Transcriber: Leonardo Silva Reviewer: Tatjana Jevdjic I'm here to recruit you. I'm here to get you to join me in creating a healthier world. But I'm also here to convince you that we can't do that within the traditional healthcare paradigm.
We have to think in a new way. We need to come together to address the underlying social determinants of health. So, if you will, close your eyes for a second, and imagine something with me.
It's midnight. A fourteen-year-old girl walks down the street. She's tired, she's hungry, she's shaking.
She's really scared. Where will she sleep tonight? How will she survive?
She's just fourteen and alone. And, yet, she knows that this was the right choice, because staying at home was scarier. Had she stayed where the abuse was, she wouldn't have made it.
She wouldn't have survived. And at least here she has a chance. So, she walks on, with one destination, one goal in mind: survival.
So, open your eyes. And, yes. That fourteen-year-old girl was me.
And I have made my way from those streets to standing in front of you today, and I learned a lot on those streets. And that's why I care about the underlying social determinants of health. I made my way from those streets to a local teen counseling center, and I made my way into the foster care system.
Now, my first placement was an emergency placement. And, when I was there, the people were – they were kind, but I didn't trust them. And so, I just couldn't let them help me.
And, just as I was starting to trust, I was reassigned to another home. My next placement was with an African American family. And they were great.
They were generous, they were kind, and maybe they didn't quite know what to do with this blonde, blue-eyed white girl. But I always felt like an interloper. And then, one day, I was doing the family laundry, and I accidentally threw a red T-shirt in with the whites.
And I was petrified. What kind of punishment would there be? What kind of retribution would be exacted?
And, instead, they said, "Don't worry! It's Ok. " And, suddenly, we were united by a common color: pink.
(Laughter) And my final foster placement was with a couple who became foster parents just to give me a home. And they made me feel safe and trusting. They gave me confidence in my abilities and myself.
Being a foster child taught me a lot. It taught me how life traumas have long lasting impacts. It taught me about race, and equality, and social justice, and it taught me that reaching out in kindness can literally save a life.
Having experienced great cruelty, I knew what it was like to feel unvalued. And having experienced great kindness, I know the importance of caring for the most vulnerable. But, you know what – In a lot of ways, I was lucky.
I was white, I was educated, I got placed in good foster homes, and, when I was there, I saw a lot of kids that weren't that lucky. And I saw them lose hope, and I saw what it did to their health. So, I embraced this life perspective.
As Franklin Delano Roosevelt said, "The test of our progress is not whether we add more to the abundance of those who have much. It is weather we provide enough for those who have too little. " And that's what addressing the social determinants of health is about.
With those lessons, I went on to medical school. I trained as an infectious disease physician, and I finished just as the HIV/AIDS epidemic was unfolding. And in that clinic, that HIV clinic that I started, I saw veterans — it was at the V.
A. — coming in, young veterans coming in, looking like old men. Their bodies falling apart, catastrophically, from this devastating fatal illness, because, remember, back then, there were no treatments.
And I saw them lose their jobs, and their homes, and their friends, as they lost their health. And the worst sadness — was I watched them be rejected by their families as they were dying, just because they were gay. And what do you think that did to their health?
And through fighting for and supporting those brave men against all those unfair judgements and the abandonment, that's where I found my inspiration. By caring for others who experienced cruelty and adversity, I was given the opportunity to repay the kindness that had been shown to me. Those patients taught me powerful lessons: lessons of acceptance, and courage, and love.
And they taught me what a physician can be and what Medicine must be. But today, tragically, Medicine is failing in our country. The fact is that the system that I work in, here in the US, spends more than twice the amount of healthcare dollars per capita compared to any other developed country, and we have worse health outcomes.
We spend 18% of our GDP and we have dismal health status in this country. The fact is, in this country we don't even. .
. too many don't even have access to this failing system. We've got 51 million uninsured and many more underinsured, and this lack of coverage translates directly into worse health outcomes.
You know, I was one of those uninsured, when I was a teenager, and I didn't have a doctor, and the only place I could go when I got sick was the local emergency room, and that's not the right place for a teenager to get help. And the fact is that our healthcare system today is characterized by unconscionable disparities: disparities in health on the basis of race and ethnicity, geography, orientation and socioeconomic status. It's shameful.
