2019

Description of the video:

So welcome we're delighted today to have Professor Michael Oaks with us. He's a professor in the Division of Epidemiology at the University of Minnesota also Vice President for Research there hasn't McKnight Presidential Fellow Fellow of the Minnesota Population Research Center Senior Advisor for the Robert Wood Johnson Foundation healthy eating Research Initiative. And now the director of the Robert Wood Johnson interdisciplinary Leaders Program which I think we're going to hear about more today >> Original trainings and sociology is current work includes methodological research as well as research that cuts across social sciences and medicine and epidemiology which I think are some of the most interesting and complicated programs that we have an epidemiology these issues around neighborhood effects around socioeconomic status and these other really kind of hard to define and hard to quantify and measure problems. He's made a lot of visits to Bloomington over the years which we learned about last night and has some current and previous collaborations with our faculty. I'm hoping that we'll have many more in the future for your talk and thank you for coming. Thanks so much >> I had a lovely visit thanks for everyone so far and it's really nice to be here. I know David Allison, your dean, can't be here. But once he invited me to his house for dinner he also didn't show. I tease David I often give talks about statistical things. But today I thought I'd do something different. I want to talk to you about this program that I get to run as well as some of the issues that I think are important for faculty like you and me. Tensions about doing public health research and advocacy. So for the next hour give or take a little bit on a share sort of an arc of a story and try to weave together some ideas but really try to open up some places for conversation for some Q and A but I think all of us faculty and grad students of course future faculty want to think about. So let me just start with this simple table and it's you know so it couldn't be more simple but this is just age group by death rates amongst rich and poor. And whatever right turns out this table was put together in the 123's in France. And what strikes me is that this table could have been published in the American Journal of Epidemiology today. You might need some p-values or some g estimation function but nevertheless the data are the data. And what really intrigues me is the health disparities observed in 1820 that are about the same ratio as they are today. And of course this is rich versus poor. You can do black and white immigrant not pick your your categories. It's this sort of simple idea that we have been working with disparities in health that has motivated a lot of my more recent Career and sort of a key motivation For this talk let's call it this afternoon. Your lunchtime hour. Most recently a few weeks ago I was invited to invite only special Conference at University of Chicago Department of Economics which some of you know is where all the nobel laureates our Jim Heckman and others it's a fancy prestigious place with amazing scholars. And the point of the conference was to bring sociologists and economists who focus on inequality together to for a two-day conference of sharing and in hashing out some things. So I gave a talk there I was invited as very and honored to be asked. What struck me was when I talked about the things I've been working on an epidemiology in the program the IRL program. I'll describe for you. With my colleagues who are really cutting edge in the social sciences thinking about inequality. Thought me a bit odd perhaps for a number of reasons but one was because I was talking about the challenge of doing something about it Advocacy. And it struck me that this leading group of scholars who are amazing every one of them were like Hey do you really want us to be activists and it's that tension that I want to talk with you about afternoon. What is our role in public health especially but as scholars as faculty neophyte and gray hair. What do we really trying to do here and that's what I want to talk with you about today. So the Robert Wood Johnson Foundation based out of Princeton New Jersey that's the headquarters. They have a campus there. There are $10 billion philanthropy actually the original money comes from Johnson and Johnson. And for decades decades they've been funding I think effectively research and other activities for health care massive thunder of Healthcare Research lot of health economics and related medical science. That is medical practice clinical work. About seven issue years ago depending who you ask. They realized that as a foundation as a major philanthropy in health they were not getting the best bang for the buck there. We're not addressing the things that they wanted to address which was improving health for most of americans. For tax reasons they're only focused on America unlike gates but so they're focused on America. And they were not getting what they wanted. So they had their executives and the board of not regions but board of directors. I have border regions got them together and what do you have a majors to cheat strategic shift and what they wanted to do was to focus the foundation not entirely but largely shifted shift that big oil tanker if you will to focus on building health equity. And if you listen to public radio building a culture of health in America right you might have heard that in radio. And so with that amongst other things they founded for new leadership programs. The idea was that they wanted to have people learn how to advocate for to do research. To do advocacy to embrace health equity as a goal to be worked on and they wanted to fund it. They wanted to shift the way we including the NIH Think about these problems frankly with the money behind it right when a cough people listen kind of thing. They're obviously not nearly as powerful as NIH but as a philanthropy. They speak loudly. So the idea of course was to embrace a more integrated version of health a whole person a whole community and they insisted on in this new effort for new collaborations. And importantly collaboration's not just in our institutions you in Minnesota and so-forth but with our community partners and frankly the people we're trying to help. And as you know NIH has PCORI and other initiatives. This is in that vain but I'd say cranked up a little higher. So the Foundation funded the tune about $50 million per year 5-0. For new leadership programs to create an ecology that we call the leadership for better health initiative. First health policy research scholars. This is a program now run out of Johns Hopkins University for doctoral students interested in health policy. But importantly most of them are not in health policy training programs there an anthropology sociology medicine economics art whatever it might be. This is you expand the discussion of where health policies discussed and so forth. So that's health policies research scholars in there a sister program of of ours. Next this interdisciplinary research leaders that's the one I get to direct. I'll come back to that. We're going to talk about that for a while. Obviously. Culture of health leaders is a program run out of a foundation out of Washington DC. This is a program for what I might just call professional people who want to do things to address health equity. You could be working in your local health department. You could be working for Target Corporation. You can be working for some other government agency and obviously not-for-profits. And the idea is to put these people together give them some skills and some resources to do things to do things to improve health. Finally Clinical Scholars. The foundation is always had for many decades a Clinical Scholars Program. This is a different one sometimes called Clinical Scholars 2. But this is for clinicians of all types not only physicians and nurses but chiropractors and P t and so on. And the ideas to how these clinicians be more active and understanding of health inequity and all that that implies and work through their clinical work as well as policies for clinical work to effect change. So this is the ecology of four major programs for leadership for better health. And now I'm going to focus on the interdisciplinary research leaders or IRL program. And yes I know they're also stands for in real life. If you're under 30 perhaps that I had teenagers so I knew that right away. So what is IRL again it's one of a family. And here we're trying to do leadership in the research domain right and we're trying to connect communities and community organizations. And researchers like you and me. Interestingly we're trying to develop leadership skills. What does that mean I'll come back to that later. This afternoon We want to have actual impact so as some of you know on NIH grants there's an impact score and men reviewers kind of say oh that's interesting the right for papers. That's a good impact. That's not the impact we're talking about here. We're talking about actually measurable demonstrable impact in people's lives and communities. We wanted to attract new people to the conversation. So places like Indiana and Minnesota and Hopkins and so forth. We're all in this game. We know how to get grants from NIH or at least try to. We know how to play it. But places that smaller schools. Smaller independent research shops are not in the game. These are often scholars of color and scholars of different kinds of disadvantage. And they're not in the conversation yet. We think they have lots to offer so we want to lift them up. We want to do more rigorous action oriented research. This rigor and action point. I'm going to come back to but that's sort of the point. And importantly at least for me alter the institutional support for what I'll call Engaged Scholars Scholars in a very public health way. You want to work with community people to get stuff done. The issue of changing the support for them is that in many institutions including my own a young faculty member might want to work with her community does. So for years rates fewer papers fewer grants and it gets denied promotion and tenure. If we as university leaders care about this thing we can't have that outcome. We have to actually embrace this group of scholars who want to do this or tell them that they're not welcome. And be honest obviously I'm for the former. So this is sort of the mission of IRL. And that's what I've been working on for about five years. What happened was I was on my desk and I heard about this opportunity for this grant to to get it this new program. And I was part of a team. We competed and we won. And then for about 2.5 years our hair was on fire trying to build it as we flew it. Interestingly I'll just note the foundation gave us no time to plan it. It was awful but brilliant because we had to just jump in. And so the team that I work with at Minnesota and elsewhere were just doing stuff trying and failing and trying to fail fast fix it and keep going. So now as halftime university administrator I think a lot about how long should we think about stuff before we do it I'm more and kind of jump in and fix it as you go. What happens well in some sense and given this audience as kind of like a college it's a three-year fellowship program. People apply to us. We have a selection process and of course review and we bring in a cohort kinda like a freshman class. And there with the program technically for three years. But since we value the alumni you can never really escape. You get the tattoo at about year two and you're stuck with us. We want to advance these people who apply who do so in teams of three people to researchers. And one community partner who formed their own team outside of us and apply to us as a team This is by design. Triads are unstable. Three persons or three tend to fight right two on 32 out of three. This is by design. We wanted some energy. We wanted to embrace that challenge of working together in a team and to have an interesting dynamic so they apply to us as a team of three people. They come they join the program they get selected and so forth with us for three years. We give them all kinds of money and resources and training and all kinds of stuff like this. And we also give them about a $125 thousand to do a small research study. A research grant as well as TE support so-forth. We pay for all the travel my budget's about $10 million a year and so forth. Importantly this kind of idea is new. We're asking them to do a research project. Yes it's small dollar though for some people that's enormous like a $100 thousand holy cow I'm going to get 7 thousand people and my survey and talk to the mayor and change five things and run an RCT. Mike Yeah I know. You can talk to 12 people in a focus group for a $100 thousand. And it's a research fellowship program where we do all kinds of training and so forth and learn how to collaborate across and outside the university castle walls thinking about really leaning into issues of equity diversity inclusion. What does that actually mean when we do it in all kinds of other training. So this is why it's both training and leadership. And still to this day years later people think it's just a researcher application and it's not it's more than that. And so people join us like wait I've gotta take classes. Yeah you're going to take some classes. So who are these people whether mid-career researchers mid-career loosely defined it's sometimes correlates with a tenure track but you don't have to be a university person at all. So you've had you know 40ish years post PHD or related training. You know how to do research. We think we hope. And you're not nearing retirement so you might be 70 but you want to work to 80. We might invest with you. If you're 60 that super young we're happy to have you aboard. It's expansive by definition or by choice because everyone's lives a little bit different. So when people ask us hey am I eligible say yes or no if we can but then we say make the case. So that's the research side and we have people most of whom are from institutions like yours and mine. We try to get people from smaller schools teaching colleges. And of course people from places like Urban Institute. Norc and other research institutes outside the academy. The community partners our leaders typically in some community based organization trying to do something in your community. We have a larger definition of who's eligible here. You don't have to be mid-career. There's some amazing younger people and amazing more older people. They work in