Good afternoon, everybody, and welcome to our fireside chat on good business. I'm Dr. Angela Michelide. I am the Vice President for Programs and Education at the American College of Preventive Medicine. And today we have the privilege of having a conversation between Bill Novelli, who is the founder of Georgetown Business for Impact and a distinguished professor of the practice at the McDonough School of Business at Georgetown University. And the session will be moderated by Dr. Bob Carr, who is a past president of the American College of Preventive Medicine. Just a few words about who we are. ACPM is a professional medical society of more than 2,000 physicians dedicated to improving the health and quality of life of individuals, families, communities, and populations through disease prevention and health promotion. Our members are licensed medical doctors or doctors of osteopathy who possess expertise in a broad range of healthcare skills, including biostatistics, epidemiology, management of healthcare organizations, research, and the practice of clinical preventive medicine. They work in a variety of settings, including hospitals, government at the local, state, and federal levels, the military, laboratories, businesses, and academia. Just a few words about housekeeping. The audience has been placed in listen-only mode. We'll be posting a recording of this webinar in a day or so on the ACPM.org website. So please do check back if you'd like to share this fireside chat with your friends and colleagues. We ask that throughout the presentation, you type your questions in the Q&A box, and those will be responded to towards the end of our time together. And we'll also be emailing you a brief survey, and we'd love to hear what you thought about today's offering so that we can improve the work that we do in the future. It's now my pleasure to introduce our moderator. Dr. Barb Carr is a physician leader, educator, consultant, executive coach, advisor, and board member with extensive experience in digital health, healthcare, pharmaceutical, and consumer products businesses. He is currently the chief medical officer and board member of Puma News. He was most recently the president of the American College of Preventive Medicine, professor and director of the Executive Master's Program in Health Systems Administration, and an associate professor at Georgetown University. He's also been a senior vice president and corporate medical director at a global healthcare firm and a flight and preventive medicine specialist with the U.S. Air Force for 12 years. Dr. Carr currently serves as the executive director of the Aegis Lab, a social impact incubator, is a member of the Johns Hopkins Bloomberg School of Public Health's advisory board, and most recently served on the board of GenomeSmart. He received his doctor of medicine degree from the University of Miami School of Medicine, his master's of public health and preventive medicine residency from the Johns Hopkins Bloomberg School of Hygiene and Public Health, and his executive coach training at Talos Leadership Institute. Dr. Carr? Thank you, Angela. I'm so happy to be here today with everyone, especially with Bill Novelli, who is not just an amazing individual, but the author of a book that we would like to kind of discuss today in our chat. In addition to the great work that Bill has done at Georgetown with the Business for Impact, he's been a co-chair of the Coalition to Transform Advanced Care, which is a national alliance to reform advanced illness, end-of-life care in the U.S., executive vice president of CARE, the CEO of AARP, the founder and president of the Campaign for Tobacco-Free Kids, and has served on the American Cancer Society board of directors since 2017. He also, which I think is important in this conversation today, founded and was the president of Porter Novelli, a global public relations agency, and has a great experience in this area of social marketing, but also kind of kindred spirits to us in the College of Preventive Medicine, was a Peace Corps staff member and started, I think, his life looking at needs and looking at the role of an individual as well as organizations in helping to address unmet needs across the world. So no one really matches Bill's experience, insight, and know-how when it comes to the intersection of business, government, and civil society sectors, and this great book really highlights how organizations can be powerful forces for good, and the individuals within those organizations can mobilize the energy of teams and organizational resources to actually change the world for the better, and I think it's a great blueprint for us as emerging leaders in health and prevention, as well as just citizens of the world to tackle some of today's most critical issues. So it's awesome to see you again, Bill. I know this past year has been a challenge for everyone. How are you doing? Bob, it's great to be here. Thank you for having me. Actually, I'm doing great. You know, I'm tired of Zooming, as we all are. Like everybody else, I think, or at least everybody on this call, I'm vaccinated. Life goes on well. Things at Georgetown are doing great, although we did have to hunker down. Business for Impact is going extremely well. We just did some really interesting studies that we can talk about. So all in all, I'm doing well, and I'm very happy. Awesome. Awesome. I'm so happy to hear that, Bill. You know, in your book, you asked if someone were running a company called the United States of America, would they invest in preventing problems before they occurred and invest or spend the money needed to fix things, you know, after they broke? From our perspective, and from yours, ours being the College of Preventive Medicine, the answer seems pretty obvious. But how has our national experience with COVID over the past 18 months reinforced some of those views or perhaps changed them? Well, you know, you called me a kindred spirit. I am so much a kindred spirit to the American College of Preventive Medicine, because I think health promotion and disease prevention is exactly where we should be focusing our national attention. And COVID