then we talk about the future of u.s.-china relations. be sure to watch washington journal, live at 7:00 eastern this morning. join the discussion. from surgeonrks general on public health partnerships and the opioid epidemic. he is followed by a panel discussion with health officials on social determinants of health. the american public health association hosted this to our event. -- 2 hour event.

>> good afternoon, everyone. i would like to welcome everybody here to our national health week celebration. we are changing our future together. is howme for this year we can work across divides, across sectors, across groups to ay toin a positive w improve the health and well-being of our community. we have exciting speakers for you today. that will be followed by a pattern. we have both at the audience here in the room and an audience out there in c-span. we are really glad that audience could be here with us as well today. i had the honor this morning of introducing an old friend. a younger man by the name of jerome adams.

dr. adams is a board-certified anesthesiologist and served as the indiana state health commissioner from 2014-2017. he has a bachelors degree in fromemistry and psychology the university of maryland, baltimore county. i like that, because my daughter went to you nbc as well -- umbc as well. i met dr. adams when both he and i served on the advisory committee for the fairbanks school of public health in indiana. , 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, because some of you know that he had to deal with one of the worst hiv outbreaks in the middle america, and

a population that people did not think would be getting hiv. it was also involved with the use of opioids and other drugs, so it was a very complicated outbreak. thenorked with his governor, governor pence with the cdc, with the local health departments and others to get their hands around the epidemic. dr. adams, i just want to publicly thank you on the work that you did with that. his model as surgeon general is better health through better partnerships. i cannot think of anyone who has a better place to bring the theme for our public health week and his motto together as a single thought. so ladies and gentlemen, the 20th surgeon general of the united states, dr. jerome adams.

[applause] dr. adams: thank you, sir. i knew you were going to do that, you try to set me up. good afternoon, everyone. >> good afternoon. dr. adams: you all can do better than that. it is fabulous to be here today. i really am excited for public health week. i was thinking about what i was going to say to you all weekend long. hopefully i do not disappoint. we are going to do some questions and answers at the end , some actually think of some good, hard at once. where going to do some selfies -- we are going to do some selfies at the beginning, because after the q and a i'm not sure you will like me very much. say public health week.

one-to-three. fornt to thank the doctor having me here and dr. benjamin. it has just been great to meet with folks who think like i think. we talked a lot about the sensible metal -- middle. i want to thank the panel. thank you for being here. i have great conversations with most of you all and every hope to tee up a great panel discussion. i am really looking forward to it. i know you are all going to learn a lot from these individuals, because they represent all different points of view looking towards the same goal. i'm so glad to hear that the theme for this week's -- this year's national public health week is doing it together. withgthening relationships

communities is key to strengthening health. i thank you all for embracing the idea of better partnerships. as your surgeon general i want each and everyone of you to know that i believe with every fiber of my being that every american deserves to live a longer and healthy life. unfortunately we are falling short of that goal. as many of you know, life expectancy in the united states has declined for the second year in a row. lisa and i were talking about it earlier. twins and mom to 2 she has got one more at home. i am the parent of three children who are just left over at the white house for the easter egg role. but you know what? inh of us and several of you this room are a part of the first generation of parents and

the last half-century who as of right now cannot tell bill children -- tell their children that they are going to outlive us. think about that. right now we cannot say that. we cannot say that our children are going to live longer than us. as the surgeon general i am determined not to except that fate for any of our children -- fate for any of our children. need to reframe the way that we think about and talk about health in this country. by now most of you in the room are familiar with the hiv outbreak and scott county -- in scott county that was mentioned. now there are over 230 cases of

hiv all related to injection drug use. the experience is that i had done that hiv outbreak are exactly why i treasure the opportunity that has been given to me to be the surgeon general of the united states. to speak atnvited large conferences and rooms similar to, or bigger than the one i am in today. i feel that i truly have the biggest impact when i can help facilitate local discussions. just as i say that all politics is local, all health is local. and i personally feel we can only meaningfully and sustainably change health when local partners come together and create local solutions. love you all like me to say this but the folks in dc are going to ride in on a white horse and save the day. there's a lot we can do from here in dc, there's a lot the federal government can do and must do but we are only going to create that change, that meaningful sustainable change when on a local level.

i want to share with you a little bit of personal story about me that you may not have heard, one of the challenging things when you're going out and getting multiple talks is sometimes people here you couple times and they get tired of the same old story so we thought of a different one to share this weekend but it drives home the point of partnership in public health week. i'm a physician as doctor benjamin mentioned and i'm proud of that but most americans think about health, they think about me in a white coat. they think about prescription medication, they think about vital signs. but we in the public health community know the reality is health is so much more healthcare. health is critical but health is so much more than healthcare. a few of you may have heard me tell the story about my childhood as a chronic asthmatic. and the frequent hospitalization as a child. the interactions i had with the healthcare sector.

