 Do you remember the time when you find out about what was going on and when you couldn't move one day in dance class? People would ask me like are you okay? I'm like, yeah, I'm just tired. I remember I asked well Why can't you dance and you showed me bruises bruises you revealed to me that there was some trouble at home You know, I tried to do everything that I was supposed to as a teacher Which I had to report and I did it anonymously of course But it was maybe days after that when you called me to tell me that you were running away my husband he had ran away when he was your age exactly and He was taken in by his choir teacher. I remember you said, you know, I don't cover my job You just wanted to help me so You've stayed with me a couple of times when you just didn't have a place to go or we needed to go pick you up and I remember when you spend Thanksgiving with my family I taught you how to make a pumpkin pie That was a really special Thanksgiving Because I had my immediate family my husband and my children my grandmother and you were there I had everybody there that I truly loved Well, I for a long time in my life didn't have that experience even call somebody your mom But just to see you the way you took care of me. That's how mom should act And I just feel like there's no way for me to thank you for everything You showed me that I'm not alone That I actually have somebody I think what you don't realize is that you helped me, too You have taught me a lot about being a teacher, but you've also taught me a lot about being a parent Just the other day someone said is that your son and I said yes You always have a family here You always will Thank you everybody. Welcome back from lunch If you haven't already, please feel free to take your seats I'm happy to hand over The next session to dr. Deconis CEO and president of Northwest Permanente who will introduce herself and dr. Murthy Good afternoon everyone. I Have the privilege of bringing us back right after lunch yay But no worries this will be a group effort and just as the childhood Trauma experiences is a village. She takes a village and this conversation will be such as well So my name is Amalda Deconis and I am an internist by training Before taking on this role as the CEO and president Northwest Permanente Northwest Permanente, we are the largest independent multi-specialty group in Oregon And I'm happy to say we are the first medical group in the world that has been certified as a B corporation and Certainly most importantly we proudly serve and care for the members of KP Northwest in Oregon and southern Washington You know when you think about Kaiser Permanente we pride ourselves in leading in prevention in thrive and population health and Our biggest opportunity one of our biggest opportunities still is in Addressing partnering broadly deeply with communities businesses lawmakers and policy makers in addressing adverse childhood experiences Which I agree with our former president of American Academy of Pediatrics in saying that this is the largest unaddressed public health threat facing our nation today How many of you if I were to tell you that one in five of us in this room Have our life expectancy cut by as many as 20 years Would do something What would it take us for us to act Nearly one in five Children in Oregon 18% suffer with live with four or more adverse life experiences and Based on the studies and that we know This alone we know four times At risk these children are for suffering and living with depression for the rest of their lives They are eight times more likely to become alcoholics 20 times more likely to abuse IV drugs and As for their life expectancy as many as 20 years shorter cut short by diabetes heart attacks cancer All because of the burden from adverse childhood experiences So this is our conversation this afternoon around the federal perspective and more and I am so thrilled to be part of you today part of this conversation and certainly honored to be joined by Dr. Vivek Murthy our 19th Surgeon General of the United States and you know During his tenure some of us think it was too short He tackled he called us to act on the opioid crisis Remember Ebola Zika Flint water Few of the crises that he and his team tackled And I must confess that when I look at his long long list of accomplishments and impressive credentials mango aficionado is One that has Yeah, it has me curious So Again, thank you. Dr. Murthy for joining us today So I will not define what a moderator does today, but again This is a conversation and while you are thinking of your questions for Dr. Murthy or myself I'm gonna start us off with Dr. Murthy as we're you're an internist. I'm an internist and we see the complex adult patients that when we really look at their history are The victims of and the outcomes really a adverse childhood experiences So we get that moving upstream is critical if we're ever ever going to make a dent in Improving people's lives never mind bending the cost curve of health care in this country. So Knowing all that what what is the role of the federal government in this effort in this? adverse childhood experiences Well, let me just say first how wonderful it is to be here with all of you It is so good to know that you are coming together to address an issue I think that is so fundamentally important not just to the health and well-being of our Community in our country, but it's important to our To answering the question of does the way our institutions run to the way our policies? You know, you know Should turn out are they reflective of the deeper values that we have as a country and I think that if you look at the gap That we have between how some of our children are raised and some of those who are the worst offer raised if you look at the Disparate health outcomes that so many of them are are facing both during childhood and later in life You see that there is a gap that reflects not just a health gap But a value gap that we have to close so it is so nice to know that people like you are coming together to think more deeply About this issue I think it's certainly appropriate that we are here at a Kaiser facility