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Today we're going to talk about[br]a very powerful idea

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that can transform the lives of children[br]around the world.

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It's an idea that's simple,[br]that's easy to implement

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and that costs little or nothing.

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But it does require[br]that we join together to accomplish it.

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But even that's good news,

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because we're living[br]in a participation age.

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We are not just consuming culture,[br]we're creating it together.

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When it comes to medicine,[br]participatory medicine,

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taking charge of our own health

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is fundamental[br]to transforming health care.

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And participatory public health

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enables us to tackle

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the world's biggest[br]health problems together.

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We can't just rely on public institutions[br]to get the job done,

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as important as they are,

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if we want to change huge things fast.

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So today we're going to talk about[br]a global, historic campaign

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called TICC TOCC.

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It's a participatory campaign.

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But first, we have to set the stage.

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There are a few things you need to know.

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There are two atoms[br]that are very common, very plentiful,

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but they all too often do not end up

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in the right place at the right time.

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And the consequences[br]for children's health,

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for their developing brains,[br]for the neurons in their developing brains

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are immense.

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The first of these is oxygen.

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I can remember, when each[br]of my own children were born,

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this sense of joy and relief[br]when I heard their first cry.

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Their lungs were filled with air.

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It's an instinctive thing in us parents[br]to feel great when they cry

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and not good when we don't hear anything.

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The first minute of life[br]is often called the golden minute,

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because it's so important.

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And the reason that it's called[br]the golden minute,

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is that there is a huge difference[br]between babies who get enough oxygen

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in that first minute after being born

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and those who don't get enough.

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In fact, the World Health[br]Organization has estimated

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that 29% of all newborn deaths[br]around the planet

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come from not getting[br]enough oxygen at birth.

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We call it birth asphyxia.

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And that's just part of the problem.

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There is a million kids who die every year[br]from not getting enough oxygen.

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There's another million or even more[br]who get enough oxygen to survive,

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but not enough to thrive,

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and they're left[br]with lifelong consequences

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like cerebral palsy[br]or epilepsy or learning disabilities

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or a developmental delay.

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And even that's not the whole story.

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One in 10 newborns around the world -

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in some places one in seven -

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get suboptimal amounts of oxygen at birth.

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In public health, there is this concept[br]that's really useful,

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called disability-adjusted life-years,[br]or a related concept,

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quality-adjusted life-years,

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and very simply, it's a measure of health.

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It's the number of years[br]of health that are lost

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because of disability or disease or death.

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And when you look around the planet[br]at loss of health in childhood,

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far and away the number one cause[br]of kids losing health

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is not getting enough oxygen[br]in the first minutes of life.

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The stakes couldn't get any higher[br]than this, for children's health.

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So how do we solve it?

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Well, one solution of course, would be

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we could just get[br]an oxygen canister in every village

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and every room where a baby is born.

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We could solve it, it's simple,

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but not easy to implement[br]and not inexpensive.

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Especially when you talk about refilling[br]the oxygen canisters,

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this would get really tough.

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Another solution would be[br]just to get a simple bag and mask

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into the rooms where babies are born.

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It's a lot cheaper[br]than an oxygen canister.

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Just pushing room air[br]into the baby's lungs

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has enough oxygen to make a difference.

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But again, it's not easy to implement.

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Another solution would be to train[br]childbirth attendants.

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There's a really cool coalition called[br]Helping Babies Breathe,

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and they're dedicated to making[br]the golden minute successful for babies.

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And their goal is to have a trained,[br]certified birth attendant

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at every delivery in the world by 2015.

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It's a great goal, an ambitious goal.

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Support them.

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But the idea we're talking about today

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is simpler, easier to implement, cheaper,[br]can make change faster

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and makes all the other interventions[br]more effective.

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Now, the other atom[br]that we need to consider today

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represents a problem[br]that's even more widespread

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than not getting enough oxygen,

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and that's not getting enough iron.

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Iron is central to our lifeblood.

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It's what allows our blood to carry[br]oxygen to our brains and the other organs.

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And when we don't have enough iron,[br]we don't make enough red cells.

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It's called iron deficiency anemia

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and it's one of the world's[br]biggest public health problems.

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Iron deficiency anemia can cause[br]poor gross motor development,

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it can cause poor memory,[br]it can cause fatigue,

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it can cause you to get sick more often[br]and have a harder time getting better.

