Well, good afternoon, everyone. Just welcome. We're so excited to be here today and for all of you for joining us virtually. Thank you to all the conference chairs and vice chairs, and really for the ACPM staff for hosting such a wonderful PM Preventive Medicine 2021 conference as well. We are glad that you are here to join us today for the Public Health Practice Innovation and Community Medicine Track Session. And today we are joined by two thought-provoking and really distinguished speakers for this Model for Community Resiliency and Healthcare Resiliency session for today. I am one of your moderators. I am Shelly Chu. I'm currently at the Maryland Department of Health as the Director of the Bureau for Maternal and Child Health. And I'm here joined today by my co-moderator, which I will let him introduce himself. Hi, everyone. My name is Ani Gurraj. I'm currently a first-year medical student also interested in preventive medicine and really excited to be a part of today's session and moderating. And during COVID, I just can't think of a more fitting presentation or topic to discuss about than resilience, both for the community and for healthcare as well. Before we begin and we introduce our distinguished speakers, there's just two housekeeping items. So one, if you're joining us, we kindly ask if you can type in your name and your affiliation in the chat box. That will help us just to even understand who is joining us today. And then two, if you have any questions, please put them in the chat box as well. Both Ani and I will be moderating, and so we will be looking at the chat box. The third thing is that the way that the session is structured is that we have two wonderful presentations. So we will save the questions and discussions for at the end as well. So please, if you have a question, please put them in the chat box. So given that, we will start off with our presentation. So our first presentation is on resilience, a premortal model in healthcare with Dr. Gwendolyn Diaz. And so I will turn it over to my co-moderator to introduce her first speaker. Thanks, Shelly. Dr. Gwendolyn Diaz has been practicing the art of health for years while she has been understanding the science of nature her whole life. Grounded in science from the College of Health and Human Science at Colorado State University, where she graduated magna cum laude, Dr. Diaz completed her clinical studies at the California College of Ayurveda, where she obtained her title as Doctor of Ayurvedic Medicine. She has widespread knowledge of yogic philosophy and has an extensive background in nutrition, herbs, meditation practices, and mental health awareness. She's a certified mental health integrative medicine provider. As an integrative preventive medicine specialist, Dr. Diaz works with patients taking responsibility for their health long before debilitating disease shows up in the body. Dr. Diaz centers her practice around healthy choices, working with the individual patient, as well as group visits to find homeostasis in the body and mind. And with that, I'll turn it over to her. Thank you. I really appreciate it being here today. It's an honor to be here. It's a great thing that I feel like not many people may know Ayurvedic medicine. And the fact that I was invited to speak today is really important. So talking about resilience, resilience falls in all sorts of levels. We have resilience in not only our patients, but we're looking for in our healthcare system. We've seen in the world of COVID over the last year in this pandemic, where resilience hasn't actually worked very well in our systems and in our patients and in our people. There's been a lot of suffering in the world and our job as healthcare is to alleviate pain and suffering. The highlights of my presentation. So I am talking about a dilemma that's a very large dilemma in healthcare. I work in private practice. So I see maybe a different sort of model than a lot of people, maybe working in the government or working in large healthcare facilities. I see a lot of people in the rural world and in the small practice world that there is a big dilemma. We don't have adequate access to healthcare. We also don't have a way to actually pay for healthcare really well. So we're going to talk a little bit about the dilemma, a solution, and this is one of many solutions. And healthcare is a huge animal and it's a huge topic. And there's many, many different facets of this that we need to discuss. And a solution that I have or that I've implemented seems to help a lot of healthcare for healthy people. There is a big section of people that are naturally healthy, that really try to take care of themselves. And it's a lot of middle-class America. And the dilemma in the room is how do we pay to keep healthy people healthy? And I want to talk about also the mutual benefits. There's mutual benefits, not only primarily for the patient, but also for the doctor and for the practice. The model of working in private practice has been really hard economically in the last, I don't know, 10 to 20 years. And as a model, if we change the way we look at this situation, it not only benefits the patient first and foremost, but it also benefits the clinic and the doctors working there. And from there, we talk about scale-up evolution. As we've learned over the last year in healthcare, we can see a different way of doing things now. And I think that the silver lining for COVID has been that maybe there is alternatives that we're all willing to look at because we have seen where our resilience has failed, and we have seen all sorts of things as far as what we can do to make healthcare a better place. So with that, I want to talk about the dilemma. We have a ginormous dilemma in this world. In America, insurance-based healthcare has been this way since the Second World War. We've developed a pretty interesting philosophy on economic-based medicine versus health-based medicine. If we have a shift in mindset, we can look about, see what makes profitability in health, not just an economic driver. I think a lot of us have seen the dilemma that's there, and it puts us as practitioners up against a wall. It also puts our patients not in the forefront of their own current health. We all have seen these statistics. These are everywhere. The healthcare industry in America, we're great at charging money. We're not so great at providing great health. We do have