the ronald reagan library, and especially our audience. this is not the end of this conversation. but it was a great start. thank you. [applause] [captions copyright national cable satellite corp. 2013] [captioning performed by national captioning institute] spring.ess is in the croesus for two weeks. a few stories coming out about kong congress is in the spring break for two weeks. a few stories coming about compromise. it is a positive sign that senators will reach their goals of unveiling a package when they return in early april. the biggest obstacle is the visa program and differences between labor and business interests. 's fullut c-span immigration coverage, including an event last week hosted by the

national hispanic leadership agenda, 30 group's coordinating town hall meetings and around the country to talk about reform. you can let us know what you think about immigration reform tomorrow morning. we will be taking your calls to discuss congress and the impending 2014 budget. we will hear from the former chief of staff to senator mccain, now the director of the reporters and policy center's -- of the bipartisan policy center's immigration center. laborad of the organizations will be our guest after "washington journal." he will continue the conversation on "newsmakers" starting at 10:00 eastern. >> this year, we received a record number of injuries from over 3500 students -- a record over 3500entries from

students. watch daily beginning at monday morning on c-span. winningtti documentary's online. >> -- you can see all the winning documentary's online. >> chelsea clinton is a board member. the panel talks about social factors that affect people's health and ways to lower costs are taking preventative measures. we will hear first from singer and actress barbra streisand. this is one hour. [applause] .> thank you start with potato chips. americans spend $7 billion a year on potato chips.

we spend $73. -- we spend $73 billion on soft drinks. we spend $110 billion on fast foods. not only does that contribute to heart disease, but our country can only find a fraction nova -- of that to spend on research to combat it. the nih invests less than 3% of its budget on heart disease. 30% of the population dies from it. most people are not aware of these stocks -- facts. women die of breast cancer each year. that is compared to around 455,000 women who die of heart disease. i became committed to doing this

work in 2007 when i learned that heart disease is the number-one killer of women in the world. it kills more women than men, and it kills more women than all cancers combined. yet most people are not aware of these stocks. -- these facts. learned that nearly all of the cardiac research studies funded during the last 50 years have been done primarily on men. needless to say, there are physiological differences between men and women. we have different coming -- plumbing. . disease presents differently in women. many people are not aware of this either. as a member of the board of directors, i am thrilled to announce the hospital is pledging to hundred dollars million to launch a national

campaign to address issues of awareness and advocacy as related to women's health. -- the hospital is pledging $200 million to launch a national campaign. the brilliant director of the women's heart center will be part of a panel of speakers today. she will share how the center is helping to change the way women are diagnosed, treated, and educated. before i return to my seat, i want to thank president clinton and his foundation for creating this form, providing leadership, and highlighting important .ssues the pledges made during this conference will undoubtedly impact many lives for years to come. thank you so much. [applause]

>> ladies and gentlemen, please welcome chelsea clinton and panelists. [applause] .> thank you and to all ofbra our panelists and questioners this morning and for providing the perfect sequeway to this panel talking about increasing access to health the lifestyles and its corollary, how to decrease access to a healthy lifestyles. -- to unhealthy lifestyles. before we start, i will ask each of the panelists to talk about the womange and ask to my left to kick us off. she is the director of the

barbara streisand when man's heart center. i hope you will elaborate on her announcement. >> absolutely. i have a cold. i do not typically sound like kathleen turner. i do direct the barbara streisand women's art center. and also direct the preventive heart center. we have worked for the last 20 years in research to close the gender gap whereby women are now the majority of heart disease victims and deaths in the united states, a clear slip from previous decades. one of the key findings has been to identify female patterns of heart disease that is not in the textbooks were being recognized by health care providers. our 20 years of work, we're still at least 35 behind the

knowledge we know about ms. our disease. that is predominantly because research was done for men and by men. >> now is being done by women? >> it is also being done by enlightened men. but we're studying women for the first time. we have for the last 20 years. i am optimistic. barbra joined our team and endowed our center five years ago. we're hoping to close the gap in less than 20 -- 35 years with her support. because of the simple adage, if you have a big problem, ask a busy woman. one of the things that is clear in our campaign is women have often change medical and social problems. our best example is mothers against drunk driving.