given that the role that you played as an institution Nearly 20 years ago in these foundational ASIS study and I will say that this room in particular Is meaningful to me because when I started my tenure as a surgeon general one of the first reports that I issued was a report on walking and walkable communities and we Launched that report right here in this room. I was standing right here on this stage at this podium And it was a wonderful way to sort of begin my tenure and to kick off a partnership with Kaiser that has certainly Lasted a long time. So it's a truly wonderful to be here you know well you know when I think about the How we're going to address this larger issue of trauma, you know among children I think the federal government certainly has a role that it needs to play and it already is playing somewhat of a role Many of you are likely familiar with the grants that SAMHSA issues the substance abuse and mental health services administration funded in part by by a piece of legislation that was passed in 2000 which has provided funding for a series of programs that both increase public awareness of a childhood trauma that helped provide training to Clinicians around how to handle and address childhood trauma and that also fund Treatment efforts in communities and as a result of that program alone. There have been over 200,000 people who have been trained through the city SAMHSA grants and there have been over 40,000 children who have received treatment as a result of these grants In the administration for children and families, which is a division within the Department of Health and Human Services The Child Health Bureau has also been funding efforts to address Child abuse and neglect which have been very important and then even if you look outside Strictly of programs that have trauma like in their in their titles We know that chip the children's health insurance program has been really important in providing kids health insurance coverage Which is absolutely essential if we want to address not just trauma, but a whole range of adversities that children are facing But there is a problem I think in how we have addressed this from a federal perspective Which is that the approach I think that historically has been taken on the federal side has been very well-intentioned but often very fragmented and Part of what we need is real collaboration across agencies and across departments To pull together a concrete target and strategy for how to address and reduce Childhood trauma because the truth is it's not just the job of the Department of Health and Human Services That we know that housing plays an important role in the health and the you know upbringing of children We know that What happens in in schools as we've talked about earlier this morning has a powerful impact on whether or not trauma is Recognized and then later addressed So it's not just HHS But we need efforts that pull together housing and urban development the Department of Education the Department of Labor as well as The Department of Justice and in particular the Bureau of Prisons Given how many children are struggling with parents who are incarcerated Without their ability to see them or communicate with them or build relationships with them in a meaningful way Now is a good question is this a pipe dreamers are possible to have this kind of interagency Collaboration well, it is possible and there's actually quite a bit of precedent for it One of those efforts is one that I was very involved with which is an interagency effort around tobacco so we recognize for example it was essential to think about tobacco not just as a Issue that had to be dealt with in clinics and in hospitals But to really think about how housing impacts smoking about how what happens in schools impacts smoking And so the interagency efforts around tobacco have been very productive and have led to some really tangible concrete initiatives Which I think are actually saving lives But we need an initiative like that a collaboration like that when it comes to childhood trauma because right now While we have a trauma, you know, we have really good well-intentioned and smart people in government There are a lot of people who have levers that can be used to address trauma who don't recognize that if you go to the Department of Housing and Urban Development and you ask them is childhood trauma part of you know, your responsibility to address is at one of your charges You may get blank stares, you know other than from perhaps a few people who will connect the dots But that is a purpose of interagency efforts It's to connect the dots and to accelerate efforts, especially efforts that have diverse root causes So that's a place where I think we would need to we need to see the federal government go I'll say one last thing on this point, which is that In 2010 when the Affordable Care Act was passed There was a little known section of that law which funded Is something called the Prevention and Public Health Fund and that fund? also pulled together or assembled the National Prevention Council, which was a Council that was charged with developing a prevention strategy for the country now as a nation We've actually never had a comprehensive prevention strategy from the federal government but that was a charge of the National Prevention Council and Very importantly the people who were put onto the National Prevention Council were the secretaries and Administrators of all the major federal agencies so they included defense and housing urban development and interior And it was because it was based on the recognition that if we really want to build a prevention-based society It's going to require all of these efforts It's going to require us to think about how we design communities how we design housing How we you know design our schools and support our schools it's going to require all of this and for a number of years the National Prevention Council was a positive force in crafting a national prevention strategy, which We issued and then later revised And in also bringing departments together to start identifying ways in which they could advance prevention so one of the