some amazing systems. We have some amazing technologies. We have absolutely amazing doctors. The way we provide healthcare is complicated, and it does not come with the incentive of taking care of the patient first. Just as an example, if we have an average American making $65,000 a year and more than a third of their income has to go to the opportunity to pay insurance that may or may not cover their health issues, that's a big dilemma. That's a huge amount of money that is not getting used wisely. It's not getting used for preventive medicine. It's not getting used for health of people or their families. That's where the dilemma of what do we do as doctors? What do we do as healthcare providers to make this system work for the patient? When I look at this problem, my background is natural medicine. I did not go to the same Western medicine school as most of you here today. I learned that medicine comes from a multifaceted approach. I learned a lot about the physical body, but I've learned a lot about the subtle and emotional bodies. When we look at health in people, I look at the needs of another on a huge primordial level. I look at the person as a whole, and it's a really important part of how my practice is set and how this healthcare model may change a lot the way that we look at medicine and how we treat people. Current models right now, the base insurance model that we have is working. There's goods and there's bads. It's also a place where victimhood takes place. A lot of people don't have much, quote unquote, skin in the game. They don't have personal responsibility in their health, and so they're kind of a fix me sort of mentality. I want to move towards a more empowered approach in healthcare for a patient, first and foremost, because it allows them to be responsible for their choices. Healthy choices usually end up in healthier outcomes, and from there, we create an opportunity to have a real conversation with real people about the real problems they have if their health goes up and down. The solution. Like I said before, there's many, many solutions in this healthcare world that we have. What I'm focusing on right now is something to really narrow in what I can change as a private practice, what I can change in terms of having a conversation with people here in this conference, and what we can talk about in the world at large. We need a solution that applies to many, many different people. Since healthcare, it's not complicated, but it's providing resilience from a patient's perspective and also providing resilience from a doctor's perspective. There's a lot of private practice that are struggling right now to make ends meet economically. They're not struggling to treat patients. They're struggling to make it or break it economically, and if we change the model around to where we can provide the care that we want for the people that we care about, I think that's true healthcare. Just to kind of give an overview, the loop that needs to be created here, and this is from personal experience, but as being a patient as well as a doctor, a lot of people have a misrepresentation of maybe what direct care might be. If you look at this model kind of like a vehicle, we don't ask our insurance to pay for things like oil changes or gasoline or putting new tires on a car. We can't ask for medicine to have insurance take care of our basic needs. We go for routine health. We have minor stitches. We have ear infections that need taking care of in our youngsters. That is just a way that we have to kind of change our belief system about how healthcare is managed. Otherwise, we are dependent on an insurance-based system for a very, very long time. Preventative and chronic care is probably the center point of a system like this. If we actually put a system towards really focusing on prevention, chronic care then becomes a lot less of a problem. We obviously know in this country, you know, the top four out of the five, you know, leading causes of death right now are entirely preventative by diet, lifestyle, way of living. And that is an important marker to remember when it comes to how we provide healthcare to our people and to our patient base. I really strongly believe in education before I believe in invasive technology. I think there's a time and a place for everything. But if we had some sort of opportunity to really focus on preventive care, we would have an entirely different conversation as far as healthcare goes. Catastrophic care then, again, there lies the proverbial elephant in the room. What happens if I get sick? I don't want to go broke. I need to be able to take care of my family. This is a really important situation that we're going to cover. So direct primary care. If we actually talk about direct primary care as a working model, it's a first step for patients. It should be a conversation that lasts a lifetime. We should have a direct care that, you know, knows everything about our lives, not just what's happening at the moment and why we showed up for an appointment. Preventive and chronic care. Again, it's not just about good diet and good lifestyle. It's about the other detriments of health. It's social responsibility, environmental responsibility. How is your mental and emotional health? These are enormous situations for people, and this does prevent health in a lot of people. And as long as we can make sure that we have abilities and access to help that situation, we are going to have a much healthier patient base. And again, catastrophic care. There's things that just go wrong. There's accidents that happen every day. There's the unforeseen diagnosis that nobody ever wants to hear. And those require real health intervention. They require a lot of team approach, and that doesn't mean that a family has any reason to think that they are going to go broke. You know, I don't know as far as experience and other people listening to this, but I know for mine, that's probably one of the biggest driving factors of fear in my patient base is what do we do if we can't afford it? So again, talking about the whole loop, if we can actually pull a system together that really takes care of the front end all the way to the back end, everything in the middle then can be focused on prevention. Prevention I think is just the factor that we have not addressed to nearly the detail that we need. Health does equal wealth. In this world, health is our