 Good afternoon everyone, my name is Deandre Calvert and I'm the Community Engagement Manager for the Program and Practical Policy Engagement here at the Ford School. I'd like to welcome everyone to our Young Leaders and Public Service event with our special guest, Mr. Michael Randall, who is the Senior Director of Community Impact for the American Heart Association. Right now, I just want to make sure everyone knows that this event is being recorded and I'd like to acknowledge Maryam Nagarin, who is our administrative assistant and our tech guru, who will be helping behind the scenes and also our Associate Director, Ms. Cindy Bank. Right now I'd like to introduce Michael. He is one of our community partners with the PCLP, the Independent Study through the Program and Practical Policy Engagement. We worked for the last two semesters now in the spring and in the fall on tobacco issues within public schools in the state of Michigan. Michael wears many hats and actually was just promoted to this current position, so congratulations on that. But it's been an honor to get to know him, working with our students and seeing all the work that the American Heart Association does. So without further ado, I'd like to introduce Mr. Michael Randall. Awesome. Thank you, DeAndre and Cindy and Maryam. Thank you for having me. It's actually been a tremendous pleasure to be working with the Ford School in this work with tobacco related issues and vaping issues within our public schools. The American Heart Association for a number of years has had an interest in preventing tobacco usage for obvious reasons. Of course, tobacco use is prevalent in individuals who end up leading the life of cardiovascular disease. However, we've seen a resurgence of tobacco usage is primarily in our younger population, middle school and high school age individuals because of the advent and the distribution of vaping products. And so there's been a renewed focus on this issue. And we were blessed and fortunate to be connected with DeAndre through La Sonia Forte through a connection there and it's really just been really off to the races. We developed the practicum, we were able to submit that and get some students interested in that. So we're in our second semester. I'm really looking at school policies and how those policies support students in their journey to prevent tobacco usage or stop and create cessation opportunities for students who are addicted. So this is a epidemic that our young people are dealing with. And it's really awesome to have students from the Ford School really help us look at these policies and figure out how to engage K through 12 education when it comes to developing policy that support of the now punitive and nature. So, once again, DeAndre, thanks for having me appreciate it. So now at this time, you can take an opportunity to explain your journey, how you got in this position and some of the work that you do with the American Heart Association. Absolutely. So, so I currently serve as the senior director of community impact for the American Heart Association. That primarily covers the entire state of Michigan when it comes to what we call our health strategies work. And that work falls into three buckets. So the first bucket is heavily focused on our clinical partners. We work with large health systems like the University of Michigan health system, Beaumont, the human forwards of the world. We also work with a lot of small fairly qualified health clinics as well, free clinics and other primary care providers as well. And a lot of that work with our clinical partners is focused on improving health outcomes for patients that are disproportionately impacted by cardiovascular disease. So we have several quality improvement programs that we offer to our clinical partners that are based on the American Heart Association guidelines around cholesterol management, hypertension management, and more increasingly type two diabetes management. So you probably are familiar with, you know, the American Heart Association guidelines 2017 American Cardio American college cardiology American College of cardiology I'm sorry I was messed up on guidelines that really help, you know, keep guardrails in terms of how physicians and cardiologists are caring for patients that are dealing with these chronic conditions. So I kind of act as a consultant I work very closely with quality improvement directors, chief medical officers, I'm really looking at those, those guidelines and creating protocols and algorithms to help improve clinical workflow, create efficiency and really prevent the misdiagnosis of hypertension and cholesterol and other things. We also work primarily in, in medication adherence as well. So statins, aspirin, other, you know, beta blockers other drugs and prescription drugs that are used to help individuals that are suffering from chronic conditions like cardiovascular disease and stroke. So that's one bucket the other bucket really focuses on our community engagement and so this is kind of where the forest pool comes in. We have several areas that we work in, in terms of creating what we'd like to call environments that make the healthy choice the easy choice. So a lot of those things are based on policy so like take tobacco for instance right, you know there's laws around, you know, age and possession usage of tobacco that help safeguard, you know, industries to prey on young people right to sell, you know, cigarettes to individuals that are underage right there's laws that protect against that so it helps to, you know, create an environment that's conducive of lower tobacco usage right and what we've seen increasingly is you know the vaping industry