>> this coming wednesday marks the 50th anniversary of dr. martin luther king jr.'s assassination. and tomorrow, remarks from historian taylor branch on the legacy of dr. king. taylor branch is the author of three books detailing the civil era and he'll be speaking live tuesday from the national civil rights museum in memphis 1:00 p.m. eastern on c-span. also tomorrow, c-span's 2020 white house coverage continues with comments from ohio governor john kasich. speaking at new england college in new hampshire. that gets under way live tuesday 5:30 p.m. eastern, also on c-span. coming up next, remarks from u.s. surgeon general jerome dams on public health partnerships and the opioid epidemic. he's followed by a panel experts n with health on social determinants of health. held by the american public

health association, this is about two hours. >> that's better. i'm dr. georges benjamin, at the e director american public health association here in washington, d.c. and so i'd like to welcome all here to our national public health week celebration. we're calling healthiest nation 2030, changing our future together. our theme for this year is across the ork divide, across sectors, across in a positive way to improve the health and well being of our community. we have a couple of really exciting speakers here for you today.

follow by a will pattern. i also want to note that we have both the audience here in the an audience out there in c-span. we're really glad that that audience could be with us here today. had the honor this morning of introducing an old friend. oung man by the name of jerome adams. dr. adams is a board certified served as ogist and the indiana state health commissioner from 2014 to 2017. he has a bachelor's degree in iochemistry and physiology -- sorry, in psychology from the university of maryland in baltimore county. because my doctor went to umbc as well. master of public health degree of the university california at berkeley, and m.d. at the indiana university school of medicine. i met dr. adams when both he and

advisory n the committee for the school of public health there in indiana. adams, when he first became the health commissioner, he was really new to this. but he got to work very quickly. he had to roll up his sleeves know e some of you may that he had to deal with one of he worst h.i.v. outbreaks in the country in middle america. that opulation of people didn't think would be getting h.i.v. and it was also involved the use of opioids and other drugs. so it was a very, very outbreak.d but he worked in a really profound manner. working with the -- his then governor. governor pence. with the c.d.c., with a local health department and others to their hands around the epidemic. so dr. adams, i want to publicly

you you for the work that did on that. that was really great work. his motto as surgeon general is "better health through better think ships" so i cannot of anyone who really has better place to bring our theme for our public health week and his model single thought. so ladies and gentlemen, the 20th surgeon general of the united states, dr. jerome adams. [applause] >> thank you, sir. all right. i knew you were going to do that, georges. trying to set me up. well, good afternoon, everyone! >> good afternoon! >> you all can do better than that. good afternoon, everyone! >> good afternoon! it is fabulous to be here today. i really am excited for public health week. i was thinking about what i was weekend say to you all

long. and hopefully, i don't disappoint. we're going to do some questions end so make t the sure you all think of some good hard ones. expects this of me, we'll do some selfies but do instead of at the end because after the q&as, i don't know if you'll like me much anymore. sure we get make everyone in there. ready? say public health week. one, two, three! >> public health week. >> all right. fantastic. fantastic. chesner for ank dr. having me here and dr. benjamin. great to meet with folks who think like i think. lot about the sensible middle and that's what i'm going to touch on a little bit during the lk and i want to thank panel. i don't know why they put you all up here before i came up but here. you for being i had a great conversations with most of you all and i really

tee up a great panel discussion. i'm looking forward to it. i know you all are going to learn a lot from these individuals because they points t very different of view all looking towards the same goal. hear the theme for this year's national public health week is "changing our future together." strengthening relationships to in communities is key improving health, and i commend you all for embracing the idea of better partnerships. as your surgeon general, i want one of you to know, i want you to know that i my eve with every fiber of being that every american deserves to live a long and healthy life. unfortunately, we're falling short of that goal. know, your public health experts yourselves. life expectancy in the united states has declined for the year in a row. we were talking about kids earlier.

of two 5 mom 1/2-year-old twins. can you all believe that? and she's got one more at home. the parent of a 13, a 12 and an 8-year-old who i just left white house for the easter egg roll. so i hope they aren't causing any incidents over there at the moment. but you know what? unfortunately, both elise and i you all in this room are part of the first in the on of parents last half of century that as of right now can't tell their children they're going to outlive us. think about that. every century and generation has been able to look their kids in the eye and say you're going to live longer than me. can't say that. we can't say that. surgeon general, i'm determined not to accept that fate for my children, for elise's children or for any of our children. my vision is for a healthier and equitable america. but it can only be achieved if the way we think

about and we talk about health in this country. by now, most of you in the room are familiar with the varying h.i.v. outbreak in scott county that dr. benjamin spoke of who i'm not going to it.abor town of 4,000 people never had more than three h.i.v. cases in year.le now over 230 cases of h.i.v. all related to injection drug use. the experiences i had and the essons i learned during that h.i.v. outbreak are exactly why treasure the opportunity that has been given to me to be the surgeon general of the united states. speak at invited to large conferences and in rooms similar to, bigger than the one that i'm in today. ut i feel i truly have the biggest impact when i can help local discussions.

just as they say all politics are local, all health is local. and i personally feel we can only local meaningfully and change health when local partners come together and create local solutions. to of you all may not like hear me say this, but, you know, the folks in d.c. aren't going a white horse and save the day. there's a lot that we can do from here in d.c. lot the federal government can do and should do and must do. create e only going to that change, that meaningful, that sustainable change on a local level. want to share with you all a little bit of personal story about me that you may not have heard. of the challenging things when you're going out and giving multiple talks is that sometimes a couple of ou times and they get tired of the same old story. so we thought of a different one weekend.with you this but i think it really drives home the point of partnerships and public health week. i'm a physician, as dr. benjamin mentioned and i'm very proud of that. when most americans think about

health, they think about me in a coat. they think about prescription medications. vital signs.out but we in the public health ommunity know that the reality is health is so much more than health care. ealth care is critical but health is so much more than health care. some of you may have heard me my the story about childhood as a chronic asthmatic hich led to frequent hospitalizations as a child. the interactions i had with the care sector peaked my interest in medicine and influenced my decision to become a physician. yet, my experiences in the hospital are not what i consider my first exposure to public health. i didn't grow up in a wealthy means.by any had two school teachers for parents. them.proud of we had four kids that ballooned up at different times in varying go to in a i'll little bit. and i honestly did not realize back then. were

but we weren't well to do. let me put it that way. but i was blessed to have loving and supportive parents who cared for me throughout my childhood away little over an hour from here in rural maryland. my parents raised me to work to be humble, and also to care for those around me. one that lesson is particularly stuck with me, perhaps a little bit too much to i'll ents' liking and share that with you now. noticed a classmate that was getting picked on or a didn't r a teammate who have a parent to spend time with, or a meal to go home to, i'd invite them to come to my house. sometimes they'd stay for a meal. night.mes they'd stay the sometimes they'd stay the whole weekend. on more than one occasion, they weeks and ral sometimes for the whole summer. that those friends weren't the fully happy energetic and vibrant people

that they could be. and i saw how they would light up after a good meal. with my family. after time with a loving and laughing place, a safe place to stay. my parents would often joke and they'd t say this but say jerome is out there collecting strays and bringing them home. and my family went as far as to welcome my friend and now my brother damien who has been in foster care e system his entire life. homee brought him into our and adopted him in a much more formal manner. at the time,ize it but this experience of a youth trying to create an environment others could thrive was really my first foray into public health. wasn't involved in making drinking water safer or promoting a vaccination campaign others have g access to nutrition and interact with positive role models and

to stay, my lace family and i were addressing the social determinants of health. a good meal prevents disease and increases overall healthfulness. also increases attentiveness at school. positive adult figures as we increase resilience to the ces that we know far too many children especially children of color face. having a faith base can increase functioningd social and allow young people to grow thrive. share that story with you for two main reasons. there's two main reasons i share you. for her with first, it's an example of the we ifacetted approach that as a public health community could be engaging in for better health and moving to health for all americans. more and, perhaps noteworthy, i did it as a child and part of a family that was

above the poverty level ourselves. so yes, we need more funding. i'm not going to deny that. you'll never hear me say as a public health advocate that we more funding need and yes, we need medical expertise. we need health expertise and grounded in the science. as your surgeon general, you that we r hear me say don't need more expertise, that and n't need more studies more science. but we can have a tremendous focus less on what we don't have and focus more on partners.aging engaging everyone to realize the potential that already exists in every single community in our country. when i was health commissioner indiana, i would go out to different communities and folks would get all excited about the commissioner coming into town. same thing happens now when i'm surgeon general. and we do a big group a round table and everyone wants me to give them all the answers.