basis to be able to do anything. The pursuit of happiness has everything to do with health. If we don't have health, all the wealth in the world doesn't do anything for us. So the mutual benefits. Making a system work has to look from multiple perspectives. We have to look from the patient perspective. We also have to look from the medical provider perspective. As a patient perspective, we have so much at stake in our health. This is their ability to go pursue their dreams, to produce things in society, to make themselves a functional member of society. We don't want to force people and pigeonhole them into a job they hate for insurance that may or may not be working for them. Health must be a daily choice. It's not just something that we're entitled to. We do have to work for it. With education, patients can become aware of this. A provider perspective. Unless we have an incentive to do things, we have to afford to be able to function as well. Our job is to take care of patients, but also our job is to teach. Our job is to empower and bring responsibility to what that is for our patients. We have to be able to have an economic means to stay in business as well. If we can show that a system like this works not only for a patient, but also for a provider, that creates a whole new conversation of what healthcare actually looks like. Just as a quick case study, I'm sure we've all seen many of this. This is a predominant situation in this country. We have a diagnosis of prediabetes. The original model says, okay, a 15-minute appointment. We did some blood work. We came up with this problem. We prescribed some medication and send you on your way. That leads down a really, really long, dark path, not only for the patient in terms of their health, but their cost of what that's going to do. You live an entire life feeling attached to having to make this health situation a focus. The other option with resilience healthcare, like I'm discussing, talks about, let's create a real action plan. First of all, let's figure out what drove that system to begin with. What drove the prediabetes? Obviously there's diet and lifestyle involved, but what about the other life stressors? If we look at things like that, have the time to look at things like that, and then also know how to alleviate things like that, we have a whole different conversation. These are situations that are full recovery is absolutely attainable. That gives people hope. Hope is real. As far as the economics go, the costs and benefits of this model has been done. The P&Ls have been there. The patient costs versus the business costs, as you can see, you can read deeper into these. Most of these are obvious right here. If we can create health, we can save patients money. If we can create health and have a business revenue for resilience care, it's a win-win situation. That changes the entire notion of what health care is to a huge amount of people. Scale up evolution. How does this look in reality? Are we going to take on the giant animal of insurance? I hope so, but as a small start, I don't know in my lifetime that I will ever change a model completely, but I think that one small group of people can certainly come up with a really extraordinary conversation on how to make the system better. I come from the place of, I guess, maybe a little bit more of the world in health care of the outsider perspective. I wasn't trained in Western medicine. I was trained in Eastern medicine and natural medicine. There is a lot more resilience when it comes to the idea of having to figure out a way to empower people to take care of themselves, empower and inspire people to want to feel good and that changes our world. If we can have that conversation and everyone can save money, money is a secondary situation at that point. I really, really do feel from the bottom of my heart that money should not be a driver of a health care system. I don't think it's good for patients. I don't think it's good for doctors and that really goes against the system, but I want that conversation to be open for a variety of reasons and for the long term benefit of all of us. So I took this from a different platform, actually, from, interestingly enough, an economic model that was talking about eight forms of capital. Well, if you translate that from eight forms of capital to eight forms of health, you realize that people aren't just their physiology. They're not just markers on blood work. They're not. They have lives. They have emotions that are driving a lot of situations. If we look at what wealth means in our health, we realize that those are all contributions to our health system, just like we've listened to in this conference. If we don't have clean water, we don't have health. If we don't have clean air, we don't have health. If we don't have safe neighborhoods, we can't have health. If we don't have good food, we're not going to make it. And this is a really bigger conversation that needs to be taken into account because to create health in a human requires all of these things. And it's a really, really important time, as we've seen in COVID and as we've seen throughout this last year. What types of health are really vital to our not just our existence, but to thrive? Our vitality is tied to all of this. It's tied to each other. Our pool of connection, although is virtual right now, it is extraordinarily important to understand our emotional and our social capital of health is probably one of the biggest contributing factors to overall lifestyle diseases. And so looking at that, I'm hoping with this presentation and with just an open discussion about what is health? What can we do to look at the differences and what can we do to actually change that in our world as we are? And one small, one small group can do amazing things. It's just one step at a time. It's standing in integrity with ourselves. It's standing beside our patient, not in front and not behind. We are here as a group, and when we do that, we can change the course of things. So thank you very much. I appreciate it. And I think we'll take questions after the next presentation. Well, thank you so much, Dr. Diaz. That was a wonderful presentation and just really, really thought provoking as well, including just thinking about health in the different formats that you mentioned, because health is just not one monolith sort of goal that we're aiming for. Our next