let me thank dr. ross league for cochairing this summit. let me thank them for doing such historic work to serve the under-served, and is great to see some money friends and colleagues in the audience, because i stand on the shoulders of all of you. you will hear from a tremendous speaker's chair the summit. let me acknowledge three of them. people i admire very much. former secretary lou sullivan. my wonderful friend and colleague, dr. david

satcher. and john ruffin from the nih. also dr. bruce geller and brad walters. you are outstanding leaders. i am honored to be standing before you. what he did in his extraordinary what life was to advance the understanding that improving health is a moral imperative. he taught us this work is the work of a lifetime. indeed, the work of many lifetimes. he taught us that the work of public health embraces the concept of health the equity. because as we have heard several times this morning, he has said

that the arc of the moral universe is long but it bends toward justice. he also said is we have heard several times of all the forms of inequality, and justice in health is the most shocking and inhumane. we are gathered here because we recognize to advance this work we have to revitalize and rebuild our community, of literally sitting at one table, recognize that we are interdependent. his message was one anchored in dignity, sensitivity, and respect.

he pushed us to carry a broader and deeper sense of duty to our work every day, to be conscientious juror to of freedom, to protect opportunity for all, and his message of health equity resonates with this audience. in one of my favorite sayings of his, he once declared, we may have come over on different ships, but we are in the same boat now. i love that line. so when we reflect on his life and legacy, his life is a work of art. that every person in our country deserves to have the full opportunity to reach their highest attainable standard of health. when we think of health we think of a concept defined by the

world -- world health organization, health is a complete state of physical, mental, and social well-being and not merely the absence of disease or infirmity. also on a personal level as a korean-american and is a son of immigrants. i often tell my colleagues and friends that my parents journeyed to this country a generation ago, searching for -- our lives reflect the american dream. i remember so clearly being raised in hearing from my parents every day how lucky we were to be born in this country, how fortunate we were to speak english as our first language,

how blessed we were to enjoy rights and freedom and how it was our special responsibility to live a life of higher purpose stronger. my mother received her ph.d. from boston university. and dr. king received an honorary degree from boston university in the same ceremony. with respect to public health and health care,, some could say

that we are facing this mountain of despair. there are many dead and obstacles. with respect to insurance coverage, we have too many millions who are not insured. racial and ethnic minorities make up -- represent one-half of the uninsured in the u.s.. second with respect to issues of work force, we know that there is a critical shortage of culturally competent provider is caring for the underserved. third in the areas of population health, we have so many areas where racial and ethnic minorities are bearing a disproportionate burden with respect to outcomes in areas such as obesity, the pack go -- tobacco dependency, hiv, a

substance used to my environmental health, immunizations. when you see these challenges and these potential giant obstacles, this mountain of despair. it -- if you always do what you have always done, you always get what you always got. what these are giant obstacles, but one of my favorite quotes is from my friend, who like to say the giant obstacles are brilliant opportunities brilliantly disguised as a giant obstacles. one of the brilliant opportunities before us at this first martin luther king health

equity summit, we can honor the history of attempts by the public health community and our nation to address these glaring inequities. 1985, the department of health and human services released the report of the secretaries task force on black and minority health. known as the heckler report. this is the first comprehensive accounting of health disparities affecting racial and ethnic minorities in the u.s. and since then, many of us, many tremendous leaders in this room and many others across the country have attempted to address these inequities through better tricare for underserved populations. better community-based prevention and many other strategies. in 2011, we know we need to do more. much more.

an individual has not started living until he can rise above the narrow confines of his individual concerns to the concerns of all humanity. right now despite some of the tremendous challenges of our time, we have some brilliant opportunities before us. late last year, -- the ten- year plan for disease prevention. healthy people is a road map and compass for country. i was privileged to unveil

healthy people 20/20. a 20/20 vision for a healthier country for the next 10 years. in that document, which stressed that it achieving health equity and eliminating disparities remains one of the four overarching goals of that effort and our country at large. also, we have had of course the passage of the affordable care act in 2010. so much discussion and conversation about the -- i would like to summarize this act in one line. it gives all people the three things i want. all people want better health, better insurance of a can have better health, and they do not want to be patients in the first place. that is what the four will care act does.

it promises better health care and coverage to 2 million uninsured americans and a historic investment unprecedented prevention that move all of us to our higher attainable standard of health. when the formal care act was being debated, former senator ted kennedy from massachusetts road, "at stake are not just the details of policy but fundamental principles of social justice and the character of our country. and in that vein, we are honored and inspired, challenge, but also motivated to implement a health reform law that will make a difference for millions of americans across this country. you know that this president, president obama has prioritized

health and health care for his administration. and you should be very proud and i believe dr. king would be proud that the -- reduce racial ethnic health disparities and achieve a vision of an asian free from health care disparities and in april, at 2011, our department was able to unveil its first-ever action plan erase disparities. the greatest federal commitment at in this field, i had the great honor of helping the secretary unveil that strategy. which is now being implemented. let me spent several minutes

reviewing the goals of this action plan and invite everyone's involvement and participation. there are some five goals to make these aspirations are reality. we're working our way to this year of 2014 were the medicaid coverage will lead to more comprehensive health insurance for millions of americans and also the start of state based health exchanges across the country. with respect to transforming healthcare, the affordable care act invest in community health centers.

it the serbs federally qualified health centers. the health reform law invest $11 billion over the next five years to improve access even further and last week, more grants were announced by the secretary and the administrator for health resource services st. administration. the goal was diversity -- diversifying the work force, creating a better pipeline for comment providers to serve the underserved. there are many action steps to send them that pipeline, recruit undergraduates from underserved communities to enter fields of public health and public service and return to their communities to help address the disparities, the glaring disparities before us. there are provisions in fact to

reach out to people with low literacy, improved health care interpretation, and translation services, and support more training of community health workers. such as promotoras. there is an emphasis on prevention. is is an essential part of a new law mandated by the affordable care act. just recently as one part of this, the centers for disease control on failed community transformation grants that motivate communities to a man's prevention and reduce disparities around the nation. we see much promising work in this area already.

as you know, the first lady, michelle obama, has helped spearhead the let's move a initiative. which solves the challenge of childhood obesity. we have a new national hiv/aids strategy. new strategies to reduce tobacco dependence, hepatitis, and many other critical areas of public health. the fourth goal is the advanced scientific knowledge and innovation and won critical part of that is a new provision of the law which will require more detailed collection of race, ethnicity, sex, primarily which, and disability status information. we believe that getting,

obtaining, analyzing this critical detailed information will help us better understand the disparities affecting african-american, asian, hispanic, latino populations and help us develop better strategies to address and eliminate disparities in the future. the fifth and last major goals are to a poll than challenge the department to improve its accountability in this area. i have a great honor of cochairing the health disparities council out of the department of health and human services that is implementing this plan as we speak. this is established through the affordable care act. this has been elevated to a full-fledged institute under the direction of dr. ruffin. we hope this addresses the

vision that was captured by dr. king a generation ago. as i close, i want to thank you again for inviting all of us to be here, to reflect on a man who has left his extraordinary legacy. i also want to thank you as he would, i am sure, for your service. fundamentally, this comes down to a sense of service to society. sometimes people define public health and science in the service of society. i close with this, everybody can be great because anybody can serve. you do not have to have a college degree to serve.

you do not have to make your subject and verb agree to serve. you only need a heart full of grace and a soul generated by love. thank you for convening the summit. thank you for keeping dr. king was a legacy alive and i look forward to working with each and everyone of you to make health equity a reality and achieve our vision for this nation for the future. thank you very much. [applause] >> we will hear more from eliminating health disparities with remarks from former it is secretary louis sullivan. this is 50 minutes.

>> i hope you're enjoying your lunch. we would like to get started with the next phase of the program. we are so honored and so pleased that dr. louis sullivan has joined us today dr. sullivan served as the secretary of the u.s. department of health and human services. that was from 1989 to 1993. where he took on big tobacco and the skirt of hiv. -- scourage of hiv. dr. sold and earned his doctorate in medicine at the boston university school of medicine in 1958.

he completed his internship and residency at new york hospital. he also did some work at the new jersey college of medicine while teaching at harvard medical school and researching at the thorndyke memorial laboratory, before becoming the co-director of hematology at boston university medical center. he also founded the boston university hematology service at boston city hospital. that was until 1995. that is when he founded the medical education program at morehouse college. dr. sullivan has received dozens of honoraria degrees and has been honored by many diverse organizations such as the southern christian leadership conference and national association of minority educators. dr. sullivan and his wife have

three children. i would like to introduce to you dr. louis sullivan. [applause] >> thank you for that generous introduction. let me say it is a great pleasure and honor for me to be here with all of you to see where we are in terms of health equity. i have enjoyed the presentations thus far. i think they're very important. coming during the week when we look forward to the unveiling of the sculpture in honor of martin luther king jr.. i think this gives us conference special significance. i happen to have been 10 feet away from martin luther king, jr. in 1963 when he gave his

talk here at the lincoln memorial. and for me personally, the other part of the book is when my wife and i were here for the inauguration of the first african-american president. mr. obama. we have made significant progress in our country but as has been noted. we still have a lot to accomplish. that depends on a lot of people. it depends particularly upon us to put the issues before the country, to lobby for those things that need to be done to lend support to those who have ideas that we think are important. and indeed to see that those individuals are put into position so they are in power. one of the comments was made about getting politics out of medicine. i agree when he said that is not

the issue. the issue is getting the right political decisions made because in the democracy, politics is intrinsic to our system. it means that we must have individuals who know the issues, who are committed to improvement, and who are willing to commit their leadership and reputation, their energy to solving the problem. that is what is important. before i began, let me make a side comment. i want to thank roger bulger for this book on paul rogers. he represented one of the things we lack today. that is, a leader in congress who has the capacity, the intellect, the commitment, and the political will to make things happen. there are a number of things that happened during his tenure

as a member of congress. while we do have friends in the congress who are interested in health, we do not have the individuals in congress to make that their number one primary party who are able to convince their fellow members of the legislature that this is something that is not in the self-interest but something that is important for the nation as a whole. health touches everything and if we do not have a healthy population, everything else is secondary. we are concerned about what is happening or not happening in our health-care system. we need to have more people like paul rogers to help in the decisionmaking process both in congress as well as in the administration. the title of my talk is " america's journey to health equity." is an overview of what has happened over the past century.

