so it was one of those great Saturday
mornings you gonna sleep in you have no
commitments the rest of the day young
man was on the way to the kitchen to get
that second cup of coffee to drink in
bed
and as he’s walking back kind of looking
out asides he walks back in the bedroom
and his wife says hey come in the
bathroom a minute I want to show you
something and on the edge of the sink is
a pregnancy strip and it’s positive and
she screams for joy he screams for joy
and as you can imagine they sit down
with that second cup of coffee and they
talked about what just happened to their
lives everything from you know we’re
gonna have a boy we’re gonna have a girl
gonna have twins what would they be
what would their names be how does this
impact our lives how are we gonna do
this with our jobs when do we tell our
friends when do we tell our parents you
know all those kind of things you’d have
in life so Monday morning comes around
they call the obstetrician the
obstetrician works the men that week and
they show up for their first appointment
and it’s kind of that typical thing they
have to fill out 75 forms many of them
poorly copied and they have to fill all
this stuff out there assured back into
an exam room you know weights blood
pressure
labs are drawn and ultrasound is taking
all this information is put together and
they’re brought back to a room and a
clinical staff person comes in begins to
review all this information that’s in
front of them and starts to talk to them
and chatting about you know what to
expect and as the person is looking at
the information suddenly goes quiet and
says the doctor will be with you shortly
so the couple will get each other kind
of concerned rightfully so and they knew
something was up so a few minutes go by
seemed a lot longer
that the obstetrician comes into the
room and begins you know do some
introductions some nice pleasantries and
then she pulls up the chair next to them
and says you know I’ve been looking at
your numbers and I’m very concerned
about your diagnosis and the couple
again very concerned they look at one
another and they go well doctor what is
it and the doctor says well you are of
four three six oh four that’s your
diagnosis and that’s extremely concerned
and they look at each other again and
the woman says to the doctor well doctor
that’s our zip code and the doctor says
exactly so that may sound like a
fictitious story that is a fictitious a
fictitious story but in America if you
live in New Orleans depending on what
zip code you live in and this could be
literally blocks away the expectancy
life expectancy difference in New
Orleans is 25 years 25 years depending
on where you live in New Orleans in
Chicago in Baltimore in Las Vegas it’s
around 15 years literally the zip code
that you were born in has a huge impact
in Washington DC it’s about ten years
and what’s interesting about that story
that is the American healthcare story
and we have a real problem with a
healthcare in America so health care has
evolved over the last 75 years and we’d
like to criticize healthcare and point
fingers at it and we should we’d be the
first to admit that but it’s a health
care system that we as a country we’ve
talked a lot about country this morning
that we created we created it over the
last 75 years and probably the last 15
presidents have said the number one
problem is out of control health care
costs and nothing is in place today to
change that in soever problem it started
back 70 some years ago when after World
War 2 people coming back from the war we
had all these advances you know it’s
interesting to know how many things
happen offworld events so we had all
these medical advances during World War
two
people came back with all this medical
knowledge and the government decided
let’s put all these veterans back to
work so what did we do
we built 4,000 the equivalent of 4050
bed hospitals across the United States
with Hil Burton dollars and then we did
some really nice things along the way we
passed Medicare and Medicaid to take
care of people but we perhaps didn’t
think of some of the consequences so in
the early days if you took care of half
of your patients were Medicare patients
they paid 50% of their bill so if you
built buildings guess what the
government paid half the costs if you
were a physician and you were doing lots
of things guess what you got paid more
if you get paid to do things you do
things so we had this great system set
up where you literally you could send
the bill off to the government and build
massive facilities you could generate
work after work after work and be paid
for it
and so we created a system that over the
last few years has gotten progressively
worse and so we sit here today
with the system that costs us over three
trillion dollars 17% 17.8 percent of our
gross domestic product
it is on its way to 20 percent a lot of
that having to do with demographic
changes and the aging of America yeah so
it’s going to be five trillion dollars
and 20% of the GDP and I think most
people would tell you nothing will
change that nothing at all and we know
the results you know the number one
cause of personal bankruptcy in United
States is health care number one cause
of seniors now causing bankruptcy and
the number of 85 year-olds filing
bankruptcy is an all-time high why
because they’re living longer they
retired too early and health care costs
are eating up all of their extra money
people are making decisions left and
right about things to pay can’t
affording health care can’t you’re
making choices about food or utilities
or feeding their pets or other things in
life and having to do you know and
having to think about health care so we
have this problem so it’s one thing if
you’re you know got your value but when
we compare America to the other
developed countries our model doesn’t
really work the third leading cause of
death in America is a hospital space
that’s a problem when you look at some
of the the graphics up there we already
talked about life expectancy we talked
