ahead of where we are right now. >> okay. that was not cheating, that was excellent. >> so i want to ask onto what you're saying sinsi because what's so missing about the integrated piece is this facilitation of work and blends funds across the sectors, so in health care it's such a small portion of solving all of our problems, i mean, it's 20% we all know that figure, 20% versus 80% of what's happening in our community and so i don't want this conversation to really get so pulled into focusing just on the delivery of public health and the delivery of health care without really regarding the other elements that are so important to supporting health and the well-being of our communities and so i think what the keyword that you used is integration, how are we -- the solution is right there and how are we integrating so that those promotoras that you talk about

actually can be rewarded, that these aren't volunteered positions because these are valued positions, so right now we don't have a systematic way of doing that so you are talking about whether that's incentivizing from aetna, put you on the spot there, from aetna or all other providers, how are we incentivizing a system that you just described and that's really where we are getting back to the system's issue and i do think that public health has that role in driving that conversation. >> yeah. i just want to make a point, we at the american public health association have a very active groups that are working specifically on point of integration across multiple sectors. >> and i just want to add, you're absolutely right, it's about making sure that those resources are there and that's actually one of our big projects at families usa is specifically helping advocates from across the country, all sorts of stakeholders think how they can

leverage medicaid and if it's something that interests you, get on the website because we have a whole project focusing on laying out, all the different pathways to get some medicaid money in and especially for population that is we really care about, t medicaid we have to start. >> okay, other very concrete ideas, anybody else? excellent. >> so just i'm going to sound like a broken record by the end of today, i apologize, but my life before doing the work i was doing, i was an educator, do i go back to we are not having conversations and highlighting as priority in early education and elementary school, at the university level there's a lot that can be done but there's a lot more that can be done if we are showing that this is a priority and i understand as a former teacher there's not much space in the day for that, there's not much time to integrate that but having really intentional kinds of curriculum

that builds itself around public issues, violence, resources, support, all of those pieces, getting the people at the table to create that and having some school systems, and some school systems do already do this and i want to be clear and right now it's vuch dependent on whether somebody goes to school or where they live or their zip code being that determinant. having something that sends the message that this is not only priority but given the funding and the time and attention that it needs will also leadtous a more positive outcome. >> can i just jump real quickly and follow up? what you're talking about is value. it's tapping into the value statement here and so there are plenty of districts across the country and i want to shout-out to potstown in pennsylvania. they started within the school and became a whole community

movement and so i think that when we are talking about what these various sectors value, that's where we can really tap into and sinsi following up what you talked about incentivizing value and people's time, i think one of the things that we forget about when we talk about addressing the social determ thans -- they had movement driven by chamber of commerce, why, they recognize that if we don't begin to address the social determinance. >> and so let me move forward a little bit because to keep you on the mic, so we are going to move to some individual

questions that we specifically want to ask our panelists to take advantage of their wisdom and expertise, so i'm going to start actually with you, ms. ellis to actually continue to what you're talking about, the question i have to you is we had multiple communities experiencing various types of adverse events, michigan, et cetera, how can the communities prepare for the events and assured resilience afterwards? >> yeah, you're talking about flynn which was a infrastructure adversity, you're talking about puerto rico which was a natural disaster, that's a different type of shock, but before i get into talking about what they can, do i want to make sure i make a level set here when we talk about resilience because we had the sergeant general speak about resilience and resilience is a really great word but i want to be clear when we talk about resilience i am not applying a term which comes from physics to the human spirit, okay, because if you understand what it means it's really

talking about how -- it's ability for optic to retain shape after receiving a shock and so if we are talking about applying the term resilience to our communities, i do not want anyone to walk away from this room or who is listening or what have you to think that we are merely wanting to help communities bounce back to what we already recognized are levels of inequity. so when i talk about resilience, community resilience in particular, we are also looking at the ability to, yes, to suffer some of these acute shocks, but the ability to actually spring forward, so -- so that's the first piece of this and so when you're talking about how do you help communities bounce back, there's the acute shock which are some that you described but we also have to recognize there's chronic adversity in our

