9
                                FUTURE OF AGING IN ALASKA
          10                      ADVOCACY CONFERENCE

          11
                                     June 28th, 2006
          12                            9:00 a.m.

          13
                                Pages 1 - 190, inclusive
          14

          15            Hosted by the Alaska Commission on Aging


          25    Realtime Captioning:  Lenny J. DiPaolo, RPR



                                                                       2


           1                     P R O C E E D I N G S

           2                             -oOo-

           3                    WELCOME AND INTRODUCTIONS

           4                              -oOo-

           5                   MS. GOHL:  Good morning everyone.  Can

           6    you take your seats.  I wanted to start with welcoming

           7    everyone once again.  And if you were not here

           8    yesterday, I welcome you.

           9                   And we have an exciting agenda and some

          10    guest speakers today, including Governor Murkowski and

          11    his group, and that will be at 11.

          12                   But I wanted to let folks know who have

          13    to travel tonight that everyone is going to go back to

          14    the hotel and then the school bus transportation

          15    service will provide a ride for folks who need -- some

          16    folks are going to the Marriott, that's a long story,

          17    you don't want to know that story, and then the folks

          18    who need to go to the airport this evening, we'll get

          19    you on the bus and take you all there at one time.

          20                   And also I wanted to introduce Lenny

          21    DiPaolo, I forgot to introduce him yesterday, he's a

          22    very important person when we have these functions.  He

          23    does a wonderful job at providing the online realtime,

          24    what everybody is seeing, and also provides

          25    transcripts.  And so I wanted to thank Lenny for his








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           1    services.

           2                   And also the presentations yesterday, I

           3    will be making those -- that information, the

           4    PowerPoint presentations available on our website once

           5    I get back to town.  We had some last minute changes to

           6    the presentations and debated about whether to copy

           7    them, and so we'll get those available.

           8                   And then if anybody would like to have

           9    one mailed to them, we should put out a pad over here

          10    and we'll have a sign-up sheet, and you just need to

          11    put your name and the town you live in and then we'll

          12    find your address based on the original registrations.

          13                   And can everybody hear me?  I wanted to

          14    also ask for anyone who has a hearing impairment, that

          15    we're not going to open the doors today or the windows

          16    because we need to keep the mechanical and the air

          17    conditioning system going because it will be extremely

          18    too warm here in the afternoon, so if anybody has a

          19    hearing impediment, you might want to move forward and

          20    be not in the back of the room, so that's just a

          21    suggestion.

          22                   And then also I'd like to know, and by

          23    representation of people standing, of where you're

          24    from, and I'm going to kind of do this in general

          25    geographic areas of the state so we can get an idea of








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           1    where everybody is from.

           2                   So, for instance, how many people, if

           3    you could stand, are from Southeast Alaska?  And I know

           4    we have people from Juneau, Ketchikan, Craig, I

           5    believe, Kake, Yakutat, Cordova, which is sort of not

           6    quite but maybe in Southeast, but maybe in -- you know.

           7    And I think I've covered -- Hoonah, Sitka, and

           8    Metlakatla, so we have a real good cross representation

           9    from Southeast.

          10                   And then how many people from Fairbanks

          11    or the Interior of Alaska?  And I know we have a whole

          12    table of people from Barrow.  I don't even want to call

          13    you Interior, because you are, like, from the Far

          14    North.  And I'm so pleased that you're joining us

          15    today, we've got seven people here from Barrow.

          16                   And I don't know if we have anybody from

          17    Southwest part of the state, the Dillingham, Bethel

          18    area or any of those areas?  No, I didn't think we did.

          19    I tried, I got information out there.  Maybe they have

          20    other things going on, fishing, yeah, subsistence.

          21                   And I know we have people here from

          22    Anchorage.  And Kenai, Kenai people, which is actually

          23    a very broad range from Seward, Soldotna, Sterling,

          24    Kenai, Cooper Landing, Fritz Creek and Homer.  So

          25    that's a broad array.








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           1                   And also the Mat-Su Valley, which

           2    includes Palmer, Wasilla, Big Lake, Houston.  We had

           3    some folks here yesterday.  Well, thank you very much.

           4    Kodiak.  Well, Kodiak, how could I forget Kodiak

           5    Island, it's one of the biggest islands in the United

           6    States, if I'm not mistaken.

           7                   Now before I introduce our guest speaker

           8    I'm going to ask Ms. Branson from Kodiak to do a brief

           9    overview on the outcome from the White House Council on

          10    Aging.  She was an at large delegate who attended the

          11    conference in Washington, D.C., and we have handouts at

          12    the table with a sheet that reflects the

          13    recommendations that Alaska made to the conference, so

          14    with that I will turn this over to Pat.

          15                             -oOo-

          16             WHITE HOUSE CONFERENCE ON AGING REPORT

          17                             -oOo-

          18                   MS. BRANSON:  We had seven delegates

          19    from Alaska go to the White House Conference on Aging

          20    last December.  Ed Zastrow from Ketchikan, Kathleen

          21    Dalton from Fairbanks, Laraine Derr from Juneau, Elmer

          22    Feltz from Wasilla, Gloria McCutcheon from Anchorage

          23    and Dr. George Charles from Anchorage and myself from

          24    Kodiak.

          25                   I'm going to read some talking points








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           1    here about what happened at the conference, and more

           2    information will be available, hopefully Linda, by the

           3    end of this month, I would think, is that correct?

           4                   So last year in preparation for the 2005

           5    White House Conference on Aging the Alaska Commission

           6    on Aging held five community forums to gather public

           7    input from around the state on the top concerns of

           8    Alaska seniors.  Other communities, and I know we did

           9    this in Kodiak, we held our own event and provided ACoA

          10    with the results, and some of you may have attended

          11    those forums.

          12                   ACoA prepared a detailed list of all the

          13    recommendations that they received and you can find on

          14    their website which is www.alaskaaging.org.  It's over

          15    40 pages in length, so you might want to preview that.

          16    Suggestions were presented for change on the federal,

          17    state, local and individual levels in the area of

          18    health and long-term care, financial security,

          19    community resources, and social well-being.

          20                   Be sure to check these out if you're

          21    looking for ideas for enhancements of any programs you

          22    may be involved with or new suggestions for needed

          23    services in your area.

          24                   The 2005 White House Conference on Aging

          25    was the fifth such conference making it one of the








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           1    longest running White House Conference series in

           2    history.  White House Conferences on Aging are held

           3    approximately every ten years, and they are known for

           4    setting the aging policy for the decade to come.  They

           5    have a lot of work in front of them with the baby

           6    boomers.

           7                   The first conference held in 1961

           8    resulted in the creation of the Medicare program coming

           9    up during the '60s.  Conferences also played a major

          10    role in shaping the Older Americans Act, which directed

          11    funds to a wide variety of programs such as, nutrition,

          12    transportation, and support services throughout the

          13    state.

          14                   The theme of this year's conference was

          15    the Booming Dynamics of Aging in reference to the

          16    coming demographic balloon of 76 million baby boomers.

          17    The first wave of boomers are reaching the age of 60

          18    this year.

          19                   The Alaskan delegates to the White House

          20    Conference, I mentioned who they were, were selected by

          21    the national steering committee and the Governor and

          22    the congressional delegation.  They joined the ACoA in

          23    sorting through the many recommendations that came

          24    through the community forums.  There were 28

          25    resolutions which the Alaskan delegation put forward to








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           1    the conference process.

           2                   Members of the national steering

           3    committee for the conference then combined the input

           4    from all the states to arrive at 73 resolutions.  And

           5    these were voted on for the top 50.  Of course the

           6    states that had a larger population than Alaska, which

           7    is most every state, had more delegates, and so they

           8    had a stronger vote.

           9                   So there were people lobbying in the

          10    elevator for the resolutions from their states that

          11    they wanted.  New York had buttons and pamphlets, and

          12    we Alaskans just did our thing, as we always do.

          13                   On the table here you'll find the list

          14    of the recommended resolutions, and in comparison to

          15    the top 50 resolutions that were voted on at the

          16    conference.

          17                   We found that our delegates did an

          18    excellent job of highlighting most of the topics that

          19    were selected as the top 10 and 50.  The top 10

          20    resolutions selected by the conference delegates are

          21    the reauthorization of the Older Americans Act,

          22    development of a coordinated long-term care strategy,

          23    enhancement of transportation options for seniors,

          24    strengthening and improvement of the Medicaid and

          25    Medicare programs, provision for geriatric education








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           1    and training for health care and direct care workers,

           2    promotion of innovative models of non-institutional

           3    long-term care, improve recognition and treatment of

           4    mental illness and depression among older Alaskans,

           5    attainment of adequate numbers of health care personnel

           6    who are not only skilled but culturally competent and

           7    specialized in geriatrics, and improvement of state and

           8    local integrated service delivery systems.

           9                   I think all those topics are most

          10    important to each and every one of us.  So we'll look

          11    forward to the report, which has gone through several

          12    review processes on the state and federal level, and

          13    that will be coming out at the end of this month as

          14    Linda noted.  So thank you.

          15                   MS. GOHL:  Thank you, Pat.  That reminds

          16    me, in today's paper there was a short article

          17    regarding the Centers for Medicare and Medicaid.  The

          18    director of that program, who was an appointee of

          19    President Bush, Dr. Mark McClellen announced that

          20    preventative health care, they are starting a program

          21    so it will be covered under Medicare, and so there is

          22    more information that will be available evidently, and

          23    we'll get the number and post it on our website so

          24    people can contact them.  And they are going to start a

          25    campaign blitz to inform the public and people who are








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           1    covered under Medicare, and that's a good thing.

           2                   I saw him a year ago at a conference in

           3    Washington, D.C., and he had talked about that at

           4    length, and he is -- actually he's a doctor, an M.D. as

           5    well as a doctor of economics.  So that's good news.

           6                   So with that, I'd like to introduce

           7    Iver, he's a commissioner from Kodiak.

           8                   SPEAKER:  I was at the Conference on

           9    Aging and one important item I think was left out, I

          10    was at the White House Conference of Aging, not as a

          11    delegate but only as a person that was at the display

          12    at the Natural Resource Center from Dr. Charles.  And

          13    while I was there a unique thing kind of happened, the

          14    Native Americans, all the Alaska Natives, Hawaiians

          15    were excluded by language looking at the topics that

          16    they talked about.  The Asian and Hispanic were the

          17    only two that were included, so we had a big job before

          18    us, and that was to get all the delegates from the

          19    states to get in line with our thinking, and that was

          20    to get the language inserted on all resolutions whether

          21    that pertained to Alaska Natives, Hawaiians and Native

          22    Americans, and we were able to do that.  And from now

          23    in the future that's going to be there forever so we

          24    did accomplish a big task besides getting the

          25    resolutions, so thank you.








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           1                   MS. GOHL:  Thank you.  And with that I

           2    would like to do a little intro on our special guest

           3    speaker from Washington state, Dr. Stephen Bezruchka.

           4    He's a member of the faculty of the Washington School

           5    of Public Health and works as an emergency room

           6    physician in the Seattle area.  He spent over ten years

           7    in Nepal working in various health programs and

           8    teaching in remote regions.  A popular speaker and a

           9    guest on alternative radio, he explores special

          10    interests in the relationship between population,

          11    health, and societal structures, the risks of medical

          12    harm and methods of measuring hierarchy in societies in

          13    order to understand the health and hierarchy

          14    relationship.

          15                   Dr. Bezruchka is involved with the

          16    population health forum, an organization of health

          17    activists which raises awareness and promotes dialogue

          18    about and explores how political, economic, and social

          19    inequalities interact to reduce the overall health

          20    status of our society.

          21                   And we have a website for more

          22    information about the population health forum that we

          23    will -- actually it's in your packets, it's right here

          24    in the presenters.  And with that, I'd like to

          25    introduce him, and welcome -- please give him a good








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           1    welcome to Alaska.  Thank you.

           2                             -oOo-

           3                    CIRCUMPOLAR HEALTH ISSUES

           4                              -oOo-

           5                   DR. STEPHEN BEZRUCHKA:  Good morning.

           6    And thank you very much, Linda, for the opportunity to

           7    come and talk to you and to MaryAnn VandeCastle for

           8    organizing this.

           9                   And they had gotten in touch with me

          10    last year and asked me if I was interested in coming up

          11    to talk to a Conference on Aging, and that was after I

          12    gave a talk about the importance of early childhood for

          13    adult health.

          14                   And then I agreed, and then some time

          15    went by, and I was coming up to this conference and I

          16    said, do you really want me to come because of what I'm

          17    going to say?  And they assured me that, yes, they

          18    really wanted to hear this material.  And so I look

          19    upon every group of people as an opportunity for me to

          20    learn something.  So in preparing for coming here to

          21    talk to you, the opportunity has taught me a lot, and I

          22    think this next hour, hour-and-a-half is going to teach

          23    me a lot more.

          24                   So I'd like to get a sense of who you

          25    are.  And can you raise your hands if you're aged 60 or








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           1    over.  Can you keep your hands up if your 70 or over.

           2    Can you keep your hands up if you're 80 or over.  If

           3    you're 90 or over.  We don't have any 90 year olds?

           4    Right there.  We have one 90 year old.

           5                   SPEAKER:  83.

           6                   DR. STEPHEN BEZRUCHKA:  Good, all right.

           7    Also, if I look around in this room, what gender do I

           8    see for the most part?  Females.  Are the people who

           9    are old in America equally male and female?  No how

          10    many more women are there than men?

          11                   SPEAKER:  Lots.

          12                   DR. STEPHEN BEZRUCHKA:  Who are over 80

          13    in the United States.  4/5ths of those over 80 in the

          14    United States are women.  Of those who are men who are

          15    over 80, almost all of them have been married.  Single

          16    men don't make it to 80.

          17                   Are there any single men in here who are

          18    80 or over?  There don't appear to be.  Let me ask you,

          19    those of you who are 70 or 80, how many were born in

          20    April, May?  Seven.  How many were born in October,

          21    November?  About the same number or slightly smaller

          22    number.

          23                   There tends to be proportionately more

          24    born in October, November than in April May if you're

          25    80 or over, which I think is quite interesting in the








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           1    United States, and I might towards the end speculate on

           2    why that might be the case.

           3                   Now can everybody hear me?  I think

           4    that's critical.  Let me just move this.  So as I think

           5    about, I don't know, I'm over 60, I'm 63, as I think

           6    about getting older and I think about issues for older

           7    people, I'm reminded last year I had dinner with

           8    somebody in Seattle whose name is Stimson Bullet, who

           9    is a retired lawyer.  And the reason I like knowing

          10    Stim is that he's a climber, a mountain climber, and on

          11    Sunday I went out and did a climb of Suicide Peak.  I

          12    attempted and successfully completed suicide.