one of the things that sticks with me the most is i would go into those communities, and there would be a group sitting here like at this table. here in person sitting this seat would be working on an issue. and that person sitting in the seat right next to them would be working on an issue and they'd be in the same community and they wouldn't realize how many in that very community were all committed to and working towards the same goal. to change health already exists in our communities. we just have to be better at unleashing it. now, please, please don't misunderstand me because former president dr. jones, dr. jones is a good friend of mine and i, we have very ibrant discussions about the role of government and about health equity and at the end of consistently tell her and i think she's finally starting to agree with me that

goals and in the same in the same end. i'm not saying there isn't a place for major systemic change in our country. no matter how many youth my our y and i help during childhood, we could never change the systemic oppression and the racism that affected many of my peers. it's too big of a hurdle for any person. any one family. and in some cases, even any one community to tackle alone. but that's why i talk about better health through better because there is so many different ways we can mprove health if we commit to working across sectors in engaging new partners. i we had another discussion talked to many of the panelists earlier. you know, i talk about better health through better and even when i look in the audience, i say it and i see people nodding their heads. believes in partnering. it's easy to say. it's a whole lot harder to do. i'm going to give you some ractical tips to being better

partners and forging better partnerships. folks to yourvite table. and go to their table! meet them where they are. folks who you wouldn't necessarily think of, we had a discussion earlier, who would that for a health issue, you needed to invite the local sheriff to come and sit down and be part of that discussion? that's what we had to do in scott county, indiana. who would think that the first person you should call when health ealing with a issue is the local priest. that's usually at the end when everything else is exhausted. well, in scott county, that's hat we had to do to solve that h.i.v. outbreak that was occurring in the community. think ve got to, again, about those nontraditional partners and invite them to your table and go to their table. them that you w care. e have a great thing, nobody

cares what you know until they know that you care. i think about motivational interviewing. anybody hear about motivational interviewing? care of patients with through that one same cycle as saying well, mr. jones, we diagnosed you with diabetes. here's all the things that science says you need to do to your diabetes. here are the prescriptions for your medicine. lose weight. exercise more. all right. see ya. bye. time and time again, we see that it doesn't work. otivational interviewing is about asking mr. jones what he cares about. instead of trying to push what i jones, asking him what he cares about and then so weg areas of alignment can get there. so mr. jones, you care about being able to see your grandkids from school. you care about being able to

or run that 5k with your daughter. you care about being able to make it to that softball game or to go on that vacation. well, great. if we want to get you there, got to get your diabetes and hear things together that we can get you there. that's motivational interviewing. our responsibility as public health professionals to show communities that we care needs rather than simply trying to ram a public health message down their throats. you know, we talked about the h.i.v. outbreak in scott county, indiana. whole lot of a folks who said, dr. adams, why didn't you just go down there nd use your power as health commissioner to open up a syringe service program? i'd gone down, if there and done that, the local heriff would have set up a perimeter around the syringe service program and arrested people as they were coming in or going out. doesn't matter what the science says. he still had his legal authority

to do that. i tried to ram it down their throats, there would have been a sermon at church the next week pastor talking about how the health commissioner came in from out of ton and was the devil trying push this on their community. engage people where they are and show them that we care. and i went to that community and i didn't come down and say you need a syringe service program. know, you said, you all have a problem. tell me how you feel we should solve this problem. tell me what your community needs. and let's figure out how we can get there together. and that's how we stopped the transmission of h.i.v. in that community. number three, last tip for better engaging partners, your target audience and adjust your messaging accordingly. a great conversation at a robert wood johnson with rich few weeks ago and he and i share this commitment to be better communicators.

much, much better at the science of effective health communication. and that's not going to be all of you all focus on but it's something that think we all as public health advocates particularly during public health week need to think about. ow can we be better and more effective health communicators? just like going to another effective communication starts with knowing what land you're in and what language they speak. anyone here speak english as a second language? language another first? so we got two folks. go outside the united states, and the americans do they do?wn, what they find a person and they start talking to them in english. expect that they're going to know english. and then when they don't know the americans, what do they do? they speak louder! hey yell at them and expect that now suddenly they're going to understand what you're

saying. we do that far too often in public health. we come in and expect they're language.peak our when they don't understand it, e yell at them and call them names and expect that somehow that's going to help them come around to where we are. couple of real practical tools for you. .wo of my favorite publications one can colin woodward's the 11 american nations. cultural anthropologist and he broke down the country into 11 distinct, what he calls, calls them he nations because they are very, very different. how big and ealize how different the united states is. i told him i wouldn't tell any old stories. the problem is you all give me microphone. i'm going to tell stories and i know everyone hasn't heard this story. i apologize to the folks that heard it. i was in switzerland and i was to a with explaining bunch of people who were not from the united states, the

united states health care system. and i was given 10 minutes to do it. right?ease, so here's what i said to them. i said, you know, when you look paris, france, and berlin, cities these are two and two completely different countries. languages different and in the last great world war, they literally tried to blow each other off the planet. way, her one had their there would not be a france or a germany right now. that's how different and distinct these countries are. but when you look at the top and controversial health issues, public health issues. when you look at guns. access to ok at health care coverage, when you rights, and 's contraception and abortion, when at drug policy and harm reduction, these two places,

paris, germany, and france, that tried to wipe each planet are closer together than dallas, texas and boston, massachusetts. we truly are a country of different nations. hook.etting the so he told me i have to start wrapping up here. 11 colin woodward and "the american nations." the other publication is robert wood johnson. new way to talk about the social determinants of health. did, they polled 4,000 voters in the country and phrases, which words resonated and which ones didn't. gave your ey practical tips. used phrases like opportunity. should have the opportunity to live a long and healthy life. shouldn't be ood hazardous to your health. it gives you practical solutions to speak a language that's going resonate when you're in a different nation that may be

part of the same country. i'd be remiss if i didn't speak such a large audience about our country's opioid epidemic. aday in america, addiction is public health crisis with an estimated 2.1 million people opioid use ith an disorder. that's more than the number of americans diagnosed with cancer year.and every but only 1 in 5 with an opioid use disorder receives any treatment at all. day, we're losing a person every 12 minutes. in the time i've been on this talking to you, someone has died from an opioid overdose. think about that. i see my role as surgeon general to educate the american people about the severity of the epidemic. everyone can be part of the solution. but all of you can play a role the opioid g epidemic. and that doesn't mean you have to drop your other priorities on opioids.lely doesn't mean that at all. i'm fond of telling folks we ride the arn how to wave. and the opioid epidemic provides

a tremendous opportunity to amplify your messaging. i was in tennessee about three weeks ago. who would have thought that tennessee in the middle of the would be leading the way in terms of talking about voluntary and long action contraception. certainly i wouldn't. but they are. they're providing voluntary long contraception le in prisons to women and doing it through the lens of the opioid epidemic. notice they had some of the highest rates in the entire country. noticed that they had the highest rates of taking children away from their mothers in the to the all related opioid epidemic. and that created a wave for them o talk about long acting reversible contraception. we know that the communities ost impacted by the opioid epidemic are often the same communities that have high obesity rates. that have low graduation rates. that are affected by aces. talk are opportunities to about so much of what we as public health advocates want to of about through the lens

the opioid epidemic. and we also know that upstream interventions would help prevent mitigate not just opioid related issues but all the care about.you if i said to audiences we've een trying for years for decades to get people to pay attention not just to addiction and not just to mental health the social to determinants that exist in all communities especially communities of color. we've got a great opportunity now because folks want to talk about that. i was at a cabinet meeting just a few weeks ago and you had the of the secretary of labor. you had the head of h.u.d. you had the head of agriculture nd all these folks around talking about social determinants of health. we have a great opportunity here nd i hate to say great in the midst of tragedy but unique opportunity to really push lens health through the of the opioid epidemic if we're willing to ride that wave. i want to close by stating that every single one of you in this

room, every single one of you and i've talked to people who have been in public health for a while, talked to folks who are college right now, some of my fellow retrievers over there still in college. is a single one of you leader in your community. by the nature of you showing up today. means at you showed up that you are a leader and you have the potential to influence other people. means you have an opportunity. also means you have a responsibility to lead by example. it's imperative that all of us maximum latforms to effect. and that starts with humility and with servant leadership. couple of challenges to leave you with. challenge each and every one of you to think about one new partner that you can invite to your table and whose table you to.go whether it's the faith based community. the educational community. e have folks here from the department of ag. law enforcement community. of one new partner whose table you can go to and sit down at.

