Good morning. It is my pleasure to introduce our first thought leader session, the A. K. Grenvick Honorary Lecture being presented by Dr. Jerome Adams. Dr. Adams was appointed as a Presidential Fellow and the Executive Director of Purdue's Health Equity Initiative in October 2021. He is also a distinguished professor of practice in the departments of pharmacy practice and public health. A regular communicator via television, print, and media, Dr. Adams is an expert not just in the science, but also in communicating the science to the lay public and making it relevant to various audiences. He has partnered with and assisted various organizations as they navigate the opioid epidemic, maternal health, rising rates of chronic disease, and the impact of suicide rates in the United States. Dr. Adams is a licensed anesthesiologist, like me, and has a master's degree in public health. In 2014, he was appointed by Michael Pence to be the Indiana State Health Commissioner. In 2016, as we all know, President Trump and Vice President Pence tapped him to be the 20th United States Surgeon General. He also became the first anesthesiologist to be a Surgeon General and the second African American male as a Surgeon General. In this role, he was the operational head of the 6,000-person Public Health Service Commission, the Public Health Service Commission Corps. He oversaw responses to three back-to-back Category 5 hurricanes and a once-in-a-century pandemic as a member of the President's Corona Task Force. A challenge that was less obvious was doing what he thought was best for the country and working simultaneously in harmony with the President, what we call politics. He was bombarded with emails, telephone calls, social media commentary, and text messages from people who thought they knew what was going on and thought they should tell him how to approach it. I should know because I was one of those people. I'm honored to have been asked to welcome my friend and my colleague, Dr. Jerome Adams, to present this morning's Thought Leader Session entitled, Crisis and Chaos, Pandemic Perspectives from the 20th U.S. Surgeon General. Ladies and gentlemen, my friend, Dr. Jerome Adams. Hold on a second, Greg. Come back. So, Greg is a good friend of mine, and we've got to get a selfie while we're out here. Fantastic. Thank you. Thank you. So, I am so pleased to be here today, and for those of you who are here who are early career or who are younger, I've got to tell you, I truly would not be in the situation that I'm in if it weren't for people like Greg. He was a mentor to me. I really grew up through organized medicine and advocacy societies like SCCM and the American Society of Anesthesiologists, and it was just such an honor to be introduced by him. Everyone, as you're able, can you stand up? I know you've been sitting for a while. I was Surgeon General. Physical activity, you know, eating right, stretch out a little bit, you know, shake a little bit. You learn better. You retain more when you're moving, and sitting is the new smoking. You all do know that. Okay, you can go ahead and take a seat. I wanted you all to relax and release a little bit because I know some of you all are triggered by that picture that you just saw up on stage. That is true, and we'll talk about that a little bit. The honest truth, and I was telling Greg this backstage, most people who I met, most of my mentors and discussed whether or not I should take the role of Surgeon General advised me against it, told me do not take that role, and the thing is, whether or not you love or you hate Donald Trump, everyone either loves or they hate Donald Trump. No one's lukewarm on the man, but we're not going to talk about Donald Trump today. I'll be doing a Q&A afterwards, and we can talk a little bit about him if you all would like to, but we will talk about my journey to becoming Surgeon General, and also why health equity is and always has been so incredibly important to me. So that's me at what many people would consider the pinnacle of their career, standing between the two most powerful men on the planet at the White House, but let's go back to a few years before that. That's me at age eight. That's me. I had hair. You know, see what D.C. does to you? I'm smiling. I'm happy. That's also me a few weeks before I almost died the first time in my life. I have been carrying around an inhaler for most of the past 45 years. Like one in nine, one in ten of you all, I have asthma, and I grew up in a rural community, and I had a severe asthma attack. I went into status asthmaticus. The critical access hospital that served my community was 45 minutes away, so my mom put me in the car, rushed me there. We got there, and they couldn't break my asthma attack. They didn't have a pediatrician on staff. I mean, again, this is a critical access hospital, so it's one physician, certainly not an asthma specialist, not even a pediatric specialist, and so they had to put me in a helicopter and flew me to Washington, D.C., to Children's Hospital in Washington, D.C., and I share that story because, again, the juxtaposition of me being in the White House as an adult, but then my first trip to D.C. being in a helicopter, not knowing if I was going to see my parents again or whether or not I was going to actually live through that episode is really jarring, but I also share that because I want you all to understand that even before we were talking about health equity, before I knew what disparities were, I understood that I faced a unique burden as an individual. I understood that my opportunities to grow up healthy, happy, prosperous were not the same as everyone else out there. The fact is there's a burden of being born black. Black Americans are more likely to be diagnosed with asthma, more likely to end up hospitalized with asthma, more likely to die from asthma, and that's particularly