after decades of preventable despite a lotng of effort, women, mothers made changes to laws. they got communities to enforce the laws. they changed culture. my young adult children would no longer get into a car after having a drink. that is a big change from previous generations. women can do this. we will not be able to change the face of cardiovascular disease in our country until we to becomeen political. women need to know heart disease is their leading health care threat for them personally and to their families. ofreness is up 50% because our efforts. it needs to go up. advocacy and the additional shape ourl help us to

local communities and state and theral laws so that women, mothers of the world, can help our families eat the fruit and vegetables and to the exercise. we have the pga commissioner. might be the main event depending on what you are here. to partner thrilled with you on this conference. we are excited by the work you are doing at the pga tour. talk about your renewed pledge today. congratulations to you and your data on the work the foundation is doing. we are excited about it. to put this into context, health and lifestyle has been a growing part of the culture of the pga

tour for a good number of years. our athletes are focused. there has been much written on one of golfer looks like today compared to 30 years ago. gary has always been an exception to that. the president this morning talk about enlightened companies that take steps to make change for their own people, then maybe the community, and hopefully the country. inlike to think we're moving those directions. wellness,, health, and the choices are what we are all about when we teamed up with what we're all about. we've teamed up with humana to screen our employees for issues. we were delighted when they invest their number one company.

97% of our employees participated in the voluntary program. we have been talking for years because it is common sense. right andoyees eats takes care of their body, they are in better employees. what struck us about the vitality program is the relationship between getting the feedback within five minutes and making behavioral change. .e saw it with our employees we have gone to other levels now. we have exercise programs. we have walking programs around our campus. we're doing a lot of stuff with food for our employees during the workday. we are not where we want to be. but we're making a lot of progress. on the community level, in northeast florida, last year we announced a $50 million

commitment from the tournament to focus on youth. education, character development, and health issues. , ase is a lot going on there are in other communities, with education. america is very robust there. we have a hot shot new superintendent from miami doing great things in a short time. last year'sf conference, we wanted to make sure we incorporated health matters into the dialogue and initiatives coming forward from those folks coming together. our pledge is in two parts. the first is we will fund a coordinator organized by the clinton foundation to work to make sure the community is

coming together on these issues. we look forward to a town hall meeting featuring your dad to raise the level of awareness and get people talking to each other. we think the combination of those things will have a real impact. the second part has to do with the national level. that is in two parts. sport, we have more hours on television than any other sport. buthas the highest ratings, we reached 160 million americans last year. we influence decision makers. a good margin. decision makers of companies and in the public sector. we want to take some of the messages and best practices from

these conferences and bring those home to america through programming. the second thing is last fall, we concluded a $100 million campaign to escalate the first tee program. it takes golf and reaches out to people that have not had access to it, largely for socio- economic reasons. last year, we reached 6 million kids who have been through the program. we teach core values in the program. last year, we added a program called the nine healthy habits. through the $100 million 10paign, we will reach million were kids in the next seven years. we are in 5000 public schools now. we will be in 10,000 through

this campaign. when we reach this 10 million kids, we will be reaching them in addition to the nine core values and the nine healthy habits. doing alike we're little bit to help. we're coming to these conferences and learning a lot. that will hopefully help us to do more. >> someone who has taught me a lot about preventative health and has been advocating about it well before it was so current to ornish. dr. dean about what your next innovation is in the field of preventive medicine. >> thank you. i am honored to be here.

or 36 years, i have directed a study -- a series of studies showing a powerful difference changes in diet and lifestyle can make. we often have a hard time believing the simple choices we make each day like what we eat can make changes. moderate exercise like walking, stress management techniques, social support, these approaches can help to prevent most chronic diseases and reverse them. we are able to show for the first time even severe heart disease can be reversed by making these changes. instead of getting worse, people can get better. the more they change, the better they get. early stage prostate cancer may be stopped or reversed by making these same changes.

tight to diabetes can be changed. when you change your lifestyle, it changes your genes within just a few months. it turns off those that promote cancer, diabetes, heart disease, and other conditions. we're using state-of-the-art measures to improve the power of these simple and low-cost interventions. telomeres can get longer. as those get longer, your life gets longer. are much mores dynamic than we realized. we can show these changes quickly. these approaches are not only medically effective, they are also cost-effective. costs byld cut overall 50% in the first year. $35,000f omaha saved per patient in the first year.

you can see the changes quickly. we have been training over 50 .ospitals and clinics we are finding we're getting up to 90% of adherence to the lifestyle intervention after one year. bigger changes in diet, better outcomes, and large cost savings. we're training the homeless shelter in san francisco on our program. over 20,000 homeless patients have been through that. we will decline in that throughout the country. that will be cloning throughout the country. we're having discussions about the deficit. 2.8 trillion in health care costs are for diseases that can be prevented or reversed by making changes in lifestyle. we have many republicans say we should dismantle medicare or reduce entitlements.

