As a one-time health care journalist and as a current member of the Colorado Health Foundation's communications team, I've long considered the Colorado Health Symposium the highlight of my professional year – the work-related equivalent of the holiday season. One of my colleagues even likened the three-day event to the health policy wonk's Woodstock – the historic 1960s music festival – only with no mud and a better venue.

At the Symposium, my peers and I can leave behind any pretense of managing a "work-life balance" and immerse ourselves fully in discussions about health care reform and how public infrastructure impacts health in low-income communities. When the planned activities run out early in the evening, I head over to the Keystone Lodge to talk health policy with other Symposium participants. I do this because I genuinely enjoy talking about health policy and because the issues discussed at the Symposium are critically important – not just for health policy wonks, but for everybody.

That's why I hope the recently published "Insights: 2011 Colorado Health Symposium" will appeal to many Coloradans who weren't at this year's event. In writing the 24-page summary, I favored "plain English" that speaks to those both inside and outside the industry over the wonkish language that sometimes characterizes these kinds of reports.

Whether you're an expert in health policy or someone who simply cares about health, the report provides some interesting answers to the most provocative questions in health care today, including: Should the Affordable Care Act be saved? How do we build healthier communities? What can businesses do to improve health for their employees? Those answering the questions include:

• Kavita Patel, MD, a fellow and managing director of the Brookings Institution, who served in the Obama Administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement

• Grace-Marie Turner, founder, president and trustee of the Galen Institute, a public policy research organization based in Washington, D.C.

• Kelly Brownell, co-founder and director of the Yale Rudd Center for Food Policy and Obesity

• Will Allen, founder and CEO of Growing Power, a farm and community food center in Milwaukee

• Pedro Jose Greer, Jr., MD, a physician who founded several free clinics for the homeless, undocumented and migrant poor of Miami

• Larry Cohen, founder and executive director of the Prevention Institute, an Oakland, Calif.-based organization which advocates prevention to improve health and reduce costs

Read the report to see why I'm already looking past the holiday season and counting down the weeks to the next Symposium, scheduled July 25-27 at Keystone.

For more Symposium-related resources, check out recorded video on Ustream and insights from plenary speakers on the future of health care on "Colorado State of Mind,". Also, contact us by email to receive information about the 2012 Symposium or to obtain hard copies of the report.

Grace-Marie Turner, president of the Galen Institute, participated in the interactive debate (view full recording) at this year's Colorado Health Symposium. This post was originally published in Health Affairs' GrantWatch Blog on August 3, 2011.

Resolved: The Affordable Care Act should be repealed and new approaches to health care reform explored.

Three of the four presenters debating the resolution before a capacity audience of health professionals agreed that the Affordable Care Act of 2010 (ACA) should be repealed and replaced.

And yet the lone debater who argued that the law should be preserved won the debate in a landslide. The audience, voting in real time on keypads, disagreed with the resolution by a margin of 79 percent to 21 percent. The debate, held on July 27, was part of the thirtieth annual Colorado Health Symposium, which was held in Keystone, Colorado.

Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, won the debate with his argument that, while the ACA is imperfect, "If this law fails, no other Democratic president in our lifetimes will ever tackle health reform again." He added, "This is our one chance to do this."

T.R. Reid, former Washington Post correspondent and author of The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, forcefully argued that the ACA falls far short of its goal of achieving universal coverage, leaving at least twenty million people uncovered. As a result, these "free-riders" will continue to get health care that the rest of us pay for and will continue to drive up the cost of care. "If France can achieve universal coverage, certainly we can do it!" he emphasized.

Following the debate, Lynn Parry, past president of the Colorado Medical Society, said, "Most of the people here tonight already support the health reform law. The real debate, then, for us was between Len Nichols and T.R. Reid," Parry said. "They both agree that we need universal coverage, but we wanted to hear their views about whether the health reform law is the best way to get there. We all know we have to figure out how to spend a lot less money and cover a lot more people."

Jon Caldara, president of the Colorado-based Independence Institute, asked the members of the audience to raise their hand if they have homeowner's insurance, then car insurance, and then life insurance. Virtually all in the audience raised their hand each time. Then he asked how many of them expect to file a claim on those policies this year. No hands went up.

He used the example to show that health insurance is indeed different, because people expect to use this insurance regularly. Yet, he argued, the cost of the policy is generally hidden from the insured, so people expect to cycle bills for even the most routine health care services through health insurance, driving up the cost of insurance dramatically.

Caldara said what people need in a health crisis is real insurance. His family's personal experience with his one-year old daughter's fatal brain tumor ten years ago and his seven-year-old son's Down's syndrome have given him enormous respect for the quality of health care delivered in this country. "In no other country would my children have been able to get the extraordinary care they received." But he said he fears that we are putting this high-quality care at great risk with the health reform law's centralized government control.

