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tv   Johns Hopkins Bloomberg School of Public Health Summit  CSPAN  December 31, 2018 3:17pm-5:50pm EST

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beholden to in this district for people that i talk to every single day and my son's legacy. i'm running because i am a mother on a mission. here in marietta, to represent everyone. >> new congress, new leaders. watch it all on c-span. >> next, a look at some of the public health challenges facing americans today. speakers include former new york city mayor michael bloomberg and former epa administrator dana mccarthy. this is about 2.5 hours. [applause] >> good morning. truly apleasure, pleasure, to be joined by so many colleagues and public health leaders from johns hopkins, maryland, and indeed, around the country. i'm really pleased to be able to acknowledge and welcome gov. tom wolf of pennsylvania.
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where are you, governor? he was in the lobby. [laughter] and my guess is he will find his way here at some point in the very near future. but i'm confident that our alumnus michael bloomberg is in the room today. [applause] $300 million used to be a really big number four johns hopkins. [laughter] but i digress. as you have seen, today's agenda is future looking, but as mike bloomberg frequently reminds us to look ahead effectively, you have to look back.
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sometimes, way back. in this case, i want to go back in 1736.gland that year, a strange disease swept across the region that would eventually claimed the lives of one out of every 40 people in the colonies, and most of them were children. it was called us wrangling angel. we call it the area. for one minister whose experiences catastrophic loss of life firsthand, the only expiration he could muster was divine retribution. he was of course off the mark. andtheria had both natural social causes, the kind that scientific truth, combined with innovative public policy, could attack. and so, over the years, the disease was systematically addressed. --st, scientists addressed identify the bacterium, the cause of the disease. next, public health experts organized mandatory testing and
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immunization for all preschool results,ren, and the not surprisingly, were immediate. a health crisis that had plagued communities around the world for centuries had been contained. in 1944, when baltimore confronted a sudden outbreak of diphtheria, we knew what to do. the teams at the baltimore city health department and the johns hopkins school of hygiene and public health, now the bloomberg school, sprang into action through a vigorous public relations and vaccination campaign. they knock elated more than 6000 children in two months, including 1300 on a single day alone, and virtually eradicated diphtheria in the city. of howon this epic tale dreaded disease was conquered to show the power of public health to change the world. however, we can surely understand that new england minister sense of despair and
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futility in the moment in which he lived, but indeed, we know of ourlic has challenges own day, the very ones the bloomberg american health initiative exists to confront can seem just as monumental, just as daunting as diphtheria did in the time of this minister . but where others throw up their hands in the face of these enormities, the cadre of experts who comprise the bloomberg american health initiative, like so many of you here today, roll up their sleeves. and they adhere to the guiding principle that might bloomberg is frequently intoned so often and so poignantly. in god we trust, everyone else bring data. it is this data-driven approach to public health that denotes, that distinguishes the bloomberg american health initiative and animates our university and school of public health. this is the place for the tools of public health or harness to challenge thinking, dismantle stale assumptions and exposed
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geek social inequities and the need of repair. a thing orberg knows two about marshaling data to tackling endemic public health challenges. but as he would be the first to admit, success in public health is not the province of solo practitioners. it requires groups of dedicated professionals like our bloomberg fellows whom you have heard from , armed with facts and embedded in the community networks to ensure that research and evidence don't languish in journals or lapse, but are translated immediately, effectively into impact on the ground. visionse, realizing this would not be possible without the unstinting support and the extraordinary vision of the man himself. know, able you all to entrepreneur, a fearless and determine public servant, a courageous champion of public health, and as his most extraordinary recent commitment of a historic $1.8 billion to
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support financial aid and access at johns hopkins attests -- and i would ask you, this is the first time i been able to publicly acknowledge with mike in the room, this amazing gift. i would ask you to please join me -- [applause] when mike gave the gift and he phoned me a few weeks ago to tell me what he was about to do, he said just understand, i'm not coming to johns hopkins to events where you celebrate it. so there's a bit of bait and switch here that is going on. i know this is painful for you, mike, but it is truly joyous for us. that gift and all the other kinds of support, and indeed to universities and students across reflects is really
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very powerful, unshakable believe in the power of universities and the power of higher education to be bastions of fact, reason, and evidence, perfect, andight, improve society and to every individual. so it's not hyperbole to note that might bloomberg has no living. in terms of his transformative inact -- no living peer terms of his impact on higher education. with great joy and admiration and affection, please help me in welcoming the former mayor of healthk city, world organization global ambassador for noncommunicable diseases, the special envoy for climate actions, but let's face it, most importantly, from our perspective, graduating class president of the class of 1964 at johns hopkins university, might bloomberg.
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-- mike bloomberg. [applause] ♪ >> thank you for those kind words. you gave them exactly the way i wrote them for you. [laughter] but i did tell ron before he started speaking, just remember, i haven't cut the check for the endowment yet. i also want to thank alan mckenzie, our talented dean of the school of public health at johns hopkins. you are doing an incredible job, keep up the great work. [applause] and to people who are leading the bloomberg american health initiative at johns hopkins, and associate -- director -- associate director michelle spencer. in doing the hard work at bloomberg philanthropy, dr. kelly henning.
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thank you all, you are the ones who are in the trenches day in and day out, doing all the hard work, and accounting there is any more important job than saving and improving lives. i know you don't get the recognition you deserve always, but you really are heroes in my book, and i thank all of you. we all owe a great debt of gratitude. when we decide to create the bloomberg american health initiative with johns hopkins two years ago, bringing people together like this was always part of our intention. all the challenges that you discussed are critically important, and our foundation is glad to support the work that many of you were doing. this morning, i would like to zero in on just one of the challenges, and that one is ripping at the hearts of so many families and communities across our country, and that is addiction. i would like to begin by asking everyone to please take a moment at the chair and see what color your chair is.
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can you remember what color it is? ok, now if you are sitting in a blue chair, please stand up. take a look around. standing. are 130 is the estimated number of americans who will die of an opioid overdose today, 130 more will die from opioids tomorrow, and the next day, and the next, if nothing changes. thank you, and please sit down. now, if you are in a red chair, please stand up. quickly, 60 of you are standing. 60 is the number of americans who have gotten a prescription for opioids in the 10 second since i just asked you to please stand. is a math. 60 prescriptions in 10 seconds, which means six opioid prescriptions are written every
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single second in this country, and i did the math myself to make sure it is right. that adds up to more than 500,000 prescriptions every single day. please sit down. now if you are in a black chair, please stand up. , one person. this one person represents one child somewhere in america, who was removed from his or her parent's care because of their opioid addiction. .ince i began speaking by the time i'm done speaking to you this morning, another child will be separated from his or her parents because of that dangers of opioid addiction. by the end of the day, that number will reach 240. that's 240 children taken from their parents, 240 families broken apart in a single day. thank you, you may sit. opioid addiction is a national
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crisis, and no community, as we know, is immune. there are three hundred 50 people in this auditorium, and i would bet that at least some of you have experienced the tragedy of this crisis in your own families. unless we act now, the toll will grow heavier and heavier. more families and communities will be torn apart. more people will be released from hospitals after overdoses without receiving the medical treatment that they need. languish inwill prisons without receiving the medical treatment they need. more people will die because medications that help cure addiction are stigmatized, and ones that can help people survive an overdose or dark -- are in short supply, and more patients will become addicted to prescription opioids when there are other, safer options available. in washington have failed to meet the challenge with the urgency and bold solutions that are required, and we cannot wait another day. we have to act right now.
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this is a problem which touches every part of our society. i believe, and i'm sure you agree, that every part of society has to be part of the solution. researchers,hers, fellows, police officers, parents. it will take all of them and especially all of you leaders in the public health field. i first became passionate about hotel when i was serving on the board of johns hopkins more than 25 years ago. publicer was dean of the health school then and he was the one that really sparked my curiosity. the more i learned about the work going on there, the more i realized what an opportunity public health offers to save and improve lives. serves ony that out the board of our foundation today, along with two other board members who make great
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contributions to our foundation. they are both here today. thank you for your commitment on these issues and thank you for your service over all these years. we really can depend on you when you are making a difference. one of the ways our foundation considers what issues to take on as i looking at the leading causes of death and analyzing where we can make a significant difference. that's why we have decided to leave the to -- lead the charge in tackling tobacco use, road safety, obesity, and other important challenges. why today we are launching a major new effort to stop the opioid epidemic in america. cdc report on life expectancy this week underscores just how important this work is. hard as it is to believe, in the united states of america, life expectancy has actually declined over the past three years. that hasn't happened since world war i, and we just cannot let it continue.
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as all of you know, opioids or big part of the problem. last year, federal drug overdoses rose by 10%, and opioids are the main driver of that increase. that is a big reason we have convened this first-ever conference and brought together so many leaders in the field. policieshat smart proven link the lives. in york city, when i was mayor, we were able to extend life expectancy by more than three years over 12 years in office. i remember after putting in the smoking ban, nobody wanted to take a picture with me. but i did get a lot of one finger waves in parades. we want to take the same bold
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approach to fighting opioid addiction. we are starting to see some progress, thanks in part to the great work done by the people in this room. just yesterday a federal court in massachusetts ordered a local jail to provide methadone to help an inmate kick addiction, ruling that we hopeful set a national precedent. but we can do more and act faster. that is why today, but to say that our foundation is launching a new effort to support the most promising work being done by state and local leaders to save it spread across the country. we are making a new commitment of $50 million for this effort and we are going to start with one state, a state that has been hardest hit by this epidemic, pennsylvania. hasstates governor tom wolf been a real leader on this issue. he has done a lot to bring people together and to expand access to life-saving treatment and will work together to launch a comprehensive effort to
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tackled opioids from every angle. this will be a statewide, all hands on deck effort to fight the opioid crisis on the scale that has never been attempted before. we work to produce over prescriptions and improve access to treatment in jails, prisons, and hospitals. we will improve access to drugs that can save lives in cases of overdose. we will help with all the groups on the forefront of this epidemic, collect and share data . we will also work to identify innovative new ways to stop addiction and overdoses. think, will create a blueprint that can spread from state to state across this country. and speed progress in that direction we will begin working in nine other states with high rates of opioid abuse. where assembling a group of fromrs within this field
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final strategies, which is a close partner of our foundation on a number of issues. together we will encourage byhington to act more boldly showing that progress is possible. until the federal government begins tackling this issue with the urgency requires, who will step in and support the states and given the evidence they need to take bold and decisive action on their own. i'm hopeful that we can achieve this working together. i'm hopeful because of people like jodee rich, who directs the center for prisoner health and human rights in rhode island. sandra danforth, michael and addiction medical doctor. nicole alexander scott, director of the rhode island department of health. susan sherman, a professor and researcher on opioids. , and opioidmore crisis specialists.
