atlanta. wednesday beginning at 8 p.m. eastern live coverage with civil rights leaders both past and present including georgia congressman john lewis, marian wright edelman, diane nash, gina bellefonte and tamika mallory. the 50th anniversary of the assassination of dr. martin luther king junior live today and wednesday on c-span in american history tv on c-span3. >> next, surgeon general dr. jerome adams speaks about the opioid epidemic and the social factors that determine how healthy you are. after his remarks a discussion on life expectancy. from an american public health association for in washington, d.c., this is about two hours. >> good afternoon, everyone.

that's better. good afternoon, everyone. >> good afternoon. >> i'm dr. georges benjamin and an executive director at the american public health association here in washington, d.c. and so i would like to welcome all of you here to our national public health week celebration which were calling healthiest nation 2030, changing our future together. and our theme for this year is how we can work across divide, across sectors, cross groups to work in a positive way to improve the health and well-being of our community. so we have a couple really exciting speakers here for you today, then that will be followed by a panel. also want to know where both the audience in the room and we have an audience out there that's in c-span so we really glad that audience could be with us here as well today.

i have the honor this morning of introducing an old friend, a young man by the name of jerome adams your dr. adams is a board-certified anesthesiologist who served as indiana state health commissioner from 2014-2017. he has a bachelor degree in biochemistry and physiology, i'm sorry, psychology, from the university of maryland baltimore county. i like that because my daughter went to you in bcs will. public health degree from university college of berkeley and is in the f indiana university school of medicine. i met dr. adams would both he and i served on the advisory committee for the fairbanks school of public health in indiana. now, dr. adams, when he first became the health commission is really new to this but he got to

where her quickly to roll up his sleeves because some of you may know that he yesterday with onf the worst hiv outbreaks 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, very complicated outbreak, but he worked in a really profound manner, working with his then governor, governor pence, with the cdc come with the local health department and others to get their hands around the epidemic. dr. adams, i just want to publicly thank you for the work you did on that because that was really great work. his motto as surgeon general is better health through better partnerships. so i cannot think of anyone who really has a better place to

bring our theme for a public health week and his model together as a single thought, so ladies and gentlemen, the 20th h surgeon general of the united states, dr. jerome adams. [applause] >> thank you, sir. i knew you going to do that, set me up. good afternoon, everyone. you all can do better than that. good afternoon, everyone. >> good afternoon. >> it is fabulous to be here today. i really am excited for public health week. i was thinking that what is going to say to you all weekend long, and hopefully i don't disappoint. we're going to do some questions and answers at the end to make sure you all think of some good hard ones because that one expects this, will do some selfies but will do upfront

because after the q&a i don't know if you all will like me very much anymore. let's make sure we get everyone in their. ready? say public health week. one, 23. all right, fantastic. fantastic. i want to thank doctor telfair for having here in dr. benjamin. just been great to meet with folks who think like i think. we talk a lot about -- i i wano thank the panel. i don't know why to put you all appear before i came up but thank you for being here. i had way conversations with most of you all and i really hope to keep up a great panel 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 towards the same

goal. i was so glad to be the theme for this year's national public health week is changing our future together. strengthening relationships within communities is key to improving health, and i commend you all for embracing the idea of better partnerships. as your 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 that every american deserves to live a long and healthy life. unfortunately, we are falling short of that goal. as many of you know your public health experts yourselves, life expectancy in the united states has declined for the second year in a row. we were talking about kids earlier. she is the mom of two, five and half-year-old twins. she's got one more at home. i'm the parent of a 13, a 12 and an eight-year-old who are just left over at the white house for the easter egg rolls i hope they are not causing in incidence

over there at the moment. but you know what? unfortunately both alyse and i and several of you all the newsroom are part of the first generation of parents in the last half-century who as of right now can't tell the children they're going to outlive us. think about that. i have a century, every generation has been a look at the kicking eye and say you're going to live longer than me. right now we can't say that. as your surgeon general i'm determined not to accept it for my children or her children or for any of our children. my vision is for a healthier and more equitable america but it can only be achieved if we reframe the we will look about and we talk about health in this country. by now most of you in the room are familiar with the varying degree of the hiv outbreak in scott county that dr. benjamin spoke of some not going to

belabor it, i found a 4000 people never had more than three hiv cases in a single year. now over 230 cases of hiv all related to injection drug use. the experience that i had and the lessons i learned during the hiv outbreak are exactly why i treasure the opportunity that had been given to me to be the surgeon general of the united states. i'm often applied to speak at large conferences in the rooms similar to, bigger than the one that an in today, but i feel actually have the biggest impact when i can help facilitate local discussions. just as they say all politics is local, all health is local. i personally feel we can only meaningfully and sustainably change health when local partners come together and create local solutions. some of you all may not like truly say this but the folks in

d.c. are not going to write in a white horse and save the day. there's a lot we can do from here in d.c. there's a lot that federal government can can't do what yo but we will only create that meaningful, the sustainable change on the local level. i want to share you a personal story that means that you may not have heard, one of the challenging things when you're going out and getting multiple talks is sometimes people hear your couple times and they get tired of the same old story. we thought of a triple and to share with you this weekend but i think it tritone the point of partnership and public health week. i'm a physician as dr. benjamin mentioned and a very proud of that. most americans think about health, they think about me in a white coat. you think about prescription medication. the think about vital signs. we in a public health community know that the reality is that health is so much more than health care. health care is critical but

health is so much more than health care. some of you may have heard me tell the story of a much older as a as a chronic asthmatic which led to frequent hospitalizations as a child. the interactions i had with the health care sector piqued my interest in medicine and influence my decisions to become a physician. yet my experiences in hospital are not what i consider my first exposure to public health. i didn't go up in a wealthy family by any means. had to schoolteachers were parents, very proud of them. we had for my kids that ballooned up at different times in varying amounts without going into, i also did not realize how poor we were back then, but we were not well-to-do, let me put it that way. but i was blessed to have loving and supporting parents who cared for me throughout my childhood, just a little over an hour away from here in rural mailing.

my parents raised me to work hard, be humble and often care for those around me. that last lesson is one that particularly stuck with me, perhaps too much to our parents liking and i will share that with you now. whenever i notice a classmate knows getting picked on or a friend or a teammate who didn't have a parent to spend time with, or a meal to go home to, i would invite him to come to my house. sometimes they would stay for a neil, sometimes they would stay the night. sometimes they stayed whole weekend on whether one occasion they stayed several weeks and sometimes for the whole summer. i often saw that those friends, they weren't the full become happy, energetic and vibrant people that they could be. i saw how they would light up after a good meal, after time spent with my family, after time with your loving and lasting place, safe place to stay. my parents would often joke, and

i shouldn't say this but they would say jerome is our chapter liking strays and bring them back over my featherweight as far as to welcome my friend and now my brother damien who's been in and out of the foster system his entire life. we brought him them into our he and adopted him, in a much more formal manner. i didn't realize it at the time but this experience as a youth, trying to create and a vibrant with others could thrive come was really my first foray into public health. i wasn't involved in making drinking water safer or promoting a vaccination campaign but by helping others have access to nutrition, helping them interact with positive role models and helping them have a safe place to stay. my family and i were addressing the social determinants of health. a good meal prevents disease and increases overall healthfulness. also increases attentiveness at

school, positive adult figures as a no increase resilience to the -- party which, special children of color face. have a safe space can increase cognitive and social functioning and allow young people to grow and to thrive. now, i share that story with you for two main reasons. there's a lot you can take out of it but there are two main reasons i share that story with you. first, it's an example of a multifaceted approach that we as a public health community shouldn't gauging in to better health. and to move towards health equity for all americans -- should be engaging in. second and perhaps more noteworthy, i did it as a child and i did it as of the family that was barely above the poverty level ourselves. so yes, we need more funding. i'm not going to deny that. you'll never hear me say as a public health advocate that we don't want or need more funding. and yes, we need medical expertise we need help

expertise. we need to be grounded in the science. as your surgeon general you will never really say that we don't need more expertise, that we don't need more studies, that we don't need more science. but we can have tremendous impact if we focus less on what we don't have and focus more on better engaging partners. engaging everyone to realize the potential that already exists in every single community in our country. when i was health commission of indiana i would go out to different communities and folks who get all excited about the health commissioner coming into town. if anything happens now when i'm surgeon general and we get a big group and we do a roundtable interview and wants me to give them all the answers. one of the things that sticks with me the most is i would go into those communities and it would be a group sitting here like at this table. this person sitting here in the seat would be working on an

