Transcripts For CSPAN3 Bipartisan Policy Center Discussion On Education Health 20240714

Hosted by the participate policy center in washington, d. C. We believe good morning, everyone. I want to welcome all of you to the Bipartisan Policy Center. Chief medical adviser here. The title of our convenient today is education and healthy, twin pail ars to thriving zunts students good to see you. For those of you new to bpc our mission here is to actively seek at a take the best ideas from both Political Parties to promote health, security as well as opportunity for all americans. We drive principal and politically viable policy solutions through analysis, negotiation and advocacy. Todays event focuses on the bi direction, health in all policies, the idea that policies outside the Health Sphere have a profound impact on healthy and therefore healthy consideration pb a considering policy make area. Its important that education is an important determinant for Health Outcomes. In addition illustrate ihle understood that healthy facilities learning and thus the Education Sector is equally interested in promoting Healthy Learning i. V. Pmt last week the bc Childhood Initiative hosted an event on appropriate child care in earning learning facilities for children thrive. We are pleased to have an extraordinary set of speaker he is to discuss the topic as part of a Panel Discussion. To start us off id like to introduce Rochelle Davis, rochelle is president and ceo of the healthiy Schools Campaign. Roeshl will be providing framing remarks for all of pups the Healthy Schools campaign is a cosponsor of the event today and played a tremendous role nationally in leading on the ground programs and influencing policy. Roeshl has long been advocate and leaders for Childrens Health from Environmental Health her in her career after over two decades. Following her remarks well have a moderated discussion followed by audience question and answer. As a reminder this event is streamed live online and the recording will be available next week. We also thank the cspan2 watching today, welcome to all of you. And with that id like to ask Rochelle Davis to come to the podium and rochelle will take us away. Rochelle. [ applause ] well, thank you anan and to the Bipartisan Policy Center for partnering with us. And thanks to all of you for being here both in person, threw the webcast and on cspan for this conversation. At Healthy Schools campaign our work is based on the common sense notion that healthy students are better learners. Since 2002 we have worked in chicago and across the country to advocate for policies and practices that ensure that all children, no matter their race, ethnicity or Family Income can attend healthy, safe and Supportive Schools. Healthiy schools can provide positively impact students all around well being, build a Solid Foundation for learning and help address the health and educational disparities impacting our most vulnerable children. This work is more important than ever. Over the past two decades the prevailens of chronic conditions impacting ability to be in school and ready to learn such as asthma, diabetes and observesty has doubled from one in eight to one in four children. And more and more children suffer from range of Mental Health issues like anxiety, depression, Substance Abuse and adhd. One in five children has a diagnosable Mental Health problem and nearly two thirds of them get little or no help. These conditions diss proportionally impact low income africanamerican, latino and immigrant children from disinvested and marginalized communities. These children disproportion knitly suffer from a lack of access to health care and attend schools with less access to physical activity, higher exposure to environmental toxins in the air and water and fewer schoolbased Health Services. Compoundi compounding these challenging many of the same children live in areas less likely to have space for safe outdoor play and many students come to schools suffering the impact of food and security or trauma. The impact of poor Childhood Health compounded by disparities in access to health care and Supportive School environments reverb rates throughout a childs live. A student malnourished or living with an unmanaged physical or Mental Health conditions will have problems concentrating in class and miss more school days than healthy students. Children chronically absent as early as preschool, kindergarten or first grade are much less less likely to be reading at grade level by third grade. And students who cannot read at grade level by the he said of third grade are four times more likely to drop out of high school. Research increasely supports a link between educational success and longterm Health Outcomes, in other words investing in education is essential to supporting a healthy population. And an educated and healthy population is essential to a vibrant and strong america. So lets for a moment imagine what it would look like if every student in this the country attended a school that supports Student Health and School Wellness as a foundation for learning. In a Healthy School teachers are given the resources and training to support students overall well being and build a safe and the Supportive School climates. Parents are welcomed into the School Community and their knowledge and leadership are valued. The school gives students access to healthy food, physical activity and clean air and water. And these are not things we can take for granted. The school actively teaches students to make healthy choice that is allow them to thrive. And physical and mental and Behavioral Health care is available. In a Healthy School students learn through lessons and through example to value their own health. Healthy Schools Campaign has worked in chicago and nationally to make this vision a reality. In chicago we have engaged parent leaders, teachers and principals and helped them advocate at the district level for healthier school food and the return of physical education and recess to the school day. And we have helped schools transform paved and over school yards into vibrant green spaces for play and learning. We see many, many amazing initiatives and programs in chicago and across the country. We applaud the school staff, families and partners who have made these changes happen. The challenge is making these changes scaleable and sustainable. To do that we need systemslevel change, including ending that schools, especially those serving students with the greatest needs, have adequate funding, including the resources necessary to support Healthy Learning. Providing schools with the knowledge and tools to understand the health needs of their students, implement appropriate policies and programs and build the partnerships they need, and incorporating health and wellness into education metrics and accountability systems so that it is prioritized and funded. Now fortunately we are at a moment that offers several opportunities to overcome some longstanding systemlevel barriers. The nations new education law, the every student succeed act, or essa, has given states new opportunities to address Student Health and School Wellness. For example, under