the case for African-American boys like me. There's inequity in diagnosis, and you all hopefully know about these studies now, but for far too long, we did not know that the pulse oximeter that they were using to determine whether or not they were going to even admit me to the emergency room, into the hospital, didn't work the same on people with the color of skin that I have, and that in many cases, they sent me home and told me, hey, you're fine. You're fine when I needed to be admitted, and we know that if you're admitted and treated promptly, you're going to have a better outcome than if you're sent home and then you have to come back in a worse state. This continues not just with pulse oximetry, but also with spirometry and lung function testing. We know, and many of you all in this audience know this personally, the algorithms that are baked into these testing devices actually have bias that causes people who are black, who are brown, to not be given the same treatments as other folks out there. There's inequality in treatment. I don't know how many of you all knew this, but asthma medications were not tested on people who represent the burden of asthma in our communities. And so the inhaler that I showed you does not work the same in me as it does in people from different cultural, ethnic backgrounds. Inequality and inequity in the air we breathe. Double your risk of asthma if you live near a crowded highway like the one you all drove in on from the airport here today. And remember this past summer when the wildfires from Canada were going all over the country? Well, many people just left and, you know, went to their vacation homes from New York City. But not everyone has that option. Inequity in caregivers, and I want you to think back to that picture I showed you that triggered some of you. I was Surgeon General 2017 to 2021. There are fewer black males graduating from medical school now than what there were 40 years prior to me becoming Surgeon General of the United States. So for all of you out there who asked the question, how could you work in that administration or for that person? The question I ask you is, how could I not? How could I say no to that opportunity? Told you about growing up and being in the hospital frequently. Ironically, I never dreamed that I could be a doctor, much less Surgeon General of the United States. And it wasn't because I didn't have the aptitude. I had a 4.0 GPA throughout high school, 3.9 throughout college. I could have been anything I wanted to be. But the truth is, I had never met an African-American physician in my life, in my entire life, despite being in the hospital almost monthly as a youth, until I got to college. I went to college, University of Maryland, went to an event like this, and I'm in the audience, up on stage is Dr. Ben Carson. And I had the opportunity to meet him, and I go, huh, I guess there are black doctors besides Bill Cosby on The Cosby Show. We won't talk about him either. I don't want to get in trouble today. But that said, you have to see it to believe that you can be it. And we know that people actually have better outcomes when they're cared for by people who they can relate to, who look like them, who speak their language, who come from their communities. And that's why it's so important that we have diversity in our ranks if we want to be able to take care of diverse populations. So I talked about the burden of being black. I've hit on many of these, but lower job rates, lower pay, lack of quality jobs, less job stability. We live in a country where, for better or for worse, most people's health insurance is tied to their job. So people who don't have good jobs aren't going to have good health insurance and good access to health care. Housing inequalities, including lower home ownership rates. Why does that matter? Well, we know that people who rent homes tend to live in homes that have more allergens in them. So that is related to your risk of asthma. Limited access to quality health care, bias, as I mentioned, higher rates of exposure to environmental pollution, less representation in research. I'm currently the head of the Association of Diversity in Clinical Trials. That's really important to me. And then distrust in the medical establishment. How many times do you go to the hospital and get told there's nothing wrong with you because the pulse oximeter didn't work because the spirometry is biased, and then you say, well, what's the point in taking Jerome, little Jerome, to the hospital anymore? They're just going to tell us there's nothing wrong with him and send him back home. All these are reasons why you have these disparate outcomes. And it impacts not just me. It impacts all of you. Did my parents take out their checkbook and pay for that helicopter ride I took from our small rural community to Washington, D.C.? Absolutely not. You all paid for that. You paid for that through higher taxes. You paid for that through higher insurance premiums. There is a cost if we don't deliver equitable care. There's a cost in terms of workforce. My mother had to take off work to come and stay with me as a young person in the hospital. My father was not as attentive at work. So that's presenteeism in addition to absenteeism. And of course, if I don't grow up, I can't participate in the future workforce. I come from a military family. The saying in the military is famously that today's eighth grader is the soldier of 2027. Well, far too many of those soldiers, those workers, are not making it to adulthood because of situations that we could prevent. So you all are familiar with this picture. I'm an anesthesiologist. I still practice about a day a week in the operating room. I really am proud of that. I'm proud of it. I'm the first Surgeon General in modern times to have practiced medicine while I was Surgeon General actively. I went to