issue and that person sitting in the seat right next to them would be working on an issue and it would be in the same community and it would realize how many people and that very community were all committed to and working towards the same goal. what we need to change health already exist in our communities. we just need to be better at unleashing it. please, please don't misunderstand me because former apha president dr. jones, she's a good friend of mine and she and i, we have very vibrant discussions about the role of government and about health equity. at the end of the day i consistently tell her and i think she is finally starting to agree with me that we believe in the same goals. i'm not saying there isn't a place for major systemic change in our country. no matter how many youth my family and i helped during our childhood, we could never change the systemic oppression and

institutional racism that affected many of my peers. it's too big of a a hurdle fory one person, any one family, and in some cases even any one community to tackle it. that's why talk about better health for better partnerships because you are so many different ways we can improve health, if we commit to working across sectors and engaging new partners. we had another discussion i talk to me at the panels earlier. i talk about battle -- better help the better partnerships. i see people nodding their head. everyone believes in partnering. it's easy to say. it's a whole lot harder to do. i'm going to give you some practical tips to being better partners and forging better partnerships. number one, invite folks to your table and go to their table. meet them where they are. folks are you witnesses don't

think after we had a discussion earlier, who would have thought that for a health issue you need to invite the local sheriff to come and sit at a big part of that discussion? that so 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 usually at the end when everything else is exhausted. in scott county that so we had to do, to solve it hiv outbreak that was occurring in the community. so you've got to again think about those nontraditional partners and invite them to your table and go to their table. number two, show them that you care if there's a great saying, nobody cares what you know until they know that you care. as a physician i think about motivational interviewing. has anyone heard of motivational interviewing? i have taken care of patients with diabetes and i've gone through that same old cycle over

and over and over again think well, mr. jones, we diagnosed with diabetes. here's all the things that science says you need to do to improve your diabetes. here's a prescription for your medicine. lose weight, exercise more. all right, see you, or by. unfortunately, time and time again we see that it doesn't work. motivational interviewing is about asking mr. jones what he cares about instead of trying to push what i want on mr. jones, asking him what he cares about and seeking a sublimest so we can get there. mr. jones, you care about being able to see her grandkids to graduate from school and you care about being able to walk or run that 5k with your daughter pick you care about being able to make it to the softball game or to go on that vacation. great. we want to get you there. we got to get your diabetes under control, and your things we can do together to get you

there. that's motivational interviewing. it is our responsibility as public health professionals to show communities that we care about their needs, rather than simply trying to ram a public health message down their throats. we talked about the hiv outbreak in scott county, indiana, and do a whole lot of folks who said dr. adams, why didn't you just go down there in jujube power to tell the commission to open up a syringe service program? if i'd gone down there and done that, the local sheriff would have set up a perimeter around the syringe service program and arrested people as they were coming in or going out. doesn't matter what the science says. he still has legal authority to do that. if i try to ram it down the throats that would've been a sermon at church the next week by the local pastor 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. i went to that community and they didn't come them say you need a syringe service program. i came in and said you all have a problem. tell me how you feel we should solve this problem could 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 tip for better engaging partners, identify your target audience and adjust your messaging accordingly. i had a great conversation at a robert wood johnson a few weeks ago, and we shared his commitment to being better communicators. we need to get much, much better at the sides that will affect health medication and that's a something all of you focus is something i think we all as public health advocates, particularly during public of wheat, need to think about. how can we be better effective

to mitigate its? it starts with knowing what land manager in and what language they speak. anyone here speak english as aa second language, learn another language first? we have to folks. when you go outside the united states and the americans come into town, what do they do? they find a person at the start talking to them in english. they expect they're going to english. and then when they don't know english, the americans can what do they do? they speak louder. they yell at them and expect now suddenly they're going to understand what you are saying. we do that far too often in public health. we come in and we expect they're going to speak our language, and then when you don't understand it, we yell at them and call them names and expect that some out that's going to help them come around to where we are.

a couple of real practical tools for you. two of my favorite publications, one is the 11th american nations. colin woodward essay anthropologist and what he did was break down the country into 11 distinct what he calls nations. he calls the nation because they are very, very different. folks don't realize how big and how different the united states is. i told them i i would tell anyd stories. the palm is your give me the microphone, i'm going to tell stories. i know i do in here hasn't heard of the store so i apologize to the folks who have heard it. i was in switzerland and i was cast with explaining to a bunch of people who are not from the united states, the united states health care system and is given ten minutes to do it. ecp, right? here's what i said to them. 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 great world war a little he tried to blow each other off the planet. if either one had had their way there would not be a france or 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 guns, when you look at access to health care coverage, when you look at women's rights and contraception and abortion, when you look at drug policy, 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 the hook, right? they told you us got to start wrapping up. so he wrote the 11 11 american nations. the other publication is robert wood johnson, a new way to talk about the social determinants of health. what they did, they polled 4000 voters in the country and determined which phrases, which words resonated and which ones didn't. then they gave you practical tips. used phrases like opportunity everyone should have the opportunity to live a long and healthy life. your neighborhood shouldn't be a hazard to health. 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 speak to such a large audience about our country's opioid epidemic. today in america addiction is a public health crisis with an estimated 2.1 million people

struggling with an opioid use disorder. that's more than the number of americans diagnosed with cancer each and every year but only one in five with an open use disorder receives any treatment at all. each day we are losing a person every 12 minutes. from the time i been on this it's talking to you some has died from opioid overdose. think about that. i i see my role as surgeon genel to educate the american people about the severity of the epidemic and that everyone can be part of the solution. but all that you can play a role in combating the opioid epidemic. that doesn't mean you have to drop your other priorities and focus solely on opioids. it doesn't mean that at all. i'm fond of telling folks we need to learn how to ride the way. feel good epidemic provides a tremendous 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 long-acting reversible contraception?

certainly i wouldn't, but they are. they're providing voluntary long acting reverse contraception to women in prison. they know they have some nice rates, not summer, the highest rates in the entire country. they noticed they had the highest rates of taking children away from their mothers in the country always to the open epidemic. that created a wave for them to talk about acting reversible contraception. we know the communities most impacted by the opioid epidemic are often the same communities that have higher obesity rates, that a low graduation rates, that are affected by -- the opportunity to talk about so much of what we as public health advocates want to talk about through the lens of the opioid epidemic. and we also know that upstream intervention would help prevent or mitigate not notches will. related issues but all the issues that you care about. as i i said to audiences, we've been trying for years, decades,

to get people to pay attention not just to addiction not just a mental health but to the social determines that exist in all communities, especially communities of color. we've got a great opportunity now because folks want to talk about that. i was at a cabinet meeting a few weeks ago and just ahead of the secretary of labor, the head of agriculture, the head of hud talk of social determinants of health. we have a great opportunity here and hate is a great in the midst of tragedy but it's unique opportunity to really push public health through the lens of the open epidemic if we willing to ride that wave. i want to close by stating every single one of you in this room, every single one of you, and i thought as a people up in a public health for a while, talk to some folks were in college right now, some of my fellow retrievers over there still in college. every single one of you is a leader in your community by the nature of you showing up today.

the fact that you shall show tt means that you are leader anja the 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 that all of us use our platforms to maximum effect and that starts with humility and with further leadership. a couple of challenges to leave you with. i challenge each and everyone of you to think of a least one new partner you can invite to the table and his table you can go to. whether it's a faith-based community, educational community community. we have folks are from the department of agriculture, law enforcement unity. think of one new partner whose table you can go to and sit down. number two, i challenge you to stop. the next time you're about to ask someone to do something that you know is scientifically valid and you know what approve individual or community health, stop just pause. stop for one second and have the

courage to instead ask the person what their goals and desires are before you start talking about yours. show them that you care before you try to show them what you know. and then finally i challenge all to think about how you can be a more effective communicator. because at the end of the day we know what to do. we're just plain lousy at getting people to do it. public health hasn't changed inn the 20 years since i got my degree. do more, the better, don't smoke, don't do drugs. all those lessons with their 20 years ago. we are 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 in a foreign language, we are in a foreign land speaking a foreign language. my motto is better health through better partnership. because no matter what area of public health you're passionate

about, if you commit to forging better partnerships and being a better partner, good health is sure to follow. thank you apha. thank you, all of you, for being here and to the folks who are joining us via webinar. thank you for bringing such a diverse group of individuals together to collaborate with one another. and i hope each of you takes the opportunity even here today to find a new partner, to get to know someone, to get to know the person next to you, to figure out how you might be able to help them 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. thanks you so much. [applause] >> did ira out of time for questions? all right, we have a little bit of time for questions. anyone? in the back. yes, ma'am.

