90 seconds to change the world | Alan Greene | TEDxBrussels

In 2010, Dr. Greene founded the WhiteOut Now movement aimed at changing how babies are fed starting with their first bite of solid food. In 2012, he launched a worldwide campaign aimed at changing the practice of Immediate Cord Clamping To Optimal Cord Clamping or TICC TOCC. He is the author of "Feeding Baby Green," "Raising Baby Green" and "From First Kicks to First Steps."

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

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

that can transform the lives of children
around the world.

It's an idea that's simple,
that's easy to implement

and that costs little or nothing.

But it does require
that we join together to accomplish it.

But even that's good news,

because we're living
in a participation age.

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

When it comes to medicine,
participatory medicine,

taking charge of our own health

is fundamental
to transforming health care.

And participatory public health

enables us to tackle

the world's biggest
health problems together.

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

as important as they are,

if we want to change huge things fast.

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

called TICC TOCC.

It's a participatory campaign.

But first, we have to set the stage.

There are a few things you need to know.

There are two atoms
that are very common, very plentiful,

but they all too often do not end up

in the right place at the right time.

And the consequences
for children's health,

for their developing brains,
for the neurons in their developing brains

are immense.

The first of these is oxygen.

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

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

Their lungs were filled with air.

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

and not good when we don't hear anything.

The first minute of life
is often called the golden minute,

because it's so important.

And the reason that it's called
the golden minute,

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

in that first minute after being born

and those who don't get enough.

In fact, the World Health
Organization has estimated

that 29% of all newborn deaths
around the planet

come from not getting
enough oxygen at birth.

We call it birth asphyxia.

And that's just part of the problem.

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

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

but not enough to thrive,

and they're left
with lifelong consequences

like cerebral palsy
or epilepsy or learning disabilities

or a developmental delay.

And even that's not the whole story.

One in 10 newborns around the world -

in some places one in seven -

get suboptimal amounts of oxygen at birth.

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

called disability-adjusted life-years,
or a related concept,

quality-adjusted life-years,

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

It's the number of years
of health that are lost

because of disability or disease or death.

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

far and away the number one cause
of kids losing health

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

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

So how do we solve it?

Well, one solution of course, would be

we could just get
an oxygen canister in every village

and every room where a baby is born.

We could solve it, it's simple,

but not easy to implement
and not inexpensive.

Especially when you talk about refilling
the oxygen canisters,

this would get really tough.

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

into the rooms where babies are born.

It's a lot cheaper
than an oxygen canister.

Just pushing room air
into the baby's lungs

has enough oxygen to make a difference.

But again, it's not easy to implement.

Another solution would be to train
childbirth attendants.

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

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

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

at every delivery in the world by 2015.

It's a great goal, an ambitious goal.

Support them.

But the idea we're talking about today

is simpler, easier to implement, cheaper,
can make change faster

and makes all the other interventions
more effective.

Now, the other atom
that we need to consider today

represents a problem
that's even more widespread

than not getting enough oxygen,

and that's not getting enough iron.

Iron is central to our lifeblood.

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

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

It's called iron deficiency anemia

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

Iron deficiency anemia can cause
poor gross motor development,

it can cause poor memory,
it can cause fatigue,

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

But when it comes to iron deficiency,

iron deficiency anemia
is just the tip of the iceberg.

Because a lot of people
have normal red blood cells

but are still iron deficient enough
to affect their intelligence,

perhaps forever.

Somewhere around two billion
people on our planet

have lost intelligence
because of iron deficiency.

It's a huge problem!

The World Health Organization estimates

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

just fix iron deficiency,

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

Huge health and economic benefit.

And it's not just developing nations.

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

iron deficiency is still common.

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

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

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

That's in the US!

At a staggering price tag

of about a 100 billion dollars
for those kids

in lifetime lost earnings

because of their decreased intelligence.

So if we were to spend billions of dollars

to fix iron deficiency,

it'd be a good investment.

And one way to deal with the problem
would be to manufacture

and package and distribute
iron supplements all over the world.

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

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

Another idea would be
to distribute iron supplements

to pregnant women around the world:

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

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

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

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

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

Another way of solving the iron problem

would be to fortify
all of our infant formula

and all of our infant cereals with iron.

And that's the leading
solution in the West.

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

And here is the clue.

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

are the babies
who are exclusively breastfed

for longer than 6 months.

And to me, I found that really
counterintuitive,

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

Why would those be the ones at risk?

I mean, it's what's got
the right nutrients.

Here it is:

breast milk is "low" in vitamin D.

Because presumably, historically,
babies got vitamin D from the sun.

Today, they spend
most of their lives indoors.

And breast milk is "low" in iron

presumably because historically,
they got it a different way.

And not from boxed cereal
and infant formula.

So I want to tell you an idea now

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

It's time to get to the solution here.

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

to change your perception.

And here is the idea:

at the moment a baby is born,

anywhere on the planet,

a third of their blood
is outside their body.

The circulation that's been nourishing
them through all of development,

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

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

until very recently,

what happened was this beautiful thing:

the baby would emerge,

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

pushing blood into the baby.

