How resilient communities can create a healthier country | Dr. Jerome Adams

i want to talk to you all today about an epiphany that i had growing up i was blessed to have parents who were extremely hard working both my parents were school teachers and they had to stretch their incomes to feed and to close me and my brothers and my sister we were a family that was rich with love for one another but no one would have called us financially rich my parents they made ends meet but there was never never much left over so if i wanted anything beyond the basic essentials i couldn't do what my own kids do today what my 14 year old did just earlier this week in yell alexa order new sneakers the fact is if i wanted new shoes i had to get a job and job opportunities were limited in rural southern maryland where i grew up but i was determined to get my pair of air jordans so like many americans for me a top priority was figuring out how to generate income now i may look like an airline pilot and on occasion i've been asked for headphones and extra snacks while traveling but i stand before you today as the 20th united states surgeon general the very same surgeon general whose warning label is on the side of every box of cigarettes sold in this country so can any of you guess what i did as a teenager to afford those sneakers close close i worked in the southern maryland tobacco fields and the irony it's not lost on me i know from the murmurs in the audience what you're thinking our surgeon general had a job that was harmful to the health of so many people even back then as a teenager you had to know that tobacco was bad for you well i watched my own grandfather suffer and die from lung cancer i had asthma myself growing up and one of my worst ever attacks came after working in a barn full of tobacco leaves hung out to dry so of course i knew tobacco wasn't healthy but i didn't connect the dots between a desire to meet my financial needs in this case obtaining the hottest new footwear and the impact my actions would have on the health of millions of americans including me and my family you see democrat or republican black or white rich or poor we all make decisions every day that compromise our future physical and mental well-being we do it as individuals and we do it as a nation and time and again what we tend to prioritize is our financial well-being and i actually see some heads in the audience shaking no no no not me so i ask you this raise your hand sometime in the last week you didn't get enough sleep you skipped a meal you failed to work out for the sake of your school or your job and i'm betting that for many of you who raised your hands at least part of your motivation was that you would eventually be compensated that you'd get a paycheck for making that choice and if i ask you what's healthier french fries or broccoli broccoli she got it and if i ask you how many hours of sleep should you get a night not how many hours you got how many hours you should get eight all right see you all are smart group you're a smart group see you ace the test the fact is in most cases you know what will make you and will make your community healthier but you still choose not to do it so why is there such a disconnect and what can we all do about it while you ponder that let's fast forward to my life after rural maryland when i became a practicing physician in indiana i worked in an inner city hospital i was very proud of the work i did but if i'm going to be honest with you i was also starting to get a little bit burned out late one night i remember a young man let's call him johnny who came in with multiple gunshot wounds i worked with johnny all night long giving him unit after unit of blood by the end of it all there was more of johnny's blood on me than there was in his own body johnny survived but i saw johnny again a year later with a stab wound johnny even came back a third time a few years after that time and again we'd see people like johnny in the hospital as a result of gang-related violence we'd patch them up but then we'd send them back out into environments that led them to us in the first place and i told you all that i had asthma i vividly remember a patient who was having an asthma attack let's call her mary mary was having such a hard time getting oxygen to her brain that she was losing consciousness i had to put a tube down mary's throat and breathe for her on a mechanical ventilator for several days mary thankfully recovered but guess what we sent her back to a housing complex that was filled with second-hand smoke you see no matter what i did as a health care provider i couldn't stop the treatment from being needed again or the trauma from happening again but at some level i could relate to what was going on with my patients you see i understood that their choices their opportunities their outcomes were in large part determined by their circumstances now mind you these patient stories come from indiana a state that prides itself on job creation a state that works unemployment is at record lows in indiana and while i was trying to figure out how to get my patients out of the hospital revolving door i learned in my other role as head of the state health department and a member of the governor's cabinet that the chief complaint from indiana businesses was a limited pool of healthy workers against the backdrop of an emerging opioid epidemic it was difficult to find job applicants who could pass a drug test those who were drug free they were often obese or they smoked where they would forego health-promoting interventions like flu shots and cancer screenings and these employees in turn they had more absences lower productivity and skyrocketing health care costs not just in indiana but nationwide almost one in five dollars our economy generates now goes to pay for health care expenses and these dollars they're not just diverted from company profits they're diverted from critical funding priorities like job creation like wage increases and like research and development and that time in my life while addressing the individual health of my patients and also the public and economic health of a state was a time in my life when a light bulb went off for me you see i realized the problems i faced with my own patients and the concerns that businesses had with workforce all had something in common there more often than not the results of environments and inequities that make it increasingly difficult for people to lead healthy productive lives in this reality it cost us all dearly despite a growing u.s economy we have millions more unfilled jobs in this country than we have people looking for work we spend more on health care than any other country it's not even close 3.4 trillion dollars yet we have some of the highest infant and maternal mortality rates and some of the lowest life expectancies even our military is being affected by the poor health of american communities did you know that 7 out of 10 of our 18 to 24 year olds in this country are currently ineligible for military service they can't pass the physical can't meet the educational requirements or have a criminal history we often think that addressing the upstream social factors that lead to these outcomes will cost too much for our economy for our businesses for all of you as taxpayers to afford but the truth is we can't afford the status quo we can't afford to keep doing the same thing and expect a different result because we all know that's the definition of insanity so what can we do well we can invest in children and families not just as social imperatives but as economic ones we can support a healthy workforce with policies that increase access to healthy food options smoke-free communities and safe attractive places for physical activity we can help businesses and communities see the value the return on investment that comes from supporting child care and a living wage fortunately across the u s businesses and communities are beginning to partner to change their outcomes let me give you just one example a major employer in a small town had so many vacancies that production and expansion were suffering so belden incorporated in partnership with the community started offering drug testing to potential employees because so many of their folks were failing the initial drug screen they guided these folks into treatment and recovery and then into jobs at their factory and i had a chance to visit belden i learned that the people who completed this program were the hardest working and most loyal employees that the company had belton's innovation strengthens the community it lowers incarceration and it meets a pressing business need and there are more examples of communities across the country partnering with businesses to improve the health and well-being of their residents and workforce like blue zones in fort worth texas like purpose-built communities in east lake georgia like health equity zones in rhode island some are investing in affordable housing and walkability others are mentoring young students to develop a pipeline and this all leads me to the point of my story when americans lack the opportunity to reach their full health and economic potential we all pay the price we pay in suffering in premature death we pay in increased health care costs and decrease productivity and we even pay in terms of our national security but we won't change individual health or avoid these consequences unless we focus on better community health through better partnerships by making the case for community health as a pathway to economic prosperity we foster investment in our communities that not only lifts up population health but also raises and sustains our collective financial success or to say it in a tweet for the millennials in the audience health is wealth you know i was lucky the health consequences i faced from working in the tobacco fields didn't prevent me from pursuing my dreams but not everyone who sacrifices health and safety for the sake of finance is so lucky i often wonder what happened to johnny what happened to mary after i last saw them in my operating room but i ask you imagine a future where johnny doesn't have to go back to the streets because there are community resilience and workforce training programs that lead him down a different pathway where mary lives in a smoke-free community and can be a healthy model employee who can support her family where a kid from rural maryland doesn't end up in the hospital or supporting an industry that kills his own grandfather for want of a new pair of sneakers i invite you all to join me and help me create unbreakable communities that are built so people can more easily make healthy choices where children thrive and where businesses invest in those communities as a way of supporting a healthy workforce and a healthy bottom line let's dare to break away from doing the same old thing and instead boldly push our nation towards a radically different a radically better and ultimately unbreakable result thank you so much for your attention