>>Thank you for joining us for the HHS black
history month observance. We will be starting our program momentarily. I would like to welcome Dr. Lin to the stage
to open us up. We’re honored to have Dr. Lin, deputy assistant
secretary for minority health and director of the HHS office of minority health. Please welcome Dr. Lin. [Applause]>>Good morning. Thank you, Kelly. I’m Dr. Matthew Lin, deputy assistant secretary for
minority health and director of HHS office of minority health. Welcome, everyone. Thank you for attending this HHS black history
month observance. This morning we will explore the work with
HHS to reduce health disparity and advice health equity for all Americans including
African Americans. An important milestone in this work took
place during the Reagan administration and then secretary Margaret Heckler with a year of coming on board
in March of 1983, she establish the secretary task force on black and minority health. The task force develop a report which highlight
disparity in the burden of death and illness of black and other minorities. With the report was released in 1985, it started
the new era in minority health issue. And it also led the development of HHS office
of minority health in 1986. Today more than 30 years later, we are honored
to be part of HHS family H. together we viewed a network of partners and a frame that reach
across the nation and around the world. We are so proud to stand with the thousands
of the HHS employee and others who do their work. Of course, our work is not done. Racial and ethnic minority continue to experience
the same disparity we documented in 1985. So this morning we will hear from some of
our leaders in HHS who are guiding sharing and measuring our progress. We’ll let you know our first speaker is someone
who is very special to all of us. Secretary Alex Azar. Was sworn in on January 29th. He spent his career working in both public
and private sectors as an attorney and senior leadership role focus on healthcare reform,
research and innovation. From year 2001 to year 2007, secretary Azar
served as many of you know as General Council for HHS and then as deputy secretary. And I’m so happy he is here with us this morning. Ladies and gentlemen, please welcome secretary
Azar. [Applause]>>Thank you so much, Dr. Lin, for that kind
introduction and for the history lesson. I actual hi hadn’t known about Margaret hacker’s
leadership in starting these efforts so thank you for that. That’s good for me to know. I’m pleased to welcome all of you here today
for this important discussion hosted by office of minority health. About the progress being made in treating
some of the most serious health threats faced by the African American community including
the crucial issue of disparities and healthcare access and outcomes. I’m proud of the work we have done over the
years and addressing health disparities and we have seen important progress in improving
health and healthcare among minority populations. The life expectancy gap between blacks and
whites is at its narrowest level since 1985. Teen pregnancy rates for girls of color age
15 to 19 decreased since 1990, fall by 56% for African American females and HIV mortality
rates among blacks have dropped by 28% between 2008 and 2012. However, we also know that challenges certainly
remain. According to our agency for healthcare research
and quality African Americans experienced worse access to care compared with whites
in 50% of the categories measured. As likely this has had an impact on the poor
health outcomes for African Americans, the most recent statistics from 2015 show black
males an females continue to have the shortest life expectancy of any group in America. With the highest infant mortality and risk
of stroke nearly twice as high as that for whites. These are critical healthcare challenges for
the African American community and nation at large. In this administration we consider it vie
vitally important to listen to experience and concerns of those on the front lines busy
working to address the health needs at the local community levels. This discussion will convene federal state
and local partners for critical discussion on African American health featuring panel
discussions, on health disparities of special concern in African American communities, including
cardiovascular health, cancer, and organ transplantation. I especially like to welcome all of the community
service organizations, service providers and health advocates in attendance here today
and let you that your input is vital as we work together to craft policy to address these
important challenges. Also here with us today for this important
discussion is Dr. Brett Giroir, new assistant secretary for health. [Applause]
Dr. Giroir, admiral Giroir is a pediatric critical care physician, a former medical
school executive and has served in a number of leadership positions in the Federal Government
as well as academia. I personally look forward to benefiting from
his insight regarding these and other critical issues. He was a high school debate champion who won
debate and also on the debate team at Harvard. Though I consider myself quite the lawyer
and debater I have to bone up as I get ready for our leadership team meeting against a
Harvard debater. Unfortunate he couldn’t get into Yale. So thank you all for coming today and know
that, please know we’re committed to working with all of you on ongoing basis to deal with
and grapple with these very important and real health challenge and health threats to
members of our community and we hope to continue to make progress as — in terms of coming
to grips with these challenge. Let me turn it over to admiral Giroir to give
you a better sense of agenda. I wish you all a productive meeting and look
forward to working with you on these issues in the months and years to come. Thank you so much. [Applause]>>I would only let the secretary get away
with those Harvard Yale jokes. Thank you, Mr. Secretary, for leading off
