Wow! What an audience and what a great day to welcome everyone, wish you a great afternoon, and to thank those who have been involved with the creation of PM 22. That includes our ACPM staff, the planning committee, including our outstanding chair, Dr. Linda Hill, and vice chair, Dr. Lisa Miller, our moderators, all of our speakers, but a special thanks to each and every one of you for participating in this in-person meeting, our first in-person meeting in three years, hard to believe. I am Dr. Tonette Krause-Wood, president of the college, and it has certainly been an honor to welcome you to PM 22, and it also has been an honor to serve as president for the past year. I would like to officially call to order the ACPM annual meeting. Now, as you know, it has been quite a year for public health, and while we've had several advances and new insights for addressing underlying mechanisms to improving the health of our communities and our populations as a whole, we have encountered major losses. I would like us to share a moment of silence to reflect on the following. For the lives lost from COVID-19 and the lives saved from prevention measures, including vaccines and new treatments, for the lives lost from gun violence and our promise to address the underlying causes, including but not limited to mental health, racism, and policies, and the loss of our dear colleague, Dr. Douglas Schuchfield, and our gratitude for his legacy in public health and Before I share my reflections as president of ACPM, I wanted to preview what you can expect in our time over the next hour and 45 minutes or so. I will share my thoughts and reflections on serving the college over the past year. And during my remarks, I will have the distinct pleasure of announcing the recipients of the President's Award. Following my remarks, ACPM Treasurer Dr. Joni Shin will briefly highlight the financial state of the college. Following Dr. Shin, I will provide the update on behalf of Dr. Mirza Rahman, our president-elect and acting ACPM, and introduce our newly elected officers and regents. Next, our ACPM CEO, Donna Grande, will share her report and her update on the activities and the initiatives of the college. In addition, she will also announce the recipients of the Volunteer of the Year Award. I will then have the distinct pleasure to return to the podium and introduce our featured and distinguished lecturer, Dr. Jeannine Austin-Clayton from the National Institutes of Health. She's a noted physician-scientist, an incredible leader and advocate in health equity with a focus on women's health and sex differences. And she will deliver this year's Dr. Katherine Burkhardt Sturtis lecture. So last month, we lost a very dearly beloved member of the college, Dr. F. Douglas Scutchfield, otherwise known to most of you as Scutch. He was a giant in the field, both physically as well as intellectually, and his contributions probably touched each of us in many different ways. I was a preventive medicine resident at Tulane when I first met, as I called him then, Dr. Scutchfield. He was bigger than life, fully committed to the field of preventive medicine and advancing public health. Over the years, I too would come to know him as Scutch and see him at meetings, discuss opportunities for the field, and learn from one of our giants. His legacy will live on, but he will be sorely missed. Now what an honor to have the opportunity to serve as your president. Sixty-eight years ago, the college was founded to create a professional home for the growing number of board-certified experts in preventive medicine. The mission of the college is its dedication to improving the health and quality of life of all individuals, their families, their communities, and the population as a whole through disease prevention and health promotion. Our organization engages an extraordinary and diverse group of physicians who serve as clinicians, public health advocates, leaders in clinical communities, academia, government, military, foundations, and industry, all who provide us with a broad lens to see our challenges and the opportunities for the disciplines that support preventive medicine. Last year at PM21, I described three near-term opportunities for ACPM, kind of the three Ps, if you will, our pledge for evidence-based, data-driven strategies, our visible presence and purpose as a specialty and an organization, and our pipeline to the future leaders in preventive medicine. Now, over the last year, ACPM has worked diligently with you and many others and has supported the translation of science into practice with new and updated position statements and guidelines, provided an avenue to data sharing, dissemination, and networking by hosting the in-person PM22 meeting, scientific sessions, and announcing the inaugural Board of Regents Scientific Excellence Award, which I'm very proud to say we had 100% participation from our Board of Regents to support the monetary prizes for these awards this year. We have built on our current partnerships with the federal funding agencies, national federal organizations, and industry to address science and implementation gaps. We've expanded on the power of prevention. We have built on our advocacy efforts, and we have focused on the partnerships and the initiatives to increase the funding platform for preventive medicine residents. Now, while we have made progress on many fronts, new trends in COVID-19, hence look at it all masked today, and updates in the field of preventive medicine are signaling new opportunities for the college. We've moved from COVID crisis to more of a COVID control with an increased emphasis now on addressing some of the collateral damage of COVID-19 on preventive screening and chronic disease management, creating the opportunity to integrate messaging and services about COVID-19 with primary, secondary, and tertiary prevention services in our communities. Although we did not achieve a change in preventive medicine residency funding levels, this has created an opportunity to pursue alternate funding mechanisms, which the college is aggressively pursuing at this time. And we were recently, know that the decision by the ACGME to allow three distinct specialties, including public health and general preventive medicine, occupational medicine, environmental medicine, and aerospace, providing us with the unique opportunity to showcase our role as leaders in public health and general preventive medicine. Building on these opportunities, it is clear that our success as a college will continue to reflect our collective efforts and the talents of ACPM that position our organization stronger in the coming years than we are today. We will continue to measure our strength of our organization through the brand recognition of preventive medicine and public health, through our membership numbers, our engagement of our diverse and highly talented volunteer leadership, our contributions and dissemination of evidence-based that recognizes the social determinants of health and differences or similarities across groups, our innovative partnerships to a stronger organization, and a grant portfolio that aligns with our mission and an increased funding platform for preventive medicine residents. No doubt we continue to have challenges to meet these goals, but within these challenges and the current public health environment lies our greatest opportunities for our field. It will take all of us. The call to action for each of you as members and would-be members of our college and our field is to get involved. Please take some risks with our organization, engage and support our efforts to achieve our pledge to evidence-based, our visible presence and purpose, and our pipeline to future leaders in preventive medicine. By doing so, you will support and sustain the power of prevention and the specialty of preventive medicine to achieve the long-term success. Thank you for this incredible opportunity to serve as your president. Now in building on it will take all of us, this is a perfect time to transition to the next item on our agenda and to recognize two incredible members of the college who are both receiving the President's Award. The President's Award honors an ACPM member in an area designated by the current president and this year we have two outstanding recipients given their significant contributions in time and expertise and in resources in advancing prevention. The award acknowledges their outstanding activities and service, their contributions to our developing policy and position statements, and the education that will bring us forward with the next generation of preventive medicine leaders that contribute to the promotion of prevention. The two recipients of the 2022 ACPM President's Award are, I must say in alphabetical order, Dr. Jacob Adams and Dr. Lisa Miller. Because Dr. Adams is not able to be here in person, while Dr. Miller comes to the stage to receive her award and if Ms. Grande can help us with the delivery of that award, I want to acknowledge Dr. Adams for his commitment to educating the future preventive medicine leaders with the commitment and his passionate contributions to the residents including establishing the Jacob and Heather Adams Scholarship Award for Residents as well as his service on the Advocacy Committee among many other contributions he has made. We congratulate Dr. Adams, sorry that he cannot be here with us today. Dr. Lisa Miller has been an amazing leader of the college, serving as Vice Chair to the Planning Committee not once but for two consecutive preventive medicine conferences. As you know, the extraordinary efforts in planning a first all-virtual meeting in 21 with a pivot to an all-in-person meeting in 2022 was not easy. And I am so ever grateful to her unwavering leadership, her dedication and expertise in planning these two conferences, in addition to what she does in directing the residency program at the University of Colorado and building the future of our profession. So thank you, Drs. Miller and Adams, you serve as outstanding role models to our profession and heartfelt gratitude and sincere thanks for all that you do. Now I would like to turn the program over to Dr. Joni Shen for the Treasurer's Thank you Dr. Castlewood. I'd like to welcome you all. As the treasurer of the college, I'm so excited we're finally here. I would like to start by highlighting the ACPM financials ending 2021. So first, I'd like to highlight the income and expenses. In year ending 2021, the income is budgeted at $6.7 million. The actual income received was $5.9 million. The budgeted expenses $6.6 million and the actual was $5.5 million. As a result, the college ended in 2021 with a positive net operating income of $386,000. That is during the pandemic. We'd like to acknowledge the stellar performance of our management team, particularly I'd like to acknowledge Melissa Ferrari and Donna for running the operations. I'd like to acknowledge our Board of Regents for their wise guidance in making some critical decisions, including obtaining the PPP loan. We are very thankful for the federal government for the pandemic relief program and we benefited two years. The loans, the PPP loans would turn into grants for our college and that contributed to the bottom line and we are very grateful. And I most grateful as the chairperson of the finance committee, I'd like to acknowledge the members who volunteer tirelessly serving on the committee, meeting every month and sometimes on short deadlines. Three of them are here with me. If I could acknowledge them, I can see Dr. Ed Fess. I know Dr. Jim Tatchy is here and I also know Dr. Lisa Waddell is here. I love them very much and I thank them for their service. With that, and I also can see Dr. Wendy Brown, who convinced me to become the treasurer and the nominee. We'll get to that later. So next I would like to highlight and make a comparison of year ending in 2021 to 2020. 