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wasr, parent whose child addicted. kathy stone, a certified high-performance coach. a doctrine dresser at johns hopkins, and brandon dell closer, the police cheese -- police chief of burlington vermont. i'm hopeful because so many people in so many walks of life are committed to fighting this epidemic. their commitment is unwavering. to them, it's very personal. >> my name is dr. jodee rich. i've spent my career caring for and advocating for haitians who are marginalized and dissidents, including those with hiv, addiction and incarceration. in rhode island, we expanded medications and documented a 61% drop in post-release overdose
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death. i'm eager and ready to do much more. >> my name is sarah danforth. proud to work for an organization that provides health empowerment services to injection drug users. i know that we can make a positive change with this opiate epidemic by including mirrors from all communities and with a focus on the perspectives and leadership from people most affected, those who use drugs themselves. [applause] clinician, educator, and researcher, i'm excited on -- to be working on ways to engage the community and combat the opioid epidemic. [applause] susan sherman. i'm a professor, researcher, and advocate. i'm excited to have meaningful
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conversations about the complex drivers of the opioid epidemic and how we all can respond in a way that focuses on programs that are evidence-based, grounded in harm reduction and include the voices of people who use strokes. nicole alexander scott. i believe that even one overdose is one too many. we need to come together as families, communities, states, everyonentry, to give with substance use disorder resources and support they need. everyone needs to know that change is possible, hope is possible, and recovery is never out of reach. [applause] >> i'm an american chief of
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police. my police department and its police officers are committed to helping americans arrived the trials of addiction. that, we areo working hard to make sure that the people we come into contact with have the best access to the medicine and treatment that they need and that they deserve. it's hard work, but our commitment is real. we cannot go it alone, and i'm grateful that we don't have to. [applause] comprehensivewo outpatient programs in baltimore. this issue is important to me because addiction is a treatable disease. we have effective treatments for opiate use disorder and patients should not have to die from lack of access to treatment. [applause] >> am kathy stone, and i have had the privilege to be clean and sober from drugs and alcohol for 33 years. [applause] i have personally witnessed the opioid crisis in the lives of
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people i know and love. i am passionate about the powerful impact that coaching and training can achieve when focused on moving family members away from patterns of codependency to become their loved ones best chance of recovery. >> the initiative founded aims to challenge stigma and discrimination associated with mental illness and substance use. i do this work because i believe were opioid addiction less stigmatized, my daughter, who died of an over dirks on february 11, 2014, would still be alive today. [applause] >> i name is amanda lattimore. because i was born to a mother
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who developed heroin addiction, i know firsthand how addiction can take hold of an individual and impact lives, families, communities. but i'm so incredibly helpful that if we all work together and we listened intently to both the voices ofnd the people whose lives are affected every day, we can overcome the open at crisis. crisis.pioid in fact, i am more than hopeful. i know we can do it together. [applause] >> thank you to this amazing group. another round of applause for all of them. [applause] now, i know we can turn the tide on this epidemic. and if we do, we can begin reversing the decline in life expectancy that has been
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happening across our country, largely thanks to the opiate overdoses. here are some of the goals that i think we should all want to see reached in the next five years. all doctors will follow cdc guidelines on when to prescribe opioids. will providers coverage for alternatives like physical therapy. all americans struggling with opioid addiction will have access to life-saving treatment and medications wherever they seek care. and that includes everyone within opioid addiction who is serving time in prison and repaying their debt to society. and all of us will work to fight stigma around addiction which prevents people from getting the help they need. we have a lot of work ahead of us, so let's get to it. and i want to thank all of you for being part of this work and for all of you -- for all you do to help people live longer and better lives. it really is inspiring to see. all the best for a productive day.
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you really are doing a wonderful thing for america and the world. thank you. [applause] ♪ [applause] ♪ >> the federal government, states and localities should
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adopt the primary goal of reducing overdose deaths. should expand their medicaid programs to increase access to life-saving addiction treatment. health systems, addiction treatment providers and prisons should offer effective medication therapy to people with addiction. instead of criminalizing addiction, government at all levels should promote a broad range of services that help people stay alive, access treatment, and regain control of their lives. cities and counties should develop recovery strategies to support housing and job training for individuals in recovery. >> please welcome the director of the rhode island department , the cole alexander scott, governor tom wolf in
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pennsylvania, and our moderator, executive director of the center for addiction, michael botticelli. [applause] well, good morning, everybody. i'm thrilled to be here with three people a who i have known to be extraordinary leaders as we think about progress in this opioid epidemic. not only are they thought leaders, but they are action leaders at the state and local level in terms of giving us hope and optimism that by using evidence and data and science, that we actually can make a change. and i think we have begun to see states and municipalities making major change in reduction to overdose deaths. i'm really excited to be here today because i do think it is really important for us to understand what is working, that there is hope, that there are over 20 million americans, including me, who are actively in recovery, and that we can make a difference on a daily basis. so i want to thank all of you for being here today. i would like to start with and first of all,
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say congratulations on your reelection. [applause] leadership matters. i was actually on your webpage today and saw your action plan for pennsylvania and sawyer strong leadership position in terms of actions that pennsylvania has taken for the opioid epidemic. i'm going to ask you to start and ask her other panelist to talk about what undergirds sure foundation and your strategy here and how do you use evidence and data to really focus on the things that we know to be effective? we have to do what works. as they are bloomberg said, a disease -- this is a disease that is killing people all across the country, and the tragedy is that we can do something about it. in pennsylvania, we have worked right from the outset. we have been doing things based on evidence, looking at things
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we can do logically and rationally to address this problem. the goal is to make pennsylvania place where no one dies of substance use disorder. dr. scott, rhode island is actually one of those states that has begun to end the curve on the overdose epidemic that we see. maybe you could talk about what you think some of the strategies are behind why we are seeing progress in rhode island. >> when the governor in rhode island established our overdose task force, we had four major strategies that we said would be very important to be evidence-based and data-driven, focusing on prevention, treatment, recovery, and reversal with naloxone. our main goal was saving lives, and so treatment and reversal were the two prominent focal points. with that, we were able to put policies in place that helped us work as hospitals better. caretablished levels of that required every hospital system in rhode island to
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maintain minimum standards of substance usening disorder, testing for fentanyl, and referring people for care, as well as engaging. cover coaches. that has made a difference. we have put the focus on expanding access to treatment. dr. jodee rich shared earlier 61% decrease in overdose deaths for those released from incarceration because of our medication assisted treatments program. we have use that type of data to say we have to continue to scale up access to medication assisted treatment, all levels, meeting people where they are. the clinicalt level. maybe can talk about the importance of clinical interventions in terms of how we need to mount a robust response against -- around this issue. x absolutely. we know that medication works
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and we know some of the barriers that providers don't actually offer medication. statek with our department of health to determine what are those barriers people --. andiding training for free he convenient location at their own clinic for medical centers are something we do. we also provide support for providers because often they feel like they need support to take on the treatment of addiction. having nurse care managers available which are supported again by our state department of health can get doctors to take this on. finally, we also provide mentorship. there's a contrary of physicians who have experienced an expertise and work with other physicians who are newly prescribing medication and taking this on and are really there to help in case people feel stuck or in cases of challenging cases are scenarios. we have to take about -- think
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about all the barriers and addressed them to be able to scale up life-saving medication. >> one of the issues we have known for a long time that presents a barrier for treatment of insurance coverage. we are beginning to see at the state and local level -- there was an interesting article about dayton ohio where the mayor talked about medicaid and medicaid expansion is fundamental. governor, i know that is particularly important to you. can you talk about the role you see medicaid and medicaid expansion playing? things,e done a lot of including having declared a disaster emergency in pennsylvania. it started with the expansion of medicaid. we have 125,000 pennsylvanians and have we not expanded medicaid, it would be a huge gap in our efforts to address this epidemic. >> medicaid expansion is critical. certainly when you look at
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federal policies that are needed, making sure that the aca and the ability to expand medicaid is protected at every level is certainly going to be a very necessary arsenal to our ability to overcome this epidemic. we also have state and local policies that we know are critical, continuing to put the community forward and making sure that those who are in recovery or the families affected by recovery or by addiction and the communities that are devastated by a have the support and resources, and the voice they need to change policies and systems and make it so that there is an opportunity to improve and overcome this epidemic at an equitable level. >> how does it manifest itself at the clinical level in terms of people's ability to have coverage and care? >> it is absolutely critical. covering both office visits and
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medication is essential. i'm in theents -- south bronx, so most of our patients have medicaid. in new york, we have been very generous in allowing medicaid to really cover life-saving treatment. so it has been critical. -- the other thing is around the locks on. having standing orders by the commissioners of health in the cities and state is an important point of access for people to be a to get naloxone and for insurance to cover that in pharmacies. >> people who were testifying right before we came on stage talked compellingly on the role that stigma plays, that we can have the most robust treatment systems, but unless we firmly diminished some of the stigma, that people will not ask for help. we know that stigma manifests itself on public attitude and the public policy level.
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maybe can talk to actions that you have seen as important or things we need to continue to do to diminish some of the stigma associated with addiction. >> in pennsylvania, we need to talk about this. this is an epidemic, not numeral failing. need to understand it. as we do, people will go into treatment, and i think this is one of the reasons why we have now brought 20,000 instances of life saved by naloxone, just in pennsylvania. when we started, it was tough to get some of the first responders to even carry naloxone. the secretary of health gave a standing order to every pennsylvanian so that every pennsylvanian has a prescription and can use it. getting beyond the stigma allows people, first responders, patients, people who need this,
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family who have loved ones that need this, getting by the stigma allows us to embrace the problem and try to address it. >> i am leading the witness here. why is your voice at the state level critical to diminishing some of the stigma? why is it important for you to talk about this? >> that is a leading question? i think it is a softball. [laughter] we have maybe hundreds of roundtables. i have led 80 personally. this is a problem that affects every corner of pennsylvania, rich and poor, republican and democrat, urban and rural. there is no family that doesn't know somebody in pennsylvania who has been affected by it. everybody is affected, and we need to say, don't cover this up. don't be ashamed of it. this is a medical problem, and let's deal with this, because we can you something about it. it needs people all over
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pennsylvania, everybody in any position to stand up and say, let's deal with this. >> wanted most consistent challenges we have seen over the last few years with our statewide strategic plan was a negative public attitudes component. it impacted every element of those four strategies, prevention, treatment, recovery, and reversal. addressing negative public attitudes as a key goal and part of overcoming those challenges. our governor similarly has activated a mental health executive order, where we have been having mental health talks throughout the state to really bring the community cost voice forward and to normalize conversations about it being ok, so that people can access the treatment, the prevention, recovery, and reversal services that we know truly save lives.