this observance and for the opportunity for me to really have the opportunity of a lifetime
to join HHS and try to improve with our colleagues our nation’s health. I’m truly excited that one of my first speaking
opportunities, this is day six at HHS, comes with this symposium, I want to thank Dr. Lin
and his staff at the office of minority health for making this happen. We should all be proud of the accomplishments
that occurred since the heckler report 30 years ago as Dr. Lin said, your work improved
the people across the nation and particularly the health and healthcare for disadvantaged
populations across the nation. We all know our work is not over. African Americans for many infectious disease
it is for several forms of cancer, diabetes, heart disease, and other diseases as well
as particular interest of mine because of all the patients I care for as a pediatric
critical care physician for African Americans stricken with sickle cell disease which robs
precious life opportunities from over 100,000 Americans in this community. one of the primary reasons I came to HHS is
because I believe we have a unique opportunity this is really the perfect storm of science
and technology and passion. Ment to make a significant impact on these
health inequalities and on diseases such as sickle cell disease. You certainly have my commitment over the
next years this will be a primary focus of our agenda which we have already started developing. The remainder of my time, because it is my
time and I get to do something I really want to do, I want to highlight the world changing
but often overlooked contribution of a legendary man, an African American man. A man whom I never had the honor of meeting
but is responsible for saving the lives of hundreds of my former patients. When I practiced ads a pediatric critical
care physician F. nearly 40,000 babies a year in the United States are born with congenital
heart disease. That means the chambers of their heart are
vessels from their heart are malformed. Many of these have a severe form of congenital
heart disease often known as — syndrome, these babies are blue because no blood gets
to their lungs because of malformation. When there’s no blood to the lungs these innocent
children frequently die within hours or days. So let me tell you the brief story how an
African American man born in 1910 in new IBERIA, Louisiana, saved the lives of my little blue
patients nearly a hundred years later. Theodore Thomas hopedded to attend college
and become a doctor but he couldn’t afford it. So he began working as a carpenter at Vanderbilt
University. In 1929 T not a great year, stock market crashed
lost his job. But through a friend he got a job as surgical
research technician with Dr. Al Ford Blaylock at Vanderbilt university, an up and coming
surgeon. Within weeks and without formal training,
Vivian Thomas was doing experimental surgery on animals by himself but because he was black
he was classified and paid as a janitor. To mass and Blaylock did research in cause
of shock and this work was credited with safing many lives in World War II but that this was
not his greatest achievement. In 1940 Blaylock and Thomas moved to Johns
Hopkins. For Blaylock it was chief of surgery position. For Thomas the only black employees for janitors
so Thomas couldn’t wear laboratory scrubs into the building. When they were confronted with the problem
of blue babies, they realized immediately that the answer might lay in a procedure experimenting
with for other reasons. But the they had no idea whether it could
be done for blue babies with heart size of walnut and desperately ill. Vivian Thomas createssed the first blue baby
condition in a dog and devised a surgical plan to fix it. After two years of work and suckerry, Thomas
perfected the procedure, so on November 29, 1943, the dawn of pediatric cardiac surgery
happened when this procedure was successfully performed on an infant. There were no instruments to do this kind
of surgery on a baby, Vivian Thomas invented the instruments designed from those he had
worked with on animals. During the surgery itself, Vivian Thomas stood
on a step stool on Blaylock’s shoulder, in the operating room, coached step by step through
the procedure because Thomas performed he is operations hundreds of times on dogs whereas
Dr. Blaylock had done it only once as Thomas’s assistant. The first threecations announcing this revolutionary
life saving surgery was published by Dr. Blaylock in the journal of American medical association. Vivian Thomas was not mentioned in the article
nor acknowledged by the surgeons. Within a year more than 200 children had been
successfully treated by the surgery. In 1968, the multitude of surgeons to Thomas
trained who then become chief of surgical department throughout America finally gave
credit to Vivian Thomas and had a portrait hung in the Johns Hopkins clinical service
building. He was awarded honorary doctorate in 1976. Today the procedure pioneered by Dr. Vivian
Thomas remains the main stay of emergency surgery for these babies, for my babies, saving
thousands of lives per year. Surgeons like den ton coolEY, world famous
credited Vivian Thomas teaching him and other it is surgical techniques that place them
at the forefront of American medicine. As Dr. Blaylock famously said about Vivian
Thomas, because it’s a perfection of Vivian Thomas’s surgery, he said, this looks like
something that only the lord could have made. I’m smart by Vivian Thomas. Not only was he responsible for my ability
to send hundreds of babies home, alive and thriving with their parents, but he’s an extraordinary
example of selfless service by man who persevered to help others even when he himself received
no credit and even worse with discriminated because of the color of his skin. So in conclusion, I thank all of you for allowing
me to share this very personal story about an African American man who influenced my
