How Lessons From Abroad Are Uplifting Youth In the United States

By Jennifer Ng’andu, a senior program officer at RWJF. Read her full bio here. Reprinted with permission from the Robert Wood Johnson Foundation’s Culture of Health Blog.

Creative programs in Latin America are inspiring U.S. communities to pursue similar approaches that connect young adults to education and employment.

Like many high school graduates in Brazil, Caroline was eager to find a job. She desperately needed money to continue her studies and pursue her dream of becoming an engineer. But two years after graduating, she was still unemployed. Caroline eventually managed to improve her job prospects in an unlikely way—through drawing, dance and breath work.

Intent on breaking free from a family history of women who weren’t able to get good jobs or finish high school, Caroline discovered a job training program run by Rede Cidadã (The Citizen Network). The non-profit organization connects youth to jobs and apprenticeships throughout Brazil, where the youth unemployment rate is nearly 25 percent.

At Rede Cidadã, Caroline joined other young people in exercises that used movement and art to help her better understand and channel her emotions while becoming a strong communicator. She learned mindfulness techniques to help manage stress and build productive relationships. While untraditional, these methods have proven effective at equipping young people across Brazil with essential life and work skills—Rede Cidadã has placed more than 60,000 youth into work since it was founded fifteen years ago. Upon completing the program, Caroline landed a job at AIC, a teleservice company in her hometown of Belo Horizonte.

Expanding Opportunities for Youth 

Caroline, 20 years old, participates in Rede Cidadã’s innovative program which incorporates movement and dance into their employment training methods.

Fresh and innovative approaches like the ones Rede Cidadã uses also hold promise for the one out of eight American youth (4.8 million) who are not in school or working—in other words, who are disconnected from life’s opportunities.

Disconnection can have dire health and economic repercussions not just for youth, but for entire communities. When youth are detached from opportunities—like the chance to advance in school, gain work experience, and build social connections—society at large loses out on their potential to strengthen the social and economic vibrancy of communities.

It’s not that there are no jobs for young people. Paradoxically, the United States is facing an impending labor force—but not work—shortage. It’s urgent that we tap into the potential of youth to ensure that every one of them can thrive and be at their most productive.

A Challenge Shared Around the World

The United States isn’t alone in this challenge. Globally, the problem is even worse with one third of the world’s 1.8 billion youth neither employed, nor in education or training. Around the world, countries are deploying creative strategies to connect young adults to jobs and education—putting them on a path to healthy and successful lives.

This is particularly true in Mexico, Colombia, St. Lucia and other countries in Latin America and the Caribbean, where one in four people are between the ages of 15 and 29. These countries are taking important steps to expand opportunities for their young people.

In fact, some of their best ideas and proven programs—like Rede Cidadã—are making their way into the United States.

Adapting Ideas From Abroad

In New Orleans, the Youth Empowerment Project (YEP) is bringing elements of the highly successful Brazilian program stateside to help local at-risk youth prepare for work, develop life skills, and strengthen ties to family and community.

YEP is thinking hard about how best to adapt some of Rede Cidadã’s healing work, which helps to foster the social and emotional well-being of young people, for the United States. For instance, the Brazilians taking part in Rede Cidadã’s job trainings readily embrace one another, build trust, and share their personal traumas. In comparison, Americans tend to shy away from unlocking those histories and the feelings that might come with them. But YEP is excited about the potential to incorporate elements such as music and dance into its work readiness programs, which it thinks would resonate with the young New Orleans it serves.

YEP learned about Rede Cidadã through (Re)Connecting Youth, an initiative of the International Youth Foundation. (Re)Connecting Youth is scouring the globe, with a particular focus on Latin America, to find creative strategies for increasing youth connection that can help fill existing gaps in services and programs within the U.S.

Specifically, they are looking for programs that have one of four features:

  1. Youth as Assets. Ensure that youth voices and young leaders influence the offering and delivery of programs for youth.
  2. Social-Emotional Programming. Ensure that youth have the knowledge, attitudes, and skills needed to successfully navigate work and life.
  3. Creative Outreach & Retention Strategies. Ensure that programs recruit and engage young people where they live, learn, work, and play.
  4. Employer Engagement. Ensure that programs bridge the gap between skills young people are building and those employers are seeking.

(Re)Connecting Youth is unearthing fascinating programs, from places such as Mexico’s Juarez, often better known for its history of violence. And it’s helping local U.S. communities explore how they might bring these solutions home. Later this year, a coalition from Baltimore will travel to Tijuana, Mexico, to visit Fronteras Unidas Pro Salud, a group that offers work readiness training programs for youth, led by youth. An exchange between youth organizations in Santa Fe and Chile is also in the works.

To build a Culture of Health we need to provide the millions of youth in America who are not in school or work with opportunities to lead healthy, productive lives. And we need to find effective and innovative pathways forward for the youth of the future.

Looking abroad for inspiration and solutions can help us get there.

Want to learn more about how the Latin American experience can inform opportunities for youth in the United States? Watch our archived webinar “Connecting Youth” in our Reimagined in America: What Can the World Teach Us About Building a Culture of Health?

What If All Children Could Attend Preschool?

By Susan R. Mende and Tara Oakman, Senior Program Officers at the Robert Wood Johnson Foundation. Reprinted with permission from the Robert Wood Johnson Foundation’s Culture of Health Blog.

In Europe, rich and poor kids alike are enrolling in early care and preschool programs in large numbers. These accomplishments offer us insights for our collective efforts to strengthen early education in the U.S.

For the past 18 years, every 4-year-old in Oklahoma has been guaranteed a spot in preschool, for free. These kids are learning their letters, numbers, colors and shapes. They’re also developing arguably more important social and emotional tools—how to make friends, feel empathy, solve problems, manage conflict. These are the kind of building blocks children need to become thriving adults. Nearly 75 percent of 4-year-olds are enrolled in Oklahoma’s pre-K program. That’s one of the highest participation rates in the country. But if we look across the United States, we see that just 61 percent of kids between the ages of 3 and 6 are enrolled in pre-K, daycare or other formal early childhood education program.

Why? Of course, many parents stay home or have a friend, neighbor or relative take care of their kid. But a recent Harvard poll of parents with children under the age of five highlights the struggles families face in finding quality, affordable child care. Many parents reported having limited options and said that the cost of child care had caused financial problems. Low-income families were especially likely to report difficulty accessing care.