presentation, our next speaker is Dr. Alan Weiss. He will be talking about the Blue Zones Project. Dr. Weiss is the chief medical officer for the National Blue Zones Project. Having practiced rheumatology, internal medicine and geriatrics for 23 years and been president and CEO for 18 years of a 716-bed, two-hospital integrated system, Dr. Weiss now has a national scope focused on prevention. After graduating from Columbia University's College of Physicians and Surgeons and subsequently completing his training at both the New York Presbyterian Hospital and Hospital for Special Surgery of Cornell University, he had a solo practice in rheumatology, internal medicine and geriatrics for 23 years. He's recognized both as a fellow of the American College of Physicians and a fellow of the American College of Rheumatology. For the state of Florida, Dr. Weiss is a past chair of the Florida Hospital Association, as well as its quality committee. The Florida Hospital Association also presented Dr. Weiss with its highest award in 2019 for advancing healthcare. So really, really pleased and it's such a pleasure to introduce Dr. Weiss, who will be speaking next. Jim, I'm going to continue actually when has developed so nicely, but really on a community level, but very, very, very congruently. So I'd like to go over in the next few minutes and leave plenty of time for discussion and questions and answers, but basically the Blue Zones project, and I'll explain what that is in a few minutes. And also focus on some real metrics that were touched on just a few moments ago about things outside of what we normally consider health, but yet account for about 80% of what happens to a person. And then I get down to COVID-19 and resilience for about 58 communities, 4 million folks that actually did better than the rest of the United States statistically during COVID. And I'll tell the secret right now is they were already Blue Zones communities. They were already healthier and better off going into it. The recent example, pre-diabetics, they had a lower incidence of diabetes. They had a lower incidence of hypertension. They were more connected in every other way. So that's really a protector for COVID or for any pandemic or for any type of stress, going into something healthy. And that's really the secret sauce, but it's not so secret. And then show some samples. And as I said, hopefully we can get some discussion going. So I'm just trying to advance. Here we are. So our health is determined by and limited by the world in which we live. So our environment accounts for about 80% of our health. Where we live, you know, the now overused thing that your zip code is more important than your genetic code is absolutely true. You can nudge environments. You can nudge people. You can get people to go in the right direction. And Dr. Galea is the chief of the Department of Epidemiology at Boston University. And I'll show some of his very nice statistical work as we go along here. So I'm going to jump forward. What happened about between 15 and 20 years ago was a fellow by the name of Dan Buechner was charged by the National Geographic to find areas around the world that were vulnerable to B100. So he traveled around and he found five areas, one in the United States, in Loma Linda, California, Costa Rica, Iparia, Greece, off the coast of Japan, and Sardinia. And those areas had more people living to be 100. And he had a worldwide map. And he ended up having a blue magic marker in his hand and circled it. And these became blue zones. The term struck. And then they said, well, why are these people living so much longer? And then take those characteristics, which I'll show in a few moments. And there's nothing obtruse or complicated about the characteristics. But then take those same characteristics and see if we can inculcate them into some communities in the United States, which is where we are right now with these 4 million people in 58 communities who did better than most everybody else during the COVID pandemic. So the nine characteristics, and there's nothing obtruse or complicated, moving naturally. People who belong to gyms feel good about it, but typically the people who sign up at the beginning of the new year saying I'm going to go to the gym three times a week or five times a week, about 70 to 80% of those folks fall off in a month or two. But just walking every day, walking in a neighborhood, having a nice area that you can be comfortable in and confident with, that makes a huge difference. Having purpose in your life, wanting to help other people, having a family, being a homemaker. Your purpose doesn't have to be to be President of the United States or something like that, but just knowing that you want to do your job. Having work-life balance. People in healthcare, and I have a lot of folks listening today to the seminar, could use help on work-life balance. I know during my two previous professional careers, I would be very critical of myself now in my former life. We're used to, particularly during the pandemic, working countless hours in the day, but getting that work-life balance. A plant-slant diet. Very interesting. These folks did eat meat. They weren't vegetarians, but they had meat for celebratory times, the ones who lived to be 100, three, four, five times a month. They also didn't overeat. They only ate until they were about 80% full, and they would have a glass of wine late at 5 o'clock in the evening, typically. But it wasn't just to gulp it down. It was a way of socializing. It was a way of connecting. It was a way of signaling something with the work-life balance. What we tell now folks who are under the age of 21 or previously had problems with alcohol, you can have friends at 5. Just do the socialization part of that. You don't need the alcohol. The bottom of the pyramid, which is very important, is having family first, loved ones first, being around families, multigenerational people, both at the level and the grandparent level where we're at right now. We'll do better when it's a multigenerational family. Belonging, having friends, having people you can call in the middle of the night. They'll take the call. They'll be empathetic. They'll want to help you. And also people who belong to a faith-based organization. It doesn't matter which faith, but if you go a few times a month to a faith-based organization, the statistics show that you live four to 14 years