speakership temporarily to move up. i think this is a really interesting piece of history that many people don't know about. we sort of think about the other things that could've happened in the time. >> watch c-span cities tour of norman oklahoma saturday at noon eastern on c-span to book tv. sunday at 2:00 p.m. on c-span three, working with our cable affiliates as we explore ameri america. >> doctor jerome adams, the u.s. surgeon general delivered keynote remarks at the american public health association national forearm in washington. he spoke about his priorities as surgeon general. >> good afternoon everyone. >> that's better. good afternoon everyone.

i am doctor george benjamin and i am the executive director at the american public health association in washington d.c. i would like to welcome all of you here to our national public health week celebration which we are calling the healthiest nation 2030. change in our future together. our theme for this year is how we can work across divide, cost sectors, cost groups to work in a positive way to improve the health and well-being of our community. we have a couple really exciting speakers for you today. that will be followed by a panel. we have audience here in the room and an audience with c-span. we are really glad that audience could be with us here as well today.

i had the honor this morning of introducing an old friend. the young man by the name of jerome adams. doctor adams is a board certified anesthesiologist who serves as t indiana state commissioner from 2014 to 2017. he has a masters degree in chemistry and psychology. : : :

. >> that he had to deal with one of 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 fine manner, working with his then governor, governor pence, with the cdc, with the local health department and others, to get their hands around the epidemic. so dr. adams, i want to publicly thank you for the work you did on that because that was really great work. his model as surgeon general is better health through better partnerships. so i can not think of anyone who really has better place to bring our theme for our public health week and his model together, as a single thought.

so ladies and gentlemen, the 20th surgeon general of the united states, dr. jerome adams. [applause] >> thank you, sir. all right. would you, i knew you were going to do that, georges. you were going to set me up. well, good afternoon, he have h- everyone. you can all do better than that. good afternoon, everyone. it is fabulous to be here today. i'm excited for public health week. i was thinking about what i would say to you all weekend long and hopefully i don't disappoint. we're going to do some questions and answers at the end so make sure you think of good hard ones. because everyone expects photos we'll do selfies up fronter rather than at the end because after the q&a you might not like

much anymore. get everyone in there, say public health week. one, two, three. all right, fantastic. fantastic. i want to thank dr. telfair for having me here and dr. benjamin. just been great to meet with folks who think like i think. we talked a lot about the sensible middle. and that is what i'm going to touch on in a little bit during my talk. i want to thank the panel. i don't know why they put you up before i came up. thanks for being here. i had great conversations with most of all. i hope to tee up a great panel discussion. i'm looking forward to it. i know you will learn a lot from these individuals because they represent very different points of view all looking towards the same goal. was so glad to hear the theme for national public health week,

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 everyone of you to know, i wt you to know that i believ with every fiber of my being, that every american deserves to live a long and healthy life. unfortunately, we're falling short of that goal. as many of you know, your public health experts you're self, life expectancy in the united states has declined for the second year in a row. we were talking about kid earlier. she is the mom of two five 1/2-year-old twins. can you believe that? she has one more at home. i'm the parent of a 13, a 12, and 8-year-old i left over at the white house for the easter egg roll. i hope they are not causing any incidents over there at the moment. but you know what, unfortunately

elise and i, several of all in this room are part of the first generation of parents in the last half of a century who as of right now can't tell their children they are going to outlive us. think about that. half a century and every generation has been able to look their kids in the eye, you will be living longer than me. right now we can't say that. we can't say that. as your surgeon general i'm determined not to accept that fate for my children, for elise's children, for any of our children. my vision is more healthier and equitable america but it can only be achieved if we reframe the way we think about and we talk about health in this country. by now most of you in the room are familiar with the varying degrees, the hiv outbreak in scott county that dr. benjamin spoke of so i won't belabor it. a town of 4,000 people, never

had more than three hiv cases in a year. now, 230 cases of hiv related to injection drug use. the lessons that i learned during that hiv outbreak, why i treasure the opportunity given to me to be the surgeon general of the united states. i'm often invited to speak at large conferences in rooms similar to, bigger than the one i'm in today. but i feel i truly have the biggest impact when i can help facilitate local discussions. just as they say all politics is local, all health is local and i personally feel we can only meaningfully and sustainably change health when local partners come together and create local solutions. some of all may not like to hear me say this but, you know the folks in d.c. aren't going to ride in on a white horse to save the day. there is a lot we can do from

here in d.c. there is a lot of federal government can do and should do and must do but we'll only create that change, that meaningful, sustainable change on a local level. i want to share with you all a little bit of personal story about me you may not have heard, one of the challenges things going out to give multiple talks sometimes people hear awe couple of time and they get tired of the same old stories. we thought of a different one to share with you, but we think it drives home partnerships with public health week. i am a physician as dr. benjamin mentioned and i'm very proud of that. when most americans think about health, they think about me in a white coat. they think about prescription medication. they think about vital signs but we in the public health community know reality is 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 about my

childhood 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 influenced my decisions to become a physician. yet my persons in the hospital are not what i consider to my first exposure to public health. i didn't grow up in a wealthy family by any means. had two school teachers for parents. very proud of them. we had four kids that ballooned up at different times in varying amounts i will go into in a little bit and honestly did not realize how poor we were back then but we weren't well to do, let me put it that way. i was blessed to have lovingnd supportive parents who cared f me throughout my childhood a little over an hour here from rural maryland. my parents raised me to work hard, be humble, also care for those around me. that last lesson is one that

particularly stuck with me. perhaps a little bit too much to my parents' liking. i will share that with you now. whenever i noticed a classmate that was getting picked on or a friend or a teammate who didn't have a parent to spend tile with, or a meal go home to i would invite them to come to my house. sometimes they would stay for a meal. sometimes they would stay the night. sometimes they would stay the whole weekend. on more than one occasion they stayed several weeks, sometimes for the whole summer. i often saw that those friends, they weren't the fully, happy, energic and vibrant people that they could be. and i saw how they would light up after a good meal, after time spent with my family. after time with a loving and laughing place, a safe place to stay. my parents would often joke, shouldn't say this, but they would say, jerome is out there always collecting strays and bringing them home and my family

went as far as to welcome my friend and now my brother damien, who had been in and out of the foster care system his entire life. we brought him into our home, 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 an environment where others could thrive was really my first foray into public health. no, 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, 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 helpfulness. it increases attentiveness at school. positive adult figures we know increase resilience especially

children of color, faith, having faith based can increase cognitive and social functioning to allow young people to grow and to thrive. now i share that story with you for two main reasons. there is a lot you can take out of it but there are two main reasons i share that story with you. first, it is an example of the multifaceted approach that we as a public health community should be engaging in to better health, and to move toward health equity for all americans. second, and perhaps more noteworthy, i did it as a child and i did it as part of a family that was barely above the poverty level ourselves. so yes, we need more funding. i'm not going to deny that you will never hear me say as public health advocate that we don't need more health funding, yet we need medical expertise, we need health expertise, we need to be grounded in science.

as a surgeon general you will never hear me say we don't knee more expertise, that we don't need more studies, that we don't need more science but we can have tremendous impact on what we focus less on what we don't ve and more on focusing engaging partners, engaging everyone to realize the tential that already exists in every single community in our country. you know, when i was health commissioner of indiana i would go out to different communities and folks would get all excited about the health commissioner coming into town. same thing happens now when i'm surgeon general. we get a big group. do a roundtable and everyone wants me to give them all the answers. one of the things that sticks with me the most, i would go into those communities, there would be a group sitting here like at this table, this person sitting here in this seat would be working on an issue and that person in the seat sitting right next to them would be working on an issue, and they would be in the same community and they

wouldn't realize how many people in that very community were all committed and working towards the same goal. what we need to change health already exists in our communities. we just have to be better at unleashing it. now please, please, don't misunderstand me because former aph president, dr. jones, dr. kaimra jones, she ace good friend of mine, she and i 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, we believe in the same goals and the same end. 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 in our childhood, we couldn't change the systemic depression and institutional racism that

affected my peers. too big of a hurdle for any one person, anity to tackle alone but that is why i talk about better health through better partnerships because there are so many different way west can improve health if we commit to go across sectors and engage new partners. one of the discussions with many of the panelists earlier, i talk better health thrgh better partnerships, and when i look in the audience i see everyone with nodding their head. everyone believes in partnering. it is easy to say but a whole lot harder to do. i will give you pratical tips being better partners and forging better partnerships. number one, invite folks to your table. go to their table, meet them where they are. folks who you wouldn't necessarily think of. we had a discussion earlier, who would have thought for a health issue you health issue you

needed to invite the local sheriff to sit down to be part of that discussion. that's what we had to do in scott county, indiana. who would think the first person you should call when dealing with a health issue is the local priest? that is usually at the end when everything else is exhausted. well in scott county that's what we had to do to solve that hivout break that was occurring within the community. u you have to think about the non-traditional partners, invite them to your table and go to their table. number two, show them that you care. there is a great saying, nobody cares what you know until they know that you care. a physician i think about motivational interview -- anyone heard of motivational interviewing? i have taken care of patients with diabetes and i gone through the same old cycle over and over again saying well, mr. jones, we diagnosed you with diabetes.