2020, if you recall, it was a very difficult time. So 2021, you already heard income 5.9, expenses 5.5. 2020, the income was 3.7 million and the expense matches that 3.7. So, oops, sorry. Okay. Thank you. Finally, I'd like to report the financial status of our college. Just to highlight three items. First is our liquidity. Very healthy at approximately 1 million. Our long term investment reserve is also healthy at approximately 1.5 million. Debt number fluctuates with the market, not to worry too much. And thirdly, oh, I wasn't meant to be funny, but thank you. Our current liability are mostly the many grants that we administer at approximately 1.5 million. So in summary, ACPM ended 2021 in solid financial standing with a current balance of approximately 3 million. With that, again, it's a pleasure to join you for PM 22. Thank you for your support of the college and for your ongoing engagement and also for your membership dues that continue to offer so we can run these meetings and provide receptions and food and beverages that you will enjoy soon. Now I turn the podium over to Dr. Castlewood on behalf of Dr. Mirza Rahman. Thank you. And thank you for adding some levity. It's always wonderful when someone has a sense of humor, even if they're not intending to have one. My husband always told me, Tonette, you have no sense of humor. He says, don't even give it a shot. I said, sometimes people find me funny. He says, well, it's not me. So you better try something else. Thank you, Dr. Shen for doing it. Glad I went into science. And appreciate all of your efforts and your two-year stint as treasurer doing a fantastic job and keeping us on the up and up. So we really appreciate that. So on behalf of Dr. Mirza Rahman, who is unable to be here today, but serves as the president-elect and as the acting secretary for the college, I have the pleasure then to introduce our newly elected officers and the regents for the ACPM board. I want to share a very quick overview of how we select our new board members. The ACPM nominations process for the board of regents is a four-step process. It begins in November of each year and runs through January. The process begins, as we said, in the fall. And once the nominations are received, the subcommittee convenes and evaluates each nominee based on qualifications of the candidate and the current needs of the college. The results in a slate of candidates. The slate is announced to the membership and introduced during our virtual town hall. Following the town hall, a ballot is circulated to eligible ACPM members to vote. Another great reason to pay your membership dues. Voting outcomes are shared during the ACPM annual meeting and new officers and regents assume their roles at the conclusion of the annual meeting. Please also note that we will be on an accelerated and condensed schedule for PM 2023, given that our meeting will be held in March, so the nominations will begin likely before November this year. So it is now my honor to introduce to you the newest members of the ACPM board of regents. We'll look at the first slide for Dr. Jim Tocci, ACPM's new treasurer. He is the medical director and executive medical policy director for the New York State Workers' Compensation Board, as well as the program director for the preventive medicine residency and medical director of the travel medicine program at Rochester. ACPM's new secretary is Dr. Jill Wallin. Dr. Wallin is a senior scientist and co-director of biostatistics at the Scripps Research Translational Institute, as well as the course director of the Introduction to Biostatistics course for the Scripps Research Graduate School. She is also faculty lead for the ACPM board review course. Elected to a new term as regent is Dr. Borj Lushniak. Dr. Lushniak is currently dean and professor of the University of Maryland School of Public Health. He is a retired rear admiral and former U.S. Surgeon General. ACPM's newest regent is Dr. Chris Purnell, a dynamic physician leader and social change agent. She currently serves as the chief of strategic integration and health equity officer at the University Hospital in Newark, New Jersey. Please join me in congratulating our new officers and regents. They will step into their new roles at the conclusion of the annual conference on Saturday, June 18th, and I of course look forward to working with each and every one of them in the coming year to help the college in fulfilling its mission. So now I'd like to turn the podium over to our CEO Donna Grande, and as she makes it to the stage I certainly want to recognize her tremendous efforts over the the last several years as we've dealt through the the roller coaster ride of the COVID-19 pandemic and what it has meant to the college and the operations. Her leadership and the engagement of the ACPM staff have been extraordinary, and I too join Dr. Shin in thanking our board of regents, all of our members, and our volunteers for extraordinary work during extraordinary times. But not that I'm amazed, I would have expected an extraordinary delivery of this community of physicians committed to preventive medicine. So Donna, thank you. If someone's not feeling well, we're going to take all precautions. Greetings, enthusiastic, passionate, preventive medicine physicians and all of these enthusiastic guests. I just have to absorb this moment because we've waited so long to come together and to be together and I'm just thrilled that we are all here together. Well, when I think about this pandemic and that fateful day in March 2020 when our Board of Regents in their wisdom decided to cancel the annual meeting that was supposed to be right here in this place, in this room in 2020. It feels like stepping back to prehistoric times and it was a little scary. It was a little unnerving when we were in 2020 and it was odd because the whole world was changing around us. We all went into lockdown, we went into unfamiliar routines, we went into very unfamiliar places, kind of like the little beast, but as time passed we actually learned to adjust, we adapted, we demonstrated our resilience, we spread our wings and we actually flew on to business as unusual, not business as usual. And yet here we are and what a difference a day makes. We are here together to learn, to grow, to share, to exchange ideas, to meet new people, to learn new tactics, techniques, and new preventive medicine skills and what a great time for us to be together. We have much to celebrate over the next few days and I hope that each and every one of you take time to celebrate your own personal advances, your own personal successes, and again a hearty congratulations to all of the fellows and award winners, but you have to come Saturday morning to the closing session for the award celebration to truly celebrate their career advances and all of the fun, fun successes. But let me share a few highlights of the year. As Dr. Krause-Wood mentioned, there's been a real deliberate, intentional focus on our presence, which means to increase the visibility of preventive medicine and the field of preventive medicine. Our purpose, more than anything, is to advance the professional development of each of you and to meet your educational needs and then to focus on the pipeline. We have over 200 residents, I believe, in the audience and that's so exciting because you are the pipeline for the future of preventive medicine and you are why we are here, to be supportive of you, to enhance your careers, and to make sure that you network, learn, and grow and meet all of the peers, mentors, and experts in preventive medicine that can open up doors for you in your career. So we're very excited about when we focus on all of these key aspects because it's all about the synergy, the energy, and the impact that we can have together to really make a difference, not only in our country, but in this profession in this field. So in the midst of the pandemic, I'll talk a little bit about our presence, we moved offices into space that was more reflective of preventive medicine. Open light, lined up desks, open space, a lot of convening areas, team building opportunities, and it's more reflective of the field of preventive medicine. And for those of you coming to DC or in DC, it is your home. So please come visit, spend some time with us, drop by if you're on your way to Capitol Hill to advocate or to just meet with the executive branch. We would love to have you there. So in addition to the space, we also focused heavily on our journal, the American Journal of Preventive Medicine, led by Dr. Matt Bolton, who's here with us today, as well as the expansion of a new AJPM Focus, the new open access journal led by Dr. Uri Jadot. There you are. So thank you both for your leadership. I also want to thank the many volunteers that have served on the Board of Governors of the AJPM for the many years of its existence. It's about volunteerism that really matters. And so we really applaud you and thank you for your many efforts. We published four manuscripts written by the Board of Regents and paired up with volunteers on what preventive medicine is, what it means, and how it serves in public health, in health systems, and in the greater society realm. And these four manuscripts were published in the journal but also turned into one-pagers that we use for our advocacy on the Hill and education of other stakeholder groups. We also, with the support of Prevention Alliance members, created the Vaccine Confident Campaign. We developed the campaign, branded