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.

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.

Can Learning Social Skills in School Pay Off Beyond the Classroom?

This post was originally published on The Robert Wood Johnson Foundation’s Culture of Health blog.

This is the first of a 5-part blog series, curated by RWJF, a TEDMED Global Partner. This blog series showcases the real and tangible ways that communities around the country are supporting the healthy development of children and young adults. The series helps to set the stage for the important conversations about child health and development that RWJF will host at TEDMED this year.

By Mark Greenberg and Tracy Costigan


Social emotional skills can help students set goals for themselves and build positive relationships with peers. They can also lead to long-term societal benefits that extend far beyond the individual child.

At an elementary school in the Menominee Nation in Wisconsin, the school day starts in an unusual way. Before they do anything else, students sit down at a classroom computer and select the face that best matches how they feel that morning.

If they’re feeling upbeat, they pick a green, smiling face. If they’re upset about something, there’s a red sad face. And if they feel somewhere in the middle there’s a yellow neutral face. This exercise helps these students develop self-awareness and emotional management skills. It also helps teachers recognize which students are having a tough day and where they might need help.

Ryan Coffey, a teacher and counselor at the Wisconsin school, calls this simple check-in an incredible tool that “can change the whole day.”

A 2nd grade Menominee student starts the day with mindfulness meditation.

“It’s about being proactive—before they blow up—instead of reactive. Because [incidents in the community] are hard on them, hard on their classmates and hard on their teacher. It’s traumatic for everyone. When they get older, those negative coping skills lead to the smoking, the drinking, the drug use. If we give them positive skills now … those are life skills they’ll use forever.”

This community has recognized, and put into practice, what research increasingly shows is clear: social emotional development is essential to long-term wellbeing and success.

In fact, building social emotional skills in students as young as kindergartners can have long-term benefits, not just for the students themselves but for society as a whole. Every dollar invested in effective social emotional programs in schools can bring an average of more than $11 in benefits in the long run.

These benefits come in a few different ways. First of all, students with stronger social emotional skills tend to do better in school. One study of eighth grade students found that a measure of self-discipline—one aspect of social emotional development—was a better predictor of grades, school attendance, and admission into a competitive high school program than even IQ.

Secondly, social emotional development can help students graduate from college and land a well-paying job. Children who demonstrate greater social emotional skills as young as kindergarten are more likely to have graduated from college and hold a full-time job 20 years later. Adolescents with these skills earn more as adults.

The long-term benefits of self-control, managing one’s emotions, and building strong relationships extend beyond the educational setting itself. Research shows that children with a stronger social emotional skill set were less likely to experience health problems, struggle with substance abuse, or engage in criminal activity as they got older.

All of these positive long-term outcomes benefit not just the student, but broader society. For instance, when students succeed in school and grow up to become productive adults, they’re ultimately supporting the overall well-being of their neighbors and communities. If, as adolescents grow older, they avoid substance abuse and crime, they’re also preventing associated societal costs.

Now, it’s no secret that investing early, supporting the whole child and student early on, pays off in the long run. Additional research further illustrates how early education programs promote social mobility within and across generations, helps prevent obesity, reduce health care expenditures and leads to overall higher-quality of life.

But what is new and exciting is that more and more schools are putting these social emotional principles and programs into practice the way the Menominee Nation is. Schools have always focused on building the academic skills and knowledge of students, and we’ve always viewed that as a long-term investment in our human capital. A large and growing body of research should make it clear that supporting students’ social, emotional, and physical health is just as strong an investment.


Learn more about research from RWJF and Pennsylvania State University, covering how teachers, parents, schools and others can support the social emotional learning of students.