is a really good example for us. So, you know, we didn't do the right things pre-COVID. We didn't do the right things during COVID. And now there's no indication that we've learned our lessons. And so why are we so myopic? As a country, why do we keep skimping on prevention? It's a total mystery. I mean, one thought is that Congress doesn't really understand it. It's not on their watch. It's the next guy's problem. It costs money. And then of course, there's us, us the public. You know, the public is not exactly prevention oriented. They're waiting for a pill or a miracle cure. And so we have a lot of work to do, not just the college, but all of us, in terms of making people understand the importance of prevention and preparedness. So, you know, talking about that across all the different sectors of society, you know, messaging is a pretty critical tool to actually understand the collective mindset of our society, but also to begin shaping if we want to shift in that mindset. So it sounds like, you know, we need to increase that muscle of effective social marketing of the message of prevention. And in your experience working, for instance, with the National High Blood Pressure Educational Program or the Tobacco-Free Society for Kids, how has that messaging across different sectors been achieved? Well, as you know, my background is marketing. I mean, that's where I started. And I evolved from a commercial marketer to what we might call a social marketer. And you're absolutely right. Messaging is critical. But before you message, you know, you've got to do the research. You've got to really try to figure out which segments are susceptible to which messages or will resonate best with what messages. You know, Bob, a good example is trying to get kids not to experiment with tobacco, not to become addicted to nicotine. And so back in the early days, the messages were about, don't smoke, it'll kill you. And kids would laugh at that, you know, they're immortal, right? So it didn't do anything at all. In fact, it probably had a boomerang effect. And it caused kids to experiment even more. And then there were another whole slew of messages about, you know, don't smoke, your hair will smell, you'll never get a date. Kids didn't care about that. They were all smoking anyhow. And then somebody came up with a really brilliant scheme. And the idea was, what are kids good at? What do they care about? And the answer is rebellion. They like to rebel against their parents, their teachers, their rabbis, their coaches, whomever. And so the idea of the truth campaign was born. So instead of getting kids to rebel against those authority figures, let's have them rebel against the guys who are selling them cigarettes, who consider them replacement smokers. And that is the guys in the suits who are working at Philip Morris and other tobacco companies. And when they did that, and the kids took off against the tobacco industry, it made a huge change. So what you had there was really good research, good messaging. And then I would add one more thing, Bob, which relates to COVID today, good messengers. Yeah, I think that last point is huge, because the evidence is out there, right? That sometimes the messages and the messengers get overwhelmed by other messengers, you know, and conflicting, right? And I think that's one of the challenges today with the way media has increased the sensationalization of messages, that some of the underlying messages are being lost with extra noise that, I guess, dilutes the effect. I think you're raising some really interesting points for us as physicians in public health and in preventive medicine on how do we increase the breadth of messengers, meaning, you know, we can't do it alone. We're a small college, but we're within a larger infrastructure of a medical establishment. And then we're within a larger structure of a community with business or organizations, government. So how do we mobilize those forces more effectively, perhaps, in your experience? Well, you know, I think a good example, there's something called the Medical Society Consortium on Climate and Health. And ACPM is a member. And so what we have here is probably 30 medical societies, all working together, all realizing that climate is a health emergency. And it's not just a health emergency for everybody, which it is, but it's particularly damaging to the most vulnerable populations. That might be geographic, it might be, you know, demographic, whatever. And so there's an example of banding together where physicians and other health practitioners can really work to put their strength into an issue. And there couldn't be a better issue at this point than climate action. But you know, I've learned some lessons along the way about messaging and messengers. If you look at back to COVID, for example, you know, there's probably five or six different segments of populations who are either vaccine hesitant, or they're just vaccine avoiders. And the question is, what is the best messenger, as well as what's the best message for each one of them. And you are so right about modern media. I mean, we've got it, we're in a pickle right now. We are way more informed, but we're not better informed. Yeah, I, you know, you raised an issue, you know, we're a medical society, and you lead and founded the Business for Impact organization at Georgetown. How can that organization and others like it kind of work with groups like ours to expand the evidence, meaning we have the evidence, but it's not in the right places, operationalize that evidence into meaningful approaches and strategies that work and that could be can be not complicated and executed. And then and then, you know, track the progress and see what's what's working and share the success stories and what's not working and share the failures as well. Yeah, yeah. You know, I'm a big believer, as I say in the book, I'm a big believer in getting everybody at the table. I think today's social and environmental problems are way too big to continue to fight and just endless combat is not going to work. So for for physicians, for you all, you know, who are the strange bedfellows? You know, in