it, and BRG Communications, who is here with us across the hall in the media room, they helped create this brand and launched a satellite media tour. Within 24 hours, Dr. Zaza, our immediate past president, and Dr. Boris Lushniak had over 40 different interviews and did remarkable work advancing not only preventive medicine but really the importance of prevention and why vaccines are so important as the prevention tool and the most powerful tool in the preventive medicine toolbox. Those efforts helped us actually be better positioned for the Centers for Disease Control funding, which allowed us and enabled us to actually expand, build, enhance, and tap into many of you who serve as ambassadors for this campaign. Would you please stand and be recognized and thank you for your efforts? So not only do you cover the map, you cover the room, so thank you so very much for all of your tenacity, effort, and energy because these ambassadors have just done remarkable work. They've actually touched, enraged, and impacted so many people across our country, and they focused on the communities that were most vulnerable and marginalized populations that had not been, the vaccine wasn't accessible, nor were they able to actually get vaccinations, or they were hesitant. And so their confidence in the vaccine and their messages and their interviews and their work really helped turn the tide to help increase the number of vaccines. If you are interested in becoming an ambassador, we have a booth right down the hall. We are actually looking to have more of you sign up, get active, get engaged, become a part of the campaign, and to continue the great work. The funding, we also had a 30-second PSA developed, and we used our own talent, Dr. Krause-Wood, in it, and if you haven't seen it, I encourage you to go onto the website and click it. It's 30 seconds, and it's fabulous, and we have over 400 million views of that PSA to date. But I can tell you the story, but I think actually it might be better for you to hear this little clip about what we've done with this campaign. for centuries. 🎵 We're doing our part to protect our community and to decrease and slow the transmission of this variant while we increase vaccination rates across the community. Pfizer and Moderna vaccines are very good at preventing disease, symptomatic disease related diseases. 🎵outro music plays🎵 So, imagine the potential if all of the ambassadors that stood up and were identified on the original map, if we expanded with each of you and your voice across the country as we look at pivoting from vaccine around COVID-19 into getting back on the clinical preventive schedules, looking at all vaccines, preparing for the next pandemic, and amplifying the power of prevention. Just imagine the power we could have and look at the numbers that that map should demonstrate anyways that we could actually grow and really advance. Are you ready to sign up? I'm going to hold you to it. As you heard Dr. Carlson-Wood mention, that's your pledge. So the list, hopefully on the closing session, we'll be able to hold out the list. Hopefully it'll go all the way off the stage of how many people have signed up to become more ambassadors and really engage in this because I think it really is the opportunity to increase the power of prevention. So with the possibility, just imagine the possibilities, right? We'll have a coordinated army or Navy or Air Force. I have to be mindful of all of our military members in the audience, but we'll have an armed service of preventive medicine physicians with tools in your toolbox to be able to talk to the media, meet with your policy makers, convene with both state health departments and your hospitals and your federally qualified health centers and mobilize your communities to really take important action on important policies that we all believe are so important. So we have the opportunity as you enhance your confidence and your own voice to use it to actually be the experts in your communities so that the media will go to you when they need to have an expert discuss public health preventive medicine. They won't go to internal medicine, no offense for those of you that are double boarded. They won't go to other specialties, they won't go to emergency physicians, but they'll come to preventive medicine physicians because you know public health. So please stop by the booth as I mentioned. I also mentioned that we've been focusing on our journal, making use of the pages that we have available to us in the journal and we thank the publisher Elsevier and we thank our journal editor and the editorial office at the University of Michigan for giving us these pages. And we highlight the incredible work of our members. So I think all, I've seen four of the five, I don't know if Tista is here with us as well, but would the four of you at least stand up because I think it's important for the residents in the room if they've read your articles or if they've read these interviews that they get to know you and learn more and seek you out so that they can understand how you got to where you are. And so those of you that are residents take note and then just tap them on the shoulder and say I'd like to introduce myself and I was impressed by the article that I read about your interview. So thank you to all of you that have been part of that. We have one a quarter so be mindful I might tap you for another article, someone along the line. But much has been done to increase our presence and we still have more ahead. So if you have your phone, if you didn't receive an email in your email with this QR code, pick up your phone, take a picture of it now and take the survey. It's a very short survey but we want your input, we need your feedback, we want to get your impressions of the topics that you feel are most important for us to hone in on and to really wrap our arms around because as you all know the preventive medicine toolbox is full of every single chronic disease, primary, secondary, tertiary prevention and we have a lot of opportunity but we want to hone in on what you believe is the most important. Okay, if you didn't get it, you can go to the booth, the membership booth, and you can actually download and get the QR code and do the survey. But so as we focus on purpose, it's really important to acknowledge that we've increased our educational portfolio. We have courses and webinars throughout the year. We expand our educational learning opportunities for you to be prepared for your MOC work, for your board exam, as well as your CME requirements for state licensing. We have a new course that's soon to be launched on the 10 essential public health services for all physicians, and we believe preventive medicine branding will position this for all physicians who believe they might be preventive medicine physicians, but then they can learn more about what true public health services are from your point of view of preventive medicine physicians. So I wanna thank Dr. Angela Michelide and the team. We have an incredible education team advancing that great work with many of our faculty. We also have a prolific grant portfolio, and I want to thank Centers for Disease Control, the Veterans Administration, and members of our Prevention Alliance for entrusting us with some really great work to advance chronic disease prevention. We have work in hypertension, diabetes, colorectal cancer screening, and a number of other topics. We've done work on a strategic roadmap on tobacco cessation and how to integrate lifestyle and preventive medicine in undergraduate medical education. So we continue to look at funding opportunities that are going to enhance and expand the portfolio of work and position us for greatness, all of the field for greatness. And there are a couple of sessions throughout the sessions and workshops throughout the conference. So please take advantage and learn more about the great work that we're doing. And I wanna thank the faculty, the advisors, the consultants, many of you who serve and work with us on those grants. So thank you very much. We also, with the growth of diversity, equity, and inclusion, we've also really focused in and honed in on our contribution to this work. We were selected to participate in a pilot program with the Council for Medical Specialty Societies and the ACGME in a program called Equity Matters. We learned and took courses on implicit bias, on structural racism and a number of other really relevant and important topics to enhance our own understanding and the opportunity for us to position both physicians and patients for greater inclusivity. We really, and these courses are available to each of you for free through our learning management system into and through into the ACGME. So we really want to encourage you to learn more, seek out these courses and really advance your own understanding of these very important topics. We also had the opportunity to honor the legacy of Dr. Daniel Blumenthal last year at the National Press Club where we honored Dr. Marcella Nunez-Smith with the first inaugural award. We have this year's award winner scheduled for September 28th with again sponsorship funding from our Prevention Alliance membership at the National Press Club and we are going to live stream it once again. So if you have not, if you did not see last year's or if you did, please mark your calendar for September 28th because it's going to be another grand event and a really riveting dialogue and discussion. So finally on the pipeline, what we're doing with, for, and in preparation of the residents, we want you to be sure to call ACPM your professional home. We are invested in you and we invest in you and your career and we hope that through the work that we're doing with the new resident onboarding in the fall, the summit and many other opportunities that you'll actually seek us out, let me know, let anyone of our team know what you want, what you need and how we can help you network, grow and continue to gain new knowledge with the field. Many of you actually are the recipients of scholarships and we'll acknowledge you on Saturday but I also want to acknowledge our donors. We created, this is the foyer of our, of our office suite and we created a gratitude wall so that we can actually honor and thank and recognize the many contributors to the, to the college over time and I'm just so very grateful that you have contributed and you've carved out important space on your annual giving for ACPM. We are a 501c3 organization. Your donations are tax deductible. Put us on your plan for next year and we'll be able to have more scholarships offered next year so we really hope that you'll keep us in mind. We will acknowledge each of the donors