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It’s a real pleasure to be here and have the honor of talking to such a distinguished group, talking about education as a key to a healthy America. One of the things that we all know is our country is not nearly as healthy as we’d like it to be. In fact, in many ways it’s dysfunctional.
In order to have a healthy America, we have to have a healthy population and healthy communities. Our population must be healthy, educated, motivated, and have hope for the future. We can’t educate people, our children who are not healthy, and we certainly can’t keep ignorant people healthy.
We must start early to make a difference. We’ll have to make sure we don’t wait too late before we start with our health education. We start with our children. The reason we start with our children is, first of all, they need it. Secondly, they have the greatest opportunity to improve. And last but not least, it will last forever. When you’re educating children, it lasts forever.
We have too many children off and graduating from our schools without having health education with shoes that light up when they walk and a brain that goes dead when they talk. So, we have to make sure that we treat all children, give them all an opportunity to get educated.
Today, we’re going to talk about some of the things that make a difference and that really make children healthy, and some of the major determinants of our health for a healthy America.
For the major determinants of health, the first we have to talk about those social and behavioral factors that influence our health. In fact, that’s 50% of the cause of premature death. We’re talking about things like drugs, drinking, not exercising as much as we should, eating too much (like me). We’re talking about environments that we need to change. In fact, inside of our housing is some of the worst environments as far as our health is concerned.
We always talk about our genetics, and certainly our genetics influence our health but probably many of these other factors influence our health more than Uncle John.
Most of our effort has been spent on access to care. We spend 88% of our health care dollars on doctoring, on access. We spend less than 4% on social and behavioral determinants that take away 50% of the problem.
What are some of the factors affecting our health? We know that poverty is a great determinant of our health. It has a direct effect. It affects where we live, where we work, what we do. It often keeps us from getting an education. If you’re not educated, you’re ignorant, and if you’re ignorant, you don’t even know how to be healthy.
It affects our housing. It affects our food. I always talk about children who are poor belong to only one club in their life. I call it the 5-H Club – the 5-H Club for children who are helpless, they’re hungry, they’re homeless, hugless, and hopeless.
We talk about lack of education. We have to educate our people to be healthy. If you have a chronic disease, which takes care of 75% of our health care problems, you have to educate people how to take care of their chronic disease. If someone has diabetes, if you cannot educate that individual how to take care of their diabetes, they will not be able to take care of their diabetes. They have to be concerned about their diet, about their nutrition. Some of the children have to be concerned about their insulin. So, we have to think about all of those things if we are going to be healthy.
Of course, we talk about risk behaviors. How you live your life more critically for longevity is more critical to your longevity than genetics. Tobacco kills more people every year than anything else. We have 443,000 people die every year as a result of tobacco smoking.
What about alcohol and other drugs? What about car crashes – young people drinking and driving. And, of course, obesity. In 1950, only 5% of our children were obese. Now, 19% of adolescents are overweight or obese.
The other thing we need to talk about is access to health care. When we talk about access to health care, we think, “Oh, well, it’s just the doctor.” It’s not just the doctor. When you talk about access, you have to think about provider access. You have to think about financial access – who’s going to pay. Down in Arkansas, we have to think about transportation access. Many of our people have Medicare or Medicaid. They have the insurance but they don’t have the transportation to get there. It’s a lot easier to train bus drivers than it is to train doctors.
The other thing that we need to worry about is cultural access. We have a country of 310 million people. Twenty-eight million were not born here. We have the most diverse country in the world, but we have to make sure that we learn to live with our diversity.
Let’s talk about some of the truths regarding our health care in America. We do not have the best health. I’ve already mentioned that. We have a shorter life span. The life expectancy rate for Japan women is 85; for our women, it’s 79.9. We’re not healthier. We rank on the World Health Organization – a scale of goodness – 57 out of 190 nations.
Our infant mortality rate for black infants is dead last. For the nation, we’re even behind countries like Mexico for our infant mortality rate. Our white infant mortality rate is about 6 or 7.