Talking about our health

Many of us have experienced some level of anxiety at the doctor’s office. There we are, sitting in a chilly room dressed in a paper thin, wearing an open-backed robe, and feeling vulnerable. We find ourselves tempted to exaggerate the amount of time we spend at the gym each week or to downplay the number of cocktails we drink on weekends. We are itching to ask whether our contact lenses can get lost in our eyes, or if that new juice cleanse has any merit—but we don’t. From worrying about looking foolish to fearing that you’ll learn that a weird mole may be much more serious than you thought, there are any number of reasons why we don’t ask our doctors the health questions that plague us. And as a result, there’s a breakdown in communication about one of the most important things we have—our health. At TEDMED this year, we’ll hear from Speakers and Innovators who are actively improving the way we approach conversations about health and the decisions we make about our care.

When communicating with your doctor, it can often feel like you don’t speak the same language. Maybe they use medical terms you don’t understand or offer prescription advice so quickly that you’re not able to absorb the fine details. However, working with your physician and navigating the health care system gets infinitely more difficult when they literally don’t speak the same language as you. That’s where ConsejoSano, founded by Abner Mason, steps in. ConsejoSano is the country’s only patient engagement and care navigation solution for the 54 million Hispanic Americans who prefer to communicate in Spanish. Driven by the goal to meet “people ‘where they are’, linguistically and culturally”, Abner believes that the company’s data analytics, multi-channel messaging, care navigation, and round-the-clock access to native Spanish­-speaking medical advisors will be the formula needed to tackle health disparities and improve outcomes for the underserved Hispanic population.

Even when there’s no language barrier between you and your doctor, having an open and honest conversation with them can sometimes feel awkward. James Hamblin knows it can be uncomfortable to have frank conversations about our health, so he uses humor to answer many of the questions that cross our minds, but that we feel nervous to ask aloud. His columns and videos for The Atlantic acknowledge that healthy choices rarely fall under “all” or “nothing” labels, and that real people fit into those categories even less frequently. James tackles complicated questions like, “if someone chooses to smoke, should they smoke filtered cigarettes?” and fundamental curiosities such as, “how does sunscreen work?” His light-hearted and fact-driven approach makes the conversation about healthy living less intimidating and more accessible.

Like James, Meg Gaines feels strongly that patients need to take a more active role in their own health. As a cancer survivor and attorney in Wisconsin, Meg is committed to improving the physician-patient relationship, which can often be defined by either distrust or implicit trust. Meg says that both can be dangerous. Meg’s philosophy is that by laying a foundation of patient, family, and community participation in health care, we can reframe the idea of health care “delivery” to health care “co-creation.”

Even when we’re able to work closely with our physicians and take control of our own health, many of us are prone to falling back on long-held beliefs and resisting scientific facts. Sara Gorman’s work examines the reasons why it’s so difficult for us to change our minds, even in the face of evidence. For example, why do so many people believe vaccines are harmful, when there is scientific evidence that they are not only safe, but beneficial to our health? Like Meg, Sara advises physicians and health care providers to reconsider their approach with patients. She also offers tips on how providers can help patients understand the health-related options they have and the role providers play in assisting people to make scientifically sound decisions.

Unfortunately, the science isn’t always so black and white. What do we do when trusted news sources treat ongoing scientific investigations as a series of press releases? Massive Science, co-founded by Nadja Oertelt, wants to change the way science is reported. Their mission is to provide accurate, detailed, and clear science stories to the public—directly from researchers and scientists. By working closely with scientists, and helping them to talk about their work in ways that the broader public can understand, Massive is opening up lines of communication between scientists and the science-curious.

Whether it’s making health conversations more accessible, helping people change their minds in light of new evidence, or taking a new approach to sharing scientific data, these Speakers and Innovators see value in improving the way we approach conversations about healthcare and health-related science. By improving lines of communication between patients and physicians—and getting everyone on the same page—we can expect higher patient compliance and better health outcomes.

Patient-artists in medical schools

The trend of including the arts and humanities in the medical education realm is growing rapidly. Studies show immersion in the creative arts improves students’ observation skills, empathic engagement, and even a comfort with ambiguity. Major medical schools around the United States are investing in artists and creating innovative programs, and patient-artists are leading the way.

As Artist-in-Residence at the University of California Los Angeles and now at the University of Southern California, I have been honored to curate gallery shows that have energized the student body and faculty into engaging around topics that bridge the continuum from bench research to patient care.