two, challenge you to stop. the next time you're about to something thatdo you know is scientifically valid, and you know will improve community health, stop. just pause. and have thesecond courage to instead ask that goals and their desires are before you start talking about yours. how them that you care before you try to show them what you know. and then finally, i challenge how you o think about effective re communicator. because at the end of the day, we know what to do. we're just plain lousy at getting people to do it. public health hasn't changed in the 20 years that i got my degree. better, don't smoke. don't do drugs. 20 those lessons were there years ago. we're just plain lousy at communicating to people what we need them to do. and it's because we don't

ecognize or we don't care that in many cases, we're in a foreign language speaking -- we're in a foreign land speaking a foreign language. my motto is better health through better partnerships area of o matter what public health you're passionate about, if you commit to forging partnerships, and being a better partner, good health is to follow. thank you, apha. thank you all of you for being here. who are joining us via webinar. bringing such a diverse group of individuals together to collaborate with one another. i hope each of you takes the opportunity even here today to find a new partner. to get to know someone. to get to know the person next to you to figure out how you able to help them and in turn they might be able to help you. t's been a pleasure to address all of you. and my best wishes for a great public health week. thank you so much. [applause]

did i run out of time for questions? little bit of time to grill me? how are you going to do it? all right, a little bit of time for questions. anyone? in the back? yes, ma'am? >> tell us all who you are, too. >> yes. ok. is it on? ok. yea. i'm carolyn and i work for the public sector services. but my background is in public health. i worked for the louisiana department of health, and also aetna medicaid. so the more i work in health care, the more the issue of housing insecurity is coming to the forefront. so you're talking about building partnerships. and i've worked on the local level and housing and health

of the road blocks, i think, is the funding and the lack of intercession of that federal level. so can you talk about that a little bit and also maybe talk hearing from 're your housing counterparts about what they need from us. >> wonderful. wonderful. thank you so much. and i'm going to step out here a little bit. things that i tell folks is we have another opportunity. no matter which side you're on r how you feel about him individually, we have a physician who is the head of the ofartment -- who is the head .u.d., department of housing and urban development. a physician. i talked to dr. ben carson. he believes that housing is health. i told you all even two years ago that we had the opportunity have a physician as head of h.u.d.? you all would say that would be fantastic! but we aren't taking advantage of him. we aren't engaging h.u.d. on a

level and on a local level as public health advocates to the degree that we could. carson believes in it. he's got initiatives out there promote housing as health. but we need to help folks nderstand, again, how to actually make that happen. and how to create healthy because individuals aren't just familiar with that. we had a in indiana, lead situation where it was a h.u.d. housing complex and once time, someone thought it was a good idea to build a housing complex on top of an old lead melting facility. and had engaged h.u.d. they had engaged public health because again, it's both ways, if we'd done a better job of that, maybe we could have avoided some of these unfortunate situations. so really, taking advantage of that. other thing is i talked about riding the wave of the opioid epidemic. one ow that the number predictor to whether or not you're going to be successful in

recovery is having permanent supportive housing. folks understand that. we have the opportunity to use the opioid epidemic to talk housing as a social determinant of health. but again, we've got to be at table. and also, really engaging folks from a business point of view. to do the things i want as from a business point of view. to of the things that i want do as surgeon general is to create a surgeon general's report in the economy. the number one thing that people vote on his jobs in the economy. the number two thing they vote on his safety, security, and health. those are typically not in the top 10. when you to create some thing that is good for health and also for lifting up the community and lifting up prosperity. then we will better be able to engage partners and not just ram it down their throats that you

need to commit to healthier housing or pay for housing but that we can show you how we can create a community that want to moveill to. everyone's talking about amazon and where they're going to take their headquarters. let's create a community where amazon says i want to come to to that community because millennials want to move there. there's streets, there's no food deserts, it's going to be a great place to bring in people and for them to be productive, for them to be prosperous but if we can do that in a back-and-forth we will be much more successful. if we approach housing and inject our public health inputs with a goal of increasing prosperity in addition to increasing housing -- being humble, i think we can be successful. great question and thank you for that. maybe time for one or two more. >> [inaudible] i'm wondering if the opioid epidemic is a good way to talk about other addictions?

louise wondered if the opioid epidemic was a good way to talk about other addictions. the short answer is absolutely. the opioid epidemic is not the problem. it's the symptom. it's a symptom of unrecognized and untreated mental health issues. my own brother is in maryland state prison and our from here because he had untreated mental health issues which he felt the need to medicate which caused and get aal $200 prison sentence. even upstream from that, at adverse childhood experience, social determinants. there's a tremendous opportunity to talk about addiction to tobacco which we know these people -- i talked to folks in one of the things i love hearing is their personal story about how they struggled with addiction and i can tell you tobacco is in so many of these. we know it can prime the rain

-- the brain for other addictions. the opportunity to talk about alcohol. let's move upstream and talk about all the other things that can be a problem and stop playing whack-a-mole. what we can do with this opioid epidemic is treat it about -- opioid epidemic. we will get our hands around it eventually and it will pop up somewhere else is something else for that on the road. if we don't did upstream so a great opportunity to talk about it. as surgeon general, i do talk about it and i plan to talk about again not just opioids but addiction. not just addiction but mental health issues. not just mental health but have adverse childhood experiences. not just resilience but social determinants and health and not just social determinants but wellness that will ultimately lead to better outcomes across the board. there may be time for one more question. >> my name is benjamin brooks, and all of unaffiliated public

-- i am an unaffiliated public health professional. call me. [laughter] i was wondering if you could talk about the role of public-private partnerships and if your office has any resources to support the development of those partnerships. dr. adams: public-private partnerships are going to be huge. they already are increasing in prominence and prevalence but we need to begin think about how we can gauge those private entities. my report on health and the economy is not about me trying to tell businesses that they need to pick up my manual. it's about me going in and saying you engage in a healthy environment, is going to be easier to recruit you. you're going to have less absenteeism showing up at work and being less productive and

have less workplace accidents. you're going to be more prosperous across the board. we just got $6 billion to respond to the opioid epidemic. is, whenever we talk to folks, nicholas it will cost so much more than that to do what we need to do. we also know that we've got congress and an american people who believe in a certain size pie and that pie made it get -- that pie may get bigger or smaller depending on who is in charge, but at the end of the day it's still going to be a finite pie and there will never be enough of that pie coming from the federal government. we've got to figure out how we work harder and not just smarter, how we engage private partners, how we engage nontraditional partners and i'm working with the military. why? seven out of 10 people in the military are ineligible because they can't pass a physical,

against me the educational requirements they had a criminal record. why don't we have dod and law enforcement and education and health all at the same table pulling their funding together and all the private groups working each of those areas trying to figure out how we can work smarter the money that we have instead of going with our head out separately to congress over and over again and making the pie bigger because my piece isn't big enough. so absolutely i believe in public-private partnerships. ma'am? >> [inaudible] i'm a student at george washington and i know a lot of students here going forward, what would be the number one piece of advice you would give us in public health? adams: as a student she

asked what would be some advice i would give you folks as they embark on their career. and this point i made earlier, i'll try to rephrase them. i would say we need to think beyond public health. we need to think about how public health needs in to the priorities of the voters. the private entities of the corporations, of the law enforcement community, of the educational community and show them how we could help them achieve their goal. focus on communication, we don't want to spend the next 20 years of your life working on an issue with your blinders on. and then re-frustrated and say i didn't really make a difference and still talking about the same thing. we can make a meaningful change if we become more effective communicators, better partners and if we become servant leaders in asking how we can serve others instead of expecting that because we've got the moral high ground and the science then everyone is going to listen to us. more practical tips, i really think it's more specific to the younger folks, take advantage of

