Hey, good morning, everybody. And thank you so much for joining us on this final day of the sessions for AOHC 2022. It is my pleasure to moderate and introduce this amazing panel. And we'll be discussing building to better health, the role of the built environment in health and well-being. And I will be your moderator, Dr. Rosandra Day Walker. I am an occupational and environmental medicine physician and a total worker health trainee funded by the CDC NIOSH. We also have our panel speakers. And this is also co-moderated by Dr. Warren Silverman. And our panel speakers, Dr. Blythe Mansfield, Dr. Karen Lee, and Dr. John Clark. No relevant financial relationships have been identified to the material presented. And these views and opinions represent ours and ours alone. So if you know me, I like to make people imagine things. So I'm going to ask you, if you feel safe enough, to close your eyes for a moment. And I want you to imagine your favorite city to visit or a neighborhood that you really loved living in or that you live in now. What was it about that environment, about the design, the architecture, the green space, maybe walking paths, shared social spaces where you could easily gather or take your family or meet friends, accessibility maybe, easy to access public transportation, clean air, happy people? What aspects of it do you wish every city or neighborhood had? All right, open your eyes. So today, we're going to talk about those aspects that maybe came to mind for you in terms of the built environment. So the built environment is a term used to describe man-made or woman-made, person-made objects or spaces that form a community. These can include buildings, roads, sidewalks, parks, schools, work sites, and homes. It can also encompass services provided to a community, such as public transportation, water, and sanitation. And so when you think about healthy communities, health and wellness, you probably think of things like access to recreation and open spaces, access to healthy foods, to medical services, environmental quality, safe neighborhoods and public spaces, completeness of neighborhoods, access to economic opportunity, access to quality affordable housing, and more. The built environment impacts the health of the public by creating spaces that either promote or prevent good health and well-being. The built environment can influence rates of physical activity through community design efforts, like planning for sidewalks. It can impact levels of fruit and vegetable consumption, such as food and beverage consumption, and it can impact the quality of life and the quality of life in the community. And through development, it can limit human exposure to air pollutants through land use planning. And as you know, these are very much analogous concepts that we in our workplaces are often charged with helping design for safety and health for workers. So our expertise and our experience is also easily transferable to healthy community design. So public health experts, like ourselves, have the opportunity and are actively working with planners, developers, engineers, and transportation authorities, among others, to intentionally design communities in ways that advance health equity, prevent disease, and improve overall health. I actually learned about this from Dr. Robert McClellan just two nights ago. He shared with me this collaborative called the Action Collaborative on Business Engagement in Building Healthy Communities. This is actually an ad hoc convening mechanism under the National Academies of Sciences, Engineering, and Medicines Roundtable on Population Health Improvement. Their purpose is to catalyze and facilitate private sector partnerships and actions of business, health, community, and the public sectors to work together to enhance the lives of workers and communities by improving the nation's health and wealth. And so when Dr. T. Gaddadi was speaking of environmental sustainability, obviously and ultimately, this is a question of just that. As the boundaries between work, home, and community life become increasingly porous, the built environment represents an even more crucial leverage point for our health and well-being. Occupational and environmental medicine professionals can serve a powerful role by informing policies, plans, and policies to improve the health and well-being and by improving policies, plans, and designs for the built environment and other social determinants of health. Today, our panelists will explore this topic and there will also be a couple of hypothetical scenarios posed to them as well as the audience to discuss tangible ways we can advocate, inform, and influence decisions that have implications on environmental health, both at home and in our communities and at work. So ask yourself, what can we be doing today, large and small, to ensure a sustainable and healthy future for generations to come? So I'd like to introduce our first panelist, Dr. Blythe Mansfield. Blythe Mansfield, M-D-M-P-H-F-A-C-O-E-M, is a diplomat and a fellow with the American Board of Preventive Medicine in Occupational and Environmental Medicine and also holds certification as a medical review officer. She currently holds the position of medical director for Unilever North America. Dr. Mansfield is a member of the Houston Health Forum, National Medical Association, and the American College of Occupational and Environmental Medicine where she serves as chair of the corporate medicine section and alternate delegate of the environmental section and past president of the Texas State Component. She lives in Paralim, Texas with her husband, children, and two dogs. Dr. Mansfield, welcome to the podium. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. Thank you. So I want to give you a little bit of history of why we are where we are now and how do we move forward. So let's talk about the early migration patterns. We know that early hominids began migrating out of Africa about two million years ago. And then homo sapiens began their migration journey about 50,000 to 70,000 years ago. But the migration to the Americas began after the end of the Ice Age. And the theory is that they came through Siberia and Alaska. It was just very cold, so they started coming here. And historically, migration patterns tended to be horizontal or latitudinal. People moved from more population areas to more rural settings. They wanted to get away from the people. So now we have different patterns of migration. That was what we've seen historically. And also, history does repeat itself. People tended to leave their homes because of war, religious oppression, for further economic opportunities. And what we're seeing now in Ukraine, we're seeing migration to different countries to escape what's going on now. So some of the patterns that we've seen over the last many years in the US are that the US has experienced major waves of migrations. And they've all been very different in a sense. And some of the, I guess, larger periods of migration happened in the 1800s, late 1800s to early 1920s. And if any of you all have been to Ellis Island, that was one of the largest immigration events that was held there. It was one of the largest immigration centers. It's a federal center where most of the immigrants came into. In fact, my great-grandfather came into Ellis Island in the early 1900s. I was able to go there and actually see his record. So if you have an opportunity to do that, I think it's worthwhile to do that. And more than 12 million migrants entered through Ellis Island. So migrants came here because they thought that they were part of the communities. And of course, that led to industrialization, urbanization, cities grew. And then we saw patterns of the Jews coming in after the Holocaust. And that was about two million Jews and about 600,000 Italians came. The peak year for immigration was about 1907, where we had 1.3 million immigrants come into the United States. And then during the Depression, we saw a plummet of immigration because nobody could essentially move. And that lasted from 1930 to about 1950 for about 20 years. But post World War II, immigration came back. People started moving back to the United States. And many of the immigrants came from Europe and the Soviet Union. And then of course, in 1959, hundreds of immigrants came to the U.S. from Cuba, many settling in the Florida area. So 1965 was a pivotal year where the federal government passed a act called the Immigration and Nationality Act. And it allowed sponsorship. So there were some shift in patterns and you needed sponsorship to get here, essentially. And so today, now we have a lot of immigrants coming from Latin America. We don't see as many from Europe as we did in the past. So the Great Migration, so it lasted about 60 years. And it was essentially a period of time where approximately six million African Americans came from the South to a variety of different cities in different regions. And the driving force was to get away from the racial violence in the South, as well as the Jim Crow laws. They wanted freedom. And so they came in waves, essentially. There were two periods of the Great Migration. The first period was from 1910 to the 1940s. So that 30 years was a time where African Americans moved mostly to northern and midwestern cities. And there were lots