A3 is here. I'm Katrina Rhodes, your chair for this year's PM21, and I'm just thrilled to co-moderate the first plenary this morning on building resilience for Dr. Alifia Mezewala, talking with outstanding panelists, including former ACPM President Bob Carr, Doctors Jane Kim and Anant Parekh, and keynote speaker, Howard University President Wayne Frederick. That really is an all-star lineup, Katrina. And later today, we're going to have concurrent sessions on food insecurity and the built environment, global preventive medicine, veteran combat exposures, USPSTF updates on lifestyle medicine, and virtual care during the pandemic. And I'm excited to return this afternoon and co-moderate with Dr. Chris Purnell our plenary session on social justice and health equity. Starting off with the talk from our keynote speaker, Dr. Ruben Warren, followed by a stimulating panel with Doctors Alifia Maybank, Ursula Bauer, and Abdul El-Sayed. I am such a huge fan of your panelists, Katrina. Incredible thinkers and speakers. And our final session of the day will be the Young Career Lecture to inspire our students and residents and young physicians with exemplary career paths from some of our most experienced KCPM members. Enjoy the day, and be sure to earn your points to enter a drawing for a complimentary registration at next year's conference. Good morning, everyone. Welcome to today's first plenary session on building resilience, lessons learned during COVID-19 pandemic. My name is Katrina Rhodes. I'm your conference chair, and I'm delighted to also moderate this session with Dr. Alifia Meziwala. We're very pleased to have with us today an outstanding lineup of speakers and panelists to engage with you on this topic. They include Doctors Wayne Frederick, Bob Carr, Jane Kim, and Anand Parekh. Together, we'll look at our main conference theme, resilience, defined as the capacity to recover quickly from difficulties and the ability to spring back into shape. We'll explore how leadership, purpose, health promotion, and health policy all contribute to these areas. We will seek to get an understanding of leadership skills transforming healthcare organizations and workforces, how individual resilience is improved through employers supporting employee resilience with wellness, identifying purpose, and addressing social determinants of health, how our veterans affairs, health promotion, and disease prevention programs also improve individual resilience. And we'll also gain a better understanding of the actions and principles that local and federal governments should be taking to ensure the resilience of our communities. I'm pleased to start the first part of disciplinary with keynote remarks from our first speaker, Dr. Wayne Frederick. Dr. Wayne Frederick is the president of Howard University and the Charles R. Drew professor of surgery at Howard University College of Medicine. Dr. Frederick. Good morning, and thank you very much for the invitation to speak today. Obviously, your theme, I think, is appropriate, building resilience, lessons learned during the COVID-19 pandemic. And I also want to take the opportunity to thank the American College of Preventive Medicine for all that you do during not just this pandemic, but ongoing to keep America safe and healthy as well. One of the things that is very important, Howard University's motto is truth and service. And basically, our motto is that we bring students here to get the truth is what I like to tell them. And that's what they get in terms of the knowledge in the classroom. But ultimately, they're here to get an education, another degree, and that education only comes alive when they leave here and go out and change the world around them. So that service aspect of what we do is extremely important. And I think during this pandemic, we learned a lot about what that resilience is. So back in May of 2020, Howard University and Bank of America got together and provided COVID-19 testing and health care to most vulnerable and underserved communities in D.C. in Ward 7 and 8, where the population is 95% African-American. And where at that time, if you remember a year ago, you had to get a prescription to get a test, you had to meet certain criteria. And we felt that at that time, before even the CDC recommendations, that that probably was going to leave the most vulnerable citizens at risk. So we set up a testing site there and we really pushed to have citizens come in. We have since had an arrangement with Thelma Fisher, a very generous grant that has allowed us to actually build a clear certified lab in our hospital to allow for testing of not just our own community, but also for the HBCU communities around us. So Norfolk State, for example, we do their testing for them and a few of the HBCUs. In February, once the COVID vaccines were available, we then set up a vaccination clinic. And this picture here is a picture of Dr. Brown, the dean of my College of Nursing and Allied Health, and a patient who actually is 103 years old. This patient came in and got her vaccine. As we talk about resilience, let's think about this woman was born around the prior pandemic of the Spanish flu and has now lived to see yet another pandemic. And I think for her, it was a full circle opportunity of a demonstration of resilience for her to come and see people looking like her providing the vaccine for her. There's so much in this picture and so much in that message on the day that she came in that I think represents that resilience in our society. Now, we think it's important for trusted messengers to be there. One of the things about resilience is how do you convey the message? And you must have trusted messengers. And so we've seen that. We have a vaccination clinic open daily. We're doing about 500 doses daily. We haven't seen the level of vaccine hesitancy that has been reported in the African-American community. We've also been able to do spot events, as it were, where we've been able to give out as many as a thousand doses at one sitting. And we've been doing that, again, trying to get to the most vulnerable. We've held vaccine clinics in different wards as well, where underrepresented parts of our population have been. And we think that that has been extremely important in terms of providing service. But being a trusted messenger in the community, we believe, has been key to that. We now have a mobile van unit, which was donated by Bloomberg Philanthropies, and that's getting us out to citizens as well in different communities. And we're expanding. Whether it's an Asian Pacific Islander's office partnering with them or partnering in the Greater Southeast Area, we're going to continue to do that. I think one of the things about the resilience that is important is the fact that you need partners. And you've heard me mention at least three different partners with whom we've worked with. And I think that that has been extremely important. Our students have been at risk as well. And we have had a food pantry at Howard during the pandemic. So although we were virtual and didn't have in-person classes, we made the pantry available to our students the entire time. The suffering that people have endured during and as a result of the pandemic is real. And that's something that we must continue to acknowledge, realize, and to make sure that we're providing people with assistance. And so while a lot of resilience has been displayed, I think we all can agree that we have a role to play in continuing to support those in our society that need that support. And I'll close by saying that ultimately, this pandemic has taught us a lot about amplifying each other's humanity. And I cannot underscore that enough. The resilience in each other, I think, is a great example of the humanity, but the interconnectedness and how we can support each other, I think, is critical. And so what ACPM does and what I hope that most of our citizens will come away from this pandemic recognizing is that while people may really buckle down and show courage and heart to get through this, they ultimately benefit from our collective support. So thanks. And I'll go on to the Q&A. Great. Thank you, Dr. Frederick, for those remarks. I will look to see if our bisons in the audience will support me here, get some questions going in that Q&A. I claim Howard through family, Dr. Frederick, many have graduated and gone through, so we do appreciate your service and leadership there. Let me ask you this question regarding your remarks. How has the pandemic and the reckoning over social justice affected students, faculty, and staff members? And how has Howard University worked to strengthen resilience among its community during this difficult time? Dr. Frederick, it appears you're muted. Yeah, absolutely. Sorry about that. Yeah, the pandemic and the social reckoning both have really impacted our community. Howard University employs more African-American faculty than any other institution in this country, four-year institution in this country. So our role in the social justice reckoning and the pandemic was absolutely critical. So what we've done is to make sure that people had a platform to express their views and concerns. We communicated the university's position on a lot of these matters early and often, and we encouraged our students, faculty, and staff to express themselves in a safe manner. So when people were protesting, we encouraged them to do so, but to do so safely, to recognize that we were still in a pandemic and they needed to be careful. The social justice reckoning is of interest because Howard University has been on a caravan to social justice for the past 153 years. And that caravan recently has been swollen by lots of people