here is all the things that science says you need to do to improve your diabetes. here are the prescriptions for your medicine. lose weight, exercise more. all right, see ya bye. unfortunately, time and time again we see it doesn't work. motivational interview something 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, seeking areas of alignment so we get there. mr. jones, you care about seeing your grandkids graduate from school. you care about being able to walk or run that 5-k with your daughter. you care about being able to make it to the softball game or going on that vacation. great, we want to get you there, we have to get your diabetes under control and here are things we can do together to get you there. that is 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, a whole lot of folks said, why health commissioner to open up synge program? if i had done that the local sheriff would have set up a perimeter around the syringe program. would arrest people going in and out. doesn't matter what the science said. he still had the legal authority. if i tried to ram it down their throats there would be a sermon next week by the local pastor how the health commissioner was coming into town and was a devil pushing this on the community. we have to engage people where we are, show them that we care.

i went to the community, i didn't come down said you need a syringe service program. you all have a problem. tell me how you feel we should solve this problem. tell me what your community needs and let's figure out how we can get there together and that is how we stopped the transition of hiv in that community. number three, last tip for engaging partners, adjust your target audience accordingly. had a great conversation with robert woods johnson with rich, and he and i share this commitment to being better communicators. we need to get much, much better at science of effective health communication. that is not going to be something that all of all focus on but something i think we all as public health advocates during particularly public health week need to think about. how can we be better and more effective health communicators. just like going to other

countries, eeffect tiff communication -- effective communication starts knowing what language you speak. anyoe sne herak english as second language, learned another language first? got two folks. when you to outside of the united states and the americans come into town, what do they do? they find a person and start talking to them in english. they expect that they're going to know english and then when they don't know english, the americans, what do they do? they speak louder, yell at them, expect now suddenly they will understand what you're saying. we do that far too often in public health. we come in and expect that they're going to speak our language. when they don't understand it, we yell at them call them names, expect them to help them come around to where we are. couple real practical tools for you, two of my favorite

publications. colin woodward the 11 american nations. colin woodward is cultural an throw poll gift. what he did was break down the country into 11 distinct, what he calls nations. he calls them nations because they are very, very different. folks don't realize how big and how different the united states is. i told them i wouldn't tell any old stories. the problem you give me the microphone i will tell stories. i know everyone here hasn't heard this story but i apologize to the folks that have heard it. i was in switzerland and i tasked with explaining to a bunch of people who were not from the united states the united states health care system is, and i was given ten minutes to do it. easy peas sy, right? here is what he said to them. when you look at paris, france, and berlin, germany these are two cities, and two completely different cntes. they speak different languages

and in the last great world war they literally tried to blow each other off the planet. if either one had their way there would not be a france or a germany right now. that is 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, contraception and abortion, when you look at drug policy and heart reduction, these two places, berlin, germany, and paris, france, that tried to wipe each other off the planet are closer to together than dallas, texas and boston, massachusetts. we truly are a country of different nations. i'm getting the hook. they told me i'm wrapping up

here. colin and the 11 american nations. the other publication, robert wood johnson the way to talk about social determinants of health. what they did, they polled 4,000 voters in the country and determined which phrases, which words resonated and which ones didn't and then they gave you practical tips. use phrases like opportunity. everyone should have the opportunity to live a long and healthy life. your neighborhood shouldn't be hazardous to your health. it gives you practical solutions to speak a language that is going to resonate when you're in different nation, that may be part of the same country. as i wrap up i would be remiss if i didn't speak up 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 is more than the number of americans diagnosed with cancer

each and every year but only one in five with opioid use disorder receives any treatment at all. each day we're losing a person every 12 minutes. in the time i've been on this stage talking to you someone died from an opioid oh dose. think about that i see my role as surgeon general to educate the american people about the severity of the epemdem mick and how everyone can be part of the solution. all of you can play a role combating the opioid epidemic. that doesn't mean you have to drop your priorities and focus on opioids. it does not mean that at all. we need to ride the wave. the opioid epidemic provides a tremendous opportunity to amplify your messaging. i was in tennessee three weeks ago. who would have thought tennessee in the middle of the bible belt would be leading the way in terms of talking about long-acting reversible contraception. certainly i wouldn't but they are. they are providing long-acting

reversible contraception is in prison to women. they are doing it through the lens opioid epidemic. they noticed so the some of but highest rates in the country. they noticed highest rates of taking children away from their mothers in the country all related to the opioid epidemic. that createdhe a way to talk about long-acting reversible contraception. know the communities most impacted by opioid epidemic are often same communities that have high obesity rates, that have kudlow graduation rates, that are affected by aces. there are what we as public health advocates but all the issues that you care about. as i said to audiences we've been trying for years, for decades for people to pay attention not just to addiction, not just to mental health and

aces and social determinants exist in all communities, especially communities of color. we have a great opportunity now because folks want to talk about that i was at a cabinet meeting a few weeks ago, you had the head of the secretary of labor, you had the head of hud, you had the head of agriculture, all these folks talking about sewing determinants of health. we have a great opportunity here, i hate to say great in the midst of tragedy but a unique opportunity to push public health about the opioid epidemic if we're willing to ride that wave. i want to close stating every single one of you in this room, every single one of you, i talked to people in public health for a while. i talked to folk in college, some of my fellow retrievers still in college. every single one is leader in your community by the nature of you showing up today. the fact that you showed up means you are a leader and you have the potential to influence other people.

it means you have the portunity, also means you have a respoibily to lead by example. it is imperative all of us use our platform to maximum effect and that starts with humility and with servant leadership. couple of challenges to leave you with. a challenge each and everyone of you to think of at least one new partner who you can invite to your table and whose table you can go to. whether it is faith-based community, educational community. we have folks here from the department of ag, from law enforcement community, think of one new partner whose table you can go to and sit down at. number two, i challenge you to stop. the next time you about to ask someone you know is scientifically valued and will benefit community health, just stop, pause. stop for one second and have the courage to instead ask that person what their goals and

desires are before you start talking about yours. show emthat you care before you tray show them what you know. challenge you how you can be more effective communicator but at the end of the day we know what we do. we're just plain lousy getting people to do it. public health has not changed for the 20 years i got my hph. eat better, move more, don't smoke, do don't drugs. all those lessons are there 20 years ago. we're plain lousy communicating to people what we need them to do and it is because we don't recognize or we don't care that this in many cases we're in a foreign language -- we're in a foreign land speaking a foreign language. my motto is better health through better partnerships. 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 individual together to collaborate with one another. and i hope each of you takes the opportunity here today to find a new partner. to get to know someone. 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 has been a pleasure to address all of you and my best wishes for a great public health week. thank you so much. [applause] did i run out of time for questions? do they have time to grill me? >> questions. >> anytime for questions, anyone in the back? yes, ma'am in. >> [inaudible].