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>> in new york, our city department of health has a campaign that really addresses stigma head on. tv, subway ads were people come forth and talk about having addiction, getting treatment, and how it has really changed their lives. so that is an important thing. i just want to add, the governor said it is a medical problem. i really think that taking this on as a medical problem is important, but historically, our systems are not set up that way. drug treatment is marginalized for the most part in our society. to address stigma, we have to bring it into the mainstream medical care. i treat diabetes, heart disease, and addiction. we need to do the same thing in emergency room's, in our hospitals, and not marginalize and but bring it in mainstream it with the rest of the health care system. [applause]
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>> i want to follow up on that because i think we heard from jodey rich in rhode island and we see the extraordinary mortality of people who are coming out of our jails and prisons who often don't get good, evidence-based treatment behind prison walls. we have to look at integration of addiction treatment and medication and her criminal justice system. talk about the importance of that strategy in terms of not only reducing overdose deaths, but getting people back to work and back to productive citizens. >> we have a lot of things to do. one of the small things, people who go to prison or treated by the medical system within the prisons, in the past, you would terminate medicaid. when you come out, it takes three months to get signed backup for medicaid. we suspended medicaid when you are in prison and the day you leave prison, you can start medicaid. that simple thing has helped in reintegrating people back into the health care system.
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right, we you are need to look at this issue everywhere as a medical issue. this is a chronic disease, like ibd's and congenital heart disease -- like diabetes and congenital heart disease. -- maybe youde could share some lessons. how did you implement this in rhode island and are there lessons others can take in how to do that at the state, county, or local level? >> we started was seeing the data and knowing that rates of overdose were higher for those who were released from incarceration. almost a quarter of people with substance abuse disorder actually contacted our corrections system, and there was an opportunity for us to engage. similarly, we made improvements. instead of waiting people off of methadone or other medication assisted treatments when they we begancarcerated,
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making sure that everyone had access to all three forms of medication assisted treatment. we also began screening of people who are incarcerated for substance use disorder and have engaged a program to make sure that prior to release from incarceration, they were already engaged in a treatment and recovery services program. so i definitely credit dr. jennifer clark, our medical director of corrections, for being a pioneer and leader in pushing forward, and certainly encourage corrections facilities throughout the nation to follow that model, the 61% decrease in overdose deaths is something that we can all benefit from nationwide. >> in addition to providing treatment in jails and prisons, i think a big issue is once people are released. we have a transitions clinic started by one of my colleagues which is specifically for people who are being released from jail
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and prison and really provides accessible treatment so people can just show up on a saturday morning, and they can get treatment reinstated immediately. again, not just for addiction, but for all of their chronic illnesses. models of -- i think models of care really rethinking how we deliver care is important, particularly for marginalized populations also very high risk of overdose. >> i think we heard compellingly from the people who were on stage before is about the importance of people with lived experience, involved in the policy and decisionmaking, whether that's a parent faked, a person in recovery or person who still using. how does that infuse the work you do? how do you think about incorporating people with lived experience in the work you do?
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>> one thing, all of this is bus policymakers have to listen and ask people, what is your experience, how would you have done this differently? how can we do something differently? we need to listen. >> hearing the voice is critical. what is actually happening and what works in the community and it helps shift our focus so that the community's voice, whether you have been affected as a family member or someone living in recovery now, can really lead the way and policies can follow with evidence and data to back it up, to really have the impact that we know is possible. >> great. >> we also -- i'm in a community health center so we are very much involved in the community and have been partnering with community-based organizations, harm reduction organizations, and syringe exchange programs for decades. listening is critical. we heard people say we want treatment at the syringe exchange program so we are studying that and again rethinking the way we deliver care is critical. >> so, we have ten seconds left. so each of you get -- i'll give you ten seconds to respond to this question. what one additional thing that you need to do and what support
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do you need either from the federal government to -- or any other entity to make sure that that?happens. -- make sure that happens? >> we need consistent help in -- and broader recognition at the federal level that this is in fact a medical problem. >> we put the systems in place and now we need make sure that everyone has access to it and we need to reach people and meet them where they and are need the support at the community level to help do that. >> i think we need at the federal level to enincentivize -- incentivize medical schools to provide the education and treatment and has to be done at a much larger level, federal level. >> thank you all. let's give them a round of applause. [applause] >> please welcome, from huntington, west virginia, police sergeant paul hunter and
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the honorable mayor steve williams and the modernator, the -- honorable moderator, the 19th surgeon general of the united states, vivek murphy. [applause] >> good morning, everyone. it is a true honor and pleasure to be here with all of you and to be here with two distinguished men who are at the front lines of addressing the opioid crisis. i'm excited to have this conversation because when you hear about the opioid epidemic, it is easy to feel despond and about the numbers going the wrong way, the number of overdose is continuing to increase, and about the extraordinary pain and anguish this is causing communities across america. when i was surgeon general, i was very intent on finding those bright spots and sources of hope. i believe we needed to hear the -- those stories in order to find the drive and the desire to keep going, and the two gentlemen here are those bright spots.
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they're sources of hope. because of what they're doing in west virginia. i first came across their work participating in the selection committee of the bloomberg mayor's challenge which awards $1 million grants to a select few cities which are working on transformative initiatives. and the day we discussed this proposal we were all so impressed with what they had done because they had really focused in on an insitsous and important problem that was affecting first responders. so i'd love to get started with you, mayor, and you, sergeant, with how you came up with the idea for this project. i'm hoping you can tell people what it is and why it's so important. >> as many of the public officials will attest, i hate social media. but i do have folks on our staff that follow it very, very closely and one thing we , continue to see on social media is overdoses were increasing. we had individuals who were
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posting on social media, let them die. that broke my heart. because i also knew and know the heart of the people of the city. i know they don't mean that. so that was telling us there's compassion fatigue within the community and if that's happening within the community, it's going to be reflected by our first responders because they are part of the community. so, in order to address the community's concerns, we had to address our first responder's concerns, thus the compassion fatigue program we have developed. >> i think it's so amazing you picked up on that. that's not unique to huntington. compassion fatigue affects people everywhere. somebody who is right there in the middle, first responders and helping to lead them on the front lines of this crisis tell , us what does compassion fatigue look like and how it is
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it manifesting? >> compassion fatigue is responding to the same type of traumatic call repeatedly. officers would respond especially to overdoses and when you responded to these overdoses, you are accustomed to solving problems and when we were initially going to calls we wanted to help people but when , we went to these calls they were very negative interactions, problems.used us we began to have problems with it. we realized that we became responding to these calls. negative>> what you would start seeing is -- they might have in several years, five or six death experiences, having that many a month. >> we were initially -- five or six years ago there were four to five deaths a year. with the overdose epidemic we began to respond to 40 to 50 death scenes a year. >> that's an extraordinary increase.
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seeing thatalso what. -- >> we're in a small town, just shy of 50,000 people, these police officers, firefighters and ems workers were responding to people who they hood gone to -- had gone school with. we have one firefighter who had five people who he went to high school with, who he saw die. you can imagine how that starts to eat. so, these are men and women who step into their profession because they're going there to solve a problem, to make sure that order is placed, and throughout this opioid epidemic, it's anything but. the problem isn't being soldiers and we have to find a way and we are finding a way. this isn't all negative. but they needed to -- they need to know that we were standing by their side and not just focus -- focused on those who we all wanted to heal, these guys and women, often needed to be healed
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as well. >> when hearing you talk, the word that pops into my mind is trauma. this experience of responding to so many overdoses and seeing people you know and grew up with, die from opioid overdoses, it's emotionally traumatic. and i think many of us don't in our own lives have tools for dealing with the trauma. i'm curious to learn about the program and for you to share that with everybody. tell us how program sought to address the emotional trauma. >> when we first started i was shocked because as we were reaching out to the police officers and firefighters and other first responders, i thought they're going to embrace this. we're talking about the science of addiction, and what they're encountering, and we got stiff-armed big-time. stiff-armed.
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simply because we started to realize, we weren't addressing their problem. the lesson we learned here is that as we learned to deal with our first responders, way also -- we also learned how to deal with the community because as the community is responding negatively, they warn to hear -- want to hear that you know -- i'm going to sound like bill clinton here -- we feel your pain. our first responders needed us to listen to them at first. and then as they started talking, then you can hear some of the things. there were some things they were doing that i honestly was going there is no way hades this will work with these guys. we were very reluctant initially. >> because we were being told about how to do so many different things and we were responding and they weren't speaking our language because we were boots on the ground and
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seeing this. then when we were provided -- we saw they actually cared for us and they were listening to us, then especially the experienced officers, we began to -- it's humbling that they were giving us things to worry about our mental well-being which went back to the community, dealing with the overdose calls, we were better on the calls. >> tell them the one thing that pisses you off that you miss. >> i am -- we love the yoga classes. [laughter] >> we love the yoga classes. we have the yoga classes two days a week, monday and friday, 7:30, and if we have to miss that class, we are very upset. >> we were preparing for this the other day. he said, yoga. he said, mayor, pity the poor fool that makes me miss yoga class. [laughter]
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>> we love it. we actually have counseling sessions. we talk about the week and a lot of it is venting and then you go into your me time with yoga. that's very helpful and the officers and first responders appreciate that. >> so this is amazing. you have counseling sessions that you have set up for the first responder, you're providing opportunities for yoga. what other kind of experiences do the officers get to have as part of this new program? >> there's discounted being used things you can go to in the community. there's massage opportunities. i have not experienced all of them, but quite a few things they provide. >> we also have a kitchen that teaches healthy cooking. they even have cooking class for the officers and the firefighters and their families, to come in. what's also been nice is a lot of the businesses are starting to step up to do things, where there's first responder night only movie night.
