2018 Public Health Ethics Forum, Part 1

2018 Public Health Ethics Forum, Part 1


>>Welcome to our 2018 Public
Health Ethics Forum, Minority, Elders, and Healthy Aging,
sponsored by the Office of Minority Health and Health
Equity, and the National Center for Bioethics in
Research and Healthcare at Tuskegee University. I’m Craig Wilkins, senior advisor within the Office of Minority
Health and Health Equity, and will be serving
as your MC today. It’s a distinct honor to welcome
each of our special guests, our plenary speakers,
our session speakers, our discussants, our
post-assessment presenters, and other students, and our
distinguished panel members. The purpose of today’s forum
is designed to reduce the gap in awareness regarding factors that affect healthy aging
among minority elders. Experts in the field
and distinguished group of elders will explain and
illustrate these factors through data, programmatic
activities, and personal experiences. This forum will address the
epidemiology of minority elders in the United States, how
to effectively recognize and support resilience
among minority elders, challenges encountered
by minority elders. The biological, social,
and cultural factors that impact healthy aging among
minority elders, and approaches for achieving healthy
aging for minority elders. I had the pleasure of being part
of a small planning committee that helped organize and
plan this year’s forum. My sincere appreciation and
gratitude is extended to each of them for all of
their hard efforts in planning this year’s forum. Their names are printed
on the agenda, and also appear on the screen. I would like to recognize
them with a round of applause after I call off
each of their names. Dr. Leandris Liburd, Dr.
Reuben Warren, Dr. David Hodge, Captain Drue Barrett, Dr.
Karen Bouye, Dr. Denise Carty, Wendy Holmes, Heidi Holt,
Tara Hurley, Ginny Kincaid, Uma Ohiaeri, Dr. Laura Ross, and Jo Valentine. Can we give them a round
of applause, please? [ Applause ] So again, on behalf of our
planning committee, our office, and Tuskegee University, we
appreciate your attendance and participation
in today’s forum. Before we begin today’s forum,
I have a few housekeeping items. If you didn’t sign in before
you came into the auditorium, please do so at the
registration table. For each of you who
register for the conference, you will receive a
link to an evaluation where you can provide
feedback about this forum. Look for the survey in your
e-mail box by next week. We really value your feedback, and your responses will
be completely anonymous. For CDC staff and others
viewing the conference on IPTV, we may not have your
registration information, so please contact us at this
e-mail address, [email protected] if you would like to
receive an evaluation survey. For those of you who are
watching online on IPTV and live stream, if
you have any questions, you can also e-mail us at
this address, [email protected] For those of you
who are interested in receiving continued
education credit, please note this information
on the bottom of the agenda. For those of you who
have ordered lunch through Which Wich, those
lunches will be available on tables in front of
rooms 246, 247, and 248, which is outside the auditorium. You take a right, and take the
first hallway on the right. On the agenda, after
Dr. Redfield’s remarks, the poster
session will begin at 11:30. The posters will be located
out in the foyer area. I would also like to ask
you, if you haven’t already, to please silence
your cell phones, your Blackberrys, and pagers. For our breakout sessions that will occur starting
this afternoon, those breakout sessions
that you will note on the agenda will
be in 246, 247, 248. For our breakout presenters,
AV support will be available at 12:30 to help you load
any slides that you may have for your presentations. Throughout the day, I’m here to answer any questions
that you may have. And now, to begin today’s
forum, I have the privilege in introducing to you
Dr. Leandris Liburd and Dr. Reuben Warren. Dr. Liburd is currently
the associate director for the Office of Minority
Health and Equity at the CDC. In this role, she leads a wide
range of critical functions in the agency’s work in minority
health and health equity, women’s health, and diversity
and inclusion management. She plays a critical
leadership role in determining the agency’s
vision for health equity, ensuring a rigorous
evidence-based approach to the practice of
health equity, and promoting the ethical
practice of public health in vulnerable communities. The Office of Minority Health and Health Equity
ensures a pipeline of diverse undergraduate and graduate students pursuing
careers in public health and medicine through
its administration of CDC undergraduate Public
Health Scholars Program, and the James A. Ferguson
Graduate Fellowship. Dr. Liburd has been instrumental
in building capacity across CDC and in public health agencies to
address the social determinants of health, and identifying and widely disseminating
intervention strategies that reduce racial and
ethnic health disparities. She has skillfully
executed innovative models of collaboration that have
greatly expanded the reach, influence, and impact
of the Office of Minority Health
and Health Equity. And raised the visibility
of health equity through peer-review
scientific publications, engagement with academic
institutions, presentations at national and international
conferences, partnerships with national and
global organization, and other communications
and educational venues. Dr. Reuben Warren is
professor and director of the National Center
for Bioethics in Research and Healthcare at
Tuskegee University. As well as the adjunct professor
of public health, medicine, and ethics, and director of the
Institute for Faith, Health, Leadership at the Interdenominational
Theological Center in Atlanta, Georgia. From 1988 to 1997, Dr. Warren
served as the associate director for minority health here at CDC. During the years 1997 to 2004,
he was an associate director for urban affairs
here at the agency for targeted substances
and disease registry. And in 2005 to 2009, he
was an associate director for environmental
justice at ATSDR. He was a director of
infrastructure development for the National
Institute on Minority Health and Health Disparities within
the National Institutes of Health in Bethesda,
Maryland from 2005 to 2007. Prior to joining CDC,
Dr. Warren served as dean and associate professor of
the school of dentistry, department of preventive
dentistry and community health at Meharry Medical College
in Nashville, Tennessee. Dr. Warren is also a
clinical professor, department of community
health/preventive medicine, Morehouse School of
Medicine, adjunct professor, department of behavioral
sciences and health education, Rollins School of Public
Health, Emory University, both in Atlanta, Georgia. And adjunct professor in the
school of dentistry and school of graduate studies at
Meharry Medical College in Nashville, Tennessee. His extensive public health
experience at community, state, local, national, and
international levels range from clinical and research work in the Lagos University Teaching
Hospital in Lagos, Nigeria, to heading the public
health dentistry program at the Mississippi State
Department of Health. Please join me first in
welcoming Dr. Leandris Liburd. [ Applause ]>>Thank you, Captain Wilkins,
and good morning, everyone.>>Good morning.>>It’s so good to look out and
see all of your beautiful faces. Welcome to the Centers for
Disease Control and Prevention. To our guests, and
to our colleagues, we appreciate the time
that you’re taking away from your desk to
be with us today, and we know that
you won’t regret it. I cannot describe how
excited I am to be part of this year’s forum on minority
elders and healthy aging. We are all in for a treat. The planning committee has
organized a lively, thoughtful, and inclusive program. A broad range of voices and perspectives
will be heard today. This will not be an
ordinary gathering of public health professionals. We have been privileged to
partner with the National Center for Bioethics in
Research and Healthcare at Tuskegee University to
host these forums since 2015. The inaugural Public
Health Ethics Forum was part of a year-long commemoration
of the life and legacy of Dr. Booker T. Washington. Founding president of
then-Tuskegee Institute, and creator of National Negro
Health Week, which has evolved to become National
Minority Health Month that we celebrate every April. Each year that we’ve come
together to plan this forum, I leave with history lessons that I would not have
learned on my own. The breadth of my understanding
of minority health, of public health ethics, and
social justice has deepened in ways that wouldn’t have
— that would’ve been absent, that wouldn’t have happened
absent this partnership. Tuskegee University
is rich in its history of scientific discovery
and conducting research — biomedical, agricultural,
and social sciences research, among others — to
improve the health status and overall possibilities of
African-Americans and others. The notorious syphilis
study, which members of the Tuskegee community will
quickly remind us was the U.S. Public Health Service’s study, marked a dark and
hurtful period. But the university’s reputation
for excellence and leadership in science and research
has not been marred. The Public Health Ethics Forums
build upon long-established relationships with the Division of Sexually Transmitted
Diseases, and CDC’s Office of Public Health Ethics. And I want to thank
Jo Valentine and Drue Barrett for taking their seat at the table each year
to plan this forum. Our goal each year is
to examine and then call out ethical dilemmas in public
health research and practice, particularly in our
work to reduce racial and ethnic health disparities, in our work to improve
women’s health, and in our work to achieve health
equity for all. This year marks the 30th
anniversary of CDC’s Office of Minority Health
and Health Equity. And I am honored to
stand on the shoulders of my predecessors, Drs. Warren and Dr. Walter
Williams, to never lose sight of the vision where all
people have the opportunity to attain the best
health possible, and to strive every day to
realize the mission possible, which is healthy
lives for everyone. If we are to achieve the mission
of protecting the health, safety, and security of
all population groups, these kinds of opportunities to bring together community
leaders, scholars, students, public health researchers and
practitioners, and national and local organizations,
are needed. Thank you for being
part of the mission, and today’s forum will leave
a mark you won’t forget. Thank you so much
for being here. [ Applause ]>>Good morning.>>Good morning.>>Dr. Liburd has said it
all, so I won’t belabor or repeat what I heard her say. I’d like to thank
you for being here. There’s a tremendous
value in presence. Presence is a powerful
message that all should hear. Not being a doctor, lawyer, or
whatever, not having two, three, four, five, six degrees, not
having even traveled the world, but just being present. The power of your presence is
what makes this forum important. If you look around,
it’s not crowded, because we were intentional
on who to invite. You’re special. Everybody can’t get into CDC. You know what you went
through to get in, and you know what folk are still
going through trying to get in. So just know you’re special. The other part about this forum
in particular is our focus on those who have
been there, done that. You know, people lament
about what it is to be old, what it is to be a
senior, to be elderly, and those who have
been there know. So we don’t debate, and
I say we, because I’m 73. Proud of it. And when I say that to my
students, to the students at Tuskegee, they look
at me real strange, like you’re not even supposed
to be alive [laughter]. What are you doing here? And so, what you’ll
hear today is those who have been there, done that. We discussed — we debated. How do we frame the conversation
with the elders who have come? And what we’ve agreed, and
maybe agree to disagree, is just being here
for them is enough. They don’t need a reference. They don’t need a bibliography. Their presence tells a story. And so, you’ll hear from
them, and just know, because they said it, it is. And if you live long
enough, you’ll find out. Let me take this last one
before we get started, because the day is full — is to talk about the
evolution of this forum. In times such as these,
ethics is a critical part of everyday conversation, and
everybody thinks they’re right. And in some ways, everybody is,
but our struggle, our challenge, is to — how do we come up
with a collective right? That’s public health ethics. How do we agree what is best for
all of us, not for you or me? You’re important. Not for you — you’re important. For all of us. And so, somewhere between what’s
best for you, and what’s best for us, comes public
health ethics. So we are supposed to debate. We’re supposed to argue, if
you will, and even disagree. But we must agree
on — what is best for the collective
is what we must do. That’s what we will do. And last and most importantly,
we’re ranging from those who have been there to
those who are coming. Please note the poster
presentations on the outside. These young scholars
— let me be clear — young scholars have worked
hard to bring science to you, and I want you to look at it and challenge it,
and challenge them. The power of their presence is
what we’re looking forward to, and the power of yours
is more importantly. So, again, welcome
to this forum. We need to hear what you think,
what you think is important. Thank you. [ Applause ]>>It’s an honor for me to introduce our opening
plenary speaker, Dave Baldridge. Dave is a member of
the Cherokee Nation, a national recognized native
advocate for elder issues. Dave has served as
executive director of the International Association
for Indigenous Aging since 2003. Prior to that, he was
executive director of the National Indian Council
on Aging from 1992 to 2002. During that time, he published
nearly two dozen monographs and papers dealing with
long-term care and elder abuse. Under his leadership, NICOA became the nation’s
foremost non-profit advocate for American Indian and
Alaskan Native elders. The organization tripled in size
while significantly influencing legislation and federal
policies affecting Indian and Alaskan Native elders. Dave has been actively
involved in public policy and research efforts on federal,
state, and local levels. He has vast experience in
the legislative, budget, and advocacy process,