>> tell us all who you are too. >> yes. is it on? i'm caroline, i work for alvarez public services but my background is in public health. i worked for the louisiana department o hor aetna medicaid. the more i work in health care, the more issue of housing and housing security comes to the forefront. you're talking about building better partnerships. i have worked on the local level in housing and health care. one of the roadblocks is funding and lack of intersection of the funding at the federal left. can you talk about that a little bit? talk about what you're hearing from your housing counterparts about what they need from us. >> wonderful. wonderful. thank you so much. i will step out here a little

bit. one of the things i tell folks we have another tremendous opportunity. no matter which side you're on or how you feel about him individually, we have a physician who is the head of, who is the head of hud, the department of housing and urban development, a physician. and i talked to dr. ben carson, he believes 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 aren't taking advantage of it. we aren't 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 has got initiatives 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.

individuals are just not familiar with that. we had a lead situation where it was a hud housing comex and once upon a time someone thought it was a good idea to build a housing complex on top of a old lead smelting facility. if we had engaged hud and they had engaged public health, because again it is both ways, if we had done a better job of that maybe we could have avoided some of these unfortunate situations. really taking advantage of that. the other thing, i talked about riding the wave of the opioid epidemic. we know the number one predictor whether you have recovery is permanent supportive housing. folks understand that. we had the opportunity to use the opioid epidemic to talk about housing as determinant of health. we have to be at the table. also really engaging folks from a business point of view. one of the things i want to do as surgeon general, create a surgeon general's report on health and the economy because

we know the number one thing that people vote on is jobs and the economy. number two thing they vote on is safety and security health, typically not in the top five or 10. if which create healthy communities not just good for health but also lifts up community and better prosperity we can engage partners. not just ram it down your throat you need to commit to healthier housing or you need to pay for housing but we show a community mill lineals will want to move do. that amazon, and amazon where they will pick their headquarters. let's pick a community where amazon says, heck yeah, i want to come to that community. millenials want to move there. there are parks, complete streets. there are no food deserts and it will be great for people to be productive and prosperous. if we do that in a back and forth, we will be much more

successful. if we approach housing and inject our public health input with the goal of increasing prosperity, inaddition to increasing housing being humble, coming in with a dose of humility we can be successful. a great question. thank you for asking that. time for one or two more? yes? >> [inaudible] i'm wondering if the opioid epidemic is a good way to talk about other addictions like to alcohol? >> can you repeat the question? >> louise, wondered if the opioid epidemic is a good way to talk about other addictions. the short answer, absolutely. the opioid epidemic is not the problem, it is the symptom. it is a symptom of unrecognized and untreated mental health issues. my own brother is in maryland state prison about an hour from here because he had unrecognized, untreated mental health issues which he

self-medicated which led him to steal $200 to support his habit, get a 10-year prison sentence. even upstream from that, childhood experiences, upstream from that, social determinants. there is excellent opportunity to talk about addiction to tobacco which leads people, i talk to folks, one of the things i love hearing personal story how they struggled with addiction. tobacco is one of many of these. it can prime the brain for other addictions. oppounity to talk about alcohol. let's move upstream and talk about all the things that can be potential problem and stop playing "whack-a-mole." what we can do with the opioid epidemic is just treat it as an opioid epidemic. you know what? we'll get our hands around it eventually, it will pop up with something else further down the road if we don't getup stream. great -- get upstream to talk about it. as your attorney general i do plan to talk about, plan not to

talk about just opioids but addiction but mental issues. not just mental health issues but adverse childhood and experience resilience. not just childhood experience and resilliance but social determinants of health. not just social determinants of health and all that will lead to bet you are outcomes across the board. time for one more question? >> thanks, my name is benjamin brooks. i am unaffiliated public health professional so call me. i was wondering if you could talk about the role of private public partnerships in your platform and if 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 and prominence and prevalee. buthear going to be huge. we need to think about how we can engag those private

entities. again my report on health and the economy. it is not about me going in and trying to tell businesses that they need to take up my mantle. it is about me going in and showing, if you engage in creating a healthier environment it will be easier to recruit people. you will have less absenteeism. you will have less presenteeism which is showing up for work and less productive. less workplace accidents. you are more product tiff across the board. we got $6 billion to respond to the opioid epidemic which is more money we have ever gotten to respond to opioids. the challenge, whenever we talk to folks they continue to tell us it will cost so much more than that to actually be able to do what we want so do. well we also know that we have got a congress and american people who believe in a certain size pie. that pie may get a little bit

bigger, a little bit smaller depend hog is in charge but at the end day there will be finite pie. there will never be enough after pie to come from the federal government to solve our woes. we have to figure out how to work smarter and not just harder. how we engage private partners, how we engage non-traditional partners m working with the military. why? because seven out of 10 people in the military are ineligible for military service because they can't pass the physical. they can't meet education requirements and they have a criminal record. why don't we have dod, law enforcement and education and health all at the same table pooling their funding together. all the private groups that work in each of those areas, figure out how we work smarter with the money we have, instead of our hands out 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? give one person -- ma'am? >> [inaudible] george washington and i know there is a lot of students here and even more listening so going forward and like entering our careers what would be the number one piece of advice you would give us to take on this path in public health? >> repeat the question, please. >> as a student she asked what would be some advice i would give to folks as they embark on their career in public health? i will hit some points that i made earlier but i will try to rephrase them. i would say that we need to think beyond public health. 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 achiev goals. focus on want to spend the next 20 years of your life working on an issue with your blinders on then be frustrated, i didn't make a difference, we're still talking about the same things. we can make meaningful change, talk about being more effective communicators and partners and servant leaders walking in how we can serve others instead of expecting it because we have the moral high ground and science that everyone will listen to us. more practical tips, more specific to younger folks, take advantage of opportunities that come your way. i did a summer at howard university acutarial science. anyone know what that is? it is all about math. i loved math at the time, ordinarily you would think that has nothing to do with public

health. i met tremendous people, gained valuable skillsets. as long as you increase your network and learning something, it is a worthwhile endeavor. so continue to take advantage of those opportunities that come your way. continue to grow, continue to expand your network, have your elevator speech tight. that is another thing i tell young folks all the time. i have the privilege of being at the side of the vice president for the last four plus years. had the opportunity, was over at the white house earlier this morning around cabinet officials and around the president. what is funny, folks sit down with me in casual setting if i had a chance to talk to president trump this is what i would say. then they get next to me in front of president trump and -- [laughter] when we talk about an elevator speech, you have got to seconds or you have got 20 seconds. what do you want to communicate what you're interested in, about what you're doing about who you are in efficient manner to make

the most use of your opportunity. it goes back to effective communication. that is what i say. one more before they give me a hook. i love being up here talking to you all. yes, ma'am. >> hi, i'm amelia roberts. graduated from lsu with my mhh last year. i did focus on aging in public health. in public health we focus on young people, children, teenagers, young mothers but we tend to neglect what we see gone through life. all feeling there is nothing left we can do for them but as most of us probably know, our population is rapidly aging. i want to hear what you think public health can do to address that? >> that is a wonderful question. i think public health could do a lot more. there is another opportunity you have. someone who worked in health and in health care, everyone is shaking in their boots about the baby boomers aging, getting to

the point where many will retire, leaving workforce. they will be on medicare. they will be drawing social security. there is 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 problem we silo things out again. we have to break out silos and bring non-traditional partners tohe table, when you talk about aces, average childhood experiences, one of things in the community having positive adult experience. i was talking with ivanka trump. she is big advocate of youth sports. one of the problems with youth sports we can't find enough coaches. parents are working with single parent households. utilizing the aging population to become coaches to engage. it will help them. but ultimately figuring out places where there is overlap, where you our missions align.

not how we help the aging in our society but how can we better utilize the aging in our society as part of an overall mission. once we get them engaged we'll help them, they will help us aconsiders the board. i think there is a great opportunity. before we leave, i can't believe nobody asked me about guns. i am disappointed in you all. i am disappointed in you all. no, no. what i would say before i leave is another tip for young folks. travel as much as you can, as much as you can. i experienced the 11 american nations just coincidentally by traveling around the country and seeing how different things are. i went to school in baltimore. lived in an apartment with walls this thick whereas 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 if the gun discharged. so in that sense, 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, how just put on an airplane this morning to send out back to northern indiana, to go back on his farm, i sat on his porch, cross coyotes run across his backyard. not having a gun is a threat to his livelihood. that is how he defends himself and his livelihood. in that local environment he sees someone wanting to take away his gun, threatening his livelihood and ultimately his life. 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, when and where they work. a policy works in one place may not work in another place. a great example for that is

syringe program. folks in new york, 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 than anywhere else. i can guarranty you take average person couldn't tellou where syringe service program, it is not something they experience in share life. go to scott county, indiana. you go to middle school, every kid can tell you where the syringe service program is. we need to make sure we're leading local conversations, coming up with local solutions. if public held at -- advocates and public health researchers we need to make sure we're evaluating those programs in a way to allow us to go to different communities, this will work in your community or has the potential to work because i've seen it work. i will i tell you when i was in indian, they didn't care what they were doing in boston.

