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