TEDMED Blog

Imagining a culture of healthier childhood

TEDMED speaker and pediatric endocrinologist Louise Greenspan has been a co-investigator in a uniquely comprehensive longitudinal North American study following young girls through puberty. We asked her to design a fantasy health intervention with unlimited resources. Here’s her vision:

Image courtesy of Shutterstock

We all know the expression, ”It takes a village to raise a child.” My fantasy intervention is based on that concept, however it expands on what the village is and what it provides. Today’s industrialized societies have fractured the extended family, resulting in most parents not having support from their own elders in raising their children. Many young parents don’t have the basic knowledge they need to support their growing families in healthy ways. While concepts about child rearing naturally change between generations, there is still a lot to be learned from those who have gone before us.

I’d love to support an intervention that provides education and assistance to families beginning from the moment they find out they are pregnant. The idea would be to start with pregnant mothers, by providing nutritional education and enhanced psychological and educational support, regardless of socioeconomic status. This education would take place in classes with members of the neighborhood who are also pregnant, thus building community.

After delivery, new parents would be encouraged to breastfeed and learn how to nurture their babies by visiting health workers who could come into the home. As the children grow, these home health workers would provide assistance and education to parents on how to feed their children, how to support their developing brains, and also how to discipline them. This way, parents could learn the facts they need to know, as well as start to develop a healthy authoritative approach to setting limits with their children. These trained workers would be available for parents to turn to for advice, to supplement the way some of us were once able to turn to our mothers and grandmothers for advice (but with the latest in knowledge and skills). The health workers would also set up support groups for families who live near each other or hold groups and classes as well.

At age 3, all children would be offered high quality preschool with a healthy lunch provided for all, and the parental support and education could continue, informed by these community schools. Parents would learn how to deal effectively with the challenges presented by their ‘threenagers’ and other toddler challenges. At entry to elementary school, the support and education would be augmented so that it would also be provided directly to the children themselves while also continuing with their families. All kids would have weekly lessons in cooking and healthy eating, and be active participants in growing and preparing healthy food at their school as part of the curriculum. Parents and guardians would participate in sessions about how to feed their children healthfully, assist their children educationally, as well as continue to be given tools about how to effectively parent their children.

Health Education would be taught to the children directly, starting in kindergarten with practical life skills, including cooking. In the early grades, the education might focus on the importance of eating a healthy balanced diet and on getting enough physical activity and sleep. As the children age, lessons would include classes on their body and health, with puberty education starting in third grade, separate from sex education, which could start in sixth grade. In third and fourth grade, children would learn about puberty and the body changes that will start and happen to everyone over the next few years. In middle school, kids would continue to discuss puberty, but would now have discussions about sex and sexuality. In high school, these topics would be discussed in more depth. The lessons learned about cooking, healthy eating, and exercise would continue throughout these years. There would also be age-appropriate mindfulness-based stress-reduction education through all of the grades, with an emphasis on this in high school. Parenting assistance and education throughout these years would reinforce these concepts and would perhaps also focus on how to enforce healthy sleep habits and limitations on screen time. The outcomes examined in this intervention would include rates of childhood obesity, early puberty, and psychological and educational diagnoses issues across the socioeconomic spectrum.

Could an intervention like this help reduce childhood health care disparities? Could it reduce parental stress and anxiety? Might it lead to more teens heading to college, thus reducing educational disparities? It is my dream to be able to study the effects of such a holistic, longitudinal, health education intervention. My hunch is that it could be game-changing.

Louise Greenspan is co-author of the The New Puberty: How to Navigate Early Development in Today’s Girls. Learn more by watching her TEDMED talk, “Weighing the causes of early puberty.”

Bridging the Gap: Neighbors Supporting Neighbors in Harlem

This guest post is by Manmeet Kaur, Founder and Executive Director of City Health Works — a nonprofit, social enterprise that aims to close the gap between hospitals and communities in Harlem.

Manmeet KaurIn order for health to flourish, we need people in our lives that make us feel supported and accepted. Social support is essential to well-being and plays a fundamental role in one’s ability to make healthier choices—it is a critical aspect of making health a shared value. Unfortunately, only half of adults in the U.S. report getting the social support they need. Those numbers are even lower among minority groups and those with lower levels of education and income.

In many countries around the world, however, communities already employ effective approaches that have demonstrated impact. In Cape Town, South Africa, for example, I worked with a nonprofit that hired people from the community and trained them as peer health educators to tackle chronic health issues. This is where I first witnessed the power of peer education and the ripple effect such educators have not only on an individual’s health, but also on other aspects of their lives.