opportunities that come your way. i did a summer at howard university in actuarial science. does anybody know what that is? it's the science of figuring out risk. it was all about math and i love math but ordinarily, you think that has nothing to do with public health. i've met tremendous people, gain ed some valuable skill sets. as long as you're increasing your net worth, learning something, it's a worthwhile endeavor. so continue to take advantage of those opportunities that come your way and continue to grow, continue to network. have your elevator speech typed. i had the privilege of being able to be at the side of the vice president the last four or five years. it's an opportunity the white house earlier this morning around the president and sit -- and folks will sit down with me in a casual setting and say,

if i had a chance to talk to president trump, this is what i'd say. then they get next to me in front of president trump and -- [laughter] when we talk about an elevator speech, that's 30 seconds. what do you want to communicate about what you're interested in, to saye you going to do who you are in an efficient manner to make the most of your opportunity? it goes back to effective communication. i would say, maybe one more lovee i go because i communicating with you all. yes, ma'am? roberts with lsu. i did get to work on aging and public health. in public health i find we can just focus a lot on young people, children, teenagers and young mothers but we can to neglect people who adversely -- who as far as we see have already gone through life.

there might be a feeling that there's nothing left we can do for them but as most of them know our population is rapidly aging. i want to get what you think public health and usually that? do to address dr. adams: that's a wonderful question. think public health to do more and there's another opportunity you have, someone who has worked in healthcare, everyone is shaking their boots about the baby boomers getting to the point where many of them are going to be retiring and leaving the workforce and they're going to be on medicare, drawing social security. there's an opportunity to bring folks to the table and talk about what we're doing to take care of individuals across the life spectrum. we have to break down the silos and bring nontraditional partners to the table. we can talk about aces, adverse experiences. the first sign of that is resilience. one of the things that having a positive adult influence. i was talking with a ivanka

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

just coincidentally by traveling around the country and seeing how different things are. i just went to school in baltimore with walls that are this thick. a the person next to me had gun, it was a direct threat to my life because it was going to come through the wall and hit me if the gun discharged. in that sense, all public health is local. just like all politics are local. in that local environments, guns were a public health care. my father-in-law who i just saw on an airplane this morning lived on a farm. and sat on his back porch and watched coyotes run across his backyard. him not having a gun is a threat to his livelihood because that's how he defends himself and his livelihood. in that local environment, he sees someone wanting to take away his gun threatening his livelihood and ultimately his life. so we need to understand that we as leaders need to foster these local conversations so that we

can again have harder policies -- have smarter policies across the board. we also need to make sure we are doing -- when we talk about public-private partnerships, we need more research we can say we need more certainty and intelligence what policies work, what policies don't and when and where they were policies work in some places but may not work and another and a great example of that is a friend service program -- is the syringe service program. i had friends in helling and san francisco wanted to tell me how to run a syringe service program -- erie,indiana indiana. i go to new york city where there's a syringe service program and anywhere else, and i can guarantee you can take the average person in new york city and they couldn't tell you where there's a service program was because not something experienced in their everyday life, even though they have got more syringes than anywhere. go to sac county indiana, you

can go to middle school and every kid can tell you where there syringe service program is. we need to make sure we are leading local conversations, coming up with local solutions and public health advocates, public health researchers, we need to make sure we're evaluating these programs in a way that allows us to then go to different communities and say this will work in your community or this won't work because i've seen it work. when i was in indiana, they didn't care what they were doing in boston. they cared what was going on in ohio. in illinois, in communities that were like their communities. to bring it back to the conversation about guns and about everything else, we need to make sure we're facilitating those local conversations that -- conversations, and that we don't go in with our own biases that because we believe something is right, or because we saw it work in one community, that's got to be the way things are going to happen in another community. what's going to happen is that community will push back, they're not going to care what you know because they don't know that you care. so thank you so much for the opportunity to address you all and i look forward to working with each and every one of you.

you're the army. i just get to stand here in the nice uniform and talk, but you are the ones who go out there and do it and i'm so thankful you're here today. i am thankful for the opportunity to serve as your surgeon general and i hope we all get a chance to talk even more in the future. so thank you to the panel. [applause] it is going to be great, it is going to be a wonderful panel and i hope you all pay close attention because i'm looking forward to it. >> another round of applause for the surgeon general. [applause] thank you. that's a stimulating speech.

we have this wonderful panel. i get to introduce the moderator. this is dr. joseph -- he is the president of the american public health association. he is a professor of public health practice and research in the carly has distinguished chair of public health, college of public health in georgia. he also serves as cochair of the department of community help a -- community health in education and department of health policy and management. he also has a masters in social a phd from the university of california berkeley and a bpa from the johns hopkins university. he's had over 33 years experience as a clinician and community advocate and public practical -- public health practitioner. joe. >> thank you.

i want to thank everybody watching or listening for coming to our panel today. i have the distinguished pleasure of introducing this phenomenal panel that you will hear about. i want to give you a little bit of background. starting with the far end, dr. wendy ellis. is the milton scholar of health policy at the milken institute school of public health and department of health policy and management. alice is the project director of building community resilience at the milken institute of public health. this is at the george washington university. this program is a space program that is aimed at building community infrastructure to promote resilience in cities and communities across the country. prior to joining george washington university she served as manager of policy at the

's office of public policy in the town hall and practiced in washington, d.c.. in 2017 ms. ellis was selected for the george fellowship for the motion of childhood well-being. a bh from the university of washington school . fromlic health and a b.a seattle university. our next panelist is the -- the associate director of education services at georgetown university. she is adjunct faculty and member of the georgetown women's and men's studies department where she teaches a class on gender violence. the morris serves on program advisory board for the

rape and insist abuse network. she -- and incest abuse network. she has worked on the victims rights amendments rights tacked -- task force. she has an m.a. from the university of nebraska at lincoln and is a licensed professional counselor in the district of columbia. ci. next analyst is cin the organization's efforts to advance health equity and reduce racial and ethnic health disparities. -- serves on the disparities the patient's outcomes institute statee foundation's advisory committee. she earned a degree from the wilson school of public health.

york j.d. from the new school of law where she was a civil rights and civil liberties fellow. the last panelist is ms. elise b. sabina. she is the national program director for the aetna foundation. foundation'sthe mission in building healthy healthyies, including cities. prior to this position she served as a program officer -- managing the integrated health care with a focus on coordination and quality. she co-authored a number of articles published in peer-reviewed journals including the american journal of public health, and archived internal medicine. theis a 2010 fellow from

kenyan institute -- keenan institute of emerging leaders. she has a bachelor of arts from the university of rochester. what we are going to do with our panel is start off with a general question. the panelists each have three to four minutes to answer the question. our first question is this. for the second year in a row, life expectancy in the united states has dropped. can you speak briefly about your work and the impact on community health and how we can turn the tide on this trend? >> i'm up? okay. my work is the building community resilience collaborative at george washington university. what we have at the heart of our work is addressing average -- adverse childhood experiences in

the context of adverse environment. the majority of us in this room understand adverse community experiences. but not every but he understands what we are talking about. they understand the lack of economic mobility. the impact of unaffordable housing. the fact that we have systemic inequities. what we try to keep the center of our work, understanding how these systemic inequities, keeping the focus on our systems, how we have done so well with regard to personal interventions, changing up behaviors. in changinggood behaviors if people go back to the same system. it is no surprise that we have declining life expectancy in our country. we have growing disparities and inequities in health outcomes,

incomes, neighborhood disparities. these are signs that -- we are in public health but are not necessarily taught dynamic systems modeling. us understanding the context in which our work is being delivered. understanding that our systems are designed perfectly for the outcome that we seek. if we see declining life expectancies, you have to ask why are our systems designed for such an outcome. it's working at that -- it has to be delivered in this design. inequality over the course of more than 200 years. eventually you will have so many people held back. the inequality goes beyond

racial disparity. that is the real example of why we have a lowering life expectancy in this country. it is not just about other people. it is about all of us. cline in metric, the de life expectancy is a great example of that. our work is really looking at working on the community, bringing the committee to the table. the community cannot affect all of the changes happening at our systems level. make sure we are setting a table that has the community voice but also has those systems operators , understanding the impact of their work in the designs we can use to address these inequities. >> thank you very much. >> good afternoon.