communities every day, drip, drip, slow drip of disaster in our communities that everyday folks are already bouncing back from, that's the problem, they are only merely bouncing back, what we need at the system's level is support and buffer that help us move forward. so that's what we are talking adequate education systems coordinated education systems, coordination between health care and our education system, coordination between court systems because unfortunately the trajectory for too many children inadequate school systems, straight into juvenile detention systems and then we know what happens from that point forward, so there has to be some other means by which we are providing support and that's really what we are thinking about when we work in the building community resilience work, is really thinking about how are you putting the resilience in a system so that information is flowing so that it's in place and when you do have one and a million, one

hundred year storms which happens every ten years, when you the disasters that are shock to the system, yes, of course, you're going to be able to respond and bounce back from that because you've already put in place on the day-to-day basis the systems and support that are helping people move forward and prevent adversity that is we are seeing right now. >> thank you very much. the next question, the same amount of time, in the wake of the me too movement, the topic of sexual harassment and assault and violence prevention it really comes to the forefront. it's impossible these days to not hear much about it. what is happening on the college campuses around this issue and then what do you think are the ways to do best practices, accomplish best practices i should say or implement them? >> so i think we know that campuses have always been great spaces for activism in that i always like to share the reason that my office exists, the

reason my position exists and my colleagues now is because of student activism on our campus saying this is what is needed and really finding ways to make that happen so activism has always been a central part of campuses. with me too, i think we've also been able to see us rise and have conversations about how do we implement by voices, how do we imply narratives and what we see happening now we hope is more what i call intersectionsal activism, right, understanding that me too and talking about narratives of sexual violence for those who find that safe to share is not something that operates by itself without partnering with and doing activism with groups that are working around racial justice,

disability justice, around lgbtq rights and recognizing that, having all those forms of activism and not taking over and not coopting which we know has been done within feminism and to say, how do we amplify the stories, how do we amplify and how do we support communities in different space who is are experiencing who are experiencing lier -- higher levels of violence and that's something that we are seeing rise out of me too, hopefully the ability to take hard looks at our ourselves and our movements and what's been happening in saying, what does it look like to really be intersectional and no coopt other people's narratives and say we operate separately. we are doing or own thing, i'm an activist for this and

activist for this and that doesn't get us to the outcome. more universities are seeing more broad requirement for mandatory education. the biggest piece for it to be effective is that it's intentional. we can say, well, just take online course or come to this program and check a box and you will get the register next semester. at georgetown students have to take online program before they come and also have to do in-person programs once they arrive but understanding that the online program in my mind is a way for us to say this is something that the university takes serious, these are topics we value and these are things that are safe for you to talk about when you're here, i don't expect them to mem rice definitions, when they come to campus, how are we building on that and how are we not stopping in october of first year in college but saying what are other ways we can access

students, so one of the other models that i think has been really successful in our campus and other spaces that have used it is a program where we as health professionals go into academic spaces, not just i teach a class but i might get invited into a professor's lecture about english to talk about something that they just read and connect to it my work on their campus in their community so they know what resources are available but also think about how their real-life applications and bringing this topic into academic space. my colleague works at eating disorder and might work at math class and calculate bmi or nutritional calculations but they're also having conversations about nutrition, about eating disorders, about support, about services, so with programs like that, we have found spaces to bring health issues into spaces where students may not self-select in

otherwise to come in and hear a program or learn more but to meet them in space where is we can help make that connection for them. >> thank you. continuing on, ms. hernández, with things you discussed already, recently as you know, there's been some attempts of rolling back protections related to the affordable care act and in several states have begun to test the boundaries of aca with modified rules, what do you think of the ramifications, state levels before changes themselves and, of course, the outcomes which you discuss so much? >> so really quickly since we are in a panel i feel like i do have to touch a little bit on what's been said and the first thing that i want to point out is thank you for bringing in puerto rico, as a puerto rican with mother-in-law who didn't have electricity for five and a half months and making sure that puerto rico is not forgotten is