          13                   And then yesterday afternoon I went up

          14    to the Alaska valley, I think it's called, over by the

          15    ski area.  And as I get older I try to do something

          16    like that.  Every year we plan an expedition of older

          17    people.  And Stimson Bullet last year was 86 and still

          18    climbing, and mostly doing rock climbing, he says

          19    because he can't carry a heavy pack.  And he can

          20    actually do harder rock climbs than I can.  And he had

          21    a picture of himself leading a hard rock climb at age

          22    86, and I was just marvelling at the ability to do

          23    this, because already he's doing things I can't do.

          24                   And then I asked him about continuing to

          25    do hard climbs when he was getting older, and I asked








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           1    him what's it like.  And he said, ah, to be 80 again.

           2    And then he said, ah, to be 70 again, which gave me a

           3    whole new perspective on what's in store as you get

           4    older.

           5                   Well, I want to get your opinions or

           6    ideas on things about what makes people healthy.  And

           7    then I want to -- I want to write some of these ideas

           8    down, and then I want to explore what we know about

           9    what produces health in populations.  What makes a

          10    country or a state within a country healthy.  And let

          11    me tell you why I started thinking about this.

          12                   I've been working as an ER doc for 30

          13    years, and I began to question a lot of things that I

          14    saw, especially with the opportunity of working in

          15    other countries.  And I came -- I found I had to change

          16    what I thought about the two phrases health and health

          17    care.

          18                   I used to think health and health care

          19    meant the same thing, and I have come to see that they

          20    are very different concepts.  And I want to get a sense

          21    from you as to what's going on.  And so I would ask

          22    you, what do you do to produce health in yourself or

          23    your family?  What do you do to produce health in

          24    yourself or your family?  Linda is going to write on

          25    the board so we can see what you say.  What do you do








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           1    to produce health in yourself and your family.

           2                   SPEAKER:  What I do is I try to maintain

           3    a life-style with traditional food.

           4                   DR. STEPHEN BEZRUCHKA:  He tries to

           5    maintain his life-style with traditional foods.  What

           6    are the traditional foods for you.

           7                   SPEAKER:  Foods from the land and the

           8    sea.  Kodiak is an island, and we are a people of the

           9    sea, so basically our food comes from the sea.  And we

          10    do have animals, but not much, but we try to live our

          11    life-style off traditional foods.

          12                   DR. STEPHEN BEZRUCHKA:  So traditional

          13    foods from the sea.  So I assume we're talking about

          14    fish.

          15                   SPEAKER:  And like seaweed, urchin, I

          16    can't name them all.

          17                   DR. STEPHEN BEZRUCHKA:  You eat

          18    traditional foods.  I might say that those are the

          19    foods that your group of people have been eating for

          20    thousands of years, and so there is maybe some good

          21    sense to do that.  Somebody else.

          22                   SPEAKER:  I used to give my family

          23    healthy foods like fish and fruits, and also stress

          24    free environment and exercise.

          25                   DR. STEPHEN BEZRUCHKA:  Healthy foods,








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           1    vegetables, and a stress free environment and exercise.

           2    Notice, she said, "I give my family foods and a stress

           3    free environment, and exercise".

           4                   It's something that -- can we actually

           5    create a situation in which there is less stress?  I

           6    think we can.  And I think that's another critical

           7    piece that is, can we give our family a stress-free

           8    environment and how might be do that?  Somebody else?

           9                   SPEAKER:  Meditation.

          10                   DR. STEPHEN BEZRUCHKA:  Tell me more

          11    about meditation.

          12                   SPEAKER:  For an alternative stress

          13    relief, meditation can bring you back to your center

          14    and bring you -- just reduce your stress of your

          15    everyday life.  And so with some of the stress that is

          16    created in life, health problems can come about,

          17    headaches and tension causes headaches, so with

          18    meditation that can be relieved some.

          19                   DR. STEPHEN BEZRUCHKA:  In a simple form

          20    can you describe what meditation is, because it means

          21    different things to different people.

          22                   SPEAKER:  Sure.  Clearing your mind and

          23    going within yourself to try to have no thought

          24    present.  Just to empty out your -- all the thoughts in

          25    your mind, come to a sense of peace.








                                                                      18


           1                   DR. STEPHEN BEZRUCHKA:  That's the

           2    critical thing about meditation, can you empty your

           3    mind?  I think it's a very difficult thing to do, but

           4    very effective.

           5                   SPEAKER:  You get more vitamins out of

           6    wild food than store bought food.

           7                   DR. STEPHEN BEZRUCHKA:  She gets more

           8    vitamins out of your own food than store bought food.

           9    And when you say your own food, what do you mean?

          10                   SPEAKER:  Moose meat, fish.

          11                   DR. STEPHEN BEZRUCHKA:  Moose meat and

          12    fish.  I hear that.  Natural vitamins, I think there is

          13    some suggestion, are better for you than the ones that

          14    you get in a little pill.

          15                   Let me go back to this meditation idea.

          16    This has actually been studied and shown, for example,

          17    that you can reduce blood pressure so you don't need to

          18    take blood pressure pills with meditation.

          19                   And I first came across these ideas when

          20    I was a medical student in the 1970s when

          21    transcendental meditation was popular, and there

          22    continue to be studies demonstrating that.

          23                   SPEAKER:  We have a group of seniors

          24    that are now meeting to do physical meditation through

          25    Tai Chi.








                                                                      19


           1                   DR. STEPHEN BEZRUCHKA:  Can you explain

           2    that?

           3                   SPEAKER:  It's a movement form that is

           4    also a meditative form that keeps our joints open and

           5    at the same time centers us and quiets our minds.

           6                   DR. STEPHEN BEZRUCHKA:  It's physical

           7    and centers.  And the word center I think is an

           8    important one.

           9                   I was in China to climb a mountain, and

          10    I remember early morning in Beijing going to a hilltop

          11    where it was full of old people who were doing Tai Chi,

          12    and there was sort of an old man who was leading and

          13    everybody was following the same movements, and it was

          14    a mystical experience as the sun came up.  And this all

          15    happened very early.

          16                   And in the workplace in China they take

          17    breaks so people can do Tai Chi.  I climbed Mt. Logan

          18    with another climber who did Tai Chi, and we were on

          19    this ridge, and he would get out there and he would be

          20    doing these an moves while we were in cramp-ons.  So I

          21    was exposed to Tai Chi in a variety of circumstances

          22    but I don't do it myself.

          23                   SPEAKER:  Tai Chi also improves your

          24    center of gravity to a lower place and improves your

          25    center of balance.








                                                                      20


           1                   DR. STEPHEN BEZRUCHKA:  Maybe that's why

           2    Rusty was better on that climb than I was.  What does

           3    somebody else do?

           4                   SPEAKER:  You know arthritis, there is

           5    no cure for arthritis, but the Native ointments and

           6    stuff are really the right -- I'm sorry, the right

           7    ointments that are Native made are a lot more effective

           8    than taking oral pills and stuff.

           9                   DR. STEPHEN BEZRUCHKA:  What she's

          10    saying is that Native made ointments work better than

          11    the pills.  I'm a scientist, so I teach in the public

          12    health school and I look at data.  I don't want to say

          13    anything in public that I can't back up with a variety

          14    of resources.  And we know that when you massage, when

          15    you actually rub the skin and use an ointment that this

          16    releases important chemicals that make you feel better.

          17    These studies exist.

          18                   It's just that why don't we do more to

          19    make people aware in this country that just massage of

          20    aching limbs or using Native ointments works?

          21                   SPEAKER:  No money.

          22                   DR. STEPHEN BEZRUCHKA:  Basically there

          23    is no money to be made from telling people to do this.

          24                   SPEAKER:  A lot of the origin of

          25    medication we use today is from Native American herbs,








                                                                      21


           1    and I believe in using that to take care of your health

           2    is really good.  But also it's really good to take the

           3    medication you're prescribed and have a healthy

           4    life-style be alcohol and drug free and cigarette,

           5    don't smoke cigarettes.  Basically cutting back on

           6    sugars, having some kind of exercise in your life, like

           7    walking, just being healthy in terms of what you eat.

           8                   DR. STEPHEN BEZRUCHKA:  Yes.  I wouldn't

           9    disagree with any of those.  And as we were hiking on

          10    Sunday up Suicide we went by some willows, and willows

          11    of course are the source of salicylate, which in

          12    aspirin and you can make salicylate ointments out of

          13    willow that can be very beneficial.  So you're right,

          14    there are a lot of these medicines that come from

          15    traditions that you had over centuries.

          16                   And I come along as an M.D., as a

          17    medical doctor, and our biomedical tradition that we

          18    use to treat people in the ER is 30, 40 years old, and

          19    a lot of what I learned when I was in medical school I

          20    can't do now because it's not considered right.  But

          21    these older traditions have been around for much longer

          22    and have been tested.

          23                   SPEAKER:  I'm from Pt. Barrow.  When I

          24    was young the elders say eat, drink, what do you call

          25    it, brak, and they told me that's good for your health.








                                                                      22


           1    Today very seldom I use medication, but since last

           2    winter I had a bit of problem this and there, my knee

           3    and my toe and whatever.  So I had three medications

           4    that I haven't used before.  So I was having it for two

           5    or three days, and I spent one day in the house, don't

           6    feel very steady, you know.  So I just give up those

           7    one medication, personally myself what the doctors gave

           8    me.

           9                   And then I had an appointment, I went

          10    over to the hospital and I told the doctor that I quit

          11    using those medications, and he said, good for you,

          12    it's good for you to quit those medications.  So some

          13    of those medications that the doctors gave us are not

          14    well treated in our system, I think.  So but I

          15    understand it.

          16                   Sometimes our older people, when their

          17    minds are getting kind of dull and then you're supposed

          18    to get it in the morning and in the evening, so I think

          19    somebody has to be kind of alerted, make sure that

          20    older people use the medication in certain times rather

          21    than using it different times during the day.

          22                   So I think our problem is sometimes that

          23    when our mind is getting dull, I think the younger

          24    people should keep an eye on us, what we are supposed

          25    to take.  I thought I would mention that, thank you.








                                                                      23


           1                   DR. STEPHEN BEZRUCHKA:  I think there is

           2    a couple very important points there.  One is you were

           3    given these medicines, and then they made you unsteady

           4    and you stopped taking them, right?  And very often

           5    when people come into the emergency department and

           6    often they are weak and dizzy or their caregiver would

           7    say, they are just not right.  And so I take a history

           8    and I ask, well, did you see the doctor recently or a

           9    nurse practitioner, what did they do?  Oh, they

          10    prescribed this medicine.  And I look at the medicine

          11    and of course it will make people more weak or dizzy or

          12    different.  And often I try to figure out do they

          13    really need this medicine then.

          14                   So a large part of what I do in the ER

          15    sometimes is get people off medicines that are making

          16    them worse.  Sometimes they need to take certain

          17    medicines.  And you talk about the importance of

          18    knowing what time of day to take them, and as you're

          19    talking about this, I recall my years working in Nepal

          20    with leprosy patients, in this remote area there were a

          21    lot of people with leprosy, and we had a medicine that

          22    you took twice a week, so you would take it Tuesday and

          23    Friday.

          24                   But this is a place that has no

          25    electricity, no running water, no communications,








                                                                      24


           1    nothing that you would -- it would be like life used to

           2    be on the North Slope or far off in Alaska.

           3                   And they had no reason to keep track of

           4    the days of the week because they were farmers, they

           5    did the same thing every day, there was no holiday, and

           6    so trying to get them to remember which days of the

           7    week they should take their medicines on was very

           8    difficult.  And so I had to sort of try to adapt to

           9    their life-style and understand their conditions.

          10                   I think you bring up another important

          11    point.  So far not many of you have said that health

          12    care is really critical for keeping healthy.  Remember

          13    I asked what are the strategies that you use to make

          14    yourself and your family healthy.  And I heard decrease

          15    stress, I heard meditation, I heard eating traditional

          16    foods.  Not a lot of people said go see your doctor.  I

          17    haven't heard that yet, except this gentleman talked

          18    about maybe not listening to your doctor.  Yes, ma'am.

          19                   SPEAKER:  Attitude, I think attitude has

          20    an awful lot to do with wellness.  We raised six

          21    children with no tobacco, no liquor, and I communicated

          22    and really tried to give them -- tell them what a great

          23    country we live in and the opportunities.

          24                   DR. STEPHEN BEZRUCHKA:  That it is an

          25    important point, attitude.  How do people acquire an








                                                                      25


           1    attitude?  Now, some people can say, well, he has an

           2    attitude problem.  Usually it's more likely he than

           3    she.  But how -- where do these ideas of attitude get

           4    under the skin, do you have any idea?  They are

           5    learned.

           6                   SPEAKER:  Usually it's from example, you

           7    learn it from who you're around, who you associate

           8    with, mostly your parents.

           9                   DR. STEPHEN BEZRUCHKA:  You learn it by

          10    example.  Do you learn it by people telling you?  No,

          11    that's right.  We tend to learn by what we observe and

          12    what we experience that seems to work.  At what point

          13    does attitude -- do you tend to learn some of these

          14    basic concepts?  How young do you appear to be when you

          15    learn these things?  4, 5 years, 3.  From the

          16    beginning, okay.

          17                   SPEAKER:  The first 5 years.

          18                   SPEAKER:  The beginning.

          19                   DR. STEPHEN BEZRUCHKA:  Somebody said

          20    the beginning.  How close to the beginning?

          21                   SPEAKER:  In the very beginning when

          22    it's just an embryo, and your attitude and your

          23    life-style is what forms that baby when it's born.  And

          24    whether it's a colic baby or a screaming baby, demand

          25    my way, these things are starting from the very








                                                                      26


           1    beginning.

           2                   DR. STEPHEN BEZRUCHKA:  How many agree

           3    with that, that these things are started from the very

           4    beginning?  Most of you do.

           5                   SPEAKER:  I disagree, I definitely

           6    disagree.  I grew up in a family of people who believe

           7    that if you lived and you were well to do, you ate

           8    meat.  And we lived in a fish community and fish were

           9    kind of the poor people's food.  Even though I caught a

          10    lot of fish, but we didn't necessarily eat fish but

          11    maybe on a Friday or a certain time.  And so my father

          12    was a smoker.  They are cultural -- we're surrounded by

          13    a culture that can change and as externalities.

