Dedicated to my Dad, a Rotarian who translated for doctors in Mexico doing eye care.

 

Today, I want to talk about the tale of two Silicon Valleys – the one that we are all familiar with filled with success, hope and health – and another Silicon Valley that is hidden from most of us.

 

When we at The Health Trust say to people: Let’s make Silicon Valley the healthiest region in America!  a common response is – aren’t we already?  We see the crowds at farmers markets in Santana Row and people walking the trails in Guadalupe River Park, and it seems like there’s a gym  or a Pilates studio on every corner so it’s easy to assume that we must be one of the healthier communities in America.

 

Then again, we also think that America is one of the healthiest countries in the world – and that would also be incorrect.  Although the United States spends more on healthcare than any other nation, we are far from the healthiest.  Globally we rank 24th on national health status, 37th on health system performance, and 72nd – 72nd! – in overall health investment performance.  The number of Americans with diabetes has increased more than six fold in the last 40 years and now affects 16 million people.  Time Magazine reported that 2/3 of adults are overweight and about half of those qualify as obese.  Is it any wonder when one of the most watched TV programs is watching people play poker. We are a long way from being the world’s healthiest nation.

 

It is true that many Silicon Valley residents are enjoying robust health and can expect to live a long life.  But that can’t be said for everyone who lives in America or in our region and what’s standing between them and wellness may not be the obstacles you think.

 

We all know that Santa Clara County is a region of great diversity.  San Jose was one of the first major cities in the country to have a  majority minority –that is no one racial or ethnic population, including white, represents a majority of the people who live here. Silicon Valley is not just the world center of technological innovation, it is a world center of diversity attracting people from every corner of the globe.  Over one third of the people who live in our region were born in another country, and almost half speak a language other than English at home.

 

But Silicon Valley is also a region of disparity.  16% of residents hold graduate degrees, but our high school dropout rate is 20%.  Can you imagine that in 2009, in a region known for having some of the best universities in the world that one out of five of our young people are not finishing high school?  What kind of jobs will high school dropouts be qualified for in this day and age? 

 

Education leads to income, so it shouldn’t be a surprise that another big gap exists in Silicon Valley between our wealthiest and our poorest residents. In 2006, it was estimated that Santa Clara County had 74,824 millionaire households, calculated on net worth not including the value of their primary residence. Compare that to the 141,000 individuals who live in poverty.  You have to work 33 hours a week at a low wage job just to afford the $1,000 rent on a studio apartment, let alone pay for food, transportation, insurance, and all of the costs of raising a family in Silicon Valley. 

 

So, what does our ethnic diversity, and the disparities we see in education and income have to do with health in our region?  Far more than you may imagine.  Consider these indicators of health:

• The richest Americans live on average 6.5 years longer than the poorest,
• College graduates live five years longer than people who haven’t finished high school  
• Although life expectancy for everyone in America keeps going up, black women don’t live as long as white women and black men don’t live as long as white men.

What we are beginning to realize is that our health is profoundly influenced by these social determinants – where we live, our income, our education, and the color of our skin – even right here is Silicon Valley.  Let’s examine the evidence.

 

The Centers for Disease Control and Prevention’s

(CDC) Healthy People 2010 health objective is to reduce the number of infant deaths in the US to a rate of 4.5 per 1,000 live births.

 

In 2005, the infant mortality rate for California was 5.3

 

The rate in Santa Clara County was 4.1. (achieving the CDC goal)

 

But if we look at racial differences:

For white babies, the rate was 3.5 (better than the goal)

 

But, when we look at Black infant mortality in SCC: the rate is 10.4—three times higher.

 

This health-wealth-education-race gradient in which every descending rung of a socioeconomic ladder corresponds to worse health and lower life expectancy means the less money you make ,the less education you have and depending on your race:  the shorter your life span and the more health problems you can expect.  Research has shown that even your zip code can be a predictor of your health because it places you either in or out of a neighborhood that is clean and safe and has access to nutritious foods, transportation, good schools well paying jobs and adequate housing. 

 

Health is more than health care.   Access to health care is very important and we are fortunate to have a safety net through the Santa Clara County Health & Hospital System and Valley Medical Center.  Our community’s overwhelming support of Measure A in the last election shows that residents understand the need for access to health care when it is needed.

 

Santa Clara County can also be proud of its high rates of children’s insurance coverage, but we still have an estimated 130,000 adults and 10,000 children and adolescents without health insurance.  And there are 151,000 residents who are underinsured.  That number is rising as more employers reduce or eliminate health benefits and more workers lose their jobs due to the recession thus losing their health care coverage and may also be unable to afford COBRA.