We lack access to health care for 52 million of our people. We all know we have a lot of disparities and isms that we live with: our racism, our sexism, our classism, and our genderism. These are issues that we must be able to address.
Sixty-seven percent of Americans are overweight. To calculate a body mass index, it’s the weight in pounds over the height in inches squared times 703. The normal BMI is from 18.5 to 24.5. Twenty-seven percent of our people have high blood pressure and they still eat lots of salt, do not drink as much water, and do not do the things they know they need to do.
Smoking is on the decline. We’ve gone from 55% of men smoking in 1957 down to 21.6%. We have far more women smoking nowadays than we did in 1955, and more lung cancer in women.
We are a health illiterate. I’ve already mentioned people cannot learn if they’re not healthy, and they cannot stay healthy if they’re not educated. We have to teach our children in schools, on TVs, whatever means we have. We have to present science-based answers rather than many ubiquitous myths. We have to protect our people by arming them with good, factual information.
As I mentioned, our present health care system is not a health care system. It’s a very expensive sick care system. We must transform that system into a health care system, and that’s the role of the leaders in health care. We can’t talk about sex in our society. We all do it, but we can’t talk about it. Sex and reproductive health problems account for 18% of the total global burden of disease the world over. Thirty-two percent of the burden among women of reproductive age. And yet, we never talk about it. We don’t educate our young people about it.
If you can’t control your reproduction, you can’t control your life. Women spend more than half their life trying not to get pregnant. We thought we went into this just say no. But there are 64 million reasons why just say no is not enough. That’s how many women there are of childbearing age from 14 to 44.
The average woman wants about 1.7 children, and we’ve got to make sure that more of our children are planned, wanted children. Sixty percent of the children born in America are unplanned. Thirty-nine percent are born to unmarried women. Thirteen percent are born to teenagers.
We’ve got to educate. The best contraceptive in the world is a good education. So, we’ve got to make sure.
The 8 tests we need to do and be aware of that can save our life are height, weight and BMI, blood pressure, mammograms, PAP or PSA, our lipid profile, hemoglobin A1C. We know that diabetes is increasing very rapidly. Many times diabetes is not picked up because you can’t fast long enough to get your blood sugar down when you go to the doctor. The CDC is recommending that anyone coming into a health care facility now have an HIV test. We used to say if they’re high risk, but we don’t know who’s at risk. We have ECHO, and we have to get a colonoscopy. Now they’re saying if we’re over 75, we don’t have to do that anymore, thank goodness.
Let’s talk about 7 characteristics of healthy people. Eat breakfast. Many of us get up and feel we don’t have time to eat breakfast. This was a 10-year study that was done. In fact, it went on for 21 years and they call it the Alameda study. Your federal government spent millions of dollars on this study, and this is what they found.
- Eat breakfast.
- Have a high-fiber, low saturated fat diet with 3 meals and 3 snacks.
- We need to consume a low-salt diet. We used to say 10 grams, then we went to 5, and now we’re at 2 ½ and I think we’re at 1 ½ now.
- We need to exercise 20 to 30 minutes every day.
- Sleep 7 to 8 hours every day. Our young people feel that they can sleep 20 to 30 hours on the weekend and sleep 2 hours during the week.
- Drink only in moderation: 1 drink for women and 2 for men. Men get the advantage again.
- Have responsible sexual behaviors. Make sure if we or our children choose to be sexually active, always use a latex condom if you’re having sex with someone that you don’t know they’re sexual history. If you ask, I can guarantee you they aren’t going to tell you.
So what’s our vision for a healthy America and for the United States?
- First of all, we’ve got to educate, educate, educate, and we’ve got to start early.
- We must aim for a society of healthy individuals and healthy communities.
- Design and develop a health care system that is patient-responsive, prevention-focused and affordable for all.
- A health care system that empowers individuals, fosters individual responsibility, human dignity, improved health status, and enhance the quality of life.
- We must make sure we transform our present sick care system into a health care system transform it into things we want. We, as the new transformational leaders of the 21st century, can do that, and we must begin on our journey if we want a healthy America.