          14                   You never asked people here whether any

          15    of them were uninsured, whether any of them were either

          16    both uninsured and had no access to a government

          17    program.  And I think you'd get a certain different

          18    response if people were clearly -- if you were dealing

          19    with the 45, 46 million people who are uninsured.  I

          20    think what you see in the emergency room, no doubt.

          21                   DR. STEPHEN BEZRUCHKA:  This gentleman

          22    raises some really important points.  And I think it is

          23    critical in any discussion that people who disagree or

          24    don't think the speaker is saying the right thing, to

          25    voice those ideas.  And so I encourage you at any








                                                                      27


           1    point, if somebody raises something or I say something

           2    that you disagree with, that you raise it at that point

           3    and we have a discussion, because how do you learn

           4    things?

           5                   If one person presents the same story

           6    and you don't hear another story then you don't get the

           7    opportunity to think critically.  Now this gentleman

           8    talked about being uninsured.  And I'm curious, how

           9    many in this room don't have health insurance?

          10                   SPEAKER:  I grew up without it.

          11                   DR. STEPHEN BEZRUCHKA:  How about 5 or

          12    so.  What proportion of people in this country don't

          13    have health insurance, or you mentioned the numbers,

          14    40, 50 million.

          15                   SPEAKER:  But it's in the 40s.

          16                   DR. STEPHEN BEZRUCHKA:  I've seen

          17    numbers as high as 75 million in this country without

          18    health insurance.  Which is the only rich country

          19    without everyone having access to health care?  The

          20    United States.  It's a disgrace for the richest, most

          21    powerful country in world history to make health care a

          22    choice, access a choice that requires money.  That is

          23    an amazing -- working in the ER I can't turn anybody

          24    away, they come through the door and I've got to see

          25    them.  I have to do a medical screening exam no matter








                                                                      28


           1    what complaint they come with.

           2                   And what I find is that there are a lot

           3    of people that avoid coming to the doctor because they

           4    can't afford it.  There are a lot of people that come

           5    and forget the bills.  And then there are people who

           6    feel they should try and pay the bills.

           7                   Just recently I saw somebody who was

           8    poor who had two hospitalizations in the last year and

           9    owed a hundred thousand dollars for those

          10    hospitalizations.  And she felt like she had to pay the

          11    bills, so she was trying to skimp on other things that

          12    were important.  And to be quite honest, I feel ashamed

          13    that I live in a country that is the only rich country

          14    in the world that doesn't provide health care access to

          15    everyone.  However how important is access to health

          16    care for our health?

          17                   SPEAKER:  Very important, preventative

          18    type care.

          19                   DR. STEPHEN BEZRUCHKA:  I used to

          20    believe this.  I've been working as a doctor for almost

          21    35 years, and I used to believe that health care was

          22    the most important factor making a population healthy.

          23    So let me try and go there.

          24                   How much of the world's health care

          25    bill, how much of all the money spent worldwide on








                                                                      29


           1    health care is spent in the United States?  We spend

           2    the largest amount.  We spend half of all the money

           3    spent worldwide on health care.  We spend half in this

           4    country.  Do we represent half the world's population?

           5    No, we're a little less than five percent of the

           6    world's population and yet we spend -- last year we

           7    spent 1.92 trillion dollars on health care.  1/6th of

           8    our total economy spent on health care.  What do we get

           9    for spending this money?  Do we get health?  Do we get

          10    health for spending half of the world's health care

          11    bill?

          12                   Well, how are we going to answer this

          13    question, do we get health for spending health care

          14    dollars?  This is an important question to ask, I

          15    think.

          16                   Well, what is health?  I've been asking

          17    you what you do to make yourselves or your family

          18    healthy, and I have been getting some interesting

          19    answers, most of which do not -- most of what you said

          20    did not imply seeing a doctor or a nurse or a

          21    physician's assistant, nurse practitioner, getting

          22    tests and surgeries, getting colonoscopies, you name

          23    it.  That's not what you said, that's not what I heard,

          24    unless somebody wants to come in now and say, yes,

          25    those are the critical ideas.  Yes, sir.








                                                                      30


           1                   SPEAKER:  I can say this.  Most men

           2    think that they are macho and they don't want to go see

           3    a doctor.  But if you listen to the women or your wives

           4    you will go and get health care.

           5                   I will say this.  I started my health

           6    care practice in 1952 in Seattle, Washington clinic.

           7    In 1985 I came down with a detected prostate cancer, I

           8    didn't know one thing about it.  That starts a person

           9    thinking about what you need to do and what you should

          10    tell and talk to each other.  From that day up until

          11    now, which I'm past 80, health care is important and

          12    you need to see your doctor.  Most men don't want to

          13    see doctors, and I think they need to talk to each

          14    other more about doing that.

          15                   DR. STEPHEN BEZRUCHKA:  All right.  What

          16    this gentleman says is, of course, consistent with the

          17    fact that women see doctors much more than men.  Are

          18    women healthier than men?

          19                   SPEAKER:  We live longer.

          20                   DR. STEPHEN BEZRUCHKA:  Absolutely, they

          21    live longer.  How much longer do women live in the

          22    United States compared to men?

          23                   SPEAKER:  Eight years.

          24                   SPEAKER:  Ten years.

          25                   DR. STEPHEN BEZRUCHKA:  That means, if








                                                                      31


           1    we're going to --

           2                   SPEAKER:  20.

           3                   DR. STEPHEN BEZRUCHKA:  Let me try and

           4    frame this discussion.  You know, I had a whole bunch

           5    of slides here, and I was going to show them, but I

           6    realized that we may do better by just trying to

           7    explain things than having you look at graphs and

           8    tables and things.  So let me continue with that and if

           9    need be -- I will show a few graphs at some point.

          10                   But what does health mean to -- what I

          11    want to do is ask you what is health for an individual

          12    and what is health for in a country?  And I find it

          13    very hard to define health for an individual.  The

          14    World Health Organization has a definition when I go to

          15    Nepal or other people quote.

          16                   The World Health Organization, it's a

          17    complete state of mental, physical and social

          18    well-being and not merely the absence of disease.  That

          19    is the World Health Organization definition of health.

          20    Not merely the absence of disease, but a state of

          21    complete mental, physical and social well-being.  The

          22    word social there is a critical one.  So that's what

          23    the World Health Organization defines as health.

          24                   How do you measure?  It's very hard to

          25    measure the health of an individual.








                                                                      32


           1                   SPEAKER:  I have two issues.  One, I

           2    have a couple issues.  One, is that I was born in an

           3    alcoholic family, and I was an only child and had no

           4    place to go, nothing to touch with reality.  I'm over

           5    70 now, and a lot of that is a change of attitude, but

           6    change of attitude doesn't have to start young.  Mine

           7    didn't really start to change until about I was in my

           8    60s in terms of a lot of things such as meditation.

           9                   But I'd like to also stress that at

          10    least with some of the newer doctors that are coming

          11    out, they are willing to recognize alternative forms of

          12    health care, and will recommend -- I had a serious

          13    sinus condition, and I was sent to a traditional

          14    Chinese medicine lady who then worked with the doctor

          15    and I was able to get rid of the problem that sent me

          16    under.

          17                   And the same thing holds true for

          18    muscular problems, I had a hip problem that was solved

          19    by alternative methods.  So I hear loudly your -- I

          20    wish we could have access to some of your ointments and

          21    stuff, because I suffer from arthritis and I am open to

          22    it.  And this is a big part of it, too much of our

          23    medicine is focusing on what you were just saying,

          24    ridding of disease and problems, and we've got people

          25    down in Homer that are on medication lists this long








                                                                      33


           1    and can't drive and yet they need to get around.

           2                   DR. STEPHEN BEZRUCHKA:  So you can

           3    change your attitude, and I think that's true.  I work

           4    on that myself an awful lot.

           5                   SPEAKER:  In talking about health care a

           6    lot of people talk about managed health care, and I

           7    feel as individuals we're managing the external factors

           8    that affect us every day.  You can try and stay

           9    healthy.  I'm a caregiver, and even though I think

          10    emotionally I manage stress, it has affected internal

          11    organs, my liver thinks it.  It's stress affecting.

          12    And many of us that have health care, we still have a

          13    deductible to pay every year, and then the 20 percent,

          14    I have a 20 percent deductible each time I see a

          15    physician.

          16                   As the population ages, even the people,

          17    even the seniors that have health care with decreased

          18    income, it makes it more and more difficult to pay

          19    those deductibles.  So you will find people avoiding

          20    their preventative care and even their routine care

          21    because of the cost.

          22                   DR. STEPHEN BEZRUCHKA:  Okay, so let's

          23    try and get to -- I said United States spends half the

          24    world's health care bill.  And then I asked -- there is

          25    a number of issues, we could go many different








                                                                      34


           1    directions.  I want to address this gentleman's issues

           2    of diet and smoking, and I want to look at early

           3    childhood.  But right now we've sort of taken a

           4    definition of an individual's health.  How would you

           5    define or what would you conceptualize the health of a

           6    country to be or a state?

           7                   SPEAKER:  Good morning.  I see you're

           8    pretty healthy.  We don't go to the bar all night and

           9    wake up at 2, 3 in the morning and come over here at

          10    8:00, we wouldn't be very healthy, I know that.  But

          11    today in our hometown in the North Slope we're going to

          12    make our area healthy.  How?  How do we need to make it

          13    healthy?  I think we're going to make it dry and let

          14    our young people, or even older people, to try and not

          15    use that drugs of any kind.  Because if we do drop the

          16    alcohol and drugs, I would see a healthy area.  Isn't

          17    that something?  Is that something that we need?  I

          18    think we all understand the alcohol and drug is our

          19    problem.  So we need as elders to try and support our

          20    young people, give the leaders the ability to direct

          21    what we should do for our health.

          22                   DR. STEPHEN BEZRUCHKA:  I want to try

          23    and bring what this gentleman said, and several other

          24    points, to a key idea.  So let me start leading

          25    ourselves there.








                                                                      35


           1                   I asked how would you define the health

           2    of a population or measure it?  And one thing you could

           3    do is to look at the amount of alcohol or drug

           4    consumption, or huffing or whatever you want to call

           5    it.  There is very important studies in the last 30

           6    years that have helped us to understand this.  How are

           7    we going -- but to be able to think about causes, we

           8    need to have some sort of hard nose definitions.

           9                   So I'm going to propose that we take as

          10    a definition of the health of a country its average

          11    length of life, how long do people live in that

          12    country, and suggest that that is a good measure of its

          13    health.  All you need to know to measure this is

          14    whether somebody is alive or dead.  All you need to

          15    know is find out at what age people die, and then you

          16    can measure the average length of life.  Now that is

          17    called the life expectancy.  The life expectancy is the

          18    average length of life of a population.

          19                   So we need to -- so we compute this

          20    number in the United States every year, and the last

          21    reported measure was in 2003, reported in 2005, and it

          22    was 76.4 years.  That is the average length of life in

          23    the United States two years ago, three years ago, was

          24    76.4 years.

          25                   So I ask how good is that?  Well, it's








                                                                      36


           1    higher than it was the year before, and it was higher

           2    than it was the year before that.  So our health as a

           3    country appears to be improving.  Is it health care

           4    that is responsible for that?  No, a lot of people said

           5    no.  Quality.  Yes, sir.

           6                   SPEAKER:  One of the things that I would

           7    like to say is that even though the United States is

           8    not providing health care, take a look at what they are

           9    doing when New Orleans had the problems.  Take a look

          10    at what they are doing with all the technology that

          11    they are doing with the medical.

          12                   In the Reader's Digest there was an

          13    article on cancer and it's so advanced now as far as

          14    the technology and what they are doing today, it's like

          15    a miracle.  And cancer is going to be on a decline

          16    shortly, and that's what the United States is doing.

          17                   And another -- there are so many topics.

          18    When I was probably 5 years old I decided I would never

          19    drink and smoke, and I never have, only because of the

          20    respect for my parents.  So that's another factor that

          21    should be brought into this thing.

          22                   And another thing at the aging

          23    commission, the president of the National Heart

          24    Association was talking about everybody should eat

          25    fruits and vegetables every day, but when we grew up we








                                                                      37


           1    never that, so there is another way.

           2                   And the people in Alaska that had it

           3    that way, it was interesting that we started looking

           4    into that and it made it a much better place, so thank

           5    you.

           6                   DR. STEPHEN BEZRUCHKA:  Let's get to the

           7    idea of a health of a nation as its average length of

           8    life.

           9                   Now this year there were the winter

          10    Olympic games, and countries compete in the winter and

          11    in the summer Olympic games, and there is one country

          12    that has won the most gold medals since 1923, and

          13    usually every year in every Olympics wins the most gold

          14    medals.  Do you know which country that is?  United

          15    States.  This year we had the second largest in the

          16    winter games, sometimes we get the second largest gold

          17    metals.  But we usually rack up the most gold medals,

          18    and in many other things we seem to do very well.

          19    We've got the most Nobel prize winners, we've got the

          20    most billionaires, we're the richest country and so on.

          21                   So if we take this measure, I've said,

          22    this average length of life lived by the United States,

          23    how does it compare with other countries?  If we were

          24    to take a health Olympics, that is if we were to rank

          25    countries by life expectancy from the highest to the








                                                                      38


           1    lowest, where would the United States stand?  How many

           2    think it has the gold medal, the healthiest country in

           3    the world?  How many think it's in the top 5?

           4                   How many think it's 6 to 10?  Ten of

           5    you.

           6                   11 to 15?  Four.

           7                   16 to 20?  Six.

           8                   21 to 25?  Five.

           9                   26 to 30?  Quite a few, all right.

          10                   Below 30?  2 of you.  Let me show you a

          11    slide, it will take me a minute to get there, this

          12    thing has got to wake up.  This is a graph of the top

          13    30 countries in life expectancy.  These are the top 30

          14    countries from the United Nations human development

          15    report published last September with life expectancy

          16    for 2003.  United States is 29th.  That is there are 28

          17    countries, or 27 if you don't count Hong Kong, which is

          18    a part of China, and the U.N. has always reported Hong

          19    Kong in these data.  There is over 25 countries that

          20    are healthier than we are.  Yet we spend half of the

          21    world's health care bill.

          22                   So we can immediately conclude that if

          23    health care is what produces health in a population, it

          24    it's not consistent with average length of life.