At the Keck School of Medicine at USC, this curation has produced exhibits that illustrate the patient experience to future medical students, faculty and researchers. The idea is that a painting or work of art can reveal useful information about a patient’s lived experience better than the medical record or a list of lab values can. This is what has led the school to integrate the shows with its core curriculum in the first 2 years and explore the possibilities that have opened up. Interviews with the artists followed by Q&A with the students have led to discussions about the clinical gaze, embodiment of illness, metaphorical language and how visual representations can allow patients and doctors to bridge the communication divide effectively and with compassion.

Image from “Artist & Researcher.” By Qathryn Brehm, Los Angeles, CA

A perfect example of this is Siobhan Hebron, a performance artist with a brain tumor. She describes her experience of living with a serious and life-shortening diagnosis with an unflinching gaze and in this way allows the viewer into an empathic engagement without resorting to a reductive stance. She is much more than her illness, and yet she is also ruled by her illness. Such is the tension that exists in the lives of those who are living with chronic or life-threatening illness. And this is the landscape that the physician of the future will have to become familiar with as technological advancements make living with chronic illness a broader and more common reality.

In the Spring/Summer of 2017, I organized “Artist & Researcher,” a show that paired artists from the community with USC’s medical researchers to create visual and representational art about their research. The thought was that translating the impact and the beauty of the research in this way would inform the lay public, patients and the medical community in general about the work being done on campus. When the show was conceived my assumption was that the flow of information would go in one direction, researcher to artist. The researcher would explain and the artists would create. However, something quite unexpected was noted to happen: the researchers said that their conceptualization of the work was altered by having such in-depth discussions with non-researchers, and that the artist’s depiction of their research gave them a fresh outlook on the subject.

Image from “Pain”, a mail in art show at USC’s Keck School of Medicine. By H.M. Murphy, San Diego, CA.

In the Fall of 2017, the show “Pain 2” explores pain and the different ways that people from different cultures might depict the subject. An international call for mail-in art was sent out earlier in the year, and the gallery received over 300 pieces of mail from 18 countries. Images about subjects as varied as a simple stubbed toe to cancer, suicide, parental detainment during WWII, to life in prison and ever-present back and head pain came in packages and postcards of all sizes and shapes. The results were revelatory. As a patient with a painful illness of my own (Gaucher Disease) I had assumed that the majority of images would be about physical pain, but in fact, almost 40% touched on emotional pain and depression. There was also one image decrying the pain of a parking ticket. A favorite pieces of mine.

Solo artist shows, mail in art show or artist and researcher shows, the response from the medical community and public has been immediate and positive. The level of engagement in the sciences is enhanced by this transmission of ideas in the visual medium, while the creativity and risk-taking inherent to the arts, in turn, informs the research process and brings us closer to the consilience of these two seemingly disparate yet deeply connected realms.

These art exhibits and the patient-artists who make this kind of art serve as a potent resource for the medical educator training the next generation of doctors. The lessons these patient-artists embed into their work are not to be found elsewhere, and do justice to the complexity of illness in a manner not available in any other medium.

Healthcare Accessibility: A Look At The Numbers

At TEDMED this year, we will hear from three Speakers and Innovators who approach health care through the lens of economics. Through their work, we will explore different ways to think about allocating our finite resources in a world of limitless possibilities.

A natural experiment is an observational study that allows for the random—or seemingly random—assignment of study subjects to different groups. These kinds of experiments are rare but important when studying ideas that are impossible or unethical to recreate in the setting of a controlled experiment. Former Emergency Department social worker-turned-Medicaid researcher Heidi Allen seized the opportunity to study one such organic experiment in 2008, when the state of Oregon decided to expand its Medicaid program. There were 90,000 people who signed up for the expanded program, but as a result of limited funding, only 10,000 people were chosen to participate by random lottery. This unique circumstance provided Heidi and her team of researchers a randomized controlled trial with which to study the effects of Medicaid coverage.