collaborations that I had when I was in the Administration and I the Surgeon General chairs the National Prevention Council, which is why I was privileged to engage with it so deeply But we work closely with the Department of Housing and Urban Development with Secretary Julian Castro to put in place rules to restrict smoking in public housing recognizing that For so many children It was in their homes in public housing that they were exposed to secondhand smoke and the racial disparities there were extraordinary And so this was an important first step that was taken But it was based on a recognition that housing development housing and urban development had a public health role to play and I don't know what exactly is happening with the National Prevention Council now There are a number of initiatives that we had over the last few years Which you know are either under review or in some cases being continued in some cases have been discontinued My hope is that the efforts of the National Prevention Council will be not only supported But actually accelerated because I think that kind of interagency Collaborative work to address core health issues like trauma is more important now than ever before Anyone with questions, please as before go to the mic, but I just wanted to follow up what what you said Dr. Murthy on Interagency efforts You know as I look at the policy landscape, you know, we human beings love our silos You know what we call the cylinders of excellence, right and Many speakers already this morning have alluded to the fact that we've got siloed policies siloed budgets budgets, so Who is the convener? Who's the catalyst? What is that thing that's gonna? Drive the interagency collaboration particularly in addressing because you and I know as we look at the landscape Healthcare education prisons corrections crime Doesn't it all just go back to what we've been talking about all day, which is this Where do we begin to? connect collaborate and create resilient families Individuals with equanimity. I mean that we're all treating as opposed to preventing who is that catalyst that's gonna? Promote this ongoing interagency collaboration to tackle aces Well, if you're specifically talking about within government who's gonna do this a single department typically can't Orchestrate that entirely on their own What it usually requires if it's truly gonna be interagency is it requires Leadership and initiative from the White House to say okay This is an issue that we think is a priority and so we are gonna mandate that all Departments participate in building and executing a collective strategy to address this issue That was something that President Obama during his time did around opioids Other presidents have done it around other issues that have been important to them There is a role also that Congress can play here as well if it creates a requirement to form an interagency Task force with a specific deliverable but this is this requires This requires leadership from a very high level To not only be instituted but then to continually have accountability So that it doesn't just become a committee that sits on a shelf and the question is like how do you get that onto the radar, you know of The White House or you know leadership in Congress and it's not easy right because there are so many competing issues and it feels These days like there's so much noise How do you and you know the press is interested in covering often things that are salacious and that are you know are Fantastic and extreme and surprising But it's sometimes these things which are not you know front-page news that make the biggest difference in the lives of the people We love so it's not easy But I do think that one of the key things that we're gonna have to do As a country if we want to prioritize children is we have to build more public awareness and support For initiatives like that for the issue of trauma as a priority And if you don't think that that that public support matters You know, I would point you to the area of breast cancer research, right? If you ask, you know, is breast cancer the the issue that affects and kills the most people, you know In the United States the answer is no it's not although it does affect millions and millions of people Including many people all of us know and love but what has been extraordinarily effective about advocacy in the breast cancer community is that There's been a remarkably successful effort to build not just awareness, but engagement Around the country from communities in funding breast cancer research and supporting treatment efforts And so you will rarely see members of Congress Valk at allocating funds to word breast cancer research But if you went into a member of Congress to members of Congress today and said, you know, we want you to fund You know efforts to address childhood trauma You may get some hemming and hawing, you know some agreement. Yes, this is important But not a whole lot of actual initiative And that's because they're they aren't hearing nearly as vocally From the public that this issue is important to me And this is an issue that I'm gonna continue to speak up on and this is an issue that we are I'm gonna pressure you on Now I want to cautious as a caution is about one thing which is that if you walk down the logic path I just laid out there you can ask the question. Well, there are many issues that are important How are we going to be fighting over a fixed pie here because who's to say that? Childhood trauma is more important than breast cancer research is more important than colon cancer research matters more than cardiovascular disease Like how do we actually figure this out? And that's where I think as a society where we have Perhaps aired a bit is in going far too downstream in thinking about how to carve up the pie We've thought okay We need a whole team and department and funding stream to deal with diabetes another one to deal with cardiovascular disease And in the same way mother that you were talking about moving upstream and how that has struck You and has struck me and many of us in our clinical practice is important to doing that We have to also think about