thank you all very very much. i am very veryhonored to be on this stage and sandwiched between these really moving speakers. thegreat news is that i am bringing you news about where the public is on prevention, andthe public is way ahead of the elites. of course, given where elites are, particularlyelites in washington, dc - i love the ones you have sent from chicago - but given whereelites are, it doesn't take very much to have the public be way ahead of them. but the otherthing that i want to share with you is, while there is definitely a need for all the ofthe public education efforts that you all are engaged in, the public is very, very responsiveto this area. they are strongly supportive of prevention. they believe it should be ahigher priority for the country than it is.
they are a little bit confused about the distinctionbetween community prevention and individual prevention, and i think that's probably oneof the most important lessons that i can leave you with, is that we have to bring that togetherin a better way. but when it's explained to them, particularly around children, peopleare very, very engaged in community prevention efforts. people believe that prevention isnot a priority. you can fool the voters some of the time, but not all of the time, apparently.and they fully recognize that prevention is not the priority that it should be in ourpublic health efforts. they give the country bad grades, c and d. they support allocatingresources, although they are tax-sensitive. and of course in this economy, in some ways,it's reasonable to be tax-sensitive. if you've
been in a recession for three years, if someonein your family's lost their job, if your wages have been stagnant for more than three years,if your kids are back home - and 54 percent of kids are back home with their parents,much to their chagrin and their parents' chagrin - then it's reasonable to be tax-sensitive.and people are concerned about spending taxes in this area, but they're still very, verysupportive of investing resources and also looking for ways that communities can cometogether and take action. women in particular are looking for twofers. of course, we'rethe ones who save the grocery store receipts to buy computers and buy green. we're alwayslooking for twofers and threefers. and this is an area where people are really lookingfor, where can we get two for one? if we look
at the data in terms of public health - andyou all can get all of these slides, so don't worry about taking notes or anything - firstof all, in terms of how america grades our health, particularly around wellness and prevention- and there used to be a time when wellness didn't test very well, it's actually improved- people have always loved prevention. in part, people think prevention is fun. it'sgoing to be good to do prevention. wellness is more like, maybe you have to cut pack onthose potato chips. that doesn't sound as fun. but now prevention and wellness are testingsimilarly. but you can see the vast majority of americans say that our country gets a cor d on this at best. the priority that people would put on prevention, 86 percent wouldmake it a top priority for prevention or wellness,
but only a third of the voters, less thana third, believe that it is a priority today. people overwhelmingly believe that communityprevention is important as well. but again, people are very unclear about what communityprevention really is. one of the most important things is to give people examples of communityprevention. i'll show you some of the more popular examples. but 81 percent believe thatit should be a priority, while only a quarter think that it is today. when we ask people,do you support or oppose investing more money and resources i community prevention effortsto make it easier for people to maintain their health and make healthier choices, when wedidn't mention taxes, 73 percent were in favor of it, 43 percent strongly. and these aregood numbers, particularly for a concept that's
still a little bit vague to people, becausepeople still think of prevention as a very individual-level activity. by two to one,the intensity is on our side. when we asked about funding, again, by under 50 percent,but still by 16 points people supported funding for community efforts, rather than saying,"times are tough, we absolutely can't afford this." people do think there ought to be thingswe can smartly spend money on that provide some of these opportunities. a real base ofsupport - and it's not surprising who the leadership is, it isn't only the medical opportunitiesprogram, which is such a terrific statement, frankly, and thank you for all your leadership.but also, the african-american and latino community is extremely oriented toward communityprevention. this is money well spent. these
communities get that you're spending moneytoday to save money in the future, and have a very, very strong understanding and very,very strong support of that. women also support it more than men, but men still support itby 10 points. now this is interesting, because men are supposed to be so anti-big governmentright now, and supporters of the tea party and supporters of paul ryan. but as you cansee, when you talk about community prevention, when you talk about national commitment andlocal involvement, you start to get the men on board as well. we then tested a numberof policy proposals. people are overwhelmingly in favor of policy proposals that involvechildren. health schools healthy kids programs - and i'll show you the wording in a moment- two for one also tested very well. again,
really appealing to mothers and women. healthschools health kids, talking about p.e., talking about a more nutritious lunch. you'll rememberwe're on the 30th anniversary of ketchup being declared a vegetable - one of the all-timepeaks for our movement, i think. you'll remember, actually, god bless him - it was a republicansenator, john heinz, who had a certain amount of attachment to ketchup, who said, "i wantto make it clear that ketchup is not a vegetable, despite my family's long attachment to ketchup."we also tested physical education three days a week and physical education every day, bothvery very very popular with people. two for one - in these tough times we have to do morewith less and find ways to promote prevention while we're doing other things. if possible,every school should have a community garden.