has taken advantage of loopholes and laws and created products that are very addictive and are being promoted directly to young people. So we really try to look at policy systems and environmental change that we can that we can help municipalities and and even even states and even on the federal level help create policies that create environments that hopefully help people make healthy choices when it comes to their cardiovascular health, which we found by science is a is a proxy for overall optimal health. So, tobacco falls into that we also work a lot in environmental spaces and so clean water clean air. We also work with transportation organizations providing transportation to low income individuals we work a lot in that space we also work in affordable housing, because affordable housing also is a proxy for life trajectory and life expectancy. And a lot of our work, we're, you know, is focused on that area, and really looking at how we can create policies and systems and environmental changes to help improve those environments. And the third bucket really is our volunteer focus, you know, we are a volunteer health organization. So we've been fortunate and blessed to work with fantastic organizations, all throughout the world that are interested in and cardiovascular health are interested in overall health and and reducing some of these disparities that we see in this area. Again, disproportionately impacting people of color and women and low income individuals. And so my work in that area is just can continue into hardest and cultivate relationships with organizations that that care and understand our mission and want to help us move forward. So that's pretty much my role at the America Heart Association. How I got to the AJ is, is kind of an interesting story. I always say that, you know, I didn't really choose population health and public health it kind of chose me. I was an urban planner by training out of college I wanted to do affordable housing I wanted to work for a local nonprofit housing developer or even working in a city planning department or something like that with a focus on community development and and housing development. I had an internship at the Ypsilanti Housing Commission not too far from campus, and I have my internship I felt they went well and I was not offered a job that was I was hoping to be offered a job but I was offered a AmeriCorps position the actual position was for a health navigator within the Washington County Health Department, and the executive director at the Ypsilanti Housing Commission connecting me with that opportunity, and I spent two years as an AmeriCorps worker working within the department, and I primarily work and benefits access so I help people get connected with Medicaid insurance, Medicare insurance marketplace insurance. This is what this was in 2013 2014 so this is right when the Affordable Care Act was passed and Medicaid was expanded in the state of Michigan. So, as you can imagine, overnight, we had close to 25,000 newly eligible individuals in the county so it was my job to go out in the county and build capacity to get all these people enrolled. And it was a challenge we had very small, many grants that we can help churches and, and schools and anyone that would, you know anybody anyone that care. We would give them small grants so they can buy laptops and printer and scanner so they can assist individuals in the community that needed to be connected with newly, newly passed Medicaid expansion right it was a very exciting time. And that was my first. That was my first, I would say, engagement when it came to like population health, population level health care. You know, looking at counties right now just looking at like direct service or point of care service like a nurse caring for a patient or a doctor care for a patient. And looking at increasing levels in the tens of thousands in terms of people that were enrolled. And so it got me interested in looking at what were some of the barriers, or what were some of the policies that could be in place to help make these processes more efficient. I would look at the Michigan Department of Health and Human Services and the role they played, you know, I would look at the county health department and the role that they played and also other social services, and the roles they played in terms of this ecosystem that was either sometimes very helpful and very useful but sometimes created several barriers to individuals that were accessing health care. So from there, I went to a Medicare managed care provider called AmeriHealth Caritas is an integrated care organization, and that was my first introduction to really looking at urban problems so that organization service to tri-county areas so McComb, Oakland, and Wayne County. And most of the patients that were serviced under this integrated care organization were in the city of Detroit and I once again was a healthcare navigator. And I was, you know, looking for hard to reach patients, right? I mean, connecting them on services, connecting them with primary care, and also doing social determinants of health screening. So I had patients that were living in very high levels of poverty, individuals that, you know, living homes with no heat, individuals that had live sewage in their basement, individuals that didn't have roofs and were using a tarp for a roof. So these were extremely impoverished conditions, and I was tasked to connect them with health care. So once again, looking at those barriers and knowing that, you know, these organizations were funded by CMS, these were Medicare funded organizations. However, we were still having issues connecting patients with their health