The experiment’s results were complicated in terms of their impact on the newly-covered patients. Some outcomes were clearly positive—such as patients experiencing declining rates of clinical depression and financial stress as their medical debts decreased. Other results were less desirable. For instance, data indicated that the newly covered patients’ physical health markers—such as blood pressure, cholesterol, and cardiovascular disease—did not significantly improve. Along with these results, valuable lessons were learned. Heidi’s landmark research helped uncover truths about the role that health insurance plays in the lives of low-income Americans with limited access to coverage.

Even for people with health insurance, trying to understand or predict the costs that will accompany health care can become overwhelming. Often, it’s impossible to ascertain the cost of medical procedures in advance, and it’s not unusual for surprise bills to arrive months after your appointment. Eligible co-founder and CEO Katelyn Gleason wants to take the mystery out of medical billing. By integrating with existing medical systems, Eligible offers patients up-front information on the price of their procedures and co-pays, allowing them to pay at the time of service instead of waiting for months to receive a bill. Eligible not only benefits patients, but also physicians—who are saving valuable time not having to track down patients’ payments, helping them to collect up to 700% more revenue at the time of service.

While Katelyn is helping patients and providers demystify health care billing, health policy expert Amitabh Chandra is focusing on the important role that precision medicine will play in the future of drug pricing. Amitabh encourages us to consider the economic choices necessary to fund the next generation of medicine, in which the creation of targeted therapies that apply to smaller groups of people will change the economics of pharmaceuticals as we know it.

Funding and research in precision medicine are booming and for good reason: this approach hopes to maximize efficiency when treating disease. Currently, the Orphan Drug Act and other FDA regulatory incentives provide economic impetus for pharmaceutical companies to pursue precision medicine research. Yet it’s important to recognize that smaller markets, less competition, high technological manufacturing costs, and increased effectiveness could all result in eventual rising drug prices. Amitabh explores how we can incentivize companies to continue making precision therapeutics that patients can actually afford.

We are excited to hear more from each of these TEDMED Speakers and Innovators about their work investigating ways we can maximize our resources in economically sustainable ways. Join us at TEDMED this year to get to know them and their work better.

What Home Means to Health

As the WHO explains, individual and community health is driven by a variety of factors including the “social and economic environment, the physical environment, and an individual’s behaviors and characteristics”. Only when a person’s social and physical environments are taken into account can we address his or her full health profile from a comprehensive and holistic perspective. This year, we will hear from Speakers and Hive Innovators who are digging into these critical social and environmental factors as a means to improve health.

Miners in Appalachia began the process of mountaintop removal (MTR) coal mining—literally blowing off the tops of mountains—in order to access coal with lower sulfur content. While this type of surface mining holds fewer health risks for miners, the health implications for people living in close proximity to MTR locations had long been unknown. After moving to West Virginia, Professor Michael Hendryx became fascinated by this process of coal extraction and began to study the relationship between mountaintop removal coal mining and the health of people in nearby communities. He discovered an independent correlation between poor health outcomes and proximity to MTR sites, likely due to increased levels of the toxicant crystalline silica (a known contributor to lung cancer that is released from coal). Michael’s findings have been met with strong political resistance, perhaps, in part, because they are based on correlations, rather than causation. As he works to establish direct connections between environmental effects and physical health, mountaintop removal coal mining continues to take place, unleashing salts and trace minerals into the air and nearby mountain streams. Michael is hopeful that his research will encourage policymakers to consider the full picture when assessing the environmental impacts of any energy source.

Like Michael, Sara Vander Zanden of The BLOCK Project recognizes that where someone lives greatly contributes to their health. The BLOCK Project presents a new solution to homelessness, encouraging communities to place a BLOCK Home in the backyard of a single-family home on residentially-zoned blocks in Seattle, Washington. Their artfully designed 125-square-feet homes are off the grid and equipped with a kitchen, bathroom, sleeping area, composting toilet, greywater system, and solar-panels. The BLOCK Project aims to “offer opportunities for healing and advancement to those formerly living on the fringes of society” by fostering connection and community relationships, halting the emotional and physical separation that coincides with the social injustice of homelessness.