essa allstate School Report cards must include chronic absent rates, which can be a powerful proxy measure of Student Health and wellness. In addition to that 36 states have included chronic abseptember rates in part of the States Educational accountability systems. States and School Districts are leveraging the new opportunities fop. For one example, since i only have you know a few more minutes, a School District in tennessee was it was hard to pick which one, okay a School District in tennessee is using funding from essa to support their School Nurses efforts to track why students are absent. In allows the district to get a more complete picture of the problem and identify ways to address it. And the Education Sector increasingly has a powerful partner in the Health Sector which recognizes that health is driven by more than what happens in a doctors office. Recently trinity health, operates in 22 states announced it will require all of its hospitals to include chronic absence in the Community Health needs assessments. Also this year the American Academy of pediatrics release add policy statement highlighting the role pediatricians can clay in addressing chronic and sins. With the education and Health Sector intercept accurating and incorporating metrics in data systems we have created opportunity for partnerships. Another opportunity to address a longstanding barrier is schools faced is recent changes in medicaid. States now have the opportunity to allow School Districts to be reimbursed for a much wider range of Services Provided by to medicaid enrolled students. We have o we are partnering with trust for Americas Health a is astate learning collaborative so schools will be able to access medicaid dollars to pay for School Nurses, counselors, social workers and other Crucial Health services. States are beginning to take advantage of this opportunity. It is important to recognize that these are opportunities. Not mandates for states and communities to address Student Health in School Wellness. There is much work still to be done at the federal and state level to support schools and communities to create the conditions that will allow all children to thrive. That is why the leadership of our panelists on these issues and the efforts of all of you who have joined us today are so important. In event provides an important chance for us to explore how to be successful in building healthy and Supportive School environments to all children can learn and thrive. Thank you. [ applause ] thank you for the opening remarks that sets the seat beautifully for Panel Discussion today. I do want to take the first maybe couple of minutes and just provide brief biography sketch of the throe panelists most know them as Public Servants but so you understand the perspective to my left senator bill frist is a heart and Lung Transplant surgeon and former u. S. Senate marj leader. He represented tennessee in the u. S. Senate for 12 years and elected majority leader in 2003 High Pressure miss service on the Senate Help Committee responsible for all federal education policy inspired him to find score, state collaborative on eggs to propel tennessee to prom enss in ray education reform state. He is currently chairman of Tennessee Store he founded in 2009 appear bps senior fellow and led many health nesht initiatives over the last decade. Thank you. Thank you. John king jr. Is the preponderate the president appear ceo of the National Education trust a nonprofit that seeks to identify and close opportunity and achievement gaps from preschool through college. Secretary king served in president Barack Obamas cabinet as the 10th u. S. Secretary of education. He joined the Department Following his tenure as first africanamerican and puerto ricoen serving as new york States Education commissioner. He began his career in education as a High School Social studies teach ner puerto rico and boston massachusetts and as a middle School Principal thank you for being here. And secretary pedro river aire was appointed by Governor Tom Wolf in 2015. Current secretary rivera serves as cht of the board of directors for the council of chief state school officers. A Nonpartisan Organization of Public Officials mo head state departments of elementary and secondary education. Prior to his appointment to governor wolffs cabinet he served as superintendent of the School District of lancaster. Additionally a class room teacher. Assistant principle, principal. Executive direct for the School District of philadelphia as well as a staff member with the philadelphia frags of teachers. Thank you again for all three of you being here. And i think you heard from rochelle, her perspective how important in bi direction alimpact is between health and education. I thought it might be helpful to start based on your experiences to share why its so important and where are you seeing signs of progress across the country. Senator. Anand. And rochelle thank you for your remarks. It set the stage beautifully. 12 years ago i was in the United States senate. After being here for a period of 12 years and having the opportunity to be in no child left behind on the Health Committee. When i came back to tennessee i knew a couple of things. This is being a doctor i wear the doctor hat first that if somebody has a College Degree or four years of continuing education after after secondary school, that they will live 5. 3 years longer than somebody who doesnt graduate from high school. I knew at the time that if somebody spent four additional years of any kind of education after secondary School Education that they would have less heart disease. That theyd have less diabetes. That they would live longer, the five years coming after that. And that knelled have less heart diaz disease, less obesity. Less diabetes. What we didnt know a after he gathered the science and evidence. When you look at health and health care and how long somebody lives or infant moerlgtsty or burden of disease, whatever it is, its not the doctor in me or in you that determines how whatever that measure is. Outcome of health. But twice or three times more important than the doctor or type much insurance or the hospital are the social determine nantz. What we learned is that education is a primary social determinant. For health. Wove health care over here and education here. What we talk about today is the nexus of the two in the just correlation but there is causality involved. Thats how i got involved and stayed on it since. Rest thats great. Secretary. Sure i want to take to the simplest level of the student. When i was a middle School Principal i recall a student who had asthma, chronic asthma. And he would miss a lot of school as a result of the asthma. But our school was in a building that was shared with a nursing home. When got a nebulizer set up in the nursing home ekds access. He went from missing a lot of school to being in school regularly. Grades went up. He was a happier student. His family was happier. Just having access to Quality Health care made the difference for his educational outcomes. So the thing im encouraged by is there is a growing Awareness Among states appear School Districts that as educators we