doing that from a policy and funding perspective And so the question is how do we fund upstream initiatives that will actually collectively? reduce the likelihood of breast cancer and heart disease and substance use disorders in 2016 when I issued the the first surgeon general's report on substance use and addiction We dedicated a whole chapter to prevention, which is not typical but we did that because we wanted to emphasize the importance of going upstream and we wanted a profile specific programs like the Nurse Family Partnership that Doug mentioned earlier today But we wanted a profile specific programs that were effective in reducing substance use disorders Now the thing about many of these programs, which is something it's not going to be a surprise to those of you in the room Is that these were not programs that went into schools and beat kids over the head and said drugs are bad drugs are bad drugs are bad That's not how they actually ended up working, but many of these ended up being school programs that Strengthened the emotional well-being of children. They enabled them to understand and process and regulate their emotions more effectively and to build connections more effectively with other people and the downstream effects of that were seen not just in reduced rates of substance use disorders But in reduced rates of alcohol use tobacco use increased graduation rates reduced teen pregnancies reduced incarceration and you know an arrest reduced episodes of violence and on and on and on though the list went now in clinical medicine, you know, I remember from my training that we would get really excited if a cardiology interventional trial came out and showed a half percent or 1 percent reduction in in the incidents of MIs of heart attacks But these interventions are having double digit Effects in terms of reductions on the outcomes that we care about Yet, they don't get nearly the same amount of press, you know as a successful Clinical trial and they certainly don't get the funding they deserve what's going to change that ultimately the only thing I believe that will change that is Not, you know, simply having stories that are shocking because unfortunately we have become immune to shocking stories They seem to be a dime a dozen these days, which is tragic But I think what is going to change that is growing public support that is not passive But that actively demands that we invest upstream with that countability Because this is a critical point to make If you have funding with no accountability Then you will likely see no change and that funding will disappear because people say it doesn't matter It didn't make a difference, right and that unfortunately has been the history of many efforts at government funding Allocating billions of dollars, you know to X project and then not really you know having accountability of the impact I worry in some ways that that is what's happening part at times with our opioid funding, right? We are putting a significant amount of money to Toward the opioid epidemic not nearly enough, but we are putting billions of dollars to address it But if we had a problem in any of our organizations in one of your schools and one of your hospital settings and nonprofit organization As a leader your job would be to identify the problem To define what you needed to do to solve it to set a timetable for resolving that and then to also create a system of accountability But if I were to ask you in the opioid epidemic for example What is where are we supposed to be in a year by what percentage are we supposed to reduce overdose deaths or change prescriptions? Where are we supposed to be in five years? Are we all clear on what it is that we're supposed to do as a society to get to that singular goal? It's more it's murky It's not entirely clear and what I worry about is that if we do all the hard work of advocacy pump money into an issue And there's no accountability and nobody can show success at the end That money goes away and it goes to the next issue and that's a product thing as something We have to be careful about as a community that's seeking to draw more attention to this issue to get more funding for this issue Is that we have to have and demand that those accountability structures be in place as well? Great, and so what I'm hearing from you is an action item from today If we truly believe that this needs to be addressed as a nation How do we all in this room? How do we all in this room commit today as a take-away action item of? public service announcement public awareness I Know many of you are engaged individually and in your organizations to really strengthen the education and awareness of our communities But imagine the power of doing this together. I Just like us to reimagine what that could look like if everybody in our organizations in this room got together and we Organically created the task force to educate the nation on what aces is impact Imagine the power of that. So I I'd like us to reimagine what that could look like because PSA not prostate specific antigen but public service awareness To your point is what's going to amplify give stereo effect to what you and I have been talking about all day And we can keep screaming about this amongst ourselves But until we have the public behind us, I don't know that the Hill I don't know that the White House. It's really gonna understand what it is and what the impact is so So thank you. Thank you for that. Let me just ask you one other point of that email though Which is we talked a lot about what you have to do what would be helpful in moving the federal government? But you know, it's it's especially important that we recognize that there are other places Where action helpful action can originate from other than the federal side, right? the state governments are often incredibly powerful, especially now as as You know sources, you know of activity and and funding and you know I think targeting state-based efforts is is exceedingly important and the same issue of local efforts But even putting government entirely aside, you know, we're when you think about Insurance companies, right? This is the world now