longer than those who don't. Pretty impressive. How do these nine easy principles and this other information get transferred into these 58 communities? So for a period of months, we'll get into some real metrics in just a moment. Communities can be transformed first by assessing where they are right now. Any road will take you there if you don't know where you're going, so you have to understand where you are. Then you've got to develop a roadmap, a plan, and now with these communities sharing best practices, then you get to these other places where people have a lower incidence of diabetes, hypertension, and other diseases. And you get to that well-being. You change around some of the environment you're in so that when you walk into a grocery store at the checkout, all the candies and sweet things, you have fresh fruit that's very attractive, maybe even prepackaged or pre-cut. And so if you're with a child at eye level, they'll grab that rather than wanting a candy bar. When you think about where you live and what you do, most people live and work within 15 miles of one geography, so your life radius. Occasionally now people commute longer distances, but with this new virtual, I'm wondering if the life radius is even going to shrink more. So working on people, places, and policy all within your 15-mile radius, you can look at some metrics. And these metrics, slightly different geography than Gwen showed us, but basically the same things, economic conditions, health care access, food access. You don't want to be living in a food desert having transportation that's easy to get to. And those social determinants of health on the bottom, they're collated into about 600 different metrics by the U.S. government, public knowledge easily available, but they can be combined with the things that are on top, which we just mentioned, the purpose, the social, also financial, physical, and community. And where you live in an index that is the community well-being index, which ranks metropolitan statistics, almost 400 of those, and all those different characteristics and gives them an overall algorithm that is very metric and very reasonable, very reproducible. And you can compare one community to the next, which is a way of telling what's going on. So you look at these graphics, and on the bottom left, you have that Boston University and Sharecare together, helped to get these metrics together. You've got a real-age test, and if you want to have some personal insight into your own health, you can take the real-age test. It's free, it's confidential, it's on the Internet, real-age by Sharecare. It takes about 10 to 15 minutes to do, and it will compare your physiological age with your chronological age. So as you get older, you can get lucky, and if you're healthy, you can really have a big decrease in your actual physiological age compared to your chronological age. So that's really the goal. You don't want it the other way around. If you're a heavy smoker, drinker, don't have purpose, you're overweight, then obviously your physiological age is going to be much older than your chronological age, and your chances of getting sick are much higher. These numbers, these 600 community parameters, combined with folks who have already taken the real-age test, and then the information is de-identified, and you can go down the zip code, and then you can get almost contemporaneous, geospatially longitudinal data. On the right is the state of Georgia, obviously the United States, and you can check everything from food deserts to premature births to air pollution to so many of the 600 different parameters. This two-way data repository allows researchers, and anybody can get on it and see what your metropolitan statistical area is like or your county is like by just going to ShareCare Community Well-Being Index, and you can go to your state, go to your county, and you can see what your parameters are. So it's free, it's open to the public, they have a richer version for academic folks, but when you're trying to decide where you want to live out your life, my suggestion is to pick a good zip code where you will thrive and do well rather than an area where you're going to be challenged and add unusual difficulties yourself. If we focus on the next to the right column, you can see some of these outcomes that you can look at. Healthier communities, the Chamber of Commerce does better, the Consumer Index is better. Interestingly enough, these New Zones communities are in schools also, and the school absentee rate goes down, not only for the students, but also for the teachers. So everybody's happier at school then. Same thing's true with the health care organizations. Their health care costs go down dramatically when their colleagues and employees, and we saw that in the system that I was involved in when we had 6,000 people we insured, and we decreased our health care costs about 50%, the majority being that we were all healthier, more engaged, more satisfied. Cafeteria changed out, we didn't have soda. We took care of our friars, so it was much healthier food in general. And a little adjustment, a little feedback, mostly on the soda, but people got into it, we had some other good drinks, and the big purveyors these days come out with healthy drinks in addition to the traditional sugar-laced sodas. So you look at all these things that people are measuring, and with the data from the real-age testing, this is just a picture you can get on your cell phone or your laptop where you can get this data. And then with that data, we're going into a community that invites us in. We can help them focus on the areas that they have concerns, show them where they're doing well, get people together. And one of the areas I visited before our Southwest Florida got into the air was up in Illinois, and I met one of the mayors there, and he said the most amazing thing was people who were living on opposite sides of the street hadn't seen each other or talked to each other for years. They were getting out now and taking walks together, walking millis, and the police noted that the crime rate went down because people were out walking around. The beach cities just south of Los Angeles, they had a childhood obesity problem across the country. They had a 55% decrease in childhood obesity. We saw the same thing in Southwest Florida. In middle school and high school, the obesity rate went down for our