where we are now and what our projections are for the future. we are at an inflection point and this gives us an opportunity to make such a comment. the next -- you have heard about the martin luther king comments he made in chicago in 1966 about the inequality that lack of health access imposes on our citizens. the next slide shows where we are as a country today in terms of spending on health care. what this shows is that we out rank all the nations by far. in the dollars we spend in our health care fizz -- system. when i came to washington in 1989, it was 11% of gnp.

this is in excess of two trillion dollars now. close to $2.40 trillion we are spending on health care 20 years later. so, we are really having a problem with runaway costs in our health-care system. that is shown by the slide. and comparing us with other nations, and yet, we do not have the best health outcomes in our country. comparing us with other countries in the world. as i was say, those costs are escalating. there are now 18% -- 16% of gnp

compared to 11% of gnp and 6.5% of gnp went medicare and medicaid were instituted in 1965. you can see we have tripled the percentage of gnp going to health services over 50 years. but yet while we do have some things to show for it, we have fallen short of what our needs are. this slide shows compared to other nations, we do not do well in terms of infant mortality. we are all ranked by most other western countries. it shows that spending money alone is not enough. we have to have infrastructure, we have to have participation by our population. simple things as pregnant mother's coming to see their obstetrician in the first trimester of pregnancy. we have to have trained individuals and a system that works, we have to have individuals who know the things

we must do in order to preserve and enhance their health. the shows also that the disparities between the white population and minority populations contributed to almost 900,000 excess deaths over three years in the nation. more than that this cost our nation $50 billion in lost productivity as well as the cost of services. with the study from the joint center for economic studies. this slide shows what happened over the past century at the time of w.e.b. dubois. major cost -- causes were infectious diseases. and malnutrition. by 1985, the time of the heckler

report, these infections problems had been replaced by chronic diseases. cancer, cardiovascular disease, cirrhosis of the liver. accidents, homicides, and so on. a similar pattern today in the report from the cdc in 2010. we have made progress in our mortality rates. note the fact that while there has been improvement in mortality by all segments of our population including our minority populations, what is striking is the way these lines do not cross. black mortality has declined. notice we are 30 years behind mortality of the white population. . this still exists -- we must do

better with our minority population. to address those things that contributed to mortality. -- having been collected in significant amounts in 40 years. you see parallel improvements in mortality rates in all these populations. similarly, life expectancy at birth has improved over the course of the 20 of century. here again, the lines are parallel. and do not cross. whereas in 1900, life expectancy was 47 years of -- for whites and less than 40 years for blacks. compared to today where it is approaching 80 years for white females and almost 70 years for

black males. you will see that while all these lights are improved, you do not see much closing of the gap. some slight closing but much more remains to be done. the report from the public health service in 2010 on health care quality and disparity shows that while access and quality are suboptimal, especially for minorities and low-income groups, quality of care is improving but access to care is not improving. we must do more. many things impinge upon this. one of the things that we have not talked about very much today is health manpower. we're going to bring 32 million more people into the health system with a successful implementation of the health reform legislation passed a

year-and-a-half ago by congress. we need professionals to take care of those individuals. we have seen in massachusetts what happened when we set up an insurance mechanism so that people have an insurance card to pay for care. but in some communities in massachusetts, there are waiting times of six or seven weeks to see a primary care physician because of inadequate manpower to address the unmet health needs that were leased by passage of legislation in massachusetts. if we do not address this issue nationwide, we will see similar issues, people having an insurance card but having difficulty getting health services. we need to address that. i am very pleased that we are giving more attention to prevention and health promotion, because it is my view we will never -- if we never engage our

citizens in prevention and health promotion, we will not solve the problem of cost control, nor will we see maximal improvement in the health of our citizens. we must have a system that works, having trained individuals, having facilities, all the things that are needed but in addition, we must have a citizenry that knows proper nutrition, exercise, childhood immunizations, all the things we must do if indeed we have to achieve maximum health. well known that the higher level of education attainment we say, the healthier that population is. prop., poor health, -- poverty, poor health, education goes together. we must address them simultaneously if we are to see improvement in the health of all segments of our population. this slide simply gives a view

of the various reports that have been issued over the years concerning health equity in the united states. the first being the publication by w.e.b. dubois when he was professor of sociology at t atlanta university. he drew attention to the lead between health status and party when he was looking at the health of african-americans in the population. he emphasized the role of poverty in affecting health. the report issued in 1985 by secretary heckler, black and minority health. to make a comment on the heckler report, in march of 1983, the association of minority health

professions schools met with secretary heckler and presented to her airport called, "blacks in the 1980's, black health professionals in the 1980's, a national crisis and a time for action." that report that was written by an analyst for the association, that was the stimulus for secretary heckler two. her own departmental committee headed by tom malone who was deputy director of the national institutes of health and a senior african-american in the department. that committee that tomblin shared then issued the report, this report which came out in august 1985. almost 2.5 years after we met with secretary heckler and got her commitment to address this issue and we are pleased that happened. as a result of that report issued in 1985, she established

the office for minority health in the office of the secretary that same year. other reports that are important, the institute of medicine's report on the unequal treatment showing that indeed, when you correct for differences in socioeconomic status, african-american still receive less optimal care than whites. showing bias in the system, often unconscious bias affecting the quality of care individuals received. in 2004, the report from the commission i chaired looking at health manpower issues and the issue of diversity, the report called "missing persons, minority in the health professions," during the 1990's, we plateaued and we are showing

signs of slipping back in terms of minority representation where we look at medicine, nursing, dentistry, public health, in psychology. a number of other reports have come out i would draw your attention to. the last two on the lower right. the first, the memoir by dr. augustus white who establish the orthopedics service at bethesda hospital during his career. i believe that was in the late 1980's or early 1990's. dr. white has become very committed to addressing the issue of health disparities and in this well written memoir of his life, talking about health disparities, i recommend that -- to all of you. it summarizes the issues we confront in the system now and shows how key in growing up in a segregated environment in

memphis, really became one of our nation's outstanding physicians and leaders in orthopedics and one of our thought leaders in the area of health disparities. the final book on the right, issued by dr. richard williams, internist at ucla on health disparities and the effect of health reform in addressing health disparities. there have been a number of publications to address the issue that helps keep the attention focused but we need to have action by our leaders in the government as well as in the private sector to address this. the next to slide simply summarize some of the things that have happened over the years -- to slides -- two slides simply summarize some of the things that have happened over the years. all those factors that have impinged upon these disparities

in health status that continue to exist today. during the second half of the 20th century, because of the very act of civil rights activities, we did see some improvement in many areas. first of all, legislation enacting many -- medicare and medicaid in the 1960's, improvement in the percentage of minorities entering the health professions. we did see some improvement. as i note on this slide, in 1983, we met with secretary heckler and presented her with this report that led her to have our own interdepartmental committee, studied this issue and come up with a heckler report in august of 1985. we saw also the first asian pacific islander health forum established and in 1989, it was

my honor to be appointed secretary of health and human services and in 1990, i was pleased to establish the office for research in minority health at nih. dr. ruffin, then the acting head of nih, he has continued in that position. until he was elevated to the senate in january 2010 newsletter. and this past year in 2010, with the passage of health reform legislation, the center was elevated to an institute. we met -- [applause] several of us met with francis collins about the desire and need to elevate the center to

end institute -- to an institute. the center had all the poor -- prudence and abilities and institute has. why do need this? our response is it has all those authorities and responsibilities, it is an institute, so why not call an institute? congress agreed and pass legislation to establish the national institute for minority health and health disparities research. we are pleased with that. it was not too long ago that we had our first minority surgeon general, dr. antonia novello, prius deputy director of the institute of child health at nih. the first woman and first hispanic to serve as the surgeon general. and as dr. ruffin noted, dr.

bernadine healy established the woman's health limit -- initiative at that time and really helped to show that women suffer from heart attack, stroke, and other diseases where they were thought to be somewhat immune from them. dr. healy did a number things -- number of things to address women's health and minority health. she pointed -- appointed [unintelligible] that and her support, she contributed to it -- quite a bit. we will -- i have commented on the sullivan commission report. what we noted in september 2004

when we issued this report which was supported by the kellogg foundation was that while we had made progress in increasing diversity in the health professions, that progress was far from what we had expected would occur during the 1960's, 1970's, and 1980's. in 1950, 2% of america's positions were african-american. by 1990, that was " -- 4.3%. one could say that one had doubled the percentage but we doubled from a small base. whereas african-americans represented 12% of the population, they fell short of representation in the general population. why is that important? it is important because dr. miriam komarmi reported that black or hispanic physicians

were three to five times more likely to establish their practices in the ghetto or barrio, they were likely to have a high medicaid population, a non-paying population as well. it is not a question of numbers but the kinds of positions we serve. - the practice patterns were different and if we were serious about doing everything we could to address the health needs of minority populations, we had to be concerned about the quality of the input into our system, the kinds of individuals who are in the system if we're seeing all segments of our population are well served. there have been a number of studies since that time confirming those findings. s the ten great

public health achievements as reported by the cdc. you can see many of them, one question, what does that to do with health? motor vehicle safety, for example. we have four to five times as many cars on our roads today as we had 50 years ago. the number of deaths from motor vehicle accidents has not increased or increased only modestly. that is because cars are designed not to be safer. seat belt use has now increased. when i went to washington in 1989, an average of 47% of drivers used seat belts. legislation and activities in various states were under way so that now, that is close to 90% of drivers using a seat belt. so that indeed, if someone is in an accident, in a car, they are much less likely to be killed or the injury is less severe.