for insurance companies is very different than what it was 10 15 20 years ago and there are more payers including Medicare but private payers as well That are recognizing that in some way shape or form that they need to start engaging in more deeply in Prevention efforts and not clinical prevention, but in community prevention that they need to start engaging more deeply in understanding and then addressing the social determinants of health and that yes that there are funding model questions to be sorted out there But this recognition is very different now than it was, you know, 10 or 15 years ago And this creates a real opportunity for us, you know, if we can pull healthcare players together Along with education players, but including insurers who you know could be funding sources to together to realize look if we invest Upstream in addressing trauma. We will decrease our health care costs Significantly down the line. This could ultimately result in cost savings for payers as well as well as for health systems Then suddenly you start to align financial incentives with the health outcomes that we all care about But you know the question people ask me all the time as well Of course, it makes sense that if an insurance company focuses on prevention that they'll save money down the line So why why haven't they done it yet? There must be something else like bigger at play But you know, sometimes it there aren't Much bigger complex issues at play Sometimes these issues are about is somebody gonna stand up and lead the conversation be the first mover Sometimes there's risk in doing that which is why you have to get people together to say We're all gonna do this together and take on the risk collectively because then each of us will bear less risk overall and sometimes if an industry is not willing to do that they need to be pressured and pushed from the outside in the way that Sometimes insurers and payers can be pushed by the clinical settings that that they help fund and by the patients that they help Serve as well. So I say this just to to emphasize that while the federal government is an extraordinarily Powerful and important lever that we can use to address childhood trauma It is not the only one and I wouldn't want us to To be despondent when efforts to move the federal government fail Because there are other levers we can can and should be working on as well Great. Thank you. Hearing none. I'm gonna keep going So we're gonna pivot off the government aspect of How we address this and go to community support, you know, I I'm a firm believer and I agree with our former first lady Barbara Bush when she said that the future of this country is not dependent on what happens in the White House, but what happens in every home and Resilient families our communities We have a responsibility to help the families the family unit to be resilient and be stronger in your mind, what does If not government, what does broad community support look like in fostering and helping families And children be resilient. What does that look like? Yeah, such a good question, you know, I don't 100% know the answer to that I do know some of the answers to that in the sense that I know what it could look like But I suspect it would look a bit different in different communities But I'll tell you why this sort of strikes me so deeply because when I was When I started my tenure as Surgeon General, I spent the first many months Traveling to different parts of the country as part of a listening tour to under asking a very simple question To communities, which is how can I help and I certainly had an agenda that I had talked about in my Senate confirmation hearing that I wanted to Implement but some voice in the back of my head just said Let's put that on hold for a moment Let's just see if everyone agrees with this agenda or just to see what they have in mind Because maybe they'll be aligned but maybe they won't and there are deeper problems that people are dealing with that Should be a high up on my agenda and aren't And I heard a lot of stories about mental illness. I heard stories about chronic illness Of chronic physical illness that people were dealing with. I heard many stories about the opioid epidemic I heard about I've heard from teachers in schools who told me that their kids couldn't smoke cigarettes Obviously in class and couldn't chew gum in the classroom, but they were vaping They were using e-cigarettes because there were no rules around them. I heard all of these stories, which are very very powerful But when I think when I sort of reflected back on many of the families that I sat with what I heard in their stories at a deeper level were stories of emotional pain And the question that I couldn't shake was what's driving that emotional pain And what is happening to us as a result of that emotional pain? That pain is the trauma in a sense that all of us have been talking about this morning that so many of us have been worried about for years And one of the big challenges that I noticed communities have Is in having a language To talk about that pain and in having permission to surface it In discussion because there was nobody who came up to me of all the thousands of people that I met all Across america and small fishing villages in alaska or small towns in the midwest or big cities on the coast Not a single person who came up to me and said hi, my name is jane doe. I'm in emotional pain Nobody said that but it was so clear like in their stories And when I started surfacing it myself a few months in and asking about it There was this visceral reaction from people this immediate flicker of recognition that yes That is what i'm feeling like inside or someone I love is feeling that And I don't know how to give words to it. I don't know how to address it, but I know it's there And it's been there for a while And so part of I think the part of what we have to do as a community is we have to Start by making it okay for people to talk about it to delve more deeply into this emotional pain You know, I think about the many patients I cared for as an internist You know, and I'm sad to say that in the beginning of my medical career