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picnics and such. some with the community, but just some that just lets them have their own down time without soul there placing demands on their time. >> that's fantastic. it strikes me and it struck me when we spoke before this event that even beyond the programs, a simple acknowledgment you see the pain the officers are struggling with and that you recognize it is valuable to address that, that in and of itself seems like an important part of the healing process. as you rolled out this program -- i know it's still early -- how are you thinking about measuring the progress that you're making and is anything surprised you learn so far. >> what surprises me at first is we had a survey of 35 of our officers and firefighters and then an additional survey of 67 of them. at first we were hearing from 39% of them that they felt they were properly trained. 39% said they felt they were
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properly trained. that left 61% on the other side. that certainly concerned me. but then i also heard that 69% said that there was not a care by the administration as to actually how this was faking -- affecting them. they were feeling we were showing more empathy to those who were fighting addiction than we were with them. so, we knew that we were going to move the dial in one fashion. we found out early early on -- shoot. not that long ago -- in 2014 when we decided to start aggressively fighting the opioid epidemic that we had to have real-time data. we were operating with what the centers for disease control was getting us, which is two years old, and in other words that was as though someone was throwing a pitch two years ago and then we're swinging two years later. you know we're going to miss the
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ball. two years ago we had one afternoon of 26 overdoses. that was when fentanyl came in into our town. if we were going on what is coming from the centers for disease control just now, today fentanyl should be -- would be , identified as entering our neighborhoods. if we can have, in our own financial system, every quarter that the largest companies of the nation can provide their quarterly earnings, why in the heaven's name can't we make sure that we're having up to date data as to what is happening in our neighborhoods? >> hear, hear. [applause] >> that's such a good point. we know that a key part of this solution to address the overdose epidemic is getting the data right, getting it more quickly to communities that need it. we are just at the point where we have to wrap up, but one of the things you have done to help
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highlight the extraordinary work you are doing in huntington, west virginia, is the fact the emotional well-being our of of our people matters, our first responders, nurses and doctors take caring of those struggling with addiction, the emotional well-being of the community members and it is becoming increasingly clear when you look at the data around emotional well-being that it is an important driver of the opioid epidemic itself. and it became very clear to me when i was serving as surgeon general if we're not addressing emotional well-being, we will not be able to address the opioid epidemic in america, and you stand out as a shining example of how to do that, and you started off with a population of first responders but i'm excited to see where , you're going because i can already see you have shifted culture around how people think about emotional well-being and they're more open to address it. i'm just thrilled you are with
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us today. i wish we had an hour more because there's so many more lessons, but thank you forow -- for the extraordinary work you're doing. [applause] >> the federal government should lead investments in evidence-based programs to help reach youth who are differ -- disconnected from school and work. decision-makers should commit the resources needed to ending youth homelessness. health departments should establish programs to improve , justes for adolescence as there are programs to improve birth outcomes. school systems should implement policies and programs that reduce suspension and expulsion and help more kids succeed. everyone working to happen young -- help young people should listen to and engage young people themselves in strategy , design, and implementation.
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>> please welcome the executive director of the boston public health commission, monica valdez lupe, and bloomberg professor of american health, tamar mendelssohn. [applause] hi, everybody. welcome. good morning. so, it's really exciting to be here today and to be able to have a conversation with you about the important work that you are doing with young people in boston. we know young people in this country are facing incredible challenges in terms of developing to their full potential. and it is really important to us to remember that these are not bad kids, the young people who are challenged and experiencing hardships. and that the issue really is about lack of access to
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opportunities and policies and institutions that are failing our young people. and health departments have a really vital role in this process to play in terms of being able to promote health and well-being for our young people. i'm really excited to hear more about the innovative work you are doing in boston to promote health in young people. can you start by telling us about how you use a public health approach to work with adolescents in terms of policies and programs? >> thank you so much for the opportunity to talk about our work in boston. and in terms of the public health approach that we take in the city, it really is a framework that we have adopted in the city, the state and across the country in terms of public health 3.0. this is really the role of our local, state health officers and their staff as being child -- chief health strategists. what that means to us is that we will use the public health data
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that we have and make sure that it is timely, actionable and that we are using it to drive program design and implementation. we also, in terms of the framework, are focused on ensuring that we are building strategic partnerships and really working beyond our comfort zone, which is in public health, healthcare partners. doing more work with the business sector, higher ed, and a really diverse partnership. philanthropy, and those are some of the key elements and when you layer that approach in boston at our health department, all of the work that we do across the organization and in particularly with our adolescent and youth programs is grounded in racial justice and health equity. and this is very, this is our northstar and that is the approach we take at the health department. >> that is wonderful. it is so important to involve the youth themselves in the
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process of developing programs and policies and will -- to incorporate their voice and their perspective. how do you do that? how do you engage adolescents in the work? >> i feel on a personal level i can share that i'm an expert on this because i have a 15-year-old son and a 12-year-old daughter. so whenever go to work and i work with our programs and the young people, i always hear my kids' voice in the background. one of our bureaus is the child adolescent family health program. that is where over eight youth enrichment programs sit within the commission. and i want to share two quick stories to give you two examples of how we engage our young people. the first i would share is around one program called our start strong program. this is a peer-based high school program where we have designed a curriculum where we engage the
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youth, it's a youth development principle. we layer it on top of that trauma informed principles to inform the curriculum. so the young people, high school students are learning about the importance of self-care, violence prevention, healthy relationships, advocacy, civic engagement. and they are with us every step of the way in terms of the agendas, presentations the way , that the different afterschool programs are led. and shortly after i returned to boston, one thing that kept coming up from the peer leaders was the influence of sexually explicit media in their relationships. and needing us to be able to help them develop skills to navigate really in essence what was pornography.
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and to be unhealthy stereotypes, unhealthy portrayals of relationships in what they were seeing in social media and pornography. i never thought as a health officer that i would be, flashforward, talking so much about pornography. and we now have a curriculum called, it is a porn literacy curriculum that we have done in partnership with a doctor. and we have sessions that the students have actually designed a facilitator's guide and we have woven that into what we provide to them. and so, that has been getting a lot of attention these days. and i just met with the staff this week to prepare for submission of our city budget for fiscal year 2020. i saw a new position, a porn coordinator. [laughter] to help us -- it is nothing i've ever submitted before. we will see how that goes.
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crossing fingers. but clearly, there is a need in terms of being able to share these approaches and they have been youth informed. >> that came from the young people. >> definitely driven by the young people. something that caught us a little off guard, but we went with it, and they helped us shape and definitely drive the discussion now. another example where we have had heavy youth engagement is on the issues around violence prevention. and it was almost one year ago to the day, when one of our students, a former student, was brutally murdered in east boston. and this was really a hard situation for the staff, the students who knew him. and a couple months later we had the mass shooting in parkland. so, one of our board members who is an assistant dean, and i pulled together you the youth
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-- together our youth advisory board. we wanted to have an informal discussion with them about duncan, about parkland, and all of the different opportunities that they were beginning to be exposed to and engaged with in both locally and nationally around gun violence. and i thought, from our perspective, that it was an opportunity for the young people because they were really mobilized around this. and young people are brutally honest. and so they told us that they were sad because of this spotlight on parkland. and suburban white youth and the reality is, this is what they face. in many neighborhoods across the city, our brown and black students, they are experiencing chronic exposure to trauma. they are not at the level of mass shootings. but many of the kids in the afterschool informal session we
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did shared stories of family members, cousins, parents were -- who are now incarcerated and they pushed us to help them think through, how do you lift up their voices? how do we figure out how to work with other city agencies and what we landed on was a student youth driven series of community meetings that happened this past summer. so every year, the health department, we have traditionally done neighborhood meetings throughout the different neighborhoods in boston. and we dialogue and this summer we held about half a dozen youth dialogues and we totally let the students drive the agenda which , was a lot for us to let go of. [laughter] because as public health practitioners, a good meeting is not successful unless we have 50 slides with charts and pie
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graphs, and the students said no slides, no public health data. you know what the issues are, we do not need to hear it, we live it. let us figure out what the questions are going to be and your role as the staff is going to help us facilitate breakout sessions. >> that is terrific. and in the short time we have left, i just want to thank you for telling us, just giving us a little a slice of what is going on and the important work that i think is really relevant for cities all around the country. so, thank you so much. >> thank you. [applause] >> the u.s. environmental protection agency should return to its mission of using science to protect and promote health in the environment. the federal government should rejoin the paris climate agreement and reinstate critical rules on coal-fired power
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plants. the department of housing and urban developers should champion efforts to end lead poisoning and develop and implement standards for healthy housing. states should conduct assessments of potential impact on air and water quality before making major decisions on transportation and energy projects. cities should invest in redesign spaces, reducen violence and improve , cardiovascular health.[music] -- health. >> ladies and gentlemen, please welcome from the harvard school of public health, professor gina mccarthy and from the johns hopkins bloomberg school of public health, professor tom burke. [applause] >> gina, this is so great. thank you for being here and it
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was such an honor to serve with you. >> it's like the team is back again! >> i know! and i remember my job interview. i was not nervous at all. we talked about public health, your background in public health and me being a public health professor. tell us about the message. >> one of the reasons why i wanted a public health person is even though it is called the epa, environmental protection agency, it is a public health agency. it is about science, is about evidence-based decisions. [applause] that is what we do for a living. >> let's talk about science a little bit because you are not -- were not always happy with the science i had to bring forward to you. >> it's true. i did not like you many of the times that you came to me. [laughter] only because when people give you real facts, you actually have to act on them! [laughter] and that is what science does it -- does. it defines the risks and helps you define solutions. science matters.
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science is fact. it is not a religion. as much as i want to deny you entrance into my office, i did never deny the science. you have to consider it. you have to protect the science and scientists that are doing their jobs, especially at epa, who -- some are out there. we love you. we support you. you are doing great work. [applause] we will get back to facts soon. >> speaking of science, the national climate assessment. all the work you did on the paris agreement to lay the groundwork for the u.s. being the world leaders in climate. we've got to talk about this a little bit. >> a lot. [laughter] climate is really the greatest public health threat of our time. i think we have made a big mistake in thinking that we are selling it as an environmental problem when the planet really doesn't care if it is warming. we care if it is warming.
