Expanding that theyre on how zip codes are an indicator of Life Expectancy. From the Computer Museum in mountain view, california, this is an hour and a half. Designed to change policy and encourage Civic Engagement in 14 california communities are affected by healthcare inequality. Prior to that selfdestruct in county health officer, and if you look at his resume use a string of academic degrees thats very impressive to say the least. He is going to be interviewed tonight by vanessa mason. The cofounder of p to help benches, Public HealthTech Venture Fund pictures also ceo and founder of riveted partners, Digital Health consultancy if she knows what shes talking about. This should be fascinating. Please join me in welcoming both tony and vanessa to the stage. [applause] [applause] all right. Well, this promises to be a lovely evening. Just if we get started with interviewing doctor eitan, he has a wonderful to show just by Building Healthy Community initiatives got started and wrote the impact they have already. Were going to watch that first. What determines how long we will live . Is it what we do . Is it who we are . Actually when he comes to predicting how long you will live, your zip code is more important than your genetic code. Heres how this works. They both have jobs, around the same age, both married and they both have two kids. She lives in a count by maria lives less than one mile away. They are similar in so many ways but heres the thing. On average residence of the hill will die more than 15 years sooner than the residence of a town. Why . Because where you live is about more than just your address. Its about your opportunities here for example, their access to Healthy Options is really different. In a town her profeminist ready healthy food options, including Farmers Markets, grocery shops and Grocery Stores. The air is cleaner and fresher and there are lots of safe, clean parks when she can exercise and her children can play. A town is good Public Schools and easy access to emergency and Preventive Health care. On the other hand, bvlle, the air is filled with truck exhaust and for food options are only choice are transforming a liquor stores, convenience stores. The schools and bvlle overcrowded and under supported. Even with maria can get her kids into better schools far away, she needs to figure out how to get them there without access to a car. So for me having to juggle so much can be a source of chronic stress which is a Serious Health risk factor. And all the residents of bville, stressed drives Health Problems like diabetes, asthma and heart disease. How did they get so different . In many cases in cities and towns across california, the root cause was racial and economic discrimination. Over the generations, poor white people and people of color were pushed to less desirable parts of town where banks refused to lend money, businesses left, jobs, too. Schools declined and neighborhoods crumbled. Everyone who could move away did. And whats more, when communities like a town and bville so unequal, bville isnt the only one that suffers. Because it turns out not only is your zip code a predictor of how long you live, so is what country you live in. Countries with the greatest income inequality have the lowest Life Expectancy. So even americans like dad were white, insured, collegeeducated and upper income, die younger than their peers in other countries. In fact, our Life Expectancy is 43rd in the world, and that number is slipping. In the end, our Biggest Health risk may actually be inequality and extreme inequality hurts us all. So what do we do . Well, if were all going to be healthier, we dont just need to help the folks in bville beat the odds, we need to change the odds for everyone. And thats what were doing. Theres a movement happening where californians, we dont follow. We lead. Were building the power to make health happen in communities across the state. We are coming together to build one california, a smarter, more inclusive and equitable state that creates health and opportunity for all of us. Join us. To learn more visit building healthy communities. Org. [applause] so thank you so much for bringing this video to us. Its a really wonderful willing way of posting what the foundational public of concept. People have a hard time understanding i know were both in this innovation picture pursuing policy. Myself through more of that technology and finance it but i to hear from you tell how did you get started with this research and kind of chart starts on the story because as we move along you guys will be able to see how technology is playing a role both in the discovery and moving this forward as well. Yes. So its actual interesting because its kind of a technological story. I was, im going to tell you the quick version of it but but i t to medical school at Johns Hopkins and for the the you who may not know, Johns Hopkins medical schools located in east baltimore, which is one of probably the worst slums in america, if not north america and it was a real shock to me because id grown up in canada and kind of candidate had sort of a deep level of investment in its people, universal healthcare, universal childcare, paid sick leave, vacations, heavy investments of public art and infrastructure. I grew up in montreal and what i got to east baltimore at us all the conditions, i was really quite shocked. It triggered this thinking in my head that in the u. S. , where you live ultimately cheaper health more than any of your genetic factors . I got interested when i graduate medical school and then i went through studies in policy, i get interested in how do you illustrate these differences between neighborhoods and the impacts, the ultimate cumulative impacts on people self . Using technology. At