representing the interests of older American Indians to
Congress, states, and tribes. He has testified before
Congress on several occasions. He has twice served on the
board of the National Committee for the Prevention
of Elder Abuse, and has been a technical
assistant contractor to the Department of
Justice Office of Violence Against Women, assisting
Native program grantees. His accomplishments include
leading national advocacy for the Older Americans Act, services for American
Indian elders. He has authored numerous papers
on Indian advocacy, health, demographics, and culture. His work has involved
extensive relationships with tribal councils
and organizations, and sovereignty issues. His publications
on a wide variety of Indian agent issues have been
widely distributed and cited. He has interpreted
Indian aging issues for congressional
sub-committees, federal task forces,
state aging organizations, long-term care providers,
Indian organizations, tribal and inter-tribal
councils. So please join me this morning
in welcoming Mr. Baldridge. [ Applause ]>>Thank you, Captain, and
good morning, everyone.>>Good morning.>>I want to start our
conversation about health ethics by looking at a few
misconceptions that Americans have about American Indians
and Alaskan Natives. [ Music ]>>Proud, forgotten, Indian. [ Music ] Navajo, Blackfoot, Inuit,
and Sioux, survivor, spiritualist, patriot. Sitting Bull, Hiawatha,
and Jim Thorpe. Mother, father, son,
daughter, chief. Apache, Pueblo, Choctaw,
Chippewa, and Crow, underserved, struggling, resilient. Squanto, Red Cloud, Tecumseh,
and Crazy Horse, rancher, teacher, doctor, soldier. Seminole, Seneca, Mohawk, and
Creek, mills, Will Rogers, Geronimo, unyielding,
strong, indomitable. Native Americans call
themselves many things. But one thing they don’t. [ Music ]>>Some of these
perceptions are romanticized. Others are derogatory. Are we noble savages,
or despicable heathens? Disney Media concurs. In either case, the
perceptions are damaging. They cause us to generalize
our opinions of Indians, who are in fact neither
saints nor sinners, and we don’t always see them
as other Americans struggling with the hassles of
daily life just like us. The romanticization of
Indians is particularly common in western art, which often
portrays a live Indian maiden communing with a white
buffalo who appears in the sky, or a wizened chief offering
a peace pipe to the spirits. And I would say only one
very rare occasions do these characterizations accurately
reflect who we really are. So, who’s an Indian? Really? Well, it
depends on who you ask. Elizabeth Warren, for example,
claims, like many Americans, to have Cherokee ancestry, although her claim
is undocumented. Cherokee interracial
marriages were and continue to be very common
since the 1880s, when this progressive
tribe was moved from Georgia and North Carolina. For many thousands of natives
mixed-marriage descendants, accurate birth records weren’t
kept, or were destroyed, and their only source of
ancestral validation consists of family stories, which were
passed down through generations. Well, for who’s an Indian, the federal government
says an enrolled member of a federally-recognized
tribe, and it brings a question of who do we serve as an Indian. For public health,
it’s tribal members. The nation’s 567 registered
tribes occupy lands in 35 states. My own tribe, Cherokee
Nation, the second-largest in the country, has more
than 300,000 members, many of whom live in other
states around the nation. Tribal lands are 14 counties
in northeast Oklahoma, and Cherokee Nation bases its
membership on descendancy. If you can show that your
ancestors were designated by the 1898 Dawes Act or other
earlier federal census rolls, you can register a member —
to be a member of my tribe. For most other tribes,
they based their membership on blood quantum, with requirements
sometimes as high as 50%. The issue of tribal
membership can become especially contentious when, say,
a small tribe operates a highly-successful
casino, as in the case of several California
Rancherias. In those cases, tribal membership can be
worth a significant fortune. Ever since our nation
was founded, the Indian issues have been
considered a federal matter, not one regulated by states. The federal trust responsibility
exists as a mandate to provide healthcare and
other services to Indians. It was established by Congress
on the basis of treaties, statute, and case law. As Congress granted
quasi-sovereign status to tribes, authorizing them to
administer their own affairs, states and tribes have
conflicted over issues of jurisdiction and services. Former Chairman of the Senate
Committee on Indian Affairs, Daniel Inouye, commented in 1998
— I was there in Washington — that Indian legal issues
are among the most complex in all American jurisprudence. Tribes and states continue to
experience conflict over matters of law enforcement,
criminal prosecution, gaming, and Indian child welfare. States don’t provide
health services for tribes, and don’t consider
themselves accountable to the federal trust
responsibility. That FTR, the federal
trust responsibility, is critical to Indian Country’s
survival, and it’s the basis for public health
entitlement in Indian Country. But here’s a little-known
aspect. I point this as a
very important one. The Cobell Commission’s
1977 final report on trust responsibility
said, quote, “The trust obligation
extends not only to tribes as governing units, but also to their members,
wherever they may be. There is nothing in
the law which holds that the federal trust
responsibility stops at the reservation gate, nor do sound policy
considerations dictate such a result. On the contrary, consistency and fairness demand just
the opposite,” unquote. Overall, the census reports
5.2 million American Indians and Alaskan Natives. Our population, fueled by a
cohort of the youngest mothers in the nation —
average age 23 — means the overall Indian
population will triple by 2050. Need to bump one here. Native baby boomers — a cohort
which will grow by 700% by 2050, are now elders, with all the
attendant problems associated with aging. Many boomers are — in Indian
Country are reaching the ranks of the old-old. And we continue, as we
have for the past 30 years, to move off the reservation. About four out of every
five Indians is now urban. My long-time colleague and
friend, Dr. Mario Garrett, is a psychology professor at
San Diego State University. He calls this the
greatest demographic shift in American history. The reasons for this
huge out-migration from reservations are multiple,
and the effects far-reaching. The implications for
public health are enormous. Our public healthcare delivery
system, primarily administered by the Indian Health Service,
is still based on a paradigm from the 1930s, when 90% of Indian elders
lived on reservations. Today, that number is
only 20%, one out of four. The paradigm continues, however, to direct our public
health services to tribes, not to individual Indians. Indians are moving
away from reservations in remarkable numbers. We leave for many reasons, but
we can no longer be considered, understood, or served as an
exclusively rural population. We leave for our health. Most health indicators
show that Indians die of higher rates compared
to whites of TB by 600%, alcoholism 500%, motor vehicle
crashes 230%, diabetes 190%, unintentional injuries 152%,
homicide 160%, and suicide 160%. Devastating. Compared with the overall
population, Indians, to put it mildly, have poorer
health and higher poverty rates. The federal trust
responsibility, our socioeconomic and political
contract with Indian Country, is clearly failing them. A few years ago, South Dakota
Senator Byron Dorgan observed that men on the Pine Ridge
Reservation have the lowest life expectancy, 55 years, of anyone in the western hemisphere
except men from Haiti. Navajo Nation, America’s
largest tribe, is as big as North Carolina,
and has as many miles of roads. Their diabetes rates are two and a half times those
of the United States. At Tohono O’odom, an
Arizona tribe 200 miles south of Navajo Nation, type two
diabetes remain among the highest in the world. We leave the reservation
to escape poverty. On San Carlos Apache
Reservation in southern Arizona, 25% live in extreme poverty,
six times the national average. We leave to escape despair. Indian youth have the
highest suicide rate of all comparable ethnic
groups in the United States. It’s the second-leading
cause of death for Native youth aged 15 to 24. Hopelessness is rampant on many
reservations for our youth. Nearly 77% of American Indians
have a high school education, but inversely, on Navajo
Reservation, again, for example, only one in four are
high school graduates. This picture holds true on at
least nine other reservations, and probably many more. It doesn’t bode well for Indian
Country’s health literacy. We leave for careers,
but only 5% of Indians and Alaskan Natives
have received graduate or professional degrees,
compared to 10% for the total population, and only 9% of American Indians
have earned bachelor’s degrees, compared to 19% for
the U.S. population. Very few career opportunities
are available on reservations, so we migrate, which continues
to fuel this massive migration. So the effects of out-migration
on reservation elders — when their sons and
daughters leave, what happens to the reservation elders? As younger natives migrate
away from reservations, fewer family caregivers
remain to take up the slack. The CRI — some years
ago, Dr. Mario Garrett and I created a report for CDC
featuring the caregiver ratio index, or CRI. It’s a ratio of how many younger
adults there are in a community for every older adult. The figure tells us how many
younger potential caregivers exist in a community
for every older adult. The results showed
great diversity among Indian communities. Some have a CRI of
six, others of zero. Low score or low
ratings indicate that these communities don’t
have informal support systems to rely on. Whereas for many Indian
communities, more than 90% of elders are supported
by their children, especially female children, in
some communities, this resource, because of out-migration,
doesn’t exist much anymore. In the U — the U.S. Census
tells us that in the 1940s, 8% of Indians lived in cities. In 1970, it was 38%. In 2010, 78% resided in cities. Today, more than 80% of
Indian people live outside the reservation in what are
known as urban areas. This brings a real challenge
for public healthcare systems. Urban Indians are often
not able to get IHS or tribal healthcare
except back at their tribe, which may be hundreds
of miles away. Urban Indian centers have a
multi-tribal service population. The clinic in Oklahoma
City, for example, serves Indians from 114 tribes. It’s huge. Many will be low income,
often socioeconomically and educationally disadvantaged. They may have low levels
of health literacy, and may not have access to
health benefits coordinators or advocates in the cities. Leaving the rez —
well, it’s a big step. It means loss of
tribal law enforcement, the tribe’s judicial system, local healthcare,
and social services. These are not available
directed to Indians in cities. It means the loss of tribal
social and religious ceremonies, and probably most of
all, it means loss of a close-knit community
which shares common values and informal social supports. Urban Indians in
cities tend to scatter, not living in ethnically-intact
communities or neighborhoods. This makes them more
difficult to serve, and again, they usually have to return to
their tribe to get primary care. Urban Indian centers — public
health for Indians continues to operate under an
outdated paradigm that provides almost all its
services to reservations. In the new Indian
America, demographically, the paradigm is no longer valid. Indian healthcare is provided
by what we call the ITU system, meaning IHS, tribal, and urban. IHS delivers care through 26
hospitals, 59 health centers, 32 health stations
around the country. That’s a lot. Tribes in Alaskan Native
corporations run 19 hospitals, nearly 300 health centers,
80 health stations, and more than 160
Alaska village clinics. Thirty-eight Indian
clinics exist in the nation, although with limited funding, their services are
also usually limited. The Indian healthcare
budget, the root of all evil, the root of most evil
in Indian Country — the Indian Health Service has
provided Indians with healthcare since 1955, including both
primary and public healthcare, along with facility
construction and maintenance. It uses a system of providers
in 12 geographic areas. Under compacting and
contracting regulations, though, several hundred tribes,
known as 638 tribes, now operate their own
healthcare systems with money that previously was
allocated to IHS. They, too, operate under the
same enormous budget shortfalls. In 1992, I was still — I was new in my job
in Indian advocacy, and I learned there
were only three tribes in the whole country
that were taking over their own health services. They do a better job,
often, than anyone else, because they’re so
culturally-couched and culturally-appropriate. Now that number of 638
tribes is greater than 400, maybe greater than 500. It’s been an enormous shift
in the delivery system. So the IHS mission has been
impossible to achieve due to historical, chronic,
and severe underfunding. By comparison, the 2018
VHA, the Veteran’s Admin — or VA, the Veteran’s
Administration, has a medical budget of about
$86 billion, more than 14 times that of IHS, while serving a
population that’s only four times greater. Indian patients still receive
only 1/3 the per capita health spending of the general
U.S. population. This is a fundamental
reason why reservations and tribal villages continue to
suffer third-world conditions and documented poor
health outcomes. Life expectancy averages
four-and-a-half years less than that of other
Americans, and even as high as 20 years less on some
remote rural reservations. In 2010, 78% lived in cities. Historically, less than 1% of Indian Health Service funding
goes to grants and contracts for services to urban Indians. Less than 1% of the budget
for 80% of the people. Probably the first public health
initiative from Indians occurred in 1763, when Jeffrey
Amherst, commanding general of British forces during
the French and Indian War, distributed smallpox-infected
blankets to the Indians, quote, “to extirpate this
execrable race,” unquote. The resulting resilience of
Indian elders is evidenced in part by their
survival of this and other genocidal atrocities
that occurred sometimes more than 100 years later, notably