coverage. So once again, I'm ruminating. I'm in my car in 95 degree weather, and I'm looking for hard to reach patients. I'm knocking on doors, and I'm thinking like, what are the systemic issues that are creating this, right? Does this individual know, even know that they've been enrolled into this health plan? Oftentimes, you know, Medicaid recipients, they get auto enrolled in the health plan. They don't even know that they have it, right? And so I would knock on their door and they would say, well, who are you? I'm from AmeriHealth. When is AmeriHealth? That's your insurance. I didn't know I had that insurance. What is that? They may have went to the emergency room and got connected with a social worker and a social worker enrolled them in the healthcare coverage. But they never followed up, and so the state just enrolled them automatically, right? And so imagine going years without actually knowing you have healthcare coverage and your teeth are rotting out. You're going deaf and you don't have a hearing aid. You're going blind and you don't have glasses, right? But you've always had this coverage, right? You just didn't know, right? These are some of the things that I was experiencing day in and day out. You know, in one day, I just got a call and it was a woman and Jenny Shelley from the AmeriHealth Association asking me if I wanted to apply for a community impact director position. And I was like, absolutely. Because I was familiar with the AmeriHealth Association. You know, I had working clinics that were enrolled in some of the quality improvement programs. I really didn't have an extensive understanding of the knowledge of what the AmeriHealth Association does, but I knew they focused on like a population level with a bunch of individuals, and they were really heavily focused on advocacy, awareness, and policy, which is kind of where I wanted to go. So, I joined the AmeriHealth Association three and a half years ago, and it's been awesome, you know, taking all of that experience from the frontline, and then figuring out how we can use the platform of the AmeriHealth Association to reduce barriers. Do the barriers still exist? Absolutely. But I think that, you know, organizations like the AHA, which has historically been focused on research, recently has looked at, you know, social determinants of health, looking at these barriers that I experienced on a day to day basis in the field. And they're actually looking at ways to solve it. You know, hiring individuals like me was not something that the AHA did, but they're really focused on those social determinants. Which, by the way, 80 to 90 percent of heart disease is preventable, right? And where we see the prevention happening is reducing these risk factors when it comes to that 89 percent, and those are the social determinants, right? The social factors of transportation, access to food, housing, air quality, water quality, education, you know, things like that. Those are where those 80 to 90 percent of risk factors live. And so, you know, if we're ever going to, you know, stem the tide of the number one killer, which is heart disease, you know, organizations like the AHA, the CDC, WHO, they have to start thinking about these social determinants if we're actually going to move the needle. So, yeah, that's pretty much, you know, my story, I was born and raised at IBC, so not far from U of Mims campus. And I've experienced these personally, you know, you know, coming from, from Ypsilanti and, you know, working class background. So it's really cool to bring all that experience and help, you know, craft initiatives and policy at the AHA that's meaningful. Thank you so much for that, Michael. And it's so interesting that the journey you take, but all with the, with the specific goal of being able to, you know, help those and communities that don't necessarily have the access that others might. So at this point, we will jump into our Q&A. We want this to be a dialogue, so please raise your hand to ask a question or you can feel free to type it in the chat, but right now I see that Nathan has his hand raised and feel free to ask your question. What's up, everybody. How's it going, Michael? Nice to meet you. Thanks for being here. Actually, it's interesting. I work in Medicaid right now. I work for the state of Maine and it's a Medicaid accountable care organization. And so basically I'm a payer, right? And so I hear you saying this, all this stuff I'm interested now from the standpoint of the American Heart Association and your experience in working with healthcare and managed care. What ways do you think that those two organizations, those two styles of organizations both involved in healthcare but kind of in different aspects of healthcare? How do you think that they could more effectively work together in order to kind of facilitate better outcomes for Medicaid members, right? I think that's something that I'm constantly trying to figure out. How can we get more of these healthcare stakeholders involved in working in the right direction at the same pace, you know? Oh man, Nathan. Well, first of all, we need to get you into the AHA number one. I didn't do it, man. It's so funny you asked that in awesome ACOs, ICOs, very similar, you know, very similar organizations. And I just had a call today about, you know, how we can bridge that gap, you know, in terms of the goals of an integrated care or accountable care organization and what the American Heart Association does. And I think about the HEDIS measures and CMS star rating and quality improvement goals that oftentimes keep these integrated care organizations or ACOs open, right? It keeps them in business, right? Looking