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So my freshman year of college

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I signed up for an internship in the housing unit

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at Greater Boston Legal Services.

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Showed up the first day

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ready to make coffee and photocopies,

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but was paired with this righteous, deeply inspired attorney

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named Jeff Purcell,

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who thrust me onto the front lines

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from the very first day.

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And over the course of nine months

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I had the chance

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to have dozens of conversations

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with low-income families in Boston

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who would come in presenting with housing issues,

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but always had an underlying health issue.

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So I had a client who came in,

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about to be evicted because he hasn't paid his rent.

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But he hasn't paid his rent, of course,

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because he's paying for his HIV medication

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and just can't afford both.

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We had moms who would come in,

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daughter has asthma,

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wakes up covered in cockroaches every morning.

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And one of our litigation strategies

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was actually to send me into the home of these clients

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with these large glass bottles.

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And I would collect the cockroaches,

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hot glue-gun them to this poster board

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that we'd bring to court for our cases.

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And we always won

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because the judges were just so grossed out.

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Far more effective, I have to say,

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than anything I later learned in law school.

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But over the course of these nine months,

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I grew frustrated with feeling

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like we were intervening too far downstream

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in the lives of our clients --

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that by the time they came to us,

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they were already in crisis.

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And at the end of my freshman year of college,

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I read an article about the work

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that Dr. Barry Zuckerman was doing

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as Chair of Pediatrics

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at Boston Medical Center.

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And his first hire was a legal services attorney

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to represent the patients.

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So I called Barry,

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and with his blessing, in October 1995

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walked into the waiting room

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of the pediatrics clinic at Boston Medical Center.

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I'll never forget,

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the TVs played this endless reel of cartoons.

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And the exhaustion of mothers

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who had taken two, three, sometimes four buses

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to bring their child to the doctor

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was just palpable.

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The doctors, it seemed,

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never really had enough time for all the patients,

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try as they might.

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And over the course of six months,

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I would corner them in the hallway

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and ask them a sort of naive but fundamental question:

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"If you had unlimited resources,

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what's the one thing you would give your patients?"

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And I heard the same story again and again,

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a story we've heard hundreds of times since then.

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They said, "Every day we have patients that come into the clinic --

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child has an ear infection,

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I prescribe antibiotics.

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But the real issue is there's no food at home.

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The real issue

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is that child is living with 12 other people

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in a two-bedroom apartment.

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And I don't even ask about those issues

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because there's nothing I can do.

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I have 13 minutes with each patient.

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Patients are piling up in the clinic waiting room.

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I have no idea where the nearest food pantry is.

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And I don't even have any help."

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In that clinic, even today,

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there are two social workers

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for 24,000 pediatric patients,

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which is better than a lot of the clinics out there.

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So Health Leads was born of these conversations --

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a simple model

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where doctors and nurses

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can prescribe nutritious food,

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heat in the winter

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and other basic resources for their patients

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the same way they prescribe medication.

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Patients then take their prescriptions

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to our desk in the clinic waiting room

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where we have a core of well-trained college student advocates

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who work side by side with these families

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to connect them out

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to the existing landscape of community resources.

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So we began with a card table in the clinic waiting room --

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totally lemonade stand style.

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But today we have a thousand college student advocates

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who are working to connect nearly 9,000 patients and their families

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with the resources that they need to be healthy.

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So 18 months ago

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I got this email that changed my life.

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And the email was from Dr. Jack Geiger,

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who had written to congratulate me on Health Leads

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and to share, as he said,

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a bit of historical context.

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In 1965 Dr. Geiger founded

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one of the first two community health centers in this country,

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in a brutally poor area in the Mississippi Delta.

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And so many of his patients came in

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presenting with malnutrition

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that be began prescribing food for them.

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And they would take these prescriptions to the local supermarket,

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which would fill them

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and then charge the pharmacy budget of the clinic.

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And when the Office of Economic Opportunity in Washington, D.C. --

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which was funding Geiger's clinic --

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found out about this,

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they were furious.

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And they sent this bureaucrat down

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to tell Geiger that he was expected to use their dollars

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for medical care --

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to which Geiger famously and logically responded,

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"The last time I checked my textbooks,

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the specific therapy for malnutrition was food."

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(Laughter)

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So when I got this email from Dr. Geiger,

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I knew I was supposed to be proud

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to be part of this history.

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But the truth is

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I was devastated.

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Here we are,

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45 years after Geiger has prescribed food for his patients,

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and I have doctors telling me,

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"On those issues, we practice a 'don't ask, don't tell' policy."

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Forty-five years after Geiger,

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Health Leads has to reinvent

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the prescription for basic resources.

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So I have spent hours upon hours

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trying to make sense of this weird Groundhog Day.

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How is it that if for decades

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we had a pretty straightforward tool for keeping patients,

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and especially low-income patients, healthy,

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that we didn't use it?