county compared to the other 66 counties in Florida. We were the best, and we were going down. Everybody else was going up. So when you get a healthy community, it spreads across generations, and it spreads in ways that are remarkable. Fort Worth, Texas, about 800,000 folks. It ranked terribly, 185 out of 190 MSAs. This was an older group back in 2014, but over the next couple years, they embraced a blues dance community, and some of the most challenged socioeconomical areas of the Fort Worth actually had the greatest improvement with marked decrease in crime rates, decreased smoking, increased in how they felt about themselves, a 14% increase in thriving, an 8% increase in saying this is a great place for them to live. Their obesity rate stayed the same, but the rest of the nation was going up at the same time. As I mentioned, 23% decrease in smoking, which is huge. That's the single greatest cause for lung disease and lung cancer. People were out walking, and their overall rate improved. They dropped down to 96 out of 383 MSAs. That was a new set of rankings, but basically a dramatic improvement over a period of a few years. We saw the same thing in southwest Florida. Actually, I think I'm wearing the same sport jacket in the center as I'm wearing right now. It's just coincidental. This is an elementary school. We had a ribbon cutting. The kids love it. Cafeteria food changes, as I mentioned, and they're more engaged. In the beach cities, they had standardized tests they give the kids every year. Their standardized test scores went up. It's probably multifactorial, not just being healthier and happier and more engaged, but everybody seems to do well, thus which the community, bringing us into the community, makes a big deal of difference. Our health care costs went down, as I mentioned, for our own employees. We had in southwest Florida about 400,000 folks. 225,000 were engaged in the project. The Chamber of Commerce loved being able to brag that we were named the healthiest city in the United States for four of the last five years. California actually knocked us out. They became the blue zones, and now they're the healthiest. We're number two. They got the bragging rights. It's a friendly competition. At the top level, it's indistinguishable among the things. What makes for success? Having a community that wants to get better, having some local funding, having local people involved. You can't, I can't roll into a community that I'm not familiar with and make a difference. We hire Fort Worth people in Fort Worth to help them. Same thing in the Beach City, same thing in Salinas. We got people whose kids went to school there, who go to faith-based organizations, who know what's going on, and they are given this playbook, basically, of what to do to make themselves more resilient and healthier going forward. Then in about a year, they start to get real results, measurable results, using the Real Age Test and the Community Well-Being Index. And then they get positive feedback, basically getting your grades back and doing well, makes you want to do more and more. And so over a period of time, you have a transformation that's shown along this baseline where you do an evaluation, takes a few months, then a year or two to implement, and then gradually start to, basically, get and grow the results and keep getting that positive feedback, which is very, very encouraging. The COVID communities, COVID was compared in Blue Zones communities to the rest of the nation. This was done in the beginning of the, a couple of months into the COVID epidemic. So, you know, it was conceived very quickly, but we had people taking the Real Age Test the whole time. And we knew, going into it, that lung disease, diabetes, hypertension were better. People did better when they were going into this. They were less likely to panic or worry. And they reported many more positive social and community behaviors because they were already networked being in a Blue Zones community. And they were more likely to exercise on their own, go out and walk on their own. Gyms were closed, obviously, and ruined the pandemic. But they also already had pre-existing healthier eating habits. So all those things add up. It's not a single bullet. It's a buckshot of healthy behaviors, much what Gwen was talking about, people having responsibility, people interacting. But this is at a bigger level of having a whole community of people who are engaged with their own health. And then it becomes a self-fulfilling, a self-perpetuating process, which is what's happening right now. So just to review and share a couple of points, I'm happy to respond with, sometimes people are reticent to get on the chat box, but alan.weiss at sharedcare.com, and I'll be quick to respond. And also you can get the real age test by real age, or just go to the Blue Zones project overview. With that, thanks for being involved and at the end of the day, I think preventive medicine is the only thing that is going to cure the rising healthcare costs. And we've got a lot of, it's a complicated problem as was said already, but getting into prevention would be a huge positive that almost no one can argue with, except the people who are currently profiting by sickness. That's not a reason to continue to reward them. So thank you for the opportunity and congratulations for being involved in a great cause of preventive medicine. Thank you, Dr. Weiss, for that great presentation. We wanted to actually spend some time now on some directed and audience-based Q and A. And we have a few questions actually ready to start off with. And so this is directed to both of you, and more specifically, both of you have touched on some promising models that can improve both prosperity and longevity. However, implementation is an entirely different question and challenge. Would you be able to share some thoughts on best practices for implementing some of these thoughts, concepts, and models at community, local, and even national levels where there's such disparities today? Sure. Yeah. Ladies first. Thank you. In my small community, this model started out of a rural healthcare need that we live 35 minutes from the first hospital. This is a real problem for an enormous part of America. So we decided to partner with our local hospital and work side by side. They have a model and they're trying to make it work. They're trying economically to function. They're