have joined, and we believe that that's a good thing. I think people have a sensitivity about what the African-American experience is like, and we have been able to underscore the changes that need to be made. The reality is people will get distracted again, and they will leave the caravan. But this time we've got to make sure they leave us with gas, with new tires, with possibly even a new engine to make sure that we can get to the destination. But the most important thing we want them to leave with is an amplification of our humanity. We want them to recognize that the African-American experience has been torturous, and that they have to contribute to a solution, and that Howard University is going to be here for that solution. So we've really wrapped that in our resilience against the times, but that's a resilience that has been there since the inception of our university back in 1867. Wonderful. Thank you for sharing that, it's quite inspiring to see how the next generation, through their educational and social justice efforts, will impact our population and the world. I will go to a few questions coming in here. I realize you're the president of the university. There's some inquiries into the Howard University Hospital and the graduate medical programs. I wonder if you could speak to, as the president, how you interact with those organizations or sects and their leaders. Has anyone ever asked about preventive medicine at Howard University, any feasibility of having a partner there or partnering within the D.C. area with other preventive medicine programs? Yeah, sure, great questions. I am the president of the university, but I'm also a faculty member in the College of Medicine. So I am an M.D., I'm a surgical oncologist, and I still practice. So I do interact very intimately with the hospital, which is a division of the university. We have a significant number of graduate medical education training programs, and we continue to lead the nation in terms of diversifying many fields, like orthopedics, general surgery, et cetera. Preventive medicine is of major interest, and we certainly are willing to partner, if not, have our own program. I've said all along that closing healthcare disparities is about maximizing our preventive medicine experience. We probably spend more dollars in our healthcare system in the last year of life than we do on prevention, and that's unfortunate. Getting people to get screened, maximizing the number of points of contact, I think are all important. And so putting the patient back at the center of our healthcare system is a major part of what we are trying to do here at the university. We are trying to afford people an opportunity to get care where they are. So our dentists, our pharmacists, our nurses, and our health professionals are all points of contact. And I think one of the things our healthcare system needs to recognize is that we need to utilize every single one of those points of contact to maximize our preventive medicine. Absolutely. And I'd like to tag onto the connection that you all as providers and with the community and your relationships onto this question that's coming in. It refers to your remarks mentioning not seeing the same level of vaccine hesitancy with your outreach efforts and vaccine efforts. So what do you attribute that and what can others learn from that? Yeah, the biggest thing that I think we've learned and that we would pass on to others is making sure that you're there with consistency. Showing up when there's a crisis is always gonna be met with suspicion and even division. So what we have done is we've been there consistently. So for the entire time, Howard's Hospital was preceded by Freedman's Hospital, which was built in 1862 to serve freed slaves coming from the South. As a result, we have built up a trust in the community with an interaction in the community over a long period of time. And I think that that's been very important. It's been important enough that in a time of crisis like this, people are more likely to listen to us. That's one. Two, there are issues such as Tuskegee where the average American cannot give you the specifics of Tuskegee. They would have heard about it, but they would be unclear about it. And we have an opportunity actually to dispel the myths by talking about it in a transparent fashion. And that's one of the things that we've tried to do, to educate people about the reality of what their concerns are about, and then to address them with what changes have been made in our healthcare system that now prevent those things from happening. Because it is, as you know, very difficult today for anyone to try to conduct an experiment like that. Lastly, most of the vaccine hesitancy, I think comes from a general mistrust in our governmental institutions. So whether it's our banking system and what happened during the financial crisis and mortgages, or the law enforcement system, and what we see on our televisions far too often in terms of the murders of black people by law enforcement, those things create a general distrust. And so what we've tried to do is also to be honest and open with listening to people. A lot of times in this circumstance with vaccine hesitancy, I feel that people are trying to overpower the sentiment and to dismay or to belittle the concerns that the black community may have. I think those concerns are legitimate, and we have to give legitimacy to those concerns by listening. And once we listen, we can be empathetic and then provide data and evidence and reassurance as to why things may be different now and people will be safe getting the vaccine. So those are the techniques that we have employed, and we've been aggressive about that. We've also put out PSAs of many of our health care leaders getting the vaccine themselves and explaining why. And so in my circumstance, I got the vaccine because I'm a practicing surgeon, but I also have sickle cell and type 1 diabetes. And I made it clear in my PSA that I had a duty to protect myself. And the best way to do that was for me to get the vaccine. Okay. Thank you for that. I will combine a couple of questions here for you. These next deal with funding. I recently saw you present, I think, and mentioned that HBCUs don't have the endowments as other institutions. And can you just speak to how our university obtains fundings for these activities and how do you approach getting support financially for these projects? And one particular project there's a question about is the mobile vaccine units. How has that been effective in addressing the vaccine outreach and helping people get second doses? Yeah, great questions. One of the things I did early on in my presidency is to set up an office for corporate relations. I believe that we have to meet corporations where they are, but then we also have to bring them into our universities. And so we've been developing long-term relationships with different corporations, letting them know what we do as a university, why and how our graduates and alum can actually be beneficial to their workforce and their company's bottom line, to be quite honest. That has put us in a very unique position to allow us to go back to them when we have ideas. And especially in this crisis, because we've had those long-term relationships, we've been able to show up, I would say at the right time with the right ideas and the right types of proposals. And so the mobile unit with Bloomberg Philanthropies represents that type of relationship. And Bloomberg Philanthropies actually gave Howard close to $32 million to offset the loan debt of our African-American students, who typically would have over $200,000 plus in loan debt. And that gift will now allow the four existing classes to lower their debt by $100,000 for each student. And that's in addition to the proposal with the mobile vaccine van. So I think developing relationships early is important and continuing those relationships and continuing to make proposals as to how things can be better. With the mobile van as well, getting into the community has been helpful because you have to remember, if you're a wage worker, taking off time to come and get a vaccine, which is not in your neighborhood, having to travel, et cetera, is a significant sacrifice. And what the mobile van unit has been able to do is to take people, take us into the community and meet the people where they are. And I can't emphasize enough how important it is to meet people where they are. And as your theme says about resilience, as I said, the definition of resilience changes for everybody's circumstance, so we have to recognize that. And so what is a convenience for someone may be a major inconvenience for somebody else and they may have to demonstrate a lot of resilience. So any assistance we can give to allow those communities to get the type of care and attention they deserve, we're gonna do that as a university. Okay, great. So tagging onto these themes, Dr. Frederick, the relationship building and establishing trust, I'm gonna pull together a couple of questions here. As the local Washington DC community struggled with COVID-19, especially those underserved minority communities, what has been the role of Howard University to serve the community? And if I could just add on to the service, if there's a separate question, if you could just talk again about the relationships and prior to the pandemic, how did Howard establish itself as a trusted voice and how has that base expanded upon with the COVID pandemic and enabled you to carry out your work? Sure, again, great questions. We've been in the community for over 150 something years. The Friedman's Hospital was built in 1862 and you have to remember at