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If we know what it takes to have a healthcare system

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rather than a sick-care system,

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why don't we just do it?

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These questions, in my mind,

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are not hard because the answers are complicated,

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they are hard because they require that we be honest with ourselves.

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My belief is that it's almost too painful

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to articulate our aspirations for our healthcare system,

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or even admit that we have any at all.

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Because if we did,

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they would be so removed

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from our current reality.

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But that doesn't change my belief

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that all of us, deep inside,

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here in this room and across this country,

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share a similar set of desires.

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That if we are honest with ourselves

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and listen quietly,

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that we all harbor

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one fiercely held aspiration for our healthcare:

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that it keep us healthy.

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This aspiration that our healthcare keep us healthy

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is an enormously powerful one.

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And the way I think about this

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is that healthcare is like any other system.

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It's just a set of choices that people make.

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What if we decided

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to make a different set of choices?

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What if we decided to take all the parts of healthcare

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that have drifted away from us

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and stand firm and say, "No.

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These things are ours.

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They will be used for our purposes.

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They will be used to realize

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our aspiration"?

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What if everything we needed

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to realize our aspiration for healthcare

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was right there in front of us

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just waiting to be claimed?

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So that's where Health Leads began.

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We started with the prescription pad --

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a very ordinary piece of paper --

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and we asked, not what do patients need to get healthy --

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antibiotics, an inhaler, medication --

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but what do patients need to be healthy,

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to not get sick in the first place?

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And we chose to use the prescription

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for that purpose.

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So just a few miles from here

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at Children's National Medical Center,

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when patients come into the doctor's office,

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they're asked a few questions.

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They're asked, "Are you running out of food at the end of the month?

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Do you have safe housing?"

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And when the doctor begins the visit,

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she knows height, weight, is there food at home,

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is the family living in a shelter.

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And that not only leads to a better set of clinical choices,

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but the doctor can also prescribe those resources for the patient,

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using Health Leads like any other sub-specialty referral.

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The problem is,

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once you get a taste of what it's like

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to realize your aspiration for healthcare,

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you want more.

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So we thought,

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if we can get individual doctors

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to prescribe these basic resources for their patients,

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could we get an entire healthcare system

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to shift its presumption?

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And we gave it a shot.

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So now at Harlem Hospital Center

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when patients come in with an elevated body mass index,

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the electronic medical record

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automatically generates a prescription for Health Leads.

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And our volunteers can then work with them

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to connect patients to healthy food and excercise programs

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in their communities.

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We've created a presumption

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that if you're a patient at that hospital

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with an elevated BMI,

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the four walls of the doctor's office

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probably aren't going to give you everything

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you need to be healthy.

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You need more.

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So on the one hand,

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this is just a basic recoding

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of the electronic medical record.

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And on the other hand,

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it's a radical transformation

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of the electronic medical record

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from a static repository of diagnostic information

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to a health promotion tool.

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In the private sector,

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when you squeeze that kind of additional value

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out of a fixed-cost investment,

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it's called a billion-dollar company.

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But in my world,

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it's called reduced obesity and diabetes.

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It's called healthcare --

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a system where doctors can prescribe solutions

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to improve health,

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not just manage disease.

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Same thing in the clinic waiting room.

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So every day in this country

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three million patients

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pass through about 150,000 clinic waiting rooms in this country.

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And what do they do when they're there?

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They sit, they watch the goldfish in the fish tank,

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they read extremely old copies

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of Good Housekeeping magazine.

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But mostly we all just sit there forever, waiting.

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How did we get here

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where we devote hundreds of acres and thousands of hours

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to waiting?

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What if we had a waiting room

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where you don't just sit when you're sick,

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but where you go to get healthy.

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If airports can become shopping malls

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and McDonald's can become playgrounds,

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surely we can reinvent the clinic waiting room.

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And that's what Health Leads has tried to do,

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to reclaim that real estate and that time

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and to use it as a gateway

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to connect patients

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to the resources they need to be healthy.

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So it's a brutal winter in the Northeast,

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your kid has asthma, your heat just got turned off,

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and of course you're in the waiting room of the ER,

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because the cold air triggered your child's asthma.

275
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But what if instead of waiting for hours anxiously,

276
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the waiting room became the place

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where Health Leads turned your heat back on?

278
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And of course all of this requires

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a broader workforce.

280
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But if we're creative, we already have that too.

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We know that our doctors and nurses

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and even social workers

283
00:10:52,466 --> 00:10:53,934
aren't enough,

284
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that the ticking minutes of health care

285
00:10:55,583 --> 00:10:57,001
are too constraining.

286
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Health just takes more time.

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It requires a non-clinical army

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00:11:01,849 --> 00:11:04,533
of community health workers and case managers

289
00:11:04,533 --> 00:11:06,149
and many others.

