Health from the Ground Up

Health from the Ground Up



is before we get into this session you know over the last couple of days have been groups and a specific group and individuals who've been meeting to talk about local solutions and you know in case we all forget it all healthcare is local everything that matters is what's happening both to individuals and individuals within communities and national numbers are just aggregate of local numbers so if you want to figure out the solution that we need people like the folks you're going to hear from here to help us define more but what the problem is and as well as what the solution is but I was remiss if I didn't recognize I would be remiss if I didn't recognize some of the work that others including a group here have been doing in terms of just thinking and brainstorming through this week so far we had a great incubator session for those of you who are in the room who were part of the incubator session Peggy saying should get up and talking about local solutions you want to recognize you all we want to recognize sorry the Aspen at Aetna foundation healthy community fellows and those individuals were part of that group yes you're gonna have to stand on Jerry you don't need to see ya as a group of folks we've been doing amazing work on the ground and we're just working to just amplify their visibility but they're very visible but just because they've been so impactful so far alright so what you're gonna hear over the next 45 50 minutes or is not it's going to be about hard discussions we're going to talk about the problem and we're gonna talk about a lot our frontline solutions and the kinds of individuals that we'll pick for this discussion I think are indicative of what we need to be a part of the solution I'll start with that these are all friends so I if I just call them by their first name it's because it feels weird to say your whole name now thanks a might call it my mom's civil Alice gram so divita to visa de vita inspired me to get into a lot more of a lot of grassroots work and not things that we should be funding and supporting oh what's unique about the Vita's vision and work is she's using food as not just part of the problem a part of the solution and using it to identify and mobilize the economy around there's some of the very entrenched social determinants of health issues and the Vita's passion is part of what we see as a motivational part of what we see happening on the ground but it's actually reflective of impact I think her work I think continues to inspire us all similarly I have to say boy Gerry Blasingame Gerry is CEO of the satiric Community Development Corporation what Jared's been doing in terms of his life's work has been looking at this issue of mass incarceration and the issue of how incarceration has been decimating and really impacting local communities local economies and redefining a lot of what's happening particularly in african-american men and for those of us who come from communities like that myself included the kinds of things we've seen it's hard for people to understand because a lot of these men sometimes boys if you look at even some of the some interesting data are invisible and what Gerry does is give them visibility and make them known to to the rest of the world an old friend also if you like to again say your whole name feels abnormal because I say Dave so an old friend and somebody who is Dave I should say Dave's whole title day is Chomsky is chief population health officer and in New York City Health and Hospitals Corporation and CEO of the New York City Health and Hospital a big hair organization I think at least 40 to 50 percent of you in this room know Dave so again just you know it's Dave because he has been a leader both nationally and locally and issues around social determinants of health underserved communities and thinking about our policy in a variety of different contexts is he like myself just had a recent kid so I'm just glad you made it and you know days I think part of the network of what we think about absolutions but an amazing individual who have a tremendous amount of respect for so here's what we're gonna do we want to start off by getting into the hard issues first and what I'm gonna do is ask you two of the panel members to give me a description give us a description for what you think what you see as the definition of the problem on the ground starting there and then we'll get into solutions DeVito yeah thanks so much and it's very hard for me to call you by your first name dr. Graham because you've earned that I'm sure and I've got to tell you something your team was out to Detroit and spent a couple of days with me I know last month and I had a bet with your team because they knew that we were going to be on this panel together and the bet was I said y'all how long is it gonna take for dr. Graham to bring up his mama before you brought your mother into the conversation that's true and the reason why I say that because in order to do this work you have to love people you have to love family you have to love those who are not family and those who are and dr. Graham I think the reason why you are so effective is because you love your family you love your mother you love your children you love your wife and so that is love really that is the solution to this problem and so I I am yeah I know you know folks in the room who know me they know if you mic me up because I'm a daughter or granddaughter and great granddaughter of a preacher you know I'm gonna take y'all to church so I just wanted to start by saying how much I love you dr. Graham and the support of the Edna foundation CVS cares has been tremendous to help us do work in the community and so I'll start really quickly before I turn it over to Jerry to identify what the problem is and quite