of jobs then that they wanted to take because many of the citizens of those cities had to go to war. So it left a lot of unopened jobs. However, when they got there to work in these jobs, they got less pay. There were housing issues. And it just kind of started the cycle that we're in now, essentially. Phase two was after World War II. And the pattern was more northern and the west. So they moved out to California and other western cities. And more jobs were created, of course. But there was still housing discrimination, which worsened. And then there were covenants placed, which there's still some, I'm sure there's places where there's covenants where African Americans or other different nationalities cannot live in certain housing developments. In fact, in Texas, I think, there's still a few, unfortunately. And there was also redlining and still segregation. So there wasn't a lot of escape from the south. Some of the things that happened during this migration period are still happening and really sets the stage of what's going on now. So this is a photo of Detroit. And I'm from Detroit. And I grew up in a city that was like dilapidated. It was pretty terrible, because I grew up in the actual inner city. And our neighborhoods were pretty much destroyed after the riots. But it's still a great place. We had a lot of air pollution, had a lot of asthma problems. And now Detroit's coming back, which is great. You wouldn't even recognize it if you haven't been there in the last few years. And so these mass migrations cause a lot of environmental health issues. Detroit is the motor capital. Well, it used to be, at least. Lots of automobiles, not much public transportation. And so we do have quite a bit of air pollution there. And of course, the factories. In many of the factories, I don't know in your cities, but in Detroit, the factories were located on the south side of town. And the south side of town tends to have more factories, which is interesting. But there's still significant racial economic disparities in Detroit and other cities like Detroit. And it's gonna take generations to solve these problems. So urbanization is essentially when a lot of people move into kind of small environments. And they're just crowded cities, essentially. And it results from immigration, people coming into the cities to work, as well as industrialization. Lots of jobs and factories and that sort of thing. So typically, in the olden days, factories were located in urban areas. And they attracted immigrants because of the jobs. So people came from rural areas. And then cities started growing at really fast paces due to the higher economic opportunities in these cities. And of course, in cities, you have incredible benefits and services. So that was desirable for people to move to cities. But at the end of the 19th century, there are a multitude of factors that just made life great in the cities. And all the electricity and access to telephones and that sort of thing. And so improved technology, I mean, we're still improving. But it was just much better in the cities than the rural areas. And then skyscrapers allowed lots of people to live in small areas such as New York City. So you probably can't see this too well, but in Asia, it's desirable to live in big cities because if you live in a large city, you're known to be more affluent. So there was a large population growth in Asia from the farm to the city. So we're still seeing this in other parts of the world. So what are the health consequences of urbanization? There's a multitude of things. And so in 2020, we're approximately, I would say 55% of people live in cities. So that's over half of the world's population. But this is predicted to increase to about 70% by 2050. And 96% of the growth is going to occur in developing countries. The impact of health is, it's ambiguous essentially because living in a city, you have more access to healthcare, more resources. However, on the downside, you have more sedentary people. There's not as many bike paths and greenery and more stressful lifestyles of hustle and bustle and unbalanced nutrition. Everybody's on the go. There's health impacts from air pollution, carbon dioxide and particulate matters. And also there's an increase in risk of transmission of communicable diseases as we've seen in COVID. And of course, more chronic health conditions due to these lifestyle factors. So rural America is struggling essentially. Majority of the farm workers in the US are immigrants. Many Americans essentially don't want to work on the farms because it's a very strenuous lifestyle, it's hard work. There are farm labor shortages. And this is because there's been a decrease in this movement into the farms from immigrants. They're starting to not want to come to work on our farms. And of course, there's labor shortages due to the rising wage demands. And so I don't know if you saw in the news the last couple of days that there's inflation. All the costs of all the farming commodities are very, very expensive. They can't run their farm, so it's gonna cost more money to buy produce and things in the grocery stores. And the rapidly aging workforce, if you work on the farm, harder work. You're working out in the sun, so you have more of a rapidly aging workforce. And of course, the H-2A visa program has been very, very difficult to get workers to work in these farms. So global warming is contributing to lots of factors. One is arable land. And we will probably likely see, and it's not known the exact percentages, but arable land is expected to increase in Russia, China, and US. However, it's expected to decrease in South America and Africa. So if you have less arable land, you have less opportunity to grow things and of course, that's going to complicate our food and security issues. So does anybody recognize this city? Yep, Chicago, anybody live in Chicago? Or does anybody live in a megacity? Houston is almost a megacity, it's not there yet. So Houston, we have about six million people and a megacity is considered to be about 10 million. And so you'll see here that in 1800, 2% of the world lived in megacities. Over 200 years, that grew to over 50% living in megacities. And so the megacities that we know of are Tokyo, we have Shanghai, Beijing, and the growth is expected to increase. So in 1975, we had four megacities. By 2000, we were at 18. So we're seeing this constant growth. And currently, we have about 28 megacities right now. And that's expected to increase to about 39 by the year 2050. So that's gonna be interesting. So your city may end up being a megacity. So living in a megacity or very urban environment, there's concerns of increases in energy consumption, heat islands are formed, which results in changes into the weather. There's more severe storms. And in general, cities tend to be warmer than rural areas. Also, there's increased radiation. The radiation is unable to really escape, so it just stays in the cities. And so by 2050, it is predicted that the global population growth will add about 2.5 billion people to urban areas. So that's tripling what we have right now. And I saw the slide in another presentation, but basically, the environmental health impacts due to climate change, I mean, it's worsening. You can see that we were at 300 parts per million back in 1950, and now we're over 400. So we are going in the wrong direction. This slide just shows how, in 2050, we're expected to continuously increase in the urban areas and decrease population in the rural areas. So this is a scene out of Star Wars, and this is scary. And I hope my city never looks like this because I couldn't even imagine living in a place like this. However, there are cities that are going to look like this. They're already starting to end up that way, and it's going to cause a lot of environmental health impacts. There's going to be new chemicals introduced. You have all these buildings and VOCs. There's so many things that come from this type of industrialization and urbanization, which is not good for the environment. And so things are likely to worsen. I don't want to be the bearer of bad news, but we have to do something about it because we don't want things to worsen. So it's important that we really start to focus on environmental health issues as physicians. We need to move to sustainable urbanization, which Dr. Day-Walker talked about sustainability, and it's a word that is very important, and I've heard several lectures about sustainability. And we need more policies, essentially, that really protect those that are more vulnerable and of lower socioeconomic status in terms of housing, where are people going to live, and how are they going to afford housing, food insecurity, that's a concern, education and health. So there's things that we need to do, and I think it's going to boil down to a lot of policymaking. And so I honestly don't like the left side of this photo. I would never want to see that with no greenery, but if we're not careful, that's what we're going to end up looking like in our cities. So with occupational environmental medicine physicians, it's critical that we understand urbanization and the built environment. And we need to utilize social determinants of health, and Dr. Clark will talk about that in the next lecture. And we need to move from being in