motor vehicle safety as one of the things that contributes to improvements in health. safer workplaces. the effect of the environment we live in. whether we have clean air and water and so on. all of these are important health advances as recognized by cdc during the 20th-century that have helped to improve the health of our citizens. this slide is a commentary on our medical education system. as we know, in 1908, abraham fleckser was commissioned to evaluate the medical schools in the united states. we had a number of proprietary medical schools. there were no uniform standards of medical education. over two years he visited each one of the schools and wrote

report. those of you who would not read it, i would commend it to you. it makes interesting reading. he describes the school in a page and a half or less and some of the language is very colorful. such as, never in my experience have i seen anything so disgraceful masquerading as a higher educational institution as this miserable example. its trusteeship to the public a service and put it out of its misery. because of the report which got plenty of attention, the number of medical schools by 1925 had decreased to 80. accreditation standards were begun in 1914 -- 1915. a number of other things happen. among the things that happened, there were predominantly -- seven predominantly black medical schools, only to survive. they were considered class a medical schools and the others were considered to be subpar.

many had been operating for profit by their owners, many of whom were positions. the profits -- process of improving medical education started with the report. during his time, he tried to justify support for the schools by saying we needed to have sanitariums to take care of the health needs in the black community. such things as tuberculosis that could be passed to the white community, we had to have these sanitariums. the justification for black schools was protection for the white population. i would love to get into his mind, whether he was doing this for political reasons or fema and what he said. i think is not known. preservedd harry wirwere among the nation's medical schools after that time.

johns hopkins was a model he held up for medical education. at least the requirements were that you had to have a high- school diploma. preferably one or two years of college education to get into medical school. they also had a curriculum structure with the science is being taught followed by the clinical sciences. that problem which is still called the flecksnarian model, by the middle of the century, we could say with confidence that the u.s. had the strongest health professions educational system of any country in the world. where you draw people from all over the world to come to our country for turning not available. with the establishments of the nih we could see -- see the same about our research enterprise.

more nobel prizes in physiology or medicine have come to laboratories than the rest of the world combined. we have leadership in science and from the institutes of health and leadership in quality american education. from the slide, we still are underrepresented in the overall health professions population. more than 30% of the u.s. population is hispanic americans, african-americans, native american, or asian pacific islander. when you look at the health professions, only 12% or 12.3% of physicians come from one of these groups. 11% of nurses, 10% of pharmacists, and 7% dentist. the u.s. census bureau has

pretend -- projected by 2042 there will no longer be a white majority population in our country. we're going through a rapid demographic shift in our country. it has been emphasized and shown that cultural competence among our health professionals is important. we have to have individuals who are scientifically well-trained but we also must be sure that they can communicate this knowledge in a way that is understood, trusted, and acted upon by their patients. i often say that we need to have well trained scientists who operate very well in our social system. having the knowledge alone and not been able to utilize it effectively is not sufficient. we have to have good science and good sociology among our health professions. this slide shows the percentage of our physicians by race today.

it has improved. we still lack the kind of representation that is needed. the same with medical school faculty. we have a greater shortage of minorities among our nation's health professions faculty. we need to have much more diverse faculty, because of mentoring, counseling, and the role models that these individuals serve as within our educational system. that is a very important consideration. finally come out you heard about the recent article published last friday in science magazine. the show's the outcome of that study. ters study by professor gine and the former deputy director of nih, this is what they found when they looked at the likelihood of success of various

applicants for ro1 grants from nih. you can see that applying for the first time, 29% were successful. when you look at african- americans, a less than half for the successful. as you have heard, the percentage of those applicants who applied for a second time for a grant is much lower among the african-american population. there may be a number of reasons for that. many of the scientists come from institutions that if those applicants are not successful, the institution does not have the resources to support that individual to try for a second time. the process may take up to a year. they have to seek other ways to support themselves and i think

that is one of the reasons, as well as the fact that with a number of minorities already being concerned as to whether the system is fair, they will take a turn down as a confirmation of their suspicion that it is not fair and they decide, try again and may pursue other fields. this slide simply shows the progress we have made over the last 50 or 60 years in the percentage of african-americans graduate from u.s. medical schools. starting in the late 1960's, this is after the assassination of martin luther king, jr. in 1968 following his assassination, universities and various colleges and professional schools examined themselves as to where they were. i was on the faculty at boston

university. i graduated in 1958 as the one black student in my class. 10 years later, being on the faculty, there were three black students in the class. i thought as a member of the faculty, you may call this progress, but this is not the kind of progress that will get us anywhere. there are a number of things that happened at universities all over the country. the results of that was the improvement in the percentage of minorities, african-americans, hispanics, and others being admitted to medical schools. we had special programs were developed at boston university. thanksgiving weekend in 1968, we had a program of 24 black students, one from each of 24 black colleges come for a long weekend where we had representatives from the medical schools at harvard, tufts, a university of vermont, boston university, university of

massachusetts. we told the students, we are very much interested in your coming to our institution. giving them all the information, etc.. rather than one, we had seven. -- seven entering freshmen. same experience with other medical schools. similar things work going on all over the country. something like this needs to be sustained. you will see that things plateaued again. the project of 3000 by 2000 was implemented in the 1980's and we saw some bumps there. you can see that since the late 1970's, we have drifted sideways. we need to do much more to address the issue of diversity in the health professions. what about the challenges for the 21st century? there are many. but i summarized some of the

major ones. first of all, improved access to health services. the path is not over. we have members of congress trying to undo what has been started with health reform. we need to make sure we do not lose ground. we need to build on what has been done. what has been done is an imperfect bill. many improvements need to be made. we certainly need to move forward from where we are. the emphasis on health promotion, disease prevention is important as i mentioned. we need to have our citizens participating actively in this process. we need to have more diversity of our health professionals, including primary care providers in our inner cities and rural areas and mid-level providers as well. we must undergo a reshuffling of responsibilities among our health professionals if we are to see that our citizens to get adequate access to health care. we also need to have a more

efficient health system that is less bureaucratic. that is very challenging. congress and state legislatures and others often put various regulatory issues on the health system in an effort to try and do get it causes problems and expenses in the health system. we have already talked earlier about political issues. we need less political ideology and fewer legal intrusions into the health system. one of the great challenges now is the overlay of liability risk in the health system. we need to address that in ways that we can assure our citizens that everything will be done to give high-quality care, but still we are dealing with biological beings. we cannot guarantee a perfect outcome. if something goes wrong, it does not automatically mean that someone did something wrong. we have to find ways to address that, to see that things are done in the right way and if

they are not done, see if there is appropriate discipline but not have a russian roulette system that drives physicians and hospitals to cover the waterfront with every possible test that can think of not for medical reasons, but for liability reasons. that adds costs, >> we also need to continue to address the highest ethical standards in our system. we can do much more today than we could 50 years ago. it also means we need to be much more careful as we tend to infringe on some ethical issues. that is an ongoing challenge that we will have going forward. finally, as our technology grows in the health system, we must not lose our humanity. ultimately, part of the healing process is the relationship between the health professional

and the individual seeking services. i still remember the second year clinical pathology laboratory when i was a medical student showing where one of my love partners received and injection of this clear liquid. we just had lectures about the autumn on nervous system. he was convinced he was getting adrenalin. he disappeared for three days. we had to call to make sure he was still alive. the next week when he came back and uncoded the various samples that we had rather than having got the adrenaline. the point is that there is value added by the relationship between the health professional and at the provider.

if the individual trust the health professional, if the individual believes that person is knowledgeable, that contributes to the healing process. we must never let technology replace the humanism that is involved in the health-care system. that is something we have to guard against. as we go forward into this 21st century with our growing ethical issues, we know that if we are successful at maintaining humanism and the system as well as incorporating actions by our citizens themselves, that 100 years ago hopefully the kinds of data we are looking at today will not exist. we will have a more prosperous and healthier population. thank you. [applause] >> dr. sullivan has agreed to take a few questions. if we have any let us ask from the floor.

sir? >> your presentation shows that health care costs are growing faster in this country than any other country. it shows that are disparities are more narrow. we also know health care is 29%, 30% of necessary. do you envision a system where the savings in the health-care system can be captured and we directed so that they can be systematically addressed a to a entire integrated system? >> thank you for your question. the answer -- the short answer is yes.

as has been commented earlier today, we have a system that is dysfunctional in a number of ways. first of all, a comment was made that if you continued doing the same thing you will be surprised getting the same results. one of the things we have right now is a shortage of primary- care physicians. i maintain that one of the reasons for that is this -- we try to recruit bright young people to become positions. but we put them in a system where they have to go into debt so that they graduate owing $150,000 or $200,000. there was a change in the system in the mid-1970s. in the 1960's and 1970's there were many sources of scholarship support for students. but it was decided that because they are high earners they should pay for their own education, there for borrowing to go to medical school or

other health professional schools. that is why today we have national defense still one program, the exceptional financial the program, the national health service, others because it was recognized that we as a nation need to invest in the manpower we needed to address the needs of the population. that changed -- it was a good example of the law of unintended consequences. what has happened is we have unloaded the expense on students so that those who are successful in going through the system repaying a hundred 50,000, $200,000 in debt. when they finish training, they are trying to establish market, they have a family, which they got to rule areas and make

primary-care were you might turn a hundred $50,000. i have personally had many students say, i would love to do primary-care but i cannot afford it. that is a systemic problem. we have set up a system that operates that way. beyond that, i am convinced on the basis of an informal survey we did one decade ago, we have set up a system now that frightens the way low-income students. at that time, the average family income of african-americans were around $23,000. we were not really getting poorer students, we were getting students to really decided that maybe this was a real possibility. those who said this is not a feel for me. i am supposed to take out loans?

