What if our healthcare system kept us healthy?
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0:00 - 0:02So my freshman year of college
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0:02 - 0:05I signed up for an internship in the housing unit
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0:05 - 0:07at Greater Boston Legal Services.
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0:07 - 0:09Showed up the first day
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0:09 - 0:11ready to make coffee and photocopies,
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0:11 - 0:15but was paired with this righteous, deeply inspired attorney
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0:15 - 0:17named Jeff Purcell,
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0:17 - 0:19who thrust me onto the front lines
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0:19 - 0:21from the very first day.
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0:21 - 0:23And over the course of nine months
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0:23 - 0:24I had the chance
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0:24 - 0:26to have dozens of conversations
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0:26 - 0:29with low-income families in Boston
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0:29 - 0:32who would come in presenting with housing issues,
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0:32 - 0:35but always had an underlying health issue.
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0:35 - 0:37So I had a client who came in,
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0:37 - 0:40about to be evicted because he hasn't paid his rent.
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0:40 - 0:42But he hasn't paid his rent, of course,
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0:42 - 0:44because he's paying for his HIV medication
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0:44 - 0:47and just can't afford both.
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0:47 - 0:48We had moms who would come in,
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0:48 - 0:49daughter has asthma,
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0:49 - 0:52wakes up covered in cockroaches every morning.
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0:52 - 0:54And one of our litigation strategies
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0:54 - 0:57was actually to send me into the home of these clients
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0:57 - 0:59with these large glass bottles.
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0:59 - 1:01And I would collect the cockroaches,
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1:01 - 1:04hot glue-gun them to this poster board
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1:04 - 1:06that we'd bring to court for our cases.
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1:06 - 1:07And we always won
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1:07 - 1:10because the judges were just so grossed out.
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1:10 - 1:12Far more effective, I have to say,
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1:12 - 1:15than anything I later learned in law school.
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1:15 - 1:18But over the course of these nine months,
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1:18 - 1:20I grew frustrated with feeling
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1:20 - 1:23like we were intervening too far downstream
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1:23 - 1:25in the lives of our clients --
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1:25 - 1:27that by the time they came to us,
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1:27 - 1:29they were already in crisis.
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1:29 - 1:32And at the end of my freshman year of college,
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1:32 - 1:33I read an article about the work
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1:33 - 1:35that Dr. Barry Zuckerman was doing
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1:35 - 1:37as Chair of Pediatrics
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1:37 - 1:39at Boston Medical Center.
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1:39 - 1:42And his first hire was a legal services attorney
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1:42 - 1:44to represent the patients.
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1:44 - 1:45So I called Barry,
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1:45 - 1:48and with his blessing, in October 1995
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1:48 - 1:50walked into the waiting room
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1:50 - 1:53of the pediatrics clinic at Boston Medical Center.
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1:53 - 1:54I'll never forget,
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1:54 - 1:57the TVs played this endless reel of cartoons.
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1:57 - 2:00And the exhaustion of mothers
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2:00 - 2:03who had taken two, three, sometimes four buses
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2:03 - 2:05to bring their child to the doctor
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2:05 - 2:07was just palpable.
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2:07 - 2:08The doctors, it seemed,
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2:08 - 2:10never really had enough time for all the patients,
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2:10 - 2:11try as they might.
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2:11 - 2:12And over the course of six months,
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2:12 - 2:14I would corner them in the hallway
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2:14 - 2:18and ask them a sort of naive but fundamental question:
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2:18 - 2:20"If you had unlimited resources,
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2:20 - 2:24what's the one thing you would give your patients?"
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2:24 - 2:26And I heard the same story again and again,
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2:26 - 2:29a story we've heard hundreds of times since then.
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2:29 - 2:33They said, "Every day we have patients that come into the clinic --
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2:33 - 2:35child has an ear infection,
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2:35 - 2:37I prescribe antibiotics.
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2:37 - 2:39But the real issue is there's no food at home.