my interest in making and influence 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 family by any means. we had four kids, that ballooned up at different times and varying amounts that i'll go into in a little bit but i obviously did not realize how poor we were back then but we weren't well-to-do, let me put it that way. but i was blessed to have supporting parents who cared for me throughout my childhood, just as a little over an hour ago from here in rural maryland. my parents raised me to work hard, be humble and care for those around me. last lesson is one that particularly stuck with me. that's blessed a little bit too much to my parents liking and i'll share that with you now.

whenever i noticed that classmate was getting picked on, or a friend or a teammate who didn't have a parent to spend time with, or anyone to go home to, i invite them to come to my house. sometimes we stay for a meal, sometimes they stay the night, sometimes a stable whole weekend. on more than one occasion a state several weeks and sometimes the whole summer. they were fully happy, energetic and vibrant people that they could be and i saw how they would light up after a good meal after a time where with a loving and laughing space, safe place to stay. my parents would often joke and i shouldn't say this but they say the rooms are always collecting sprays and bringing them home and my family went as far as welcome my friend and now my brother stan been in and out of foster care system his whole life and we brought him into our home and adopted him.

and in a much more formal letter. i didn't realize it at the time, but this experience as a youth trying to create an environment where others could drive was really my first foray into public health. no, i wasn't involved in making drinking water saver or promoting a vaccination campaign by helping others have access to nutrition, helping them interact with positive role models and a safe place to stay, my family and i were addressing the social determinants of health and good meal prevents and increases overall health. also it's an increase of business at school. it increases resilience to the eight, we know for committee children, especially children of color are safe. having faith and increase cognitive and social functioning and allow the people to grow.

now, i hear that story with you for two main reasons and there's a lot you can do but there are two main reasons i share that story. first, is a multifaceted approach that we as a public health community should be engaging in to better health. and to afford health equity for all americans. perhaps more noteworthy, i did as a child and i did it as part of a family was barely above the poverty level ourselves. so yes, we need more funding. we're not going to deny, you'll never hear me say is a public health advocate we don't need more funding. and yes, we need medical expertise, we need health expertise, we need to be grounded in the sciences. the surgeon general, you will never hear me say that we don't need more expertise, you don't need or studies, that we don't need more science. but we can have a tremendous impact, we focus less on what we

don't have and more on better engaging partners. engaging everyone to realize the potential already existing in every single community in our country. you know, when i was held commissioner of indiana, i would go out to the communities and would get excited about the health commissioner and what happens now and i'm surgeon general, you group to get around the table and everyone wants to meet you all the answers. one of the things that sticks with me the most is i would go into those communities there be group senior disabled. and this person saying here and this person would be working on an issue and that person sitting in the seat next to them would be working on issue and it be in the same community and they would realize how many people in a very community were also all

committed to and working towards the same goal. >> what we need to change health already exists in our community, we just have to be better unleashing it. please don't misunderstand me because former pha president, doctor jones, he's a good friend of mine and she and i am a we have very vibrant discussions about the role of government and about health equity and the end of the day, i consistently tell her and i think she's finally agreeing with me that we believe in the same goals in the same ends. i'm not saying there isn't a place for major systemic change. no matter how many you my family and i during our childhood, we could never change systemic oppression, institutional racism that affected my fears. it's too big hurdle for any one person, anyone family and in some cases even anyone community to tackle alone. i thought about better health

through better partnerships there are so many different ways we can improve health we commit to working across sectors and engaging new partners. we had another discussion i thought many of us earlier. talk about better health and better partnerships, even when i look at the audience i see a few people nine their heads. everyone believes in partnering. it's a whole lot harder to do. i'm going to give you practical tips to being a better partner and forging better partnerships. number one, invite your table. and go to their table. meet them where they are. we had this discussion earlier, would've thought for a health issue you needed to invite the sheriff to come into town 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 you're dealing with a health issue is the local priest? that's usually at the end when everything else is exhausted question mark in scott county, that's what we had to do. to solve that hiv outbreak occurring in the community. so we got to again think about not additional partners and invite them to your table and go to their table. number two, tell them, show them that you care. here's a great saying, nobody cares what you know until they know that you care. as a physician i got motivation. a motivational interviewing? >> there are patients with diabetes and i've often had that same cycle over and over again saying well, mister jones, you're diagnosed with diabetes. here's all the things that science says you need to do. to improve your diabetes. your prescription or your medicine, lose weight, exercise

more. unfortunately, time and time again we see that it doesn't work. motivational interviewing is about asking mister jones what needs. instead of trying to push what i want on mister jones. asking him what he cares about and seeking areas of alignment so that we can get there. mister jones, you care about being able to visit your grandkids you care about able to walk or run that 5k with your daughter. you care about being able to make it to that softball game or go on vacation. great. we want to get you there. we've got to get your diabetes under control and here are things we can do together to get you there. motivational interviewing. it is our responsibility as public health professionals to show communities we care about