at Sand Creek, Colorado, and Wounded Knee, Montana,
where hundreds of men, women, and children were slaughtered. Today, although plagued
by health and socioeconomic disparities,
which remain huge, the wellbeing of Indian elders remains one
of the highest values expressed by the nation’s 567 tribes. They are revered
as wisdom-keepers, examples of courage,
and spiritual leaders. They have served in
the U.S. armed forces at three times the rate
of other Americans. Public health messaging works
for Indians when it is — the successful public
health initiatives that follow share
some things in common. I’m going to name
three or four of them that I think are wonderful
— wonderful examples. They all use Indian providers, both organizationally
and personally. These programs are not
only conducted by Indians on the ground, but
have been created from the outset with
Indian input. The Eagle Books were designed by
Georgia Perez, a Pueblo woman, and implemented by
CDC’s Native Program. The IHS Special Diabetes Program
for Indians began supported by the tribal leaders’
Diabetes Committee. Indian direction, Indian input. The Palliative Care Program
at Fort Defiance began with strategies of the IHS
hospitals’ palliative care team. They were all Navajo local
residents, deeply couched in their culture, and
friends with their neighbors. Let’s look at the Eagle Books. By the way, thanks to
Delight Satter, these are available at the
table during the break outside. We have sample copies for you. They have been a
spectacular success for us. It was created in — the series
of four books was created in 2006 by CDC’s Native
Diabetes Wellness Program. Targeted to children
ages four to nine, it features animal characters —
a wise eagle, a grateful rabbit, a clever trickster coyote,
and four young Native friends who promote the gifts
of healthy food, and the joy of physical
activity. More than three million of these
books have now been distributed around the world. The first year alone, requests
came in from as far away as Pakistan and Argentina. Dawn Satterfield, director of the CDC Native
Diabetes Wellness Program, just had surgery, and
can’t be with us today, but she’s arranged,
thanks to Delight’s help, for copies of the book to
be available for you guys. At the Smithsonian — in 2008, CDC convinced the
Smithsonian’s National Museum of the American Indian to host
an exhibit of 72 paintings, the book’s original artwork. After a long show at the
museum, the books were featured in a traveling exhibit. Through the Eyes of the Eagle
, illustrating healthy living for children, which
visited dozens of tribes over the next six years. Another spectacular
public health success began when Congress established
the Special Diabetes Program for Indians, the SDPI, in 1997, to address this growing
epidemic. These tribally-based programs
have become the nation’s most strategic, comprehensive,
and effective effort to combat diabetes
and its complications. SDPI currently provides grants
for more than 400 programs at tribes in 35 states. Another great example — despite
multiple researchers concluding that discussing negative
information, like end-of-life care, was
considered culturally offensive and potentially harmful by
86% of Navajo elders, in 1990, at the Fort Defiance IHS
Hospital, Dr. Tim Domer and his Native team turned that
conventional wisdom on its head. Using a new approach
based on PACE, the Medicare hospice benefit, and Eric Coleman’s
care transitions model, this team increased
patient completion of durable medical powers
of attorney from 4% to 89%, and advanced directives from
1% to 85% over nine years. Wow. Those numbers are far
above national averages. Working at this remote
reservation location with a highly traditional
service population, Domer said simply, “We
work to build trust.” To their great credit, CDC,
the Alzheimer’s Association, and other national organizations
have collaborated since 2001 to create a national
public health agenda through the Healthy
Brain Initiative for addressing Alzheimer’s
disease and related cognitive
health diseases. The agenda is expressed through
a series of roadmaps designed to define and implement a
series of collaborative goals and actionable objectives,
or action items for our public health system. The first two roadmaps covered
the periods 2000 to 2018. The next one, for 2018
through ’23, will include, for the first time, American
Indians and Alaskan Natives. Earlier this year, the Alzheimer’s Association
contracted with my team, the International Association
for Indigenous Aging, to conduct two national
consultative webinars, one for tribal health directors, one for tribal senior
program directors, to learn their thoughts about
the roadmap, and the effects of Alzheimer’s in
their communities. We learned that really no
systematic initiatives are in place to address this crisis. The HBI, for the first time, will now include Indian Country
— an Indian Country component, and it is launched through
consultation with Indians. So where does that bring us? On August 19th through
22nd, in the year 2000, more than 1000 Indian elders
from 105 tribes came together at Duluth, Minnesota for
the National Indian Council on Aging’s conference. For three days there, inspired
by messages from tribal and spiritual leaders,
the elders deliberated, then created a spiritual
message to America. I quote some excerpts
from their message. “We pray that we can respect
the diversity of America. All life is sacred. We pray to learn ways to
settle differences peacefully, teach respect for each
other’s ideas, value honesty on all levels, from
children, to parents, to community, to governments. We will be happy only when we
create peace with each other. To the seventh generation
— ” excuse me — “survive. Keep your hopes and dreams. Take care of yourself. Remember your spirit. Be there for each other. Respect courage. Share knowledge. Always keep learning. Remember your true values.” If we listen to them,
we’ll be okay as their public health partners. Thank you very much. [ Applause ]>>Okay. Yeah. Thank you, Mr. Baldridge,
for a fantastic presentation. We have a few minutes
for any questions for Mr. Baldridge at this time.>>Yes, go ahead. Sorry.>>I just wanted to thank you
so much for that perspective on Native Americans and the
journey that they’ve been on, in terms of their healthcare, and throughout the last
many years, the struggles that they’ve been up against. What would you suggest
would be next steps for us, in terms of solutions to
some of these problems and inequities in
service delivery?>>The elements that have made
our public health programs successful in the
past are just key. At the very top of the list — I’ve been told that the most
important issue for every tribe in the entire nation
is self-determination, and so often, we bring our
programs to them top-down. The program is developed, and then we’ll see how we can
implement it in Indian Country. These successful programs,
some that I’ve described, have started at the
conceptual level by including Native
people, whether it be tribes or Indian organizations,
or experts about an issue. But that involvement
from the start seems to be a fundamental key level. So I’d say develop every
program with Native — you know, Native partners
from the very start.>>Thank you.>>And thank you
for your question.>>I have a question.>>Yes, ma’am?>>Yes, I’m sorry I
was a little late, but what is the predominant
tribe — the predominant three
tribes that are concerned with the issue of — in the
conference that you attended, the issue of Alzheimer’s
disease?>>That’s a good question. What three tribes –>>The predominant three tribes.>>– are dominant
in the consideration of Alzheimer’s disease?>>Yes, and I’m sure you
covered placement, such as — Emory has rehabilitative
hospitals, and Emory has an
assisted living program. So where — what kind of placement facilities
— or does that exist?>>Very good question, too. Earlier this year,
the Administration for Community Living, the
ACL, issued $5 million worth of Alzheimer’s and
related dementia grants. Some went to states. Another category included
nonprofits/Indian tribes. Because the need is so
great in Indian Country, my organization started
identifying tribes that were deeply
involved and eligible to apply for these grants. In order to apply, you
have to be a member of an existing coalition that
is addressing Alzheimer’s and dementia locally. We searched for three months. We could not find a tribe
that is part of a coalition. We ended up talking with the
United Nation in Wisconsin. They are a tribe that’s
very capable, that are part of a small state
coalition, but essentially, Indian tribes were excluded
from the application process because we don’t have yet
coalitions in Indian Country. I am sorry. I could not name
three tribes to you that are doing effective work
with Alzheimer’s disease.>>Thank you. And the second part
of the question?>>Sorry?>>Second part of
your question –>>The second part of the
question — oh, is that — I guess that response
would be applicable also to the second part. Since there were no coalitions,
then they were not eligible to receive part of the grants
for placement for assistance. Is that correct?>>Yes. Next steps
we could take — during our consultative
webinars, we got more than 40 responses
from tribal health directors and tribal senior
program directors. They indicated that the
awareness of Alzheimer’s and dementia is high, and
Indian people are afraid of it, yet nothing programmatically
is being done to address it. We’re not getting early
diagnosis from physicians. We don’t have community programs on the ground to
help with stuff. And so, my thinking
is that we would start with inter-tribal councils. There are a dozen of
these around the country. They range from the Northwest
Portland Area Indian Health Board, which serves 42
tribes as its members, and the health directors of each of those tribes will
be part of the board. The Five Civilized
Tribes in Oklahoma, some of the nation’s largest
and most progressive tribes, only has five tribal members, but the intertribal councils
deal with the health interests of all of their member tribes. And I believe that’s
a really viable point of entry to Indian Country. I hope that helps.>>Thank you very much. Thank you.>>Thank you, Mr. Baldridge. I was wondering what kind
of advice you might have for those programs,
particularly at CDC, where most of our funding
goes directly to states. And you mentioned
that states sort of don’t see their
responsibility to the tribes. They see it being a
federal responsibility. So how do we facilitate
better relationships? Because I work in the
Division of STD Prevention, and most of our funds
go directly to states and city health departments. And so, I’m really
concerned, because we also want to make sure all populations
get the services that they need. So how do we build better
bridges, and what can we say to states to help them
better engage to working with the Native American
populations?>>If I could — if I
could answer your question, I would become the most famous
Indian you ever met [laughter]. That antipathy has existed,
as I mentioned, for a number of years, decades, and
we’re finding cases now, as America becomes more
homogenous in many senses, and Indians are far
more acculturated — I mean, our baby
boomers ride Harleys. The partnerships are springing
up between progressive tribes and progressive states. There are other states — I could name four
or five easily — where the states have not
supported tribal interests at all, and that
antipathy still remains. But I think there are
examples in many places now of emerging new partnerships
between tribes and states. The need is so great, yet the
states are strapped for money, just like the federal
government in many cases, and they can’t afford to
target a special population that they don’t have a
mandate to serve specially. So a difficult one, but
I think it’s doable. Yes, ma’am?>>Thank you, Mr. Baldridge,
excellent presentation. You pulled together a lot of
really, I think, important facts for us to think about as an
agency as we’re moving forward with our programmatic work. So my question is
building on the question that was asked a minute ago
about placement of individual who have Alzheimer’s
or related dementia when they need assisted living,
or skilled nursing care — so in other words, long-term
services and supports. You mentioned the
caregiving ratio, and how we’re seeing
people leave reservations, and families — younger —
and we see this in, you know, some cities across all
different racial ethnic groups, that the kids are moving out
and leaving mom and dad there. And so, I guess my question
is, what is the picture of caregiving and support? So are there assisted
living facilities? Where do American Indians
and Alaskan Natives go when they don’t have
family or other people to help provide care for them? So what happens? If you could, tell us a
little bit about that, please.>>That informal care system
has been profound for, you know, centuries almost,
and so we’re — I’m seeing a lot of elders who
are caregiving for other elders. So if there’s an
out-migration of kids, we’ve got to work
with who’s left. I think some tribes are having
success with localized programs. They have, for example,
volunteer groups who meet to discuss Alzheimer’s,
and what they can do as caregivers about it. And they’re — those
programs originate locally, in the communities,
and they’re not funded. I mean — and they’re sparse. Excuse me for a second. There is a lot of denial
— as you mentioned, there is across the
U.S., probably, about the embarrassment of having a grandma
with Alzheimer’s. Families really value their
privacy, and in small, isolated communities,
that’s a really valued and difficult commodity. So it’s a family matter
is a common response, as we turn away from it. It’s just a normal part of
aging, as we turn away from it. But we’re just at a
point in Indian Country of recognizing our
denial for one thing, that it really is not normal,
and that it is a problem — behavioral health diseases. And so, we have so far to
go, and certainly, I guess, from my perspective, we
really need direction and participation with CDC. That’s the best I
can do for you. Sorry. Anyone else with any
comments or questions? Well, thanks. I really treasure my history
with CDC, and being able to work on some of these
projects, like with Lisa and with the Eagle
Books over the years. So please, just keep the faith, and remember those Indian
elders’ message, you know. Stay strong, hold
strongly to your beliefs, and they will lead us all to
the heart of Indian Country. Thank you very much. [ Applause ]>>To introduce Dr.