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2:39 - 2:41The real issue
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2:41 - 2:43is that child is living with 12 other people
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2:43 - 2:45in a two-bedroom apartment.
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2:45 - 2:46And I don't even ask about those issues
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2:46 - 2:49because there's nothing I can do.
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2:49 - 2:51I have 13 minutes with each patient.
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2:51 - 2:54Patients are piling up in the clinic waiting room.
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2:54 - 2:56I have no idea where the nearest food pantry is.
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2:56 - 2:59And I don't even have any help."
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2:59 - 3:00In that clinic, even today,
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3:00 - 3:02there are two social workers
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3:02 - 3:04for 24,000 pediatric patients,
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3:04 - 3:07which is better than a lot of the clinics out there.
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3:07 - 3:10So Health Leads was born of these conversations --
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3:10 - 3:11a simple model
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3:11 - 3:13where doctors and nurses
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3:13 - 3:15can prescribe nutritious food,
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3:15 - 3:16heat in the winter
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3:16 - 3:19and other basic resources for their patients
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3:19 - 3:22the same way they prescribe medication.
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3:22 - 3:24Patients then take their prescriptions
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3:24 - 3:26to our desk in the clinic waiting room
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3:26 - 3:30where we have a core of well-trained college student advocates
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3:30 - 3:32who work side by side with these families
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3:32 - 3:34to connect them out
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3:34 - 3:37to the existing landscape of community resources.
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3:37 - 3:40So we began with a card table in the clinic waiting room --
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3:40 - 3:42totally lemonade stand style.
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3:42 - 3:46But today we have a thousand college student advocates
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3:46 - 3:50who are working to connect nearly 9,000 patients and their families
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3:50 - 3:53with the resources that they need to be healthy.
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3:53 - 3:55So 18 months ago
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3:55 - 3:58I got this email that changed my life.
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3:58 - 4:00And the email was from Dr. Jack Geiger,
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4:00 - 4:03who had written to congratulate me on Health Leads
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4:03 - 4:04and to share, as he said,
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4:04 - 4:07a bit of historical context.
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4:07 - 4:10In 1965 Dr. Geiger founded
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4:10 - 4:13one of the first two community health centers in this country,
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4:13 - 4:16in a brutally poor area in the Mississippi Delta.
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4:16 - 4:19And so many of his patients came in
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4:19 - 4:21presenting with malnutrition
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4:21 - 4:23that be began prescribing food for them.
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4:23 - 4:26And they would take these prescriptions to the local supermarket,
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4:26 - 4:28which would fill them
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4:28 - 4:30and then charge the pharmacy budget of the clinic.
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4:30 - 4:33And when the Office of Economic Opportunity in Washington, D.C. --
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4:33 - 4:35which was funding Geiger's clinic --
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4:35 - 4:36found out about this,
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4:36 - 4:37they were furious.
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4:37 - 4:39And they sent this bureaucrat down
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4:39 - 4:42to tell Geiger that he was expected to use their dollars
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4:42 - 4:44for medical care --
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4:44 - 4:47to which Geiger famously and logically responded,
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4:47 - 4:49"The last time I checked my textbooks,
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4:49 - 4:54the specific therapy for malnutrition was food."
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4:54 - 4:55(Laughter)
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4:55 - 4:58So when I got this email from Dr. Geiger,
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4:58 - 5:00I knew I was supposed to be proud
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5:00 - 5:02to be part of this history.
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5:02 - 5:03But the truth is
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5:03 - 5:05I was devastated.
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5:05 - 5:06Here we are,
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5:06 - 5:1045 years after Geiger has prescribed food for his patients,
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5:10 - 5:12and I have doctors telling me,
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5:12 - 5:16"On those issues, we practice a 'don't ask, don't tell' policy."
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5:16 - 5:19Forty-five years after Geiger,
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5:19 - 5:20Health Leads has to reinvent
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5:20 - 5:23the prescription for basic resources.
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5:23 - 5:26So I have spent hours upon hours
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5:26 - 5:30trying to make sense of this weird Groundhog Day.