their needs rather than trying to ram a public health message down their throat. we talked about the hiv outbreak in scott county and there were a lot of folks who said doctor adams, why didn't you go down there and use your power to open up a service for them? if i'd gone down there and done that, the local sheriff would set up a perimeter around the service center and arrested people as they were coming in for going out. it doesn't matter what the signs said. he still have the legal authority to do that. if i tried to ram it down their throats, there would've been local pastors talking about how the health commissioner came in from out of town and was the devil trying to push this on their community. we have to engage people where they are and show them that we care and i was in that community and i didn't say you need a service program, i came in and 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. that's how we stop the transmission of hiv in that community. number three, last steps to better engaging partners, identify your target audience and address your messaging accordingly. i had a great conversation and a robert wood johnson prospective a few weeks ago and he and i shared being better communicators. we need to get much better at the science that is effective health communication and that's not going to be open you all focus on but it's something that all public health advocates, particularly in the health realm need to talk about. how can we be more effective communicators. just like going to another country, effective communication starts with knowing what land you are in and what language they are speaking. anyone here speak english as a second language, learn another language first?

we've got two faults. when you go outside the united states and the americans come into town, what do they do? they find a person and start talking with them. they expect they're going to know english. and then when they don't know english, the americans, what do they do? they speak louder. they yell at them and expect that now they are going to understand what you are saying. we do that far too often in public health. we expect they're going to speak our language and then when they don't understand, we yell at them and call them names and expect that somehow that's going to help them around to where we are. a couple of practical tools, two of my favorite publications, one is helen woodward the latin american nations area colin woodward is a cultural anthologist and what he did was break down the country into 11 distinct what he calls nations

and he called them nations cause they are very different, folks don't realize how different the united states is. i told them i wouldn't tell any old stories, i'm going to tell stories but i know everyone in here heard this story i apologize to those who have heard it. i was tasked with explaining to a bunch of people who are not from the united states, the united states state health care system and i was given 10 minutes to do it. easy, easy. your what i said. you know, when you look at paris france and berlin germany, these are two cities and two completely different countries. they speak different languages and in the last right world war, they literally tried to load each other off the planet. either one had their way, they 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 most controversial health issues, public health issues, when you look at what's done, when you look at asset health care coverage, when you look at immigrant rights and contraception and abortion, when you look at drug policy and reduction, these two places, berlin germany and paris france that tried to wipe each other off the planet are closer together than dallas texas and boston, massachusetts. we truly are a country of different nations. i'm getting to the. they told me i got to start wrapping up here. we're going to let the american nations, the other publication is robert wood johnson and we have a way to talk about the social determinants and what they did there was pull 4000

voters in the country and determine which phrases and which words resonated and which ones didn't. and then they gave their practical tips. use phrases like opportunity, everyone should have the opportunity to live a long and healthy life. your neighborhood should be added to your house. it gives you practical solutions to speak the language that's going to resonate when you're in a different nation. that may be part of the same country. as i wrap up i'd be remiss if i didn't see such a large audience about opioid attacks. today in america addiction is a public health crisis with an estimated 2.1 million people struggling with opioid addiction. that's more than the number of americans diagnosed with cancer every year but only one in five receive any treatment at all. they were losing every 12 minutes and from the time i've

been on the state talking to you someone died from it opioid overdose, think about that. i see my role as surgeon general educate the american people about the severity of the epidemic, and how everyone can be part of the solution. all you can play a role in combating the opioid epidemic. that doesn't mean you have to drop your other priorities and focus on opioids. it doesn't mean that all. i'm tired of telling folks we need to learn how to ride the wave. with the opioid epidemic provides an opportunity to amplify your messaging. i was in tennessee about three weeks ago. who would've thought that tennessee in the middle of the bible belt would be leading the way in terms of talking about voluntary reversible contraception. certainly i wouldn't. but they are. they're providing voluntary contraception in prison to women and are doing it through the lens of the opioid epidemic because they notice they had some of the highest rates in the last syndrome in the entire

country. they know this because they had the highest rates of taking children away from their mothers in the country, all related to the opioid epidemic that created a way for them to talk about reversible contraception. we know the communities most impacted by the opioid epidemic are also the same communities that i have high obesity rates, low graduation rates, that are affected by age. there are opportunities that talk about so much more about what we want to talk about through the lens of the opioid epidemic. and we also know that upstream interventions would mitigate not just opioid -related issues but all the issues that you care about. as i said to audiences, we've been trying for years, for decades to get people to pay attention not just to addiction, not just the mental health but to the social determinants that exist in all communities but especially communities of color. we've got a great opportunity now for folks who want to talk

