How We Are Building a Culture of Health in America

These remarks were originally delivered on July 13, 2015 at at the 2015 health luncheon at the 106th NAACP National Convention in Philadelphia, PA. 

Good afternoon.

And thank you, Da’Quan for that wonderful introduction.

Before I begin my talk today, would you all join me in a moment of silence to honor the lives and memory of those we lost in Charleston last month, and to show our profound connection to, and humble appreciation for, the amazing grace that their families have demonstrated.

Let me start by saying how honored I am to be here. Ever since I was a little girl growing up in Seattle, I knew that when you really needed to bring people together to tackle a serious issue, you could rely on the folks at two places to get it done – church, and the NAACP.

No matter how intractable the problem might have seemed, the NAACP was able to combine skill with will to wrestle it down and deal with it straight on. And that’s the reason I’m here today. Because I know that you share my conviction that everyone in America should have the opportunity, and the means, to live the healthiest life they can.

And if we work together, we can make that happen.

Harriet Tubman once said that we all have ‘the patience and the passion to reach for the stars to change the world.” And the star I’d like us to reach for is a nationwide Culture of Health.

Now, what does that mean, exactly?

Well, the phrase “Culture of Health” can mean different things to different people. But in general, it means recognizing that health is an essential part of everything we do and that every person deserves the chance to achieve well-being.

No matter who they are. No matter where they live. No matter how much money they have. Or what physical or psychological challenges they happen to face.

In a Culture of Health, our children’s well-being is a matter of fact and not a matter of chance. Doctors, and other care providers, work as partners with their patients, getting involved in their care both inside and outside the clinic.

And compassion is considered part of the cure.

Industry leaders know that good health boosts the bottom line. And they do their part to keep their employees – and their communities - vital and productive. In a Culture of Health every one of us has an equal opportunity to pursue a fulfilling, productive life - for ourselves and for our loved ones.

Oh, I know it’s a big star to aim for. But think for a moment about how out-of-reach Harriet Tubman’s goals must have seemed at the time. When you embrace that thought, you know that building a Culture of Health that includes everyone in America is something that we can, and will, achieve.

And when we do, we’ll have a powerful story to tell.

It will be a story about how we didn’t just shake our heads in dismay at the fact that - after years of being remarkably low - the suicide rate among black children has nearly doubled over the past two decades. It will be a story about how we overcame the unacceptable fact that when compared to their white counterparts, black men in our nation are 30 percent more likely to die of heart disease, 60 percent more likely to die of stroke, and 200 percent more likely to die from diabetes or prostate cancer.

And it will be a story about how we rejected as inevitable that African American kids – more than one-third of whom are overweight or obese today – have a real chance of becoming the first generation to live sicker and die younger than their parents’ generation.

Now, I’m calling this vision a Culture of Health. But you might see it more as a Culture of Care, a Culture of Well-Being, or a Culture of Empathy and Equity. The truth is it’s all of those things knit together, because health is so much more than simply not being sick. It’s a vital aspect of how we live, work, play, and pray. It’s about how we raise and educate our children. And how we make decisions for our families.

A Culture of Health respects the rich diversity of our communities, the long, strong legacy of our different histories, and the importance of our family and ethnic traditions. And it accepts – and respects – that maintaining well-being can mean something very different to those of us who are living with chronic conditions – be they physical or mental.

Now, I know that I don’t need to remind this group about the transformative power of having a dream. But Dr. King also taught us that “change does not roll in on the wheels of inevitability.” So, if we want the health of our nation - and our people - to change, we have to work together to make it happen. And let’s be honest, right now the health of all Americans, and the state of our entire health care system is not exactly a badge of pride.

Heart disease, cancer, and stroke still account for more than 50 percent of all deaths in America each year - regardless of income or ethnicity. Every day there are tens of thousands of hospitalizations – and re-hospitalizations – that don’t need to happen. And the quality, the cost, and the patient experience under our current system is far too often disparate, disorganized, and dismissive.