my day, I've I've negotiated with and worked with the tobacco industry, the pharmaceutical industry, which you know, so well, big food and beverage companies. Now I'm working with oil and gas, believe it or not. So the idea, I think, is we've got to we've got to get together and we've got to talk and fight. We're not going to always agree on everything. And no permanent enemies, only only permanent principles, permanent values. And it takes some courage to do that. It takes some courage to sit down at the table with somebody you don't agree with. And so the idea really, I think, is is build those coalitions, build those partnerships, talk and fight. And and, you know, don't don't let the as we like to say, don't let the perfect be the enemy of the good. I think that's amazing insights, Bill. I also think that, you know, you've raised some issues around tough issues that are just now being talked about. You know, we we care and do a lot of work in health equity at the college. And, you know, this last year has shown the the effects and the and the evidence of structural racism and the political divide across our society. You know, how can we as as physicians work with others to get out of of a rut? I think of what we're in and and really uncover novel ways to approach this that that create meaningful differences in the outcomes from what we're what we're seeing today. Any any ideas from your experience working across such a broad policy industry, social sector? Well, you know, I'm an incurable optimist. So I really like the work that you're doing and that others are doing in health equity. I mean, we've got to tackle the social determinants of health. We've got to do something about it. If we ever expect to have a really just society. But of course, health equity is part of social equity, and it's so big and so broad. I mean, we're talking about housing. We're talking about criminal justice, education, all these other things as well as as health. And I think we're making progress. I think, first of all, we've had an awakening and we can't let this slide back. And you know, Bob, you come from a corporate background. You know that when corporations tackle something, an example today, I think, is getting more minorities on the board, you know, making sure that they're more diverse. And there are business cases for all this. This is not just the right thing to do. I think that now is an is an opportunistic time to tackle these things. And you know, I think that we've got to get, as you said earlier, all the all the parts of society together. We've got to get into policy and policy advocacy. We need corporate involvement. We need everybody, the faith community, the universities, everybody. And nobody, no single group can lead this. You know, we've got to lead from the middle. And in that leadership, I assumed in your experience working on these very large cross society challenges in the past and your work probably with AARP and aging, one of the challenges to align incentives, right, because everyone in those different sectors has a what's in it for me, right? I hate to bring it down, but an organization is there for a purpose. And so they have to meet their strategic goals and they have, you know, kind of a value proposition that they're offering to society or to their customers. So how do you begin that process of convening to first assess the variety, the dissonance of values and dissonance of what value propositions of all of the organizations and then begin to align it? Do you have any kind of words of wisdom on that? Well, first of all, I think what's in it for me, is an opportunity. When you think about corporations, you know, they're, they're obliged to make a profit. And so what we can say to corporations is we can show you how to make a profit. By building social and environmental strategies into your core business, you can do a better job for your stockholders. If you if you pay attention to the rest of your stakeholders, there are a lot of companies that are doing that. I want to give you a quick example. At Business for Impact, and I talked about this in the book, we just did a big study for AB InBev. So this is the biggest beer company in the world. And they probably have 200 brands in maybe 70 countries. And they know that they just can't keep pushing volume, pushing beer, pushing beer, that they have to do something about responsible drinking. If they don't do that, they're not going to have a license to operate in many countries. And the regulators are going to come down on them. And they also do think it's the right thing to do. So we did this study. And we basically said to them is, you know, you're on the right track here. But here are 10 ways that you can do a better job. And so here you have a beer company that's profit, profit conscious, profit motivated, but they have a strong commitment to responsible drinking. And whenever we took this study, and we this was only last week that we did a webinar to to basically, you know, promote the thing and announce it and talk about what we learned. They had both their incoming and outgoing CEOs of AB InBev on the call. I mean, they're proud of this. And they see that this is going to help them to do a better job marketing their products. So they're working on low income, excuse me, low volume, low alcohol, no alcohol, beer, they're working on all kinds of things. And eventually, companies like that are going to be in the mainstream. That's a great example. And one I think we can maybe build on in our own college strategy going forward of of mobilizing, you know, ways of getting our message in. I remember reading where the shaving company Gillette and the Procter and Gamble company that makes one of the I guess it must be Colgate. No, no, it's not Colgate. It must be Crest decided to turn off the water while they were shaving and while they were brushing their teeth. With a message, you know, why are you turning off the water daddy or mommy and the message is because you know, we need to save water. And that one little element, which, you know, has, you know, been shown to save gallons and gallons of water across the world because you're