health care is critical but health is so much more than health care. some of you may have heard me tell the story about my childhood as a chronic asthmatic which led to frequent hospitalizations as a child. the interactions i had with the health care sector piqued my interest in medicine and influenced my decisions to become a physician. yet my persons in the hospital are not what i consider to my first exposure to public health. i didn't grow up in a wealthy family by any means. had two school teachers for parents. very proud of them. we had four kids that ballooned up at different times in varying amounts i will go into in a little bit and honestly did not realize how poor we were back then but we weren't well to do, let me put it that way. i was blessed to have lovingnd supportive parents who cared f me throughout my childhood a little over an hour here from rural maryland. my parents raised me to work hard, be humble, also care for those around me. that last lesson is one that particularly stuck with me. perhaps a little bit too much to my parents'

- [narrator] for decades, the u.s. has been a leader in promoting global health. it does so through foreign aid designed to improve the welfare of others, as well as through emergency assistance to fight epidemics like zika and ebola. but foreign assistance has fallen out of favor with some in washington, who argue the u.s. should help itself before helping others. that puts them in confrontation with policy makers who say aid is a good strategy, keeping americans safe from epidemics at home and improving the health, economies, and security of neighbors abroad. does investing in global health improve america's security and other national interests? global health: preventing pandemic, next on great decisions. - [voiceover] great decisions is produced by the foreign policy association, in association with thomson reuters. funding for great decisions is provided by pricewaterhousecoopers, llp. - [narrator] promoting global health has long been a shared goal of the international community. - when the plague hit europe in the 14th century, about a third of europe peris

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

health director. today we have our regional area filled with people that kind of graduated from the health department. so marin county, san mateo county, alameda county, and we're working with our bay area regional health and equities initiative to really bring the directors of health at least from the contiguous counties to think about regional approaches to the work that they've been doing. the county -- we've got a bond of 2016, and we are going to be rhenvating and expanding our southeast health center. this is a -- a view of what it will look like, and that's a $30 million renovation. the fact that we are an aca provider, electronic health records systems, we are bringing in to replace a major legacy clinical and billing systems, and this is our billing systems that you can see as i discussed with you for medi-cal is responsible for over $650 million of annual revenues. the electronic health record system will not only be an ability to bill better but also to ensure that our providers have a full

and the national health service. in the recruitment of people to write those mental health services. it's also about ensuring that we can enter at an early age for those young people who develop mental health problems. the initiative for the training and schools so they're able to identify mental health problems and able to ensure that young people get the support they need. in 2012 the health and social care act did get a labor amendment act. sadly the money never followed. the charity said recently our overstretch services are failing. it highlights the horrifying figure that male suicide is the biggest killer of men under 45. eighty-four taking their lives every week. the amended mental health services a priority. i fully acknowledge and accept the very genuine concern about mental health. but they have fewer resources. so why does the analysis by the psychiatrist show mental health trust have a hundred 5 million less than they had six years ago. it's not just a question of what is happening inside the health serv

. -- in health. this can be a prejudicial cycle. education levels can play a prominent role in dietary habits. we know for dietary quality is more common in people from lower socioeconomic status. childhood obesity can lead to negative health outcomes later in life. socioeconomic status. it may have more immediate outcomes like an increased risk of type two diabetes and less effective school engagement, or stigmatization and bullying. the persistence and growth in health disparities mimic trends in nutritional disparity. from 1999 to 2010, researchers have observed an improvement in the average quality of the american diet as people reduce consumption of sugar, sweetened beverages, fruit juices, while increasing consumption of whole fruit, whole grain, polyunsaturated fats. family income and educational level or positively associated with healthy eating. the gap widened over time. those with limited educational and economic opportunities are also more likely to suffer poor nutrition. this exacerbates

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 myexperiences 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. >> whene

health, college of public health in georgia. he also serves as cochair of the department of community help a -- community health in education and department of health policy and management. he also has a masters in social a phd from the university of california berkeley and a bpa from the johns hopkins university. he's had over 33 years experience as a clinician and community advocate and public practical -- public health practitioner. joe. >> thank you. i want to thank everybody watching or listening for coming to our panel today. i have the distinguished pleasure of introducing this phenomenal panel that you will hear about. i want to give you a little bit of background. starting with the far end, dr. wendy ellis. is the milton scholar of health policy at the milken institute school of public health and department of health policy and management. alice is the project director of building community resilience at the milken institute of public health. this is at the george washington university. this program is a space program t