about that. i was a cabinet meeting and you have ahead of the secretary of labor, the had of hud, agriculture, all these folks talking about social determinants of health. you have a great opportunity here and i have to say great and miss the tragedy but it's a unique opportunity to really push public health or the lens of the opioid epidemic if we're willing to ride that way. i want to close by stating that every single one of you in this room, every single one of you and i talked to people who've been in public health for a while, but for that are in college right now, some of my fellow retrievers over there in college, every single one of you is a leader in your community, by the nature of you showing up today. the fact that you showed up means you are a leader and you have potential to influence other people. it means you have an opportunity, it also means you have a responsibility to lead by example. it's imperative all of us use our platform for maximum effect

and with fervent leadership. >> a couple challenges to leave you with. challenge each and every one of you should think of at least one new partner you can invite to the table and whose table you can go to. whether it's the faith community, educational community, we have books here from the department of agriculture, from think of one new partner whose table you can go to and sit down. number two, i challenge you to stop. the next time you're about to ask someone to do something you know is scientifically valid, and you know will improve individual community health, stop. just pause. stop for one second and have the courage to instead ask that person what their goals and desires are before you start talking about yours. show them you care before you try to show them what you know. and finally, i challenge you

want to think about how you can be a more effective communicator. at the end of the day, we know what to do. we're just playing lousy at getting people to do it. public health hasn't changed in the 20 years since i got my ndh. two more, be better, don't smoke, don't do drugs. all those less were there 20 years ago. where just plain lousy at communicating to people what we need them to do and it's because we don't recognize or we don't care that in many cases we are a foreign land speaking a foreign language. my mother is better health through better partnership because no matter what area of public health you are passionate about, it's about forging better partnerships and being a better partner, good health is sure to follow.

thank you aph a, thank you all of you for being here and to the folks joining us by webinar. thank you for bringing such a diverse group of individuals together to collaborate with one another. and i hope each of you take the opportunity here today to find a new partner and get to know the person next to you and figure out how you might be able to help them and in turn they might be able to help you. it's been a pleasure to address all of you and my best wishes for a great public health week. thank you so much. [applause] did i run out of time for questions or do they have time to grill me or what are we going to do? all right, a little bit of time for questions. anyone? in the back, yes, ma'am. [inaudible] and tell us all who you are, too.

>> is it on? i'm caroline revealed, i work for the public sector services but my background is in public health, louisiana department of health and also medicaid. the more i work in healthcare, the more the issue of helping health and security is coming to the forefront so you're talking about building better partnerships and i've worked on the local level in housing and healthcare and one of the roadblocks i think is the funding and the lack of intersection of that funding at the federal level. can you talk about that a little bit and also maybe talk about what you're hearing from your house counterparts about what they need from us? >> wonderful, thank you so much and i'm going to step out here a little bit. one of the things i tell folks is we have another tremendous opportunity.

no matter which side you're on or how you feel about individually, we have a position at the head of housing and urban development, i thought that doctor ben carson. he believes that housing should help. i told you all even two years ago that we had the opportunity to have a physician as the head of hud, you'd say that's fantastic that we aren't taking advantage of it. we aren't engaging hud on a national and local level as public advocates to the degree that we could. doctor carson believes in it, we've got initiatives out there trying to promote housing and health but we need to help folks understand how to make that happen, how to create healthy housing because individuals just aren't familiar with that. when i was in indiana we had a situation where it was a hud housing complex and once upon a time someone thought it was a

good idea to build a housing complex on top of an old lead facility. it we had engaged hud and they had engaged public health, we've done a better job of that then maybe we could have avoided some of these unfortunate situations so really taking advantage of that. the other thing, i thought about riding the wave of the opioid. we know the number one predictor two whether or not you're going to be successful is having permanent housing. folks understand that. we have the opportunity to use the opioid epidemic to talk about housing as a social determinants. we got to be at the table and also really engaging folks from a business point of view. one of the things i want to do is investigate the surgeon general's report on helping the economy because the number one thing that people vote on his job as an economy. the number two thing they vote

on his safety and security. health is not even in the top five or top 10 but if we could help understand how we can create housing communities that are not just good for health but also for lifting up the community, 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 millennial's want to move 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 that community because millennial's 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 can inject our public

health inputs with a goal of increasing prosperity in addition to increasing housing, we can be humble coming in with a dose of humility, i think we can be successful so a great question and thank you for that. maybe time for one or two more. [inaudible] >> i'm wondering if the opioid epidemic, you talk about other addictions. >> elise wondered if the opioid epidemic was a good way to talk about other addictions and the short answer is absolutely. the opioid epidemic is not the problem. it's the symptom. and it's a symptom of unrecognized and untreated mental health issues. my own brother is in maryland state prison hour from here because he had untreated mental health issues which he felt the need to medicate which caused him to steal $10,000 and get a 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 for other addictions. opportunity to talk about alcohol. let's move upstream and talk about all the other things that can be a problem and stop playing laughable because what we can do with this opioid epidemic is treated about and opioid epidemic. we will get our hands around it eventually and it will pop up somewhere else is something else further down the road if we don't get upstream so a great

opportunity to talk about it and 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 health professional. 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. >> 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've just got $6 million to respond to the opioid epidemic. it's more money than we've ever gotten to respond to opioids. you know the challenge is whatever we talk to folks they continue to tell us it's going to cost so much more than that to be able to do what we want 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 bigger or smaller depending on who's 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 smarter and not just harder , and 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, cannot pass the educational requirements because they have 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 with the money that we have instead of going with congress over and over again and making the pie bigger because my peace isn't big enough. so absolutely i believe in public-private partnerships.