they cared what was going in ohio, kentucky, illinois, in their communities like their communities. to close it bring the conversation back about guns and everything else, we need to make sure we're facilitating local conversations that we don't do in with our own biases suspect we believe something is right, we saw it work in one community that it has got to be the way that things will happen in another community because what is going to happen, that community is going to push back. they will not care what you know because they don't know that you care. so thank you so much for of the opportunity to address you all. i look forward torquing to workh each and everyone of all. you are the army. i get to stand in the nice uniform and talk. you are the ones that go out and do it. i'm so thankful that you're here today. i'm so thankful for the opportunity to serve as your surgeon general. i hope we get a chance to talk more as the future comes. thank you, georges, and thank

you for the panel. [applause] it is going to be great. it will be a wonderful panel. i hope you all play close attention because i'm looking forward to it. thank you, georges. >> another round of applause for the surgeon general. [applause] >> well, thank you, stimulating speech, we get to have this wonderful panel. i get to introduce the moderator. so this is dr. joseph telfair. joseph is the president of the american public health association. he is professor of public health practice and research at the pence disnguished chair of public health at college of public health in states borrow, georgia. he is dual chair of department of health, behavior education

and department of health policy and management. he holds a master in social work and mph from the university of california at berkeley and drph in the, from the johns hopkins university. he has had over 32 years of experience as clinician, community advocate and public health practitioner. our president, of the american public health association, dr. telfair. gill. >> thank you. >> thank you very much, dr. b and thank you to the surgeon general. i want to thank everyone who are attending. y'all who are watching and listening i want so thank you for some toing our panel today. i have the distinguished pleasure to introduce the phenomenal panel you will hear about. as i start i want to give a little background on each of the panelists. starting at far end here i want to, is dr. wendy ellis and she

is the milton scholar of health policy at the milton, milken, sorry about that milken institute school of public health and department of health licy and management. miss ellis is the project dior of building community resilience, the collaborative at milken institute of public health. this is at the george washington university. this program actually is a strength based program aimed at building community infrastructure and promoting resilliance in communities across the country. prior to joining george wash university she served as manager of childhood policy nemours, policy practice here in washington, d.c. in 2017 miss ellis was selected for the doris fellowship for the promotion of child well-being and milken scholar at milken institute of public health where she is right now. she holds an mph pro the university of washington school

of public health and a bs from seattle university. our next panelist is swear. miss is director of sexual assault prevention services at georgetown university. she is adjunct knack cult and member in the georgetown women's and gender studies department where she teach as class on gender violence. miss spears serves as program advisor, on program advisory board for the rape abuse, incest national network and has could facilitated the d.c. university consortium. she also participated as a member of the d.c. assault response team and d.c. assault victims rights amendment task force. her bs in education and ma in counseling psychology from the university of nebraska at lincoln and she is licensed professional counselor in the district of columbia.

our next panelist is cynthia hernandez director of health equity at families usa. and where she leads the organization's effort to advance health equity and reduce racial and ethnic health disparityies. she serves on addressing disparities advise already panel for patient outcomes institute for cory and robert wd johnson state strategies advisory committee. miss hernandez castillo heard a ab from woodrow wilson school of public health and international affairs and jd from new york university school of law where she was the hayes civil rights and civil liberties fellow. our last panelist is miss elise sabina. elise is the national program director for aetna foundation. responsible for directing the

foundation's national and international program supporting the federal foundation's mission of building healthy communities, including healthy cities and healthy counties challenge. prior to this position she served as a program officer and managed portfolios of national and international grants and digital health and enat that greated health care with focus on coordination and quality. she has coauthored a number of articles having been published in peer review journals. american public health, preventative medicine and archives of internal medicine. she is 2012 fellow in the grant makers keenan institute for emerging leaders and health philanthropy, sorry, and she earned her masters in public health from the university of north carolina chapel hill and bachelor of arts from the of the ever rochester. what we are going to do with our panel is we're going to start it off with a general question. the panelists each have three to

four minutes to answer the question. our first question is this, for the second career in a low-life expectancy in the united states has dropped. can you speak briefly about your work and impact on community health and how we can turn this tide on this trend? >> that's me? i'm up? okay. so my work as dr. telfair described is the building community resilience collaborative at george washington university. really what we have at the heart of our work is addressing average childhood experiences and context of adverse community environments. so most of us in this room understand adverse community environments as social determinants but unfortunately when we go and we speak to other sectors they don't necessarily understand what we're talking about. but they certainly understand lack of economic mobility, the impact of unaffordable housing, the fact that we have

inequities, systemic inequities. so when we really try to keep at the center of our work really understanding how those systemic inequities, keeping focus on our systems as opposed to just as we've done so well in public health, with regard to personal interventions, changing of behaviors. because it is no good to change behaviors and some people right back out into the same systems. so our work really highlights the fact it is no surprise we have declining life expect tan is? our country because we have disparities in healt inequities, out comes, incomes, neighborhood disparities. ese are signs tt we're not in systems, we're in public health, we're not necessarily taught about dynamic systems modeling but it is so key to us understanding the context which our work is being delivered.

our systems are designed perfectly for the out comes we see. if we see decline being life expectancies you have to ask why our systems designed for such an outcome? it is not going to be about changing individual behaviors. it is working at the systems level to reengineer, just as you reengineer, you wouldn't expect a iphone assembly line to suddenly turn out an android. no, you have to redesign it and delivered in it design. some of our social policies were deliberately designed to have inequality over course of more than 200 years, absolutely eventually you will have so many people are held back and inequalities going beyond just racial disparities. i think opioid crisis is really excellent example of that. that is the real example of why we have a growing, or lowering life expect san sy -- expectancy. it is not about those people in ward 7, ward 8, it is truly

about all of us. that one metric, the decline in life expectancy is really great example of that. that is why our work is really looking at not just working upon community, bringing community to the table, discussing this. but at same time, community can't affect all changes happening at our systems level. making sure we're setting a table that has the community voice but also has those system operators understanding the impact of their work and the systemesns that we could get truly to address these inequity ies. thank you very much. >> good afternoon. so, as i was stating in my introduction, i work at georgetown university where i oversee the sexual assault intervention program. that incorporates an include interpersonal violence of all kinds. relationship violence, stalking harrassment working with

prevention work. at the beginning i would like to take a moment to highlight a couple things i think themes have already been set for the conversation today earlier. but my background, i've been doing this bork around advocacy and activism in this field for 18 years. my background is not in public health. this is really critical and important example what it means to be in spaces with one another. when you look how violence impacts community health, and outcomes, it is a natural connection, right? so, i actually had an article i was reading recently that, radical feminism coexist as a public health issue? the short answer is yes, it can. so but really it is only been in the past 18 years, probably the past five to 10 years, that i have done this week we've really been engaged in doing prevention work and using public health models to so further that

occupation. it is working in silos and setting groundwork in grassroots organizations now needed. we're in a space where we say the model of public health makes a lot of sense for thinking about doing our prevention work. not just saying we need to have responses for survivors in our different communities and spaces we're in but also talking about getting to a place where we're preventing violence before it occurs. how are we educating and setting that, setting the tone for that and spreading message around that. in doing this work as practitioner, we know work is correlated not every survivor will experiee, cinated with interpersonal violence, higher incidents of eating disorders, higher iidents of ptsd, self-medicating with alcohol or drugs. my office actually sits in a space where we are with other

practitioners who work around substance abuse issues with my colleague who specializes in eating disorders because we know that so often they coexist. there is that outcome around trauma that we are working at addressing because we also know being a victim of some kind of a trauma around violence puts you at higher rates for being revictimmized again. we have this other arm in our office and in the work that is being done around responding to survivors which is prevention piece. i will talk more about that in a little bit but making sure we are saying, how are we talking about a culture or society that reinforces some of this messaging, that is creating these, creating violence which 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 of getting into the spaces that they need to be in, the conversations with the enhancement of title ix over the past five to seven years. . . in elementary school and about harassment in the relationship? i think that's one of the best next frontier for us, turning the tide and being able to start addressing the issue at its core and its impact on public health overall >> you all. it's the speaker looking one class that one, okay. wow.