What’s Happening in Other Countries?
Unlike the U.S., many European countries have nearly universal participation in preschool—rates of 95 percent or higher. What’s more, these countries have high rates of participation even among low-income families. A recent scan of child care and early education in Europe, conducted by the American Institutes for Research with a grant from RWJF, identified several promising strategies that could increase participation in early childhood education in the United States, particularly among the most vulnerable.Some of the most innovative ideas the report spotlights:

● A continuous birth-to-school system: In Sweden, Family Centers provide prenatal and maternal health care, child health care, day care, preschool, and other social services in a single agency and location from when a child is born until they’re ready to enter school.

● Community and family engagement: In Belgium, early childhood education agencies use family supporters called “gezinsondersteuners”—paid staff members recruited from local communities who provide support and advice to new parents or to parents who recently immigrated into Belgium. A significant part of their work involves connecting those parents to other child and family services, including referrals to health care services, social workers, and employment agencies.

● Extra support for the most vulnerable: In DenmarkNorway, and the United Kingdom, low-income parents who don’t have traditional work schedules can receive subsidies to help them cover the costs of care outside of “core” hours (typically 9 a.m.–3 p.m.)

Similar strategies were behind the success of programs across the continent and underscore how we have much to learn from our neighbors overseas.

The European experience also strongly suggests that the best way to reach vulnerable families is to provide universal access to early care and education programs—where all children, no matter where they live or how much money their families earn, have the option to enroll in high quality and affordable child care.

Europe’s accomplishments offer us insights for our collective efforts to strengthen early education in the U.S.

Challenges Can Be Overcome
Every child—and every family—in the U.S. should be able to access high quality, affordable child care and preschool. And we need to make sure the people who have the toughest time accessing these services are not left behind.

Of course, it’s not going to be easy. But it wasn’t easy for European countries either. They faced resistance among teachers about losing their academic focus and becoming “child care providers,” and resistance among parents about early care and education becoming too “school-like” and academic for their younger children. They encountered parents whose cultural norms, lack of awareness and mistrust of government agencies kept them from enrolling their children in the formal programs that were available to them. They navigated a fragmented child care and early education system far removed from similar services for school-age kids. They worked hard to keep the costs of early child care and education services manageable. During the recession, which hit many European countries especially hard, they fought to maintain public and financial support for universal early child care and education.

And they overcame these challenges.

Our Children, Our Future
We’re encouraged that cities and states across the U.S. are embracing universal pre-K and taking steps to improve the child care facilities and preschools our children attend. But it’s time to accelerate these efforts. The repercussions of not doing so are already being felt by families across the country. And are hurting us as a nation.

One thing we can all agree on is that early childhood matters. The earlier we start to nurture children’s well-being, the better chance we have to put them on a path to success.

Read the report Connecting All Children to High Quality Early Care and Education to get started.

New Solutions to Old Health Problems

“Insanity is doing the same thing over and over again and expecting different results.” We’ve all heard this famous quote, and you’ve probably heard it applied to a range of different situations. When it comes to health and medicine, it definitely rings true. In order to move past limits and find new solutions, we have to be willing to reassess the old way of doing something and be open to approaching problems from fresh, new angles. That’s exactly what these six TEDMED 2017 Speakers and Innovators are doing—they’re confronting tough problems in health and medicine with out-of-the-box thinking. They’ve embraced the fact that in order to get the health outcomes we want, we need to try something new.

When it comes to surgical training, the standard approach is “see one, do one, teach one.” After watching a procedure completed once, surgeons and surgeons-in-training are expected to be able to perform the procedure themselves and also be capable of teaching another surgeon how to do it. This is the way surgeons have been trained for generations. But Justin Barad, Co-founder of Osso VR, knew there had to be a better way. He and his team have developed a new surgical training platform that hopes to transform the way surgeons learn to operate. Using realistic virtual hands-on simulations, surgeons trained with Osso VR have the ability to rehearse and master procedures—rather than just watch them—before operating on patients. Additionally, the company’s highly portable VR training enables surgeons everywhere to have access to cutting-edge education. Osso VR not only intends to optimize patient outcomes by allowing surgeons more opportunity to practice hands-on, but also to close the gap in surgical training around the world.

When it comes to finding new ways to improve patient outcomes, there’s plenty of room for improvement across the board. In recent years, patient compliance has taken center stage, and most people have focused on the different strategies providers can use to get their patients to remember to take their pills. At Lyndra, CEO Amy Schulman sees the problem from a different perspective. Instead of working to change the patient, she and her team have set out to change the pill. Lyndra is revolutionizing the way in which we take our medications by turning the daily pill dose into a weekly or monthly dosage. With their ultra long-acting oral drug delivery platform, Lyndra is able to reduce the frequency of how often a medication must be taken, which helps the 50% of patients who fail to adhere to their prescription regimen to stay on track with their treatment.

Adherence is also a big issue when it comes to diabetes. From monitoring blood sugar to taking insulin, diabetic patients are forced to take on a huge responsibility in managing their health. However, Fractyl has set out to change the way we treat Type 2 diabetes patients. To start, they’ve shifted attention away from the pancreas, which as the producer of the hormone insulin, has been the focus of mainstream diabetes treatment. Led by Harith Rajagopalan, Co-Founder and CEO, Fractyl is instead focusing on the gut. By targeting the upper intestine, or duodenum, Fractyl addresses a root cause of insulin resistance: the altered intestinal lining of diabetes patients, which has become damaged due to high sugar Western diets. Through their minimally invasive outpatient procedure, Fractyl works to reverse insulin resistance, the hormonal imbalance that causes diabetes, by resurfacing the gut lining of patients. For the 100 million plus diabetes patients worldwide, this procedure could be a game changer—one that means they no longer have to take daily insulin. Furthermore, and importantly, employing Fractyl’s procedure could help to reduce the massive physical and financial burdens of diabetes management that we face on both individual and societal levels.  

The team at Freenome, lead by CEO Gabriel Otte, is also looking to improve the patient experience and doing so by striving to change the way we approach diagnosis. Instead of waiting until patients are symptomatic, they are developing precise and proactive screenings for a range of diseases, including cancer. By combining machine learning, biology, and computer science, Freenome’s blood test looks for changes in DNA fragments over time as a means to detect disease in its earliest and most manageable stage. Gabriel and his team want to change the paradigm—instead of fixing health after we become sick, they want to find disease while it’s still manageable and allow patients to maintain their health.