about costs when we compare how we do
against other countries even though we
pay so much more we get a lot less and
on every health metric European
countries do much better now some of
that there’s some nuances for that we
kill a lot more people with guns we have
a lot more traffic accidents so some of
those statistics are there but really
what’s happened is we’ve created a
healthcare system that is really really
not changing nor do I see any path that
it’s going to change again if you talk
to legislators many times you have this
discussion they go yeah we kind of know
and maybe when we hit a wall we’ll fix
it well I think we hit a wall a long
time ago what’s interesting about the
evolution of healthcare and think about
it from your own perspective so you come
into an office you have a procedure and
you are prescribed two treatments a
surgery drugs that can be incredibly
expensive and yet in healthcare we never
ask you you know do you have food on
your table can you actually afford this
procedure do you you know have a job you
know are you a victim of domestic
violence and really what’s happening
there’s a movement in United States to
really begin to talk more about the
social determinants of health so when
you look at your health as an individual
it is largely determined by where you
grow up your zip code
many people call it your zna it is more
important than genetics and it’s more
important than anything else we do in
health care and really those
determinants of life are really have a
profound impact
so in Ohio for example we are thirty
eighth for infant mortality for
Caucasian babies thirty-eight babies
dying in the first year of life forty
ninth there’s only one state worse for
african-american babies dying in the
first year of life yet we have some of
the best children’s hospitals in the
United States some of the best health
care in the United States and we spend a
lot of money in the state of Ohio and
it’s just a great proxy for what happens
United States so why is that why would
we be 49th for infant mortality for
african-american babies and it’s the
social determinants of health these
social issues that impact people more
than ever before so when you look at the
statistics again you see 20% of your
health is related to healthcare and
again three trillion dollars on the way
to five trillion for that piece and all
those other issues including the social
determinants of health are critically
more important to your health and
well-being
and I think that makes sense to you
hopefully you don’t hang out in doctors
offices you don’t hang out in emergency
rooms and really it’s all those other
things than life and yet in health care
we didn’t train people to ask those
questions we didn’t train management
people to think about those things and
all we thought about was as long as we
take care of you inside of our walls we
have done our done our job what happens
after you leave if you live in a box if
you don’t have food if you’re a victim
of domestic violence if you you don’t
have transportation problems if all
these are the problems in life happen
hey that’s not our problem in fact we
don’t even ask you about it and so
really if you think about how our system
evolved clinically it really isn’t very
logical and it doesn’t make any sense
now it’s interesting in the European
countries they spend many of the
developed countries spend the same
amount of money that we do but they
spend about half what we do on
Oh care and they spend the other money
on the social determinants of health so
you know the idea and this is not a
popular idea in health care don’t get me
wrong it’s to flip the model is to take
the money that we put into medical care
today and put it into the social
determinants of health now there is a
massive industry in America that’s built
around medical care hospitals health
systems physician groups Pharma drug
suppliers medical equipment and they are
powerful people and yet they are vital
big vital part a big part of our economy
so how do we begin to make that
transition over a period of time how do
we begin to ask organizations to stop
doing some of the clinical things we do
and begin to do some of the social
things and the good news is there’s
dialogues I’m going on today to talk
about those things actually there are
members of Congress talking about a
commission that would be appointed to
say a non-traditional Commission to say
let’s change our model let’s pick a date
and time or we’ll allow people to adjust
accordingly
and let’s change it to a much more
social based model because when we look
at all the factors of cost what we’re
getting for our dollars and really what
impacts people’s lives we have just a
lot of model to exist that really really
makes no sense so this is this idea and
this is what a few organizations are
looking at and a few people are doing I
will tell you it’s not necessarily a
popular notion if you ask people if they
do social determinants of health think
oh yeah yeah well we do that we support
the farmers market we put a banners in
our cafeteria and so but the real idea
here is to look at those 10 domains of
social determinants so today we are
screening for these 10 domains and not
everybody likes health care doing this
but really when you start to look at
these issues food insecurity in this
country a hunger as a healthy health
issue 13% of
solds are food insecure 19% of
households of what children are food
insecure 33% of single moms and children
are food insecure
that means they miss 100 meals a month
so first they miss a hundred meals and
secondly depending on how what kind of
income stream they have the food that
they may be buying they may only be able
to afford food that it’s not
particularly good so we did some work
with some education around obesity and
what we found was not that we had a
problem with education around nutrition
what we found is that kids were hungry
and we had this fundamental need to
think about hunger as a health issue so
go back to the expectant mother not
eating right a child not eating right
