How resilient communities can create a healthier country

[Music]

[Music]

i want to talk to you all today

about an epiphany that i had growing up

i was blessed to have parents who were

extremely hard working

both my parents were school teachers and

they had to stretch their incomes

to feed and to close me and my brothers

and my sister we were a family that was

rich with love for one another but no

one would have called us

financially rich my parents

they made ends meet but there was never

never much left over so if i wanted

anything

beyond the basic essentials i couldn’t

do what my

own kids do today what my 14 year old

did

just earlier this week in yell alexa

order new sneakers

the fact is if i wanted new shoes i had

to get a job

and job opportunities were limited in

rural southern maryland where i grew up

but i was determined to get my pair of

air jordans

so like many americans for me a top

priority

was figuring out how to generate income

now i may look like an airline pilot

and on occasion i’ve been asked for

headphones and extra snacks while

traveling

but i stand before you today as the 20th

united states surgeon general

the very same surgeon general whose

warning label

is on the side of every box of

cigarettes sold

in this country so can any of you guess

what i did as a teenager to afford those

sneakers

close close i worked

in the southern maryland tobacco fields

and the irony it’s not lost on me

i know from the murmurs in the audience

what you’re thinking

our surgeon general had a job that was

harmful to the health

of so many people even back then as a

teenager

you had to know that tobacco was bad for

you

well i watched my own grandfather suffer

and die from lung cancer

i had asthma myself growing up and one

of my worst ever attacks

came after working in a barn full of

tobacco leaves hung out to dry

so of course i knew tobacco wasn’t

healthy

but i didn’t connect the dots between a

desire to meet my financial needs

in this case obtaining the hottest new

footwear

and the impact my actions would have on

the health of millions of americans

including me and my family

you see democrat or republican black or

white rich or poor

we all make decisions every day that

compromise our future physical

and mental well-being we do it as

individuals

and we do it as a nation and time and

again what we tend to prioritize

is our financial well-being

and i actually see some heads in the

audience shaking no no no

not me so i ask you this

raise your hand sometime in the last

week

you didn’t get enough sleep you

skipped a meal you failed to work out

for the sake of your school or your job

and i’m betting that for many of you who

raised your hands

at least part of your motivation was

that you would eventually be compensated

that you’d get a paycheck for making

that choice

and if i ask you what’s healthier french

fries or broccoli

broccoli she got it and if i ask you

how many hours of sleep should you get a

night

not how many hours you got how many

hours you should get

eight all right see you all are smart

group you’re a smart group

see you ace the test the fact is

in most cases you know what will make

you

and will make your community healthier

but you still

choose not to do it so why is there such

a disconnect

and what can we all do about it

while you ponder that let’s fast forward

to my life after rural maryland when i

became a practicing physician

in indiana i worked in an inner city

hospital

i was very proud of the work i did but

if i’m going to be honest with you

i was also starting to get a little bit

burned out

late one night i remember a young man

let’s call him johnny who came in with

multiple gunshot wounds

i worked with johnny all night long

giving him unit after unit of blood

by the end of it all there was more of

johnny’s blood on me

than there was in his own body

johnny survived but i saw johnny again

a year later with a stab wound

johnny even came back a third time a few

years after that

time and again we’d see people like

johnny in the hospital as a result of

gang-related violence

we’d patch them up but then we’d send

them back out

into environments that led them to us in

the first place

and i told you all that i had asthma i

vividly

remember a patient who was having an

asthma attack let’s call her mary

mary was having such a hard time getting

oxygen to her brain

that she was losing consciousness

i had to put a tube down mary’s throat

and breathe for her on a mechanical

ventilator

for several days mary thankfully

recovered

but guess what we sent her back to a

housing complex

that was filled with second-hand smoke

you see no matter what i did as a health

care provider

i couldn’t stop the treatment from being

needed again

or the trauma from happening again

but at some level i could relate to what

was going on with my patients

you see i understood that their

choices their opportunities

their outcomes were in large part

determined by their circumstances

now mind you these patient stories come

from indiana

a state that prides itself on job

creation

a state that works unemployment is at

record lows

in indiana and while i was trying to

figure out how to get my patients out of

the hospital revolving door

i learned in my other role as head of

the state health department and a member

of the governor’s cabinet

that the chief complaint from indiana

businesses was a limited pool

of healthy workers against the backdrop

of an emerging opioid epidemic

it was difficult to find job applicants

who could pass a drug test

those who were drug free they were often

obese

or they smoked where they would forego