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so climate is all about a direct threat to ourselves. and mostly it is about a threat to our children. and what kind of future we want to leave them. and so you have to look at the science. you have to understand that there are actions we must take now. , theaw the ipcc report most recent report on national climate assessment that looks at regional impact. and you looked at the countdown report. and the exciting thing is, they all included health. it is about time. they started talking about the health challenges we are facing today. one of the things that tom and i were going to make you do, because we really like bloomberg, is to get you all to stand up. because all of you are impacted by climate change today and all of your children and your grandchildren will be impacted tomorrow by what we do and what we don't do to address climate change. [applause]
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it is time to act. >> absolutely. and, gina, we have some old threats that we still have focus -- have to focus on. you mentioned our children. lead is still a challenge and still a problem for our children and you really pushed us to take a public health approach to it. >> yes, because it always amazes me that we are dealing with sort of antique things. like lead. how long have we known that lead is a danger? since the early civilization. they figured it out. we are still talking about it. one of the challenges of lead is that it is not just about our water systems. which are important to look at. lead intof delivering our kids and hurting them. the challenge that we face is much more systemic than that. you know, we did great as epa i think to get the lead out of gasoline and really make huge
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improvements in keeping it out of our air. the challenge we face now is that with a changing climate we , have to invest in our water system. when you look at flint, that was not just about lead. it was about old aging water systems. it was about not having economic structure to be able to support clean water being delivered. especially to the most vulnerable communities. and don't think that was not about poverty and communities that were left behind with no voice. that will consistently happen and be exacerbated in a changing climate. because we know that public health impacts hit the most vulnerable first. low income, communities of color, those who are basically homeless, who are indigent, they are most at risk. and so we have to look at the environment. we expect that in 2050, we will have about 9.6 billion people. 2/3 are estimated to be living
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in urban areas, 75 percent of the buildings that need to be there to support them do not exist today. isn't it time to see where we spend most of our time? which is in our homes and offices and buildings. as we make them to become more efficient, we are capturing all of this and other flame retardant in the products. we are exposing ourselves to them. we half -- have to be smarter. we have to think about health as we think about climate. it is the most important lens for us to look through and so we need to think about building differently. not just in our homes. >> right. and that was one thing that you did. at epa we had laws and we had our lanes. you didn't stay in lanes. you reached out. >> no. i wasn't good at it. [laughter] >> whether it was energy or working with the other departments. >> shh. [laughter] >> no one will hire me.
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for crying out loud! no, i think the value of a bureaucracy is that you have to focus in certain areas. but the best thing about a bureaucracy is actually the work together. because everything matters. if i do something at epa it's -- if i do something at epa, it's going to matter to doe, it will matter to hhs. all of the alphabet soup things need to go away we are doing -- when we are dealing with people's lives. they don't just want a job. they prefer to breathe. you know? and we need to stop thinking that these are dynamic problems that can't be reconciled. and start talking about what people need, not what our bureaucracy needs. and that means we have to get out of our own little closets. >> absolutely. and one of the exciting things about the bloomberg initiative is, it is talking about the future and how we think about cities, how we think about communities, and the built environment not in these narrow , lanes. but inclusively, using tools like health impact assessment which you have pushed. and that allows us to get public health at the table.
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>> it sure does. i think the exciting thing is you have all of these reports that told us that we have real challenges, and we have to act fast on climate change. but the interesting thing was that each and every one of them ended up by talking about the fact that we can do this. we know the science. we understand the technology. we have solutions that are readily available, that if we all could participate and get access to those, then we can make this happen. what we do not have his -- is political will. but what i see now with the federal government sound asleep on some of the most critical issues, the rest of our democracy is waking up. and bloomberg is helping to support efforts at the grassroots, efforts in the urban areas to rethink because we need to turn climate change, which is a tremendous public health problem, into the most wonderful public health opportunity, if we think about all of the resources that are going to be spent on climate and we look at each and every one of
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them as an opportunity to invest in public health today, wow! we move toward a more sustainable, healthy, clean and just future. if we just think like that, it is not a problem. [applause] >> that is what we have to do! i -- >> i know the scientific community hears you. the public health community hears you. the business community is wising up. you presented incentives for them. >> i'm working for a firm in new york to learn the economics side of this. it's not a place where i have been comfortable, but the cool thing is that they just invest in sustainability and products that help with health. and you make money on that. so, the business community is waking up a lot so we have the structure in place that our country has always had to move forward. it's called every level of government. it's called the government
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government of, by, and for the people. let us make demands on those people. let us tell our politicians who they can be what they need to , say, what they need to do. let's do business with businesses that actually share our core values. we can make the world work again because we are the [music] -- because we are the united states of america. thank you. [applause] gentlemen, please welcome dean emeritus and professor of public health and board member of bloomberg philanthropy, alfred somer. [applause] >> that is a tough act to follow. [laughter] >> good morning. it is a real pleasure to participate in this inaugural bloomberg health summit sharing , the many ways in which public health can make a positive
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difference in the lives of millions of americans. i'm especially pleased that the inspiration of mike bloomberg we -- who we were fortunate enough earlier to hear, the support of bloomberg philanthropy's have led to this important meeting between faculty of the bloomberg school of public health and so many other concerned and committed leaders and organizations around the country. as we know too well, there is plenty to do. obesity, violence, addiction, disconnection. when these come together, the consequences are dramatically increased. they pose a serious existential threat to their communities. mutual engagement and collaboration strengthens our ability to address major challenges to americans' health and well-being and that is where -- the reason we are here today. as an important example, our country's embarrassingly
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excessive maternal mortality. among the 31 oecd countries, leading market economies, the u.s. ranks higher at number 30 than only mexico. pregnancy related mortality in the united states is three times higher than in canada or the united kingdom. only in the u.s. is maternal mortality rising. key factors of course include deficiencies in our provision of healthcare, high rates of chronic illness and intimate partner violence and addiction. fortunately, there are leaders employing public health tools and insights, committed to making a real difference. i am pleased our next panel which will discuss this persistent issue, include muriel bowser, the mayor of washington -- washington, d.c., who recently convened a summit on maternal and infant health. and christy turlington burns,
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the founder of every mother counts. their conversation will be moderated by dr. nadine gracia of trust for america's health. [applause] >> good morning. it is a pleasure to be with all of you this morning for such an important conversation about maternal health and how we have a truly national imperative to improve maternal health. i'm sure we can all agree that it is embarrassing, shocking, and tragic that we are talking about rising rates of maternal mortality in the united states in 2018. especially when we know maternal health is often considered an indicator of the health of a nation. we are here today with incredible leaders, powerful women who are leading the way and leading the charge in addressing and improving maternal health. really excited to have this
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conversation with the both of you. we know certainly in public health that there may be an experience or certain factors that motivate and inspire leaders to take action on an issue and make it a priority. i would love to start hearing from both of you about what has inspired you, what drove you to make maternal health such a priority and focus of the work that you do? mayor, we can start with you. >> absolutely, and thank you both for your work in this area. and for us in the district it is an issue that we have certainly been focused on. and in talking with the doctors and stakeholders that work with women and families each and every day, they've always been concerned about premature birth and making sure that women and families have access to care. i think my laser focus this year, the kind of impetus for us having a convening of mayors from around the country, hearing serena williams' story and the
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points that she made, i think cut across socioeconomic and so many different experiences that -- and her focus on the particular impact on american -- african-american mothers who are getting access to care and fighting to be heard. and that in our city, i wanted to make sure that we looked at that experience and used it to talk about women who are not multimillionaires and world-class athletes that have access to the best care has the dust but had -- but had the very same experience. >> the power of story, utilizing the power of story, but being able to say, how does this affect the everyday woman am a the everyday mother -- woman, the everyday mother. >> for me it was a very personal , experience that led me to this work.
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when i became a mother, i was a -- became a global maternal health advocate. after delivering my daughter a -- i hemorrhaged. before that experience, i really was not aware that the rates globally were what they were let , alone the united states. which was 41st at the time and we have fallen back to 46, i believe, today. just learning the information and having the person -- personal experience is what led me on my path. it led me to columbia university. it led me to make a film, " no woman, no cry," which was the first film that we made to put the faces to the statistics. are embarrassing and shocking. but when you hear women speaking about their experiences and the providers who are trying to meet their needs and meet them where they are, to hear those perspectives, i think is such a powerful tool. my organization was founded after that film and that
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experience to try and bring more people into the conversation. >> wonderful. we are hearing from both of them about the power of story combined with the data to really be able to build a case and build a narrative of how we take action on such a critical issue as improving maternal health and data has been such an important theme and focus of the initiative and something that we've continued to talk about since the summit yesterday when it started. doctor sommer shared some statistics. some additional statistics and you both alluded to it are the disparities, the racial disparities that we see in maternal motoric -- mortality with black rim and -- black women experiencing rates 3 to 4 times higher than white women of maternal deaths. where women of color generally have childbearing complications that are higher than white women. can you tell us both how you have used data to really help inform the initiatives, the work you are doing?
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in particular, the disparity of improving equity as well. >> one of the initiatives we are focused on, and i know cities around the nation are. looking at maternal mortality review committees. so that in each and every case, we can examine what happened if we know about causes, if we know about -- all of the issues around the providers and the experience. and that will allow us to have a dispassionate view of what happened to inform all of our practices and policies and procedures. that is one thing that we are doing. >> as important as the quantitative data is, which is really what sort of alerted me to the scope of this problem in the u.s. and globally, is really the qualitative data. that's what we've been really focusing on at every mother counts. through the storytelling, the filming, the documentation of
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experiences of both patients and providers, that we can elevate this issue and inform people who are, in some instances have the , ability to make choices around the healthcare. but in other instances, people falling through the cracks of our health care system did -- to make sure that every mother everywhere has the same access to respectful quality and equitable healthcare. >> absolutely. i will say the importance of the storytelling, we are seeing it here throughout the summit. we've heard some incredible -- for example, from young people from baltimore yesterday. they told their story as we were talking with the issue of power and connecting missing youth and leadership. leadership we talk about a lot in public health. about the importance of leaders. not only the federal level but also locally to be able to really impact change and one of the things we knows that the -- we know is that mayors have incredible influence in working with elected officials to really raise awareness of public health as being a front and center issue that requires attention
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and certainly within issues such as maternal health. mayor bowser, you launched the first ever summit on maternal and infant health in d.c. in september. you brought people from around the country. given your platform as the nation -- mayor of the nations capital. what was your vision for that summit? what do you hope moving forward -- >> first of all, we were just blown away by the participation. it is our first time. we honestly thought that we would have a couple hundred people from d.c. that came to the convening. we started, i think, planning in may or june for september summit. and the response was so incredible from physicians that -- who came from around the country. d.c.esbitt leads the health. she tapped in her network around the nation.
