New york famous book row that ran along Fourth Avenue from astor place to union square with 48 used bookstores that competed with one another they have all shuddered except for the strand so thank you for a shifts readers we are Still Family Owned and thriving in fact 400 events and discussions just like tonight and even tonight we have four events it is really fun. [applause] and also thank you cspan for filming this. Happiness is the best medicine us some large enough to send every family of four check of 40000 for their care and happiness is not a big ticket item. Our guest tonight doctor harding will discuss this as an assistant professor of psychiatry at Columbia UniversityMedical Center and diplomat to the american board of psychiatry and neurology work in the emergency room at the New York Presbyterian Hospital and as a daughter of a 91 yearold i spend a lot of timeld there so i have a lot of admiration. She has appeared on Good Morning America netscape and u. S. News world report. Doctor harding is here. [applause] starting with the story with a groundbreaking new research thatws shows how community and environment and the purpose could have a greater impact on our health than anything that happened in a Doctors Office. Doctor harding in conversation as an adjunct professor at the Columbia School of Public Health and for 12 years the chief medical officer the nations largest state Mental Health agency where he continues as a distinguished psychiatric advisor. The addictions solution ertreating the dependency and opiates and other drugs. Inso a family guide to Mental Health care, please welcome doctors harding to the strand for thisan important discussion. [cheers and applause] first of all thank you with that introduction and it such an honor to be at the samee bookstore really i did not grow up in new york but the strand has a mystique to it if you are sitting here among the books it is just really the highlights of my life. Thank you so much and to be surrounded by so many people that i absolutely love. This is an incredibles treat for going to see so many faces from so many different periods. Thank you so much. Because this is a book about kindness just want to take one second and say hello to your neighbor and say hello to your neighbor. Good evening. We wanted to get to know you as ourkn guests a little bit more. How many of you are scientist . How many are from the Mental Health field . How many are writers . Journalists . They are a special form of writers. How many are here tonight because you are a relative . [laughter] how many are here because you are her neighbor and you rely on her medical advice . [laughter] and we think this is a book about vampires . But it is not it must be in another room. And some of you probably wondert what is the deal with the rabbit. That. L talk about so lets learn more about you, kelly. We have heard you have a pretty busy life as emergency room doctor, youou have three childre children, how in the world do you gather the time and energy to write this book . I have to say this book is an incredibly Important Message i know many in the room know this but it became something that was so urgent to get the message out i know this is something you also share aet passion about Public Health or is an important story we are not talking about that affects every Single Person in thisin room. So tell us about the rabbits. [laughter] the central characters. So before i get to the rabbits i want to Say Something as a clinician raise your hand again. As clinicians there is a lot of mystery with the mismatch between what we expect with the disease and what actually transpires in life and in the hospital so those that have a serious diagnosis on paper they are not doing well but then you meet them and they are functioning and doing and living their life fully on the flipside those maybe if you look at the labs and imaging it looks okay but they are not functioning. This mystery propelled me through many years of education psychiatrist thought it was the mindbody connection i ended up Better Research fellowship looking at medically unexplained symptoms i did not have a full answer until i heard about the rabbits. So this was part of your discovery of what you had been searching for. Exactly. One of my mentors at harvard told me i thank you might want to hear about these rabbito studies. I heard something about the social world impact but didnt know the details so i searched and i finally tracked down the rabbits of the late seventies. The studies were done with the intention of looking at heart health and rabbits at the time it wasnt known if a highfat diet made a difference to heart health they were all genetically the same in the fed the highfat diet read the results something was wrong one had far Better Health out outcomes than the others in the scientist said there was something wrong with the protocol but everything checked out so they looked at who was caring for the rabbits one was a very caring woman pwho is actually picking up the rabbits not just giving them avkibble that loving them and talking to them and they realize that could it be the social environment changes their physiology. To their credit because that was a radical idea at the time they replicated the study with tightly controlled physicians with the exact same results so a lot of the studies are serendipitous but this is an example because this is groundbreaking to show the social world has an impact but it was just the beginning of a much bigger story. And then this is the nature of really good science if it doesnt make sense you dont dismiss it you pursue it and thats what they did. So that protective effect the nurture that the colony of rabbits received protected them from disease. That is a phenomenal thing to discover. So the fact that somehow the social world is changing our physiology and that defies our understanding of how the body works