When I returned to my hometown of New York City, I immediately saw the potential to adapt this model of health care delivery from abroad and apply it to my neighborhood here in East Harlem. This is a neighborhood in which life expectancy is 9 years lower than the life expectancy of residents of midtown Manhattan. 50% of healthcare spending in this community is on only 5% of the population. The level of chronic illness in this community is so great that clinicians struggle to deliver the high-quality care patients need. They often aren’t able to support patients through the necessary long-term nutritional and behavioral changes to keep chronic illness under check. They are completely overburdened.

That’s where City Health Works comes in.

Inspired by community health worker innovations from South Africa, City Health Works engages community members to serve as the bridge between the doctor’s office and the real challenges people with chronic illnesses face on an ongoing basis. We don’t replace traditional medical care. We simply fill a gap between the health care system and the everyday lives of the people that system is meant to serve.

We start by finding and employing individuals living within the neighborhood who have a strong sense of empathy and good listening skills, are non-judgmental in nature, and can speak to shared life experiences. We train them to become health coaches: we teach them how to build relationships with their patients and truly get to know their needs, which often go beyond health and health care. In addition to receiving training on basic health care in a clinical environment, health coaches learn how to make referrals to services like banking and housing, and recommendations for recreational activities, such as local walking groups, knitting clubs, and bingo nights.

Hospitals and clinics can refer patients directly to us. They refer individuals who struggle with multiple chronic diseases and the stressors of poverty, old age, physical and mental limitations, and language or literacy barriers. Most of them experience depression and struggle with social isolation.

We pair each patient with one of our health coaches so they can receive personalized support and the resources they need to make healthy choices. Initially, there is some hesitation on the part of patients. Health choices are, after all, deeply personal. But once they learn that their coach is from the same neighborhood, they grew up down the street from them, or they even live in their same housing complex, they become more comfortable. Trust is assumed and they open up.

Today, our health coaches meet one-on-one with more than 300 patients in East Harlem on a regular basis. Over the first two years of the program, we measured depression levels amongst our patients and found that simply having a health coach who visits them regularly had a huge effect on their social and emotional well-being. Coaches have a powerful ability to motivate their patients, help them build self-confidence, and strengthen their ability to manage their lifestyle and medical care. We are proving that adding extra support for those who need it most not only saves money, but saves lives.

By adopting practices from outside of the U.S.––an approach for which the Robert Wood Johnson Foundation is now actively seeking proposals––City Health Works has been able to provide critical social support for the people in New York City who need it most. We are changing attitudes about the role of community, fostering health as a shared value, and changing our patient’s expectations about the level of care they should be getting. By fostering an engaged community, we are breaking through the walls of isolation and building a Culture of Health.

Recognizing the TEDMED 2016 Research Scholars

Image courtesy of ShutterstockEach year, TEDMED relies on a carefully selected group of passionate, objective experts spanning the biomedical spectrum from across the globe, including faculty, post docs, graduate students, medical students, public health professionals, entrepreneurs, innovators and science journalists. These experts help assess the credibility of the science upon which TEDMED’s editorial priorities are based.

We deeply appreciate the time and energy our 2016 Research Scholars devote to enriching the quality of our curation process. We asked them to share more about their attraction to the program and their experience so far — here is what a few of them had to say:

“I’ve loved seeing the diversity of nominations, and the challenge of whittling down the array of fascinating people to those who will make a great TEDMED program,” says Layla McCay. “Having had the experience of being in the TEDMED audience myself, I know I want to encounter ideas I can trust, be thrilled by game changers, find synergies across disciplines, and start thinking differently about how things are done – and could be done. I’ve found the experience of reviewing nominations to be rather like a being a judge at The Moth storytelling show: how engaging are the nominees’ stories? Inspiring? True? How compellingly can nominees present their ideas to a discerning TEDMED audience? But it’s made even more interesting because I also have to ask: what’s the evidence behind nominees’ ideas, why are they the right people to speak on the topic, and how might these ideas have an genuine, meaningful impact on people’s health?”

Image courtesy of Shutterstock.“TEDMED makes a communication impact without oversimplifying research in science and health. This is my goal too. I wanted to learn with those who reach and inspire people across cultures from all walks of life,” observes Amy Price. “Reviewing nominations has opened my eyes to the value and power of hard work clothed in elegant simplicity.”

Maya Das wanted to be a Research Scholar in order to “contribute to a forum that brings together people who are seeking innovative solutions to tackle the complexities of health and medicine.” Her experience reviewing nominations has allowed her “to devote time to exploring current issues in health and medicine, to consider broader public policy questions related to clinical research, and to systematically examine what makes someone a credible and engaging ‘expert.’”