A BLOCK Project home, designed by BLOCK Architects.

Surprisingly, our physical environment’s impact on our health starts as early as in our first home—the womb. In her research, neuroscientist Jill Goldstein explores the impact of a fetus’s physical environment on the prenatal development of the brain. Jill’s research has identified that prenatal disruptions (such as a traumatic experience or chronic stress) for a pregnant mother can impact her developing fetus’s brain circuitry. These changes in circuitry can predispose the fetus to certain chronic diseases—such as depression or CVD—years down the line. Stressful external circumstances—such as living in socioeconomically disadvantaged areas—can be physiologically internalized and not only affect an expectant mother’s well being, but also that of her unborn baby.

As these Speakers and Hive Innovators show, addressing the influences of our social and physical surroundings can improve health outcomes beyond the limits of our previous understanding. We’re excited to showcase these individuals and their game-changing work at TEDMED 2017—and we hope that you’ll join us.

We shouldn’t wait for child sexual abuse to occur before we act to prevent it

Written and submitted by Elizabeth Letourneau.

Elizabeth is the inaugural director of the Moore Center for the Prevention of Child Sexual Abuse and Professor at the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health, and is a past president for the Association for the Treatment of Sexual Abusers. Elizabeth spoke on the TEDMED stage in 2016, and you can watch her talk here.


Child sexual abuse is a preventable problem that causes needless suffering and harm. We can prevent it, yet we wait before we intervene, usually acting only after harm has occurred. Most cases of child sexual abuse – about 80% – occur in someone’s home while nearly 20% take place in institutions, including schools, camps, religious facilities, foster care and other youth-serving settings. In rare instances, abuse occurs in public spaces such as parks or shopping malls. Different settings offer different challenges and opportunities for prevention. Likewise, people who engage in harmful sexual behavior with children do so for a variety of reasons.

It’s not widely known that children and adolescents account for as many as half of all sexual offenses against young children. They may be acting impulsively, acting out their own abuse, or experimenting with age-inappropriate partners. Many simply may not know that engaging younger children in sexual behavior is harmful. Likewise adult offenders engage in these behaviors for many reasons. Different prevention programs and policies are needed to address the different factors that influence child sexual abuse.

To a large degree, our nation has ignored prevention in favor of after-the-fact interventions that focus on mandated reporting and criminal justice sanctions. When we have focused on prevention, it has been with school-based programs that attempt to train children to distinguish between good and bad touches. Yet no single approach can possibly be sufficient. What is needed – what is long overdue – is a comprehensive public health approach to the prevention of child sexual abuse.

We do not need to start from scratch to develop a national public health approach to child sexual abuse. Many youth-serving organizations already mandate child sexual abuse prevention training for staff and volunteers. We can look to them for good and promising practices. For example, Boy Scouts of America requires two adults to be present for all interactions with children. Likewise, training programs have been developed by organizations such as Stop It Now! and Darkness 2 Light to help parents, teachers, and child care workers detect and intervene in child sexual abuse. Essential to these and other efforts is empirical evaluation to determine their effectiveness. We would not release a vaccine without rigorous testing, and we should not broadly disseminate prevention practices unless and until we are certain they do the job of preventing sexual abuse against children.

A comprehensive public health approach will bring needed empirical rigor to this field and will help us expand prevention efforts to – for example – deter children, adolescents, and adults from engaging in abusive behaviors in the first place. As I discuss in my TEDMED Talk, we have begun to make exciting progress in this area.

A public health approach will also help us to move beyond focusing solely on the behavior of individuals to focusing on prevention at the community level, including design and messaging. For example, the Boys and Girls Clubs of America have invested deeply in identifying structural changes to their buildings that might reduce the risk of child sexual abuse. Some of their efforts, such as placing windows in all interior doors, increase the visibility of adult-child interactions. Does making such interactions more visible and “interruptible” discourage abusive behavior? Perhaps. But before we recommend that everyone remodel their buildings, it would be prudent to gather some data. The YMCA is looking into the use of creative signage to see if these can impact the behavior of adults towards children. Wouldn’t it be amazing if architects, structural engineers, and designers helped us solve the problem of child sexual abuse? The public health approach encourages such multidisciplinary collaborations.