I told the audience at the symposium that I am particularly concerned about the law's impact on vulnerable Americans, described in more detail in a book I co-authored titled Why ObamaCare Is Wrong for America. Current Medicaid recipients, most of whom have few, if any, other options for coverage, will soon be forced to compete for care from a limited number of Medicaid providers with the sixteen to twenty-five million people added to the program under the reform law. The ACA could shred the safety net because it does not increase capacity or make desperately needed structural reforms to Medicaid—it simply drives more people into the program. I agree with Edward Miller of Johns Hopkins Medicine who argued in a 2009 Wall Street Journal article, in its Opinion section, entitled "Health Reform Could Harm Medicaid Patients," that our system simply doesn't have the capacity to absorb so many more patients so quickly. The most vulnerable will be harmed the most. I said that we absolutely do need health reform but argued that the ACA builds on dysfunctional systems in both the private and public sectors, and it will cause a cascade of negative consequences:

• Employers are looking for the exits and could send tens of millions of people who have job-based coverage now to the exchanges for subsidized insurance, causing the cost of the law to soar in a time of severe governmental budgetary crisis.

• While states have major responsibilities to implement the ACA, the majority are rebelling, with twenty-eight states challenging the law in the courts. States face at least $118 billion in new mandated costs during the first decade of full implementation of the ACA.

• The ACA, with its 159 new boards and commissions and programs, moves power over decisions away from doctors and patients and toward technocrats in Washington who will try to regulate our health sector into functionality. A true patient-centered system would recognize the reality that medicine is moving toward personalized care, not centralization, and health care financing must support rather than fight that trend.

I argued that the focus instead should be on solutions that concentrate energy and resources on the uninsured and the most vulnerable in society. I said that we could get much closer to universal coverage with properly structured subsidies that don't disrupt the coverage that tens of millions of people have today.

T.R. Reid, while an admirer of government health systems in other countries, concluded that we must respect the culture of the United States and work toward reform that includes both private- and public-sector programs but which gets to universal coverage. Only then, he said, would we be able to eliminate the problem of free-riders who drive up the cost of care for everyone.

I pointed out that the cost of uncompensated care is estimated at $43 billion a year, representing 1.7 percent of our $2.6 trillion in health spending—in my opinion, hardly a reason for such dramatic centralization of our health sector.

Len Nichols said that the ACA provides tremendous opportunities to experiment with new care delivery and financing models. He suggested that if providers don't like the regulations that have come out for Accountable Care Organizations, for example, they could just ignore them and design their own. He implored, "We have to make the incentives work."

Jan Kief, speaker of the house of the Colorado Medical Society, said afterward, "The debate was fascinating and challenged the views of many people in the room, forcing us to think outside the box. It's clear that putting extra pressure on a dysfunctional system could create real chaos."

Kavita Patel, fellow at the Brookings Institution, commented, "The debaters went beyond the political rhetoric of 'repeal and replace' with a substantive dialogue about the important subtleties of health reform."

There was not a single point of difference in the number of people who agreed and disagreed with the debate resolution when votes were tabulated before and after the debate. But there was movement inside the numbers, and I swayed the most votes—from 3 percent who originally agreed with me to 9 percent who agreed at the end of the debate. (And I won the coveted box of Colorado peaches, as a result.)

The 2011 Colorado Health Symposium, entitled "State of Health: Seizing Opportunities, Achieving Results," attracted 450 attendees. Many more people were turned away. Colorado Health Foundation President and CEO Anne Warhover moderated the debate and chaired the conference. Chris Adam, president of Engaged Public, facilitated the interactivity.

 Amber Banducci is an MPH candidate at the Colorado School of Public Health. Banducci is interested in health care policy, particularly when it affects hospital administration operations, and the resulting health outcomes of patients. Banducci is attending the Symposium as part of its Symposium University program.

Today's discussion touched on a myriad of important topics to wrap up the Symposium. Some of the presentation highlights were cultural competency, the Affordable Care Act (ACA), Children's Hospital Colorado innovations, and business in health care. Dr. Ian Smith started the day by bringing to light how the lack of cultural competency can have detrimental effects on the health care system and the outcome of patients. Dr. Smith emphasized that cultural change is inevitable, and we should embrace these changes to be at the forefront of effective and quality care. Cultural competency is more than overcoming language barriers; it is interacting with and treating patients in a way that respects their cultural mores. The presentation elicited audience members' concerns about how to address the issue of cultural competency. A concern I had that another audience member presented is the conflict with generalizing interactions based on race or ethnicity and treating each patient as a unique individual. How does a physician apply their cultural competency without losing the individuality of the patient during brief physician-patient interactions?