Also, as you’ll see in this short video link which is part of a longer film made by the Ounce of Prevention Fund - too many of our youngest children continue to be exposed to forms of toxic stress - like extreme poverty, family violence, and substance abuse.

Toxic stress like this can severely compromise children’s chances to succeed in life, and even lead to early death.

This is sobering stuff. I know. And we will not achieve a Culture of Health if we continue down this path.

But the good news is that, as a nation, we are facing up to the fact that we’ve been heading the wrong way. And we have started looking for new roads: ones that will broaden our concept of health and lead us to better – and more integrated – ways of improving it.

Now, some organizations – like the NAACP - have long recognized that health is connected to social justice. One of this organization’s founders, W.E.B. Dubois, wrote about it more than a century ago. But for a while that critical tie he stressed seemed to get lost in the shuffle. Yet, in recent days I’ve noticed – and I’m sure you have too – that more and more people are starting to make the connection once again.

And that groundswell reminds me of a passage from Hemingway’s classic book, “The Sun Also Rises.” There’s a spot in the novel where the character named Mike explains how a major change in his life happened: He says it came about “gradually and then suddenly.” And that’s exactly what I’m seeing. Gradually and suddenly people are getting more serious about making our nation a healthier place for everyone.

I’m hearing them ask what they can do to make it happen in their homes, in their neighborhoods, in their towns, in their schools. Are you hearing it, too?

Not too long ago, I heard Jose Gomez Marquez from MIT talk about innovation. He told a story about how he showed a picture of a blind person to a group of students and asked them: Can this person drive a car? And, of course, the students began to debate whether it was possible or not.

Then, the professor showed the same picture to different group of students and asked: How can this person drive a car?

And - you guessed it - the students instantly started coming up with ways to make it work.

I’ve thought about this a lot. And it’s made me change the way I talk about building a Culture of Health. I’ve stopped asking if it’s possible. And I’ve started talking about how we can do it.

How can you and I do it?

How can urban and rural communities do it?

How can industry, and architects, and educators, and neighborhood leaders do it?

How can we all work together to make getting healthier a national movement?

Well, one way is to help people understand just how many things influence health. Things they may have never thought were directly linked with health. Like poverty and violence. Education and economic opportunity. Affordable housing. Safe streets. And supportive social networks – real connections to real people. I call that moment of recognition having a light bulb moment.

Let me tell you when that light bulb moment first happened to me. I trained as a physician at Harvard and rotated through a hospital in West Roxbury, a few miles away. That is where I met a patient that I will forever remember as “Patient Ruth.”

She appeared at the admitting station late on a cold winter night, homeless and helpless. Her feet were swollen. She wore a pair of flimsy house shoes. Raw leg ulcers made walking painful. Her medical chart was thick. She'd been to the hospital many times before.

We did what we always did- gave her a few hours in a warm bed, some antibiotics, a decent meal. But the next morning she had to go because according to the “rules” our job was done.

So she limped out the door, straight back into the dark tunnel of problems she faced every day: No home. No job. Lousy food, and no family or friends to turn to for help. Our care ended at the front door of the hospital, and that is so short-sighted.

What if instead of ushering her back into the cold, we could have asked what she needed to keep from having to come back? And then what if we linked her to those people or services?

That was my light bulb moment. And believe me, once that light turns on, you can't help but see that health is influenced by every aspect of how and where we live. In fact, where you live can affect your health so much that your zip code at birth may be as important as your genetic code in predicting how well, and how long, you live.

Take a look at this Washington, D.C. metro map.

See the red line? Babies born and raised out there in affluent Montgomery County, can expect to live to be 84 years old. But if you happen to be born and raised just a few subway stops way, in downtown D.C., - where in some neighborhoods the unemployment rate is 16 percent, and 27 percent of children are living in poverty - your life is probably going to be shorter. Up to seven years shorter.