Reuben Warren, who will be moderating our
panel session this morning. Dr. Warren?>>This is a very,
very special session, because it’s really
targeted to those who need to learn something. So I suspect that means
everybody in here. And what we really
want to do is — — have a conversation. Thriving and aging
with dignity — and the planning committee
worked very hard to try to figure out what
we were supposed to learn from this session. So we sat, and we had
discussions and debates about the objectives
of the panel. What is it that we
are trying to achieve? We talked about objectives,
and so I’m going to read them to you, so you can see
if we accomplish them at the end of our conversation. To identify biases
that comprise — that compromise healthy aging. And I’m saying those so you
can reflect on your own biases. I mentioned it this morning. Students where I teach
have a bias about me, so I say without
apology, “I’m 73.” And they’re shocked, so their
biases become very obvious. And what it says — what I
take from that is that — what are you supposed — what
are you doing here, old man? That’s the bias that
I see in their face. Explore community understanding
about the difference between being viewed
as elderly, and elder, and an emerging elder,
Dr. Georges. We wrestle with that
in our panel, in our planning committee. I got offended. We started talking
about elderly, and all the conversation was
about dying, and suffering. And I said, “No.” So let’s shift the paradigm. Let’s think differently,
if you can, and I’m sure when you finish listening
to our elders, you will. Examining ethical considerations
that should have — that should drive public
health efforts related to achieving healthy aging. What should public health do? And most of the folks in
public health are not elders, so I would argue that
they ought to listen. And that’s part of what we
brought the elders here for us to do, learn how to listen. And to assure social justice in
the experience of healthy aging. Social justice, in my
view, is public health 101. So that’s what we intend to
do with this group of elders, and so what I — I’m not going to ask them questions
for them to answer. I’m going to read the questions, and let them respond
to the questions. But before I do that, I
want to take one moment and let them introduce
themselves, because I wouldn’t — I
couldn’t be so insulting to say I know who you are. So let them tell
you who they are. So why don’t we start
with my immediate right, and just let one of our
elders say who you are, your background, and
where you’re from, and anything else
you want to say? And we have a mic.>>Yes, my name is Elias Segada. [assumed spelling]. I was born in Puerto Rico,
USA, and I am 88 years old. [ Applause ] Thank you. And it’s funny — I
have three cancers. They have been treated at Emory, and the main one that’s
giving me now, like, more trouble is a bone cancer. And I’m getting chemotherapy
for that, but I’m doing okay. I live in Duluth, and
I am — I’m retired. I look at what you were saying
— I mean, every day, I mean, I look at — I live day
by day, and I feel happy. I feel happy. I — when I’m going to
sleep at night, sometimes, I get a little — and then
I think of what I’m going to do the other day, what I’m
going to have for breakfast. I have to prepare it
myself, because I live alone. But I feel happy. I watch my TV, and my computer. I mean, I love my computer. Because of my computer, I read
papers from all over the world. I read newspapers, and then I — if I cannot see the letters
well, I put them bigger, and I am — I could say
I’m living a happy life.>>Fantastic. Okay.>>And that’s what I’m doing. [ Applause ]>>Ms. Cruz?>>Yes, my name is Nadine
Irene Istanislau-Cruz [assumed spelling]. I’m an immigrant
from the Philippines. This year, my mother,
who is alive, turned 97, and I turned 70. And our newest grandchild
was born, and he’s three weeks
old [laughter]. So this is a good year. I don’t like credentials
for myself. I think of myself primarily
as a person who’s searching for different ways of looking
at things that are in front of our faces, like growing old,
and being at that stage in life where I think more
closely or more seriously with intentionality about how to
die well as part of living well. And as part of being healthy. So I’ve worked mostly in
higher education over 30 years in what is called
public service education, so I’ve taught service learning,
civic education, public service, scholarship at various
institutions in the United States, and I
have also run a consortium of 18 colleges. So I’ve been connected with
education for a long time, but I’m also a very, very
deep critic of the very thing that I’m associated with. So my typical way
is to be a critic of the conventional way
of looking at things. So I will be speaking out
about how I feel uncomfortable with how elderly and elder
is defined, at least as far as I can — as far as
I hear it around me. Thanks. [ Applause ]>>My name’s Chester Antone. I’m from Arizona,
southwestern Arizona, a member of the Tohono
O’odham Nation. Our nation borders on Mexico, and we have been primarily
involved with healthcare as a politician, I
guess you might say, but I don’t lie [laughter]. But yeah, I was in denial for
quite a long time until CDC and Tuskegee told
me I was elder — elderly, so here
I am [laughter]. So, yeah, it’s — we run into
a lot of the issues nationally with the Native American
population elderly, and we talk about it. We try to figure out ways of — how to serve, because
in our way, and most Indian communities,
the elderly are special. They’re honored,
but as you’ll see, some of the conversation may
turn into a gradual erosion of what we used to be. But I’m here, so I’ll
be participating. [ Applause ]>>You too.>>It’s your turn to talk now.>>Okay. Good morning.>>Good morning.>>My friends –>>Yes.>>– and I say you are my
friends, because you’re here. My name — I’m going to
give you a long name. My name is Mamie Viola
Henry Watkins-Clemmons And it took me a
bit over 100 years to get here, to be
here with you. [ Applause ] Thank you. Thank you very much. I guess you would like to
know a little something about my background, which
I don’t have long enough to tell you about it [laughter]. But I was born in
Evergreen, Alabama, and when you think
you’re in Evergreen, go a little further
out to China — China, Alabama. And I was told by several
they don’t know how we got to be there, because it
was back in the woods. I was fortunate to be
born of two parents that were both schoolteachers,
and to be able to go to school to your relatives — it
takes a bit [laughter]. But I’m thankful to be here,
to tell you a little something about it — my education,
if you call it that. Able to walk to school while
others rode buses to school, but we were able to
be taught of things that would concern
you later on in life. Meaning that there’s no stopping
place if you really want to be somebody, so to speak. So I’m very grateful
this morning to be here to tell you a little about
life, education a bit. Being taught by my parents,
then being taught by my brother, who moved from the country
all the way to Tuskegee, and after Tuskegee, many,
many other places — but I’m thankful —
grateful to be here now. Sound a bit repetitious,
but that means that’s so I’ll be able to let
you know, and you may want to ask questions after that. But able to go to
school, to walk to school. After being — finishing
12th grade, and moving to Alabama State
Teachers’ College at that time, being able to teach on a
provisional certificate, meaning that the
community wanted you. I walked two miles
to a two-room school, where two teachers taught,
and kept warm by a stove that wood was cut to make fire for the children
in order to study. Moving from there, being at
Alabama State University now, to Tuskegee, and you’ve
heard a lot about Tuskegee. You will be hearing
about Tuskegee. Then, receiving a BS degree from
the University of Pittsburgh. Now, I’m able to tell you
a little about the school, and the teachers that came from
that two-teacher school room. We could point them. Yeah.>>We going to get to
that later [laughter]. I’ve been knowing Ms.
Clemmons for a long time, and she taught me
— she’s Aunt Mamie. So I’m — just wanted to let
you know, that’s Aunt Mamie. Let me ask — that was the
answer to the first question, so I didn’t have to ask. Tell them something
about yourselves. What I’d like to know
now from the panel is, what has most impacted
your life? We’re going to start
at the other end. What has most impacted
your life?>>I’m trying to think. I’ve already done
so many things, but I believe my mother had such
an important part in my life, mainly making me and my personality
as a positive person. I’m an eternal optimist, and
what — the way she taught at –>>Speak a little louder.>>– can I — yeah. Can you hear me now?>>Yes.>>Yeah. Sounds like
an American [laughter]. Anyway, can you hear me now? [ Laughter ] Thank you for telling me. I was born in — as I
told you, in Puerto Rico at such a long time ago,
and it was so, so different. We were poor, and it was
different at that time. I know someone here asked a lady
that she has 101, but I have 88, and it was so different. But that was what most
impacted me, was my mother.>>All right. Next?>>What has most impacted me? I’m going to say it
straight-up, because it’s part of what I would like to share. There’s a lot of
stigma attached to it — is that when I was three or
four years old, somebody came into our house, pointed
a gun at my father, and gunned him down
and killed him. My mother, during World War II,
saw her fiancee shot and killed by an American soldier who thought they were
the Japanese enemy, because all Asians look alike. Those killings are part of — I think of inter-generational
racial — historical racial trauma,
and a lot of what I have — most of my 70 years has been
focused on the particularities of my individual family. And it has taken me a
very, very long time to see my family’s health in the
larger context of large swathes of history and social systems. And so, that’s what I
hope to be able to share, is what I have struggled to
figure out about my own life in the context of the
larger historical drama, to figure out how to be a
healthy, thriving older person.>>What has impacted me
the most in education? My mother, who really didn’t
know too much made sure that I sat at the table and
did my homework every night under the — there
was a kerosene lamp. For her to do that made
me pursue education at different times in my
life, and eventually make it out of the University
of Arizona, and that’s the first
in our family. But the other thing that I think
had more of an impact on me, as far as how I view life, right
now, as being something given to you by the Creator,
that you should honor it — I came to that realization
by having to have lived through many dark moments. I’m an alcoholic
for maybe over — been sober now for
over 20 years. But — [ Applause ] — but that experience has
taught me the value of life now, and I just want to be a part
of it now, and be happy, and do what I can
for the people.>>The most important thing
— the one most important –>>The one most important thing in my life has been the prayer
life of my parents, and the idea that was put into my
head was that you can — there’s no height that you
cannot reach if you are willing to pay the price all the way. So I’ve been impacted by
people, dealing with people, knowing people, and being
a part of their lives. That has impacted my life, to
want to be a loving person, and be loved by those. [ Applause ]>>This question is a
little sensitive one. Give me an example of
something that’s been a bias or a prejudice to you —
something or some event, bias or a prejudice to you. Yes, sir.>>I — I studied
in the University of Miami Coral Gables long ago. And at that time, I remember
there was still segregation, which when I came,
was so strange to me. Because we didn’t have
that in Puerto Rico, but I felt segregated — what
struck me — once, it was a — like a chauffeur of a bus. And I handed him some money,
and he made some comments. I don’t even recall it
now, but I felt myself — he made some comments as to
— because he heard my accent, as to derogative [inaudible], and I probably couldn’t
understand part of it. But a friend of mine
that was with me — he was from Cuba,
and he heard it. He knew a lot more
English than I did at that time, so
he answered him. And, I mean, that’s an occasion
I can remember when I felt like — like, prejudiced
because of my –>>Thank you.>>– you’re welcome.>>There are so many [laughter]
that I — throw out a few. So I used to have
hair below my waist. I chopped it all off because
I could never, it seemed, establish a sense of my
authority with the long hair. And so I chopped it off because
nobody believed I was actually the teacher in the class. So where’s the teacher? Well, I’m the teacher. Oh, you don’t look
like the teacher. That was one of many. Another would be, like, oh,
why are you so emotional? Followed with, why are you
so analytical [laughter]? And so, either I was
overly-analytical, or overly-emotional, and then
the last one — example — there are just so many, but I’ll
just throw out these three — is — so I was invited
to give a presentation on United States-Philippines
relations. And at that time, it was
during the dictatorship of Ferdinand Marcos,
and I was working on a social justice movement
on human rights violations under the dictatorship
of Marcos. And then, I included why the
United States was implicated in giving military aid to a
dictatorship for the containment of communism in southeast Asia. And the response at the end of my presentation was not
curiosity about anything. It was, “Well, why don’t
you just go back, then, to the Philippines, if you
don’t like it here so much?” So, a few examples.>>My experience has been that a
corporation in our native lives from things outside coming
in has been most difficult. And I don’t want to say anything about something that’s true
nationally among tribes, but in my particular tribe, it seems that a corporation
has kind of led us to become like the federal government. And the same thing that oppressed us,
we seem to oppress. We learned it. If you look at our
system of government, ours is a three-branch
government, but all that bureaucracy
is the same. But we still argue with
the federal government about their bureaucracy,
which we inherited, and that has kind of, like, a
negative effect on how we feel about Indian for our elders. Because that’s what I said
earlier, that we’re seeming to lose that which we
had for our elders. We have an adult
protection ordinance. Why? To illustrate that how far
we’ve come to get to that point where we actually
need an ordinance. And long ago, we didn’t — we didn’t need an ordinance
because it was just natural. You took care of your
elders like you go on a hunt and you were able to get lucky
to bag a deer your first time. Take over to the elders. You don’t get nothing out of it. Then after that, you always
have to give some to the elders. So it’s — it changed from
that due to the time period. And I guess that’s
what I wanted to — how to answer that question.>>The great part of my
life has been to be happy. To be happy and to make
those around me happy. And whatever I could do to
see happiness even in the face of a child, if the child
looked worried at school, I’d like to make him happy. And I’ve always thought of this. If you are happy, can’t anyone
make you mad [laughter]? If you can make me
angry, then you’re smarter than I am [laughter]
because I believe that no way should we walk around sad even though
things may not go according to the way even others