Walter Reed Medical Center and practiced. And that really informed my approach during COVID. Why? Because I wasn't just sitting in a boardroom making up things. I literally was in the operating room understanding what it meant not to have access to PPE, what it meant to work in an environment where you're wondering, oh, my gosh, what's this new virus and is it going to impact me? Am I going to take it home to my family? But this is me in the operating room when I was much younger. And I want to tell you a really quick story about a young man, let's call him Johnny for the sake of HIPAA, who came into my operating room. Johnny, I'm going to cut straight to the chase, was in a gang. He'd been shot. He came in, and he was nasty to everyone in the trauma bay. But we had to take him to the operating room. And so we go to take him back to the operating room, and his demeanor changes like that. And I remember putting him to sleep, and he grabbed my arm. I'll never forget this. And he goes from yelling and cursing and screaming at everybody to tears coming out of his eyes and he says to me, Doc, please, please don't let me die. Please do not let me die. And I said, Johnny, we're going to do everything we can to take care of you. I'm going to be here with you the entire time. You've got a great team. I promise you we're going to take great care of you. And I kept my promise. Eight hours later, we actually were in the operating room, multiple units of blood products, left, went to IR, came back again because he still was bleeding. I kept my promise. Two weeks later, Johnny walked out of that hospital, and I was like, yeah, this is why I went to medical school. Just like Grey's Anatomy. Saved a life. You know, I was charged. I was pumped. What's interesting is about a year and a half later, Johnny came back again. This time he'd been stabbed. I go, huh, interesting. We patch him up. We send him out. And about another year later, Johnny came back, and he'd been shot again. Let me tell you, the third time Johnny came back, I wasn't pumped anymore to take care of him. I was like, why am I eating bad hospital food? Why am I missing my daughter's soccer game? Why am I hurting my health, and I'm not changing his outcome? And I tell you this because we know that we're facing a workforce burnout crisis in critical care medicine in particular. And I'd argue it's not too much of epic. It's not too little tai chi or chai tea. It's the fact that we are putting in the effort, and we're not feeling like we're getting a return on our investment. Some of you all are scared of hard work, but you don't want to work and feel like you're not getting anything out of it. And no one's talking about this. No one's talking about the fact that that's where I think a lot of the burnout is coming from. It's wasted effort. And why does that matter? Well, it matters because we did everything right. Every hit, every quality measure for Johnny. We got his antibiotics in on time. We made sure he didn't have a catheter-related infection. You know, we did everything right, but Johnny kept coming back. Why does that happen? That happens because we didn't ask, Johnny, do you have a home to go home to when we discharge you to the hospital? Are we sending you right back to the gang? Johnny, can you get a job and actually take care of yourself and be able to do your physical therapy and rehab? No. You know, we don't ask those questions, and so we're falling short in terms of being able to take care of Johnny, and we're going to see him over and over and over again. So fast forward a little bit more to my time as Surgeon General during the pandemic. Well, what did we learn? We learned that certain people were at higher risk of getting COVID-19. You know, a lot of people were able to just go home and kick up their feet and watch Netflix and, you know, and order food in. I mean, I don't want to downplay COVID in any way, shape, or form, but I will tell you that a lot of folks, especially in the beginning of COVID, were very happy to have paid time off work, you know, and time with their family. A lot of folks out there didn't have that opportunity. Frontline workers, bus drivers, people who were delivering your food back and forth, people who live in crowded housing, those folks all had a higher risk of getting COVID. We also know that some people, once they got COVID, had a much higher risk of being hospitalized and dying. And who were those people? Those are people like Johnny. Those are people like me as an 8-year-old. Those are people who didn't have the same opportunities to make healthy choices that many of us actually do. So anyone heard of W. Edwards Deming? He's a famous systems engineer who says every system is perfectly designed to get the results that it gets. Nothing that you see in medicine that you dislike is happening by accident. It is happening on purpose because we designed the system that way for it to happen. And he also says that no matter what you all intend to do as individuals, no matter how well meaning you are, a bad system is going to beat a good person every single time. One more quote, from MLK, we just had a day honoring him last week. Of all the forms of inequality, injustice in healthcare is the most shocking and the most inhumane. That's incredible to me that someone who literally was assassinated because of his civil rights stance says that the most, the most shocking inequality he has ever experienced is inequality in healthcare. Now, I show that because I want you to really quickly understand that while what he said is still true today, it is incomplete because there's a difference between equality and inequality and equity and inequity. And this picture says a thousand words, so I'm not gonna explain it to you, but I want you to understand that even equality is not enough, giving everyone the same thing, giving everyone that