thank you very much for inviting me to the discussion. it's exciting to be part of a public health discussion, especially one that's been very focused on the last 37 years, getting coverage for everyone. but our central mission is we believe 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. i want to with regards to what happened in the last year, i think it's 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 . that's the problem with averages, that in the cloud, what's happening to the community and it was interesting that there was so

much media attention to this statistic and then when they started digging in to exactly what the cdc data was, the only group that actually saw a detriment in their life expectancy was white women . and that in itself i think has a lot of, and especially looking at the reasons, the causes of death being what some have called disease of despair, accidents with suicide, neurosis from drinking, those kind of things. it becomes really apparent there is a huge problem. a connection i think that we see with -- with what jen was talking about and what's happening in communities, particularly in communities on top of these dynamics. women are also more likely to suffer problems from having downturns in the economy and unemployment and so forth that man so that's important for us to call outjust as 's important to call out that life expectancy for all

hispanics and for black men actually increased so there's something that we are doing right somewhere. and for black women and white men, it's just kind of stayed level. it sounds like, i don't want to make it sound like we're nitpicking but it's important as we think about what's happening in communities to understand exactly what is the burden of health, negative healthoutcomes in different communities are sharing . putting that aside, we are seeing disparities, racial disparities. so we're also seeing that african americans still have a much, these changes in trends among white people, african-americans are much higher rate of, lower life expectancy at a rate of serious chronic diseases etc.

. so one of the things we as a family in the usa, you understand that coverage, we've been doing that forever, we need to have health insurance in this country because it was designed for this. you can have other debates about universal healthcare but in this country having insurance whether 's vernment insurance or private insurance is the entryway into being able to get the healthcarethat you need . that includes healthcare like the mental health and substance abuse and all those treatments and prevention services so necessary to stay healthy, but we also understand that is barely the tip of the iceberg. health doesn't happen inside doctor's office or inside the clinics. , health happens in communities and part of it, we are shifting to right now is figuring out how do we change the way healthcare is paid for. >> so that things that are valuable, to individuals in

particular communities are supported . there's a lot of, help is the biggest sector of our economy . there's a lot of resources there that probably could be better invested in things like housing or in community health workers, community health organizations because i can speak that language, they are natives to that country, the surgeon general was talking about and to make those connections so a lot of it where figuring out right now is we can use what's in the healthcare system right now in terms of funding and in much better ways from a public health perspective but you all understand in terms of prevention and promotion but also because we just know it's going to work better and that, with a lot of communities are struggling is because they can't connect to their health care system, that really has so many resources in it and not necessarily resources that provide the best care atthe right time .

we need to adjust that. >> sohink i, we attack thalife expectancy statements a bit more and have a broader look at it, we know based on the research that there's a predictor of your life expectancy and your health outcomes and your genetic code. so as a foundation, we use that statement as a foundation of all our work that we do. it's about building healthy communities and i think we touched on what you guys were saying. what we do with our work as we support local partnerships to address the underlying social determinants of how thingsthat happen outside of the doctor's office , we talked about this today, in fact, two of our signature initiatives are cultivating healthy communities grant programs which by the way is accepting peace, we have put a plug-in for that. and that are helping cities

and counties challenging, ask local organizations and partnerships to look outside of the healthcare space and address at least one of five domains that focus on social determinants, community safety, environmental exposures, that build environments, social and economic factors and healthy behaviors. what we are seeing with these programs, is it reminds me of what the thing about emotional interviews, motivationalinterviewing for communities, at the community level . these programs have produced these exciting and innovative homegrown solutions, that are focusing on what the communities feel are really important to them, so we said let's work on the social determinants and these bro domains but it's important to you and let's work on that together. and we are seeing examples of suspense, some word spotlight award winners in our

challenge. then over virginia, working on putting in place effective policies to address the obesity epidemic or candid new jersey nets looking who overflowed it and improve water quality in their communities. i think that's really turning the tide in the life expectancy issue, it really is going to take leadership. it's going to take leadership that is committed to addressing the health equity. and these social determinants that contribute to these disparities at the local level, so that's where we have to put our resources . >> thank you 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 everyone. >> so our next big question, this is a general question for the panel and you all can

chime in any order you feel comfortable. we look, we act in public health are looking to achieve a healthier nation in 2030. which means for us making a concerted effort to tackle many of the social determinants and moving upstream to focus on prevention which is something that you all had just brought up . the focus that you have on prevention, targeted prevention and the intent and message that match what it is that we are trying to accomplish and that we do this, in other ways at the systems level but as well as at the ground level and recognize these diverse outcomes are critical. so from what your perspective is, what you think is important as we are moving forward to achieve this healthiest nation and what you see as a priority that you if you had your chance, you could put together your priorities, one or two because you don't have a huge

amount of time. what would be your priorities to achieve this outcome? anybody can start. >> i'll go ahead and today is the first day of mth w and i'm going to lead with mental health matters. and yes, my work is deep and adverse childhood experiences but we know these adverse childhood experiences have a longitudinal impact on development as well as outcomes across the lifespan and by taking that lens, the trauma lens, you automatically become multi generational in thinking about what you're looking at e becausre notjust going to address child exposures. you have to think about that in the context of their family as well as their community because there's community level, that we need to prevent. i would think that putting that at the forefront, you're going to get to all of these other chronic adversities, chronic diseases that we have

discussed nausea and research ad nausea in public health. and really begin to think about it from a prevention standpoint. i would also say because you're looking at whether what are universal, because if your feet in the cdc data, you understand that aces are truly a american public health issue. there's more than 50 percent of our population has at least one. and we also recognize that there is a differential outcome for individuals, so yes, more americans have two aces in this last recent wave of data. but we also know that depending on what type of community you are in and what type of supports are in place, your outcomes are going to be very different so that begins to the value of addressing these social determinants so i would say the second priority in thinking about this from a trauma perspective and artwork from a prevention and aspect of that is the

importance of cross sector collaboration. we've all heard about public health 3.0 but i think this is the opportunity for us to think about how do we as leaders together these other sectors. and really think about ourselves as conveners. we hold a lot of data, that is our central role, we collect all this data, data are powerful but so are the data that come from other sectors as well as the community itself. a lot of that qualitative data that we overlook is very, i think, telling so i have to say you priorities, thinking more of a trauma lens to take and understand the impact and appreciate the impact of these early adversities across the lifespan, secondly, seeing that truly putting action that public health 3.0 model so that are theonveners bringing together multiple sectors, to truly collaborate and bring our community. >> thank you.

>> anybody else? >> i can be very brief. but one of mine was the trauma informed lens being so critical. with the work specifically that i do, the movement has been veryreactive . because to me, it needs to be in building movements but in order to grow into change, there needs to be a proactive one so how are we not just talking about how to identify problematic relationships or abusive relationships but how are we providing models for healthy relationships, language for consents, those pieces that need to start early and often because men are lost in the conversation to think about reacting to something and then another piece that as a mental health practitioner is a fit and also, recognizing that support looks different for different communities so not having one model of mental health or one model of providing support but really engaging and going into faces

and understanding what community needs are. to be able to provide the supports that are outcomes after adverse effects. >>. >> i'm going to do something boring which is we need to make sure everybody has health insurance. because you won't be able to access the counseling or mentally the preventive care or anything unless you have that ticket, that golden ticket of having health insurance but we have to remember that health insurance, and insurance card is like a cell phone. it's only as good as the network is on so for a lot of communities is not providing what we need, not justbecause the network isn't good but because the correct appropriate services are not culturally competent , sources are not available or people cannot connect to healthcare systems that leads me to number two which is really unique, there are estimates of one third of healthcare spending is wasted . is wasteful or duplicative. we also need to work on

getting enough of the health care they need at the time and end up having bad outcomes afterwards. we need to figure out, in a community that's happening now changing the way we prepare for healthcare to make sure that we are taking what is really a deeppocket , healthcare system funding and finding ways to diverge at least some of it and push it into the needs of communities and it can be double and that's why i say it's focus on community health workers, not only because it is effective and evidence is fantastic, you're investing in a job in a community when it's done right that has all sorts of economic spillover that is also because they are like a little heat where you can divert some of that money from the hospital system for the community heth center and push it into someone's home if what they need is an air cleaner for their asthmatic child or remediation or so forth. they are such an incredible opportunity to start thinking a little spigot.