around you they may go of what you have seen or
what you have learned. But you become that type of
person that you can climb as high as the good
Lord would let you go. That’s what I think.>>I asked Aunt Maime to give
me an example of something bad or some prejudice,
she wouldn’t do it. She translated happy
no matter what I say. I said it about five times. It all came out happy. [laughter]. It all came on happy. The last question before
we open it up for you to ask them questions is
what advice would you give our audience? What advice would you
give our audience?>>I would give you advice
that to live this life, to live is just a miracle. And enjoy your life
and do the thing that makes you happiest
as much as you can. And enjoy doing that,
doing what you really feel passionate about. For a long time, I tried to do
what others thought I should do and it didn’t work for me. So I mean, that’s the advice. I mean, follow your —
follow your vocation, whatever you feel like. Like doing that makes you happy.>>What did you mean by
the — what kind of advice?>>Any kind that
you want to give.>>Oh.>>It’s yours [laughter].>>For me, I guess the
advice is what I’ve — I’d like to share as an advice,
what I’ve been trying to do which is to develop some
metaphors or pictures or visuals or vision of what it
means to become elder and in the latter
stages of the life cycle. And I don’t know what
it might be for you. It has helped me through a
lifetime of chronic depression which I think is a very
stigmatized illness. In my community of
Filipino-Americans, they will cite obesity,
hypertension, and diabetes and won’t say anything about the
high suicide rates of females, of Filipina-Americans. So some of my visuals
are two and I’d like to share that as an advice. One is that one metaphor
I think of for myself to make me feel happy
as a useful person is as an old-growth tree. When you think about
in the Redwood Forest, the old-growth tree with all the
roots interacting underneath the soil, all we need to do
as an old-growth tree is to stand tall and standing. Because then the new
growth and the seedlings and all that they can come. And we develop a big forest. And to a great extent, it
sounds like a passive thing but it’s a very active thing
and it is centuries’ old. And so there is an
inherent integral value to being an old-growth tree. And if I’m a kind of human — the metaphor of an old-growth
tree, it is important for me to stay standing. And so that gives me incentive to overcome a lifetime
illness of depression. The other visual that
I use and I share it as an advice is the
metaphor that transition. So I transition from
firefighting which is like active, heroic,
risk-taking, at the barricades, physically fit, able
to do lots of things, and feel useful that way. But I’m no longer firefighting
in the sense that I don’t have that part of my life anymore. But I can be weaving. And weaving is integral to
the value of all communities. Weaving is invisible. It’s not heroic,
not seen as heroic. It’s seen as feminine. It’s everyday but all
communities cannot survive without the constant weaving
of the fabric of humanity and community and without the
constant mending of that fabric. And I can do that even when I
can no longer be physically fit, as long as I can interact with
people, I can still have value as a weaver of society. [ Applause ]>>Advice, I think that we
— that when it comes time –>>What advice would you give?>>– to go wherever one would
go when it all ends, is to have, is to make your life,
your characteristics, your [inaudible] and
traditions, you know, you leave that into memories
of people that you’ve known in the hopes that you really
[inaudible] your life well, will have not — it
would have some value. Your life had a value. And hopefully, it will
pass on to the people that remember you
the way they do because you have these
good things about you. I think that will be the advice
I would give to live your life like that, to leave
a good memory. [ Applause ]>>I learned early in life
that prayer moves mountains. And I wanted to know,
“Well, what is real prayer?” So I brought to my
knowledge from the Holy Spirit that I could pray in
seven W’s and just about cover what God
would have me be and do. The seven W’s of prayer,
I will give them to you. You might want to
write them down. [ Laughter ] Number one, I pray that
God’s Will will be done. W number one. That I really don’t
know everything about me but there is some higher power
somewhere that knows about me. What I need, what
I can do at all. So W number one, I pray
God’s Will be done. Number two, I pray that
it be done in His Way. You know, when I
started out to school, I didn’t know exactly
what I wanted to be or even what I could be. But I remember that a higher
power knows all about it. So I want His Will to
be done in His Way. We may not learn all that
we want to know quickly. But we might have to
bypass some things in order to get to the best things. I pray that His Will
be done in His Way, the way He wants to do it. I may not know. I may not understand. So I pray that His Will,
His Way and then His Word. We studied the Word. Everyone knows something
about the Word bible. So if it’s according to His
Word, I know it’s all right. His Will, His Way, His Word and
then all I have to do is watch. Watch and pray. And while I’m watching, while
I’m watching, I have to wait. When I was teaching
all of provisional and there were two ways
school, I did not know that I could be 100
and one and be here and give you some knowledge
of what I have gone through. So His Way and then I
have to learn to wait. Wait till the proper time. I may not be able to
do what I want to do but there is a time element. His Way, His Will, His
Word, and then wait. And while you’re waiting, don’t
forget while you are waiting, there must be some
work done [laughter]. There’s something
you have to do. There’s something
you have to know. So that’s His Will, His Way,
His Word, then wait, watch. Watch and then wait
then continue to work because the Word says, “I
must work the works of Him that sent me while it is day. Night cometh, no man can work.” So we don’t just sit and
wait like we’re waiting on the street car
or a bus [laughter]. But there must be
some work done. So then we work the works of
Him that sent us while it’s day. Night cometh, no man can work. And after we have let His
Will be done, in His Way, through His Word, while we just
watch and pray then we wait. We wait on the Lord. But we don’t wait empty handed. We wait while we are working. We continue to work. You know, I thought about that
work part and I learned to work because I — when I would see
this elderly gentleman plowing and you may not even know
what the word plow [laughter]. But he was plowing a mule in
order to raise vegetables. I would have him sit
down under the shade tree and wait while I go
around a row or two and do what he did
with the plow. And I was only an upper teenager at that time but
I wanted to help. And while I was waiting and I saw an elderly person
drawing water out of a well, turning a [inaudible]
to get water. And I stopped to
help them draw water. And then with the drawing
and the waving, I had to wait until the cows that we milked. I had to wait until they
grazed in the wood and come. And I had to draw water
to give the animals water. And I thought to myself, “It looked like they never
would stop drinking water.” They were thirsty. So with that, and I repeat those
seven times, the seven W’s — God’s Will, His Way, do His
Word while we watch and pray and then we wait on the Lord and
while we’re waiting, we work. And after we have done
that, you can feel like worshipping [laughter]. You feel like worshipping because you’ve done
something that helped with it. So I am very thankful to have
been able to see how to work and make vegetables grow so
that we could eat properly and your health could be good. You’d be strong and mighty. [ Applause ]>>And I suspect you have
some burning questions. Why don’t you ask the elders
the questions you might have?>>Good morning. I’m Debra Joseph. First of all, I want
to say I am so proud of each and every one of you. I’m so thankful that you
showed up this morning to share your knowledge
and wisdom with us. And I’m extremely blessed
to hear what you have to say because you guys truly
spoke from your heart. [ Applause ] And my question to whoever
wants to take it is, “How do we make sure that
your voice is heard?” Today, everything is driven
by technology and I hear from my mom all the time, she don’t even understand
what the computer is so let alone turn it on or done. I was impressed when you said
you read all the different newspapers on the computer because I can’t get my
mom to even turn it on. But how do we ensure
that your voice is heard? Not only as we try to carry out
this thing called public health but to ensure that your
messages keep going on from one generation
to the next.>>I’d like to jump in and
suggest that maybe we shift from thinking mostly
about the individual voice of minority elders to organized
associations and groups. For example, in the
Filipino-American community, one of the assets even though
people keep saying all these risk factors, all
these deficiencies, I keep thinking why don’t
we think about the pluses. And the pluses are people
congregate around food, music, events that are
intergenerational. And so hearing the elder
minority’s voice, I suspect, will be more sustainably heard
if the unit of focus is a group like the family or association. The joke goes, if there are
10 Filipino-American families in a town, there
are 30 associations that are Filipino-Americans
[laughter]. They like to be in groups. There are groups for dancing. There are groups for
meeting over food. There is groups over
baptisms and weddings. People are always
gathering. I think that particular minority
voice will be very well heard if we focus on the groups
and not one by one by one through a survey or
the usual methods.>>I’m glad that technology is
so if you can push that button you’ll have a mic. So I won’t have to run around,>>I can’t move it.>>Yes, my name is [Inaudible]. And I first want to say, I’m
going to ask you this question as an older son who
is now dealing with an 88-year-old father
and an 82-year-old mother. A father who just came
from beating colon cancer and is trying to
rehabilitate and the siblings and I are trying to step in
there and help without hurting or making my parents feel
like we’re taking over or somehow not trying
to take away from them still being
the parents. My question to you is this. What are the things
that we should avoid that might hurt them
or make them feel that they don’t have value
to us as mom and dad anymore or that we’re trying
to take over?>>I think that [inaudible]
— trying to — I mean, just listen to them. Be as much as — spend as
much time as you can with them and that’ll be any — just
listen to what they say. Whatever, you can
just tell them. I want to know about these
and they can give you. There is so much, for example,
I can give to my two daughters. So much. They have their lives. They married late because
they have circumstances. They have to work and study. But one of them is a doctor in
medicine in a psychiatry center. And she has a — and she
has only one daughter. When she — well, she has
a lot of things that take. The other one is a veterinary
doctor and she is only — the only — she owns
a clinic and she is — she has two daughters. They are like — I
feel sometimes like I, myself, I’m irrelevant. But you were implying that. There is nothing I can — I cannot order or give
them to — to mind. I just, when I read,
I print a lot. And what I do is I just give
them the prints because I know that if I tell them to
go and go to a place in the web, they may not do it. But if I give them a printout,
they may read or read it, if they find it interesting. I’m making it sure to make them
feel that they have something to give that the
experience they have, hurried life is worth a lot. You see, really,
it is. And just, just listen. Just listen.>>Thank you.>>Just a few words, I think
the main thing would be to communicate. Talking about things, really
you get what your elder wants. And just for an example,
through our [inaudible] my mom wasn’t sick. She always found a way
for a time to tell us when she calls what
she wanted us to do. Tell us [inaudible] her control. We just listened and do
what she expected us to do. So I think talking
with your loved ones at that level is
the best thing to do because it also helps
the family. There is no infighting
over anything. It’s just done the
way it should be.>>One thought I have
and I struggle with that. My mom is 97 and has
felt like we’re taking over because she needs so much
assistance and help is I found that I need to actually
deliberately develop a “curriculum,” so that I don’t — when I visit, start immediately
with, “We need to do this and we need to do that. And there’s this appointment. There’s this reservation. And what have you decided
about this and that?” So instead, I start with,
“You know, here’s a photo of the grave site of our
father, your first husband. And we’re trying to figure out,
you know, who’s he related to?” So I come with set-up questions
where it’s valuable to me but it’s clear she’s the
one that has the source. So that every single interaction
is a mutuality of needs that I need this for
the ancestry of my kids, your great-grandchildren and I’m
going to start there instead of, “We need to do this,
this, this, this, this. And why haven’t you
done that, that, that?” You know, and so there’s
a practicality to it but always softened, I guess,
by a mutuality of needs that isn’t quantifiable.>>Thank you.>>Okay, as speaking of what
you learned along the way, in learning to meet
people where they are, not trying to make them
what you want them to be or what you think should be. But in order to meet
them where they are and receiving their attention. As I sit here, and as I look,
I think I’ve seen every face in here because my mind has gone
in that direction in dealing with students, in dealing with
auditoriums full of people. I can look and tell the
ones that are bored. [ Laughter ] I can learn and tell there
are some I have looked at you already that you
have made my life better because you have looked
like you were interested. Whether you’re not, I’m not. [ Laughter ] So as I looked, as I looked,
I can pick out a few people. I can point out some right now. I could pick out a young
man that has listened to every word I’ve said
and he has listened. And then, I’ve seen
others that said, “Well, they may — they didn’t stop.” [ Laughter ] Yeah, when are they
going to quit? When they will quit [laughter]? They said the same thing over
and over again [laughter]. I’ve heard that before. I’ve heard other people
say the same thing. And now, here they come with
the same old story [laughter]. Bring me something new. I appreciate you on this. [ Laughter ] I like your questions.>>Yes, one more.>>I’ve been — to this one?>>Oh.>>There’s a question
out here for you. Thank you.>>I’d like to know
like when sometimes, I try to remind my mom and
she’s like 89 years old. And I have to remind her
all the time, you know, to take her medication
at a certain time. And she tells me, she said,
“Oh I can’t go down there. They don’t [inaudible]
up when the expense of it and everything.” So my question is, “How do you
feel about the prescriptions or the way your doctors
take care of you as far as the insurance companies or
your medications and stuff? Do you feel like you’re
adequately taken care of as a senior citizen? I mean, do you think the
doctors or the pharmacists or — are they just as attentive to
