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I'm here to recruit you.

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I'm here to get you to join me
in creating a healthier world.

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But I'm also here to convince
you that we can't do that

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within the traditional
healthcare paradigm.

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We have to think in a new way.

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We need to come together 


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to address the underlying social
determinants of health.

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So, if you will, close your eyes
for a second,

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and imagine something with me.

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It's midnight.

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A fourteen-year-old girl
walks down the street.

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She's tired, she's hungry,
she's shaking.

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She's really scared.

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Where will she sleep tonight?
How will she survive?

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She's just fourteen and alone.

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And, yet, she knows that
this was the right choice,

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because staying at home was scarier.

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Had she stayed
where the abuse was,

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she wouldn't have made it. 


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She wouldn't have survived.

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And at least here she has a chance.

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So, she walks on, with one destination,

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one goal in mind:

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survival.

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So, open your eyes.

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And, yes. That fourteen-year-old
girl was me.

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And I have made my way
from those streets

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to standing in front of you today,

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and I learned a lot on those streets.

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And that's why I care about the underlying
social determinants of health.

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I made my way from those streets
to a local teen counseling center,

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and I made my way into
the foster care system.

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Now, my first placement
was an emergency placement.

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And, when I was there,
the people were – they were kind,

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but I didn't trust them.

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And so, I just couldn't
let them help me.

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And, just as I was starting to trust,

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I was reassigned to another home.

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My next placement was with
an African American family.

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And they were great. 


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They were generous,
they were kind,

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and maybe they didn't
quite know what to do

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with this blonde,
blue-eyed white girl.

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But I always felt like an interloper.

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And then, one day,
I was doing the family laundry,

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and I accidentally threw
a red T-shirt in with the whites.

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And I was petrified.

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What kind of punishment
would there be?

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What kind of retribution
would be exacted?

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And, instead, they said,
"Don't worry! It's Ok."

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And, suddenly, we were united
by a common color:

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pink.
(Laughter)

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And my final foster placement
was with a couple

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who became foster parents just
to give me a home.

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And they made me feel
safe and trusting.

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They gave me confidence
in my abilities and myself.

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Being a foster child taught me a lot.

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It taught me how life traumas
have long lasting impacts.

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It taught me about race, and equality,
and social justice,

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and it taught me that
reaching out in kindness

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can literally save a life.

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Having experienced great cruelty,

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I knew what it was like
to feel unvalued.

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And having experienced great kindness,

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I know the importance of caring
for the most vulnerable.

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But, you know what –

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In a lot of ways, I was lucky.

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I was white, I was educated,

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I got placed in good foster homes,

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and, when I was there, I saw a lot
of kids that weren't that lucky.

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And I saw them lose hope,

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and I saw what it did to their health.

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So, I embraced this life perspective.

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As Franklin Delano Roosevelt said,

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"The test of our progress
is not whether we add more

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to the abundance
of those who have much.

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It is weather we provide enough
for those who have too little."

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And that's what addressing the social
determinants of health is about.

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With those lessons,
I went on to medical school.

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I trained as an infectious
disease physician,

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and I finished just as the HIV/AIDS
epidemic was unfolding.

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And in that clinic,
that HIV clinic that I started,

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I saw veterans — it was at the V.A.
— coming in,

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young veterans coming in,
looking like old men.

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Their bodies falling apart,
catastrophically,

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from this devastating fatal illness,

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because, remember, back then,
there were no treatments.

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And I saw them lose their jobs, 


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and their homes, and their friends,

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as they lost their health.

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And the worst sadness —

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was I watched them
be rejected by their families

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as they were dying,
just because they were gay.

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And what do you think
that did to their health?

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And through fighting for
and supporting those brave men

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against all those unfair judgements
and the abandonment,

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that's where I found my inspiration.

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By caring for others who experienced
cruelty and adversity,

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I was given the opportunity
to repay the kindness

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that had been shown to me.

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Those patients taught me
powerful lessons:

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lessons of acceptance,
and courage, and love.

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And they taught me what
a physician can be

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and what Medicine must be.

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But today, tragically,
Medicine is failing in our country.

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The fact is that the system
that I work in, here in the US,

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spends more than twice the amount
of healthcare dollars per capita

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compared to any other
developed country,

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and we have worse health outcomes.

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We spend 18% of our GDP

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and we have dismal health
status in this country.

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The fact is, in this country
we don't even...

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too many don't even have access
to this failing system.

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We've got 51 million uninsured
and many more underinsured,

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and this lack of coverage
translates directly

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into worse health outcomes.

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You know, I was one of those uninsured,
when I was a teenager,

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and I didn't have a doctor,

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and the only place I could go
when I got sick

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was the local emergency room,

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and that's not the right place
for a teenager to get help.

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And the fact is that
our healthcare system today

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is characterized
by unconscionable disparities:

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disparities in health on the basis
of race and ethnicity,

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geography, orientation
and socioeconomic status.

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It's shameful.

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And I know.
Look at these numbers.

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Blacks on average live
about 4 to 7 years fewer than whites.