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But when it comes to iron deficiency,

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iron deficiency anemia[br]is just the tip of the iceberg.

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Because a lot of people[br]have normal red blood cells

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but are still iron deficient enough[br]to affect their intelligence,

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perhaps forever.

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Somewhere around two billion[br]people on our planet

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have lost intelligence[br]because of iron deficiency.

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It's a huge problem!

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The World Health Organization estimates

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that if we could just fix that one problem[br]in a developing nation,

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just fix iron deficiency,

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we would increase their productivity[br]about 20%, their GNP by 20%.

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Huge health and economic benefit.

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And it's not just developing nations.

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In the developed world,[br]in the United States where I come from,

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iron deficiency is still common.

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The latest estimate[br]in the United States is that kids today,

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who are 0-5 years old, in the US,

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together have lost 9 million IQ points[br]from not getting enough iron.

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That's in the US!

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At a staggering price tag

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of about a 100 billion dollars[br]for those kids

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in lifetime lost earnings

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because of their decreased intelligence.

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So if we were to spend billions of dollars

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to fix iron deficiency,

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it'd be a good investment.

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And one way to deal with the problem[br]would be to manufacture

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and package and distribute[br]iron supplements all over the world.

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And there's people doing that,[br]it's a great idea.

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Tens of millions of kids have been helped,[br]but it hasn't solved the problem.

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Another idea would be[br]to distribute iron supplements

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to pregnant women around the world:

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there are fewer of them, it would help[br]the moms, the babies, great idea.

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I support a group called[br]Vitamin Angels that's doing that.

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I've traveled with them to villages[br]that had never seen a doctor before

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and seen the impact of getting iron[br]and other micronutrients to them.

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It's very cost-effective, it's very cool.

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Another way of solving the iron problem

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would be to fortify[br]all of our infant formula

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and all of our infant cereals with iron.

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And that's the leading[br]solution in the West.

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But there's something kind of off kilter[br]about that solution.

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And here is the clue.

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Among the highest-risk kids in the world,[br]for iron deficiency,

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are the babies[br]who are exclusively breastfed

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for longer than 6 months.

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And to me, I found that really[br]counterintuitive,

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because breast milk, human milk[br]is the perfect food for human babies.

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Why would those be the ones at risk?

0:09:01.790,0:09:04.139
I mean, it's what's got[br]the right nutrients.

0:09:04.163,0:09:05.734
Here it is:

0:09:05.758,0:09:09.596
breast milk is "low" in vitamin D.

0:09:10.314,0:09:14.729
Because presumably, historically,[br]babies got vitamin D from the sun.

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Today, they spend[br]most of their lives indoors.

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And breast milk is "low" in iron

0:09:24.310,0:09:30.006
presumably because historically,[br]they got it a different way.

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And not from boxed cereal[br]and infant formula.

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So I want to tell you an idea now

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that I want you to remember[br]for the rest of your lives.

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It's time to get to the solution here.

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I want to ring a bell[br]that can't be unrung,

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to change your perception.

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And here is the idea:

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at the moment a baby is born,

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anywhere on the planet,

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a third of their blood[br]is outside their body.

0:10:05.654,0:10:09.034
The circulation that's been nourishing[br]them through all of development,

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a third of it is still outside their body[br]at the moment of birth.

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And for all of human history,[br]for as long as we have been humans,

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until very recently,

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what happened was this beautiful thing:

0:10:22.165,0:10:23.565
the baby would emerge,

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and then you would see the umbilical cord[br]would start pulsing, pumping,

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pushing blood into the baby.

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And the baby would get[br]about 30% more blood

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during the 90 seconds or so longer[br]than we currently allow the blood to flow.

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What does this 30% extra blood do?

0:10:47.230,0:10:51.055
Well, first of all, they're basically[br]getting iron supplements,

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without the packaging,[br]without the manufacture,

0:10:53.354,0:10:54.816
without distribution.

0:10:54.840,0:10:59.066
They're getting iron-rich blood,[br]enough iron to last them for months,

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and largely eliminate iron deficiency[br]anemia in kids without cost.

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They're not just getting iron though,[br]they also getting oxygen!

0:11:10.550,0:11:11.748
Before a baby is born,

0:11:11.772,0:11:14.829
they get all of their oxygen[br]through the umbilical cord.