have to be thoughtful about who how we Better Connect kids and families to Quality Health care services. Three quick examples. There is partnership between childrens defendants fund and the superintendents secretion to use the School Enrollment process opportunity to talk with families about their enrollment in health care, whether thats medicare or chip, one of the Health Care Options on exchanges. Or personal health insurance. But making sure families are attentive to kids having access to health care. Thats one. Two, we see and we heard about this in the discussion of essa. We see states paying attention to chronic absenteeism. Whats nurnlsing about that is not just noticing the did it rt data pinpoint but dressing the homelessness or housing security or addressing Food Insecurity that a family might be experiencing or helping a family strategize around transportation or whatever issues get in the which of kids missing school. A third example is around food. One of the key things that we know has made a positive difference in kids lives all over the country process is the free and reduced priced lunch over the country. Many kids have the was best meal of day there. Many schools have breakfast programs. Thats important step. Many make sure kids access food in the summer. Less than 20 of the kids accessing the meals during the school year access meals during the summer. But we can do better. Some communities do food trucks in the community so kids have easy access to food. During the summer. There is also a Pilot Project at the department of agriculture putting additional dollars on the electronic benefits card so families can access meals over the summer. And we know that program is working well and increase in the likelihood that kids have access to quality meals. So there is a lot of evidence i think that people are paying more attention. And we need to get some of the policy barriers out of their way. And also as rochelle talked about, work to scale some of the solutions. Great. Yes, i think piggy backing off what my colleague shared. Rochelle did a great job in kicking off as well as the senator in ooifgt and recognizing the social determineants of health. Id like to share in State Government i learned we dont always engage in the best ways around pushing initiatives threw but with you bun thing government does well it setting conditions, conditions for success, sometimes conditions for lack of success. But at the end of the day we do set conditions by which communities, neighbors and institutions live by. And you know over the course of my career given are really fortunate i was able to to return and teach in the community i grew up in. I understood that if i really wanted to help others break the cycle of poverty education was the key. You know, really being steadfast and focuseding on improving the quality of education of students in my class, Building System and beyond. But what i quickly learned is that we couldnt focus on you know the traditional abcs of learning without really realizing those social determinants of health, realizing there are students in the communities that would live in live with Food Insecurity every day. You know deal with issues of homelessness, physical and Mental Health needs. And quite frankly many of those in some of the most vulnerable kuntz lack access to quality access around those needs. As a teacher as on a small scale. Providing laundry cards or meals in the class room or tokens for public transportation. I was able to support the 100 plus students in front of me every day. I started focusing on those areas. As a School Administrator and then ultimately district administrator and now secretary, continuing to look at opportunities to expand that reach but more importantly solicit other partners that can better serve our students. As a teacher it may have been the corner store other than. But now as secretary im fortunate that it can be the secretary of department of Human Services or secretary of agriculture at state level pch department of corrections or labor and stre. What weve been trying to do and i know well debt get deeper around this. Backup. But ungd if we have the responsibility and opportunity to set conditions for practitioners in the field every day by working together to ensure we have a really direct rich narrative around which we exist, how we should be best serving our communities, focusing our collective impact in erms terms of mission to serve the vulnerable communities and being unapologetic about equity. And what we have done today in the commonwealth of pennsylvania with the support of the governor, we have defined equity by saying it makes the resources, opportunities and supports available to communities when they need them, how they need them. No now not how and whefl we we feel like giving it tomorrow. But making sure they have the resources to be successful. And when they need. Everything from Educational Opportunities to health and Human Services impact. Educate. Education is a powerful determinant of health. Health impacts learning. Areas such as physical activity, nutrition, critical safety, environmental conditions of the schools. Critical schoolbased clinics, a lot of good literature improving gpa and Health Outcomes. It sounds lie we no this is pretty important. Maybe secretary king can we get to to your point about barriers. We might see pockets of success here and there. But what are the Biggest Barriers whether a state or School District, or Health Provider or Health Insurer in testimonies of collaborating, bringing education and health together, are the bar years funding, accountability, data, culture . Can you go through maybe what are the most important barriers as to why these two sectors we know its important. We know that bi direction alimpact. Ill start off because ill take the stand of reflecting the health part of the healthy and education part. You just saw we saw we can get programs but how do you take them to scale. And scale is alignment around common goals. Ill let my colleagues talk about the pure education. But the health part of it we have two problems. On the funding side at the state level and most of the education is not federal positive. But city state level state budgets are set its security and safety and health, medicaid and education. You have to balance your budget. If you put more money in Education Health comes down but more on thor end. Health comes up but education goes down. What we need to do and ill speak from the health perspective. Because its a parallel to what health care used to be ten years ago really before president obama began to really put together valuebased health care spending. Not just fee for service. Not just more pliess you do you get petitioned mor primary care visits pur for heart visits. But reimbursed not Just Health Care which that is fee for service. But more health. And well being. The words in the introduction we used. The outcome for both is well being, is fulfillment, productivity. In health care whats happened a fee for Service System instead that we move with leadership of the past administration and being supported by the Current Administration is valuebased care. If you look at