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And I know, because I heard those
stories of "why",

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from the African American
HIV patients

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I took care of in that HIV clinic.

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And it's because of the social
determinants of health.

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Martin Luther King said,
"Of all the forms of inequality,

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injustice in healthcare
is the most shocking and inhumane."

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And my message today

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is a call to action for each one of you.

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Remember I was going to recruit you

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in the health professions,
but here's the important point:

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far beyond!

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Because you have a way
to correct this injustice.

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I submit to you that one reason
we spend so much on health

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and see so little in return

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is that we're spending
money on the wrong things!

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We have a system of "sick care",
not healthcare.

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We treat patients after they get sick,

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but we don't provide the services
and opportunities they need

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to keep them from ever becoming
patients in the first place.

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We need a new paradigm!

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One that's reactive.

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I mean, proactive! Not reactive.

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One that is primary-care-based,
not acute-intervention-based.

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One that coordinates care,
rather than fragments care.

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One that is population
and community-based,

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rather than hospital
and physician-based.

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And we, most importantly,

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need to move from the traditional
medical model

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to a model that embraces the social
determinants of health.

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And we now understand
that the health of a population

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is predominantly determined
by factors other than clinical care,

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and hospitals and physician offices.

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In fact, that's only 10% of what
determines a community's health.

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The other 90% is behavioral
and social factors.

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And what do I mean
by social determinants of health?

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I mean factors like
socioeconomic status,

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education opportunities,

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occupation and job security,

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housing, safe neighborhoods,

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social status

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and one that is particularly
important to me:

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the feeling that you have
a place in society,

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the feeling that you have
a social support system,

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the feeling that you are valued.

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And we know that those
who feel unvalued have poor health.

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So, I saw kids,
when I was in foster care,

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with no chance for an education,

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and I now know that, if they didn't
get a high school diploma,

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they were more than five times
as likely to have poor health,

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compared to me,
getting a college education.

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And I saw kids who had experienced
nothing but poverty,

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and I now know that they're eight times
as likely to be in poor health

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as their more fortunate counterparts.

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My experiences
have shown me the link

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between these social
determinants of health

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and status of health in a community
and in a person.

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And so these realities demand

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that we address the social
determinants of health.

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And here's the message:

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health cannot be the sole
responsibility of physicians.

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We must all come together
in new partnerships —

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government and community groups,

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academia and business —

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to ensure that everyone
has access to education,

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to job opportunities,
to safe neighborhoods.

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So, you don't need to go
to medical school to improve health.

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You need to care.

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And health must not be limited
to a single domain.

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We need to talk about health
in all policies,

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and understand that every
social policy in our country

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should consider the impact on health.

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Now, it's been said that we can't afford
for the healthcare system

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to take care of all
these social problems.

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Well, I'm here to tell you today —
We have the money to do this.

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We're just spending it
on the wrong things.

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So, if you look at this chart,

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you will see the United States
right here in red, in the middle.

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We spend a lot more
on traditional healthcare,

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but a lot less on social services.

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Add those poverty reduction programs
together with healthcare

209
00:12:01,617 --> 00:12:03,609
and we're right in the middle.

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We're just spending money
on the wrong things.

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We need to reduce poverty,

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we need to give
education opportunities,

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we need to create job opportunities,


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because if we do,
people will be healthier

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and we won't have these huge
expenses in medical care.

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My call to action today,
I believe, is urgent.

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We all need to come together

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to address the social
determinants of health,

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to challenge the inequalities
and disparities

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that are so deeply ingrained
in our country,

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create social policies that
will ensure a better health for all.

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As President Obama said,

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"Every once in a while,

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a moment comes where you'll have
a chance to vindicate

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all those best hopes
that you had about yourself

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and about your country..."

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I would submit to you.

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It's a challenge.
Look inside yourself.

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Examine your life experiences.

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Define your core values.

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What are you going to do?

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Ask yourself:

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What country do you want to live in?

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One in which social deprivation
defines your health status?

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One in which the circumstances
into which you were born

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determines your life expectancy?

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Or do you want to live in a country
in which we all come together

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to address the social determinants
of health?

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A place in which we come together

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to bring all our diverse perspectives
and experiences

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to ensure a better health for all?

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Our life experiences define
what we'll prioritize;

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how we use the opportunities
that we've been given.

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00:14:03,615 --> 00:14:09,080
For me, my life experiences bring me
powerfully and inevitably

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00:14:09,269 --> 00:14:11,652
to helping the vulnerable,

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00:14:11,652 --> 00:14:15,266
to ensuring social justice
in our society,

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to taking care of those who have been
forgotten by society.

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So, I ask you:

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How will we treat
our most vulnerable?

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Will we have the political will
to address poverty,

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to develop national policies
that address education,

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job opportunities,
neighborhood safety?

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Will we have the courage

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to change the way that we spend
our healthcare dollars

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and use them to address
the social determinants of health?

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And, most importantly:

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Will you join me?

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Will you lead this change?

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Because now is the time.

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Thank you very much.

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(Applause)