With great pride, we recognize the dedication of the 2016 class of TEDMED Research Scholars:

Ron Alfa, MA – Neuroscience, Medicine

Bhagwan Aggarwal, PhD, MBA – Healthcare Industry

Aimee Arnoldussen, PhD – Neuroscience, Medical Devices

Benjamin Bearnot, MD – Medicine

Christos Bergeles, PhD – Medical Imaging & Robotics

Alexander Blum, MS – Telecommunications, International Development

Edward Cliff, BMedSci (Hons) – Medicine

Maya Das, MD, JD – Clinical Research, Health Informatics

Lisa Fitzpatrick, MD, MPH – Medicine, Public Health

Jonathan Fritz, JD, MS – Healthcare IT

Mary Joy Garcia-Dia, DNP, MA, RN – Nursing, Healthcare IT

Holly Goodwin, MBA – Applied Physiology & Bioinformatics

Emilie Grasset, PhD – Immunology

Amy Ho, MD – Medicine

Andrew M. Ibrahim MD, MSc – Medicine, Health Policy, Design

Sherese Johnson, MPH, PMP – Public Health

Neeti Kanodra, MBBS – Pulmonary & Critical Care Medicine

Syed Khalid, BS – Medicine, Medical Devices, Neuroscience

Tamar Lasky, PhD – Epidemiology

Layla McCay, MBChB, MS – Health Policy, Psychiatry

Vanessa Mason, MPH – Digital Health

Maria Noviani, MD – Medicine, Cellular Therapy, Immunology

Madhukar Patel, MD, MBA, ScM – Surgery, Bioengineering

Bryon Petersen, PhD – Stem Cell Biology, Bioengineering

Miguel Pineda, MD – Medicine (Urology)

Amy Price, PhD – Neuroscience

Priya Raja, BA – Medicine, Public Policy

Sudah Yehuda Kovesh Shaheb, MD – Endocrinology, Medical Anthropology

Arpi Siyahian, PhD – Biotechnology

Jing Wang, PhD, MSN, MPH, RN – Nursing

Sebastian Wernicke, PhD – Bioinformatics

Teresa Wilson, MA – Healthcare IT

Flaura Winston, MD, PhD – Pediatrics, Behavioral Science, Injury Prevention

Wendy Youngblood, MA – Education, Humanities

Marta Gaia Zanchi, PhD – Digital Health, Biodesign Innovation

Crazy about CRISPR

This guest blog post is by Sam Sternberg, a TEDMED 2015 speaker. You can watch Sam’s TEDMED talk, “What if we could rewrite the human genome?”, here. 

This thing called CRISPR seems to be all over the news these days, whether as a miracle treatment to cure genetic disease, an eradication strategy to rid the Earth of mosquitoes (together with Zika virus and the malaria parasite), a weapon of mass destruction alongside North Korean nukes and Syrian chemical weapons, or the reproductive technology that will usher in an era of so-called designer babies. CRISPR was even featured in the recent comeback season of the X-files, in conjunction with aliens and a global pandemic. What could possibly unite all these divergent topics?

The common thread is DNA, and more specifically, an amazing new tool that makes editing DNA virtually as easy as the “find and replace” function in word processing software (check out this neat video for an animated explanation). Of course, scientists have had the ability to modify DNA in the laboratory for decades – even to synthesize entire microbial chromosomes from scratch. But using the CRISPR technology, it’s now possible to rewrite DNA inside living cells with the same kind of control and accuracy, and to tweak billion-letter genomes in almost every way imaginable: deleting genes, adding genes, inverting genes, repairing genes, even turning genes on or off. After three short years of research and development, scientists have been hard-pressed to find things that CRISPR can’t do.

shutterstock_353873630So what is CRISPR, anyway? Although the acronym alone won’t tell you much – CRISPR stands for clustered regularly interspaced short palindromic repeats – the story behind these repeats, and how they came to revolutionize biology, is pretty cool. The short version: after first being detected in E. coli in 1987, CRISPR remained a complete mystery for nearly two decades, until scientists studying yogurt-producing bacteria realized it was a type of antiviral immune system. Subsequent research in flesh-eating bacteria not only revealed how CRISPR naturally worked, but also how it could be redesigned and repurposed for DNA editing in other organisms. (You can read more about some of the breakthrough discoveries here and here.)

After the first reports surfaced in 2013 demonstrating successful editing of the human genome, the CRISPR technology was rapidly applied to a huge number of plants and animals, everything from common model organisms like rice and mice to more exotic species like broccoli and butterflies. Meanwhile, labs all around the world began using CRISPR because of its low cost and easy implementation. Today, even ordinary online shoppers can order do-it-yourself CRISPR kits to edit DNA in the comforts of their own home.

Having spent my PhD years studying CRISPR in Jennifer Doudna’s laboratory, starting well before the technology exploded, I’ve been mesmerized by the myriad ways in which DNA editing is transforming biological research. After all, DNA contains the blueprints for all living things, and we now have total mastery over these blueprints, to alter them in virtually any way that suits our needs or fancies. Yet with this newfound power also comes a responsibility to use it safely, and ethically.