value for the care in outcomes and its well being then immediately you go not to fee for service but you go to reimbursing for things well talk a little bit about medicaid and it was introduced earlier. And thats sort of funding. If you Want Better Health well being for the Just Health Care you got to value and major determinant as i opened with statistically is the education itself. So right now for the piers time medicare is beginning to reimburse for social determinants in food which again we are talking about food, getting people moving in schools and then the School Nurses coming in from the delivery system. All of a sudden we begin to reimburse here in washington, d. C. In had medicare not medicaid of things like food, and transportation, and even housing. That need to come down to the medicaid level and he well be looking for science. Again its the common goal, common alignment about well being of health that will drive it. One last thing at the state level the budgeting is siel os. And the budget something education and focused on education. Fighting for every dollar and you got to balance the budget and it is health. And not until we bring the committees together at the state and federal level around the common goals and just jumping to the very end at the end way you do that is at the local Community Level well come to that eventually i believe. Thaet great, senator. Secretary. Agree with everything the senator said. A couple of things i would add. I think we have a political will challenge and a administrative well challenge and the culture will challenge. The political will challenge ill give you an example. The states doing Medicaid Expansion see are the about Health Outcomes for the churn. The politics are complicated. The senator knows more about that than probably anyone else in the room. At the end of the day we no that increasing medicaid participation will lead to Better Health outcomes for kids and families. One of the Interesting Data points we see from Medicaid Expansion is that actually even if the kids would otherwise be eligible for chip or other programs they are more likely to participate if their parents are able to access medicaid through Medicaid Expansion. If you go to the doctor and keggi taking care of your health care youre more likely to make sure your kid is getting regular access to health care. Thats a political will problem. The administrative will problem is we put out a guide a joint sort of tool kit between the Education Department and health and Human Services during the Obama Administration to help School Districts think about schoolbased health service. And particularly trying to figure out how to leverage medicaid dollars to support schoolbased Health Services in schools serving large numbers of lowincome stupts pch its a hassle. Bureaucratic hassle in many states, the rules are quite complicated. And the result is that people dont follow through on creating the schoolbased health opportunities. And its a lost opportunity for kids and families. We just know people are more likely to Access Health care if its immediately available to them at the school setting. The culture problem ill give you one example that troubles me a lot. Johns hopkins did a study in baltimore. Fascinating study. They looked at kids and reading outcomes and found, shockingly that if you cant see the board or read the book, you do worse in school. I nope its a shocking finding. Similarly shocking if you provide appropriate vision services, you can see the board. And read the book, wait for it. You actually do better in school. Right . So you know, i make light of that study. Its important studied but whats frustrating is the result wasnt that every School Started making sure that every kid had vision screening and had access to appropriate vision care. There are kids who are being held back, all right, they are being told theyre not good at reading, captain read because of something thats so simple, just untreated vision care. Thats a culture problem. Wove got to get much better at understanding of intersection between health and education. Speaking from the state perspective and really taking into context what john shared, i think with i noticed over the past few years and observing some of the systemic barriers that exist in local government right now is far too often we used policy to influence practice as opposed to using practice to really inform good policy. And over the course of the past few years we nanld thousands of stake holeders from everything from essa to our School Improvement focus on opportunities. And what we have realized is that in many instances there could be myren tweaks to la language that would would allow a district leader or class ram room practical nisher to use resources or time differently to build in eye health care. A School System or into, you know, the traditional block of time. You know, looking at dental care, and looking at, hearing, you know, and other types of support services. But what has happened over the course of you know, of some rigid policy language being created its been interpreted in ways where folks just thought they could not focus in areas and only areas that would better serve students and communities holistically. And so whereas weve been trying to influence and create and draft new policy that takes into account the holistic needs of students but it takes as much if if not more rg in reprogram or deprogram many some of the old misgnomers what had already been assumed around the language of law or policy, or the responsibility of a system, to allow them to think of the kid, the community, the client first. And you know that was one of the areas thats been most surprising to me. As we think specifically around medicare and medicaid and other federal dollars being utilized for you know for health and physical and Mental Health support, you know, the biggest the biggest barrier that exists between agencies has been the the any told us did told us we couldnt do it that way. And so you ask, who is they . Its funny no one knows who they is. Im just waiting for the time i meet someone and he is like, im they. All right. Its all your fault. And the other, you know, this misrepresentation of law and language of law and policy. You know, its interesting, i have now defaulted to always asking first before moving any further, show me. And then us sitting down and looking at the language of law and policy and then why do we interpret it this way . Can we think differently around the system to better support the communities and fulfill our mission . I will share with you one of the things that we have been able to do in pennsylvania, i meet monthly with my colleagues in the office of Human Services and the office of labor and industry, secretary of agriculture and the secretary of the department of corrections. And we take an hour, less than of half of the time is to discuss breaking some of the systemic barriers that exist between either relationally or in practice between agencies. With you we spend as much time discussing opportunities moving forward. And as a result, you know, thinking about nuanced changes within language that would allow for better Mental