that time, Friedman's Hospital was where black Washingtonians could get care. And so there are many black Washingtonians who were born in Friedman's Hospital who for generations now, their generations of progeny still live here in the DC area. And so that relationship has been longstanding and consistent. And we've insisted on sending our students and trainees into those neighborhoods, our nutritional science students, as an example, shop with the citizens of Ward 7 and 8 where it's 95% African-American. They go to the groceries with them. The only two groceries is a food desert there, but they also go to the convenience stores on the corner stores where they've been trying to assist those owners with providing healthy alternatives. And so it's been important for us to continue that relationship throughout and to be there through thick and thin. And I think that that's extremely important. So during the pandemic, standing up to the testing site, first and foremost, I think was absolutely critical in making sure that people were available to be able to get tests and know what their circumstances were, and also to redirect them when necessary to sources where they could get care, et cetera. And you have to remember not everyone can isolate and quarantine in the way we were describing. So we had to offer them opportunities and various opportunities to do that. We also, by directive of the mayor, expanded our facility as well. We also participated in a vaccination trial, the COVAX vaccination trial, which we think was important to be able to recruit minority patients to a clinical trial we thought was important. And I have to be honest, I was a bit worried about this because two vaccines were already available from Pfizer and Moderna. And even with those vaccines available, we decided to participate in the trial and recruit patients. And we were able to hit our quota of patients very quickly. Again, demonstrating that that longstanding relationship was working. So as I said, it can be something that you attempt to do in a moment of crisis. It has to be something that you are working on with some consistency so that when the crisis does hit, you have an established relationship and establish, I would say, a veracity with the community that they can trust you to assist them and to guide them. Wonderful, Dr. Frederick. And I want you to know you have reporters in the audience who have entered some questions here. So I'm gonna try to combine a few from the Q&A box that we have live as we wrap up this first part of our session. There is a question about what your views are on primary care in Washington, DC. Is there enough there to help promote health? And I'd like to tag onto that, promoting resilience in individuals and ask you a question about the term resilience. Some people may consider that that says a disadvantaged people should solve their own problems. Just give your view on resilience and how, or the question is, if you have any suggestions on how to prevent resilience as being used as a way to imply that for disadvantaged people. Yeah, great question. I think the best way to do this is with a pictorial. And that is if you look at three people trying to watch a soccer game with a fence in front of them, one person being extremely short, the other person being of medium height and one person being tall who can see over the fence. You may think when you think of resilience that the shortest person needs to jump and hang on to the fence and look over. And that's difficult. That might be displaying resilience, but that's a disadvantage. You can give everybody a stool. The tall guy doesn't need it. The middle guy will benefit from it. And the shortest guy just may barely be able to see over the fence. But ultimately what resilience is about is supporting people finding justice and justice is if you move the fence completely so everybody could see the game. And so the barriers that exist, while they may not exist for everyone, what we should be working on doing is removing the barrier. And I think that that's where resilience meets opportunity and also meets empathy. And that's where we wanna be. And the last thing I'll say on the primary care physician thing, absolutely, I think we have to promote primary care physicians, but I wanna be clear. We have a complicated and complex healthcare system. And I still think that we underutilize other healthcare providers. We put physicians at the center of our healthcare system far too often. And I say that comfortably as a practicing GI surgical oncologist. And I think we underutilize other people. We all are supposed to go to the dentist every year, if not twice a year. We get our blood pressure checked, et cetera there. We could get screenings for diabetes and other types of things. Those healthcare providers are fully capable of extending our healthcare system and putting the patient back at the center of our healthcare system so that they become the object of our affection, if not the object of our obsession. Absolutely. Those are great final remarks there for primary care in Washington, DC. I also wanna mention another popular topic amongst the attendees is supporting the interest in the DC area and having a preventive medicine program. And so many of us are interested in working with you and Howard to see what partnerships and programming we can set up. So I look forward very much to working with you and the ACPM team and Bison alumni, all the PMR advocates here on that. So thank you very much, Dr. Frederick, for being with us. I know you have other obligations today and we're just so honored that you're able to share your time with us. And I will like to now transition to the second part of this plenary and turn things over to moderator, Dr. Alifia Meziwala. Thank you. Hello, everybody. Thank you so much, Dr. Frederick and Dr. Rhodes. I'm excited to take over for the next hour and have a really interesting conversation with the remainder of our panelists. In our conversation today with Dr. Frederick, we just saw an example of how Howard University's heroic efforts have helped serve the community. It's a great example of service leadership from leaders of organizations and businesses in our communities. And an example of how strong leadership, effective communication and responsiveness is so essential to building trust in the face of a crisis and ultimately helping a community become resilient. In the next hour, we'll continue to explore the theme of resilience. We have a great panel of speakers lined up for you today. So first, we're gonna have Dr. Bob Carr, who on a personal note is a wonderful human being and an eternal optimist. He's had a three decades long impressive career. He retired as the chief medical officer of GlaxoSmithKline. Most recently was the past president of the American College of Preventive Medicine. And now is the chief medical officer for Kemano, a precision and wellbeing technology company. After Dr. Carr, we're gonna have Dr. Jane Kim speak. I've only recently met Dr. Jane Kim, but she's articulate and passionate. I'm impressed by her decade long career in which she's focused on primary care, women's health, health promotion and wellness, and health promotion and wellness. Today, she's now the chief consultant for preventive medicine at the Veterans Health Department. And excited to hear from her on the really important and interesting work that the Veterans Health Department is doing to enable health and wellness in our veterans. And then our final speaker will be Dr. Anand Parekh. He will explore the role of government and policymaking in helping us build resilient communities. I will speak on a personal note regarding Dr. Parekh. One, he's one of the kindest and most effective leaders I know. I'm so fortunate because I think he was my first boss in the non-clinical setting. When I made the transition outside of clinical medicine and into public health and policy, Anand was my first boss. So, and early in my career, he's demonstrated to me the amazing influence and long lasting impact that physicians in public health can make. He himself has had a phenomenal career. He rose up to the highest ladders of leadership at the Department of Health and Human Services, both under the Bush and Obama administration. He was an early leader in shaping the directions of the Centers for Medicare and Medicaid Innovation. And today he's influencing public discourse and policy from his perch as the chief clinical advisor for the Bipartisan Policy Council. I'll have to put another plug in for Anand. He's known to be politely curious, never letting the status quo or naysayers from asking tough questions. He's an example of persistence and staying true to one's ideals. And he's probably one of the humblest advocates of public health and prevention we have in Washington, DC. So thank you, Anand. It's the first time I've ever gotten a chance to introduce you in public. So I had to take a moment and put in a plug for you. Well, with that, I'll ask our speakers in order, Dr. Carr, Dr. Kim, and then Dr. Parekh to present. Let's try to limit our presentations to about five to seven minutes, and then we'll turn it over. We'll all kind of regroup for a moderated Q&A. And for those of you in the audience, please feel free to participate. All of you have experienced this transformative year, have had to actually think about and be resilient in your own ways, in your specific settings. And so we'd love to hear from you as you listen to these wonderful speakers. If any questions or thoughts come to mind, please use the chat button to submit your thoughts or comments and questions. And so with that, Dr. Carr, I will turn it over to you. Thank you so much, Alefea, and