a role of, oh, we're just trying to prevent injuries, and we're trying to prevent work exposures, such as asbestos and organic solvents, etc. But we need to move to be more inclusive and be more citizen and community-minded, while building strong relationships with governments, community partners, urban planners, and environmental engineers. And this is definitely a paradigm shift. This is something different that we haven't done in the past in our field, but we need to think more broadly beyond the workplace and develop additional skill sets in data and tools. And our partnerships are going to look different. We used to have partners that were solely working with safety professionals, industrial hygienists, and OSHA regulators, but now we need to add more people to our partnership circle, to our ecosystem of partners, and those people are going to be very important to us. And they still include industrial hygienists and safety professionals, but we need to involve engineers, environmental engineers, urban planners, waste managers, chemists, recycling specialists, and agricultural planners. So this is Dr. Wadi Waste, and Dr. Wadi is a practitioner, environmental health doctor, and he was very disturbed by the beach that he used to play on as a child. When he returned years later, he saw a bunch of plastics on the beach, so it really inspired him to become an environmental health physician that focuses on plastics. So why would any doctor get involved with plastics? And so you need to figure out what is your why, and what is it in your environment that you created in your mind today that you want it to stay the same, right? And so the reason why he did it is because he found that plastics are damaging to humans. You can see these chemicals in plastics, and we all know that BPA-free plastics truly aren't chemical-free. There are other chemicals that are in plastics, and so that's why we need to care about plastics. So we all need to get involved in environmental health issues, plastics. That's a whole other lecture. I'm not going to go into plastics, but it's something that we definitely need to consider for the future. And that's it. Thank you. Thank you, Dr. Mansfield, for really setting the stage and helping to identify some concerning trends. But as we know, in our field, where there is a lot of potential challenge also lies a lot of opportunity. So that brings me to my next speaker, Dr. Karen Lee. Dr. Karen Lee is a board-certified in occupational and environmental medicine, as well as public health and general preventive medicine. Since completing OM residency at Mount Sinai, she has stayed on as staff physician at one of the World Trade Center health programs, where she performs medical monitoring and treatment for responders affected by their exposure to the World Trade Center disaster, as well as work-related illness or injury evaluations. Her current area of interest is in the relationship between stress and weight management, and also developing pilot materials for clinic providers on building stress resilience and healthy eating. She's a volunteer commissioner for the Jersey City Environmental Commission, which is appointed by the mayor to advise on local issues of environmental sustainability. And she's actively involved in promoting education on climate change and environmental sustainability at the K through 12 grade school level. So it is my pleasure to introduce Dr. Karen Lee. Hi, thank you very much for coming. So I was asked to talk a little bit about how I came to get involved in my environmental commission. And I'm hearing a lot of reoccurring themes. In the wellness talk, there was a talk about return of investment. And I think environmental sustainability, just like employee health, is very similar. Environmental sustainability, we have a difficult ask. We're asking for a significant upfront investment with little to no meaningful return of investment until further down the road. And that can be difficult. And strictly speaking, in terms of budget or taxes, it can be difficult to ask leadership to make these considerations. But I think as occupational medicine physicians, we're familiar with the language, and we're uniquely comfortable with being able to translate the science and the benefits of environmental sustainability. So to talk a little bit about how I first got involved, two factors. It was my first resident case at Celikoff, and I kind of wanted to do a case study. It might help with board review, too. And why I stopped running at my local park in Jersey City. And I'll talk a little bit about environmental commissions. I've gotten to know a little bit more about environmental commissions outside of New Jersey and San Francisco through Eddie Ahn, one of the environmental commissioners in San Francisco. And I'll give you a little peek at a presentation that I did for my environmental commission on urban microclimates. And some of the work that we're doing at the JCEC. Oops, sorry. I think I might have... That's strange. Okay. So this is my first case as a resident at Mount Sinai. It was a 52-year-old gentleman presented at Celikoff. He was diagnosed with a high-grade upper tract erythelial carcinoma of his right kidney, which was now metastatic to his lungs. He was diagnosed at the age of 38, and this was a medical legal referral from his lawyer. He was a lifetime non-smoker, past medical history of hypertension, multiple bladder surgeries, and he had no allergies. His occupational history, he'd worked starting at the age of around 21 at the MTA as a bus shifter. And so his role was basically to alternate between driving buses and shifting buses in several bus depots in the New York area, buses to and from the garage for maintenance and inside the depot. And his concern was really about asbestos exposures. He was concerned that, was asbestos exposure in his workplace related to his upper tract erythelial carcinoma? So these were his reported exposures. He said, well, there was a lot of asbestos in the hallways and the vents, pipes. He said a lot of idling buses. His typical shift was around eight hours a day, five days a week, and he'd done this for almost 20 years. And he remarked that when he got home, he'd blow his nose and his nose was all black from all the soot from the air. He was also exposed to grinding metals from the machine shop. And in terms of ventilation, there really wasn't much ventilation. The bus depot was an enclosed space. There were fans in the summer months, but during the winter, those gates were closed. It was limited ventilation and no PPE. So just to give a little bit of context about urethelial cancer, it's also called transitional cell cancer. It's very common in the bladder. The ratio of urethelial cancer in the bladder relative to the upper urinary tract, the ureter, and pelvis is 50 to 3 to 1, so it's much more common in the bladder. It's multifocal, so it starts in one area and you're more likely to develop it in the other. So in his case, it started off in the ureter and he later on developed it in the bladder as well. It's more common in men. It's also more common in the seventh decade of life. So for this patient, it was very unusual. He developed it in his late 30s. It was also more common in smokers, and he was, again, never a smoker. So risk factors for urethelial or transitional cell carcinoma. Cigarette smoking, the patient wasn't a cigarette smoker. Occupational exposures, he denied any of these occupational exposures. This is sort of where board review might come in. So he had never worked in the rubber or chemical industry, no work in dyes or paints, benzidine, iodine, and anethylene, no exposures to other of these chemicals, and exposures specific to upper track urethelial carcinoma, denied any exposures to rare herbs or finacetin. So looking at the evidence for urethelial cell carcinoma, he really didn't have any of those exposures, but what he did have exposure to carcinogen-wise on evidence review was diesel exhaust gas. So the International Agency for Cancer Research categorizes diesel engine exhaust, had recategorized in 2012 from a group 2A, which was likely carcinogenic, to a group 1, which was carcinogenic to humans. And the EPA's position is that diesel exhaust is likely to be carcinogenic in humans. So the conclusion from the case review, so the case was that we determined in discussion with Dr. Meyer, is that given this gentleman's reported exposures, his history as a lifetime nonsmoker, his work exposure, intensity, duration, absence of family history, lack of exposures to other high-risk chemicals, it's likely that his diagnosis is associated with occupational exposures. So that was the background of the case review. And now to the reason of why I stopped running in Jersey City. If you're not familiar with Jersey City, it's the second largest city in New Jersey. It's about 300,000 people, and this is downtown. All this construction had happened in the last 15 to 20 years. This is downtown Jersey City. About 50 years ago, downtown Jersey City looked more like this. This is Liberty State Park, and the EPA said it was a legal dumping ground. Now left picture is Jersey City in the 1970s, right is Jersey City now at Liberty State Park. So a lot has happened in Jersey City in the last 15 to 20 years, and there are parts of Jersey City today that