The team at Zipline saw an old, persistent problem and created a totally unexpected solution. Many countries face difficulties maintaining adequate stocks of medicines in rural areas due to high cost and challenges related to proper storage conditions. In places such as Tanzania, where 68% of the country’s 55 million people live in rural, or Rwanda, where 70% of the country’s 12 million people live in hard to reach areas, the challenge of providing patients with the medical care they require has long been a difficult limit to overcome. In response, Keenan Wyrobek, Zipline’s Co-founder and Head of Product and Engineering, and his team are building and deploying drones—or “Zips”—that deliver life-saving medical supplies, including blood and medications, to remote areas. These drones are capable of carrying out 500 deliveries per day, navigating through difficult terrains and gaps in infrastructure, and flying at all times upon request. Zipline has been deploying Zips throughout Rwanda since late 2016, and they recently announced their plan to expand to Tanzania. By thinking truly out of the box, Keenan and the team at Zipline are confronting accessibility issues and transforming healthcare for millions of people.

Drug pricing is another seemingly intractable issue in health and medicine. Take for example cancer drugs that cost a patient over $100,000 per year. A physician at Memorial Sloan Kettering Cancer Center, Peter Bach is confronting the complex drug pricing issue head-on. As Director of the hospital’s Center for Health Policy and Outcomes and the founder of the Drug Pricing Lab, Peter and his team strive to change the way we think about drug costs. By bringing more transparency to the drug pricing process and identifying rational approaches, Peter works to balance getting patients the treatment they need, while also ensuring drug developers have adequate funding to research, improve, and develop important therapeutics. To do this, the DPL team researches ways to reduce the cost of drugs, educate health professionals and policymakers, and promote policy reform. In service of these objectives, Peter and the DPL launched the DrugAbacus in 2015, an interactive tool that allows users to compare the actual prices of certain cancer drugs to their prices based on value. Through his work, Peter is shifting the focus of drug pricing and putting patients at the center of the conversation.

From the inside of an operating room to the hills of Rwanda, these six Speakers and Innovators are taking on the status quo and driving big changes in health and medicine. At TEDMED 2017, we’ll hear from these outstanding individuals, as well as dozens of others, who are all working in that fertile zone between “what is” and “what could be?”. Their efforts are pushing past perceived limits, driving innovation, and improving health outcomes for all.

The Human Brain and All Its Complexities

From thoughts and feelings to neurons and pathways, we humans have been trying to better understand our minds and uncover its mysteries ever since our brains developed the capacity for modern human cognition. However, despite the huge advancements brain research has made in recent decades, we are only beginning to scratch the surface of this intricate and fascinating organ. At TEDMED 2017, we’re putting the brain center stage with Speakers and Innovators who are doing groundbreaking work in fields such as brain development and genetics, neurodegenerative and neurological diseases, and human cognition.

Neuroscientist Guo-li Ming is creating and using brain organoids—miniature, simplified, lab-grown versions of organs—to model diseases and experiment with new treatment options. Specifically, Guo-li and her lab at the Perelman School of Medicine at the University of Pennsylvania are focused on the Zika virus and the severe brain defect it causes, microcephaly. After the recent outbreak of the Zika virus, no one knew what exactly was causing microcephaly, which was a major roadblock to helping patients and finding potential treatment options. However, in early 2016, Guo-li’s lab, along with researchers at two other universities, published groundbreaking studies that showed how damage to neural progenitor cells could explain the reduced brain volume in babies that had been exposed to Zika in the womb. Because of Guo-li’s research, doctors, scientists, and researchers have a better understanding of the disease— which will hopefully lead to a clearer path forward in terms of treating Zika patients.  

Steven McCarroll is also exploring new ways to study the human brain and the conditions that affect its development and function. As a geneticist, Steven is particularly interested in the role that genes play in developing the brain differently in different people. At the McCarroll Lab in the Department of Genetics at Harvard Medical School, Steven and his team of scientists are developing new technology that combines genetics, molecular biology, and engineering in an effort to uncover the causes of mental illness. In 2016, the McCarroll Lab published studies linking schizophrenia to specific gene variations that recruit immune molecules into “pruning” synapses in the brain, a discovery that is leading toward new ways of thinking about the biological basis of schizophrenia and new approaches for discovering medicines to the treat the illness.

At Yumanity Therapeutics, Chee Yeun Chung and her teammates are working to develop new treatments for neurodegenerative diseases that are caused from protein misfolding. Currently, there are over 55 million people affected by these diseases, with no kind of effective cure or treatment to change the pathology of their conditions. Along with Chee, Yumanity’s Scientific Co-founder and Associate Director of Assay Development, the team focuses on repairing the specific phenotypes of the cells and pathologies of the diseases caused by protein misfolding. Their goal is straightforward: to develop novel therapies aimed at improving the outcomes for these patients. They do so by using an integrated three-platform system comprised of a phenotypic screening platform to model disease pathologies, a human neuronal platform, and a drug-target identification platform. Combining all three of these platforms allows Yumanity to expedite their process of identifying new possible disease-modifying drugs and targets to improve the prognosis for the millions of patients affected by neurodegenerative diseases worldwide.

Like neurodegenerative diseases, neurological diseases are a condition that affects millions of people—Parkinson’s alone affects 1 million Americans. At Cala Health, Founding CEO Kate Rosenbluth and her colleagues have embraced electricity as a novel therapy to target neural circuits to “retune’ the body. Their technology, neuroperipheral therapy™, combines innovations in three categories—medical devices, consumer electronics and individualized medicine—to provide non-invasive treatment for patients suffering from neurological diseases. Currently, Cala is working to alleviate the symptoms of the essential tremor by stimulating nerves using a body-worn electronic. With their technology, Cala hopes to use electricity as a means of providing individualized medicine and custom therapies to patients with a range of nervous system disorders.

Similar to Cala Health, Kernel is also developing new technology to help us better understand and treat various neurological diseases. Chief Commercialization Officer Dan Sobek and his teammates are not only working on next-generation brain interfaces that aim to treat neurological conditions like Parkinson’s Disease, but also mental and degenerative illnesses like depression and Alzheimer’s. In parallel, the company is also developing consumer-grade devices that are able to “listen” to the brain and gather information. By accessing and then interpreting the brain’s complexities, the team intends to develop applications to “illuminate the mechanisms of intelligence and extend cognition.” Ultimately, Kernel aims to explore the possibilities of enhancing the brain—making humans smarter and one day even interfacing with computers.