I really appreciate your kind words and hello everyone today. I'd like to share with you some insights on some of the under-recognized drivers, factors and enablers that can actually help identify, help us monitor and actually build and strengthen these resources that lead to resilient individuals and communities. We've seen over the past year how the pandemic has amplified gaps in our health systems, wreaked and upended the economics and the uncertainty around those economics with individuals and families. We've also seen all time highs in anxiety, loneliness, and really a disproportionate effect across a broad swatch of our society in all areas of physical as well as mental and emotional and spiritual wellbeing. I think one of the factors that we need to understand is that when we're looking at resilience, it's not a static thing. It's dynamic, it's affected by environment. It's also affected by events and how you respond to those events. And this is just a natural language processing of input of individuals, about 10,000 individuals over a period of six months, looking at different emotional sentiments. And so if we are to meet people in a timely way, we need to actually be able to help them monitor self-level as well as within our organizations, whether they be public health organizations or employed organizations. So we have a better understanding of how do we intervene in a more timely way to help the individual manage this emotional volatility at times and help build that level of resilience. We also have seen, and this is a recent poll in December and January of this year and built on in March of this year, an under-recognized area of essential needs not being met in full-time employed populations, which is not unusual. Nearly one in three have experienced food insecurity and challenges in utilities and in housing insecurity. And so I think all organizations have to look at these areas and not just assume they're in just the classic vulnerable communities, but they could be across all of our society and every organization can really look at ways to better identify and better support meeting people where they are. I think the biggest factor in understanding resiliency is that it gives one also agency to act and seek out those resources. So one of the challenges is if a person isn't resilient, isn't hope-filled, those resources may be further barriers to access. Helping people build those inner resources of resilience actually help them then access and feel like they can have a change when they need those essential services. The other thing is that resilience does matter and study after study has shown that if people have resilience within themselves, within their families, within their communities, they actually have better health outcomes in spite of the same adverse environmental and social conditions. So building that and understanding that is an important element of physical health, even though we may think it more in the mental health. We also know that one of the biggest and strongest activators of resilience is this concept of purpose. And we do know that purpose supports a better emotional recovery, having a strong connection to purpose. It supports an ability to manage a challenge. It also is one of a strong association of decreasing risk of death and morbidity, even over more traditional things such as drinking, smoking, exercising, which is very interesting. And yet our organizations, our health systems don't necessarily capture the risk factor of purpose. What is your connection to purpose? And how is that helping you activate change, activate emotional regulation, healthy lifestyle, and access needed resources in the community? Nietzsche said that he who has a why to live can bear almost anyhow. Can bear almost anyhow. And it's very true today that purpose is this central organizing theme that helps us have the ability to pull from within and from around us a more optimistic and hope-filled future. Interestingly, in neuroscience, they are looking at the ventromedial prefrontal cortex, which when you're thinking about your purpose and you're thinking about your values, this is the part of the brain that gets stimulated. It leads one to more future thinking, more openness to change, as well as more importantly, it mitigates the amygdala, which is your threat response. And as you are in adverse social and environmental conditions, or you're undergoing a forced upon change or change you may not want to do, that amygdala gets heightened and you see all of that as threats. So being able to focus on it, there's a scientific basis perhaps for how purpose can moderate and mitigate the adverse effects of the cortisol and adrenaline response from the amygdala activation. So just recently looking across a whole variety of life and health outcomes, we've seen that when you characterize an individual through a low or high connection and strength of their purpose, we see statistically significant differences in things like overall resilience, in the ability to emotionally regulate themselves, depression levels, anxiety levels, in engagement with work, even vaccine willingness. This is a poll that was conducted over a series of three months by the Harris Group and ProMedica Health System in Ohio. And just very interesting data that maybe is not as recognized in our system, sorry, the slides I've got to catch up with. And this data I think is important as we understand how we respond to an individual and understand what we can do more in terms of identifying a risk factor that may improve their inner resilience. So this is just a simple example of how regular practice focusing on building resilience through purpose activation, insight and meaning throughout the day, strengthening that muscle of self-awareness and then applying it to new actions and new sustained growth. So in closing, purpose really does drive prevention and the understanding of one's connection to purpose, amplifies future thinking, motivates action and sustains change, and then strengthens the emotional self-regulation, reduces that stress response and is foundational to our resilience. So we should begin to look at it and capture it as a modifiable risk factor and use it to help build resilience. Use it to help build a resilience across our populations that we serve. Thank you so much. I appreciate the time and I'll pass it on to Elafia. Hi, good morning, everyone. My name is Dane Kim. I work for the Department of Veterans Affairs and I'm here to tell you some of the ways that VA has supported its veteran population in the largest integrated health system in the United States throughout the COVID pandemic. In particular, how our healthy living approach has, I think, been just a cornerstone of ensuring and maintaining resilience throughout what has been a very difficult time for all of us, but certainly for our veterans as well. I'll go on to the next slide as the technology catches up here and thank you. And tell you about the VA's mission and vision and how what we do in my center, which is the National Center for Health Promotion and Disease Prevention, aligns with what Veterans Health Administration as a whole is setting out to do. So there are a few things I wanted to call out here in terms of VA's mission. Part of our mission here clearly pulls out the importance of resilience, I think, is that we are here to honor America's veterans by providing exceptional healthcare that improves veterans' health and well-being. And to go into our vision, we are looking to do that in a way that's patient-centered and evidence-based and emphasizes a prevention and population health approach, which I know is music to my ears and probably to this audience as well. So how do we do that is the question. So one other thing I wanted to pull out is the whole Department of Veterans Affairs strategic plan also calls out the importance of health promotion and healthy living here. The importance of one of our strategies is to adopt healthy living practices that deter or defer preventable health conditions. So it's certainly a priority not only for Veterans Health, but for all of our veterans, regardless of how we serve them in our agency. So to pull it into how do we do this, for Veterans Health Administration, there is a center, the National Center for Health Promotion and Disease Prevention, and our charge is to implement this throughout our nationwide healthcare system. I will be talking more in detail to give you an overview of how we do this, but I really think throughout this pandemic that what we do here has been a cornerstone of how to help our veterans maintain and develop resilience and develop strategies throughout this past year or so. So I will just be telling you more about what we do. So many of you probably know that in Veterans Health, we serve a population of which there are many veterans who have chronic health conditions, not only just one, but multiple, and this has a high cost to our system. So given this, and I think because our intent is to have our veterans be well, first and foremost, how do we help those who have chronic conditions in particular, but also all of our veterans achieve healthy living? So one of the ways we do this in VA is that we have people in each medical center and sometimes as well in each clinic that are the boots on the ground to help implement preventive medicine measures at the front lines. So they are people who train and also implement prevention programs in each facility. And I'll be talking a little bit more about what each of these individuals does, but certainly this is our workforce that we support throughout VHA. In addition, this past year has been our vaccine coordinators who