really haven't been touched by the gentrification. This is the Brogan Lafayette neighborhood, and Jersey is also very diverse. There's an Indian Square, and we have an Arab population in sort of the Kennedy Boulevard area, and African American, it's in Southeast Asian, and whatnot. All this to say that Jersey City is very urban, very diverse, and very dense. So this is the park where I like to run, and if you look, there's a track there, and basically if you run three laps, you get a mile, and next to the track is a playground. You don't really see it very well here, but next to the playground is a little street, and if you run on this track, before you even approach the playground, you can smell the diesel exhaust from the two ice cream trucks that are parked there from morning to day. And sometimes when I would pass the playground, I would see mothers watching over their kids as they're playing in the playground with the baby in the stroller, and the stroller would be parked right in front of the exhaust pipe. And this would happen through the day, because these ice cream trucks don't move. They just stay there. So that's why I stopped running. So how I got involved in Jersey City Commission was, I had this interesting case about a gentleman with upper tracheoarthelial carcinoma, was very sad, metastasized to his lungs, and then I was running, and I saw a lot of these things happening in the park, and it was a little bit unsettling. So I reached out to the environmental commissioner in Jersey City and said, can I get involved? And she's like, yes, we need people with science backgrounds to come. So I signed up, and just a little bit of background information, each state has different ordinances. So in California, so I mentioned I reached out to some environmental commissions. In California, their environmental commission is actually part of a city agency, the Department of Environment. So they get funding, and they get full staff. They get to share millions of dollars in funding from the Department of Environment in California. In Jersey City, we're an advisory body, and this is our bylaw. So we don't get funding. We can apply for grant funding, but we're not funded by the city or the state. And our bylaw essentially is, our role is for the protection, development, and use of, to advise leadership on the protection, development, and use of natural resources, and the use to do research, although we don't have funding, so I'm not sure how we can do research, but I'm working on that, and to coordinate activities with unofficial bodies for similar purposes, and basically to recommend planning and development for these sort of natural resources. So I asked Dr., when I started, I asked, reached out to Dr. Silverman, see how I can be most useful to the Jersey City Environmental Commission, and he said, why don't you talk about urban microclimates? And I thought, oh, that sounds really interesting. Like, what is that? So I started looking into it, and I thought, this is really, really relevant. So I'm going to share the presentation that I did with the Jersey City Environmental Commission, and just to give you, I don't do any research in this. This is just sort of what I summarized from research, and that's what I'm presenting to the Jersey City Environmental Commission, who, again, are a lay audience. So what is a microclimate? A microclimate is a area which can be as small as your backyard garden, or as big as a city, that has changes that is different from its surrounding area. What is different? It could be temperature, wind speeds, humidity, solar radiation, and maybe when we're talking about humans, we also want to throw in air pollution, concentration, and distribution. We tend to think of micro, we tend to think of, when we think about urban microclimates, we think there's a tendency to focus on heat, thermal heat islands. And we know that cities are getting hotter. Climate Central, which is an organization of scientists and news reporters, reported that in New York City, they did a survey of the 63 biggest cities, and they reported that on average, New York can be as, New York City can be as high as 20 degrees hotter than the surrounding cities. We know that there are several reasons for this. This is sort of the urban island effect. We know that in cities, there are structures that are hard and dry, roofs and sidewalks that absorb and remit heat, as opposed to sort of your natural landscapes that tend to provide more of a cooling effect, and shade, and you tend to have evaporation of moisture that provides a little bit more of a cooling effect. We also know that materials in an urban setting, pavement, roof, tend to reflect less solar energy, and so when they absorb the heat, it tends to build up during the day and tends to get slowly released after sunset. And we know that in urban settings, the geometry of the building, so the spacings and dimension of the building can also affect temperature. So when obstructing neighboring buildings, so for example, when you have a lot of buildings together and obstructing winds, you can build this thermal mask of heat that cannot really easily, buildings that can't then easily release their heat. And you also see what's these narrow buildings, particularly densities, you have these tall narrow buildings that can block natural wind flow, and that could also prevent the cooling effect of winds. And you also have heat from heating human activities, like vehicles and ACs, and you turn on the AC, it adds temperature to the surrounding environment, and also there's industrial contributions, which generates a lot of waste heat that can contribute to the urban heat island. Geography as well, if you have mountains surrounding area, it can block the wind from reaching the city, or it can even create wind patterns that can go through the city. So when we talk about heat, then we want to talk about the heat effects. This was from the American, these infographics are from the Association of Public Health and the CDCs. I really like infographics. So it talks about here, oh, I can't really see it, I'm sorry, I can't really see that. So it states that about 1,500 Americans die from heat, particularly children and elderly are particularly affected. I'm sorry, I can't really see very well from here. You tend to see risks are dehydration, heat stroke, cardiac arrhythmias, respiratory issues. So there's significant health impacts to these heat effects. Like we said, we talk about microclimates, not just temperature, it's also wind. It's also air pollution, air quality, moisture. And we know that in microclimates, air pollution also tends to get amplified in cities. And so our sources of air pollution are your particulate matter. These are from smoke and dirt, particulate matter formed from smoke and dirt and soot, as well as ground level ozone that's made from emissions, those volatile carbon emissions and nitric oxide from cars, mostly from cars in cities. You tend to see more mobile sources as opposed to stationary sources in cities that combine when volatile carbons and nitric oxides combine with heat in the city, you tend to form the ozone. So it tends to get concentrated in cities as well. And there's a nice pictorial. This was done by a Harvard design urban planner. This is in the 1980s. And it's a nice quote. She said, there's a nice pictorial, that there's mounting evidence that local concentrations of air pollutants are greatly affected by the form of the city, but there's been relatively little attempt to enhance street level air quality through the manipulation of urban form. And this is sort of a nice pictorial. You have these urban canyons that are flanked and winds creating a vortex, recycling, reintroducing your air pollutants from vehicle exhaust back down at the ground level. And the health effects of, this is from the public health infographic from the public health of England. There are short and long-term effects of air pollution, short-term effects, you have exacerbation of asthma, coughing, wheezing, more emergency room visits, long-term effects, strokes, lung cancers and cardiovascular disease. Other health effects of air pollution, also from the public health of England, and affects people throughout their lifetime, in pregnancy can lead to low birth weight, in the elderly can lead to asthma, accelerated decline of lung function, lung cancer, diabetes, dementia, heart attack and heart failure and stroke. So it affects people throughout a lifetime and across all ages. So you might be wondering, what is being done from a regulatory point of view about these microclimates if we know that the air pollution and heats are bad for health and they tend to be amplified in cities due to microclimate effect, what's being done at the regulatory level. And it's interesting, this is a really interesting review article that I found by Ann Carlson, who's a professor of law at UCLA, and she titled it, The Clean Air Act's Blind Spot, Microclimates and Hotspot Pollution. And her argument, so I'll just read it. The Clean Air Act has a major blind spot, small microclimates that contain levels of deadly pollutants that can far exceed federal standards. These hotspots contain pollutants that exacerbate asthma, increase respiratory and cardiac deaths, and may cause developmental problems in children and