just building in an implicit behavior that you know, everyone sees and oh, yeah, it makes sense. But before no one ever thought of it, and you just keep the water running, right. So I think more we can do about that. But again, this is not our specialism. And I think the more we can connect with people like yourself, Bill, groups like Business for Impact, other, other sectors that can really help us be partners. I mean, we don't we don't have the ability to become specialists in all of this, but we can look at your skill sets and look at the other other strengths and pull this in. So I think this is really good. You know, food for thought for us going forward. Sorry, go ahead. No, I was gonna say water is a great example. So you know, not every company really has the ability to, to build really good social strategies into their core business. So let's take Coca Cola, for example. Now they do have some products that are good for you, whether it's water or tea or whatever. But for the most part, you know, they're selling sugar water. So how can Coca Cola get on this bandwagon? So what they've basically said is, we use a lot of water to manufacture our products. So we're going to focus in the area of water conservation. And that may not be turning their product line into something that's good for us. But it is, it is an important strategy, and it helps society. And we need to give them credit for that. I think that's, that's a great, you know, what can they do? And you know, maybe moving to things like stevia, and natural sugar substitutes to get us hooked off of the, the the actual sugar could be another, you know, avenues that they have the power to do that in their formulation. Yeah, you know, it just reminds me of in your book, you described a conflict between Walt Disney and his brother about which buildings in Disneyland first, the castle or the hotel, and the castle was first, what is the castle that ACPM should build in order to attract more physicians, you know, to join our profession and our cause? Boy, good question. Well, that that story was to try to demonstrate the difference between leadership and management. So when when Walt Disney and his brother got the idea of building Disneyland, his brother said, Well, first, we build the hotel. And Walt said, No, no, no, first, we build the castle. So the idea is the castle was an example of leadership. And the hotel was an example of management. And of course, we need both we need both if we're going to really do anything, leadership and management. And the reason I think so, so much of your organization is, it cuts across all dimensions of medicine, of good health. I mean, you, as I understand it, you have members from from so many different medical disciplines. This is a I'm not sure there's any other medical society quite like that. I think this is a real avenue. And you and I talked about leadership, I think this is an avenue where you can build leadership, and really make it go somewhere. Yeah, I totally agree. I think we also are benefited by having that diverse group of individuals in a diverse set of organizations in which they apply their craft. So we have people in industry, we have people in government, we have people in policy, we have people in insurance, we have people in startups, and we have people in health. So, you know, we do have the fingers and the connections and the networks, it's mobilizing them with, like you said, the right level of mastery and the right partners so that we can kind of pull together going forward. You know, many of our college members are great in medicine. And one of the things that we need to be a better messenger to be a better influencer is leadership. And I noticed that in your book, it's chock full of details, people, dates, locations, success stories, as if you must have a photographic memory, or you know, how did you manage to capture all that detail, you know, in journals and in what I'm very curious, because I think your success perhaps is, is predicated on some of those techniques that we can all learn from. Well, I can I can assure you that I do not have a photographic memory. But what I did do was I kept the journal over all the years that I've been working, starting way, way back. You know, when I was an assistant brand manager at Unilever, I've kept a journal, kept the journal, kept the journal. And every year at the end of the year, I would reread it, I would read through the journal. And I would say to myself, do I give myself a B plus an A minus? What kind of grade do I get for this year? And it was a way really, of being retrospective, but also to try to think ahead. And now I teach a course in ethical leadership. And what I say to these MBA students is I want you to write a diary, a diary of your leadership experience. Now, some of these people are 2526 27, they haven't had a lot of leadership experience, but they've had some. And I say to them, I want you to list your ethical dilemmas, such as that you have had them. And then you're going to talk about them in class. And then I want you to promise me something. Three years from now, you're going to read this diary. And you're going to assess how well you've done. Then I say to them, and send me an email, let me know. Well, you know, I think you're describing what more and more evidence is showing that you can transform areas of your life and areas that you connect with, through successful incremental change. And you build habits in micro elements, not all overnight, you know, a huge change. And so perhaps journaling is that great ability to intentionally act and then reflect, gain an insight, use that insight to then tweak that next intention, right. And so you have a circuitous kind of improvement cycle of your, you know, self, because I think a lot of it is, you know, self development, but also that of your leadership and your ability to influence because I think your success across all those various sectors says not only, you know, are you an intelligent individual who has pulled together a great ability to understand messaging, but you influence and you lead. And so I think we can all learn from that. And, you know, I've always