throughout the COVID-19 pandemic have been working on planning and then implementing COVID vaccination for our population. And one thing that has been a cornerstone of our approach since prior to the pandemic, but certainly has been as important or more important throughout is our healthy living messages, which align with our evidence-based recommendations for care. I wanted to pull out here that sleep well and manage stress have been very popular throughout the past year. And we have certainly had a lot of ways to support our clinicians, helping our veterans to sleep well through what have been probably some nights of insomnia with worry, as well as to manage their stress with everything that's been going on. But certainly the other messages are ways that we support our veterans and have continued to support them in developing ways to live healthy despite whatever conditions they're in, whether it be in quarantine or isolation or just not able to see their friends and family. We've been trying to help them be creative through our clinical work for supporting them. A key way that we do this is to promote veteran-centered self-care and self-management support. We as a health system are not there with our veterans 24-7. So how do we give them skills to do this on their own? So that is a core way, that core principle that we use in our program. And again, I think this is really a whole person-centered approach here. Whole Health is maybe initiative you've heard of at VA. And I think it just points to the importance of the person. And I'm talking about programs here, but I think one of the key takeaway points is that we always think about our veterans, what they need. It really comes down to the individual. And so we want to empower and equip them the best we can with these programs and make it personal. So I'll just fly by some of our core components of our programs because certainly we wanna keep our veterans well and resilient and how do we do that? One of the ways we do that in VA is through a set of clinical preventive services guidance, many of which are based on the ACIP and USPSTF recommendations. But we have a set of experts review those and vote and approve those for VA. So all the things that we know well through those two organizations, we pull into VA and tailor for our veterans. So another core program is our health promotion and disease prevention program through which we have a lot of clinical health coaching, training and dissemination throughout our nationwide network. We also have a number of tools to help at the point of care with these discussions on how to make changes to your physical activity, to your eating, et cetera. So these workforce and the tools go hand in hand in the front line. We also know the importance of health education and information and communicating clearly with health literacy in mind to our veterans. And so we have a national program to create an approach to health education throughout the enterprise that is evidence-based and applies core principles. And we also have a veterans health library that is a online library of information tailored for veterans that is widely available direct to veterans through the web or through our channels through our clinicians as well. Knowing the importance of weight management, certainly now more than ever with the COVID pandemic and the impact that COVID has had on overweight and obese individuals, we have continued with the MOVE weight management program, which is a comprehensive lifestyle intervention through now mostly telephone and video modalities, but creeping back to the face-to-face as a restrict. Certainly infection control and vaccination was a key priority for VA prior to the pandemic, but even more so with COVID. So we have continued and built upon this platform to help us through the pandemic and all that came with it. And the last thing I wanted to mention is a way that we are looking to help our workforce catch up with preventive services for veterans. And this is through an online tool available through our electronic health record that identifies key preventive services and helps to get our veterans engaged and back into care. And with that, I will leave you with a few links for resources if you'd like to look at them later, but I'd like to turn it over to my colleague, Dr. Preck, to continue on with his presentation. Thank you, Dr. Kim. I wanna first start by thanking the American College of Preventive Medicine for the invitation to be here. I wanna thank Dr. Messi-Walla for that gracious introduction. She's a star in her own right. So you all should know that. And I wanna thank Drs. Frederick, Carr, and Kim. It's great to be on this panel with you. I think we've heard during this session the importance of universities, employers, and health systems in promoting resilience. What I wanna just spend a couple of minutes talking about is the importance of policymaking, policy makers, really supporting resilience. And when I think about resilience, when I think about resilience, this ability as has been articulated to spring back, I think many of the same factors that support resilience are in fact factors that support preparedness. I see resilience and preparedness as two sides of the same coin. And so when you think about sort of preparedness, particularly preparedness for an event like we're experiencing right now with COVID-19, obviously you need science. You obviously need a focus on issues related to leadership and communications. You need a global focus as well. But we also need a public health system, a public health system that works for all of us. We need a focus on equity, and we really need an understanding of how to improve our underlying health status. In many ways, that gets us really back to prevention. And so when we think about those policies out there that can promote prevention, there are a lot of things that we can do at the federal level. Number one, ensure that prevention is not just one of, but the number one priority of all of our departments. Jane just talked about the VA, so Health and Human Services, for example. Based healthcare transformation and the quality metrics that are the currency of this transformation really focus in on prevention and really focus on the incidence of chronic diseases, the prevalence of chronic disease risk factors. We need to make sure we deliver evidence-based community prevention programs. We need to invest in prevention research. But the policy that I want to just spend a couple of minutes focusing on, it really comes down to resources. We need to really take this moment as we think about resilience and prevention and what we've gone through with COVID-19 to ask ourselves some very basic questions of how we spend our health resources in this country, because ultimately how we spend our resources reflect our priorities and those priorities reflect our values. And the question before all of us is how healthy of a nation do we aspire to be? And so when I think about the lessons learned of COVID-19 and I think about resilience, I think the lessons learned are really sort of instructions in terms of where we need to spend our health resources, as well as that all of us see too often in our society. So in this first slide, let's see if the clicker works here. So I think in this first slide, I'll use an example that I often use that if you really want to improve population health, I call it the four Ps, you need to invest in prevention, need to invest in public health, and you need to invest in primary care. Unfortunately, if you look at the $4 trillion that the nation nearly spends on health every year, only 5% of that investment goes into clinical preventive services. Only 3% of that investment goes into governmental public health activities, and only 6 to 7% go into primary care services. And that's half of many of our peer countries around the world. So if you go through each one of these, and I think the other speakers have already emphasized many of this, when it comes to prevention because of COVID-19, millions of Americans have missed high value clinical preventive services, which include many mental health services and substance abuse counseling services. We know at baseline, we already had suboptimal uptake rates of many of these clinical preventive services. The CDC has previously estimated that up to 250,000 Americans die each year from potentially preventable deaths just from the five leading causes of death. And we know from just recently published data that related to COVID-19, 63% of the hospitalizations can be attributed to conditions such as obesity, high blood pressure, diabetes, and heart failure. So we know that these clinical preventive services matter. We know also from a public health perspective that we have a significant per capita investment gap when you think about what does it take to assure the conditions of populations can be healthy. And researchers have really looked at this and estimated that there was about a $34 per capita gap. So about a $10 billion investment that's needed in public health to support foundational public health services from maternal and child health, to chronic disease prevention, to injury control, to communicable disease prevention, as well as the capabilities that allow health departments to really work in these areas, surveillance and laboratory capacity and building partnerships. And so there's a significant investment that needs to be made there. And in fact, my organization, the Bipartisan Policy Center, we currently have a bipartisan group that's looking at how do you better finance a public health system for the future. And certainly for primary care, we know we're not investing enough. Interestingly