I didn't ask that much about emotional pain because I wasn't taught that in medical school Right, I was taught to ask a whole bunch of other questions. Uh, and but you know emotional pain was really kind of low on the list so That I think is one of those powerful things communities can do is to think how in my school In my workplace in my family Can I start to talk about? Emotions talk about the pain that we may be experiencing talk about the trauma that may be affecting all of us Because as we've discussed earlier today that the trauma that we're concerned about is is really Two types of trauma, right? It's a trauma. Well, you know that occurs when something happens to you Whether that's an episode of abuse or neglect or whether that's you living In a family a situation that's unstable But there's also the collective trauma that we experience every time there's a mass shooting in our country Millions of people around the country who live thousands of miles away are traumatized by that again and again every time A person of color is Has their life taken from them by someone in law enforcement that sends ripples all across the country From parents who are worried to death about their children and from young men and women who wonder if they're going to make it to their 18th or 25th birthday I want to say that with the mass shootings what we focus so much on that I think there's far greater trauma that happens in our communities as a result of the Smaller scale shootings that don't make the papers Ones that not only traumatize individuals, but That lead children to lose mothers and fathers and siblings And that lead people in their neighborhood to wonder if it's safe to walk down the street if we want to take ownership Of our well-being as a community It starts with acknowledging what's happening to us With make creating a space for people to actually talk about that without judgment And I say this particularly for men Because I think that we live in a society with a brand of masculinity That tells us it's not okay for guys to Talk about emotions much less experience them We tell young boys That they have to be self-sufficient and that being dependent on anyone is uh You know is a sign of weakness or not being a real man That's really crippling to young men And I don't think it's a coincidence that when young boys shift How they talk about relations how they talk about relationships from Talking about loving their friends and being very open with their emotions to when they're early adolescents being very stoic That that coincides with a dramatic increase in the self-harm and suicide rate among young boys So this is a place where all we don't need federal action or government action of any sort This is a place where we as individuals can begin these conversations and we could lead by example As people told me before I had children. They said your kids won't listen to what you say They'll listen to what you do and when we model behavior That shows children are children that it's okay to Acknowledge and talk about what's happening to us at an emotional level There's a greater likelihood that they will follow through and do the same Thank you. Yes, please Hi, I'm sorry. I'm short um Don't be sorry. Don't apologize It's really good to to hear all this conversation and I'm really glad that you brought up the issue of kind of the collective pain that you were That you were identifying and especially in connection with Then all of the data that has come out about the so-called disease of despair That hit the radar once there was a certain class of people Who are articulating or we were seeing the results of that collective pain, right? so in the context of a lot of this being rooted in the You know community there was a slide earlier this morning about like this the community trauma um at which is in itself also rooted in Decades and decades and generations of Privileging some communities with resources and assets And then using other communities You know overwhelming them with risks and lack of resources It's hard to imagine how Community by community, especially in those that have been not to get into a deficit framework But those that have been clearly under resourced over time How do we get the resources into those communities other than through some sort of federal framework, right? so Having been in that federal space. Where do you think would be the most effective ways to get to some of those? That redistribution of risk and resources and health that has to happen If we really do want to get to a place Where we achieve health equity Well, I mean this is it's such an important question and uh, it's a tough one, right because money as always feels like it scares and the people who often have power don't want to Often divert money from the places that it's traditionally been going so So this is hard, but I think When I talked earlier about the importance of building Power and advocacy and bringing communities together that are Understand where we need to focus our efforts and are willing to push their elected leaders to do so That's building political power Right and political power doesn't have to be partisan power But it has to be power that we choose to amass for the purposes of achieving a goal And I think equity has to be at the at the top of the list In terms of that goal like look, this is a fun. This moment in our country Is one where we have to ask ourselves a fundamental question of values, which is what values are going to guide us In our policies in the movements that we build in the programs that we support and run in the institutions that we manage What values are going to guide us And what I worry about whenever somebody tells me, you know, I voted for you know, john doe for uh for mayor I don't really agree with john's like, you know philosophy. I don't really like john I don't think john shares my values, but you know, john is going to pass policy x, which I like And it's going to help me so i'm going to vote for john that always sends chills down my spine Because we don't know 99 of the decisions that our leaders make because we can't keep track of all of that You have to trust in the