the development of a child malnourished
and think about what that does and yet
we spend three trillion dollars on
health care and we don’t provide the
basics of needs when it comes to food
security so again a lot of organizations
are beginning to screen for food
insecurity providing short-term food
needs providing food pharmacies and
beginning to start to address those
issues employment is a critical issue
the best thing you can do for an
individual get them off to a healthy
start you know provide education provide
a path to a job that allows them to fill
the things in life and again when we
look at health and well-being those
things are important so when you see
people begin to do these things in
health care and people say well what in
the heck why are you doing this stuff
and it’s because those social
determinants of health aren’t critically
important so when you see people invest
in economic development when you see
people doing things and hunger when you
see interest already we’ve talked about
pre-k and education and the importance
of having a solid education when you
think about changing neighborhoods if
you you know are interested there are a
lot of cities in America now where where
people are patting themselves on the
back saying look at this great city come
back whatever city you like just just
Google A Tale of Two Cities two
we know our tale of two cities Detroit
and what you’ll find out is that the
downtown’s are doing great and people
all excited but the neighborhoods the
health of the neighborhoods are either a
static or they continue to go down and
the reason for that is clear it is those
social determinants of life and those
are the things as we begin to look at
them we have to look at those
collectively and also individually Jim
Collins wrote a great book good to great
many of you have read good to great it’s
probably studied it in school on the way
he wrote a better book called good
degrade in the social sectors took him a
year to write good degrade took him
three years to write good degrade in the
social sectors and I think it’s 40 pages
and what he said and good to great in
the social sectors was I was wrong
didn’t say that that’s kind of what he
said said I was wrong
it’s not how much money you make it’s
how what kind of impact you make
relative to your resources so everybody
here has different resources
individually you work in organizations
that have different you know resources
we live in different communities at
different resources but if we all make
an impact relative to the resources that
we have and we all begin to think of our
work in life not business to business
but business to community or business to
society and we look at those goals which
people now are realizing is act actual
success or organizations and we look at
that as a community and we look at that
as trying to improve communities really
what we find in life is as YouTube says
where you live should not decide whether
you live or whether you die thank you
very much [Applause]
mornings you gonna sleep in you have no
commitments the rest of the day young
man was on the way to the kitchen to get
that second cup of coffee to drink in
bed
and as he’s walking back kind of looking
out asides he walks back in the bedroom
and his wife says hey come in the
bathroom a minute I want to show you
something and on the edge of the sink is
a pregnancy strip and it’s positive and
she screams for joy he screams for joy
and as you can imagine they sit down
with that second cup of coffee and they
talked about what just happened to their
lives everything from you know we’re
gonna have a boy we’re gonna have a girl
gonna have twins what would they be
what would their names be how does this
impact our lives how are we gonna do
this with our jobs when do we tell our
friends when do we tell our parents you
know all those kind of things you’d have
in life so Monday morning comes around
they call the obstetrician the
obstetrician works the men that week and
they show up for their first appointment
and it’s kind of that typical thing they
have to fill out 75 forms many of them
poorly copied and they have to fill all
this stuff out there assured back into
an exam room you know weights blood
pressure
labs are drawn and ultrasound is taking
all this information is put together and
they’re brought back to a room and a
clinical staff person comes in begins to
review all this information that’s in
front of them and starts to talk to them
and chatting about you know what to
expect and as the person is looking at
the information suddenly goes quiet and
says the doctor will be with you shortly
so the couple will get each other kind
of concerned rightfully so and they knew
something was up so a few minutes go by
seemed a lot longer
that the obstetrician comes into the
room and begins you know do some
introductions some nice pleasantries and
then she pulls up the chair next to them
and says you know I’ve been looking at
your numbers and I’m very concerned
about your diagnosis and the couple
again very concerned they look at one
another and they go well doctor what is
it and the doctor says well you are of
four three six oh four that’s your
diagnosis and that’s extremely concerned
and they look at each other again and
the woman says to the doctor well doctor
that’s our zip code and the doctor says
exactly so that may sound like a
fictitious story that is a fictitious a
fictitious story but in America if you
live in New Orleans depending on what
zip code you live in and this could be
literally blocks away the expectancy
life expectancy difference in New
Orleans is 25 years 25 years depending
on where you live in New Orleans in
Chicago in Baltimore in Las Vegas it’s
around 15 years literally the zip code
that you were born in has a huge impact
in Washington DC it’s about ten years
and what’s interesting about that story
that is the American healthcare story
and we have a real problem with a
healthcare in America so health care has
evolved over the last 75 years and we’d
like to criticize healthcare and point