really important. i'm really grateful about that and you don't bounce back, they have to bounce beyond because what the hurricane did that was a disaster but the real disaster was the decisions that were made by the federal government before the hurricane that made them vulnerable to the -- the health crisis that is there now and also makes sense, thank you very much for raising that, and i'm really excited that you mentioned the issue of intersectionalty, even in me too movement very few people understood that way before white actresses were tweeting me too, terana burke, african-american woman, started talking about me too seven or eight years before but when time magazine made the cover she was not on that cover and that's where i have to take my hats off to the kids in parkland who have been very

intentional about pointing out, oh, yeah, you care about us now because we latable to you but the plaque lives matter young people have been talking about violence in the neighborhood and gun issues for a long time, yet, you didn't give them the time of day on the contrary you even try today demonize them. i'm really happy to have this kind of conversation in the space like this. as far as what's happening with affordable care act, until last year we had never had more people with health insurance in this country ever and it's thanks to the affordable care act, in fact, one thing that people didn't know, didn't get a lot of attention is for the first time black children and white children were equally likely to have health insurance, no disparity in health coverage between black children and white children and that's enormous, right, but what we are seeing right now an administration that because they were unable to through congress dismantle for

ideological reasons the affordable care act, they are now in this big campaign to basically sabotage affordable care act through actions by the administration and i think there are two failing examples that affect what decisions are making, one is the waiver process, basically they're using the ability for trying to get changes in how medicaid is implemented under states to do what at end of the day will do bad things for consumers, one of the most failing ones is requiring work requirements for people who on medicaid and that is no -- they say it's about, well, being employed is a social determinant of health, we want to encourage that. it's making it harder for certain people to be able to keep their medicaid. right now we know that the majority of people, majority of adults on medicaid actually work or have somebody in their family

that works and it's really about cutting the program and their whole list of other things that they are doing to medicaid programs that states are now, some states are taking advantage of to basically cut how much they are spending on health care for their constituents rather than improve health care for them. the other issue is what these junk plans that now are going to be allowed. incidentally, so there's a regulation that you can comment on until april 23rd, there's still an opportunity to just send a note saying that this is a terrible idea which is letting more plans exist that do not have the consumer protections that were set up under the affordable care act, right, it used to be you could have a temporary plan for three months but now a temporary plan would be 1 day shy of a year and you're not going to have the protections against previous existing conditions and you're not going to have the supports

to make sure that you're getting high-quality care, you're not going to have the ability to make sure they don't take you off because you got sick and you're not going to have all sorts of protection that is really change people's ability to get the care that they needed but i also want to point out that the states are doing positive things too because i don't like being just gloomy too. >> yeah, that's helpful. [laughter] >> and let me be clear, there's still opportunity, it's gloomy but still a lot of opportunity to raise voices about how unacceptable. if you want more information about how to do that, go to families usa website. a wowm of examples of things that are positive of states that are trying -- even in the context of what's going on right now, trying to to improve access to health care and one example is in new mexico, for example, they just passed a state legislature, they call it memorial, a resolution to investigate letting people buy into medicaid with their own money, like using their money and the premium tax credit and

all of that to buy into this existing program which right now in new mexico it's something like over 08% of providers actually accept medicaid so it's one option that's actually helping trying to figure out more people to get them good-quality health coverage. >> okay. >> the other is what's happening in maryland, they are trying to figure out now that they are not going to implement the penalty for not having insurance, the state is trying to figure out how to have their own system to encourage insurance and instead of just a penalty, that money is a down payment into helping pay for insurance that works for them. so there are interesting things happening as well. >> thank you, we appreciate it talking about strength as well. all right, last question, so the aetna foundation along with u.s. news and world report just released healthy community index and you know there's a number of

these types of indexes out there, can you talk a little bit about what's the level of contribution that your index would make particularly as we work towards finding best practices to deal with these issues? >> yeah, absolutely. so we would like to think of it not as much as index or ranking but more of like as a tool because it really gives communities, provides every community out there with information on how they are doing. you put in your information, you can see how your community is doing, it's different because it compares to the communities, counties across the country not just within the state and it is also the first to adopt the measurement framework for community health and well-being that was developed by the national committee on debt vital and health statistics and includes measures such as equity which is new for ranking of the