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if people were available they , wanted to be there. as a mayor what i know is our , situation in d.c. is not unique. where we have a great number of women of color who are insured. 97% of the people in washington, d.c., have insurance, so we want to make sure they are using it. so, we had over 1000 people come to that convening. valerie jarrett participated with us, as well as kathy hughes who leads one of the largest urban radio networks across the nation. and so, we wanted that information not just to be shared at the convening, but across the nation. that was important. what the doctor and her team have done since then is have had smaller convening's of the stakeholder groups who were there, so that we can really layout -- lay out what we want to do moving forward. i expect that we are going to in
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addition to the maternal mortality review committee, also convene a task force on the buckets of work that we identify that we need to work on in the city. that will be an ongoing effort that will lead to our next convening. probably next fall. >> christy, your work at every woman counts, it is global. certainly you work here in the united states but also around , the world. as we talk about leadership and the role of various sectors will -- we all have a role to play. you hear that message often, not only in government, but other sectors have a role to play in improving health, including maternal health. can you talk more about every mother counts and what you view as the vision and the role of nonprofits and for them -- philanthropy to improve maternal health? >> i think foundations are filling the gaps. we want to work in partnership with government certainly.
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in order for initiatives to be sustainable, you really need to think about the collaborative approach. so we see that the world over. i think for an organization like ours, which is still fairly small, we have been so focused on raising awareness, engaging the public, the people that are not necessarily brought into this conversation or weren't we first became part of it. and then investing in community led initiatives where the people that are in the communities themselves are going to have the best information and access about the needs of the community. and so, really get behind the -- getting behind those leaders and trying to get them to lift what they need. because they know what is needed and they know how to do their job best. it has been a great role for us to play and then we play another facilitating role. we can bring different partners together to share their learning and experience. which is so great about the convening example the mayor gave. we look to do more of that in the future. i think this is a important time for this issue.
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we need to work together to make sure we are reaching everyone that needs reaching. >> you both raised two important issues of community engagement and sustainability. often times when we are trying to actually do work in communities, often the community members themselves or community leaders may not have a seat at the table. how do we really talk about and advanced this kind of work where we understand maternal health is -- as a pillar in all communities but where the , communities themselves are truly meaningfully engaged and we can sustain that work? because sometimes it may not be across administrations or priorities may change for different organizations. how do we embed this kind of focus on maternal health in communities? >> that is a great question. one that, sometimes when you have a crisis situation, every -- the reaction of the government is to throw things at the wall and see what sticks. i want to do that sometimes, too. but what is important in this
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work i think is looking to see what has worked in other places and making those investments. that is what our department is focused on. one very, i think, thing i did not expect from the summit was to see so many young women there and women of the whole spectrum with their kids. and what i was struck by is that we do not see these people who are in this room, i don't see them regularly. i do not see them at our community meetings in the evening. i don't see them down at council hearings. and this was an opportunity for them to be seen and heard and engaged. i think the way to keep them engaged is to have some meaningful work and the task force. the reason why i have not announced it yet is because i want to make sure that we know what their agenda is and it is going to mean something and it is going to be able to deliver something. but also look at the
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initiatives that they are bringing forward. they are saying this will work in their community. then line those activities up for investment as well. administrator, former administrator say a little bit earlier that our values are represented in what we're doing about health and climate change. i would add that our values are represented by how we value women and childbirth. why are women dying in our country giving birth? given our vast prosperity and technological advances and our expertise in health. we can, with the right focus and investment, really make a sizable impact on maternal health and infant health. i know we can do that. you ask -- what do mayors do in that regard? and youg we are doing, have worked in the federal space, is make sure that our
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nation is doing what it should do. that is reflected and making sure everybody has access. -- access to insurance. that is reflected in making sure that we do not experience the shortages in specialty care. in vulnerable communities -- if we have high risk pregnancies we need doctors that can address those pregnancies and make sure those communities have access to that expertise. we can do all of those things. it also means addressing families where we have them every single day for eight hours. at school, rec centers, so that we are addressing the whole families. and that is the challenge of local government. and calling on our federal partners where we need them so , that we have a champion on the hill as well as in statehouses and governor's offices around the nation. >> we are running out of time. i will add one thing briefly.
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one way we bring community members' voices to the forefront is through our storytelling. we have a series called giving birth in america. we are taking a state-by-state. -- state-by-state approach. what are the challenges and opportunities? there have been phenomenal community leaders like jenny joseph in central florida. we have done this in california, montana, louisiana. we are filming now in new mexico. trying to get into the communities, bring the members from the communities through their patient care, to really see them at work and to see how they are addressing the needs. >> wonderful. while we do not have time to talk about it on the panel today, one of the things for you all to know is in addition to their work certainly in promoting high-quality care and maternity care is also a focus on the social determinants of health and understanding that our health is so strongly influenced by the conditions in which women and families and communities live and children go
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to school. it has intergenerational effects. ehe mayor and christy ar focused on that emphasis in a short -- in addition to ensuring there is high quality care for women. please join me in thanking our panelists. [applause] >> thank you. >> the u.s. department of agriculture should promote healthier foods for food assistance and school lunch programs. congress should reshape agricultural subsidies to promote production of corn and sugar to instead promote production of healthier products. cities and states should use mass media to warn consumers about the health risks of sugar sweetened beverages. cities and states should not -- should enact taxes on sugar sweetened beverages.
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communities should mobilize and demand healthier food in schools and workplaces and curb the marketing of food that particularly contributes to childhood obesity. please welcome vice president for nutrition of the center for science and the public interest, the deputy commissioner of prevention and primary care, new york city department of health, sonja angel, and commissioner philadelphia department of public health, thomas farley. [applause] >> good morning! here with a couple of longtime colleagues and national experts in how we prevent obesity and other diseases related. one of the things that we know about our diet is that it is driven by an unhealthy food environment. and that means the solution to these problems is to create a healthier food environment.
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first let me turn to you, you've been involved in food policy for several years. tell us something about some of the big wins we've had in the past in creating a healthy food environment and maybe some future ones. >> we are actually making some good initial progress. we have gotten trans fat out of the food supply. we have brought nutrition into the restaurant setting by requiring calories to repost the -- be posted on menus and menu boards. and we have gotten an update to the nutrition facts label also added sugars and daily value are listed so people can see that just one coat has more than your whole day's budget for added sugar. now probably some of you are thinking like, oh yeah, you got these things done during the obama administration but things have changed a little bit in washington, d.c., in the last couple of years. but it is important to keep in mind that for all of these policies we were laying the groundwork long before president
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obama was elected. so with school food we working on state and local policies, litigating against the soft drink industry for having soda in schools, and building a coalition so that when that moment in time came, where we could pass policy, we were able to pass the act. grocery stores are pushing unhealthy foods on people especially in low-income neighborhoods. we have to deal with restaurant food which is next biggest source of calories for people. first focusing on kids meals and we have passed over a dozen policies to get things off of the menus. but we have to work on that until restaurant foods really provide healthy options for families. >> great. >> sonja, you are involved in an initiative to address salt, which is now expanding. tell us about what they have done and where it is going. >> the national salt reduction initiative was established in 2008. and really, at the time we were trying in new york city and how
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to address hypertension and how do we get sodium down in the diets of new yorkers? we know that three quarters of the sodium in our diet is not what we are adding at the table -- it is already in the food. it is the unhealthy food environment you are referring to. the challenge though is that the food supply is national for processed and packaged foods, not local. what we did, at that time, the federal government wasn't interested on acting at sodium. this is not just a problem in new york city. share. a problem we all we started reaching out to other organizations and created a national partnership. together, we created a database set target for sodium reductions for the industry, and then we got commitments and secured them. we monitored changes over time. we found about a 7% reduction in the amount of sodium.
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we realized we have a model that works here. we have been very fortunate, and the issues around sodium have been adopted, and the fda is pleased they are moving forward to a model similar to the salt reduction initiative, which means we can back off from that. we thought sugar, that is a huge problem. foods have added sugar in them. we can't exercise healthy choices if we don't have healthy choices. we want to put choice back in the hands of all of us so we can have a healthy diet. now the national salt reduction initiative is called the national salt and sugar reduction initiative. [laughter] [applause] the preliminary targets are out and we are moving forward. >> we are excited to be taking that model which has shown to be working.
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to chime in on one initiative in philadelphia to address the sugar conduction -- consumption. that is the sugar tax. [applause] >> thank you. that enthusiastic about it. ounce. is 1.5 cents per the tax has been a win all around. we have seen a reduction in sales of sugary drinks. reductionre showing of 35% to 40%. the tax is generating $75 million a year. the mayor is using this to provide pre-k to millions of children and to rebuild parks and recreation centers. [applause] thank you. sodau might imagine, the companies don't like this at all.
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they made a bunch of claims that were not true as far as the economic impact. we measured that there has been no decline whatsoever in employment in the grocery store industry. there has been continued growth in the food and beverage industry. it is a win all around. we have a number of examples of things that have been successful. what sort of lessons do you think we should take on food and environment in the future? >> one of the big ones where people tend to not have a lot of hope on central policy is that we can have change policy. it is possible. we have done at the national level, state, local, and corporate level. -- industry often opposes ok, maybe always opposes everything i worked on, and they say it is impossible, it will cost too much, it will kill jobs. they cry wolf regularly. but if we work together, we can overcome that opposition. i think if we work together not
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just here in the u.s., but globally. companies are multinational. we need to share successes on tactics and messaging. we need to try and increase the number of policies that were able to adopt and achieve them more quickly. >> great. sonja, what are your lessons? >> i would echo this need for global learning community , because it is from one another , the evidence that we have and things that we implement we learn how to innovate on top of that and spread. so absolutely, and that is really what this is all about as well. another really important lesson for us is to be laser sharp in our focus. so --used first on sodium. that has been important for building through the process of changing the food supply at large. the last thing to comment on is data and measurement. it is really important for us to have evaluation processes in
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place to be sure that what we are doing works. if it doesn't, we should not be afraid to retreat and divert directions. other we have finite resources in public health, so we have to use them well. another reason we must measure is that we have to move toward an equitable and fair and just food environment. we must really make sure the changes we are making benefit not only overall, but that all populations are brought up by these efforts and we leave nobody behind. the other key piece is measurements to document and show we are doing the right thing. >> certainly low-income people faced an unhealthy food environment. one lesson i would draw from this is that the person you think about, it is so incredibly complicated with tens of thousands or hundreds of thousands of products, many different channels diversifying every day, it feels impossible for us to have impact on them. but if you have a real focus on the areas where the data says they will have the greatest
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an impact. can make cumulatively across all the different initiatives on salt the overall food environment changes and people are eating healthier. >> absolutely. i think in public health, we are do-gooders. we want to change things and there are lots of ways we can enrich people's lives, and it can be overwhelming, but choosing areas of focus and sticking with them for the long-term is the recipe for success. >> great. we are out of time here thank you so much and let's get back to work. [applause] ♪ >> because alcohol use is associated with higher levels of violence and suicide, state legislatures and congress should increase taxes on alcoholic beverages. state and federal agencies should provide universal access
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to programs that promote positive behavior and academic success among young people. >> stet legislatures and congress should require background checks and permits for gun purchasers, disarming domestic violence perpetrators, allowing law enforcement to deny concealed carry licenses, and remove guns in high-risk situations. use approaches informed by public data to prove -- promote risk reducing behaviors. >> ♪ ♪ >> please welcome bloomberg professor of american health, daniel webster. regent professor college of public health university of arizona, mary,.