And the baby would get
about 30% more blood

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

What does this 30% extra blood do?

Well, first of all, they're basically
getting iron supplements,

without the packaging,
without the manufacture,

without distribution.

They're getting iron-rich blood,
enough iron to last them for months,

and largely eliminate iron deficiency
anemia in kids without cost.

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

Before a baby is born,

they get all of their oxygen
through the umbilical cord.

And in that golden minute
after they're born,

all the circulation is changing around
and the lungs are starting to open up,

they're still getting oxygen
through the cord.

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

oxygen is coming through.

And it's not just oxygen.

They get red blood cells,

the only cells in the body
that can carry oxygen.

They get 30% more blood volume,

60% more red blood cells,

in that extra 90 seconds.

It's red cell rich blood.

It's a packed red blood cell transfusion.

You know, recently,
Lance Armstrong has made the news,

even though he never tested positive
for drugs in his blood.

But allegedly, his wins
in the Tour de France came in part

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

And that's a technique we know works.

When you get extra red blood cells,
you got extra strength, extra endurance

and it's been the state
of nature for newborns

since the beginning of human history,

to get this pack of red blood cells.

And it's not just red blood cells.

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

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

But the most immediate cause
of newborn death is infections.

32% of all newborn deaths
is from infections.

The umbilical cord blood is rich
in white blood cells to fight infections

and antibodies that mom has created.

Perhaps the most important thing

is that that umbilical cord blood
is packed with stem cells,

these cells with genetic potential
to prevent and repair

damage throughout the body.

You'll be learning more
about stem cells later today,

but just one example.

We've learned just in recent years
that muscular dystrophy,

that we used to think was primarily
damage to the muscles, isn't.

It is primarily damage to the stem cells
that repair muscle damage.

Babies, throughout most of history,
had gotten cutting-edge medical treatment,

an autologous stem-cell transplant
at birth, as a course of nature.

But, in 1913 an idea took hold in the West

and spread around the globe.

And idea was this:

as soon as baby emerges,
to clamp the cord,

to surgically clamp it.

To cut off, to choke off
the supply of oxygen,

to cut off the flow of blood,

to lock out the white blood cells,

to lock out the antibodies

and to take that umbilical cord,
stem cell treasure

and throw it in the trash.

Which, I think, is one of leading reasons
that we have chronic illnesses

rising in kids today.

Thankfully, many kids have
sufficient reserves

to be able to handle that loss.

But many don't.

That leads us to the TICC TOCC campaign.

Very simple idea:
Transitioning Immediate Cord Clamping

To Optimal Cord Clamping.

It's not a business,
it's not even a non-profit,

it's a shared idea.

Waiting an extra 90 seconds or so,
till the cord stops pulsing,

the way we have throughout
almost all of human history.

This is a powerful participatory idea,

and one that's really easy to spread.

Far easier to spread than it is
to spread supplements,

or equipment, or antibiotics,

and certainly than stem cell transplants.

It's something that I'm convinced
that we can do.

And why am I convinced we can do it?

Because we've done it before.

Back in 1913, when the idea
of clamping quickly spread,

that was foreign,

but it spread across the globe,

even in the places no physician
had ever been,

because the 20th century saw
what had been unprecedented advances

in travel and in communications.

It was airplanes and telephones
that let it spread.

But today?

Today, we have the internet.

Today, we have mobile technology.

Today, we have YouTube.

Today things can spread
Gangnam Style around the globe

faster than you can imagine.

On Facebook, there are a billion people

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

we can reach everywhere.

Twitter's even closer,
3.43 degrees of separation.

And I've been in the most remote villages.

They have no electricity, no toilets,
but people have cell phones.

This is something we can do.

Bang!

We can take networked bits
and get the atoms we need

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

The TICC TOCC movement has a motto.

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

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

Because the first intervention
of the 21st century medicine,

the first thing that we do for a baby,

is surgical clamps and severing
that has no evidence base.

There is no credible evidence of benefit.

There is solid evidence, though,

that it depletes iron stores,

that it decreases oxygen,

that it diminishes
oxygen-carrying capacity,

that it deters our abilities
to fight infections

and that it deprives babies

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

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

of doing it the way
nature has always done it.

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

I object to the term -

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

It's on time.

So how do we participate in this together?

How does a TICC TOCC campaign work?

And it couldn't be easier.

To participate, it's only two things.

First, request optimal cord clamping
for your loved ones.

And second, share this simple idea
with your networks.

Your social networks, online and off.

Preferably as loud and as far as you can.

But just request it and share it.

And that's it!

We can change the world.

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

Primates too have umbilical cords,
and they instinctively wait.

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

And it's not just primates.

Mammals, throughout the world,
have umbilical cords.

And they instinctively wait.

None of them will actively sever the cord,

they'll wait.

Today,

TICC TOCC,

more than a quarter
of a million babies will be born.

For most of them,

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

This intervention works
for kids born by C-section,

or vaginally, born on time or early,

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

We can change it.

Let's do it.

Thanks very much!

(Applause)