Senator Hank Brown followed by highlighting some of the challenges of the ACA and the aspects that are likely to stick for at least several years. There has been some media and public speculation about the life of the ACA. Sen. Brown asserted that the bill would not likely be repealed in the near feature, and that the bill pre-appropriated funding for the regulatory phase of the bill, thus funding is stable for the implementation of the ACA for at least several years. It was refreshing to get an honest legislator's perspective on the state of the ACA, which has a tendency to mystify the public.

A variety of perspectives on health care problems and solutions were presented through the rest of the morning. I particularly enjoyed Jena Hausmann's honest and direct presentation on the innovative solutions Children's Hospital Colorado is implementing. Children's Hospital has implemented some creative changes such as telemedicine, electronic health records, automated reminders using text messaging and other technology, and performance transparency. There was one concern that I had regarding performance transparency. If a hospital is alone in posting performance in their market, could this be detrimental to that hospital's business due to the consumer's inability to compare performance to other hospitals?

Reflecting upon the Symposium as it comes to a close, many important and difficult health topics were covered over the past three days. Many questions were answered, and of course, we still leave with many uncertainties. Despite the uncertainties, health professionals leave the Symposium today with renewed motivation and new ideas that will inform their practice. It is inspiring to see a large group of passionate health professionals dedicated to improving our nation's health. I am honored that I could participate in a stimulating discussion of problems that challenge our nation's health and learn about the many creative and innovative solutions that are being developed and implemented. Walking away with a better understanding of the state of our nation's health and a toolbox of ideas for solutions, I can be a more engaged and effective contributor to the health community. I cannot thank the Colorado Health Foundation enough for giving me the opportunity to participate in these important discussions and develop my skills as a health solutions leader.

Mannat Singh recently graduated with a master's in public administration from the University of Colorado, Denver, School of Public Affairs. Her interests are in public will and advocacy, and how they can promote new and innovative health policies. Singh is attending the Symposium as part of its Symposium University program.

This Symposium experience has been unlike any event I have ever attended. In three days I have watched leaders educate, encourage and motivate the audience, I have been inspired by moral entrepreneurs, participated in the form of a "mystery challenger" for the interactive debate on the Affordable Care Act, attended a reception which placed me in a room with people who I would in no other situation have been able to engage with, and was just interviewed for a radio story by the Colorado News Connection! I have had an enriched experience, to say the least.

The interactive debate on the Affordable Care Act was an entertaining forum from which to gain information, hear the opinions of leaders in policy and health care, and get some very direct questions answered. The participants were Jon Caldara, Len Nichols, T.R. Reid, and Grace-Marie Turner. They were all extremely passionate, articulate and used their personalities to sell their opinions - each of them brought a different flavor to the debate ranging from soft and sweet to bold and bitter. As a mystery challenger, I was given the daunting opportunity to challenge one of the participants, the renowned Dr. Len Nichols, director for the Center for Health Policy Research and Ethics. My question, centered around his position on the Affordable Care Act and what moderate politics means for today's policy environment, was followed by an extremely articulate limited-to-one-minute response–and I could not have been more excited to be a part of that event at the Symposium.

In my interview with the Colorado News Connection, I mentioned something that I haven't stopped thinking for the past three days: conferences are exciting in that the attendees and participants feed off of each other's energy and enthusiasm. You can almost physically see the transfer of attitudes, ideas and potential for new and strengthened connections. The exchange of information, beliefs and values is the perfect mix to promote reform and solutions as they relate to health care - and the Colorado Health Symposium optimized that potential.

A side note for other students or recent graduates: the general moral of the story here is NETWORK, NETWORK, NETWORK. The guidance, help and insider knowledge gained from networking with professionals in any field of study or work is an invaluable asset and the most important skill to build. The importance of networks, connections, and relationships was so clearly evident over the duration of this conference.

My final thoughts on the Symposium include a list of ideas, websites, nonprofits, and concepts to follow up on in terms of research, looking for opportunities, and finding ways to participate and integrate. For those following via the various social media outlets provided by the Colorado Health Foundation, the opportunity to pick up on some of these points of interest may have been lost and I would like to offer it up for anyone who is interested:

• Websites to look at: FastFoodMarketing.org; CookingMatters.org; HealthPolicySolutions.org; Ashoka.org; RevFoods.com

• Books/Documentaries to find: The Immortal Life of Henrietta Lacks; No One Cares What You Had For Lunch; Sick Around the World

• Nonprofits to learn about: Cooking Matters; Ashoka Innovators For the Public; Food, Inc.