anybody else? [inaudible] >> i'm a student at george washington and i know a lot of students are here and listening, so going forward what would be the number one piece of vice you -- advice would give us in public health? >> can europe the question, please -- can you rip the question, please? >> 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 feeds the into priorities of the voters. the private entities of the corporations, of the law enforcement community, of the educational community and show them how we can help them achieve their goals.

focus on communication, we don't want to spend the next 20 years of your life working on an issue with your blinders on. and then be frustrated and say i didn't really make a difference and i am 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 and how we can serve others instead of expecting that ask 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 opportunity that come your way. i did a study at howard university in actuarial science, anybody know what that is the ech? it's the science of figuring out risk and it was all about math and i love math but ordinarily, you think that has nothing to do with public health and i've met

tremendous people, gain 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 expand your network and have your elevator speech ready. 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 down with me and casual setting and say i have a chance to talk to president from, this is what i'd say. folks sit in front of me in a casual sitting and say if i have a chance to be with the president this is what i would say. then they get next to me in front of president from and. [laughter] when we talk about an elevator speech, that's 30 seconds. you got 20 seconds, what do you want to communicate about what you're interested in, what you're doing about who you are in an efficient manner to make the most use of your opportunity. it goes back to effective communication. that is what i would say. maybe one more before they give

me the hook, because i love the government talking to you -- i love being up here and talking to you. yes ma'am. >> amelia roberts with graduating from 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 whoend to neglect people have already gone through life and we seem to feel that there is nothing else we can do with them. but as most of them know our population is rapidly aging so i want to get what you think public health and usually address that. >> 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 in their boots about the baby boomers aging getting to and 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 lifeof spectrum -- spectrum. -- things out again, we got to break down the silos and bring 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 ivanka and 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 align and not just saying how do we help the aging in our society but how can we better utilize the aging in our society as part of an overall mission?

and once we get them engaged, they will help us across the board. i think 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 in you all. no, but what i would say before i leave is another tip for 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, and lived in an apartment where the person next to me had a gun. it was a direct threat to my life because it was going to come through the wall and hit me if gun discharged so in that sense, all public health is local just like all politics are local, in that local environments, guns were a public health care. -- public health concern. my father-in-law who i just saw

-- put 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 environments, 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 -- smarter policies across the board. we also need to make sure we are doing it, and we talked about public-private partnerships, we need more research we can say we touch us so we can say with more say with 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 and our fulton la and san francisco wanted to tell me to run a program in early 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 got more ranges 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, -- and if -- as public health advocates, as 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 kentucky, in illinois, in communities that were like their communities. but 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 and expects 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 because 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 so thankful for the opportunity to be your surgeon general and i hope we all get a chance to talk even more in the future. so thank you george and thank you to the panel for being patient with me. [applause] it's going to be great, is going to be a wonderful panel and i hope all of you pay close attention to this because i'm

looking forward to another round -- i'm looking forward to it. thank you. yup. another round of applause for the surgeon general. [applause] >> thank you. that was a stimulating speech. it's a wonderful panel so i get to introduce the moderator. this is doctor jill, she is the president of the american public health association. he is the 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 -- health and education and department of health policy and management. he holds a masters in social

work and mph 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 health practitioner, our president, in the american public health association, doctor gil. [applause] >> thank you very much, doctor b. thank you to our surgeon general. again, i want to thank everyone for attending and you all who are listening, i want to thank you for coming to our panel today. i have the distinguished pleasure of introducing the phenomenal panel that you had to -- you are going to hear about. as i get started i want to give you a little background on each of the panelists. starting with at the far end

introduce doctor wendy ellis and she is the milton scholar of health policy at the milton, milken institute school of public health and department of health policy and management. s. ellis is the project director of building community resilience, collaborating at the milken institute of public health at the george washington university. this program is a space program in that building community infrastructure to promote resilience in the cities and communities. prior to joining george washington university she served as manager of policy at the morris pop town hall and practiced in washington dc. in 2017 ms. ellis was selected for the george fellowship for the motion of childhood well-being and also in the summer. she holds an mph from university of washington school of public bs fromnd a

seattle university. >> our next panelists is janet motel swear. she is director of prevention services in the associate director of health education services at george pound -- georgetown university. she has an adjunct faculty and member in the georgetown women's and gender studies department where she teaches a class on gender violence. as the program advisor for the program advisory board for the rate of use national network and has full facilitated edc university consortium. she also participated as a assaultf the d.c. response team and the dc also -- assault victims rights on the task force. her bf in education and an a in accounting psychology are from the university of nebraska lincoln and she's a licensed professional counselor in the district of columbia. our next panelists is sissy hernandez cassio, director of health equity, families usa.