democrats are saying to raise taxes. it is not a lot of overlap. if we can address the fundamental causes of why people get sick, we can have better health care available for more people of lower-cost. the only side effects are good ones. >> brian, what brings you out here -- ryan, what brings you out here today with us? >> thank you for allowing me to take part in this. if there is a hierarchy, i am close to the bottom, unless anybody needs hotels in fort lauderdale. i am here representing an organization called hei hotels and resorts. we are a privately owned company. i will kind of frame this -- my brief five minutes that i get to talk about access and lifestyles, by quoting one of

the most difficult bosses i have ever had. we were out to dinner one night and i presented all these great plans about how to change the hotel and he said, "change is great until it affects you." it really sunk in. i would like to take a completely unofficial poll, and you will be judged by those around you, and i encourage my panel members to participate as well -- is there anyone here who had a professional athlete or a movie star as a hero growing up? i can see you through the lights. i know you are there. we are completely different from the line level employee in a hotel. according to the hotel motel lodging association, the average education of a hotel employee is the fourth grade. according to tufts university, 60% of all immigrants in the united states and gateway cities work in the hotels. in addition, in a text in the hospitality workplace, it indicates that we are the leading employer of minorities

in the united states. that is a pretty sobering fact. i'm not sure who really watches cdc statistics every year, but last fall, they came out with statistics that african- americans lead the population in obesity at 49.5% of the population. it is closely followed by mexican-americans at 40.5%. these are our employees. in 2010, things changed. they really did. i want to use my company as a microcosm as to what can be accomplished. first of all, as we all know and can all respect, health care costs continue to rise. in 2010, it became so burdensome to the employee and employer that we figured that the only way to make a change was to change behavior. the first thing we did was partner with cigna healthcare and come up with a consumer- driven health-care program. for those of us in the hotel industry, this is very unique. we are one of two companies

currently involved in this program. you can go online and shop for any kind of procedure. we joked about shopping for a heart surgeon, but the level of clarity of where your interest dollars are going to a non- health care worker is absolutely staggering. as many of my colleagues have said, we offer complementary biometric screenings for our employees. you can get your bmi, your blood pressure, and other key statistics, and more importantly, we give you ways to make things things better. we offer what we call the employee assistance program. everything from legal advice to marital counseling to financial advice -- anything we can do to help our associates. a happy and said a sissy it is more productive, and you get better bottom-line results and long term results. .- a happy and fit associate we believe the uninsured and

underinsured should get the same access as those of us who have insurance. that's why the services are complementary. we started going from the macro level to the micro level. we changed our employee meal program. simple things like changing the plate size. we went from a 9.5-inch plate to a 7.5-inch plate. we mandated more nutritious menus in all of our hotels. i'm still trying to get my team to catch on to what quinoa actually is, but slowly but surely, in winning them over. i am painting a rosy picture here. i want to give you some aggregate results. like i said, things can be painful. let me give you the good news, and then i will give you the bad news. in our first year, we know -- we lowered the number of people with high cholesterol from 10% to 2%. in terms of high risk -- and these are people we would consider to have a fatal disease -- we lowered from 17%

to 10%. my favorite statistic of all is we lowered the number of smokers in our population from 20.5% to 10%, and this is all in the matter of the year. we are back in 2012, and the chairman of our company, who you will hear from later today, attended the clinton initiative, and he came back to us and said, "guys, we've done well, but i want a commitment to action because that is what the initiative is about." i want a commitment to action from each and everyone of you as it relates to wellness. we have 5000 employees. today, we have 1200 commitments to action to wellness. this could be everything from losing 10 pounds to seeking psychiatric care when you need it. again, we have the tools and resources available to get you there. here's where things get really personal -- when i was 12 years

old, i saw my father experienced his first heart attack. as a father myself -- i have two young boys, and i married my high-school sweetheart who plans to keep me around -- my commitment to action was to become heart healthy. my cholesterol levels are astounding even to my doctor. [applause] thank you. me, byfor them, not for all means. but i had an even better story for you. there's an individual who works in my organization who lost both her husband and mother the same year. in the following year, she drinkingin bed she -- cheap chardonnay and watching reruns of "general hospital." for lack of a better term, she was a mess when she came to us. her commitment was she would use every single one of the

programs that was available to become a better person. to date, she is off 3/4 of her medication. she has lost 50 pounds. not that age makes a difference, but she is a good 20-plus years my senior, dating a very nice gentleman who is five years my junior. [laughter] i am telling you that it works. in the end, my job was to tell you about the successes. i really want to challenge each of you to make a pledge or commitment to action to make access to health lifestyles part of your workplace or organization. if you can give me one story as good as hers, it probably would have been worth your time. thank you. >> thank you, ryan. senior vices is the president for sustainability at walmart, another company that takes health and wellness very seriously for your employees but increasingly for your customers as well.