again on Saturday so please stay tuned for that. Additional support for the pipeline has to do with our advocacy efforts and we have a very ambitious goal. We have current funding at $7 million. That doesn't fund enough. It's unbelievable that our federal government has not increased the funding to support all of the programs. Only 50% of the slots that are approved are funded and they're not all funded by HRSA. We want to increase this over the next three years to $52 million and we need every single voice. We need every single voice, all of you, active, engaged, not only in the topics of interest with your elected officials but we also want you to add in and we believe that HRSA's budget needs to be increased to full funding to $52 million to fully fund the public health general preventive medicine slots. It's unbelievable to me. Earlier this year we had a virtual Hill briefing and we'll continue to do this because we think it's a real great opportunity to educate the staff of the elected officials and three of our volunteers offered incredible insights about their research, evidence-based research, the community needs, as well as tobacco cessation and work with the veterans. So Dr. Carlson Wood, Dr. Purnell and Dr. Linda Ferry gave riveting talks that were really incredibly inspiring and educational for the elected officials and their staff and we have repurposed these and retooled these to continue to educate the Hill members. So in order for us to go from $7 million to $52 million, just imagine in 2024 when we're all together in Washington, D.C. for this conference, if you all bring your clinical jackets and each of you join us and we have some buses that happen to drive up to Pennsylvania Avenue or up to Capitol Hill and we start letting your voices run wild on the halls of Congress, just think about the voice, the power, the story, not only on the halls of Congress but also in the media that we will be able to spin and to educate and to raise that awareness. So please mark your calendars for 2024. Also mark your calendars for this Friday. We have a workshop, both media and advocacy, to sharpen your edges, gain new knowledge, gain new experience and position you for greater confidence to be an ambassador and then to keep your practice going so that you can also be up on the Hill. Also want to say we have postcards out at our membership booth. It will take you, I promise you, two minutes, two minutes out of your time to write a quick little note on the back about what's important for you to communicate to your elected official. Just write it on the postcard, leave it at the booth, we'll make sure it gets to your representatives in Congress. So postcards, take them with you, mail them if you want, if you want to take a stack and have more thoughtful conversations with your elected officials on postcard, but please do so. Do pick those up. So to complete all of this work, it truly takes a village. And I am immensely, immensely grateful for the team of professionals that are a small but mighty team in our DC office. These 14 individuals do the work of 50 and I want you to please stand and be recognized. It is just an amazing honor to work side-by-side with these individuals who care so deeply about what you do, and it's just really tremendous. I hope you reach out and get to know them, because it will really make a difference in their experience and in yours. So in closing, I want to thank you for your support, your attention, all of your leadership and your passion, everything that you do for the health of society. When we ended 2019, which was the last time we were together in Pittsburgh in Mike Parkinson's backyard, we had a call to action to be bold. Be bold. Be proud about preventive medicine. Use your voice. Speak up and speak out. This year, I'm going to leave you with a final word of hope. I hope you have fun. I hope you meet new people. I hope you stay healthy. We will be wearing masks unless you're speaking or eating or drinking. So stay healthy, and I hope you join us on Friday for the Rockies game. We have great fun in store for Friday. All the residents have tickets, so we hope that you'll get them on Friday, and we hope you'll have great fun. So I want to just thank you before I transition to the Volunteer of the Year Award, and I just want to say, have fun. So we're at that part in time where I get to segue into the Volunteer of the Year Award. Well, it brings me great joy to announce the Volunteer of the Year Award winner. This award is given to a member, I'm going to have to read this because I don't have it memorized, but it's to a member who has shown humility in the face of challenge, dedication beyond measure to the mission of ACPM, tenacity and resolve in advancing the work of the college, and a passion that runs incredibly deep into their own blood. It's a recognition of a volunteer who offers tireless energy, personal time, and immense effort to the college, and is an amazing leader, guide, advisor, and partner to me in my role as CEO. While there have been many members who have volunteered their time, their service to the college, given the pandemic and the immense needs that we've had this past year, the opportunities, there are two awardees. First, as you saw in the sizzle reel, that's what we call the little reel, the little reel of our efforts around the Vaccine Confident campaign. Our Vaccine Confident campaign has been a tremendous effort and provided us with so many opportunities to expand and enhance the visibility of the profession. There has been no greater spokesperson but Chris Purnell. She has made herself available morning, noon, night, and all the hours in between to actually be on CNN, MSNBC, and all sorts of local media throughout this country, numerous stations and media outlets. She's a go-to person for when media outlets need an expert on public health and preventive medicine. She sets the stage right on what it means to be a public health advocate, physician, and passionate preventive medicine professional. The second one is someone you may not see as visibly, but whose passion, tenacity, and insights have been incredibly instrumental to me since I arrived at ACC. So, since I arrived, and throughout this past year, we addressed some really challenging opportunities, not only with our residency programs, but also we really looked at how and what we needed to do with our work with the American Journal of Preventive Medicine. Dr. Deborah Porterfield joined the Board of Governors to the AJPM in the past year, and we've made incredible progress, engaged in so many ways with our colleagues at APTR, and all of the incredible board members and the editorial staff. And I feel that we've really ensured that the relationships with our colleagues have been strong, and that our shared vision for the journal and all that it means continues to be advanced. So ladies, would you please come forward and accept your awards? Okay, I'm an emotional person Seeing the joy that these awards give our members just really warms my heart, too So it is just a real honor to work with So many incredible volunteers But I just want to say this portion of the meeting this session of the state of the college now comes to a wonderful conclusion and as The happy unicorn does I turn the podium back over to dr. Krause awood who will announce? the very Thank you. Well, what an amazing update. Thank you, Donna, the staff, and all of our volunteers for making this possible. As we look over the last two years, we have truly been through COVID hell, in some cases hurricanes, and certainly high waters and others, and yet we emerge as productive and engaging in everything that is public health and preventive medicine. We have a lot more work to do, but as we reflect on what has been accomplished just in the last year, it is certainly heartwarming, and it's only possible because of our leadership, because of our volunteers, and because of our members. Relevant to today, I really want to do a special recognition of our chair and our vice chair for PM 22, Dr. Linda Hill and Dr. Lisa Miller. They truly have been extraordinary. I recognized them early in the meeting, but it's never enough to thank people who've done an extraordinary job, along with the members of their committee. I do want them to stand and be recognized, and we're going to give them another round of applause for exceptional service and planning. Thank you all so very much, and now we will transition to a moment I think we've all been waiting for, and that is to hear from our distinguished lecturer for PM 22. Appointed by the ACPM Board of Regents in 1979 to recognize Dr. Catherine Bukot Sturgis's outstanding contributions in research, in teaching, and in service in the field of preventive medicine, the annual, as we call it, the KBS Lecture is the highest award from ACPM, and it provides an opportunity to nationally recognize leaders who have explored key issues and innovation in health promotion and disease prevention. I must say it is a distinct pleasure and an honor to introduce this year's speaker and the recipient of the KBS Award, Dr. Janine Austin Clayton. A physician scientist and a recognized academic leader, she serves as the associate director for research on women's health, and she is also the director of the Office of Women's Health, which many of us know as ORWH, at the National Institutes of Health. She is the architect of the NIH policy requiring scientists to consider sex as a biological variable across the research spectrum, from basic science through to clinical and population science. This policy is part of NIH's initiative to enhance reproducibility, rigor, and transparency that builds the evidence base for what we do as physicians and what we do to improve the health of our communities. As co-chair of the NIH Working Group on Women in Biomedical Careers and NIH director, Dr. Frances Collins, Dr. Clayton also leads NIH's efforts to advance women in science careers. She has been a vigilant advocate for the BIRCWH program, the K-12 Building Interdisciplinary Research Careers in Women's Health, which has increased the number of highly qualified women and some men who are focused on research that increases our knowledge and our evidence base for addressing issues relevant to women's health and understanding sex differences. In 2021, Dr. Clayton was elected to the board of directors of the American Association for the Advancement of Science, most of us know as the AAAS. She is the author of more than 120 publications, journal articles, and book chapters. Dr. Clayton is a native Washingtonian. She received her undergraduate degree from Johns Hopkins with honors and her medical degree from Howard University of Medicine. It is