we should use our school facilities afterwork for exercise programs. when we repair parks and streets, let's build bike pathsand playgrounds, which makes sense. for minimal cost and effort, we can get multiple benefits.people overwhelmingly love this initiative, and women in particular. people also likebuilding it into science classes. and you know who liked best building it into scienceclasses? african-americans and latinos, who thought, this is a science you can use. thisis a very important piece of that. other things - better food policies are very popular withpeople, and also changing food incentives. ands this whole thing about food deserts andgetting produce into our food pantries and our grocery stores is extremely popular withpeople. people in urban communities and particularly
in lower-income neighborhoods are aware thatthey have more liquor stores than they have grocery stores, and are upset about that.they're wanting to see that change. finally - this is nice that people like this, butwill they ever vote it? in fact, 66 percent of the voters say yes, i would be more likelyto vote for someone who came out for these programs. we also tested targeting programs,and really, people like programs across the board right now. they do not like targetingin general. we just finished a whole bunch of work on english-language learning, andpeople liked it much better when bilingual education was expressed as any child couldgo into it. and we said to people, "wait a minute, your child already speaks english.what does your child need bilingual education
for?" and they go, "well, they don't speakvery good english, so maybe it would be good to get them in there too. it sounds like awhole other language." so in general, people like broader programs. but people do likeit when it's targeted to certain neighborhoods, although they don't like as much expressingincome or racial targeting. the one exception to that is african-american voters. they dolike it better when it's expressed as income and race. and finally, our best messages.our best messages work to really anchor, and if i could leave you with one thought, it'smaking good healthy choices easier for people. that really resonates because it still hasthe individual piece to it - people love the word "choice," and we're using the word "choice"now as part of communities as well as individuals.
people think everything is getting hardernow, so the idea of making something easier is very, very popular with people. but hereare the best messages, overwhelmingly, and you get three quarters of the voters sayingthis is convincing, 40 percent saying very convincing - those are good messages. anythingto do with children. contrary to the opinions of some of our elected officials, people believethat you can't tell kids to wait five years while we get our act together. they kind ofmarch on relentlessly. and you're about to hear from a governor who always had that kindof dialogue with her voters and was really a national leader on that. michelle obama- we tested her language. not her name, because we didn't want to have the polarizing effectof obama, although michelle is very popular.
her language tested off the charts. individualresponsibility, and then also giving examples. there are many people out there who think,"this sounds like a good idea, but has anybody done it? i don't know how we can get it done."giving examples of other cities that have been successful, very successful. so hereyou see the language - kids are our future, we need a healthy future, it's important toget preventive care. and in fact, her obesity effort is really, really popular when it'sexpanded to other, broader prevention efforts. and then individual responsibility - yes,there's a role for individuals, but we as a community make these individual choiceseasier and give examples of what other cities have done. so the great news is, it is yourtime. it may seem in many ways like it is
the toughest of times, but actually, thereis really an emerging public consensus here that needs to be nurtured, needs to be educated,and needs to be tapped into. the biggest thing that i would say is that we need to definewhat community prevention is for people. we need to start this locally, at the grassroots.it will be some thing that will trickle up rather than trickle down. we need to includeindividual responsibility with community responsibility, but talk about making healthier choices easierfor families. and then, we really need to tap in here to women in particular. for moms,and all the women in our society, talk to them about how we can do things better forkids. talk about how we can get two for one here if we're smart. and talk about how wecan combine, how it's been successful in other
cities and how we can combine individual responsibilitywith community prevention. thank you for all you do, i hope that's helpful in your efforts,and - are we taking questions now or later? i can take a couple questions now. so - questionsfrom people or comments or examples. question? we definitely want lois to be heard, becauseshe has been doing some of the greatest work in this, particularly geared towards women'shealth care. it's so good to see you. "thanks so much, linda. i'm delighted to hear thispresentation, and not surprised to hear that women are really strongly in favor of prevention.i wonder if you could say a little word about how we could all use the opportunity thisyear to make contraception a preventive service under the health reform act." i think thisis an enormous opportunity, and we're hopefully