frankly the problem is we really want to solve the issues that affect individuals as it relates to health care the problem is freedom if we can get folks free and what I mean free give them choice give them agency we can solve the problem so many people aren't and so when I look at the problems in my community as it relates to freedom I want you all to think about three buckets within the social determinants of health three buckets what do we mean when we mean social now what you want to think about the environment the social environment that folks live in I want you all to think about identity how folks identify themselves but more importantly how others identify them then I want you to think about folks position in life there's social economic status those are the challenges and the problems that I face in the city of Detroit what do I mean by environment many of the people and the communities that I serve and I am helping and they are teaching me just as much as I'm teaching them live in communities and many of them not by choice is because due to systemic and institutional racism their neighborhoods and communities have been redlined and as a result of being red line many of those communities have been extracted from resources or they haven't been tended to so the environment that in which they live in and in my case in Detroit I'm the executive director of a nonprofit called Food Lab Detroit the environment that many of the community members that I work with every day their environment looks very bleak as it relates to food retail not having access to a full-service grocery store or a sit-down restaurant or cafe where they can meet friends and family members over a cup of coffee or a hot tea the environment last but not least or next is the identity how we see ourselves and how others see us black Latino immigrant it is this other arena that removes us from people who don't look like us and that makes us wash our hands of the problem so many of the people who are work with identify as african-american that next Latino or immigrants and to mark into our community and then last but not least what is their social status many of them my low income many of them stay in marginalized communities and as a result of all of that if we look at these problems dr. Graham and Gerry and Dave through I would call an equity framework or racial justice framework many of these problems are because we have failed to deal with racial justice in inequality in this country and if we can have honest conversation starting today about how we tackle that problem I got it I just caught it you caught it I love being with her got so much energy so one another problem that I see is the ova policing of some of our neighborhoods I grew up in the inner city and we would see 3 4 or 5 times a day the police now I live in the suburbs of Greenville I hardly ever see a police when you take a breadwinner out of the family and incarcerate them most of the time the person that's been incarcerated is probably the person who's the breadwinner so you're taking finances out of the house you're taking bread off the table you're taking transportation maybe away you're maybe taking someone who can maybe able to help somebody with homework who knows I was sharing the other day in the inner city most of the kids don't even go to get checkups I grew up in a very poor inner city of Greenville and I didn't go to the dentist until I was 18 years old so those are the type of problems that we're living with and it's systemic most of these men who imprison their dads were in prison and so all you see is you you see people that you look up to who are people who are committing crimes that the only way they can survive because there is no chance once you get a criminal background you're marked for life it's like Houston praying with a scarlet letter you know a 48 thousand collateral consequences in the United States that bar people from getting jobs housing occupational licenses when I got out of prison I tried to go back to school to finish my degree in architecture they told me that I couldn't get licensed as an architect because of my criminal background I could not get a Pell Grant because of a drug charge not a murder not a rape but a drug charge so these are some of the problems that our people are facing and it's mostly black and brown people you know I gave to t6 yesterday you know but one in six Hispanics are likely to go to prison one in three black men and I say one in 17 white males but it's mostly the poor who are being affected mostly the poor so we have got to do something and it takes us as citizens and not only at the local level but also as far as policy we have to begin to change policy and speak up in those of us who have a voice we have to speak up so I'm gonna pass it you Dave well I agree with so much of what has been said already I think for me the way that I want to add to the conversation is from my entry point as a clinician I get to be a primary care doctor at Bellevue Hospital which is part of the public health care system for New York City and for the patients that I take care of and really if you ask any clinician in our health system they'll say sure the social determinants of health I get it you know I understand it when I'm taking care of a patient who is living in a homeless shelter and therefore isn't able to store their insulin to address their diabetes or I get it when I'm midway through counseling a patient on healthy eating and I realize they've gotten this glazed look on their face and I dig a little bit deeper and I understand that the problem isn't volitional in terms of being able to make the right choices to eat healthy but it's because maybe there's enough cash at the end of the month to buy you know any food much less healthy food and so I think the way that I want to