same pulse oximeter is not enough. Why? Because some people need a different type of pulse oximeter. We need to understand that different people, different patients, different communities have different needs, and that's what equity is about. We also have to understand that healthcare is not health. You're not gonna be able to solve inequity in the ICU. We spend about nine cents, nine out of every ten cents in healthcare on things that happen inside the hospital walls, the clinic walls, that traditional medical model. But that's only about 20% of what determines whether or not we are going to ultimately be healthy. The other 80%, talking about Johnny here, it isn't the things that our HEDIS measures are typically based on. It's, again, health behaviors that happen in the community. It's social and economic factors. Does Johnny have a job? Does Johnny have access to school? Physical environment, what's your housing situation look like? These are the things that determine whether or not Johnny is gonna come back over and over again or whether or not that little eight-year-old with asthma is gonna be a frequent flyer in your emergency department. So, what is health equity? Well, it's when everyone has a fair opportunity to make healthy choices and can be their healthiest and happiest version of themselves. There's a whole lot of conversation about wokeism and, you know, people wanna act like different words are politically charged or bad. Equity is just when everyone has a fair opportunity to make healthy choices. And if you're someone who uses a wheelchair, we wanna make sure you have a ramp to get on stage. If you're someone who lives in a rural community, we wanna make sure you have access to broadband so that you can participate in your telehealth visit. That is health equity. There's equity within organizations. There's traditional DEI. There's equity within patient populations, healthcare equity. And then there's equity within communities. That is the broader health equity that I wanna talk about. And health inequities are a major contributor to what I call our US health disadvantage. This is why it matters. And this is why it matters. So, we have an international audience here today. When you compare the United States life expectancy to our international partners, our OECD competitors, since 1980, our life expectancy has been lower than theirs. And that gap has been widening. It's actually been widening since 1980. We fell off the rails during the pandemic. But again, we are not doing well in terms of our outcomes here in the United States. And the interesting juxtaposition is we actually spend about three to four times as much as any of those nations on healthcare. Remember W. Edwards Deming? Every system is perfectly designed to get the results that it gets. We have a very expensive system that isn't delivering the results that other people are enjoying for spending a third less money than what we're spending. So, when I was Surgeon General, I actually wrote a report that was unlike any other report that had been written by that office because it wasn't written for a health audience. It was actually written for a business audience. It was making the case that our poor health is hurting our economic competitiveness and we need businesses to actually lean into creating healthier communities so that we can improve outcomes. Again, I love all the vendors who are here. Thank you so much if you're a vendor. But their new device is not going to change the fact that we're spending more and more money and getting worse and worse life expectancy. It's not. But actually leaning into creating complete streets so that people can exercise, making sure people have access to fresh, nutritious, healthy, affordable foods, that's going to change outcomes for far more people and to a far greater magnitude than the latest new ICU device that you're going to hear about over and over and over again at this meeting. So, I took this approach to Indiana, my home state, and we were actually able to increase public health funding by 1500%. For those of you all who don't understand how important this is, Indiana is consistently ranked in the bottom in terms of public health spending. It's a very red state. Not quite as red as Arizona, but we're right up there with Arizona. And we were able to increase public health funding. Why? Because we actually made the economic case for public health. We said it makes it easier to recruit workers, makes communities more attractive for businesses, reduces health care costs for businesses. Do you know that the number two expense for most Fortune 500 companies, no matter what they do, is actually health care? How many of you all have a General Motors car? Chevy, Cadillac, anything like that? General Motors, when you buy a General Motors car, you are paying more for their health care costs than what you are for the steel that goes into that vehicle. So, how are you going to be competitive internationally if that continues? So, at Purdue, which is where I am right now, we're leaning into a health equity model where we're focusing on healthy behaviors, social and economic factors, and the physical environment. The goal is ultimately to create high opportunity neighborhoods. Remember, I said health equity is when everyone has an opportunity to make healthy choices. We want quality schools for Johnny. We want parks and green spaces. We want access to healthy foods. We want healthy living conditions and access to local suppliers. If we can create those communities, Johnny won't come back over and over again. Maybe we will never see Johnny in the first place, which is ultimately what we want. That's the system that we want to build where Johnny never has to come in to see us in the first place. So, what can you as critical care practitioners do to promote health equity? Well, first of all, you can understand