thought that an athlete starts off their life as an ordinary individual, but they become extraordinary through that training log, which is very much like a journal. And they assess, you know, did their hydration, did their training, did their mental preparation, did their actual performance meet their expectation? If not, why not? What were the barriers? What were the enablers? And then they use that for the next day or next week training, right. So I think we can all use that. And that's a great, great piece of advice for all of us to really begin to capture and record so that we can gain insight about ourselves and the experiences. Yeah, exactly. So and I think it takes a certain amount of college courage to journal about your mistakes. You know, I really messed this up. I remember a mistake I made way back at Porto Novelli. I did not win the biggest contract that we had. In other words, it came up for renewal. And we didn't get it. And I blamed myself for it. And I think I was right in attributing it to me. I've never forgotten that I read that I reread that passage five times over the years. And I never forgot it. And I don't think I've ever repeated it. Well, that that showing a vulnerability is is an important part of leadership. And oftentimes, the way that physicians are socialized is to never ever show that you don't know something or that you don't have the right answer, because that's how we're kind of trained. So when when, how difficult is it to own up? And you know, how did you find that courage to, you know, embrace that that that failure and then publicly kind of connect with others on? Well, um, I don't I don't know if it's courage or whatever it is. But I think we need to talk about those things. I'm not saying, you know, write a full page ad and put it in the New York Times. But I think we need to talk about those those things, not just among ourselves, but people who are close to us. So there was a big job I wrote, I wrote about this in the book, there was a really big job that I wanted. And I didn't get it. And I was so bummed out. I can't tell you. I mean, it took me weeks to deal with that. And my wife said, Look, you did your best get over it. That wasn't good enough. I was flagellating myself over this thing. But it all worked out for the better. First of all, I learned from it. Secondly, I went on to an even bigger job where I could make a bigger contribution. And, you know, things work out if you're if you're willing to face up to them, I think. I think that that's true also, in organizations, but not often true in medicine, organizations are now learning to fail fast and fail forward, right? But the medical profession, if we look at like articles, we never see negative articles are very rarely do we see what's not worked, what's failed, because we don't print that in our journals, right? out on that opportunity to learn from the failures of others and learn what not to do. And, you know, we do tend to look at the critical success factors, that's great. But, but, you know, we do need that, that reflection, I think. So that's really, really great insight. Um, you know, on a personal note, like, the last chapter of your book is on, you know, what do we owe our grandchildren? And what do we owe our future generations? I think, you know, like, what, what, what do you what do you think can be a motivator? Because I think your, your discussion about getting into the minds of people is a little bit like we, we think of when we talk about motivational interviewing, we try to get at what makes that individual really tap into their motivation, what, what, what matters most to them? And then how can we use that to help them understand their health and their and the behaviors that maybe we would like them to consider doing from a different motivation than just, you know, it's what we're telling you to do? What do we owe our future generations? I think that you think that we could really benefit by it from the college? Well, um, I spent a long time thinking about that chapter, what do we owe our grandchildren before I ever wrote it. And I was thinking to myself, you know, Bob, all four of my grandparents came to this country from someplace else. And as I was growing up in this family, and as I became a young adult, I used to think to myself, what are the family values? And a bit a better way to say it is what are the immigrant values? And I finally thought to myself, they are love of country. I'm talking about love of the United States. I mean, immigrants are here because they want to be. The next thing was strength of family. And we see that all the time. The next one was a reverence for education. And then the last one was an appetite for hard work. So I thought those are the values. And I want to try to live those values. And I want to try to teach those values to my grandkids. And they have so much, you know, American kids today have so much, what what can we teach our grandkids? And I didn't want to put too much in there. Because you know how kids are, you tell them too much, and they turn you off. But I talked I talked in there about being ethical, which is not that easy to do sometimes. I talked in there about really having a responsibility, a personal responsibility. But we need to couple that with a kind of collectivism. We need to get that balance right. And then the next thing is, you know, right now, we're in a tough spot in this country. We are very divided. And what we have here is we have a great country, not not a perfect country, but a great country. And so we've got to look at climate action, we've got to look at what you were talking about earlier, in terms of health inequity, you got to look at all the things that are plaguing us. And we you and I and everybody else on this call, we have got to step up and make the country better so that we can hand it over. That's that's our legacy. That's our obligation. I couldn't agree more. I think that that's not a motivator to act. You know, I don't know how we can not preserve it for the future. What what silver linings have you learned throughout your your career in life? Well, I guess several. Number one, the most