 

But health coverage and access to care is not the whole story.  Because they focus on solving a health problem when it already exists.  They are not getting at the root causes of ill health much less figuring out strategies to prevent the health problem from occurring in the first place.   I’ll give you an analogy, we all know that aspirin can cure a headache, but none of us think that a lack of aspirin in your diet is the cause of a headache.  Yes, we want to make sure that people have aspirin when they need it (accessible health care), but the more important question is: what is causing the headaches to begin with.

 

The intuitive answer is to focus on individual behavior.  If we just wouldn’t smoke, or overeat, or if we would exercise more we would all be healthier.  All absolutely true.   Everyone could improve their health by making wiser decisions about their diet and exercise.  But if we know what we should do to be healthier, why don’t we do it?  Does any smoker not know that smoking is harmful to their health?  Why don’t smokers just quit?  There’s a lot more to it than just knowing what to do to improve your health.  The environment effects the choices we make.

 

A single mom in East San Jose might need to learn more about nutrition, but it’s a safe bet that she knows that her kids should eat fruit and vegetables.  But if she must send her child to a school that has a lousy lunch program, there are only fast food restaurants and liquor stores in her neighborhood and there are no parks or safe places for her child to walk to school or play, how could the environment not effect her choices (any more than we chose what to eat at today’s lunch.  Certainly we all selected the amount and which food we wanted to eat but we all chose only from what the environment offered. )  

In Santa Clara County there are four times as many fast food restaurants and convenience stores than supermarkets and produce vendors.  In our region, less than 6% of our population walk or bicycle to work.

 

The built environment around us has a profound impact on our community’s health and on individual’s choices.  Health and wellness are effected by the decisions we make as a community because they are engrained in our institutions, culture and policies.

 

San Jose is one of the largest recycling cities in the country, why? Because we are so educated, because of a recycling educational campaign, because we are so ecologically aware?  All may have been helpful but the reason we are so successful is because of blue garbage cans, we made the environment more likely that we will recycle because it’s more convenient.  If I have to drive down the street to recycle my aluminum cans, I won’t do it.  Blue garbage cans increase the likelihood that I will recycle. 

 

So then, what prevention changes in our environment must we insist on in order to increase the likelihood that we will make choices that will improve the health outcomes for Silicon Valley?

 

To start, progressive cities are becoming increasingly aware of the relationship between land use decisions and the health of their communities, and we are seeing more cities beginning to discuss adding Health Elements into their General Plans.  The availability to access to grocery stores to buy healthy food, locating housing and jobs closer together so that walking, transit and bicycling is more likely, and making sure there are safe and convenient sidewalks and trails, are examples of how policy decisions made in general plans can improve health outcomes. 

 

What could we do to make it more likely that Silicon Valley could improve our oral health?

 

Over 100,000 children in Santa Clara County need to see a dentist.  We can invest in more high capacity facilities like The Health Trust’s Children’s Dental Center that we opened in East San Jose last June which can provide 15,000 appointments a year, but a more upstream prevention strategy would be investing in an environmental change in the community – in this case, fluoridating our water supply – so that children have less need of dental work.  Despite unanimous agreement among all leading medical and scientific experts: The American Medical Association, the last five surgeon generals, the American Dental Association and the Centers for Disease Control –that community water fluoridation is an effective, safe and inexpensive way to prevent tooth decay, most of the people who live in Santa Clara County do not have access to a fluoridated water supply.  (AND MOST DO NOT EVEN KNOW THAT THEY DON’T HAVE FLUROIDE IN THEIR WATER!) According to the CDC, fluoridation is one of the greatest medical breakthroughs of the 20th century and we don’t have it. If you live in Campbell, Gilroy, Los Altos, Los Gatos, Monte Sereno, Morgan Hill, most of San Jose, Saratoga, and parts of Cupertino, your children’s and your own oral health is at risk.  Dental decay is the greatest chronic childhood disease – and it is preventable.  Why would we allow our children to experience pain, infection, tooth loss, and missed school days if it can be avoided?  I encourage you to support Santa Clara County Board of Supervisors President Liz Kniss’s challenge to Silicon Valley she made yesterday in the State of the County address to fluoridate water in all of our communities in the next five years.

The important thing is to get upstream. SLIDE-Not just give the aspirin, not just build the dental centers, but activate PREVENTION solutions to address the root causes.