will you talk a little bit about walmart's pledged today but also be transformed of work you have done in your company in your stores? >> as we think about how to help our customers, we spend a lot of time understanding their lives. we have about 140 million people that come into a wal-mart every week. many of these people have really complicated lives. they are on tight budgets. they have multiple jobs. they have challenges from a health perspective. when we talk to them, there were a couple of things they brought up that were real barriers to them eating healthy. for a lot of people out there, they talked about food deserts'. having a store that is too far away that you really cannot get fresh food. price was a barrier for a lot of our customers. they felt like fresh fruits and vegetables and healthier foods

were more expensive. and understanding what a healthier choice is is something that can be more complicated if you are not spending a lot of time understanding that, so we made a commitment two years ago that i'm going to talk a little bit about and one that we made recently that is kind of an extension to that. two years ago, we made a commitment that we would make healthier food more affordable and more accessible to our customers. there were five major ways we were going to do that. the first was about fruits and vegetables and price, so we committed to save our customers $1 billion a year when they bought fresh fruits and vegetables at wal-mart compared to when they would buy them anywhere else. we have been tracking that, and this is the end of our second year. for the second year in a row, we have exceeded that number. >> how have you done that? >> there's several ways we have done that -- by doubling the amount of locally sourced

produce, by decreasing waste and spending time focusing on the distribution center and our system around healthy, fresh produce, and then we have actually communicated, i think, how people can choose fruits and vegetables and use the more in their diets so we can help them get used to buying and using. if you are on a tight budget and counting every penny and you buy and have to throw something away, you do not want to buy it again. we've been working on helping them become more familiar with how to use for its and vegetables in their diets. -- fruits and vegetables in their diets. we have also worked on reformulating many of the package goods they buy, and we committed to decrease sodium by 25%, added sugar by 10%, and remove all the remaining industrial produced trans fats, so that is taking out all the partially hydrogenated oils, so we are tracking our suppliers.

we have identified the categories, and we are doing a survey, and we have back from them information on the formulation of their products so we can track what is happening from a formulation standpoint. one big initiative we undertook is a very simple icon on our private brand to help customers know what a healthier choice is. we met with a lot of external experts -- doctors, nutritional lists, members of the government, people in academia -- and we worked for two years ." a definition of "healthier in its simplest form -- and we have made it transparent and ourssible to everybody on website, but you have to include a whole grain, lean protein, low fat dairy, and you get excluded if you have too many saturated much too much sodium, too added sugar, so we made a pretty

simple definition, and we just put the icon on our private brands. we are in the process of rolling that out, and 1300 of our private brands will have this icon on the package, so when you are shopping, if you go to pasta, you will see that whole wheat pasta halves -- has the icon and white does not. when youyou navigate are really busy -- >> are you seeing a lot of purchasing patterns change? >> we are still rolling it out, but we have partnered with hunan of vitality, and they are offering their vitality healthy food, which is an initiative that they can sign up for where they get a 5% discount on the great for you items. we announced that in september, roll it out in january, and we are watching it closely. we have built 50 stores in food

deserts' that we have opened already. we have the commitment for 200 additional in the next several years, and our foundation has donated $18 million for nutrition education, for things like helping people shop, learning how to cook. all of these together -- we are two years into a five-year commitment, and we are working closely with our suppliers, our associates. they are obviously part of this. and we are working with a lot of great partners in the foundation to help on the education site of it. >> thank you. dr. david satcher, the 16th helped general of the united states, whom you also saw in the introductory video, whom i know is incredibly focused on food deserts'. one thing that might seem completely improbable to all of us sitting here is that where we are right now at the la quinta

inn is surrounded on four sides by food deserts. if you go to the usda website, you can have in an address and see if where you are fits into a food desert, and where we are is in multiple food deserts right now. 20% of low-income people who live in california do not have access to healthy foods within multiple miles of their home, not even within the one-mile circumference that we saw in the video, so we know this is a problem. in this neighborhood where we find ourselves in this state and certainly in our country. david, could you talk about your pledge and also talk about food deserts specifically because it is so sadly relevant? >> is that why it is called palm desert? >> you have to ask someone with a bit more local history. >> thank you very much, chelsea.

