This has been a great conference hasn’t it? So how about we show a little love to
Georges and everybody who spent so much effort and time making the last few days such a wonderful
experience. So let’s have a round of applause, standing ovation, yeah I like it.
Thank you Georges, this has been really terrific. So here we are at the closing session and
I’m delighted to have been asked to come and talk to you about what it’s going to
take for APHA to reach the goal of helping the United States be the healthiest nation
in just a generation because that’s exactly the Robert Wood Johnson Foundation is working to achieve
as well. In fact we’ve officially embraced building a culture of health as our organization’s
vision. We’ve made it the central aim of everything we do. And judging from what I’ve
heard from so many of you it’s clearly your central aim as well. And that’s the reason
I’m looking forward to hearing what wise words our panelists are going to give us later
on in the afternoon. So let me begin by saying we all know that
making this country the healthiest in the world is going to require a major shift in
our values and in the actions of everyone. It’s a shift that’s going to require we
make health a key part of everyday life. Why? Because as you know health is the bedrock
of personal fulfillment, it’s the backbone of prosperity, and it’s the key to creating
a competitive nation. We all know that with health our children can grow up making the
most of life’s opportunities. Our businesses can rely on the vitality of their workers
and our military can perform at its highest level. If we achieve this shift in just a
generation our country will have a powerful story to tell. And it will be a story about
how we came to understand that health means so much more than simply not being sick and
how we recognize that it’s a vital aspect of how and where we work, how and where we
live, how we raise and educate our children, how we make decisions about our families.
It will be a story about how we rejected this inevitable. Our kids are 30 were already obese
or overweight have a real chance of living sicker and dying younger than their parents.
And it will be a story about how we overcame the dismal fact that this year, in 2014 a
group of military leaders told congress that a shocking 75% of America’s youth are too
fat, too poorly educated or too involved in criminal nonsense to serve in the military.
It will be a powerful story about how we resolve to no longer accept that our nation spends
$2.7 trillion on health care and yet continues to lose $227 billion in productivity each
year because of poor health. Yeah, building a culture of health is an idea
that will require us to stretch our current understanding of what health is in ways that
we’ve never done before. It’s going to be a view that respects America’s rich diversity,
our different backgrounds, our family and ethnic traditions, and the right for health to
mean different things to different people. It’s a view that recognizes that we all
have a right to equal health, no matter what our background, our heritage, or our current
state of health. So what does a culture of health look like? Well it certainly looks like the
World Health Organization definition of health but I also want you to imagine a society where
promoting health is as important as treating illness, where everyone can get high quality
health care when, where and how they need it. I want you to imagine doctors openly sharing
medical notes with their patients and then honestly discussing the value and price of
those treatments in a way that lets patients get well and save money. I want you to picture
neighborhoods and cities where all of our children’s health is a matter of fact not
a matter of chance. I want you to imagine every family, every town, where we know for
sure that our employers, our mayors, our educators are all working together to give everyone
the tools and opportunities to make healthy choices. It’s a bold idea and it’s one
that I believe is possible. Now when I say this to public health audiences like you,
I know what you’re thinking. That I’m a little naïve, ill informed, you know the
bubble over your head is saying Risa come on nice fairy tale but what about the harsh
realities? I mean our current system is not the healthiest. We’re facing a raft of professional
and political and economic challenges. You know the recent cases of Ebola in the US are
good examples of how the persistent cracks that we have in our preparedness system, misunderstanding
and the serious consequences of the massive cuts that our health departments have
endured over the years are taking their toll. And on top of that too many Americans still
have avoidable chronic illnesses. Every day, tens of thousands of hospitalizations or re-hospitalizations
happen that don’t need to, heart disease, stroke, cancer still account for 50% of deaths
in America. And as we’ve underscored at this conference the effects of where you live
are so profound that your zip code may in fact be as important as your genetic code
in how long and how well you live. Take a look at this slide, it's the DC metro map
and if you look at the red line there, babies born out of the top of the red line can expect
to live 84 years. But if they’re born downtown just a few subway stops away, they’re gonna
live shorter, actually 7 years shorter. And right here in New Orleans it’s even worse.
A person living in Lakeview, about 6 miles from here can expect to live 25 years longer
than someone born, raised in Iberville which is very close to the French Quarter. Now,
needless to say these are not hallmarks of a culture of health. But I want you to remember
this slide because I’m going to show you how these alarming images in the destruction
that was caused by Hurricane Katrina combine to spark an impressive public health movement
in this resilient city. But in the meantime let me go back to the
challenges that our nation faces when it comes to building a culture of health. I want you
to think about our youngest children. We know that when it comes to them research tells
us that critical learning happen from them moment of birth until 3 years old. And yet
in most states they can’t go to school and to public school until they’re 5. And for
far too many of our kids, adverse experiences like extreme poverty, family violence, substance
abuse, can create kind of toxic stress that severely compromises their health over their
lifetime and can even lead to early death. We’re painfully aware that in our current
system, the quality, cost, and patient experience for far too many Americans is disparate, disorganized
and dismissive. Now, how many of you are aware of Jeff Brenner’s work, the hot spotting
in Camden in New Jersey? Show your hands. Yeah, yeah go Jersey. The data that he’s
collected shows that 1% of patients account for 30% of the hospitalization cost. That’s
why he calls them super utilizers. Their expenses could clearly be prevented by coordination
and prevention. So these are the harsh realities and these are the issues that you deal with
every day. You know better than anyone that we are not going to achieve a culture of health
if we continue down this path.
But my hope is that by putting our heads together we can
begin building a movement that will start America down a new path. And of course you
know that that can only happen if our society undergoes a fundamental change in our perspective
on what constitutes health. America has to experience a kind of light bulb moment, a
moment that shines a beam of recognition on just how these serious, complicated and very
different issues are in fact intrinsically connected.
So let me tell you about my light bulb moment. I trained as a physician at Harvard and we
rotated through one of the hospitals in West Roxbury a few miles away. That’s where I met
a patient who will forever to me be patient Ruth. She appeared at the admitting station
one cold winter night, homeless and helpless. Her feet were swollen and she wore only a
pair of house slippers. She had raw leg ulcers that clearly made it very painful for
her to walk and her chart was thick because she had been to the hospital many times. And
so we did what we always did. We gave her a few hours in a warm bed, some antibiotics,
a decent meal. But the next day she had to go because our job was done according to the
rules. So she limped out the door and straight back to that dark tunnel of problems that
she faced every day, no home, no job, lousy food and no family or friends to help and
connect her. Our care ended at the front door of the hospital and that was so very short
sighted. What if instead of ushering her back into the cold, we ask what it will take to
keep her from coming back and then what if we have set her up linked her to the services
and the people that can actually keep her out of the hospital? In fact, why can’t
setting patients up with what they need to stay out of the health care system be the
fundamental goal of every visit?