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And in that golden minute[br]after they're born,

0:11:17.399,0:11:21.019
all the circulation is changing around[br]and the lungs are starting to open up,

0:11:21.043,0:11:24.104
they're still getting oxygen[br]through the cord.

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During that golden minute[br]while the lungs are getting set up,

0:11:28.621,0:11:30.261
oxygen is coming through.

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And it's not just oxygen.

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They get red blood cells,

0:11:34.080,0:11:37.309
the only cells in the body[br]that can carry oxygen.

0:11:37.333,0:11:39.069
They get 30% more blood volume,

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60% more red blood cells,

0:11:41.649,0:11:43.442
in that extra 90 seconds.

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It's red cell rich blood.

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It's a packed red blood cell transfusion.

0:11:48.425,0:11:51.758
You know, recently,[br]Lance Armstrong has made the news,

0:11:51.782,0:11:57.696
even though he never tested positive[br]for drugs in his blood.

0:11:57.720,0:12:02.429
But allegedly, his wins[br]in the Tour de France came in part

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because he was infusing himself[br]with his own red blood cells.

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And that's a technique we know works.

0:12:10.628,0:12:14.152
When you get extra red blood cells,[br]you got extra strength, extra endurance

0:12:14.176,0:12:16.955
and it's been the state[br]of nature for newborns

0:12:16.979,0:12:18.772
since the beginning of human history,

0:12:18.796,0:12:20.725
to get this pack of red blood cells.

0:12:20.749,0:12:22.448
And it's not just red blood cells.

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It's even richer in white[br]blood cells, comparatively.

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You know, I said that lack of oxygen[br]is the biggest cause of loss of health.

0:12:30.887,0:12:35.597
But the most immediate cause[br]of newborn death is infections.

0:12:35.621,0:12:38.312
32% of all newborn deaths[br]is from infections.

0:12:38.336,0:12:42.787
The umbilical cord blood is rich[br]in white blood cells to fight infections

0:12:42.811,0:12:45.405
and antibodies that mom has created.

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Perhaps the most important thing

0:12:48.017,0:12:52.565
is that that umbilical cord blood[br]is packed with stem cells,

0:12:52.589,0:12:56.842
these cells with genetic potential[br]to prevent and repair

0:12:56.866,0:12:58.152
damage throughout the body.

0:12:58.176,0:13:00.658
You'll be learning more[br]about stem cells later today,

0:13:00.682,0:13:01.926
but just one example.

0:13:01.950,0:13:04.712
We've learned just in recent years[br]that muscular dystrophy,

0:13:04.736,0:13:08.005
that we used to think was primarily[br]damage to the muscles, isn't.

0:13:08.029,0:13:11.926
It is primarily damage to the stem cells[br]that repair muscle damage.

0:13:11.950,0:13:17.523
Babies, throughout most of history,[br]had gotten cutting-edge medical treatment,

0:13:17.547,0:13:22.483
an autologous stem-cell transplant[br]at birth, as a course of nature.

0:13:23.303,0:13:29.304
But, in 1913 an idea took hold in the West

0:13:29.328,0:13:30.954
and spread around the globe.

0:13:30.978,0:13:32.208
And idea was this:

0:13:32.232,0:13:36.335
as soon as baby emerges,[br]to clamp the cord,

0:13:36.359,0:13:37.717
to surgically clamp it.

0:13:37.741,0:13:40.673
To cut off, to choke off[br]the supply of oxygen,

0:13:40.697,0:13:43.427
to cut off the flow of blood,

0:13:43.451,0:13:45.480
to lock out the white blood cells,

0:13:45.504,0:13:47.472
to lock out the antibodies

0:13:47.496,0:13:52.953
and to take that umbilical cord,[br]stem cell treasure

0:13:52.977,0:13:54.365
and throw it in the trash.

0:13:57.818,0:14:01.760
Which, I think, is one of leading reasons[br]that we have chronic illnesses

0:14:01.784,0:14:03.327
rising in kids today.

0:14:05.114,0:14:08.734
Thankfully, many kids have[br]sufficient reserves

0:14:08.758,0:14:10.894
to be able to handle that loss.

0:14:11.663,0:14:13.780
But many don't.

0:14:15.459,0:14:17.880
That leads us to the TICC TOCC campaign.