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health care is critical but health is so much more than health care. some of you may have heard me tell the story of a much older as a as a chronic asthmatic which led to frequent hospitalizations as a child. the interactions i had with the health care sector piqued my interest in medicine and influence my decisions to become a physician. yet my experiences in hospital are not what i consider my first exposure to public health. i didn't go up in a wealthy family by any means. had to schoolteachers were parents, very proud of them. we had for my kids that ballooned up at different times in varying amounts without going into, i also did not realize how poor we were back then, but we were not well-to-do, let me put it that way. but i was blessed to have loving and supporting parents who cared for me throughout my childhood, just a little over an hour away from here in rural mailing. my parents raised me to work hard, be humble and often care for those around me. that last lesson is one that particularly stuck with me, perhaps too much to our parents likin

>> so the department of public health operates community behavioral health services. >> chair cohn: okay. >> the assisted out patient treatment program is one program that's also operated by community behavioral health services. when we are looking at whether an individual necessitates the restrictive services provided under mental health conservatorship we are first trying to find out whether the individual has the capacity, the willingness to accept services on a voluntary basis. the first point of entry would really be through some of our community-based clinics and certainly we have intensive case management programs that are provided by the city and also funded through city contracts out to cbos. many of those case management programs help to keep individuals that may be struggling with mental illness but not gravely disabled. those programs can be vital to keeping those individuals independent and safe. the department of ageing and adult service also operating the adult protective services program. about 50% of the cases that adult protective services intervening with involve what

also our environmental health in the department of health and housing, hazmat, and food safety. also, if you don't know, we do weathers and measures, so every time you go to the store and put something on a weight to ensure the number of pounds, we license those, and our massage programs in which we provide outreach to massage partners to ensure that they are within the law. we also are doing a lot of work around vision zero trying to have zero pedestrian fatalities, and our lead program is our assistance and diversion program for those who experience addiction. staff will be combined with a quote on what they do what they do, and we encourage everyone to follow on the sf dph facebook and dph twitter, so we want to make sure that we all celebrate public health week, april 2nd through the 8th. i also wanted to just acknowledge the fact that we are -- will be sending, as you know, in september of 2017, we had a terrible hurricane in puerto rico, and one of the doctors isn't here today. he really made the point of what are we going to do this in response? it's taken us a while one,

health care for the homeless program. that really confuses people because most cities around the country don't. but looking at places that have really been sophisticated about how do they -- really thinking about homelessness as a special population, boston, we're in regular contact with, new york city, we're in regular contact with. baltimore, we're in regular contact with. chicago, we're in regular contact with. los angeles is learning a lot from us here. i guess your predecessor brought some of that to them. when i talk to people in los angeles which has problems with homelessness that boggle my mind, they are pumping me for any possible information that they can get because they're really starting behind where we are. so yes greenwood i also have an opinion about that, but i'm often humbled about my opinions and how reality based they might be, but it's my observations that almost all the services that you see in the eco system are episodic, meaning you come in, you meet criteria, you get really excellent care, gettin

which is the department of health and human services is one of the richest fields along with a massive opportunities and health related computer spending by the departments of defense veterans affairs and treasury the d.o.d. market is very weak said steve coleman a harvard management professor and contracting specialist the two growth markets are cyber security and health care so everybody is trying to get into those so like i said when we look at two thousand and eleven in the charts go parabolic they go in a direction very much like the dot com sector was that libya no i think we can prove because they're saying the analysts looking at the time this is in two thousand and fourteen they're saying the department of defense contracts are very weak whereas all the new money going well the department of health and human services and how to plunder those and this has done very well for them and in fact for traditional defense contractors health care isn't the new oil it is the new f. thirty five fighter or is the class destroyer of course the f. thirty five which lockheed martin built is t

we have a health care master -- health care services master plan already that talks about community health needs and then, you know, if there's any hospital that seeks to expand or build in the future, they have to show that they're meeting the community needs in order to get the land use permits. so i feel like we've really kind of pushed the boundaries over our local control on this issue. but what we haven't done, as far as i know is this comparison study in one very clear way and place and that we could utilize and that advocates can utilize in order to highlight the savings that these hospitals are getting and what they're giving in turn and then compared to one another. so that would be my suggestion for moving forward. >> supervisor fewer: commissioner pollock, did you want to speak? >> commissioner pollock: thank you. and i appreciate commissioner ronen's experience on the issue and just sort of what's tied to it. thinking also of what miss stricker said in terms of what's tide -- tied to the state regulatory agencies versus the local agencies is something i would be interested in.