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What if a small part of that next healthcare workforce

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00:11:09,299 --> 00:11:13,000
were the 11 million college students in this country?

292
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Unencumbered by clinical responsibilities,

293
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unwilling to take no for an answer

294
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from those bureaucracies

295
00:11:19,950 --> 00:11:21,883
that tend to crush patients,

296
00:11:21,883 --> 00:11:23,833
and with an unparalleled ability

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00:11:23,833 --> 00:11:25,285
for information retrieval

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00:11:25,285 --> 00:11:28,266
honed through years of using Google.

299
00:11:28,266 --> 00:11:30,799
Now lest you think it improbable

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00:11:30,799 --> 00:11:32,416
that a college volunteer

301
00:11:32,416 --> 00:11:34,199
can make this kind of commitment,

302
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I have two words for you:

303
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March Madness.

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00:11:38,117 --> 00:11:42,084
The average NCAA Division I men's basketball player

305
00:11:42,084 --> 00:11:45,349
dedicates 39 hours a week to his sport.

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Now we may think that's good or bad,

307
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but in either case it's real.

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And Health Leads is based on the presumption

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that for too long

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00:11:53,750 --> 00:11:56,300
we have asked too little of our college students

311
00:11:56,300 --> 00:12:00,065
when it comes to real impact in vulnerable communities.

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00:12:00,065 --> 00:12:01,418
College sports teams say,

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00:12:01,418 --> 00:12:03,483
"We're going to take dozens of hours

314
00:12:03,483 --> 00:12:07,367
at some field across campus at some ungodly hour of the morning

315
00:12:07,367 --> 00:12:10,183
and we're going to measure your performance, and your team's performance,

316
00:12:10,183 --> 00:12:12,349
and if you don't measure up or you don't show up,

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00:12:12,349 --> 00:12:13,799
we're going to cut you off the team.

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But we'll make huge investments

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00:12:15,687 --> 00:12:16,899
in your training and development,

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00:12:16,899 --> 00:12:20,317
and we'll give you an extraordinary community of peers."

321
00:12:20,317 --> 00:12:22,132
And people line up out the door

322
00:12:22,132 --> 00:12:24,917
just for the chance to be part of it.

323
00:12:24,917 --> 00:12:26,134
So our feeling is,

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if it's good enough for the rugby team,

325
00:12:27,617 --> 00:12:29,732
it's good enough for health and poverty.

326
00:12:29,732 --> 00:12:33,000
Health Leads too recruits competitively,

327
00:12:33,000 --> 00:12:34,481
trains intensively,

328
00:12:34,481 --> 00:12:36,450
coaches professionally,

329
00:12:36,450 --> 00:12:38,399
demands significant time,

330
00:12:38,399 --> 00:12:39,766
builds a cohesive team

331
00:12:39,766 --> 00:12:41,250
and measures results --

332
00:12:41,250 --> 00:12:43,933
a kind of Teach for America for healthcare.

333
00:12:43,933 --> 00:12:46,033
Now in the top 10 cities in the U.S.

334
00:12:46,033 --> 00:12:48,352
with the largest number of Medicaid patients,

335
00:12:48,352 --> 00:12:51,566
each of those has at least 20,000 college students.

336
00:12:51,566 --> 00:12:54,767
New York alone has half a million college students.

337
00:12:54,767 --> 00:12:57,816
And this isn't just a sort of short-term workforce

338
00:12:57,816 --> 00:13:00,066
to connect patients to basic resources,

339
00:13:00,066 --> 00:13:03,667
it's a next generation healthcare leadership pipeline

340
00:13:03,667 --> 00:13:06,117
who've spent two, three, four years

341
00:13:06,117 --> 00:13:07,618
in the clinic waiting room

342
00:13:07,618 --> 00:13:11,602
talking to patients about their most basic health needs.

343
00:13:11,602 --> 00:13:13,351
And they leave with the conviction,

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00:13:13,351 --> 00:13:15,183
the ability and the efficacy

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00:13:15,183 --> 00:13:18,966
to realize our most basic aspirations for health care.

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00:13:18,966 --> 00:13:21,984
And the thing is, there's thousands of these folks already out there.

347
00:13:21,984 --> 00:13:25,801
So Mia Lozada is Chief Resident of Internal Medicine

348
00:13:25,801 --> 00:13:27,216
at UCSF Medical Center,

349
00:13:27,216 --> 00:13:29,549
but for three years as an undergraduate

350
00:13:29,549 --> 00:13:31,182
she was a Health Leads volunteer

351
00:13:31,182 --> 00:13:34,184
in the clinic waiting room at Boston Medical Center.

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00:13:34,184 --> 00:13:37,899
Mia says, "When my classmates write a prescription,

353
00:13:37,899 --> 00:13:39,917
they think their work is done.