as was stated in my introduction, i work at georgetown university where i oversee the sexual assault and prevention of graham. -- program. we oversee domestic violence of all kinds. we work with survivors of but also doing prevention work. i would like to take a moment to highlight a couple of things. the theme has already been set for the conversation today. i have been doing this work on efficacy and activism -- advocacy and activism in this field for 18 years. my background is not in public health. it is a great example of what it means to be in spaces with one another. when you look how violence impacts community health and outcomes, it is a natural connection. i had an article i was reading recently.

coexistcal feminism with the public health issue? the short answer is, yes. it has only been in the past five to 10 years that we have really been engaged in doing prevention work and using public health models to further the conversation. we are setting the groundwork and the grassroots organizing that is needed. model makes a lot of sentence for our prevention work. for some people -- talking about how to we prevent this violence before it occurs? how are we educating in setting the tone for that? rkry quickly, in doing this wo

as a practitioner, there are some things we know that are correlated. correlated with interpersonal violence, higher incidents of eating disorders, of ptsd, of self-medicating with alcohol or drugs. whereice it's in a space we are with other practitioners who work with substance abuse issues. my colleague specializes in eating disorders. we know that may often coexist. there is that outcome around trauma that we are working at addressing. we know that being a victim of some kind of trauma around highere puts you at a rate of being victimized again. we also know the work we have done about survivors which is the prevention piece. are -- how are

we talking about a culture or society that reinforces this messaging, that is creating the violence, which can impact public health and community health in such a large way. turning the tide in that space that we see as practitioners is starting the conversation earlier. colleges are doing a great job right now of getting into the spaces that they need to be in, the conversations with the enhancements of title ix over the last seven years. more universities and campuses have been able to bulk up their prevention and mandatory conversations. time we get students when they are 18, they have experienced violence before they came to us. how are we experiencing conversations about bullying, sexual-harassment, consent,

models for healthy relationships? that is one of the frontiers for us. turning the tide and addressing the issue at it's core. >> thank you both. speaker-looking one. there. >> okay. thank you for inviting me to this discussion. it is important to be part of a public health conversation, especially coming from healthy families usa which has been focused on getting coverage for everyone for the last 30 years. our central mission is that we believe everybody in the united states should have the opportunity to have the highest possible health and the highest quality health care available. has regard to what happened with expectancy of

life, we need to break it down. it sounds gloomy and things are not necessarily as bad as it sounds overall. that is the problem with averages. it kind of clouds what is happening to the communities. there was so much media attention to this statistic. when they started digging in to what the cdc data was, the only group that saw reductions in life expectancy was white women. that, in itself, has a lot -- especially if you look at the reasons, the causes of death. being what they call diseases of despair, accident, suicide, cirrhosis from drinking. it becomes clear that there is a huge problem. thatonnection that we see

jen was just talking about. what we see in communities, communities on top of these dynamics. women are more likely to suffer problems from having downturns in the economy, unemployment, and so forth, than men. it is important to call out. life expectancy for all hispanics and for black men increased. there is something that we are doing right somewhere. for black women and white men, it stayed level. i don't want to make it sound like we are nitpicking. it is important as we are thinking about what happened in communities to understand exactly what is this burden of negative health outcomes. putting that aside, we are seeing disparities, racial

disparities, reducing. we are also seeing that african-americans still have -- despite these changes and trends among white people, african-americans have a much lower life of expectancy and exposure to chronic diseases, etc. we understand that coverage -- it is in our dna. you need to have health insurance in this country. it was designed for this. we can have debates about universal health care or whatever, but in this country having insurance whether it is government or private insurance is the entryway to get the health care that you need. that includes health care like mental health, all of those treatments and prevention services to stay healthy. we understand that is barely the tip of the iceberg.

inside of a happen doctor's office or a clinic. health happens in communities. part of the ships now is figuring out how do we change the way that health care is paid for so that things that are valuable to individuals in particular communities are supported. health care is the biggest sector of our economy. there are a lot of resources that could be better invested in things like housing or community health workers. because they can speak the native to the country like the surgeon general was talking about and make that connection. we can use what is in the health care section right now and much better ways from a public health perspective that you understand in terms of prevention.

we also just know that it will work better. where a lot of communities are struggling is where they can't connect to this health care system. thatecessarily resources provide the best care at the right time. >> thank you very much. >> these are really good points. if we unpacked the life expectancy statement of bit more and take a broader look at it, we know based on the research that your zip code is a greater predictor of your life expectancy than your genetic code. we use thatation statement. it is about building healthy communities. it touches on what you are saying. we support local organizations

and local partnerships to address the underlying determinants. signatures are cultivating the healthy community grant program which is accepting applications. and how we are challenging partnerships to look outside the partnership space to addressed one of five domains that focus on the social determinants being community safety, environmental exposure, social and economic factors and healthy behaviors. what we're seeing with this program, this is motivational interviewing for communities at the community level. these excitinged

solutions because they are focusing on what the communities feel are important to them. we work on the social determinants for the broad domains but what is important to you? we are seeing examples of success. in denville, virginia there putting in place effective policies to address the obesity academic -- epidemic. that turning the tide on the life expectancy issue is going to take leadership. leadership that is committed to addressing health equity in the social determinants that continue to this disparity. >> thank you for everybody's

answer and a reminder for the audience. fewill have a chance for a questions at the end of the panel so think about what you might want to ask to everyone. question, and this is a general question for the panel. you can chime in anywhere that you feel comfortable. we in public health are looking to achieve our healthiest nation in 2030 which means making a moverted effort to upstream to focus on prevention which is something that you all brought up. the focus that you have on is a messageention that matches what you are trying to accomplish. we do this in other ways of the systems level but also at the ground level and recognizing

that these diverse outcomes are critical. for the panel what do you think is important to achieve this what aret nation and your priorities if you have the chance to put together your priorities? anybody can start. >> today is the first day of mth w, i believe mental health was the theme. i will say that mental health matters. adverseis steeped in childhood experiences that we know to have a longitudinal impact on development. youaking the trauma lends automatically become multigenerational.

you're not just going to address the child exposure. you have to think about that in the context of their family and their community. forefront that at the you'll get to these other chronic diseases that we have discussed ad nauseam. and really begin to think about it from a public standpoint. whatse you're looking at is universal -- if you are steeped in the data, you understand that this is an american public health issue. our populationf has one, but we recognize there is a differential outcomes. have two aces in

this last wave of data, but depending on the community you're in and the supports your outcome will be different. i would say that the second priority in thinking about this from a trauma perspective is the importance of cross sector collaboration. we all heard about public health 3.0, but i think this is the opportunity for us to think about how do we as leaders bring together these other sectors. we hold a lot of data. powerful, but so are the data that come from other sectors as well as the community itself. a lot of that qualitative data that we overlook is telling. if we have two priorities, taking more of a trauma lends to

understand and appreciate the impact of these early adversities across the lifespan than truly enacting and putting into action the public health ones so that we are the bringing together multiple sectors and are truly collaborating. very brief. one is the trauma lends being so critical. with the work that i do come of the movement has been very in order to grow and change there needs to be a proactive one. so how are we not just talking about how to identify problematic or abusive relationships, and how are we providing models for healthy relationships. those are the pieces the need to

start early and often. the other piece is a mental health practitioner is removing stigma and recognizing that support looks different for different communities. but having just one model of health but engaging into these whats, understanding community needs are. boringll say something witches, we need to make sure everybody in this country has health insurance. thewon't be able to access hell think -- the counseling or the preventative care and thus you have the golden ticket of health insurance. we have to remember that health insurance is like a cell phone. it is only as good as the network it is on.

correct services are not available or culturally competent. number two.e to there are estimates that one third of health care spending is wasteful or duplicative. we also don't have enough people getting the right health care at the right time. we need to figure out what is happening right now, changing the way we pay health care to make sure we're taking what is a deep pocket, health care system funding and find ways to divert at least some of it and push it into the needs of communities. you're investing in the community when it is done right. it has all sorts of economic spillover effects.