a variety of settings But they're keenly interested we hope we want them to be to be selected to be a leader in whatever thereafter. We want this team to work together to try to break down some of the barriers that I described earlier that some of you might know about. And so they join us for three years and here's sort of a diagram of the three-year experience. There's several things going on at the same time. They join us in September and go through the three years until the August. In the first six months we take first their proposed research project that they told us and that got selected on. And we tell them why they can't do it that way. It's too ambitious. It may not be rigorous enough. They may not have a good comparison group. They might want to run some fancy clinical trial. That's just not going to happen or they may not really understand community engagement. So we have a whole team what I call my research team who helps them get better they're sort of consultants. We are agnostic about methodology or approach. You can do qualitative quantitative RUN a trial. Do mixed methods whatever you want. Just want you to do a better. And so we have teams of people to help them do better. So they have to sort of refine the research proposal in the first six months. Before they can get approved to get the actual 125 I hold that back. So that I have some stick over them as the leader. And then in the middle and this sort of purplish top thing you can see they do the research project for about two years. And then the last six months we want them to disseminate their findings. Importantly yes dissemination includes typical academic papers. We want Op-Eds. We want Twitter you want talking to your local civil board to the federal Senate whatever you're into do more. Just academic stuff academic stuff matters. It's good for all of us but we want more than that. We think that the real action is getting the word out beyond the academic walls. So then in this sort of middle road there's this idea of translation and action and that starts from day one. We think about the research project for a moment one of what will it achieve WHO it'll help and how did they know and do they care so this is with a deep engagement with community and our community partners on these teams are essential to this. So we're trying to get away from the model which isn't always terrible but not always optimal of the academic coming to the community and saying hey I know what's best or hey I can get something out of you you study you do my thing and split. We're thinking about the community engagement as a relationship. And what does the community want and of course there's a negotiation. Some of you know and some of these approaches. Some of the scholars say Hey what community do you want and I'll help you with anything you can do. I actually think that's a mistake. I want to be more humble. I have some skills in this narrow area of research. And I can help you with that. I can't solve all your problems. So that notion of dissemination is thought about from ground one moment one as well as the engagement and then research and training. We have all kinds of mini courses online like YouTube TED talk kind of things as well as more Online courses we have in-person meetings three times a year. We have all kinds of speakers calm and that kinda stuff. What's different in the IO program from previous Foundation programmes is people don't come to Minnesota to stay. They stay where they are. It's a national thing. We do distributed learning we use the zoom platform. We've tried many zoom seems to work best and some other online tools. So it's like an online thing for grownups trying to figure out how to get better. And then of course they become alumni. We have now one cohort who's graduated who is alumni. And we don't let them leave they got to now give back and they've got to do their networking to hopefully affect change. So the elements of the program is all the good difficult stuff teamwork you know you and I probably aren't trained to work in teams. The model of the great scientists working frankly in his laboratory. In his way persists there's one PI and our program. There's no PI. They're all in it together. Universities don't know what to do with this. They call me and say well who's the PI who's in charge of the Money Mike they all are. We can't given the money. Well yes you can or I'm taking it back. Fascinating so teamwork leadership training. What does that mean to be a leader in the research space the community leaders see more straightforward. Research Leader. I'll come back to that later this afternoon I want to teach them about methodology. You might be a good trialist awesome. We want to teach about the value of qualitative research. You might know qualitative research cool. I'm going to teach you about counterfactual inference. People in their mid careers have been doing it for awhile and we all get kinda stuck. So we're trying to expand some minds. Now that you have to change your career but you're more aware of stuff. We teach them about the policy process. How to policymakers come about their opinion how did they introduce a bill including how to corporate executives make policy it's not just governmental policy its policy and a local community center. It's policy perhaps in the church or other institution. And of course it's policy at corporations. And then dissemination I mentioned that we insist on interdisciplinary collaboration and teams of researchers have to come from different disciplines or different backgrounds. This is actually interesting. I've done a lot of interdisciplinary work and sometimes I see on a committee an application from an interdisciplinary team. One is in Renaissance English. Yeah there's in classical English for them. They're completely different unless you're a chemist than they're exactly the same. So it does depend on where you sit. So this interesting topic for us again community engaged action research. And what we do is you'll see in a minute we have Cohort specific focus areas themes. So I advertise here's the focus for the new year and people apply if you're interested in that topic and they stay with that. The idea here is to have some cohort ness a group of people working on similar problems as well as hopefully having some you know seven or 15 research reports at the end we can I can frankly say something about what we learn from every team that's been doing the work in the area. We want them to collaborate with the other programs in our ecology. And of course an active lemma All these things are going on simultaneously. People asked me Michael. How do you know when the programs working I don't I don't we're doing 12 things at the same time. Hard to measure. And I I sometimes push back even the Foundation when they say we want something to know when it's working it can give me a few things. But as you know you might know there's other stuff their successes that don't get measured. I don't wanna lose that. So I just tell them to give me the money. Our curriculum won't surprise you collaboration and engagement matters. Importantly the community member is by design and I had this when I was writing this grant where my ulcer was growing in the shower I said to myself the community member isn't a researcher. But she or he should become a research leader. Which is to say someone who says hey researchers I need this question answered or don't come to my community with that approach. Or I know how to understand quality research or not. So there are research leader on behalf of their community without being a researcher necessarily themselves. So that's a lot about this engagement. Change leadership. You and I work on papers read stuff about changing the world to improve health. How does it actually happen very difficult so we have a whole curriculum on that policy and communication. As I mentioned how does that process work and of course rigorous methods I talked about that. I want to come back to the word rigorous. It's an interesting word later in the talk. So we have this four-part curriculum we put together and throughout the whole thing we have these leadership ideals that we try to work on these leadership ideals are across all four programs. We're always trying to weave in. So again the teams have a research project. It's about a $125 thousand and some universities wave. The FAA the overhead some say no we only give them 12%. So it's a foundation grant you can't get 5475 Wherever you are NIH. But that's part of it. We hope I argue that this program is really good for universities to waive the overhead because we're developing human and social capital. Amongst the researchers it's an investment right okay so people propose a topic I told you we make them get it better. But as I mentioned I don't care if it's qualitative or quantitative doesn't matter to me. Just get better at it. We want it to be rigorous but it's a two-year study and there's not a lot of money. So we often like frankly I'd talk to my own doctoral students slow it down narrow it it's too big it's too far. Now what's interesting is somebody's coming organizations. A $100 thousand grant is massive. And so we're trying to have this conversation about what's reasonable and hopefully the benefit of doing something quality that can be leveraged for future work in some way I'm trying to teach them the hunt right I give them a little something make them better position them network them. Teach them some skills They can go on with their careers and do even better. For me I'm most interested in not what they do at the end of the fellowship but five years hence right so what are the projects there's there's everything case studies qualitative interviews evaluations of programs. All kinds of stuff basic data analysis doesn't matter to me. I'm really agnostic just to something that has the potential to have change. Sometimes that change people want to do is direct awesome. Sometimes hey I'm going to show something and then show some Maier. How this observational data finding is useful to her and how she should make that change as mayor. Awesome. Action-oriented From the start. Here are the cohorts we have now four cohorts in the program one it's graduated. We're recruiting for the fifth. I'll come to that. So these are these themes are focus areas. And you can see they're all more or less in the social determinants of health area housing and development early childhood and health. That was the first one those people who've graduated prevention of violence. Resilience. Resilience is an interesting one. I want to do something and mental health. My colleagues said no that's too narrow BY resilience. I think it was a mistake. I'll share with you that I think that resilience is too broad. There's all kinds of people working on resilience from different angles. We don't have that cohort NES that I desired. So I'm learning every day chord three. Intentionally was focused on rural health different components of rural health. But I want to be clear that most of our people come from city and do City kinda urban stuff. But rural health matters as you well know. Most recently court for community development and health. What does this where you might know that there's there's whole groups and investments to make a new mall and new community center a new church and these are a massive investments from communities Funded often by various kinds of Bank and Bank like institutions. So what's their role our game of urban planning health racial segregation school location. This is community development. And so now we have a cohort of people teams working on the same thing. And then the last one here you see at the very bottom if you can see it is how do we link clinical data in social service data if you've ever had to literature most of it is how to take social service data and help the pediatrician know what her patients about super important. I also want it to go the other way. I want the pediatric data as appropriate to go to the social service workers. So they know what's going on in the doctor's office. So it's bidirectional. That's a challenge but that's what this group is working on. The court we're advertising for now that'll be open in January if you're interested is I know it's environmental health But this is environmental justice. This is environmental equity. This is environment and the old school way of biosphere. Toxins lead paint pollution noise other things right so we're interested in environmental equity as a focus for the cohorts that will join us next year. Again applications open in January and then families and children especially fathers and health. Most of you know every big school has or is related to a maternal and child health program. Super important For many years I asked my friends in the MCH programs. What about the dads were the guys oh yeah we should work on that. Well now I'm going to give me some money to work on that. So I'm trying to shift the conversation. That's what I get to do now I'm so lucky to where we focus our attention. So this is what's coming up for court five court six and beyond. I don't know yet. We'll just see what the world brings. How long will this go i don't know. I don't know how long the foundational fundus it's indeterminate. I don't know how long I can do it. I'll tell you a little more about some of the struggles toward the ends but anyway this is where we're headed. And so far it's been a fun fun right. Here our map of our teams. These are people the teams from all of the country you can notice. There's also Puerto Rico and Hawaii. And as you can see but the the red or the past projects in the blue are current. So these you know we try to get when we select our cohorts diversity in all that it means geographic obviously race and gender sexual identity and so forth. We try to be as diverse as any group of people can. It's not always possible. It's been hard for us to get teams in the Mountain West. There's fewer schools and frankly fewer interested in community engaged efforts. It's fascinating. So people all over. How do we do in terms of recruiting Well I know I had show you some data basically about 60% of the fellows identify as white 40% not. That's probably the right ratio. You know who knows a little more little less but we strive for that. We try to do whatever you think about this. We also think about where they're coming from. In each cohort I like to have some superstar researchers from Michigan or Indiana. People who know what they're doing solid establish research then I want to take some risks. People from University of Delaware people from a small school in Texas wherever and