 

There are humane and compassionate reasons to care about the health status of everyone in our community, but there is also a bottom-line financial reason to be concerned. 

We all bear the financial burden for disease in our community through increased medical costs, lost economic activity and lowered business productivity.  The U.S. loses over $1 trillion every year in work productivity due to chronic illness.  Locally, the costs are also high.

 

Think about this. Over half of the adults who live in Silicon Valley are overweight or obese. 

  One in 10 adults in Santa Clara County have diabetes, and the frequency is higher for Latinos, Asians and African Americans.  In middle age adults, 50 to 64, that rate jumped to 22% for Latinos and 16% for African Americans. The price for the average hospital stay for a patient with diabetes is $9,400.  The cost to the employer for that stay in the hospital is as much as $30,000 in employee absenteeism, job impairment, and disability.  That adds up to $1.5 billion annually in Santa Clara County – about 29% of all health care dollars spent in the county every year.  And if you want to hear a truly frightening statistic, try this one.  The Centers for Disease Control and Prevention are predicting that with the increasing rates of child obesity, one in three children born in 2000 could develop Type 2 diabetes as adults.  One in three!  Think about what that is going to cost us in the future, to say nothing of the toll it will take on the lives of the individuals and families.

 

Last week The Health Trust hosted a Health Equity Summit in which Dr. Julie Gerberding, former director of the Centers for Disease Control and Prevention spoke of the CDC’s goal of making the United States the healthiest nation, and the tough challenges that we must overcome to achieve this goal – many of them related to health disparities.  So what are these challenges and what can our community do.

It is unconscionable that black babies in this county die at a rate three times the rate of white babies.

 

It is unconscionable that 20% of our youth are  dropping out of high school.

 

It is unconscionable that in the Valley of the heart’s delight, the produce capital of the world, we have four times as many fast food restaurants as produce markets.

 

It is unconscionable that we see tooth decay worse here than in some developing countries because San Jose is the largest city in the US without fluoride.

 

What if we made a commitment to reduce black infant mortality?

What if we made a commitment to say all our children will graduate from high school?

What if we made a commitment to tackle the complex engineering feat and capital costs needed to fluoridate our water—when has an engineering feat ever stymied Silicon Valley?

 

We need to ask ourselves two questions:

If not now, when and if not here, where?

 

This is Silicon Valley.

 

 

And now you may be wondering: what can I do?

 

Everyone in this room is a leader in your business, in your local community. There is a lot you can do.

 

For those employers and employees in the audience——I challenge you to look at your workplace and ask yourself, does your work place environment support people’s effort to lead a healthy lifestyle? Do you encourage exercise and healthy nutrition in the work place or is crispy cream donuts standard fare in your staff room.  Be creative, innovate, and ask your employees or co-workers what would help them?

 

Make a commitment to supporting investments in education, job creation and livable wages.

 

Make a commitment to tell our elected officials that you support health elements being included in general plans and fluoride to all parts of our valley.

 

Make a commitment to work with your fellow Rotarians on a health agenda.  Rotarians excel at innovation. The Monadnock, NH Rotary sponsors free health screenings. The Petaluma Rotary has created “Rotary Walks” which organize weekly public group walks. The Seattle Rotary has created Rotary First Harvest to deliver surplus fruits and vegetables from local farmers to those in need. The work you have already done with adaptive playgrounds and supporting parks and recreation is a wonderful environmental change.  What if this Rotary built a community kitchen to feed all the hungry in the Valley? After all, as your mission reminds us:  Rotary is service above self. Rotary is serving the community where we live, here in Silicon Valley.

 

Inequities result from disparities – the gaps that separate the two Silicon Valleys we’ve talked about today.  We can only achieve health equity when individuals in our community do not experience differences in health because of their race, ethnicity, education, income or neighborhood.

 

The measure of a healthy region is when the poorest among us, the most vulnerable, enjoy the same health and wellness as the rest of the community.  When their health is good, all of our health is good.

 

Let me close with the following quotation:

 

When health is absent

Wisdom cannot reveal itself

Art cannot become manifest

Strength cannot be exerted

Wealth becomes useless

And reason becomes powerless.

 

Herophilus figured out in 300 BC that health is the key to releasing the creativity, innovation and energy that makes Silicon Valley a global leader. Over 2000 years later, we now realize that we need to be concerned not only our own health and that of our family, but with every person in our community.  Only when we accept the challenges, create a prevention and environmental culture to address the social determinants of health, can we enjoy optimum health and wellness. Only then will we be able to say that Silicon Valley is the healthiest region in America.

Thank you.