In New Orleans, it's even worse.

A person living up there in Lakewood can expect to live 25 years longer than someone over there, in Iberville, which is only about six miles away. The difference between these communities is that Iberville has an unemployment rate that is more than three times higher than Lakeview, a high school graduation rate that is 18 percent lower, and a crime rate that is 60 percent higher.

And here in Philly, the disparities are just as stark. I live nearby, in an area called Washington Square, and just the other day I was out for a walk thinking how dramatically the health factors differ in the neighborhoods just a couple of miles to the north, a couple of miles to the west, and over the Ben Franklin bridge in Camden.

Needless to say, in a nation that prides itself as being a land of opportunity, health disparities as pronounced as these are not acceptable.

So, what would a robust Culture of Health look like? Well, just imagine if every family, in every town, had easy and equal access to the basic building blocks of well-being, if doctors openly shared their medical notes with their patients, and honestly discussed the price and value of treatments in a way that helped them get well and saved money.

Picture what it would be like if all of us lived in cities, towns, and neighborhoods built to encourage health. And our communities were places that not only provided our children with the promise of upward mobility, but also showed them a pathway to achieve it.

Imagine safe, economically-mixed neighborhoods with lots of inviting, open spaces where we could meet up with friends, plant a community garden, or just enjoy the sunshine.

A Culture of Health is all those things. The big question is how are we going to get there?

Well, every journey begins with a few small steps. And one way each of us can start is by making the automatic things we do every day a little healthier.

As I’m sure you know, studies show that sitting 8-10 hours a day is associated with bad things: diabetes, heart disease, and a shorter life. But what you may not know, is that if you walk for just two minutes after sitting for an hour, you can combat some of those negative effects.

So the next time you’re out sitting in your car doing errands, why not park in one of those empty spaces on the other side of the parking lot, instead of fighting for that space right in front of the door? When you’re sitting on the bus why not hop off one stop earlier?

And how many of you have ever stood around waiting for an elevator that is as slow as molasses, thinking - “I could have been there by now if I’d climbed the stairs?” Do it. Climb the stairs!

What if towns and cities started making their communities places where both the young and old can live safely, stay active, and get the care they need? What if all of our employers, our mayors and our educators worked side-by-side to provide us with the tools, and the information we need to make smart, responsible choices?

These are the kinds of things that I think about when I ask myself how we can build a Culture of Health together.

Gradually and suddenly. That’s how we’re going to do it.

Let me introduce you to a few individuals and organizations that are already demonstrating how to do it.

This is the Rev. Michael Minor of Hernando, Mississippi. Not too long ago, he had the crazy idea that he would ban fried chicken from church suppers, because he was tired of conducting funerals for people dying from avoidable diseases. Well, you can just imagine how well that idea went over at first.

But Pastor Minor was committed to leading his flock down a new path. And today, not only do his church suppers feature healthy pot-lucks, but there's also a walking track around the building, and a blood pressure monitor in the lobby. And what's more, members of his congregation have become “health ambassadors” spreading the news of good health to others in the region. And Rev. Minor has created a curriculum to help other churches start health and wellness ministries. And it has been adopted by the American Heart Association.

The important thing to remember about the good pastor is that he didn’t set out to build a national Culture of Health. But that’s exactly what he’s doing. It’s what CVS did last year as well when it made the decision to follow Target’s lead and stop selling cigarettes and other tobacco products.

And it’s what the American Academy of Pediatrics did when it officially recommended that doctors should advise parents to read books like Cat in The Hat and Harold and the Purple Crayon or any other story to their kids on a daily basis.

Gradually and suddenly.

Nobody knows better than the NAACP that that’s how a social movement is built…One –intentional –action –at –a- time. And nobody knows better than you that action is the only thing that is going to make a Culture of Health happen.

Not me standing up here talking about it.

But all of us, working hand-in-hand, cranking up the volume on a nationwide push for change.