sort as well as infrastructure and housing and really does look across all of the factors that contribute to ma makes a healthy community. our -- one other thing important thing is that to ensure fair comparisons, u.s. news has presented the data by peer groupings which take into account economic population density as well so what we are hoping to accomplish with the healthiest communities project is to give the communities data so that they can understand how they're doing, what the opportunities are for improvement and also to inspire change by showcasing the best practices that are out there across the country and our goal is not just to recognize the folks that are make significant improvements, but how they

pursue improvements in health but looking at all of the broad determinants and categories that they are based on while no two communities are the same, we do feel that there are lessons out there to be learned by what's already happening and we believe that this project is going to shine the spot slight on folks that are doing well so folks can use those lessons. so really, again, it's a tool, it's something for citizens and policymakers and local leaders to use to assess the health of their communities but also to use as they develop blueprints for change moving forward. >> all right, tools that allow us to measure both challenges and successes and to share them both, excellent, excellent. so that is the individual panel questions, so we have about, time, about -- we have, okay, so we have about 20 minutes or so

to entertain questions actually from the persons that are here as well as from the panel, so what we will do to be fair is that do we have any web cast questions that we know of? okay. not seeing any. let's start here with the in-person questions, anybody has in-person questions. there's someone, you're not at the mic, there's a mic there. >> hi, thank you -- >> we need you to -- we need you to have the mic. and welcome by the way, good to see you. >> great to be here, thank you very much for terrific discussion from the panel. [inaudible] >> it seems that no where -- hello. i don't know thousand -- [laughter] >> okay. push it up.

>> we could trade mics. trade mics with you. >> hello. oh, yes. well, thank you for a terrific discussion, university of maryland school of pharmacy, behavior head program, it seems that no where is the issue more compelling than among the newborns, it's the intergenerational problem and issue that we see and perhaps no more compelling than during addiction at least in my field and seems from our work at least that there are many barriers, some of them really having to do not -- definitely with access, definitely with the social determinant of health, but compellingly fear of losing custody of the newborn which really depends on social services, yes, we have all those

sectors available to help, how can we best utilize and ledge the services that we have in social services perhaps in maternal and child care, i would love to hear from the panel across your issue concerns? >> anybody can answer but we try to keep the answer to about a minute. >> i have a very specific example from the ph.d program in portland. this was brought together by portland public schools, kaiser permanente and several other providers and what they've done is recognize the fact that, you know, particularly for people that are that situation where, you know, crossing that bridge between maternal health and child health and then the social service's bridge we are working in different silos, how do we

work in this community care team and using the school as a hub they've actually done that or they have the, you know, health care based in the school, they have the social services through the trauma informed practices that are happening within the school for the school staff to have been trained as well as having behavioral services that are not just there for the students but also there for teachers because let's face it, i mean, a lot of our teachers are living on the front lines of community adversity but also if there's an adversity as being suffered and felt wide widespread throughout the school that they are getting the secondary trauma. i think it's a great health care practice, example of how you can bring sectors together to have better communication and coordination, of course, the one problem that still exists is how do we knit the resources together because we still have very much policy issues with regard to sharing of data and information but also sharing

resources and revenue in order to best serve our families and communities. >> okay, thank you. anyone else? >> i guess, i will put my lawyer's head on and say that all of what you're saying is true, but it doesn't get to the issue of if you think that coming clean and trying to get services is going to put you on the map of child services, that's the hugest incentive and that's something that's typical in terms of a lot of communities not feeling that government entities are actually there to help them, are there to basically regulate them, lock them up and take away their kids and that is a huge -- that's more than stigma, that's a huge cliff to have to climb off of and that's going to take law enforcement and the legal system to decide that it's something that they need to work on. maybe the way that drug courts were created at some point