There are no doubt myriad ways to effectively prevent child sexual abuse just waiting to be found. But we need the will to put significant resources into designing and testing these before-the-fact interventions. What we’ve been doing for the past 30 years – teaching our children how to protect themselves, mandating teachers and others to report abuse, and relying on law enforcement strategies – just isn’t enough. We can do much better. We can develop and fund a national public health prevention program to keep children safe from sexual abuse.

The Healing Power of Art

Art exposes us to new ideas and people we may never otherwise meet, allowing us to have unique emotional experiences and to feel connected to one another. It promotes dialogue and creates a platform for us to share experiences and ideas. Research shows that the simple act of engaging with art is connected to positive health outcomes, such as reduced stress and anxiety.

TEDMED has long celebrated this connection between art and health. For example, in 2015, creative art therapist Melissa Walker took our stage to share how she engages patients with traumatic brain injury and post-traumatic stress disorder through making masks, giving service members a non-threatening platform to unravel their stories and unlock their emotions. And, last year, artist and patient advocate Ted Meyer shared his story and showcased his 18-year project Scarred for Life which chronicles the trauma and courage of people who have lived through accidents and health crises.

This year at TEDMED, we will hear from two artists who use their artistic talents to communicate stories about themselves and their communities. By sharing personal experiences of loss and healing, and depicting the emotional experiences of entire communities, these two artists are using are promoting well-being through their unique artistic outlets.

For cellist Zoë Keating, music has always been a means of risk-taking and personal expression. With her husband’s encouragement, Zoë gained the confidence to conquer intense stage fright and to pursue a professional career in music after spending several years in the tech world as an information architect. When her husband was diagnosed with stage IV non-smoker’s lung cancer, Zoë’s story pivoted and she took on another role—that of the caregiver. She paused her career to care for her husband and their young son, documenting their family’s experience navigating the complicated US health care system and their insurance battles on her music blog. After her husband died, Zoë coped and communicated through her music.

Zoë describes her music as a lifeline—a way for her to rebuild her world after loss and move forward. Scientific research has reinforced the healing power of music: researchers have found that music is intertwined with our experiences, creating musical and emotional memories which we can unlock to promote healing and recovery. For example, patients with brain injuries may be unable to talk, but are able to use singing as a starting point—propelling them on the path to regaining speech. Zoë remains an advocate for patients like her husband and continues to perform original songs influenced by her experiences and emotions. Each piece of music she performs is a story that brings her closer to her audiences than ever before.

Like Zoë, Artist Jennifer Chenoweth has experienced personal trauma and found healing through her art. Growing up, Jennifer faced physical and emotional challenges, and art provided her with an outlet and a community that she says helped lead her on a path to wholeness. Jennifer describes art as the “door to stories,” and through her XYZ Atlas project, she uses art as a way to explore how experiences create a sense of belonging and why we become emotionally attached to certain places.

Jennifer Chenoweth’s Hedonic map of Austin

By correlating psychologist Robert Plutchik’s wheel of emotions to a color wheel and using hundreds of anonymous responses to a survey about where individual emotional experiences have occurred, Jennifer created a “hedonic map” of her hometown Austin, Texas. The National Endowment for the Arts uses similar techniques to provide healing experiences for military veterans. The idea behind this program is that creative platforms help both patients and providers gain a more coherent understanding of the patient’s underlying status, making “invisible wounds” more visible and readily addressed. Jennifer sees emotion as a surrogate for health status. Her maps allow her to visually demonstrate both the disparities and commonalities of individuals in the community, providing lessons of compassion and connectedness.