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5:30 - 5:32How is it that if for decades
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5:32 - 5:35we had a pretty straightforward tool for keeping patients,
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5:35 - 5:38and especially low-income patients, healthy,
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5:38 - 5:40that we didn't use it?
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5:40 - 5:43If we know what it takes to have a healthcare system
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5:43 - 5:45rather than a sick-care system,
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5:45 - 5:47why don't we just do it?
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5:47 - 5:49These questions, in my mind,
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5:49 - 5:52are not hard because the answers are complicated,
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5:52 - 5:58they are hard because they require that we be honest with ourselves.
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5:58 - 6:01My belief is that it's almost too painful
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6:01 - 6:04to articulate our aspirations for our healthcare system,
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6:04 - 6:07or even admit that we have any at all.
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6:07 - 6:08Because if we did,
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6:08 - 6:09they would be so removed
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6:09 - 6:12from our current reality.
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6:12 - 6:15But that doesn't change my belief
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6:15 - 6:18that all of us, deep inside,
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6:18 - 6:21here in this room and across this country,
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6:21 - 6:24share a similar set of desires.
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6:24 - 6:26That if we are honest with ourselves
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6:26 - 6:28and listen quietly,
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6:28 - 6:30that we all harbor
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6:30 - 6:34one fiercely held aspiration for our healthcare:
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6:34 - 6:37that it keep us healthy.
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6:37 - 6:40This aspiration that our healthcare keep us healthy
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6:40 - 6:42is an enormously powerful one.
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6:42 - 6:45And the way I think about this
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6:45 - 6:47is that healthcare is like any other system.
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6:47 - 6:50It's just a set of choices that people make.
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6:50 - 6:51What if we decided
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6:51 - 6:54to make a different set of choices?
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6:54 - 6:57What if we decided to take all the parts of healthcare
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6:57 - 6:59that have drifted away from us
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6:59 - 7:01and stand firm and say, "No.
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7:01 - 7:03These things are ours.
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7:03 - 7:05They will be used for our purposes.
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7:05 - 7:07They will be used to realize
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7:07 - 7:09our aspiration"?
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7:09 - 7:11What if everything we needed
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7:11 - 7:13to realize our aspiration for healthcare
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7:13 - 7:15was right there in front of us
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7:15 - 7:16just waiting to be claimed?
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7:16 - 7:19So that's where Health Leads began.
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7:19 - 7:20We started with the prescription pad --
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7:20 - 7:23a very ordinary piece of paper --
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7:23 - 7:27and we asked, not what do patients need to get healthy --
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7:27 - 7:30antibiotics, an inhaler, medication --
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7:30 - 7:32but what do patients need to be healthy,
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7:32 - 7:35to not get sick in the first place?
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7:35 - 7:37And we chose to use the prescription
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7:37 - 7:39for that purpose.
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7:39 - 7:40So just a few miles from here
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7:40 - 7:42at Children's National Medical Center,
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7:42 - 7:44when patients come into the doctor's office,
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7:44 - 7:45they're asked a few questions.
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7:45 - 7:48They're asked, "Are you running out of food at the end of the month?
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7:48 - 7:50Do you have safe housing?"
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7:50 - 7:52And when the doctor begins the visit,
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7:52 - 7:55she knows height, weight, is there food at home,
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7:55 - 7:56is the family living in a shelter.
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7:56 - 7:59And that not only leads to a better set of clinical choices,
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7:59 - 8:03but the doctor can also prescribe those resources for the patient,
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8:03 - 8:07using Health Leads like any other sub-specialty referral.
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8:07 - 8:09The problem is,
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8:09 - 8:11once you get a taste of what it's like
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8:11 - 8:13to realize your aspiration for healthcare,
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8:13 - 8:15you want more.
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8:15 - 8:16So we thought,
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8:16 - 8:17if we can get individual doctors
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8:17 - 8:21to prescribe these basic resources for their patients,
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8:21 - 8:23could we get an entire healthcare system
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8:23 - 8:26to shift its presumption?