These Speakers and Innovators are working on ways to better understand the intricacies and address the challenges of the complex human brain. From creating brain organoids to model diseases and test treatments, to uncovering the gene variations associated with mental illness, to developing new treatment options for neurodegenerative, neurological, and degenerative diseases, TEDMED 2017 will feature individuals who are doing pioneering work in their fields to advance our understanding of our body’s most critical organ.

Helping Young People in Crisis, One Text at a Time

Written by Tracy Costigan. Tracy is a distinguished behavioral scientist and a senior learning officer at the Robert Wood Johnson Foundation. Through her role, she is involved in the process of understanding and measuring key health and health care issues essential to the Foundation’s strategy to move our nation toward a Culture of Health.

Reprinted with permission from the Robert Wood Johnson Foundation’s Culture of Health Blog.

It began with a shocking text message that left the staff at deeply shaken.

The non-profit organization was originally created to promote youth volunteer and social action opportunities. It uses texting—the primary way in which teens communicate—to send thousands of daily messages alerting members to clothing drives, health fairs, park clean-ups, and more. Responses have been common. In addition to the usual sign-up requests, texters have also sought advice on how to handle a bully at school or help a friend struggling with addiction.

But as DoSomething’s CEO Nancy Lublin explained in a memorable TED Talk, one particular message from an anonymous girl changed their world.






DoSomething’s alarmed team asked who was assaulting her. A few hours later they got this reply:




And a few minutes after that:





Staff scrambled for guidance from a nearby sexual assault center and reached out to the girl again, but sadly, never heard back. Yet the anonymous girl’s desperation and courage spurred Nancy Lublin into convening a small team that created the Crisis Text Line.

Throwing Out a Lifeline with Text
Crisis Text Line initially launched quietly in Chicago and El Paso using 4,000 mobile numbers that were pulled from the database. A text message invited recipients to opt in.

Despite the complete absence of marketing to promote the new effort, it grew at lightning fast speed as recipients spread the word across their own networks. Within four months, Crisis Text Line was in all 295 area codes of the United States yielding faster geographic growth than when Facebook launched.Now an independent nonprofit, Crisis Text Line provides free, text-based support to people in crisis anywhere in the United States, 24/7. Their average texter is 18 years old and Lublin notes that text has proven to be an ideal way to counsel young people. It offers anonymity, privacy, and access to a team of trained professionals who can work together to provide support that’s tailored to the crisis at hand. According to Lublin, almost two thirds of all texters are sharing something for the very first time that they never felt comfortable confiding in friends or family. This underscores just how trusted the service and medium are.

Many messages express struggles with anxiety and bullying; suicide and depression comprise 35 percent of messages received. Staff perform on average at least one active rescue a day, intervening when a texter has shared plans for imminently harming themselves or others. Real-time surveying of texters also reveals that the service is reaching rural and low-income areas. For example, they are disproportionately reaching the state of Montana which ranks number one in the nation for suicide rates, and where the Native American population is also high. In fact, 6 percent of Crisis Text Line texters self-report as Native American—a very sizable percentage considering that only 1.7 percent of people in the United States are Native American or Alaska Native.

After a little more than three years of operation, the organization’s volunteer Crisis Counselors and texters have exchanged more than 30 million text messages, accumulating the nation’s largest set of crisis data. It created to help researchers, journalists, and public health experts better understand what drives teens to crisis and help policymakers and community leaders work together to focus on prevention.

Expanded Data and Analytics will Help Inform Interventions
The Robert Wood Johnson Foundation (RWJF) recognizes the incredible impact that Crisis Text Line is having on social and emotional development of adolescents across the country. That’s why we recently funded a major expansion of Crisis Text Line’s data infrastructure and analytics program. Our goal is to help stakeholders use local, anonymized data to examine patterns of adolescent crises. This will inform interventions that can promote the health and well-being of our future generations.

Researchers are already taking advantage. For example, social work and public health experts at the University of Montana are sifting through tens of thousands of messages to better understand patterns of suicidal thought in the state. They hope to learn why Montana texters are ranked number one in the nation for prevalence of suicidal thoughts by exploring how suicidal ideation correlates with seasonal events, such as harsh winter weather and the academic calendar. They will also explore how loneliness, substance abuse, and relationship changes may affect suicidal thinking.

When their analysis is complete, researchers will work closely with state, tribal, and nonprofit leaders to improve mental health and suicide prevention programs and better target local interventions.

We hope this evidence-based, coordinated approach will spread throughout the United States, covering a wide variety of issues, including relationship challenges, eating disorders, LGBTQ issues, and other sources of teen stress and anxiety. You can view broader trends uncovered by the analytics team, and explore the interactive data visualizations available at

We R Here 4 U
We believe that whatever your geographic, ethnic, socioeconomic, or physical circumstances, you deserve an equal opportunity to live the healthiest life possible. That’s the essence of a Culture of Health, the Northstar that guides the work of RWJF.

Building a Culture of Health requires more than treating illness; it means creating an integrated and comprehensive approach. A Culture of Health puts well-being at the center and ensures that all children and families have access to the social and emotional building blocks of lifelong health and resilience. Crisis Text Line is advancing that vision by supporting teens and deepening our understanding about the root causes of stress and anxiety among young people today.

Finally, if you or a loved one are experiencing a crisis, please text 741741 from anywhere in the United States. Trained Crisis Counselors are always available, and the service is free and confidential.

Learn more about Crisis Text Line’s Open Data Collaboration and apply for access to this new resource.→

Charting New Territories in Health and Medicine

When it comes to the future of health and medicine, the newest and boldest ideas often seem like they’re straight out of a science fiction movie. From genetically modified organisms to artificial intelligence at the doctor’s office, the latest research and headlines are generating feelings of excitement for some people—and unsettled feelings for others. At TEDMED 2017, we will feature Speakers and Innovators who are working on cutting edge endeavors that are not only pushing boundaries, but that are also bringing with them the potential for tremendous change and advancement in the fields of health and medicine.

