0:00:03.465,0:00:05.907
I'm here to recruit you.

0:00:06.568,0:00:11.369
I'm here to get you to join me[br]in creating a healthier world.

0:00:14.101,0:00:18.467
But I'm also here to convince[br]you that we can't do that

0:00:18.467,0:00:21.537
within the traditional[br]healthcare paradigm.

0:00:22.228,0:00:25.021
We have to think in a new way.

0:00:25.021,0:00:26.562
We need to come together [br]

0:00:26.562,0:00:30.738
to address the underlying social[br]determinants of health.

0:00:33.826,0:00:37.961
So, if you will, close your eyes[br]for a second,

0:00:38.468,0:00:41.988
and imagine something with me.

0:00:41.988,0:00:43.985
It's midnight.

0:00:43.985,0:00:47.447
A fourteen-year-old girl[br]walks down the street.

0:00:47.447,0:00:50.725
She's tired, she's hungry,[br]she's shaking.

0:00:50.725,0:00:52.987
She's really scared.

0:00:52.987,0:00:56.683
Where will she sleep tonight?[br]How will she survive?

0:00:56.683,0:01:00.225
She's just fourteen and alone.

0:01:00.763,0:01:04.573
And, yet, she knows that[br]this was the right choice,

0:01:04.573,0:01:08.238
because staying at home was scarier.

0:01:08.238,0:01:11.553
Had she stayed[br]where the abuse was,

0:01:11.553,0:01:13.714
she wouldn't have made it. [br]

0:01:14.238,0:01:16.091
She wouldn't have survived.

0:01:16.091,0:01:19.211
And at least here she has a chance.

0:01:19.229,0:01:22.616
So, she walks on, with one destination,

0:01:22.616,0:01:24.819
one goal in mind:

0:01:25.172,0:01:26.760
survival.

0:01:28.346,0:01:30.529
So, open your eyes.

0:01:30.914,0:01:34.783
And, yes. That fourteen-year-old[br]girl was me.

0:01:37.322,0:01:41.225
And I have made my way[br]from those streets

0:01:42.103,0:01:45.359
to standing in front of you today,

0:01:46.605,0:01:50.370
and I learned a lot on those streets.

0:01:52.167,0:01:57.089
And that's why I care about the underlying[br]social determinants of health.

0:01:57.089,0:02:01.794
I made my way from those streets[br]to a local teen counseling center,

0:02:01.794,0:02:05.214
and I made my way into[br]the foster care system.

0:02:05.733,0:02:10.376
Now, my first placement[br]was an emergency placement.

0:02:10.677,0:02:14.773
And, when I was there,[br]the people were – they were kind,

0:02:14.773,0:02:16.855
but I didn't trust them.

0:02:16.855,0:02:21.062
And so, I just couldn't[br]let them help me.

0:02:22.741,0:02:25.775
And, just as I was starting to trust,

0:02:25.775,0:02:28.587
I was reassigned to another home.

0:02:29.494,0:02:34.036
My next placement was with[br]an African American family.

0:02:34.036,0:02:36.171
And they were great. [br]

0:02:36.171,0:02:38.520
They were generous,[br]they were kind,

0:02:38.520,0:02:40.211
and maybe they didn't[br]quite know what to do

0:02:40.211,0:02:43.125
with this blonde,[br]blue-eyed white girl.

0:02:43.509,0:02:46.613
But I always felt like an interloper.

0:02:46.613,0:02:50.465
And then, one day,[br]I was doing the family laundry,

0:02:50.465,0:02:54.881
and I accidentally threw[br]a red T-shirt in with the whites.

0:02:57.517,0:02:59.544
And I was petrified.

0:02:59.544,0:03:01.579
What kind of punishment[br]would there be?

0:03:01.579,0:03:04.892
What kind of retribution[br]would be exacted?

0:03:04.892,0:03:08.965
And, instead, they said,[br]"Don't worry! It's Ok."

0:03:09.467,0:03:15.038
And, suddenly, we were united[br]by a common color:

0:03:15.652,0:03:18.379
pink.[br](Laughter)

0:03:19.380,0:03:22.816
And my final foster placement[br]was with a couple

0:03:22.816,0:03:26.018
who became foster parents just[br]to give me a home.