you enough to make you feel like that they’re
taking care of you, doing the best they
can to help you? Do you any of you feel like they’re neglecting
you in some facet? Or do you think the
government is shortchanging you in some facet?”>>I would like to clarify what
the questions are that you have.>>Well, how do you feel
about the way your doctors that you go see for treatment? How do you feel about the
way they take care of you? Or whether or not they’re — your insurance companies that
give you, you know, care, that helps you out,
pay for your medicine and do you think your doctors
give you enough adequate care, you know, from the
insurance that you have?>>I feel like, I feel like
maybe I’m expecting too much. But sometimes, when I go
in to see my physician and I think we get as a
system, Kaiser Permanente in California is
excellent system. I feel the absence of an
understanding of aging.>>Amen.>>Because I go and I say I
have these aches and pains or whatever, and I can’t tell
if that would have been the case for a 20-year-old, a
30-year-old, a 40-year-old, an 18-year-old or
it’s part of aging. And when I ask, “Is this
part of aging as opposed to, I don’t know, some other, is it
a symptom of some other thing?” The reason why it matters to me
is because I feel like if I know that it’s part of aging then my
expectation for my acceptance of it is different than
if, oh, this is a sign of some big trouble
that we really need to correct at age 30, 36, or 40. Whereas if this pain is going
to be with me for the rest of my life, I need to begin to
have a transition within myself that this body is going
to be aching like this for the next 20-some
years if my mother’s age of 97 is an indication of
how much longer I’m going to live then I need to
expect to live like this for the next 25, 30 years. And often, the physicians
don’t know the difference between a symptom of at this
stage in life as opposed to some other stage in life. And there, I feel that
there is a deficiency, even in excellent
medical systems that don’t have any
gerontology background.>>That’s right.>>Right. [ Applause ]>>I, myself, I feel — you
know, I have so many things that are wrong with my body
mainly because my mind is okay but there are so
many [laughter]. That said, I have
so many doctors. I tell you. [ Laughter ] My– Really,
I mean my social life — [ Laughter ] — is with doctors. [ Laughter ] I myself– But you know, my father
was a doctor, a physician. And he used to say that if you
would allow the patient to talk, he will bring you the — I’m
lack of words, the diagnostics, the diagnostics on
a silver plate. Just listen to the patient. And sometimes, I mean, the way
the system is, some doctors, they are — they
just want to leave. They don’t [laughter], they
don’t want you to explain. And then that, together
with the fact that I am, in lack of words, due
to my lack of whatever and my brain is not working the
same as when I was 30 years old. And they either have,
I used what I said, general rule I made up. I feel that I am getting a
very good medical care here in Emory. I had in this Oncology
Department, I am getting — what service? Okay.>>I found out this. We need doctors but I found
out a doctor can only do for you what you have
already kind of explained to them what’s happening
[laughter]. And we can remember
in going to doctors, doctors are not mind readers. I’ll say that again. Doctors are not mind readers. I didn’t get anything from it. [ Laughter ] Maybe you think doctors
are mind– Maybe you think doctors
are mind readers. They should read your mind and know what you are
doing and not doing. But they can really only
go by what you tell them, really to a certain extent. And you don’t tell it all,
they can’t work well at all.>>That’s right.>>So we need doctors. That’s all I can say.>>Amen.>>Why don’t we have a kind
of closing comment from each of our scholars at
this, on the stage because we have to move on? So any closing remarks that
you might wish to have, sir? Any closing remarks?>>As to myself personally,
I would stress the importance of your mind, of your attitude. It’s so important. I mean, I go to — for example,
to Emory and oncology and I just like everybody there. I love the nurses. I love the doctors. I mean, it is — God
really is love, I believe. And I feel myself oh, good, when
I’m in contact with persons. And I — that makes me feel
good to just — just that. I mean, be appreciative of —
that they are doing for you and that they are human beings. And that they may have days when they are not really,
I mean, too likeable. But I’ve got, when I have
nothing to give, I give a smile. I smile. I smile
and I love people and that makes me feel happy. And that’s so important
that they think — the mind, it’s so important. Even though I got like I
told you, so many doctors. Specialist in that,
specialist in that other and then I have an agenda. Today, I have to go —
sometimes, I have to go to one in the morning and
one in the afternoon. And I keep my medicines– Oh, I have these timekeepers
because I have, in the morning, I have to take a medicine, wait half-an-hour
and take another one. Wait 15 minutes and
take about 20 of them. [ Laughter ] I tell you. I have sometimes
difficulty swallowing it but I have found
a way [laughter]. I do swallow them. And I’m doing fine. I don’t like, I don’t
want to die. No, no, no. No, no, no. I love life.>>You got it together. [ Applause ]>>Well, since the title
of this is Minority Elders and Healthy Aging, I
can’t help but think about how my individual struggle
for health has got to be in the context of
so many minorities across the decades have suffered as people’s histories
of oppression. And I can’t help but think
that my individual struggle to be happy can’t happen without
an understanding of how that is in the context of my
peoples having been oppressed and having suffered
intergenerational historical racial trauma. And that seeps into life in ways
that because we’re in the water of it, becomes so every day
and ordinary that it becomes like part of the
accepted by nature almost. So when I think even of
my mother, who as a widow with two kids, became
a professional. She adopted all the ways of
modern European-based medicine and abandoned all the various
Filipino indigenous native practices that now we are
scientifically studying and saying, “Oh, these are
really good things to do, these herbal medicines,
these et cetera. Now, we have scientific
validation of it.” But that was part of
her colonial mentality. So she adapted into the
imperialist paradigm [laughter], abandoned what was ordinary
and every day and accessible without expensive
prescription medication. And so I feel like part of the
challenge with minority elders and healthy aging, I think, is
first for somebody to do the R and D work, the intel — the labor to somehow put
everything together and make it into an integrated whole. So that what was abandoned
because oppressive, imperial, colonial, heavy erasure
of what was known to people becomes integrated
with modern medicine? And that somehow, I have a
feeling, if we can do that, that would be part
of the healthy aging of minority communities. [ Applause ]>>My closing remarks, pretty much at the same
lines of my colleague here. But there’s a thing
called the — that we came up with and it’s
called the cultural wisdom declaration wherein we
declare that we know that our traditional
practices work. We’re also asking
federal agencies, any agency that has
the resources that they need to work with us. CDC is a good example of
at least one, Good Health and Wellness in Indian Country. That happened over a
series of three meetings with traditional healers,
development of their language, finalized it, made a
part of that [inaudible]. I think that’s where we need
to go now, to include us. Include us rather than
do something for us. You need to do it with us. [ Applause ]>>I know you probably would
like to hear maybe something that you think maybe would keep
you healthy, wealthy, and wise. You would like to
get a certain age or you wonder maybe how
a person got that age. One thing, be happy. Make others happy around you. Do what you can do for yourself. Only depend on others
for what you cannot do. I can still cook good food,
clean food, healthy food. I can still do it
because you keep doing. Don’t stop doing
what you can do. Don’t stop doing what
you think you can do because sometimes your
thoughts will carry you astray. Continue to do what you can do.>>Yes.>>I’ll say it again. I’d like to repeat it again. Do all that you think
you can do even that you think you cannot do. Make a try. Try for yourself. When I broke my leg, as
I’m in these chairs now, broke my leg in three places. It was healed. Oh-oh, I won’t say that.>>Go and say it.>>It was healed. I won’t say without a doctor,
but they didn’t have to cut it. They didn’t have to do that. But I look to the higher
power, God, that has done all that for me, because I made the
promise to myself and to others that all that I can do
— if I’m preaching, I can preach from a wheelchair. Nothing is wrong with my mouth. I may not hear as well,
but they made hearing aids. Sometimes they don’t work well. I don’t see as well at times. Got my glasses. I mean. I will be
looking terrible if I didn’t have my
dentist to make some teeth to make me look a little better. So my hearing, my
seeing, my talking — I’m still adhering
to what I’m saying. I know what I’m saying. I know where I am. Those are big things that we
can do for ourself to continue to live and live long. I said that I was going
to keep preaching if I had to preach from a wheelchair. And you know what happened. [ Laughter ] I said they made
all these things. I started out with one cane. I walked with one cane. They told me about
the doubled cane that you walk with
and take steps. I tried that, too. I got one of those. So I said the next day
if you can move better if you get the one
with the wheels on it. I got the one with
the wheels on it. They said, you can
push your own self. And I learned to go to
the bathroom by myself which was very healthy. Here I am today, all
the way from Pittsburgh, Pennsylvania, and we had to. The doctor even got a hitch so
I could bring my standby with me so that I could look
good, feel good, travel a little faster,
you know. It even has speed on it. I was told by one of the
officers when we came in the gate out there, he
said the speed limit is — you can’t do it. [ Laughter ] I had been told, I had
been told, I had been told that I sometime could speed. So I’ve been watching
the speedometer, I’ve been watching the
speedometer to be sure that I’m not speeding
on these grounds around. So you can take this. You can be happy. You can be happy. I was even happy at a funeral. Had the people laughing
at the funeral, so — and I said that I would
keep talking as long as I could remember to
keep my news right up here and not say too much, if I
could listen a little more and speed a little less,
then I could move on. And you come to the next stop. So I just say again that
this is a wonderful world. Keep living in it. Keep helping others
to live better. Keep helping others to
feel good about themselves because if you don’t
feel good about yourself, nobody else is going to do it.>>Yes.>>So we do it, and
I appreciate that. I still cook. I still can cook. I still can wash clothes. I still can be clean. I can still wash my body and still smell good
when you are coming. [ Laughter and Applause ]>>Let’s stand up and thank her. Let’s stand up. [ Applause ]>>One thing I say to you, and I got that from
William Cullen Bryant, William Cullen Bryant’s
“Thanatopsis.” I try to remember
something from school. The last verse of
“Thanatopsis” says, “So live, that when thy summons comes to
join that innumerable caravan, which moves to that
mysterious realm, where each shall take his
chamber in the silent halls of death, thou go not like
a quarry-slave to his grave, soothed and sustained
by an unfaltering trust, approach thy grave like one who
wraps the drapery of his couch about him, and lies down
to pleasant dreams.” [ Laughter and Applause ]>>Couldn’t get any
better than that. Could not get any
better than that. [ Applause ]>>Thank you. I am very pleased and
excited to be able to introduce the CDC
Director, Dr. Robert Redfield, who has been with us
for not a long time. He arrived in March
of this year. Dr. Redfield is the 18th
Director of the Centers for Disease Control and
Prevention and Administrator of the Agency for Toxic
Substances and Disease Registry. He has been a public health
leader, actively engaged in clinical research
and clinical care of chronic human
viral infections and infectious diseases,
especially HIV, for more than 30 years. He served as the Founding
Director of the Department of Retroviral Research within the U.S. Military’s HIV
Research Program and retired after 20 years of service in
the U.S. Army Medical Corps. Following his military
experience, he co-founded the University
of Maryland’s Institute of Human Virology with
Dr. William Blattner and Dr. Robert C. Gallo,
and served as the Chief of Infectious Diseases
and Vice Chair of Medicine at the University of
Maryland School of Medicine. Dr. Redfield made several
important early contributions to the scientific understanding of HIV including the
demonstration of the importance of heterosexual transmission,
the development of the Walter Reed Staging
System for HIV Infection, and the demonstration of
active HIV replication in all stages of HIV infection. In addition to his
research work, Dr. Redfield oversaw an
extensive clinical program providing HIV care and treatment
to more than 5000 patients in the Baltimore-Washington,
D.C. community. He served as a member of the
President’s Advisory Council on HIV and AIDS from 2005 to
2009, and was appointed as Chair of the International
Subcommittee from 2006 to 2009. He is a past member
of the Office of AIDS Research
Advisory Council at the National Institutes
of Health, the Fogarty International
Center Advisory Board at the National Institutes
of Health, and the Advisory Anti-Infective
Agent Committee of the Food and Drug Administration. Please join me in
welcoming Dr. Redfield. [ Applause ]>>Thank you very much. Thank you very much for
the kind introduction. I also want to thank
the co-sponsors, the Tuskegee University’s
National Center for Bioethics in Health, and the
CDC’s Division of Sexually Transmitted
Diseases, and our Office of Minority Health
and Health Equity. I also want to recognize the
30th anniversary of the Office of Minority Health that works
to advance health equities. And I want to thank all of you
for coming to be part of this because some day, and sooner,
because of the efforts of people like you, a health equity
will become a reality. Life expectancy has come a long
way in the last half-a-century and we need to do a lot to
improve the lives of people over 65 for all Americans. If you reflect back in 1900,
the average life expectancy for all races was
about 47.3 years. By 1970 it had jumped to
70.8 years, probably one of the greatest achievements
in public health and the advances in
the 20th century. Leading causes of death have
changed just a light slightly. In 1950, the top five causes
of death were heart disease, malignant neoplasms,
vascular lesions that affected the central
nervous system, accidents, particularly motor vehicle
and all other accidents, and early infant
mortality and disease. In 2016, you remain number
one, heart disease, number two, the same, malignant neoplasms, number three now was
unintentional injuries and accidents, and then
number four was chronic lower respiratory diseases,
and then number five, cerebral vascular events. So very minor changes,