values of that person in their perspective And so to me Equity has to be a priority But will only be a priority reflected in our policies and in our government if we as voters demand that Of the people that we put into office at every level at local state and federal levels Look on a On a deeper level I think the the question of values to me boils down to the fundamental question of do we want to live In a nation that is governed by fear Or in a nation that is inspired by love It's a somewhat binary choice, but it is the choice Right when we are living from a place of fear We see a lot of what we see today. We see people acting out of anxiety We see a lot of anger. We see insecurity And we see out and out fear when we are acting from a place of love as all of us have experienced at some point in our lives That's a place of generosity of compassion of inspiration of kindness. Those are the things that flow from love And right now our world is locked in a struggle between love and fear And the question is what's going to tip it one way or the other? One thing I do know is that when children Live parts of their life in deep fear For long periods of time that is deeply traumatic And one of the most powerful antidotes to trauma is in fact love It is the love that you get from your parents from your teacher from friends It's knowing that you matter and it's knowing that you belong Such powerful things that we can provide to children and that we can provide to ourselves Because the truth is The trauma that we're talking about today is not just affecting kids It's affecting adults How is a child supposed to heal if their parents themselves are deeply traumatized and their teachers are too? We are all living the result Of trauma that we have not acknowledged And that we have often underestimated And so this to me this boils down to a fundamental question Of values but a question also of do we want to live in a nation of love or fear? And my wife and I thought deeply about this a few years ago when we found out we were pregnant for the first time We have a 22-month-old at home and a five-month-old at home and When our 22-month-old when we were pregnant with him, you know, we were so excited. We were just absolutely thrilled We had been wanting to have children. We were so excited to be parents and We sat down though after looking at that pregnancy test and seeing that it was positive and just Hugging each other and just have you know just crying over And just being so thrilled we sat down and we it started to sink in and and we started thinking about what was happening in the world We started thinking about the fact that Young men had lost their lives in communities As a result, you know of violence We started thinking about the fact that young women were the result Were the were the victims, you know of sexual assault all over our country and on college campuses And we started to think about our child and what kind of world we were bringing him into Would he be safe when he went to school? Would he be supported by people in his neighborhoods? Would he live in a world that was powered by love or one that was constrained by fear? That's what we thought about in that time and we knew as two people we couldn't solve that entire problem But what we knew then and what I know now Is that each of us in our own way Can put our finger on that scale and can tip that balance more toward love In the work in the interactions we have with the people around us and the causes we choose to focus on On the matters in which we choose to speak up about you know if if it turns out that speaking up on The behalf of children and the people you love makes people label you as controversial and political Then you should do it anyway Because it's worth doing it's what matters And we need more people in our country who are standing up For what matters for the for our values as opposed to specific policies and positions And finally on this just remember this what you read in the newspaper Is not a true indicator Of where the country is in terms of how people feel If you read the papers you would assume everyone in this country is cynical They don't want to be involved You know in any causes they're just focused on themselves everyone has turned inward That is not the case all of you are living proof of that But I want to tell you that you are not the minority Because when I reflect on the people I met over the last few years when I during my time in office I met people who were scared. They were worried. They were feeling cynical but underneath that Was idealism and a desire to feel hopeful Underneath that was a desire to want to be a part of making their community better And each time one of you stands up to speak up on behalf of children Each time you stand up and push your government to do the right thing for our kids The ripple effects are extraordinary you inspire people around you You let them know that it is possible to stand in strength Even in the face of great adversity So that's why I'm so grateful that all of you are taking this Up upon you know They're taking this issue on that even in tough times that you're not backing down But I want you to know that you give strength to others When you speak up and when you do the work that you have been doing so I'm very grateful to you for that great Did you have comments there? Maybe one last comment or question I am also short Thank you so much for everything that you've said and particularly what you've said in the past couple of minutes It's very moving and Just to lift up some of what you've been talking about I do think that in this conversation about trauma We do have to figure out how do we language this in a way that makes sense to people And you named emotional pain as something that everybody feels I feel like when we Expand our lens not just about trauma, but also about stress I feel like that word really and people can really relate to stress that it that kind of language allows us To move towards What gregory boyles talks about is radical kinship, right? Where we stand with people in the margins not because we're trying to make a difference But because they make us