i was just listening to you and hoping that you would keep talking. >> maybe after you. >> let me say that first i am pleased to be part of this panel and to be part of this conference again. when i became surgeon general in 1998, after serving for almost five years as director of the cdc, i was told what they tell every new surgeon general -- "you are now the nation's doctor." outi believed it, so i set to develop a prescription for the american people. i remember that president clinton had asked me to represent the united states at a global conference on health and disease prevention, so we worked to develop this prescription just in time for that conference, and it went quite well. we stood out because there is no other country in the world that

has a surgeon general, but i just wanted to say that on this prescription, of course, using data from the cdc especially, we talked about the importance of regular physical activity, and we were very precise about the minimum. we talked about fresh fruits and smoking,s, avoiding responsible sexual behavior, and we talked about managing stress in our lives. i must say that throughout the country, during my years as surgeon general, i really pushed this prescription. later, i was asked by the world health organization to serve as a member of the commission on social determinants of health. there were 24 of us, and we went at over the world looking how social factors were impacting the help of people in the world, from india, brazil,

canada, australia -- we visited all of these places. what really became clear was our conclusion, and that is that social determinants have a far greater impact on health outcomes than health care. since that time, i have tried to integrate concerns about social determinants of health with health care. i believe very strongly in health care. it has been my career. i agree that when you look at the impact of behavior that it is very clear that behavior has a much greater impact on health outcomes than health care, but what is also clear now is that there are social factors that influence behavior. when you have communities where there is no access to fresh fruits and vegetables, where it is not safe to stand out on the

porch, let alone walk or jog in the morning, then we have to be aware of that. that has been our major concern. we have worked with communities now for three years. what we have learned is that there are major barriers to access to healthy lifestyles, but many of the solutions also are in these communities. >> can you give us a few examples? >> we have three leadership development programs. one, of course, is for physicians and public health leaders, but we have also developed community health leadership programs, so we invite churches and employers to recommend people to spend 12 weeks with us one day a week to help develop strategies for improving behavior in their communities. we have had some really interesting outcomes. more recently, especially working with parents in a community that is 80% single parents, predominantly black.

we have been able to dramatically engage parents in improving parenting, beginning with pregnancy and development of the baby in utero. we have measured the impact of not just on the children but on the parents, and one of the most striking things was when we were able to show that depression in this population was so prominent, and it dramatically decrease when they engaged in these leadership development programs. we believe that it is possible to really promote healthy lifestyles and to help transform communities. one of our graduates live in a community where it was not safe to get out and walk. what she did as a project was to engage people in that community in developing modified neighborhood watch programs. they not only watch out for each other, they actually got out into the community and walked together and did things together.

she dramatically reduced crime in that community but also made it safe to be physically active. basically, we believe that we can work with communities. there have been programs where buses have taken a fresh fruits and vegetables. chicago has demonstrated that, showing that you can use other strategies for getting fresh fruits and vegetables to people. we have a major problem, and i believe we should invest in solutions to these problems. i think the affordable care act, especially the prevention agenda, allows us to do that better than we have before. i will close with this, but i think the key word, the most important word in the affordable care act is probably "incentives." we can incentivize per mention -- prevention and health promotion. we can do a better job in our

homes and communities. our pledge is to continue to work with some of the most difficult communities in this country and to try to incentivize prevention and healthy behavior's but also to promote leadership in those environments. on thent to build beautiful work you are doing. this often pervasive idea that changing lifestyle is for affluent, educated people only, and yet you and others have shown that when the incentives are line, that can change. one of the things i forgot to mention is that it took us 16 years, but we were able to get medicare to cover our program, in part with president clinton's help along the way, and i want to publicly thank you for that. i thought it was just the medical science that would change medical practice, and i was wrong. because medicare is now covering

our program, most other companies are doing so as well, and it creates a new paradigm between health care and not just sit care by allowing the doctor to give me enchanted with medicine by practicing the kind of medicine that involves not just a doctor but dietitian, exercise physiologist, clinical psychologist, yoga and meditation teacher, a nurse working together as a team, and we find we can make medical care available at much lower cost. instead of trying to make dr. see fewer patients in less time for less income, which is driving the best doctors out of medicine, we can create a new paradigm based on the quality of care and not just the amount of care. >> that is a perfect segue into something that was frequently discussed this morning, which is --this ecosystem, government federal government, state government, local government, private companies, philanthropic organizations, school districts