but then thinking about the mechanism the main thing is we now have four decades ofnc science since then that shows to the field of Public Health that shows how the social world impacts all of our lives every Single Person in this room are listening on tv they are impacted of the kindness they are giving others and receiving. It comes back to so many different factors related to Mental Health and thats where we enter the discussion. You say these are hidden factors. Are they yet to be discovered . What is hidden . With the social determinants or social dimensions but the thing to keep in mind its always the things in the daytoday relationships what happens in our homes, workplace schools, communitie schools, communities, neighborh broaderto social environment, it comes down to how we take care of one another. So this raises the point that i want to take a second to think about kindness in real life so in my life flushes take a second and think about somebody who is shown you kindness recently just for a couple seconds. Now for me this exercise is very easy now im looking at a sea of people sitting next to me. But kindness makes us feel good but there is emerging science its really cool how the body works and how the social world is changing who we are. So you say these moments of kindness are going to make a difference and it seems like such a rich resource. Actually am curious to your thoughts why do you think it is so underused . I will let you get away with that. [laughter] honestly after i wrote my book, he sent me a book it covers a lot of the same things there are all the secrets that are headed in plain sight basically. Its hard sometimes to take science and implement that day today with the mindset so thein goal of the book i realize when i started the school of Public Health this is information that needs to be in every Single Persons hands because they need to recognize their actions do matter. It turns out a bigger predictor of her health by far is yourct workplace. We think of health like diet and sleep in exercise of the trip to the doctor but not really our workplace as having such an important impact or the neighborhood or access to food or those stress h levels. And its a conversation we need to talk about because the other piece is Mental Health and t that has a lot of stigma for sure and you have seen it firsthand throughout your career. Yet another Public Health problem is loneliness how do you connect loneliness to the problems with our health and helping one another and kindness . It comes down to taking care of one another. As a society were not doing a great job in loneliness is a big piece. Theres all this data that loneliness is as detrimental to your health such as smoking 15 cigarettes per day or alcohol use or high Blood Pressure how many times does your doctor ask if you drink or smoke that whens the last time you called a good friend or saw someone you cared about . Do you have someone to reach out to . It turns out that is critical. Have you gotten a hard time from your colleagues that we are missing the boat asking about smoking or drinking that we are missing the relationship parts of our lives. Is that a hard time quick. I would love to hear from colleagues in the room about thisth but i was just talking about this with the medical students there is record numbers of burnout with physicians those that work in medical care a big piece of that the Current System is not acknowledging the major determinant of our health which brings me to a statistic. Medical care is only about ten or 20 percent of our overall health. But yet when it comes to how much we spend on healthcare and how we think about 95 percent ofre dollars are on medical care and administrative cost. That being said it is important access to medical care is critical but at the same time we have to see the Bigger Picture of health and that includes our communities thinking of the School System and all these other things that are minimized with biomedicine. Is a hard to be kind . What are the barriers. [laughter] what gets in the way . So in my experience writing the book kindness is a practice and its something you have to do every single day we fail that it but its recognizing we can continually strive for. Not talking about grand measures of kindness by looking the person who gives you the coffee in the morning to say good morning and human decency and how we treat other people through society for those that are not as fortunate as we are. Is kindness different from niceness . Thats a good question i dont know the answer. [laughter] once again i have to answer my own question. I think they are closely related i think in the Public Health world or the medical world when we talk about all the social factors, it boils down to one of the great pleasures of writing this book was hearing my wonderful editor to say how do you talk about this to people who werent scientists or academics . It really came down to kindness because that is the golden thread and it has a Ripple Effect because if you act with kindness to someone else you just feel good when somebody smiles at you or do something nice or puts a hand on your shoulder or somebody that has your back we know those things they make us feel better but now increasingly get the science to show it we have to do more of that. I just feel so lucky because this room is filled with people who have had my back i am just so grateful and gratitude is also good for health. Thats another important idea that you have advanced that is gratitude tell us about the practice of gratitude. What is really neat is it dovetails not just kindness to yourself but also to others in an easy way to do that is start with gratitude. When we think about that person that was kind to us increasingly the studies show that mindfulness and gratitude is good for our body. It comes down to stress we know that is inevitable i like how you talk about stress