354
00:13:39,917 --> 00:13:41,633
When I write a prescription,

355
00:13:41,633 --> 00:13:43,900
I think, can the family read the prescription?

356
00:13:43,900 --> 00:13:46,083
Do they have transportation to the pharmacy?

357
00:13:46,083 --> 00:13:48,533
Do they have food to take with the prescription?

358
00:13:48,533 --> 00:13:50,783
Do they have insurance to fill the prescription?

359
00:13:50,783 --> 00:13:53,466
Those are the questions I learned at Health Leads,

360
00:13:53,466 --> 00:13:55,216
not in medical school."

361
00:13:55,216 --> 00:13:57,200
Now none of these solutions --

362
00:13:57,200 --> 00:14:00,170
the prescription pad, the electronic medical record,

363
00:14:00,170 --> 00:14:01,317
the waiting room,

364
00:14:01,317 --> 00:14:02,485
the army of college students --

365
00:14:02,485 --> 00:14:03,668
are perfect.

366
00:14:03,668 --> 00:14:06,168
But they are ours for the taking --

367
00:14:06,168 --> 00:14:07,500
simple examples

368
00:14:07,500 --> 00:14:11,001
of the vast under-utilized healthcare resources

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00:14:11,001 --> 00:14:13,916
that, if we reclaimed and redeployed,

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00:14:13,916 --> 00:14:17,333
could realize our most basic aspiration

371
00:14:17,333 --> 00:14:19,117
of healthcare.

372
00:14:19,117 --> 00:14:22,333
So I had been at Legal Services for about nine months

373
00:14:22,333 --> 00:14:25,066
when this idea of Health Leads started percolating in my mind.

374
00:14:25,066 --> 00:14:28,000
And I knew I had to tell Jeff Purcell, my attorney,

375
00:14:28,000 --> 00:14:29,419
that I needed to leave.

376
00:14:29,419 --> 00:14:30,382
And I was so nervous,

377
00:14:30,382 --> 00:14:32,916
because I thought he was going to be disappointed in me

378
00:14:32,916 --> 00:14:35,966
for abandoning our clients for some crazy idea.

379
00:14:35,966 --> 00:14:37,950
And I sat down with him and I said,

380
00:14:37,950 --> 00:14:39,833
"Jeff, I have this idea

381
00:14:39,833 --> 00:14:42,252
that we could mobilize college students

382
00:14:42,252 --> 00:14:45,186
to address patients' most basic health needs."

383
00:14:45,186 --> 00:14:46,767
And I'll be honest,

384
00:14:46,767 --> 00:14:50,066
all I wanted was for him to not be angry at me.

385
00:14:50,066 --> 00:14:51,533
But he said this,

386
00:14:51,533 --> 00:14:54,881
"Rebecca, when you have a vision,

387
00:14:54,881 --> 00:14:58,732
you have an obligation to realize that vision.

388
00:14:58,732 --> 00:15:01,833
You must pursue that vision."

389
00:15:01,833 --> 00:15:05,099
And I have to say, I was like "Whoa.

390
00:15:05,099 --> 00:15:07,116
That's a lot of pressure."

391
00:15:07,116 --> 00:15:08,515
I just wanted a blessing,

392
00:15:08,515 --> 00:15:10,066
I didn't want some kind of mandate.

393
00:15:10,066 --> 00:15:11,633
But the truth is

394
00:15:11,633 --> 00:15:14,416
I've spent every waking minute nearly since then

395
00:15:14,416 --> 00:15:16,200
chasing that vision.

396
00:15:16,200 --> 00:15:19,382
I believe that we all have a vision

397
00:15:19,382 --> 00:15:21,283
for healthcare in this country.

398
00:15:21,283 --> 00:15:23,482
I believe that at the end of the day

399
00:15:23,482 --> 00:15:25,316
when we measure our healthcare,

400
00:15:25,316 --> 00:15:28,132
it will not be by the diseases cured,

401
00:15:28,132 --> 00:15:30,650
but by the diseases prevented.

402
00:15:30,650 --> 00:15:33,667
It will not be by the excellence of our technologies

403
00:15:33,667 --> 00:15:36,167
or the sophistication of our specialists,

404
00:15:36,167 --> 00:15:38,966
but by how rarely we needed them.

405
00:15:38,966 --> 00:15:40,450
And most of all,

406
00:15:40,450 --> 00:15:42,967
I believe that when we measure healthcare,

407
00:15:42,967 --> 00:15:45,650
it will be, not by what the system was,

408
00:15:45,650 --> 00:15:48,416
but by what we chose it to be.

409
00:15:48,416 --> 00:15:49,483
Thank you.

410
00:15:49,483 --> 00:15:59,733
(Applause)

411
00:15:59,733 --> 00:16:01,000
Thank you.

412
00:16:01,008 --> 00:16:10,331
(Applause)