Karen Hogan and her fellow co-founders at BioRealize wanted to help more people solve problems using biology, but they had to clear some major hurdles first. For one, designing genetically modified organisms is typically limited to people with biology degrees—due in part to the complex and tedious lab operations that usually accompany the work. Also, standard lab equipment is expensive, meaning that access to established labs and research centers is required in order to work with GMOs. BioRealize’s solution: the Microbial Design Studio, a biofabrication machine that makes it possible for anyone to design, culture, and test genetically modified organisms. Using this new platform, the design and fabrication processes are streamlined and automated, and users are able to harness the full capabilities of a biology wetlab in an affordable, countertop piece of hardware. This user-friendly platform is also networked, facilitating increased collaboration and allowing people to run experiments in parallel as a means to test and validate reproducibility.

While making biology more accessible to all seems like something everyone could get on board with, next-generation “accessible biocompanies, such as BioRealize, have been met with some resistance and fear around the issue of allowing people outside of universities and corporations to experiment with GMOs. Despite this resistance, the team at BioRealize maintains that making biology more accessible—and introducing diversity into the field—is crucial if we are going to design the next generation applications of biology and meet the challenges of the future.

LabGenius CEO James Field shares this point of view. He and his team are also paving the way for new biological advancements, therapies, and discoveries. However, instead of focusing on research performed by people, LabGenius is empowering EVA—the company’s artificial intelligence-driven evolution engine—to unlock a new wave of bio-augmented materials using AI and a library of synthetic DNA. They are building EVA to be capable of designing, constructing, and empirically testing trillions of unique genetic designs until she finds a high performing synthetic DNA sequence to test in living organisms.

Using this new approach, LabGenius and EVA are developing new and advanced biomaterials that they believe have the potential to address multiple high-value challenges—such as curing previously incurable diseases. Additionally, since EVA is automated and runs on a closed-loop approach, developing new biological products gets progressively easier over time, expanding the pace and scope of invention, which is a benefit to all. The team understands that for many, the idea that life can be altered in a lab may already be controversial—and that adding machine-learning robots into the mix will certainly be grounds for interesting debate. However, they’re embracing EVA’s ability to yield new and exciting bio-materials, which may ultimately help us humans to solve some of our most challenging health problems.

The potential for artificial intelligence to bring major advancements to health and medicine extends beyond the lab. Enlitic is using deep learning artificial intelligence to build solutions that make doctors faster and more accurate. COO and Lead Scientist Kevin Lyman helps the company to design deep learning networks that draw upon the world’s growing collection of medical data—comprised of things like patient histories, lab tests, and medical images—in order to distill actionable insights that can improve the accuracy of medical diagnoses, as well as accessibility and patient outcomes. It might sound like this type of technology is designed to replace doctors and radiologists. However, the company’s solutions are designed to support healthcare teams by giving them the insight of billions of clinical cases and helping them to access the collective intelligence of the global medical community. Enlitic’s solutions help doctors help you—by using it, they’ll be able to detect diseases sooner, which will allow for earlier diagnoses and pave the way for the development of novel courses of treatment.

Greg Corrado, co-founder of Google Brain and a Principal Scientist at Google, also believes pairing doctors with artificial intelligence has the potential to make both stronger. A former neuroscientist, Greg develops products that put AI to work. For example, machine learning computers are taught to do repetitive tasks like sorting objects into categories, and they are then corrected by humans and learn from their mistakes. Greg is investigating ways to apply this technology to medicine in a way that makes physicians more efficient at similarly routinized medical tasks, which could help achieve better health outcomes for all.

Among the possibilities that Greg envisions are AI systems that help physicians more efficiently update and sort through electronic medical records, assist with diagnostics, support clinical decision making, and even help out with writing a doctor’s note or billing. Greg’s hope is that these technologies will act as powerful “force multipliers” for doctors, benefitting providers and patients alike.

The future of healthcare is exciting; but advancements like these come with heavy ethical baggage. As a bioethicist and a Professor of Law and Bioethics at the University of Wisconsin-Madison, Alta Charo helps decipher a path forward as society struggles with balancing the potentially life-saving benefits of scientific advances with the unsettling sense of the unknown that they often bring. For instance, in 2017, Alta was part of a committee appointed by the National Academies of Sciences and Medicine to make recommendations on the ethics of human gene editing. The committee addressed the issue of editing genes in human reproductive cells, ultimately advising that gene editing should only be permitted if it’s being used to prevent a serious disease or disability for which there aren’t any treatments. Controversy surrounding scientific progress has occurred throughout history, and Alta works to help tackle the difficult but important questions around how we as a society should respond when faced with these dilemmas.

From designing GMOs outside of the lab to embracing AI to help improve patient outcomes—not to mention the ethical dilemmas that surround such endeavors—the coming years and decades are sure to bring extraordinary changes and challenges to the fields of health and medicine. These Speakers and Innovators are paving the way towards this unknown future, and they are having to navigate new roads to make it a reality. Join us at TEDMED 2017 and hear directly from these thought-leaders on how their work is surpassing limits and helping to create a healthier future for all.

Does the Mind Impact Health? A Researcher’s Insights

Alia Crum, PhD, is an assistant professor at Stanford University and is the principle investigator of its Mind & Body Lab. She has won the National Institutes of Health New Innovator Award, a mention in the The New York Times Magazine’s “Year in Ideas,” and was a speaker at TEDMED 2016. Dr. Crum has also worked as a clinical psychologist for the VA healthcare system and as an organizational trainer and consultant. Read more about her work here.

Reprinted with permission from the Robert Wood Johnson Foundation’s Culture of Health Blog.

Three days before my regional gymnastics meet in Arkansas I landed awkwardly on a practice vault, clashing my inner ankle bones. The pain was excruciating – as was the prospect of an injury crushing my dream of competing nationally. I was determined to go on, so I decided to adopt the mindset that I could mentally overcome my physical injury. I diligently iced, taped and tended to it while visualizing myself making it to nationals in spite of the setback.

I competed and placed high enough to qualify, and was elated as well as surprised by how little the pain had affected me. Another surprise: An x-ray the next day showed that my ankle had been broken.

My experience at age 10 shows the power of mindset – the frame of mind through which we perceive, interpret and organize an inherently complex world. The ability to make sense of the world through our mindsets is a natural part of being human. But the mindsets we hold are not inconsequential. In fact they change reality by influencing our attention, affect, motivation, and physiology. I had decided my injury wasn’t going to influence my performance, and almost impossibly, it didn’t.