a private hospital. They are completely self-sustained. And in COVID, that was a big problem. Now they are trying to make it. And when we work with them as a direct model, we want supportive health with people. We don't necessarily care which direction it comes from. But once they realize that this model isn't a direct reference to hurting them, it actually helps that model. Our direct care is online with our local hospital. And so there's options for people. If you have insurance, that's great. You can go one route. If you don't have insurance, that does not mean that you are not entitled, obligated or otherwise need care. And that has become really popular here because there is so many people in a very, very awkward predicament of I can't go to the hospital because it will cost too much. And so we do want to use that to help understand there's multiple ways to get this problem solved. And all of us are on the same page. We all are in support of each other. And I think that's a really important way to do it. So to add to Gwen's, never underestimate the influence an individual can have. A person in a community who's passionate about making a difference and collaborative with those around him or herself can make a huge difference going forward. And that's typically how Blue Zones communities have started. Right now we're looking at Scranton, Pennsylvania. There was a person there very passionate about getting started. Got some other people involved. You know, they're going through the assessment phase right now. Albert Lee, Minnesota, same idea. That's how it started. So you can start small. There are playbooks, literally, about what works and what doesn't work. Including this slide presentation, I'm happy to share with anyone, but there are no secrets. And it's just a question of, we've got 10 years of best practices in 58 communities with 4 million people. We're happy to share. It's gonna do everybody good to decrease the demand of sickness, okay? Healthy people are more productive, so it helps the gross domestic product. Sick people take resources out of the product. We're in a globally competitive world right now. And if we don't decrease the amount of money we're spending on healthcare, I know to the congregation right now, and you're all on board, we're gonna be in big trouble. And our kids and our grandkids, and you all are younger and have younger kids. I've got grandkids in the other part of the building right now, the home I'm in. So that matters long-term, and we're going to come to a difference. Right now, you've got physicians, and I used to be a, I'm still a physician. I used to be a practicing private. And then you've got healthcare hospitals. You've got the insurance companies. You've got big pharma, and you've got the device manufacturers. So what's common about all those folks? They all do well when there's sickness. The physicians take care of sickness. The hospitals take care of hospitals. The device manufacturers do hip replacements and heart valves, pharmacy, and so on. And the insurance companies actually like to have a lot of insurance, because they get a percentage of the pay month. And if their costs go up, they raise the premiums. So it's a direct disincentive to have healthy people. That's not sustainable. And people are realizing that now more and more, and COVID was bad, but it did shine a bright light on the, not only the inequities and inequality, but also this broken model. There are a bunch of folks writing about it. I do a weekly blog right now with Sharecare, and I put it on LinkedIn, and I put it on Facebook. But basically, I've got a bunch of articles, recent one being prevention, the cure for the rising healthcare costs. So you all know that, and we all know that, but the incumbents, and I used to be an incumbent, I sent two kids to medical school on rheumatoid arthritis. I mean, how good does it get? I used to say, instead of having a wellness center, we need a sickness center, like a martini bar and a cigar seller and a place to do unsafe things. And then everybody would giggle at that part, but it's a bad idea. But get people out, have them have purpose, work-life balance, get them to move naturally, and you'll see the health cost, go to get counseling, get with when, and have a real relationship about, and real coaching and mindfulness and stress reduction without having to use a bunch of pills and everything else. We just have to change our mental attitude and take away the profit margin, start paying for prevention rather than paying for sickness. Thank you so much. Well, the next question that I see is just a question about sort of health equity and what implications do your models have for health equity and how has health equity framed the development and piloting of your ideas from ideation to delivery? And then where can your work go further in addressing unique needs of special populations and communities? Fort Worth, Texas is the perfect example. They have a real challenged area. We did the whole assessment and got the local owner of like a 7-Eleven, add a bit more fruits and vegetables in, police went in, it used to be a drug hangout, changed the whole area, but you got hypnosis and you got to do the treatment. Yeah, I agree. I think you have to look at the individual situation and the individual problem. I work a lot with rural healthcare because that's where I practice and there is definitely different disparages in the rural America, but there's also advantages. I live in a valley that has the most per capita organic farms in the state of Colorado, which I'm super proud of. There's a movement here that is designed for creating good food and creating good food systems and all of the things that come with agriculture, we have health disparities, we have health economic issues, we have migrant workers, we have not a lot of socioeconomic base to support an enormously growing population. So we come up with plans that serve communities. I don't look at it as a singular problem, I look at it as a community. And when as a group, we come around that and really take care of our own, we make enormous impacts. And whether that's to go next door and help a person out that just broke their leg and can't drive to town, that's a big deal when you live in rural America. Also to just take care of our children. Our children can still walk home from school. Creating a safe neighborhood is first and foremost, to