homeless, mental health issues, and substance use issues. are we doing anyone a favor by living, letting them be on, you know, leaving them on the street to slowly die? that's compassion? it -- i just don't understand why we don't make choices and make decisions that, to really try to address this. i've heard from folks with, who have been in leadership to not build a new jail who are supportive of this because where do these individuals end up? they end up in jail. they end up in jail. it's not like people with severe mental illness who are homeless, substance using, are just having a normal life on the street. and the other thing is, once we get people into treatment, it does not mean we are incarcerating them, we are starting them on a path of careless and less restrictive. but i think we tend to look at the best case scenario and say well, it's going to be that individual. that individual and i know individuals, you know, a kid i talk to at least once a week. this is not going to apply to that kid who is service resistant, as they call i

our concern as future nurses and the health and well-being. as a result of the advocacy of nurses the h2j2 collision of which we are a part and the families of our patients at st. lukes make a commitment last fall to provide care to our remaining subacute patients however we are here today to state in no uncertain terms that this commission beige does not gdoes not go farenough to addree services in the city and county of san francisco. cpmc and must commit to accept new subacute patients and make permanent commitment. shamefully, cpmc has rejected this idea and has only outlined the plan to disrupt the remaining subacute patients by transferring them to beds on a skilled nursing unit on davies campus this summer. subacute nurses do not wish to transfer their employment to davies campus. nurses there do not belong to the unit. st. lukes nurses that transfer there immediately lose the -- union nurses speak out publicly as i am today in the interest of our patients because the union and solidarity of our patients gives us the ability to do so. u

on health care while canada spends about 11.5% on health care. the united kingdom, britain, england, scotland, ireland, wales, the u.k. spends about 9% of its g.d.p. on health care. germany and france spend about 11%. we spend substantially more and yet we do not have the best outcomes in the world. we have to look at the system and whether it's working for the american people. i'm just -- i just make this point because we realy could join the rest of the world and have more affordable, more effective health care. it's not only countries like germany, france, canada that spend less and get better outcomes than the united states. it's also new zealand, norway, denmark, sweden, all have systems that are similar in style and they cover more people and the people benefit from that. our systems like medicaid and medicare are some of the most popular systems out there. people tend to like it. i'm not sitting there trouble-free. anybody who thinks there's some program made by human beings that's going to be absolutely perfect all the time of course they

care market as the article then says if health care is the new oil as. investors hope this was the market to get into right the american program this is the almost a million people went bankrupt because the medical establishment the defense industry and the health insurance industry targeted them for death and now they are dying as predicted good on you maybe your plan to kill people is working so essentially a medical procedure that cost five hundred dollars. the medical industry these guys now working for the health of the defense contractors and presumably they're threatening you not with losses but with actual weapons of mass destruction will come to your home if you don't pay the health cost and they'll say a procedure that is five hundred dollars and cost of the say we're going to charge a twenty thousand dollars in the us you pay us obamacare which works out to you know two or three thousand for that procedure and by the way we want to actually pay for the procedure because there's a deductible that means that we won't actually pay for anything so

saturday was world health day and this year marks a significant milestone for the world health organization it's been seventy years since it was established by the united nations in the decade since the well's health organization has played a key role in eradicating diseases that once killed millions and works to promote healthier lifestyles and improve access to health care around the world but it's go . all of universal health coverage remains elusive. fighting disease with injections test tubes and pills this was the public face of the world health organization in the one nine hundred seventy s. the agency's mission was to make health care a basic human right it's great to success was stamping out smallpox polio and childhood paralysis have also been drastically reduced thanks to a worldwide program of immunization one hundred ninety four countries have joined forces in the w.h.o. but big challenges remain if this isn't viruses don't need visas to cross borders and infection can jump from one country to another within a day unless we really improve practical worldwide health care no one

but as i said earlier, what the health department has is the san francisco health code that we're required to enforce. we don't have discretion in cases where markets or businesses are beloved by the community, we have to follow the same law regardless of who it is. if this was a legal reason for granting a permit, i can assure you we would have done that as inspector young testified earlier, she spent time with the appellant going through it, and if there was some reason for issuing the permit, we would have already done that. where we're at, at this point, is that the department of public health, i can't break the law to meet a community need. i have to enforce the law as it is. to issue a permit in this case would require us to break our own code, and that's kind of where we're at this evening. >> question on either you or miss young, the 50 -- does 45 represent the density cap established in 2015. you are required to review that density cap every two years. what did 2017 show? >> so we work in conjunction with the -- another branch within the health department, and they have not submit