she leads the organization's efforts to advance health equity and reduce racial and ethnic health disparities. she serves on the addressing disparities panel for the patient centered outcomes institute. and the robert wood johnson foundation state strategies advisory committee. ms. learned hand is -- ms. has her ba from wilson school of public health, and international affairs and a degree from your university school of law where she was a civil liberties fellow. and our last panelist is miss b. sabina. she is the national program director for foundation responsible for directing foundations national and international program supporting the federal foundation building health communities including

helping -- healthy cities and healthy counties challenge. prior to this position she served as a program officer and managed portfolios of international grants in the digital health and integrated healthcare with a focus on coordination and quality. she has co-authored a number of articles and review journals -- and has been published in a peer-reviewed journals including the general public health, predictive medicine and archived internal medicine. she's a 2012 fellow and in the grantmakers and health insurance institute for emerging leaders. and she earned her masters from the university of north carolina chapel hill and the university -- bachelor of arts from the university of rochester. what we are going to do with our panel is we're going to start off with a general question. the panelists have 34 minutes to minutes -- 3-4 minutes to answer

the question. our first question is this. for the second year in a row, in the united states is dropping. so can you speak briefly about your work and its impact on community health to how we can turn the tide on this trend. so my work is the building community resilience collaboratives at george washington university. what we have the heart of our is addressing adverse policy -- childhood experiences in the context of adverse community environments. the rest of us in this room understand adverse community environments as social determinants but unfortunately when we go and we see two other -- speak to other sectors, they don't necessarily understand what we're talking about. they certainly understand lack of economic mobility, the impacts of unaffordable housing, the fact that we have inequities, systemic inequities and so when we really try the -- try to keep at the center of

our work, really understanding -- systemic and negri's systemic inequities have been. that can be a focus on our system as opposed to just having done so well in public health with regard to personal intervention, changing our behavior because it's no good to change behaviors and send people back to the same system to our work really highlights the fact that there is no surprise that we have declining life expectancies in our country because we have growing disparities in inequities in health outcomes and income, neighborhood disparities so these are signs of, we're not in a system, where in public health we are not necessarily taught about dynamic systems modeling but it's so key to us understanding the context in which our work is being delivered. and so really understanding from dynamic systems modeling's that our systems are designed for the outcomes we see so if we see declining life expectancies, you have to ask why are our systems designed for such an outcome?is

it is not going to be about changing individual behaviors, it is working at systems level so we can reengineer just as you would not expect an iphone assembly line to suddenly put out an android. you have to redesign it. it has to be deliberate in its design. because so many of our social policies have this inequality -- have been designed to have this inequality over the course of more than 200 years, absolutely, eventually you're going to have so many people that are held back and inequalities going beyond just racial disparities. is ank the opioid crisis excellent example of that. but that is the real example of why we have a growing lowering life expectancy in this country so it's not just about other people or those people. it's really truly about all of us and i think that one metric, the decline in life expectancy is a great example of that. that's why our work is really

looking at not just working upon communities but bringing community to the table. discussing this, but at the same time the community can affect all the changes happening in our systems level so making sure we are setting a table that has community voice but also those system operators understanding the impact of their work and the system designs that we can get truly to address these inequities. >> thank you very much. >> good afternoon. so i work at georgetown oversee thewhere i andal assault response program. prevention we also incorporate and include the personal violence of all times so stalking, harassment, working with survivors but also doing prevention work. at the beginning i would just like to take a moment to kind of .ighlight a couple of things

my background at doing this work around advocacy and activism in this field is for 18 years. my background is not in public health, but i think this is a really critical and important example of what it means to be in spaces with one another. when you look at how violence impacts community health and outcomes, it is a natural connection, right? i had an article that i read recently. can radical feminism coexist as a public health issue? the answer is, yes, it can. but really it's only been in the probably the past 5 to 10 years that i've done this work that we been engaged in doing prevention work and using public health models to further that conversation. it's been operating in silos in some ways and in setting the groundwork and just grassroots organizing that was needed.

but now we're at a space where we can say the model of public health is what makes sense for us to think about doing our prevention work, not just saying we need responses for survivors in our communities, but also talking about how do we get to the place where we are preventing the violence before it occurs and how are we setting spreadingor that, and the message around that? so very quickly, in doing this work as a practitioner there's some things that we know are correlated. not every survivor will experience, but coordinate with interpersonal violence higher , incidence of eating disorders, higher incidence of ptsd, higher incidence of self-medicating with alcohol or drugs. my office sits in a space where we are with other practitioners who work around other substance abuse issues.