life and practice every day and has continued impact on babies and families throughout the
world. And once again, I truly honored to join all
of you in our efforts to improve the health and well being of every single person in our
nation with the focus on bringing health for all. Thank you, very much and I give you back to
Dr. Lin. [Applause]>>Thank you, Dr. Giroir, for being here today
and welcome to the department T. this is second time I listen to Dr. Giroir’s talk, very inspirational,
your story touched my heart. And I’m sure in the next 10, 20 years we’re
going to work together to eliminate the disparity among the minority and in the United States
to improve healthcare for the United States. Thank you. Our next speaker is the nation’s 20th United
States Surgeon General. Our neighbor and office in Rockville. He is the board certified anesthesiologist
and from year 2014 to 2017 he serve as Indiana state health commissioner. Leading over activity such as address the State’s opioid and
HIV outbreak. He’s model of surgeon general is better health
through better partnerships– this is fundamental belief HHS office of minority health, in fact the
theme for national minority health month in April is partnering for health equity. Ladies and gentlemen, please welcome United
States Surgeon General, Vice Admiral Jerome Adams. [Applause]>>Good morning, everyone.>>Good morning.>>Great to be here. Thank you, very much, Dr. Lin, for inviting
me. Thank you Dr. Giroir for sharing that story
— Giroir for sharing the story I heard several times but you can’t hear it enough because
it illustrates the challenges that we have had to face and that we have had success overcoming
throughout the years. I’m proud and humbled, proud and humbled to
be standing here with you today to celebrate black history month. It’s a celebration and also a remembrance
for me. You heard about the disparities, you heard
about challenges. Both my grandfathers died from disparities. One of my grandfathers died from a stroke
and you heard secretary Azar talk about the impact of stroke on the minority community,
twice. The risk of whites. My other grandfather smoked for most of his
life. There are many disparities in smoking that
led to lung cancer that was diagnosed late. Again, another disparity. He had surgery successfully but had cardiac
complications from his surgery and died from a heart attack. Yet another disparity. My uncle on my father’s side, oldest uncle
died from metastatic prostate cancer at a very young age. Many cancer disparities exist if in the African
American community. So again, we’re here to celebrate but we’re
also here to remember and I for me, this is personal. It’s very personal. And I I’m so glad you’re here today to celebrate
and remember this black history month. As your Surgeon General, I’m extremely proud
to wear this uniform and serve our country. I have the privilege along with Dr. Giroir
of leading the United States public health commission corps, uniform service of over
6500 officers dedicated to promoting, protecting and advancing the health and safety of our
great nation. Of particular note N addition to being excellent,
excellent in promoting health in our country, the United States public health service by
most metrics is the most diverse uniform service. 24% of our officers are minorities compared
to 24% of DOD. We’re not supposed to compare and contrast
but I’m proud of that. And a whopping 53% of core officers are women
compared to 15% in DOD. So we’re doing a heck of a job in the corps
and we want to keep on improving. We want to keep on improving. Speaking of DOD I looked to the naval academy,
I want toed go coming out of high school. Unfortunately I suffered from severe asthma
at that time, a condition which by the way still disproportionately affects black males
and the condition prevented me from serving. However, my many days and nights being taken
care of by others in the hospital and like — enlightened me to another form of service,
through the medical profession. Though I was unable to serve my follow Americans
by protecting them from enemies abroad, I saw by providing medical care, my patients
and my country safe from infectious disease and from chronic illness. I was fortunate to have been born in the latter
half of the 21st century. I didn’t have to go to a segregated school. I was able to apply for college and medical
school scholarships that were not restricted by race. While I had to work incredibly hard to overcome
barriers of the race and socioeconomic status which still exist, had I been born half a
century earlier, my choices would have been much more limited. Dr. James McCain Smith found that out in 1830. He couldn’t go to medical school in New York
so he had to go to Scotland to pursue a medical degree and then he returned home to serve. Returned home to treat the city’s poor. The degree he earned in 1837 made him our
nation’s first African American doctor. Dr. McCain Smith opened the door just a sliver
and many others followed including myself. However, 150 years after Dr. Smith while I
was a child in the hospital, there were still no black doctors available to participate
in my care. Black physicians comprise still less than
6% of all physicians. As a matter of fact I share this story at
the white house with the president, the first time I ever interactd with a black physician,
someone who looked like me was in college when I had the opportunity to meet and speak
with Dr. Ben Carson, to see a black man making such important contributions to the field
of medicine gave me a reason to believe that I could do the same. And my parents were teachers. They pushed me hard but never in my life had
I seen, had I had a chance to talk to black doctor. That’s one reason black history month is so
important. People question what why are we doing it,
what’s the value, role models are critically important. If we want to address inequity and disparities
we have to give hope to people. Black history month is about hope and Dr.