hockey, pay them back? how can i expect my parents or others to support me. that is one of the systemic problems. that sister our country since we are a capitalistic system that we tend to attribute the body to income. that is something that needs to change. we need a reward for cognitive based services as well as procedurally based services. he said this morning that we set up a system to break -- pay for procedures. we should be getting -- which should really be paying for good outcomes. if we also do a better job of informing our citizens of those

things they must do, simple things like regular exercise, proper diet, etc., vaccinations for their children -- when i was secretary, i was going route to philadelphia, fresno, dallas, talking to groups where we had measles outbreaks. there was failure of the immunization of our children. we had the vaccine, the science was there, but the understanding in the community was not there. that is what i mean when i say we have to make sure our citizens and of the things that they must do themselves. if we can do that, that the savings can go into other areas. we have now is unsustainable. we have to make those multiple changes. >> let us take one more question, please.

>> i am a country doctor, i am proud to say i am a physician. we have a new deal at a baptist university. the first year we received about 1200 applications for 100 seats. this year, the second year, we have received 1700 applications for the same 100 seats. the need is there, the people are willing. as a side note, as a physician training doctors and my office, they have got to learn how to do a good physical examination. it will miss some unnecessary testing because they know how to examine a patient. the third deal is the college president that houses the school came to the dene and said, how many democrats do you have it this year's class?

he said, sir, we do not take political parties into consideration. he said, you know, democrats like obama. we happen to have 10% black students at that university that year. that was what dr. king happens to be the president of that college -- that is what he happened to be getting at. >> that is a good example of the fact that where we have made good progress in some areas, many other areas we have not. so we have to indy to address those kinds of issues. where there have been improvements, there are still many challenges. some of those are simply going to take time to demonstrate to the population that those students, it helps improve the community, that kind of thought

process can change. one other comment i would make as well is, i am very intrigued by the article in the new york times a couple of weeks ago about the new medical school in kansas were the students are being trained in rural areas. the hope that they will stay in the lower rear areas. one other feature of that school, there was no tuition. a it would not load onto those students the heavier debt burden that might draw them away from a rural area to aid in urban areas where the income potential could be much greater. we followed that with much interest. cleveland clinic was starting a new medical school where there is no tuition for the students. that is really something we will be following with great interest. we as a nation have made a

serious mistake by letting the tuition is to get out of control at the same time we have undercut student financial aid and expecting our students to be paid in the way we want them to behave rather than do -- behaving as rational thinking human beings who have to discharge a financial obligation to have incurred during their years in health profession school. >> it has been more than a privilege to have you. thank you. [applause] >> here is a look at our prime- time schedule on c-span. a discussion on 12 education and possible reforms in preschool programs. at 8:00, president obama on capturing the capital city of tripoli. after that, more about the situation in libya with ban ki moon.

>> for politics and public affairs, non-fiction books, and american history, it is the c- span that works. it is available on television, radio, and of line. search watched and share all of our programs which c-span's video library. we are on the road bringing our resources to local communities and showing events from around the country. it is washington your way. the c-span networks, provided as a public service. >> join us later tonight for the communicators. you will hear from marc rotenberg and larry clington. they will discuss cyber threats against the united states.

that is that and o'clock eastern on c-span to. after that it is "booktv." we will check in at the harlem book fair, fredomfest, and the roosevelt. now, a discussion on early childhood education and possible reforms including head start. it is hosted by the brookings institution.

part of the feature is steve barnett. when you publish something inside, they have a communications department that used to be in the gestapo. they completely control you. we planned it this event, we had arrangements under way. they told us we could not tell anybody that there was even an article in science that was in any way involved in this event until wednesday at 2:00. -- i am sorry, thursday at 2:00. then they would not let us give the members of the panel a copy

of the article until friday morning. i spent part of this weekend writing a letter to the c i a highly recommending that they send somebody over to science so they can learn how to truly guarded their secrets. these guys are amazing. they did help us in some ways. it was a struggle. let me start by apologizing to the panelists, especially to steve. i know exactly how to make sure that this event gets zero coverage. the way to do it is emphasized that this is a very positive story. about a $7 billion program that unrolls 9 million preschoolers. in washington, could stories do not sell. this is a great story. it is a story of scholarly research that shows that head start should be able to bring lasting impacts.

it is a story of committee professionals called, "the committee on read designation of head start." it was appointed by a republican administration passed by a democratically controlled congress. they produce a report offering clear and compelling recommendations about how to approve had start treated as a story of a democratic association and implement and actually improved the committee's recommendations for reforming head start. it is a story the headstart program has responded positively to the criticism and into the reforms that are proposed by the obama administration. it appears to fully support the administration plan for improvement even though it will likely involve the closing of some had star centers. here is how we will tell the story.

first, stephen barnett and a wonderful colleague of mine, steve and i did do an article. we are just about out of copies, but it is available on our website if you would like to have a copy. none of the papers in their exceed 3000 words. that is pretty good when it is all scholars. i was pretty pleased about that. he is going to give his view of the article. like any reviewer is before him, he concludes that head start is underperforming. rather than adopt a defensive approach, the obama administration has proposed provocative well thought out reform plans based on the committee every designation that will harness -- harness market forces and replace ineffective ones.

yvette sanchez fuente his here. we will have a panel. first. jerlean daniel, who was a member of the reed designation committee. then jens ludwig, who is one of the most accomplished and wise of those who has defended a head start over the years that it does produce long-term impacts. then we have yasmina vinci who is a representative all of the people in head start. i want to wreck a mind --

recognize her. as i understand, there are working with the administration and working hard. i was recently at las vegas and decided i would take advantage of it and go to the head start center. they do all about what the administration was doing. they were using class -- some of you may know about it and you may hear more about in a few minutes. we will have a discussion and i will moderate. then we are going to turn it over to questions from the audience. with that, steve barnett. >> i think the first one, and

you will hear this over and over, that the administration's proposed reforms are vital. they should be fully supported by the early childhood it field. we are recognized that early headstart is part of this and it needs to be included in the reforms. thatd, the state council's each has on early childhood now shouldn't focus on raising quality and effectiveness, not on increased coverage. increased coverage should come after week raise quality and effectiveness. then there is a serious need for deregulation. the regulation ought to take place in the context of a new experiment -- a new program of experimental research that will provide better information

about what in fact is the most effective approach to providing early education for young grandchildren and working with their families. not that that is not important from three to five, but i think it is more important from birth to three. how do i get to these confute -- conclusions? i got here by asking a question. this is really the central question of my paper, which is can large-scale public programs produce long-term gains for children in poverty? if so, how and under what conditions? part of the evidence for this is in your chart. people often talk about what the research says about this or that, and they take studies that they like that illustrates their

point of view. greg killian and his colleagues published in the 2010 and analysis of the literature from 1960 until 2002. it summarizes the e fax any program that served 8325 your old. it could also have been a program that was just nine months. this chart summarizes the e fax of the cognitive domain. it was not the only domain that was looked at. but because of studies have focused on that to a lesser extent, you cannot really break those defects out in the same way and look at the influences on them in the same way that you

can analyze the data on cognitive and pacs because there are so many more studies that measure this. one of the it things that makes a difference is the quality of the design. in studies that use more rigorous search designs. the e immediate impact or the impact at the end of treatment which was typically at age five was about 0.7. seven tents of the standard deviation. to put that into perspective, head start children start about a standard deviation behind. if you want to think about the achievement gap for kids by headstart or other programs for children in poverty, what is the gap when they enter kindergarten? it is about a standard deviation. on average in the literature, 70% of that was close.

does that persist? that is my key question. the answer is yes, but not at that magnitude. if you look at ages 5-10, they are about 3.35. so about half of the impacted at kindergarten entry persists later on. this is not just an average. if you look at studies, you see a kind of persistent picture of that. i think it is a good rule of thumb that long-term impacts are likely to be about half of what are impacts are. so because there were so many studies of cognitive and packed, the researchers could actually look at what was associated with bigger or defects or smaller the facts. three other things stood out. one, if a direct instruction was used in a major way in the

program, a fact sizes or longer. if there was individual is station, there were larger the fact sizes. now, at the paper i look at -- randomized trials to by far the largest trust we had? . it is interesting to look at where these fit in. for head start it is the impact of one year. for early headstart, it is the impact of two and a half years. in the mena analysis, that could be anything from six months or nine months up to five years. it is not a one-year program estimate. so across both the head start

and early headstart studies, we seen a modest initial gains across multiple domains. when you're a head start produces an effect of just under 0.2. no significant effect on the nine others. 2 and 1/2 years of enstar produce the effects of 0.1 to 0.15 over across a bunch of measures, but not across all of them. these are substantive if small gains. they do not persist to kindergarten. they do not persist in first grade. there is a follow-up of early headstart. 45 measures, no significant effect on any of them. i think this is what you -- again going back, if you think about what initially facts are, divide those and have. it is not surprising we would

not see those. it would be undetectable essentially later on. now, i think it is fortunate we just do not have research on head start, we have research on other programs. i talk about a bunch of that in the paper. only some of it is summarized in this chart, but this includes the appearance centers which i think are important because they are relatively high quality. they are feasible. we have a very long-term call-up and a benefit cost analysis that shows pay off of 10-1. universal pre k in tulsa, oklahoma in a study done, studies by the national institute and others in oklahoma

and new jersey using regression continuity designs which are relatively regulus and -- rigorous way of estimating impact and for comparison i put headstart impact on same measures on the chart. the numbers are adjusted to noncompliance. that is important. in a randomized trial, people do not necessarily do what they are told to do. that is a good thing about people, but it makes it hard to do a perfect randomized trial. you can adjust to that. you can see they are smaller. these are the impacts of one year of the program at kindergarten entry. i think it is pretty clear, chicago chop parents centers, oklahoma, new jersey, the effects are very similar. would you get to literacy, they bounce around a little more.