enough, our primary care spend rates nationally, if you look at Medicare, if you look at commercial insurers, in fact, in many cases are falling. And we've seen the importance of primary care yet again during COVID-19, as well as the need to move from... I would request all of you to look at this recent report that came out of the National Academies of Science and Engineering and Medicine that really focuses on re-imagining primary care, the need again for payment transformation, the need for universal primary care, as well as increasing the spend rates in primary care. So we know we need to invest in a lot of these areas. All of this relates to preparedness. All of this relates to resilience as well. But this final slide also shows us that we can't just focus on what's within the four walls of the clinical setting or even public health, that we need to even go beyond. And this slide summarizes a series of studies, the first slide all the way on the left, of how the United States compares to other countries around the world when it comes to the ratio of social services to healthcare services spent. And in most of our peer countries, the social services to healthcare services spend ratio is about two to one. In our country, it's one to one. And there's significant data that shows that the higher that social services to healthcare services spend ratio, the better the outcomes. This is an association that's also seen in states across the country. So if you look at the middle graph here, you'll see the 50 states in the country. And those states that have a higher, once again, social services to healthcare services spending ratio, they have, in fact, a reduced prevalence as well as mortality from chronic conditions. So we know the underlying social determinants of health are absolutely critical, as other speakers have already articulated, to underlying health. And in many ways, the recently passed American Rescue Plan, even though it didn't receive bipartisan support in Congress, there was bipartisan support amongst the American public, really get at many of those important social determinants of health, whether it's childcare, whether it's housing, whether it's nutrition. Trust for America's Health, a nonprofit in Washington, D.C., in 2019, I think, looking at how they promote health, as well as potentially control costs. So all of these policies, whether it's universal pre-K, school nutrition standards, housing, earned income tax credit, paid family leave, all of these policies end up ultimately building resilience. They ensure preparedness and they build resilience. And so it's the combination of what's happening within the clinical setting, as well as what is needed in terms of policies focused on the social determinants of health. I think that's really what gets us to increase resilience and what's a key lesson with respect to COVID-19. And the final point that I'll make is, when you look at all the public health challenges that we have in this country right now, COVID, whether you look at the opioid epidemic, the obesity crisis, whether you look at disparities that we have based on race, based on geography, based on income, I think we need to come to the realization that at the end of the day, we want to build resilience. We need to ensure that we're prepared. We need to elevate prevention. We need to get to really improving the underlying health status of the American public. And again, I think that's, and the way to do that is really to make these critical, critical investments. So thank you very much and looking forward to the discussion. Thank you, everybody. So it's a wonderful, wonderful conversation and we already have some questions coming in from the audience. So I'm excited for the 30 minutes that we have. I think we have a lot of different themes to explore. And so why don't we just get started? So I think the first theme that I think would be really wonderful and helpful to explore for this audience is around the epidemic of chronic disease. Anand, you brought this up, Jane, you're obviously doing, you know, very, you know, programs kind of focused on helping veterans with chronic disease and health promotion. So the first question I have for both of you, for really anybody, but Anand, I'll start with you, is how do we leverage the disruption that COVID has created over the course of the last decade or the last year and a half to really kind of take this moment and reinforce changes in people's lifestyles, positive changes, to really help kind of combat that epidemic of chronic disease? Are you there? Yes, Alethea, was that directed towards me? Sure. Why don't you go ahead and start and then anybody, please jump in. Sure, sure. Well, you know, I think taking sort of points across the presentation, you know, I think it's really an all of the aboard strategy, sort of it's reaffirming the importance of physical activity and nutrition and ensuring that, you know, we're avoiding substances and avoiding substance abuse, but it's also looking at sort of mental health and well-being as Dr. Carr mentioned, having a sense of purpose. I think all of this should be really a reset, I think, for the American public in terms of how to stay healthy, no matter what adversity we're facing. And COVID-19 is here and now, but next year it may be a different type of adversity. But I think it's a moment to sort of reset and recalibrate individually and personally. And then I think policies need to follow. Yeah. So let me maybe speak from my own experience as a physician who's worked now at an integrated delivery system and primary care, and then now at insurance, we can build the programs, we can pass the policies. At the end of the day, engagement in terms of lifestyle interventions and changing behaviors, it really comes down to the individual. And so, and perhaps I'm kind of addressing this initially to Jane, but please, again, everybody in the audience, how do, you know, we can, how do we actually address some of the barriers that individuals have in participating in the right activities and, you know, behaviors that will ultimately lead to that change and kind of that healthy lifestyle that we're all discussing today? Yeah, that's a great question. I think one example I wanted to pull out is our MOVE weight management program, which has been ongoing for more than a decade, but this past year was very challenged with constraints of travel and isolation with the pandemic. What the MOVE program did is mainly move online to telephone-based and virtual video visits for individual and group sessions. And we found that was very popular with veterans. They didn't actually want to come in for all the sessions that were weekly over 10 to 15 weeks. And so, I think making the sessions more convenient for them was received very well. And so, I think that's something that we found will be successful and will continue and I hope extend our reach that just happened to come about because we were forced to explore that and to change. I will say that one thing in relation to that is that people have to be very creative with weight management this year with all the restrictions with gyms, clothes, and food being maybe less accessible. And so, we have some great success stories that we, I think, will be well-served in sharing to other veterans. There is a veteran who lives in Wisconsin, I think, and he went out every single day to walk for 30 minutes. And he said, I just bundle up like a little polar bear and get out there. I don't care what the weather is. And so, things like that, I think, are just tremendous testaments to what people were able to do. And I think the peer-to-peer inspiration has always been there for VA, but we hope to build upon that and say, hey, even in a pandemic, with all the restrictions, people found a way. So, those are just a few things that come to mind with that question. Yeah. So, Bob, I want you to hear from you. Go for it. Just, and I think that everyone has mentioned the fact that we need to meet people where they are in the moment they need an intervention. And we have to also use not just medical and our medical expertise, which is probably more geared towards chronic disease treatment versus more upstream using our colleagues in education, and in technology to actually understand what is the mindset? What are the insights that people have? And how do we build self-coaching and give them micro, you know, kind of micro habit successes that then build that sense of not just resilience, but hey, this is good for me as opposed to the belief that, you know, what I'm currently doing is okay and it's not going to affect me. So, I think this whole area of technology allowing for and actually reducing costs could be something that we could take from this last year that could actually amplify perhaps our effectiveness within the building of agency, building of resilience, and the building of activated change in these lifestyle areas. Yeah. I'll just add that I think whether you, you know, talk about weight management or vaccine uptake with respect to COVID-19, trust and building trust is absolutely critical. And it's sort of the message as well as the messenger incentives, aligning the incentives both sort of consumer as well as provider, I think is critical. And then, as Jane mentioned, sort of the default, how do you make the healthier choice the easier choice? And sometimes that means, you know, meeting people where they are, going to people where they are, increasing access. So, I think it's really, I think trust incentives and making the healthier choice the easier choice all help sort of change behavior, whether you're talking about the traditional prevention space or to ensure they get a