at the end of the day it's about resources and resources are not an accident . the system is designed to get the outcomes they have and what's been happening is there really under resourced and we need to figure out how we use some of these resources and divert them into the communities that need the most in concrete ways that will change the lives of children and families. >> briefly, i think it's about pushing out the message that all health is local. and really starting at the community level and adjusting it, adjusting the issues but really creating these healthy community agendas and involving the leadership to create these healthy communities agendas. this work has already started, it's happening at the local level is up to us to share the spotlight on it and to push it out there and as a public health report, we can do that. at the foundation we're trying to do that. so i think from where we sit,

as a critical piece. improving the nation's health is going focus what are the best practices out there and how can we replicate those in similar communities across the nation. >> so we still have a few minutes on this question so i will ask the panelists to react, one minute if you will and ask you to do something that we tried to avoid in public health which is a luti for a complex problem so i'm going to ask you to provide an in a minute a certificate, as concrete as you 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? >> i thought about this before so i guess i'm cheating but i believe that if we go through a place where every single person who wants to have a partner from their community, like a

community health worker or a fear navigator ora community health representative, whatever flavor you need , it's available to help you navigate not just the healthcare system but the system that you live in so that you can make a better life for yourself . i think is going to be essential in making sure there is this ability, that there's agency for individuals to help, whether you're a young mama, whether your getting out of prison or whether you have chronic disease, whether you're dealing with addictions, whatever. >> you should be able to have somebody you understand your language, understand your social context to help you on that path and i think if we had, funded and integrated into our healthcare system, we be so many miles ahead of where we are right now. >>. >> that was excellent. >> so i want to add to what you're saying, because what is so dismissing about this

integrative piece is its facilitation of work and funds across systems. in healthcare it's such a small portion of solving all our problems. 20 percent, we all know that figure, 20 percent versus 80 percent of what's happening . so i don't want this conversation to really get so cold into focusing just on the delivery of public health and the delivery of healthcare without really regarding the other elements that are so important to supporting health and well-being of our community. so i think the key word that you used is integration. how are we, the solution is right there. how are we integrating that those healthcare that we talk about, the healthcare workers and navigators you talked about can be rewarded. that these are volunteer positions, because these are value positions. right now we don't have a systematic way of knowing so you are talking about whether that's incentivizing it.

>> put you on the spot there but from an or from all our other providers, how are we improvising a system? and that is really where we are getting back to this issue. i do think public health has that role in driving the conversation. >> we at the american public health association have an active set of groups in specifically on the point of integrationacross multiple sectors . >> i wanted to add you are right. about making sure those resources are there and that's one of our big projects, is it's physically helping advocates from across the country offer the stakolders, think about w they can leverage medicaid funding to help pay for community health groups. please get on our website, we have a project focused on laying out either a pathway

for getting some medicaid money, we have to start somewhere. it's medicaid we have tostart . >> other concrete ideas, anybody else. >> i'm going to sound like a broken record by the end of today but in my life before doing the work i did, i do go back to, we are not having these conversations and highlighting them as a priority in early education in elementary school . the university level, there's a lot that could be done but there's a lot more that could be done if we are showing this is a priority and i understand there's not much space, there's not much time to integrate that but having really intentional things that build on itself around public health issues around violence, resources and support, all those pieces and getting all of the people at

the table to create that and then having schoolsystems , school systems do already do this i want to be clear about that right now it's very much dependent on where somebody goes to school, where they live,where their zip code is . though i think having some thing that sends the message that this is not only something that's a priority but that is given your time and attention. >> cannot say something really quickly and follow-up, what you're talking about is value and what is, it's pping into t value statement. there are plenty of districts across the country and i want to shout out pennsylvania, done and what they started was the value of understanding the early intervention and they started within a school . and it became a whole community movement. so i think that when we're talking about what's these various sectors value, that's where we can really tap into and following up also on what

you talked about with regard to incentivizing and valuing people's time, one of the things we forget about when we talk about addressing it this is a business community. in kansas city, one of the communities i had an opportunity to do some work in, they actually had a whole adverse childhood experiences and resilience driven by their chamber of commerce and why? a recognized that if we don't get to address the social determinants, they're not going to have a healthy workforce, they're not going to retain businesses because of that again driving what we can message , the value statement we can message to these efforts to address this issue . >> let me move forward a little bit because we're going to move everyone to some of these questions that we specifically want to ask our panelists to take advantage of their area i'm going to start. to actually continue on what you're talking about.

the question that i have to you is we had multiple communities experienced varying types ofadverse events , taxes, etc. so how can this community best prepare for these events and also assure the things afterwards. >> you're talking about an infrastructure adversity, you're talking about puerto rico which was a natural disaster, that's a different type of shock but i want to for i get into talking about what they can do, i want to make sure i do a levels when we talk about resilience because we have the surgeon general speak about resilience, you hear me talk about resilience and resilience is a great word but i want to be clear, when we talk about resilience i am not applying a term which comes from civics to the human spirit. okay? because if you understand what it means, is really talking about how it's an ability for an object to retain shape after receiving

shock. so if we're talking about applying the term resilience to our communities, i do not want anyone walk away from this little room for his listening or what have you think that we are merely wanting to help communities bounce back to what we already recognize our levels of inequity. >> so when i talk about resilience and when we talk about resilience, community resilience in particular, we are also the ability to yes, use suffer some of these acute shocks but the ability to actually bring forward. >> so the first piece of this. and so when you're talking about how do you help communities bounce back, there's the acute shocks which there's some of those which you describe but then we also have to recognize the economic diversity in our community every day, drip, slowrip ofisasr in our communities that every day. already dumping that from d that's the problem, they're only bouncing back.

what we need is a systems level, are those supports and buffers that help us move forward so that's what we're talking about, adequate education systems. coordinated education, coordination between healthcare and education systems, coordination between our court systems because unfortunately the trajectory for too many of our children is going from inadequate schools to straight into detention systems and then we know what happens from that point forward. there have to be other means by which we are providing support, and that's truly what we're thinking about, we work in the building community resilience works is really thinking about how are you putting the resilience in a system so that information is going, so the supports are in place so that when you do have what could be the one in 1 million, 100 years happening every 10 years, but when you have these disasters

that are shocks to the system, of course you're going to be able to respond and bounce back from that, because you've already put in place on a day-to-day basis those systems that support that are helping people move forward and preventing a lot of the adversity we see right now. >> thank you, i want to move to mister greer. the next question, the same amount of time and in the wake of the 72 movements, the topic of sexual harassment and assault and violence have come to the forefront. it's impossible as you say not to hear much about it but what is happening on the college campuses around this issue? and then what you think are the ways to do best practice or implement them? >> i think we know that campuses have always been rate spaces for activism. i always like to share that the reason my office exists, the reason my position exists and in my colleagues now is because of student activism on our campus, saying this is what's needed and really

finding ways to make that happen so activism hasalways been a central part of campuses . with me to, i think we've also been able to see a rise in our conversations about how do we implement voices? how do we amplify narratives and voices and how do we recognize what's missing and what narratives and stories are missing . what we see happening more now , i hope, is more what i call intersectional activism. understanding that me to and talking about narratives of sexual violence for those who might not face theirshare , is not something that operates by itself without partnering with and doing activism with and working with groups working around racial justice and around lgbt to rights and recognizing that having all of those forms of activism in the same space at the table

and not taking over, not co-optingwhich has been done within feminism . to say how do we amplify this story? how do we amplify the narrative of how we support these people in indigent spaces are experiencing higher levels of violence, who are more likely to make official reports? that's something we need to get a rise out of me too, hard look at ourselves and our movement and saying what does it look like to really be intersectional and what does it look like to share spaces and not again, co-op other people's narratives or say we operate separately so we'reall doing our own thing and i'm an activist for this , that doesn't work and that the outcome that were hoping for. we also with the enhancement of title ix, more universities are seeing more broad mandatory education,

that's the biggest piece of that for it to be effective is to let it be intentional. so we can say just take an online course or come to this program and check the box and you will get to register next month but really saying with our georgetown partners, we have to do an online program before they come. >> .. in october of the first year in college but saying what other ways we can access. one of the models that a think is been successful on our campus and other spaces that used it as a program where we as health professionals going to academic

spaces. i teach the class but as as a health professional i might get invited into a professors lecture around english to talk about something they just read and connected to my work on their campus and their community so they know what resources are available but also think about how there are real-life applications in and bring this topic into an academic space. my colleague works with eating disorder. she might go to math class and they calculate bmi or talk about nutritional calculations. but they are having conversations about nutrition,, about eating disorders, about support, about services. with programs like that we have found spaces to bring health issues into spaces where students may not self select in otherwise to come in and hear a program or learn more, but to meet them in spaces where they can help make that connection for them. >> thank you. so continue on.