powerful lesson I've ever learned is team building. You know, when I was at AARP running AARP, I used to say, 100 decisions a day are being made here that are influencing this organization. And I'm making maybe five of them. So who's making the other 95? And the answer is team leaders, teams, working down through the organization. Teams move mountains. So I think I think team building is really, really important. And if you're going to be a team leader or a team builder, you have to learn humility. You just can't say here's the way we're going to do it team. You have to say what's wrong with my idea. So team building and humility are two good lessons to learn and to practice. And then another lesson I think is what I call renewal. So, you know, whenever you talked about where I've come from, and a little bit about my bio, somebody might say, well, geez, that guy's had a lot of jobs. And what I say is, I've done my best. I've made a difference. I've had a good run. Now I'm going to move on. And I think it's very renewing to do that. But it's good for the organization as well. So those are those are some lessons that I like to practice. Those are awesome. You know, and I think that as we look at going forward from where you came from, in the way that messages were communicated different, different channels, the channels have shifted, right? Now the power of the money is within the large social media platforms and large technology companies, which is great in terms of scalability and being able to find stuff 24 seven. But it also can be nefarious and how they shape the messages, what they what you, you know, want to see or what you what you're not given, as well as it creates opportunities for people to opine without a lot of evidence, and, you know, trying to keep up with all of the misinformation. So I guess, you know, it's, it's a big issue. But what can we do in understanding social media as a lever, two examples, I'll just share and maybe you can give your thoughts on it. I know that one large social media platform that is focused on veteran health and military members, maybe two million members, has entered into a pilot study with Harvard and Veterans Administration to use natural language processing to understand when people are struggling to the point of maybe committing suicide. And early intervention through a machine learning, a natural language processing could be huge. Rather than using the natural language processing to give us ads about things that we're typing or things that we're focusing on, right? So with that power to shape more insight about the dynamic nature of the population, but more importantly to help maybe have public service ads, what do you see the future of these large giant social media platforms in terms of health and health behavior, either in a positive or negative way? Yeah. Well, here's how I think about it. And you're so right about veterans. I was in a veterans conference a couple of weeks ago, and this guy who was a senior officer got out of the military and he ran his resume through one of those, I don't know what you call it, an algorithm to see what he would be best at as a civilian. And it said he would be best as a security guard at Arlington National Cemetery. So, you know, that's the kind of thing that we have to deal with. So, you know, these artificial intelligence can be good, it can be bad. It's a tool. And so, you know, I think about this two ways. Number one, if we're going to make real change, we have to operate at the broad environmental level. We have to change social norms. You know, we were talking about smoking before. We managed to change the social norms and expectations around smoking, but we haven't around obesity. And in order to create environmental change, we need policy. Policy above all, the media, technology, but we need to really work on policy advocacy. Then there's the individual behavior change. You know, you, me, our families, that kind of thing. And there we've got to get down to the grassroots. Physicians are at the grassroots. They can make a big difference. We used to have this policy advocate at AARP, and she used to say, the best lobbyists in the country are doctors, because they lobby you when your clothes are off. Yeah, physicians are great. I'll call them grass tops and grassroots champions. And at that level, I also think faith based organizations are powerful. I've always worked with faith based groups. And you can get underneath all that social media and get down to where the people are. And it may not be easy to change their views, but for many people, we can make a difference. Yeah, you raise a really great point about trusted advisors, in a sense, trust the trusted, you know, peers are really trusted. And you get a lot of your health information and your suggestions about, you know, which vendor to use, which store to buy it from your peers. But those trusted advisors, maybe we need to do better at really vetting, you know, who are the most trusted advisors in a community. And I'm sure it's different for different, you know, communities for different parts of the country, you get an array and maybe help, you know, use those channels in a different way. Maybe using, you know, group, so social media pages, you know, I'm just kind of thinking out loud. Yeah, well, the three, the three most common message sources are celebrities. You know, they could be movie actors, athletes, whomever people who are famous, and then experts. And the experts can be physicians, they can be scientists, it can be lots of different kinds of people. And then the average Joe, you know, people like me. And without question, physicians are way up there, way up there in terms of credibility. Yeah, I think the big concern now is the lack of credibility of science, right? There's this pervasive growing distrust of science, unfortunately, because I think the way we've messaged in the messengers are not always consistent, and therefore, confused, right? We have a question from the audience, which I think is a really good one. You know, at times, it can seem like the changes needed are just overwhelming. How do you recommend choosing what to