0:03:26.018,0:03:28.232
And they made me feel[br]safe and trusting.

0:03:28.232,0:03:32.238
They gave me confidence[br]in my abilities and myself.

0:03:33.652,0:03:36.730
Being a foster child taught me a lot.

0:03:36.730,0:03:41.639
It taught me how life traumas[br]have long lasting impacts.

0:03:42.087,0:03:45.337
It taught me about race, and equality,[br]and social justice,

0:03:45.337,0:03:48.589
and it taught me that[br]reaching out in kindness

0:03:48.589,0:03:51.475
can literally save a life.

0:03:53.167,0:03:56.492
Having experienced great cruelty,

0:03:56.492,0:04:00.439
I knew what it was like[br]to feel unvalued.

0:04:00.439,0:04:03.502
And having experienced great kindness,

0:04:03.502,0:04:08.121
I know the importance of caring[br]for the most vulnerable.

0:04:08.783,0:04:10.547
But, you know what –

0:04:10.547,0:04:13.481
In a lot of ways, I was lucky.

0:04:13.481,0:04:16.272
I was white, I was educated,

0:04:16.272,0:04:18.780
I got placed in good foster homes,

0:04:18.780,0:04:22.806
and, when I was there, I saw a lot[br]of kids that weren't that lucky.

0:04:23.422,0:04:26.157
And I saw them lose hope,

0:04:26.157,0:04:29.369
and I saw what it did to their health.

0:04:29.369,0:04:32.665
So, I embraced this life perspective.

0:04:33.434,0:04:35.299
As Franklin Delano Roosevelt said,

0:04:35.299,0:04:38.905
"The test of our progress[br]is not whether we add more

0:04:38.920,0:04:42.318
to the abundance[br]of those who have much.

0:04:42.318,0:04:47.233
It is weather we provide enough[br]for those who have too little."

0:04:47.251,0:04:52.839
And that's what addressing the social[br]determinants of health is about.

0:04:53.900,0:04:56.629
With those lessons,[br]I went on to medical school.

0:04:56.629,0:04:59.187
I trained as an infectious[br]disease physician,

0:04:59.187,0:05:03.596
and I finished just as the HIV/AIDS[br]epidemic was unfolding.

0:05:03.596,0:05:06.974
And in that clinic,[br]that HIV clinic that I started,

0:05:06.974,0:05:10.340
I saw veterans — it was at the V.A.[br]— coming in,

0:05:10.340,0:05:13.791
young veterans coming in,[br]looking like old men.

0:05:13.791,0:05:18.079
Their bodies falling apart,[br]catastrophically,

0:05:18.483,0:05:20.093
from this devastating fatal illness,

0:05:20.093,0:05:23.798
because, remember, back then,[br]there were no treatments.

0:05:24.397,0:05:26.848
And I saw them lose their jobs, [br]

0:05:26.848,0:05:29.986
and their homes, and their friends,

0:05:29.986,0:05:31.559
as they lost their health.

0:05:31.559,0:05:33.390
And the worst sadness —

0:05:33.390,0:05:38.284
was I watched them[br]be rejected by their families

0:05:38.362,0:05:42.159
as they were dying,[br]just because they were gay.

0:05:42.159,0:05:45.632
And what do you think[br]that did to their health?

0:05:46.801,0:05:50.923
And through fighting for[br]and supporting those brave men

0:05:50.923,0:05:54.676
against all those unfair judgements[br]and the abandonment,

0:05:54.676,0:05:58.117
that's where I found my inspiration.

0:05:58.117,0:06:02.466
By caring for others who experienced[br]cruelty and adversity,

0:06:02.969,0:06:05.943
I was given the opportunity[br]to repay the kindness

0:06:05.943,0:06:08.569
that had been shown to me.

0:06:08.569,0:06:11.587
Those patients taught me[br]powerful lessons:

0:06:11.587,0:06:15.779
lessons of acceptance,[br]and courage, and love.

0:06:15.779,0:06:18.744
And they taught me what[br]a physician can be

0:06:18.744,0:06:21.865
and what Medicine must be.

