Financial Health is Public Health | Kara Walker | TEDxWilmingtonSalon

I am the product of social mobility and

financial progress these are pictures of

my great-grandparents on the right hand

side are pictures of my

great-grandparents who came from the

Netherlands to this country through

Ellis Island looking for better

opportunities they landed in the fields

to provide better opportunities for

their family and their children on the

left-hand side or my great-grandparents

on my father's side who came through

many many trials and tribulations who

picked cotton for five cents a week and

we're just a step away from being

sharecroppers living under Jim Crow laws

and told their children go up north for

better opportunities and better jobs

things could have been different for me

in my family I'm fortunate my parents

were both first-generation college grads

and made wonderful choices for me and my

brother but easily along the way I could

have made different choices and

certainly things could have been

different for me things could have been

much more similar to they were for

hundreds of patients that I've seen over

the years you could be there now you

could be there too sitting at the table

with a stack of bills water electric

trash service that credit card full of

charges for the start of the school year

you can't send the kids to school naked

right and there's a cable and internet

bill which maybe you could do without

you don't need your shows every night

but you need that internet because what

happens when the kids come home with

questions that you don't know the answer

to I don't know what number bonds are do

you and then there's that car payment

which you need but realistically the car

was on its last legs before I even

bought the car and that's just what's on

the table tonight

you don't know what else is going to

come in and you know what else needs to

happen everyone needs to be fed

your kids are looking up at you those

beautiful smiles you're full of pride

but your daughters looking up with that

smile only a mother could love you know

she needs a dentist and probably an

orthodontist your son

he definitely needs I glasses and you

know just by the way he's squinting when

he's looking at the television what is

the cheapest meal for tonight and then

again tomorrow it's your list of worries

a stack of bills a need for medical care

don't let anyone tell you your financial

health doesn't have anything to do with

the health of your family it has

everything to do with it a study by the

Congressional Budget Office has shown us

that income in America is becoming even

more concentrated today the richest 10%

are becoming even more rich and living

longer and the median are growing more

slowly and those who are born in poverty

are having even more difficulty finding

opportunities for jobs and education

even more we know that people are

becoming even more concentrated and

where they live by race and income

pockets of segregation are bringing all

of us down we know that this means fewer

opportunities for all of us to have

better jobs and better education the

Urban Institute has studied this and

modeled it gregory axe has shown that if

we could get to just average levels of

segregation in cities like chicago this

would provide better opportunities for

everyone and for blacks it would mean

that $2,400 more would be in people's

pocket every year it would mean that

80,000 more people would have college

degrees and the homicide rate would be

reduced by 30% this is a challenge

and this is what we need to work on I'm

a family physician by training so I

often think about patients that I've met

over the years and I'll tell you this

story we'll call her mr. Rivera for

today I met her in the clinic of San

Francisco she came into this country

looking for better opportunities

escaping war and poverty

she had a third-grade education had

small kids and was very hopeful she also

had diabetes and every visit we would

try and try to get her diabetes a little

bit better under control and every time

she told me I'm doing so much better but

the reality was it wasn't budging

I kept increasing her insulin up and up

and up to the point that I really didn't

think this was working it wasn't making

sense anymore and it hit me over the

head at that particular visit I asked

her where are you keeping your insulin

and she said it really depends on where

I'm staying this week which friend's

house and when I'm at a shelter it's not

possible

this is not uncommon it is the social

determinants of health that matter most

more than anything I learned in medical

school the World Health Organization

that's estimated only 10% of what I do

as a doctor actually matters it's

everything else that makes a bigger

difference jobs income transportation

housing neighborhoods

it is these issues that impact health to

a greater extent and for the family that

shares medicines because well the

symptoms are similar to the person who

does grins and bears it and hopes the

problem will go away these are the

issues that impact our health and the

health of families more than anything

else even more we're trying to figure

out how to

address the chronic stress that death

can create this chronic stress creates a

toxic reaction in our bodies that can be

measured by small molecules called

biomarkers it actually changes how our

hormones work and creates the chance for

stress to actually reduce the length of

our lives on top of that it creates

difficulty coping people tend to do

things differently over eat exercise

less maybe sleep less on top of that

they may be depressed and coping by

drinking alcohol or maybe even using

substances or gambling we can work on

this together even more we know that no

matter what else we do more than

anything incomes matters more than other

factors like age and race if you are

wealthier you live longer on top of this

study by the Robert Wood Johnson

Foundation that showed that income

matters we've also seen in the reports

of what people say in our country the

Gallup share card report 2014 financial

rankings also showed that people who are

struggling financially are more likely

than those who are less financially

secure and those who are thriving

financially to report things like higher

rates of obesity high blood pressure

diabetes on top of that people who are

thriving financially are more likely to

report other positive behaviors like

eating healthy produce exercising and

maybe even sleeping better people who

are struggling report just those things

that we talked about earlier if you're

struggling you're more likely to report

sleeping less being depressed anxious

and maybe having more difficulty

managing your health

all of that puts you at greater risk for

things like heart disease cancer

and other problems that's shorten your

life on top of that this Gallup share

card report showed that many people who

are struggling financially do just what

we talked about earlier they're more

likely to delay needed medical care as

30% of people in America have reported

this is our opportunity to make a

difference and help people where they're

at and address the other factors that do

certainly make an impact we know that

more than anything else from studies

about what type of job you have or where

you live income matters we can do

something about this we can make a

difference we can coach people we can

stand by them when they need it most

in fact in Delaware this is just what

we're doing through the Stand By Me

program since 2011 we've had a program

called Stand By Me which focuses on

financial empowerment it leverages the

capacity of local and state agencies

private businesses philanthropy

nonprofits colleges and communities it

brings services to people where they are

and where they're at and what they need

most it goes beyond just the basics of

budgeting and saving but it gives people

the skills to maybe buy that first home

or buy that first car and it tells

people how to avoid the dangers of

predatory loans get out of debt and

focus on everyday budgeting sometimes

you need to know a little bit beyond the

basics just like all of us you have a

car and you need to know sometimes

whether you need a major overhaul from

the mechanic or whether you just need to

add a little oil or gas we teach the

basic indicators of whether you're on

track and how you can thrive financially

how we can reduce that toxic stress and

how we can help people manage and also

healthier in Delaware I serve as

Secretary of Health and Social Services

and I know we need to do more to go

beyond the typical social programs I

know with federal leadership one day we

should be able to get to a place where

we align our social programs where we

align welfare and food stamps and

housing programs and what we're doing to

provide people those supports when they

need it most when sometimes people just

need a basic minimum rainy day fund and

we know the evidence is out there that

people really just need cash and not

governmental oversight but until we get

there let's coach people let's empower

people to go beyond just needing those

supports in place we can do this we can

do this together collectively and we are

doing it in Delaware and it's making a

difference since 2011 over the past six

years we've helped over 15,000 people

collectively we've gotten people out of

debt that's totaled about seven million

dollars people have saved a collective

almost 1 million dollars and the average

credit score has increased by 88 points

if you've been there you know that's

tremendous and we can continue on this

path by focusing on financial health

we're going to keep working on this

together and we can do this we want a

healthier community we want lower rates

of diabetes we want fewer people with

obesity and high blood pressure we want

fewer sub though fewer people using

substances and we want a healthier

environment we can do this by focusing

on financial health financial health is

public health trust me I'm a doctor

you

[Applause]

you