[inaudible] >> and tell us who you all are, too. >> is it on? okay. i'm caroline, i work for a public sector service. my background is in public health. i worked for the louisiana department of health and also for medicaid. the more i work in health care the more the issue of housing and housing insecurity is coming to the forefront. you would type of building better partnerships, and i've worked on the local level in housing and health care and one of the roadblocks i think is the funding and the lack of intersection of that funding at the federal level. so can you talk about that a little bit, and also maybe talk about what you you are hearingm your housing counterpart about

what they need from us? >> wonderful, wonderful. thank you so much pick on going to step out here although all . 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 them individually, we have a physician who's who is at the f the department, the head of hud, housing and urban developer, a physician. i've talked to dr. ben carson. he believes that housing is health. if i told you all even two years ago that we had the opportunity to have a physician as head of hud, you all would say that would be fantastic, but we are not taking advantage of it. we are not engaging hud on a national level and on a local level as public health advocates to the degree that we could. dr. carson believes in it. he's got initiative out there trying to promote housing as health but we need to help folks understand again how to actually

make that happen, how to create healthy housing. because individuals just are asked me with that. when i was in indiana we had a lead 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 smelting facility. if we had engaged hud and it engaged public health, because again is both ways, if we've done a better job with that the maybe we could have avoided some of these unfortunate situations. .. and again we've got to be at the table and also, engaging folks from a business point of view. one of the things i want to do

as attorney general is create -- surgeon general, is create a report. one thing they vote on jobs and the economy. the number two, safety and security, health, typically not in the top five or top ten. if we can help understand how we can create housing communities that are not just good for health, but that are also good for lifting up the community, lifting up prosperity, then we'll be able to better engage partners and not ram it down their throats, you need to create housing. we can show how to commute a community that millennials will want to move to. everyone is talking about amazon and where they're going to create their headquarters. let's create a community, heck, yeah, i want to move to that community. the millennials want to move there, parks and streets and no

food desert for them to be productive and prosperous. if we can do that and back and forth. if we have housing and inject an increasing goal of prosperity to increasing housing, again, being humble. coming in with a dose of humility. i think we can be successful. maybe time for one or two more. >> [inaudible] >> i'm wondering if the opioid epidemic and other addictions like alcohol. >> lou ease wondered if the opioid epidemic is an opportunity to talk with others. absolutely. opioid epidemic is a symptom of unrecognized issues, my own

brother is in a prison because he had unrecognized, untreated issues and led him to take $200, and there's a social determinant. there's a tremendous opportunity to talk about addiction to tobacco which we know leads people-- of' talked to folks and one of the things i love hearing is their personal story how they've struggled with addiction. and tobacco in so many of these it can prime the brain for other addictions. an opportunity to talk about alcohol. let's move upstream and talk about all the things that can be a potential problem and stop talking about whack-a-mole. once we talk about the ep yoid epidemic, treated as just an opioid epidemic, we'll get our hands around it and pop up as something else down the road if

we don't get upstream. as your surgeon general, i do talk about and i plan to talk about not just opioids, but addiction. not just addiction, but mental health issues. not just mental health issues, but childhood experiences and resilience. not just adverse childhood experiences, but social determine nants of health, but better across the board. maybe time for just one more question. >> thanks, my name is benjamin brooks, an unaffiliated health professional. so call me. i wonder if you could talk about the role of public-private partnerships in your platform and whether the surgeon general's 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 they're going to be huge and how to engage those. again, my report on health and the economy, not about me going in and trying to help businesses that they need to pick up my message, it's about me going and in showing you engage in creating a healthier environment, it's easier for you to recruit people, you will have less absenteeism and less presenteeism, showing up and being less productive. you're going to be more prosperous across the board. we just got $6 billion to respond to the opioid epidemic, which is more money than we've ever gotten to respond to opioids. you know the challenge? whenever we talk to folks, they continue to tell us it's going to cost so much morme than to to be able to do what we want to do. we also know that we've got a congress and an american people

who believe in a certain sized pie and that pie may get a little bigger, a little smaller depending who is in charge, but at the end of the day, there's going to be a finite pie and there will never be enough from the federal government to solve our woes. we've got to find out how to work smarter and not just harder. how we ingauge -- engage in partners. and so many are ineligible for military because they can't pass the physical or they have a criminal record. and we have dod and pooling together and private groups trying to figure out how to work smarter with the money we have instead of going

separately to congress over and over again, make the pie bigger, make the pie bigger because my piece isn't big enough. absolutely, i believe in public-private partnerships. i have the hook, one person-- ma'am? [inaudible] >> i know there's a lot of students here and even morley morley'sening. what would be the advice you'd give us on the path to public health. >> can you repeat the question, please? >> as a student what advice would i give to folks as they embark on their career in public health? it hits a point i made earlier, but i'll try to rephrase them. i would think that we need to think beyond public health and we need to think about how public health feeds into the priorities of the voters, of

the private entities. of the corporations of the law enforcement community of the educational community and show them how we can help them achieve their goals. focus on communication. you don't want to spend the next 20 years of your life working on an issue with your blinders on and then, be frustrated and say, i didn't really make a difference, i'm still talking about the same thing. we can make a meaningful change if we become more effective communicators and better partners and again, if we become servant leaders and walk in how to serve others instead of expecting because we've got the moral high ground and science behind us that everyone is going to listen to us. more practical tips, more specific to younger folks. i say, take advantage of opportunities that come your way. i did a summer at howard university in actuarial science. anyone know what that is? that's the science of figuring out risk and it's all about math and you know, i loved math

at the time. ordinarily that has nothing to do with public health. i met some tremendous people and gained some valuable skill sets. as long as you're increasing your network and learning something, it is a worthwhile endeavor. but continue to take advantage of those opportunities that come your way, continue to grow, continue to expand your network, have your elevator speech typed. that's another thing i tell folks all the time. i've had the privilege to be at the side of a vice-president for the last four-plus years. had the opportunity over at the white house earlier this morning around cabinet officials and around the president and what's funny to me, folks will sit down with me, you know, in a casual setting and say if i had a chance to talk to president trump this is what i'd say. and then, they get next to me in front of president trump and-- . [laughter] >> and we talk about an elevator speech, you've got 30 seconds, or you've got 20 seconds. what do you want to communicate about what you're interested

in, about what you're doing about who you are in an efficient manner to make the most use of your opportunity and it goes back to effective communication. so, that's what i would say. maybe one more before they give you the hook because i love being here talking with you all. yes, ma'am. >> hi, i'm amelia robert with ocr, also graduated from lsu last year, where i did some work on gauging in public health. in public health we tend to focus a lot on young people, children, teenagers, sometimes even young mothers, but we tend to neglect people who, as far as we see, have already kind of gone through life and there all seems to be a feeling there's nothing left we can do for them, but as most of us probably know most of our population is rapidly aging. i want to know what you think that public health could do to address that. >> that's a wonderful question. i think that public health could do a lot more and there's another opportunity you had, someone who worked in health and in health care, everyone is

shaking in their boots about the baby boomers aging and getting to the point where any of them are going to be retiring and leaving the work force. they're going to be on medicare, they're going to be drawing social security, there's an opportunity like never before to bring folks to the table and talk about what we're doing to take care of individuals across the life spectrum. the other people is we silo things out and we've got to break down silos and bring people to the table. and when you talk about adverse childhood experiences the flip side is resiliency. one thing to build resiliency, have a positive adult influence. i talked with ivanka trump and she's big on youth sports. one of the challenges is we can't find enough coaches, parents are working or single parent households. trying to utilize the aging population out there to become coaches, to engage, it's going to help the kids, it's going to help them and ultimately

figuring out places with are there's overlap, where our missions align and not just saying, how do we help the aging in our society, but how can we better utilize the aging in our society as part of an overall mission and once we get them engaged. we'll help them, they help us across the board. before i leave, i can't believe nobody asked me about guns. i'm disappointed in you all, no, no. what i would say before i leave. to young folks, travel as much as you can. i've experienced the 11 american nations just coincidentally travelling around the country and seeing how different things are. and i went to school in baltimore. lived in an apartment with walls this thick. where if the person next to me had a gun, it was a direct threat to my life because it was going to come right through the wall and hit me in the gun discharged. so, in that sense and all

public health is local just like all politics are local. in that local environment, guns were a public health concern. my father-in-law, who i just put on an airplane this morning to send back out to northern indiana lives on a farm and i sat on his back porch and watched coyotes run across his back yard. him nothing having a gun is a threat to his livelihood because that's how he defends himself and his livelihood. in that local environment, he sees someone wanting to take away his gun and 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 smarter policies across the board. we also need to make sure we're doing-- we talked about public-private partnerships. we need more research so we can say with more certainty and intelligence, what policies work, what policies don't, and when and where they work.