going to get the opportunity to work withlois and many of you on this effort. i think this is a huge, huge opportunity. first ofall, people believe overwhelmingly that contraception is a core, basic health care piece. they arewildly supportive of it. you may have seen that the washington post did a great pollwhere they asked people, what's the number one word you would describe the efforts toshut down the government over funding for family planning for planned parenthood? andpeople said, "my number one word is ridiculous." planned parenthood was also over 65 percentfavorable. over three quarter of americans believe that contraception should be madeaccessible and affordable for all americans. but what is coming up is this opportunityto have it included as a basic preventive
care and therefore include it in policiesand mandated coverage by insurance. our belief is - and we're hopefully going to get to dosome polling on this - that this is a threefer, really. first of all, very popular policy.but also a great opportunity to get people's costs down. one of the problems we have inaca is it's perceived overwhelmingly by voters to increase people's costs. this is goingto be a very good opportunity to decrease people's costs. and then women are infinitelyrelieved to hear that being a woman is not a preexisting condition. this is another opportunityto drive that message home. so lois, thank you so much for your question, and i hopewe get to work with all of you on this and can share this information with you. otherquestions or comments? "hi, pat sloan. i would
like to encourage with that contraceptionthat we include hiv prevention, so that we look at all aspects of contraception." very,very good point. and you know, one of the things that is so interesting about hiv prevention- and you know it, but it's interesting that the public is increasingly becoming awareof it - people are very, very supportive of hiv prevention, but there used to be an agefactor in terms of how relevant this is, etc. and now, we've started to see an uptick interms of interest in healthy sex and healthy sexual lifestyles in older people. thank you,viagra. so we're actually seeing an uptick in support of hiv and stds, etc. because ofchanging - i won't get into the graphic details there, but changing lifestyles among olderamericans. "hi. thank you for your presentation.
i'm matthew marsom from public health institute,and i wonder - i saw the general comments about taxation and the impact that had onresponses, but did you go deeper on the question of soda tax or sweetened beverage tax andthe response to that?" we did. you can have this whole presentation - the data is here,let me see if i can find it. or actually, i can just tell you what it was. i'm not surei can fund it fast enough for you. it's really interesting because people have very mixedviews about taxing junk food and taxing sodas. they start out weaker on it than other formsof taxation, and then, as many of us know who've been involved in these soda tax campaigns,once you try to put this initiative on the ballot it takes almost nothing to be defeated.the bottlers come in and the soda industry
comes in and we can't hold our support. it'sjust inconceivable. i mean, god knows why americans will not tax soda. actually, thenumbers have gotten somewhat worse, too, and we thought they were going to get better.in this recession, we're so short of revenue - okay, let's go after coke, even if it isthe dream. and people said, "no, are you kidding? that's the only luxury i can afford anymore,is junk food and soda." it's very tough, honestly. people start out in favor of it, but weaklyin favor, and then it's very, very hard to maintain that support. now, having said that,there are other aspects of the campaign that are quite popular, like getting soda and junkfood out of schools. very, very popular with the voters. sometimes i think if we put thetaxation into a specific fund, we could increase
and maybe hold the support longer. but it'stough. the soda tax in particular is tough. "hi, debbie walker from abt associates. thankyou for that great presentation on what you've done. i want to ask you a question. you didn'tuse the words "public health." it was important to understand the community piece, which iskey, even though that's so linked to what we do or facilitate, and there's so much elsewe do in public health for the whole system. so your advice on what you've learned on that."really good question, and i think this is an area - of course a pollster would say this,right? - i think this is an area that we need more research in, preferably with lake research.but here's what we know. public health is very popular with the public, but public healthalso has a downscale connotation to it which
prevention does not have. and you saw howpeople were nervous about the targeting. people thought, for example - and it's so frustratingyou could just scream, right? - people were supportive of the public plan, but they didn'twant to be in the public plan. they assumed the public plan would have lower quality.similarly, public hospitals - and the public hospitals are meeting here as you speak, soyou guys get together for that taste of chicago. you know, people really support their publichospitals, but they don't want to go to their public hospitals. so public health has a littlebit of a downscale connotation to it. i think, however, that prevention - it's implicit inyour question - is this wonderful opportunity for synergy here. because prevention doesnot have a downscale connotation. if anything,