-- the remarkable testimony we heard from the cut cellists superintendent giving 18,000 kids and ipad and asking for help to figure out what should go on it to a power kids over their own lives and destinies -- we heard from the coachella superintendent. what is the role of government in incentivizing companies like walmart or smaller companies to go into food deserts or supporting other parts of the hotel industry to make good decisions or encouraging other marquee events or organizations to do what you have done or to , orurage the right research david to ensure that there are safer alternatives for people to go and walk an exercise that may not be next door but are not too far away in many of our cities? what is the role of government in encouraging what ultimately, i think, are the smart business

decisions but also are the right thing to do? --i will start and say that and women call for this regularly -- women make 80% of the health care decisions. women continue to provision the home. women regulate children's lives, their screen time and are increasingly calling for physical education back in school. i think the direct answer to your question is it is necessarily going to be a partnership between local, state, and federal government, but, clearly, it is going to be in the consumer area, and my advisement to everyone on this panel is -- try to think like a woman. >> it is easier for some. >> she will be making those changes. another good example we have of women -- in the 1960's and 1970's, started by our national cholesterol education program,

our federal government and our nih -- a challenge america's mothers to reduce saturated fat in the diet. this.vid will remember women reduce our consumption -- children -- i remember. i was a child. i could not drink whole fat milk anymore. the butter went away. there was no more lard. the nation's cholesterol levels dropped 20 points, and heart disease bell at that time as well. that is my take-home message. think about women. i think we are in the driver's seat. >> any other reactions? >> i think in some cases incentives can be helpful, but in other cases, you have to understand the unintended consequences. >> what do you mean by that? to you as a company? >> anything. we spend a lot of time trying to get the right metric to get the

right progress to make sure what you want to have happen is actually happening. i will give you an example. with the labeling of trans fats, that was something that brought awareness where people were -- manufacturers all of a sudden were thinking about "if i have to report this separately, that is going to be something that people will be paying attention to, so i need to think about that. one decision that was made was you could label something as zero if it had up to one-half of a gram or 0.49 grams. i was hearing discussions about -- and if you add that to serving size and you have multiple serving size, you have not actually eliminated trans fats. i heard some people talking about how they were going to move from 0.2 grams of 0.4 grams because they could get some of the taste back, but they could still report out at 0, and that was an unintended consequence. when we came out with our

eliminating the indiana produced trans fats, we told our suppliers we do not want to see partially hydrogenated oils in the ingredient statement. that is a very simple example of and i did take consequence by how you communicate or how you think about it. something beneficial happened -- people were thinking about trans fats and working on it, but the way that it was stated, you have some unintended consequences that you have to pay attention to. >> incentives matter, but so do metrics. i want to go to the audience for questions in a moment, but i want to let david say what he wanted to say. >> i want to go to your question this morning about medical education. termse a major problem in of medical students not going into primary care even though we all agree that that is what we need. i think the answer is pretty clear -- we have not incentivize primary care.

we have been paying people to do procedures. we need to change that and incentivize primary care. i to take a while. i think we will see a change, but we have to send the right message to medical students. they come to medical school wanting to do with the country needs, but they are discouraged when they see the rewards that go to primary care as opposed to other areas. i think the government can incentivize. >> i totally agree with what you are saying. as a small example, we've been contacted by thousands of health care professionals who want to train in a program with no advertising, no pr, nothing just because they heard medicare is covering it because it is a way of creating a new paradigm of medicine where you can spend time with patients, work with these other professionals to leverage your time, to get more income for you, and because of the affordable care act where you are reimbursed not by procedure but by diagnosis, the

incentive to turn on their ears, so it makes economic sense as well as medical sense to do the right thing for your patient. have a question on the other side of the podium. could you please tell us your name. >> my name is haley thomas, and with the alliance for a healthier generation, and i have a question for ms. thomas. what your doing with wal-mart is really great, but i noticed that there are fast food restaurants in your stores. it is kind of like -- do you go for the fruits that are better for you or do you go for the kids' meals and things like that? especially for kids, i know it is a struggle. >> thanks. [applause] >> thank you, haley. in the discussions we have had with our customers, they want to ,till be able to have choices and there are occasions when they want to make a choice that is more indulgent.