I want to put them together they can learn from each other. There's that kind of diversity to it's mostly female is just bugs me. I wish more males were interested in this kind of engagement work. I worry that it's two female feminized. They think that's a mistake. So we weren't trying to attract some men too. And again this is self-identified sex gender. What are the teams >> Like well here's one team. This is from Really Washington DC. These are people who've graduated Derek mini mini full loves a distinguished scholar of race relations. She's one of the people I wanted in the cohort to give us some ballast her wisdom and experience has been super helpful for me as a person as well as the cohort. These guys are working on gentrification. And as you know so many urban areas are trying to improve and make life better with better stuff for everyone. What happens Is housing costs go up. The people who were living there can no longer afford it. So this is a comparative study of Washington DC Shaw in New Jersey orange that are different stages of gentrification. And this team is trying to figure out how do they work with through evidence the developers to ensure that there's opportunities for low-income people of all sorts. So that's their research project. Some folks and Native Americans north of me and the Great Lakes area Melissa Nikki and Joseph. There trying to figure out how traditional indigenous people or Native American Indian ways improve health. This is a fascinating. Fascinating and sometimes difficult tension between the ways you and I might think about health and then are brothers and sisters and some of the reservations in northern Minnesota in Dakota. So this team's working on that and fascinating great work. Teams in Florida working on farmers farm laborers. I should say Here's a health economist and some other people and they're trying to figure out people who pick the fruit you and I eat everyday how to improve the health from toxic exposure to overly stressed work to school to transportation. I mean that challenges are endless and they're trying to find some leverage point with data to improve those health outcomes. We have to team from Indiana. This is the first one. These folks are working on incarceration or had they've graduated. Now this is Cohort one. They come from pediatrics. So they're in Indianapolis. Last I checked. But it'll try and understand how policies for incarceration are affecting families and children in particular. Apparent sometimes both parents get incarcerated. And then what happens to the health of the remaining child and so they've been working on that second team in Indiana. This is ongoing. Again mostly pediatrics. And again incarcerated. This was not a mistake. We thought wow to teams and Greater Indianapolis working on incarceration. They should know each other. They did not before the program. They applied independently. So then we put them together. We have even more synergy. That's kinda thing we're working on. And of course teams like this all over the country as you saw from that map all doing different stuff focused on the themes more or less >> Put them together in a big bucket at a little soy sauce and hopefully they do some improving stuff. Want to spend a little time talking about what we're learning with some data How's it working and then I wanna shift and some more richer discussion. And then we'll I'll stop and we'll have some conversation about this work. So of course a bar graph and what you have here in the purple is before they join the program and the blue is after. The vertical axis is the old-fashion Likert scale one to 55 being better than one right so higher bar better. What are these sort of bar clusters >> Understands how leadership approach reflects own values. A key component of leadership is what do we value so lot of leadership trainings to come clear of why we're working towards some goal. So we train on that. You can see from before and after these on average people live improved. Understand the values partner bring to collaboration. Every one of us is the group projects in school. I hated it I wouldn't do it as a teacher. Now I make all these folks do it. You gotta work together. And you can see there is some improvement here Emotional Intelligence key component of leadership. Maybe a key component of research really have empathy and understanding for the people you're studying. Hopefully to help not just exploit engage stakeholders. We do a lot of work with the teams about how to talk with people. So forth and how to build an effective campaign. See now you got your research study. So what it gets published in your favorite journal. Do you want to leverage it or not if you do how do you do it how do you get other people on board from the community from the government maybe from corporations and so forth. How do you begin a movement toward improving health so all these go up i'm not surprised. I don't have any variances here but who cares about that means more understand federal policy. Yup they learned about that state policy learned about that local policy learned about that. We do lots of training and how policy works. Interestingly I'm as interested in helping people understand social norms which I think are more fundamental to policy that's harder to measure and harder to talk about. Experience in non traditional dissemination Twitter. I'm surprised that so many people who joined the program aren't Twitter savvy. There's a massive and interesting almost always helpful and non crazy academic Twitter sphere. And so using Twitter an outlet for what you're learning and what you're trying to do can be super-effective. We do this we have training courses and how to write an op-ed for a newspaper New York Times or your local paper or school paper. And again media outlets. Everyone improves good. Understanding community needs. Yeah that's fascinating. We can break this up by way you the researcher or community people. This one's interesting because people say they come in knowing a lot about community needs our community teammates dispute that. So the academics that yeah we know at all and the Camino parsing No you don't know anything. So it's a fascinating tail on this one. How the research will benefit the community same problem here. The researchers tend to think ex-ante when they begin they know how their research will help the community. The community has very different ideas about what that means. Team is accountable to the community. As a way of application they come in. And they say we represent this community as a great love it. How are you accountable to them and who are you accountable to and how do you measure that people kinda get pale. We do video interviews. It's fun to watch. But this accountability really matters. Because if you don't have that you're still separate right you still separate And then how to describe decisions and again everyone improves fair enough. More of this stuff. How do you do action research people think they know how to do it. Then they said he knew how to do it better. I can tell you that when worries me because as director that I don't know how to do it it gets really difficult. So this is an interesting data point. Understand rigorous methods. No I've taught research methods for 20 years. Most of the people do not know rigorous methods. They don't understand counterfactuals or even good qualitative research solid ethnography. It's what's fascinating. Sir I'm sharing with you that these are the data but I'm telling you from my seat. I'm not sure I believe at all. Explain the inference for causal inference or policy. Yeah okay sounds good on paper. But if you've ever worked with a politician to try to get something done. They probably don't care about your inference or causal. Then want to know the story of little Billy or sue that has a cute picture that they can leverage for their own political gain. So this is what we're trying to get at. And again communication for non. Researchers is a little bit different data Australia who cares it's still sort of the improvement stuff. Improved research capabilities not much not much change. For me the problem areas I think people are overestimating what they know when they come in. It's fascinating. And again this is all about how they improve. So as a general rule I find it interesting that for my seat and from C to the research team who reviews they're sort of provisional application there off but they think they've got it all. So this to me is an interesting level of forgive me arrogance of some of our research colleagues who think they know more about this than they do particularly in this space of community engagement and action orientation. We have quality and we do we evaluate these people that's crazy. I I don't have monitors all of them but pretty close. And so we have some qualitative I'll just share a couple of things. This is a team that graduated from Carolina didn't understand policy advocacy but through this work and the program realize that in this case Diana's work was really important to policy and they actually had some major change in North Carolina and actually Louisiana from a weird thing when the big hurricane came they just had the right people in the network and they actually had some positive change for health equity in Louisiana as result of this network from the IRL program. So Donna had a good experience. Memphis this team was working on not changing public housing codes but actually enforcing them. So there's policy on the books. Better housing there's codes not enforced. The lack of enforcement is a fascinating problem for public health. So you can have any policy you want if no one does anything about it it's useless. So this team was working on that with lawyers and researchers and so forth. And as you can see they had a successful feeling as well from the program. And then last one I think oh nope that's good. I don't wanna go too far that. So qualitative quantitative data. Some improvement do I believe at all some of it Yeah not so much other stuff. The challenge here is some stuff I'm going to talk about now which is what are we really doing in this program what are we really trying to get across so I want to start with some simpler stuff and they get in some >> I know for me at least more intellectual challenges to share and discuss with you. First research is best when it's in partnership. The fundamental premise of the IRL program is that your research is better. On a given population when you actually talk with them you learn what their perspective is and their problems are and their lived experiences. You might still be using federal data sets survey data set. That's cool. But how you frame your question how you ask the question how you interpret the results is enhanced by having boots on the ground >> Old-fashion shoe leather epidemiology. So that's a lesson that I think is even stronger in my mind. And when I wrote this original grant so solid their policy impact may not surprise you This is not easy. I served as a university representative the Minnesota Legislature. I learned a lot about the process there. It may not be may not blow your mind but many policymakers just don't understand or care about research. So we do research at places like this in my shop amazing stuff. And we think it's going to affect policy and it just doesn't and there's some real reasons why I chair one of the NIH study sections and of course there is impact and people write applications. This will have impact. The Senator the mayor wants to know and I say show it to me show me the letter that the mayor says she'll change her mind. If your research shows a versus B doesn't happen. We have this game we're playing with each other that our research will affect policy and it's hard to show. Anyway leadership training right now I run a leadership program. What the heck is that I don't even read about elite research leadership. It's amazing there's military which is actually probably the best >> Then there's business which is the worst and medical which is close to worse. Here's what a typical leadership book will do. It'll find some leader that they say is awesome. It could be Bill Gates. It could be some general. It could be someone else that is so-called amazing in their field. The figure out what those attributes are of that person and say that's what everyone else needs to do. Appreciate that's exactly backwards. What any of us would do as a research study right >> No randomized trial of go through this program or not and see what happens to your leadership skills at time T2. Instead it's really a case control study with a lot of bias built in. So as I've engaged more at this literature I'm just fascinated at how poor we understand how to grow and develop leaders. There's some stuff of course emotional intelligence. You know making sure you care about your troops are your people of course. But after that it gets slippery. And there's this fascinating entanglement between leadership and management. You might have seen this in some of your university administrators. They're more managers than leaders There are different things right so that's a challenge that I've been working on for a while and trying to get cleared my head. Irl this thing I do is like a college which amazing people in some difficult people write sometimes the quote students are restless and they want to take out the president and occupy my office and I love it and I hated it at the same time. So this is interesting because we have you know these are grown-up professional people. They have opinions on everything. And then you get them together. They have group opinions. So this is just the challenge of this kind of adult education stuff and trying to do something in a new space in a new way. May interest you conversations about race gender equality sexual orientation. These are not easy. We have 45 or a 150 people in a room talking about historical structural racism or gender issues or any other carving point in society. People have feelings. People have lived experience in this space of doing something that we're trying to address this stuff. It's not easy. It's simply not easy. People have called each other. They've called me racist. They've called each other all kinds of names as they're trying to work it out and then hopefully there's a big group hug >> We often but not always get there. To have that authentic conversation that most of us really don't want to have is super important in this world that I'm trying to facilitate so I don't have an answer here. I'll just say that it's difficult. I come from Boston originally and I moved to Minnesota been there almost 