Ben Carson instilled that hope in me that I could become a doctor. With the meeting with Dr. Carson was my first
interaction with a black doctor, a rich tradition and history in the medical field from African
American physicians, nurses, pharmacists, all sorts of different health professionals. Rebecca Lee CRUMPLER was a nurse in the 19th
century but strove to further studies so she could better serve patients. She became one of the first women ever to
aid tend medical school and was the first African American woman to obtain a medical
degree. Perhaps one of the most well known physicians
in the history of our country and black physician is Dr. Charles drew. He changed the face of modern medicine. Dr. Drew’s first ever exhaustive but his innovation
touched millions of lives with his work that enabled the first mass collection of blood. It built a foundation for what would be known
later as the American Red Cross blood bank. Were it not for — millions of lives, black,
white, and other colors would have been lost here and abroad. Dr. Drew made those contributions despite
the practices of the day which required blood not only to be separated by type, A, B and
O, but also by race. That’s how far we have come. However, it’s important to not just focus
on opportunities for care givers but also that we focus on equity and how we treat people
who need care. Race, whether intentionally or unintentionally
is a dividing factor in the treatment received by patients across our country. That is why the work of ms office of minority
health is so very important. We must work to ensure OMH work on health
equity is part of and informs everything. .
Everything that we do. In my only specialty of anesthesiology, less
than 3% of practicing physicians are black. This is particularly problematic because studies
have shown doctors are less likely to prescribe pain medication to African American patients
compared to white counter part under similar circumstances. They’re less likely to receive aggressive
standard of care cardiac interventions compared to their white counterparts. We know this is in part due to physician struggling
to empathize with patients whose experiences may differ from their own. A problem we know can be medicated by increasing
the diversity of the healthcare population. It’s also critical we remember black Americans
more likely to bear the brunt of poor health in our communities. According to CDC data, black Americans are
more likely to be overweight, to suffer from high blood pressure, and to be an overall
poor health. I stand here today as your United States Surgeon
General, I look like a fit guy. I have hypertension. I’m pre-diabetic. I have ever risk factor in the world for a
premature death and if I have to deal with that, if I can’t mitigate those alone, none
of us can do it alone. If we want to work toward a more equitable
healthy nation we must pay attention communities of color,the communities that people HIV in
and address the health disparities and inequities we know limit their opportunities. In closing T I’m deeply honored to be here
today with Dr. Lin, with Dr. Giroir and to have had the — Giroir and to have the opportunity
to hear the words from secretary Azar in celebration of black history month. The contribution of black Americans are an
important part our neigh’s history. I have the unique opportunity as your 20th
Surgeon General to be part of that history. And follow in the footsteps of others in my
family and serve my country in uniform 25 years ago, I proudly do so today. As ta nation Surgeon General, I have been
given an opportunity to address health disparities across the country by race, by geography,
by income and by nature of being a veteran and for that I’m extremely grateful. Dr. Martin luther King once said an individual
has not started living until he can rise above the narrow confines of his individualistic
concerns to the broader concerns of all humanity. I tried to live this motto to its fullest
in both my work as physician and now as your Surgeon General. You have my sincere promise to shine a light
on health disparities wherever they exist and to do all I can to lift up our nation’s
health. But I can’t do it alone. And neither can the office of minority health. Health equity cannot be just the mission of
OMH and we can’t just talk about it in February. We live in a nation where everyone deserve
it is opportunity to be healthy regardless of skin color, regardless of profession, regardless
of ZIP code. We won’t get there unless each and every one
of us, each and every one of you commits to addressing health inequity as part of everything
we do, every day of the month, every month of the years. Only with your help can we achieve Dr. King’s
dream of equitable healthy and prosperous nation for everyone. Thank you and God bless America and most importantly
have a happy, healthy and equitable black mustry month — history month. [Applause]>>Thank you, Jerome, for very thoughtful
and inoperational message. Our next — inoperational message. Our next speaker this morning is Dr. Eliseo
Perez-Stable. Director of the national institute of minority
health and health disparities at the national institutes of health. He will — institute leading the work across
NIH on minority health research and activity, recent work including research to learn more
about the buy logical social factors that cause health disparities. Eliseo expertise span a full range health
disparities disciplines. His research interests have centered on topics
such as improving the health of underserved populations and promote delivery and diversity
in biomedical research. Everyone, please welcome Eliseo Perez-Stable. [Applause]>>Good morning, everyone. Thank you for having invited me to be here. And thank you for your words, Jerome, and
to the secretary who spoke earlier today. It’s an honor to share with you thoughts about
NIMHD and Dr. Gibbons will also present about heart lung and blood and NIH. I want to start with a little bit of history. And I think earlier we heard this quote about