different and when we have that sort of proximity It allows us to lead from a place of love as opposed to a place of fear Which is so important because what we know is that fear and stress actually exacerbate things like implicit bias and stereotype thinking So really coming at this from from both ends becomes really important And the last thing I just want to lift up is the psychological safety even google is talking about this now, right? That psychological safety the ability to know that I might make a mistake If I take a healthy risk and make a mistake. I'm not going to be crucified for it Ends up being how we help you have more productive and healthy people in companies and citizens and communities so um, I think Trauma fragments and there's all these different ways of talking about this But the more we can bring that language together as you've talked about Um, I think that we'll be able to make a difference, but thank you so much for everything you said Yeah, I appreciate that I also want to thank you because you brought the lens at least for my learning today of As I think about policies procedures tactics strategies for capy northwest Is this trauma reducing or trauma inducing? That lens is very helpful. So so thank you for today. Yeah, well you said it was so beautiful Thank you for for sharing that I felt sort of a little shiver when you when you shared those words Look you're you're absolutely right that um Language is really important and one of the things that we're also fighting against Is fragmentation it feels like there are so many causes out there Uh, which one do you support? How do you get the attention of the public people are hearing about climate change? You're hearing about how you know people being uninsured with health. They're hearing about all kinds of crises I think that there is a larger umbrella though that we can think about childhood trauma under and that's under the umbrella of emotional well-being and with the counterpoint of emotional well-being being pain and stress and trauma And when when I came out of office I having worked on a number of issues But including opioids in particular and addiction more broadly I was thinking about what what what should I do now if I want to make a contribution to the world? Where can I help and what I concluded was That as opposed to focusing specifically just on opioids or just on Gun violence or just on e-cigarette use That the place that I want to focus was on the deeper root cause of emotional well-being for children And adults for all of us And it turns out that if we are thoughtful about this and skilled in how we communicate about this We can help people see that emotional well-being is connected to all the other big issues We care about that emotional pain that I was seeing everywhere as we all know Translates in part to a greater experience of physical pain And when we are struggling to figure out how to deal with people who are who have chronic pain who are using opioids It seems so obvious now that we should not just be looking for a location of physical injury But we should be looking more deeper for a source of injury But I think that this umbrella of emotional well-being is is really important. It's an issue I've decided to focus my time and attention on it's why My colleague Jessica and some of us have decided to work on building an institute to lift the profile of emotional well-being to build public support for it to lay out an agenda from a policy and scientific perspective so that We and to try to build action collaboratives to execute these agendas so we can make emotional well-being the foundation You know of our society not just an afterthought, but I think that is Language and creating those umbrellas are really really important And I think the language that you just used now is very moving and I think it would speak to A lot of people so I applaud you for focusing on that But I want to say that the most important ingredient that we need To build a movement to improve the emotional health of our children and adults to reduce trauma is we need passionate people like you You know when you think about how big movements are billed The most important ingredient in building movements is not money And it's not infrastructure. Those are really really important But it's the people and it's often a small group of people who get together and decide, you know what? We can live a better way and we are going to ensure that we live a better way And we are going to be the ones who build that movement whether we affect 10 people or 10 million people And so I know it can be I've worked on building organizations before I know it can be a lonely journey. It can be a tough experience But I do want you to know that when I come here and I was sitting in the back some time ago listening to The panel earlier and hearing the questions that were asked. I want you to know that I draw hope from you as well and it gives me Encouragement and inspires me to know that of all the things that you could be doing And probably making more money doing some of those things that you have chosen To focus on kids to focus on reducing trauma Because you recognize that at some point our values have to matter more And if we truly are a society that values All life where every person has worth Then we have to act that way We have to reach out to those who are less fortunate than us We have to help that child Feel that just because their mother is in prison or because their father Is using heroin does not mean that they are fundamentally broken as well We have to help them understand that just because they may not find love at home does not mean that they are not worthy of love And so that is the inspiration that you have provided me But there are many more people who will be inspired by the movement that you are building But let's yeah, let's focus on that language It's build that broader tent an umbrella that can bring people in and then let's help the country see the connections Between our emotional well-being and all of these outcomes that we care about that we read about in the papers Great. Thank you very much. Thank you. Dr. Murphy. Thank you all