Change the odds for health | Anthony Iton | TEDxSanFrancisco

Change the  odds for health | Anthony Iton | TEDxSanFrancisco



in the fall of 1985 has left home and traveled to an unfamiliar country I landed in this place the experience at this place radically changed my life trajectory this place horrified me yet at some level it fascinated me in many ways I'm still coming to terms with what I saw in this place where is it Beirut Belfast Bosnia before I tell you let me tell you about where I grew up Montreal Canada is a beautiful cosmopolitan and diverse city it hosted the 1967 World's Fair the 1976 Olympic Games remember Nadia Comaneci and the perfect-10 in gymnastics I was there it's a city that's rich in parks and open space outdoor cafes public art street theatre high-quality housing and a state-of-the-art public transportation system my brothers and I grew up in Montreal in the 1960s 70s and 80s and we felt nurtured by that city see Canada has a strong social compact with its citizens we all know Canada has universal health care but it's also got a universal Child Care Benefit paid vacation guaranteed sick leave high quality community resources parks recreation centers and community infrastructure and highly subsidized post-secondary education I went to McGill University basically for free Canada invests in its citizens when I graduated college I was told that Johns Hopkins was the best Medical School in the world and in fact there's a saying in Hopkins which is we may not be the best but there's nobody better when I landed at Hopkins I was delighted it was elated to have been accepted there and I walked through the doors out into the community and this is what I saw I landed in East Baltimore and I had never seen anything like it I was being toured around by an upperclassman and he saw the look of shock on my face and he said what's wrong with you and I managed to stammer when was there a war here and I'll never forget what he said to me he looked at me with this look of utter disdain and he said what you expect it's the inner city what did I expect I was supposed to expect this these atrocious and dehumanizing conditions were a norm in an American city and I was left to wonder is the u.s. really a first world country I saw children and the clinics at Johns Hopkins and I couldn't help but wonder what would have happened to me if I'd grown up in East Baltimore what I have been able to attend Johns Hopkins Medical School and become a doctor what is owed to these children they didn't create this environment yet they have to navigate it every single day of their lives what is the American social compact does it even exist unlike Canada or other Western democracies the US doesn't have universal health care it doesn't certainly have a universal Child Care Benefit it doesn't have highly subsidized post-secondary education the u.s. doesn't have much by way of universal social benefit policies at all this is the land of the so-called American Dream but what are the fundamental agreements that underlie that dream as I looked around East Baltimore I a hard time imagining any social compact whatsoever and I wondered for the low-income residents of East Baltimore was it they really ever had a meaningful shot at the American dream I noticed something else in East Baltimore as I wandered around and looked into the eyes of children I started to notice something that was very disturbing I noticed an absence of hope an absence of light these kids were barrage with a message every single day of their lives that they weren't valued that they didn't matter and they internalize that and that caused frustration and anger and eventually despair and a loss of hope and as that happened you could see the lights literally turning off in their eyes this is what happens to people when they feel they don't have control when they don't have a sense of agency I'm gonna get back to that a little bit later so here I was this young medical student at this prestigious Medical School and I felt like I was learning so much about medicine but outside the walls of the fortress Johns Hopkins I had no idea what was happening in the streets and this question started to incubate in my mind in America when it comes to your health does your zip code matter more than your genetic code 25 years later that quote was attributed to me by Forbes magazine as the number one healthcare quote in 2013 let me tell you how that came to be starts with death after I graduated Hopkins trained in internal medicine I subsequently ended up being the health officer of Alameda County the health officers job and it's a great job for data junkies like me is to be the registrar of all deaths in Alameda County there about ten thousand deaths in Alameda County every year and each of those deaths has a death certificate and I have to sign each of those death certificates so I used to say in Alameda County you're not dead until I say you're dead and I knew having been in East Baltimore that there was a story to be told in these death certificates hidden within these death certificates that we could tell about how opportunity is laid out in a society on a death certificate you know what somebody died of you know what age they were when they died you know their race ethnicity and you know where they lived and those four pieces of data in tens of thousands of certificates can tell you a lot about a community so we took Alameda County in every neighborhood now limini county and we calculated on average how long people could expect to live in their neighborhood and that map ended up on the front page of the San Francisco Chronicle those green areas our neighborhoods where people can reliably expect to live 80 years the red areas people can only expect a little about 74 years and the yellow areas are inventory in between 74 and 80 now in the city of Oakland we found neighborhoods that were close together within a couple miles of each other where the life expectancy difference was greater than twenty years and it wasn't just in Alameda County I had to go back to Baltimore I had to see how that played out in Baltimore there our neighborhoods were on average people only live to 58 years old we went to Minneapolis st. Paul to Seattle to Philadelphia to Boston to New York to Cleveland to LA everywhere we looked we found life expectancy differences on the order of 15 20 25 years in the same city so what's happening in these low life expectancy communities well very simply put these communities are functioning like incubators of chronic stress our fractured social compact has rendered these places without the basic social political and economic infrastructure that people need to be able to pursue the American dream bad schools poor housing inadequate health care poor transport lack of jobs high crime neighborhoods that are policed like military zones a lack of access to parks grocery stores and even in some cases no access to fresh safe drinking water any human being placed in such circumstances inevitably develops chronic stress that's