0:06:22.711,0:06:27.528
But today, tragically,[br]Medicine is failing in our country.

0:06:28.716,0:06:33.503
The fact is that the system[br]that I work in, here in the US,

0:06:33.503,0:06:37.181
spends more than twice the amount[br]of healthcare dollars per capita

0:06:37.181,0:06:39.245
compared to any other[br]developed country,

0:06:39.245,0:06:42.514
and we have worse health outcomes.

0:06:43.221,0:06:46.405
We spend 18% of our GDP

0:06:46.405,0:06:50.647
and we have dismal health[br]status in this country.

0:06:52.200,0:06:55.303
The fact is, in this country[br]we don't even...

0:06:55.303,0:06:58.936
too many don't even have access[br]to this failing system.

0:06:58.936,0:07:03.488
We've got 51 million uninsured[br]and many more underinsured,

0:07:03.488,0:07:07.220
and this lack of coverage[br]translates directly

0:07:07.220,0:07:10.131
into worse health outcomes.

0:07:12.381,0:07:17.360
You know, I was one of those uninsured,[br]when I was a teenager,

0:07:17.360,0:07:18.902
and I didn't have a doctor,

0:07:18.902,0:07:21.099
and the only place I could go[br]when I got sick

0:07:21.099,0:07:22.800
was the local emergency room,

0:07:22.800,0:07:27.337
and that's not the right place[br]for a teenager to get help.

0:07:28.321,0:07:31.724
And the fact is that[br]our healthcare system today

0:07:31.724,0:07:34.624
is characterized[br]by unconscionable disparities:

0:07:34.624,0:07:38.540
disparities in health on the basis[br]of race and ethnicity,

0:07:38.540,0:07:43.131
geography, orientation[br]and socioeconomic status.

0:07:43.996,0:07:46.106
It's shameful.

0:07:47.474,0:07:50.600
And I know.[br]Look at these numbers.

0:07:50.600,0:07:55.214
Blacks on average live[br]about 4 to 7 years fewer than whites.

0:07:56.473,0:08:00.116
And I know, because I heard those[br]stories of "why",

0:08:00.742,0:08:02.806
from the African American[br]HIV patients

0:08:02.806,0:08:05.629
I took care of in that HIV clinic.

0:08:05.629,0:08:08.740
And it's because of the social[br]determinants of health.

0:08:08.740,0:08:11.641
Martin Luther King said,[br]"Of all the forms of inequality,

0:08:11.641,0:08:15.148
injustice in healthcare[br]is the most shocking and inhumane."

0:08:15.148,0:08:16.919
And my message today

0:08:16.919,0:08:19.186
is a call to action for each one of you.

0:08:19.186,0:08:21.669
Remember I was going to recruit you

0:08:21.976,0:08:24.825
in the health professions,[br]but here's the important point:

0:08:24.825,0:08:26.544
far beyond!

0:08:26.544,0:08:30.867
Because you have a way[br]to correct this injustice.

0:08:30.867,0:08:34.502
I submit to you that one reason[br]we spend so much on health

0:08:34.502,0:08:36.779
and see so little in return

0:08:36.779,0:08:39.416
is that we're spending[br]money on the wrong things!

0:08:39.416,0:08:41.445
We have a system of "sick care",[br]not healthcare.

0:08:41.445,0:08:43.982
We treat patients after they get sick,

0:08:43.982,0:08:47.293
but we don't provide the services[br]and opportunities they need

0:08:47.293,0:08:50.625
to keep them from ever becoming[br]patients in the first place.

0:08:50.625,0:08:52.558
We need a new paradigm!

0:08:52.558,0:08:54.066
One that's reactive.

0:08:54.066,0:08:56.028
I mean, proactive! Not reactive.

0:08:56.028,0:08:59.499
One that is primary-care-based,[br]not acute-intervention-based.

0:08:59.499,0:09:03.290
One that coordinates care,[br]rather than fragments care.

0:09:03.290,0:09:06.410
One that is population[br]and community-based,

0:09:06.410,0:09:09.680
rather than hospital[br]and physician-based.