• Themes, ideas, concepts for consideration: Led by passion, guided by intellect; patient centered/centric care; dogma vs. evidence; optimal defaults vs. disastrous defaults; targeting of vulnerable populations; change agents; MacArthur Genius Grant; urban farming; moral entrepreneurs; "Don't Suck!"; If it bleeds, it leads; cultural competence; means-testing for entitlement programs

• Statements that stuck: "Monkeysphere: we are wired to recognize a certain number of people as "us" (research suggests around 150-200 people) and the rest as "them" – we need to stretch the monkeysphere"; "The difference between scientists and journalists is that scientists throw out the top- and bottom-most extreme numbers, and journalists throw out the middle"; "Your grandma would not recognize the stuff in grocery stores today as food"

Thank you Colorado Health Foundation and all the people who gave me the chance to be an active participant!

Quote of the day:

"Every year, it's like we dump out a jigsaw puzzle and we put it together again and try to figure out what works. It's frustrating and seems to get more so." – Sharon Linhart, founder and managing partner of Linhart PR, on the challenges of insuring employees

Businesses nervous about reform
Panelists expressed concerns about health care reform and its effects during this morning's discussion on "the business of health care" on the third and final day of the 2011 Colorado Health Symposium. U.S. Sen. Hank Brown kicked off the morning's proceedings. Now senior counsel for the Denver law firm Brownstein Hyatt Farber Schreck LLP, Brown predicted many employers will drop health coverage altogether due to increased insurance costs and regulatory burdens associated with the Affordable Care Act.

Brown said the ACA will lead to dramatic increases in health care costs and force more people to enroll in government-sponsored insurance plans. Due to restrictions in federal funding, Brown predicted that Medicare will become "needs-based" and available only for those who can't afford other coverage. "You may like or dislike this phenomenon, but it's coming," Brown said. He also predicted the recent expansion of the Medicaid program will be scaled back considerably, leading to additional cost-shifting in private insurance plans.

Sharon Linhart, founder and managing partner of Linhart PR, a Denver-based public relations firm, said she is among many small business owners who are apprehensive about the ACA. "We're obviously concerned about increased costs and regulations," Linhart said. While some colleagues are optimistic that the ACA will lead to lower premiums, less sick time and reduced productivity, many are confused or uncertain about what reform will mean to them. "If the new regulations [from the ACA] are as onerous as they're predicted to be, we could consider discontinuing [insurance coverage] and just pay the fine. Hope I haven't been a 'Debbie Downer,' but that's a little bit of a reality check."

Kate Sullivan Hare shared her insights dealing with business and health care. Hare led policy efforts for nation's largest business lobby, the U.S. Chamber of Commerce and for the nation's largest retailer, Wal-Mart. Now director of public outreach and public affairs for the Robert Wood Johnson Foundation, Hare said the U.S. Chamber lost one-third of its membership when it worked to forge reform policy that included tax credits for businesses that offer insurance, mandates for employers to provide insurance and expansion of public plans. "A lot of partners withdrew from the partnership because it did nothing to address the factors that drive costs," she said. "But frankly, I'm not sure a lot of those factors can be addressed through legislation."

Jena Hausmann, senior vice president and COO of Children's Hospital Colorado, said the ACA clearly will impact "business as usual" at the hospital system. "It will require a paradigm shift, but we'd rather drive change than be the victim." Hausmann said advancements in health information technology, health information exchange, coordinating care, improving quality and safety processes will help Children's Hospital realize cost savings and improve care.

Also at this morning's session, Kirsten Saenz Tobey, co-founder of Revolution Foods, shared her vision for providing healthy, fresh foods for students on a daily basis.

Streaming of Friday's plenary speakers is available through Ustream.

Keynoter takes aim at disparities
Insensitivity to ethnic and social differences compromises the quality of health care that minorities in America receive, said Dr. Ian K. Smith, a health care author and media consultant. Best known for his appearances on cable TV's "Celebrity Fit Club" series, Smith presented the keynote speech at the third and final day of the Symposium. Smith emphasized the importance of "cultural competency" in health care, adding language and cultural barriers could impact the patient's experience and medical outcomes. "You need to have to have a blank mind for everyone who walks in that door," he said. "Physicians have to treat everybody differently."

Henneberry earns Iglehart award
Joan Henneberry received the distinguished John K. Iglehart Award for Leadership in Health Policy during a July 28 reception at the Colorado Health Symposium. Presented by the Colorado Health Foundation, the award recognizes individuals whose wisdom, involvement and leadership helped define and move forward positive reform in health care.