some of the literacy members are easier than others. they're easy to teach. depending on what exactly is in your literacy measure, you can produce carry large affects very quickly. there is additional research and science would not let me put in the paper because it is not been in a peer review journal yet. there is a randomized trial of tennessee's creek a program, and the institute is actually -- our institute has actually done regression continuity studies in eight states. i wanted to show if you look at the broader literature and not just what i was able to present, the picture looks the same in terms of larger impacts from the

state preschool programs mostly in the public schools where at least under the auspices of public education. for example in new jersey, that program include head start, a private preschool programs, operating to the public schools. i think is important to look beyond the kindergarten data. if we follow them a little bit longer, what would we see at great to? what we are not seeing the detectable effects? chicago child parents center's one-year of the program in effect size of 0.2-0.3. come up 0.4-0.54 two years. and relatively inexpensive model. i would say in many ways it is comparable to the chicago child parents centers producing a fax

that are very similar in size. if you want to know if today's programs do this, my answer is yes. we can replicate pretty much what was produced by the chicago chops centers which had a benefit cost ratio of 10-1. i think this raises some questions about why this might be, how do headstart and early headstart differ from what appeared to be more effective programs. some of these are somewhat speculative. my thinking about this is that there is less explicit teaching and act -- academic emphasis on average. there are lower teacher qualifications, lower teacher compensation of about half what it is in the public school. a lack of connection to the

public schools, and it more provision of a comprehensive services. now, we have a couple of things i regard as a demonstration proves of my speculation. in tulsa, you have universal preschool that provides a public teacher in all of the preschool programs including head start. so you can look at tulsa public schools, tulsa headstart, and the national head start and the impact study and compare estimates at kindergarten entry. the difference between tulsa headstart and nationally is that tulsa headstart has public- school teachers paying public school salaries. we see a larger effects about the same size in these other studies. i do not know if this is because of the connection to the public schools and better academic focus. that is certainly possible.

it is also possible that it has to do with peer learning. in tulsa public schools, you are in general public schools. new jersey's program was a resort -- result of a court order. we took the system we had a child care and at some programs and the public schools and in five years we had every teacher with a four year degree and early childhood certification, master teachers, maximum class size of 15, high standards and accountability and an improvement system. the maroon color is what it looked like afterwards. you can see a dramatic shift in the quality of the preschool program after these reforms. a very important part of this is the standards that i talked about. it is also the continuous improvement cycle. it operates at the classroom

level, at the district level, at the state level you develop standards. you analyze and plan. you implement the response to that. i think the same concept needs to be taken into headstart and state pre k and implemented from the top down. i see that happening as part of the state council, as part of the early learning challenge fund, and part of the administration's proposed reforms. in conclusion, early education can be a -- all programs are not like the ones that i presented data for. that is the top of the distribution in terms of program quality. we need richer educational experiences, where resources in the classroom, parenting education needs to use more specific models. it has evidence of effectiveness. we need to develop new models

beyond that. i made a bunch of recommendations, but it is not that strong. we need a program of research to inform this. thank you. [applause] >> today at what to take some time to share with you what this administration is doing to ensure that head start programs are doing the very best that they can for the millions of children with serve every day. when also know that quality early education can help kids get ready for school and success. that means that our ability to ensure that all children have the opportunity to reach their

full potential depends on us investing early on and that providing the high quality early education that can make a difference for a child's life. headstart is a critical part of that investment. nearly 1 million children attend head start programs across this country every day. many of these programs are strong. there are setting an example in the field for evidence based high-quality early education programs. but we do know that some programs are not strong. there is a substantial room for improvement in many of those programs. over the last three years under the leadership of deputy assistant secretary joe lombardi, we have taken an aggressive reform agenda that will bring it the best evidence based practice into head start class and, will hold programs accountable for the quality of

instruction that they provide, we will establish outcomes to ensure family engagement, and we are going to require low performing programs to compete for funding. evidence indicates that head start helps get our most vulnerable children ready for kindergarten. but we can and we must use in these impacts. the children come from families and communities facing enormous economic and social challenges. head start serves the most accurate children including children in the welfare children, homeless children, english language burners, and children with disabilities. that is why this administration is committed to ensuring that every head start program provides high-quality care and education services. our reform agenda is bold, innovative, and it is built upon

the best evidence available. our agenda is designed to ensure that all had start children are ready for success in kindergarten and that all had start programs are high quality and well managed. so the reforms that have garnered the most public attention are those related to inquiring low performing programs to compete for continued funding. last fall the department of house and human services received able to implement what the head start law calls a designation renewal system or what the community most often refers to as three competition. we will issue a final rule this year allowing us to begin the competitive process in 2012. for the first time in the history of headstart, these proposed regulations will require grantees that are not providing quality head start services to compete for

continued funding. the proposed rule lays out seven specific performance conditions that will require programs to compete and it requires that at least 20% of all programs stand for competition. these seven specific program conditions fall under the quality, licensing operation, and fiscal and internal control. many have argued that the proposed rule is too tough. this administration believes that no role is too tough or standard of excellence too high when it comes to the children that we are serving every day. under the proposed rule, one way that low performing programs would be identified would be based on the validated evidence based classroom assessment tool known as class. the proposed rule would take this sign based rule and put it to good rule identifying

programs that are not making the grade and requiring them to compete for funding. while there will be modifications, i can assure you that it will feature a robust approach to competition. we are committed to the principle that if a program is not delivering high-quality educational experience, that our children deserve, we will through competition shift funding to a more capable organization and we will hold those organizations accountable for providing a quality head start experience. while our plans for competition have garnered the most public attention, we received over 16,000 comments. i can tell you that that takes a little bit of time to get through. other pieces include creating a school readiness framework that head start programs must use to

inform their curriculum, their approach to professional development, and a mechanism for evaluating teacher and child performance that produces the data needed to engage in continuous quality improvement. we are taking concrete steps for on the ground practice. we are developing better linkages between headstart and the public schools that children enter after they leave head start. and we are improving our monitory system to ensure program integrity, quality efforts, and to identify poor performing programs. i want to talk a little bit about each of these. as we laid out in the road map to excellence, we design initiatives that use the latest evidence of promoting positive sustain the child outcomes. school readiness means that children are ready to succeed in

school. have the cognitive knowledge necessary to understand literacy and math. the have critical thinking skills to solve problems and ask probing questions. they have the ability to solve regulate and demonstrates of control so that they can sit, listen, and focus. it also means that parents are involved in order to ensure the long-term lifelong success of their child. one of the strengths of headstart is its focus on ensuring that families are receiving the necessary health, mental health, education, and other social services they needed to achieve. the head start readiness framework is not just words on a piece of paper. the framework lays out in clear terms what every headstart program needs to do to be effective and it provides a way to measure headstart program's

performance against this framework. under the framework, all head start programs will have to implement and integrated curriculum that addresses the central domains of school readiness. they will have to collect data, analyze it, and review it regularly to attract children's progress. they will have to make early learning available to children and 2 professional development strategies in order to improve services to children. they will have to have an individual wallace plan that promotes healthy development for each child. in addition, a process that promotes an understanding of their child's progress, ongoing communication schools to exchange information about kids and families and a learning community among staff to promote innovation, continuous

improvement, and integrated services across education, family services, and health. headstart programs will be expected to adopt and a light it established goals. they will be expected to create and implement a plan of action for achieving these goals. they will expect progress on an ongoing basis, aggregate and analyze data three times a year. they will examine data for patterns of progress for groups of children in order to develop and implement a plan for program improvement. the framework sets the stage for the rest of the agenda that is focused on improving classroom practice. that way readiness and a child development goals are met. we have made significant investments in improving classrooms with a focus on providing quality instruction

and social emotional support. this includes a launch of a better coach initiative, a revamped training system, and the use of the classroom assessment scoring system. to inform program improvement and professional development. there is much that we already know. for example, research indicates that better child outcomes are associated with high quality, adult child interaction, or specifically, children need teachers who can provide which stimulating environments and opportunities. we know that the connection between the quality of the implementation and the outcome are obtained through the professional development. one example of how we are doing this is class, which most of you are familiar with. you know that it measures how they promote thinking and

problem solving and the developer, plaques language skills. since teacher child interaction are an important measure of quality, the department of health and human services have provided training for every program across the country, more than 2000 education specialists and other core debtors have been trained and are in utilizing it in their classrooms every day. many programs are following our lead and using it on an ongoing basis. as noted earlier, classed as one of the seven indicators in competition. one example of this is the city of chicago. they have teamed up with the developers of clasped and it will be implementing it throughout their programming. the city of chicago is one of our biggest -- to use it to develop professional development that meets the need of kids

