>>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]
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