because it was recognized that incarceration was not the solution and maybe that's what needs to happen, i'm just making things up as i go along but it's not, you know, everything can be perfectly aligned and knit the way you're talking about and if you don't get to the piece of the punitive nature of addressing these issues, there's not going to be make much of a different for a -- for some people. >> juvenile justice system as well as their adult courts are also part of this trauma informed movement and you've seen this also, you know, shelby county is also a great example where they did the entire trauma transformation system, social system, so i think that you're right, you have to have law enforcement in line but most importantly you also have to have community members engaged and helping to inform the conversation so that they are understanding how the different determinants and exposures manifest themselves in a family. >> both of you saying is that we

actually have great things in place but to be effective we have to -- the bottom line is trust. >> yeah. >> all right, we have another question from the audience. okay. we will have one here. >> with so we do have a question from twitter and it's from the university of kentucky, their public health program and it says what advice would you give us future doctors to help create a healthier future for children in regards to obesity? >> maybe you want to say a word or two. okay. >> i have a short answer and a more complex answer. i've had -- i have had the joy and privilege of working with a lot of young people in health policy that then went to become doctors, are in the process of

becoming doctors and i think the most important thing you can do is to get out of your office, right, once you're a doctor, get out of the office, get involved, the power of your light -- white coat in determining who gets what when is enormous, if you can figure out a way to continue to be engaged in health policy and public health issues once you're a doctor, that is enormously useful especially if you're on top of that from a community that is dealing with disadvantages, but the more -- the quick answer and it's very simple is, we need to push breast feeding, at the end of the day, a lot of foundations who are focusing on that but there's such good evidence about the long-term effects, positive effects of first -- what do they

call them, first foods, first foods in having long-term health benefits including in prevention of obesity and there's so many stupid barriers that can be eliminated and a lot of work that can be done, you know, on a one-to-one cultural level to bring the numbers up. >> can i just add to that because we also need to remove the barriers, we don't have equity in people's ability to breast feed, so, right, but one of the things that i want to say with regard to the question that was posed is that my -- my mentor, he will kill me if he hears me, world expert on obesity, one of the things that brought me around childhood experiences because he is an md is this understanding of the intersections between adversity and mental health and obesity or people with obesity and so i

would say for a young physician, someone who is training is to really begin to look beyond just the diagnoses and have the conversation, understand what is going on and the trauma-informed conversation about not what is wrong with you but what has really happened to you, what is happening in realtime, this really began to unpacked the sources of obesity but the sources that are underlying that disease. >> thank you very much, makes sense. also in the social worker arena, if i can bring social worker into this, so remember that part of the work that can be done very effectively is understanding the context in which the persons that you're dealing live and in those factors that push against, all the factors that pull against, whether or not you're supporting those, i agree 100%, we need to pushback against the diagnoses itself and create opportunities. okay, next, we have another --

yes, ma'am. >> hi, hello. hi. my name is samantha mendoza, the question is more geared towards ms. sabina, you said we have to push the idea that all health is local, i'm wondering what we can do as nation to make sure that the community health programs are being formed in all communities instead of the ones that could have the resources for it? >> it's a good question. you know, i think -- i think it's going to start where the people are, so i think what we need to do is give folks the resources and it might not just be financial resources, it might be -- what i was talking about before, the tools, the information, the data, something to catalyze, something to start the conversation, bringing people around the table, that has power in itself and then when you get folks talking, they start feeding off of each other,

you're connected here, you have business resources, you have that resource, we tend to get hung up on financial resources and for good reason, i get it, absolutely, but i think there's power in every community. i think the hard part and what is our challenge is the public health work is figuring out how to get everyone around the table, that's where i would start. >> thank you. i think we have one more question. let's the hands have been going over here but let's take the one from the very back, if we can. >> thank you. my name is kelsey and my question from two experiences, one is -- as the student we talk a lot about experience and the ways of conceptualize what communities are feeling and as practitioner we use a lot of data and i'm wondering how do we