help frame the problem is that we have to start thinking about so what there's been so much conversation about social determinants of health already and you know I'll just note this is not a new conversation the community health center movement in the United States grew out of an awareness that there are social determinants of health and they are predominant when we think about what actually affects health outcomes so we should feel a great deal of impatience that things have not changed over the last few decades and and you know in some ways over centuries in the United States and so if we take that idea that we really need to get to the core of the so what I think it helps us think about things a bit differently one way that I've started to put it together is really we need to take the conversation just as as my predecessors articulated from social determinants to social justice and figure out what are the you know the steps along that road so again just putting on my clinical hat you know one one way that I think about it is you have social needs you know for any individual patient it could be housing or education and you move to social services which is a way of addressing those individual social needs then you have social care which is really taking a step back and realizing that it's not about point solutions to point problems it's about recognizing that people come in you know in whole packages and their physical health and their behavioral health and their social needs are all intertwined and we have to reckon with the complexity of the interactions among those things and then finally we have to go from social care to social justice which is being very honest about the fact that the reason that there is that complex interplay is because of things like mass incarceration and income inequality and racial discrimination in our country and so you know one way to just wrap that up is invoking the Martin Luther King quote that I'm sure is familiar to so many of you the arc of the social determinants universe is long but it bends toward social justice and that's I think still more aspirational now than it is a reality and it's going to take a lot of leadership from people like the folks that are gathered here today to make that transition thank you for that David you know it's funny whenever a lot of us here you know we speak in different places you get interviewed and people always say there's no social determinants of health thing that everybody's talking about I was like from where I'm from we've been living that a long time ago inside every new to you but it's um it's been old and part of our a lot of our lives for a long time so it's important to understand the history of this to understand we're gonna go solution we're gonna pivot now towards this concept our own solutions for folks here understanding what's happening on the front lines is the only way to know what to do next we can come up with theories and and publications and things that are esoteric but unless you're engaging people right where they are arriving stan is local community a lot of people feel invisible they feel invisible for the world and these are the kinds of efforts to that allow men who may be in prison people who are in communities that are desolated to feel visible and that's why I wanted to have you hear directly from these folks about what the problems are so now let's turn a little bit to talk about solutions and what I would like for each of you starting with your DVDs to talk a little bit about what you think the ingredients for success are and then take a second to talk about your work specifically and how that's a part of it yeah if I could they've kind of draw this thread as long as we're quoting people I'm not gonna quote him directly but I do want to lift up something that he talks about all the time and if you have not heard of a gentleman by the name of Bryan Stevenson I highly recommend that you do some due diligence he just created amazing Museum down in Mississippi the lynching Museum but he's a lawyer and he only takes cases for young people that's on death row but Bryan Stevenson is absolutely amazing and one of the things that he talks about dr. Graham which I believe is part of the solution now I'll say I believe what has made me so successful Bryan Stephan talks about proximity yes you have to be proximate to the problem to be able to solve the problem so many of people that when they see communities that are in despair communities like neighborhoods in the city of Detroit that yes may be sufferings from blight yes may not have the best school districts yes may be occupied by a majority of black and brown bodies they say nope I don't want to live over there mm-hmm not me I'm not gonna send my children to that school system I'm not gonna live on that block because the yuck that got blighted houses I'm gonna live someplace else they're not proximate to the problem so they can't be proximate to the solution because believe it or not the community has the answers they just don't have the resources to solve the problem but the great thing is is that the communities that I work with every day are finding those solutions and so I'll say this proximity is super important when you're talking about solving a problem and the work that we do at Food Lab is really starting to tackle when we talk about social justice the root problem for us is how can we help folks not only to access healthy fresh food in their communities but might we do this in a way that also empowers them and improves their social economic status by taking their ideas incubating their dreams and helping them to launch fresh healthy food businesses right in their neighborhoods in their community so I'm doing two things at one time I'm bringing fresh healthy food into the community and I'm doing that via