is the foundation for a lot of the citywide health planning processes, including the community health improvement plan, san francisco's health care services master plan, the san francisco department of public health population health division static plan, and then each of the nonprofit hospitals, community health needs assessments, and their own benefit plans. so essentially this kind of joint collective needs assessment that happens is what informs those nonprofit hospital community benefit plans, but essentially, it is up to those hospitals to create the plans themselves right there, and there isn't kind of external oversight in that besides the statewide office of health planning and development. part of this initiative where it came from is i understand there was a 2014 initiative published. i've handed out copies of that report to you all. on page 20, there is a list of recommendations that they included. most of these as kind of have been noted are -- would be -- need to take place at the state level. there are recommendations with regards to hospitals themselves making changes

health problems worldwide it according to the world health organization every ten patient suffers from migraine so i think it's a great idea to develop an app to help migraine patients and this is what it high so your profession make you up with the idea to develop an app actually a friend of mine suffered from my grandmother in thirty years and she came up talking to me about her problems with. it was pretty obvious to to make something against develop a tool that basically helps patients to proactively do something against if you take a look at the app store you can find a lot of apps which helps patients with headaches what makes gaps special that's right so what we're doing is actually were having two parts right so on one side we're figuring out personal triggers factors that can be a lot. of migraine could be lifestyle factors whether factors and so on so we're figuring that out with our software and on top of that we're offering actually therapy methods that you can do. take a look at yes sure that my cellphone with me so so basically if you look at the app it's a chest but guid

care as two thousand and eleven purchase of health data firm van gent instantly made it the largest contractor. to medicare and medicaid huge government plans for seniors and the poor quote they saw that their legacy defense market was going to be taking a hit said sebastian le gonna an analyst the technology business research a market research firm and they knew they was going to inject funds into the health care market as the article then says if health care is the new oil as investors hope this was the market to get into right the american program this is the almost a million people went bankrupt because the medical establishment they defense industry and the health insurance industry targeted them for death and now they are dying as predicted good on you maybe your plan to kill people is working so essentially a medical procedure that cost five hundred dollars the medical industry these guys now working for the health of the defense contractors and presumably they're threatening you not with losses but with actual weapons of mass destruction will come to your home if you don't p

and put in a mental health rehab program that is licensed by the health care services administration of the state. because these were conservatorship, they considered it like prisoners, so they have a whole different licensing process and demands on what a building should look like if they're a prison locked facility. so we had to argue the point of what their role is and that's beds are. we got through that and opened up in the ninth month, so i think we did a great job of timing. this last year we expanded our respite expansion, focus on the shelter clients. i talked about the nurses in the shelter. we identify individuals in the shelter system that are not thriving physically and medically, or with addiction or mental illness. i think that's the end of my apprentici presentation. i look forward to questions. >> supervisor cohen: we have a ton of questions. if we make gains in dealing with drug addiction and mental health, do you think this will have impact on the number of homeless people. if we wrap our minds around solving the health crisis needs? >> it's going take that and the

we learned a lot about cardiovascular health but not the rest of the overall health. think fat was the problem, we now know it's simple carbohydrate calories that make much worse for the obesity epidemic. we take way too much simple sugars in our diets. and finally, exercise really does make a difference. exercise allows our body to cleanse itself in a way that was just discovered in the noble prize was one last year, or a year 1/2 ago now for the discovery of process where we clear out outsides during exercise on a hard moanal basis and rejuvenate cells. we don't moe how much that factors in. so, when you are obesity you don't exercise as much. it's a compounded problem in that case. >> walking past the gym equipment isn't enough you have to use it. >> you actually have to use the gym equipment. if you think about how our lives have changed you don't walk the doirns you used to. you don't do physical fitness as a daily basis. you go to a gym but you're not doing physical thing in your life. >> for teenagers coming into your life, is alcohol the biggest problem or dru

higher participation rate and the other idea i came up with is health care health care spending you and i have talked about obamacare you know after twenty years overseas we return here and it's quite a sticker shock to see that we were able to be treated fairly equally to all other members of society in france or united kingdom at the same rates we pay the same tax rate and we receive the same treatment here states there is not only a massive bureaucracy but a massive imbalance in terms of justice and injustice there so we'll pay we pay this year twenty six thousand four hundred in premiums but we still have five thousand dollars in developed a bill to even receive any treatment it seems like a lot of money right add that up because that's twenty six thousand four hundred just to get medical care and then five thousand on top of it thirty one thousand dollars. well if you earn under a certain amount you get it all free so yeah that goes into your calculations of should i participate in the jobs market and earn forty thousand dollars but then i have to come up with thirty thousand thirt