Experiencing the powerful effects of mindset as an athlete inspired my career as an academic health psychologist. It led me on a journey to find out: just how important are mindsets? Where do they matter most? How can we leverage them to improve health and wellbeing?

The resulting past ten years of research by my colleagues and I has revealed that mindsets are in fact powerful and are often overlooked. Here are some insights from our work.

Your beliefs about stress influence how it affects you.
Stress is a great example of how mindsets can be self-fulfilling. Stressful situations are unavoidable. And yet we’ve found that most people perceive stress as negative – even debilitating. Media or public education campaigns warn us about its harmful effects. However, ample evidence suggests that stress can enhance how our minds and bodies function. It’s how a person thinks about stress that can determine its effects, according to our research.

For example, in one study we told participants – employees in a financial company that was downsizing – that stress can help rather than hurt them. As a result, they reported fewer symptoms of depression and anxiety, higher levels of optimism, and improved work performance versus the control group. In another study we showed that adopting a “stress is enhancing” mindset leads to optimal physiological stress responses, marked by moderate levels of cortisol and high levels of the growth hormone DHEA.

These beliefs about stress tend to be self-reinforcing. So if stress helps you succeed, it reinforces a mindset that stress is helpful. This is particularly important to model for children. Parents can help in explaining that experiencing stress or even failure is a natural part of life that helps us learn and grow stronger.

Mindset magnifies the benefits of exercise.
Another area in which mindsets matter is exercise. In 2007 Ellen Langer and I studied hotel room attendants whose work involved strenuous physical activity. Two-thirds of our study participants had the mindset that they were not exercising enough, that their physical labor was “just work” and not “good exercise.” Once my colleagues and I pointed out that pushing heavy carts, vacuuming, and lifting heavy mattresses qualified as sufficient exercise, they showed improvements in weight, blood pressure, and body fat over the course of four weeks. A control group had no changes. For these room attendants, a small change in mindset measurably impacted their physiological heath. This means that acknowledging the physical nature of our active jobs, or of everyday activities such as housework, grocery shopping, and playing with our kids can help us reap more health benefits from them.

More recently, graduate student Octavia Zahrt and I found that people who perceived themselves as less active than others had up to a 72% higher mortality risk 21 years later than those who perceived themselves as more active, controlling for actual levels of physical activity.

A mindset shift can help you crave healthier foods.
Having trouble sticking to your healthy-eating resolutions? Our research suggests that shifting your mindset can help. On two separate occasions, participants in one of our studies were given a 380-calorie milkshake under the pretense that it was either a 620-calorie “indulgent” shake or a 140-calorie “sensible” shake. When participants drank what they believed was an indulgent shake, they had a significantly steeper decline in ghrelin, a hunger-inducing hormone that regulates metabolism, than when they drank what they thought was a “sensible” shake. Their bodies responded as if they had actually consumed more calories.

Brad Turnwald and I have found that many restaurants describe healthy-menu items using plain language that doesn’t suggest they are exciting and tasty. Yet as we learned in another study, describing vegetables using enticing adjectives traditionally reserved for unhealthy foods – “rich buttery roasted sweet corn,” “slow roasted caramelized zucchini bites” – increased vegetable consumption by 41% compared to the standard approach of touting their health properties.

The moral is that if you want to feel deeply satisfied with healthier foods, eat in a mindset of indulgence! Viewing healthy foods as decadent versus depriving can transform your food choices and your health. Building on these findings, my lab is now designing interventions to help children and adults adopt the mindset that healthy eating is indulgent and fun.

The placebo effect is part of good medicine.
Much of the medical community views the placebo effect as a mysterious, irrelevant, response. Our research instead reveals that it comprises measureable psychological and social components that we can harness to improve health and healthcare: the body’s natural ability to heal, the patient’s mindset, and the physician’s bedside manner.

My lab and others (including the Program in Placebo Studies at Harvard) are studying which mindsets are at play, how they interact with and activate patients’ physiology, and what health care providers can do to shape mindsets that boost the body’s natural healing abilities.

In one study, Lauren Howe, Parker Goyer and I found that when a provider showed competence – such as familiarity with a treatment – and warmth, such as understanding a patient’s needs, values and goals – patients had a stronger response to an inert cream they believed would treat an allergic reaction. This shows that providers can enhance the effect of a drug or treatment with their actions and words. A social context embedded with warmth and competence is especially important in disadvantaged communities where trust in providers may be lacking.

Healthy thinking supports a Culture of Health.
Expanding our definition of health is essential to achieving a Culture of Health. “Health” has traditionally meant an absence of disease. More recently, the definition includes behaviors as well as social demographics and the environment.

Our research adds one more dimension: the critical role of healthy thoughts.

And the role of healthy thoughts is more than just positive thinking. As the studies I described illustrate, mindsets must be specific to have impact: “My work is good exercise.” “Stress helps me thrive.” “This doctor understands me.”

These specific beliefs yield tangible physiological and behavioral consequences. They are further shaped by culture, parenting, healthcare policies and public health messages, and by organizational dynamics, marketing and media.

We can now also see that many current approaches to motivating healthy behavior may, in fact, be counterproductive. For example: constantly warning against the negative effects of stress can reinforce an unhelpful mindset that stress is debilitating. Touting a food’s health properties over its flavor also reinforces the counterproductive mindset that healthy eating is depriving.

I hope these findings will motivate schools, community organizations, health care professionals and others to promote education and awareness of the impact mindsets have on our lives and work to more effectively leverage mindsets to improve health and healthcare.

Mindsets are just one piece in the larger puzzle of factors that influence health. But as I learned at age 10 and continue to learn in my research as an adult, mindsets have a measurable affect on health, and real implications for healing.

A Conversation About Raising Health with Rich Besser

The TEDMED Community is comprised of a powerful network of thinkers, leaders and doers who commit their energy and time towards making the world a better and healthier place. The Community is one of impact and purpose with no shortage of passion from all different points of view, backgrounds and areas of expertise. We rely on our Community to help amplify the voices of those working on the frontlines of health and medicine around the world, whether by collaborating with our Editorial Advisory Board in helping to design the Stage Program, working with our Research Scholars to evaluate potential Speakers, or engaging with Community members in important conversations at TEDMED each year. This passionate group of individuals constantly inspires us.