they are a key where you can divert some of that money and push it into someone's home if what they need is something for their asthmatic child. it's about resources. resources are not an accident. o helpstem is designed t the problems that they have. they are under-resourced. we need to figure out how to use these resources and divert them into the communities that need them the most in concrete ways. is really about pushing out the message that will help. starting at the community level and addressing the issues. we are creating these healthy community agendas, involving the

leadership to create these agendas. this work has already started at the local level. it is up to us to shine a spotlight on it and put it out there. as a public health workforce, we can do that. from where we sit, that is a critical piece. the bestolks what are practices and how can we replicate those across the nation? >> we have a few minutes on this question. i will ask the panelists to react. to do something that we try to avoid in public health which is eight solutions -- a solution for complex problems. i will ask you to provide as simply and is concretely as you can to address this question. what can we do in a specific way

to have these outcomes? >> i thought a lot this before so i guess i am cheating. i believe if we get to a place whoe every single person once to have a community advocate or promotora, or whatever flavor of what you need, is available to help the health care system that you live in so you can make a better life for yourself, that will be central in making sure there is ,his ability, this agency whether you are a young mom, whether you're just getting out of prison or incarceration, whether you have a disease, or are dealing with addictions -- you need someone who understands your language, your culture, your social context, to help you

on that path. if we haven't funded and integrated, we could be so many miles ahead of where we are now. >> that was not cheating. that was excellent. >> i want to add to what you are saying. what is missing from his integrative piece is this facilitation of work. and blends into the funds across these sectors. health care is such a small portion of solving all of our problems. it is 20% versus 80% of what is happening in the community. conversationthis to get to just focusing on the delivery of public health and health care without regarding the other elements that are so important to supporting health and the well-being of our communities. the key word she used his integration. the solution is right there.

how are we integrating so that those promotoras, those health care workers, those navigators, can actually be rewarded. that these are not volunteer positions. right now we don't have a systematic way of doing that. you are talking about whether that is incentivizing it from an aetna or our other providers. how are we incentivizing the system you described? that is getting back to the systems issue. i think public health has that role in driving the conversation. >> we, at the american public health association, have an active set of groups working specifically on this point of integration across multiple sectors. >> it is about paying, making sure those resources are there. that is one of our big problems,

physically helping advocates from across the country think about how they can leverage medicaid funding to help pay for community health workers. please get on our website. we have a project focused on laying out all the pathways to get some medicaid money. we have to start somewhere. for the populations we really care about, it is medicaid where we have to start. >> i will sound like a broken record by the end of today. my life before doing the work i did -- i was an educator. i go back to, we are not immersing and having these conversations and highlighting them as a priority in early education and elementary school. at the university level there is a lot that can be done, but there is more that can be done if we show that this is a

priority. i understand there isn't much space in the day for that, but having intentional curriculum that builds on itself around public health issues, violence, resources -- all of those pieces , getting all of those people to create that. some school systems already do this. right now it is dependent on where somebody goes to school, their zip code. having something that sends a that funding this is not only the priority but giving of the time and attention it needs. >> what you are talking about is value. tapping into the value statement. there are plenty of districts across the country, want to shout out to a town in withylvania, they started

the value of understanding early intervention. they started in the school. it became a whole community movement. when we are talking about what alue, various sectors v that is what we can cap into. -- tap into. following up on what you said about valuing time, one of the things we forget about when addressing social determinants is the business community. in kansas city, where i had the opportunity to do some work, they had a whole adverse childhood experiences and resilience movement driven by the chamber of commerce. we know that if they don't address that they will not have a healthy workforce. cannot track and retain businesses. driving the value statement we can message to these multiple sectors. >> let me move forward a little

bit and keep you on mic. we will move for everybody to submit the questions specifically that we want to ask the panelists. i will start with you. to continue on what you are talking about. we havetion i have is, multiple communities experiencing various types of adverse events, flint, michigan, houston texas, etc.. how can these communities prepare for these events and the resilience afterward? >> you're talking about flint, which was an infrastructure adversity, puerto rico was a natural disaster. that was a different type of shock. before i get into it, i want to make sure i do a level set when we talk about resilience. we had the surgeon general speak about it, you have me talk about it. resilience is a great word. when we talk about resilience,

i'm not applying a term which come from physics to the human spirit. if you understand what it means, it is really talking about the ability for an object to retain shape after receiving a shock. if we are talking about applying the term resilience to our communities, i do not want anybody to walk away from this we are merelythat wanting to help communities bounce back to what we already recognized were levels of inequity. when i talk about resilience, community resilience in particular, we are also looking at the ability to discover some of these acute shocks, but the ability to spring forward. that is the piece of this. when you are talking about how

to help communities bounce back, there is a cute shock, but -- acute shock, but we also have to recognize there is chronic adversity. the every day drip drip of disaster that every day folks are merely bouncing back from. we need at the system level the supports and buffers to help with the move forward. that is what we are talking about with coordinated education systems. coordination between our court systems. manyrajectory for too children are going from inadequate school systems straight into juvenile detention systems. we know what happens from that point forward. there has to be some other means by which we are providing support. that is what we are thinking about when we work in building community resilience work. how are you putting the resilience in a system so that

information is flowing, so that supports are in place, so when you have the one in a million, 100 year storm that happens every 10 years, when you have these disasters that are shocks to the system, of course you will spot and bounce back because you have already put in place, on the day-to-day basis, the supports that are helping people move forward and preventing the university that we see now. here.ant to move the next question, the same amount of time. in the wake of the me too movement, the topics of sexual assault, violence, and prevention have come to the fore. what is happening on college campuses around this issue? what are the ways to do best practices? thatthink that we know

campuses have been great spaces for activism. i always like to share that the reason my office exists, my isition, and my colleagues, because of student activism on our campus saying this is what is needed and really finding ways to make that happen. activism has always been essential -- a central part of campuses. with me too we have also been able to rise and have conversations about how do we amplify voices, narratives, and stories and how do we recognize which stories are missing? what we are seeing more now, we hope, is what i call intersectional activism. understanding that me too, and talking about narratives of sexual violence, for those who find that safe to share, is not something that operates by

itself, without partnering with and working with groups working on racial justice, disability justice, lgbtq rights. recognizing that having all of those forms of activism in the same space at the table, not taking over, not co-opting, which we know has been done within feminism, saying, how do we amplify the narratives and how do we support communities in different spaces who are experiencing higher levels of violence, ways to seek support, to make official reports for good reasons. that is something we are seeing rise out of me to, the ability the ability to take a hard look and see what does it look like to be intersectional? what does it look like to share spaces and not co-opt other

people's narratives, i have an activist for this, you are an activist for this. the doesn't get us to the outcome we're hoping for. with the enhancement of title ix, more universities are seeing more broad requirements for education. the biggest piece for that is that it is intentional. we can say, take an online course, check the box and register next semester. really saying, how do something build? they have to do an online program before they come. they have to do in person programs. understanding that the online program in my mind is a way for us to say this is something that the university takes seriously. these are topics we value and these are things that we can talk about while here. when they come to campus, how

are we building on that? how are we not stopping in october their first year in college and what are the ways to access students? one of the things that has been really successful is a program as health professionals go to academic spaces. i a health professional, might get invited into a professor's lecture around english to talk about something they just read to connect it to my work and their community so that they know what resources are available and think about how to realize the application and bring the topic into an academic space. my colleague reading about eating disorders might go to a math class where they talk about bmi. they are also having conversations about nutrition, eating disorders, support, services.