increase cancer risks. The most prevalent of these pollution hotspots occur in predictable patterns along heavily trafficked roads and industrial facilities. Low income communities and communities of color are more likely to live in polluted microclimates and suffer health effects as a result. And she has an interesting thesis and she cites an article, what she argues is that the way these pollutants are being monitored and measured under the Clean Air Act and how they're regulated through the National Ambient Air Quality Standard really hasn't caught up with what we know about the effects of hotspot air pollution and heat. And so for example, the National Air Quality Air Standards rely on both the coordination of federal and state efforts to monitor air pollutant levels, mostly the state monitoring stationary sources of air pollution, and the federal monitoring, with the exception of California, monitoring the mobile sources of transportation emissions. And there's really been a, and her argument is there really has been a reluctance to regulate sort of mobile sources of these pollution admissions and sort of a blind spot to this. And the way it's done also is there are sort of very few or small number of monitoring stations that are used to, and a lot of mathematical modeling of how these ambient air pollution is measured. And that this can actually mask hotspots from, for example, near traffic areas. So areas that might be designated as meeting federal criteria standards may actually not. She cites an interesting study, oh dear, sorry, up here. This is from Yale. This was, that looked at children's exposure to diesel exhaust in school buses. And she, and this was by, and it found that in Connecticut school buses, they looked at particulate matter 2.5, that levels of particulate matter 2.5 were five to 15 times higher in the school buses than in ambient levels outside of the school buses, and could also exceed federal standards. Oh, God, I'm so sorry. So what's being done at sort of the regulatory level? California's kind of special. They do, so this is something that Eddie On had shared with me. He works with, he has his own nonprofit called Brightline Defense, and he was able to get some funding through some of the state to do some local air quality monitoring through after this bill was enacted. And what this bill basically said was that AB 617 was that it encouraged, encourages sort of community health programs to create programs for better air. So they do local community air monitoring. They fund research and grants to improve local air quality. And one of the things he's doing is he's installing these clarity air monitor nodes within traffic intersections, and this data would be available publicly so people who don't have, who can't afford to buy their own local air monitor can access this data online. So in terms of, I hope I'm doing this right. So in terms of what we've done at the Jersey City Environmental Commission is, this is in the last couple of years as we started, at least since I've gotten involved, is we successfully instituted a plastic bag ban, and that's sort of our infographic. And we've also worked with the Association of New Jersey Environmental Commissions for a grant to do a pollinator garden. There's a tendency to look for a low-hanging fruit because our commissioners are really only stated for three years, although we can be asked to, for a long, to extend our commission. But I'm sort of working on doing some more interesting projects. There's also right now a lot of talk about the pay up for climate, so essentially holding sort of these fossil fuel industries accountable for climate change, and it's happening at the federal level, and there are these lobbyists who are coming to each individual state and local cities and advocating for us to support resolutions to have these fossil fuel industries held accountable and essentially pay up for climate change. And that's something that we had presented to our local councilmen, and they had passed as well. Current work, so there was a picture of Liberty State Park in 1970s and then now, and one of the things that's happening is there's private interest, and there are some individuals who are interested in turning that into a golf course. So we've been working on preserving that space, and published a letter in the Jersey Journal to please pass the Liberty State Park Protection Act, and that's still in the works. And serendipitously, I belong to a book club from my old university, and I was working on introducing climate change education in Jersey City Public Schools, and a fellow Princeton alum had said, oh, I know someone who actually stopped teaching and started her own nonprofit to develop curriculum, a free curriculum for teachers to teach climate change. I'm like, oh, that's great. And so that's subject to climate, and I reached out to Margaret, and we're actually trying to pilot some of the materials with the Jersey City Public Schools, and New Jersey actually became the first state to enact, to mandate a climate change adaptation into the K through 12 curriculum. So we're trying to support their efforts by helping them pilot some of the subject to climate materials into the Jersey City Public Schools. And we're also working really closely with the mayor's office and the Office of Sustainability. I mentioned that Jersey City Environmental Commission, we're not a city agency, we don't get funding, but the Office of Sustainability is, and they do get city funding. So they're working on energy benchmarking in the municipal buildings, and we're trying to work closely with them to give them some guidance about that too, as well as academic partnerships with public health, working to improve some of our programs. We have a green business program, and I'd like to do some program evaluation to sort of see how we can better help our green businesses. And that's it. Thank you. Thank you so much, Dr. Lee. So obviously, it is not that far-fetched for us to actually get involved in these groups, and to be able to have input and real influence at these large-scale levels as MDs. And I couldn't help but think, you know, raise your hand if your occupational and environmental medicine board score just went up by a few points after that talk. So now, with that being said, it is also my honor and pleasure to introduce Dr. John Clark, who will also be discussing his experience in this realm, as well as some really novel ways that he reaches his audiences. Dr. John D. Clark, MD, MBA, MS, FAAFP, is board-certified in occupational medicine. He is the Director of Occupational Medicine at Cornell University, but will be transitioning next month to the roles of Chief Medical Officer and Director of Occupational Medicine at Brookhaven National Laboratory. He also serves as a consultant for large organizations. He completed his BA in Sociology and Music at Columbia University, and his medical degree at the Econ School of Medicine at Mount Sinai. He completed his residency in occupational and environmental medicine at Harvard, where he served as chief resident, and completed his residency in family medicine at New York Medical College, where he also was appointed as chief resident. Dr. Clark earned an MBA at Cornell Business School and a Master of Science in Healthcare Policy Research and Leadership at Weill Cornell Graduate School of Medical Sciences. He has a passion for writing, producing, and performing health hop, medical and safety rap songs, and has produced several CDs, videos, and public service announcements. Dr. Clark, welcome to the podium. Thank you. Yeah, I need the clicker. Yes, can you hear me? Is my lavalier on? Well, good morning. All right, let me get this right. Good. So, how many of us are familiar with social determinants of health by a show of hands? And I'll admit that I didn't really know much about it until I was doing my master's at Weill Cornell, and this came up quite a bit. In fact, when I trained in family medicine, it was the late 90s from 97. Sorry, yeah, 97 to 2000. Back then, it was known as underserved communities. So, it was kind of like the same elements applied. So, the CDC defines social determinants of health as conditions in the places where people live, learn, work, and play that affect a wide range of health and quality of life risks and outcomes. Now, what I say is we, as occupational medicine providers, should kind of think of social determinants of occupational health because there are nuances, and I'll share an example. So, after the pandemic, Cornell University leadership recognized that they could do more for employees. So, I'm currently working with them on developing an employee health program versus just occupational medicine. And I was having a meeting with one of the high-level personnel and benefits, and she shared her story of, you know, years back, she got injured at work. She fell, hurt her wrist, but to this day, she struggles with chronic pain and limitations because, at that time, when she tried to get treatment, she couldn't find a provider that did workers' comp, right? There were no providers available in the local area. Once they heard it was a work injury, they wouldn't take her case. So, for her, that represented, even though, yes, she had a PhD, she's from a high socioeconomic status. From a primary care