your money or your health. a difficult choice and an alarming trend people with insurance are making paranoid about privacy on the internet you should be. tips on protecting yourself and your information lessons from dad when it comes to investing the father/daughter team with a common sense strategy to help with your money. and want to see what $250 million will buy oil billionaire boone pickens is selling the old homestead. you have to see this to believe it "on the money" starts now >>> this is "on the money", your money, your life, your future. now becky quick. >> we begin with the ever-rising cost of health care. a study found even people with health insurance are deciding to skip doctors visits and medical tests. it is because of a fear of the bills that will follow they're making a choice of cost versus care. it is this week's cover story. >> you know, health care is very expensive for us. >> the affordable care act was signed into law eight years ago, but for many medical care today is less affordable t

finally, on another matter -- health care. next week health insurance companies will begin to announce their initial proposes rates for 2019 in each state across the country. and when they do, every american should remember that president trump and congressional republicans have spent the past year and a half trying to sabotage our health care system in a way that could increase costs and decrease access to quality health care. it's true that last summer the senate republican effort to repeal our current health care system and gut medicaid, an effort that would have left tens of millions uninsured and raised costs on millions more, ended thankfully for the american people in failure. despite that legislative failure, president trump, his administration, and congressional republicans have committed several other acts of sabotage, raising premiums and hurting health care, all it seems to me for political vendetta. for a long time the president refused to guarantee that the administration will honor the cost-sharing program which

i am larry gostin, i am the director of the world health organization on center of public health law on human rights. it is my great pleasure to welcome you here to georgetown university for a very important and topical debate. this is being cosponsored by the dean's office and the institute and several student groups are here at the law center, active minds, human rights action and students for democratic reform. i don't know if any of you manage to get to the march for our lives on saturday. i suspect many of you did. i was there and it was truly inspirational. and, the reason it was inspirational is because it was led and articulated by the young people of america. and, what wonderful, brave courageous leaders they are and the youths of our future are absolutely right than on a question of gun violence where youth is at the eppi center of the violence and fear that they ought to be ton leaon the lead. they are and tonight as well. some context, every year, 38,000 people die of gun violence. this is more than a hundred human beings everyday, day after day, it is enduring and rarely

the health subcan i, -- health subcommittee is currently holding a series of hearings on opioids. last month i introduced with congressman guthrie of kentucky the comprehensive opioid recovery centers act, h.r. 5237. this legislation would fund designated treatment centers where individuals with comprehensive patient-centered care for opioid addiction and other substance abuse disorders. it's our intention to build model practices for treatment and recovery that can be duplicated nationwide. i'm also working on legislation that would clarify the food and drug administration's authority to consider potential for misuse and abuse when assessing risk and benefits of controlled substances for approval. our expert agencies must have clear authority to consider the potential harm of medical therapies and protect americans if the harm outweighs the benefits. federal programs like medicaid, medicare, coverage through the affordable care act are critical ensure -- in ensuring americans struggling with opioid abuse have access to treatment and recovery. the kaiser family foundation reported

center that focuses on providing care for those with behavioral health needs. finally jewish home which is one of the largest community providers of skilled nursing beds in the city has several acres and have expressed interest of development there, but that is a longer term strategy around 5-10 years. >> supervisor ronen: how long would that take. >> i would estimate one to two years to go through the regulatory processes. though our immediate need is about developing our current bed capacity in the city, we also know there is a need to look at a range of options that support people at home and also keep the capacity that we have here in the city and so a second strategy is really around looking at ways we can incentivize the facilities to preserve and create the beds that we have and includes office of workforc economic workforce d development. -- the third strategy is about examining ways to improve discharge planning so we make sure that patients who is need skilled nursing care can get to skilled nursing care and patients who might be able to be supported

in disturbing health care out of the major centers to where the health care need is. and i think that is part of the answer. we are exploring with dea the next iteration of that, how can -- have abe telehealth prescription in a rural community where they may not be an mhc provider? there are certain barriers, but we are working with -- on that. i don't want to take up all the time. but i would be happy to follow up. >> i will follow-up with what the admiral said. there are a lot of barriers. one of the ways we are working on them are through the projects we have approved. on issues ofbased guidance we stated last november. something we're very interested to see the results of those five states and what's happening there and how we can work with other states to provide flexibility. >> thank you, senator. we are going to wrap up for to quickly. we have a little business left to do. i am going to reiterate a couple of points. first, i would like to enter into the record senator roberts questions on when we wrap up, we're going to ask that there be a response for question