Engage with RWJF at TEDMED 2016

Last year at TEDMED, we kicked-off a conversation with our partner, the Robert Wood Johnson Foundation (RWJF), around building a Culture of Health – a movement to improve the health and well-being of everyone in img_2000America. Our discussion last year focused on Making Health a Shared Value, one action area of the RWJF Culture of Health Framework, and this year we’re excited to explore another action area – Creating Healthier, More Equitable Communities. This conversation will be inspired by your perspective and input about what makes your communities – the places where you live, work, learn, and play – healthy, and the role we can all play in making them healthier, and more equitable.

From now throughout TEDMED 2016 and beyond, we look forward to creatively exploring RWJF’s 2016 TEDMED What If? question: “What if we valued our community’s health as much as our own?”

We’ll start this conversation with a pre-event #healthycommunities social media campaign – so join us on Twitter @TEDMED and @RWJF to share your thoughts about the importance of #healthycommunities and pictures of healthy places in your own community. We’re starting today, so look for these prompts and share your responses – we’ll incorporate them into an installation in The Hive onsite in Palm Springs!

How could grocery stores better support a Culture of Health? #healthycommunities

How would you reimagine playgrounds to build a Culture of Health? #healthycommunities

How could parking lots be used to create #healthycommunities?

How can transportation policy better support #healthycommunities?

Also, stay tuned for a ten-part Blog Series, curated by RWJF, showcasing the real and tangible ways that communities around the country are implementing programs focused on health and equity. Featuring each of the seven RWJF 2016 Culture of Health Prize winning communities, and several guest posts from TEDMED community members, this series is sure to inspire us all to improve the health and equity of our own communities.

img_2011Continuing what we hope is a robust and dynamic conversation and engagement on-line leading up to TEDMED, a Creating Healthier, More Equitable Communities Lunch will take place in Palm Springs on Thursday, December 1st. Over lunch, the entire TEDMED Delegation will gather as a community to explore programs, activities and policies that play a vital role in creating healthier, more equitable communities and help to build a Culture of Health around the country.

We can’t wait to hear from you and learn about the big and small ways that you are improving the health and equity of your community!

A Culture of Health Includes Everyone

This guest post is by Sam Vaughn, TEDMED 2015 speaker and Neighborhood Change Agent in the City of Richmond, California. You can watch Sam’s TEDMED talk here.

Sam Vaughn 2A person can have a healthy heart and diseased lungs, or a healthy brain and kidney failure. Would you consider that person healthy? Society is quite similar. Until we create a culture of health that is inclusive of all citizens, we cannot consider ourselves a healthy society. Thus, we cannot create a healthy society until we deal with issues of personal security, like crime and gun violence.

As I mention in my TEDMED talk, at the Office of Neighborhood Safety, we identify individuals who are most likely to be perpetrators or victims of gun violence. We work with them through a program called the Operation Peacemaker Fellowship, a seven-step process to help them become self- and socially-aware of their roles in society, and to affirm their God-given and Constitutional rights to happy, safe and successful lives. Perhaps most importantly, we meet and accept them where they are, with no judgement, and recognize the social, structural and strategic injustices that they have faced most of their lives. We challenge them to accept that, despite those injustices, they still have a responsibility to themselves, to their families, and to their communities to do better.

The first step of the Fellowship, and one that is vital to our success, is for us to build a relationship with these individuals. Most young people don’t care what you know until they know that you care. Once trust is established, we create a LifeMAP with them, helping them see that a different future is possible by showing the changes that others have made. We help them envision a future as bright and fulfilling as they can possibly imagine, and we connect them to resources and service providers that can help make that dream become a reality. We connect them to mentors and coaches, a group we call Elders, who are older successful men of color who have successfully made changes in their own lives, and are now reaching back to help others.

Vaughn Picture Request (1)

Sam Vaughn, Devone Boggan, and Fellows on a retreat at the Teotihuacan Pyramid of the Sun, Mexico City.

Additionally, in a step riddled with great risk but even greater reward, we take the Fellows on trips around the globe, to help them see how good life can possibly be and get them addicted to living. The catch to this amazing travel opportunity is that they must travel with someone from what would be considered a “rival community.” As they begin to see themselves, and the world they live in, in a different light, they start to see each other differently as well.

Because we believe hard work should be rewarded, we provide a stipend to our Fellows, a practice that is seen as controversial by some. Critics frequently disparage this, claiming that we are paying criminals not to commit crime. Let me counter that by saying that, when I was young, my parents would give me $5 for every “A” I got on my report card. Were they paying me to go to school? Absolutely not– they were rewarding me for working so hard. We aren’t paying these young men for what they aren’t doing. We are rewarding them for what they are doing.