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-- mary koss. >> thank you all very much. [applause] this is an incredibly important panel talking about violence. let me start with you, daniel. why community-based programs are important as opposed to just focusing on law enforcement. are obviously where the conditions that most directly affect violence. we have a capacity to change. we have already heard a great example that has been demonstrated in randomized trials in greening.
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changing the environments. changing the alcohol environments. more density of alcohol outlets in a community we know leads to more violence. >> we should try to zone away the liquor stores? abouthave to be careful how much alcohol we put in a community and also careful about the hours that they are open for business. researchimpressive showing that restricting the number of alcohol outlets and business hours leads to less violence. me turn to your field of expertise, which is restorative justice. explain to us exactly what that means and give us an example of how to implement it. >> thanks. i would like to do just a little training first. the violence against women act was first passed in 1994. it was part of the omnibus crime control bill.
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that created a response to domestic violence and sexual wheelt that is like a with the hub being the criminal justice system, and shelters and services are the spokes. i don't think we realize as a field that what we were getting was a program that put us in a directing our clients into the criminal justice system. a dream one night because i had been doing a study following women for two years of their recovery from rape, especially looking at self blame and shame. those were the biggest symptoms and of how long symptoms lasted.
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the dream was i saw this car crash because i realized the criminal justice system exists to assign blame and to determine punishment. it turns out that does not map very well on what most women say they want from justice. as awant to be validated legitimate victim. they want voice. they want to say this is how it impacted on me. say, int to be able to want impact into what is done to this person. i want to be sure it won't happen again. that is when i started searching .or an alternative i stumbled upon restorative justice 17 years ago. i have been trying to advocate for this approach. >> explain exactly what it is.
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>> it is this. restorative justice has three customers. community, the victims, the alllies, and the wrongdoer came. family, andictim, friends. those are the three customers of restorative justice. restorative justice assumes a wrongdoer and that a harm has been done. for which reparation and rehabilitation needs to occur. that is the gist of restorative justice. >> jt, you work a lot in violence prevention. a lot of people think, isn't that the role of the police? tell me how you do it and why you think you do something police departments can't do. >> i will tell you why.
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it is not only the role of the police because communities are made up of the people who live there. police work is a job. people have to stake responsibility for their own communities, first of all. that is why we have programs program roca and others in baltimore. people have to start taking responsibilities for their own communities, because we know the people who live in our communities. we know the things that happen in our communities. so why should we be the same was -- once to try and prevent some of those things to stop some of those things from happening? >> we hear about baltimore, will -- we all have conceptions in our mind. i come from new orleans. people have conceptions from hurricanes, what the neighborhoods are like. certainly with fault more in the past 10 years, is developed a lot. tell us what it's really like in baltimore and if things are changing.
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>> i am hopeful. things are constantly moving forward. despite the landscape, despite the national landscape and what it looks like in baltimore, living there and being part of the community my whole life, i see the little bit differently. -- it little bit differently. i do see the hope. i do see that things are changing. i do see there are plenty of opportunities to continue to grow. i feel like we have to do a much better job of being involved as acommunity, and the city as whole, partnerships, being relentless about the partnerships to help the communities. roca does.what the cycle of break incarceration that transforms the life's of young people. we target high-risk young men between the ages of 16 and 24 years old. it is a goal to transform their lives. we do that a couple of different ways.
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people change in the context of relationships. we try and form trusting, transformational relationships with these young men with the idea of helping them drive the change they want to see in their lives. people are tired. people don't want to continue to live like that. anyone with the belief that they do is been -- misled. notguys on the streets do want to live that way. they look for opportunities and want people to step in. the problem is they have been let down by so many entities that trust is very hard for them. >> i will ask all of you this. i will start with jt. me. describe it to you've got a certain neighborhood, a certain set of blocks, certain groups of people. how do you go in and do something? do you find a leader? do you have data that says these are the people at risk? say something? >> absolutely.
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most of the time you knock on the door, the answer is no. [laughter] but the beauty of it is we don't take no for an answer. [laughter] that just means i will see you tomorrow. [laughter] that is the piece that young people don't expect. they expect you to give up on them once they tell you know, but when you show a relentless nature and you don't give up on them and keep coming back day after day, when you show up in the alley where they are trapping, show up on the corner, wherever it is you have to find them -- >> and when you get them to yes, what did they do? >> that's the easy part, because then we can actually start the real work. getting to yes is about finding out what it is you need and what you need to do. yes allows us to implement those things in their lives and helping them get on that path. >> james, can you walk us through the way you do it when you go into a community? researcher.
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i mostly study brilliant things that jt is involved in. [laughter] >> give us the best practices that you have found across your research. >> sure. modelis a cure violence for example that has had great success. some success in baltimore, but challenges as well. this is a program model that jt has spent years working in baltimore on. it involves street outreach with very credible people, known people. jt hit the nail on the head with trust. it is all about trust in these relationships. this program model is first and foremost going to try to interrupt and mediate conflict. people get shot over things they really shouldn't get shot over. relatively minor disputes. it really is powerful to have
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somebody with credibility to come in and change those norms. the terminology is intro violence. that program model was even made more powerful when in addition to that, you can think of it as an ems system. there is a crisis, we are going to try to keep people alive so nobody gets shot. that is what cure violence is best in. model is the best thing to get people on a healthy, safer trajectory, recognizing all the trauma and challenges they have faced. those seem to be the key ingredients. it is always risk focused. you have to go to the shooters and people likely to be shot. that is hard work. if you don't do that, if you are not touching the highest risk people, you will not affect gun violence.
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those i think are the common denominators. it is very risk focused. it is built on trust. it is a commitment to getting people on healthier paths. mary, listening to them carefully, without stereotyping, they seem to be aimed at more young men who are vulnerable. you obviously have a broader aperture and you are looking for potential victims. do you think it is good to focus on different groups or get a holistic approach that includes mothers, women and girls, and children as part of the process? >> i think it is very important and a central value of restorative justice that you include all of the affected, as many as you can i ran a program called restore.
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going? we get it it took a visionary who would not take no for an answer. it took a county attorney or a district attorney to say, yes, you can do it. what does restore consist of? between aface meeting wrongdoer, a person harmed, and the family and friends of those people. i want to just hit on the word conflict, because it is wrongly used when applied to restorative justice. we assume an unequal playing there is a harm that was done and that there is somebody responsible for the harm. what that accomplishes is it gives the victim immediately that validation that she or he is seeking.
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support ofs the family and friends, because they are not worried about -- they are not torn up about, did she do it? sure if a rape thely happened, or maybe house skills were not what they should be. who knows? it makes it clear that a wrong was done. say, why would victims want to participate in something like this? because theyate want to tell their story. they want to have input in what to hear and they want person take responsibility that it was someone else deciding to do this to them. it wasn't a conflict. it was wrong. words, we only have
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about 10 more seconds. in any city ofs groups that are trying to do things. around the country, there seem to be multiple innovation-type programs. unlike in other fields of public health, it is more consolidated, like tobacco reduction or automobile or opioids or obesity. there are just a few break -- big groups. given the fact that there are so many different rooms in this field, how important is it to form partnerships and how do you go about that? >> that is key, we have to form partnerships are the reality is that young people continue to die. if we continue to work in silos, young people continue to die. we have to be strategic about partnerships that we form. we have to be open to working with different partnerships, unconventional partnerships. many people have the
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misconception that law enforcement is not a partnership we should have. law enforcement is absolutely a partnership because they deal with the young people that are dying. >> and you are able to do it better in baltimore than five years ago? >> we are getting there. we are definitely getting there. we will be relentless about pushing the need of partnerships just as we are relentless about chasing down these young people. >> thank you for what you all do. >> thank you. [applause] >> ladies and gentlemen, please welcome the president of planned parenthood, lena when -- leana wen. [applause] >> good morning, everyone. i am so glad to be here with a group of people -- leaders who see big problems and jump in, take action, and implement. mayor michael bloomberg exemplifies this eco-spirit i know we are all impressed by all
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he has done. any of you are here from the johns hopkins bloomberg school of public health. your motto is saving lives millions at a time. mayor bloomberg has saved these lives and transform so many more. i hope you will join me in thanking him for being our public health hero. [applause] until last month, i served as the health commissioner in baltimore city. in facing an escalating number of opioid overdose deaths, issued a blanket prescription for naloxone, the antidote, to every one of our residents in the city. in three years, everyday residents saved nearly 3000 lives. addiction is a disease. it must be treated with science and evidence, as you heard from many, including from one of my heroes, michael botticelli today. the signs and evidence showed that it would exist but the health care system isn't
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anywhere close to be dividing -- providing treatment to all those who need it. so we learn from our colleagues in rhode island about how they've asked hospitals to step up. along with my colleagues, i convened all 11 hospitals in baltimore to start standardized levels of care. in the spring, we opened the beginning of a 24/7 er for addiction and mental health. i talk about this because public health saves lives. if we ask now, with urgency, driven by compassion, and guided by science, a program that our very own doctor josh started when he was a health commissioner in baltimore for healthy babies. now we have over 150 public and private partners who are dedicated to one goal. reducing infant mortality. we conduct home visits to pregnant women, educate on the abcs of safe sleep, and provide resources like mental health support, housing, and free
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cribs. in seven years, we reduced infant mortality city wide by nearly 40% and cut the disparity between black-and-white infant mortality by over 50%. [applause] we decide all those who said, infant mortality is just too complicated. there are too many factors that contribute to it. yes, there are. but public health is the intersection, and we can convene all sectors and set a clear north star. several years ago, a study in the city found that up to 10,000 children needed something as basic as eyeglasses, but were not getting them. we at the health department worked with johns hopkins and your president ron daniels, warby parker, and multiple groups to set up a program to provide eyeglasses in screenings for every child who needs them,
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for every child, every grade k-8 right in their schools. ,the students do not have to miss class and parents and caregivers do not have to miss work. i have an 8-year-old girl who is receiving her new pink frames. she put them on in her teacher asked if she saw a difference. she said, no. so she was asked to read a page. first without glasses. she read slowly. then she read it again this time with her glasses. this time, she had no pauses. her teacher asked her again if she saw a difference. she said no. [laughter] she wasn't impressed. screener who had been working with us in the health department for over 20 years had tears running down her face. she could see the different type of future that this girl will have , all because she got a pair of glasses. when oneublic health, small intervention can change