And I know. Look at these numbers. Blacks on average live about 4 to 7 years fewer than whites.
And I know, because I heard those stories of "why", from the African American HIV patients I took care of in that HIV clinic. And it's because of the social determinants of health. Martin Luther King said, "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.
" And my message today is a call to action for each one of you. Remember I was going to recruit you in the health professions, but here's the important point: far beyond! Because you have a way to correct this injustice.
I submit to you that one reason we spend so much on health and see so little in return is that we're spending money on the wrong things! We have a system of "sick care", not healthcare. We treat patients after they get sick, but we don't provide the services and opportunities they need to keep them from ever becoming patients in the first place.
We need a new paradigm! One that's reactive. I mean, proactive!
Not reactive. One that is primary-care-based, not acute-intervention-based. One that coordinates care, rather than fragments care.
One that is population and community-based, rather than hospital and physician-based. And we, most importantly, need to move from the traditional medical model to a model that embraces the social determinants of health. And we now understand that the health of a population is predominantly determined by factors other than clinical care, and hospitals and physician offices.
In fact, that's only 10% of what determines a community's health. The other 90% is behavioral and social factors. And what do I mean by social determinants of health?
I mean factors like socioeconomic status, education opportunities, occupation and job security, housing, safe neighborhoods, social status and one that is particularly important to me: the feeling that you have a place in society, the feeling that you have a social support system, the feeling that you are valued. And we know that those who feel unvalued have poor health. So, I saw kids, when I was in foster care, with no chance for an education, and I now know that, if they didn't get a high school diploma, they were more than five times as likely to have poor health, compared to me, getting a college education.
And I saw kids who had experienced nothing but poverty, and I now know that they're eight times as likely to be in poor health as their more fortunate counterparts. My experiences have shown me the link between these social determinants of health and status of health in a community and in a person. And so these realities demand that we address the social determinants of health.
And here's the message: health cannot be the sole responsibility of physicians. We must all come together in new partnerships — government and community groups, academia and business — to ensure that everyone has access to education, to job opportunities, to safe neighborhoods. So, you don't need to go to medical school to improve health.
You need to care. And health must not be limited to a single domain. We need to talk about health in all policies, and understand that every social policy in our country should consider the impact on health.
Now, it's been said that we can't afford for the healthcare system to take care of all these social problems. Well, I'm here to tell you today — We have the money to do this. We're just spending it on the wrong things.
So, if you look at this chart, you will see the United States right here in red, in the middle. We spend a lot more on traditional healthcare, but a lot less on social services. Add those poverty reduction programs together with healthcare and we're right in the middle.
We're just spending money on the wrong things. We need to reduce poverty, we need to give education opportunities, we need to create job opportunities, because if we do, people will be healthier and we won't have these huge expenses in medical care. My call to action today, I believe, is urgent.
We all need to come together to address the social determinants of health, to challenge the inequalities and disparities that are so deeply ingrained in our country, create social policies that will ensure a better health for all. As President Obama said, "Every once in a while, a moment comes where you'll have a chance to vindicate all those best hopes that you had about yourself and about your country. .
. " I would submit to you. It's a challenge.
Look inside yourself. Examine your life experiences. Define your core values.
What are you going to do? Ask yourself: What country do you want to live in? One in which social deprivation defines your health status?
One in which the circumstances into which you were born determines your life expectancy? Or do you want to live in a country in which we all come together to address the social determinants of health? A place in which we come together to bring all our diverse perspectives and experiences to ensure a better health for all?
Our life experiences define what we'll prioritize; how we use the opportunities that we've been given. For me, my life experiences bring me powerfully and inevitably to helping the vulnerable, to ensuring social justice in our society, to taking care of those who have been forgotten by society. So, I ask you: How will we treat our most vulnerable?
Will we have the political will to address poverty, to develop national policies that address education, job opportunities, neighborhood safety? Will we have the courage to change the way that we spend our healthcare dollars and use them to address the social determinants of health? And, most importantly: Will you join me?
Will you lead this change? Because now is the time. Thank you very much.