0:14:17.904,0:14:22.110
Very simple idea:[br]Transitioning Immediate Cord Clamping

0:14:22.134,0:14:24.709
To Optimal Cord Clamping.

0:14:24.733,0:14:27.384
It's not a business,[br]it's not even a non-profit,

0:14:27.408,0:14:29.137
it's a shared idea.

0:14:30.141,0:14:34.701
Waiting an extra 90 seconds or so,[br]till the cord stops pulsing,

0:14:34.725,0:14:37.328
the way we have throughout[br]almost all of human history.

0:14:40.636,0:14:45.842
This is a powerful participatory idea,

0:14:45.866,0:14:48.143
and one that's really easy to spread.

0:14:48.477,0:14:51.351
Far easier to spread than it is[br]to spread supplements,

0:14:51.375,0:14:53.378
or equipment, or antibiotics,

0:14:53.402,0:14:56.950
and certainly than stem cell transplants.

0:15:01.667,0:15:04.000
It's something that I'm convinced[br]that we can do.

0:15:04.024,0:15:05.812
And why am I convinced we can do it?

0:15:05.836,0:15:07.890
Because we've done it before.

0:15:07.914,0:15:13.151
Back in 1913, when the idea[br]of clamping quickly spread,

0:15:13.175,0:15:14.447
that was foreign,

0:15:14.471,0:15:16.494
but it spread across the globe,

0:15:16.518,0:15:19.003
even in the places no physician[br]had ever been,

0:15:19.027,0:15:24.868
because the 20th century saw[br]what had been unprecedented advances

0:15:24.892,0:15:27.415
in travel and in communications.

0:15:27.439,0:15:29.932
It was airplanes and telephones[br]that let it spread.

0:15:29.956,0:15:31.295
But today?

0:15:31.319,0:15:33.487
Today, we have the internet.

0:15:33.511,0:15:36.031
Today, we have mobile technology.

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Today, we have YouTube.

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Today things can spread[br]Gangnam Style around the globe

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faster than you can imagine.

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On Facebook, there are a billion people

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and on average, we're only[br]4.74 degrees of separation,

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we can reach everywhere.

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Twitter's even closer,[br]3.43 degrees of separation.

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And I've been in the most remote villages.

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They have no electricity, no toilets,[br]but people have cell phones.

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This is something we can do.

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Bang!

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We can take networked bits[br]and get the atoms we need

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to the developing neurons[br]and they'll unleash genetic potential.

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The TICC TOCC movement has a motto.

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It's a common phrase: "first do no harm."

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I hope you'll never hear it[br]the same way again.

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Because the first intervention[br]of the 21st century medicine,

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the first thing that we do for a baby,

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is surgical clamps and severing[br]that has no evidence base.

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There is no credible evidence of benefit.

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There is solid evidence, though,

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that it depletes iron stores,

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that it decreases oxygen,

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that it diminishes[br]oxygen-carrying capacity,

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that it deters our abilities[br]to fight infections

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and that it deprives babies

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of some of the most unique[br]and important cells in their body.

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If you look up, there is big scientific[br]evidence showing the safety and benefit

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of doing it the way[br]nature has always done it.

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It's often called delayed[br]cord clamping in the literature.

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I object to the term -

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it's not late, it's optimal cord clamping.

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It's on time.

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So how do we participate in this together?

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How does a TICC TOCC campaign work?

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And it couldn't be easier.

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To participate, it's only two things.

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First, request optimal cord clamping[br]for your loved ones.

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And second, share this simple idea[br]with your networks.

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Your social networks, online and off.

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Preferably as loud and as far as you can.

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But just request it and share it.

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And that's it!

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We can change the world.

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It's not just humans who have done this[br]through all of human history, by the way.

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Primates too have umbilical cords,[br]and they instinctively wait.

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None of them will sever the cord[br]before it stops pulsing.

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And it's not just primates.

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Mammals, throughout the world,[br]have umbilical cords.

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And they instinctively wait.

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None of them will actively sever the cord,

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they'll wait.

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Today,

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TICC TOCC,

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more than a quarter[br]of a million babies will be born.

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For most of them,

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it'll be clamped immediately[br]and thrown in the trash.

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This intervention works[br]for kids born by C-section,

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or vaginally, born on time or early,

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whether you want to bank[br]the cord blood stem cells or not.

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We can change it.

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Let's do it.

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Thanks very much!

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(Applause)