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'se trajectory of people lives. to be sure, there are detractors. how many people told -- told our predecessors that they should not take on the tobacco industry or saying public health has no role in automobile safety? but how is the world different today because public health took on those industries and refused to be silenced? nowadays, there are a lot of people who told us that public health has no role in violence prevention. really, they haven't heard the last panel. [laughter] but they also haven't treated patients like i have been the er to see that gun violence is undeniably a health issue. you have heard about in fall two more, the safe streets program uses a public health approach to violence interruptions that prevents hundreds of shootings every day. there are those who tell us to stay away from political issues. we are not the ones who have made healthcare political. getting cancer screenings or medications shouldn't be
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political. having access to the full range of reproductive health services from birth-control to safe legal abortions, shouldn't be political. [applause] ensuring that everyone has quality, affordable healthcare, privilege,and not a shouldn't be political. [applause] but if others have made healthcare political, public health needs to fight back with everything we have. in baltimore, when the trump administration slashed our teen pregnancy program, we sued them and we won. [applause] now as president of planned parenthood, i am leak in -- leading an organization that has to fight every day just to provide public health care in our 600 health centers. any day now, we could lose title x funding, which provides family services to 4 million low income
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women. with this new supreme court, we are facing the real probability that roe v. wade could be overturned or further wade coule overturned or further eroded, which means 25 million women, one in three of reproductive age, could be living in states where abortion is outlawed and criminalized. public health voice, our advocacy, our fight is more important now than ever. we have been through tough times before, but we will win because we have science and truth on our side and a lot of supporters. there are twice as many supporters of planned parenthood as members of the nra. [applause] dr wen: we will win because standing up for the public health means we are on the right side of history. to those who say it is not in public healthay
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is in every lane, so thank you to mayor bloomberg and the public health initiative for fighting for the public's health. thank you. [applause] dr. wen: i am now honored to facilitate a panel conversation with house leaders who i welcome to come join me, university of maryland trauma surgeon dr. cooper, the new york city department of health assistant director hillary cummins, and dr. kira, secretary of the delaware department of health and social services. please welcome them. [applause] ok, so i have the easy job of asking them questions. dr. cooper, tell us about the efforts you have led to treat
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violence as a health issue. tell us how you can encourage us and other hospitals. dr. cooper: thank you for the question and the opportunity. 1970's thate early it was said violence is a public health crisis. it has taken us a while to walk -- lock on to our role on this process. it has only been the past few decades hospitals and health have seen what we can be a part of, but why should we be a part of that? if you look at this across the country, 30% of all of our with violent injuries will return to the hospital with a similar kind of injury. when they come back, their chance of dying is much higher,
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as much as tenfold higher. patients who are victims of violence, we have an opportunity and obligation to see what we can do to keep them from coming back to our hospitals. victims ofese violence committed to our hospital. we do a great job. as hospitals we do a great job saving the lives of these victims of violence. over the past decade, we have brought new things that impacted lives saved. but they are coming back. we asked what could we do differently? what are the factors that put
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the -- these are things you could all -- lack of education, substance abuse, etc. we took that information and created [indiscernible] intervention program. we instituted and did a randomized prospective study geared toward the question what could we do different? half our patients got the program, half did not. 46 percent, [indiscernible] showing we as a hospital could intervene in this process, we could save lives. what we are doing now, and as a part of that process we have now -- i am founder of a program --t is a program that would i would encourage you to google. we have a goal to grow
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hospital-based [indiscernible] programs. our data shows it does save lives in, and on that network, it will show some of the papers that show that ability to save lives. it is important that we use data to drive our processes. if we don't use data, hospital administrators will not listen. that is one of the driving forces what we are doing. is second thing we have done , after having our hospital-based programs, we saw that for the violence, it requires something different. oure cases don't come to departments with severe injuries. they are part of the environment though. we started a hospital-based domestic violence program.
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our ed's, there were several questions to be asked to any woman presented to our e.d.. the first year we got 100 patients total. 400 and so on.
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we hope to publish that to 400 . we hope to publish that to show a hospital-based domestic violence program will allow you up to this panel, you name some of the really important actions hospitals can take. issue wase first big leadership, this morning, and how vital that is to changing practice, system. i think my wish list is we need executive leadership in health care systems to think about overdose prevention and addiction treatment really across departments, across all parts of the hospital system and into the community and in partnership with public health. with executive level partnership, system change can happen. that needs to regard somebody coming in for example after an
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overdose as a time critical, time sensitive event like a stroke, like thinking about getting medication into a person to save brain tissue. same thing. steps are clear, and we know what some of those high-impact strategies are, offering medication treatment in a timely fashion. at the same time addiction is a chronic illness. think about hiv, and think about the radical changes we were able to make both in inpatient and outpatient care around hiv-aids. when i trained, we didn't have expertise, and we didn't have care teams that included multiple health professionals, people with lived experience, people who could advocate for people with substance use or at
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risk for developing and addiction. addictioneveloping an area those are important lessons where it is a time sensitive condition and chronic illness. whipping high-impact strategies come clear, changing prescription behaviors. changing default and electronic health records so people coming in for an acutely painful condition walk out with three days of prescribed medicine. think about where the morphine treatment is or is not available, then at an executive availableuring it is in primary care, specialty care, whether addiction, surgery or ob/gyn, wherever patients are. think about strategies to help keep people safe who at the
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moment are not ready or interested in changing their drug use but can take important steps in improving their health, getting naloxone, getting sterile syringes, learning the risks of fentanyl, the highly potent opioid that is increasing the risk of substance use right now. dr. wen: thank you. spent --. walker, you you set a target for health spending and core metrics. how can the health system do a better job in partnering so we can really focus on social inequity? dr. walker: we have been on a journey. i likened this conversation around spending on health care being on a long family car trip with the health care systems in the united states. you start out, you are excited, everyone has their map, pictures, they are excited to get halfway.
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then halfway through, everyone in the back is ready to get out and stretch their legs, maybe there is crankiness and discomfort. that is where we are, where the health care system isn't exactly pleased during the journey, but now we have gotten to a place where the governor issued an executive order, and we are focused on data transparency. we have watched this path of a new conversation, on that road trip we are getting out of the car, taking pictures, posting on facebook. we are excited to get started. we are going to have a commitment where partners come to us around drain -- around data transparency for prospecting and where we want to be on a growth trajectory and how we want to embed transparent measures around quality, how we have an open conversation as public health officials and health systems around three critical issues around the
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state, primary care utilization and preventable department use, opioid overdose death which are rising, and cardiovascular disease and prevention. those are places we can come together, highlight areas of success where health systems are coming to the theater -- the table and figuring out ways to create solutions. but also bring new partners to the table. we need primary care, not just about health systems. we need reimbursement that aligns with the goals and quality spending, and we are working together. journey has just begun, but it does require new partners coming together and the health system playing a world in
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in -- april -- playing a role in that. we have to be open to us in our various roles as we think about how hospitals can partner to do public health better? i will start with dr. cooper. one of the things hospitals have is -- s something they are always decreasing my reimbursement. >> [laughter] dr. cooper: they are trying to push the idea of population health in our communities. i agree with that concept. one of the things that helps -- health care assistance can do is -- that health care assistants can do is take care of populations of of communities
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they are involved in. communities from a population health perspective, we can increase the overall level of communities. were the health care systems can play that role is they can be leaders. they can provide the clinics, primary claire -- primary care clinics. other things needed to move those communities forward our food deserts, to look at -- forward are food deserts, pest likeol, housing, things employment, how do you get the business community to invest in grocery stores that are large grocery stores, not small community stores that are -- that adequately supply food
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choices those communities need? and other things, the politicians needed to get the communities involved, to get other resources needed throughout the communities. if you are able to approach healthrom a population perspective, those are the things that will impact violence. better schools, hospitals. communities where violence taken place, all the things i outlined to you. -- they lacked the things i outlined to you. we need to bring all those other parts, pest control, vacant housing, food deserts, as a part of those. do systems can you would think politicians could, but i am not sure they perspective to do
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it. health care symptoms -- systems go in with the sort of moral authority to drive that process. that kind of approach to our where violence takes place, not only will it impact violence, and police being a impact that, it can other health care things as well. diabetes, all those things that are problems that violent communities have also asthma astes, hiv, well. -- health care systems can be a leader in driving the process that looks at, that works on ovulation health --
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population health, it is a i am aof saying hospital, i will take ownership of west baltimore or east baltimore and get all the other parts, pest control, a part of it, and we will do it for three years. and then after that the community is on their own. then let's go to the south and can, by standing up those communities, begin to impact the process and move in a different direction. dr. wen: we don't have much time left. dr. kunins: to really plugged us in public health -- really plug us in public health, making connections between local public health -- we have skilled and resources in public health, and it is our job to reach out to health systems not just as regulators but with data,
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science, and ask how can we help you achieve your mission? dr. walker: health care systems play a huge role creating the solutions necessary right now. they can demand more in terms of payment models, delivery system support so we are reimbursing for value, and that needs to happen over time and can't happen with a light switch turned on, but we have to figure out how to ask for that change and transition together. cms is supportive of states taking the lead, health care systems and delivery systems should be out there putting ideas forward. dr. wen: join me in thanking our participants. [applause] ♪ [captions copyright national cable satellite corp. 2018] [captioning performed by the national captioning institute,
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which is responsible for its caption content and accuracy. visit] announcer 1: the united states senate, a uniquely american -- institution, since 1789. >> raise your right hand. announcer 1: wednesday c-span takes you inside the wednesday n takes you inside the senate come a learning about the legislative body and its informal workings. >>conflict and compromise with original interviews, key moments in history an unprecedented access, allowing us to bring cameras into the chamber during a session. follow the evolution of the senate into the modern era from advice and consent to the pe


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