business ownership entrepreneurship creating businesses by the people who actually live in those communities and neighborhoods so that they may have agency they may have an opportunity now to make money they may now have an opportunity to be small-business owners they now have a say and Jerry before I turn it over to you I want to share a story there is a business within the Food Lab community so fool AB is a nonprofit organization and we provide incubation we provide business dication technical assistance finance helping entrepreneurs launch into food retail businesses and one of our businesses the name of it is folk folk Detroit and Kiki and Rowhani two women they own folk Detroit and it's a restaurant that serves breakfast and brunch and they pride themselves on locally sourcing their ingredients from Detroit farmers Detroit has about 1,600 farms and Gardens within detroit proper and I'm sitting at folk one morning as I typically do and it's beautiful morning and I'm sitting outside on the patio out front and the server serves me my breakfast I tend to get the same thing every morning it's called the breakfast brekkie Rowhani is from australia so she had to put something on the menu that reminds her of home and his scrambled eggs wheat toast salad I sit there give my cup of coffee and I taste the salad and I just put my fork down I'm like oh my god salad greens are so good they were they just delivered and the server said yeah divita Greg just dropped him off this morning I'm like oh my god tell him like the spiciness in the like I can still taste the flavor like he just picked them like they're so fresh I love them I don't even need any dressing I can just eat it wrong the ladies that were sitting next to me now I'm in Detroit I'm in the hood and I have to say these are two white women from the suburbs they're sitting next to me and they just stop and look at me like excuse me I said yes she says who's Greg I said Greg is the farmer they're like y'all know who the farmer is who brought the salad greens and we're like as a matter of fact then his name is Greg his wife's name was Olivia dick his daughter's name is Mila and they live down the street around the corner four blocks to the left and the name of the farmers brother nature they're like what we're like welcome to Detroit like it's just kind of like this is what we do in like it's this normalization that of course we know the owners of course we know the server's of course we know the farmers of course we know the farmers family because when you are proximate you want to make sure that I'm paying the server well so folk is a no tipping restaurant because the server's and the people who are work there are taken care of of course I'm gonna pay $18 for my breakfast because I know that Olivia and Greg and their family are going to be paid a fair and living wage for the greens that they dropped off dr. Graham what I'm trying to do is dismantle this whole destructive and global and oppressive food system and make it local make it personal make me care about food because I care about the people who made it [Applause] yeah have you tagging now I get to tag you so I'm gonna quote someone yes let's do it so Glenn Martin who started just leadership he says it like this those who are closest to the problem are closest to the solution but farthest from the resources in power and so what we've done it so terry has been able to take community development infuse it with re-entry 20 years ago Richie wasn't even a word and so I didn't have anything to work with someone came up to me one day and said Jerry you're an asset to South Carolina you're doing affordable housing workforce development political advocacy and he went on and on and these are all Community Development resources and so when you go into a community you can't tell a community what they need it's the people who live in the community or the ones who need to be empowered to move so those of us who've been incarcerated we know so one of the things that we've been able to do is we've been able to take men and women who get out of prison and put resources in their hand and let them take their own lives back reintegrate them back into society and their families a lot of times we forget about their babies and there's Grandmama's uncles and auntie's who need these people who are getting out my own life I was the first graduate of my program 20 years ago I had to understand how to balance a checkbook I had to get my credits straight now I wanted to become a homeowner as we all know SS its power we have to be able to have access we have to be able to have financial resources to be owners most people who live in in the inner city don't own anything and that's why people to robbing and stealing and doing all kind of crazy things because that's what people do when they don't have anything to do so we've been able to take these men and transform their minds give them clean affordable housing let them become entrepreneurs teach them that they can balance their checkbooks they can come home every day and don't have to stay up all night have a structured environment a lot of the guys would not go to the bank to cash their checks when it came to our program they were afraid they were afraid the bank is gonna take their money because they grew up with somebody putting money under your mattress on the shoebox and so we taught them about banking and we had a program banking the unbanked you know helping men and women to get back and realize that they can become owners that they are fathers and they are mothers so this is what we're doing in Greenville we have men who graduated from our program who are homeowners and business owners now I want to talk about something else that some of y'all don't even realize when a person goes to prison they don't exercise they don't eat right