fingers at it and we should we’d be the
first to admit that but it’s a health
care system that we as a country we’ve
talked a lot about country this morning
that we created we created it over the
last 75 years and probably the last 15
presidents have said the number one
problem is out of control health care
costs and nothing is in place today to
change that in soever problem it started
back 70 some years ago when after World
War 2 people coming back from the war we
had all these advances you know it’s
interesting to know how many things
happen offworld events so we had all
these medical advances during World War
two
people came back with all this medical
knowledge and the government decided
let’s put all these veterans back to
work so what did we do
we built 4,000 the equivalent of 4050
bed hospitals across the United States
with Hil Burton dollars and then we did
some really nice things along the way we
passed Medicare and Medicaid to take
care of people but we perhaps didn’t
think of some of the consequences so in
the early days if you took care of half
of your patients were Medicare patients
they paid 50% of their bill so if you
built buildings guess what the
government paid half the costs if you
were a physician and you were doing lots
of things guess what you got paid more
if you get paid to do things you do
things so we had this great system set
up where you literally you could send
the bill off to the government and build
massive facilities you could generate
work after work after work and be paid
for it
and so we created a system that over the
last few years has gotten progressively
worse and so we sit here today
with the system that costs us over three
trillion dollars 17% 17.8 percent of our
gross domestic product
it is on its way to 20 percent a lot of
that having to do with demographic
changes and the aging of America yeah so
it’s going to be five trillion dollars
and 20% of the GDP and I think most
people would tell you nothing will
change that nothing at all and we know
the results you know the number one
cause of personal bankruptcy in United
States is health care number one cause
of seniors now causing bankruptcy and
the number of 85 year-olds filing
bankruptcy is an all-time high why
because they’re living longer they
retired too early and health care costs
are eating up all of their extra money
people are making decisions left and
right about things to pay can’t
affording health care can’t you’re
making choices about food or utilities
or feeding their pets or other things in
life and having to do you know and
having to think about health care so we
have this problem so it’s one thing if
you’re you know got your value but when
we compare America to the other
developed countries our model doesn’t
really work the third leading cause of
death in America is a hospital space
that’s a problem when you look at some
of the the graphics up there we already
talked about life expectancy we talked
about costs when we compare how we do
against other countries even though we
pay so much more we get a lot less and
on every health metric European
countries do much better now some of
that there’s some nuances for that we
kill a lot more people with guns we have
a lot more traffic accidents so some of
those statistics are there but really
what’s happened is we’ve created a
healthcare system that is really really
not changing nor do I see any path that
it’s going to change again if you talk
to legislators many times you have this
discussion they go yeah we kind of know
and maybe when we hit a wall we’ll fix
it well I think we hit a wall a long
time ago what’s interesting about the
evolution of healthcare and think about
it from your own perspective so you come
into an office you have a procedure and
you are prescribed two treatments a
surgery drugs that can be incredibly
expensive and yet in healthcare we never
ask you you know do you have food on
your table can you actually afford this
procedure do you you know have a job you
know are you a victim of domestic
violence and really what’s happening
there’s a movement in United States to
really begin to talk more about the
social determinants of health so when
you look at your health as an individual
it is largely determined by where you
grow up your zip code
many people call it your zna it is more
important than genetics and it’s more
important than anything else we do in
health care and really those
determinants of life are really have a
profound impact
so in Ohio for example we are thirty
eighth for infant mortality for
Caucasian babies thirty-eight babies
dying in the first year of life forty
ninth there’s only one state worse for
african-american babies dying in the
first year of life yet we have some of
the best children’s hospitals in the
United States some of the best health
care in the United States and we spend a
lot of money in the state of Ohio and
it’s just a great proxy for what happens
United States so why is that why would
we be 49th for infant mortality for
african-american babies and it’s the
social determinants of health these
social issues that impact people more
than ever before so when you look at the
statistics again you see 20% of your
health is related to healthcare and
again three trillion dollars on the way
to five trillion for that piece and all
those other issues including the social
determinants of health are critically
more important to your health and
well-being
and I think that makes sense to you
hopefully you don’t hang out in doctors
offices you don’t hang out in emergency
rooms and really it’s all those other
things than life and yet in health care
we didn’t train people to ask those
questions we didn’t train management
people to think about those things and
all we thought about was as long as we
take care of you inside of our walls we
have done our done our job what happens
after you leave if you live in a box if
you don’t have food if you’re a victim
of domestic violence if you you don’t
have transportation problems if all
these are the problems in life happen