One of those individuals is Rich Besser, the new CEO and President of the Robert Wood Johnson Foundation. Recognizing Rich’s knack for storytelling and obvious passion for creating a healthier world, we asked him to be TEDMED’s first Session co-curator. The result of this collaboration is the impressive TEDMED 2017 Session called Raising Health. We recently spent some time talking with Rich about his connection to the session and the importance of creating a society that values the health of all children equally.

TEDMED (TM): We are excited to have you as TEDMED’s first Guest Curator of a session! What does this opportunity means to you, and why did you want to focus the session on “Raising Health”?

Rich Besser (Rich): I think this is an incredible opportunity to reach an important audience. The opportunity to be a guest curator gives me the chance to try and change how people think about health in many ways. As a pediatrician and a parent, I know the key role that children play in the health of a community and the health of society. Pediatrics is all about potential and what you can do to make sure that a child has the opportunity to grow up healthy. What I’m hoping here is that with this session people will start to think about all of the things that go into creating the circumstances for a child to be healthy. The speakers that I pulled together for this session look at those circumstances in many different ways that I think will expand the thinking for our audience.

TM: If your session was not limited by time, what are the other topics and themes that you would include?

Rich: I would expand the session to tackle some drivers of health that are a little more challenging to grasp, like housing and transportation and linking those directly to children’s health. I think this session will get people thinking in new ways and expand their ideas as to what it means for us all to embrace the children in our community and give them healthy beginnings.

TM: Given the synergies between your personal commitment to improving health and TEDMED’s commitment to sharing the important work and ideas of those leading the way, is there a recent story that has inspired you as you’ve transitioned into your new role at RWJF?

Rich: I’m really new to the Foundation and it’s been an incredible experience getting to know about the work. I’ve never worked at a place where people have more passion for the mission than they do here at the Foundation, and that’s one of the things that really attracted me here.

During the years that I spent at ABC News, I continued to work as a general pediatrician at a community clinic up in Harlem. Once a week, I would leave the wealthy neighborhood around our offices, get on the number 1 subway train and travel about 15 minutes to clinic where I would care for children, 80% of whom were in foster care. Their stories were just incredible and the experiences that these children, at a very early age, had gone through were incredible. Many had parents who were incarcerated or struggling with issues of addiction. Some children were homeless or physically or emotionally abused. And I know from data that the Foundation and others put out that the future for the children in that community was totally different from the children who lived near our studio around Lincoln Circle. And that’s not acceptable. Geography should not define destiny.

Here at the Foundation, that disparity is not acceptable. So, to be working at a place where the mission is all about ensuring that everyone in America, especially the most vulnerable, has a fair and just opportunity for his or her best health and well-being, to me is an absolute privilege. And to bring that message to TEDMED for me is just a wonderful opportunity.

TM: When you think about your time at TEDMED, are there a couple of things that you hope the community takes away from your session? And when you think about yourself personally, what do you hope to take away from the experience?

Rich: I’m looking for new ideas. I like to talk to people who either haven’t thought about these problems before or are coming at them from a totally different perspective, because I think that’s what challenges us to think about new things and try new potential solutions. What I hope they take away from this session is not just mind expansion, but I hope they come away feeling some ownership of the issues that we’re raising and feeling some inspiration to action. If they walk away asking, “what can I personally do to help my community raise healthy kids, to make sure that every child in my community has the opportunity to live a healthy life?” then I think this session will really be a success.

TM: This year, the TEDMED event theme is “Limitless.” When we think of our theme this year, it’s guided by the idea that–just as your fingerprint is unique impression of you, so is your contribution to shaping a healthier world. As part of the event, we are asking that all of our community respond to this. What would your response be – how are you shaping a healthier world?

Rich: You know, I am trying, through the work that I do and through how I lead my life, to help create a society in which we all value every child as if they were our own and where we are creating the circumstances so that every child has a chance to be their most successful and their healthiest. I remember when I was in college feeling a sense of idealism and wanting to make the world better. People would say that you grow out of it. I haven’t grown out of it and I hope I never do because I think that when you’ve got big goals and you really believe in the power of change, and the power of people coming together, and the goodness of people, that is when we can make a big difference in the world for people now and for future generations.

Learn more about the Raising Health Session and the inspiring Co-host and Speakers who will bring it to life:

Rich Besser, Pediatric Health Reformer
Camila Ventura, Zika Family Caregiver
Chera Kowalksi, First Responder Librarian
Dan Knights, Computational Microbiologist
Heidi Allen, Health Access Investigator
Howard Stevenson, Racial Literacy Leader
Jill Goldstein, Clinical Neuroscientist
Sandy Hassink, Pediatric Obesity Fighter

Working with our body’s defense system

When foreign microbes invade our bodies, our immune system—complex networks of cells, tissues, and organs—spring into action to protect us. But the immune system has been historically tricky to understand: sometimes it attacks itself, such as in the case of autoimmune disease, and in other cases, it can be harnessed as a treatment option to fight certain diseases, such as cancer. This year at TEDMED, Speakers and Innovators will share how they’re each working to create a better understanding of our immune system and how this internal defense system keeps us healthy.

At his lab at the Technion-Israel Institute of Technology, systems immunologist Shai Shen-Orr is committed to understanding the complex immune system from a more integrative—or systems—level. To do this, the lab is pulling together data mined from scientific publications using a software they developed called immuneXpresso, which helps to connect the dots between the interactions of various cell types and regulatory molecules. This information is then combined with genomic-level data in an effort to create a fuller picture of our immune systems, and to enable a better understanding of how its individual parts work together to orchestrate immune responses.

Additionally, Shai is working to identify biomarkers for health and proper immune function. Biomarkers represent an increasingly exciting area of research, not only because they help to advance our understanding of the inner workings of the immune system, but also because changes in biomarkers can indicate responses to a variety of factors such as pathogens, environmental changes, and disease. When we know how and why the different components of our immune system respond to certain triggers, we can translate that knowledge to advance medicine through the development of new and improved treatments and cures. Importantly, we can also harness these insights to help us understand more complex systems in our body more generally.