vaccine. It's been so unfortunate, Anand, we've had you cut in and out, but I think, but that's fantastic. And you've, both of you, all of you have highlighted a handful of themes that I want to make sure that we explore. But before we move into the theme of trust and then also just the power of technology, I'd like to, Bob, ask you a question around the role of employers. So, you know, we heard obviously from Jane's perspective, you know, integrated healthcare system and the role that the health system and, you know, stakeholders have in our community in terms of building resilience. We've heard from Anand. Help us understand what your perspective is in terms of what role do employers play in helping employees and then indirectly helping build resilience in communities? Thank you. That's a great question. I think part is not to be another bear, to be an amplifier of negative culture. So, I mean, the things that are in an employer's control, work environment, the work culture, the benefits, the resources, all of those can be very, very positive and supportive of what their individual employees' needs are. I shared with you this statistic of like 30% of full-time individuals over the past year have experienced one or more of the classic SDOH, you know, essential needs not being met. Employers don't even know that. And yet employers can actually leverage some of their resources to make avail community resources using technology as well as the benefits in their own, you know, health plans. So, I think, you know, making sure that their benefits are focused on more upstream behavioral elements and, again, you know, our health is dynamic. It's not more data points outside the walls of the health systems. We need to leverage, you know, our systems. Case in point, maybe, Dr. Kim, you know this, RallyPoint, which is a social media platform like Facebook, is actually mining through natural language progression, natural language programming, suicide ideation and feelings of overwhelm and intervening immediately with VA pop-up, you know, referral. That's the kind of insights that we need so that we can, you know, not just assume that they're the in-between visits, but the technology is connecting and engaging on an ongoing basis. So, now, all of you have mentioned technology. So, let's explore that a bit. And, you know, Anand, I'm going to start this question with you. You know, when the COVID pandemic happened, I mean, government was wonderful. Our government payers were wonderful in responding to making it easier to do telemedicine and telehealth. And, you know, I think across the board, it's been probably one of the best stories out of the pandemic is just how we've been able to leverage technology to really kind of provide care and address needs. So, I guess let me ask you this question. Do you think virtual care is here to stay? I do. I think it's here to stay. And I think you're seeing bipartisan interest among lawmakers to extend a lot of the telemedicine, telehealth provisions that we've seen during COVID-19 that have helped so many people. I think at the same time, I think we need increased research to better understand where is telehealth and telemedicine the best in terms of improving outcomes and reducing preventable healthcare costs. So, it's a tremendous opportunity from a health service research perspective as well. But I think policies, Alifia, will need to follow. For example, the Diabetes Prevention Program, now Medicare pays for that. Unfortunately, you know, there have been issues related to will they pay for virtual sessions of DPP. And I think those are the types of policy questions. there are millions of people who can benefit from sort of virtual care. Thanks. Bob, I'm going to ask you kind of your perspective on technology. You obviously are a chief medical, you're currently a chief medical officer of a technology company. Help me understand your thoughts on how you use technology to scale kind of what you talked about, the ability to give people purpose. Thanks. I think going back to telehealth, that's kind of taking our classic practice model and making it remotely or virtually available, right? I think there's a bit of disruption needed in using machine learning and some augmented intelligence to meet people with their diverse needs and their diverse perspectives to, in a precision wellbeing way, right? Not like precision medicine, but a precision wellbeing, so that you create a curated set of resources that actually will help them in their unique environment or their unique situation. So technology, we use it to amplify the ability to change beliefs, the beliefs that hold people to certain behaviors, and then give them micro moments of success so that they can build habit upon habit upon habit in a more positive basis. So it's an intentional change cycle that is allowed to be delivered 24-7 whenever the person wants it rather than in an appointment kind of basis. So it's scale and it's amplification of existing kind of science. That's how I see it. But I think we need to disrupt some of our thinking about how we begin to look at these other factors and home in on, if the person doesn't have a strong sense of purpose, well, how do we build it? If they're not resilient, how do we build that first before we offer up an exercise regimen or a reduction in nutritional change when their resilience may not even allow them to accept that change? Mm-hmm. Great. So I'm going to take a question from the audience. It's really around healthcare financing and resiliency. And I think this question is directed initially on to you, but I'll let anybody in our panel speak to it. And so the question is, the connection, Dr. Parekh, that you showed between social services spending and healthcare spending seems to be key to funding public health and preventive medicine work, and to also revolutionizing how we insure and promote health. Has there been any discussion of new models of funding that link social services and healthcare funding in a type of ACO or ACC, so Accountable Care Organization or Accountable Care Communities type model? Could this be a way of sharing massive amounts of money we give to healthcare with the social determinants of health sectors? And so, Anna, this is a fun question for you to answer because you and I were thinking about this 10 years, over a decade ago when we were at CMMI. And I'd love to hear, you know, get your perspective on, you know, what, how, you know, you talked about resources and the fact that we're a $4 trillion healthcare, you know, we spend $4 trillion in healthcare as a country. How do we actually appropriately transfer some of those dollars from the acute care setting to the social and public health sectors? Yeah, thank you for that question. You know, again, I think it starts, again, when we think about sort of value-based healthcare transformation, as I mentioned, quality metrics are really the currency. So it starts with those metrics. You know, for diabetes, we can't just be concerned about hemoglobin A1C levels or process measures. That's important. Outcome measures are important. But really we need to also... ...are critical metrics. Will the clinical community collaborations be formed to really get at improving underlying health status? So I think we need to change some of the incentives. We also need to ensure that new models, so alternative payment models, like ACOs, that these metrics are embedded in them. And there are a number of models that are currently being tested. One is called accountable health communities, really to focus in on screening for social service needs for individuals and to connect the healthcare system with the social services sector to improve outcomes and reduce preventable healthcare costs. So we need to take all the learnings from models like this to ensure that all alternative payment models are connecting healthcare and the social service side. And then to the extent that there are savings there, that all sectors share in those savings. That way there's an incentive for everybody to collaborate. So I think these alternative payment models, where you're going away from fee-for-service, will really allow all of us to get at some of the underlying issues that weren't in a traditional healthcare system paid for. That's great. And so, Jane, I'm going to ask you a question. So I think the purchasers and payers of healthcare, whether it's government or insurance companies, can put all these types of different payment models in place. But at the end of the day, how do we actually change the actual care delivery to realize some of these outcomes that we want to see? And so I know that you shared with us some of the programs at the VA. I'd love to better understand some of the efforts that you've made to work with the providers and the physicians and the clinicians to create that culture change, so that there is more of a focus and a reorientation to prevention and behavior change. Yeah, I guess I'll speak on maybe two points. One is, I think, some of the, or a lot of the power of the VA healthcare system and the successes we have on the accountability metrics, which do line up with what the private sector is also accountable for, is our truly not just health system approach, but whole person approach, which really drew me to VA. But we can address the needs, whether they be social, financial, housing, whatever needs the veteran has, really, even through death benefits of the whole veteran. So I think just having the resources available within our integrated health system to also meet the other needs that a person may have, if they're homeless, I don't think they're going to be thinking about physical activity that much. They're