the time this was in the early 1990s, Geographic Information systems were just sort of coming online and i cut it got hooked on gis. If we can bring up the slide, i just want to show just a couple slides of the sort how we approached this work. I do that . Debacle. So most of you probably dont recognize this but you all have one of these at some point in your life. This is a death certificate, and when you are the county health officer, you are the registrar of all births and deaths. There are about 10,000 deaths a year in this county. I get really excited with the technological possibility of using these death certificates to start painting a picture of the distribution of death across Alameda County. Each death certificate needs my signature on it before the body can be buried or cremated or whatever is going to happen to it. Its a real opportunity to get very good data because you can refuse to sign a death certificate to the certificate is completely filled out and you all the data you need. On the death certificate the date of its most critical for doing this is the age at which somebody dies, their race ethnicity, what they died of an way they live. All of that information is on the death certificate so you can take a death certificate and you can plot a map. Visit Alameda County which is shaped like a boot. Each of those boundaries are census tracts in Alameda County, about 150 of them. You can calculate in any given senses attract the average age to which somebody can expect to live. When you do that the green areas are neighborhoods that would Alameda County where people can expect to live greater than 80 is picked the right areas are areas with people cannot expect to live about 74 years, and then the yellow is in between 74 and 80. You noticed very quickly that are clusters of red areas. There are neighborhoods in Alameda County what people die earlier than others. This is a phenomenon that you contract is over decades. This is not a fluctuating phenomenon. These neighborhoods have been essentially concentrated neighborhoods of premature deaths for decades. This was very interesting. This ended up on the front page of the San Francisco chronicle, and people would say to me after this happened, it caused a bit of a stir, they would say whats the story with Alameda County . Why is it so inequitable . My answer was, its not just Alameda County. So we had to start looking around the country for other places where we could replicate this gis analysis. It was something that wasnt really done at the time, to look a relatively small geographic areas in calculating Life Expectancy for a neighborhood. And then comparing those neighborhoods to other neighborhoods in the same city or the same county. We took our map of Alameda County and i had to go back to baltimore because thats where i had come out of school and this it triggered my whole interest in this issue. Baltimore there are neighborhoods where people on average live into their late 50s, and so they were dramatic disparities across the city of baltimore. We went to cuyahoga county, cleveland, which showed neighborhoods with 25 years of Life Expectancy difference between neighborhoods that were within a mile and half of each other. New york city hermetic disparity, seattle, los angeles, minneapolis, boston, philadelphia, san antonio. Everywhere we looked. We havent found a city in the United States yet that doesnt have a significant Life Expectancy difference from neighborhood to neighborhood. This is the american pattern. Before you really had the technological ability to bore down into neighborhoods and use larger data sets that sort of discernment these patterns, we didnt understand this. We now understand that you can have two contiguous neighborhoods with a Life Expectancy difference of 15 years. Thats a fixed difference. Its not something fluctuates from yeartoyear. And try to understand that is what i have spent my career basically doing. So thats how i got into this. Yes, and that is certainly the problem at hand and i see that in my work as well. We are a fund that is infested in prevention and Health Care Disparities trying to find technology that addresses of those. So the question is unfortunately universal and persistent and were going to get into may be how we address that today. Some of the more into the policy perspective, like queen of the zip codes in house relationship is here the aca is on everyones minds. Visit our is it going to be gone at any point in time . From your perspective, like how has the aca help to decouple the relationship between the zip codes and health, and how could repeal a fact that relationship . Yeah, so this is a little complex. Its not really that complex but you might think its complex the way i explain it. [laughing] health care is important for you because obviously when you get sick you need access to healthcare. Healthcare helps you avoid adverse consequences from being sick. But thats not the most important reason that the aca improves health. One of the things we try to explore in these neighborhoods where you have chronically low life expectancies trying to understand what are the drivers of that . Was happening to people in these communities . The things that you come away with most obviously is that people in those communities, mostly low income communities, are facing inexorable stress. Basically every system that theyre trying to engage is failing them, transportation, housing, employment, criminal justice. Even water in some instances. So people are navigating in an environment we are constantly facing stress, and stress is basically a balance between resources and risk. And in those communities of their facing enormous risks and the have limited resources. They are constantly other ballots. What