every day. we are improving linkages between the public schools. strong linkages can accomplish several goals. they can ensure that head start educational goals are matched up to what the schools think are important. they can ease the transition for children by making sure that schools have good information and are prepared for children coming from head start. they can improve current engagement at the critical point when the child is transitioning from head start to public school record at the office of headstart, we are focused on fostering collaboration between local programs and public schools to promote continuity between early education experiences and ensure that the gains it started in headstart are built upon an elementary school. head start programs are required to work with our local education

agency partners to ensure the appropriate alignment of school readiness goals. finally, let me talk a little bit about our ongoing monitory. it is a huge part of what we do every day in head start. beginning in fiscal year 2012 just to run the corner, the office of headstart will begin implementing monitoring 360 to ensure that every grantee is doing what it must do to prepare students for school. monitory 360 can nec's existing key oversight activities, multiple sources of data, and it risked dated to gathering analyzing and acting upon information about grantee performance on a continuous basis. monitoring 360 will increase our understanding of grantees ongoing efforts to ensure

children are making progress, and parents are fully engaged in ways that are meaningful and effective. in addition to more rigorous reviews of grantees in turn of ongoing monitoring, data collection and analysis, and self assessment, federal on-site reviews will include the use of class and randomly selected classrooms. this will allow us to intervene early and it to allow oversight when grantees are failing to provide quality services. just as importantly, the information gathered through this more expensive monitoring process will form the basis for decisions about real competition. in conclusion, ed always describe headstart not just as the program but as an evolving concept. two years since we released the head start roadmap to

excellence, we continue on that rope that. we are working every day to intensify our impact, to ensure accountability so that every child in a head start program has the best opportunity to reach his full potential. head start children need and deserve the most effective early education program possible. every day we at the administration are taking aggressive steps to meet our commitments to them. thank you. [applause] >> now, let us hear some --

>> let us hear some reactions from people who actually know something about head start. let us start with jerlean daniel. she was also on the we designation committee that made the initial set of recommendations that the administration has taken up on. >> thank you for the microphone.

i was wondering how i was going to do this. >> we have had a lot of experience with you. you do not need a microphone. >> do not tell all my secrets. thank you for this opportunity to talk about early education reform. while we seem to be focusing on head start, i think one of the things that is important to note is that for a number of years head start has really been the most together model of early childhood, if you will, tried to build a system, looking at professional development, parental involvement. it really is -- steve talked about the chicago studies, in its own way head start really is that model trying to take it to scale. it is trying to take it to scale. taking something to scale is

really difficult as steve has pointed out. it is particularly trying to take it to scale in a shifting terrain. the children who are served by headstart are some of our most vulnerable children. even our definition of vulnerable children has shifted over time. at one time we were talking about primarily low income white and african-american children. demographics of our country have changed quite a bit. now we are talking about low income children for whom english is not the first language. the tides of change are happening at all times. when you talk about taking something to scale, you always have to think about what modifications need to take place for these particular children that are being served at this particular time.

when we talk about early care and education and hats are specifically being the robust programs, part of being a robust is really knowing whom you are serving, why we are doing it, what the ultimate goal is. i think you -- i thank you for really pointing out to was, what is the bottom line? we want all of the children of this country to try to reach their full potential. that is not a simple task. i was honored to be part of the we designation committee and it to serve currently on the headstart research and evaluation committee. what i would tell you about the we designation work is that it was a vibrant group of professionals who sat down together, there were researchers, practitioners -- it

was a nice mix of individuals. they were asking each other all the hard questions. they were trying to make sure that what ever we landed, we had a research evidence to support it. whenever the research evidence was a little thin, what we said was, ok. this is important. as soon as you have some research that will help us move in this direction. we try to give at the office leeway to move even beyond the life of the committee. i am it really pleased with the road map and the direction that the office has taken this program. i think it scoops up all of the pieces necessary. looking at classroom interaction, professional development of teachers, looking at who the children are being

served and not losing that really important thread of each individual child homegrown advocate. that is their family, the parents. they have got to be part of what we are doing here. no child exists and floats around the world without being connected to a family. far beyond preschool years, a child needs a family to be an advocate for them. yes, there is a lot of work to be done. i feel like the field and headstart are on their way to getting that were done. we have gone through some serious economic times are now. we have got -- we do not yet have a universal health care also we are trying to get there. we do not have it.

we still have children and families who are vulnerable. states are having to do all kinds of -- make all kinds of cuts. what i would like to suggest is that even though we are on hard economic times, we should not lose sight of the lessons we have learned about how critical early care and education frame is. i believe steve pointed out in the pregame report that some states are lowering their standards and terms of pre k. this is not the time to do that. i frankly would say it is never a good time to lower the standard lower than what we know to be good for young children and their families, to be good for early childhood programs. we learned so many lessons.

we were told the importance of starting really young. we knew that all along from research that happened. neighborhood set it up for us to see more clearly. we were told it is important that the teaching of young children be highly intentional. that means -- and steve talking about direct instruction. in the field, we talked about capital d i or yet small be accurate i will support with col. that means that a teacher is highly intentional. she has put together what she knows about childhood emotional development. she knows that emotional development is connected to cognitive development. she knows is to become

literate, to become proficient in math and science. what we are looking for it is a highly skilled intentional teacher. you have to have professional development opportunities for that to happen. steve mentioned oklahoma. those were highly trained teachers. one of the things that happen when you try to take something to scale is sometimes you do not have all the people that you need. you have to grow them. head start is one of the main fields for growing teachers. i am delighted that at this point, a 53% of the teachers now have bachelor's degrees. another 12% are enrolled in school. yes, we have a lot to do, but the kids are worth it. thank you. [applause]

>> there is a lot i agree with, but we also have some points of disagreement. it makes this panel interesting. what i want to do is make four points. it will put the discussion and to some larger context. the first thing that i wanted to say is that every educational institution has room for improvement. my wife is a recovering preschool special ed teacher. she worked in fairfax county virginia public schools. i work at the university of chicago. on a daily basis, we compare

notes about all the things that we saw that can be improved. i think it is great that the administration is thinking about ways to strengthen the program. given that, though, there has been a lot of what i think of as a very overheated rhetoric about head start. most of the people in this world of familiar with joe klein's recent essay in "time" magazine. it is criminal to fund, and so on and so on. consider the question of how much change is needed and how much better we think we can actually do with a program like this? the advocacy organizations are going to say that the problem that people are focused on right

now is when the federal government sponsored this study, the problem that people are focused on is that when you look at kids at the end of first grade, but you do not see any difference. the habit is the groups are going to say, when you look at the kids the day they are leaving head start, the program looks pretty good. that is a very self-serving argument. because it is self-serving does not mean it is wrong. if you look at the graph, i applauded -- have plotted the grey lines and a show at the control difference in the achievement test scores for the four-year-old kids that were in the experiment. the y-axis is the impact.

the first datapoint their -- there are kids leaving head start. that is about a quarter of the black-wide test score gap. the other point up there is the short-term impact of head start on kids who are in the program and the 1980's. the nice thing about looking ahead -- looking is that we can follow them out into adulthood to see what the program did over the long term. what they did find is that the initial impact about -- it translates into long-term

benefits in terms of things like earnings and high school graduation rates that generate lasting improvements that produced dollar benefits to society that are large enough to justify the program's cost. it generates benefits in excess of cost. what is new in the experiment is not that the program is getting less effective, but rather that the rate in which the benefits fadeout is decelerating. you can see that from be graf -- the graph. that is key. i want to consider how concerned we should be that the difference and the experiment between the treatment and the control kids and has court impact is fading

out so quickly. -- test score impact this fading out so quickly. the initial impact is consistent with long-term and benefits. the rate of fadeout is accelerating over time. what should we think about what is going to happen for recent kids? let me see if i am smart enough to actually do this. i want to show you some additional data that many of you might be less familiar with. this comes from a recent paper that looks at the class size experiment. what you can see -- the y-axis is trest score gains.

the x-axis is grades. what you can see is that there are sizable impact of being in a higher quality kindergarten. it fades out almost immediately. he took kids in this experiment and linked their data to irs earnings records when the kids had reached adulthood. what you can see in the tennessee data is if you try to predict the effect of being in a high-quality kindergarten on adult earnings, using the test scores for the kids when they're leaving kindergarten, the benefits translates into increased earnings of $600 more per year over their entire adult time period despite the

fact that the test score the game's fate out immediately. this does not guarantee that we will see the same sort of benefits in the experiment, but it does make you realize that very rapid fade out of test scores impact is not necessarily inconsistent with long-term improvements. ok, suppose that you were concerned -- we do not know what this rapid test score fadeout means. say you want to do something about it. what should we be focusing on to try to lock in gains that head start makes? a lot of people focus on the possibility that low-quality elementary schools might squander the benefits that the program generates. i am skeptical of that

hypothesis. we look at the long-term impact of head start on kids who were living in the 300 poorest public schools added united states in the 1960's. these are african-american kids in the mississippi delta. attending the lowest quality public school that you can imagine. we see evidence of long-term head start benefits for those kids. more plausible is a hypothesis that steve mentioned in the paper is the possibility that elementary schools, over time, might be getting better at mediating skill deficits among kids who are not getting high- quality preschool experiences.