we havegrams like that, found spaces to bring health issues into spaces where students may not self select otherwise, to come in and hear a program or learn more. mr. telfair: thank you. continue on, ms. hernandez-cancio. with things you discussed already, recently, as you know, there's been some attempts of rolling back protections related act, andfordable care several states have begun to test the boundaries of aca with modified rules, what do you stateof the ramifications , levels before changes themselves and, of course, the outcomes which you discuss so much? >> since we are in a panel, i do feel like i have to touch a bit on what has been said. thek you for bringing up

puerto rican woman, as a puerto rican with mother-in-law who didn't have electricity for five and a half months and making sure that puerto rico is not forgotten is really important. i'm grateful for that. they have to bounce back beyond what the hurricane did. that was a disaster, but the real disaster, before the hurricane that made them vulnerable, the health crisis that is there now, and also it makes sense. thank you. i'm grateful that you also mentioned intersection elegy. even in the me too movement, understood that way before white actresses were tweeting me too, tarana burke, an african-american woman, started working with young african-american women on issues of domestic violence and about me too seven or eight years before, but when "time" magazine

made the cover, she was not on that cover. and that's where i have to take my hats off to the kids in parkland, who have been very intentional about pointing out, oh, yeah, you care about us now because we are relatable to you, but the black lives matter young people have been talking about violence in their neighborhood and gun issues for a long time, yet, you didn't give them the time of day. on the contrary, you even tried to demonize them. i'm really happy to have this kind of conversation in a space like this. as far as what's happening with the affordable care act, one thing that is important to understand is that until last year we have never had more people with health insurance in this country, ever. it is thanks to the affordable care act. in fact, one thing that people didn't know, didn't get a lot of attention, is that for the first time black children and white , children were equally likely to have health insurance. there was no disparity in health coverage between black children and white children. that is enormous.

right nowe are seeing is an administration, because they were unable, through , to dismantle, through ideological reasons, the affordable care act, they are now in this big campaign to basically sabotage the affordable care act through actions by the administration . think there are two really salient examples that affect what decisions are being made. one is the waiver process, basically they're using the ability for trying to get changes in how medicaid is implemented under states to do what -- at the end of the day, it will do bad things for consumers. one of the most salient ones is requiring work requirements for people on medicaid. they say it's about, well, being employed is a social determinant of health, we want to encourage that. but that is not what this is about. it's about making it harder for

certain people to be able to keep their medicaid. right now, we know that the authority -- majority of adults on medicaid actually work or have somebody in their family that works. it's really about cutting the program. their whole list of other things that they are doing to medicaid programs, some states are taking advantage of to basically cut how much they are spending on health care for their constituents rather than improve health care for them. the other issue is these junk plans that will now be allowed. incidentally, there is a regulation you can comment on until april 23. there is an opportunity to send a note saying this is a terrible letting mores plans exist that do not have the consumer protections that were set up under the affordable care act. you could be that have a temporary plan for three months, but now it could be one

youshy of the year, and will not have protections against pre-existing conditions, or the support to make sure you are getting high-quality care. you're not going to have the ability to make sure they don't take it off because you got sick. you're not going to have all sorts of protections that changed people's ability to get the care they needed. i also want to point out that the states are doing positive things, too, because i don't like being just gloomy too. mr. telfair: that's helpful. [laughter] ms. hernandez-cancio and let me : be clear, there's still opportunity, it's gloomy but still a lot of opportunity to raise voices about how unacceptable. if you want more information about how to do that, go to families usa website. but there are examples of things that are positive, of states even in theing to, context of what's going on right now, trying to improve access to health care. one example is in new mexico. they passed a state legislature they call it memorial, a

, resolution to investigate letting people buy into medicaid with their own money. like using their money and the premium tax credits and all of that to buy into the existing program, which right now in new mexico is something over 80% of providers actually accept, medicaid. it is one option actually helping and trying to figure out how to get more people good, quality coverage. the other thing is what's happening in maryland, they are trying to figure out, now that they are not implementing the penalty for not having insurance, the state is trying to figure out how to have their own system to encourage insurance. instead of the penalty, that money is a down payment into helping pay for insurance that works for them. there are interesting things happening as well. mr. telfair: thank you. we appreciate strength as well. talking about strength as well. less set of questions. ms. sabina. the aetna foundation along with u.s. news and world report just

released healthy community index , and as you know, there are a number of these indexes. can you talk about the level of contribution your index will particularly as we work towards finding best practices? ms. sabina: absolutely. we like to think of it not so much as an index or ranking, but more as a tool. it really gives communities, provides every community out there, with information on how they are doing. put in your information and you can see how the community is doing. it is different because it compares community counties across the country, not just within the state, and it is also the first to adopt the measurement framework for community health and well-being that was developed by the

national committee on vital and health statistics. it includes measures like equity, which is a new ranking, as well as infrastructure and housing, and all the important factors in what makes a healthy community. one other important thing is that u.s. news has presented the -- peerp regrouping's groupings, taking into account economic population density as well. what we are hoping to accomplish with the healthiest communities project is to give the communities data so that they can understand how they're doing, what the opportunities are for improvement, and also to inspire change by showcasing the best practices that are out there across the country. our goal is not just to recognize the folks that are make significant improvements,

in also to inspire change how communities look at health, how they pursue improvements in health by looking at all these broad determinants and categories that it is based on. while no two communities are the same, we feel there are lessons to be learned by what's already happening. we believe this project will shed a spotlight on what people are doing well so others can use those lessons. again, it's a tool, it is something for citizens and policymakers and local leaders to use to assess the health of their communities, but also to use as they develop blueprints for change moving forward. mr. telfair: all right. measureo allow us to both challenges and successes and to share them both. excellent, excellent. so that is the individual panel about --, so we have

how much time? we have about 20 minutes or so to entertain questions actually from the persons that are here as well as from the panel. so what we will do to be fair is that, due we have any webcast questions that we know of? ok. not seeing any. let's start here with the in person questions. we need you to have the mic. and welcome, by the way. good to see you. >> great to be here. thank you very much for this terrific discussion. i'm from the university of maryland pharmacy -- [inaudible] it seems that nowhere -- hello?

[laughter] mr. telfair: we could trade mics. trade mics with you. >> hello. oh, yes. well, thank you for a terrific discussion. i am from the university of maryland school of pharmacy, behavioral health program. it seems that no where is the issue more compelling than among the newborns, at least to me, because it is the intergenerational problem. thanps no more compelling during addiction, at least in my field. from our work, at least, that there are many barriers. some of them really having to do -- definitely would access and ,ocial determinants of health definitely with potential misunderstandings about the treatment -- but compellingly,

fear of losing custody of the newborn, which depends on social services. yes, we have all those sectors available to help. how can we best utilize and leverage the services that we have in social services perhaps , perhaps in maternal and child care, perhaps in communities? i would love to hear from the panel. can answer, anybody but we will try and keep the answer to about one minute. >> i have a very specific example from the phd program from our partners in portland. this was brought together by portland public schools, kaiser permanente, concordia university, the health care provider within the school, and several other providers. what they've done is recognized the fact that, you know, particularly for people that are in that situation where, you know, crossing that bridge between maternal health and

child health, and then the social services bridge, where all are working in different silos. how do we work in this community care team? using the school as a hub , they have actually done that. they have health care based in the school. they have the social services through the trauma informed practices that are happening within the school for the school staff to have been trained, as well as behavioral health services that are not just there for the students, but also the teachers. let's face it. a lot of our teachers are living on the front lines of community adversity, but also if there is adversity being suffered and felt widespread in the school, they are also getting secondary trauma. carenk that's a real great practice example of how you can bring these various sectors together to have better communication and coordination. of course, the one problem that still exists is how do we knit the resources together?

please don't have very much policy issues with regards to sharing of data and information, and also resources and revenue in order to best serve our families and communities. mr. telfair: thank you. anyone else? >> i guess i will put my lawyer had on and say that all of what you are saying is true, but it doesn't get to the issue of, if you think that coming clean and -- getto give services services is trying to put you on the map of child services, that is a huge disincentive. of a lot ofcal communities, not feeling government entities are there to help them, but are there to basically regulate them, lock them up, take away their kids. that is more than stigma. that is a huge cliff to have to climb. take sadly, is going to law enforcement and the legal system to decide that it is

something they need to work on. maybe the way drug courts were created at one way, recognizing that incarceration was not the solution, maybe that's what needs to happen. whether it's some kind of outside family court situation. everything can be perfectly aligned, and if you don't get to the piece of the punitive nature of addressing these issues, it will not make a difference for a lot of people. >> i was remiss and adding the fact that moment county's juvenile court system was also part of this, informed movement. is also another example where they have done the trauma transformation of the court system and social service systems. i think you are right. you have to have law enforcement involved, but also you have to have community members engaged to inform the conversation so

they are understanding how these different determinants and exposures manifest themselves in a family. mr. telfair: so what both of you are saying is that we actually have great things in place but to be effective, the bottom line is trust. >> yes. mr. telfair: all right, another question from the audience. ok. we will have one here. >> so we do actually have a question from twitter. it's from the university of kentucky, their public health program. "what advice would you give us as future doctors to help create a healthier future for children in regards to obesity?" mr. telfair: anyone? maybe you want to say a word or two. >> i have a short answer and a more complex answer.