what we have been focused on is making sure that they have a choice in understanding what is healthier as well, so we have been spending time trying to educate on fruits and vegetables. if you go into our stores now, we have the great for you icon on the fruits and vegetables. we talked about the health benefits, and then a simple way to pick and prepare. we are trying to make the choices that our customers make easier for them to make a healthier choice. we are not removing choices. we still sell birthday cake and ice cream so they can celebrate birthdays and things like that, but we want to make sure that they can see how to make the healthier choices. >> i live in new york city where our mayor has decided that certain choices should be more expensive than other choices and currently has a proposal pending that would eliminate from fast food restaurants, from convenience stores, from regular

restaurants and movie theaters, supercedeshere sodas. he says you can always just buy more of the smaller size that can add up to a big one. he thinks that default choice should no longer be an option. before i take another audience question, i want to take a quick poll of the panel -- how many of you believe in taxing and healthy choices or removing certain and healthy choices? taxing and healthy choices? choices?g unhealthy >> can i refrain that when your done? >> can i ask how many people think certain choices should be eliminated altogether? or do you believe people should always have choices, and the onus is on those of us who care about this issue -- hopefully all of us in this room -- to ensure that people have the right information to make the right, healthy choices for

themselves and their families? >> i think the issue -- >> sorry, quick poll. how many of you think that certain choices should be eliminated altogether? anyone? >> [indiscernible] should been i think eliminated altogether. [applause] >> good point. >> i think tobacco for children, obviously. drugs -- over the counter drugs need to be more carefully regulated. and our narcotics. -- eed to rework this >> mayor bloomberg will be so disappointed that none of you agree with his 16-ounce soda than -- but ban. david. he has one vote. >> going back to the farm bill itself -- i worked with the ceo of mcdonald's to get salads on the menu. that came from spending years

with them to do that. the problem is because of the perverse -- talk about unintended consequences -- the perverse incentives of the farm bill make the salad $6.99, and the berger is 99 cents, so if you are on fixed income, you get a lot more calories for your dollar by eating junk food because the food is not priced in the real cost. >> that is why i asked about taxation. >> we just need to remove the tax incentive on the other end. >> that is a different question. >> i have two points on the question of fast food in walmart. i remember watching an interview, and it was the ceo of burger king. at the time, they were coming out with the triple, quadruple, gonna kill you baconator. -- tody asked him consumers not want salads? don't they want a more healthy option? he says not all. he says they want a choice.

if they want a salad, they have a salad. recently,an applebee's and they have listed the caloric intake and what exactly you are eating in their restaurant. i made a change in my choice from the size of the stake i was going to eat, realizing how much more that was in it. that is where we need to make a difference. >> we had calorie labeling in new york city, and what the research has shown is that it actually is influencing the drink choices people make but not the food choices. but we only have a few years of data. >> we should just not forget that 80% of medicare expenditures are for chronic diseases that are preventable. price foring a great a healthy choices.

them byn influence taxes, i think that is a good choice. >> we have another question down here. to have millions of people that have access to the health care system in the next several years. we talked about primary-care physicians, we have to encourage more to go into primary care. what about the idea of supporting nurse practitioners as an important part of taking care and delivering health care to many people who come into the system? >> what do you think? >> i think that is critically important. in the state of california, nurse practitioners are licensed, and they can prescribe, and they serve a critically important primary care space for us because we are so under supplied for primary- care physicians, and we also are under supplied for the number of medical schools that would be needed just to serve california. i am very much in favor of it.

we rested -- recently had a a californiand as licensed physician, i voted for it. >> i agree. the committee look at the role of nurse practitioners, but it really shows what we could do by appropriately using as practitioners. it also goes back to the comment this morning about teams, and again, your question about how to better train physicians to be members of a team. if we could take a team approach to health care, we could get much more out of our system. >> hour nurse practitioners work under a physician's supervision using protocols. they did not go to medical school, but they are very competent within their scope. >> we have one last question from twitter. what is the one thing consumers can do that will make the biggest impact on their health? maybe each of you could talk about this from your own perspective. >> i think the biggest thing facing women right now -- i will

stick with my theme -- is that young women now are smoking more than their mothers. they say they are doing it for weight management purposes. >> is that true across the country? >> it is meant to be. in fact, the most common time for women to start smoking now is that first year in college. i would ask us all to become -- again, the personal is political, and we need to continue to regulate tobacco and tobacco products. it is a horrible thing. taxatione with heavy on tobacco or making tobacco illegal, illegal, -- making tobacco illegal, actually, would be fine with me. it is just crazy. from a consumer's standpoint, you have to have some relationship with your quality of life and where you are going in life, and a lifestyle includes eating right and