          25                   Now this is really important to me for








                                                                      39


           1    the following reason.  When I went to medical school in

           2    1970, United States was here.  When I went to public

           3    health school in 1992, United States was here.  When I

           4    went last year United States was here, it was 27.  So

           5    our health compared to other countries keeps

           6    decreasing.

           7                   In the early 1950s we were in the top 5.

           8    At that time Japan was way over here somewhere.  That

           9    is Japan was even less healthy compared to other

          10    countries 55 years ago than we are today.  And that

          11    almost every year our health compared to other

          12    countries keeps declining.

          13                   So let me ask two questions.  The first

          14    one is, if any of you have been to these countries in

          15    which people live longer than the United States,

          16    speculate on why.  This includes all the other rich

          17    countries and a few poor ones as well.  Why?

          18                   SPEAKER:  Where they are 90 and 100

          19    years old they can still farm, and there is not much

          20    doctors in there.  You could see, they are very

          21    conscious of their health.  So at age 100 they can

          22    still plow the land.  So maybe it's kind of a

          23    life-style that really affects their health.

          24                   DR. STEPHEN BEZRUCHKA:  So let me just,

          25    for all of you to hear.  She says in the Philippines








                                                                      40


           1    that are people 80, 90, a hundred years of age, and

           2    they don't have many doctors, and the older people are

           3    pretty active, and she feels their life-style affects

           4    their health.

           5                   Let me just go there with this point

           6    because you've asked -- you said there is a lot of old

           7    people in the Philippines, and I don't have good data

           8    for the Philippines, but which countries has the most

           9    number of people per hundred thousand that are age a

          10    hundred or older?  I call this the oldest old, where

          11    are the oldest old?

          12                   SPEAKER:  Japan.

          13                   DR. STEPHEN BEZRUCHKA:  Correct.  Japan

          14    has 33 per hundred thousand people living over the age

          15    of a hundred.  How many does the United States have per

          16    hundred thousand that are age a hundred or over?  18.

          17    18 per hundred thousand, Japan has 33.  Why?  Well,

          18    first of all, where are the oldest old in the United

          19    States?  Can you put them geographically somewhere.

          20                   SPEAKER:  Probably a nursing home.

          21                   DR. STEPHEN BEZRUCHKA:  Utah, outside

          22    the city?  Which states?

          23                   SPEAKER:  Florida.

          24                   DR. STEPHEN BEZRUCHKA:  No.  They are in

          25    the midwest, and that's where the 4/5ths women and the








                                                                      41


           1    men, if they are there are married.  So the oldest old

           2    are not in this country.

           3                   What are the -- where is the highest

           4    concentration of the oldest old in Japan?  Okinawa,

           5    that's correct.  How do you know this?

           6                   SPEAKER:  I've been there.

           7                   DR. STEPHEN BEZRUCHKA:  Okinawa has the

           8    oldest old.  It's a thousand miles -- I'll show you

           9    some maps, off Okinawa.  Tell me a little bit about

          10    Okinawa.  Anybody else been there?  Let's hear what

          11    it's like in Okinawa.

          12                   SPEAKER:  I feel like I'm on the spot

          13    all the sudden.  Okinawa is an island off Japan.  It's

          14    very inclusive.  The impression I got from talking to

          15    the older locals is they didn't consider themselves to

          16    be Japanese, they kind of like to consider themselves

          17    as being their own country.  Being that I saw him speak

          18    yesterday I have to add that there was not a huge

          19    difference economically when you looked at the island

          20    and its environment.  There was not Hillside versus

          21    Mountain View, it was pretty similar all across the

          22    island.  And I also saw that their older population was

          23    like, in the Philippines, they were very active.

          24                   DR. STEPHEN BEZRUCHKA:  And one other

          25    gentleman, had you been to Okinawa?








                                                                      42


           1                   SPEAKER:  Well, I understand their diet

           2    is much different than ours and has less fat,

           3    apparently a lean diet.

           4                   DR. STEPHEN BEZRUCHKA:  I haven't been

           5    to Okinawa, but what I've heard about the diet there is

           6    they eat a lot of pork fat and they eat a lot of

           7    noodles.

           8                   The older people are very active.  They

           9    tend to have strong family networks, strong sense of

          10    community, and when they are a hundred they are still

          11    working.  They have a purpose in living and they are

          12    respected.

          13                   I used to -- like I spent a lot of time

          14    in Nepal, and lately when I'm walking on remote trails

          15    and people call me grandfather.  And here somebody said

          16    grandpa, and that would be a put down, but in Nepal

          17    it's a form of respect.  And in places where the oldest

          18    old exist in great numbers they are really respected,

          19    you respect your elders, and in this country we kind of

          20    have all these disrespectful terms of address and jokes

          21    about older people.

          22                   And I think that that's part of the

          23    reason you can't age very well in this country compared

          24    to other countries.

          25                   So we don't have that many oldest old.








                                                                      43


           1    And they tend to be concentrated in the midwest.  The

           2    other interesting thing about Okinawa and Japan and the

           3    United States that's been studied is something that I'm

           4    sure all of you are concerned with or deal with, and

           5    that is Alzheimer's disease.  The old people in Okinawa

           6    have much less Alzheimer's disease than the rest of the

           7    Japan and much less than the United States.  That is

           8    there is less dementia among older people in countries

           9    like Japan, and especially in Okinawa.

          10                   And you're right about the -- they see

          11    themselves as different, and they are, they are --

          12    there is something about an isolated group of people,

          13    maybe part of Japan, in which they feel special.  And I

          14    wonder if the Alaska Natives have some of those same

          15    characteristics.

          16                   So what is it about a society that

          17    allows, for example, countries such as Japan, or even

          18    our neighbor -- how many have been to Canada?  Most of

          19    you.  Canada is much healthier than the United States,

          20    why?

          21                   SPEAKER:  The elder care is much

          22    different.  I visited someone who was taking care of a

          23    dementia person, and there was a small home, a one

          24    bedroom home built right next door on their property,

          25    our friend was taking care of a dementia patient.








                                                                      44


           1                   On their property the government built a

           2    small one bedroom home called a grandparents' home, and

           3    it was for the husband, he would come over and visit

           4    his wife and feed her lunch every day.  I think that

           5    family involvement, and I see this with my husband,

           6    family involvement keeps people alive and alert,

           7    mentally alert much longer.

           8                   SPEAKER:  Well, Canada has a single

           9    payer health care system so people are not reluctant to

          10    go to doctors.  And the health care system there is

          11    more focused on preventative medicine than cure

          12    necessarily, only cure when they need to.

          13                   DR. STEPHEN BEZRUCHKA:  They have a

          14    single payer health care system and it is somewhat

          15    focused on prevention.  When I bring up Canada people

          16    say that people can't get their surgery right away and

          17    things like that.

          18                   SPEAKER:  I know from living in Seattle,

          19    I had heard that the medical center worked with

          20    traditional healers, Natives from Canada to take care

          21    of a patient, and I don't think there is that much

          22    poverty in Canada.

          23                   DR. STEPHEN BEZRUCHKA:  Very important

          24    point.  Not that much poverty in Canada.  Which country

          25    has the most child poverty?  That is, what percentage








                                                                      45


           1    of a children live in poverty, and among which rich

           2    countries has the most?  United States.

           3                   We have a lot of poverty in this

           4    country, and we could get into a definition of poverty,

           5    but that would get into a bunch of numbers.  But when

           6    you do that, and UNICEF for example ranks countries by

           7    poverty, and we have the most.  A quarter of the

           8    children, according to UNICEF definition, live in

           9    poverty, compared to one or two percent in some of the

          10    healthiest countries.  And that is probably the most

          11    important factor affecting the health of a population

          12    is the relative poverty, that is how much do you share

          13    the pie, the resource pie that a country has that

          14    determines its health.  Let me say that again.

          15                   The most important determinate of the

          16    health of a country is how the pie, the resource pie is

          17    shared with the people.  Countries that share the pie,

          18    so to speak, are healthier than countries where a few

          19    people get the big slice.

          20                   Now let me try and give you a measure of

          21    how a country shares its pie that might make sense to

          22    you.  And that measure is how much you pay the CEOs,

          23    the heads of big corporations in a proportion of the

          24    average workers' pay.  How much do the CEOs, the Warren

          25    Buffet, Bill Gates or the head of Exxon, how much do








                                                                      46


           1    they get as a proportion of the average workers' pay?

           2                   Well, in this country I'm going to use

           3    the figures that were in the New York Times January

           4    25th, 2004 first page of the business section, just so

           5    that I have a data source that we can tie these

           6    together.

           7                   There they said that we pay our CEOs 531

           8    times what an average worker makes in the United

           9    States.  That is the CEOs make in half a day what most

          10    people are lucky enough to make in a year.  Or a CEO

          11    makes in two weeks what most of us make in a lifetime.

          12    531 times what an average worker makes.

          13                   What was it in 1980?  In 1980 it was

          14    only 40 times.  That is we only paid our CEOs 40 times

          15    what an average worker made in 1980.  Now we don't have

          16    good data for the 1950s, but I would bet you it was

          17    closer to 10 to 20 to 1.  It certainly was lower than

          18    40 to 1.  And you know how much less people make now

          19    compared to the bosses than they used to.

          20                   Well, what about Japan?  What does a

          21    CEO -- what does the head of Sony or one of these big

          22    corporations make in Japan as a proportion of the

          23    average worker's wage.  According to the New York Times

          24    that day it was 10 to 1.  That is a boss in Japan only

          25    makes 10 times more than an average worker.








                                                                      47


           1    Furthermore, the boss has about the same size office,

           2    he wears the same clothes, he eats in the same

           3    cafeteria, and the workers tend to be friends with

           4    their bosses.  That is you might invite the boss to

           5    your child's birthday party.  Furthermore the boss

           6    would probably come.  They see the business as a

           7    family, as a part of a big family.

           8                   What is it in Canada?  According to New

           9    York Times again, the boss in Canada gets 20 times what

          10    an average worker makes.  But in this country the boss

          11    makes 531 times what an average worker makes.

          12                   In Seattle where I live there are a lot

          13    of very wealthy people, and the Seattle Post reported

          14    in May that the highest salary last year in Seattle was

          15    $464 million.  So that's what we're talking about.  We

          16    are talking about a few people making enormous amounts

          17    of money in this country, and the largest amount of

          18    child poverty of any rich country.  That is how we

          19    share the resource pie.  Is that good for our health?

          20    No.  The studies show that the gap between the rich and

          21    the poor is the most important factor affecting the

          22    health of a population because that determines the

          23    amount of care and sharing, the amount of support.  It

          24    determines the nature of relationships, and those who

          25    are not at the top are under much more stress in








                                                                      48


           1    society by being lower down.  And the studies show that

           2    that stress is what is killing us.

           3                   Now when does that stress begin to

           4    matter most?  When does the stress of the gap between

           5    the rich and the poor appear to matter most?

           6                   SPEAKER:  During your pregnancy.

           7                   DR. STEPHEN BEZRUCHKA:  That's

           8    absolutely correct.  The most important time for

           9    successful aging is somewhere between the time of

          10    conception and age 5.  Our studies are showing that the

          11    early part of life is where most of our health as

          12    adults is determined.

          13                   Now, yes, you can have a tragedy such as

          14    Princess Diana who died in this horrible crash, but for

          15    averages, populations is the early part of life.  So we

          16    can ask the question, what do we do in this country to

          17    support good early life?

          18                   SPEAKER:  There is women and infant

          19    children program for women who are pregnant and while

          20    the child is young, but we should look, too, at Alaska

          21    versus the other states, because Alaska is number 1 in

          22    income equality because of the Permanent Fund Dividend

          23    and we don't have too many really wealthy people.

          24                   DR. STEPHEN BEZRUCHKA:  Alaska has no

          25    billionaires, at least in the Forbes March 28th








                                                                      49


           1    Magazine that listed the 791 billionaires, none were

           2    from Alaska.  United States has half the billionaires.

           3                   But it appears early childhood is the

           4    most important time for determining our health as

           5    adults.  What is the earliest sort of thing after we're

           6    born that's really important?  Since there is a lot of

           7    women in this room, some of you might relate to this.

           8    As soon as an infant -- I've asked the question, there

           9    is an answer.

          10                   SPEAKER:  My guess is a mom of a 3 year

          11    old I can say breast feeding.

          12                   DR. STEPHEN BEZRUCHKA:  Bonding --

          13    breast feeding.  We have lots of studies showing that

          14    breast feeding is better for your health.

          15                   SPEAKER:  I think the best is prenatal

          16    care is very important to be given to all our mothers

          17    because that will determine the health of the children.

          18    If you give prenatal care and early child development,

          19    you know, activities and health care, then we will have

          20    very strong and healthy population.

          21                   DR. STEPHEN BEZRUCHKA:  Early prenatal

          22    care and successful child development.

          23                   SPEAKER:  I would say your

          24    immunizations, you don't have children dying of cancer,

          25    polio in the early ages.  They don't have rheumatic








                                                                      50


           1    fever and all the things we had, they have gotten

           2    chicken pox.  It's gotten so a child is much healthier

           3    as they are growing up because they didn't have these

           4    catastrophic diseases.

           5                   DR. STEPHEN BEZRUCHKA:  That's an

           6    important point.  Immunizations are not that important,

           7    and why would I say that?  And I have to finish in

           8    about 20 minutes and I haven't gotten to some of the

           9    main points yet.

          10                   But let me sort of say a couple things

          11    early childhood, breast feeding, child development.

          12    What happens when a baby is born?  As soon as it opens

          13    its eyes, what does it look for?  The mom.  Does it

          14    recognize the mom?  It recognizes a pair of eyes.  If

          15    it sees those eyes again and then again and it

          16    recognizes the same eyes.  The baby is hard wired to be

          17    able to figure out if that that's the same pair of eyes

          18    or not, and once it seems to think like the same pair

          19    of eyes is in front of me most of the time, then as it

          20    gets older and crawls back, ah, the same eyes are

          21    there, I feel safe.  And then it will venture forth a

          22    little further and come back, the same eyes are there.

          23                   A British psychiatrist studied early

          24    attachment, and he termed attachment as being secure,

          25    and in infants that are securely attached they can








                                                                      51


           1    venture forth and explore their environment and come

           2    back to that safe base, and that seems to predict good

           3    mental health and physical health and fewer behavioral

           4    problems, compared to a child which the eyes are

           5    different every time, and then it doesn't know.  Where

           6    are the eyes that I'm familiar with?  It's ambivalently

           7    attached.  Or if those eyes are hostile, if they don't

           8    envelope the baby after its born, then the attachment

           9    is insecure, and those factors are related to poorer

          10    health.