Earlier this year, Colorado Gov. John Hickenlooper appointed Henneberry as the executive director of the Colorado Health Insurance Exchange. In this new role, Henneberry will oversee the implementation of a new marketplace where individuals and small businesses can purchase health insurance coverage. Previously, Henneberry served as the executive director of the Colorado Department of Health Care Policy and Financing, the state agency responsible for public health insurance programs including Medicaid and CHP+. The award is named after John K. Iglehart, founding editor of Health Affairs a health policy journal. In conjunction with the Iglehart Award, the Foundation will make a $10,000 contribution to a health care nonprofit of Henneberry's choice.

Don't miss "Colorado State of Mind"
Friday, July 29 at 7:30 p.m., Rocky Mountain PBS will air the edition of "Colorado State of Mind" taped on Day Two of the Colorado Health Symposium. The show features Symposium speakers Kavita Patel, Barb Yondorf, Joe Greer and Jena Hausmann.

Symposium news highlights
KUNC, a public radio station serving Northern Colorado, featured Kelly Brownell's comments about taxing sweetened soft drinks on its website yesterday. Brownell, a psychology professor from Yale University, said at yesterday's Symposium, such taxes could reduce consumption of soft drinks and obesity, while raising revenue for state and local governments. Also, Colorado Public News posted a story about the Symposium on its website.

The discussion continues...
The 2011 Colorado Health Symposium may be over, but the event continues to play out online. Morning sessions from the Symposium are available via Ustream. You can also catch up with the Symposium via Twitter. Follow Symposium happenings by "liking" our official Facebook page. These online resources extend the Symposium beyond the walls of the conference center. Also, read the Symposium blog for insights before, during and after the Symposium.

Speaker slides available online
Looking for great statistics or tidbits from this year's Colorado Health Symposium? Many speakers' PowerPoint presentations are posted on our website.

Next up: The 2012 Colorado Health Symposium: July 25-27, 2012

Oscar Paniagua-Morales is a sophomore at Mesa State College and aspires to go to medical school and become a physician. He would like to specialize in nephrology to learn more about his kidney disease and help others who are going through the same issues. Paniagua-Morales is attending the Symposium as part of its Symposium University program.

"A physician's role is to improve the health of his patients," said Pedro Jose Greer, MD, an acclaimed doctor who has won several awards for his dedication to improving health care in the United States. This morning, he gave the audience at the Colorado Health Symposium his views on health care and the tremendous shortage of minority students entering medical school. Dr. Greer also pointed out that 70 percent of students entering medical school in this country have family incomes of a quarter million dollars. In my opinion, this statement implies that minority students from disadvantaged backgrounds applying to medical schools are having a hard time getting in, and according to Dr. Greer, this is not likely to change in the coming years.

In my experience as a Latino student, one of the problems students from disadvantaged backgrounds face when applying to medical school, is that some of them did not get the tools needed to succeed in their early school years. I don't think this problem starts in college but during high school, when students are at greatest risk of dropping out due to factors like having to work to help support the household, or getting pregnant in their teen years. If the student manages to make it to college, he still has a very steep mountain to climb. He must keep focused and determined to do well in school in order to be competitive for medical school admissions. He must break out of his expectation that if his parents did not go to school, he shouldn't either; or if his parents got by working low paying entry-level jobs, then, he doesn't need to attend school.

The lack of role models in the Latino population makes it harder to even think of some day becoming a physician. I must emphasize that we do have successful Latino role models in the United States but they are still in the minority. We have excellent role models like Dr. Greer from Florida and Dr. Quinones-Hinojosa from Johns Hopkins, who have amazing backgrounds that inspire students today, but we need more people like them. In addition, the U.S. government, the nonprofit organizations, and the medical schools, need to create and continue to support programs that can help minority students reach medical school.

Mannat Singh recently graduated with a master's in public administration from the University of Colorado, Denver, School of Public Affairs. Her interests are in public will and advocacy, and how they can promote new and innovative health policies. Singh is attending the Symposium as part of its Symposium University program.

Initially, this blog entry was going to focus on the Discovery Session "An Uneasy Alliance: Health Care and the Media" but I cannot help but first touch on the inspirational morning session we had, even though I can't possibly do it justice.

This morning, Kelly Brownell, co-founder and director for the Yale Rudd Center for Food Policy & Obesity, Will Allen, founder and CEO of Growing Power, Inc., Larry Cohen, founder and executive director for the Prevention Institute, and Pedro Jose Greer Jr., MD, assistant dean for Academic Affairs of the Florida International University School of Medicine, together captivated a massive hall full of health professionals, who all wanted to understand "The View from the Street." Watching these phenomenal leaders was an experienced unmatched to any other. The roles they have taken upon themselves, the passion they have for their causes, and the unendingly positive, optimistic, and encouraging attitudes with which they carry out their work is something to aspire to. You could literally feel a growing buzz of excitement and ideas in the room as these presenters shared their experiences.

