The River of Health: Jandel Allen-Davis at TEDxMileHigh


Translator: Denise RQ
Reviewer: Helena Bowen So I was standing on the banks
of a swiftly flowing river, when I heard the cry. I jumped into the cold water,
and I swam forcefully against the current and made my way to the struggling man. I grabbed him, I pulled him to the shore,
I laid him on the banks of the river, I applied artificial respiration
in order to revive him. And just as he began to breathe,
I heard another cry for help. So I jumped back into the cold water, and again struggling
against the strong current, I made my way to the struggling woman,
I grabbed on hard, I pulled her to the shore,
I laid her on the banks of river, I applied artificial respiration. And just as she began to breathe,
I heard another cry for help. So I jumped back into the cold water,
I swam against the current and I am getting tired now. But I do make to the person,
and I grabbed the struggling man and pulled him to the shore,
I laid him on the banks of river, I applied artificial respiration,
and just as he began to breathe, yep, I heard another cry for help. Near exhaustion, it occurred to me
that I was so darn busy jumping into the water,
grabbing a hold of these folks, pulling them to the shore,
applying artificial reparation that I had no time to take a look upstream and see who’s pushing them in? (Laughter) Well, this metaphor tells a story
beautifully and yet tragically of the American approach to health care. In short, we’re so darn busy downstream
pulling bodies out that we lack the time, the energy, and even the will
to go upstream, figure out who’s throwing them in
and telling them to stop it! (Laughter) But you know as I thought about
that metaphor, the other thing I know is that fixing health care
won’t fix health care. And the more I’ve thought about
that metaphor, and all the tributaries that are along it, what we tend to think is that
there’s some one space way upstream, just this one space
that holds all the answers, but in fact, I think there are
multiple tributaries all along that river that provide opportunities for us
to intervene and stem the tide of lives that are actually entering
our health care system. So we invite you to take a walk
with us along our imaginary river. And let’s explore
some of those tributaries and the opportunities
they provide to intervene. Well, actually, the first place
along our river that we come to is the health care system, because we do
need a system that’s functional. We need be assured
that it’s not going to harm us, and that we can stand
a pretty darn good chance that it won’t bankrupt us;
and currently today, that’s not the case. It’s expensive; we spent
$2.7 trillion in 2012 on health care, and we ranked dead last when compared
to six other industrialized nations when it came to system performance. Hundreds of thousands of people
are harmed by our system. And tens of thousands of people
are actually killed by our system when they enter our walls of healing, because of how we operate, or not. And very few of us, very few of us
would give our system every time a letter grade A
based on our care experiences. You know, America needs a system
that’s safe, that’s timely, that’s effective, that’s efficient,
that’s equitable, and then most importantly,
that’s patient-centered. Currently,
that’s not consistently the case, although lots of folks around the country, and even in our own community
are working on this. But you know what, even if we did have
a system that worked perfectly, that didn’t harm us or didn’t bankrupt us, all that assures is that we won’t do
those things when you enter our doors. So what else can we do? Well, let’s keep exploring. The second place that we come to, the second tributary
that so important that we come to is the whole idea
of the timely prevention of clinical, the timely use of clinical prevention. Did you know that three quarters
of our health care dollars are focused on
preventable chronic conditions and yet only 3%
of the trillions of dollars that we’re spending annually
in this country are focused on protecting health
and preventing illness and injury? Just using nine clinical
preventative services could result in up
to 50 to 100,000 avoidable deaths annually in our country. Half of us aren’t even receiving
recommended preventive services. Fifty percent of the people
in this country with high blood pressure are not in control. And sadly, people living with diabetes, 30 to 50% of them, are in poor control. You know what? We can do better than this, we can, and that take us
to the next place on the river, the so-called space
of personal responsibility; yeah I hear you. (Laughter) Personal responsibility. There is a relationship
between the 12 leading causes of death in this country
and our lifestyle choices. But there is not a topic
that engenders more emotion than this whole notion of personal
responsibility for my behavior, especially when it comes
to obesity prevention. (Laughter) Is it my responsibility to change? Or am I victim of circumstances
and society needs to change? Well, whatever end the spectrum
you come out on in terms of this kind of binary
either or way of thinking, the fact is that our lifestyle changes are adding unnecessary cost
to the health care system, it’s robbing us of our ability
to be our best at home and at work, and it’s cutting short far too many lives. So what else is up the river? Let’s just keep walking. That brings us to this place
called healthy environments. Our environments
are literally making us sick, either because things as basic
as the quality of our air and water or the status of our infrastructure. And then there is
the so-called heal activities, that is healthy eating and active living. You know, addressing
all of these issues are laudable goals and a ton of stuff gets in the way
of actually being able to deal with it. Do you live in a place
with clean air and water? Are your neighborhoods
walkable and bikeable? Do you feel unsafe because of violence? Do you have to shop for your food in corner convenience stores
or liquor stores? Are healthy food options
available and affordable? And since we know that your zip code
matters when it comes to health outcomes, what are we doing? What are we doing to work, and what’s our responsibility
to work on improving our communities? Well, the one thing we do know is that focusing on this work
is incredibly important, and yet a lot of stuff gets in the way, and that brings us
to the next space on our river: the so-called
social determinants of health. Well, the social determinants
are those conditions into which we’re born,
grow up, live, and age, and the structures we put in place
to deal with illness. All of those things are shaped
by a wider set of courses: economics, our social policies,
and actually even politics. The critical ones include race
and ethnicity, education, and economic self-sufficiency, and while that’s important
and it affects everyone, this is particularly important for women, and they’re all also
very much intertwined, so let’s just look
at one of them: education. A child born to an educated mother is twice as likely