because, a policy that works in one place may not work in another place. a great example of that, the syringe service program, folks in new york city, l.a., san francisco, wanted to tell me how to run a syringe program in rural indiana. i go to new york city where there are more syringe programs and average ask every person and they don't know where the syringe service program is. even though they've got more than anywhere else. and you go to scotts, indiana, you go to the middle school and they can tell you where the program is. we need a public health advocate and researchers, and make sure that 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 has potential to work because i've soon it work. let me tell you when i was in

indiana, they didn't care what they were doing in boston. they cared what was going on in ohio, kentucky and illinois and communities that were like their communities. so, to close it and bring it back to the conversation about guns and everything else. we need to make sure we're facilitating those local conversations and that we don't go on with our own biases and expect that because we believe something is right or asaw is work in one community that's the way it's going to happen in another community. what's going to happen, the community is going to push back and they don't care what you know because they don't know that you care. thank you for the opportunity to address you all and i look forwarded with working with each and every one of you. you're the army and i get to stand here in a nice uniform ap talk, but you're the ones that actually go out and do it and i'm so thankful you're here today and thankful for the opportunity to serve as your surgeon general and hope we get a chance to talk more as the

future comes. thank you for the panel for being patient with me. [applaus [applause] >> it's going to be great and a wonderful panel and i hope you all pay close attention because i'm all looking forward to it. thank you, georgia. another round of applause for the surgeon general. [applaus [applause] >> well, thank you. after at that stimulating speech, we just have this wonderful panel and i get to introduce the moderator. so this is dr. joseph telfair. joseph is the president of the american public health association. he's professor of public health practice and research and a distinguished chair of public health at college of public

health in georgia. and dual chair of partner of community health and education and department of health policy and management. he holds both a masters in social work and mph from university of california at berkley and drph at johopkins university. a public health practitioner, our president of the american public health association, dr. telfair. joe. [applaus [applause] >> thank you very much, doctor. and to our surgeon general. thank you everyone for attending and you all who are watching or listening, i want to thank you for coming to our panel today. i have the distinguished pleasure of introducing the phenomenal panel that you're going to hear about. as i get started i just want to give you a little bit of

background on each of the panelists. starting with the far end here, i want to talk about dr. wendy elliss and she is the milton scholar of health policy at milken-- sorry about that mill kin institute of public health and management. miss elliss is the project director of building community resilience and awareness at mill kin public health at george washington university. this program actually is a strength-based program aimed at building community infrastructure for resilience in communities across the country. prior to joining george washington university, she served as manager of childhood policy for policy and practice in washington d.c. in 2017, miss elliss was selected for a fellowship for the promotion of child well-being and also a milken

scholar at milken health where she is right now. she holds an mph from washington. and bs from seattle university. our next panelist is jen, awareness, sexual assault and awareness services at georgetown university. she also is an adjunct faculty and member in the georgetown women's and gender studies department where she teaches a class on gender bias. she served on the program advisory board for the rape, abuse and incest national network and has co-facilitated the d.c. university consortium and participated as a member of the d.c. assault team and d.c. assault victim's rights amendment act task for of the her bs in education and ma in

counseling, psychology from the university of nebraska at lincoln and she's a licensed professional counsellor in the district of columbia. our next panelist is hernandez castillo at families usa and where she leads for health equity and reduce racial health disparities. and she's at the patient center outcome institute, and the robert wood johnson state strategies advisory committee. miss hernandez earned ab from wood droe wilson school of public health and international affairs and jd from university school of law where she was a civil rights and civil liberties fellow. and the last panelist, miss

ellyse sabina. she's responsible for directing the foundation's national and international panel building healthy communities, including healthy cities and counties challenge. prior to this position, she served as a program manager and managed the folio of national and international grants and digital health care with a focus on coordination and quality. she has co-authored a number of articles published in peer reviewed journals.: she's a 2012 fellow in the grant makers and health institute for leaders and health philanthropy and earned her master's of public health and bachelor of arts from university of rochester. what we are going to do with

our panel is we're going to start off with a general question. the panelist each have three to four minutes to answer the question. so, our first question is this, for the second year in a row, life expectancy in the united states has dropped. so can you speak briefly about your work and its impact on community health and how we can turn this tide on this trend. >> okay. i'm up, okay. so, my work, as dr. telfair described, is building the resilienc resiliency. what we have is addressing adverse childhood experience and adverse community environment. those of us in this room understand adverse community environment social determine nates, but when we speak to other sectors, they don't necessarily sawn what we're talking about, but they lack of

economic mobility, lack of affordable housing, and the fact that we have systemic inequities. so when we try to keep at the center of our work, understanding how the systemic inequities, keeping it focused on the system and just as we've done so well in public health with regard to personal invention, changing of behaviors, because it's no good to change behaviors and send people right back out into the same system. so, our work really highlights the fact that it is no surprise that we have declining life x xek-- expectancies in our country and we have growing disparities in income, neighborhood disparities. in public health we're not talked about dynamic systems modeling, but it's key to understanding the context in

which our work is delivered. so, really understanding from dynamic systems modeling that our systems are designed perfectly for the outcomes that we see. so if we see declining life xek t xek-- expectancies, why are our systems designed for the outcome. it's not changing behavior levels. you don't expect an iphone line to suddenly turn out an android. no, it has to be delivered in its design. because so many of our social policies are deliberately signed to have the inequality over the course of 200 years, eventually you'll have so many people that are held back and the inequality is going beyond racial disparity and i think the opioid crisis is an excellent example of that. that's the real example of why we have a growing or lowering life xek --

expectancy in this country. it's really truly about all of us. that one metric, the design in life expectancy is really a great example of that so that's why our work is really looking at not just, you know, working upon community, but bringing community to the table, discussing this, but at the same time community can't effect all of the changes that are happening at our system's level. make sure we're setting a table that has a community voice, but also has those system operators understanding the impact of their work and the system designs that we can get truly to addressing these inequities. >> thank you very much. >> okay. good. good afternoon. so, as i was-- stated in my introduction, i work at georgetown university where i oversee the sexual assault and prevention program. and that incorporates and includes interpersonal much all

kind. stalking, prevention work. at the moment i'd like to take a moment to kind of highlight a couple of things that i think has been set for the conversation for today earlier. but my background, i've been doing this work around advocacy and in this field for 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 in spaces with one another because when you look at how violence impacts community health, and outcomes, it's a natural connection, right? and so, i actually had an article that i was reading recently that was can rod cal feminism co-exist as a public health issue. the short answer, yes, it can. really, it's been the past 18 years, probably the past five to ten years that i've done this work that we've really

been engaged in doing prevention work and using public health models to further that conversation, it's been really operating in silos in some ways, and sort of setting the groundwork and just that grass roots organization, organizing that was needed, but we're now at a space where we can say the model of public health is what makes a lot of sense for us to think about doing prevention work, not just saying we need survivors in the communities in different spaces we're in, but talking about how do we get to a place on violence before it occurs and setting the tone for that and spreading the message on that. so, quickly, in doing this work as a practitioner, there are some things that we know are correlated. not every survivor would experience, but correlated with interpersonal violence and higher incidents of eating disorders. higher rates of ptsd, higher