standpoint, she wasn't impacted negatively by social determinants of health, but from an occupational medicine standpoint, she was. She didn't get access to the care she needed. Another example is, recently, the medical leaves department contacted me because an employee needed to get an IME, but there were no providers, right? And the closest was 60 miles away in Syracuse. So, yeah, Cornell is in Ithaca, which is in central New York. Have any of you been up there? Oh, okay. So, you understand. Yeah. So, there are five key areas of social determinants of health. The first is healthcare access and quality. So, this comprises access to services, access to primary care, insurance coverage, as well as health literacy. Then, there's the neighborhood and built environment. So, this talks about quality of housing, access to transportation, access to healthy food, quality of air and water, as we just heard about, as well as neighborhood crime and violence. The third is social and community context. So, this is an individual's cohesion within their local community. So, civic participation, issues like discrimination, their workplace conditions, and other issues like incarceration. The fourth is economic stability. So, this is socioeconomic status, income, poverty, the cost of living, employment, food security, and housing stability. The final is education and access, education access and quality. So, whether someone is a high school graduate and whether they've enrolled in higher education, their ability to attain education in general, their language and their literacy level, as well as early childhood education and development. So, why is this relevant to us as occupational medicine providers? I say because we have the power, right? Now, do any of you remember that song, You Got the Power? So, think of that song as we're, you know, going through this portion. So, the power we have is that we're connected, right? We're in a unique position at an organization where we can connect with employees. And we actually have the means of identifying what the social determinants of health are for those people. Then, we can connect with the community where we work. Also, we have connections with HR. Often, occupational medicine is housed under HR. And depending on your role, you may have the audience of the senior leadership of the organization. Now, urban resilience is a concept. So, when Dr. Silverman, he invited me to the conversation about the environment, the focus was on climate change. So, the concept of urban resilience is the ability of a city or urban system to overcome shocks and stresses, including those produced by climate change. Historically disadvantaged communities may lack the urban resilience and resources to recover from the effects of climate change. And employers should consider innovative solutions to support such communities. So, urban resilience can be seen through the pandemic for all of us, right? So, I just highlighted certain elements of that statement. So, the ability of a city or urban system to overcome shocks and stresses, disadvantaged communities may lack the urban resilience to cover. So, I'm going to talk about Ithaca, where I live and work, as an example to demonstrate urban resilience. So, there's a saying, Ithaca is gorgeous. So, if you ever have a chance, visit Ithaca because it's surrounded by over 150 waterfalls. If you're into hiking and trails, it's beautiful. These are just some of the images. It's a small college town. However, Ithaca has the jungle, right? So, I first learned about this from my daughter because I would notice that, you know, sometimes there were homeless people that would be in the Walmart and you never see them on the street. So, I was like, man, these people must hitchhike. But then my daughter says, no, daddy, they live in the jungle. I said, the jungle? Well, I've been to Ithaca. So, she says that, you know, the jungle is this area behind Walmart where you have a homeless village and they live there. And if you've been in Ithaca, you know how cold it gets in the winter, right? So, Ithaca has a very high poverty rate. And, in fact, the poverty line for 2022 is 27,750 for a family of four. Back in 2000, when this data is from, the number was $26,200 per year. So, when you break it down by race and ethnicity in Ithaca, you see the black population has a 52.9% poverty level compared to the national level of only 25.2%. And the black population is 3.8% of the Ithaca population. For Asians, the number is even higher, 63.1% poverty rate compared to 11.9% across the country. And the Asian population is 16.7% of the population in Ithaca. So, those of a mixed race, two or more races, is 60.7%. Those who are white is 32.3% poverty level compared to 10.3% across the nation. So, Ithaca across the board has a higher poverty rate across the board. And for Hispanics, it's 49.5%. So, the example of urban resilience has to do with the fact that when the pandemic hit and the schools shut down, there was a delay in Ithaca before they could reopen the schools. And it was based on a good thing, which is equity. So, the school district values equity, and they said, we're not going to start school until every student has the ability to attend classes virtually, right? And many families didn't have computers or internet access. So, it was a delay in the rollout. Ithaca also has food insecurity. So, there were some families who literally their children would not have eaten without school lunch. So, Ithaca continued to have the school buses go out to deliver lunch to people's homes because without that, people literally would starve. So, what they did, and this demonstrates how corporations and organizations can help, you know, communities overcome urban resilience, is Ithaca School District teamed up with Spectrum. So, the school district obtained Chromebooks for every student and had those delivered to their homes. And then Spectrum provided free equipment as well as free internet service so all of our students could access Wi-Fi. So, between that, you know, this is an example of two components of social determinants of health that, you know, we saw a success, but it involved the organizations actually proactively doing things. So, now I'm going to talk about social determinants of health from as an occupational medicine physician, what you can do. So, again, we have power and one of those elements of power is being connected with the community. So, for me, there's an organization called Greater Ithaca Activity Center, GIAC for short, which is the main community organization that helps families and people in Ithaca. So, I'm a board member of GIAC. I'm also active in my church. I'm a trustee at my church. And I'm also involved in the Rotary Club and I was asked to be a board member there as well. So, that positions me to be aware of some of the challenges that the community faces. You know, they have senior breakfast program. And, again, back to hunger. When they have a food drive at GIAC, you know, Cornell will often donate meals. And in like only an hour, 1,500 meals get obtained because of the level of poverty in the region. So, there's food pantries, tutoring, after school care that's affordable for families. And these are some of the things that are available in the community. So, I'll shift to the pandemic again. So, in March 2020, the pandemic hit, right? And a lot of the systemic barriers began to surface, right? We saw disparities, right? We saw people and I'll share my own personal story, right? So, I'm in Ithaca, my wife and I. She's a nurse practitioner. She worked in the ICU up there. And her parents lived down in Rockaway, Queens. Anyone familiar with Far Rockaway? So, you understand, right? So, what occurred was this was late March. And, you know, my wife was fairly close to her parents. So, they would talk nearly every day. We didn't hear from her parents for a couple of days. And she said something's not right. So, she drove down, four hours, went down to their apartment to discover they were both gasping for air, right? She called 911. They got to the hospital. However, if you remember back late March of 2020, that's when New York, right, was in a crisis. So, imagine the one hospitals, Peninsula Hospital, was overwhelmed. In fact, there were no beds in the hospital. Her parents remained in the waiting room to the ER for two days. No oxygen, nothing. And she was there for about maybe seven days before she was able to get let upstairs. So, they finally had been taken upstairs to a room. And because she's a hospital, you know, has credentials, they allowed her to go up. And what she saw was that, hey, they were not receiving care. You know, she's an ICU nurse, and she was the director of the ICU at the time. So, she was able to get them airlifted to Ithaca. And the contrast in Ithaca is there were no patients in the hospital at all, right? They had plenty of ICU availability, but it was too late. And they actually both passed away on April 10th, right? And what was disturbing is their condition, right? And it was clear that it could have been avoided if they had access to care. Her mother, both of her lungs were collapsed because the vent settings were inappropriate. And her father had advanced. They both had the cytokine storm. So I saw personally the impacts of the disparities that had, and