0:09:09.680,0:09:11.640
And we, most importantly,

0:09:11.640,0:09:15.129
need to move from the traditional[br]medical model

0:09:15.129,0:09:18.474
to a model that embraces the social[br]determinants of health.

0:09:18.474,0:09:21.724
And we now understand[br]that the health of a population

0:09:21.724,0:09:25.918
is predominantly determined[br]by factors other than clinical care,

0:09:25.918,0:09:28.095
and hospitals and physician offices.

0:09:28.095,0:09:32.889
In fact, that's only 10% of what[br]determines a community's health.

0:09:32.889,0:09:37.340
The other 90% is behavioral[br]and social factors.

0:09:37.340,0:09:40.611
And what do I mean[br]by social determinants of health?

0:09:40.611,0:09:43.778
I mean factors like[br]socioeconomic status,

0:09:43.778,0:09:45.394
education opportunities,

0:09:45.394,0:09:47.462
occupation and job security,

0:09:47.462,0:09:49.991
housing, safe neighborhoods,

0:09:49.991,0:09:51.636
social status

0:09:51.636,0:09:54.224
and one that is particularly[br]important to me:

0:09:54.224,0:09:57.833
the feeling that you have[br]a place in society,

0:09:57.833,0:10:00.896
the feeling that you have[br]a social support system,

0:10:00.896,0:10:03.266
the feeling that you are valued.

0:10:03.266,0:10:08.123
And we know that those[br]who feel unvalued have poor health.

0:10:08.477,0:10:11.102
So, I saw kids,[br]when I was in foster care,

0:10:11.102,0:10:13.370
with no chance for an education,

0:10:13.370,0:10:17.635
and I now know that, if they didn't[br]get a high school diploma,

0:10:17.635,0:10:21.104
they were more than five times[br]as likely to have poor health,

0:10:21.104,0:10:23.936
compared to me,[br]getting a college education.

0:10:23.936,0:10:27.648
And I saw kids who had experienced[br]nothing but poverty,

0:10:27.648,0:10:31.265
and I now know that they're eight times[br]as likely to be in poor health

0:10:31.265,0:10:34.393
as their more fortunate counterparts.

0:10:35.746,0:10:39.001
My experiences[br]have shown me the link

0:10:40.040,0:10:43.297
between these social[br]determinants of health

0:10:44.865,0:10:48.721
and status of health in a community[br]and in a person.

0:10:48.721,0:10:50.834
And so these realities demand

0:10:50.834,0:10:53.526
that we address the social[br]determinants of health.

0:10:53.526,0:10:55.020
And here's the message:

0:10:55.020,0:10:58.386
health cannot be the sole[br]responsibility of physicians.

0:10:58.386,0:11:01.094
We must all come together[br]in new partnerships —

0:11:01.094,0:11:02.794
government and community groups,

0:11:02.794,0:11:04.722
academia and business —

0:11:04.722,0:11:07.553
to ensure that everyone[br]has access to education,

0:11:07.553,0:11:10.575
to job opportunities,[br]to safe neighborhoods.

0:11:10.575,0:11:13.635
So, you don't need to go[br]to medical school to improve health.

0:11:13.635,0:11:15.556
You need to care.

0:11:15.556,0:11:18.611
And health must not be limited[br]to a single domain.

0:11:18.611,0:11:22.615
We need to talk about health[br]in all policies,

0:11:22.615,0:11:26.717
and understand that every[br]social policy in our country

0:11:26.717,0:11:29.847
should consider the impact on health.

0:11:29.847,0:11:34.456
Now, it's been said that we can't afford[br]for the healthcare system

0:11:34.456,0:11:37.727
to take care of all[br]these social problems.

0:11:37.849,0:11:42.760
Well, I'm here to tell you today —[br]We have the money to do this.

0:11:42.760,0:11:44.991
We're just spending it[br]on the wrong things.

0:11:44.991,0:11:46.814
So, if you look at this chart,

0:11:46.814,0:11:51.200
you will see the United States[br]right here in red, in the middle.

0:11:51.200,0:11:54.422
We spend a lot more[br]on traditional healthcare,

0:11:54.422,0:11:57.012
but a lot less on social services.