After the morning session and a lunch break, I headed for the Discovery Session on "Health Care and the Media." In attendance were Michael Booth from The Denver Post, Diane Carman from the School of Public Affairs and the University of Colorado Denver (my campus!), Cynthia Hessin from Rocky Mountain PBS, Andis Robeznieks from Modern Healthcare, Eric Whitney for Colorado Public Radio and Tim Wieland of CBS4 Denver. The facilitator for this discussion was the great T.R. Reid, who also participated in the exciting interactive debate last night.

Themes included: The importance of trust and reliability in reporting; the development of a fan based on that trust and loyalty; the inability to separate the politics out of content when discussing health care in the news arena; the tendency of reporters to turn back to politics (because it is harder to get to the "nitty-gritty" of the actual policy issue than to discuss the politics surrounding the issue); the dramatically changing landscape of media; and the problem with American objectivism (that the objective culture in journalism is effectively watering down opinions - my attempt to paraphrase a somewhat controversial issue), and "if it bleeds it leads."

In the end, I saw the "uneasy alliance" as an issue of dependency. Individuals need a news outlet that discusses health policy issues, and news outlets need experts who can accurately cover issues of health policy. Those experts need to be able to effectively reach their audience (the public), and in order to do so health policy needs to be broken down into understandable terms. What can be lost in translation can also be lost in politics, and because individuals rely on the media for health policy issues this is effectively their only source of information. This increases the importance of accuracy in reporting but also ease of understanding. As I see it and reflected upon it, it becomes a loop of potential for miscommunication - making all the panelists' roles all the more crucial.

Dang will be attending graduate school at Colorado State University in the fall to study molecular, cellular and integrative neurosciences. She believes that understanding policy is crucial to the next generation of health care leaders. Dang is attending the Symposium as part of its Symposium University program.

How often do you walk out of your house with your shirt on backwards? Not often (I hope). And if you did, someone would let you know. Yet when you are drinking a 20 oz. bottle of soda with your combo meal from McDonald's, would anyone step in and say "That's a bad choice?" No, because as a society we would consider that rude.

My point: Do we have notions and opinions about health in our communities backwards? We are more worried about a person's apparel and would easily voice our opinion to save a person from embarrassment, but we may never be vocal about health risks that can potentially save a person's life. The solution to this problem is not to call this person out, shouting "You're the root of the obesity epidemic!" but to change the mentality of the community to value the importance of health, making that the norm.

Today's morning session, entitled "The View from the Street" featured epic speakers discussing the hard realities—the battles and triumphs of creating health in their community.

Larry Cohen, founder and executive director of the Prevention Institute, showed the audience an advertisement from KFC, stating "Buy a mega jug of soda for $2.99 and KFC will donate $1 to JDRF." Sounds wonderful, except that JDRF stands for the "Juvenile Diabetes Research Foundation." We emphasize the importance of preventative care (which by the way only makes up four percent of current medical expenditures), yet live in a society that does not nurture or support health as much as it should.

Dr. Kelly Brownell, co-founder and director of the Yale Rudd Center for Food Policy & Obesity, furthered the point of why most people don't live healthy lifestyles and are not in a rush to change. What he considers "disastrous defaults" includes the acceptance of bad foods (i.e. deep fried butter), inappropriate portions and food marketing from various industries. The average teen in the United States sees five fast food ads per day. Preschoolers see more than 1,000 ads per year for unhealthy foods. Have you heard of Bunnies or Puffins? These are among the healthiest cereals according to a report by the Yale Rudd Center. But I guarantee most people have heard of Reese's Puffs and Lucky Charms, deemed as the lowest nutritional cereals.

"It is unreasonable to expect people to change their behavior easily when so many forces in the social, cultural and physical environment conspire against such change," quoted Cohen. We need to make health the goal of the majority. It needs to be the default option for everyone—rather than making recommendations about taking care of yourself, change the mentality to a more compulsory concept.

How do we approach this problem? Some say education, but is that enough? The majority know that soda is bad for you, but the average person consumes approximately 50 gallons a year. We need action.

Take the amazing example of Will Allen, the founder and CEO of Growing Power, Inc.. This former professional basketball player created the farm and community food center in Milwaukee. He received the "genius grant" from the John D. and Catherine T. MacArthur Foundation by thinking outside of the norms and creating effective urban farming. We need more Will Allen revolutions in the world.