in your work and we have to think about buffers because its a big part of the book to build up our reserves and resilience that when it comes up it doesnt knock us on the floor. The inflammatory process is a phenomenon and it essential to the development of disease and disability. How was kindness and antidote to antiinflammatory whsponse . Help us understand. This is some of the coolest science the neuro immune system us not understanding how that was working to explain with theti patients i was seeing they are not feeling well but we cant find something wrong on the traditional path because the test dont measure the right things necessarily. But also what is cool is in this country we separate the mind and the body in a very physical way with mental hhealth with places of care but we dont think of people there is a doctor for every bit of your body weve gotten so specialized on the one hand its helpful but we still need to step back and look at the Bigger Picture it with these conversations happening in bookstores and communities around the country. Are you asked to coach my friends how to talk to their doctor about the inflammatory response or kindness or those social factors that determine health . How do people know how to bring this up with their doctor quick. Its fascinating i am curious to hear your response but people will say have this one doctor who is phenomenal and asking these types of questions like the way people currently they dont ask about their social life in a ten minute focused visit and thats if you aref lucky that feels like opening the lid of pandoras box. So the key way that i talk about raise your hand if you are familiar with aces. I am impressed. So one of the things are experiences that happen that are present in our environment like smoking in the forties people really didnt think it caused lung cancer took many years to figure f out this is causing diseases across the board. So trauma is one of those and etwe dont really talk about it many doctors dont know about it but there is an easy test you can take online called the aces is too high with a history of trauma but every other person you pass on the street has some history of trauma in their past there is a lot of shame and stigma so people dont talk about it but it comes back to the question so what do you do if somebody is unkind . Because hurt people hurt people if somebody isnt present but that is part of the story because people think kindness is great until suddenly there is a structural situation or somebody yells or cut you off in traffic but actually its about conflict resolution navigating our world to hear other peoples differences in the way that we can problem solve and that were not doing a good job of that right now and for our society and health frankly we need to have moreav conversations where we can create a bridge. Thats a good concept what are examples of the experiences that children have that leave them with this residue for the rest of their lives . Im glad you mentioned that. Anything during childhood could have a lifetime consequence when it comes to health the first study was an incidental finding that was too curious to let go so what is so interesting is mike the loss of a parent or witnessing abuse or the things you would think about harshly talk to but what is empowering is having some ability to come in all different modalities address the traumas that they have. And these are traumas that can be identified early in a childs life. When that happens what can be done to help spare the child the problem quick. A lot of this work is done in california is not just happening in the clinic seeee you identify aces and from there a lot of the resources are things in our community but this isnt what we are supporting with the current Healthcare System but a lot of interventions make a huge difference on health are lowcost the rabbit effect are things you dont have to have a white coat and the vast majority of the program you just have to have the Good Intention there is a lot of Peer Health Educator program so theres ways to get i involved this is just one example of hundreds so it turns out volunteering is good for your health. You live longer. And then to get involved in. Do we ha teachers in the room . Awesome. Pictures that you are really in the healthcare business so the statistic was mind boggling for every one life saved with biomedicine education saved eight. But it turns out you really dont need a white coat to help people. I have incredible students in the room i dont want to minimize that but i also want to say and then to participate whether you know whethers or not. So now im really making a point to reach out to people when i see someone in need i dont necessarily walk by the think of something creative. So now the writing and then the speaking that has changed you spend with the biggest changes in the last week. I was sharing earlier i didnt think anybody would show up but someone with us we were shopping the idea around and said kindness doesnt sell. Incredibly heartwarming it turns out fallout of my chair because of it but people do care about kindness because rat a critical point of the communities where we talk about p it. Of that important change will require all of that. Thats very good message to leave us with and maybe now there are some comments or questions from our guests. So now we get to get copies for everybody we know. Thankfo you. I am a happiness engineer. I do this. So this response relationship on kindness receiving or giving. [laughter] that raises the important point because we talk about how people are in a lot off pain if they look for a pill or to the Doctors Office you just have to do the Google Search why do i feel so tired or alone . That wont necessarily come in a pill we can overdose on but i cant remember a single case in the emergency room somebody overdosed on kindness. [laughter] may be a somebody is