an individual has not started living until he can rise above the narrow confines of his
individualistic concerns to the broader concerns of all humanity. And since it is history that we’re talking
about today, I did want to put this in the context of the last 60 years, what Dr. King
restarted for our country which is far from over, ongoing all the time issue that makes
United States such a great nation. He was referring to service with this quote. Dr. Lewis Sullivan, was the first black secretary
of health and human services and followed Dr. Heckler’s report by starting the office
of minority health at NIH, office of minority health started in the department under president
Reagan and then under President Bush secretary Sullivan started office of minority health
which became the center of minority health and health disparities and eventually the
institute in 2010. Dr. Sullivan also appointed fist director
— woman director of NIH so he is I think the visionary. And I think in the spirit of honoring those
that came before us, it’s important to remember this history. Secretary Azar mentioned that data and I did
want to spend just a minute on reflecting on the fact that there have been remarkable
improvements in after African American health the last to years. This is often overlooked as we focus on the
persistent disparities and inequities that exist. He mentioned life expectancy improvements,
there’s still a gap. African Americans blacks are four years, three
years shorter life expectancy, but the progress has exceeded projections and expectations. Most of this is due to a decrease in cancer
deaths, cardiovascular deaths and remarkable progress in the control of HIV disease. We can also see from this graph, cross over
in mortality that happened in older adults. So over age 65 now you get to 65 and you’re
black you have a longer life expectancy than if you’re white. true for last ten years or so. There’s bigger gaps in younger age particularly
mid life, this is where we can do more work. Now, I want to stalk about NIMHD, national
institute of minority health and health disparities. We have created a research framework to capture
the excitement about research in science in this field, this is something that’s come
together over the last ten years or so. We are talking about all kinds of factors,
not just social factors or access, but also biology and behavior. Let me take you quickly through this route. So first of all physical activity, diet issues adherence to
recommendations from the physicians, other factors related mostly around individual behavior
and less focus on other aspects. Now we’re kind of understanding
often occur in early life and how it impacts your health at age 40 and 50. So this is — and be able to measure with
biomarkers, not just how someone feels or reports or observations made in the clinical
setting. The biological revolution that happened the
last 20 years perhaps being with the human genome project but expanding to include all
kind of information about metabolic pathways, that help explain why we see big differences
in cancer rates, diabetes rates or other manifestations or earlieren set of disease or more severe
manifestations of disease. Similarly there’s other things on the horizon,
microbiome is well established as a mechanism, the brain initiative has shown us all kinds
of networks occurring in the brain that are just beginning. Right now still at the level of mice but it
will I think at some point near future be involving humans much more and extra cellular
RNA. The other topic that has changed in the last
20 years is importance of place. There is saying that ZIP code is more important
to your health than genetic code that is used by researchers in this field. Not just your place and safety and space,
access to transportation and healthy food but also people, and cultural interactions
and social cohesion and community resilience. We have known for decades you talk and interact
with people your health is better. Back in the 1970s studies show that if a man
was married, after a heart attack he did better than if weren’t married. As you can imagine. Lastly I’m general internist, I was a primary
care physician prior to coming to NIH. What happens in practice is really important. Clinical research for me is more than clinical
trials, more than observational studies, I want to know what goes on between patient
and clinician, what the tests ordered, drugs prescribed, are they appropriate, what’s the
quality and I look for NIMHD to expand our research portfolio in this area. We have embarked on the scientific advancement
plan to try to present our agenda on research, it’s exciting an area we look to champion
field of minority health and health disparities as an institute and to capture all these elements
I have summarized for you briefly. We want to strengthen the science. Being at NIH is really about the science and
to really inform and arm our colleagues in the service areas and policy programs and
public health to make changes. One of the strategies is to increase the investigator
initiated research. I think the timing is right to let scientists
come to us with ideas and for me to get my colleague at the NIH to create other kinds
of programs that will explore minority health and health disparities from a scientific perspective. We’re also work on evaluating reporting research
and I’ll summarize that with part of strategic plan. Also important to emphasize the work force
diversity, Jerome’s anecdote about black physician he saw was when he was in college is a telling
statistic. We haven’t made sufficient progress in that
whole area. This is an intervention that could probably
make a difference. The statistics from AAMC show that as of the
graduating class, of 2014, five to six percent of physician, five% African American, 5% were
Latino. That’s just not good enough. We need to make a difference in that area. .