what that would happen to you what happened to me chronic stress makes it much more likely that you'll develop cardiovascular disease diabetes any forms many forms of inflammation that's how the outside world gets under the skin and changes our physiology in this country low-income people are physiologically different than high income people not because they were born that way but because we made them that way with our policy or more at often it's the absence of policy in the face of abject need and that policy creates a high degree of social vulnerability so that these communities like in East Baltimore are susceptible to any threat that comes along whether it be a foreclosure crisis hiv/aids a heroin epidemic or even a hurricane so our policy is literally making people sick and killing them prematurely how does this work physiologically well the body perceives a stressor through the brain the hypothalamus sends a message to the pituitary gland which sends a message to the adrenal glands which release a cascade of hormones amongst which cortisol is one low-income people in this country are awash in cortisol and it's not just low-income people in their cities low-income people that are living in America's Rust Belt our working-class communities are increasingly facing the same kind of stressors this kind of chronic stress actually changes physiology it changes your behavior and it changes how your genes are expressed so chronic stress which is driven by the policies that we've created is as lethal as any knife or any gun – not just low-income people the u.s. life expectancy now is 43rd in the world and slipping so we know that 80% of what affects our health happens outside the healthcare system yet we still operate through the medical model the medical model basically says that bad behavior produces disease which produces premature death so we use ambulances and emergency rooms to try to prevent death we use 15-minute clinical encounters to try to change the course of disease and we use brochures and pamphlets to try to change people's behavior and this is necessary but it's a three trillion dollar enterprise it's bankrupting us and it's not improving our health but there's so much more to this story the low-income people in East Baltimore didn't create East Baltimore government policies and private policies created East Baltimore why because of a narrative of exclusion a narrative says that those low-income populations are not entitled to a fair and robust social compact and the consequence of this is dramatic and it's not just low income people increasing data suggests that white educated and insured populations in this country are in much worse health than their peers internationally this broken social compact hurts all of us I'm not immune you're not immune the fate of this child is all of our fates so there's no pill MRI or fancy surgery that's going to solve this problem so rather than using the old prescriptions it's time for a new prescription for health rather than asking people to beat the odds it's time to change the odds and that's what we're doing we're working to create a whole new approach to health in California we've put a billion dollars on the table it's a billion dollar bet that we can prove that there's a better way we're organizing people to come together to reweave California social compact and these people are taking control of their environment and they feel agency let me tell you what this looks like Fresno California if any of you had lunch today you probably had fruits or vegetables that came from Fresno it's a 20th congressional district one of the poorest congressional districts in the United States it also feeds the world in 2014 the Board of Supervisors and Fresno decided that they wanted to cut off health care to 5,600 low-income undocumented fresnels many of whom are farm workers who are feeding us every day as a toil in the fields but then something happened people stood up advocates activists and they said no this will not happen on our watch they organized they came to the Board of Supervisors and they said you will not do this and the Board of Supervisors back down in the fresno school systems young people organized because 15,000 kids are suspended and expelled in Fresno every year young people organized and they went to the district and they said no you won't do this we don't want to be fed from the school-to-prison pipeline and they forced the district to adopt restorative practices and suspensions plummeted 43 percent and it's not just in the school system and South Fresno where they're one-quarter the number of parks that you have in north Fresno people got together they organized they held press conferences they talked to the mayor and they forced the city to update its parks master plan and just this week Governor Brown signed a bill that brings seventy million dollars to Fresno to address that inequity let me tell you about Long Beach in Long Beach the port of LA Long Beach is one of the largest ports in the United States it wanted to expand its rail yards to run 8,000 trucks through a neighborhood in Long Beach that already has high rates of asthma high rates of cardiovascular disease and high rates of emphysema people organized they said no and they got the port to back down in Coachella in the United States in 2016 their places in this state where people can't get access to safe potable drinking water a hundred and fifty thousand Eastern Coachella Valley residents had no access to safe drinking water they organized change the way that the district the water district at elections and now they have a representative and an opportunity to get infrastructure for themselves in the eastern Catawba Valley I could tell you about Richmond where violent crimes are plummeting because of work being done there I could tell you about City Heights where Muslim students now have access to healthy halal meals the odds are changing in California fifty thousand people working together to create a new social compact and it's yielding results hundreds of policies all over the state three hundred thousand fewer suspensions and expulsions in California over the past three years five million people newly insured a million people now eligible to reclassify their felonies into misdemeanors quarter of a million undocumented kids eligible for full scope health benefits California is changing we're changing the narrative we're building a social compact for everyone how long will you live go to our website put in your address and you'll find out you may be surprised thank you you

6 comments

  1. I so appreciate Dr. Iton's experience, and commitment. I have had the opportunity to sit with him along with many leaders in the safety net in Oregon. His perspective and information changed our path in the most profound way!

  2. Would Tedx Talks have any research on medium size cities that zip codes are not the codes or code words for establishing difference in treatments and health inequities.

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