Should CRISPR be used to alter the human genome for generations to come, by editing DNA in fertilized embryos? To create genetically engineered designer pets, such as miniaturized pigs or extra-muscular dogs? Or to spread new traits like malaria resistance or female infertility into wild insect populations? By removing many of the technical barriers that previously limited attempts at DNA manipulation, CRISPR has changed the question facing society from “If we could do it, would we want to?” to, “Now that we can do it, should we?”

Scientists and a wide range of stakeholders have already begun tackling some of the issues raised by CRISPR, and governmental officials are quickly following suit. In the U.S., within the next year or so, we can expect the announcement of an updated system for the regulation of genetically modified products, and a comprehensive study outlining recommendations for the responsible use of gene editing in humans.

There are reasons to proceed cautiously and prudently. But I hope that – even with all the concern surrounding CRISPR – we don’t lose sight of the incredible possibilities. In a medical first, DNA editing saved the life of a one-year-old girl suffering from leukemia last fall, and that may be just the beginning. Whether as a tool to expose the vulnerabilities of cancer, a therapy for patients afflicted with HIV/AIDS, or a cure for muscular dystrophy and sickle cell anemia, CRISPR offers real promise to solve some of the world’s most challenging diseases. Let’s see what a few more years of research can achieve.

Overheard at TEDMED: Let’s Dance

Optimized-MichaelPainterThis guest blog post was written by Michael Painter, senior program officer and senior member of the Robert Wood Johnson Foundation’s Quality/Equality team.

Most have seen Derek Sivers’ 2010 TED talk, “How to start a movement.” In it a horde of dancers danced. That horde didn’t come out of nowhere of course. It started with a single nutty guy’s idea of a dance. Soon another joined, then more and more. Those two eventually became that dancing horde. Change—even big change—is like that dance. It starts small. An idea moves out of a mind into a conversation. Sometimes a small conversation, even over lunch, turns into a bigger one—a much bigger one.

At TEDMED 2015, TEDMED asked its community to dance about health. They asked each of us: what is your role in building a Culture of Health? Sure, we can agree on an ultimate far-off health goal for the country: everyone would have the hope, the means, and lots of opportunities to lead the healthiest lives possible. There are many (many) ways to get to that future. Some of those ideas can be remarkably different—most of them aren’t easy—but together they will help us create our Culture of Health dance.

TEDMED drove that conversation—that dance—with open-ended questions to spark powerful discussions about the role of health in our lives and communities. More than 800 TEDMED Delegates participated on-site, and over 150 contributed their perspectives online in response to thought-provoking questions like:

  • What is masquerading as health?
  • How can business positively impact society’s health?
  • Name one small shift that would make the biggest impact on health?
  • What is the secret to making health a shared value?

Blog post 4A dance floor is only as rich as its many wild dancers. The TEDMED team captured over 1,000 responses that reflected a range of diverse thoughts and insights from health care professionals, government officials, scientific researchers, entrepreneurs, journalists, bloggers, and more.

Blogpost3These TEDMED dancers pointed to barriers and opportunities that will help us all make health a shared value. For example, many questioned whether we have placed too much trust in technology and the latest health apps and gadgets, instead of focusing on building real-life social connections and trusting human relationships. Conversations also highlighted the importance of addressing social determinants (such as housing, discrimination and economic status), and debated whether the government should try to provide incentives for healthy behavior.

TEDMED saw some emerging themes in the Culture of Health dance, summarized in the attached piece. Take a look. See what you think. Help us keep the conversation going in your communities – both online (using the #CultureofHealth and #TEDMED hashtags) and off. We can absolutely build our healthy future—but only if we dance together. Is your toe tapping yet?

Meet Dr. Pamela Wible, physicians’ guardian angel

In this interview, TEDMED’s Dr. Nassim Assefi and founder of the Ideal Medical Care movement Dr. Pamela Wible discuss physician suicide, sexism in medical school, and how to escape “assembly-line medicine.” You can watch Pamela’s TEDMED 2015 talk, “Why doctors kill themselves,” here.

Pamela Wible

Nassim: You’re one of the few physicians I know who’s been outspoken about physician suicide, open about her own history of depression while in medical practice, and proactive in addressing medical student and physician mental health. How did you become such an activist?

Pamela: I’m an activist and community organizer at heart. I was born into a family of physicians, activists, and entertainers. My grandfather started the motion picture workers union in Philadelphia. I’m related to Curly, Moe, and Shemp of the Three Stooges. It’s in my blood to be joyful, comedic, and lighthearted, but also to speak up for the oppressed and victimized. I’m a born healer and problem solver—whether it’s a patient with an ingrown toenail, a doctor with PTSD, or a suicidal health system. I’m curious, relentless, and very vocal about injustice. Yet without action, words fall flat. Action is what excites me most.