Health Service Providers in schools. We work with the department of Human Services now to create a reporting system. If a student goes into a homeless shelter we can access the information to connect them to other services needed whether food security, access to quality and henlt services, whether its something as simple as clothing. With working the department of ag we utilize state dollars to build infrastructure to allow for systems that keep them from better accessing federal you know department of agriculture dollars. Something like kiosks for grab and go programs for breakfast and so, you know, schools werent able to utilize that federal funding because they didnt have the tools to utilize that type of feeding. Why not invest a few Million Dollars to build is that infrastructure within a school . The department of corrections we work with them to build Parent Resource Centers in their women prisons. So when when a family comes in to visit you know a mother that happens to be incarcerated they have the same access to information around social services, Educational Services that you would if you were to visit your school for enrollment. By working together you can better focus on what our communities need as opposed to trying to meet the mandates thats quite frankly often under assumed law or policy language. Ill just add, another barrier not to why because hopefully well get to the solutions. Right now the Robert Johnson Foundation Reports regularly that only 25 of students in the country have access to a school nurse. Access, not in the schools themselves. And as we have seen as society has gotten more complex, as we have seen changes like more diabetes, more metabolic disorders. We have seen an 85 increase in the reported chronic disease and disability area in schools today. And its just asking too much for teachers and principals when a quarter an absolute quarter of of population has a chronic disease. We mentioned asthma, allergy, diabetes, the whole range of diseases or disability, not to have access to a Trained Health personnel of some sort. And so within the structure of the school and the good news because we can all say there is progress made. We have a tendency as part of the coordinated Schools Program for centralized 15 years and were the only state in the country that every School District has implemented that particular program. And with that we have seen a dramatic increase over time, number one, of in our schools themselves having access to Health Personnel. Dramatic as well as increase in activity thats we put food and activity and moving dramatically changed that over time. Still a long way to go but the neat thing about that when you look at outcome measures, whether the increase in activity or in education in terms of performance on math tests and science tests or in cognitive reasoning or showing up for school, to be able to access the Health Personnel when you need them instead of having to leave the school or take the time of the principal in the day. Thats a structural impediment today that looks more a at from the health angle, instead of dumping on the school we have to merge those two together now that we have the science. If we share the science, we share the cult, we continue to invest in education and health, that will come back and health with one of the three anyway, the culture in the challenges that we have. Thats great. If we could focus i think the specific barriers we talked about, the opportunities we already started talking about. Essa sounds like it provides an opportunity i think part of essaed funds can be used to support School Nurses. There is a focus of chronic absences, a critical proxy for health, as rochelle mentioned. Medicaid, another opportunity. Do you all think the most important opportunities to bring the sectors together are they at the local level, state level, federal level . Is it really the Public Sector that has to lead, the private sector . Probably allel the botch but talk about the most important opportunities today to get to where you all are articulating where we need to go from a policy perspective . Where do we need to take to lead and to skel and replicate. Senator frist you talked about the pockets of examples. How do you scale and repel kate. What are the most important opportunities. In my opinion, having experienced, you know my role as secretary and how i was fortunate enough to land here, i think we have to start locally. We have to engage local stakeholder. At the end of the day the policies we inform you know are usually implemented to did to improve the quality of life for local communities. And i think especially now that communities are coming so much better informed than engaged they really hate when we do things to them. Even if its a perceived, you know, positive intent, if we do this for all the right reasons if we dont involve them in the process there is going to be pushback. And i do think as we have been able to inform as much policy as we have in the commonwealth of pa, those where weve been most successful is when we engage the local community. Its when we articulate their needs and thoughts through our lens to policy makers that we start to see the most traction. I will also tell you at the state level one of the challenges we have that our federal counterparts dont have an we have an expiration date. If youre in State Government i get this for two teams item im lucky. Most secretaries of education dont get to do this for two terms. We have to maximize the tupt we have in front of us and serving our constituencies as quickly and aggressively as possible. And i will share, i think that the importance of the relationship between Public Sector and private sector is especially important. Becauseway we dont always have the Public Sector but absolutely use is the space to be nimble and to create a sand box to, you know, to try and to create policy and initiatives that may be forward thinking. And were under a microscope. If if i spend a dollar on a failed project, there are 40 people with pitch forks and tempos that want to drive me out of the statehouse. I think the where the partnership between public and private is extremely important is that, you know, through our private sector partners, you know, we have more robust think tanks. We can look to better articulate our plans moving forward. But create the opportunity to experiment. And you know, and use those way we learn through that experimentation experimentation. And you know and those resources to better inform the practice. All right. I guess to build on pedros point. There is a tremendous leadership opportunity here for governors and legislatures because health and education are the two dominant things on which they spend money and they have the opportunity to realize the financial benefit of smart longterm investments. So for example we know having a nurse visit new parents early on improves longterm educational outbreaks and health outbreaking. Its a long lead time you need to the raeltds the benefits. But for a governor and legislature thinking about a state like tennessee, whats best for tennessee not this year, not even this term, but for the next 20 years, next 30 