rates of self-medicating with alcohol or drugs. and my office sits in a space where we're with others who work with substance abuse issues with my colleague who specializes in eating disorders because we know that so often they co-exist. there is that outcome around drama that we are working at addressing because we also know that being a victim of some kind of a trauma around violence puts you at higher rates for being revictimized again. but then we also have this other arm in our office and in the work that's being done around responding to survivors is the prevention piece. we'll talk about that in a little bit. and making sure that we're saying, how are we talking about a culture or society that's ento,ing this messaging that's creating this, creating the violence which then ends up impacting community health in such a large way. so, very quickly, i think part of turning the tide in that space that we really see as

practitioners in this area is starting the conversation earlier. so, colleges are doing, i think, a really great job right now of sort much getting into the ooh spaces that they need to be in. the enhancement of title nine over the past, five, six, seven years, more campuses have been able to bulk up their programming, their mandatory conversations with students and i'll talk about this more later. but, also, by the time we get students when they're 18, they've experienced violence before they ever came to us. so, how are we having conversations about bullying in elementary school and about sexual harassment, consent, and models of healthier relationships. so, i think that that's one of the next frontiers for us in turning the tide and being able to start addressing the issue at its core in terms of the impact on public health overall. >> thank you very much. and thank you both. >> please, the speaker--

the one that says speaker. >> okay. wow. so, first of all, thank you very much for inviting me to this discussion. it's exciting to be part much a public health conversation and especially from the direction that's been focused the last 37 years on getting coverage for everyone. but our central mission, we believe that every single person in the united states deserves to have the opportunity to have the highest possible health and the highest possible quality health care available to them. so, i want to-- with regard to what's happened in the last two years of life expectancy. i think it's really important to break it down a little bit. because it sounds terribly, terribly gloomy and things aren't necessarily as bad as it sounds overall, right? that's the problem with averages, that it kind of clouds what's happening to specific communities, and it was interesting that there was

so much media attention to this statistics and then when they started digging into exactly what the c.d.c. data was, the only group that actually saw reduction in their life expectancy was white women. that in itself has a lot of -- especially looking at the reasons, that kind of the causes of death being what some have called, you know, the diseases of despair, accidents, suicide, cirrhosis from drinking, those kind of things. it becomes really apparent that there is a huge problem, a connection, i think, here that we see with what, you know, wh what, what they were just talking about and what's happening in communities, particularly in communities that on top of these dynamics, women are also more likely to suffer problems from having downturns in the economy, unemployment and so forth than men.

so, i think that that's really important for us to call out. just as it's important to call out the fact that life expectancies for hispanics and men increased and something we're doing right somewhere and for black women and white men, just kind of stayed level. it sounds like, i don't want to make it sound look we're nit-picking on things, but it's important on what we're thinking in communities to understand exactly what is this burden of negative health outcomes, the difference between these. and now, putting that aside, you know, we are seeing-- we are seeing disparities, reducing. but we're also seeing that african-americans still have a much, despite these changes and trends among white people, african-americans have a much, much higher rate--

lower life xexpectancy and rates of chronic diseases, et cetera. one thing we do at families usa, we understand that coverage, we've been doing that forever, you need to have health insurance in this country. we can have other debates, universal health care, whatever, put that aside. in this country having insurance, whether it's a government insurance or private insurance, it's health care like the mental health subsidies and all of those treatments and preventive services necessary to stay healthy, but we also understand that that is barely the tip of the iceberg. health doesn't happen inside a doctor's office or inside the clinics, right, or the hospital. health happens in communities. and part of it, 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 and in particular to communities, are supported. right? building, health care, there's a lot of health care, the biggest sector of our economy, right? there's a lot of resources there that probably could be better invested in things like housing or in community health workers, working a lot with community health workers because they can speak that language. they are natives to that country that the surgeon general was talking about and can make those connections. so, a lot of what we're figuring out now is we could use what's in the health care system right now in terms of funding in much bet are ways from a public health perspective, but you all understand in terms much prevention and promotion, but also we just know it's going to work better and that, where a lot of communities are struggling is where they can't connect to this 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 adjust that. >> thank you. >> thank you very much. >> really good points. yeah, so, i think, you know, if we impact that life expectancy statement a bit more, and take a broader look at it. we know from the research your zip code is a greater predictor of your life expectancy and health outcomes, right? and at the foundation, we use that statement as a foundation of all of our work that we do. it's really about building healthy communities and i think that touches on what you guys are saying. what we do with our work, we support local organizations and local partnerships to address the underlying social determi determinants, in fact, two of our signature initiatives are cultivating healthy communities and grant programs accepting applications now and i had to

put a plug in now for that and our healthiest cities and counties challenges, ask local organizations and partnerships to look outside traditional health care space and address at least one of five domains to focus on the social determinants, these being community safety and environmental exposure, the social and economic factors. and healthy behaviors. and what we're seeing with these programs, it's really exciting, it reminds me of what dr. abbott was saying about motivational interviewing, this is motivational at the community level. these programs have produced exciting and innovative home grown solutions because they're focusing on what the communities feel are really important to them so we said you guys work on the social determinants and broad doe mains, but what's important to you and let's work on that together. and we're seeing examples of

success, some of our-- spotlight award winners and our challenges, you know, danville, virginia, working on putting into place effective policies to address the obesity epidemic or camden, new jersey, working on sewer overflow to improve water in their communities. so, i think, that really turning the tide on the life expectancy issue, it's really going to take leadership. it's going to take leadership that is committed to addressing health equity and these social determinants that contribute to these disparates at this local level and so that's where we have to put our resources. >> thank you very much for everyone's answer and a reminder for the audience here and outside, please, if you will have a chance for a few questions at the end of our panel, so, please think about what you might want to ask to everyone. so, our next big question, and this is a general question for

the panel and you all can chime in 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 many of the social determinants of health and really move upstream to focus on prevention, which is something that you all had just brought up. and i mean, the focus that you have or prevention, targeted prevention, intent. that the intent and the message match what we're trying to accomplish and that we do this in the other ways at the systems level, but as well at the ground level and recognize the diverse outcomes are very 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 a priority, that if you had your chance and you could put together your priorities.

one to two, because if you don't have a huge amount of time, is what would be your priorities to achieve this outcome. and anybody can start. >> okay. i'll go ahead and today is the first day of mthw and i believe that behavioral health, so i'm going to lead with mental health matters. yes, my work is steeped in the adverse childhood experiences, but we know that these adverse childhood experiences have a longitudal impact on development as well as outcomes across the lifespan and by taking that lens, the drama lens, you automatically become multi-generational in thinking about what you're looking at because you're not just going to address the child's exposure, but you have to think about that in the context of their family as well as in their community because there's community level traumas that we need to prevent. i would think that putting that ott the forefront, you're going to get to all of these other

chronic adversities, chronic diseases that we have discussed ad nauseam and researched ad nauseam in public health and really begin to think of it on a prevention standpoint. i would also say because you're looking at what are universal because if you're really steeped in the c.d.c. data, you understand that aces are truly a public health, american public health issue. more than 50% of our population has at least one, but we also recognize that there's a differential outcome for individuals. so, yes, more than-- more americans have two 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 support is in place your outcomes are very different. so that begins to speak to the value of addressing the social determinants. so i would say the second is thinking about this from a

trauma perspective and prevention, and the cross-sector of collaboration. we've heard about public health 3.0, but i 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 role. yes, we collect data, data is powerful. so are the data that come from other sectors, as well as the community itself. a lot of that qualitative date that that we seem to overlook is very, i think, telling and so, if we put-- it i had to say two priorities, you know, taking more of a trauma lens to really understand the impact and really appreciate the impact of these early adversities across the life span and secondly, seeing that truly enacting and putting in action, that public health 3.0 model so that we are the conveners bringing together

multiple sectors and truly clap collaborating to truly build the community. >> thank you, miss elliss. anybody else? >> i can be very brief because one of mine is the trauma informed lens being so critical. with the work specifically that i do. the movement was 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 pieces that need to start early and often because it's often been lost in the conversation to think about how to react to something. and the other piece as a mental health practitioner is removing stigma and recognizing that support looks different for other communities, not having one model of mental health and

one model of providing that support, but engaging and going into spaces and understanding what community needs are, to be able to provide the support for better outcomes after adverse events. >> thank you very much. >> i'm going to say something, which is really to make sure that everybody in this country has health insurance because you love being able to access the counseling or the preventive care or anything, unless you have that, you know, ticket, that golden ticket of having health insurance, but we also have to remember that health insurance-- an insurance card is just like a cell phone, only as good as the network it's on. for a lot of communities it's not providing what we need. not just because the number isn't good, but the correct appropriate services are not culturally competent, services are not available or people cannot connect to the health care system so that leads me to number two, which is we really-- the estimates of one third of health care spending is wasted.