20 years. It's different culture. I still feel alien. The thing about Minnesota that people have said that I think is true is it's polite but not honest. A lot of us are polite but not honest. In in this space it really matters. These are hard conversations. So another challenge >> Look there's amazing people over this country doing amazing stuff. We have people apply that We can't accept when we do mom. And I'm like What are you doing in San Antonio What are you doing here this like the people doing public health work in our country are amazing. So I want to give you some hope there. Just some crazy amazing people really after it doing great stuff and I get to of course work with a fraction that I'm honored to but you know I'm not sure you get to see what I see and I want to leave you with some sense of my gosh people are amazing all over the land. Okay let's shift to a few decision points that I think are interesting intellectual struggles with me. What are we doing together science or research here's what I tell my students. You can be an outstanding researcher and not be a scientist at all. Political opposition research you love or hate Donald Trump or Hillary Clinton. Anybody want. And your job is to find everything bad about that person and disseminate it. You can be really good at that. That's great research. It's not science. Scientists of course is striving for the truth Trying to look at the whole package trying to look at the good and the bad and all angles and be exhaustive in their research and their date and so forth. That's a different animal This world of doing something There is an essential tension of how much do you need to know before you pull the trigger to act how much more testing of lead paint in houses do we need we clearly know what LED does to the human brain particularly young people's brain children's brand. How many more studies do you need yet there's other things where we're not quite sure. And maybe a little bit of evidence will serve your political end. Because you think it's right without the data. So this tension between being exhaustive doing rigorous study I'll come to that. We're in a minute. Being a researcher for advocacy or a scientist with evidence-based recommendation as an essential tension that I'm not sure it gets enough attention. I don't have an answer to this but I'm telling you I started with this all the time. The community partners. Want action. The old-fashion researchers were going to study it more. That tension's good. But then I say let's do something with this. And it's like lighting the fuse. It's important but I want us collectively particularly in the institutions like yours and mine to think about what are we really doing here and I think public health has a particularly important role in that space. As I mentioned from pure sociology or economics who are more academic right Public Health has always had a role to do something but it's tension. Are we doing something with evidence that feels good to us or that's correct challenge. Some of you know this is that picture of the Broad Street pump handle right the famous story that origin myth of epidemiology. There's cholera in the 18 fifties destroying parts of London and John Snow the anesthesiologists says it can't be miasma. A little more work. Says it's OK. It's in the water. Let's remove the Broad Street pump have action. This is the foundation of public health advocacy inaction cool right that's how it starts. But of course it's not so clear. You might know that after that Broad Street pump handle was removed. The local community were pissed. We're angry the pump handle was put back on two days later and they threw a party when it went back on. Furthermore the other issue in London at the time of cholera we talk about the origin of germ theory awesome but it's also a case of course of corporate malfeasance. One water company was polluting when they shouldn't have been breaking the law. So we talk about this major insight into science. They created modern epidemiology and germ theory which is true. But there's another story here. There was corporate malfeasance. Breaking the law. We don't talk about that. So what is the role of removing the metaphorical pump handle inside the academy is it our job to do that Is it our job when we partner with our community members to get out there and solve the problems with them or are we more academic pointing out the problems and saying y'all go get after it. I don't have an answer but this is an intention that's in the IRL program. I think it's in this health equity work and I want to lift it up and struggle with it a little bit. Little more on this. In Minnesota I think like a lot of places the twin cities are vibrant diverse all kinds of immigrants amazing people. It's a melting pot. We have the great University of Minnesota out state rural areas are different. We're a state university. Some of our state legislature's say when I give money to the University of Minnesota I'm giving money state money to a Democrat factory. Kids come they become liberal democrats. They vote against me. Some of the public half I don't know give or take really don't trust what goes on in your institution or mine. Particularly in this area of advocacy I think the basic sciences are easy. Apolitical even medicine medicine as you probably know sidestep a lot of political stuff. There was social medicine that died by mistake because that political medicine was controversial became public health. So the number or proportion of people who think what we're doing inside the academy is left-wing or right-wing. Most of them think we're far to left and therefore are biased and therefore nothing we say is true. That's a problem. Whether you think it's stupid or not it's still a problem particularly at state universities like yours and mine I'd see broader but nevertheless. So this is that other issue of advocacy which can make it even worse when I and others go to the local PTA Board and say don't do that. Here's 12 reasons. Why better be sure my evidence. And if my evidence is more policy advocacy because it feels good to my progressive mind versus hardcore science that I can proven defend. I'm even on less solid ground. This issue was big in sociology. I follow it a little bit. Is a very senior sociologist talking about. This is a recent paper that the more sociology becomes politically engaged the less credibility it has is that the story of public health I don't know. It's that essential tension. Somehow we I think we have to talk about it more. That's my point here. Here's Stanley Fish the humanities professor who was in the news and yeas old fashion literature a literary critic. And his basic point is academic institutions should not be political at all. Get rid of all that politics because you undermine the credibility of the institution. It becomes yet another political institution as opposed to the guardian of truth. I don't know if that's true but it's an interesting point. So this advocacy versus not advocacy I suppose academic thought is a great tension. And I think it's really paramount in public health. I'm always talking about rigorous research. It's in my DNA Quality transparency reproducibility All of it might be in yours. I imagine it is since you're here. But if you ask cuny members what they hear in feel. When you tell them you want to do rigorous research. They hear and feel something different. Here's some data for them. You know we would use all time. That's an illusion. You're not talking about us. Its colonial Western exploitive. My point is free me and you I suspect largely rigorous research. Ya go let's get it right. Others that's exploitive. That's a perception >> This is not from the right-wing farmer. This is from urban people and others Native Americans who say no you're rigorous research is actually harming me. That's a problem. We have to work on that collectively. So rigor these words that we like that we write about are actually depends on where you sit. I'm now if it matters and I are talking about credible research it's my euphemism for rigor because rigor triggers people. We have a newsletter IRL newsletter blog kind of thing. One of the fellows distinguished person solid professor what a blog is >> Or statement is science is inherently racist. And I said Do you really think inherently SCADA scholar what do you think yep. Okay now of course approve that academic freedom. But it's an interesting point. Now I trust you and I agree there are some racist scientists. And some science has been racist unquestionably at least in my head but isn't inherent. That's a very interesting statement. That's the tension that's in the IRL program in this work across all these dimensions. I bring it up to you because we can't shy away from it. If we're going to do this work. Okay shift gears a little bit I'm almost done >> Three-year program in the second year of your fellowship there's no spring meeting. Just the way it works. People said Hey Michael What about the spring meeting in year two Nope so then one day early on had an idea let's see if we can get people to work together. Collaborate solve a collective action problem. And so I'll incentivize that. So here's what I did. I said okay cohort no year to meeting. I'll give you $50 thousand total not a penny more. And I'll give you all the support from the staff that you need. But you've gotta decide what you guys want to do together. Everyone has to be involved. Almost everyone. You've gotta work that you can't just have three people decide. You have 45 people in your court. You got a 44 or 45 people say yep we agree that this is where we're going now not everyone has to go. They might have an event court one went to Puerto Rico. They did some outreach after the big hurricane four years ago. Awesome. So simple rules work on it together. Most people participate and do something consistent with the mission because we like all good. We're going to take your money go on vacation. I can't approve that. Ok So that's the basic plan. How does it work in practice >> These are engaged similarly situated mentally people. It breaks down. There's in-fighting people calling each other names. Yelling at me for setting up the structure how dare you do this for an optional meeting I say this because in this very safe setup world of people who are bin in a program together for a year with an optional idea to get something do sum together. Now the 50 thousand won't typically be enough if they go on a trip. So they have to use some of their own grant money so it's not complete funding but it's enough to get him going. I worry how we're going to solve global warming. This is a pretty Setup group and yet they fight and they can't solve it and it breaks down. So what does this mean for how we're understanding how we work together to solve our collective problems. Years ago I got a call from my dean. He said Michael you're gonna get a call from the local CEO of the health organization wants to understand health disparities wants to improve the health of the people living around the hospital headquarters. Cool the guy cause he's like hey Mike DIC. Alright so I'm I gotta call me Dr. oaks. And he's like I've got $10 million had calming Mike. So want to invest $10 million the neighborhood so cool. So I brought my team my graduate students and I brought the community together and I said well you guys want to work on. What's the important thing to improve the health of your community 500 answers. More police. More food more vaccines. Free rectal exams. Some physician wanted that colonoscopy right everything more police less police everything. There's no sense of collectively what should we work on first >> This is not necessarily a problem but when you only have a limited budget and limited time how do you get people to decide how can you and I as brothers and sisters figure out what we want to do together that's a problem for public health because we're all trying to improve community health. I know it. But what do you mean by community health whose health how are you going to get there I don't see a Latin literature about this. The IRL program has revealed that to me. At Minnesota we have this big program to help partly my fault >> Helps support scholars doing engage research. I understand there's some work here as well awesome. But it's difficult. What do you mean by engaged research we like to say at Minnesota just cuz you serve your kids PTA doesn't mean you get tenure right you gotta do more than that. So is engaged research only Outreach. Do you have to be teaching do you have to do scholarship How do you note when you see it it's not just another NIH grant or another paper it's different. So if I'm advocation for this thing in the IRL and to grow at bigger how do you know when it works I don't know an idea yet but it's interesting problem. And then finally finally I run a research leadership program. Boy What's that it occurred to me several years in. I don't really know what a research leader is. I get money I spend money and I advocate. But what does it think about it who in your head do you think is a research leader someone with a 1000 peer reviewed publications or 500 or some crazy number. Somewhat lots of grant money the Dina like that. That's a lot of ICR. Someone who had a deep ends maybe one paper with some deep insight and how the world works. Maybe they're a leader or someone who's had a clear impact. Think about that we don't really talk about leadership amongst researchers but you kind of know it when you see it I guess. Is the great teacher. I don't know. So when we talk about research leader I'm gonna confess I'm not really sure what I'm striving for. Now I've offered a definition in one of our blog posts and if this a person of course not a puppy who conceives you gotta think about it articulates share it's an enacts gets something done. A vision of how scientific research that's not a mistake. It's not political research. It's for me scientific research. Co-produced with community partners professional researchers together to drive a measurable outcome in health and health equity. So you got an idea you gotta run with it. You gotta get people on board and it's for me it's gotta be scientific based. That's where I am today with what. Now this isn't Research Leader everywhere. It's within my own little domain. It comes back to old professor shut the noose graph. Rich and poor people black and white dying earlier later. This is a challenge this is what we do in public health. Do we care? I think so. How do we get it done? I don't see enough of this conversation. And that's what I'm sharing with you today. That's it.