at improving their quality of care. That's how they're able to continue to get funded through, you know, CMS and other organizations. So I think that we need more organizations that have individuals like me and you in their organization, if that makes sense. I mean, I came to the American Heart Association and I would say these things like we really need to work with more ACOs and ICOs because I see this energy. And, you know, oftentimes it's like, okay, that makes sense. But sometimes it may fall on deaf ears of individuals, as I've already said, like HEDIS measures, people may not know what that means, but you do because you work in the space. So our goals are very similar, but the lingo and the vernacular and the lexicon is different. So it's going to take individuals like us to help be a translator, if you will, because the AHA wants people to use their guidelines when it comes to hypertension management, cholesterol management, type 2 diabetes management, and ACOs want to close care gaps. So those are the same end goal, just different routes. And so if we work together, sometimes we can even augment individuals staffing, right? I always tell quality directors at an ICO or a friendly qualified health clinic or even a health system, look at me as an extra set of hands. I can help you reach your goals and you can help me reach mine. And so you said it, right? Sometimes oftentimes it comes down to the purse, right? It comes down to keeping organizations sustainable and keeping them open. And I'm 100% okay with having that conversation. I think it's interesting. I mean, one of the things that we do, right? You mentioned HEDIS measures, it's like, we need our organization internally just needs to transition into a more of an outcomes oriented measurement system versus like a process oriented measurement system. And I think that that's like very clearly, or I hear that kind of reflected in the same thing that you're saying. It's like, how are we making sure that we're adhering to ACA or AHA guidelines versus just making sure that these processes are done from the standpoint of the provider, right? Like, it's just an interesting kind of dilemma and the ability to fix that is so much easier said than done, you know? Man, maybe you're absolutely in my head right now. I mean, you're absolutely right. You know, oftentimes payers are just doing things for complying sake, right? How can we stay compliant and not end up in receivership, right? And so, but ultimately, you know, Nathan, and you'll see as you progress in your career, sounds like you're going in the right direction. But one, you'll see that it's not just payers, right? Our healthcare system as a whole has gotten used to the status quo, just keep the lights on, stay in compliance, you know, keep CMS out of your hair. We have to get out of there. We have to get more focused on and more aligned with better health outcomes. I think that's why we all got into this space. Nobody got into this space to just keep the doors open, right? We got into this space to help individuals, right? So, you know, but it's hard when the day-to-day is, you know, just putting fires out, right? And so at some point during that day, when you're definitely putting fires out, we have to have conversations about how we can, you know, work a little bit more upstream to improve better health outcomes. Thank you. Well, actually, there's a question in the chat that we'll go to if you'd like to unmute and ask. Hi, Mr. Randall. Thank you so much for your talk. I wanted to ask about the community's response to efforts to integrate care, and especially in terms of the AHA's efforts because there, I'm sure there is a sort of gap in knowledge, like understanding exactly, especially when it comes to like CPR and care that can be provided by bystanders. So you could talk about that a little bit. Integrate care. So, yeah, I'll start with CPR and, you know, we've definitely seen an influx in organizations, faith-based organizations, community development corporations, a more of a shared responsibility when it comes to improving overall out-of-hospital cardiac arrest rates. The city of Detroit is almost dead last in the country when it comes to survival rate for out-of-hospital cardiac arrest. And so I think that the AHA, we've been trying to get the awareness out of those rates, and I think that it's done a good job because we've seen an influx in, I would say, non-traditional or non-healthcare organizations that are more interested in integrating, you know, CPR training and other, you know, CPR-related educational opportunities within their organization. But we have a ton of work to do when it comes to integrating CPR education. We're also integrating behavioral health. We've definitely seen an influx of the need for that, especially during the pandemic. So we have a long way to go, but I do think that there's been ground softening that's been happening for the last several years when it comes to welcoming non-medical or, you know, non-traditional organizations to the table and really figuring out how we can create more community health initiatives that integrate, you know, behavioral health, CPR, and other things that can potentially be administered or, you know, be championed. We use that word champion a lot. So, you know, we have a lot of conversations with our ambassadors or ambassadors in the community. We really, really try to create community clinic linkages that can reinforce care and non-healthcare or non-clinical settings. And, you know, I've been enthusiastic about the energy and the interest of organizations that are looking to really help facilitate those opportunities in the community. Thank you. Absolutely. Cindy, you