Nassim: You’re a somewhat controversial figure in such a conservative profession. You wear glitter, throw Pap parties, and even deliver balloons and homemade soup to your patients during house calls. Is this quirkiness and whimsy an intentional strategy to spread joy and love in your medical practice or just an extension of who you are? Have you ever received pushback from a mistrusting patient or colleague?

Pamela: My personality and my glitter are not strategic. I’m just being me. I find that when I am free to be myself, my patients feel free to be themselves. Authenticity is therapeutic for us all. Authenticity is also sorely lacking in health care, much to the detriment of physicians and patients. Medicine has too many starched white coats and not enough color, soul, and feeling. My patients are relieved and even thrilled to meet a “real” doctor who is a “real person.” Once (in response to an article I wrote for a medical journal) I did receive a letter from a male clinic manager who claimed my appearance was unprofessional. I recited his letter and responded to his concerns in my TEDx talk, “How to get naked with your doctor.”

A surprise birthday party physical at Pamela's clinic.

A surprise birthday party physical at Pamela’s clinic.

Nassim: You’re a pioneer of the Ideal Medical Care movement, have written a book about it, and offer courses and retreats to help doctors escape “assembly-line medicine.” Can you give me the nitty-gritty on ideal medical clinics?   

Pamela: I’m simply practicing medicine the way my dad used to practice as a neighborhood doctor back in the 1950s (though I’m pretty sure he didn’t throw Pap parties for his ladies). Like my dad, I have no staff and I’ve never turned anyone away for lack of money. My dad and I genuinely love people, and I’m sure patients can feel the love.

I see 6 to 8 patients per half day for 30-60 minute visits. I document on an electronic medical record that I created myself on my Apple laptop. I accept insurance and submit claims in 1-2 minutes after each visit through a free online clearinghouse. I roll out the red carpet for every patient, whether millionaire or homeless. It’s VIP without the fee. By cutting out the middlemen, I decreased my overhead from 74% at my favorite assembly-line job to nearly 10%, leaving me with 90% of the revenue I generate. Physicians who practice this way can exceed their previous full-time salaries working a fraction of the hours. However, most doctors enjoy their newfound freedom and autonomy more than money. No amount of money can compensate for a miserable life and most doctors today seem pretty miserable.

Meanwhile, I’m happy. My patients are happy. I feel like I’m on vacation 24/7. I rarely get after-hours calls. Plus, I’ve never sent anyone to collections in 11+ years. This feels like the only viable way to practice medicine.

Best of all, our clinic was designed by my patients. I held town hall meetings and invited my entire community to design their ideal medical clinic. I collected 100 pages of written testimony, adopted 90% of citizen feedback, and we opened one month later with no outside funding.

What Pamela calls the "reverse white coat ceremony" physicians' retreat.

What Pamela calls the “reverse white coat ceremony” physicians’ retreat.

Nassim: Your mother, Dr. Judith Wible, is a psychiatrist and has a scholarship for visionary female medical students in her name. Did she play a role in your activism? 

Pamela: Yes. My mom is an activist and leader in the women’s rights movement. During my childhood she took me in my stroller to women’s liberation marches, bra burnings, and all of that. She and I went to the same medical school too, and what she went through was much worse than what I had to deal with due to out-of-control sexism and harassment.

Nassim: You’ve had some major success lately. A new book, Physician Suicide Letters Answered, that was #1 on Amazon for Medicine for a month after release, a new house bill in Missouri that addresses depression and suicide in medical schools, and you’re being featured in an upcoming documentary, Do No Harm, by an award-winning filmmaker, Robyn Symon. Are you optimistic that all this attention will translate into more compassionate medical education and practice for the students and doctors?

Pamela: I’m a perpetual optimist. All these successes couldn’t have happened without public and professional support and a willingness to finally address medical student and physician suicide. It is a defining moment for us all.

Nassim: So, what’ s next for you?

Pamela: I’ve been sent on some Michael Moore-style missions through hospitals with secret film crews for the documentary. That’s really fun! I’d love to dig deeper into investigative journalism.

Building Healthy Cities

This guest blog post was written by Gil Penalosa, Founder and Chair of the Board of 8 80 Cities and World Urban Parks, as well as former Commissioner for Parks, Sport and Recreation for the City of Bogota, Colombia.

CicLAvia Wilshire 06-2013

CicLAvia, Wilshire Boulevard (2013)

How would your life be different if you lived within a culture of health?

Consider the city. Over 85% of us in the U.S. live in cities. Think about how you go to places, where your children go to school, where your friends live, how you cross the street. This built environment – one that can feel so comforting and routine – is actually damaging to your health.