Dr. Brownell had a proposal of taxing one penny per ounce of sugar-sweetened beverages to deter people from drinking empty calories. Doesn't sound like much, but he projected that the tax can decrease consumption of these beverages by 10-23 percent, reduce health care costs by $50 billion over 10 years, and even generate $150 billion in tax revenue for Colorado in 10 years. Do you think this a practical solution?

Thus far, it is not mainstream to be healthy when we have so many influences from industries that advertise otherwise. We need change. Maybe one day it won't be strange to say to someone, "Excuse me ma'am, you're drinking a soda and taking years off of your own life."

Wade Faulk is an MD/MBA candidate at the University of Colorado School of Medicine. He plans to pursue a residency and career in orthopedic surgery. Faulk is attending the Symposium as part of its Symposium University program.

During this morning's session, "The View from the Street," I had the pleasure of hearing Dr. Pedro Jose Greer Jr. speak. He is assistant dean of Academic Affairs and chair of the Department of Humanities, Health and Society at the Florida International University School of Medicine. As a medical intern, he founded the Camullus Health Concern, which now serves more than 10,000 homeless individuals a year in Miami-Dade County. In 1991, he founded the Saint John Bosco Clinic, which serves disadvantaged people in Little Havana, and serves as its medical director. Dr. Greer is the recipient of many awards, including three Papal medals, the MacArthur Genius Fellowship and the Presidential Medal of Freedom Service Award. In 1994 he was named one of Time Magazine's 50 Young American Leaders Under the Age of 40.

Born to parents who emigrated from Cuba, Dr. Greer graduated from the University of Florida with a BS in chemistry and earned his MD from the Pontificia Universidad Católica Madre y Maestra. He spoke of the need to change how we educate medical students and practice medicine. He gave insight on how we need to be more aware of the social causes of disease and the realities of poverty and social injustice, stating, "We can take care of a patient's disease, but what we need to ask ourselves is what can we do to take care of his or her life." He overcame many obstacles as an individual of Cuban descent and a disadvantaged background. His story is absolutely awe-inspiring and helps me see where I can go, and reminds me to never forget where I came from.

Statistically, I am not supposed to be where I am in life. I was born to a mechanic father with a high school education and an immigrant mother who has not yet achieved her GED. Growing up, my parents were never able to clench a position for our family above the poverty line, but we still had a great life. The real challenge came when I was 14 years old. My father died suddenly from a heart attack at age 41. He was always my role model and his death was a crippling blow to my entire family. My younger brother was then only 3 years old and my mother, from South Korea, was forced to work at night for minimal wages as a result of her limited job choices in Julesburg, Colo. At the time of my father's death, I was the oldest male in our household and my two older sisters were away at college. Consequently, I was faced with the challenge of being a father-figure to my younger brother and being a breadwinner at 14 years of age. Each person in my family contributed in every way that we could to the family income and to provide moral support for one another. My sisters worked to support themselves in college and send home money for groceries and bills. For my contribution, I washed dishes at a local restaurant during the week and worked on farms and ranches on the weekends. I also took care of my brother. He came with me everywhere. I brought him to class with me some mornings when my mom was not able to make it home early enough from her night shifts. He would come with me to sports practice where he participated as the "waterboy" and I would play with him between drills. I excelled in school and in my athletic endeavors. My efforts were directed at setting an example for my brother and earning scholarships, which would enable me to attend college and pursue my dream of becoming a doctor. Today, I am a fourth year medical student at the University of Colorado School of Medicine earning a dual MD/MBA.

As Dr. Greer alluded to, and as I have experienced, minorities in medical school are few and far between. Many more programs should be put in place to enable more minority and lower socioeconomic (these tend to go hand-in-hand) students to attend higher education. Medical schools across the U.S. must take responsibility for this lack of diversity, in both the student body and faculty and these schools should be held accountable if this issue is not addressed.

According to the AAMC Data Warehouse: Minority Physician Database, while African Americans and Latinos are among the fastest growing segments of the population, they are also the most severely underrepresented minorities in medicine. Today, African Americans, Latinos, and Native Americans together make up 28% of the U.S. population. However, only 6% of practicing doctors come from these groups. Currently, only about 14% of students applying to and graduating from U.S. medical schools are African American, Latino, or Native American. In the next 15-20 years, the nation is projected to confront an overall shortage of physicians, but the need is, and will continue to be, particularly great for minority physicians. By 2050, racial and ethnic minorities are projected to account for half of the U.S. population. Although the number of minority students entering into medical school is increasing, this number is not growing at a rate that will ensure the nation has the supply of minority physicians it needs.