and one of the things I found out 15 years ago that people were coming to our program with diabetes high blood pressure high cholesterol heart disease that's not my job I just want to give somebody a bed and help them get a job and send them on their way but how can you watch somebody die who you're taking care of I had a 65 year old man who did a 20-year sentence come to my program he had a triple bypass while he was in prison in a stroke nobody would take him because he was disabled in the first time his application came across my desk I denied it my program manager came back to me he said what are you doing if we don't take him he's gonna die I said he just can't sit around all day in the first day he came he came in my office knocking on the door and he said thank you with tears in his eyes he graduated from our program we were able to get him medical attention he did not have a cane when he left our program he got an operation on his hand that was stuff that they did not give him medical attention while he was in prison he left our program walking without a cane had his own place it was engaged to get married these are the type of things that organizations like citerior do all over the US and so we don't realize sometime that when we lock somebody up we are paying anywhere from 23 to 87 thousand dollars a year to keep somebody in prison and then we release them and we expect them to do good how do we expect somebody to do good when we give them a laundry bag with a bar soap you know in a tube of toothpaste some t-shirts and say bye that's what we do in America we need to start setting people up for success and not failure so organizations like sotiria and other transitional houses and re-entry services are paramount here but I'm trying to work myself out of a job mm-hmm I don't want to do this forever so I want to start with the children teach the children financial literacy teach them you know that they can go to college around my table when I grew up college was never a dinner conversation people one of my high school teachers told me that I need to go to college I didn't have parents in my home and most of the men that are in prison don't have parents so what's the solution the solution is first of all people don't need to go to prison we are locking up too many people in America for nothing nonviolent offenses should not be penalized in prison I wish we didn't have prisons at all because I'm gonna go do something you say it it's love oh yeah and I'll end with this when you punish somebody without a relationship you create rebellion and that's what we do in America we are breeding rebellion in our inner-city neighborhoods and so we need to loving more and caring more about our people humans citizens so that's what I believe and that's what we do we love people and people come to our program and they say why are you doing this we say because we love you and they start drawing me and start crying because nobody has ever told them I love you a simple word I love you can change the world that's too simple but I was gonna come in real quick day before you before you say something I was going to come into that there is a saying that we have that if the young people can't feel the warmth from love they'll burn the neighbourhood down just to get close to the flame to feel warm like that's you love is the counterintuitive to pain and destruction and if we can just love to learn to love you'll be amazed at how many problems we can solve do that I feel like I should start with a quote but I would really want to quote Gerry on agency and divita on proximity and I think you know so much has been said that is powerful about that contours of of the solutions that are worthy of these deep entrenched problems and I think what I would add briefly to that is is scale and a sense of urgency and I think the things are these two things are related I think about scale again from my vantage point in the healthcare system where we have three point six trillion dollars flowing through the United States healthcare system that is not directed toward health it's directed toward healthcare and this is important this is important when people are sick so so don't get me wrong but a lot of the conversation that we're having during this session presupposes that people care about health and not about healthcare so a big part of what we're trying to do in changing that where I get to work at New York City Health and Hospitals is making it so that the funding the infrastructure everything that goes into this huge apparatus in healthcare 20% of our nation's GDP is better aligned with health and not just healthcare so you know we have embraced the idea that social determinants of health are a fundamental part of our mission and we've tried to do that in a way that is concrete and hard-nosed so for housing for example we look around at the latent natural resources that exist within our own system for example the fact that we have buildings on our Hospital campuses that can be turned into housing and so we've done that at some of our hospitals and you know to echo my colleagues when someone who has been living on the street or living in a shelter comes into their own home for the first time what they talk about is is really about dignity and it's that reflection of love they talk about what it's like to be able to cook a meal for themselves or for a family member they talk about you know what a nice thing it is to be able to groom oneself in the privacy you know of their own home and so you know those are the things that we're trying to redirect the vast resources within healthcare toward three point six trillion dollars but paired up with this idea of scale has to be a sense of urgency and I feel that and particularly in conversations about social determinants of health where it's too easy to