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8:26 - 8:27And we gave it a shot.
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8:27 - 8:29So now at Harlem Hospital Center
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8:29 - 8:33when patients come in with an elevated body mass index,
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8:33 - 8:34the electronic medical record
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8:34 - 8:38automatically generates a prescription for Health Leads.
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8:38 - 8:40And our volunteers can then work with them
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8:40 - 8:43to connect patients to healthy food and excercise programs
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8:43 - 8:44in their communities.
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8:44 - 8:45We've created a presumption
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8:45 - 8:47that if you're a patient at that hospital
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8:47 - 8:49with an elevated BMI,
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8:49 - 8:51the four walls of the doctor's office
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8:51 - 8:53probably aren't going to give you everything
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8:53 - 8:54you need to be healthy.
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8:54 - 8:55You need more.
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8:55 - 8:56So on the one hand,
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8:56 - 8:58this is just a basic recoding
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8:58 - 8:59of the electronic medical record.
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8:59 - 9:01And on the other hand,
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9:01 - 9:03it's a radical transformation
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9:03 - 9:05of the electronic medical record
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9:05 - 9:09from a static repository of diagnostic information
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9:09 - 9:12to a health promotion tool.
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9:12 - 9:13In the private sector,
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9:13 - 9:15when you squeeze that kind of additional value
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9:15 - 9:17out of a fixed-cost investment,
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9:17 - 9:20it's called a billion-dollar company.
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9:20 - 9:21But in my world,
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9:21 - 9:24it's called reduced obesity and diabetes.
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9:24 - 9:26It's called healthcare --
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9:26 - 9:29a system where doctors can prescribe solutions
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9:29 - 9:31to improve health,
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9:31 - 9:33not just manage disease.
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9:33 - 9:35Same thing in the clinic waiting room.
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9:35 - 9:36So every day in this country
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9:36 - 9:38three million patients
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9:38 - 9:42pass through about 150,000 clinic waiting rooms in this country.
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9:42 - 9:44And what do they do when they're there?
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9:44 - 9:48They sit, they watch the goldfish in the fish tank,
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9:48 - 9:50they read extremely old copies
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9:50 - 9:52of Good Housekeeping magazine.
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9:52 - 9:56But mostly we all just sit there forever, waiting.
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9:56 - 9:57How did we get here
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9:57 - 10:00where we devote hundreds of acres and thousands of hours
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10:00 - 10:02to waiting?
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10:02 - 10:03What if we had a waiting room
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10:03 - 10:05where you don't just sit when you're sick,
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10:05 - 10:07but where you go to get healthy.
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10:07 - 10:10If airports can become shopping malls
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10:10 - 10:13and McDonald's can become playgrounds,
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10:13 - 10:16surely we can reinvent the clinic waiting room.
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10:16 - 10:18And that's what Health Leads has tried to do,
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10:18 - 10:20to reclaim that real estate and that time
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10:20 - 10:22and to use it as a gateway
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10:22 - 10:23to connect patients
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10:23 - 10:26to the resources they need to be healthy.
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10:26 - 10:27So it's a brutal winter in the Northeast,
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10:27 - 10:30your kid has asthma, your heat just got turned off,
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10:30 - 10:32and of course you're in the waiting room of the ER,
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10:32 - 10:34because the cold air triggered your child's asthma.
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10:34 - 10:37But what if instead of waiting for hours anxiously,
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10:37 - 10:40the waiting room became the place
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10:40 - 10:42where Health Leads turned your heat back on?
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10:42 - 10:44And of course all of this requires
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10:44 - 10:46a broader workforce.
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10:46 - 10:49But if we're creative, we already have that too.
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10:49 - 10:51We know that our doctors and nurses
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10:51 - 10:52and even social workers
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10:52 - 10:54aren't enough,
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10:54 - 10:56that the ticking minutes of health care
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10:56 - 10:57are too constraining.
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10:57 - 10:59Health just takes more time.