years, then you start to say yeah we should make sure certainly every low income family gets the nurse visitation opportunities. You you might say we have less than 20 of kids taking advantage offree and reduced price lunch in the summer. What could we do as a state to radically increase the number so kids are healthier, because that leads to Better Health and educational outcomes for the longterm . So id love to see more kind of governors and legislatures stepping up to take leadership on these issues. But, look, we as a you can have to help them by rewarding longterm thinking and not focusing all of our elected officials attention on just what happens tomorrow. Again, i will build and at the federal level i loved it. I loved the Health Company pb the United States senate and being majority leader. And it was great. But i think i think we covered sort of the no child left behind expect aches raised, gaps addressed but no direct mention of health. A Natural Evolution with under your leadership under the Obama Administration was essa where you had the door open. It has to be reflected further and comes back to really the culture statement. Because culture is built at the local level. It has to be in instead of 40 oh billiondollar in medicaid only 3. 5 or 4 billion in health. 4 out of 400, the data is dramatic in terms of jobs, productivity, fulfillment, contribution to gdp over time. So we have to have the federal level. The state level is where most of the education activity dsh but every governor is an education governor. Lets face if ive known lots of governors and all have Education One of the two. Thats good. And it has to start at the top. We need a president to put it out ontheand first lady by Michelle Obama who talked about lets move. And talked about garden. That is really important. But it does only go so far. Because it does do matter what, again, the culture. What is that culture of health . And as rwj puts a huge amount of emphasize on it what is it. Its simple. Its aligning the intersection where we know outcomes in value depends on education and basic access to services themselves. And so uly it comes down to the local level because thats where you build political support. Thats where you dsh thats who elects the Congress Person and elects the governor. Because theyre all going to run on it. And then demanding the accountability, demanding the execution. When we started the score. The clabive on reform of education tennessee is at the bop bottom and we are happenway where now we need to be in k through 12 education. And i learned. And i had the idea to start it and stepped out of the way. The reason weve been successful is changing the culture at the local level and implementation of the policies and execution of the policies themselves. And you do that by only building a Grass Roots Movement of alignment around incentives. This is what will happen if you do. Thats why you have to think longer than beyond the next election and nifrpg longterm. The thing is it does work. The newness of it is taking health care over 3 trillion. 18 of our economy Unlimited Money to education over here where were not whether its compensation for materials on compensation for teachers and leadership we are expecting so much. But by marrying the two together with a clear cut alignment of the sort of data and statistics nar there then we can Start Building the support. Then we can get appropriate access to health care. We can look at things like telemedicine which to date the technology is there. You dont necessarily have to have the nurse in every particular school. You start thinking creatively and out of the box where you can take the good programs out there and go to school. But youve got to be able to change that culture. Now we have the evidence and the data to do that. Ill i dont mean to advertise but this a year and a half ago score brought together 50 oh people. Thats why cspan is important today and the media 37 we did a Better Health, better learning. And with we did it score. The statewide dwras Roots Organization that works with ideas and leadership, political advocacy and the other partner with that was Nashville Health which is a totally independent group but its looking at the well being of a community of nashville, what health and well being is all about. Which means as rochelle said, the hospital the first time in the last six or seven years theyre looking at assessments of the community as part of the nonprofit status. They have to do it because of policy. But the good thing about it when with they go in the community, a hospital, and they look at what is actually working there they say, yes, it makes sense. Our hospital should get involved in our kmupt. Our hospital should adopt schools. Our hospital should go to Blue Cross Blue Shield and do a program like in tennessee where they put money into education, in program called go noodle which looks not at the food but looks at the activity and 100 million minutes because of that grant of physical activity that teachers use in three to fiveminute video willings. Thats where the intersection goes right at the heart of the culture. Great. Great. A lot of momentum, letteredship in the private sector, Healthy Schools campaign. S. C. O. R. E. I want you to put your public seccer hat back on former or current. Im been trying to run from that. How difficult is it to really the promote the cross sectoral partnerships. Secretary, you talked beabout when you were with health and Human Services you were able to do something in school based services. Secretary rivera you talked about monthly meetings with many counterparts. Im curious whether these examples are more of the norm or exception. And senator frist there was a Health Committee sure. How difficult is it to get folks in interested in health and education actually help them understand how their policies impact the other sector . Whats some advise you all have for are your current and former colleagues either on the hill or cabinet secretaries at the federal level. Cabinet secretaries at the state level, how they come together and work to bring, elevate both sectors, connect them this is for extra krid forequestion. How do you frooel deal with things like secretary king you talked about the Breakfast National breakfast problem, lunch program, 30 million kids on the school lufrm program. 