it's wasteful or duplicative. and there are entire communities who aren't getting enough of the health care that they need at the right time and end up having the outcomes afterwards, righting complications and so forth. we need to look at the way of changing the way we pay for health care to make sure we're taking what is really is deep pocket. health care system funding, and finding ways to divert at least some of it and push it into the needs of community. then it can be very simple and very, very focused on community health care workers, not just they're effective and they're fantastic and you're investing in the community in a job in a community when it's con right. they have all sorts of spillover effects, but also because they're like a little key where you can divert some of at that money from the hospital system or the community health center and push it into someone's home and what they need is an air cleaner for their asthmatic child or remediation from mold.

there's like an opportunity to take a spigot away from, at the end of the day it's resources and our resources are not an accident. right? as they're designed-- a similar design to get the outcome that they have and what's been happening is the community is really j under resourced and we need to figure out how we use some of the resources and divert them into the community that meet the most in effective concrete ways that will change the lives of children and families. >> thank you. >> yeah, briefly, i mean, i think it's really about pushing out the message that all help is local and really starting at the community level and addressing the issues, but really creating these healthy community agendas and involving the leadership to create these healthy community agendas and the thing is, this work has already started. it's happening at the local level, but it's up to us to shine the spotlight on it, and to push it out there and to-- i think as a public health work force, we can do that.

at the foundation, we're trying to do that. so, i think, you know, from where we sit, that's a critical piece, improving the nation's health is, you know, showing folks what are the best practices out there and how can we replicate those in similar communities across the nation. >> okay, so we still have a few minutes on this question, so i will ask the panelists 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 a complex problem. so, i'm going to ask you to provide in a minute as specific and concrete as you possibly could, to address this question. what do we need? what can we do in a specific way to look at-- to have some of the outcomes? >> so, i thought about this before so i guess i'm cheating, but 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 po navigator or a community health, or whatever flavor you need, it's available to help you navigate, not just the health care system, but the systems that you live in, so that you can make a better life for yourself. that, i think, is going to be central in making sure that there is this ability that there's, you know, agency for individuals to help and whether you're a young mom, whether you're just getting out of prison or incarceration, whether you have disease or dealing with addiction, whatever reason, you should have somebody who understands your language, your culture your social context and help you on that path. if we had that funded and integrated in the health system we'd be so many miles ahead of where we are right now. >> and that was not cheating. that was excellent. >> so, i want to add onto what

you're saying, because what is so missing about this integrated piece is this stilltation of work and actually blends into funds across these sectors. so, and health care is such a small portion of solving all our problems. i mean, 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 community. and so, i think what the key word that she used is integration. how are we-- the solution is right there. how are we integrating so that those that you talk about, the health care, the health care workers, those navigators that you talked about actually can be rewarded, that these aren't volunteer positions because these are valued positions.

right now we don't have a systemic way of doing that. and put you on the spot there, but at aetna or other providers, how are we incentivizing the system that you described. these where we're getting back to the issue and i think that public does have the role in driving that conversation. >> and i just want to make a point, we as the association, has a very active set of groups that are working specifically on the point of intervention across multiple sectors. >> i want to add, you're absolutely right. making sure the resources are there and that's one of our big projects at families usa helping advocates across the country also stakeholders think about how they can leverage medicaid funding in particular to help pay for community health workers. and if there's something that interest you, get on our

website, we have a project laying out a pathway to get at least some medicaid money in and we have to start somewhere, especially for the populations that we care about, it's medicaid where we have to start. >> another concrete idea. anybody else? it's excellent. >> so, i'm going to sound like a broken record by the end of today, i apologize, but in my life before i assumed the work i do now, i was also an educator so i do go back to we are not immersing in having these conversations of highlighting them as a priority in early education and elementary schoolment it he university level there's a lot that can be done, but there's a lot more that can be done if we show it's a priority. i understand as a former teacher there's not much time in the day for doing that, but the kind of curriculum that builds on itself around public health issues and resources and support and all of those pieces

getting the people at the table to create that and then having school systems. and some school systems do already do that. so i want to be clear and right now it's dependent on where somebody goes to school or lives and determinant on the zip code. i think that having something that sends the message that this is not only something that's a priority, but that it's given the funding and time and attention that it needs will lead to more positive outcome. >> can i jump in quickly. what you're talking about is value. it's tapping into the value statement here. there are plenty of districts across the country, and i want to shoutout to pottstown in pennsylvania, they started the value of understanding early intervention and started within the school. and it became a whole community movement. and so, i think that when we're talking about what these various sectors value, that's

where we can really tap into it and cinsi. following up on incentivizing and valuing people's time. i think one thing we forget about when we talk about the social determinant is the business community. so in kansas city on one of the committees i had an opportunity to do work in, they actually had a whole adverse childhood experiences and resilience movement driven by the chamber of commerce, why? because they recognized if we don't begin to address the social determinants, they won't have a healthy work force and not be able to attract businesses. so i think that can go to the value statement of these multip multiple issues to address the issues. >> and let me move forward to keep you on the mic. we're going to move everyone to 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, miss elliss, to

continue on what you're talking about. the question that i have to you, we had multiple communities experiencing various adverse events in flint, michigan, houston, texas, et cetera. how do communities best prepare for these events and also, a short resilience afterwards. >> sure,you're talking about flint, a infrastructun infrastr adversity and puerto rico, a different type of shock. and i want to, before i get into talking what we could do, i want to do a level set here when we talk about resilience. we had the surgeon general speak with resilience and you hear me talking about resill yens. and when i'm talking about resilience, a word from physics to the human spirit. it's an ability for an object to retain shape after receiving a shock.

and so, if we're talking about applying the term resilience to our communities, i do not want anyone to walk away from this room or who is listening, what have you, to think that we are merely wanting to help communities bounce back. so what we already recognize are levels of inequity. 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, that's the first piece of this. and so when you're talking about how do you help communiti communities, the acute shock, which are some of those of which you describe, but then we 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're only merely bouncing back. what we need are systems level, supports of buffers to help us move forward so that's what we're talking about adequate education systems. coordination between health care and our education system. coordination between our court systems, unfortunately the trajectory of too many of our children are going from inadequate school systems, straight into juvenile detention systems and we know what happens from that point forward. so there has to be some other means by which we're providing support and that's what we're 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 the supports are in place, so that when you do have what may be the one in a million 100 year storm which now happens every ten years, but you know, when you have these disasters that are shocks 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 those systems and supports that are helping people move forward and preventing a lot of the adversity that we see right now. >> thank you very much. so, i want to move to the next question, the same amount of time. in the wake of the #metoo movement, the talk of sexual harassment and assault and violence prevention have really come to the forefront. it's impossible these days not to hear much about it. what is happening on the college campuses around this issue and what do you think are the ways to do best practices, accomplish best practices, i should say, or implement them. >> i think we know that campuses have already been great spaces for activism and that i always like to share that the reason that my office exists, the reason my position exists and my colleagues now, is because of the 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 #metoo, i think we've also been able to see a rise in conversations about how do we implement our voices, how do we amplify stories and look at where stories and narratives are missing. what we see more of now, we hope, what i call intersectional activism. right, so understanding that #metoo, 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 and working with groups that are working around racial justice, around disability justice. around lbgtq rights. and recognizing that, having all of those forms of activism

in the same space and at the table and not taking over, not coopting as we know has been done with feminism. how do we amplify the narrative and how do we support communities in different spaces who are experiencing higher levels of violence and your less likely to seek support, to make official reports for very good reasons. that's what we're seeing rise out of #metoo, the ability to take hard looks at ourselves and our movements and what he is been happening and saying, what does it look like to really be intersectional and what does it look like to share spaces and not, you know, again, co-opt other people's narrative. saying i'm an activist for this and you're an activist for this and it's not getting the outcome we hope for. we also, with the enhancement

of title 9 more universities are seeing more broad requirements for education, but the biggest piece of that for that to be effective is that it's intentional. so, we can say, oh, well, just take this on-line course or come to this program and check a box and you'll get to register next summer. but, really saying how does something build, right? so, with our-- at georgetown, students have to take part and they have to do an on-line program before they come and also have to do in-person programs once they arrive, but understanding that the on-line program in my mind is a way for us to say this is something that the university takes seriously. these are topics that we value and these are things for you to safe to talk about while you're here. i don't expect them to memorize definitions, but when they come to campus, how are we building on that and how are we not stopping in october of the first year in college, what are other ways to access students. so one of the other models i think has been successful on our campus and other spaces that used it is a program where

we, as health professionals go into academic spaces, not just i teach a class, but as a health professional i might get invited into a professor's lecture around english to talk about something they just read and connect it to my work on their campus in their community so they know what resources are available, but also think about how they are realizing applications and bringing the topic in an academic space. my colleague might talk about eating disorder and might calculate bmi or nutritionals. ...