my colleagues specializes in it in disorders. we know that so often these issues coexist. that outcome of around trauma that we are working at addressing. we know that being a victim of some kind of trauma around violence the two higher rates kind of trauma around violence the two higher rates for big the demised again -- being victimized again. making sure that we are saying, how are we talking about a culture or society that we enforce his some of this message and that is creating these -- parading the violence that and up impacting community health? of turning the tide in that space -- so very quickly, i think part of turning the tide in that space that we really see as practitioners in the area is starting the conversation earlier. colleges are doing a great job right now of getting into the spaces that they need to be and and the conversations with

the enhancement of title mind many campuses -- title ix over the past 5 to 7 years, more universities and campuses have really been able to bulk their programming, prevention, mandatory conversations with students. again, i will talk about this more later. but often by the time we get students that are 18, they have experienced violence. how are we having conversations about bullying in schools and one to have next frontiers for us in turning the tide and being able to start addressing the issue at its core in terms of impact of public health overall. >> thank you very much, and thank you both. please. it's the speaker looking one, the one that says speaker. >> that one, okay, first of all, thank you very much for inviting me to this discussion, it's exciting to be part of a public

health organization especially coming families usa that's focused on getting coverage for everyone. our central mission is that we believe that every person in the united states deserves the opportunity to have the highest possible health and the possible , quality health care available to them. so i want to -- with regards to what's happened in the last two years of life expectancy, it's important to break it down because it sounds terribly gloomy and things aren't necessarily as bad as they sound overall. that's the problem with averages, it clouds what's happening to specific communities. what was really interesting was that there was so much media attention to this statistic and then when they started digging into exactly what the cd data that the onlys

-- theith the increase only group that actually was white women, that in itself -- especially if you're looking at the reasons, the cause of death being what some have called diseases of despair, accidents, suicide, cirrhosis from drinking and those kinds of things, it becomes apparent that there's a huge problem, a connection i think here that we see with what -- jen was talking about and what happened in communities particularly in -- in communities that on top of these dynamics, women are also more likely to suffer problems from having downturn in the economy and unemployment and so forth than men. i think that's really important for us to call out just as it is important to call out the fact that life expectancy for all hispanics and black men actually increased. so there's something that's being -- that we are doing right somewhere and for, you know,

black women and white men, it kind of stayed leveled. i don't want to make it sound like we are nit-picking on things. it's important if we think about what's happening in communities to understand exactly what is the burden of health, of negative health outcomes that different communities are sharing. now putting that aside, you know, we are seeing disparities, racial disparities reducing, but we are also seeing that african americans still have a much despite these -- these changes and trends among white people, african american rate much lower life expectancy, et cetera, so one of the things that we do at families usa is we understand that coverage is -- it's in our dna, we have been doing that forever. you need to have health

insurance in the country because it was designed for this, we can have over debates about whether universal health care, whatever, you can put that aside, in this country having insurance whether it's government insurance or private insurance is kind of the entry way into being able to get the health care that you need and that includes health care like the mental health and stuff used in all of those treatments and preventive services that are so necessary to stay healthy but we also understand that that's barely the tip of the iceberg. health doesn't happen inside a doctor's office or inside the clinic, right? or the hospital, health happens in communities and part of what we are shifting to right now is figuring out how do we change the way health care is paid for so that things that are valuable to individuals in particular communities are supported, right? finding, health care is the biggest sector of the economy, right, there's a lot of

resources there that probably could be better invested in things like housing or in community health workers. we have been working a lot with community health workers because they can speak that language, they are natives to that country that the surgeon general was talking about, and can make those connections. what we are figuring out right now is we can use what's in the health care system right now in terms of funding in much better ways from a public health perspective that you all understand from prevention and promotion. we know it's going to work better and that where a lot of communities are struggling is where they can't connect to the health care system that really has so much -- so many resources in it and not necessarily resources to provide the best care at the right time, so we adjust that. >> thank you. >> thank you, thank you very much. >> really good points. yeah, so i think if we unpack

that life expectancy statement and at the foundation we use that statement as a foundation of what we do. it's really about building healthy communities and touches on what you guys are saying, what we do is support local organizations and local partnerships to address the underlying social determinants of health. happened outside of the doctor's office, we talked about that. two of initial initiatives are cultivating grant programs which is accepting applications for that, i had to put a plug for that and ask local organizations and partnerships to look outside of the traditional health care space and address at least one of five domains to focus on

social determinants. these what we're seeing with this program, this is motivational interviewing for communities at the community level. they are produced these exciting 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 danville, virginia there

, putting in place effective policies to address the obesity epidemic. i think 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 contribute to this disparity. >> thank you for everybody's answer and a reminder for the audience. we will have a chance for a few questions at the end of the panel so think about what you might want to ask to everyone. our next big 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 concerted effort to move upstream to focus on prevention which is something that you all brought up. the focus that you have on targeted prevention is a message 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 healthiest nation and what are 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. my work is steeped in adverse childhood experiences that we know to have a longitudinal impact on development. by taking the trauma lends you 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. so putting that at the forefront 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. because you're looking at what

is universal -- if you are steeped in the data, you understand that this is an american public health issue. more than 50% of our population has one, but we recognize there is a differential outcomes. more americans 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. data are powerful, but so are 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 lens to understand and appreciate the impact of these early adversities across the lifespan and truly enacting and putting into action the public health model so that we are the ones bringing together multiple sectors and are truly collaborating. >> i can be very brief.

one is the trauma lens being so critical. with the work that i do come of the movement has been very reactive, 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. not having just one model of health but engaging into these spaces, understanding what community needs are.