12 million in the School Breakfast program. You know, the jurisdiction over those programs are usda, thats department of agriculture. Sometimes you deal with departments that go well beyond just health and education. Talk to us about whats the advice you have to ensure and promote cross sector aldepartmental partnerships to really integrate the two spheres. I think trust and collaborative habits are big challenge. And sometimes you can get folks organized around a particular initiative and then they move onto something else. You have to have kind of a regular partnership, often driven by a set of common goals. If you say we are going to collectively try to make sure that across agriculture and education and health that more students are participating in the summer lunch program, here are our metrics, our starting pinpoint. Here is how we make progress. I think you need to do that not at the federal and state level but at the level level. All right, getting the local superintendent at the table with the person who runs the local hospital with the person running the local university, with the folks who run local communitybased organizations and faithbased organizations. And say loob, collectively we know chronic abseptember eeism is at 20 . We want to deduction reduce that by 20 a year over the next five years how do we do florida . And then commit to ongoing dlab ration and trust building. Now there are things policy makers can do to make it easier. We can make data sharing easier. Thats an obstacle. We can improve the training of professionals. If you look at superintendent or principal Training Programs you would not find a lot of discussion of health care, social determinants of health, intersection between health and education issues like Adverse Childhood Experiences and the impact that has on young peoples longterm health. We can do training better. We can do data sharing better. And then we can break down some of the silos, senator frist referenced this. There are the very stark silos around budgets. And people feel like thats my dollars. Im happy to collaborate but dont come for my money. There are Committee Oversight silos within legislatures. We have work to do to sort of breck down the silos so that people have a sense of shared responsibility. Yeah, i think, you know, first and foremost it is recognizing the fact that when collaborating and being transparent and trying to be, you know, clear in terms of what you hope to accomplish, there is a great level, a great deal of vulnerability. Thats the role we live in as Public Servants. I often equate this job, being a secretary is like being a superintendent in the middle of the snowstorm and having to decide whether or not to close schools. And any parent knows how much the parent harnts the superintendent when they decide to close or not close a school. Often with we make the decisions around big decisions. If there is advice, its we have to be explicit around what feed we are looking to address and what goal we are hoping to accomplish. You know, just to pick one specific instance, when we looked at summer feeding, one of the obstacles we faced was the need for it to be congregate feeding. We need to bring the population of students together in order to to use the federal funding to provide the summer feeding option. And so we had to bring, you know, partners together from both the community but across agencies to find a way to get provide summer feeding opportunities in some of the most vulnerable dispersed communities. Everything from we have had communities create the equivalent of a school lunch truck, you know, for example, and so they have outfitted full modes of transportation to serve as a Group Feeding location. We have utilized libraries to provide the services. We worked with our Church Partners to provide the services. And, you know, by not bringing everyone together we would have never been able to tackle that issue. Now, when interpreting the need, the fix, really reviewing language, you know, some of the many of the conversations were extremely, you know, passionate and everyone had an opinion. And everyone, you know, understood their role in this to be sometimes as rigid as it could possibly be. But by not dressing the vulnerabilities but staying focused on working through those we would have never found ways to serve students in the vulnerable communities. I think its at every level, the federal, state and local level. And what we need it comes back to leadership at the top whether governor, president of the United States, or first leading say its a priority. Its always a priority but now we have the data to show why its such an important priority. If you look at sort of the various buckets there, the food issue we talked a bit about. But the breakfast programs have showed better people show up for school on time when you see the data and you put it out to whether its a federal official or the Health Committee, its just clear cut overall. And there are other things, there are processed foods at lunches today killing our kids. We at the federal level theyre subdsing sugar and sugary beverages and vending machines. And those are battles that have to be fought. But food ultimately is what goes into our body that gives us health and well being. It is hard because the government is a policy level can really create problems. And not intentionally but just the idea that we are 30th in the world in education and therefore you need more science and you need more met and you need more basically skills, which is all really important and that was a part of what i was and no child left behind and looking at the gaps in the disparities in pointing for the first time but it goes down to the individual teacher that im going to solely be judged, underscores, and expectations that are defined just in terms of scores that means im going to sacrifice recess, whether i have to punish or discipline a student im going to take away what they love and it can be counterproductive if we are relying around the health and wellbeing and productivity and a good job. So the moving aspect of it and i use an example of getting people moving not just at recess, and the programs out there which we will continue to encourage that but when we set up a word system we do not want to be punishing the Movement Activity and we have to take it to the next level and say we have to be careful with that and thats all at the federal level and the third category getting kicked out a nature that is increasingly hard to do but one thing, with the ipads and the phones and electronics today, usually that means regulations where you can go on field trips or bring you know, nature to the schools themselves and learn you know lifecycles and the natural laws out there and it turns people to science but when you get there, and the last bucket, as to a positive standpoint, healthcare would like to leave people is that education is just not funded well in this country. Throwing money i just education without the maser construct does not work but without the Major Contract we have the data for it, it would be executed and implement beyond that but there are as i said over 80 of our communities are in healthcare today and we are making the statement communities and assessments were very clear that a hospital and a community and see what is dragging people down overall in terms of health, is basic access to education. And the movement aspect and so for me getting that healthcare involved in the community as they increasingly are, is a very positive way where both of you who has been arguing times in education to at least look to that as assistants over time. Making the federal and state policy good, to get the barriers out of the way, but ultimately able take this momentum from down below to actually change the direction so that execution can actually happen. Great. Thank you. I want to offer you all an opportunity to make some final comments but lets move onto the audience q a i am sure there will be some questions in the audience