Now, NIMHD launched into supporting trainees. We have now a K program that is just been
started though we have had other kind of Ks. We sponsored a week — summer institute at
NIH for post graduate fellows and trainees and assistant professors to engage in what
NIH is about and give some aspect of research and minority health and health disparities. We have a robust loan repayment program, we
fund pre-doctoral and doctoral students with individual grants, diversity supplements which
are available to individuals from under-represented minorities or socioeconomicically disadvantaged
background or those with disabilities. That’s an NIH wide program. Our strategic plan is in advance stage right
now though we are entering the final and most important phase. We have designed this category of our goals
and categories and goals. Categories to look at what NIH does in minority
health, health disparities includes science research but also important research sustaining
categories. The research sustaining categories including
training capacity building and inclusion so the diversity in the clinical research. We also design issues around collaboration
and dissemination particularly on building a research community. Some of this is reflected in our work together
as directors of office of minority health, which I have been very engaged with over the
last 2 and a half years. We are now in the phase of looking at having
listening sessions that are being scheduled as we — as I speak for the next thee months
and then hopefully submitting for process through clearance later this summer. We’re excited about this important, actually
mandated strategic plan. Finally let me end with programs that has
been very much endorsed by our staff, the further on my mind is a particular program
that focus on African American men and mental health. Men in general are less EMOTIVE, they don’t
express as much, as a clinician I’m very sensitive to that. Frequently everything is okay but you have
to dig in a little bit. This is focused on depression. We know depression is common. 5, 10% of adults have major depression. It’s also the main risk factor for suicide
which is the mortality aspects of mental health. That we most worry about and that we haven’t
figured out how to really decrease or prevent despite many years of research. So on my mind is a community service as an
engagement for African American men and NIMHD is proud to support it. So thank you for your attention and thank
you for having us come. Dr. Lin, thank you. [Applause]>>Thank you, Eliseo. For you great presentation. Really looking forward to learn more about
the fascinating work that you have been talking about. Thank you. Our next guest this morning, very important,
is Dr. Gary Gibbons. Director of the national heart lung and blood
institute at the NIH. He is a cardiologist who joined NIH in year
2012. He is also help formulate the position at
Stanford University, Harvard medical school, and Moore house school of medicine. The Moore house, he fund cardiovascular research
institute. One of the first of his kind is historical
minority institute. Ladies and gentlemen, please welcome, Dr.
Gary Gibbons. [Applause]>>Good morning. Real privilege to be part of this meeting
this morning and esteemed panelists. It’s been actually quite inspirational for
me. And an opportunity to share a little bit about
our prospective at national institutes of health, particularly national heart lung and
blood institute where it’s my privilege to be director. It is indeed a privilege of public service. Indeed that was part of my inspiration this
morning. Is that we have all been part of the similar
calling, if you will, that’s what we share as an HHS family is that commitment to serve
our nation and to do so in a way that brings health and science to all communities in a
way that’s transformative. As I took on this mission of turning discovery
science into the health of the nation, it struck me about this black history month celebration
how we all came to this point of service, certainly this was not something I designed
and reflected on the fact that I am a grandson. My grandmother was born in to a family in
rural Georgia as sharecroppers from just a couple of generations away from slavery. And at that time a little black girl wasn’t
valued so much to have the need for education so she could barely read and write and actually
became a domestic, cleaned floors for other families all her life, all the way through
to her 70s. And so she was always my inspiration, taught
me so much about a work ethic that I hold to this day. I was intrigued when there was banter about
Harvard and Yale, as I said wept to Princeton. And I remember my grandmother coming to those
graduations. So for the daughter of a sharecropper, couple
of generations from slavery, to see her grandson graduate from Princeton, I think tells you
a lot about black history and where we have come as
a country. [Applause]
I hope part of what we do today is to make history. That’s why we have this opportunity in service
to our country to make an impact. To make a difference. That’s why all of us are here and do what
we do every day. We have challenge as shown on this slide. These are part of portfolio of our mission,
heart lung and blood diseases. These are among the major killers of men,
women, of all races. And ethnicities in this country and major
cause of disability among children and asthma. And particularly pointed disease in sickle
cell disease, as well, just throwing each of those and what we’re hoping to do to make
history, in addressing health inequities. One of the other elements is that we build
on really a legacy of excellence in public service in NHLBI. We’re celebrating our 70th anniversary this
year. So we have the privilege of continuing that
legacy. The national heart institute, it was known
then by hairy Truman, began at the height of epidemic that was going on in coronary
heart disease in the middle of the last century. As a result of a lot of investments in biomedical