going to be thinking of, how do I get a roof over my head so I feel safe? We can address that in VA. So I will say there is some, hopefully some precedent that VA has set to address the whole person and all the needs that a person may have, even to transportation. How do you get to an appointment, and if you can't get to an appointment, we'll come to you. So those are just some of the ways that I see these had success. But in terms of how to reorient our clinical frontline, really mainly primary care providers, but also others to address prevention, I think is through the healthy living teams that I mentioned in my presentation, having people whose job it is in each facility to help clinicians not only remember, but have skills to address this, either in their patient panel or individually with veterans. One thing is motivational interviewing training, and I'm a primary care physician, and my thing that I took away from MI training is, it actually doesn't take longer than talking to a veteran without MI, and it's more effective. So it does not waste your time, it actually is a better way of talking to a patient. So those are the kind of things we do to help give people skills, also have decision support in our electronic health records to support all our preventive services, or most of them. So those are kind of a couple of ways that I'm thinking of that we support our frontline clinicians to help veterans. Great. Good. So I'm going to come back to a theme that I think Anand brought up earlier. It's really around the concept of trust. So actually just yesterday, I was driving home and I was listening to a speaker on NPR just speaking about the erosion of trust in public health. And I think for all the things that we're all trying to do, and all of you are trying to do every day, we, I think, have a real public health crisis in terms of, and perhaps one would say it's a crisis with government, more broadly, is trust of the public trusting our healthcare providers, our government, our public health leaders. I just wanted to pause and get a sense of kind of just comments or thoughts from all of you. All of this great work, whether it's policies or programs or technology, how do you ultimately get it into the hands of people and get them to use it if trust is eroding? And perhaps how do we deal with the erosion of trust? It's a tough question. I think from an employer's perspective, trust is essential with any intervention that you bring onsite or a part of a benefit plan, that there's a sense of confidentiality, that there's a sense of you're not going to be using this information inappropriately before technology in those areas are used. When you show that because of, let's say, an analysis of emotional sentiment in our population over the first six months of 2020, very, very distinct ways that a message from the CEO or a revision of a health plan benefit can increase gratitude, decrease anger and frustration and actually shift. Knowing that is important. Understanding the insights and the consumer mindset of your employees, of your patients, of your communities, I think is important. We've got to be better miners of that insight, as well as we have to be more on point with a group of evidence-based messaging and not clutter the bandwidth with all of this other stuff that makes individuals trust us less and feel confused, perhaps. Okay. Yeah, I agree. I think trust begins locally. And if we want to rebuild back trust in scientific agencies and government, we need ambassadors that are close to individuals, so their families, their friends. I think healthcare professionals, a usual source of care, can be tremendous ambassadors in order to reaffirm sort of the evidence base and the science. Ultimately, trust takes the right message as well as the messenger, again, whether it's COVID-19 vaccine uptake or behavior change or a variety of different prevention programs. But I think trust starting locally, speaking with empathy, developing those connections, and I think all of that will help sort of restore sort of faith in government and help people sort of separate sort of fact versus fiction. Dana, anything else to add there? Go ahead. I was just curious about the use of media. The New York Times article, I guess it was three weeks ago, looked at last year as an overriding negative bias in all of media, right? And that's a significant barrier for resilience if everything is always negative. And how do we get not just ambassadors, but very skillful journalists and voices to articulate not just negatives, but some of the positives that can help us? And so I think we need to go outreach more in that public relations space, so to speak, of journalism and the media. Great. Perfect. Well, we're coming to time. And so I want to just take a second and kind of say thank you to all of you, summarize some of the learnings. I mean, today we began with Dr. Frederick, who gave us an example of how a university and a healthcare organization responds to the community. And how important it is to have partnerships as a key to really kind of enabling trust and enabling the sort of service that perhaps a community needs during a time of resilience. We heard from Dr. Carr, who actually really, I think, presented the idea of purpose being a modifiable risk factor. And I think that's something very powerful that I'm definitely going to take away. And the importance of building resilience. You can't have resiliency if you can't give somebody purpose. And I think that that's something that requires more thinking and more thoughts. So thank you for bringing that kind of insight to this conversation. Dr. Jane Kim, you walk through all the various efforts in kind of a holistic patient-centered approach that the VA is taking around really trying to meet the individual where they are. And creating programs that ultimately enable an individual to really kind of focus on themselves and become more healthy. And we talked about some of the barriers and challenges that all of us face in trying to get patients and individuals to be better engaged in terms of our healthy lifestyles. And then finally, Anand, Dr. Parekh really gave, I think, an important takeaway point about resources. And what it means, you know, at the end of the day, we can talk about prevention. We can talk about resilience. But ultimately, how we spend our healthcare dollars in this country really speaks to the priorities. And the importance of all of us as physicians, public health leaders, to be out there speaking about the importance of the right policies and actions to help us ultimately build the community and the society and the healthcare system that we all want. So we have two minutes. I'm going to, you know, at the end of the day, community resilience is about all of us individually finding our own way of being resilient. And so I'm going to ask all of you to just maybe share a personal note. We've all had a difficult year and a half. What have you learned about yourself or what have you done that has helped you be more resilient over the course of this last 15 months? And so we'll end with that. Bob, you want to go first? Sure. I think one of the things that I focused on was connecting with people in my neighborhood that I never really connected with before. And we created, I think, a sense of community within a community. And that rich, diverse community enriched me. But also, you know, I'm going to pull that through. I'm not going to let the busyness of my past life kind of get in the way with the community around me and just go and use a house as a, you know, come and sleep and leave again. You know, there's a richness there. And I found that very powerful. Great. Thank you for sharing. Don't be shy, Jade. Yeah, I was trying to get to mute. So I will say that Dr. Carr's presentation resonated with me in terms of the importance of mental health. And I will say my job day and night for the past six months has been leading the rollout of COVID vaccination for the entire VA system. A lot of stress. So I will say that I fell down but had to lean on support to get me back up from a mental health standpoint. So I can't say enough how important it is to acknowledge that, to get the stigma off of mental health. And truly, if people need help, to encourage them to do that. So that's just one thing that I wanted to highlight. And thank Dr. Carr for bringing that out. Thank you. I'll just end by saying, you know, I think it reaffirms the importance of family and friends and having a circle of supporters around all of us. And we need to do the same for the people around us. Because, you know, we'll all get through the pandemic. But we need to be there for one another. And so I think it's a constant reminder that we're all connected and we all need to support one another. And I think when it comes to sort of normalizing and renormalizing, as we slowly start to get out of COVID-19, we're going to have to support people as well in that. Because everyone's going to readjust differently. So I think that patience is going to be very important and something that I continue to be reminded of. Well said. Thank you. Well, thank you, everybody, for joining this session on building resilience. We appreciate your time. I hope you walked away learning something and continuing to think about purpose and finding resilience in your lives on a daily basis. And so with that, I'll give it back to the American College of Preventive Medicine to end the webinar. Thank you.

resilience

individuals

communities

dynamic nature

purpose

essential needs

support systems

COVID-19 pandemic

healthy living approach

veterans

trust

effective communication

technology

social determinants of health