          11                   We are the -- I don't know if you

          12    believe in -- many of you have a Biblical perspective,

          13    but if you believe our closest cousins are apes, we are

          14    the only primate species with whites in our eyes.  Go

          15    to the zoo and look at the other monkeys and see if

          16    they have whites in their eyes, do they?  No.  Why do

          17    we have whites in our eyes?  For secure attachment

          18    basically.

          19                   First of all, whites in our eyes and

          20    looking at one another and the way we perceive people's

          21    faces in our face is very important for good social

          22    relations.  If I was standing up here wearing

          23    sunglasses do you think you would think that what I'm

          24    saying -- I don't know what you'd think, you'd think

          25    I'm off the mark anyway -- but if I was wearing








                                                                      52


           1    sunglasses you wouldn't find much of what I say

           2    credible.

           3                   But gaze is a very important social clue

           4    in human beings, and whites in our eyes tell me, are

           5    you looking at me, do you think I'm kind of silly, do I

           6    have your attention.  And I can tell just by the fact

           7    that you have whites in your eyes, even over there in

           8    the corner, oh, you just looked away.

           9                   But it's most important in the first

          10    couple of months of life when you come out and you see

          11    your mother, could be a father, but it's got to be the

          12    father there again and again and again, in order for it

          13    to be a secure attachment.

          14                   SPEAKER:  Not all cultures feel that eye

          15    contact is the only way to communicate.

          16                   DR. STEPHEN BEZRUCHKA:  That's correct.

          17    A lot of Native cultures, I know from the Washington

          18    state Natives that they avoid gaze, but I think in

          19    early life, gaze on a mother is very important.

          20                   Now if that's important, if contact with

          21    a single pair of eyes is important, and breast feeding

          22    is important, and how could a society decide as a

          23    nation to foster that kind of secure attachment and

          24    breast feeding, how could it decide to do that?

          25                   SPEAKER:  We need parental education.








                                                                      53


           1                   DR. STEPHEN BEZRUCHKA:  Okay, we need to

           2    teach them.  But I as an ER doc was constantly telling

           3    my patients, quite smoking, quit drinking, don't shoot

           4    up, and they didn't listen.  And that's the problem, a

           5    lot of people don't listen to what you tell them.  Yes,

           6    you've got to stay home and be there with your baby.

           7    But I've got to go to work and make money to be able to

           8    feed my family, I've got to make money.  You've got to

           9    breast feed.  No, but I've got this infant formula at

          10    the hospital and it's so much more convenient and I

          11    won't get stretch marks.  So those are the issues.

          12                   So how might you have rules in society

          13    that would make it easier for people to breast feed and

          14    to be securely attached with their infants?

          15                   SPEAKER:  Cultural values.

          16                   DR. STEPHEN BEZRUCHKA:  Okay, how many

          17    of you buckle your seat belt when you get into the car?

          18    We have a rule that says click it or ticket is what we

          19    say in Washington state.  So what rule might we have in

          20    society that would make it easier for this to happen?

          21                   Maternal care.  You get paid when you

          22    have your baby just like you're working.  Does the

          23    United States have a paid maternal leave policy?  No.

          24    The United States -- it depends on the state or area.

          25    Some states do and some states, if you have a certain








                                                                      54


           1    number of employees in your corporation, like I work at

           2    the University of Washington and our health care

           3    coordinator, when she had her baby she had no paid

           4    maternal leave and if she didn't come back in four

           5    months she lost her job.  So that's for a state

           6    employee in Washington state, that's the law.

           7                   Let's take a healthier country than the

           8    United States.  Let's take Sweden, the 6th healthiest

           9    country in the world.  What is the law in Sweden for

          10    maternity leave?  Two years, you're right.  In Sweden

          11    you have to take a year's maternity leave or combined

          12    maternity paternity leave.  You can't get out of it.

          13    It's the law.  You can't get out of it.

          14                   What about your job and your pay?  It's

          15    full pay, you get full pay in Sweden for the first

          16    year, and if you as the mother take the whole year,

          17    it's combined maternity/paternity, if you as the mother

          18    take the whole year, what happens to the dad?  He's got

          19    to take 12 weeks, he's got to, you can't get out of it.

          20    You cannot go back to work in Sweden if you have a

          21    baby, and you get full pay.

          22                   After the first year the second year is

          23    optional at 80 percent pay.  80 percent pay for the

          24    second year.  Then for the third year if you want to go

          25    back to work you can, and you can put your baby, your








                                                                      55


           1    child by then, your toddler, in a day-care center.  Who

           2    runs the day-care centers in Sweden?  The state.  The

           3    country does.  What are the -- and how much do they

           4    cost?  Free, right.

           5                   What are the requirements to work in a

           6    Swedish day-care center?  You have to have a Master's

           7    degree in play.  You have to have a Master's degree in

           8    play to work in a Swedish day-care center.  Why, what

           9    is day-care all about?  It's about playing.  You need

          10    to have specialists there to help you socialize with

          11    other children so you learn good social skills.  That's

          12    how Sweden structures its early childhood experience.

          13                   And so a much higher proportion of women

          14    in Sweden breast feed, they have fewer behavioral

          15    problems when they enter school.  We don't have

          16    comparable data on elicit drug consumption that I could

          17    really quote, but there are much lower levels of elicit

          18    drug consumption.

          19                   Now let's try and get to -- by the way,

          20    some of you might ask the question, so we've looked at

          21    the health Olympics at age 0, that is the average

          22    length of life.  How well do we do when we're seniors,

          23    that is are we the healthiest seniors in the world?

          24    Well, I've implied not.  This is life expectancy for

          25    women at age 65, and this is the wealthiest countries,








                                                                      56


           1    and we're still down at number 20.  And that's '99 and

           2    we've fallen somewhat since then.

           3                   SPEAKER:  Now I'm really confused,

           4    because those of us who are in our 60s were raised at a

           5    time when the mothers stayed home because they couldn't

           6    get equal opportunity in the workplace.  And so

           7    seemingly I was raised straight along by my mother who

           8    could only work part time and really couldn't make a

           9    career.  And so why wouldn't this play out in this

          10    graph?

          11                   DR. STEPHEN BEZRUCHKA:  That's a good

          12    question, and, you know, I don't think I can give you a

          13    very easy answer other than there are many factors, and

          14    I said early childhood represents about half of how

          15    well we do as adults, and the other half actually from

          16    the 1958 British cohort study, which is our best source

          17    of data, are cumulative and pathway factors.  That is,

          18    obviously it's not just securing your attachment on

          19    your mother that is everything, it's one very important

          20    factor.  And I'm just presenting it to give you an

          21    example of how countries can do that.  So there isn't

          22    a -- there are many other factors obviously as well.

          23                   Now what I've been saying is that our

          24    health compared to other countries is not that good.

          25    Does anybody else agree?  Well, our federal government








                                                                      57


           1    makes exactly the same statement when the future of the

           2    public's health of the 21st century, written by the

           3    Institute of Medicine, and they write on page 20, for

           4    years life expectancy of both men and women have lagged

           5    behind those of their counterparts in most industrial

           6    countries.  That is crafted to mean that it didn't

           7    always used to be the case, that is we used to be one

           8    of the healthiest countries in the world and somehow we

           9    slipped behind.

          10                   Then on page 59 they give you the

          11    reason.  A smaller gap between the rich and poor is

          12    associated with better health.  And they write, more

          13    egalitarian societies, those with a less steep

          14    differential between the richest and the poorest, have

          15    the better average health.

          16                   Exactly what I've been saying.

          17    Societies with a smaller gap between the rich and the

          18    poor are going to be healthier than societies with a

          19    big gap between the rich and the poor because they are

          20    going to have more policies to share the wealth and

          21    provide early childhood and provide effective schooling

          22    and health care services for everybody, subsidize

          23    transportation and so on.  So that is sort of what the

          24    feds say, and there isn't anything that I haven't told

          25    you that you won't find in a major federal source.








                                                                      58


           1                   And I just wanted to point out that we

           2    start our life in a womb with a view.  That is the

           3    fetus is very aware of the world around it and it knows

           4    what's happening.  It sees the stress that the mother

           5    is exposed to the stress in society, and it begins to

           6    create its own stress hormones and that's been well

           7    studied, and we've not all born equal.

           8                   Somehow we have this idea in the country

           9    that we all start at age 0 equal, and some are just

          10    more equal than others, and so those who have had a

          11    more privileged existence, in fact, do a lot better.

          12                   Early childhood stuff, I have a variety

          13    of Institute of Medicine reports on that.  But I want

          14    to just close by looking at how Alaska does compared to

          15    other states.  There is a group called the United

          16    Health Foundation that has created a difficult to

          17    understand composite health indicator, but a lot of

          18    people are using it, and Alaska ranks around 30 in the

          19    health of its citizens in that state.

          20                   The important thing, as somebody

          21    mentioned Alaska has a small gap between the rich and

          22    the poor, and I'll get to that, but the important thing

          23    is that Alaska's health compared to other states has

          24    been rising, and that's pretty remarkable.  That is the

          25    health of people in Alaska has been improving compared








                                                                      59


           1    to other states.  The states with the worst health are,

           2    not unsurprisingly, Louisiana and Mississippi.  And

           3    Minnesota is the healthiest state in the country and

           4    they have maintained that for many years because they

           5    have a much smaller gap between the rich and the poor.

           6                   Washington state where I come from is

           7    sort of fumbling along.  And the important thing that

           8    you may be aware of in Alaska is Alaska has the

           9    smallest gap between the rich and the poor, and this is

          10    going to do you well in the future.  That is the health

          11    of Alaskans I think is going to continue to improve

          12    compared to other states, as it has been over the last

          13    15 years.

          14                   You're going to see a continual

          15    improvement, and that is because it is the poorest 5th

          16    in Alaska that has seen the greatest percentage change

          17    in income over the last 20 years because of the Alaska

          18    Permanent Fund, because of a lot of federal spending.

          19    People here are benefitting, and your health is going

          20    to improve compared to other states and I think I can

          21    predict that.

          22                   It was the richest 5th that saw the

          23    smallest percentage increase in income since the early

          24    '80s.  This is the only state in the union with that

          25    picture since the 1980s.  In all the other states it's








                                                                      60


           1    been the opposite.

           2                   Now this is for the country as a whole,

           3    we're looking at the change in family income.  Who got

           4    the biggest gains?  And in the 1960s it was the poorest

           5    5th that saw the biggest gains in income, and in the

           6    1990s it was the poorest 5th saw the smallest gains in

           7    income in this country.  And that's been a major factor

           8    in our relative health decline compared to other

           9    countries.

          10                   So Alaska in the 1980s and '90 looks

          11    like the U.S. in the 1960s whereas the rest of the us

          12    follows this pattern in which we give more to the rich.

          13    These are choices we make.  We decide how much the rich

          14    should have, and that is important to understand, that

          15    if we continue to subsidize the rich, it's not good for

          16    our health.

          17                   So let me, rather than go through all

          18    these slides, which would have made your eyes gloss

          19    over, what I've done is tried to engage in a discussion

          20    with where you're at about issues such as diet and

          21    meditation and exercise.

          22                   And I think the critical thing is just

          23    as we compare ourselves with other athletes in the

          24    Olympic events, we need to compare ourselves with other

          25    countries.  And we should have a health Olympics, and








                                                                      61


           1    if we did we would find we're not doing that well among

           2    other countries.  If we were 29th largest number of

           3    medals in the winter games or in the summer games there

           4    would be a presidential commission to investigate why

           5    are we doing so poorly in the athletic events.

           6                   We have goals for our health presented

           7    by the Center For Disease Control & Prevention, the

           8    healthy people of 2000 and healthy people 2010, and

           9    Alaska has its own state goals, but we don't compare

          10    ourselves to other countries.  And I think that's what

          11    we should be doing because we can learn much more about

          12    what produces health in society by comparing ourselves

          13    with our countries and understanding what they do.

          14                   All we seem to do in this country is

          15    spend more on health care, and a quarter of our

          16    economic growth from 2000 to 2005 was taken up by the

          17    increase in health care costs, and yet compared to

          18    other countries our health declined.

          19                   So I think people in Alaska are uniquely

          20    situated to see improving health in the coming years.

          21    The Alaska Permanent Fund is an incredible mechanism

          22    that does that.  I think a lot of the federal spending

          23    in this country -- in this state, if it's done wisely,

          24    can really improve the health of Alaskans, and I think

          25    it would be a very good place to grow older.








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           1                   And I have only been up here a few days,

           2    but I visited friends that moved here in the 1970s and

           3    I have enjoyed some activities with them.

           4                   Well, what are you going to do with this

           5    information?  Well, I hope that this afternoon I can

           6    spend an hour with you telling you about what I've been

           7    doing or what you might consider doing with the idea

           8    that a smaller gap between the rich and the poor, a

           9    society that cares and shares more, a society that sets

          10    up rules to promote early childhood can be a healthier

          11    society, and that furthermore it doesn't require

          12    spending an additional penny for health care services,

          13    all it does is all of us deciding how we should

          14    redistribute the pie that's very big in this country.

          15                   It's a big pie, it's certainly enough

          16    for all of us, but we have to decide who gets the

          17    biggest shares.  And in Alaska you've been increasing

          18    the size of the shares going to the poorest 5th, and I

          19    think you need to continue that.  I will give you a

          20    copy of all those slides and put them on the website

          21    and our audio recording as well if you like.

          22                   MS. GOHL:  We're going to take a 15

          23    minute break, and I ask that you come back on time and

          24    we're expecting the Governor to be here at 11:00, and

          25    thank you very much.








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           1                           (Break)

         

           9                   MS. GOHL:  Our e-mail address

          10    individually is on the brochure for the Commission on

          11    Aging.  So you can e-mail MaryAnn, she's going to be

          12    the contact for this.  If I read it you'll take forever

          13    to write it down.  So with that, did everybody enjoy

          14    lunch?  Very good.  Thank you to the Senior Center,

          15    their volunteers, they really made this run very

          16    smoothly, and I hope you enjoy the guest speaker.  And

          17    where is Dr. Bezruchka?  Sitting over here waiting

          18    patiently.

          19                             -oOo-

          20                 STRATEGIES FOR SUCCESSFUL AGING

          21                              -oOo-

          22                   DR. STEPHEN BEZRUCHKA:  It's a pleasure

          23    to be back and I want to see what we can do this

          24    afternoon.  And I'm curious, were there people who

          25    weren't here this morning?  One or two.  So absent you








                                                                     106


           1    two, can some of you in the audience give us summary or

           2    a few words about what you learned this morning about

           3    what makes a population healthy and what makes an

           4    individual healthy and how we might structure healthy

           5    aging?