focus on? And kind of where do you start? Wow. I like, you know, I guess I'm Don Quixote. I like to tilt at windmills. I like to take on big things. So an example is climate action, which we've talked about. And you know, you don't have to be President Biden to work on climate action. I mean, you know, ACPM is working on it right now. I'm working on it right now. I think we need to tackle the big issues, the big, important, tough issues. But then beyond that, we all have our passions. So, you know, I have a strong affinity for working on advanced illness and end of life care. You mentioned that earlier. I think that's a topic whose time has come. And it's not just hospice, it's palliative care. It's a lot of different aspects of that issue. So I would say, number one, tackle big things. You know, somebody said, don't get into the trombone oil business. That is to say, don't work on small things. Work on big things. But of course, if you have a passion for something, then I say pursue it. I think you're absolutely right. I do think that the biggest things that we need to address are the hugest challenges are really great places to start. The first question I would say, though, when I'm in the room is, who's missing? Because for us to be successful, you know, we each bring our channels, we each bring our networks, we each bring our competencies, our like thought collectives. But without it, you can't make a difference. And there was a great community that was a recipient of a Robert Wood Johnson award to actually define what does community health mean. And health care was only one 10th of how they defined health, right? They looked at economic vitality and safe neighborhoods and kindergarten readiness. That's how that community defined it. So if you don't have all those people in the room to tackle that big issue, so I think the first thing I would do is to assess, do we have the right players? You know, for the why? I mean, you have to define what is what are we doing? What's the why? And then do we have the right players? And if not, how do we mobilize each one of our passions down our competencies and our strengths? So I think that's a great I'm totally with you. Who's missing? It brings us back to everybody at the table. So we can't work on obesity without getting the fast food industry and the beverage industry at the table. We might not agree with what they're doing all the time. But we need to get them at the table. And so who's missing is a key question. Great. And just relevant to that. Another question from the audience is that, you know, you're an expert, Bill, at really taking the pulse of populations of knowing that consumer insight and mindset. What current attitudes or misperceptions regarding health or health care represent maybe the greatest opportunity for ACPM to address or the greatest challenge for us to address and engage? Wow. Well, you know, when you talked about today's social media, I was talking to an oncologist about a month ago. And he said, you know, I was sitting in my office discussing a diagnosis with my patient. And while I was talking to her, she was Googling the disease. You know, social media are so difficult for all of us, for our patients, for everybody. And I think that, you know, one of the things I like to talk about is crossing the aisle. And so what I mean by that, and you know, Bob, you've seen this, the really good policymakers are people who can walk across to the other party and try to get something done. And I think we need to do that as individuals. So I have members of my family I can't talk politics with. I can talk football, I can talk family. If I talk politics, you know, we get into it. So what I say to myself is, I can't just stop there, I've got to figure out how to cross the aisle. So what I've been working on lately is saying to them, well, let's talk about something we can agree with. Can we agree, for example, with immigration? No, we can't agree on that. How about climate action? Can we agree on that? Well, we can agree on parts of it. I think we need to cross the aisle, where we work at places of worship, in our families everywhere. If we don't do that, we're going to end up with a divided nation. And I think a biggest challenge to that is the fact that individuals tend to be in echo chambers with the sources of information they get. So they don't want to cross the aisle even for information. The networks they watch, the papers they read, they're very aligned to that. I think one thought in your consumer days, you know, polling and the concept of getting in the minds of people through product reviews and work with Unilever to really find out, you know, why do I buy Tide versus Game? What really motivates me? You know, do we need to do more of that? An interesting poll from Harris that I was reviewing over the last six months showed that one in three fully employed individuals have food insecurity and housing insecurity, which is shocking in a sense. I mean, it shouldn't be, but, you know, we never thought that fully employed would have as much as, you know, we perceived in the vulnerable zip codes across the country. That tells me that, you know, we're in a precarious time where there isn't a lot of reserve and pushing a lot of people and COVID just exposed a lot of that economic uncertainty. So do we need to pull more or do we need to gather more insights of what people are thinking so that we can do it? Is that where you find your success has been in each one of those sectors influencing change? Yeah, I think that's essential. There's so much survey research done today that we don't have to do it all ourselves. You know, we can collect existing research and really study it, but I think oftentimes we have to go deeper. So I'll give you some quick examples. One is we did a study of the gig economy and gig workers, and it is amazing to see how many differences there are among these gig workers. Older gig workers are very different from younger ones in terms of what they want, what they're willing to do, how they treat their jobs. If you're going to appeal to them, if you're going to find ways to make them more secure, you've got to understand