affects all of us some of us might wake
up in the morning and we have some pain
maybe a pain in the knee or a back pain
that just won’t go away
some of us might suffer something far
more serious like heart disease or
cancer or have had a stroke or two and
if you suffer them now then you know how
important poor health can be for you and
if you don’t remember that at some point
you probably will I want to talk about
the differential experience of health
why is it that some people suffer and
other people don’t and what is it that
we can do about that
after all 69% of us just this year said
we want to be a little bit more healthy
want to lose some weight help is
something that’s on the tip of all of
our tongues on the edge of all of our
minds so we might have googled something
and you see here healthy steps to to
healthy living or eight ways that you
can optimize your health or we might
have gotten one of these a fitness
tracker that I wear that helps us to
keep track of how much physical activity
we have we’ve done how much we walk or
how much we run and that’s because we
assume that health is about lifestyle
that we have a choice about the kind of
health that we might experience or
perhaps somebody might have gotten you a
gift that allows you to take a cheek
swab and see what your genes tell you
about your past and maybe your future
after all there are tons of studies that
have linked all kinds of genes to all
kinds of outcomes here you see studies
find more genetic links to obesity
so we also assume that health is about
our genes health is either about what we
choose to do in our lifestyles or health
is embedded way before we ever had any
choice in the matter but I want us to
look at the evidence what does the
evidence actually tell us what does
science tell us about the experience of
good health what you see here is a map
of premature death for a hundred
thousand people all over the country in
which you should see is that it’s not a
ubiquitous experience there are certain
places where health is worse than
other places and that takes us to the
first fact which is that place matters
more than either lifestyle or genetics
and we can dig deeper we can ask
ourselves about the variation in the
experience of health and wellness among
those who are poor what I’m going to
show you is data by Raj Chetty and
colleagues and economists at Stanford
who wanted to ask where is it that the
poor live longer versus shorter lives
what you see here is a map and you can
immediately look at our corner of the
world the edge of the thumb and you see
that that’s red generally when you see
red on a map bad thing
what you’re seeing here is a graph of
life expectancy by income percentile and
you’ll note among both men and women
that generally income is associated with
better health but what you’re seeing
here is a contrast between New York City
and Detroit and you see that after the
50th percentile you have this unraveling
of the two curves how do we explain that
but first the second fact is that place
matters even more for the poor I want to
get a little bit personal because I
lived in New York just two years ago and
when I moved to to Detroit my life
expectancy didn’t really go anywhere and
that’s because I’m insulated by the fact
that I have money and resources and
education and human capital so if I
choose not to eat well it’s not because
I was a prisoner to my context it’s not
because I didn’t have that on offer it’s
because I didn’t leverage everything I
had to go off to the grocery store and
get a healthy meal or go out to the gym
and exercise I want to contrast that
with miss joy she’s a 66 year old woman
who I take care of in in Detroit she’s
somebody who is part of the 677 thousand
people who I’m responsible for as the
health director in the city and if I
were to say Ms joy you know you really
ought to eat better you know what you
tell me that is lovely except for the
nearest grocery stores about three miles
away from my house and I don’t have a
car so I can’t really get there and well
if you want me to exercise that’s really
great too except for you know what time
the Sun Goes Down it’s about 6:00 I get
home from my second job around 6:00 and
I’d love to go outside and I’d love to
take a walk but unfortunately my
neighborhood it’s a little scary after
dark so I hear you about healthy
lifestyles like that’s just not going to
kind of challenge is not uncommon in
Detroit we know the Detroit’s are
relatively poor city with a poverty rate
around 40% but it’s not just about
poverty it’s about the alchemy of
poverty and racism over a very
particular geography because remember
place matters more it matters even more
for the poor Detroit is a huge city you
can fit all of Boston San Francisco and
Manhattan on our city and still have
room to spare so we have poor people in
a big city that’s highly vacant what
you’re seeing here is the e flux from
Detroit not since 1967 when it started
but in the last completed decade between
2000 and 2010 and it’s really hard to
get around the tragic irony of the Motor
City is that only about 40% of
Detroiters have regular access to a car
20 percent have no car at all and 40
percent they might have a car but it’s
shared with so many people or it’s so
broken down that they can’t really rely
on it and the way that you or I might be
able to and lastly we cannot ignore the
fact of race what you’re seeing here is
a map of redlining this is a map from
the late 1930s by a group called the
Hearn brothers who were real estate
moguls in Detroit and what it shows you
is where people of particular races
could live and not live and so what has
happened over 60 years is we have
concentrated poor the poor and
minorities in particular parts of our
city even as we built highways for
certain people to be able to leave we
did not build public transportation we
built highways because who built Detroit
the automotive industry which gives us
through the third fact that health is
about access right the reason place
matters is because health is about
access to food and exercise and
education and health care and social
support and about exposure to things
like trauma and violence and racism but
there are opportunities Public Health is
what we as a society do collectively to
assure the conditions within which
people can be healthy to assure the
conditions within which people can be
healthy public health is about place and
the first opportunity that we have is to
be able to think about access to food
and exercise and education and
healthcare and social support and
exposure to trauma and violence racism
and invest in public health the second
to think about what causes disease in
the first place heart disease is the
most common killer in American society
in the global overall so I want us to
think about what causes this gentleman’s
heart attacks now I know this gentleman
looks a lot like President Barack Obama
I mean the former president no harm so
uh so let’s ask about what causes heart
attacks in President Barack Obama not to
but let’s get down to it so what causes
heart attacks if this was a room full of
medical students you guys would tell me
something like this
atherosclerosis right it’s one you have
infestation of the intima by cholesterol
over time that causes a blockage of a