Description of the video:

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>> I'd like to welcome everyone it's a great pleasure to have us all here gathered together this day on behalf of the you know us and certainly welcome everyone to the 3rd speaker in the colloquium series as you know Dr Pate we had a very successful colloquium series now over the last couple of years and we're very honored that you're with us here today represents our 3rd speaker of the year the analysis and certainly conveys his apologies that he couldn't be here but I think he spent some time with you last night so we did and I know Dr Pate is meeting with lots of people in the schools with this to be really good experience for you so it is indeed my pleasure to formally introduce Dr Russell Pate professor in the department of exercise science in the Arnold School of Public Health at the University of South Carolina.

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He said several administrative positions which include the role as chair of the department of exercise science he's also been the associate dean for research and vice provost for health science at the unit health sciences at the University of South Carolina he is an exercise physiologist with interests and physical activity and physical fitness in children and the health implications of physical activity he has published more than $300.00 scholarly papers and he's authored or edited 8 books his research has been supported by the National Institutes of Health the U.S. Centers for Disease Control and Prevention the American Heart Association and several private foundations and corporations and he heads a research team that is currently supported by multiple grants from the in age and the C.D.C. he coordinated the effort that led to the development of the recommendation on physical activity in public health of the at the U.S. Centers for Disease Control and Prevention and the American College of Sports Medicine in 1905 and he served on the U.S. dietary guidelines Advisory Committee from 2004 during 20032004 the Us physical activity guidelines advisory committee 2007-2008 an Institute of Medicine panel that developed guidelines on prevention of childhood obesity He currently serves as the chair of the National Physical activity plan Alliance and he served on several leadership positions with the American College of Sports Medicine and in 1994 he served as that organizations president he is the past president also of the National Coalition on promoting physical activity in 2012 he received the honor Ward from the American College of Sports Medicine with great ovation Let's welcome Dr Russell.

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Thank. Thank you very much wonderful to be here I know the exercise physiologist in the room are going he's an exercise as you know. Used to be tried to be at least for a while. It's wonderful to be here. Great to see so many old friends and make some new friends and I'll save you know by way of introduction that there really is not or to be invited here to I you you know better than I But you know this institution has such a long and remarkable history in my field to define my field as physical activity and health and you know this institution goes way back in that domain and so it's a real honor to get to be here and I love to visit places like this one because you know when you're when you're outside a particular institution you have a you know you think you have a sense of what you know what's going on there usually it's not that accurate and you learn a lot more when you get there and talk to people and it's been wonderful to meet so many folks and I mean a few more before right before I leave and clearly great things are are going on here and it's it's a pleasure to be here just to hear about it.

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So. It was suggested by my title I'm here to tell you what I think we can and ought to be doing to increase the physical activity level of the U.S. population. I'm going to take a few minutes to get to that part of the talk but that's basically what I what I'm going to do.

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I'll also tell you what I'm not going to do or not spend much time on 1st I'm not going to try to convince you that physical activity is important to human health. It's pretty unlikely you'd be sitting in this room if you didn't didn't believe that. And you know I'll say Well I think the physical activity public health community has got a lot of challenges and a long way to go I think we can count as a success the fact that you're hard pressed to find anybody in this society that wouldn't say that physical activity is important to health if we've done anything we've gotten that out there people do know that so that's good to start at least.

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I'm also so I don't talk about that because I don't think I have to talk about it and 2nd not going to say much about. The importance of physical activity to public health. And I could I wouldn't mind doing that. I think again you know this audience probably has a.

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You know general sense that physical activity is important to public health but I'll bet even in this group there are people that wouldn't rank physical activity as high on the public health pecking order as I think it ought to be I'd love to take the time to argue with you about it.

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Like a good academic there's nothing I like better than you know begin to you know an academic issue. And I think it's true in the public and really in professional settings in public you know diverse public health settings you know I think I think people don't rank physical activity as high on the priority list in public health as I think it deserves to be but I don't think I want to spend all my time today trying to change your mind about that if it needs changing.

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What I am going to do is talk with you about 2 activities that have consumed a lot of my professional life over the last decade and. One of those has to do with public health guidance and speaking to the public about physical activity and what we think people ought to be doing and then the 2nd is National Physical activity plan which is a comprehensive strategic plan for dealing with the issue right promoting physical activity so that's where I'm heading.

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And so 1st I'm going to give a little context about. Speaking to the public about physical activity and then I'll focus on the most recent federal physical activity guidelines which were released just about a year ago. Not quite a year ago and that I'm going to segue to the National Physical activity plan as a way of.

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You know kind of getting to the point of what I think the high priority actions would be that we can and ought to take so little quick history here on physical activity guidance. You know the idea that physical activities are good for people. Not new it's not new at all I don't know that Hippocrates had much data science the way we would define it today to base that conclusion on but.

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You know you pretty bright guy and I guess was able to extrapolate from his own experience or the people around him and you know there are a lot of those quotes you know just go go to Google and you can get all kinds of them you know from great scholars of history you know that just I think intuitively figured out that activity is pretty important to health and quality of life more recently.

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You know I think there have been influential people speak trying to speak to the public eye maybe effectively speaking to the public in this country one of them I guess from my use was Bonnie prudent who had made the cover of one of the very early editions of Sports Illustrated and to an interesting gal I mean she she did have a bit of an academic.

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Career she had hooked up with Hans Krauss and they you know they did this study that today wouldn't get published in your local newspaper. You know let alone in a scholarly journal but got it with it and sort of what I'm going to come back to sort of the relationship between science and policy but that was a hugely impactful little article.

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That she was involved with times Crowe's you know they compared you know not very representative sample of American kids with a not very representative sample of European kids and the American kids didn't didn't compare very well got everybody got energized about it and jumped up and started doing all kinds of things you know and.

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You know we've got 12 library just more. Information today about this and it's very hard to move policy so interesting phenomenon. You know I went to University of Oregon and crossed paths with a guy there named Bill barman who was a track coach he was a lot more than a track coach although that's what he Samus for this was in the days when a lot of coaches were also professors and you very profound proud of being a professor full professor at the University of Oregon and he took a sabbatical in the sixty's went to New Zealand saw a bunch of people running who were not athletes.

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Well that's bizarre you know nobody in America would do that right and they came back and hooked up with his personal physician while the heiress and they wrote a book that took off you know it was sort of timing is everything and so barman was to you know talking to the public about about physical activity.

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You know Ken Cooper came along in the late sixty's early seventy's and you know was an Air Force physician and got out of the Air Force and started an institute in Dallas wrote wrote the aerobic sport which I used as a textbook for my jogging classes when I was a graduate student at the University of Oregon and I will say if you've still got that dusted off and open it up and look at the erotic point system.

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It was sexist because men were supposed to get 30 points and women were supposed to get 24 I know it I'm not endorsing that I think women ought to get 30. But if you figure out just do the math and figure out what. It takes to get 30 points in Cooper's aerobic 6 point system it's not very different from the current public health physical activity guidelines so people had a huge impact on communicating with the public and in the seventy's you know the American College of Sports Medicine which of course headquartered up the road in Indianapolis began producing it's.

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On a 5 year revision cycle its guidelines on exercise testing and prescription and I'll draw your attention just to this information from the 1st few cycles are still on a 5 year revision cycle. But you know this audience will appreciate what that recommendation looked like when it 1st came out in 1975 so some of it hasn't changed that much right 3 to 5 days a week 2045 minutes duration 70 to 90 percent functional capacity people in this room know what that is.

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That's intense activity they're not very many people in this room that could do what 80 percent v o 2 max for a very long time right and. But it sort of says something I think about where our field came from you know one way I sort of trace the history is I think we started dealing with this field.

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At the very high end of the physical activity exercise intensity range and in a very structured approach to recommending physical activity and so these guidelines really were set up for clinical application but they had a much broader impact and I think the fact that these guidelines were getting out of the clinic and out of the lab and into the community is reflected in how these guidelines evolved so the frequency and duration recommendation didn't change very much but the intensity range came way down right to 40 to 85 percent of you and I think that was reflective of the fact that you know the science was coming along people were starting to figure out that it probably doesn't have to be a really intense highly structured activity in order to be influential in terms of health outcomes.

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So it was mentioned that I was involved in that in the 1995. C.d.c. a.c.s.. Recommendation on physical activity and public health and I know people wonder they look at that and you ask how the hell did you end up as 1st author. And it's a good question. And the answer is.

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I was president elect of a c s m and I was personally acquainted through the running world with some people at a c.s.m.. And I think I'm sorry at c.d.c. And I think that this was at a time when physical activity was was beginning to get something of a foothold at c.d.c. And I think folks there were you know kind of looking for.

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Non-government partner to work with you know putting together something and you know so the phone rang and I said Yeah sure let's let's do it you know that's where it came from it it most definitely did not emerge from somebody looking at my c.v. and my publication record at that time and saying I was the right one to to lead the effort but I was standing there and I said yes and that's how it happened.

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I should have retired as soon as this paper came out. It's only been downhill since then but. It you know timing is everything and then there's that and I think this did resonate you know it was kind of at a point where the world was ready to hear that something other than lycra was important to you know an active lifestyle and so you know I'll tell you a little story about this.

[00:15:02]
We really decided before we came together we we met in Atlanta for like a 2 and a half day meeting to figure out what to put in this in this paper. And I think we really had decided before we ever got there or what the content of the you know the core recommendation should be we spent most of the 2 days trying to figure out how to say it right and so we were a bunch of amateur Hills communication people.

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We went in knowing that what we wanted to do was have a simple public health actionable message and as I had you know make no judgments about whether we got it right or not. You know we ended up saying every U.S. adult should accumulate 30 minutes or more of moderate intensity physical activity on most preferably all days of the week I can't even begin to tell you how long we spent on the most preferably all pieces you know but you know I will say this since since that 95 article our public health guidelines on physical activity have only gotten more complicated more verbose longer more bells more whistles more cavity hats more adjustments and I you know I don't I don't know whether that's good bad or indifferent but.

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You know they they clearly have gotten longer and you know in that initial effort. People also started thinking about public health guidelines for physical activity and kids and the health education authority in the u.k. got there 1st as you know some folks in San Diego had done one here in the U.S. that really was sort of.

[00:16:44]
You know up for the exercise prescription approach and it probably wasn't really a public health oriented guideline so the folks in the u.k. took that on came up with this recommendation which is all children and youth should participate in physical activity that is of it least moderate intensity for an average of one hour a day so the question would be why an hour if it if it's 30 minutes for adults why an hour for kids.

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Well I was there in the room and I'll tell you what I think happened. People started putting accelerometers on kids looking at the associations between objectively measured activity time spent in moderate to vigorous physical activity and kids weight status and if you looked at how that how those relationships looked at 30 minutes of moderate intensity physical activity it didn't look like it was enough and so people said Ok well we better make it more than that and so we landed on an hour or so if you think sometimes that these these are you know these guidelines are just the result of this carefully titrated examination of the science not always you know you're trying to say the best thing you can say you know that you think is consistent with the evidence.

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I actually think this is work that you know it. Is worth talking to dinner last night I think people can. Have internalized the kid guideline hour a day more effectively than they've internalized the adult guideline to be really honest with a lot of people can say you know kids out to be active for an hour you know and I think it's just easy to do you recall so there was a little hiatus in the.