health-promoting interventions

like flu shots and cancer screenings

and these employees in turn they had

more absences

lower productivity and skyrocketing

health care costs

not just in indiana but nationwide

almost

one in five dollars our economy

generates now goes to

pay for health care expenses and these

dollars

they’re not just diverted from company

profits they’re diverted from critical

funding priorities

like job creation like wage increases

and like research and development and

that time in my life

while addressing the individual health

of my patients

and also the public and economic health

of a state

was a time in my life when a light bulb

went off

for me you see

i realized the problems i faced with my

own patients

and the concerns that businesses had

with workforce all

had something in common there more often

than not

the results of environments and

inequities that make it increasingly

difficult

for people to lead healthy productive

lives

in this reality it cost us all dearly

despite a growing u.s economy we have

millions

more unfilled jobs in this country than

we have people looking for work

we spend more on health care than any

other country

it’s not even close 3.4 trillion dollars

yet we have some of the highest

infant and maternal mortality rates and

some of the lowest

life expectancies even our military is

being affected by the poor health

of american communities did you know

that 7 out of 10 of our 18 to 24 year

olds in this country

are currently ineligible for military

service

they can’t pass the physical can’t meet

the educational requirements

or have a criminal history

we often think that addressing the

upstream

social factors that lead to these

outcomes will cost too much for our

economy

for our businesses for all of you as

taxpayers

to afford but the truth is

we can’t afford the status quo

we can’t afford to keep doing the same

thing and expect a different result

because we all know that’s the

definition

of insanity so what can we do

well we can invest in children and

families

not just as social imperatives but as

economic ones

we can support a healthy workforce with

policies that increase access to healthy

food options

smoke-free communities and safe

attractive places for physical activity

we can help businesses and communities

see the value

the return on investment that comes from

supporting child care and a living wage

fortunately across the u s businesses

and communities are beginning to partner

to change their outcomes let me give you

just

one example a major employer

in a small town had so many vacancies

that production

and expansion were suffering so belden

incorporated

in partnership with the community

started offering drug testing

to potential employees because so many

of their folks

were failing the initial drug screen

they guided these folks into treatment

and recovery

and then into jobs at their factory and

i had a chance to visit belden

i learned that the people who completed

this program were the hardest working

and most loyal employees that the

company had

belton’s innovation strengthens the

community

it lowers incarceration and it meets a

pressing business need

and there are more examples of

communities across the country

partnering with businesses to improve

the health and well-being of their

residents and workforce

like blue zones in fort worth texas

like purpose-built communities in east

lake georgia

like health equity zones in rhode island

some are investing in affordable housing

and walkability

others are mentoring young students to

develop a pipeline

and this all leads me to the point of my

story

when americans lack the opportunity to

reach their full health

and economic potential we all

pay the price we pay in suffering in

premature death

we pay in increased health care costs

and decrease productivity

and we even pay in terms of our national

security

but we won’t change individual health or

avoid these consequences

unless we focus on better community

health through better partnerships

by making the case for community health

as a pathway to economic prosperity

we foster investment in our communities

that not only

lifts up population health but also

raises

and sustains our collective financial

success

or to say it in a tweet for the

millennials in the audience

health is wealth you know

i was lucky the health consequences i

faced from working in the tobacco fields

didn’t prevent me

from pursuing my dreams but not everyone

who sacrifices health and safety for the

sake of finance

is so lucky i often wonder

what happened to johnny what happened to

mary

after i last saw them in my operating

room

but i ask you imagine a future

where johnny doesn’t have to go back to

the streets

because there are community resilience

and workforce training programs

that lead him down a different pathway

where mary

lives in a smoke-free community and can

be a healthy

model employee who can support her

family

where a kid from rural maryland doesn’t

end up in the hospital or supporting an

industry

that kills his own grandfather for want

of a new pair of sneakers i invite you

all to join me

and help me create unbreakable

communities

that are built so people can more easily

make healthy choices

where children thrive and where

businesses

invest in those communities as a way of

supporting a healthy workforce

and a healthy bottom line

let’s dare to break away from doing the

same old thing

and instead boldly push our nation

towards a radically different

a radically better and ultimately

unbreakable result thank you so much for

your attention