with distinct pleasure that I welcome Dr. Janine Austin-Clayton to the stage as this year's KBS lecturer. in-person speaking engagement and I'm doing it for you, Tonette, and for ACPM. I wouldn't be here unless it was a place, a forum, and a purpose that I believed in personally, so I want to thank you, Tonette, and ACPM for this honor, for selecting me to be honored in this way, and I'm delighted to be here. I'm especially excited because there are residents here. You mentioned that, Donna, and residents and our young people, you know, I feel like an old lady saying that, but our young people are our future and I'm excited to be here with you. So I decided to feel like I'm with kind of at home with my own community even though this isn't my community, so I'm going to approach you all in that way as not preaching to the choir but coming home. Getting it right, the key to equity and improved health of all is my title. So I'm going to start with a little bit of opening. We are in the second section as we we aren't healthy until we're all healthy. The third is the missing link, understanding sex's role in health and disease. Fourth is a diversity dividend, talking about productivity, innovation, and equity, and then I'll close with a few remarks. It really is my pleasure to be recognized in this way and to recognize Dr. Catherine Bucotte-Sturgis who had incredible accomplishments at a time where it was quite challenging for women in medicine, and I definitely identified with some of the challenges that she went through, so thank you again. She's pictured here in this picture in this photograph with President Kennedy, and she was one of two women in this press conference where there was a discussion about medical care of the agents, so clearly a trailblazer. So I want to tell you a little bit about myself and how I got to be doing I was doing research on Sjogren's Syndrome, JIA and uveitis, graft versus host disease. When I read a paper that was a meta-analysis. This must be just because of age. Age could not account for this difference, this sex difference that I did not learn about as a resident and that couldn't be explained. And it really disturbed me that we could not explain the fact that 2 3rds of the world's blind are women. And the US data are not quite 2 3rds, but more women than men are visually impaired. And this is what got me interested in sex and gender and health and disease. So you know that saying, what you don't know can't hurt you? Well, I think we all know what you don't know can hurt you. And I have a couple of examples here. First, the crash dummies that we use in the United States, we have safety requirements and regulations that we must approve new vehicles, new features in vehicles using crash dummies that are based on anthropometrically appropriate men. There are no female crash dummies that are required. The ones that are used are based on just shorter men. So the pelvis is not adjusted. The changes in our neck muscles are not adjusted. And as a result, you can see that the safety features that we have don't protect women as well as men. There are well-documented differences in patterns of trauma and injury. Women are more likely to be trapped in automobile accidents and have different patterns of injury. They're more likely to have pelvis injuries, spine injuries. And so here's an example of how health and disease is everywhere. And not accounting for sex differences in this way is affecting and harming women. The spacesuits that our astronauts wear are designed for men. And clearly, they don't fit women quite the same. And that's a problem as well. I was privileged to work with some folks at NASA to talk about the sex differences in space travel and its effect on the body for women and men, bone density changes in women, and some ocular diseases that are more common in women than in men, probably related to radiation exposure during space travel. What about medications? Well, there's some medications, as we all know, that work better in one sex or the other. But there's also a medication, elastatron hydrochloride, that is only FDA-approved for use in women because it doesn't work in men. So we don't want men to be prescribed a medication that doesn't work for them. So this does go both ways. And certainly, lots of things are overlooked in terms of the care of women. And that's related to the life course. I'll talk a little bit more about that. So we aren't healthy until we're all healthy. You heard this during the pandemic. And I'll talk a little bit about the pandemic, but also other factors there, life expectancy, maternal health, and, of course, the role of preventive medicine. So what is health equity? This is a CDC definition where every person has the opportunity to attain their full health potential. And no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances. The Robert W. Johnson Foundation definition is everyone has a fair and just opportunity to be as healthy as possible. So these are kind of, at least the CDC one, is aspirational, full health potential. This group has a great appreciation for the impact of the social determinants of health on our health status. Conditions in which we work, live, play, worship, and age have a wide range of effects on our health. comparing the United States to other high-income countries in terms of life expectancy changes. Over the past several decades, the life expectancy of the United States has increased and as it has in other peer countries. Well, but you can see we're quite far away from comparable countries. And then if you look at what's happened because of COVID, life expectancy has gone down for all countries except for Australia and Japan. And we're farther and farther away from comparably situated countries. Why might that be? So if you look at this data by sex, you don't have to read the countries on that left bar. The United States is at the bottom for both men and women. Our life expectancy is the worst. And as a result of COVID, our life expectancy at birth by race and ethnicity, the overall is at the top there and you can see that reduction. But then you see the differences in the reduction for non-Hispanic black populations, second row, and then Hispanic populations, which started at a much higher life expectancy with the higher Hispanic paradox and then the reduction for non-Hispanic whites. So we can see that that race disaggregation demonstrates health disparities and health disparities in the reduction in life expectancy. And in fact, here's one of the most salient examples of health disparities and the differences in health in US versus the rest of the world. The United States is actually the most dangerous place in the developed world to deliver a baby. This is the data compared to our peer countries. And on the right, you can see the overall data for the United States and then separated by race and ethnicity. And that high bar is for black women in the United States. And I always leave this slide up for like a few seconds because it's just so disturbing that the likelihood of a black woman dying, giving birth today, exceeds that of her mother and her grandmother. And that is actually the same for white women as well. They're more likely to die than their mother was or their grandmother was. Clearly, we are going in the wrong direction here. And I promise I don't have too many slides with a lot of data on them, but I thought I needed to share with you this most recent CDC data, which compares 2018, 19 and 20 in terms of these death rates. And they've increased significantly for women in the United States. The rates for black women are three times that of white women the rates for American Indian, Alaskan Native women are twice as high as white women. The rates for everyone increased over these three year period with a 48%, so nearly 50% increase in maternal mortality. for the first time an increase in maternal mortality for Hispanic women. So clearly, we're not doing something right. I promise I won't harp on this too much, but this is the last slide on this, which compares education and race and ethnicity. And the fact that a black woman with a college degree is more likely to die when delivering in that postpartum year than a white woman with less than a high school degree says that there's something we're not doing right. And in terms of advancing health equity, we have work to do. So you'll often hear people say this is about race, or they'll say this is disparities by race, or African-American women have different risk factors. So I would say that it's not about race. It is about racism, and that racism, a structural issue, and discrimination, an interpersonal issue, are part of a black woman's lived reality, and that these differences have health consequences. The impact and disadvantages of this lived reality are cumulative. They're biological. They're physical. We can measure them by looking at things as basic as leukocyte telomere length, telomere shortening of our white blood cells. I promised I wouldn't show all of this basic biology, but it's pretty profound that we can measure racial discrimination in validated instruments. It's correlated with CRP, inflammatory cytokines, premature aging, immunologic aging, shortening of telomeres. And clearly, this is having an effect on our populations. Most of the maternal deaths are preventable. This is Shalon Irving, who was a member of the United States Public Health Service, who was dual PhDs, was a health disparities researcher, and unfortunately passed away several weeks after delivering. So your multiple PhDs, your great health insurance or coverage, and your status as an officer in the Public Health Service doesn't protect you. What about the health of women as they're going into pregnancies? So it's not just pregnancy. It's just not postpartum care. The number of women that are hypertensive before they are pregnant is increasing. And there's a disparity by region. So it's higher in rural locations. And obviously, this is an underestimate, since there are many women who are not diagnosed there. And pre-pregnancy obesity is also an important factor. And you see the racial and ethnic disparities there. So women in the United States, reproductive age women, are less healthy, more unwell, before they become pregnant than ever before. So you all know this data. This is one of the slides I used from our 30th anniversary, that cardiovascular disease is the leading cause of death among women, killing more women than all forms of cancer combined. And what is that related to? Bias in care, studies not looking at differences by sex, studies not being designed to detect differences by sex, a lack of awareness about symptoms. I mean, this is a group that knows all