[00:18:29]
Late ninety's and early 2000. You know so those proclamations that I've cited kind of sat there as sort of the state of the art and then it was getting toward the end of the George w. Bush administration. And you know some people have been clamoring for hey can we get the federal government off the mark here and you know get some federal guidelines on physical activity and part of that under our breath we would say since 1980 you've been doing this for a diet you know isn't it about time we caught up here and you know did this for physical activity I didn't really think anybody was hearing it but there was a woman named Penny Slade Sawyer who was working in the office of disease prevention and health promotion in the Department of Health and Human Services.

[00:19:20]
Who was it you know you know you know influential leadership position there in that agency and it turns out she was personally acquainted with the big guy you know with with w. and from Texas and she saw an opportunity you know and basically she said you know I think there's a legacy thing here and she went went to him went to George w. Bush said.

[00:19:44]
You know I think I think we should do this and I think would be great if you could get it done before the end of your administration and he said Well Ok good for you if you can sell it to Leavitt and get him to pay for it then fine so Mike Leavitt was the secretary of Health and Human Services she sold it to him he said Ok but you've got to hurry because we've got to get this done before we leave office right and so it was a mad scramble for about a year to get this thing done and basically they dusted off the dietary guidelines protocol applied it to physical activity went through all the same steps that I'll tell you about here in a little bit and so the 1st federal guidelines came out.

[00:20:25]
There was no law no so what I tell you about Penny. But there was not then and there is not now a law that says we will have physical act federal physical activity guidelines the bill's been in or deuced multiple times. In about 5 years ago it came that close to passing and then Ted Cruz blocked it and I mean it will not use Ted's name because he deserves to have his name mentioned.

[00:20:57]
And you know. I'm sorry I've learned the hard way public policy in this country is hardball Ok it's not softball it's not got I got great data here you don't listen to me talk about my great data No it's hard it's hard ball stuff right so you have to hold people accountable.

[00:21:20]
But we do have the guidelines and fast forwarding 10 years from 2008 the folks in this you know were hoping that a law would be passed because the law probably would have made it easier for them to find the money within the agency to do it again in 2018 the bill never passed they said no we've got to do it so they found the resources to.

[00:21:47]
Update the physical activity guidelines for release in 2018 so this is what the process looks like it starts with appointment of a so-called Faca a federal advisory committee which comes with a lot of reviewing and screening and bureaucracy and stuff but eventually some people get appointed to a scientific advisory committee that committee meets still it drops a lot of public meetings and endless number of conference calls the rule is if half or more of the committee convenes it has to be public which means either in person you know with the door open or if it's a conference call it's got to be publicly announced and you know the public can call in and listen and so on so we don't do that very often but there are a lot of committee meetings that are by conference call goes on for about 2 years eventually that that committee produces a.

[00:22:47]
Scientific report that summarizes the relevant science and then turns that over to the secretary of Health and Human Services who tasks the staff in that in that agency with developed taking the science the summary of the science and translating it to the public health guidelines and then that is eventually released to the public and that happened for the $2800.00 version of November of last year.

[00:23:16]
So for the 2018 iteration of the guidelines these are the subcommittees that were established and you know these decisions are made kind of at the very beginning of the process so to be honest with you. You know how how the how the committee decides to organize itself has a big impact on what comes out the other end because you can only do so much you get a sort of the limit the task and so you can see what the committee going in thought it was going to focus on so the Aging Brain Health Brain house was not there as a focus area in 2008 was in 2008 team cancer cardio metabolic health dose response relationships.

[00:24:03]
Chronic conditions promotion of physical activity which all come back to sedentary behavior which of course I have something to say about here a little bit and and use which was the committee that I was focused on so question is what came out of this 2018 process and I can tell you right now.

[00:24:27]
The core guidelines for adults and for school age kids really did not change so some people look at that and they go well that's boring you know. You did all that spent all that money all that time and they didn't you well Ok let me give you my admittedly biased spin on that Ok I think they didn't change because they're both grounded in a very solid science that you do not expect to whiplash all over the place in a decade right I mean I really think if the science changed.

[00:25:05]
You know the conclusions of the report and ultimately the guidelines would change and they may at some point I mean there are certainly issues that. You know may may result in a modification of those guidelines. But you know that was not the case here with the 18 guidelines that were released so for adults it remained 150 to 300 minutes of at least moderate intensity activity less time if the intensity is higher some sliding scale combination of the 2.

[00:25:40]
Erotic activity should be ideally distributed throughout the week and also person should perform resistance exercise at least 3 days a week so that that's not really different from what was there a decade earlier in the same is true for school age kids and how are moderate to vigorous physical activity vigorous at least 3 days a week muscle strengthening and Boehm strengthening activities also at least 3 days a week so not not a change there.

[00:26:10]
But there were new things in the in the scientific report and in the guidelines this time around and I think it's worth noting those because I think it does show how the field is is evolving so one thing that we dipped our toe in the water this time and I predict that 10 years from now you know the group will do a lot more with us you know so much of what has constituted the scientific evidence that our field is grounded in is based on epidemiology and sort of.

[00:26:47]
You know experimental trials focused on either non communicable disease outcomes or the physiology that sort of links to. Get to those outcomes and. Not nearly as much of our research is focused on the very short term either immediate or near term changes that result when someone increases their activity level so.

[00:27:18]
Somewhere here there is a connection between physiology and psychology and I think our field is starting to pay attention to more effectively. You know how many people in our society really can think about some wonderful health outcome that may be there when they're 65 years old and they're right now they're they just graduated from college and they're trying to figure out what their life's going to look like I'm sorry that that's probably just not that God knows there are people that are very disciplined and you know they say God I see I should do that and and they figure out how to do it maybe has 10 percent of the population that's not most people most people are just trying to figure out how to cope right and you know get through the day of the week and you know they get kids hang in here and you know 2 jobs and you know it's it's it's a challenge so I think it's more realistic that the real drivers here are more proximal And it's you know seeing change you know either immediately or in the very near term or in a matter of you know kind of kind of weeks you know but not years right and so there was some focus on the short term benefits this time quality of life reduced to hangs a blood pressure insulin sensitivity and so on my prediction is that column is going to grow the next time all right and I and I think it I think it should other also additional long term benefits you know the science supporting physical activity and health.

[00:28:57]
It just gets stronger every month you know it just keeps keeps mounting you know and. And then also we're learning a lot about the impact that physical activity can have on persons who already have chronic conditions of one sort or another and you know that's a growing body of evidence as well that I'll say more about here in a bit so you saw that I chaired the use committee and I chaired it in 2008 as well in 2008 we were not able to say anything about physical activity and kids under age 5 or under age 6 and.

[00:29:39]
Consequently the guidelines in 2008 didn't say anything about physical activity in and kids younger than 60 but that's Jan The science has changed and you know we certainly know more about physical activity and health in that in that under 6 age group most of what we know is in kids 3 to 5 we don't yet know much about kids under 3 and.

[00:30:03]
Microbes are actually working on a project right now with can with kids from 6 months to 36 months of age but we have a long way to go with you know with with kids younger than 3 but there's quite a lot there on 3 to 5 year old kids and so there was enough in the scientific report to inform at least the beginning of a guideline for kids in the 3 to 5 year age group and it basically says preschool age kids should be physically active throughout the day to enhance growth and development adult caregivers of preschool age children should encourage active play that includes a variety of activity types if you read a little further down there is reference to 300 minutes of physical activity that's total physical activity like moderate intensity.

[00:30:47]
And that's about the median level for the 1st 3 to 5 year old kids so we'll see maybe that moves up in the you know into the headline the next time. So we're hearing a lot about sedentary behavior these days and to be really honest you know we were impaneled to inform the physical activity guidelines right not the sedentary guidelines so we had to think about you know how are we going to handle this knowing that you know lots of people are interested in sedentary behavior these days.

[00:31:21]
And so where we where we landed was to focus on the interaction between sedentary behavior time spent sedentary time spent in physical activity and. You know we went through about 30 iterations of this heat diagram I hope you like this one because it's the one we ended up picking but.

[00:31:45]
So this is this this is drawn from a from a large scale study that all 2nd in the u.k. published a few years ago that it is essential is intended to look at the interaction between time spent sitting in time spent. In moderate to vigorous physical activity and that in the take home message here is if you're meaning the physical activity guideline you're out there at kind of at the higher end of the activity continuum sitting probably doesn't have a big impact on your health outcomes but of course most people are not meeting that guideline they're kind of back at a lower activity level and the lower your activity level the more impactful your time spent sitting is on health outcomes so we tried to show the interaction between the 2 take home message move more sit less not sure that should be the physical activity guideline but that's another whole discussion that we could have some time so we tried to try to you know bring together those $21.00 of the toughest communication challenges I think around this whole issue is on the one hand to put out there it discreet guideline you know that 150 to 300 minutes of you know moderate rigorous physical activity and at the same time effectively tell people well if you're not meeting that guideline just do more and you'll benefit if you do but that is the truth and I don't know if this is going to work or not but.

[00:33:21]
You have also you know I call him the patent burger curve you've all seen these are you can sort of you can kind of put whatever on the you know on the horizontal axis here you know it can be heard disease outcomes type 2 to you name it right they all kind of look the same but you know if if meeting the guideline is in here which of course is where this curve levels off you know kind of gets down about as low as it's going to get it but you can see moving from there you know kind of no reportable physical activity just to they're halfway to the guideline you know has a big risk reduction effect so the you know the challenge is figure out how to point at that level as a guideline this is what we want people to aim for and at the same time say if you're not doing that at least you know get down that curve always right and if I mean it's a health communication nightmare you know to really try to figure out how to get that out there the science is fairly straightforward and people in this room can understand the point but how you get that out there you know and Shape magazine or somewhere you know it's just it's hard because that's where people get their health you know or on the internet someone.

[00:34:40]
We didn't hear much about Brain Health in 2008 there was a big focus on it this time both cognition and you know dementia quality of life a kind of a broad constellation of factors were studied in that area and you know a lot of positive findings and reason for recommending physical activity for that purpose and the same is true with the chronic conditions there were there was a huge effort made this time to review the effects of increases at all activity and persons with kind of the full range of chronic health conditions and the mindset was not as physical activity cure these problems it is what does physical activity do to its or other health care or wrist aches in persons you know with the fill in the blank major departure in 2018 was the inclusion of a major component of the report and ultimately the guidelines themselves based on the physical activity intervention literature so.