tngs you've already discussed already, recently as you know there's been some attempts of rolling back protections related to the affordable care act. in several states a begun to test the value of aca with some of the modified rules. what you think of the ramifications at the state level before this change themselves and, of course, the outcomes with which you discuss so much? >> really quickly sent for in the panel i thought i would touch globe on what's been said in the first thing i wanted to point out is thank you for bring in puerto rico, the puerto rican family who had a mother-in-law, who didn't have electricity for five and have much vacation puerto rico is not forgotten. it supports are really grateful for that and the fact you don't bounce back. that's about beyond because what the hurricane did. that was a disaster but the real disaster was the decision made

by the federal government before the hurricane that made them foldable to the health crisis that is there now, and also this make sense so thank you much freezing day. i'm excited you mention the issue of intersectionality because even in the #me too movement very few people really understood that way before they were tweeting me too, and african-american women have been working with young african-american women on it -- issues of sexual violence, like seven or eight just before but when time magazine made the cover she was not the cover. that's why i take my hats off to all the kid inarkland w have been very intentional about point out that you care about is now because we are relatable to you at the black lives matter young people of the target of violence their neighborhood and get issues for a long time, yet you didn't give them the time of

day. on the country you even try to demonize them. i think i'm really happy to have this kind of conversation in a space like this. as far as what's happening with the affordable care act, one thing that's important understand is would never come,l last year we never had more people with health insurance in this country, ever. it's thanks to the affordable care act. in fact, one thing people didn't realize, to draw a lot of attention is that 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 chilled white children, and that is enormous. what we are seeing now is an administration because they were unable through congress to dismantle for very ideological reasons the affordable care act, they are now in this big campaign to basically sabotaged the affordable care act through actions by the administration.

there are two really salient examples that affect the decisions that states are making their what is exploiting the medicaid 1115 waiver process. basically they are using the ability for trying to get changes in how medicaid is limited in their states to do what every candidate 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 as a social curtailment of health and we want to encourage that. that's not what this is about. it's about making it harder for certain people to be able to keep their medicaid. we know the majority of people, majority of adults on medicaid actually work that somebody in the family that works and it's really about cutting the program. there's a whole list of other things that they're doing the medicaid programs that states

are now, some states are taking vantage of to basically cut how much there's been on health care for their constituents rather than improve health care for them. the other issue is what these junk plans that now are going to be allowed. incidentally, so there's a regulation that you can comment on until april 23, so there still an opportunity to just send a note saying that this is a terrible idea, which is letting more plans exist that do not have the consumer protections ever set up under the affordable care act. it used to be you could have a temporary plan for three months but now the temporary plan can be one day shy of the year and are not going to have the protections against previous conditions, you will not have the support to make sure you're getting high-quality care. you're not going to have the ability make sure they don't take you to the doctor because you got sick. you will not have all sorts of protections that really change peoples ability to get the care

that they need it. 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. there's too opportunity. it's gloomy but there still a lot of opportunity to raise your voices about how this is unacceptable. if you want more information about how to do that, go to the families u.s.a. website. a couple examples of things that are positive, states that are trying 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 the call at the memorial but it's some sort of resolution to investigate letng pe medicaid wn monday, like using their money and the premium tax credit and all that to buy into this existing program, which right of the new mexico it's something like over 80% of providers accept medicaid. it's one option that actually

helping trying to figure out how to get more people good-quality coverage. the others what's happening in maryland. they are trying to figure out now that they're not going to estimate the penalty for not having insurance, the state is trying to figure out how to have their own system to encourage insurance. and instead of just the penalty, that money is a down payment into helping pay for insurance that works for them. so they are interesting things happening. >> thank you. we appreciate talking about strength as well. last question. set of questions. the aetna foundation along with "u.s. news & world report" just released the healthy community index. you know there's a number of these types of indexes out there. can you talk about the level, what's the level of contribution that your index will make, particularly as we work towards finding best practices to deal

with these issues? >> absolutely. we like to think of it not as much as an index or a ranking of more like a tool. it really gives communities, provides every command out there with information on how they're doing. you put in your information and you can see how your community is doing. it's different because it compares the communities, counties across the country, , t just within the states, 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. it includes measures such as equity which is new for a ranking of the sort, as well as infrastructure and housing so it really does look across all of those important factors that contribute to what makes a healthy community. oneernt thing, to ensure fair

comparisons, u.s. news had presented the data by peer grouping which taken to economic factors and population density as well. so what we're hoping to accomplish with the healthiest communities project is to give the communities data so that they can understand how they're doing, what the opportunities are for improvement and also to inspire change by showcasing the best practices that are out there across the country. our goal is not just to recognize the folks that are making significant improvements in the spaces but also to gain inspire change in how communities look at health, how they pursue improvements in health, i looking at all these broad determinants and categories that it is based on. no two communities are the same, we do feel that there are lessons out there to be learned

by what's already happening. we believe this project is going to shine the spotlight of folks that are doing well so that their folks can use those lessons. so really again it's a tool, it's something for citizens and policymakers and local leaders to use to assess the health of the communities, but also to use as they develop blueprints for change moving fort. >> so tools that allow us to measure both challenges and successes and to shut them both. excellent, excellent. so that is the individual panel questions. we have about -- time? we have, okay, we have about 20 minutes or so to entertain questions actually from the in persons, the persons that are here, as well as from 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 here with the in person questions. anyone have questions? you're not at the mic, okay. 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 and thank you very much for terrific discussion from the panel and -- [inaudible] >> it seems that no -- hello? i don't know how to -- [laughing] >> pushed it up. >> we could trade mics. take mics with you. >> hello? yes. well, thank you for terrific

discussion, university maryland school pharmacy. it seems that no is the issue more compelling than among the newborn, at least to me because it's the intergenerational problem, an issue we see. and perhaps no more compelling than during 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, not, i mean deathly 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 hinges on social services. yet we have all the sectors that are not they're available to all. how can we best utilize and leverage the services that we have in social services, perhaps in maternal and child care, maybe coverage, communities are

others? i would love to hear from the panel. >> anybody can answer but we tried to keep the answer to about a minute. >> i have a very specific example from the phd program from our partners out in portland, oregon. this is a collaborative that was brought together by portland public schools, the university, chilean family services which is a health provider, kaiser permanente within the school and several other providers. what they've done is recognized the fact that, particularly for people that are in the situation where crossing the bridge between the maternal health and child health and in the social services a bridge, we are all working in different silos. so how do you create more of this community-based care team? and so using the school as a hub they have done that, where they have the health care is based in the school. ey have the sl services

through the trauma informed practices that are happening within the school for the school staff to have been trained as full as having behavioral health services that are not just there for the students but also therefore 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 as being suffered and felt widespread throughout school that they also getting that secondary trauma. i think that's a real great care practice, , example, of how you can bring these various sectors together a better munication and coordination. the one problem that still exist is how do we need the resources together? we still have very much policy issues with regard to sharing of data and information but also sharing resources and revenue in order to best serve our families and communities. >> thank you. anyone else? >> i will just put my lawyers

hat on and say all of what you're saying is true but it doesn't get to the issue of if you think that coming clean and trying to get services is going to put you on the map of child services, that's a huge disincentive and that is something that is typical in terms of a lot of communities that feeling that government entities are there to help them by other to basically regulate them, lock them up and take away their kids. that is a huge, that's more than stigma. that's a huge clip to have to climb off of and that sadly will take law enforcement in the legal system to decide that it's something they need to work on. maybe the way that drug courts were treated at one point because it was recognized that incarceration was not the solution, maybe that's what needs to happen, whether there's some sort of alternative family -- i'm making this up as a go alone, but it's not, everything can be perfectly aligned and if

you don't get to the piece of the punitive nature of addressing these issues, it's not going to make that much of a difference for a lot of, for some people. >> i was remiss in adding the fact that the juvenile justice system as well as their adult court also part of the trauma formed a movie and using this also, shelby county is also another great example within done and the tired, transformation of the court system, social services system. that is, you're right you have to have law enforcement but most important you'll septet community members engaged in helping to inform the conversation so that their interest in how different determinants and is different exposures manifest themselves in a family. >> what bothered you in adjective question regarding, we have great things in place but to be effective, the btom line is tst. trust. >> all right. we have another question from the audience.