i have had the joy and privilege of working with a lot of young thate in health policy went on to become doctors. the most important thing you can do is get out of the office. once you're a doctor, get out of the office, get involved. the power of your white coat in terms of talking to decision-makers and deciding who gets what and when is enormous. if you can figure out a way to continue to be engaged in health policy and public health issues once you're a doctor, that is enormously useful, especially if you are on top of that, from a community dealing with disadvantages. answer that is very simple, we need to push the -- breast-feeding. at the end of the day, i know a lot of foundations are focusing on that, but there is such good evidence about the long-term

first -- whatt of do they call them in kellogg's? first foods, or something like that, and having long-term health benefits, including the prevention of obesity, and there are so many stupid barriers that can be eliminated and a lot of work that can be done on a one-to-one cultural level to bring the numbers up. ms. ellis: can i just add to that? we also need to remove barriers because we don't have equity in people's abilities to breast-feed. sayof the things i want to with regard to the question that mentor onis that my the project, and he will kill me if he hears me refer to him as a world expert on obesity, but one of the things that brought into the fold around adverse experiences, because he is an

md, this understanding of the intersection between adversity, mental health, and people with obesity. i would say for a young physician, someone who is training, to really begin to look beyond just the diagnoses and have that conversation and understand what is really going on. is a trauma informed conversation of not just what is wrong with you, but what has really happened to you, what is happening in real time, to unpack not just the sources of obesity, but the sources underlying that disease. mr. telfair: thank you. makes sense. also in the social worker arena, if i can bring social work into this, we have the push and pull of the context. remember that part of the work that can be done very effectively is understanding the context in which the persons that you're dealing live and in those factors that push against, all the factors that pull against, whether or not you're supporting those. i agree 100%, we need to

push back against the diagnoses itself and create opportunities. ok, next, we have another -- yes, ma'am. >> hi, hello. my name is samantha mendoza, the -- i am an intern for united nations foundation. my question is geared toward ms. sabina. you said we have to push the idea that all health is local. i'm wondering what we can do as nation to make sure that the community health programs are being formed in all communities instead of the ones that could have the resources for it? ms. sabina: that's a good question. you know, i think -- i think it's going to start where the people are. i think what we need to do is give folks the resources. it might not just be financial resources, it might be -- what i was talking about before, the tools, the information, the data, something to catalyze, something to start the conversation, bringing people

around the table. that has power in itself. then when you get folks talking, they start feeding off of each other, you're connected here, you have business resources, you have that resource, and the power of partnership does come about. we tend to get hung up on financial resources and for good reason, i get it, absolutely, but i think there's power in every community. i think the hard part and what is our challenge is figuring out how to get everyone to be around the table. that's where i would start. mr. telfair: thank you. i think we have one more question. let's the hands have been going over here, but let's take the one from the very back, if we can. thank you. my name is kelsey and my two peskyfrom experiences, one as a student,

we talk a lot about theories and ways to conceptualize what communities are feeling, and as a practitioner, we use a lot of data. i'm wondering how do we, as an industry, move away from talking about the community as an object, and talk about how we are the community, we might have ptsd, we might have people in the room who have broken windows . that's why they are in the industry. the question is how do we create a more inclusive workforce beyond community health workers, how do we make sure that they are equitably paid, there are real pathways, and we include people meaningfully within the conversations? mr. telfair: thank you. excellent conversation in question. ms. ellis: with our project, one of the things that we made conscious is trying to build the bridge between health care and our other systems with communities not, you know, the other way around, thinking about pulling community into the conversation, but really pulling our systems into the

conversation that's already occurring at the community level. one of the things that we talk about is the fact that, because in public health and across sectors, we're very good at collecting data and identifying priorities based upon the analysis of our own data and , and then putting that upon communities and saying these are the priorities based on our analyses, so what we try to do is saying, that's great you have , the system indicators, but i really think what you need to do is have the conversation because the community has its own data . the data is just as valuable and sometimes it's a little more precise than what you have collecting it from the systems level. really understanding that at the heart of all of this work is data, but there are no stories without data, and no data without stories. so, again, that brings in the community narrative and actually having community having the input. with regard to your set -- question, when you're talking about the service delivery or you're talking about program

delivery, if you don't have individuals with lived experience -- that doesn't necessarily mean you have to have ptsd yourself to be but you have to really understand exactly the context in which your treatment or your program is being have a realnd relationship with the people you actually serving. if your program doesn't reflect the community of which you serve, we are only compounding the problem. we will keep making the same mistakes. it is just like you are weaving a cloth. you wouldn't think about making a red dress and never having thread put -- red right?, is that obvious. if you want to create this tapestry, it is much stronger tensile of the thread and how dense the weaving

is. when you have the individuals that are coming from the community, that makes a much more richer tapestry, a much stronger fabric of which is going to carry and hold the community. mr. telfair: thank you, ms. ellis. one thing, given your neck of the woods, i'm guessing that there are a lot of persons who themselves have taken on that role of what you're speaking but i think the other challenge if , if i'm hearing you correctly, is -- we have a minute, so let me just make it real quick. so the other challenge is that health, we have people who really want to work in it, but it boils down to, how can they support themselves? how can they find the means to continue? s. schweer: in terms of the work? thetelfair: doing the work, reality of having to make a living and do it or things. is that part of what you're asking about?

>> i think more about how do we as an industry become more inclusive? we often talk about broken windows. people in the room did not grow up with broken windows. how did we change our language and framework to be more inclusive? schweer: this really resonated, when wendy was saying this earlier, it is so important for us -- for example, a specific example on our campus. we go into spaces that have greetings and things that already exist, meetings already happening, maybe within the lgbtq resource center, and going in and not assuming we understand sexual violence and here is what the data says about communities that experience at higher rates. that doesn't work. the qualitative piece is so critical. because if we are only looking at quantitative data, for example, i believe there's one research study that has been done around survivors who identify as deaf or hard of hearing. yet, we know in qualitative

data, in conversations within communities, that those experiences are occurring at high rates. how are we? merging all of those pieces? one of the things i do as an educator and trainer who works specifically around interpersonal violence, i set the tone when i go into every space and name it, and saying, how are we cognizant of people in the room who have experienced this? we come from different lenses, but we are making -- naming the space in the room. it's easy to other conversations, right, and say people who experience violence have lived with broken windows, but to say we know that there are people in the community and spaces who have experienced that so let's have a conversation keeping that in mind. mr. telfair: i apologize, our time is up. i know given the panel, they have a lot more to say, but we have to cut it off there. i apologize for those who have more questions. but i do want everyone to thank the panel, please.

[applause] normally, we would have a wrapup, but we are a little short of time.i will turn it over to our director, dr. georges benjamin, with a few final comments. i want to give my personal thanks to everyone who participated, either on the that, you in the audience, this is a great honor for us to have you here and we hope you can make a difference moving forward, not just this week, but making public health week every week. thank you. [applause] benjamin: for the slide we have with national public health week, you can also go to the national public health week website. we have lots of tools and resources. if you go to the last slide, i also want to thank the aetna foundation for their strong support for this forum, and

invite everyone to the reception to follow immediately afterwards. thank you very much. [applause] >> c-span, where history unfolds daily. in 1979, c-span was created as a public service by america's cable television companies. today, we continue to bring you unfiltered coverage of congress, the white house, the supreme court, and public policy events in washington dc and around the country. c-span is brought to you by your cable or satellite provider.

>> next, remarks from the wells .argo ceo and we will look back at the aiswold v. connecticut case, challenge to the law that criminalized the use of breath control, at 9:00 eastern. nouncer: wednesday morning, we are in helena, montana, for the next stop on the 50 capital store. -- capitals tour. bus,ll have a guest on the during washington journal. next, the wells fargo ceo talks about the rebuilding efforts of the company after it was sanctioned for mishandling auto insurance and mortgage fees. he was also criticized by senator elizabeth moran last month over his pay increase. he sat down for an interview at the oi