of this. But also, that last bullet, which is getting more and more visibility in the press, is that women's health concerns are not being taken seriously. So when they present to the emergency room or report vague symptoms like shortness of breath or increased fatigue, and they're 35 years old, nobody is thinking that it's ischemic heart disease. They have no obstruction on the angiogram. Are we going to look further and look for microvascular disease? Our patterns of presentation are different. And this is part of what's accounting for what we're seeing. Today, over 50% of African-American women over the age of 20 have some form of heart disease. This second one is new data. Over half of black women over 20 are hypertensive. Clearly, that is contributing. And of course, African-American women are twice as likely to have strokes as compared to non-Hispanic white women. So the data are what they are. And they are telling us that there's something wrong with how we are addressing these issues across our health care system. And everyone has heard the news about COVID-19 amplifying existing health inequities. And you can see here rate ratios by ethnicity and race. And you can see they differ, of course, by cases, hospitalizations, and death. And if you dive a little deeper, the few states that are reporting their data disaggregated by sex, gender, race, and ethnicity, which is very few, this is data from Georgia and Michigan from last year. And it's mortality rates from COVID. And you can see, of course, overall, we know that more men are dying from COVID than women overall. But when you disaggregate the data by race and ethnicity and you adjust it for age, you see a very different pattern. So black women's COVID-19 death rates in Georgia and in Michigan, two very different states, were almost four times higher than the rate of white men, three times higher than the rate of Asian men, and higher than Asian and white women's rates. And of course, it's social factors that are playing a role here. And while men do have higher rates secondary to COVID-19 overall, that sex disparity does not hold across all racial groups. And the health risks, of course, are structured in complex ways that reflect systemic and other inequities. One of the most important developments in the past 30 years, I promise you I'll lighten this up a little bit, at ORWH and at NIH is the fact that women's health is being conceptualized as everything that affects a woman from head to toe across her life course, far beyond reproductive health. Women are increasingly and incredibly diverse. Men and women are different, and all women are not the same. And we think about this through a life course perspective, but literally from head to toe, taking into consideration internal and external factors. And I looked at your mission, and Dr. Crystal Wood mentioned it a while ago, you're dedicated to improving the health and quality of life of individuals, families, communities, and populations through disease prevention and health promotion, which really appealed to me. So much of what we do is something is broken, and we try to fix it because somebody comes to us already with a problem, not so much we try to predict what is going to happen and prevent it. But you all do that all the time. And our multidimensional framework that we use for NIH-wide, looking at women's health research, and thinking of that across the life course so that we know if a woman has gestational diabetes, she's increased likelihood of having type 2 diabetes. But does that mean our electronic health records ask a woman who's 60, did you have gestational diabetes? No. Does it mean that we ask a 55-year-old woman with TIA symptoms, did you have preeclampsia? Pretty much no, because we haven't integrated a life course perspective into the way that we practice medicine. We haven't leveraged the value of data analytics through our electronic health records to make this even more effective. So the next section is the missing link, and it's sex as a biological variable. And this slide is meant to kind of look like the slide that comes up on your GPS when you put in your route that you want to go, you put in your destination, and your Google Maps or your other map will ask you if you want to go with these two different routes or three different routes. So when I talk to folks about the differences between men and women, I'll talk about the fact that we may just follow a totally different course to get to disease. But what if the diagnostic test on that course is a diagnostic test that only picks up one course? Right? Obstructive patterns of coronary artery disease, for example. That's the gold standard for diagnosing coronary artery disease. But that gold standard is patterned after the way that the disease shows up more commonly in men. So that means we are missing opportunities to prevent progression to diagnose. So unidimensional research is the research that we've been really trying to do or the research that we've been really doing at NIH. We just had our 30th anniversary. Women's health is not that old at NIH. And of course, the research has been based on a default 70 kilogram man that I learned about in Goodman and Gilman. There may be a few people as old as I am who remember that pharmacology textbook. 70 kilogram man, calculate this. Right? So we assumed that also what was fundamental in biology was what was shared between men and women. That's what's shared. That's the ground truth, and that's what's fundamental. But other factors came into play, for example, with thalidomide and the consequences, the teratogenicity of thalidomide, that resulted us seeking to protect women or protect developing fetuses from research. Today, we know we need to protect people through research, not from research. But women were excluded from clinical trials for a very long time. There was a predominant use, and there still is, of male animals in preclinical research. So that's unidimensional research. So in this JACC paper, I was recently was thrilled that they put an entire seminar focused on sex differences and heart disease. We talked about how sex and gender influence all aspects of cardiovascular health and disease from epidemiology, through pathophysiology, through diagnosis, clinical manifestation, progression, response to treatments, and of course that we need to study sex and gender and report results by sex and gender, which we don't do enough of, and that contributes to disparities. But that's the central illustration in that paper is our approach to integrating sex and gender across the biomedical research continuum. So in those preclinical animal studies, look at sex differences. As you translate to first in human, look for sex differences in adverse effects, right, even in early phase studies, so that you can design a phase 3 clinical trial that will actually have the power to look at effectiveness in each sex and be able to look at perhaps differences in adverse effects. Not even saying that your power to detect sex differences, just look within each sex, because otherwise we just won't know. And so these traditional heart disease risk factors we all know, this is, you know, bread and butter to this group, diabetes and smoking and physical activity, dyslipidemia, but on the right side of that slide are gender-specific risk factors. This paper called them non-traditional. I don't think that 50% of the population is non-traditional. I would just say that it's a little different, but that's what they call it. And you know you've heard this atypical chest pain, you know, you all know what I'm saying. So how does that knowledge gap play out in real life? Because it's, you know, people say this is not really important, you're just, this is politically correct, your whole office should be abolished. I mean people tell me that all the time. It's like, okay, we're fighting so that won't happen. But in real life, women who have MIs are less likely to receive guideline-based treatments. That's real life. Women with AFib are less likely to receive appropriate anticoagulation treatments. That's real life. And this last one really bugs me, because this is not about medicine, this is about EMTs in the field. So individuals who are found unresponsive, women are less likely to receive CPR from EMTs than men are. So these notions, this lack of intentional integration of consideration of sex into what we do has real-life consequences. So here are some examples. So it's well known that normally women have lower blood pressure than men, normal people, right? That's well recognized. But what hasn't been really looked at is what is the cutoff for where hypertension and systolic blood pressure elevation results in cardiovascular disease as complications. So this study looked at sex-specific cutoffs, and to the right of the dotted line has a ratio greater than one, and for women it's in red, and for men it's in blue, and this you can see for women it's at the top between a hundred and a hundred and ten millimeters of mercury. The first start of increased risk for cardiovascular disease. All of that is below. If we now know, because we look at this data in a sex desegregated way, that there are differences. I'm not just saying the blood pressure was different. I'm showing you data. This is not my data that shows that systolic blood pressure is associated with increased risk of these complications. But our hypertension treatment guidelines are not sex and gender aware or sex and gender informed. What's happening to all those women with systolic blood pressure under 140, yet alone all the women, like me, who are hypertensive, who may or may not be completely treated. I talked a little bit ago about women not being included in studies and designing studies. And I think this group is well aware that once drugs are in the market, that's where we find those rare events in terms of complications. And 80% of the drugs withdrawn from the market had sex effects and had greater health risks for women than men. Half of them were because women were more likely to take those medications because they were for diseases that are more common in men. And some of them were just because they were the same sex ratio, but women were more likely to have complications from the medications. Here's some of them. You might remember some of these. Terfenadine and Fenfen, I think a couple of folks here remember those. I used to take Seldane every day for urticaria, chronic urticaria. So I'm glad I'm here, that I didn't have one of these fatal arrhythmias a couple of years ago when I used to take that medication every day. So sex differences in pharmacokinetics and pharmacodynamics. Here's our pharmacology 101 slide. I think people think