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10:59 - 11:02It requires a non-clinical army
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11:02 - 11:05of community health workers and case managers
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11:05 - 11:06and many others.
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11:06 - 11:09What if a small part of that next healthcare workforce
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11:09 - 11:13were the 11 million college students in this country?
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11:13 - 11:16Unencumbered by clinical responsibilities,
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11:16 - 11:18unwilling to take no for an answer
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11:18 - 11:20from those bureaucracies
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11:20 - 11:22that tend to crush patients,
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11:22 - 11:24and with an unparalleled ability
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11:24 - 11:25for information retrieval
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11:25 - 11:28honed through years of using Google.
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11:28 - 11:31Now lest you think it improbable
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11:31 - 11:32that a college volunteer
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11:32 - 11:34can make this kind of commitment,
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11:34 - 11:36I have two words for you:
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11:36 - 11:38March Madness.
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11:38 - 11:42The average NCAA Division I men's basketball player
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11:42 - 11:45dedicates 39 hours a week to his sport.
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11:45 - 11:48Now we may think that's good or bad,
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11:48 - 11:50but in either case it's real.
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11:50 - 11:52And Health Leads is based on the presumption
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11:52 - 11:54that for too long
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11:54 - 11:56we have asked too little of our college students
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11:56 - 12:00when it comes to real impact in vulnerable communities.
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12:00 - 12:01College sports teams say,
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12:01 - 12:03"We're going to take dozens of hours
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12:03 - 12:07at some field across campus at some ungodly hour of the morning
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12:07 - 12:10and we're going to measure your performance, and your team's performance,
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12:10 - 12:12and if you don't measure up or you don't show up,
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12:12 - 12:14we're going to cut you off the team.
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12:14 - 12:16But we'll make huge investments
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12:16 - 12:17in your training and development,
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12:17 - 12:20and we'll give you an extraordinary community of peers."
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12:20 - 12:22And people line up out the door
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12:22 - 12:25just for the chance to be part of it.
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12:25 - 12:26So our feeling is,
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12:26 - 12:28if it's good enough for the rugby team,
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12:28 - 12:30it's good enough for health and poverty.
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12:30 - 12:33Health Leads too recruits competitively,
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12:33 - 12:34trains intensively,
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12:34 - 12:36coaches professionally,
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12:36 - 12:38demands significant time,
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12:38 - 12:40builds a cohesive team
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12:40 - 12:41and measures results --
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12:41 - 12:44a kind of Teach for America for healthcare.
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12:44 - 12:46Now in the top 10 cities in the U.S.
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12:46 - 12:48with the largest number of Medicaid patients,
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12:48 - 12:52each of those has at least 20,000 college students.
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12:52 - 12:55New York alone has half a million college students.
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12:55 - 12:58And this isn't just a sort of short-term workforce
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12:58 - 13:00to connect patients to basic resources,
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13:00 - 13:04it's a next generation healthcare leadership pipeline
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13:04 - 13:06who've spent two, three, four years
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13:06 - 13:08in the clinic waiting room
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13:08 - 13:12talking to patients about their most basic health needs.
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13:12 - 13:13And they leave with the conviction,
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13:13 - 13:15the ability and the efficacy
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13:15 - 13:19to realize our most basic aspirations for health care.
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13:19 - 13:22And the thing is, there's thousands of these folks already out there.
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13:22 - 13:26So Mia Lozada is Chief Resident of Internal Medicine
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13:26 - 13:27at UCSF Medical Center,
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13:27 - 13:30but for three years as an undergraduate
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13:30 - 13:31she was a Health Leads volunteer
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13:31 - 13:34in the clinic waiting room at Boston Medical Center.
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13:34 - 13:38Mia says, "When my classmates write a prescription,
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13:38 - 13:40they think their work is done.
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13:40 - 13:42When I write a prescription,
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13:42 - 13:44I think, can the family read the prescription?
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13:44 - 13:46Do they have transportation to the pharmacy?