If you looked down on the average U.S. city from the air, you would find that 15 – 25% of the land is paved with streets. Of the land that is public – as in, not privately owned –  streets occupy between 70 – 90% of space that we all share. In this environment, the automobile has become our community connector. Children used to walk and bike to school, now they are driven. When our children make new friends at those schools, we drive them to their play dates. Parks are few and far between so we drive the kids to soccer practice. As cities spread, we drive for an hour or more to report to work. With all these cars on the road, we advocate for wider streets with more lanes and higher speed limits. In many communities, sidewalks do not even exist.

This method of navigating our built environment is killing us. Studies show that the chances of being killed increase by 75% when hit by a car going 35 mph versus one going 20 mph. Around the world, a person walking is killed by a person driving a car every 2 minutes. Twenty years ago, no state in the US had a population with an obesity rate over 20%. Today, there is not a single state whose obesity rate is less than 20%. Concern over obesity is not aesthetic: it causes heart attacks, respiratory problems, cancer, depression and anxiety.

And the challenges are increasing. Currently in the US there are 42 million people over 65 years old; in just 35 years, this number will double to 85 million. Of all the people who have ever lived to 65, half are alive today. We are living longer – much longer – yet our cities are becoming less friendly to older adults. As wider streets lead to longer crossing times, older people are being killed in crosswalks at 4 times the rate of their proportion of the population. The main issues facing the elderly are isolation and mobility. How are we going to address those if we continue to build communities that quite literally threaten their lives?

How do we change the future? To live a culture of health, citizens can no longer be spectators. We must act. We must each commit to participate.

Call on your governments – elected officials and your city staff in departments of planning, transportation, public health, education, parks and recreation – to commit to working with each other and with other sectors like businesses, media, activists and universities to guide the development of our cities with people in mind, creating healthy communities where all people will live happier.

Reclaim your streets. Walking and bicycle riding are the only individual modes of mobility for all people under the age of 16 and for many adults. Safe and enjoyable walking and cycling should be a right for all people. Support budgets that include money for sidewalks. Advocate for Open Streets, the closing of streets to cars on Sundays so that people can use this public space to walk, bike, be with each other. Make it easy for people be out and about in their communities, to visit other neighborhoods, to meet other people meet as equals.

Support investment in parks, large and small, that thread through your city, in all neighborhoods so that every child has a play area within ¼ mile at any given time. If land is not readily available, public properties can be converted for recreational use. School playgrounds can be used by the school during the weekdays but open to the community in the evenings and weekends.

We must improve the use of all land that is public. It belongs to all people. We must stop building cities as if everyone was 30 years old and athletic and create great cities for all. Any city, of any size, should pay attention to how well they treat its most vulnerable citizens, including children, older adults, disabled and poorer residents.

How is your city doing? You don’t have to be an expert to assess whether a park, street, sidewalk, school, library, actually any public space invites people to walk or ride. Simply use 8 80 Cities’ practice. If evaluating an intersection, think of a child you love, someone around 8 years old. Now think of an 80-year-old that you love. Would you send them across that intersection? Would they feel safe? Can they walk to school or to a park? If your answer is yes, it is good enough. But if it is no, it must be changed. The 8 and the 80 year olds are indicators. If a city promotes a culture of health for them, it will promote a culture of health for everyone, a built environment where everyone can live the healthiest lives possible.

Charting the Next Course: Women Speak from a Mighty River

By Christine McNab, guest contributor. Can Tho, Viet Nam

She’s petite, yet stands tall and steady, strong shoulders and arms steering eight foot-long oars through a swift Mekong current. It’s dawn, and many women do the same, navigating their low wooden boats through a jigsaw of vessels at the Phong Dien floating market. Women here do a brisk trade in produce, exchanging pounds of watermelon, daikon, pineapple, cabbage, morning glory, onion and squash for Vietnamese Dong. The bounty from the Mekong Delta provides much of the food energy for Vietnam’s 90 million people. Women are at the heart of this essential commerce.

“Vietnamese women are often in charge of driving the small boats, and buying and selling at the fruit and vegetable markets,” says Maru, my guide. The work is taxing – a technique combining crossed arms and oars to nudge the boat through narrow spots; a one-legged start of a long motorized rotor for speed, and hours under a searing sun. Our driver, Tay, has been steering boats for more than twenty years. “Women here work very hard,” Maru tells me.

I want to find out a lot more about Tay and Maru, and I will this week as part of my new multimedia project, A River Runs with Her: the Lives of Women and Girls on the Mekong.