as industry move away from talking about the community as an object and talk about how we are the community and like we might have ptsd, we might have people in the room who have broken windows and that's why they are in the industry, and the question is how do we create a more inclusive workforce beyond community health workers, how do we make sure that they paid and people are meaningful with the conversations. >> excellent question. >> one of the things that we made conscious is trying to build the bridge between health care and our other systems with communities not, you know, the other way around, thinking about pulling community into the conversation but really pulling our systems into the conversation that's already occurring at the community level, so one of the things that we talk about is the fact that because in public health and

across sectors are very good at collecting data and identifying priorities based upon the analysis of our own data and then putting that upon communities and saying these are the priorities based on our analyses and what we try to do is say, okay, that's great, you have the system indicators but i really think what you need to do is have the conversation because the community has its own data and the data is just as valuable and sometimes it's a little more precise than what you have collecting it from the -- from the system's level, so really understanding that at the heart of all of this work is data but there's no stories without data and no data without stories and so, again, that brings in the community narrative and actually having community having the input, with regard to your question is when you're talking about the service delivery or you're talking about program delivery, if you don't have individuals i want to say with lived experience, that doesn't mean necessarily that you have to have ptsd yourself to be

effective and delivering program, but you really have to understand the context in which your treatment is going -- or your program is being delivered in and the people -- and have a real relationship with the people that you're actually serving and so if that community, if your program doesn't reflect the community of which you serve, we are only compounding the problem, we are going to keep making the same mistakes because we don't have that, it's like you're weaving a cloth. it's that obvious. if you want to create this tapestry and as tapestry is much stronger based on the thread and how dense the weaving is, when you have the individuals that are coming from the community, that makes a much more richer tapestry, a much stronger fabric of which is going to carry and hold the community.

>> thank you, ms. ellis. given your neck of the woods, i'm guessing that there are a lot of persons who themselves have taken on that role of what you're speaking but i think the other challenge if i'm hearing you correctly is the -- the -- we have a minute so let me just make it real quick. so the other challenge is that we do have like in public health, you have people who really want to work in it, however, it boils down to the question how can they support themselves, how can they find the means to continue, i was wondering, not the last coment -- comment, but -- >> in terms of how to be in the work and support -- >> given the reality of having to make a living and do other things. is that part of what you're asking about? >> how do we become more inclusive because we talk about broken windows. people in the room didn't grow

up with broken windows, how do we change language and framework to be more inclusive in addition to economic piece. >> really briefly knowing that this is the ending point, this really resinating when wendy was saying earlier, it's so important for us, for example, just a very specific example on our campus, we go into spaces that have greetings and things that already exist, meetings already happening maybe between the lgbtq resource center and going in not assuming we understand sexual violence and here is what the data says about communities that experience at higher rates because that doesn't work and the qualitative piece is so critical because if we are only looking at quantitative data, for example, i believe there's one research study that has been done around survivors who identify as deaf or hard of hearing. we know in conversations within communities that those experiences are occurring at

high rate. how are we merging all of those pieces, but i think one of the things that i do as an educator and trainer and who work specifically around interpersonal violence, i go into every single space and name it and say how are we cognizant in the room who have experienced this, we come at this from different lenses but naming the space and the room so it's easy to other conversations, right, and say people who experience violence or people who have had -- lived with broken windows, we know that there are people in the community and spaces who have experienced that so let's have a conversation keeping that in mind. .. .. [applause]. >> normally we would have a wrap up, but we are short in time so

i will turn it over art director to have a few final comments and i went to give my thanks to everyone who participated either on our panel, you in the audience and this is a great honor for us to have you here and we do hope that you can make a difference moving forward, not just this week, but making public health week every week. thank you. [applause]. >> for the slide we have their with national public health week, also you can go to national public health week.org with tools and resources for you for this week. go to the last slide. i also want to thank the foundation for their strong support for this forum and invite everyone to the reception following of payment-- immediately afterwards. thank you very much. [applause].

[inaudible conversations] [inaudible conversations] [inaudible conversations] >> the house and senate are in a two-week break. the houses back in session tuesday, april 10. no official schedules been released. like apple to gavel coverage on our companion network, c-span. of the senate reconvenes monday, april 9, at 3:00 p.m. to work on it executive nominations and a