           6                   Let me get another microphone here.  I

           7    want some people in the audience to inform the others.

           8    What did you learn this morning or what did you

           9    disagree with this morning?

          10                   SPEAKER:  The gap between the rich and

          11    the poor is the most important factor affecting the

          12    health of a country.

          13                   SPEAKER:  I was surprised that you said

          14    that eye contact was the most important thing and not

          15    voice.

          16                   DR. STEPHEN BEZRUCHKA:  Okay.  Let me --

          17    this is important.  Eye contact is very important very

          18    early on in life because we're not vocal.  And one of

          19    the interesting things that we can now with MR imaging

          20    techniques and PET scans find areas of the brain that

          21    are very active at different parts of life.  And in the

          22    first few months it's the visual cortex that processes

          23    sight, and it's the right brain that is really -- our

          24    brains form and reform neural connections all the time,

          25    but they are very plastic in the first few years of








                                                                     107


           1    life.  So the first part to light up is the visual

           2    cortex, that's the part that is processing information

           3    and receiving visual stimuli and is extremely active.

           4                   And that sort of peaks around six months

           5    of life.  And following it is the auditory cortex, that

           6    is the part that receives sound.

           7                   And so I told you about the importance

           8    of secure attachment based on visual clues.  And then

           9    what seems to be the next important phase is

          10    vocabulary, is language.  We're not taught language,

          11    those of you who speak a variety of indigenous

          12    languages, you don't teach your kid languages, they

          13    pick it up.  We're hard wired to learn language.

          14                   So after the first few months as the

          15    auditor cortex is processing information, and if you

          16    provide an environment in which the infant receives a

          17    wide variety of terms of words used in a variety of

          18    different ways, it then does better when it gets into

          19    school.

          20                   On the other hand, if an infant receives

          21    only cease and desist orders, shut up, don't do that,

          22    you're bad, if that's the primary content of the

          23    language, we have studies showing that these people

          24    won't do well when they get to school, they have

          25    behavioral problems.








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           1                   So in the first few months it's the

           2    visual cortex, then it's the hearing and auditory

           3    cortex, visual is still important, and then in the age

           4    2 to 3, it's the frontal lobes become very active and

           5    form and reform neural connections.

           6                   And what are the frontal lobes.  I'm old

           7    enough to see people that had frontal lobotomies, and

           8    they had that portion of their brain removed for

           9    treating psychiatric problems, and these folks have no

          10    social skills whatsoever.  Our frontal lobes are our

          11    social origins.

          12                   We have the biggest frontal lobes of all

          13    primates, and that's because we have to function in a

          14    bigger group size.  Sort of group size of different

          15    species is directly related to the size of their

          16    frontal lobes, and we have big ones because we have to

          17    function in large groups.  So that's a little more on

          18    those issues just to clarify, but more summary of what

          19    happened this morning.

          20                   SPEAKER:  We learned that Japan has the

          21    most longevity of any other country in the United

          22    States, and they are eating their indigenous foods and

          23    we wondered if ours are the same way.  And also I have

          24    a question for you.

          25                   DR. STEPHEN BEZRUCHKA:  Okay.








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           1                   SPEAKER:  If eye contact is really

           2    important, what about a child that is born blind, what

           3    difference or context would that change?

           4                   DR. STEPHEN BEZRUCHKA:  Okay, very

           5    important question.  What happens if somebody is born

           6    blind.  One of the things that I realize from this

           7    morning was I make statements about populations.  They

           8    are statements about averages or distributions, and

           9    then there is individuals.

          10                   And an individual -- a statement you

          11    make about a population does not actually address a

          12    specific individual.  There are always exceptions to

          13    any general statement.  And so the honest answer is I

          14    know that children that are born blind do not have the

          15    pineal gland operating and have melatonin spikes at

          16    night, and so they don't have jet lag, for example.

          17                   But your question I can't answer.  What

          18    happens to non-sighted children in terms of secure

          19    attachment, and I'm not aware that that's been studied

          20    but I think it would be a fascinating thing to study.

          21                   SPEAKER:  How about touch, I mean touch

          22    is one of the most primal aspects.

          23                   DR. STEPHEN BEZRUCHKA:  Touch is very

          24    important, and in my experience in Nepal, having had a

          25    lot of delivery experience or obstetrical experience in








                                                                     110


           1    Nepal, often with disasters that I don't want to talk

           2    about, but I worked in a high valley, and after an

           3    infant was born the grandmother would take them outside

           4    and massage them with butter in the cold.  And they

           5    would do this massage regularly, and they felt that

           6    they were massaging a personality quality.  We had this

           7    discussion this morning about attitude.  That there is

           8    sort of massaging attitudes into children.  Now that's

           9    their interpretation.

          10                   From a biomedical perspective what we

          11    know is that massage releases white blood cells into

          12    the circulation that can fight infection and deal with

          13    inflammatory responses and things like that.  The other

          14    thing we know about massage is that it releases

          15    oxytocin.  One of the things I haven't done is talk

          16    about the biology behind the hierarchy health and the

          17    gap between the rich and poor relationship.  There is

          18    actually biology behind all of this, pathophysiology,

          19    why we get certain diseases related to that.

          20                   And most of it is through the stress

          21    hormone response adrenaline and cortisol.  But then you

          22    take the opposite perspective and ask about is the

          23    stress response different in men and women.  What is

          24    the stress response?  It's the fight or flight

          25    response.  There is imminent danger, suddenly we have








                                                                     111


           1    an earthquake and this building starts shaking, what's

           2    going to happen?  Your pulse will go up and your blood

           3    pressure will go up.  You just had lunch, you're going

           4    to stop digesting that, you're going to be ready to

           5    run.  Your pupils will dilate because we need all the

           6    visual clues we need.  Now that's a very good stress

           7    response.

           8                   If we turn it on to save our lives, it

           9    works very well.  But suppose we turn it on all the

          10    time because we're angry with our boss or we have

          11    problems with our relationship, or the kids are on our

          12    nerves, and in Seattle I see road rage, I don't know if

          13    you have it here.  If you turn that stress response on

          14    all the time when there isn't the building shaking or a

          15    grizzly bear charging at you, then it does harm.

          16                   So the stress response is really good

          17    for getting you out of trouble, but if you turn it on

          18    all the time you get most of the diseases that we have

          19    to suffer with.

          20                   Now is the stress response the same in

          21    men and women?  Suppose a woman was standing here with

          22    her child and the building started shaking, would she

          23    run away?  No, she would tend to befriend the child,

          24    she would care and share, a calm and connection.  So

          25    the stress response in women is actually different than








                                                                     112


           1    it is in men.  But did I learn that in medical school?

           2    No.  Why?  Well, men studied the stress response in men

           3    and assumed it worked for everybody.  Of course it

           4    doesn't.

           5                   So women are different for many reasons.

           6    And part of the reason that women live longer than men

           7    is that they have a care and share calm and connection

           8    stress response in addition to the taking care of

           9    getting out of danger, but they will attend to their

          10    child.  And that is mediated through a different

          11    hormonal mechanism and the hormone is oxytocin.  All I

          12    learned in medical school is that oxytocin expelled

          13    stuff.  If I wanted to induce labor I could give

          14    somebody oxytocin.  When breast milk is secreted there

          15    is an oxytocin induced phenomenon.  But it's also a

          16    neurotransmitter in the brain, and it's released during

          17    massage, it is released during the stress response to

          18    foster calm and connection.  It's released doing a lot

          19    of good behaviors, such as gossip.  Gossip is sort of

          20    equivalent to how monkeys will groom one another.  It's

          21    also released during trusting behaviors, and there is a

          22    branch of economics called neuroeconomics in which they

          23    study trusting behaviors in economic transactions, and

          24    they find that oxytocin as a neurotransmitter is

          25    released in the brain.








                                                                     113


           1                   So we want to foster more of the calm

           2    and connection, tend and befriend response, rather than

           3    the chronic stress of dealing with road rage or

           4    wondering how you're going to pay the bills at the end

           5    of the month.  I've gotten carried away.  What else did

           6    you learn this morning?

           7                   SPEAKER:  You talked about the -- we

           8    talked about the measurement of health of a country and

           9    we said that it's the life expectancy, the average

          10    length of life, and you quoted that the U.S. has 76.4

          11    years, and that we rank actually 29th among the rich

          12    nations.  And then we listed, we talked about the first

          13    ten and Japan being number 1.  And I believe it was

          14    already said that the oldest population was in Okinawa.

          15    And then we talked about that the oldest population

          16    here in the United States is in the Midwest.

          17                   And we also mentioned about the summer

          18    Olympics, how we must look at some of those that the

          19    U.S. has won a lot of gold medals and that tells us

          20    something there.  And we also looked into the relative

          21    poverty in a country, and I could go on, but I took

          22    notes.

          23                   DR. STEPHEN BEZRUCHKA:  You took a lot

          24    of notes, and that's really good.  Maybe if I could

          25    summarize -- well, okay, so we've learned that the gap








                                                                     114


           1    between the rich and the poor seems to be a very

           2    important factor impacting a country's health, I think

           3    it's the most important factor.  But the gap between

           4    the rich and the poor seems to matter most in early

           5    childhood, and that there are biological -- now I've

           6    talked about the biology behind this, and so what are

           7    we going to do with this information?

           8                   First of all, you shouldn't believe a

           9    word I've said, okay, you should not -- if this is

          10    really important to you, you should not believe a word

          11    I've said, because anything that's really important you

          12    have to figure out for yourself.  And so if our health

          13    as a country or health of Alaskans as a state is

          14    important to you, you have to verify these ideas.  Are

          15    they in fact true?

          16                   I presented some federal sources and

          17    I'll present a few more that say, well, the feds say

          18    this stuff is true, since we always believe what the

          19    federal government tells us, perhaps we should believe

          20    this, too.

          21                   So that's the first challenge is to

          22    verify that what I've said is true, and then what are

          23    you going to do with this information.

          24                   SPEAKER:  With all this information that

          25    you have shared to us, we could advocate for the policy








                                                                     115


           1    maker or monitors to develop some kind of program that

           2    would respond to preventative health care assistance

           3    from the womb.

           4                   DR. STEPHEN BEZRUCHKA:  So we need to

           5    tell our policy makers this stuff.  I started out

           6    thinking that.  I sort of gave my first talk in public

           7    about these ideas in 1995, and I actually talked to a

           8    group of doctors, and I thought -- and I talked to more

           9    and more doctors, and I thought that they would be

          10    interested in doing things to improve our health as a

          11    country.  Guess what?  There is no money in health.

          12    It's all in disease.  It's all in treating disease, so

          13    they are basically not interested.

          14                   I found doctors are just not interested

          15    in producing health, they are interested in treating

          16    disease because that's where the money is.  And I

          17    talked to policy makers, I talked to our

          18    representative, Jim McDermott, who is a very

          19    progressive person in the House of Representatives

          20    about these ideas.  And you know what Jim said, he said

          21    well, where are my voters on this issue?  And I

          22    couldn't answer him.  He said, I'll respond if that's

          23    what the voters want.  So what are we going to do about

          24    it.  Are our policy makers going to listen to these

          25    ideas or do we have to get the voters out.








                                                                     116


           1                   SPEAKER:  Listening to your presentation

           2    this morning, I learned how we relate to the Lower 48,

           3    how we relate to the rest of the world as far as how we

           4    fit into the picture, and I also learned from you what

           5    we can do to enhance the life-style and longevity of

           6    our people.  And part of it is money, a big part of it

           7    is money as you stated, and even though we're not going

           8    to be able to get the money from the legislature, from

           9    Congress, Washington, D.C. right away, that doesn't

          10    mean we go to sleep.  That means we have to roll up our

          11    sleeves, that means we have to work harder, and I

          12    really appreciate what you said, thank you.

          13                   DR. STEPHEN BEZRUCHKA:  I think the

          14    issues are entirely about money, but they are not about

          15    spending more money, they are just changing where the

          16    money gets allocated.  That's our challenge.

          17                   SPEAKER:  I kind of heard from this

          18    morning that just in this room alone we're a diverse

          19    group, which is good, and I heard from the Alaska

          20    Natives that we're seasonal people.  And I know from

          21    our elders, I was told that teaching begins in the womb

          22    so that kind of coincides with what you were telling

          23    us.

          24                   DR. STEPHEN BEZRUCHKA:  Yes, I think

          25    that's really true, teaching or learning begins in the








                                                                     117


           1    womb.  And we have measurements.  We have measurements

           2    showing that a fetus actually looks around at the world

           3    and it perceives the stress in the world outside, and

           4    it makes its own stress hormone.

           5                   Now why would a fetus make their own

           6    stress hormones and what do the stress hormones do?

           7    What they do is mature the organs, especially the

           8    lungs, because it's a stressful world out there.  You

           9    may not be inside the womb for very long, so when you

          10    get pushed out you want to have lungs that will breathe

          11    for you so you might survive.

          12                   Now what do doctors do when they are

          13    faced with an imminent delivery of a pre-term baby,

          14    they give the mother prednisone, which is the stress

          15    hormone we're talking about, for just that reason, to

          16    mature the lungs.

          17                   Other comments from this morning?

          18                   SPEAKER:  From this morning I think

          19    initially you had a little bit of the old nature versus

          20    nurture argument going on initially saying how much was

          21    environment, how much actually takes place.  Another

          22    thing is I didn't believe anything you say because you

          23    can't show cause and effect because of all the

          24    extraneous variables, but when you present the

          25    correlational studies demonstrate the relation of








                                                                     118


           1    variable studies which say if you have this then you're

           2    going to have that.  So I think a lot of people

           3    believed what you said because they knew where the

           4    research came from.  So you can't disregard correlation

           5    studies.

           6                   I worked social services and the early

           7    head start was one that could secure funding because

           8    they did show the positive correlation that the program

           9    had, they showed early intervention, and they showed

          10    there is a window period.  And that's early

          11    intervention, they are talking birth to 3, they say if

          12    you didn't make it by birth to 5, now they are saying

          13    birth to 3.  So they programs have been funded, even

          14    though it's tight right now, I believe.

          15                   But you said if money isn't there, and

          16    the ability of people to show to make the correlation

          17    studies is the first step and the step in the right

          18    direction to getting the funding you need to solve the

          19    problems as we recognize them.