be able to feel safe is an extraordinarily big part of health care. Thanks, thanks all. Our next question wants to take a different angle. Can you share what outcome as part of your work has most surprised you or changed your thinking? Are there any certain learnings or insights you've gained during your work which you'd like to further highlight or talk with the audience about today? Sure, I can certainly answer that. You go, go ahead, you go first. I have learned, I think I learn every day probably the power of the human spirit. I think in medicine that sometimes we don't take a step back and look at that, we can go through our days and kind of tunnel vision. But when we look at it from a bigger, wider perspective, and I look at people, struggling on many, many different levels. If there's just an ounce of help, an ounce of support, even an ounce of just empowerment to do the right thing, it becomes a snowball in their lives. And I really feel like creating that, our job to teach as doctors is more important than diagnose. And once that happens, we become their best cheerleader. We also become their best friend. We are a support system. And for me, I think that's the most important thing and first and foremost, creating a support system, whether that's physical, emotional, spiritual, all of those things take a really, really big impact on the facets of health and what we wanna do. And so I think I've learned creating trust in people and also acting in integrity with self. There's a Ayurvedic, a Sanskrit word called svasta, and that means established in self. And when I look at that in my patients, if I can create that and help them define that in themselves, health flourishes. It's a beautiful thing. So yeah, I've learned that. And I honor people every day because that's an important part to healthcare. So let me add a statistic. In Southwest Florida, there are 400,000 people, give or take. We've added statistically 0.6 years of life expectancy to 400,000 people. Entire practice of 23 years and 18 years as a hospital administrator, I never did anything like that. The Blue Zones Project basically changing, nudging people in the right direction to be healthy added six tenths of a year of life expectancy. We also dropped cardiac mortality to the lowest in the state of Florida, an 80% decrease for the rest of the nations. So talk about taking 400,000 of your friends and giving them each a half a year of life, a little more than a half a year of life. That's astounding. Wow. Thank you. The next question is, what are some areas of practical improvement you're hoping to focus on in the future? So for example, modern improvement, implementation, finances, stakeholder collaboration. I feel like a lot of what medicine could promote is the idea, we've learned a lot in COVID about telehealth, right? We've almost all had to experience and upgrade our practices to make that a very viable situation for all of us. But what I've also learned in that technology is also the ability to treat people that can't get to my office. I have a patient base that's literally all over the world now. And that is a lovely, lovely situation to be in for not only me, but for my patients. They can seek out specialized care. They can seek out what they need. They have a choice in that. They're not dictated via their network, their in-network providers or their that. When you take away those rules, it becomes an entire different conversation of, wow, what does a patient really need? And I think the technology has helped. I think that COVID has had the silver lining is that it also has allowed us to seek multiple avenues for health. And I think that that's going to continue to develop. So I hope that group health visits become a very big modern phenomenon because I think that people in numbers and support groups, especially for things in the chronic care world are awesome. I don't think that it takes one person. I think it takes a community. And so I see that as really promising going forward. Along the same lines, if we can get the Blue Zones principles distributed across the country in rural areas, socially, economically distressed, inner city, that would help everybody. If we could add years of life expectancy, the COVID year of life expectancy, you just got to take that off the table. Unfortunately, it's just a statistical aberration. It's an outlier. But normally life expectancy in America was going up and it went down for three years in a row and then it started to go up again. If we can accelerate healthy life expectancy we're 320 million people. Without the world, that would be a big deal. There, in fact, we've got 4 million. We're past the pilot project. Now we've got to get to the distribution phase and using a telemedicine and digitalization to do that, just as you take the real age test digitally and just like you get an app for whatever it is. That's possible. I agree face-to-face, not face-to-face, but interaction as we're doing right now is wonderful. But in order to take mass, we do got to get it to, so we can get to a lot of different communities. And we're talking with huge cities right now and large communities just about doing this very same thing. What's happened in the past is people looked at it, they get frustrated after a couple of years and they get learned helplessness where basically they just multi-generational learned helplessness and it's just very discouraging. So we got to break in, break that cycle, get them to try something else that works, that we've proven it works and get them to embrace it. Great, thank you so much. And I'm looking at our clock and we're at the end of our session. So I just wanted to thank our wonderful speakers, Dr. Diaz, Dr. Weiss, just for parting with us your wisdom and just really great lessons learned as well. And so just thank you so much and thank you for all those who've listened in and for your questions as well. And thank you so much for, it was really a great, great session. And I hope everyone enjoys the next, the rest of the conference as well. Thank you everyone.

Community Medicine Track Session

Dr. Gwendolyn Diaz

model for community and healthcare resiliency

direct primary care

importance of prevention and chronic care

improved patient care

economic sustainability for healthcare providers

Blue Zones Project

environmental determinants of health

positive impact on health outcomes

shift towards prevention