Near Can Tho, Viet Nam, March 2016. Photo: Christine McNab

Tay has done the hard work of steering boats on rivers and tributaries of the Mekong Delta for more than 20 years. (Near Can Tho, Viet Nam, March 2016. Photo: Christine McNab)

I’m devoting 2016 to this self-funded project for many reasons. For one, I believe attaining gender equality is at the heart of international development. Many studies, history, and a lot of common sense tell us that we can only make progress when women have the same rights, access to education, health, jobs and justice as men. Women have made great strides in much of the world, but in too many places, women and girls are simply valued less. Equality means equal value, and it also means equal voice.

We don’t hear from women enough. The Economist recently published an excellent essay on the importance of the Mekong River to biodiversity, culture, and Asia’s economy. I admired the reporting, but noticed there wasn’t a single female voice in the piece. Instead, women were in the kitchen making soup or in bars serving beer. I want to hear more from these women.

The newest international Global Goals for Sustainable Development, set by international leaders last September, include important targets for women’s equality, for education, health and participation in governance. The goals are hopeful and ambitious. I wondered what women living in communities along the Mekong think about these goals? What do they need to achieve them?

And then, there’s the mighty Mekong itself, a legendary, 2700-mile artery connecting six countries, many cultures and one of the most bio-diverse areas of the world. Its waters are a lifeblood for millions. As the climate changes, the Mekong, and the traditions and economic lives of millions are changing with it.

Tay doesn’t speak much as she drives her boat down a Mekong Delta tributary. But I want to know what she thinks about all of this. I think it’s her time, and time for all women, to tell the world what they think.

Learn more about A River Runs with Her project in this 1-minute video.

To follow the project, see www.ChristineMcNab.com, add http://www.christinemcnab.com/her-stories/ to your RSS feed, or follow along on Facebook.
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Christine McNab is a global public health worker and communications expert. Her TEDMED talk illuminates the story of how she combined her passions and partnered with the Gates Foundation to create what might be the most artistically crafted vaccine promotion campaign ever.

Design can transform healthcare services and spaces

By Stacey Chang, Executive Director of the Design Institute for Health, a collaboration between the Dell Medical School and the College of Fine Arts at the University of Texas at Austin dedicated to applying design approaches to solving systemic health care challenges as an integrated part of medical education and training. Stacey is also a member of the TEDMED 2016 Editorial Advisory Board.

Stacey ChangRecent developments in medical research have focused significantly on individual health. From personal genome sequencing and microbiome analysis to the influence of a person’s specific environment and behaviors, it’s clear that – as we develop new therapies – there’s tremendous value to be derived from considering what makes each of us biologically unique. Yet, our collective health outcomes as a society inexorably worsen. Although our technological virtuosity shines, we still seem unable to address aspects of health that are broadly universal and shared across the collective of human society.

As we seek new approaches and creative problem solving, “design thinking” should continue to become an increasingly powerful tool for identifying and solving these complex health challenges. Most casual observers view “design” as an aesthetic discipline that gives rise to beautiful things – for instance, we are all familiar with the output of interior designers and graphic designers. Design thinking, however, is not about the output, but rather the perceptive, inspired methodology that leads to that output.

Specifically, design thinking begins with research that reveals the deeper needs of the humans in the system, needs that they are either unaware of or unable to describe. The research, qualitative in nature, is a savvy combination of psychology, sociology, and anthropology. It leads to insights that are the inspirational spark necessary to develop completely new solutions (not just incremental revisions of existing tools or constructs, an unfortunately common response in healthcare). Those solutions are then built and tested, but in quick, low-resolution iterations. The resulting failures are of low consequence, but rich with learning, and the rapid-cycle revision leads to large-scale interventions that have already had the major risks resolved.

Design thinking is a fundamentally different approach to problem solving, and particularly unique in health. After more than a decade practicing design thinking at the design firm IDEO and leading the health side of the business, I founded the Design Institute for Health last year. As a collaboration with the new Dell Medical School and the College of Fine Arts at the University of Texas at Austin, we are positioned to apply design thinking in Central Texas with the goal of developing a model for what the health system of the future looks like.

We’ve already begun to remake services, environments, infrastructure and incentives. For example, through our design research, an underlying insight we identified was that the more you give a patient (a person, really) increased control and ownership over their experience, their anxiety will lower, they’ll be more engaged, and they’ll feel more empowered to develop self-efficacy. Though obvious in hindsight, it turns out that this is applicable across the entirety of people’s experiences in health, and is also consistent across every demographic divide.

The Children's Medical Services, at Broward General Medical Center, in Ft. Lauderdale, Florida. Home Visits with Nurses and Social Workers, June 10, 2011. Inter Professional Nursing.
Home visits with nurses and social workers at the Broward General Medical Center in Ft. Lauderdale, Florida. Image courtesy of the Robert Wood Johnson Foundation.