about the sex differences that might be a result of body weight or body surface area, but they don't think about all of the other differences. And there are many, but I won't go into many of those because I think you guys are well aware of them. But lately, I've been thinking about another issue. As a government employee, I fill out many ethics forms. I get asked lots of questions. You guys don't get to have to fill out these forms. But on a serious note, I want to talk about these things that we learned when we were learning how to write protocols. And they're these basic principles from the Belmont Report. Beneficence and our duty to maximize benefits and minimize risk. So if we only study males or study mostly males, we're denying potential benefits of research to people that we exclude. And in some cases, for example, cancer trials, that's actually access to the most cutting edge treatment. We certainly have equipoise about whether the treatment works or not, but you can't access those treatments in some cases except for through clinical trials. Respect for persons talks about the fact that we treat individuals as autonomous and being able to give consent. So if we don't include pregnant women in our COVID-19 vaccine studies because we're not sure if it's safe, which we're never sure that it's safe as we go into a study, we're also saying that we don't. Is that consistent with respect for persons? And what about the principle of justice, which talks about fair allocation of the benefits and risks of research, and the burdens of research, and that you can't deny a person a benefit to which they are entitled without good reason? So I'm going to ask you a rhetorical question. Today, women are included in NIH-supported clinical research In fact, women represent 50% of NIH-supported clinical trial participants, and that is a great success. However, fewer than one-third of NIH-defined phase three clinical trials ever report their results by sex. Fewer than one-third. Phase three clinical trials, you're making treatment decisions based on that data, ever report any sex-specific results. Your mother enrolled in that study. She was subject to the risk. We can't use her data to inform your aunt's treatment decision because that data is never published. Is it ethical to include women in clinical research when the benefits of the clinical research are not being accrued to women? Because we do not report our results by sex for the largest clinical trials that are designed to inform your treatment decisions. Is that ethical? Rhetorical question. But we, as a public-funded agency, we have a duty to really think about this, how we use our funds. Are we being prudent? Are we being wise? Are we being efficient? Are we being just? So as we think about these terms, sex and gender, I've updated these slides. You guys are the first ones seeing these. Because these notions are evolving over time. And we now understand sex. You've heard this phrase, every cell has a sex because of the chromosomal complement. But every cell has a sex. And it could be XXXY, Turner syndrome, XY, and other variations. And that is defined based on anatomical and physiologic traits, which are listed there. Gender is a multidimensional social and cultural construct. It incorporates gender roles, gender dynamics, gender identity. It incorporates stereotypes, for example. And both sex and gender affect health and disease. And we need to do a better job about introducing both of these concepts and using these terms correctly, because they're often conflated. So as scientists, as clinicians, as leaders, it's important for us to use these terms appropriately. So we've talked a little bit about exclusion of women. And it was in the 1980s that NIH started talking about this. And the United States is one of the few countries that actually has a law that says that women must be included in underrepresented racial and ethnic minorities as well. And NIH defined phase 3 clinical trials in NIH clinical research, not pharma sponsored research, not other research. NIH clinical research, clinical trials represent less than 10% of all the clinical trials that are conducted. So the other clinical trials upon which we're And FDA is making decisions, are funded by others. But the 21st Century Cures Act has made some advances there, paved the way for pregnant and lactating people to be included in clinical research, now requires a disaggregation of the results of those applicable phase 3 clinical trial results that I talked about before by sex, gender, race, and ethnicity, but only into clinicaltrials.gov. And if you've ever been to clinical trials, you'll know that clinical trials are into clinicaltrials.gov. And if you've ever been into there, it's not that easy to navigate. But at least they must be reported now into clinicaltrials.gov. So that is huge. And we're now reporting inclusion numbers by disease category on the NIH website. So sex has these effects on levels of biology. So it's obviously at a genetic level. I think you might be surprised if I said that 14,000 genes are expressed differently in your body just based on your chromosomal complement. And I think we all realize that gene expression has consequences. So really, we're just touching the tip of the iceberg at what's happening there. At a system level, the immune system, just used as an example here, at the organism level. And all of these levels are interacting with each other at the same time. So if we're not accounting for them, I think we might be missing important information. And that was part of the reason that we advocated for NIH developing a policy that requires investigators to account for sex as a biological variable into research design, analysis, and reporting for vertebrate, animal, and human studies, and to justify single sex studies. This went into effect in 2016. And this is data that shows the percentage of applications that use the terms male, but not female, male and female. And you can see on the left, after the SAVV policy went into effect, a very noted increase in the use of the terms male and female. And on the right, a corresponding decrease in the use of the terms female, but not male, and male, but not female. So this landscape analysis is showing a change related to SAVV policy. And we really do think that this will represent, as it moves forward and is continued to be applied, and implemented a seminal change in research in generating that evidence that you use to practice medicine every day. So I go into this last section, which is on the diversity dividends. I'm just going to show a little bit of data. This is AAMC data on the proportions of women in academic medicine, moving from medical students at over 50% on the left to deans and department chairs at 18%. Women have actually been at least 50% of medical school admissions for some time. For life sciences, PhDs, it's over 30 years. Women of color, unfortunately, are represented at much lower levels than expected, dramatically underrepresented across every level, much higher in the lower ranks, and with little improvement over nearly a decade. So this is one of my favorite slides. And this is a paper that coined this term, the diversity dividend. And we hear about it. You'll hear about publicly traded companies that have more women on their boards, do better. We know that diversity in science, from Scott Page and others' works, diverse teams come up with more creative and distinct and innovative solutions. You could put a bunch of Mensas in the room, and they will come up with a solution. But they'll be more similar. They predict gender, heterogeneous, problem-solving teams generate more influential, higher impact factor papers. But the graphic, which is a little hard to read there, is really important. So it's not just mix up the team, and you're going to get innovation out. You have to have a supportive environment. You have to have team science. You have to have engaging mentors and managers. You have to have an organizational context that is ready to take advantage of the diversity, to reap the diversity dividend. So now with everybody having an EDI director, are we going to be able to do this better and get more discovery out? Or is it lip service? I challenge every one of you who's involved in any organization. I'm not talking about ACPM. I'm just talking about any organization that you're in that has a new diversity director. Making sure that the organizational context is set up so that there is a real change, that it's not lip service. I think everyone in this room agrees that prevention is the clearest path forward to improved health for everyone. Women make 80% of health-related decisions, 8-0. Economic analyses done by the RAND Corporation demonstrate that an increased investment in Alzheimer's research, rheumatoid arthritis research, and cardiovascular research, each reap. For Alzheimer's disease, it's a 224% ROI. For cardiovascular disease, it is over 9,000% ROI. It's like, this must be wrong. This must be wrong. Wait, I'm not understanding this. 9,000% ROI for increasing investment in women-focused cardiovascular research in terms of economic benefit, people in the workforce longer, decreasing caregiving costs. So as women play central roles in society as decision makers, as providers, as caregivers, as mothers, among other roles, their health and well-being are central to the health and well-being of society. And you could argue right now, even more so in the middle of a pandemic. So the COVID-19 pandemic has forced a lot of people to look at things they weren't looking at or willing to look at before. Or they're just not able to ignore things they could ignore before. So we have a chance to do a reset, like a hard reset. Sometimes that. medicine, we run the risk of losing all of the hard-fought gains in gender equity. We also know that women physicians, women scientists, and the questions that are going to be asked and answered. We're changing the people who get to make the funding decisions, who are going to decide if this study gets funded or this study gets funded. One of my privileges is being able to design research programs like the BIRCWH, but also one called U3 on understudied, underreported, and underreported populations. of those other analytes that we measured. entire leadership and membership of ACPM. I applaud all that you do and look forward to following you going forward. Thank you so much. Thank you. Absolutely. It's a huge problem, as you are well aware. And this issue of pregnant women not being included in research and there not being appropriate incentives for individuals to include in corporations and pharma, for example, to include pregnant women in research has compounded that. So