hey that’s not our problem in fact we
don’t even ask you about it and so
really if you think about how our system
evolved clinically it really isn’t very
logical and it doesn’t make any sense
now it’s interesting in the European
countries they spend many of the
developed countries spend the same
amount of money that we do but they
spend about half what we do on
Oh care and they spend the other money
on the social determinants of health so
you know the idea and this is not a
popular idea in health care don’t get me
wrong it’s to flip the model is to take
the money that we put into medical care
today and put it into the social
determinants of health now there is a
massive industry in America that’s built
around medical care hospitals health
systems physician groups Pharma drug
suppliers medical equipment and they are
powerful people and yet they are vital
big vital part a big part of our economy
so how do we begin to make that
transition over a period of time how do
we begin to ask organizations to stop
doing some of the clinical things we do
and begin to do some of the social
things and the good news is there’s
dialogues I’m going on today to talk
about those things actually there are
members of Congress talking about a
commission that would be appointed to
say a non-traditional Commission to say
let’s change our model let’s pick a date
and time or we’ll allow people to adjust
accordingly
and let’s change it to a much more
social based model because when we look
at all the factors of cost what we’re
getting for our dollars and really what
impacts people’s lives we have just a
lot of model to exist that really really
makes no sense so this is this idea and
this is what a few organizations are
looking at and a few people are doing I
will tell you it’s not necessarily a
popular notion if you ask people if they
do social determinants of health think
oh yeah yeah well we do that we support
the farmers market we put a banners in
our cafeteria and so but the real idea
here is to look at those 10 domains of
social determinants so today we are
screening for these 10 domains and not
everybody likes health care doing this
but really when you start to look at
these issues food insecurity in this
country a hunger as a healthy health
issue 13% of
solds are food insecure 19% of
households of what children are food
insecure 33% of single moms and children
are food insecure
that means they miss 100 meals a month
so first they miss a hundred meals and
secondly depending on how what kind of
income stream they have the food that
they may be buying they may only be able
to afford food that it’s not
particularly good so we did some work
with some education around obesity and
what we found was not that we had a
problem with education around nutrition
what we found is that kids were hungry
and we had this fundamental need to
think about hunger as a health issue so
go back to the expectant mother not
eating right a child not eating right
the development of a child malnourished
and think about what that does and yet
we spend three trillion dollars on
health care and we don’t provide the
basics of needs when it comes to food
security so again a lot of organizations
are beginning to screen for food
insecurity providing short-term food
needs providing food pharmacies and
beginning to start to address those
issues employment is a critical issue
the best thing you can do for an
individual get them off to a healthy
start you know provide education provide
a path to a job that allows them to fill
the things in life and again when we
look at health and well-being those
things are important so when you see
people begin to do these things in
health care and people say well what in
the heck why are you doing this stuff
and it’s because those social
determinants of health aren’t critically
important so when you see people invest
in economic development when you see
people doing things and hunger when you
see interest already we’ve talked about
pre-k and education and the importance
of having a solid education when you
think about changing neighborhoods if
you you know are interested there are a
lot of cities in America now where where
people are patting themselves on the
back saying look at this great city come
back whatever city you like just just
Google A Tale of Two Cities two
we know our tale of two cities Detroit
and what you’ll find out is that the
downtown’s are doing great and people
all excited but the neighborhoods the
health of the neighborhoods are either a
static or they continue to go down and
the reason for that is clear it is those
social determinants of life and those
are the things as we begin to look at
them we have to look at those
collectively and also individually Jim
Collins wrote a great book good to great
many of you have read good to great it’s
probably studied it in school on the way
he wrote a better book called good
degrade in the social sectors took him a
year to write good degrade took him
three years to write good degrade in the
social sectors and I think it’s 40 pages
and what he said and good to great in
the social sectors was I was wrong
didn’t say that that’s kind of what he
said said I was wrong
it’s not how much money you make it’s
how what kind of impact you make
relative to your resources so everybody
here has different resources
individually you work in organizations
that have different you know resources
we live in different communities at
different resources but if we all make
an impact relative to the resources that
we have and we all begin to think of our
work in life not business to business
but business to community or business to
society and we look at those goals which
people now are realizing is act actual
success or organizations and we look at
that as a community and we look at that
as trying to improve communities really
what we find in life is as YouTube says
where you live should not decide whether
you live or whether you die thank you
very much [Applause]
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