Studies show that minority physicians are more likely to treat minority patients and indigent patients and to practice in underserved communities. Studies also indicate that when minority patients can select a health care professional, they are more likely to choose someone of their own racial and ethnic background. These relationships are characterized by higher levels of trust, respect, and the increased likelihood that patients will recommend their physician to others. The nation needs a culturally competent health care workforce—one with the knowledge, skills, attitudes, and behaviors required to provide the best care to a diverse population. Exposure to racial and ethnic diversity in medical school contributes importantly to the cultural competence of all of tomorrow's doctors. A diverse student body brings an array of ideas to the learning environment; helps students challenge their assumptions; and broadens their perspectives regarding racial, ethnic, and cultural differences.

Who knows who the next Dr. Greer (½ man, ½ amazing) will be, but more of us should be given that chance.

Works Cited

1. AAMC Data Warehouse: Minority Physician Database, Applicant-Matriculant File, and AMA Physician Masterfile, as of March 16, 2006.

2. AspiringDocs.Org: An AAMC Campaign to Increase Diversity in Medicine. 2006.

3. Diversity in Medical Education: Facts & Figures 2008

4. Diversity in the Physician Workforce: Facts & Figures 2006

5. Institute of Medicine Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR (eds). Unequal Treatment: Confronting Racial & Ethnic Disparities in Healthcare. Washington, DC: National Academic Press, 2003.

6. Kaiser Family Foundation, based on Table 3: Annual Estimates of the Population by Sex, Race and Hispanic or Latino Origin for the United States: April 1, 2000 to July 1, 2007 (NC-EST2007-03). Population Division, U.S. Census Bureau.

7. U.S. Census Bureau, Population Division and Housing and Household Economic Statistics Division.

 Amber Banducci is an MPH candidate at the Colorado School of Public Health. Banducci is interested in health care policy, particularly when it affects hospital administration operations, and the resulting health outcomes of patients. Banducci is attending the Symposium as part of its Symposium University program.

Three engaging speakers with important public health messages started off the second day of the Symposium. The focus shifted from medical care yesterday to prevention today. As a young public health professional, these were the messages I was craving to hear. Improved medical care is an important part of improving the health of our nation, but as emphasized by Larry Cohen from the Prevention Institute, behavioral and environmental factors play a significantly larger role in determining health. Prevention through behavioral and environmental change to improve health, extend life, and improve quality of life is at the heart of public health.

Kelly Brownell from the Yale Rudd Center for Food Policy and Obesity brought up several critical points for effecting widespread change that will improve the health of many. Within the scope of the obesity epidemic in the United States, Brownell highlighted that current mechanisms to address health problems have had minimal impact on improved health outcomes. He stressed that legislation that creates new and improved "defaults" before the individual's decision-making process will lead to a healthier environment and help individuals make better choices, specifically when it comes to diet and obesity.

Larry Cohen echoed and expanded on those ideas. Educating people on the benefits of exercising, healthy diet and other healthy behaviors is ineffective without an environment that is conducive to engagement in healthy behaviors. Changes such as building sidewalks for safe walking, building parks for exercise, and zoning for increased access to healthy foods are necessary for people to engage in safe and healthy behaviors. Will Allen, the founder and CEO of Growing Power Inc. shared his efforts that coincide with the methods and goals Cohen and Brownell highlighted. Allen's inspirational story of engaging children in farming for healthier eating, increased activity and increased sense of responsibility led to a standing ovation.

As a current MPH student and an aspiring physician, Dr. Joe Greer Jr., assistant dean for Academic Affairs and chair of the Humanities, Health and Society at Florida International University, gave an inspirational speech that particularly resonated with me. I plan on attending medical school in the near future, and people often ask me why I am earning an MPH degree. I would give me best answer and reply that I want to understand the complex health system in which I will be practicing, understand the big picture of health to be a better physician, and participate in local public health policy. After today's discussion, I am even more confident in my decision to obtain an MPH. A hot word today was "integrate" — integrating public health principles and evidence into the practice of medicine is a necessary step in improving our nation's health. Dr. Greer asserted that fundamental changes in American medical student education must occur so students can learn to practice with compassion and address the social determinants of health.

As Dr. Greer put it, the audience and speakers today are truly "led by passion and guided by their intellect". The presentations today inspired the audience and stimulated honest discussion that will hopefully inform their public health and medical care practice. I am ecstatic that health professionals understand public health's many opportunities to significantly improve our nation's health. There are a couple take-home messages from today's discussion. First, prevention, particularly through legislation and policy, is critical in making significant improvements to our nation's health. Second, better integration of public health into medical education will develop physicians with a broader scope of health knowledge that they can use to practice with compassion and a deeper understanding of the social determinants of health. I am leaving today inspired and confident that I can be part of the solution.

How do you feel about the emphasis on public health in improving our nation's health? How do we take these stories of success and inspiration and apply them in practice?