had your hand up? Sure. Michael, this is just wonderful. And your passion for what you do really comes through. And I was really struck by you talking about how public health found you. And it's a great example and something I often tell students about, you know, walk through that open door. You don't know what it's going to be and you've got to try it out. And even if it's a little bit different than what you think you're going after, you never quite know where it's going to take you. So thank you for sharing your story. My question is more on how many years ago, before I started working for the university, I was working for a government contractor that did a lot of work for the Center for Substance Abuse Prevention. Did a lot of work on alcohol, tobacco and other drug prevention. Back then, and this is mid 90s or early 90s, it was like we really had a hard time pushing the idea of prevention because it was, I mean, while people sort of understood it. And I think we all understand if you prevent something from happening. It's a good thing and that happens with heart disease, certainly. But because we really couldn't put a dollar amount on it, sort of a hard sell. So, in the sense in the policy world now of is the prevention argument stronger or being being heard and being acted on. Well, certainly in heart disease. It's really, really hard to fundraise on research when the, the, the entire research community says that about 80 to 90% of heart disease preventable. Right. And so, you got to work in prevention when it's just overwhelming in terms of the risk factors that, you know, that lead to cardiovascular disease and stroke and, you know, looking at diet and sodium levels and and exercise and the impact that that has on, you know, your cardiovascular health. So we've seen a lot of funding in the prevention side. I mean, I pretty much work in the prevention side. A lot of the work that we do in the community around policies systems and environmental changes are our gear toward prevention. So I do see, you know, a number of opportunities in that space and I think that the community has kind of got with the program, if you will, on prevention when it comes to funding for that for tobacco and substance abuse. It's difficult. It's really difficult. It's extremely political. It's extremely political. When it comes to, to choice, right, and preference, right, we're seeing that in vaping as well. You know, you may have parents that say hey, at least they're not smoking a pack of cools. You know what I mean? Like this is, you know, so it's vaping form of prevention for more traditional, you know, tobacco usage, right? And so I guess when I say political, I mean, it falls into do polarizing schools of thought, right? So it's difficult to to fund things around prevention when it comes to that if it's such a hot button item and it's very contested. That can really mess up a grant cycle, right? You know what I mean? You're putting in a narrative to get this program funded and then you're having people even on the planning committee that have these, you know, very polar viewpoints. And that's what my experience has been. You know, I was just thinking about DARE, right? I'm a kid of the 90s and so I believe that DARE was very effective. I mean, I remember my DARE classes. I remember the sheriff department coming into our classrooms and giving us those DARE bumper stickers, right? I never used those type of jobs. I mean, I think it was very effective. I mean, it wasn't like those drugs weren't available, but I remember those DARE classes and I recently just looked up an article and then like DARE was 100% not effective. And some instance and increased the usage of it, right? So again, he's very polar, you know, experienced it. And all of it is qualitative, right? Everybody is like, well, did it work? I don't know. What are the numbers, right? And so, you know, that's something that's a challenge that we've had. You know, we have fantastic partners like the CVS Foundation who just believes in this, right? Like they removed tobacco products from their stores, right? And then their stock price went up, right? And so, you know, what we've been seeing is, you know, organizations like I'm going to take a leap of faith because I just know that this is probably what we should be doing. And CVS, you know, has been one of those partners that said, like, look, we're just going to do this because we know that this is the right thing to do. So I don't know the answer to the question exactly, but that's kind of been my experience. Yeah, no, I appreciate that. And I just wanted to make one other comment is somebody very close to me who was a recovering alcoholic was well into recovery from alcohol and then gave up smoking. She said to me it was far more difficult to give up smoking than alcohol to show just what a strong drug that is. And that's what we're seeing. You know, look what the vaping industry has done. And, you know, we would do, you know, before COVID we would do community conversations at some of the largest schools in the state. We would have people outside protesting, you know, protesting the right to, you know, consume substances. And, you know, so it's a very, it's a very interesting space to work in and navigate. And, you know, your, your, you know, your, your story about your friend. Our stories that we typically use when it comes to, you know, working with, you know, with Lansing and maybe doing phone calls to, to lawmakers and galvanizing some of our volunteers. And we typically don't go to charts and pie charts and graphs. We use stories like that. You know, we use these very personal and very personal anecdotes that help