TEDMED has always championed the role of art in health and its potential to promote well-being, whether by simply using exposure to uplifting art to expedite the healing of patients in the hospital or by creating a new platform to evaluate our communities and promote dialogue. These Speakers are making the invisible visible, and facilitating new ways for us to embrace our connectedness.

Challenging the drug development status quo

Written and submitted by Sharon Terry

This guest blog post is by Sharon Terry, President and CEO of Genetic Alliance and Founding CEO of PXE International. Sharon spoke on the TEDMED stage in 2016, and you can watch her talk here.


We are told frequently that we’re fortunate to live in a new golden age of medicine, that advances taking place in genomic research, immunology and other biomedical research fields are bringing us closer to a horizon that will see more effective treatments and even cures for the diseases that have plagued humankind for generations.

And yet, the reality, to this point, is somewhat less glowing than the sales pitch. A study cited in the New York Times found that we’re spending more money than ever on drug development with fewer positive results to show for it. The study found that, for every billion dollars spent on pharmaceutical research and development since 1950, the number of new drugs reaching the marketplace has fallen every nine years by roughly half. So, we remain in a state in which there are thousands of diseases, but only hundreds have treatments.

There are a number of reasons to which we can point for this declining productivity in the drug development pipeline, from the higher costs of conducting clinical trials to the need for Food and Drug Administration reforms. From my own experience, however, I would strongly suggest that the biomedical research infrastructure needs to take a hard look at itself and ask, first, whether a hypercompetitive, non-collaborative approach to biopharmaceutical science is conducive to achieving optimal progress and, second, why it is not actively engaging some of its most valuable resources—patients and family members.

In my 2016 TEDMED talk, I discuss my family’s personal experiences with the medical research community after my two children were diagnosed with PXE, a rare genetic disorder that results in a slow advance of premature aging. After the diagnosis, we were contacted by researchers asking for blood samples for a research project focused on identifying the gene that causes PXE. Only two days later, another research center also wanted blood samples. Not wanting my young children to be stuck with needles twice, I asked if they could share the samples taken by their Boston counterparts. They looked at me as if I was suggesting using leeches and spells to cure this disease.

That’s when we realized that the world of biomedical research is an alien landscape to those of us who are unfortunate enough to be dependent on it. There is intense competition between scientists and academic institutions. Ok, I know that competition can generate great progress in an economic paradigm. But, in academic research, where information is critical to medical breakthroughs, and tax payer dollars are supporting the work, the hoarding of data in order to get more funding, more published articles, a better tenure track, and faster promotions is antithetical to what we need for our, and our children’s, health and wellbeing.

This experience also drove home the “us versus them” nature of researchers’ relationships with research participants and their families. There is a great deal of conversation and rhetoric around participant and patient engagement. In most cases, though, that phraseology is often code for recruiting more clinical trial participants to increase sample sizes. In seeing patients only as data points instead of true partners, biomedical researchers are missing a key opportunity to advance and accelerate their work.

My organization Genetic Alliance, in partnership with Private Access, is putting this theory into practice through an undertaking called Platform for Engaging Everyone Responsibly (PEER). The individuals participating in PEER are much more than statistics in a limited disease silo. They share health information and “patient reported outcomes,” from their lived experience, which warrant attention and resource commitment. In one example, we’ve worked closely with a number of sickle-cell patient advocacy organizations, learning from individuals about the aspects of the condition that matter most to them. Combining this with socioeconomic data, we were able to provide the FDA—for its patient-focused drug development program—valuable data from individuals who can’t come to Washington, DC for a hearing, and who are unlikely to use the agency’s web-based system to record comments.

This effort to better engage patients as true experts, is an initiative for which we should have the support of the full biomedical research establishment, instead of resistance. Too many times the experience of people living with a condition is dismissed or overlooked. There should not be an “us versus them” dynamic to pursuing treatments and cures. It remains, since my children were first diagnosed with PXE in 1994, a mystery as to why we’re not all in this together, pulling in the same direction.

It is clear that the status quo, when it comes to drug development, is not working. What will it take for us to wake up and realize that individuals and their families are not only demanding a change, but we’re leading the way to change.