that. And another example is last year we did a study of young people, millennials and Gen Z in the time of COVID. And what we found was that these people, just as you say, are insecure. You know, a lot of them lost their jobs. A lot of them can't save for retirement. But what we found was that women, young women, were way worse off than young men. Part of it had to do with childcare and not having childcare so they couldn't go to work even if they had a job to go to. You know, we've got to understand that. And then we've got to dig deeper and do qualitative work to really understand those populations. If we don't do that, we're not going to be able to appeal to them. I so agree. I think you mentioned earlier, and it's relevant to one of the issues that ACPM is working on right now with the CDC and vaccine hesitancy between the people who are vaccine hesitant and the people who are vaccine avoidant and the issues like what are the opportunities for us to better message around those? You know, if you identify different subpopulations, how would you begin to approach us engaging those populations in a different way so that we have different outcomes from what we currently have? Well, where we are today is, I think what we need to do is first go after the low-hanging fruit. So if you look at the vaccine hesitant, you know, a lot of African Americans are vaccine hesitant. And we all know why, because, you know, they go all the way back to Tuskegee. And even if they're too young to remember that, they still have that image in their minds. And they also, in many ways, and you know this better than I, they get less medical care, less maternal and child care, less palliative care, less pain management. And so they think to themselves, you know, this system is working against me. I don't trust this system. I think we can work with that population through their faith leaders, their community leaders, whatever, through their physicians, a lot easier than we can work with the people who, I have friends who say, I'm not going to get vaccinated. I don't want to be a government serf. Well, we're not going to change his mind. So I say go after the populations, Hispanics, African Americans, you know, people who are really low income and who don't understand what it costs to get vaccinated. They don't have transportation, you know, those kinds of things. I think that's how I would lay out the marketing plan. And I guess you would try to unpack the unique little insights of, you know, they're vaccine hesitant. Why? And then you get that wide, you go, why? And you get that wide, you go, why? Right? You dig deeper into the underlying, you know, core belief issue. Is it trust of the system or is it, you know, I just don't know anyone or the mixed science of the news, you know, identifying that that one person died who was vaccinated from COVID, but, you know, 400,000 didn't. And that one is sticking in your mind. So, you know, trying to unravel those core beliefs, I think is probably the art of what social marketers do. Then they get down to that. Okay. How do we shift that belief? How do we shift that belief? So that eventually the underlying behavior shifts, right? So, yeah. And keep our own opinions out of it. We are not part of the target audience. Right, right. But that's our own bias, right? We have our own influence. Our own biases going into that. Well, we're coming up to time. And, you know, I know, I think we have one more question, you know, and it's more of what's next for you? You know, what are your next ventures and how can we be a part of it? Because we would love to, you know, be a part of how you've been able to mobilize a variety of sectors for good. And we would like to be a part of that. So anyway, what's next for you? Well, I'll say two things. Number one, I don't have a rocking chair in my future. So I'm working on business for impact at Georgetown, working with students whom I love. They're tomorrow's leaders. Beyond that, I'm really focused on advanced illness and end of life care. I've been doing a lot of work on the Medical Society Consortium on Climate and Health. That's an area where we can definitely work together. And then I'm working with a group trying to get the federal government to double the science and technology budget over the next five years. And I would love to work with ACPM. I think we have a lot of things in common. And there's nothing better than to work with a great team. Right. I would echo that. And I think that that last part of getting that budget focused more upstream. Yeah. And getting investment from private sector more upstream on preventive interventions instead of the, you know, the 90% being on treatment of existing disease. And, you know, I think that would be huge. And how do we influence the ratio of the investment? Because increasing it, if it continues to go 95% towards downstream care, you know, that's not still going to help. It gets back to your original question. Why aren't we paying for prevention instead of paying to fix it? Right. So I want to thank you. And I hope the audience echoes my gratitude for your time and your wisdom and the ability that you've been able to share through your book and your other books, you know, your life insights, which I think are very valuable for us as both clinicians, but also as, you know, citizens of the world. Well, Bob, I want to thank you. I want to thank Angela. And I want to I look forward to working together. Great. Thank you so much for this really inspirational fireside chat, Bill and Dr. Carr. We want to invite you to our next webinar, which will be on July 27 at two o'clock. We'll have a really fascinating overview of writing for publication with Dr. Robert Wallace, who's been on the on the forefront of publications, especially in our American Journal of Preventive Medicine. We also will be sending out the events survey. So please fill it out if you have a moment. And we have so much information on the ACPM.org website in terms of education and events. So I invite you to log on and get involved with ACPM. Thank you very much. Thank you, everyone.

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