to potentially usher in funding and resources to help, you know, create opportunities for prevention. Keep up the good work. Let you know how it goes. I'm in the fight. Michael I had a question for you. I was wondering how do you navigate equity in the state of Michigan. You know, I'd like to joke. Much one giant farm surrounded by water with, you know, like a, with a baker's dozen of cities, half of which are very suburban and the other half are very, very urban very black. When you are faced with different health issues. Do you run into any barriers trying to have specific focus in these communities or, you know, how do you, how does that you and the organization kind of navigate the different spaces within our state. Absolutely great question. I started with personally. So personally, I'm a black man. So, you know, anytime I come into the room, I bring myself with 100%. I'm a black man. I come from a primarily African American community. And I've lived these barriers myself. So you cannot tell me what someone is experiencing or what you think someone is experiencing until you've lived it. I've lived. So I bring those experiences with me. And I, and I would encourage anyone that's on this car is going to do this call to do the same. You have to bring yourself into conversations, especially when it comes to your profession, your specialty. And where you work in your focus area and that goes for African Americans or goes for other minorities, LGBTQ women, you have to bring that experience with you because you are an advocate for said community period. So I really, really strongly advocate for that. When it comes to health care quality of care and health outcomes is absolutely and help as as absolutely in health equity issue. Right. The numbers do not lie. Individuals and certain demographics and populations and geographical areas are disproportionately impacted by chronic disease. It is that simple. And so, if we want to target a focus group or a specific area geographical area. We're using the data. You know the American Heart Association is a as a science based organization. We funded research close to $5 billion for the last 90 to 100 years. And so the things that we do in terms of initiatives and focus area is very steeped and rooted in science and data. So if I work with a fairly qualified health clinic in the city of Flint, and their population health data shows that they have a hypertension control rate within this clinic of 30%. And I also look at their demographic and their demographic is 80% African American. And we need to go into that clinical partnership with an understanding of how hypertension impacts African American individuals. Period. What me and they can we're talking about in terms of improving quality of care and care gaps right. So now you overlay that with social determinants, you look at the educational level. You look at their access to transportation you look at their house. Right. You have to take those factors into consideration. You have to, or you're not going to improve those care gaps if you have community health workers, then they're all your staff that are familiar with these barriers. The population is being disproportionately impacted by these chronic conditions. If you don't look at the social determinants you're not going to be able to treat them. Period. So that's working way way way upstream. But you have to approach these things with help with with an equity lens. And it's about looking at the science and about looking at the data. So that's how we navigate I think the American art associations doing a tremendous job, you know where there's areas where I'm critical. When it comes to this, I think that we're doing a tremendous job, because we're letting the data drive our initiatives, our resources and our focus area. And, you know, I cover the entire state of Michigan. So, you know, looking at county level city level data to figure out where to pinpoint initiatives and where to solve problems. Thank you. Thank you for that. I was wondering, does we have another, another question if you'd like to unmute. I'm sorry. For the last point. I just wanted to ask, has there ever been an instance where there was a need or a desire for a certain kind of intervention or effort, but there wasn't enough data to support that like, but you probably have input from the community or from experts that this is something we should try. So, so so not really in my purview, you know the American Art Association. What I will say is that we're very focused. And so we have certain areas that we want to influence and impact. And so there may be an instance where individuals may want the American Art Association to do specific things. And so what we do is we try to look within our goals as an organization. Look at our impact goals when it comes to increase in life expectancy by 2024. You have to be extremely focused and disciplined if you're going to get to those goals right. And so we might have an organization that might come to us and say you know what Michael. I want, you know, the American Art Association do a health fair in my community. Right. We have to look at those initiatives and really figure out if it's going to move us forward in terms of increasing life expectancy, which is the overall goal. So, could that health fair where we're doing blood pressure screening, absolutely that could, that could definitely make an impact, micro impact in that community, more people are screaming for for for blood pressure and then more people are connected with primary care right, or we could take a step back, and we can work with the local health system. And so we create a continuing screen opportunity for all patients