Jo Ivey Boufford, MD, NYAM President, Delivers 2011 Commencement Address at Pace University

NYAM President Jo Ivey Boufford, MD, received an honorary degree and delivered the commencement address at Pace University on May 22, 2011. The following is the text of her address.

Thank you, President Friedman, Provost Feldman, Dr. Bianco, Deans, honored guests, faculty, graduates, family and friends. I am very grateful to receive this honorary degree and to be invited to greet and congratulate the Class of 2011.

First, let me begin by expressing my admiration for each of you who are graduating for your accomplishments—and express my congratulations and respect for your family members, spouses, partners, and friends who provided the love and support so critical to completing this important phase of your careers!

It’s a special pleasure to address this class, which includes the first graduates of your new College of Health Professions—the Lienhard School of Nursing and the Pace Physician Assistant Studies Program. But my message today is that in reality you are all health professionals now. 

Whatever career path you choose, you will have the opportunity to create healthy communities, particularly if you work in partnership with each other. Before I tell you how, let me explain what the problem is and why you can, indeed, why you must be, part of the solution.

Did you know that the US spends more per capita and a larger percentage of its GDP than any other nation on health? What we have to show for these expenditures is impressive – the world’s most technologically sophisticated personal health care system alongside tremendous advances in biomedical research.

But their combined effect on the overall health of the US population has been disappointing. Among the world’s richest countries, the US currently ranks 23rd globally in infant mortality, and  21st in adult life expectancy. One in three adults is obese and 7 out of 10 premature deaths are from generally preventable non-communicable diseases like heart disease, cancer,  respiratory diseases, and diabetes.  In many parts of our country and here in this City,  health disparities are actually increasing, especially in  poor communities, which are often communities of color.

So why have our investments not resulted in higher levels of health? We now have a great deal of evidence showing that health is affected by many factors or determinants—not only health care; in fact, only about 10% of premature deaths in the United States are due to a lack of access to personal health care. 

Twenty percent are due to the physical and built environment, like pollutants in the air we breathe and urban planning that doesn’t provide adequate, safe spaces for physical activity. And 50% of premature mortality is due to risk behaviors like smoking, unhealthy diet, lack of exercise and alcohol and substance abuse, all behaviors that are heavily influenced by the socioeconomic conditions in which people live—conditions that limit the healthy choices they can make. 

The most important conclusion to be drawn from these findings is that if we are going to create healthy communities, all the many stakeholders in the community—businesses, community-based organizations, schools, the media, the health care system and local government public health professionals must:

l) share a good understanding of the health problems they face,
2) be aware of  the actions that have been proven to work, and
3) develop agreements to work together to act for health.

Health is truly everyone’s business.

U.S. policymakers have been slow to realize that while we need to maintain the quality of our biomedical research and  medical care enterprise, we have to improve the balance of our investments in health, and strengthen personal and community based prevention that tackles the risk factors that are making us sick.  

The current health care reforms begin to put us on the right track. The commitment to providing universal financial access to the health care people need and the personal preventive services appropriate to their age without co-payments are a critical step to addressing significant health disparities in clinical care.
But, the reforms also provide unprecedented financial support for programs that act at the community level to prevent tobacco use and promote exercise and healthy diet—these programs require the expertise of all of those stakeholders and community groups I mentioned earlier working in partnerships for health.
This commitment to interdisciplinary action and a team approach to problem solving is fundamental to the education you have all received here at Pace.

We are fortunate to live and work in a city like New York which has become a global example of a city that considers the health impact of all its policies.  Mayor Bloomberg, a financial expert by training has become a true change agent for the public’s health. He has  harnessed the regulatory powers of city government to create environments that steer the public towards  healthy choices by banning smoking in most public places, banning trans fats in restaurants, requiring calorie posting by fast food chains, working with food producers to reduce the  salt content in their products, and proposing taxes on sugar sweetened beverages.

And as examples of health action in city agencies and sectors that we may not think of when we think about health, like transportation, environmental protection, parks and city planning, we have seen the establishment of bike lanes, play streets, pedestrian malls, and free fitness programs are being offered in parks, community centers and housing complexes. While they have not all been without some controversy, it’s usually reflected the need for greater community consultation and dialogue—fundamental to any lasting health change—and the positive results are beginning to show.