[00:35:53]
You know it was mentioned that I did the dietary guidelines once on the physical activity lines twice and the 1st dietary guidelines experience on the 1st physical activity experience when like this. You guys get between the lines and stay there all right your job is reviewed the literature the scientific literature on the relationship between this behavior and health outcomes right we'll figure out later.

[00:36:22]
What to say about all that right that changed in 28 team and this time it was decided upfront. You know by the feds that the intervention literature on physical activity should be should be reviewed and then reported out both in the scientific report and in the guidelines and it was a Herculean task you know Abbie kangen you know that committee I know worked very hard to try to review that you enormous and growing literature and I refer it to you but they looked at a lot of different intervention settings and and strategies and you know tried to rate the literature there so that's what I think a little new maybe a lot new in some cases and.

[00:37:13]
I was pleased that when this all rolled out. A figure a lot like this was included in the in the material that h.h.s. released. It basically is intended to say. You know there's not going to be a magic bullet here you know we're not we're not going to find one you know perfect solution to promoting physical activity in the population we're going to have to hit this in every sector of society in every way that we effectively can which was I thought a perfect segue to the National Physical activity plans I'm going to tell you a little bit about the history of the plan and then use its content to tell you about some high priority steps that I think we should take so you know.

[00:38:02]
National plan is a comprehensive set of strategies that include policies practices initiatives aimed at increasing physical activity in all segments of the population so this is the development of the plan started in 2007 when some folks at c.d.c. were preparing for the release of the 2008 physical activity guidelines and I think we're aware and right that just having guidelines all alone was not going to you know shift physical activity in the population and they felt there was a need for a companion.

[00:38:40]
Resource that would in a sense build out from the guidelines. So you know we pulled together a group of people that you know kind of developed a process that is still active in evolving today there was some c.d.c. funding to get going we formed a very small Coordinating Committee began approaching national not for profit organizations to put money in the pot.

[00:39:08]
We said to ourselves at that point. You know we could probably get this going with the money that c.d.c. made available but that that's really it not a good idea Ok the better idea is let's see whether people are interested in this or not and if they weren't willing to.

[00:39:27]
You know what let's put it this way if a large organization like the American Heart Association is not prepared to put 10000 bucks into something that and we're probably not ready to do it right so why why full with it and so that we said Ok you want to be at the table with this thing you know write the check for 10 k. and you're in and so you know if you'll see about 20 organizations did and you know that was encouraging I guess that they were willing to do it you know we had a meeting in d.c. there's a lot of people came to and I'm kind of fast forwarding here but in 2010 the 1st National Physical activity plan was was released.

[00:40:08]
We had been scrambling full tilt for 2 or 3 years to get to that point and I honestly had not thought very much about what was going to happen after that we knew that. Based on the history of national Siskel activity plans in other countries most of them die all right this big big process you know usually government mediated and you know to develop the plan and then if you look around 3 or 4 years later that you know it's just the Web sites dead.

[00:40:43]
It's gone right nobody nobody don't want it and you know or you know the administration turns over and there's a new agency had and it wasn't their thing and you know so if it's gone well. You know I thought the people at c.d.c. were wise. To face this thing or encourage us to base it outside of government so this whole thing for 1012 years has been pretty connected to government but not in government right so it's based out in the private sector.

[00:41:17]
But 2010 came we released the 1st plan. And at that point it started to look like this thing was going to fizzle Nope no existing organization really was picking it up we offered it and c.p.p. hey that kind of didn't really work out and so about a year went by and you know we sort of looked at one another and said we we better do something to say it's going to fizzle away and so we created a 5 a one c 3 National Physical activity plan alliance.

[00:41:51]
And launched into developing a revision an update had a 2nd meeting in d.c. and in 2016 released a fully updated National Physical activity plan these are the logos and names of the national for the most part national. Not for profit health organizations I'll say see a sound that I know many of you are close to this key supporter of this as has been American heart but there are a lot of smaller professional organizations that.

[00:42:23]
You know the National Academy of can he see how edgy and the American Can he see how much he Association and and some big health organizations American Cancer Society Diabetes Association and so on so it's a real mix of organizations that have been involved in this thing. So it's a coalition you know managed by a board with members from those organizations that have committed funding and.

[00:42:54]
In 2013 this new 5 a one c 3 rolled out the mission is basically to maintain and nurture the national plan and try to expand its its impact and so little bit now about the content organizational scheme and content of the current national plan is working organized around 9 societal sectors you know we thought a lot at 1st about how should it be organized around age groups or you know some other way of you know some other scheme and the reason that we landed on sectors was that we do this thing was going to be comprised of a bunch of policy recommendations and so on and it just seemed like talking to a particular sector was maybe the best way to do this but I admittedly there are other ways of doing it.

[00:43:45]
You know between the 1st iteration of the plan and the 2nd one a couple things change we had 2 sectors one was face based that was a mistake the 1st time I don't know how we missed that but there wasn't that was not a sector in the you know in the 1st iteration and I think we hadn't even released the 1st plan before it became pretty clear that was a mistake you know.

[00:44:08]
So we corrected that and we also added a sport sector sport was sort of embedded in one of the other sectors and. You know I think people in this room know there's a lot of interest right now in sport as. As a means of promoting physical activity at the population level and if you were paying attention to the news you know the.

[00:44:33]
Department of h.h.s. just within the last month released a huge sport strategy the whole back story that I'll tell you later if you want. But you know sports you know getting some real focus in in the physical activity public health arena these days so the plan if it's anything is comprehensive right it's a ton of stuff.

[00:44:59]
Across all the Dion sectors 50 strategies and $264.00 tactics and a bunch of objectives under many of the tactics so it's very detailed. You know do we expect anybody to do all that now of course not now I mean it's a menu right and I honestly the idea is because these are all vetted by expert panels that are that have expertise in in the various areas.

[00:45:26]
These are all evidence based is the evidence uniform Well God Now you know I mean it it goes from you know there are 50 you know clinical trials that have shown something to you know that this is been tried on a large scale in Idaho and it produced some nice outcomes right so it's a you know highly variable levels of evidence but I don't think there's anything in there at 4 for which you'd say this is a pipe dream nobody's ever done this and you know we have no idea whether it works or not so they're all evidence based.

[00:46:01]
In a sense the idea is if. Do some of the work for people who are interested in acting in this area right so they don't have to do their own let's search right it's sort of Ok here's some stuff that a group of experts think is you know is worthy So when we updated the plan we had to to see new sectors added objectives revamped a lot of the strategies and tactics and I'm now going to cherry pick.

[00:46:32]
Out of out of all that and and tell you 10 of these that I think. If we did them all and I'm not saying any one of these would move the dial but I think if we did did a good job with all of these it would have a real impact.

[00:46:50]
So how did I pick these. Well for each of these I think there are there is there is good evidence to show that you know that the initiative can work right that if implemented with fidelity that it it can produce change and physical activity in a target audience.

[00:47:12]
And in this is that I think the important part and it has been tried in the real world right so these are not just scholarly you know research products that you know there there's evidence that you know there can be uptake on these things and you know in communities or you know in a practice setting.

[00:47:35]
So. A few of the strategies in the in the plan we refer to as overarching strategy so they're not buried in one of the sectors there they were they were drawn from the review across the content of all the sectors and you know about a half dozen of them and the idea is these really are.

[00:47:59]
Broadly impactful. Cross-cutting strategies and if we acted on the strategy it it would. Be important across multiple sectors right Ok so here's 11 of my favorites as establish it c.d.c. and office of physical activity and health and you know what's that mean you many of you know there's already a physical activity branch in the.

[00:48:31]
Division of nutrition physical activity in obesity in the chronic disease center it at c.d.c. And you know great people you know doing a good job they're working hard Ok so this is not intended to you know cast aspersions that you know what we do have right now. What we do have right now is in the context of the federal health bureaucracy tiny.

[00:48:59]
I think you may be surprised to know there has never been a federal appropriation by Congress specifically targeted at physical activity in public health now c.d.c. has been working on this for quite a long while always by pulling resources from discretionary pots right where they could but it's never been Congress said you guys need to get on this and here are some money to you know to work on it.

[00:49:28]
And that was true the guidelines you know it was just Health and Human Services carved out the money from you know wherever they could find it. It's but you know. We are serious about things we figure out how to how to deal with it and so the model that we've sort of had in the back of our minds for this is the office on Smoking and Health right which has been there for a long time decades.

[00:49:58]
Yet we've produced surgeon general reports on Smoking and Health year after here after so how how many how many surgeon general's reports on physical activity if we had to see a little test one quite a long while ago. And. We're we're just not investing Ok And because of that there really is not a negative comment on the folks that are there they're doing the best they can do with the resources they have but you know our Department of Health and Human Services is not seriously invested in this issue and so think of this office of physical activity and health a sort of a metaphor for what we ought to be doing it is get invested in this issue you know how things work you know and not much money stays at CDC very long most of it flows out to the state health departments and you know other other on the ground entities and that's what we need to be doing you know we need to build a public health infrastructure in this country that is dealing with physical activity you know we're never going to solve the problem just by scrolling money at it strew the through the Department of Health and Human Services.

[00:51:15]
But there is some level of investment that I think you've got to have there. To provide leadership and you know what public health does people in this room know very well is mobilize resources for murder you can find it in communities and states and coalesce it bring it together and focus it on solving a problem but it takes leadership to do that and I just don't think we're for sufficiently.

[00:51:41]
Invested at the at the federal level right now a 2nd is another you know core public health function Ok that the strategy is establishing a robust and comprehensive surveillance system for monitoring compliance with physical activity guidelines we do some of that now. And what we do almost nothing with is monitoring the status of environments policies and programs that we know impact people's physical activity.

[00:52:11]
So you know it's a sort of a promise in public health that you deal with the issues that you monitor right so surveillance is a core public health function and you know it's not like we don't have any resources for physical activity we have some but I describe it as Swiss cheese and I think there's some substance there or there are an awful lot of holes and in the system and we need to we need to improve that and there have been a number of groups over the last 23 years that have made recommendations through the.

[00:52:47]
National Academies of Science regarding enhanced surveillance or physical activity. There may be some people in this room that were the right age to be targeted with a verb you may remember a verb the verb Now Ok so we've never done in this country a true national Sissoko activity campaign you know large scale media based campaign.

[00:53:15]
And I think we if it was designed right and resourced adequately I think we should do it and I think it would I think it would help if we did that we've not ever done that what we did do. Or we have over 15 years ago now is something called the verb campaign.