or learn more, but to me to do and places where we can help make that connection for the. >> thank you. continue on. with the things you discussed already, recently as you know there's been some attempts of rolling back protections related to the affordable care act. in several states have begun to test the boundaries of aca with some modified rules. what you think of the ramifications? particularly at the state level for these changes themselves and, of course, the outcomes which you discussed so much. >> really quickly since we're on a panel i thought i would touch a little bit of what's been said. the for sale want to point out is thank you for bringing in puerto rico. a mother-in-law who didn't have electricity for five and half months, making sure puerto rico is not forgotten his own importance am really grateful about that. the fact they have to balance

beyond because what the hurricane did, that was a disaster but the real disaster was the decision is made by federal government before the hurricane that made them vulnerable to the health crisis that is there now and also this make sense so thank you very much for racing that. i'm really excited that you mention the issue of intersectionality because even in the #me too movement very few people really understood that way before, before they were tweeting me too, an african-american woman had been working with young african american women on issues of sexual violence and started talking about me too like seven or eight years before. but when time magazine made the cover she was not on that cover and that's where have to take my hats off to all the kids in parkland who've been very intentional about pointing out you care about this now because we are relatable to you but the black lives matter you and

people have been talked about violence in the neighborhood and cut issues for a long time, yet you didn't give them the time of day. on the contrary you try to demonize them. i'm really happy to have this conversation in a space like this pic as far as what's happening with the affordable care act, one of the things that support understand is we've never, to last year we have never had more people with health insurance in this country, ever, and it's thanks to the affordable care act perkins act one thing people didn't know, didn't get a lot of tension is, for the first time black children and white children were equally likely to have health insurance. there was no disparity in health coverage between black children and white children, and that is enormous. what we're seeing now is an administration because they were unable to, through congress, dismantle for ideological reasons the affordable care act, they are now in the state campaign to basically sabotage

the affordable care act to actions by the administration. there are two failing examples that affect what decisions are making. what is exploiting the medicaid 1115 waiver process. basically they are using the ability for trying to get changes in how medicaid is a permitted under state to do what at the end that they will be really bad things for consumers. one of the most salient ones is requiring work requirements for people who are on medicaid. they say it's about, well, being employed is a social determinants of health. we want to encourage you. it's about making hard for certain people to be able to keep their medicaid. right now we know majority of people, majority of adults on medicaid actually work with somebody in a family that works, and it's really backhanding the program. there's a whole list of other

things that they're doing their medicaid programs, that states are now, some states are taking advantage of to basically cut how much they're spending on health care for their constituents rather than improve health care for them. the other issue is what these junk plans now are going to be allowed. incidentally, so there's a regulation that you can comment on until april 23, third, so there's still an opportunity to send a note saying that this is a terrible idea, which is leading more plan plans exist o 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 not temporary plan can be one day shy of a year and are not going to have the protections against previous existing conditions, you will not have the support your getting high-quality care, you will not have the ability to make sure that don't take you off because you get sick.

you are not going up all sorts of protections that really changed peoples ability to get the care they needed. but i also want to point out that states are doing positive things because i don't like being just gloomy, right? >> that's helpful. >> and let me be clear. they're still opportunity, it's gloomy but there still a lot of opportunity to raise your voices about this is unacceptable. if you want it more information about how to do that just go to families usa website. there's a a couple examples of things that are positive, states can even in the context of what's going on now, , trying to improve access to health care. one example is in new mexico, for example, they just passed a state legislature, or they call it memorial that it's some sort of resolution to investigating people buy into medicaid with money. like using their money and the premium tax credits and all that to buy into this existing program, which might have new mexico something like over 80% of providers accept medicaid.

it's one option that's actually helping trying to figure more people to give them good quality health coverage. >> okay. but the others what's happening in maryland. they are trying to figure out now that they're not going to implement the penalty for not having insurance, the state is trying to figure out how their own system to encourage insurance, instead of just the penalty, that money as a down payment into helping pay for insurance that works for them. so there interesting things happening as well. >> take you. we appreciate you talking about strength as well. last question. set of questions. the at the foundation along with u.s. news and world report just released -- aetna -- healthy changes index. there's a number of these type of index is out there. can you talk about how the level, what's the level of

contribution to in this way, take a as a work towards finding best practices to deal with these issues? >> absolutely. we like to think of it not as much as an index or ranking more like as a tool. 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 commute is doing. it's different because it compares 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 a ranking of this sort as well as infrastructure and housing, so it really does look across all of those important factors that contribute to it makes a healthy

community. one other thing, important thing, to ensure fair comparisons, u.s. news has presented the data by peer groupings which take into account economic factors and population density as well. what we are hoping to accomplish with the healthiest community 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 making significant improvements, but also to again inspire change in how communities look at health, how they pursue improvements in health, by looking at all of these broad determinants and categories that it is based on.

while no two communities are the same, we do feel that there are lessons out there to be learned of what's already happening. we believe this project is going to shed, shine a spotlight of folks that are doing well. so there folks can use those lessons. so really a game it's the 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 parts. so tools that allow us to measure both challenges and successes and to share them both, excellent, excellent. so that is the individual panel questions. we have about, time? about how -- okay come with about 20 minutes or so to entertain questions actually from the in persons that are here as well as on the panel. what we will do to be fair is

that, do we have any webcast questions that we know of? okay, not seeing any. let's start you with the in person questions. anyone has any in person questions? there's a mic there. [inaudible] >> 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 thank you very much fa terrific discussion from the panel. [inaudible] >> it seems that nowhere -- hello? it seems i don't know how to -- [laughing] okay, push it up. >> we could trade mics. we will trade mics with you.

>> hello? >> yes. >> thank you for terrific discussion, i'm from university of maryland school of pharmacy, behavior had program. it seems that no is the issue more compelling and among the newborns, at least to me because it's the intergenerational problem, an issue that we see. perhaps no more compelling venturing addiction, at least in my field. and it seems from our work at least that there are many barriers, some of them really having to do, i mean, definitely with access, definite with the social determinants of health, definitely with potential misunderstanding about the treatment but compellingly fear of losing custody of the newborn which really fringes upon social services. yes, we are all those sectors that are available to help. how can we best utilize and leverage the services that we have in social services, perhaps

in maternal and child care, maybe in coverage as in community or others? i would love to from the panel across your issue concerns? >> anybody can answer. try to keep the answers to about a met. >> i have a very specific example from a phd program from our partners out in portland, oregon. this was a collaborative that were brought together by portland public schools, the university, family services which is a behavior health provider, kaiser permanente which is in health care provider within the school and several other providers. what they've done is recognized the fact that ticket for people that are in a situation where come across that bridge between maternal health and child health and the social services bridge were all working in different silos. so how do you create more of this community based care team? using the school as a have they've actually done that way

they have, health care is based in the school. the heavy social services through the trauma informed practices that are happening within the school so the school staff has been trained as well as having behavioral health services that are not just there for the students but also there for teachers. because let's face it, a lot of our teachers living on the front lines of community adversity, but also if there's an adversity fisting suffered and felt widespread throughout the school, that they're also getting that secondary trauma. i think that's a really great care practice, example, of how you can bring these various sectors together to a better communication and coordination. of course one problem that still exists is how do we need the resources together? we still a very much policy issues with regard to shrink the data and information but also sharing resources and revenue in order to best serve our families and communities. >> thank you. anyone else?