Recent air quality testing in the Times Square car-free pedestrian plaza has shown dramatic reductions in nitrogen and carbon emissions from reducing motor vehicles. And more change is planned for the future. By 2030, the City plans to create 400 acres of new parkland by revitalizing the waterfront; add 200 miles of bike lanes, plant 1 million trees, and make sure that all New Yorkers live within 10 minutes of a green space.

Another project being implemented in NYC is designed to address the fact that, by 2030, over one fifth of NYC’s population will be over age 65—there will be more older persons living in the city than school children and they will be one of the most diverse older populations in any city in the world.
 
The Age-friendly Cities model was developed by the World Health Organization to shift the way we think about Aging as an opportunity and not just a problem!  We at the New York Academy of Medicine are supporting a public private partnership Commission for an Age-friendly NYC appointed by and working closely with the Mayor and City Council.

The work of the Commission and the City is shaped by information provided by thousands of seniors from all 5 boroughs on how modifications in domains like housing, public spaces, transportation, community and civic participation, and health and social services could improve the quality of their lives and make it easier for them to stay active and engaged and give back to the city they love.

Local businesses and community organizations are taking note and making changes.  At the same time, the Mayor’s Office and the City Council asked all city agencies to examine their work through an “aging lens”.

Their first reaction was “we don’t do aging, the City’s Department for the Aging does.” But once they began to think about the realities of how their work can impact the lives of seniors, the City came up with 59 unique initiatives specifically aimed at improving the quality of life for older adults. The Commission has just issued its first annual report with very good progress implementing aging improvement districts in East Harlem, the Upper west Side and Bedford Stuyvesant; defining and enrolling age friendly businesses, and developing age friendly schools, colleges and universities. Perhaps Pace can lead the way in this latter program.

Housing is also critical to health. Just last week, the first-ever grant from the U.S. Department of Housing and Urban Development (HUD) to improve indoor air quality and eliminate household environmental conditions that exacerbate asthma symptoms was awarded to a faith based community organization Little Sisters of the Assumption with deep roots in East Harlem, a low-income, minority neighborhood where asthma is a leading cause of school and work absences, emergency room visits and hospitalizations. NYAM will partner with them to evaluate the project goals to reduce the number of missed school and work days and hospital visits by at least 40% and use the evidence  to inspire similar initiatives elsewhere in the city and across the country.

As you can see, the physical, social and political environment is becoming more welcoming for new investments in community health and prevention and the evidence is emerging to demonstrate the return on investment for every dollar put into healthy interventions in the workplace and community, many within 2-5 years.

Even the global community has set goals for health and development and is making unprecedented investment in global health: both to address the major disparities among countries and within countries and because it is increasingly clear that a healthy population is fundamental to successful economic and social development.

Billionaires like Bill Gates and Warren Buffet have committed their wealth to assure the global availability of medicine and of vaccines to save the lives of millions of children. This September for only the second time in its history, the UN General Assembly will have a debate among heads of state on  a health issue—the growing epidemic of non-communicable diseases, not only in  high income countries, but in developing countries as well.

As I hope you can see, while those of you graduating from the College of Health Professions have made a career choice to develop and use your  expertise to work in the health field, each of you, whether preparing to be future teachers, lawyers, IT experts, artists, writers, investors, business owners, urban planners, legislators, and active citizens in your own communities, will be needed to bring your unique expertise to tackle  the many challenges to good health that we are now coming to understand.  

I encourage you to apply the critical thinking skills and the professional values you’ve acquired through your Pace education to become a force for change in the health of your own communities and to contribute to eliminating the health disparities that affect many of our people. Each of you can make a difference through your work, your commitments to your family and community and your advocacy for the kind of policies and programs that will make it easier for everyone to make the healthy choice. Thanks you for what you will do in the future, and congratulations!

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Posted on May 23, 2011

Contact:
Andrew J. Martin
Director of Communications
The New York Academy of Medicine
1216 Fifth Avenue
New York, New York 10029
212-822-7285
amartin@nyam.org

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