prevention has a little bit of an upscaleconnotation to it. people think, "well, prevention's all fine and good, but who can afford thatmore expensive food, or whatever it is? who can support that extra tax?" and you know,america, it's reasonable to be concerned about that, because four months ago, we had thesingle biggest increase in food prices due to oil and gas prices that we'd had in 32years. and the biggest jump was 50 percent increase in the price of organic vegetables.so i think it's reasonable for people to be worried. i think there's this really interestingmarriage of prevention and public health. so know that you're wildly popular, it's justthat it's kind of like environmentalists. we asked the question, "would you like togo to dinner with an environmentalist?" and
people said, "well, it would be very interesting,they'd talk a lot, i'd learn a lot. i'd only want to do it once though. it would be exhausting."so you're kind of like that. people love you, but they don't necessarily want to be withyou all the time. "this actually is kind of related to where you were going to. a lotof your framing was around chronic diseases. can you talk about infectious diseases andprevention where now you have more issues of maybe protection, and the issue of safetynet and support for services for individuals that may not be covered under the aca? howdoes the public react to that and is there any support in that?" very good question.first of all, people are wildly in favor of the public health aspects that get to infectiousdiseases. that part is actually very easy
to get support for. when you were giving thatlitany of "it will be inspected" and all of that - the public is wildly in favor of that.they can't believe we're cutting back on inspectors. the infectious diseases, if something goesthrough the community, or you've got to sort out whether the tsetse fly is here or in westafrica because people don't have the best sense of geography and they're not sure howlong it took the fly to get over here. after all, there's a penguin in new zealand now,so who knows? people are very, very strongly in favor. infectious disease is actually easierthan the other aspects of public health. having said that, i think people assume it's coveredin aca, frankly, and would have no idea that it wasn't. "thank you so much. i'm sana chehimiwith prevention institute, and i'm really
interested in a lot of the messaging aroundindividual responsibility and making the healthy choice the easy choice. we do a lot of mediaanalysis at prevention institute, and one of my questions for you is, based on the researchyou've done, what are some thoughts around how we expand people's understanding thatwhile certainly there's an element of individual responsibility, we're making choices in acontext where most of us actually don't have true choices? our options are actually beingexternally controlled, whether it's what our kids are served at school, but also what isor isn't in our supermarkets or what we have access to in our communities." so there isa huge racial divide on this question. anglo white people, caucasians, they believe youhave choices. they don't buy that analysis
that many of us do not have choices. and ofcourse, some of that is probably income related. but latinos and african-americans, independentof income, absolutely accept that analysis that you don't always have the best choices,that we don't have control. what we found time and time again was that what is reallypowerful here is to not see the choice and control terrain to the other side. so, toengage that, to co-opt that, we've got to say that we need to make healthier choicesavailable to people. that worked a lot better, to say "we've got to make healthier choiceseasier for people" than to say, "they don't have healthier choices." because when we said,"they don't have healthier choices," people just argue, argue, argue - "yes they do, thisis america, people have choices here, what
are you talking about." when we say, "we'vegot to make it easier," it's like, "thank god, finally, someone gets it." so just anentirely different kind of framing. so i think there are some education efforts to go onin terms of what real healthy choices mean. and it's easier - it's what we call in ourbusiness the responsive cord, where if you try to tell people something - and i thinkyou guys have it in your business, too, right? if you try to tell people something, theytry to fight you, fight you, fight you. you let them conclude it, like, "yeah, we needhealthier choices. damn, how come we don't have these choices?", then they respond muchstronger. so it seems like the best thing is a bracket, if i say, "yes, there's individualresponsibility here, but we've got to make
these choices easier," and then, as peoplethink about what are good choices, what are the kids of choices they can have in theircommunity, they'll conclude, "hey, we don't have enough of this." and women in particularwill conclude, "we're treating this as zero-sum and it's not. why can't we walk and chew gumat the same time?" they really are like, we should be able to have it both ways. "goodafternoon, jillian tucker bellis from the colorado department of public health and environment.i was very pleased to see your data on the overwhelming support for two-for-one, specificallyutilization of schools, but my question is the implementation phase. when we in coloradotry to address this and have initiatives such as that, we have a litany of unfunded mandatesas well as liability. what are the system
changes that you would support to help addressthose issues?" you know, i should let that be answered by someone else. i'm not a policyexpert and i don't pretend to be one. but it's a very good question that you raise,and frankly, it's the same kind of problem that we have with the after-school programs.it sounds very logical to the public and they have no idea why we can't implement this.so maybe - my time is up as it is anyway, but maybe one of the future speakers can addressthat, and it's a very, very important, good question. thank you so much.