there was a task force on pregnant and lactating women in the previous administration that was carried through the Biden-Harris administration and has 17 recommendations on specific steps that we must be taking. There are, I understand, moving forward with those 17 recommendations that are available on our website at NIH. So I would say that that is one of the most meaningful ways that we can move forward if we're able to implement some of those. Thrill, RSV vaccines, and any other infectious disease. And the COVID vaccines were a huge problem. We didn't have any data. We were telling pregnant women that we wanted them to be vaccinated. We didn't include them in the initial studies. So again, this notion of getting it right from the beginning means we need to do that from the outset and inform individuals so they can make an informed decision and trust them. So good luck at Meharry with that. Sir? Hi, good afternoon. And thank you so much for your talk. It was very insightful. I think we all learned quite a lot of information and really appreciate you coming here and sharing this with us. My name is Rona Ghia. I am a resident at the Emory Preventive Medicine Program in Atlanta, Georgia. It's very interesting. As I was hearing your talk, in one of our public health classes currently, we have to design a mock grant proposal. And actually, our team chose to make a proposal studying the cardiovascular outcomes, specifically in women. And one of the things that we discovered was that there is a lack of research specific to women and that they have poor outcomes from all areas of the clinical piece. One of the questions I wanted to ask you is that, in your expertise, what are some ways that we can encourage and empower women to really join these clinical trials moving forward? And also, the other gap that you mentioned with the kind of lack of data sharing, what are some ways that we all, as a preventive medicine community, can kind of get involved and move the ball forward on that? Thank you. Actually, the data show that when you ask women and underrepresented minority groups to participate in clinical research, they're no less likely than others to participate. The issue is they're not asked. And so we keep citing real historical reasons. similar to themselves, they're just as likely to participate. With women, we have an entire inclusion toolkit on our website called Inclusion of Women in Clinical Research, and it talks about ways to encourage women in terms of whether you need to adjust your enrollment times, do you need to do that in the early morning and the evening, very practical case studies, with the way that you present your advertisements and your publicity, all of that is there. But I think that the second, leading from that into the second piece, is what I wanna answer is are we designing the studies in a way that asks questions that are relevant to how the disease manifests in women and men? And then the data sharing piece. So preserved rejection fraction heart failure. Sex difference is very clear. Heart failure studies notoriously low enrollment of women because the studies weren't designed specifically for that. So sometimes you need to design a single sex study to look at the pattern of disease in a single sex because we have a lack of knowledge about that. There's nothing wrong with a single sex study under those circumstances. Not because you don't wanna deal with the estrous cycle in your female mice, that's not okay. But it is okay to say this disease manifests differently. Men with this manifest differently. That's fine. Data sharing, new data sharing policies just came out. I don't know if you saw those and I've been following them really closely because I think they're gonna be helpful in terms of getting data, sex desegregated data more available. So anything that's NIH funded, the data are supposed to be shared and the data sharing plan is supposed to be approved upfront. So there's a lot of attention to that at NIH right now. So I'd encourage you to take a look at that new data sharing policy, bring it up at your class and you all can do an analysis of what you think will happen and follow it over time. But you can ask for any data from an NIH supported trial and you could ask for the data to be desegregated by sex. And certainly now that ancillary data can be provided on public journal editors, there's no issue of print or space, that data should be made available. It's federally funded, it's funded by you. It's taxpayer. on several levels. I hope I don't advertise my naivety, but I've heard the term the feminism of men and how environmental, genomic, technological impacts are impacting what we consider what a man and a woman traditionally are. What are your thoughts on exploring how those changes of what it is to be a woman or a man impact your research? Outstanding question. And that's why I put in the slide about gender. Because now you're getting into gender. This is not about sex, per se. This is about gender. So male, female, sex, man, woman, gender diverse person, gender. And our understandings of gender are changing. And gender is fluid. So in a certain context, a gender identity might be different. My first answer is that we need to do a better job of incorporating ascertaining gender in our studies. There is no NIH agreed upon definition of gender. We do have a sexual gender minority research office and supported our office and other parts of NIH supported a new National Academies report on sex, measuring sex, gender, gender identity, sexual orientation, and other related domains. So there's a new National Academies report about how important it is to measure these variables that affect health in our studies. So we need to do better about ascertaining sex and gender and other variables because they have a direct impact on health and disease. In terms of it being a moving target, it is. And I think we have to accept that. Instead of saying, it's too difficult, we're not going to do it. And I don't think that people are going to tolerate us saying that any longer. And so we just need to accept that we do the best we can at this time. But let's move forward. Let's use this instrument to ascertain gender. Let's look at the effects of sexual orientation on this particular outcome because we know that there's data that suggests there's a relationship. Let's design a study to look for that. Let's fund that research. So we do have now an NIH-wide strategic plan for the first time on sexual gender minority research in the new office. And then we're supporting their first funding program, which they patterned after our Sex and Gender Administrative Supplement Program. Dr. Karen Parker is the director of that office. So we're working together to see what we can do to encourage our 27 institutes and centers at NIH to incorporate these domains into their ongoing research. But SGMRO is going to be asking specific questions. So my last feedback to you is to ask the question. Because if we don't get questions asked of us, sometimes we don't have to move forward. If we put out an RFI, for example, we put out RFIs before every strategic plan, request for information, you should respond. We look at those responses. ACPM should respond as an organization. We look at those responses. So speak up. Have your voice heard. And there's new funding available for this type of research. Well, I guess it is really no surprise to anyone why Dr. Janine Austin-Clayton was selected as the KBS awardee this year. She certainly aligns completely with the vision of the KBS awardees. And I think that's a great thing. She certainly aligns completely with what we are moving forward with in the coming years on our pledge for evidence base to look at the data, look at the science, and where there are gaps, we need to fill those. Our visible presence and purpose to take this data and address the social determinants of health and the other factors that may lead to health inequities. We need all of our people to be healthy and to be engaged and involve citizens. And this is one way that we can do that. And of course, her call to action and this wonderful show of our residents who stood up asking questions for the pipeline to the future of the preventive medicine leaders. It truly is amazing. And thank you again for an outstanding presentation and a fabulous lecture that already you've got wheels turning among everyone in the room. And hopefully we can move this forward as a college and participants in making a difference in our communities. You know, we heard a call to action to do several things. In the presentation today, we've also heard a call to action from our CEO of what is available for our engagement. And of course, across the way, we need to make sure that we're all fully engaging to move the field of preventive medicine and public health forward. A noted leader in leadership, an expert in leadership made a statement that said a leader is someone who knows the way, goes the way, and shows the way. So our call to action is review the evidence, understand the field to know the way. Show the way by your actions, getting involved with the college, doing the work that matters, responding to the RFIs, engaging in the research, making sure we're inclusive of women, minorities, and all people so that we have the evidence base. Because as we know, any progress we made, as we found out during COVID, moves at the speed of trust. Data, real evidence base, helps build that trust. And lastly, the call to show the way, and in that way, we need to support our future preventive medicine leaders, our residents, our fellows, as we look to the future of our field and what we can do in preventive medicine as a whole. Again, huge thanks to everyone who has made PM22 possible. Sincere thanks to our staff and to you all for attending. We hope that you will join us at the reception. It is on the 38th floor of the Tower Two. Now, we're in Tower One. Tower Two is across the way, but we have our able and outstanding ACPM staff will help guide you over there. It's a beautiful view of Denver, and we look forward to seeing you there. So with heartfelt thanks and sincere appreciation for all that you all do for the college and our field, thank you for being here, and we look forward to seeing you at the reception. Thank you.

Janine Austin-Clayton

physician scientist

women's health

Catherine Burkhardt Stetis Lecture

American College of Preventive Medicine

sex as a biological variable

advancing women in science careers

American Association for the Advancement of Science

equity and improved health

understanding sex and gender

lack of representation

diverse teams in research

data sharing

healthcare disparities

inclusive approach