We need to move health to the top of the list of American values. We need to work across sectors and cultivate communities that make healthy choices possible for everyone.

We need to: make physical activity part of every child’s everyday experience, make healthy foods affordable and available, in all neighborhoods, and we need to eliminate—and I do mean eliminate—sugar-sweetened beverages before the age of 5 – so every child in American can grow up at a healthy weight. No matter who they are, or where they live.

And while we can – and certainly should – applaud the Supreme Court’s decision about the Affordable Care Act. We also need to ensure that everyone who is eligible for health care coverage knows how to get it. And how to make the most of their benefits.

And, we need to find a way to get everyone to understand that we will never be a healthy nation if we continue to be a violent one.

What happened in Charleston is a tragedy that will forever change the families of those who were struck down, will forever affect the community, and will forever be remembered in American history as yet another act of pointless violence that has wounded our nation’s reach for unity.

This has been a year of such sorrow and pain and the dissention and unrest we’ve seen in our cities has been fueled by decades of frustration and inequity.

Violence. Insecurity. Despair.

These are all health issues because nearly one in every five Americans lives in neighborhoods with limited job opportunities, low-quality housing, pollution, and unhealthy food options.

And while I think we can all agree that people are, indeed, responsible for the personal choices they make. We must also make it abundantly clear that the choices that you, or I, or anybody makes depends on the choices we have.

Our society will not achieve a true Culture of Health as long as some of us continue to face far greater barriers to health, safety, and opportunity.

Now, I know these aren’t easy issues to address. But as I said when I began – I’m turning to you because you are leaders who know how to get difficult things done. And the time has come for us to make a seismic shift in the way that we deal with health.

We need to change our expectations as a nation. And recalibrate our behavior as individuals. We need to build focused and forceful partnerships. And bring everyone under the tent.

This is a video about a program in Northern California - called the Emergency Medical Services Corps – that is really doing something special.

Gradually and suddenly, that’s how we are going to build a Culture of Health for all.

Now, when you set a goal it’s important to know how you’re going to achieve it. Right? What indicators are going to determine if we really are moving toward a Culture of Health? They have to be mileposts that reflect the social, economic, physical, and environmental factors that we’ve been talking about. And they have to show whether our efforts really are building healthier, more equitable communities.

I’m talking about indicators that gauge things like the affordability of housing, and the diversity of neighborhoods, the prevalence of community-oriented policing, and the percentage of young people who say they feel safe in their communities.

Now, let me say right here that it comes as no surprise to me that the NAACP is already making inroads in several of these areas. I’m thinking about your work focused on reforming our criminal justice system and how you’ve decided to make HIV-AIDS a social justice issue, encouraging the church to lead the way in changing how we interact with the men, women, and children dealing with the disease.

All of this speaks to the mighty power of your ongoing passion and persistence. And how important it is that all of us to stick to these commitments until we see success.

At RWJF, we’ve created a national prize to honor communities that have placed a priority on the health of their citizens. These are the winners from 2014.

We’ll be announcing this year’s winners in October. In each of these places ordinary citizens have driven change by forming partnerships with business, civic organizations, universities, and government. And together, they've worked as a united front.

Now, I'm talking about places that are very different economically, and geographically. Let me show you a short video about what one of these inspiring communities is doing to build a home grown Culture of Health.

That’s what happens when you stop asking if we can build a Culture of Health, and start asking how we are going to help each other do it.

It’s going to take the innovation and input of many. And that means you and me.

So this is what I’m going to ask of you today:

Let’s work together to spotlight and support initiatives – like the one in Durham– that gives everyone a role to play in improving their own health and the health of their loved ones.

Let’s share what works with others so that no one in America will ever feel as if better health is beyond their reach.

Let’s demand equal opportunity for well-being for everyone

And let’s heed the call of Dr. King and recognize the “fierce urgency of now” so we can give our children, and our children’s children, the gift of health that they so richly deserve.

Thank you, and God bless.