we do have a question from twitter and at some university of kentucky, their public health program. it says, , what advice would you give us as future doctor to create a healthy future for children in regards to obesity? >> in the panel. can i -- do you want to say a word or two? >> i have like a short answer and him or complex answer. i have had the joy and privilege of working with a lot of young people in health policy that then went to become doctors, or in the process of becoming doctors. the most important thing you can do is to get out of your office. once you a doctor it out of the office, get involved. the power of your white coat in

determining talking to decision decision-makers are people and make them who decide what gets what and when is enormous. if you keep your getaway to 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 are on top of that from a community that is getting with disadvantages. the quick answer, and very simple is, we need to push breast-feeding. at the end of the day, a lot of foundations who are focusing on that but there's such good evidence about the long-term effects, positive effects of first -- what do they call them? firstfruits, something like that. in having long-term health benefits, including in prevention of obesity and there's so many stupid barriers that can be eliminated and a lot

of what can be done on kind of a one-to-one cultural level to bring those numbers up. >> can't i just add to that? we also need to remove the barriers. 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 posed is that my mentor, he will kill me if he hears me refer to them as a world expert on obesity, but one of the things that brought him to the folder about adverse childhood experiences, because he is a md, is this understanding of the intersection between adversity, mental health and obesity, of people with obesity. and so i would say for a young physician can someone who's training usually begin to look beyond just the diagnoses and have that conversation, understand what is really going

on but very much the trauma informed conversation of not what is wrong with you but what is really happening to you, what is happening in real time to really begin to unpack touches the sources of obesity but the sources that underline that disease. >> thank you very much. makes sense. also in the social worker been if i could bring social work into this, we have the concept of push and pull in the context. remember that part of the work that can be done very effectively is understanding the context in which the persons you are dealing with live, and 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. next. we have another -- yes, then. >> hello? my name is samantha. i'm an intern for united nations foundation and this question more geared toward ms. sabina. you submit to push the idea that

all help is local and a monkey what we can do as a nation to make sure these communities health programs are being formed in all juniors instead of the ones that could have the resources for it. >> it's a good question. you know, ihink it's going to start where the people are. so i think what we need to do is give folks the resources, and it might not just be financial resources. it might be kind of what is talking about before, , the too, the information, the data you're something to catalyze, something start the conversation, we need people around the table. that has not in itself and then would you get folks talking and they start feeding off each other and you are connected here, you have business resource, the power of partnership really does come about. we can to get hung up on financial resources, and for good reason, i did it,

absolutely, but there's power in every community. the hard part in what is our challenge public workforce is figured out how to get everyone around the table so that's where i would start. >> thank you. i think we have one more question. let's see, the hands have been going up over here but let's take one from the very back if we can. >> thank you. my name is kelsey and my question, from two experiences, one as a student. we talked a lot about theories and ways to sort of conceptualized what communities are feeling. and then as a practitioner we use a lot of data. i'm wondering how to as industry move away from talking about the community as a third object and talk about how we are the community and like we might have ptsd, we might of people in the room who bron winws for

reality and ask whether in the industry. my question is how do we create a more inclusive workforce beyond community health workers? how do we make sure they are equitably paid, the rbo pathways, we including people meaningfully in the conversation? >> thank you for your excellent questions. >> our project with building community present one of the first things we really made conscious is trying to build a bridge between health care and other systems with communities. not the other way around. inking about holding community into the conversation but really holding our systems into the conversation that's already occurring at the community level. one of the things we talk about is the fact because the public health and across sectors would get a collecting data and identifying priorities based upon the analysis of our own data and then putting that upon community and cds save these or priorities based on our

analysis. what we try to do is really say okay, that's great. you're these indicators but i think what you need to do is have the conversation because the community has its own data. that data as just as fallible and sometimes it's more precise than what you have collecting it from the systems level. so really understanding that at the heart of all of this work is dated but there's no stories without data, no data without stories. again, that brings in the community narrative and having community having the input. with regard to question is, when you're talking about the service delivery or your talk about program delivery, if you don't have individuals, i want to say with lived experience, so that doesn't mean that you have to ptsd yourself in order to be effective in delivering the program but you have to really understand exactly the context in which your treatment or your program is been delivered in, and the people have a real

relationship with the people that you're actually serving. if that community, , if your program does reflect the community of which you serve, we are only company the problem. we will keep making the same mistakes because we don't have that. it's like you are reading a cloth. you wouldn't think about making a red dress and never having red put into. it's that obvious. if you want to create this tapestry and this tapestry is much stronger based on the tensile of the threads and how dense that weeding is. so when you have those individual data coming from the community, that makes a much richer tapestry, and much stronger fabric of which is going to carry and hold that community. >> thank you. i was wondering, given your neck of the woods, i'm guessing there are a lot of persons who themselves have taken on the role of which are speaking, but

i think the other challenge it by appearing you correctly is the, we have a minute so let me just make a real quick. so the other challenge is that you do have like in public health your people who really want to work in it. however, it boils down to the question of how can they support themselves, how can he find the means to continue. i was wondering, not the last, but maybe -- >> so in terms of how to be within the work and support themselves? >> and being able 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 are asking as well? [inaudible] >> more inclusive. we talk about broken windows. people in the room didn't grow up with -- [inaudible] to be more inclusive in addition to the economic part. >> really briefly knowing we are at any point.

this really is raising what wendy was saying early because it's important for us, for example, a specific example on a campus. we go into spaces that have walked in our. >> greetings, think that already exist, meetings that happening with made in the lgbtq resource center, going in and not us and we like okay, we understand sexual violence and here's what the data says about two two mes experience at a high rate. that doesn't work. the qualitative piece is so critical because if we are on a look at quantitative data, for example, i believe there's one research study that's been done around survivors identified as deaf or hard of hearing. yet we know in qualitative data, in conversations within communities that those experiences are occurring at high rates. how are we merging all of those pieces? one of the things that he did as an educator and a trainer and who would specific about interpersonal violence is i set

the tone with the way go into every single space and name it and say how are we the cognizat people i the room who have experienced this we come a thi of different lenses but name of the space in the room. people say people expense violence or people of broken windows but to say we know that their people in our community and our spaces who have experienced that so let's have a conversation keeping that in mind. >> i apologize for our time is up in a given discount they have a lot more to say but we've had to cut it out there and i apologize for those with questions but i do want to anyone to thank this panel, please. [applause] the nominal group. normally we would have a rap that we are little short on time so i will turn it over to our executive director, dr. georges benjamin so we can a few final comments and then i just want to give my personal thanks to everyone who participated either on our panel, to any audiences, and this is a great honor for us

to have you here. we do hope that you can make a difference moving forward, not just this week but making public health week every week. thank you. [applause] >> i will refer to folks for the slide we have with the the natl 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 just also just like the foundation for the strong support for this forum and invite everyone to the reception that policy merely afterwards. thank you very much. [applause] [inaudible conversations] [inaudible conversations]

[inaudible conversations] today is the 50th anniversary of the assassination of martin luther king, jr., and tonight american history tv will be live at 8 p.m. on c-span3 from memphis for an event looking at the legacy of dr. king and the direction of the civil rights movement today. >> monday on landmark cases cats versus united states where charles cats, a bookie was tape recorded by the fbi while transmitting illegal bets from a telephone booth on sunset boulevard in los angeles. the supreme court's decision in this case ultimately expanded america's right to privacy under the fourth amendment and forever changed the way law enforcement officers conduct their investigation took our guests to discuss this case are jeffrey rosen.

watch landmark cases monday and join the conversation. our hashtag is landmark cases, and follow us at c-span, and we resources on our website background on each case. the landmark cases companion book, a link to the national constitution center's interactive constitution, and the landmark cases podcast at c-span.org/landmarkcases. >> now a conversation with u.s. naval war college professor karl walling on combating islamic terrorism. he argues muslims are the best messengers for countering terrorist ideologies and the military is the least effective way to fight terrorism and extremism.