that does is it creates a fancy word the way of explaining it is called out the static load but actually chronic stress. That changed your physiology and the changes your genetic expression and over time it actually mimics premature aging in these populations. So the issue of the aca is that the reason the aca is particularly beneficial for your help, and all of the western democracies around the world that have universal Healthcare Systems so to recognize this, is that it reduces stress. It allows you not to have to worry about what will happen if you get sick or your children get sick, or you get hit by a bus or what have you. So that aspect of it by reducing the load actually has profound Beneficial Health impacts. And thats the fundamental approach that weve taken in our work. Wonderful. And its something that weve been keeping close track of, i know tom price Just Announced their trying to scale back bundled payments. Paying for outcomes is stored td introduce questions about whether or not that is still going to be around. So getting more into the work, so how are your local partners really using technology to improve the health of the communities that you work with . Yeah, so i love technology. I mean, its just fun to work with. Its great. We have data sets that we never had before. We have the ability to manipulate this massive tomes of information and get a relatively small questions. But the thing that we recognize i think that is most important about technology where the real potential lies because of this recognition of health, not just time a low income people, not just the people of color. Were talking that all americans, all of us in this room are experiencing allostatic load for it varies in terms of its manifestations. Again, this risk versus resources balance. A lot of the risks are societally created risk, unnecessary, manmade. The way other societies attend to them is through policy. Universal healthcare is one obvious example of that but also subsidize education and housing policies that reduces the risk that people have to face. So this notion that people are experiencing this heavy risk, this burden of risk in their lives is a fundamental issue with trying to address in tackling these problems. How does Technology Work for that . We recognize when people can participate specifically in their environments, fundamental would talk about people who feel they lack of control over whats happening for for the lack of control is very bad for your health. I can go into the physiology of that, but bottom line is feeling that you lack control or agency is bad for your health. So if you want to help people develop agency or sense of control, one of the ways that you do that is to organize them, to bring them together with similarly situated people to have them start tackling things that are presenting essentially risks in their lives. One of those things is government, unfortunately, or the lack of policies where people are looking for policies to benefit them or their families. So technology that allows people to participate civically, tuple, express their opinions locally, whether it be city council, school board, with the services that theyre getting, to rate those services, and so theres accountability to some of the service providers, thats health protected. So part of our strategy is to essentially facilitate voice in communities so people have more control over the resources that are ostensibly designed to serve their needs. They also have the ability to hold systems accountable for more equitable use of resources. Great. And i know for a lot of you who arent technologists, hearing as talk about healthcare, its kind of a a hard thing to wrap your mind around that healthcare is not actually the same thing as health when you look at media and read about it that those two things often get conflated but they are, in fact, to completely things. A lot of what youre working what my work and thinking about a fight and the stars for investing in where interested in addressing these issues like how can we alleviate though sources of stress, like working technology address transportation . Working at address of the sources of stress and the social determinants of health that are really driving a lot of stress and problems. You are obviously officiating but a researcher at heart so where can Technology Help playable doctors, advance practice and would accelerate potential interventions or things that can really help to address this problem . I think one of the challenges, im an internist, you know, the paradigm of medical care is sort of like these 15 minute interventions in a cubicle, you know, where this doctor sort of this gorgeous this information, you do, takes that and applies it in their daily lives. Thats a failed paradigm, and the notion that sort of experts hold the answers i think is a flawed notion. And so many of the community in which we are working on trying to we designed a Healthcare System, trying to think of healthcare more from the perspective of how do we bring people together in a way where they can help each other, as opposed, and many of the challenges, the 21st century challenges are challenges of chronic disease. They are not challenges of Infectious Disease or acute problems as much as they were in the 19th century. Our Healthcare System is to a 19th century design where you go into an expert an expert gives you a drug and that drug solves your problem. The 21st century problems are heart disease, cancer, stroke, chronic lower respiratory disease, chronic diseases which are more related to the environment and the lifestyles to which People Living. Those lifestyles are shaped oftentimes my policies where in some cases is the absence of policy in the face of abject need. To bring peopl