obviously, with infant mortality being one that obviously got off the
list and, unfortunately, pulmonary disease coming
back into being one of the major causes
of mortality. But recently life
expectancies plateaued. If you look at since 2001, there’s been an additional
year gained in life expectancy. But between 2010 and 2016, really it’s not really
moved at all — 78.7 years. The National Council of — and Institutes of Medicine
report their study. Looked at some of the gaps,
particularly in the people over the age of 50,
and they highlighted that since 1980 Americans
have the lowest probability, the lowest probability of
surviving to age 50 compared to all other high-income
countries. Older Americans reach 50 now — it’s hard for me to say that
50’s older, but I guess it is. I guess, you know, I’m kind of
holding on to be 70 as older, but older Americans,
which they said — those of us who reach 50 now
reach it in poorer health and face greater mortality
from chronic diseases. And this is driven by
a number of factors. Obviously we sill have
a significant infant mortality rate. We have significant
mortality related to drugs. We have significant mortality
related to diabetes and obesity. We have higher — they say we
have the highest, actually, for — of diabetes and
obesity among other countries. We have higher rates
of heart disease. We have higher rates
of injury and violence. And we have more adolescent
pregnancies and STD’s. And we have a high
prevalence of HIV infection. There’s not any one common
thread that will explain. And obviously Americans with healthy behaviors still
have higher rates of disease. There are a number of social
determinants of health that play important roles. Obviously a very important
recognition, the important of social determinants
of health as predictors of health later on in life. Americans’ access to healthcare
and behaviors greatly influenced by social factors
and the environment. Obviously lifestyle, health
policies, and social values. All of these can influence
what one’s health status is, particularly as one crosses
the threshold of 50 and beyond. But there are some good
news for older Americans. Higher survival actually for
those of us that live past 75. There’s really higher rates of
cancer screening and survival in those of us that
are over the age of 75. There’s better blood pressure
control and cholesterol control which obviously is
important as you saw that heart disease
remains the number one, and there’s lower
rates of smoking. But life expectancy still
varies between populations. Life expectancy today in the
United States for Caucasians about 79 years, for African
Americans it’s 75.5 years, for Hispanics it’s
actual 81.8 years. And so there are differences
in different ethnic groups. It’s important for us at
CDC that we don’t just study and describe, but that we
actually put science into action and we try to explore the gaps of healthcare among
diverse older populations with different social
determinants and different inequities so
that we can begin to put science in action to improve
a health outcome. Some of the important
determinants of the diverse population over
65 from 2016 really looked at health-related
quality of life. We looked at fair or poor health
conditions among different populations and including
African American, American Indian and
Native populations. Clearly there’s healthcare
access issues that have been evaluated. There’s obviously the
importance of staying engaged in regular medical care,
particularly as you get older, and there are a number of
areas where individuals end up missing those appointments
because of financial concerns. Obviously there’s health
behavior issues, particularly that we need to be
concerned about smoking and the use of alcohol. Different ethnic groups have
greater challenges here, obviously in some of the
Native American populations. I was kind of surprised to see
in our recent MMWR that looked at smoking in different
populations across the country by different age groups. Actually it turned out
that the Native American and American Indian population
had their highest rates which may not have
surprised people in this room, but what surprised me — they had the highest
rate across the board — the highest rate for
cigarettes, the highest rates for juuling, which
is a, you know, a — highest rates for the
alternative tobacco uses. So clearly a lot to do. And, again, this
led to other issues. They also had the least amount
of exercise that were engaged in their daily lifestyle
which may have some impact on the complexities that we have
with weight status and obesity. But there are some good news,
is we begin to look at some of the health inequities across
in disparities and actually between 1999 and 2015, there’s
actually been a narrowing, at least of the life expectancy
gap, okay [phone ringing]. That was the WHO, okay? So we’ll just put them
on hold for a second. We’ve got a little bit
of an outbreak going on in the DRC right now, but
we’ll get right back to them. Should have turned my phone off. But I will say there has
been a narrowing, you know, of two years in the
last 15 years between the life expectancy
in African Americans and Caucasians, which is, again,
progress in the right direction. And really what has driven that
is a decrease in heart disease. Can I give that to you and you
figure what to do with that? Decrease in heart disease,
cancer, and death rates. But, again, we need to
be vigilant in trying to continue to improve that. We need to understand
the unique challenges that face different
portions of our population across the country and begin
to confront the determinants that will affect
life expectancies. For example, you know,
across the board. I think we’re going to see in every population there’s
unique health challenges. Obviously I look forward to
talking to you about that. I’d like to sort of end with — to finally just ask you to
do one thing for me which is to recognize that you
should never underestimate the possible. And to realize that some day,
and those of you who know me in my past life, you will know
the biggest thing my wife used to tell me that — I
happen to be Catholic — she told me that the Bishops or the Cardinals were
probably going to kick me out because I would argue
with them that they need to spend their energy
really focused on one of the greatest injustices
that exist in the world, and that’s health inequity. So never underestimate
the possible because I do believe some day
health equity will become a reality and we need to
continue to recognize that that’s what’s required. Thank you very much. [ Applause ] They say I have a
couple of minutes to — if there’s any questions
or anything, I do have about a couple
more minutes if anybody who have questions, feel free. If not, I hope you have
— well, okay, go ahead.>>Sir, I have a question. I’m Frentress Truxson with the Diversity Inclusion
Management Team here at CDC. And I would like to ask
you, from your travelling’s and discussions with some
of the leaders of the world and of the state, can you tell
us what you see right now is the biggest obstacle to us
achieving health equity for all?>>Well, I think that’s
an important question. I think first what I would
say is what frequently is the biggest obstacle for us achieving any great
thing is what I asked you to do, which is never underestimate
the possible. I do believe, when I talk about
health equity, and I’ve done it for much of my career, many
people think that I’m talking about something that’s
no in the real world. So, first and foremost, we have to realize it’s in
the real world. Those of you who know me
know that I’m a man of faith. I don’t consider
that a disadvantage. I don’t think God intended
us to have health inequity. I think health inequity
is a consequence of man’s choice, right? So it’s time for us to
first see it’s possible. It’s also important
for us to see that it’s not what
was supposed to be. And since it’s a
consequence of man’s choice, man’s choice could go
on a path to correct it. So I think, really,
that’s the biggest thing. The second biggest
thing, truthfully, I think comes back
to the individual. Health inequity is more
driven by individual choice than I think some
people want to recognize. You know, when my friend Dave
Thatcher was Surgeon General he did a large report on
health inequity as many of your probably know it
and read, because many of us believed at
that time that the key to health inequity
was health access. And Surgeon General
Thatcher’s report actually came to the conclusion
it wasn’t access. So, again, I’m going to come
back to our social determinants of health that have
an impact on health. And the reality is,
if you had told me as a scientist even 10 years ago
that things that happened to me when I was young — my
father died when I was five. Life was pretty tough
at the beginning — that that somehow had an impact
on my health when I was 65 or 67, which I am now, I would
have told you there’s no way that had any impact
on my health. The reality is that science
is showing that early events in life actually have
major impact on health. So one of the more important — I was just arguing that
I’d like to bring a death to what we call the
fifth vital sign because I do think it
helped set the stage for the opioid pandemic
that we have today, that we overreacted
to pain control. The real fifth vital sign we
need is the social determinants of health so that we get
people to start to focus on what are the social
determinants — what the air filter
situation is, what the food security
situation is. You know, these are the
things that are going to be really important. So I think to me those
are the two things that I would say you’ve got
to understand it’s possible and it’s what was intended, and it was our choice
that it’s not there. And then I would say to
really underscore the personal responsibility to begin the
path for each individual to move towards life’s choices that gives them a greater
shot at health equity. Any other question? Yeah?>>Okay, I’m going to try this. My question has to do with in
— when you say health equity, and based on what
you were saying, does that include
medical training of — and my contention is especially
for gerontology and stuff like that, is that the training
of those persons in the medical and health professions tend to
temper how this thing works. So does health equity
also include education of those persons coming
through the system that are providing services
in the health fields?>>Again, a very good question, and obviously my
response would be yes. Again it goes back to whether
people, the health system has to understand, the doctors
and the whole system, has to understand that health
equity is the goal line, you know. There is a tendency I
think sometimes to believe that certain health
conditions in certain portion of the population
are not moveable. Obviously I think the experience
that most physicians get in the training of geriatrics
is highly inadequate. So I would agree
that health equity — in order to get to
health equity we have to have a highly educated
medical enterprise that understands
that the goal line. I mean, obviously,
to get health equity in different age
group populations, in particularly the
elderly in geriatrics, we have to get a health
system of individuals that are trained in that. One of my proudest moments as a
physician, and I cared for prior to getting deeply
engaged in urban AIDs, so I cared for a number
of elderly individuals, and I was so proud when I
finally got them almost, you know, off all their meds. Some people come to like
on 40 medicines, you know, from like 32 different
doctors which they continue to refill even though they
hadn’t seen those doctors. And to try to go through and
say, do you need this medicine. Well, here’s three
medicines, ma’am. They’re actually kind
of the same medicine. Okay. And to really get
them down to maybe they’re on two medicines or one
medicine or even no medicines, a lot of times you got to
get a guarantee if you look at an elderly patient
population, a lot of times they’re
on lots of medicines. And you really need to train
gerontologists and physicians that can go through and take
the time to understand exactly. I will tell you there’s
never been clinical studies that show the impact of the
combinations of most medicines that most elderly are on. If you take the average elderly
individual and they’re on 10 or 12 different medicine — there’s never been a study
to show what those 10 or 12 medicines actually
do when they’re in the same person
at the same time. So I take great pride in the answer is not
necessarily a new prescription. But I would tell you there’s a
lot of healthcare professionals who have not been trained
in geriatric medicine. So what you do and continue to
do I think is very important. It’s part of the solution. It’s probably much
more important than what I said immediately
because it’s more immediate. You’re going to make
a greater impact by training gerontologists
and general internists and general medicine and
family doctors in how to think about the principles of practicing medicine
for the elderly. And the answer is not
just more medicine.>>Well that means that their
understanding and acceptance of holistic living —
eating well, exercising, to if not complement then
maybe remove some of the pills and some of the medications
for a longer healthcare life.>>Well, I think you
raise an important point. And, again, I think
unfortunately a lot of people, again, by different
age groups that are in the medical profession,
do have a tendency to think that the easiest answer
is another prescription. I will say when I became CDC
Director I was 235 pounds, okay? Let me just take a look. [ Laughter and Applause ] Now that wasn’t because I came
up with some great epiphany. But those of you who know me,
I have a wonderful woman, Joy, I’ve been married to for 45
years — 43 years, and she said, you’re the CDC Director. You cannot go down there
and stay at 235 pounds. You know, how can
you set an example? So I will say today
I’m 214, okay. Hopefully, if you come back in six months I’ll
be [applause] 200. And that’s all based on
really three principles. Eating properly, and actually
my wife is pretty much a fanatic on that. She thinks we should have at
least a 12-hour fast every day, so you’ve got to
figure out when you eat. And actually there’s
a lot of truth to it. You can lose weight and
will eat everything you do if you just don’t eat
for 12 hours a day — like from 7:00 at night
to 7:00 in the morning. You do need to exercise. That exercise doesn’t
have to be strenuous. You can just walk, you know,
20 miles a week, you now, or a couple of —
three miles a day. And more importantly that a
lot of people don’t realize, you really do need to sleep. And if you can do those things, you can start creating
a healthy lifestyle. I would say that most
people in medical training that are younger than the age of 50 probably don’t understand
how important those three elements are. And they need to
have that reinforced.>>I was wondering,
as a physician and patient empowerment
I think is — patient empowerment is
extremely important. And I had written
this book we made into a movie called Doc
Hollywood and I came across a lot of doctors who I
was able to interview for a book on symptoms that are
life threatening. So people know when to
go to the emergency room. And we got the rights of
that back from Random House, and now it’s a free app. And we’d just like
people to know that if you have a headache,
fever, and can’t put your chin in your chest, then you don’t
take an aspirin and go to bed. And we’re trying to figure
out how to we get the word out that that’s there. It’s been published in a