>> i i guess i will put my lawys have on and say all of what you think 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 a map of child services, that's the biggest incentive and that is something that's typical in terms of a lot of community is not feeling that government entities are there to help them but are there to basically regulate them lock them up and take away the kids. that is a huge, that's more than stigma, right? that's a huge cliff to have to climb off of that sadly will take law enforcement and the legal system to decide that it's something they do work on. maybe the way that drug courts were created at some point because his recognize that incarceration is not the solution, maybe that's what needs to happen. whether this some sort of -- i just making up things as i go

along, but it's not, everything can be perfectly aligned the way you're talking about, , and if u don't get to the peace of the punitive nature of addressing these issues, there is not going to be, not going to make that much of a difference for a lot of people. >> i was remiss, the juvenile justice system as well as their adult courts are also part of this trauma informed movement. using this also, shelby county is a great example would have done an entire trauma transmission of the court system, social service system. i think you're right, you have to have law enforcement in line but most important he also to have community members engaged in helping to inform the conversation so there understand how these different determinants and these different exposures manifest himself in a family. >> what both of you and exited question are saying is we have great things in place, but to be effective, the bottom line is trust.

>> we have another question from the audience? we will have one here here. >> we do have a question from twitter and its from the university of kentucky, their public health program. it says what advice would you give us as future doctors to help create a healthier future for children in regards to obesity? >> can i ask maybe, do you want to say a word or two? >> i have like a short answer anymore complex answer. i've had the joy and privilege of working with a lot of young people in health policy that and went to become doctors, or are in the process of becoming doctors. the most important thing you can do is to get off of your office. once your doctor, get out of the

office, get involved. the power of your whitecoat in terms of talking to decision-makers and people who decide who gets what and when these enormous. if you can pick 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 quick answer, and very simple is, we need to push breast-feeding. at the end of the day, a lot of foundations for focusing on that, but they're such good evidence about the long-term effect, positive effects of first come first, what do they call it? firstfruits or something like that, first food to never 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 on kind of a one-to-one cultural level to bring those numbers up. >> can i just add to that? we also need to remove the barriers because we don't have equity in peoples ability to breast-feed. but one of the things i want to say with regard to the question that was post is that my mentor on the project is actually, he will kill me if he hears me refer to him as a world expert on obesity but one of the things that brought him to the fold around these experiences, because he is an md, is this understanding of the intersection between adversity, mental health and obesity, or people with obesity. and so i would say for a young physician, someone who is training come is truly began to

look beyond just the diagnoses and have that conversation, understand what is really going, so very much the trauma informed conversation about not what is wrong with you but what is really happen to you, what is happening in real time. to really begin to unpack not just the sources of obesity but the sources that underline that disease. >> thank you very much. makes sense. also in the social worker arena if i could bring social work into this, with accounts of the push and pull in the context of remember part of the work that can be done very effectively is understanding the context in which the persons you are dealing with live. in those factors that push against and all the factors that pull against, whether or not you're supporting those, i agree 100% we need to push back against the diagnoses itself and create opportunities. okay, next. >> my name is samantha and i'm an intern for united nations foundation and this question is

more geared towards ms. sabina. you said to push the idea that all help is welcome and i'm wondering what we can do as a nation to make sure these communities health programs are being formed in all communities instead of the ones that could have the resources for it? >> it's a good question. i think it's going to start where the people are. i think what we need to do is give folks the resources, and it might not just be financial resources. it might be kind of 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 bowed in itself. when you get folks talking, they start feeding off each other, you're connected here, you have resources and the power of partnership really does come about.

we tend to get hung up on financial resources, and for good reason, i did it, absolutely, but i think there's power in every community. the hard part in what is our challenge is the public health workforce figure out how to get a going around the table. so that's where i would start. >> thank you. i think we have one more question. the hands have been going over here but let's take someone from the very back, if we can. >> thank you. my name is kelsey and my question, from two experiences, one is as as a student we talka lot about series and ways to serve conceptualize what communities are feeling. and then as a practitioner we use a lot of data. i'm wondering how do we as an industry move away from talking about the community as as a thd object and talk about how we are

the committee and like how it might have ptsd, , we might of people and rebel broken windows and that's why they're in our industry. my question is how to create a more inclusive workforce beyond community health workers? how do we make sure there are equitably paid, there are real pathways including people meaningfully in the conversation? >> ask him questions. >> in our project with building committee resilience one of the first things we really made conscious is trying to build that bridge between health care and other systems with community, not the other way around, thinking about pulling community into the conversation but really wholly our systems into the conversation that's already occurring at the community level. one of the things we talk about is the fact because in public health and across other sectors were good at collecting data and identify priorities based upon the analysis of her own data, and then putting that upon

communities and cities are of e priorities based on our analysis. what we try to do is really say okay, that's great, you've got the system indicators but it really think what you need to do is have this conversation because thick unity community s own data. that data is just as valuable and sometimes a bit more precise and what you have collecting it from the systems level. really understanding that at heart of all of this work is dated but there's no stories without data and no data with the stories. that brings in that community narrative and having community, having that input. with regard to your question is, when you talk about the service delivery or you're talking about program delivery, if you don't have individuals, i want to say with the lived experience, so that doesn't mean necessarily you have to ptsd yourself in order to be effective in delivering a program but you have to understand exactly the context in which your treatment

for your program is being delivered in and the people and have a real relationship with the people that you are actually surfing. if that community, if your program does reflect the community of which you serve, we are only compound the problem will keep making the same mistakes because they don't have that. it's like you are reading a cloth. you wouldn't think about making a red dress and never having read thread put into it, right? i mean, it's that obvious. if you want to create this tapestry and this tapestry is much stronger based on the thread and that dense that thread, that weaving is, and so when have those individuals that are coming from the community, that makes it much richer tapestry, and much stronger fabric of which is going to carry and hold that community. >> i was wondering, 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 speaking about but i think the other challenge, if i hear you correctly, -- we understood. we have a minute so let me make it real quick. the other challenge is we do have like in public health, your people who really want to work in it. however, it boils down to the question how can you support themselves, how can i find it needs to continue? i was wondering, not the last comment but maybe -- >> in terms of how to be within the work and support themselves? >> in the capital to support themselves and continue doing that work given the reality of having to make a living and do other things. is that part of what you're asking as well? >> more about how to become more inclusive what's we often talk about like broken windows. people in the room didn't go up with broken windows side saying how do we change the language editor framework to be more inclusive?

>> i i also real briefly knowing that this is the ending point, this really resonated what wendy was saying earlier because it's important for us, like, for example, just suspects -- specific case on our campus are we going to spaces that of greetings and think that already exist, meetings are happening maybe between lgbtq resource center, eggeling and not a cynic we and here's what the data says about communities that experience at high rate. that doesn't work. the qualitative piece is so critical because if we're only looking at quantitative data, i believe there's one research study that's been done around survivors identify as deaf or hard of hearing. yet we know in qualitative data, in conversations within communities that those ces are occurring at higher rates. how are we merging all of those pieces? one of the things i get as an educator and a trainer who works

specifically about interpersonal violence is i set the tone with that when i go into every single space and name it and say how are we cognizant of the people in the room who have experienced this. we come at this from different lenses but naming the space in the room. it's easy to other conversations and say people who experienced violence, people who lived with broken windows. but you say we know that their people in our community and to spaces who experienced that so let's have a conversation keeping that in mind. >> i apologize for our time is up and i know given this panel they have a lot more to say but we had to cut it up and i apologize for those unit questions. i do want up going to thank this panel, please. [applause] phenomenal group. normally we would have a wrap up but we are short a time some going to turn it over to our executive director dr. georges benjamin so we can a few final comments. i does want to give my personal thanks to everyone who

participated either on our panel, you and the audiences, 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 that making public health week every week. thank you. [applause] >> the slide we have with national public health week, also you can go to national public health week.org. we have lots of tools and resources for you for this week. if you go to the last slide, i want to also just think the foundation for the strong support, for this forum and invite everyone to the reception that follows afterwards. thank you very much. [applause] [inaudible conversations]

[inaudible conversations] live this morning on c-span2, coverage of discussion on the future of iraq and syria. this is on the u.s. institute of peace in washington, d.c. we will be hung over the next several hours from journalists who have been working in the region, iraq's ambassador to u.s., the head of u.s. central command. this is live coverage here on c-span2. [inaudible conversations] [inaudible conversations]

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[inaudible conversations] [inaudible conversations] >> good morning, everybody. good morning and welcome to the u.s. institute of peace here my name is nancy lynn or, i'm delighted to welcome you here