focus on you know the innovative pilots we talked about in the same breath you know an app a new app that helps someone locate food banks which don't get me wrong is a good development it's a useful thing but at the same time we have policy changes at the federal level that are currently being finalized by the US Department of Agriculture which would buy their own count take seven hundred and fifty five thousand people off of the rolls of snap which would be catastrophic for food security in our country so we need to have a sense of you know the relative impact of these things and have a sense of urgency to really direct our energies and our advocacy toward the things that are going to make the biggest impact that are going to affect the people that we are trying to serve at scale Wow okay we're gonna gear up now to go next Cooney thank you for that Dave you know what's interesting I get to run an organization that does pretty cool things like you know invest in folks ID to Vita and help them change the world and you know it's not just dad who you know that's broader organization invest more than billion dollars in housing and do all these kind of cool things sometimes I think back to kind of how life started and I want to throw a my quote now and then with all the questions I think about you know where I was great now I had and I wouldn't have even thought and this was possible and so there's concepts or proximity and understanding what's happening locally is real because I know I felt invisible no I'm very visible but back then things are very different and the one quote that changed my life was somebody who said to me just because things have been doesn't mean that is how it has to be and she hammered at home all the time you know she would always be you know I'd always be like well nobody's done this should I go that's because the way things I mean doesn't mean to be and has driven me to be able to kind of do the kinds of things that were doing now but you have to understand what's happening in local communities because all health is local and you have to know what's happening to be able to do that know understanding the theory is not good enough understanding people's what's about by the way that person was Sybil Alice Graham aka mom all right we're going to go to Q&A we have ten minutes ten minutes for Q&A Christopher help hi thank you all for doing this it's it's kind of a question for Gerry and Aviva I think this idea that you're close to the problem and that's at the same time just away from the reason and at the same time I was struck with this the idea of these two like women who are having breakfast with you at this restaurant what had them come there did you have more conversation with them and after they were struck by the fact that you know you knew all the people who were involved in the process was there anything interesting that came out of that conversation and are we maybe supposed to conclude that the solutions we can really trust and rely on like the cavalry has already come it's the people who are actually on the ground nearest the problem yeah so it's interesting Christopher I'm I'm in my head thinking like how to succinctly answer your question and what I mean by that is when I first started talking about the determinants of health from this social framework of environment identity and position I described the environment in the city of Detroit in terms of what was in terms of what was there but I didn't describe to you is that what is coming and so the reason why I'm sitting in this neighborhood in the city of Detroit at this Abbott farm-to-table restaurants that is a breakfast in a brunch location and the reason why sitting next to me were two white women for the suburbs can be easily summed up in one word and that one word is gentrification there are neighborhoods in the city of Detroit that for decades Christopher had been redline resources had been extracted neighborhoods had been ignored but because of this migratory pattern where people are now leaving the suburbs and want to return back to urban communities and cities those people who stayed in those cities those people who stayed in those communities those people who stayed in those neighborhoods and made a way out of no way urban farmers who took blighted land and turned them into urban agricultural farms my grandmother's had no idea dr. Graham went farm-to-table was she was just eating the food that she had grown and many of the entrepreneurs that I worked with when I described these different types of trend farm-to-table knows the tale they're like what are you talking about baby that's just the way we used to do things and so they've made these neighborhoods cool again authenticity and culture social cohesion and conviviality all those things that people quite frankly crave for but didn't get him in the cul-de-sacs that you all were living in they want that warmth they want that love they want that connection and you didn't get it when you drove through your cul-de-sac and push the garage door opener in your car and went straight from your car into your garage from your karate to your home and you didn't even know who your neighbors were that too is isolation and you want that warmth now and you're coming back to the cities to get it so the reason why I was sitting next to those women is because there's this desire now to be in community in a neighborhood there's this desire for authenticity there's this desire to return back to the neighborhoods in the city of Detroit and that's exactly what they were doing like so many others do and did we have a conversation absolutely we did did I recommend more fool at businesses that they should visit you bet you I did and so conversations meeting people closer showing that warmth at fool Lab Detroit it starts around the table some women