under a certain demographic or income level that they can get those screenings for free year round. Right. So now you've gone from 20 to 30 person impact to 20 to 30,000. That's kind of how we have to look at opportunities so I will say that there has never been an instance in my tenure that we've, you know, now had the data to support a certain initiative wherever you see people you'll see heart disease. And so we're needed everywhere, but we have had to take a very focused approach to our 2024 impact goal. We're looking at a population level and figuring out how we can, how we can best serve the needs of, of our partners. Thank you. Let's go. Okay, I got a question along those lines. Oh, sorry, let's sign it. That's all right. I already asked a question. That's okay. I think about, you know, your role at the American Heart Association and I think about how does the American Heart Association define success for you and your team, and then what are the challenges that you face with achieving. And then the third part is how can the University of Michigan resources help you to achieve that. Oh, man. The last one is an easy one. So I'll start with the hard one. How do we define success. So, you know, we've been blessed with a tremendous brand. So, you know, people know they see the heart and towards they know what the American Heart Association is. They pick up a box of Cheerios, they pick up a thing of almonds and they see a little heart check. You know, we have a tremendous brand, right. But because we have a tremendous brand and tremendous awareness of who we are, it comes with a huge responsibility, right. You know, heart disease is still the number one killer. You know, I've been with the American Heart Association three and a half years it was the number one killer three and a half years ago it still is today even among a global pandemic. So defining success in my opinion is looking at those three buckets that I mentioned in my introduction, supporting our partners, supporting our clinical partners, support our community partners, and supporting our community initiatives and engagements. If I've covered those three areas and my team as well has covered those three areas, you can sleep well at night. Heart disease is probably the number one killer tomorrow morning. But we've definitely moved toward more individuals leading longer and healthier lives free of chronic conditions right. Some of the reciprocity comes in on the patient level and and Nathan probably appreciate this because he gets to connect directly with patients. I don't get that as much anymore. But when I do, you really see the work in motion. I do a lot of education modules with patients that, you know, of our FQHC partners are clinical partners that are looking to reduce their they've gotten a diagnosed type of intensive and they're really trying to work to reduce that reading. So, you know, we give them nutrition support we give them education. So sometimes I'm able to do those and that's really awesome really being able to see that reciprocity on that level on the patient level really taking ownership agency of their health. But that's that personally that helps me that that gives me some reciprocity that I know that we're moving in the right direction. Again, you know, piggybacking off my previous point about you know population level and the HAP and very focused we have very specific goals every single year in terms of our number of engagements what we're focusing on in terms of policy systems and environmental changes, and, and how we're improving the clinical experience for patients no matter where they come from walk of life ethnicity gender. Whenever you enter the clinical setting. And if you're hyper if you're diagnosed with a chronic condition, you should receive the best care possible and we can actually track that. You know, we can look at our health outcomes. And we can look at levels and blood pressure readings and figure out on a population level, if your patients are getting healthier and improving their, their health. And so we have mechanisms in which we can, we can track that with our clinical partners to see if they are adhering to these guidelines, and that is, and that those guidelines are actually improving people's health outcomes. So that's how we kind of measure success on a year to year basis. To the question about you know how the university can be involved. This is, is fantastic. I feel like I really kind of cracked the net. I mean, there's been years of, you know, I know the Sony we've talked about this, there's been years of reaching out to university and I feel like I just met the right person, and then I met the right person again, and now we're here. So I think that continuing this is extremely important. We do have shared values we do have shared goals. We have a fantastic awesome health system through the University of Michigan that has several clinics off throughout the state of Michigan. They have some of the best researchers in the world. They have some of the best faculty in the world. The impact that we can make from southeast Michigan can have a global impact. I mean, we have the shared network and awareness and resources to actually have a global impact from where we are. And so we need to continue to grow this relationship from where it's at. With that understanding that we can have a very catalytic catalytic impact on the rest of the world. And I forgot your third, the third part of your question. That was it was about how the university could. Okay. Thank you. If you'd like to circle back. It's part of my, that's actually perfect. Part of my question anyways. All right, do we have any more questions it's been a great