because when my wife was in New York, she stayed in Long Island, in Suffolk County, which is predominantly white. And the hospital there was similar to Ithaca, right? But she was unable to get them transferred because by law, the ambulance had to take them to the closest hospital, right? So social injustice became magnified. So May 25th was a pivotal day, right? So a lot of people were home and looking at social media during the pandemic. And then the Amy Cooper incident demonstrated how, you know, white privilege, systemic racism can actually be weaponized. That same day, George Floyd is killed. So you see that, okay, that's a real weapon that actually can result in the death, right? So this led to now, I guess the country was moved, where now you started having organizations discuss disparities. Cornell, along with several companies, and this is just a few. I was able to find some articles from back then that talked about these companies that now made Juneteenth a holiday within the organization. Now, Juneteenth has been around since 1865, right? However, in less than a month, organizations, right, made this a holiday. So I say that to demonstrate that organizational change is often difficult and it can be slow, but with the right issue at the right time, it's very fast. Because if any of you have worked in academia, you know, it's very slow. But Cornell, yes, we now celebrate Juneteenth. There's raised awareness. So this led to some discussions, and there was an employee of color forum that, you know, the focus was what can Cornell do, right? And this was employees of color from across the university. It was over 300 people. And one of the issues that came up was how do we successfully recruit as well as retain people of color? How do we address equity in the community? So Cornell is interesting where, you know, I'm black and I hold a leadership role. The dean of students is a black woman. The head of student disability services is a black man. However, I've been working there for five years and in the Achmed Clinic, I've never had a black patient, right, because the jobs that have folks, folks who need the Achmed services, there's certain jobs in facilities and maintenance, and they're really not black patients, black employees. So I spoke up at this meeting, and one of the things I said is, well, Cornell should proactively start recruiting people from the local community. There are high levels of poverty and there are people who need jobs. And guess what? Cornell has a high turnover rate of people of color, like myself, in a month I'm leaving, right? And that happens where a lot of the people of color have been recruited. They'll do a national search, bring people in. But for those of you who have been in Ithaca and maybe from the city, I see you smiling, it's an adjustment and it's a culture that you may not be able to, I don't wanna use the word tolerate, but it's a certain environment that you may not wanna stay for a long term. However, people who were born and raised there of color, they're already there, they're gonna stay. So make efforts to actually hire them. You support the local economy, it provides economic stability, neighborhood upkeep and infrastructure. The municipality is funded by taxes. If people don't have jobs, there's less money that goes into the infrastructure. And reduce the attrition rates. Now, one of the areas of social determinants of health is education. So Cornell supports education. So if you're an employee, they'll pay for you to do a degree. And in fact, if you have children, they'll cover 50% of their tuition at Cornell and 30% of tuition at any college of their choice. So now you can open up the doorway for folks to have access to education, even for the next generation. And guess what? With employee benefits, you now have access to healthcare services. Now, you keep hearing about return on investment and it's true. So what I did is thought about the bottom line. Because what occurred is six months later, someone from HR called me and said, they were at that meeting and they liked what I said, it resonated, they're building a new dorm and they're gonna need tons of workers and they're building a dining hall. So they wanna hire from the community. And they knew I was tied in with the community. So they said, could you work with me to kind of help us to be able to successfully recruit people of color from the neighborhood. But I knew I had to present the business case. And that's one of the fundamental issues is you always have to remember that a corporation's mission is to increase the wealth of the shareholders. And that's really what it's about, the bottom line. So organizations are obligated to do that. So if you present to them an initiative that costs money, they may be torn with, okay, this is costing money, how am I gonna increase the wealth of the shareholders? And yes, sustainability and corporate social responsibility is good for PR, but sometimes they need to demonstrate a little more that, okay, if we do this, it's gonna now result in a benefit to the bottom line. So what I did is I started with the mission and core values of the organization. Because sometimes it's hard for an organization to look at the facts that, hey, we say we do this, we say this is our mission, but then they don't actually do it. So at Cornell, part of their mission is, Cornell aims through public service to enhance the lives and livelihood of students, the people of New York and others around the world. Core value is we value engagement in our community, our state, the broader world, learning about their needs and strengths and applying the knowledge we create for the benefit of society. So Cornell, the business, what is the business of Cornell? Elite academic experience and outcomes for the customers who are the students. The value proposition and the brand of Cornell, what is that? So that's providing, yes, an elite academic experience, an Ivy League degree, access to top researchers, esteemed faculty, and yes, a safe, beautiful community environment, Ithaca, right? However, why Cornell may not attract customers willing to pay 61,000, like that's tuition, right? That's not even room and board, it's $61,000. And well, why would a customer not be willing to do that? Well, joblessness, right? So joblessness leads to increased crime, which can result in urban blight, right? So when you think about it, okay, if we're not employing people from the local community and we have a high level of poverty, well, some of the esteemed faculty and researchers may not wanna live in Ithaca, right? Students don't feel safe, parents may not be willing to shell out $61,000. So the value proposition drops, the brand diminishes, and the only thing you really have is the Ivy League degree, but guess what? There's several other Ivy League schools and other schools that are not Ivy League that are also prestigious and attract students. So the outcome was, yes, we did a job fair, I was able to connect HR with GIAC, and they hosted a job fair. And I don't take credit because all I did was serve as the bridge. Where the initial meeting was me simply meeting with HR as well as the director of GIAC and saying, hey, this is the agenda. The one thing I did say is that, hey, if you're gonna do it, make sure people get jobs. Because one of the worst things you can do is have an initiative where you say you're gonna do something, but people don't get it. So what Cornell did, which was a great strategy, is they hired people on the spot. So that day, when people came, they had hiring managers that offered jobs. So 75 people got jobs. 75 families, you know, it changed their life in that way. So for me, social determinants of health began years ago. Again, it was before it was a thing. And health literacy is a component of that. So back in 1997, New York City had an epidemic of asthma. And one of the big questions was, how do we effectively reach young asthmatic children? And a large part of our population of parents of the asthmatics were young people as well. So a rap song, right? So I'll give my background. So I started writing rap songs at eight years old, started producing beats at 13, majored in music in college, and actually was serious about it. Got offered a record deal between my junior and senior year of college, but opted to go to medical school. Made my parents really happy, right? And what I would say is back then there was no YouTube. So to get in, you know, so I had one of the Isley brothers was gonna sign me and take me for, so I was legit. And that's why my parents were scared, right? Yeah, so we did a study. I'd created a rap song, did a study, and we looked at it and 78% of the population at a high school believe rap could be used to teach. 