          20                   DR. STEPHEN BEZRUCHKA:  That's a very

          21    important point, you don't want to believe what I say.

          22    Correlations do not imply causation.

          23                   So how do we decide that a bunch of

          24    studies actually imply that there is a causative

          25    process going on, something actually causes something








                                                                     119


           1    else?

           2                   Well, again, I'd like to go to what the

           3    feds say and I saw in the paper there is a new Surgeon

           4    General's report on smoking and the hazards.  Well, the

           5    Surgeon General in 1964 produced a report linking

           6    smoking and bad health.  Before that we didn't know

           7    whether smoking was good for us or bad for us, and the

           8    surgeon general came out with being specific criteria

           9    to say that the relationship between smoking that's

          10    found in these studies and bad health is causal, and

          11    they laid out criteria to infer causality.  There had

          12    to be my studies by many different investigators on

          13    different populations, and they all had to show the

          14    same thing.

          15                   There had to be a dose responsive

          16    effect, more inequality leads to worse health.  There

          17    had to be the chicken before the egg, which came first,

          18    did you become poor and get sick or were you sick and

          19    became poor, and mostly it's you were poor and you get

          20    sick.

          21                   Finally there had to be biologic

          22    plausibility, is there hard science behind this.  And

          23    yesterday with the Institute For Social and Economic

          24    Research I reviewed the studies and showed a lot of

          25    graphs, and I haven't done that with you, but if I did








                                                                     120


           1    we would see these studies.

           2                   So how are we going to use these ideas

           3    to look at successful aging?  And I think if I can

           4    summarize, the health of populations is mostly

           5    determined by the rules governing how we share the pie,

           6    that healthy aging requires a society to have more

           7    social justice, more economic justice.  It's an issue

           8    about justice.

           9                   Justice as a word, as a concept, has

          10    sort of left our vocabulary in the last few decades.

          11    We don't seem to be concerned about justice or

          12    fairness, so we need to reshift the discussion there.

          13                   Structural medicine is more about

          14    ensuring that everyone gets an equal share.  Early

          15    child is important.  And Alaska's health is improving

          16    and that's a good sign.  And I showed the top 30

          17    countries of life expectancy, and we sort of teased

          18    things out there.  And I'm going to fast forward to say

          19    the feds backed me up on there.  More egalitarian

          20    societies have better average health.

          21                   Now I didn't present the stuff on early

          22    childhood, but again another report shows of all

          23    aspects of an early child's environment, the family

          24    socioeconomic status is most powerfully associated with

          25    cognitive skills when they enter school and the








                                                                     121


           1    influence of socioeconomic status during early

           2    childhood years appears to be more stronger than

           3    socioeconomic status in later years, early childhood is

           4    very important.

           5                   Children in single parents are greater

           6    risk.  There are a few periods in brain development

           7    during which impairment of stimulation of nerve

           8    pathways will forever limit functioning.  That's that

           9    window with secure attachment, with the auditory cortex

          10    and the frontal lobes.  If you don't do it in the first

          11    five years of life, you can't make up for it later.

          12                   Another part of that report, two

          13    essential conditions that shape the well-being of young

          14    children and their development trajectory is the need

          15    for stable and loving relationships with unlimited

          16    number of adults.  And the second thing is a safe and

          17    predictable environment.  Again, what the feds say.

          18                   And similarly, stress resulting from

          19    that can have dramatic effects to health and

          20    development and so on.  Supporting and nurturing

          21    caregiving can protect offsprings from adverse

          22    outcomes.  That is you can make up for a lot by taking

          23    care of people.

          24                   And so what we're stuck with, I think in

          25    the United States, is we're going in the opposite








                                                                     122


           1    direction.  That is we're cutting taxes on the rich

           2    ever more, and so the homeless family goes down to the

           3    Income Gap Store to look at the new tax cut fashions

           4    for the fall, whereas in the much healthier United

           5    Kingdom, if you've ever been on the subway there they

           6    have these signs, we need to mine the gap in this

           7    country between the rich and the poor.

           8                   Now let me -- there are many other

           9    indicators that I could show, and I won't do these,

          10    that show that we're not doing well in any of this.

          11    And -- please.

          12                   SPEAKER:  Since we've been doing so

          13    unwell, how come nobody told us we were doing so unwell

          14    all these years?  With all the studies you guys did,

          15    how come you guys never gave us the information, hey,

          16    we're not doing too well here.

          17                   DR. STEPHEN BEZRUCHKA:  That's an

          18    important point.  Everybody wants to hear good news.

          19    We heard some good news from the Governor this morning.

          20    People in the United States don't like to hear bad

          21    news.  And so part of the problem is we academics have

          22    not been very good at getting the word out because

          23    mostly we write papers for publication that gets us

          24    promotions, and eventually we become chair of the

          25    department and retire and push up daisies.  That's not








                                                                     123


           1    what academics do, we don't really work hard to spread

           2    the word, and maybe we should, and I'm trying.

           3                   So what you need to do as seniors is

           4    refocus some of the issues from the ones that you

           5    normally look at, the need for senior housing, adequate

           6    food, what not, towards spreading this word out and

           7    recognizing that caring for others appears to have

           8    better health benefits than receiving the care.

           9                   Again, sometimes I show a lot of these

          10    studies, but this is a study looking at mortality rates

          11    among those who received care versus those who give

          12    care.  And not unsurprisingly what this shows is that

          13    those who receive care do less well than those who give

          14    care.  So those of you who are working to help others

          15    actually get health benefits from that.

          16                   SPEAKER:  I was told that when you take

          17    care of an Alzheimer's patient you lose at least three

          18    years of your life.

          19                   DR. STEPHEN BEZRUCHKA:  She was told if

          20    you take care of an Alzheimer's patient you lose three

          21    years of your life and you're right.  That is spouses

          22    caring for Alzheimer's patients have worse health than

          23    those that don't have that unfortunate thing.  There

          24    are always exceptions and always special cases, and

          25    you're right.  So that's important to recognize.  It's








                                                                     124


           1    tough.

           2                   Now, why do we have so much Alzheimer's

           3    disease in this country?  Average man has much less.

           4    And a lot of it has to do with stress, and as we get

           5    older we have all these services that take care of us

           6    and we're no longer mentally challenged.  And remember

           7    Okinawa has much less Alzheimer's and older people

           8    continue to do meaningful work.  And studies show you

           9    either use it or lose it.  And we're creating

          10    conditions from mindless watching television.  In the

          11    little brochure they talk about a study in neurology

          12    that showed if you solve puzzles it delays the onset of

          13    Alzheimer's, and if you watch television it hastens it.

          14    Because one is a mindless activity and the other one is

          15    a mindful activity.

          16                   So caring and sharing really is the

          17    critical thing.  Remember I mentioned early childhood,

          18    and I said how Sweden provides maternity leave, you

          19    have to take it in Sweden.  The United States,

          20    Swaziland in Africa, and Papua New Guinea are the only

          21    three countries in the world, are the only three

          22    countries in the world without a paid maternity leave

          23    policy.  They are the only three countries in the world

          24    in which there isn't a national policy mandating that

          25    if you work and have a baby you get time off with pay.








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           1    Now the countries differ by how much time that you have

           2    off, but we are the only three countries that do that.

           3                   So one of the issues -- now I want to

           4    move on and say what are we going to do about this?

           5    Andrew Grove said you get what you measure.  Now what

           6    do you measure every minute of every business day in

           7    the United States?  Money, you measure money, you

           8    measure the stock market, it's reported every minute of

           9    every business day.  It must be the most important

          10    measure in this country, right?

          11                   Well, so we must get whatever it is that

          12    the Dow Jones is measuring.  What s it that the Dow

          13    Jones measures?  Certain stocks.  Basically it's

          14    measuring wealth creation.  If everybody gets it is it

          15    wealth?  No, it's only wealth if a few people have it.

          16    So you get what you measure, so we in the United States

          17    measure wealth creation, which is, by definition, for

          18    the few.

          19                   You know, everybody has cellular phone

          20    or a microwave or VCR, and so those aren't signs of

          21    wealth.  A big yacht is a sign of wealth these days.

          22    We never measure measures of our health compared to

          23    other countries, either mortality measures or other

          24    social measures.

          25                   We don't -- how many of you are aware








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           1    that we have one-quarter of the world's prisoners in

           2    this country, we have one-quarter of the world's

           3    prisoners.  So if we take the part in the constitution

           4    that says that we have life, liberty and the pursuit of

           5    happiness, but we don't have as long a life as people

           6    in other rich countries, so we don't appear to have

           7    life.  We have the illusion of liberty with the quarter

           8    of the world's prisoners, and I heard we are shipping

           9    prisoners down to Washington state.

          10                   SPEAKER:  Arizona.

          11                   DR. STEPHEN BEZRUCHKA:  Arizona, sorry,

          12    we want to build prisons to keep the prisoners, let's

          13    have less prisoners.  Put the crooks in jail, put the

          14    people that rob hundreds of millions of dollars from

          15    corporations, put them in jail, the white collar crime.

          16    And we're about the pursuit of happiness, that's true,

          17    but I won't talk about happiness measures, but we don't

          18    do so well there either.

          19                   So The Strategy of Preventative Medicine

          20    is a book written by Jeffrey Rose, a leading

          21    epidemiologist writing about preventative medicine.

          22    And the last two sentence in his book are:  The primary

          23    determinants of disease are mainly economic and social,

          24    and therefore the remedies must also be economic and

          25    social.  Medicine and politics cannot and should not be








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           1    kept apart.

           2                   So health is really all about politics,

           3    and we're not talking about republican/democrat

           4    politics, we're discussing about how to share what is

           5    ours.  And the solution is this an armored vehicle

           6    outside or hospital in Seattle, and it says on the

           7    back, the system is the solution.

           8                   You need to put in place systems that

           9    don't depend on individuals deciding what to eat or how

          10    much to exercise, we need to put in place systems that

          11    result in the outcomes that we want.

          12                   If we put in -- if we require the

          13    President in the State of the Union message to actually

          14    describe the health of the Union in comparison to other

          15    countries, and suppose this year in January he said,

          16    well, my fellow Americans, our health compared to other

          17    countries has now declined so there are 28 countries

          18    healthier and last year there was only 26, suppose

          19    everybody heard that, then we might think there is a

          20    problem that needs addressing.  And then that might

          21    lead to systematic change.

          22                   And the basic systematic change is this

          23    one.  We need a new surgery that's going to be done

          24    that's going to take money from some places and put it

          25    other places.  This is the kind of surgery we need.








                                                                     128


           1                   None of the things we need to do are

           2    things we haven't thought of before.  So, for example,

           3    this is a front page of the New York Times, America's

           4    leading newspaper with a headline from April 28th,

           5    1942.  The headline reads:  25,000 income limit asked

           6    by President.

           7                   A democratic president proposed a

           8    maximum wage in this country of $25,000 a year in 1942.

           9    He didn't do it because he thought it would be a nice

          10    idea.  There was a lot of political pressure for him to

          11    do that.  Now he died before anything happened there,

          12    but it only resulted because of political pressure.

          13                   Another thing is our taxes in this

          14    country are very low, and the poor pay proportionately

          15    many more taxes than the rich.  Now some of you may

          16    remember that in the 1950s the highest tax rate during

          17    the Eisenhower Era was 91 percent.  That is if you made

          18    a million and one dollars you paid 91 cents of that

          19    next dollar in tax.  Our tax rate was 91 percent in the

          20    early '50s when we were one of the healthiest countries

          21    in the world and we spent money on GI loans and VA

          22    mortgages.  We spent a lot of money for the welfare of

          23    the poor, and the lowest tax rate was in the '20s.  And

          24    this only goes up to 1998.  But our highest tax rate is

          25    now down to around 35 percent, and the lowest tax rate








                                                                     129


           1    stayed around 20 percent, so proportionately the poor

           2    are paying much more in federal tax.  We could go back

           3    there.

           4                   Now a republican president, Richard

           5    Nixon, in August 1969 proposed a negative income tax.

           6    He said if you have income we'll tax it, and if you

           7    don't have income we'll give you income.

           8                   A republican president actually proposed

           9    a negative income tax in the family assistance plan.

          10    And guess what, newspaper reporters and editorials were

          11    95 percent in favor, they thought it was a brilliant

          12    idea.  Let's give money to the poor instead of just to

          13    the rich.

          14                   Well, it passed the House of

          15    Representatives and it was defeated in the Senate and

          16    Nixon got embroiled in Watergate and he lost interest

          17    in it, and if the President didn't push it, it's hard

          18    to get it done, so it never came to fruition.

          19                   Some of you may be old enough to

          20    remember the Family Assistance Plan legislation of

          21    President Nixon.

          22                   So here is a republican President

          23    proposing a negative income tax, and a democratic

          24    President proposing a maximum wage.  We could go back

          25    to these ideas.  It's not like it's not things we








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           1    didn't think of before.

           2                   So what we need to do is promote

           3    policies that help early life.  And we need to have

           4    strategies, and we need to think of sort of dominos.

           5    If you line up a bunch of dominos and you tip that one

           6    over then they all fall down.  What would be the domino

           7    effect for improving health of this country?  What

           8    would it be?

           9                   SPEAKER:  I would assume that it would

          10    impact the whole world.

          11                   DR. STEPHEN BEZRUCHKA:  I think you're

          12    absolutely right.  If we improve health of this country

          13    we cannot do so without policies that are going to help

          14    everybody throughout the whole world.

          15                   SPEAKER:  You only have a few minutes

          16    and we're on a tight schedule, but one of the darker

          17    implications for a group of older people sitting in

          18    this room is euthanasia might be a great policy to

          19    shift wealth down to the childrearing population.  It's

          20    a pretty horrible thought, but it's not the precedence

          21    for that.  In other words, encouraging people as their

          22    social responsibility to die.

          23                   The second thing is, the second thing is

          24    left out of your equation are social units.  And I

          25    think they percolate throughout all of this.  What








                                                                     131


           1    role, what productive role -- now I'm arguing the other

           2    side -- what productive contributory role do older

           3    people play in given the realities of no maternal

           4    leave, what should they play?  Should they be paid to

           5    play that role?  And these are some other -- you've got

           6    a million different implications.

           7                   Just to close, on that 1942 thing, you

           8    know, Roosevelt was co-opting the progressives, Henry

           9    was, so he was pushing them out of the picture, just as

          10    the democrats co-opted progressives today.  So some of

          11    these things are kind of -- I would consider that there

          12    is a historical context to some of these things.