kids who are not in head start, the teacher redirects time toward re mediating. it comes from scores of the national assessment of educational process that are in this picture. you can see from 1971 to 2008, test scores are going up for ninth graders in both reading and math. if this is what is going on, it raises the hypothesis that one of the best ways to lock in the benefits is to expand access to the program. let me stop there. >> i will get myself in a little trouble here. i think it is important to know that the bush administration was intent on reforming head start and resulted in what i would

describe as warfare between the head start and the bush administration. the obama administration is doing reforms and the national head start association appears to be fully cooperating. they are working hand and glove to try to improve the program. i think part of that must be due to the next speaker, thank you for coming. >> [inaudible] thank you for including me. thank you to steve. earlier this year, when head start was in danger of having children cut out of it, that they signed this great letter to

congress urging congress to maintain the current levels. you are in sync with the nobel laureate. two years ago, i came to the organization. i am in classrooms where iac the power and the possibilities. -- where i see the power and the possibilities. i hear from alumni all the time. teachers, doctors, lawyers. prize-winning paulettes', public servants, -- prize-winning poet

s, public servants. this year's grammy winner, she was there yesterday at the front of the magazine. instead of sharing all of their stories, i'm going to focus on three key points about reforming early childhood education. that is today's topic. first of all, research really matters. it matters because it shows over and over again ways that head start works. research matters to head start. let me say to use some of the things that those 300 researchers work -- wrote to congress. head start raised test scores.

it makes it less likely that children will repeat a grade. for those of you who live in montgomery county, i want to point out one of the studies. they found that the maryland public school paid $10,100 per child per year in special education costs for children who had been in head start. head start graduates are more likely to graduate from high school and attend college. they are as much as 25% less likely to smoke as an adult. in here, many more benefits. my second point is that head start in 2011 is not your mother's head start. much change has taken place.

the administration's a roadmap to excellence and all the reform efforts, and natural progress that is happening. what i see, and this is totally my experience, i see head start collaborates with schools in the community. just last week, i was in montana. head start programs are getting agreed teachers' trade -- teachers. in rural areas, that is not an easy task. they are using data to individualize instruction. they are transforming parenting and i see enormous creativity and innovation on the ground.

most of these reforms have not yet begun when the study was underway. remember, the early study was done when the program was brand new. sometimes it seems that this study, begun at a very different time, with all the concerns, at this study is always being used to make sweeping generalizations and recommendations or even budget decisions. it brings me to my third point. this is a very tricky time for head start, and for all of early childhood education. most of us are really working toward once in a generation reform. this administration, we are all

lined now around the reform agenda. because it is really about improving outcomes for the most vulnerable in this, -- youths, head start is really a cornerstone of that agenda. to be more effective, we do need bachelor degree level teachers. we need smaller classroom sizes. we'd better support for our special-education families. we need better connections with schools. we need quite a bit. here's the tricky part. we must work very carefully together to get to that. otherwise, we will not have the resources. we must honor our differences, but we must set some of them aside. better system coordination, efforts to cut red tape and inspire innovation.

reforms will acquire investment. time, people, money, no matter what the delivery system is. at the moment, we are staring down the barrel of a cannon loaded to end our programs. what to do? my proposal is very modest trade i would like to invite everybody to come and visit the new head start, see for yourself. keep the things important conversations going so our collective wisdom can help us all through this tricky time. let us be aware of what had once we might prompt in this shift first, came later political environment. we all want the window of

opportunity opened for future prize-winning poets. he grew up in a very violent neighborhood in portland, oregon. he recently wrote, my experience in head start help to guide me into the adult i have become. i believe there is a direct line between my creative life, a sense of self-worth, and my early success as a poet in my experience at head start. thank you. [applause] >> i will pose a couple of questions to the panel. i want to emphasize something.

the way this review is going to work is that in the next three years, a third of the programs will be reviewed every year. that review will result in a minimum of 25% of the review programs failing. that is not something that came from the read designation commission. we could've never got an agreement on that. that sent an enormous signal to the country. this is real. 25% of your going to have to compete for your money. i want to talk about this. the kind of internal discussion, and i would like to hear your response how the center's hill about this. >> to clarify, that 25% currently is part of a proposal. as most of you, -- as most of you know, we are moving into writing and releasing a final

proposal by the end of the gear. there is -- and of the year. there is a three-year transition period. within that three-year transition period, we'll be looking at data coming after june 9 of 2009. we collect data on all the programs. with that, most of you probably know that we monitor about 525 programs a year. we will take those 525 programs in the first year, all of them based on the proposal will be compared to the seven conditions. from there, within the seven conditions, if you do not get to the 25%, we would have to kick in an a condition. it talks about -- we suggested two things. we got some comments on.

the two things would be using noncompliances. for those of you who do not know, when we go out on monitoring reviews, we make decisions about whether programs are in compliance or not. the second possible option would be kicking in and not their instrument. one example -- to be very honest, the 16,000, is that we receive, we probably say the majority of the comments were on the 25%. some of them were very much, this is not the right thing to do. believe it or not, the community realizes that it is time to hold our programs more accountable. programs would like to have more information about how does this really work. that is just a proposal.

those are the pieces that you will see in the final period -- final. >> we had consultations daily. that inform our national response. people were saying, take 40, take 50. 25 felt like ok, we have a quota for traffic tickets. the that was the major objection. we are as good as our programs

are. the field was very, you know, not aware that competition is going to be a fact of life. they did not say -- let's move forward. >> ok. thank you for that. one other thing that i think is really important to emphasize is that -- the difference between this system that you have invented -- i think this is an important point. this is going to be based on actual observation in the classroom with this instrument that enjoys a very good reputation.

actually going into the classroom and seeing what happens. logically -- >> randomly selected classrooms. >> the judgment is based on what transpires between teachers and students in the classroom. without that, in the evaluation is flawed. you have to know what actually happens in the classroom. how did you select the class? are you confident it is a good instrument? are you satisfied? a lot of head start are already using it. are you confident? >> we absolutely are. as we continue to get a lot of feedback and talk with the developers and researchers, we feel confident and the data that we will get.

it is research based. it is validated. we also like it because you can give programs their scores on the information right away. they can make decisions about how they're going to use that information in order to design professional development or change what is happening in the classroom where made decisions about the curriculum. how are you doing with the implementation of your curriculum? >> what to the programs think? >> i just want to remind -- the classroom environment is higher than other settings. this is like a compliment. this is the teacher-child interaction adding to that. >> yes. >> it stems from this

fundamental challenge that we have right now that we have no idea what the kids skills are that are carrying these long- term benefits. for these studies that looked -- we have reading and math scores when the kids are down. and we have data on the adult outcomes. we see this course fadeout and the adult outcomes persist. most people assume that the thing that is generating these long-term benefits is some sort of early childhood impact on behavioral skills. we do not have any direct measures of what those things are. right now, we assume it is a matter of process of elimination. it has to be that because it is

not the other stuff. >> there is a lot of that, by the way. >> i am sympathetic to the administration. i do not know how to solve this problem. what it means is that we do not know exactly what the target is that we should be focusing on. it is hard to see what a good head start program is it you do not know what the key to the skill sets is that generates these long-term benefits. >> i think we do know. the studies, to me, it is all like magic. >> dark matter is magic. >> the skilled woodcarver find a beautiful madonna in every log.

and these are very skilled woodcarvers working on the studies. i think we know a lot from other studies about the things that you carry on -- carry long-term benefits. part of it is the common to the fact of -- cognitive the fact, language effect, self regulation part of it are other social and emotional skills. you do not have to look at u.s. literature. there is literature worldwide on this. i think we have a pretty good idea what it is -- it is not just one of these domains. it is all these domains. i do think the field needs measures of the spirit we have ok conative measures, -- field

needs measures on those. there is a need for the federal government to support the development of -- to go back to the drawing board on measures. right now, each state is faced with the job of trying to create measures. each program is faced with coming up with measures. that is not a great way for that to happen. that is an opportunity for a lot of people to fail. everybody would be happy using more or less the same measures. some federal efforts to help develop those for the whole field, i think, would be hugely productive. to measure not just the kind of stuff -- cognitive stuff, but social skills, these other things. so that programs can adopt these with some confidence that they really a measure what they're supposed to. >> you know, the focus is based

solely on cognitive achievements, which data shows is less than half of the equation for success. i am a consumer of research, not a producer. you guys probably know what he is referring to when he says the data shows that cognitive achievement is less than half of the equation. there must be something that he is referring to. >> i would like to point to -- we do need more research around the social-emotional piece. if he were going to measure a child's progress, you need something that we can use. i am not surprised that we do not have those assessments because at the heart of much of

that our cultural issues. what does a particular social behavior mean in which context? it is quite a thicket to get through. generally speaking, what does a child use of literacy for? they use it to maneuver their way for the world. they use it to negotiate, they use it to try to intercede with their peers. they use to try to get what they need at of adults. -- out of adults. it is a hazy box. we do see the results of a child you had self regulatory skills, who mastered some of that literacy area. and put it all together down the road.

we do need some more measures. my caution would be bad just as it really matters when you are talking about assessments on him in the assessment -- on whom the assessment was validated. you cannot just pick anything out of a box somebody out here. this is very careful work that needs to be done in a systematic way. i would hope that as we pursue this work, we do not go back to a mentality of -- it is up or down, good or bad. it should not be this either or kind of dichotomy. what is it that we need to be

doing to make all of early childhood meet the needs of children and families in a high- quality way? how do we keep progressing? that is what this conversation ought to be about. >> the congress of the united states and the president have focused their attention on one of the smallest parts of the federal budget to get all of this so far. appropriated money. that is where head start is. it appears that they are about to do it again. if the committee is not successful, there will be automatic cuts. what are you doing to make sure that head start does not get a big pcut? >> turn it over to the advocates. >> part of what our assessment is is that if people knew enough

about its -- there is a very big grass-roots campaign to let people know about the impact. last week, we were in montana. the chairman of the subcommittee was a visiting a head start. if he was not impressed with that, -- those are the kinds of things better part of the strategy. -- that are part of the strategy. allow members of congress to see pieces of research, to see, in reality. he talked to the parents. he played in the sandbox.