lot of other languages. And the other question
I had real quickly is, I’ve been involved in
medical research a lot, but we’re working with
some George Tech students on connecting people who
live longer with a disease and see what they
do in common, it might not be a patented drug. It could be something
they’re eating. And how could we get
more groups to consider that type of research where –>>Well, your second question is
easier for me in the sense that, you know, getting big data on population health I
think is really important. And continuing to stay,
if you will, data-driven, open-minded about what it
is that is associated in — with better health
and better survival. You know if any of you have
followed that one, one, you know, one decade
coffee is bad, the next decade’s coffee is
good, one decade coffee’s bad. You know, one decade drinking
a glass of red wine is good. Two glasses of red wine is good. No alcohol is bad. Next year, alcohol is bad. I think the only thing that
we’ve agreed on in medicine since we finally
recognized the obvious with my friend Everett Koop, who
I have great admiration for him because when we started
with cigarettes, it was the cigarettes
weren’t the problem. You just needed low-tar
cigarettes. You’ll be all right. And then it was, well, no — it’s filtered cigarettes
was first. And then maybe it
wasn’t the filter. Maybe you needed low-tar
filter cigarettes. And then Everett
Koop finally came out and said, you know what? You don’t need cigarettes. It’s smoking that’s the problem. So I do think population-based
studies that can have the robustness
like the Framingham Study to help people look at. And they need to
include parameters that may be they instinctually
don’t think should be concluded. I’m going to come back to
that idea of just getting six to eight hours of sleep a night. I think people underestimate
how valuable that is. And obviously how valuable it
is to walk three miles a day. You know, I don’t think
that’s been quantitated in a meaningful way . Your second question is I do —
you know, I think it’s important to get the proper health
information to people so that they can make their
own proper informed health decisions, you know? We were just talking
about that yesterday. We were having an exercise. If you’ve seen a lot of
people around here — there’s a lot of people
around here, about 400, because we’re doing an exercise
right now on a flu pandemic. So we’re — it’s sort
of a mock situation for the last three days
that we started with day 35 into a major flu epidemic
to a new strain of flu which was causing a pandemic and significant mortality
and morbidity. And, of course, I asked
a similar question when we had our guidance
to the American public — and, again, this is a
mock guidance, right, because we’re just
going through it. But the guidance was if
you’re sick, stay home, because we don’t want
people with flu coming to the emergency room. But I said, but we need to put
a little more guidance in there because how about if you’re
really sick and you’re not going into respiratory failure? We don’t want the
person to think, well, CDC said we should just
stay home, you know? We don’t want you coming in with
average flue, but we also know when your respiratory rate
gets up over 22 to 25, we want you to come
to the hospital. So same type of thing. Because they way I would
have read the message — the CDC told me to
stay home, right? And then, you know. So I think you’re
right on how you get that proper messaging,
the different things. There’s obviously a number of
people you can connect here. One of the important roles
CDC has is in communication, in division vehicles
that we communicate with the American public
and the healthcare teams. They constantly get people to
understand what our position is on how to improve health or
how to minimize health risk, so I’d encourage you while
you’re here to interact and get in line for some of the people
that do that for a living. That’s okay. Two more questions
and we’ll finish up.>>Thank you very much. My name is Sonia Hutchins,
and I am a professor at Morehouse School of
Medicine in the Department of Community Health and
Preventive Medicine. I’m a recent retiree of the
U.S. Public Health Service and spent 31 years at CDC. And I was just curious to
know what your thoughts are about whether you had
an opportunity to look at the Health Disparities
Dubcommittee recommendations to the Director. It’s the Advisory
Committee to the Director, and whether you had time to
look at their recommendations. And the reason why I bring
that up is because they look at success stories across the
agency to see what we were able to do to overcome some health
inequities by allocation of resources based on need. And the good example of that
is the child vaccination story. And so I was wondering if you
had an opportunity to look at the recommendations from the
Health Disparities Subcommittee of the Advisory Committee
to the Director. And what your thoughts, if
you had a chance to look at those recommendations,
what were your thoughts about that for the Agency?>>First, thanks
for your service. Second, I haven’t read those
— that document, but I will. I think there’s somebody in
here that’s taking care of me. We’ll make sure I
get that document so I can look through it. It’s hard to put things into
action if you don’t do them. I remember one of the jokes that
I helped my brother and I did as a cartoon in the 1980s was
a picture of President Reagan and he was saying his horoscope. He was reading his horoscope. And his horoscope said, your
legacy will be determined by your response to
the AIDS epidemic. And then the President’s — you know, the cartoons that
my brother drew says, he says, hey, Nancy, what’s AIDS? And then right behind
the President was about five Congressional reports
that we collected on AIDS, like the first AIDS
Commission, the thing — they’re all stacked
behind his desk. So it was sort of
a the same comment, that if you have reports
and you don’t read them, and you don’t put
them in action, then what’s the purpose
of these reports? So I’ll take a look
at it and see if there’s other ideas
that we can look at. There clearly are
actionable items that can make a difference. I have learned in my career,
thought, the biggest obstacle — this is why I keep saying
it over and over again, and some people think
I say it too much — is the biggest obstacle
is people don’t think it’s possible. And most people don’t spend time on something they’ve already
decided it’s not possible. So the first thing
you’ve got to get people to understand is all
things are possible. Okay? And I will say that when
John Kennedy said he was going to put a man on the moon, 1962,
right, I don’t think a lot of people thought
that was possible. But when Neil Armstrong walked
on the moon in 1969, he did it. And I would say we didn’t
have the scientific solution. Those of you who know me know
one of my aspirational goals is to eliminate disease when we
have the capacity to do it. And so, first and foremost, is to eliminate the AIDS
epidemic in America. We have the tools to do it. But most people don’t
believe it’s possible. So it’s hard to get a
commitment to do something that most people
don’t possibly — those of you who know
me know I worked closely with President Bush
on the PEPFAR Program where we brought AIDS
therapy to Africa. I was one of the first to
treat people in Africa along with Paul Foreman in Haiti, and most people thought
it was impossible. But when President Bush sent his
team to see what we were doing in Malawi and they saw what
Paul Foreman was doing in Haiti, they found that, wait a
minute, it is possible. So then the question is,
do you want to do it? And then the next question
if you want to do it, then how much is it
going to cost to do? And then once you know how
much it’s going to cost, then how are we going to do it? And I think the AIDS Program
in Africa was a great example of President Bush seeing the
possible, leading the nation to John Kennedy man-on-the-moon,
seeing the possible. Leading a national to act. So I would argue health
equity seeing the possible. Unfortunately, and this is where
I look for other organizations to get engaged in this battle, unfortunately health
equity’s probably going to be a longer battle
than my lifetime. But you’ve got to get institutions
committed to the possible. And whether that’s
government institutions, faith-based institutions,
the ones that somehow seem to stay focused for
the longer road, sometimes they’re
faith-based institutions. That’s why I think they’d
kind of see, you know, being the social conscience
to get health equity as the possible independent
of their denominations. I think that would really
be a great effort, you know, because I do think it’s hard
for other organizations, whether it’s a medical school, whether it’s a health
organization, to really stay on point as you’re
trying to do it. But we as healthcare
professionals can go after incremental steps, you
know, proving health equity and a decrease in
health disparity. And I think what I said in
my talk is we should be proud of the fact that we’ve
made some progress, right? We’ve still got a
long way to go, but we’ve made some progress. But it’s still true that your
life expectancy is more dictated by what zip code you were
born in in the United States than probably anything else. And that’s a problem. Was there one last question? And that’s it. Right there. Alright, we’ll do two — if
it’s quick — is it quick?>>Basically.>>How you doing. I’m Kevin Williams. I’m an Assistant Professor of Healthcare Leadership
at Mercy University. And I’m also,
[inaudible] MPH Class at Morehouse School
of Medicine. And I’m sitting in this room
largely because I was exposed to the five sciences of public
health through Morehouse School of Medicine, and also
through a program, Regional Research Center
for Minority Health working with the Office of
Minority Health under Dr. Warren’s leadership and Dr. Karen Bouye. And I just wanted to see what is
your administration’s commitment to training other workforce,
the future workforce of public health practitioners, particularly minority
public health practitioners, to look at these morbidities
and mortalities from being — from the community actually
[inaudible] the science and being able to
practice public health?>>We just had a meeting
this morning with some of my colleagues at
CDC, and I was going through the five key
core capabilities that need to be built. The third one on that list
was, of course, was workforce. And we went through some
of the great programs that were implemented at CDC
— the EIS Program, right? Then we looked at the next one which was the Public
Health Associates Program which is a great one. The Laboratory Leadership
Program. And I said, my challenge
to them was, okay, what’s the next great program
because we clearly need to keep building
public health capacity. What’s the greatest gap that we
need to try to fill right now with a historical
program that will — EIS Program’s historical. Tom Freedman, one
of my predecessors, did the Public Health
Associates Program. It’s really making an
impact across the country where we have people in
all the health departments around the United States. He told me when, when he — he gave me advice
and I took the job. He said, the one thing
he asked me to do was to treasure that program. I’ve gotten to know it. It’s a great program, the
Laboratory Leadership Program. So I would tell you that the
Workforce Development is key. If any of you have great ideas where you think the
greatest gap could be filled as we develop the next
historical program to continue to enhance the public health
workforce of this country, we’re very open to it. I’m committed to try to
understand what that is. You can’t try to build
seven different programs at the same time and think
that they’re actually going to ever make an impact. So I am trying to understand
during my, who knows, tour of duty, you know. It’s one of the realities. It’s not fun that I left
a lifetime tenured job that I could have until I
was hopefully 100 years old. And you’re here and
you don’t really know. But I do want to make sure
that we make an impact on workforce that, like
Tom, lasts beyond me. I haven’t decided is that,
you know, where that gap is, but I know that it’s
an important gap. Last question and
then I got to run.>>Thank you. My name is Dr. Yep
and I’m Associate Dean of Academic Affairs at the Claremont Colleges
[inaudible] Colleges. I’m gifted with teaching
Community Health, Health Inequities in California, working alongside
immigrant refugee elders. And I appreciate your
opening about an invitation for a paradigm shift
which is what is possible. And my grandma lived until
she was 102, and when she was in hospice care, the
social worker asked her, what did you fear? And she said, that
people will lose hope. And I think in many ways what
you offered is to not lose hope. So what do you think is the
biggest social determinant? We talked about social
determinant of health, but what do you think are social
determinants of paradigm shifts, because you’re inviting
us to do a paradigm shift.>>You know, that’s a — obviously a very
good question, again. And, you know, I
have to be honest, I’m not sure I know
the answer right now. I think it is — you
know, I gave a talk. I have two children
that are doctors. I gave a talk when they
got their white coats. My son got his white coat. The Dean decided to
let me give the talk. He didn’t know what
he was getting into. And I tried to decide,
what do I tell, you know, all these 200 medical
students, you know? And so I decided to, you
know, to keep telling next to parenthood, I felt that medicine was the greatest
vocation one could have, and of course, you know,
my son was in the audience. And then I went through a
series of like four points. One was, you know, continue
the daily commitment to self-education. And I went through how, when
I was in medical school, there was not sonograms,
CAT scans, there was no AIDS, you know. This is a profession
that you’ve got to stay. The second was to never deny
your patients the opportunity of the advice of one
of your colleagues. And I would just
never give an answer when the answer is I don’t know. That’s how I treated the story because I gave you the
answer I don’t know. Okay. And don’t deny
your patients the benefit of one of your colleagues. And please don’t teach somebody
something that you just have to teach because you don’t want
to say you don’t know, so you — now you taught somebody
something wrong. The third, which caused the
Dean to fall out of his chair — not literally, but I did
see him definitely posture and tighten up. I said, and the next thing
you need to do is you need to learn to love our patients. And everyone said, what? And I went to the story
how my first son died and how the doctors were
really brutal to my wife and I. And how a number of my
patients had taught me that they were no
longer just my patients. They’re no longer my friends. They’re actually
people I really loved. And then the final thing I
told them is keep a journal about your enthusiasm of
medicine as you’re going through it because one day
you’re going to need to open up that journal and remember
how enthusiastic you were. So I don’t know the
answer to your question. It’s an important question. I think part of the theme of my
answer is you’ve got to care. And I don’t think we teach
that well, ironically, in a profession that
is all about caring. All right? So maybe you’ll come up
with a better way to do it. Thank you all. [ Applause ]>>Thank you again,
Dr. Redfield. Thank you.

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