talk about the so the leaders in the neighborhood those were close until the problem close to the solution we forget about people who live in their neighborhood a leaders that's right we forget about grandma maple who sits on the front porch and rocks all day long and nobody looks at her as a leader we forget about the young drug dealers who are actually running the neighborhood they are the leaders people are afraid of them we forget about Ned the wino who grew up in the neighborhood but he was traumatized had PTSD growing up as a child Lee he began to drink out of the wine bottle but if you go X near the wine or something he can tell you but we don't resource those people we don't help them so we're not going to a community I find the Grandmama's the drug dealers and the winos and I empower them to help me so that's what I mean that's what we mean by those who are closer to the problems closer to the solution I was a reformed drug dealer and now I'm leading my community because people resource me because I gain their trust you know Dave you said something about like having having a sense of value or having agency or a sense of self-worth one of the things that coming from and being born and raised in the Baptist Church one of the things that I observed even when I was a little girl in granddaddy or daddy or Papa would preach and we would be in church is that particularly for men is that these may have been men outside of the church who janitors these may have been men who were outside of the church who were bus drivers or service workers or Pullman porters people who might have been looked down on or expected to do things for other people but when they got into the church they were deacon Dave I know it's your man when they got to the church they were the head of the trustee board when they got that's where they found their self-worth that's what they found their sense of agency that's where they found their pride their sense of identity and it was that that held them and I'm not trying to say that the church is the answer but we've gotten so far from it and the thing is is that what is that Jerry what is that thing that is bringing our communities back together when you take mom out of the house or daddy out of the house and you lock them up and we're caging bodies what is that thing Jerry that keeps us together what is that thing that if the tution that structure that continues the whole family and how it's missing I know people have a bunch of questions all right well when I got time for one more before somebody's gonna be a big giant hook and pull me up I see there was one lady back there I know I'm sorry for buddy we're just gonna do this one real quick is that fair enough okay okay we're not the biggest and I I love that you guys are out there right now and I feel so humbled by all of your work I my question is about the difference between the narrative of the Lone Ranger and the narrative of the community potluck are coming together right so when in in history class we're taught that we had the Montgomery bus boycott was the result of Rosa Parks standing up I mean refusing to stand up right well she took a stand you know what I mean but in reality there was this whole network of people that were behind her right that's the community public best though like we bring things together and we make social movements happen so could you speak a little bit about the how we tend to honor in favor the narrative of the lone ranger over the narrative of the power that is in the collective what a thoughtful question I'm happy to start and I'm sure you guys have thoughts as well you know I think about it when we look at something that has worked extraordinarily well you know in a particular community or you know in a neighborhood and you know everyone for good reason points to that and says what a what a valuable effort you know I'm so glad that this charismatic leader was able to galvanize their community and figure out how to you know how to change this entrenched problem you know I'm a doctor so I'll use a medical analogy it's it's like you know I remember when I was a medical student I would go on transplant missions and what always struck me about that was the the care the sophistication the team work that went into transplanting an organ from one person to another person and so in my own work you know I think about that a lot just as you said you know the the idea that everyone likes the pioneer you know the first to accomplish something but what is less celebrated are the people who are trying to do that transplantation of innovation of change the hard work of adapting something that grew out of you know circumstances in a particular place and bringing it to another place and I think what we should do is figure out how we can celebrate those you know those efforts to transplant even more and I think that's really connected to this idea of scale because to solve something in one community should be looked at as just the beginning and then people who are able to bring that from one point of light to a thousand points of light are really people who should be lifted up as as well so on that note here's what I want you to do we're gonna recognize that the people sitting here are heroes and you know quite frankly are a part of why the future is gonna be different we're gonna have to end on time just because I know I should do that but I would like you to engage support they're all come from different backgrounds continue to lift up tweet about their work and what's the other thing people do about tweet and adults I'm asking you Instagram about their work and if people do that and stuff like that because this is what needs to be lifted up for things to be different good enough all right all right cool are we done

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