he listened to the community people. there was an elementary school principal who said, i see the difference in kids who aren't head start -- are in head start. those are the kinds of people that the community board's members were talking about accountability of heads mark -- head start. we're trying to change minds one at a time. >> they are about five times more impressed by one experience like this than 10 random studies. you're on the right path, i believe. ask a question that does not last longer than 45 seconds. >> a couple of direct questions.

i worked for many years before unicef. i am an educational consultant. i worked in the field of preschool education for many years with unicef. promoting all this in the middle east, to some success. what amazes me is that it is still a struggle here when most of the rest of the world has accepted the linkage between healthy productivity, how the education -- healthy education and achievement. first of all, we're talking about numbers. somebody mentioned that 1 million beneficiaries, what does that represent? why are we only getting to a million? collapsing families and economies would suggest that there are many millions of

children that need this. you talk about 360 assessments. i am a researcher as well. to what extent are parents involved in 360 assessments? that brings us to a number of issues raised about measurable or difficult to measure indicators. if we do not get to the families and we do not get to the reinforcements that is going 9, nothing really will stick. one of the reasons why it is not sticking is that we are not

involving parents. >> lets us answer the question. >> currently, there are approximately a little over 960,000 children served and head start. we have head start and we have early head start. with our preschoolers, we are serving 40% of the eligible population. in early head start, we are serving less than 5% of the eligible population. a lot of that is based on money. on average, our kids are about 7000 or 8000 a year. >> there are other programs. >> we also have to be careful.

eligible population is defined in terms of population characteristics of a moment in time. for example, children below the poverty level. fortunately, children do not stay below the poverty level, many times. people are moving in and out of poverty. it is very hard to target at a given time the characteristics of the kids in head start. i think the number of kids that we have to serve is much larger. we are not serving half the target population in head start. maybe a quarter. >> a fuad state preschool, -- if you add state preschool, you are up to? >> half. >> half of kids --

>> right. >> the one thing that i want to add to the discussion on the issue of access is i go around talking about head start. i hear people saying that we should be focused on improving teacher pay and reducing class size and increasing a fraction of teachers with bachelor degrees. it is also true is that we only have a subset of the kids enrolled and a program trade in a world in which the administration said we will spend $50 billion more on head start per year, this panel would have no trouble agreeing on how we would allocate the extra $50 billion. in a world of very constrained resources comic the question is

whether it -- resources, whether we should focus on increasing program quality or expanding access. debra phillips and i wrote a paper -- >> it was the one we mentioned earlier. >> we argued that there was a fair amount of evidence to suggest that there are reducing returns for program quality. the highest bang for the buck right now is to push on the access to mention rather to improve the program quality. both would generate benefits in excess -- both would be great things to do if we had the money. if we only had the money to do one, i would prioritize access over program quality. >> but may be very clear that some --let me be clear that the

360 is our effort to manage the data that we collect. the law does require for parent involvement in local programs. parents have a lot of leverage in terms of what kind of curriculum is being used. prue or the people being hired? how is the money being spent? at the local level, parents have to be very involved. >> [inaudible] >> we have performance standards. there are very specific performance standards about the participation of parents as well as how do programs form relationships between -- with parents in order to help parents achieve individual goals. it is of the individual level and also at the program level where parents can get involved. >> next question. >> i have two questions for

steve. the core of your presentation is comparing several other types of studies. i'm interested mother of those studies are capturing information about -- if those other studies are capturing information about the disadvantaged kids. are we comparing apples to apples? what is your point of view on the reform strategy that the administration is following? would you recommend anything different other than your call for more research on effective practice? >> thank you, tom. yes, we are comparing apples to apples. to the extent that there are differences in the populations, they are biased against studies that serve broader populations because the effects are bigger,

the more disadvantaged kids are. people have adjusted. let's only looked at the kids who could get into head start. the differences are bigger if you do that. to the second in more important question, i applaud what the administration is doing, but i think there is a classic management problem. i think there is a natural reaction that any administration of any program to increase regulation. i think head start the exactly opposite. head start and early head start has philosophical models that are not the most effective. what i do not see is a reconsideration of them and a willingness to basically take

off a lot of the constraints, to move in the other direction of deregulating, allowing innovation, and moving away from this model. it is not as the programs i talked about. it has impacts -- at multiple sites around the country. when you have that kind of evidence, i think you have to allow fundamental reconsideration of the basic model and allow people to use different approaches constrained by producing results in the classroom for kids. >> i just want to say one thing. an important part of steve signs paper is that we have a bunch of large scale state-sponsored pre- k programs ever during much better than head start.

i do not want to open the door to a big research food fight. i did just want to go on record saying i am not convinced myself that these state pre-k programs are that much better than head start. >> this administration is absolutely in favor of innovation. one of the things that we have to keep in mind is that head start is a local program. it is federal to local. we have not added any additional regulations. but i also want to be very clear about is that the pieces that are things that program should a bad -- should have been doing for many years. we're just increasing our efforts to ensure that these

things really are happening so that we do see progress for kids and families in the program. >> let me take to questions. let's go over here to this side. >> i am the director of the nonprofit education and advocacy group strengthening young families. i have a research-related question. related to the use of the randomized control group. it is really two closely related questions. as i understand it, you have to multiplied this by thousands of times. your basic setup is that you have two similarly situated children and you give one the services and the other you give the child those services. you compare which child does

better and by how much over a period of time. a first of all, especially given the fact that families tend to be involved in many different service agencies. you have some gatekeeper that has concerns about both families. do you really have a situation where one kid gets head start and one kid gets nothing? or do you have the other child in other services, or do you have say it -- or do you have somebody saying, put the neediest. program.the head start don't we have an ethical problem? >> next project -- next question. >> i have a question regarding

head start and special needs. some of theg programs are not meeting the basic requirements. >> what are the controlled kids? >> the relevant question is what happens to these head start t? the fact that they get child care and other things is a good thing for the control group. that is the comparison you want, not the comparison of nothing. nothing is not the real world. the real world is getting these other things. there is also some crossover. there are ways of adjusting for that. those are state of the art in

the report. the ethical issue was dealt with by a in rolling kids in programs or the capacity was not there to take all the kids. they could not take all of them if they had wanted to. what is the fairest way of deciding? make a lottery is one option. special needs kids? >> the majority of our programs, the law requires that 10% of the kids be children with identified disabilities. it requires that a child be identified by a local education agency. one of the things we're working with is helping to build the relationship so that this can happen on a much quicker basis. we also know that -- >> you are saying that the local agencies do not do the evaluations and you cannot get the kids.

>> it depends where you are acts. some of them are very good. some of them are strapped for funds. some of them take much longer than others. the summer is a tough month. it can vary from community to community. the majority of the programs figure out ways to provide services. we cannot actually count them. >> figuring out how you have a stronger, better relationship between head start and the public schools is very important. public schools do not always refer them to head start. they may not want in there and that is a real problem. >> interesting. two more questions. >> good morning. i am a kindergarten teacher for the past 11 years.

i am wondering if you could talk a little bit about the administration's efforts in terms of strengthening and enhancing the relationship between public schools and our local head start. >> all the way over on the outside. >> i am from the georgetown university law center. we hear a lot about the socio- economic integration in the schools. it is politically powerful. it is not something that we have talked about at all today. i know head start is a totally different model. is this something that is discussed in academic literature? is this something that the advocacy groups talk about? if not, why not? >> ok. >> which question are you talking about? >> the first one, to our revised, we are establishing the

sixth national centers with huge universities and other research groups. we're gonna focus more on working hand-in-hand with local programs. we have some really good examples right now that we are working on. last year, we had the city of chicago, and there are a couple of other models we're looking at in order to disseminate information. >> the second question? >> you were talking about are we having conversations about mixing populations? ok. all right. i think one of the dilemmas we face as a country, do we expand the service or do we increase the quality? on the one hand, steve is

saying, do not put more rules. if you do not have rules, how do people know how to move in that direction? things like universal pre-k, and there was some trepidation that this would -- i am trying to think of the word i want to use. less money was available for low income children. i think that somehow we have got to find the balance between making sure we meet the needs of the most vulnerable children. also, doing what we know is good practice for all the children. i would point out that this is going back a ways. when we were looking at segregated schools many years ago, one of the important decisions, when you have the schools segregated, the more

disadvantaged population was not getting the quality of education that they needed. the loss sent -- law said, put folks together. how do we make sure that everybody is really getting what they need? i would suggest that it is a combination of the strategies. a framework such as the monitoring system that head start has put into place. you need a framework for people to work with. also, the collaboration among schools and community-based programs. we are in this together and it is not a race. when we have the sense that to we are a community, we will be

at the best advantage. we have not quite figured out how to do that without an either-or mentality. >> in the currents head start program, up to 10% of the kids can be above the income requirements. there already is a provision for at least some integration. i do not know the extent to when that actually happens. it is allowed by the current rules. last question. >> hi. i am a psychologist at the university of maryland in baltimore. i have the fortunate experience to be an education consultant in head start. the clinic i am working with now is helping to train the baltimore city head start.

i know that one of the things we talked about today is how we access and a measure of the social-emotional impact. i know that it is happening pretty heavily throughout the state of maryland. i was wondering if someone wants to comment on those efforts. >> it is the national program right now. it is funded jointly to the office of child care. they really are out and about around the country. they have worked with several states to develop separate models. we see that moving forward and will continue to be a huge part. >> please join me in thanking the members of the panel. [applause] i give you very short notice for this event. three years from this date, we will have an event on how this worked out.

on september 13, in this very room, the census euro released its poverty numbers and income numbers. we will have an interesting event in this room. i hope as many of you as possible can come. thank you for coming this morning. [applause] [captioning performed by national captioning institute] [captions copyright national cable satellite corp. 2011]