research changes in public health practice, tremendous progress has been made reducing
that scourge, that epidemic over the last 50 to 70 years. Yet despite all that success, it has not been
uniform to all communities. There’s still some lagging behind most recent
cardiovascular mortalities shown here graphically and geographically. Notice a striking pattern expecting America’s
heart land, you can see that band of red there, West Virginia, Kentucky, Arkansas down into
the southeast Louisiana, Mississippi, Alabama. So these are communities that appear to be
particularly burdened by cardiovascular mortality. Suggesting that indeed we’re not really fulfilling
our mission until our discoveries and our advances penetrate all communities. Through our country. In that regard, it — that geographic pattern
also tells us something. Clearly is ole Eliseo was mentioning, we know
a lot about biology and genetics but we also are starting to appreciate again how much
place matters and that addressing health inequities we appreciate, it really is a complex problem,
if it were simple we would have solved it over the last 25 years, its complexity tells
us we have to attack it in a very strategic way, probably multiple levels. As a system sort of problem, a systems approach,
appreciates that we’re dealing with determinants of health that not only relate to the individual
and individuals biology and genetic makeup but embedded within family, within community,
within a social environment, and all of these elements work together with inner play to
influence health and health outcomes. As an HHS family, I believe this challenges
us, if we’re going to solve this problem we have to attack it in these multiple angles
in a full pronged approach that appreciates this complexity as it cuts across our mission
areas. Indeed when it comes to hypertension a key
driver of disparities in mortality strokes, heart attacks, we see higher prevalence among
African Americans in particular T. not only increased prevalence of hypertension but when
it comes to controlling that hypertension, we often find it’s inadequately controlled. Hopefully the Surgeon General’s is under control,
I take my medications as well for hypertension. But we can do better. One of the studies shown here of our cohorts,
cardio study has been tracking individuals since teenagers and young adults. One observation was if an African American
grew up in a segregated neighborhood, and remained in that segregated neighborhood,
the blood pressures tend to be higher than those that grew up in a segregated neighborhood
and moved to one that was more diverse. We don’t know the causality of that but is
it something about how that vocal environment may have been getting under the skin and affecting
trajectory of blood pressure with longer term implications. As we look at patterns of where people live
and work and play and pray and how much that influences their health and health outcomes,
we are gaining greater insights in complexity of those factors and determinants. One of the key observation, I think we’re
starting to understand is how these social determinants get under the skin and can change
biological systems and pathobiology of disease. One of those areas relates to try to understand
why would be living in a food dessert or having less access to healthy lifestyle affect your
body and blood pressure. Turning out when it comes to fruits and vegetables
you know they’re colorful. If you ask why so colorful? Particular chemicals, phytochemicals that
are part of their texture, that gives them that color but also gives them other properties,
properties about how they affect free radicals that influences biology. Moreover we’re learning that you have literally
trillions of organisms living on you and in you and around you. Sometimes people get the Willies when you
say that. But those organisms are co-existing with you. They’re helping you digest your food. And they’re metabolizing what you eat as much
as you are. Ibility in fact, they’re helping you metabolize. What they then metabolize comes back and absorbed
in your body. What we’re listening is that shape of how
much fruits and vegetables changes the balance of those microbes live in you and change the
balance of what they generate in your body. And we’re learning that that can affect obesity,
diabetes and indeed heart disease. So there now is greater understanding of the
mechanisms that are involved in which the — where you live can actually affect your
DNA. Change your epigenome, changes your microbiome. Changes your immune system. All of which influence the course of disease. This is important because as we see those
factors that determine that high blood pressure, we know we have to do things to combat and
certainly NHLBI, we’re pleased with this sprint trial that was done. In which we compare more aggressive targeting
strategy, target blood pressure in hope of preventing heart attack and stroke more effectively. Indeed, it’s a land mark study. In order to pursue that though, it’s notable
that we want to be sure that this was generalizable to all communities that might be affected. A critical aspect of our research agenda,
we’re inclusive of a diverse population that reflects America. Indeed I think the sprint investigators were
very effective in doing so. And as a result we have a sense that indeed
aggressive approach has benefits across various demographic groups. It’s not enough just to do these trials, these
clinical efficacy trials, it’s important also they — the results have an impact and penetration
and uptake in all the communities that are most burdened by these risk factors. So work remains and we hopefully can partner
with you to see how we can be sure that these new insights that are going to save American
lives really gets to them in the real world and not just in clinical studies. Part of that involves funding implementation
research in which we try to promote innovation, new knowledge, about how we can ensure what