0:11:57.012,0:12:01.617
Add those poverty reduction programs[br]together with healthcare

0:12:01.617,0:12:03.609
and we're right in the middle.

0:12:03.609,0:12:07.061
We're just spending money[br]on the wrong things.

0:12:07.061,0:12:09.885
We need to reduce poverty,

0:12:09.885,0:12:12.161
we need to give[br]education opportunities,

0:12:12.161,0:12:14.533
we need to create job opportunities,[br]

0:12:14.533,0:12:17.260
because if we do,[br]people will be healthier

0:12:17.260,0:12:21.152
and we won't have these huge[br]expenses in medical care.

0:12:21.644,0:12:25.540
My call to action today,[br]I believe, is urgent.

0:12:27.109,0:12:30.078
We all need to come together

0:12:30.078,0:12:32.393
to address the social[br]determinants of health,

0:12:32.393,0:12:35.197
to challenge the inequalities[br]and disparities

0:12:35.197,0:12:38.572
that are so deeply ingrained[br]in our country,

0:12:38.572,0:12:43.209
create social policies that[br]will ensure a better health for all.

0:12:45.090,0:12:47.612
As President Obama said,

0:12:48.827,0:12:51.027
"Every once in a while,

0:12:51.027,0:12:54.447
a moment comes where you'll have[br]a chance to vindicate

0:12:54.447,0:12:58.502
all those best hopes[br]that you had about yourself

0:12:58.502,0:13:01.462
and about your country..."

0:13:02.187,0:13:05.156
I would submit to you.

0:13:05.156,0:13:08.275
It's a challenge.[br]Look inside yourself.

0:13:08.280,0:13:10.601
Examine your life experiences.

0:13:10.601,0:13:13.495
Define your core values.

0:13:14.171,0:13:16.918
What are you going to do?

0:13:17.856,0:13:19.896
Ask yourself:

0:13:19.896,0:13:23.056
What country do you want to live in?

0:13:24.087,0:13:29.040
One in which social deprivation[br]defines your health status?

0:13:29.842,0:13:33.865
One in which the circumstances[br]into which you were born

0:13:33.865,0:13:37.371
determines your life expectancy?

0:13:37.786,0:13:41.769
Or do you want to live in a country[br]in which we all come together

0:13:41.769,0:13:44.591
to address the social determinants[br]of health?

0:13:44.591,0:13:47.197
A place in which we come together

0:13:47.197,0:13:50.933
to bring all our diverse perspectives[br]and experiences

0:13:50.933,0:13:54.324
to ensure a better health for all?

0:13:55.185,0:13:59.672
Our life experiences define[br]what we'll prioritize;

0:13:59.672,0:14:03.615
how we use the opportunities[br]that we've been given.

0:14:03.615,0:14:09.080
For me, my life experiences bring me[br]powerfully and inevitably

0:14:09.269,0:14:11.652
to helping the vulnerable,

0:14:11.652,0:14:15.266
to ensuring social justice[br]in our society,

0:14:15.835,0:14:19.901
to taking care of those who have been[br]forgotten by society.

0:14:19.901,0:14:21.654
So, I ask you:

0:14:21.654,0:14:25.515
How will we treat[br]our most vulnerable?

0:14:26.176,0:14:29.621
Will we have the political will[br]to address poverty,

0:14:29.621,0:14:33.471
to develop national policies[br]that address education,

0:14:33.471,0:14:35.916
job opportunities,[br]neighborhood safety?

0:14:35.916,0:14:38.521
Will we have the courage

0:14:38.521,0:14:42.189
to change the way that we spend[br]our healthcare dollars

0:14:42.189,0:14:46.755
and use them to address[br]the social determinants of health?

0:14:47.344,0:14:49.326
And, most importantly:

0:14:50.172,0:14:52.437
Will you join me?

0:14:52.775,0:14:55.252
Will you lead this change?

0:14:55.252,0:14:57.409
Because now is the time.

0:14:57.409,0:14:58.856
Thank you very much.

0:14:58.856,0:15:01.520
(Applause)