As a result of this insight, we’re designing outpatient clinics with no waiting rooms (because isn’t waiting just actually a process failure?) where patients and their families are granted their own private room for the duration of their stay. It becomes their personal space, where they can control everything from lighting, to entertainment, to the layout of the space. In this environment, we also ask them to take a more active role in their own care and make decisions, enabling them with information and perspective along the way.

We have also found that care providers (doctors, nurses, and staff) want to be recognized as humans, as well. They hate the system that has turned them into robotic executors of process, instead of providers of human care. In pursuit of efficiency, many nursing functions are parsed into smaller and narrower bundles of tasks. Pre-operative nurses onboard patients, but rarely spend more than ten minutes with a single patient before they’re handed off, and the bed is turned. This assembly line scenario is akin to the automotive assembly line worker who puts the same four screws into the same plastic part over and over again for an entire 8-hour shift. To upend the model, we’re redesigning the roles, so the nurses cover pre-op, intra-op, and post-op; in doing so,the nurses see fewer patients in a day, but develop a meaningful relationship with them throughout the entire stay. While this demands more of them in breadth of skill, it turns out that giving staff more control and ownership over their experience also makes them more engaged and empowered, and delivers a better outcome.

A deeper understanding of human motivation can lead to meaningful impact. In the end, scientific advances are an important and necessary component of the advancement of our society’s health, but it only represents one edge of innovation. To achieve our collective wellbeing, we must ultimately engage everyone in pursuit of better outcomes. We need to redefine health in terms that people can embrace and influence, giving them the agency to act on their own behalf. We might, perhaps, call this a culture of health.

Promoting Health Equity by Choice

This guest blog post was written by Dr. Mary Travis Bassett, the Commissioner of the New York City Department of Health and Mental Hygiene. Dr. Bassett spoke at TEDMED 2015.

mary-bassettNew York City is one of the most diverse but racially segregated cities in the United States. Neighborhood segregation and structural racism, including poor housing conditions and limited educational opportunities, have led to unacceptable health disparities in our city. In turn, these health disparities have led to many lives – mainly the lives of poor New Yorkers and people of color – being cut short.

On average, New York City residents are expected to live longer than the average person in the United States. However, within the five boroughs, health outcomes can vary substantially from one subway stop to another. Average life expectancy rates can obscure those worrying variations between neighborhoods. In places like the South Bronx and Brownsville, Brooklyn, where I first lived when I was a little girl, people can expect to live lives about 8-10 years shorter than a person living in Manhattan’s Upper East Side or Murray Hill.

The usual explanation for these unhappy odds is that people in these neighborhoods are making a whole series of bad lifestyle choices. They eat too much, don’t exercise, smoke, drink, and so on. I’d like to challenge everyone to think differently.

Instead of thinking that people in Brownsville live shorter lives because they are choosing to eat unhealthy foods and choosing not to exercise enough, let’s think of how a lack of choice can impact a person’s health. For example, people don’t choose to live in a neighborhood where it’s unsafe to walk or exercise outside at night. People don’t choose to rent an apartment in a community that does not have a grocery store nearby. No one chooses to take a job that pays a wage impossible to live on, let alone live healthy on. The problem is not lifestyle choices that are bad for one’s health, but having too few choices that negatively affect a person’s health.

When we think about health, we have to think about restoring choices. For people to live healthier, they need good housing, a more livable wage, a good education, and safe spaces to exercise. All of these help build a neighborhood where people look out for each other. To achieve health equity, we have to confront all of the factors that affect a person’s ability to live a healthy life. That’s why as health commissioner, I will use every opportunity to speak out against injustice and rally support for health equity.

Our new initiative, Take Care New York 2020, seeks to do just that. It is the City’s blueprint for giving everyone the chance to live a healthier life. Its goal is twofold — to improve every community’s health, and to make greater strides in groups with the worst health outcomes, so that our city becomes a more equitable place for everyone. TCNY 2020 looks at traditional health factors as well as social factors, like how many people in a community graduated from high school or go to jail.

Additionally, the City’s investment in Pre-K for All will go a long way toward addressing the inequalities we’ve seen emerge so early in life, which reverberate across the lifespan. Investing in early childhood development is an anti-poverty measure, an anti-crime measure, and it is good for both mental and physical health. For example, the number of words a child knows at age 3 predicts how well he will do on reading tests in third grade, predicts his likelihood of graduating from high school, and so on. Early investment is key to undoing decades of injustice.

I believe that achieving health equity is a shared responsibility, and we can only accomplish real change by working together. This is a big challenge, but I am hopeful. New Yorkers are fortunate to have a Mayor and an administration that is committed to addressing longstanding inequality. Every city needs such committed leadership if we are to see a day where someone’s ZIP code does not determine their health. I hope you will join us on this pursuit of equity.