          13                   DR. STEPHEN BEZRUCHKA:  Okay, I actually

          14    have a chapter in a book I read that sort of filled me

          15    in on this.  But it was a policy proposal, and given

          16    the circumstances we could craft more appropriate ones

          17    today.  Your idea about euthanasia of older folk,

          18    evolutionary why do women live longer than men, it

          19    seems to be a universal.  Why do women have menopause?

          20                   SPEAKER:  Men do, too.

          21                   DR. STEPHEN BEZRUCHKA:  Yes.

          22                   SPEAKER:  So that they don't have

          23    children up until the time they die.

          24                   DR. STEPHEN BEZRUCHKA:  The reason is

          25    that they don't have children up until the time they








                                                                     132


           1    die, and they use that time to care for grandchildren.

           2    In other words, the evolutionary biologists have

           3    proposed the theory, and there is some confirmatory

           4    evidence that we have evolved so women live longer than

           5    men and undergo menopause and aren't fertile so they

           6    can raise their grandchildren.

           7                   So maybe we men, we would die anyway,

           8    but the women are around to take care of our

           9    grandchildren.  And of course I see this in the ER

          10    often, I see kids being raised by their grandmothers.

          11    We need those grandmothers.  So there are some

          12    important policy issues there.

          13                   I think what we need to do is to talk

          14    about these ideas and spread the word.  Basically you

          15    need to educate yourself, and then you need to -- by

          16    educating yourself, by the way, I put over here a few

          17    CDs of talks I've given, and you're welcome to pick one

          18    up and I would appreciate it if you'd pay me $5.  The

          19    actual cost of ordering it off the website is $15, and

          20    if you can't afford it, please take one.  But listen to

          21    these ideas and discuss them in various places, so you

          22    need to learn these ideas.

          23                   You have a reading packet, there is

          24    sources on the website there.  And then you need to

          25    inform others.  As I put it, you want to plant brush








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           1    fires in other people's minds.  You can say, do you

           2    realize we're not the healthiest country in the world

           3    despite spending half of the world's health care bill,

           4    or we don't have that many oldest old compared to Japan

           5    or Canada.

           6                   And then so what I've done is recognize

           7    that talking to doctors doesn't do it.  Talking to

           8    policy makers doesn't do it.  And even talking to

           9    ordinary voters doesn't do it so much.  But I found

          10    that young minds are much more receptive to these

          11    ideas, so I have tried to find ways of talking about

          12    these ideas in middle and high schools.  And I make, as

          13    a part of the courses I teach at the University of

          14    Washington, the requirement that they go out and

          15    disseminate.  And I want you to consider that you might

          16    go and teach some of these ideas in schools.

          17                   And I think it would be a wonderful

          18    thing, and you need to craft some strategies, and you

          19    may say, I'm not going to high school.  But here we

          20    went to a high school in Seattle and we had a health

          21    Olympics staging in which a student read the script and

          22    runners crossed the finish line, there is Japan coming

          23    in first, and there is Canada coming in, and there is

          24    the United States struggling 4.6 years later not doing

          25    very well.








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           1                   And my students find other ways.  This

           2    is two students that I worked with now that one has

           3    graduated and the other one is finishing up, and she's

           4    discussing two baseball teams.  The top player is paid

           5    25 million and another player paid was paid 8 million

           6    and another player was paid 400,000.  And she was

           7    asking which team would you rather play for and which

           8    team would do better in the league.  And of course we

           9    have studies showing that teams that have smaller

          10    salary gap between their players play well, play better

          11    than teams with a bigger salary gap.

          12                   And then they put names on the players

          13    and on the teams, and it was a very good way to teach

          14    these ideas in a high school setting.

          15                   Andrea Voght (ph) taught grade 6 girls,

          16    and she would have a variety of exercises getting them

          17    to decide what they think.  So she would say agree

          18    disagree, all you need to be healthy is good food and

          19    exercise and a doctor.  And students would go to one

          20    side of the class or the other and say why they agreed

          21    or disagreed, and as discussion ensued students would

          22    change sides.  And it was this sort of physical process

          23    and critical thinking process that seemed to work out

          24    very well.

          25                   Here is another one, the rules governing








                                                                     135


           1    our society affect everything we do, wear and eat.  The

           2    rules governing our society affect everything we do,

           3    wear and eat.  You can see these students get really

           4    engaged, created really good opportunities.  And then

           5    at the end -- she did this for five weeks in the

           6    schools, two separate classes.  They sort of had a

           7    debriefing.

           8                   One of the things we talked about was

           9    the high rate of teen births in the United States and

          10    how that's related to the income gap, and I haven't

          11    talked about that.  But here the students said, before

          12    I came here I thought there was something wrong with

          13    those people, like why would you want to become a

          14    teenage mom when you don't have an education.  And then

          15    I realized they don't have a choice.  And that's what

          16    the studied showed.  Teens have babies for specific

          17    reasons that actually are related to the structure of

          18    society just as other -- you know, young teenager girls

          19    play out the stress in American society by having

          20    babies, and boys shoot, those are the two ways that

          21    young people play out stress in our society.

          22                   This is a student teaching this year up

          23    in a school in Kenmore, and she develops her own sort

          24    of learning materials.  She's using Martin Luther King,

          25    become active in what you believe.








                                                                     136


           1                   And another thing that we found

           2    interesting, again, somebody else is doing this, I'm

           3    presenting other people's ideas.  These are a bunch of

           4    family practice doctors at Providence in Seattle where

           5    I do a yearly session, and they do a breakfast in which

           6    they take people in tenths of the country and give them

           7    a proportion to their wealth.  So the richest tenth has

           8    a lot of food, and the poorest tenth gets a slice of

           9    doughnuts.  So here it is this year, the top tenths

          10    she's got all this stuff, and this person here is sad

          11    she didn't get very much, and this guy has a slice of a

          12    grape.

          13                   So somehow you want to make it clear to

          14    people what are the ranges of ideas that we're talking

          15    about.  Produced websites, this is our population

          16    health forums website, but this is kind of more for

          17    people who can follow data and things.  One of my

          18    students produced a more flashy website for high school

          19    students, and they had this tour, she used the road

          20    sign metaphor at various cul-de-sacs in a community and

          21    so on to get at these ideas with warning signs and what

          22    not.

          23                   And these days, especially more and more

          24    people are finding the web a really good source of

          25    information, and you want to somehow foster critical








                                                                     137


           1    thinking in that.  I think as you learn some of these

           2    ideas you can talk to various groups, you can talk to

           3    seniors groups.  I talked to homeless seniors in

           4    Seattle, and that's quite interesting.

           5                   Here I had this group of homeless

           6    seniors and I asked them, I said when did homelessness

           7    first appear in America?  A guy over here said, Reagan.

           8    Everybody else said, yeah.  They knew that Reagan

           9    stopped funding for low cost housing and he forced

          10    mental health services to be cut, and they were on the

          11    street.

          12                   And I teach a lecture and an

          13    undergraduate course in homelessness at the University

          14    of Washington, and the students are all young and they

          15    never remember that we had a time when there was almost

          16    no homelessness around.

          17                   So give lectures and presentations.  Do

          18    it in small towns.  I found it's easier to get a

          19    response in a small town newspaper than you will in a

          20    big town daily.  Make an organization.  This is our

          21    population health forum, and we go to fairs and

          22    exhibits and the students talk to various people and

          23    staff, mine the gap T-shirts from England.

          24                   And something else is happening in

          25    Washington state, a campaign to make Washington the








                                                                     138


           1    healthiest state in the country.  Washington is about

           2    the 15th healthiest state, so our Washington health

           3    foundation wants Washington to beat Minnesota and

           4    become the healthiest state in the nation.

           5                   SPEAKER:  Tell us what is Minnesota

           6    doing that we could emulate.

           7                   DR. STEPHEN BEZRUCHKA:  It has a small

           8    gap between the rich and the poor and it's had it for a

           9    long time.  You've decreased your gap, comparable to

          10    Minnesota, and if you just keep it small and not have

          11    an increase and provide more broadly distributed state

          12    services and social services and networks, that your

          13    health will keep improving as I sort of pointed out

          14    this morning, I think.  But you've got to monitor it.

          15    You should be monitoring this, and maybe you ought to

          16    have a campaign to make Alaska the healthiest state in

          17    the country instead of Washington.

          18                   Now this Washington health foundation is

          19    using some kind of strange strategies to do that.  This

          20    woman is the biggest loser, that is she lost the most

          21    weight in some weight loss campaign so she gets to be

          22    on the cover of some magazine.  Telling people to lose

          23    weight, although it's not a bad idea, is not the way to

          24    propel Alaska or Washington to be the healthiest state.

          25    The people in Minnesota, if you look at them, some of








                                                                     139


           1    them are kind of big.  So I think this is the wrong

           2    focus, but it makes attractive covers.

           3                   About population health, all of us have

           4    access to newsletters or bulletins blogs, these

           5    websites and you can do that.  And the population is

           6    important.  I wrote this piece for Seattle's homeless

           7    newspaper, Real Change, I think there is a copy in your

           8    packet, or the Washington Health Foundation, or I'd

           9    written one for News Week or whatever.

          10                   But, for example, this is a physician's

          11    assistant, Jim Anderson, and he wrote an article for

          12    his PA journal, his physician's assistant journal about

          13    these ideas.  So think about the kind of media sources

          14    you have for which you can write about these ideas.

          15                   Produce posters or graphics.  Here is a

          16    copy of this poster that I produce or got produced

          17    actually, took six months of getting the wording

          18    through a committee for a conference on spirituality

          19    and health hosted by Swedish Hospital.  And put it up

          20    in some a prominent location, and it's got United

          21    States as the 29th.

          22                   Andrew Vogt taught a course at a high

          23    school this spring called world health and art

          24    activism, and one of the things the students had to do

          25    was produce some art.  And this student produced a








                                                                     140


           1    poster about stress.  He feels a lot of stress.  And so

           2    what he learned was wealth in equality creates health

           3    in equality.  Close the gap and we'll all be healthier.

           4    Great poster and it really grabs you.

           5                   And so whatever kind of people have

           6    these -- I'm saying somebody else, do the things that

           7    you enjoy that you have skills at that you can keep

           8    doing for longs periods of time that spread the message

           9    and that will be affective.  If you do something that

          10    somebody else tells you that you don't enjoy you won't

          11    do it for very long and it won't be very good.

          12                   But the ability to present art is really

          13    interesting.  This is up in the north part of Lake

          14    Washington in Seattle is a billboard:  You think

          15    smoking kills, try working a dead end job.  It's really

          16    got it there.  I was amazed.  I don't know how this

          17    poster got up there, but maybe we can get a community

          18    to erect some really useful billboard like that, and

          19    talk about the United States being so poorly.

          20                   SPEAKER:  We don't have billboards.

          21                   DR. STEPHEN BEZRUCHKA:  Okay.  So you've

          22    got to change rules or make new ones, and you've got to

          23    maintain your livelihood.  It's very hard to get paid

          24    for doing this stuff, okay.  It's not where the money

          25    is, so I keep my night job.  I work in the ER in order








                                                                     141


           1    to be able to come and do this sort of thing.

           2                   After you've created awareness then you

           3    need to organize.  Now we've lost the skills of

           4    organization, but perhaps one of the best is Dr. Martin

           5    Luther King, Junior.  And how many of you know that in

           6    the summer of 1968 Martin Luther King was organizing

           7    the poor people's campaign which was to be an

           8    encampment of 500,000 people in the mall in Washington,

           9    D.C. for the whole summer, and every day they would go

          10    to their legislators and press for an economic bill of

          11    rights.  That was King's plan.

          12                   Could you imagine?  It's okay to have a

          13    million people march for a day, but if you have 500,000

          14    camped on the mall in Washington, D.C. and every day

          15    they go to their legislators and press for a bill of

          16    rights, boy, that could be really effective.

          17                   Not everything works, but it might be,

          18    you've got to have some strategies, we need different

          19    strategies and we need different things than we do

          20    today.

          21                   Think about back in April in France

          22    there were huge demonstrations over what issue?  The

          23    issue was whether or not companies that hired young

          24    workers could fire them after six months or two years.

          25    In the olden days they could fire them after two years,








                                                                     142


           1    but now they wanted to increase the time they had job

           2    security to only six months, and they mobilized

           3    millions of people, these young folk under 25 got their

           4    parents, got the union leaders and so they actually

           5    defeated for the first time in the history of France,

           6    they defeated a law that had already been passed just

           7    because of the force of numbers.  They realized it

           8    wasn't good for them.

           9                   So basically I was going to suggest some

          10    work at your table but I don't think we have time.  So

          11    what I'm suggesting is that to build a healthy society

          12    one of the things I haven't talked about, everybody

          13    needs the basic needs first, food, water, shelter

          14    security, that takes precedence over the gap between

          15    the rich and the poor, everybody needs enough to eat, a

          16    roof over their heads and a clean environment.

          17                   We're not doing badly with that in the

          18    United States.  Then we need policies to promote social

          19    and economic justice that foster caring and sharing

          20    relationships.  Women and children first always, in

          21    other words everyone does better where women do better.

          22    And so policies that promote women's rights and time

          23    for all the activities that women do without their

          24    having to be everything to everybody.  Health care has

          25    a small role but not all that much.  And education is








                                                                     143


           1    important.

           2                   And the personal choices we make, you

           3    know, if you want paper or plastic, may not be -- are

           4    not all that important, the personal choices we make

           5    for our own welfare.  The most important ones are made

           6    at the societal or grass roots level.

           7                   And Margaret Mead made this statement,

           8    she said:  Never doubt that a small group of

           9    thoughtful, committed citizens can change the world.

          10    Indeed, it's the only thing that ever has.

          11                   So I urge you to work with me on this.

          12    And then we are led to believe that they lived happily

          13    ever after.  I'll end with that and thank you for the

          14    opportunity to talk to you.

          15                   MS. GOHL:  Well, thank you very much,

          16    doctor, we're so happy you were able to be here and you

          17    have great ideas and some great materials that we'll be

          18    able to utilize.  And then also Dr. Bezruchka's

          19    presentation PowerPoint, we will have available

          20    eventually on our website.

          21                   DR. STEPHEN BEZRUCHKA:  The website is

          22    there on the speaker's info and a whole bunch of

          23    references.

          24                   MS. GOHL:  In the packets.  You're

          25    welcome to e-mail him if you need assistance or








                                                                     144


           1    guidance or direction.  Please take a break, 15 minutes

           2    and when we come back we'll have a couple last

           3    presentations.

           4                            (Break)

           5