exercise, and that just does not happen. role models, people that you look up to, being educated about the relationship is important to allow them to make those choices. they do not grow up, unfortunately, making those choices. when we started the program, people ask why we would try to bring golf to these kids who could not afford it in these communities? what we found was they get into a program, and they start to develop role models, and suddenly, their life changes. if we can use that same formula to get kids to think about being the next tiger woods, the next roy mcelroy, and it goes across all sports -- the nba guys should be talking to kids in communities, and they do a lot, about "if you want to be like this, this is what you got to do." >> if you are not the next tiger woods, you will still grow up being a healthier person than

you would be if you did not have that relationship. >> exactly. as far as the government goes, we are looking at this stupendous cost of not changing, and we tax to help make the think we havest to have a broader vision and get aggressive about tackling this problem. i have not heard anything in the last six months on the debate about if i should pay more taxes versus if we should put an aging woman on medicare. i have not heard anything about concrete steps to change behavior, and we all recognize and everybody talks about how it is 75% or 80% of the problem. >> walk. meditate. erie love more. all those things really matter, but we need to get away from fear-based approaches or punitive approaches. we have learned through doing this for decades that when a sustainable is feeling good.

because these biological mechanisms are so dynamic, when you change your lifestyle, your brain gets more blood, you think more clearly. you can grow some of your brain -- neurons. you do not age as quickly. get moreal organs blood. those are the things that encourage the quality of life. fear of dying is not sustainable, but joy of living is. [applause] >> i really think the one thing that consumers can do differently is understand what is healthy for them. i know that the government releases a lot of information on body mass index and where you are supposed to be, but in speaking with your primary physician, you need to understand what is a healthy weight for you, what is a healthy cholesterol for you because not everybody is going to have a 5% body fat and be able to run a marathon in 5 minutes. it will not happen. to get long-term results, we need long-term changes, educating yourself on what is good for you will be the first

step. >> i think people need to think small changes and keep working at it and not get overwhelmed by the enormity of it. if you ate more fruits and vegetables, did not drink your calories, made a couple of simple choices and then made that work and then move on to the next thing, i think people would feel a little more encouraged, and it would help them take charge of their health. >> if i had only one, i think it would be physical activity. walking 30 minutes four days a week was the best prescription that he could give almost any patient, like we talked about this morning. >> even people who are overweight or obese who are physically active on a regular basis are healthier than people who are not physically active. even people who smoke and the physically active on a regular basis are often healthier than people who are not active, so i would say physical activity. >> terrific. tremendous thanks to the panelists. we did not talk about other

threats to a healthy lifestyle, which i know will come up later -- the over use of prescription drugs and the use at all of illegal drugs, guns, which clearly have been front and recent national conversation, but we did talk about so many things that might seem so quotidian but are not simple -- how to eat healthy foods, how to walk more, how to have patience, how to think positively in this changes so that it does become sustainable for yourself and your family. thank you all for all the word you are doing. thank you for joining me today. i hope you will all come back next year. thank you. [applause] the health care industry, like making patient data more accessible and sharing information between hospitals and insurance companies. former president bill clinton spoke at the event during the q&a session. this is part of the clinton

foundation's annual healthcare conference. it is about an hour. >> this conference is astonishing by mere fact of what it accomplished last year in setting the ball forward. as president clinton said, we cannot do it without a 's, privateof ngo corporations, public corporations, and government, but if anybody knows bill clinton, there are two things that he asks of everyone -- one, that people share their toys, and two, when you leave the room, you have an assignment for the following year. last year, that was his mantra, that everyone has something to do and report back. if we are going to kick the can down the road, everybody has to have an assignment. i'm going to call out chelsea clinton for a second because she and i have known each other for a gazillion years, and we have spoken about the earnestness of , and herve a full life

grandmother was one of those people who thought that everyone had a moral responsibility to make the world a little better. there is a lot of dorothy in chelsea. as chelsea tells her stories at nbc news and runs forums like this, i think it is a fair shot to say that we see a generational hand off of trying to make the world smarter, better, and more cohesive. the fact that this conference is now in its second year and is still robust is a real tribute to the president and to the extraordinary legions of people he has behind this stage who helped to pull this off. i would like to pull up my panel members. i'm not sure in what order everyone is sitting, but let's take it from here. baggett,