[00:53:32]
It was before social media so I'm not sure what they actually did with you know with any longer generalized to the world today but. It was well resourced the congressman was it was when the government had money and a congressman was retiring they asked him what would you like as a going away gift he said Well I'd like I'd like to do something for child health so they appropriated a bunch of $1000000.57 I think it was sent the money is c.d.c. it took them about 2 years to figure out how to spend it and lo and behold they decided to do a physical activity campaign aimed at tweens right so I was around the edge of this thing on a sort of a visor Evaluation Group so I sort of saw what they were doing and I remember thinking.

[00:54:24]
This is great God and I'm excited we're going to do this and then my 2nd thought was not a snowball's chance in hell this thing is going to do anything. And I was wrong it did they designed it really well did a lot of. Market research with kids.

[00:54:44]
Segmented the population you know so it was the goth kids in the you know you know the jock kids and they you know they knew all the you know all the groups and they bought a bunch of Nickelodeon time and and and arm twisted and got a lot of free time to cook to go with the time they were paying for and they had a very clever evaluation strategy I thought because they knew in each media market in the country how much exposure there was and it wasn't uniform it was highly variable across you know media markets in the country and damned if they didn't show an association a change in physical activity in the kids in that in that age group.

[00:55:27]
Associated with the you know level of exposure to the you know to the campaign so you know I think there's evidence that we could do this if we you know if we put our mind to it I wish we would go for verb look for verb search search verb Google for Ok Now some that are specific to the.

[00:55:48]
Individual sectors you know in the education sector Hi You know I don't need to tell this group are long we've been trying to. Create a more robust physical education. Effort in this country and you know I'm not saying we should give up on it but I'm more encouraged about what's happening with something called the Comprehensive School physical activity program model and it says yes what yes we should do the best we can do with p.e. but we should also have kids active in the classroom we should have active transport to and from school we should after some of it active after school programs recess in the elementary schools as we should make we should make schools.

[00:56:29]
A place where kids are consistently active and you know I can't think of a better way to describe what I think the norm is right now I think it is cruel and unusual punishment to take a 9 year old kid and make him sit all day I would watch to do that I don't want to do that today and a long ways from 9 years old not you know in that's what we do you know we condition kids we teach them how to be inactive for extended periods of time and we need to quit doing that they don't learn they don't learn optimally you know that way and so I mean courage to about this this effort you know this is kind of the graphic that you know captures the model but I'm encouraged that you know there's some major effort c.d.c. has a has a I think a well developed program around the comprehensive school physical activity program shape America the you know professional society has a lot of activity in this area so I think it's getting some traction in the public health sector you know the currency of the realm is building cross-sectional partnerships and coalitions and you know I think we just need a lot more public health agencies.

[00:57:45]
Focused on that. You know I think and I hope the situation in the state health department in Indiana is better than it is a lot of places but you know so many public health state public health agencies are just hollowed out you know I mean if if there if there's federal money to support something then then you know they mobilize and get the money and do the work but states are not funding their public health departments very well and you know so you know I guess the progress is most states do have it least a person that's charged with physical activity promotion as part of the job Some have you know you know greater investments in personnel but we need.

[00:58:31]
You know we need a better investment at the state level so that public health agencies can do what they do well when they have the resources which is bring people together and. And change communities and you know this does happen some places and you know I've got I love what they do they're told pull this up sometime if you want.

[00:58:55]
If you want your mood lifted little pet Ok look at it look at what the active living council in San Antonio has done and got it it's just if you like public health it it got it's just so good you know and there's nothing mysterious about it but you know they have just pulled a lot of people together you know around this issue and they've done nice things so you can do it you know it can be done in the health care setting sector you know we need to keep working to institutionalize physical activity assessment advice promotion figure out how to effectively do that working from the clinical environment and you know we're just down the road from a.c.s. And here which is of course made a major investment in exercises medicine which is really aimed at compilation that and you know it's been a successful enterprise.

[00:59:50]
And you know it it did it to the extent that I've been around this it's been an education and you know what it takes to really get some of these things done you know it mean it means showing up at you know these very inane meetings where testimony is being given that will result in you know in some guideline or regulation you know maybe changing when it comes out 2 years from now and you know but that's how it works you know I mean it it it's you just have to get in and do the boring stuff you know that you know that it takes to change these you know these very large systems.

[01:00:34]
So we've had great work done I think in the transportation land use and community design sector you know this is a pretty advanced scientific professional group a lot of work has gone on over the last 20 years or so in this area. And this this is a strategy that I really like at least and I was telling somebody about it earlier.

[01:00:57]
That community planner should in a create active design principles in the land use transportation community an economic development what's happening. You know now that when you know a community is going to do a large scale development they have to produce an Environmental Impact Statement right so you have to say you know what's going to happen you know as if this is going to result in polluting something or you know.

[01:01:20]
And the idea here is let's do the same thing around physical activity you know when somebody's going to do a major development they're going to build a park or a new you know a new housing development or skyscraper or whatever it is I get the community planners to think about what's the impact of this development on physical activity in the people that are going to you know live or work in this development or be impacted because it's going to be dropped down in the middle of their communities so it's a it's sort of you know let's raise the profile get everybody thinking about these things but you know it's just a long history of build the highway down the middle of a neighborhood so that the kids on one side of the highway can't get to the park or the swimming pool that's on the other side and it's like what would please you know what are you doing.

[01:02:10]
You know I know I know I know your group here and I you is you know in the process of building recreation into a public health unit so you know I think let me just say I think without I don't have the knowledge about that you know the specifics I think there's a real opportunity there and you know this is one of the sectors in the plan and you know I think the strategy I like is is community should develop new and enhance existing community recreation fitness and park programs.

[01:02:40]
You know it's true that. Huge segment of our population lives quite proximal to a park and we have a whole lot of perks and you know now that doesn't mean they're all nice doesn't mean you know there aren't broken bottles land around in a lot of them. But there's a huge resource there and you know just to grasp for a 2nd there were we're analyzing some of our data right now and we've been trying to we're sort of trying to explore the concept of physical that you've all heard of food deserts right again so we're trying to explore you know the idea of physical activity deserts and Deb Cohn out in California this is kind of coined the term play desert kind of applied to kids so we've been looking in our data at this and frankly the thing that out of a bunch of.

[01:03:34]
Factors that we've looked at in a g.i.s. database proximity to a park is the strongest correlate to kids' activity level I don't know why I don't know if it's that they're using the park or that there's something about the neighborhoods that have a park nearby that you know results in the kids being more active but Parks matter Ok and I think we just ought to be making sure we're using them programming them.

[01:04:00]
Developing them to the to the best of our ability and there are efforts out there are r.x. is a partnership between recreation organizations and clinical organizations. Back in business and industry of course huge numbers of people in our society spend a lot of time wherever they work and you know one strategy is that businesses should provide employees opportunities and as center halves to adopt and maintain a physically active lifestyle a lot of progress has been made in this area with larger employers there's still a lot of work to do with smaller employers and that's where most people work so you know there's there's a remaining opportunity there are some nice efforts out there one of them is that the c.d.c. workplace health model American Heart Association is all over the work place right now as as you know as a setting for you know reducing cardio cardiovascular disease risk so I think there is a real continuing interest in in this.

[01:05:05]
Sport I said it's a new new sector in the plan sports organization should adopt policies and practices that promote physical activity so you know you all know as much about the sport world culture as is anybody. And you know I think it's probably true that while the idea that people will be active when they're involved in sport you know is probably back there in the you know in the background somewhere as an you know as inducement to promote organized sport programs but I don't think that's been the primary saying Hi I don't think there's been a whole lot of focus on it and you know it pains me to you know go to some you sport competition and see most of the kids standing around you know there's no there's no need for that one freak and waste But you know they get the uniform mom writes the check pays the fee they drive on their.

[01:06:06]
Stand around you know it's like don't do that you know what a waste it doesn't have to be that way but you know it often is so I think there are a lot of groups thinking now about you know how can we make this a better you know a better more impactful setting and I don't know if you know some of you probably are aware of the Aspen Institute's Project play but if you don't know it I encourage you to go to that website and take a look at what they're doing and.

[01:06:32]
It really is all and it trying to make sport. A really a better experience for kids and deal with deal with some of the problems that we know are there with you know sort of hyper competitive tennis and. You know the people have and it's ironic I mean if we know anything about you sport it's why kids drop out because people have been studying it for decades and you know we need to figure out what and what to do about that so getting near the end here where to where do we go well.

[01:07:06]
You know physical activity is a complex behavior. People do it in a lot of different forms in a lot of different places with a lot of different people for a lot of different reasons and so I don't think it's going to be straightforward and easy for us to figure out how at the population level to deal with this challenge and I think we probably ought to assume that we've got it attack it on all fronts that you know we do need to work on what I've been talking about a lot here which is public policy.

[01:07:45]
And we need to change our communities we need to change the institutions that we spend a lot of time in schools and workplaces and ultimately we've got to get this down to the thing out to the proximal family. You know micro social environment where people spend their time.

[01:08:05]
And I think we've got to have you know we've got to aim at all of those levels in the in the social ecological model and you know we're going to make some mistakes you know we're probably going to try some things that don't really work very well but that happened with tobacco too you know I think public health in this country and look at what's happened with tobacco use in this country and I know we've got the vaporing thing that's you know jumped up on us here but you know if you look at the long term tobacco use trends in this society we've done some damn good work Ok that was me that's an addictive behavior you know and it's not easy to change and we figured out how to make large scale societal change around that but we got we made a lot of mistakes right it was decades before anything really changed very much right that worked and we had a kept trying different things and you know finally we've figured out if you tax the devil out of it you know that you know that limits access and you know we find we found a few things and you know.

[01:09:05]
Got a little bit of evidence on 2nd hand smoke and then we milked that sucker for all it was tortoise right you know it is a way of you know talking to policymakers about it so you know with physical activity we've got to do the same thing we've got to keep trying and we gotta keep trying things some will work some won't work.

[01:09:25]
And you know hopefully as we you know work our way through this you know we'll will land on some things that really are impactful So the question is. Not what can the world do or not but what can the broadly defined physical activity public health world do but you know it really does kind of come down to What can can each of us do you know in our in our settings and my my suggestion is look at the plan pick a setting you're interested in.

[01:09:57]
Review the strategies that are there and see if you find a couple you like and then work ample met them right and I encourage you to hear by deputize you you're an official representative of the National Physical activity plan March right into the school board or the County Council or your Congressperson's office and say I'm here representing the National says a collectivity plan alliance and I think it's ridiculous that we're not doing x. and tell them about it so it's a great honor to be here and thank you very much for your attention.

[01:10:34]
Thank you.