coronary artery which blocks downstream
blood from parts of the heart which
kills the heart which causes a heart
attack that’s it’s a right answer but we
have to think upstream what are the
causes of the causes things like
hypertension and high cholesterol and
obesity but let’s keep asking what
causes a heart attack things like
smoking and poor diets and low physical
activity and smog you guys know the
drill already right what causes that
social policy poverty and economics our
second opportunities that we have to
think upstream it’s not enough for us to
be focused just on pathophysiology in
the physical realm we have to be
thinking about pathophysiology in the
social realm and let’s think about the
consequences of a heart attack his
gentlemen here he has a heart attack our
protagonist he he suffers from a heart
attack and he just moved into a really
nice home in a nice neighborhood what
happens well unfortunately the average
heart attack cost you about seven
hundred sixty thousand dollars that’s
with the ACA and so what happens he
can’t actually pay right he had to make
whatever it was payment that he that
that missed what his insurance could
have paid for him and this gentleman
unfortunately loses his home so he’s
forced to move somewhere else so we see
how poor health shapes poverty and so we
look in his new home and then we asked
well what are the kinds of things that
his child could be exposed to in a home
like this dirty water paint chips which
cause lead poisoning which then drives
how poverty shapes poor health keep
going that child who is exposed to the
lead in the home and now suffers in
school because that kid never had the
shot that you or I might have had to get
to school with a healthy mind it was
poison before ever before he ever
started we reify the relationship
in poor health and poverty keep going
that child now lives in the same
neighborhood that’s going to expose his
children to the same things and we reify
the relationship between poverty and
poor health public health is about
addressing this challenge and that
opportunity is to tackle feedback cycles
to be asking ourselves where is it that
we can intervene where we can address
these vicious feedback loops that trap
people in both poverty and poor health
and that takes me to our work at the
Detroit Health Department what we do is
we leverage health to disrupt
intergenerational poverty our goal is to
be thinking about the barriers that
children face to being able to learn and
earn like any child anywhere in America
and our job is to systematically
dismantle them so that those kids have
the same shot at the life trajectory we
all want for our kids I want to talk
about four outcomes that we’re talking
about that we’re working very very
heavily on share with you a couple of
projects that we’re building poor infant
health did you know that a baby whose
preterm is likely to earn about $3,000
less at 30 than the child who wasn’t
preterm unintended teen pregnancy a
woman who chooses not to get pregnant
but becomes pregnant anyway before she
graduates high school her likelihood of
dropping out of high school is 50% and
the likelihood of her child being pre
term goes up twice asthma it’s a single
leading health cause of school days
missed poor vision if you can’t see the
board you can’t learn the board and so
we’re tackling these problems because
they are a core to that feedback loop
between poverty and poor health let’s
talk about poor infant health first
we’re building a program where we are
teaching women across our city to be
able to mentor women throughout their
pregnancy it’s called sister friends and
the goal of this is both to provide a
mentor for a woman who becomes pregnant
walk her through negative nine months to
one year at the same time be able to
connect her to the number of resources
that are there unfortunately infant
mortality is far more common among the
most vulnerable and so if we can’t reach
out via the best resources that we have
which are Detroiters then we can’t
address the challenge unintended teen
pregnancy we know that long-acting
reversible contraceptives are the
leading way to prevent unintended teen
pregnancy these are modalities of
contraception that don’t require
point-of-use
you don’t have to take a pill every
night you don’t have to use a condom
when you have sex but unfortunately on
about 2.5 percent of young women in
Detroit use these even though their
first line so we’re trying to take a
multi-modal approach to this first we
want to make sure that doctors in
Detroit know how to use long-acting
reversible contraceptives second we want
to make sure that people know about this
oftentimes people don’t know that you
can get an implant or an IUD and it’s
good for three to five years and you
don’t have to worry about getting
pregnant thereafter and then we want to
be able to provide access to these
services and places that are discreet
and not stigmatizing and so we’re
thinking about being able to put these
in places that you wouldn’t otherwise
think about going to get preconception
services like a rec center where you
could be just as well going to play
basketball asthma or asthma
hospitalization rate is three times as
high as the rest of the state of
Michigan like I said that yields
children not in school not learning and
this is largely because of the number of
high emitters across the city of Detroit
we are a relatively industrial city and
so there are a number of polluters who
live in and around our city which
creates the context for asthma and what
we’re doing is we are equipping children
with inhalers that are equipped with
sensors and every time a child uses that
inhaler it sends information out to a
cloud and what that allows us to do is
to generate an asthma heat map to be
able to give families and doctors taking
care of children with asthma real-time
information about their risk of an
exacerbation and then lastly poor vision
I want to share with you a couple
statistics 35,000 children in Detroit
are going to test positive for a vision
deficit 35,000 a year positive for a
vision deficit in about 30% of them on
average over the past several years
would come back the next year screened
again meaning that we weren’t able as a
system to give them a pair of glasses so
we’ve launched a program where we’re
teaming up with a non-profit to be able
to do a full optometric exam at school
provide children a pair of glasses every
kid in Detroit who needs a pair of
glasses will get one two weeks
delivered at school and what you’re
seeing here is a picture from the launch
after all 69% of us this year made a
goal about our health we decided that we
wanted to be a little bit healthier we
wanted to lose weight stay fit and
healthy but unfortunately not all of us
have access to that when I drove here
the 45 minutes that I drove here I drove
nine years of life expectancy but when
we asked ourselves how that can happen
in the richest country in the world we
have to be focusing on opportunities to
invest in public health to tackle
feedback cycles and to think upstream
all right guys wait up wait up wait up
so my mom’s never gonna believe this I
got to get the selfie okay all right
ain’t you all to put your arms up let’s
go let’s do this all right ready one two