conversation. I would like to give a shameless plug for for our work through the PCLP and everything that we've been able to do and hopefully it's been a big benefit to the, you know, to the AHA and the communities that you are representing. If you don't mind, would you mind just giving kind of a brief, kind of brief description of what we've done and the work that you hope that our students research will help spur. For sure for sure. So, you know, it's definitely been a breath of fresh air, a really a jolt of energy, getting the students involved. You know, Karina and Sharon are doing an amazing job, really helping us define how students will how faculty in public school can help support students when it comes to this issue of vaping. And so the first semester, Brea and Aaron, you know, did a great job, really looking at how we can look at public records and public data and create a scoring system for where schools were in terms of their level of punitive behavior, if you will, within those policies, right? The American Heart Association doesn't believe, and again, the data and the science backs it up that that punitive measures will help prevent tobacco usage. Just doesn't you kick a kid out of school, they're more than likely to continue to use if not increase their usage because now they're at home. And now they're dealing with, you know, with with disciplinary issues with their parents. And now they're either kicked off the football team, the basketball team, the cheer squad. So that doesn't help. And also they're getting further and further behind in their studies, which also doesn't help because now they're academically performing poorly, and it just kind of pause and examine which you get to get the truth. So, you know, what Aaron and Brenna were able to do was help us define a scoring system of school policies and really figure out where they were and how we could potentially engage based on that score. So if they score low in terms of their punitive measures, then the AHA could potentially come in and help craft policy that helps support that school. If they're not doing punitive measures first, not kicking kids out of school on their first or second possession charge, right? If they score higher on that scorecard, those schools probably were very punitive in nature, and the AHA potentially would have to work through several conversations with the school leadership and staff to really figure out where there may be some areas that we may be able to redirect and help define a policy and craft a policy that's more supportive to students. So that was the first iteration of students that we're working with with Sharon and Karina, and they're really helping us craft ways in which to engage school staff. So Karina is a registered nurse, so we're really excited to have her aboard because what they found in their research is that school nurses are typically the individual within a public school that are spearheading anti-vaping campaigns within their student population and also figuring out ways to help craft policies and school policies that are more supportive in nature. So with that finding, we are approaching schools, hearing them out, and then developing strategies not only on the policy side but also on the student engagement side. Working with the National Honor Society, working with other national student body organizations to really figure out how we can create awareness campaigns with students along with crafting that policy. So it's been amazing. Like DeAndre said earlier, I wear several hats. And so having that additional brain power and charisma around these issues is really, really, really valuable. And I think that this year having the students a little longer, we're definitely going to be able to make some more anyway. So my goal within the practicum is for us to actually change policies within the timeframe that we have. I want students to come in and leave and being able to put a feather in their cap and saying like, hey, we were able to actually craft policy that was enacted and as a result of my work, my students are being more supportive. So that's a little bit of what we're doing. It's a little bit more detailed than that probably, but it's 530 minutes late and it's starting outside. No understandable that I think that's the best way that in in the soft. Thank you everyone so much for attending and all your wonderful questions has been a great dialogue of everyone can unmute and join me in thinking Michael for his time. This is great. Thank you. I appreciate this. Absolutely. Thank you. This is great. Thank you. Just say also thank you for being such a wonderful partner. Oh, no, thank you all like this is, this is absolutely. This is definitely a result of several years. Cultivating a relationship with the University of Michigan. Definitely want to say thank you to you all as well. DeAndre, Cindy lasagna. Merriam all you. This is this is fantastic. It really is and also want to thank Linda Laren. She's a chief operating officer of Michigan health system. She's been awesome as well. So I'm really encouraged by this partnership. I'm really looking forward to the work that we're going to continue to accomplish the years to come. Awesome. Well, as Merriam put in the chat, please look out for our next young leaders that will be on the 16th. And with Andrea LaFontaine, the executive director for Michigan trails and green waves alliance and a former state legislator. So he's always trying to offer as many opportunities we can for our students and be a resource to everyone. With that being said, I'll say have a great day, but by looking outside, I should, I guess I should say have a great night. Thank you. Take care.