>> i will say something boring , which is we need to make sure everybody in this country has health insurance. you won't be able to access 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. the correct services are not available or culturally competent. that leads me to number two. 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. the system is designed to help 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. >> it 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. showing folks what are the best 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. i ask you to do something that we try to avoid in public health which is a solution for complex problems. i will ask you to provide as concretely as you can to address this question. what can we do in a specific way to have these outcomes? >> i thought about this before so i guess i am cheating. i believe if we get to a place where every single person who once to have a community advocate or promotora, or whatever flavor of what you need, is available to help the

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 this 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 had that 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 this 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. i don't want this conversation 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 do -- 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 message 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 pennsylvania, they started with the value of understanding early intervention. they started in the school. it became a whole community movement. when we are talking about what these various sectors value, that is what we can 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. if they don't address that they will not have a healthy workforce. they cannot track and retain businesses. that is 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. the question i have is, we have 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 room to think that we are merely wanting to help communities

bounce back to what we already recognize are levels of inequity. when i talk about resilience, community resilience in particular, we are also looking at the ability to suffer some of these acute shocks, but the ability to spring forward. that is the first piece of this. when you are talking about how to help communities bounce back, there is 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 adequate education systems. coordination between our court systems. the trajectory for too many 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 respond 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 adversity that we see now. >> i want to move here. 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 forefront. what is happening on college campuses around this issue? what are the ways to do best practices? >> i think that we know that campuses have been great spaces for activism. i always like to share that the reason my office exists, my position, and my colleagues, is 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 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, and are less likely to seek support, to make official reports for good reasons. that is something we are seeing rise out of me too, 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? 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 -- how does something build. with georgetown, 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 of 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 where we, as health professionals, go to academic spaces. as a health professional, i 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 they know what resources are available and think about how to has real-life 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. with programs like that, we have 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. to meet them in spaces where we can make that connection for them. 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 to the affordable care act, and several states have begun to test the boundaries of aca with modified rules, what do you think of the ramifications, state 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. thank you for bringing up the 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 excited that you also mentioned intersection analogy. even in the me too movement, very few people 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. but what we are seeing right now is an administration, because they were unable, through congress, 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. i 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 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 idea, which is letting more plans exist that do not have the consumer protections that were set up under the affordable care act. it used to be that you could have a temporary plan for three months, but now it could be one day shy of the year, and you 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. 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 this is unacceptable. but there are examples of things that are positive, of states that are trying to, even in the 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. last 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 make, 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 data by p regrouping's -- peer 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 making significant improvements, but also to inspire change in 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. a tool to allow us to measure both challenges and successes and to share them both. excellent, excellent. so that is the individual panel questions, so we have about -- 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 -- do 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. perhaps no more compelling than during addiction, at least in my field. it seems from our work, at least, that there are many barriers. some of them really having to do -- definitely would access and social 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 in maternal and child care, perhaps in communities? i would love to hear from the panel. mr. telfair: anybody can answer, 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. i think that's a real great care 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 -- because we still have many 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 -- hat 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 trying to get services is trying to put you on the map of child services, that is a huge disincentive. that is typical of a lot of 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. that, sadly, is going to take 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. shelby county 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. it says, "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 people in health policy that went on to become doctors. i think 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. the quick 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 positive effect of first -- what -- 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. one of the things i want to say with regard to the question that was posed is that my mentor on 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 -- brought him 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. 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 question, from two pesky -- from two 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 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 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 effective -- but you have to really understand exactly the context in which your treatment or your program is being delivered, and have a real 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 red thread put into it, right? is that obvious. if you want to create this tapestry, it is much stronger based on the 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 i'm hearing you correctly, is -- we have a minute, so let me just make it real quick.

so the other challenge is that in public 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? ms. schweer: in terms of the work? mr. telfair: doing the work, the 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? ms. 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 naming the space in the room. it's easy to other conversations, right, and say people who experience violence are people who 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 panel, you in the audience, that 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] dr. 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] [indiscernible] ♪

journaln's washington were news and policy issues impact you. coming up this morning we discuss recent diplomatic and military developments in china. talkshe eurasia group's about the future of u.s., china relations. be sure to watch it at some :00 eastern this morning. up next, i conversation on race relations and the media, including the 50th anniversary of the kerner commission the port -- report on media diversity. finalists -- panelists include andrd lewis, bill plante marina nelson.