the communities you work in and the demographics of the people you serve. If you don't understand that black children are three to four times as likely to have and to be hospitalized and to die from asthma, then you're not going to understand that that little black boy in front of you has unique needs that you need to address. Ask. Ask your patients and families about social drivers. You know, again, someone can come into your hospital with DKA, and many of you will have taken care of someone with DKA, and again, you've hit every quality metric in the world. You know the number one predictor of whether or not someone's going to end up in the hospital with DKA is whether or not they have access to food. Food insecurity. How many times do you pay attention at all or as much to food insecurity in your patients as you do to making sure you got the insulin drip dialed in just right? The hemoglobin A1C isn't going to change based on what you do in the ICU. It's going to change based on what's happening in the community and the social drivers. Implement. Implement programs that can help change outcomes. So in our hospital, again, I work at a level one trauma center. We take care of the knife and gun club, people like Johnny. We have a great violence interruption program, and we were able to significantly lower recidivism once we took advantage of that opportunity. Yes, it's a tragedy you're in the ICU, but it's also an opportunity for us to say, hey, Johnny, let's really think about what we can do to prevent this from happening over and over again. Let's get you into an educational program. Let's make sure you have housing. Let's make sure you understand crisis management and anger management and conflict resolution. And then advocate. Advocate for broader systemic change within your hospital. I spent several years as the chair of my hospital P&T committee. Lots of opportunities within your own system for you to do that. But within your community, within your state, nothing more powerful than you going to the statehouse and advocating for change. The legislators in Indiana still remember the day, I mean, and I shouldn't have done this in hindsight, but I literally was leaving a trauma case, and I had to testify. So I ran from the OR to the statehouse in my scrubs with my white coat on. But they still remember, and no matter what you say, it's going to be much more impactful when, you know, when you're saying it as a critical care provider and within your nation. So, I want you all to know that I actually talk about these issues in my book that I wrote about the pandemic. These are some of the lessons from the book, my top ten lessons. Lesson eight, we cannot be a healthy nation without health equity. We saw this during the pandemic. We saw that the same people who are disproportionately likely to die from cancer or maternal mortality or opioid overdoses were the people who were getting hardest hit by COVID-19. You're going to see it happen over and over and over again if we don't address the root causes of health inequities. And we have to remember that economics and health are intertwined. What's interesting about the pandemic is so often it was you're either pro-COVID or you're pro-the economy. That is a completely false narrative. The fact is, being smart about and controlling COVID actually leads to a more open and prosperous economy. And ignoring it causes shutdowns. So, I know that SCCM has several copies of my book here, but if you all are interested, it's available on Amazon and it actually came out last week on Audible for those of you who like to listen to it, listen to your books like I do when you're driving. But again, I talk about a lot of these issues. And the book isn't wonky. I want people to understand the context of the decisions we were making. A lot of the challenges that we faced. It's not about apologizing. You know, we made a lot of mistakes. It was a once-in-a-century pandemic. But we're not focusing on the right issues to actually address those mistakes. What do I mean? I want to tell you all a really quick story. I said I wasn't going to talk politics. This isn't a political statement. I'm going to give you a context. October of 2020, Joe Biden and Donald Trump were in a presidential debate. And Joe Biden pointed out that 200,000 people had died of COVID in October of 2020. Remember, we had no testing, widespread testing. We had certainly no vaccine at that point. We had very little PPE, few resources, 200,000 people died. It's a tragedy. Joe Biden said any president responsible for this many deaths should resign immediately, should no longer serve as president. That was his last pitch to America for kicking Donald Trump out and bringing in the Biden administration. 200,000 deaths. Fast forward to the end of 2021. Anyone know how many people died in 2021 with vaccines, with testing, with treatments? 360,000. 360,000 people died in 2021. So I don't say that to criticize the Biden administration. I say that because the premise that changing the resident at 1600 Pennsylvania Avenue and the surgeon general and the FDA commissioner and the CDC director was going to change our trajectory has been proven categorically false. Absolutely 100% false. Politics, Democrat versus Republican, that did not change our COVID outcomes objectively. We actually got worse in 2021. Why? Because we were focused on the wrong things. We weren't paying attention to the root causes. And that's the point I make in this book. I also tell some funny stories in the book. I got to meet, I was telling folks backstage, I got to meet some amazing people. Nick Saban, I got to talk to the Alabama football team when they were trying to figure out how to start playing sports again. Another funny story. Everyone asked me, when was the moment things changed in 2020? Was there an aha moment? Yes. It had nothing to do with