63% indicated they actually listened to it. A mean score in questionnaires increased by 36.5%. And we used a music video and the rap. And the population was largely Asian and white. And I say that because people often assume, well, hip hop is black and Hispanic, but no, it's teenagers and young people. And we had follow-ups that show it left a lasting impression and Health Hop was born. So I created that. The picture on the left with LL Cool J is from the video. So the hospital I worked at, they had sent a copy of the tape to a reporter who wrote an article and so they produced a video. We had LL, that's the surgeon general at the time, Dr. David Satch, who came to the hospital when we released the video. And then I started producing CDs. So I made CDs on a wide variety of subjects. There was some publications and YouTube videos. And I mentioned that, oh, and there was a study in the nursing journal using the CD that showed it was effective at teaching. So I share that because what better thing to do than create an SDOH rep, right? And this was part of my capstone in business school where I was in a group that was tasked with creating a program that targeted pharmaceutical personnel. So industry recognizes the value of SDOH. And this company was trying to target or get pharmaceutical people to understand what SDOH was and why it's valuable to integrate that into their marketing and strategy. So without further delay, I'll play the social determinants of rap. And do we have sound? Good. ♪ Dr. Clark, treat that beat ♪ ♪ Social determinants of health, what is that? ♪ ♪ Conditions, environment and wealth does impact your life ♪ ♪ Where you go, care for self and live at ♪ ♪ Education and whatever else comes with that ♪ ♪ SDOH is the literal acronym for what limits care ♪ ♪ And individuals accessing ♪ ♪ Dr. Clark hoping something critical's happening ♪ ♪ About to get open with that lyrical acumen ♪ ♪ Compliance is the key to improving our healthcare ♪ ♪ Social determinants of health, how we get there? ♪ ♪ Health literacy is key to achieving the best care ♪ ♪ Social determinants of health, how we get there? ♪ ♪ Neighborhood in trouble is supposedly poor ♪ ♪ Healthy food insecure with no grocery store ♪ ♪ Access for sure, it could open the door ♪ ♪ Healthy foods stop diseases, we're hoping to cure ♪ ♪ Need to give care, beginning with access to hospital, pharmacy, clinic, or practice ♪ ♪ Transportation problems, got them staying for hours anticipating, waiting, hating, making patient encounters ♪ ♪ Healthcare quality determined by poverty, socioeconomic status, wealth, money, economy, language, culture, race, views, and your philosophy, education, level, college, equality, and the policy ♪ ♪ Social determinants and social psychology will show the dichotomy, growth, and guide policy ♪ ♪ Access increases when known and tried properly, health literacy improves, care goes to high quality ♪ ♪ Compliance is the key to improving our healthcare, social determinants of health, how we get there? ♪ ♪ Health literacy is key to achieving the best care, social determinants of health, how we get there? ♪ Thank you. Applause Microphone live. Yes? Okay. So that was excellent, and thank you. So, we have ten minutes left. I originally had planned for some scenarios where the audience could get engaged and our panelists and sort of debate, you know, what are some ways that we can impact, you know, today, if our CEO or our boss were to come to us and say, hey, I'm going to give you a large sum of money, I want you to take this and do one good thing for our community, for our surrounding community. But you're probably chomping at the beets. You probably want to ask some questions to our panelists. So I'll open the floor for that now. But first, I really want to thank our panelists. I want to thank Dr. Blyde-Madsville, Dr. Karen Lee, and Dr. John Clark for being so engaging and open and putting their time and effort towards this panel. And I especially want to thank Dr. Warren Silverman, because my program director at the time, Dr. Perkinson, reached out to me and said, hey, I think you would be good to reach out to Dr. Silverman and put together an environmental health panel. Even though I had never done anything really in that area. And Dr. Silverman was just an amazing mentor and guide and connected me with all three of these people. And I think this panel turned out great. So please do give everybody a round of applause. And questions, please. Questions or comments. Well, I just want to say that one of the lessons that you can learn from all of this is that as occupational and environmental health doctors, you're a respected member of your community. I've personally never had any problem making an appointment with a state or federal legislator to discuss issues. They're willing to talk to us. We're also people in the community that know what's going on health-wise. We know more about these factors than most people do in the community in terms of the health of the community. As we move forward in the future and things change, we're the people that probably can help with those changes. Now, don't underestimate the power of legislation. You know, how many of you are older than 65? Okay. Maybe I shouldn't ask that. But anyway, we have in our memory the impact of the Clean Air Act and the Clean Water Act. When I was young, I lived in Central Jersey. I used to go into New York City all the time. And as we'd get close to the George Washington Bridge, you could hardly see only the tops of the buildings because there was so much smog. Because every building had an incinerator. And you took your trash and you threw it down the chute and it was burned. Nobody could even think of taking fish out of the Hudson. We remember that, the older guys. Younger people, you've had the advantage. I remember when we'd leave New York City in the evening, the sunset, the sun would be giant and red because all of the oil refineries were there. You remember all that, right? Legislation can make a big difference. The social issues are important. I would say if you have an affluent couple, young family, and they want to move somewhere, what's their first question? School district. If you are not affluent, if you have a difficult economic situation, you don't have that opportunity. You're guaranteed to be in a difficult situation. You go there for what you can afford, right? It's not just urban either. If you want to get a lot or a house in the least expensive place, you're going to wind up buying a house next to a big factory or an industrial center because that's where the cheap property is, even in rural areas. Or you may be out far away from economic opportunities or social opportunities where you live. You may not have access to theater. You may not have access to various things. These disparities are issues that are built into our culture. I just wanted to make a few comments that you guys have the power to make changes and that you have the opportunity of bridging between the science and the knowledge and the legislation that can change things. You should take that responsibility. I talked about government, but actually, as Dr. Clark said, it might be the leaders of a corporation. It might be people that can make the changes at different levels. It might be your community, local organizations, but really, it makes a big difference. You can change the world. So, any questions out there? Yeah. I had a question for Dr. Clark. Were you able to have any follow-up with the people that were hired at Cornell? Are they still working at Cornell, or have you seen them in your clinic? Great question, but no, I haven't had any follow-up. I don't know the names or anything, but that's something I thought about to see if, yes, this did lead to a long-term change. But, yeah, I don't. Anybody else? I'd like to just make a comment. First of all, it was a wonderful panel. I really enjoyed it. But I just want to come back to the Action Collaborative because it's an opportunity, first of all, to learn what's going on around the company, where businesses, the private sector is connecting with the public sector and NGOs to build healthier communities. So, there are archived lots of case presentations going on around the country. As well, for those of you who are engaged in this work itself, to present your work because it gives us an opportunity to spotlight the good stuff that's going on and some of the strategies for actually how to help bring together business in a community to make it happen. And we have time for one more question or comment before our time is up. But feel free to ask the panelists or any of us the questions afterwards. So, I wanted to just thank all of the panelists for an excellent presentation. And I'm going to tell you that Dr. Clark and I go back a long way. He was my associate medical director when we worked together at Con Edison of New York. And I just want to say I'm extremely proud of where he's gone since then. But I wanted to just say to you as a panel that you've given me a lot of thought for what I might want to do. And one of the things that, you know, with the only changes that are going on with legislations revolving around marijuana and the marijuana laws, I think that that is one of the areas that as physicians we all should have some impact because of what that is doing to our youth and what it is saying to our youth. And I really feel very strongly about it as a medical review officer because I actually see the end effects of that. And I wanted to make sure that you know that you've given me a charge at this point and really appreciate it. Thank you. Thank you. Well, I guess we're out of time. Thank you so much for coming.

built environment

health

well-being

architecture

green space

accessibility

air quality

urbanization

urban microclimates

pollution hotspots

social determinants of health

occupational medicine providers