Our final step is to introduce our Fellows to mainstream society and the workforce through subsidized employment. In this stage, they develop a strong work ethic, effective workplace communication and the skills of being a team player. Eventually, they become employable by their own means, without subsidy.

Frankly, our goal is to provide these individuals with what every young person in this country receives when they grow up in a healthy, nurturing community. We’ve been successful. Of those who have participated in our Fellowship, 94% are alive, 84% haven’t been injured by a firearm, and 79% have not been suspects in new firearm-related crimes. During the period of our interventions with these youth, the city of Richmond, California has experienced a 66% reduction in firearm assaults and a 55% reduction in firearm related homicides between 2007 and 2015. By attending to these young men who are and have been traditionally underserved and abandoned by the mainstream services platform, the City of Richmond is creating a culture of health in a once dangerous city that is today a much more desirable place to live, learn, work and play.  

Making Connections Through Data

Lori Melichar photoLori Melichar is a director at the Robert Wood Johnson Foundation—the largest philanthropy in the United States dedicated solely to health and health carewhere she focuses on discovering, exploring and learning from cutting edge ideas with the potential to help create a Culture of Health. She can be found on Twitter @lorimelichar.

Data about us—where we are, what we’re buying, what we’re reading—is being collected everyday, everywhere. Our cell phones, TVs, wearables, watches and even our Facebook feeds collect data about our daily lives. The Robert Wood Johnson Foundation (RWJF) is convinced this data also contains important insights into how we live, learn, work and play—and we think harnessing these insights could lead to major improvements in the health of all Americans.

Efforts to make sense of all this personal data and unlock the knowledge within are underway.

RWJF grantee Health Data Exploration Network has been bringing researchers and makers of health apps and devices together to explore the connections between community environments, individual behaviors and health. One such study enables RunKeeper participants to share their data with researchers who want to understand how the built environment relates to types and amounts of exercise over time.

Researchers at the University of Pennsylvania—another RWJF grantee—are exploring whether what people post online could give health care providers clues about their patient’s health. 3,000 people have agreed to give these researchers access to their electronic health records along with their Facebook, Instagram and Twitter data.

Using Apple’s ResearchKit platform, grantee Sage Bionetworks has been able to capture data on abilities affected by Parkinson’s Disease. Thousands of people completed tasks using their iPhones—from completing a speed tapping exercise on their phone’s touchscreen to measure dexterity, to using their phone’s microphone to record themselves saying “Aaaaah” to measure vocal characteristics—to generate that data. What’s more, over 10,000 of these individuals have agreed to share their data with researchers worldwide to help accelerate our understanding of Parkinson’s. Encouraged by this incredible response, we recently launched the Mood Challenge, seeking proposals from researchers who want to use ResearchKit to further the understanding of mood and how it relates to daily life. And soon, Android users will also be able to participate in mobile health studies thanks to ResearchStack.

The question of privacy has been central to all of these data sharing efforts—and it’s a big one. To get people to share their data, they need to feel comfortable doing so. What we’ve learned is that we can gain that comfort and trust by designing studies in ways that allow people to choose how to share their data and with whom. We have been excited to see that so many people are willing to donate their data for the public good. And we are hopeful that this number will grow. To us, that demonstrates a real shared value around health.   

Now, with all this personal health data at our fingertips, we have a responsibility to make that data actionable—to share back meaningful information with citizens, providers, and policy makers so they can make choices that support the health of their families, their communities, and themselves. While progress has been made, there are still hurdles to overcome and still so much work to do to maximize the impact of this shared data.

For data to be actionable, it needs to be relevant and representative of healthy people and those who are ill, and needs to represent all facets of the American population, not just those who regularly visit their provider or purchased a smart watch. It also needs to be inclusive of data about the social determinants of health. We are concerned that research and applications built using data that is only representative of a certain subset of the population will produce solutions that only help those communities.

Actionable data doesn’t always need to be quantitative. We also need to understand how emotions and qualitative information can be incorporated into data-driven efforts to improve health and well-being. We note with interest the work of MyCounterpane, who is working with individuals and caregivers living with Multiple Sclerosis to collect emotions as a way to understand the impact of the disease beyond the physical effects. Grantee Atlas of Caregiving is using wearable cameras and sensors to understand how caregivers spend their time, how stress plays into caregiving, and which activities are most stressful. Importantly, they also measure moments of joy and happiness.

How can you help? If you have a cutting-edge idea for how to improve learning from health data, consider joining the Health Data Exploration network or submitting a proposal to the Foundation. Finally, find me on Twitter and keep the conversation going. I’d love to hear from you.

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.”

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?

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.

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.