There is still much to be discovered in terms of how the immune system operates in response to various pathogens and diseases. The immune system becomes even more complex and difficult to understand when it functions abnormally in patients with autoimmune disease, in which it mistakes normal cells as foreign and attempts to protect the body from itself. Dr. Betty Diamond has devoted her career to understanding autoimmune diseases and the various systemic defects that are often present in autoimmune patients as a result. Specifically, her work focuses on the mechanisms of DNA-reactive B cells in patients with lupus, as well as the role of antibodies that breach the blood brain barrier in patients with and without autoimmune disease. Currently, she and her team are researching if these antibodies breaching the blood brain barrier are responsible for some instances of autism and PTSD. With her research, Betty aims to unlock new methods of preventing and treating autoimmune diseases.

For the millions of people worldwide who suffer when their own immune system turns against them, today’s treatment options are limited and inefficient. For instance, many existing treatments such as systemic steroids and immunosuppressants act broadly throughout the body. As a result, the body is forced to absorb the consequences of unnecessary systemic exposure, which may leave the patient with unwanted side effects. Alivio is pioneering a new approach for treating autoimmune and inflammatory diseases based on the concept of targeted immunoregulation. With co-founder Dr. Aleks Radovic-Moreno, the company’s novel hydrogel technology is offering an alternative treatment for autoimmune and inflammatory diseases. By entrapping immunoregulatory drugs and adhering them to inflamed tissues, Alivio’s hydrogel delivers drugs locally based on the level of inflammation. It’s not a one-size-fits all, systems-wide dose—if there’s a flare of increased inflammation present at a particular location, then the patient receives more drugs to that spot.

With autoimmune and inflammatory diseases, protecting the body from its own strong defense system is a complex and difficult challenge. However, the power of the immune system can also be harnessed for good. Oncologist Lennie Sender is exploring the potential of immunotherapy and immunology to treat different types of cancer. At TEDMED, Lennie will share his insights into immunotherapy’s potential to be the latest “breakthrough” in cancer treatment since chemotherapy. Since its advent, there have been numerous conflicting reports about whether immunotherapy (or immuno-oncology) will be a “silver bullet” for different types of cancer, or if such expectations are based on hype or limited evidence. Many of the misconceptions about immunotherapy’s potential are due to our limited understanding of the immune system and how it protects us from disease, and Lennie will shed light on these complicated topics during his Talk.

Comprehending the complexities of the immune system is an ongoing challenge, and these Speakers and Innovators are advancing our understanding of this intricate system each day. From working to understand the immune system and autoimmune diseases from a more holistic perspective, to harnessing the power of the immune system to fight inflammatory diseases and cancer, TEDMED 2017 will feature pioneers who are pushing the limits on what we know and what we can achieve.

Building healthy foundations for life

If we want to build a stronger foundation of health for tomorrow, we need to start with our children today. This year at TEDMED, the program will showcase Speakers who are are dedicated to supporting young people in shaping positive, healthy lifestyles. From helping children living in challenging environments to make healthier choices, to supporting transgender teens and their families with mental and physical health services, to providing young people with new tools to deal with the effects of race issues, these three TEDMED 2017 Speakers are empowering the next generation to navigate today’s complex health challenges and to take charge of their own health.

Physician Sandy Hassink has dedicated her career to helping children achieve a healthy weight. As President of the American Academy of Pediatrics (AAP) and Chair of the AAP Institute for Healthy Childhood Weight Advisory Board and Steering Committee, Sandy aims to ensure every child has access to a healthy and supportive environment, where nourishing food and opportunities for physical activity are readily available. Unfortunately, many Americans don’t live in communities that enable healthy behaviors. For instance, over 23 million Americans (including 6.5 million children) live more than one mile from a supermarket. With this type of statistic in mind, Sandy stresses the importance of understanding that the health decisions people make go beyond willpower or lack of knowledge, and she focuses instead on the ways a person’s neighborhood and physical surroundings ultimately affect their diet and activity choices. Furthermore, Sandy believes influencing healthy behavior is less about telling people what to eat or how to move and more about getting families and children involved in shaping their own healthy lifestyles. Bringing health closer to home has the potential to make long lasting positive impacts—as Sandy puts it, “good nutrition in childhood sets the stage for lifelong healthy eating.”

While childhood obesity is considered one of the nation’s largest health concerns, other important issues related to the health of young people have started receiving more attention in recent years. Gender dysphoria, or the distress that occurs when an individual does not identify with the sex and gender they were assigned at birth, affects an estimated one in 30,000 males and one in 100,000 females in the United States (though data is limited, and studies from other countries suggest this number may be higher). Yet when pediatric endocrinologist Ximena Lopez was first approached by parents looking for medical advice for their child, who was struggling with gender dysphoria, Ximena learned that the only experience her hospital had with transgender youth was in the psychiatric ward. Due to reasons such as discrimination, bullying, isolation, and lack of support, the prevalence of suicide attempts among transgender individuals is 41%—compared to 4.6% of the overall U.S. population. Ximena knew she had to do something to help. In 2014, Ximena founded the Children’s Gender Education and Care Interdisciplinary Support Program, or the GENECIS Program, at Children’s Health in Dallas, Texas, which has grown from five patients to 60. The multidisciplinary team at GENECIS works with patients on everything from medical interventions to mental health support. Ximena stresses that early intervention, treatment, and parental support are key ingredients to a successful outcome. “The parents feel like you’re saving their children,” she says, “and these patients feel like you’re saving them.”

Children and young people confront different types of health stressors every day. Race issues, often a taboo topic and not openly discussed, can be at the root of emotional stress for many young people. Howard C. Stevenson believes it is essential that everyone is given the tools and skills to openly talk about race and to express ourselves in a healthy way when faced with racially stressful situations. To foster these types of important conversations, Howard promotes racial literacy—“the ability to read, recast, and resolve racially stressful encounters”—in schools, families, and communities. At the Racial Empowerment Collaborative, where Howard is Executive Director, programs like EMBRace (Engaging, Managing, and Bonding through Race) are designed to help children and parents reduce and manage racial stress and trauma. Instead of internalizing the emotions connected with racially charged encounters, these programs empower young participants with the tools to successfully navigate difficult conflicts. Through the Collaborative, Howard is helping youth to reduce stress, build confidence, and to stand up for themselves in a productive and healthy way.

The Racial Empowerment Collaborative at Penn GSE.

Kids are the future. Yes, it’s a cliche, but it’s also the truth. These three thought leaders recognize the importance of equipping the next generation with the tools they’ll need to navigate important health decisions and empowering them with the knowledge to live healthy lives now and into adulthood.