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13:46 - 13:49Do they have food to take with the prescription?
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13:49 - 13:51Do they have insurance to fill the prescription?
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13:51 - 13:53Those are the questions I learned at Health Leads,
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13:53 - 13:55not in medical school."
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13:55 - 13:57Now none of these solutions --
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13:57 - 14:00the prescription pad, the electronic medical record,
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14:00 - 14:01the waiting room,
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14:01 - 14:02the army of college students --
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14:02 - 14:04are perfect.
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14:04 - 14:06But they are ours for the taking --
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14:06 - 14:08simple examples
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14:08 - 14:11of the vast under-utilized healthcare resources
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14:11 - 14:14that, if we reclaimed and redeployed,
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14:14 - 14:17could realize our most basic aspiration
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14:17 - 14:19of healthcare.
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14:19 - 14:22So I had been at Legal Services for about nine months
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14:22 - 14:25when this idea of Health Leads started percolating in my mind.
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14:25 - 14:28And I knew I had to tell Jeff Purcell, my attorney,
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14:28 - 14:29that I needed to leave.
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14:29 - 14:30And I was so nervous,
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14:30 - 14:33because I thought he was going to be disappointed in me
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14:33 - 14:36for abandoning our clients for some crazy idea.
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14:36 - 14:38And I sat down with him and I said,
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14:38 - 14:40"Jeff, I have this idea
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14:40 - 14:42that we could mobilize college students
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14:42 - 14:45to address patients' most basic health needs."
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14:45 - 14:47And I'll be honest,
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14:47 - 14:50all I wanted was for him to not be angry at me.
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14:50 - 14:52But he said this,
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14:52 - 14:55"Rebecca, when you have a vision,
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14:55 - 14:59you have an obligation to realize that vision.
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14:59 - 15:02You must pursue that vision."
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15:02 - 15:05And I have to say, I was like "Whoa.
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15:05 - 15:07That's a lot of pressure."
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15:07 - 15:09I just wanted a blessing,
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15:09 - 15:10I didn't want some kind of mandate.
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15:10 - 15:12But the truth is
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15:12 - 15:14I've spent every waking minute nearly since then
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15:14 - 15:16chasing that vision.
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15:16 - 15:19I believe that we all have a vision
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15:19 - 15:21for healthcare in this country.
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15:21 - 15:23I believe that at the end of the day
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15:23 - 15:25when we measure our healthcare,
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15:25 - 15:28it will not be by the diseases cured,
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15:28 - 15:31but by the diseases prevented.
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15:31 - 15:34It will not be by the excellence of our technologies
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15:34 - 15:36or the sophistication of our specialists,
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15:36 - 15:39but by how rarely we needed them.
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15:39 - 15:40And most of all,
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15:40 - 15:43I believe that when we measure healthcare,
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15:43 - 15:46it will be, not by what the system was,
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15:46 - 15:48but by what we chose it to be.
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15:48 - 15:49Thank you.
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15:49 - 16:00(Applause)
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16:00 - 16:01Thank you.
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16:01 - 16:10(Applause)
- Title:
- What if our healthcare system kept us healthy?
- Speaker:
- Rebecca Onie
- Description:
-
Rebecca Onie asks audacious questions: What if waiting rooms were a place to improve daily health care? What if doctors could prescribe food, housing and heat in the winter? At TEDMED she describes Health Leads, an organization that does just that -- and does it by building a volunteer base as elite and dedicated as a college sports team.
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 16:34
Jenny Zurawell edited English subtitles for What if our health care system kept us healthy? | ||
Jenny Zurawell approved English subtitles for What if our health care system kept us healthy? | ||
Jenny Zurawell edited English subtitles for What if our health care system kept us healthy? | ||
Morton Bast accepted English subtitles for What if our health care system kept us healthy? | ||
Morton Bast edited English subtitles for What if our health care system kept us healthy? | ||
Timothy Covell edited English subtitles for What if our health care system kept us healthy? | ||
Timothy Covell added a translation |