we know actually has impact and go from knowledge to action that has impact on the health of
the nation. We have done some of that collaboration here
collaboration with PCORI related to innovation approaches and health systems to see how we
can indeed improve hypertension control and indeed many of those studies are taking this
multi-level systems approach to see how we can enhance control hypertension and have
impact. Moving quickly to lung disease and asthma. Again, we had disparities and appreciate Surgeon
General sharing his history, that is not uncommon story in which there’s a greater burden of
asthma here, as Eliseo pointed out often we recognize Hispanic populations define not
monolithic, indeed per toery caps have a high risk of asthma as well and suffer from number
of health disparities in this space. So from ER visits to hospitalizations to death,
there’s clearly a great burden for this condition. It is really one of those again where the
whole environment and where you live and work and play, makes a difference in terms of your
life course and your health outcomets. This is also an opportunity, we believe, to
not only advance basic science and clinical trials but to see how indeed we can recognize
this as a multi-level disorder that needs multi-level interventions and reduce those
disparities. Indeed funding projects, they’re taking a
community perspective, bringing together primary care schools, the family, the whole environment
that surrounds that child and influences whether indeed they’re going to have a good outcome
or not, how we can potentially prevent them from going to the emergency room as failure
of our therapies. My final example relates to sickle cell disease. This is a disorder that as you are aware,
was pick up and appreciated by a cardiologist who recognized these strange cells that were
sickle shaped. And about in 1946, Linus PaulY found a molecular
defect in the hemoglobin molecule that generated this abnormal sickling pattern. So it was one of the first molecular disorders
in this age of personalized precision medicine, we have known about what causes it for a long
time. Yet despite that discovery, many years ago,
this was almost a death sentence to have this diagnosis. Few lived beyond childhood. Fortunately related to clinical trials done
by NHLBI NIH that life expectancy has expanded from a death in childhood to 40s and 50s but
that’s still not good enough. Clearly we have some unfinished business when
it comes to sickle cell. As you are aware, and was pointed out, this
is a disorder that causes death in children still. As shown on that map. We did a clinical trial to reduce stroke. We found that children with sickle cell disease
between two and five, one out of five kids had a sign of a silent stroke. Can you imagine? A 7-year-old with a stroke. My mother died of a stroke in ’70s. 7-year-old with a stroke. Yet we understand at the most basic molecular
level, I think that’s something unacceptable. I think it’s something we can make history. We believe technologies are at hand. Where we should be able to transform the lives
of whole generation of people living with sickle cell disease. We now have tools that enable clinicians and
scientists to correct that molecular defect. Crisper CAS technologies, gene editing tools,
basically molecular scissors that cut out abnormal DNA code and ensure the right code
is put in. That capability exists today. And I believe we are on the threshold of transforming
whole generation of people living with sickle cell disease as a result. So we’re committed to a full court press on
sickle cell. In which we want to go from literally nucleotides
to neighborhoods. From basic clinical trials, implementation
science, including leading edge genetic curative therapies. We hope to to it in public private partnership
which industry can contribute as well with new technologies and tools. We see this as a I believe a public health
imperative. And incredible scientific opportunity to make
such a transformative effect on group of patients with rare disorder. This is something we can do as a HHS family. Collectively. Because indeed, it involves so many elements. That are part of our portfolio and part of
public service. We believe as part of this circumstance circle
of partners, we can make history, we can make black history by eliminating those strokes
in those children and having a stroke free generation. I hope you will join us in this effort. Thank you for your attention. [Applause]>>Thank you, Gary, for you wonderful presentation. Sickle cell disease is of particular interest
to me and I’m happy to see that as one of your priorities. This will conclude our program. Let’s thank all of our speakers for helping
to deliver such a great event. Thank you. [Applause]>>As I said earlier at the beginning, this
leader who are helping to guide the department”s work to improve health and healthcare for
minority across the nation. They provide useful guidance and information
for us this morning thanks to everyone here and on the live stream here. For joining us for this observance of black
history month. Thank you for all of the work that you do
and that we do together to reduce health disparities and advance health equity. This is crucial work and it is helpful to
move us closer to be a nation where everyone has opportunity to reach their full potential
for good health. Our country spend money, more money around
the world but our healthcare rate probably around 30, 35 around the world. So I hope we work together, important ads
we eliminate the health disparity, I think we will — our nation will have good health
in the future. So we hope to see you again in April. In our national minority health month. Thank you for coming and I want to thank my
staff and other staff in HHS, help to put it together. I really appreciate it and thank you, Chris,
for you taking a picture. [Applause]>>Thank you all. See you again. Thank you. [Applause]