healthcare. Anyone remember the moment things changed in 2020? It was when the Oklahoma City-Utah Jazz basketball game got cancelled on live TV. When they pulled Rudy Gobert off the court. Sports, again, community, is an important part of what we do and why we do it. Oprah Winfrey called me out of the blue during the pandemic. And I tell the story about her in this book. Amazing. I was at the lowest point. I was literally ready to quit. And Oprah called me and talked me off a ledge. Axel Rose attacked me throughout the pandemic because he hates Donald Trump. He hates Donald Trump. And he attacked me as a proxy. But, again, it's a fun read, but it's a read that helps you really understand the context. Not just for me being, again, a practicing clinician, one of the few, not just me being, you know, the only African-American in the room, but really helping people understand the broader community context of what was going on. I'm over time. You all are over time. But I just want to really quickly hit a couple of slides because I know you all are going to be talking a lot about AI and digital health. And I actually spoke at the United Nations General Assembly a few months ago talking about digital health to an international audience. And I was talking about this in this concept that I call digital health equity. And, ironically, the week after that, the Biden administration issued an executive order on AI oversight. This is incredibly important for you all because you all use all these devices where AI is going to be incorporated. And the promise, again, is that it's going to solve all your problems. It's going to make all your patients healthier. Well, that can happen. Digital health can improve health outcomes. Telehealth increased access. Electronic medical records to look for individual or population-level patterns. Wireless medical devices and wearable technologies. Incredibly important. I mean, now, well, I don't want to get in trouble. This is the new one where they can get your paw socks. It's illegal now. But, again, they can measure all sorts of different things now through wearable devices. Text message reminders and interactive health technologies. How many of you all have gotten a message on your phone from CVS or Walgreens lately telling you to refill your prescription? Here. Virtual and augmented reality is an educational tool teaching diabetics how to better care for themselves. Gamification. Smart homes or environments. Gosh, what if I'd had an Amazon Alexa back when I was growing up telling my mother, the air quality is bad today. Don't let your own go outside. So, what is digital health equity? Well, it's health equity in the digital space. It's making sure everyone has fair access to, trust in, and benefit from new digital health technologies. So, all communities can become and to stay healthy. And we need to be aware of equity and ethics concerns such as the digital divide. Not everyone has access by geography, by education, by age, by economics. Bias is the obvious one. We also need to ask ourselves, how is this information being used? Are you giving information back to people? Who's profiting from it? All this can hurt trust and cause communities not to want to engage in digital health technologies. So, what are the policy levers that we can use to advance digital health equity? Research, payment, what are we paying for? Regulation, privacy and transparency, access. Again, just as with the other areas of health equity, in the digital health equity space, you all can do things to make sure they're actually improving outcomes. And representation and communication are key. You need to have diverse representation at the table to see your blind spots. You need early and frequent outreach to communities, especially marginalized communities, to build trust. Example, telehealth grew by 7,000% during the pandemic. We've been talking about this for 20 years, you all. The pandemic pushed us off the ledge. 7,000% increase in telehealth. That's a great thing, right? Well, interestingly enough, what we found was the growth of telehealth during the pandemic occurred mostly in more affluent and metropolitan areas. So, this 7,000% increase that we all laud actually increased health inequities because not everyone has access to broadband and to technologies to be able to utilize these visits. Not everyone has the educational knowledge or the trust to want to be able to do that. And you think about a mental health telehealth visit. What if you live in a crowded house with 10 people? Where are you going to be able to sit and talk about whether or not you've got suicidal ideation in a private way? Again, all these are issues we have to think about and tackle, otherwise we're going to increase disparities. And hopefully, you all know about this. Breast cancer modalities, screening modalities, are fantastic. They've lowered overall mortality for breast cancer and women to the point that now it's not even the number one cause of death anymore. Now, the big talk is about colon cancer surpassing breast cancer and lung cancer. Well, the challenge is that actually, even though overall mortality has gone down, disparities have increased. Why? Because women of color don't have access to the best screening modalities. And so, again, I just give those to you as examples because as W. Edwards Deming said, and in closing, every system is perfectly designed to deliver exactly the results that it does. And so, I challenge all of you all to really lean into creating a better system so that we really can improve outcomes and it will be better for our patients, better for our communities, better for our economy, and better for all of you. Thank you so much. I really appreciate the opportunity. Thank you.

health equity

social determinants

systemic changes

digital health

public health funding

healthcare advocacy

COVID-19 pandemic