to reach his fifth birthday. Educated mothers are 50% more likely
to immunize their children. A girl armed with just the basic education is three times less likely
to contract HIV and AIDS. I’m going to tell you something:
we can do better than this. We absolutely can do better than this. That takes us, when we think about these
social determinants to another space, because how do we not lose hope? Where do we even begin? So I’m here to tell you
that maybe there’s another space. What if there’s another space way,
way upstream on that river, and in fact, at the headwaters
of every single one of those tributaries? And what if, in this space,
and in all over this country, there are beacons of light
that could shed light on what are the foundational elements
that are required to build healthy communities and healthy societies,
wherein the health care system is there when you need it,
and only when you need it? Well that place, that space,
is all about community. It’s all about
being connected to each other. Responding to adversity in ways that ensure that we’re going to come out
on the other side smarter and stronger than we were before, that we’re building up a set of assets
that enable us to live our best lives. In this place, health
is an enabler of living. It’s not the end goal. In this space, we don’t view health
as the absence of illness, rather that sweet space
wherein we can live our best lives. In this space, we’re in relationship
with each other. We’re connected to each other,
we care about one another. In short, we love one another. There are people all over this world,
and in fact this country, that get it. Dr. Don Burwick gets it. Dr. Burwick started the Institute
for Health Care Improvement, and this organization is transforming
how health care is delivered all over this nation. Yeah, there’s measurement,
there’s protocols, and he standardizes processes,
but what Dr. Burwick got when he started this institute is that it was all about
building health care teams. It was about learning from our mistakes and it was about leaning into
the discomfort of interdependence because we knew when we did
that we’d get better outcomes. There are communities in Nigeria,
Uganda, and Tanzania that get it. In these small villages
that are extremely impoverished, people living with HIV/AIDS are complying
with their medication regimens better than we are in this continent. They’re getting over 90% compliance
for treatment. It’s all because the community
and the care providers have set the expectation
that people with this disease are going to take their medication because they’re important
to the whole community, and if they don’t take their meds, how ever are they going to
take care of their families? It’s all about lifting up
the value of social relationships in order to stem the tide of the disease
that’s decimating a continent. Arthur gets it. His YouTube videos had over 9 million hits and it chronicles the story of a veteran
as he made his transformation from a man who had to walk
with ankle braces and crutches back to his confident, completely
independent, and very fit self. There are people all over this nation
that wake up some morning and say, “You know what? It does start with me. I have to do it myself,
and I can’t do it alone.” When they make that determination, the cheering squads come out
all in force to support them. Our own North Middle School gets it. This school has made a decision
to plant a community garden and it brings the community together. Folks get a little physical education,
they learn a little science, a little math, and this fall,
they’re having their first farmer’s market and they’re going to sell their produce. Geoffrey Canada gets it. His Harlem Children’s Zone
is a model for this nation. 100% of those kids
graduate from high school and go onto a secondary education. While his teams are creating places
and spaces for kids to learn, They’re also meeting basic human needs, because they understand that the social
and the economic returns on that are huge. I could tell you a whole bunch
more stories, but we don’t have time. But what I will tell you is
all these stories are about connection, they’re about resilience, they’re about
building up social capital. Let me tell you all something. It’s instinctive to rush into a river
when somebody’s drowning to try and save their life,
and in American health care, we’ve created a set of values
and a culture that completely reinforces
this very basic human instinct. As a physician, when I save a life,
I’m deemed a hero, you guys pay me handsomely for it, and I get an incredible gratifying feeling
to be in peoples’ lives at this most vulnerable time
in this most sacred of ways. But I believe that there’s
another instinct that’s way more basic and way more primal than that, and that’s the instinct
to be connected to each other, to be in relationship with each other,
and to celebrate our interdependence, and when we do this, we end up
building up this cache of assets that actually positively improves
what we see downstream in terms of health and health care. Eric Klinenberg wrote an article
in the January 7th issue of the New Yorker magazine
called “Adaptation”, in which he said, “Improving our community’s infrastructures
is necessary, but hardly sufficient in order to reduce the amount of death
and destruction that comes from any one of a number of natural disasters.” He went on to talk about
the Chicago heat wave of 1995, in which 739 people perished. He tells a story
of these two African American communities that sit right next to each other and for all intents and purposes,
they look exactly the same. Same levels of violence, same amount
of poverty, the same number of elderly. In one community, the death rate
per 100,000 people was 333. In the adjacent community, it was 3. The difference: cohesion. People were connected to each other,
they knew their neighbors, and they were checking in on them. So when I read this, there was
this moment where I stopped, and I reflected on my own life. My family lives in one
of the more affluent neighborhoods in the front range,
and I barely know my neighbors. If I were to die
when my husband was out of town, how long would it take
before anybody even knew it? What if there was an opportunity to have made a difference,
to have saved my life, if I were differently
or better connected to my neighbors, and far worse, as a physician, what if the same was happening
in one of their homes, and I was powerless
to do anything about it because I wasn’t connected
and didn’t know? So you know what? I have a call to action
for you and for all of us. If you imagine our imaginary river,
go back to our imaginary river, and you think of all of those tributaries, there’s a place
that every single one of us either live, learn, work, play, or pray. We have a responsibility
in every one of those places to build community, because until or unless we do,
health care is going to remain broken. And fixing health care? Sorry, it won’t fix health care. Thanks. (Applause)

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