and we have roaming microphones i think on both sides so please just raise your hand and introduce yourself as well. Yes. Is this working . Okay, thank you very much for the talk. I realized of course i was an international economist, and an educator as well. So, i can see a lot of things here on what you are saying as being very important. But i realized that you havent mentioned a very important stakeholder in this whole system. And, it is not just the people at the local level and the state level, but what about big pharma, and actually, you can talk about this better than i can. But for example, what im thinking of as far as the education and the healthcare, our children will have to select , they will have dyslexia, they are in normal schools and classrooms, and they have a lot of problems and the problems are not just in the schools but also at home with the parents who do not know how to treat them. One of the big problems of course is something that does not provide for anything that really helps those students, without making them as you know, different in the classroom and of course our teachers are not prepared to deal with the brightness of those students who need to have a different kind of educational system. Can you talk a little bit about how maybe big pharma can be involved in this type of thing and not only with the proper education having the proper medication, but also, can they make these medications less expensive . I think, first of all i love your question but im not going to be able to answer it but i will turn to my colleagues, i think though you bring up the point that there are huge stakeholders and you brought up when i did mention to others, that are outside of the normal purview, of the true experts, and people who are in education. And now is the time to open up our spirit to reach out and educate them and maybe put political pressure and expose them in certain ways. I mean sugar that is the kind of thinking that actually i have no idea exactly how to get them involved but i think it is a wonderful idea and i do think we need people in the schools or by telemedicine, accessible to people so it is not the teachers that it falls upon and the principles it falls upon and that is something when you talk about telemedicine and Virtual Health and hospitals reaching out and doctors reaching out and pharma, also a part of that equation again pharma is such a big issue i am just not an expert. If you guys have anything to comment on that. I just would say quickly on the dyslexia point i think we do have a real training gap around the science of reading in Elementary School educators, now, a real gap in reading specialists and high need schools, so we both arent identifying the kids early enough, who have this and we are not necessarily providing it as a country the kind of instructional support that students need and i do think there is a problem at times for students that are misdiagnosed and prescribed medication. For what they actually needed was good reading instruction in the first place and so that is a real problem. And there are some states that i think are working hard on improving screening for dyslexia and improving training of teachers and administrators around dyslexia. A making sure quickly we are one of the states that is actually just now completing a. M. Dyslexia projects where we just tracked a number of identified classrooms and students and have been comparing the reading levels and reading attainment levels, with understanding and the language will show you know longitudinal growth so in the tail end of that, of that study and so they can support the efficacy of some of those programs im going to be really honest, so there is two hats i wear, the first hat is yes, that works it is great, you know maybe i cant give you forecast of what the studies will show but then i have to put on you know, my financial administrator hat and say how we are going to pay for it and many of those programs are extremely robust, they work but we have to try to find the funding which is why it is important to continue. I think there is a question one question here, and one of the middle. My name is anna burns and im actually with the national schoolbased health alliance, and last month we released a census study of all the School Based Health Centers Across the country, so i just wanted to give a quick number the 6. 3 Million Students currently have access to schoolbased help here nationwide, and one of the trends that we have been seeing over the last five or six years is the emergence of telehealth, particularly in rural areas and medically underserved areas, how do you all see telehealth kind of coupling with education and the coming years. Again i will let my expert colleagues in education but, i do, i am very involved with the largest Telemedicine Company in the world, it is called tele dock and i have seen the manage and within eight minutes we can reach 8 Million People every year and it is low cost 40 to talk to a boardcertified physician, i need the math, but to show the reach, we have been using infrastructure and we have the knowhow, our federal legislation, effective january has broken down the barriers when i started telemedicine and telehealth would not be reimbursed by states, when i started, now that it is. Huge impact, technology, it is simple, it is an expensive, and so i will take it from there but in terms of access, we are not going to be able to put a notice in every school, we need a nurse or a Health Personnel, that expertise when 25 of the population has a some basic health needs every day, so telemedicine to me and here is why i am optimistic in many ways is a huge opportunity that barriers at the state level have been broken down the last two years and at the federal level have been broken down into telemedicine has been used and in east tennessee and the foundation has used not telemedicine but teledelivery of health into schools with huge success. And again in is one of those areas that now the ecosystem has lowered the barriers i think we can expand greatly. Most of you probably have experience with telehealth. The thing i will say is that it is a way to address some needs obviously that cannot address all needs and we need to have a greater sense of urgency around needing the healthcare needs of real kids and i think not just about access to nurses and doctors but access to dental care, so, you know, to go back to the point about Medicaid Expansion while we have seen it, the state that have pursued expansion we have had a strengthening of rural healthcare, and the survival of rural hospitals where as in states that have not expanded medicaid, any of those hospitals are closing so there is a real urgency around directing resources to addressing rural health needs. For us we, our department and he was, Human Services we have been really informing what the practice will look and can look like and it does look like not only for traditional telemedicine but for Mental Health services as well, so in working with our superintendents, and their teens, but understanding what their needs are, how they have been unsuccessful, and how we have been able to utilize some type of hybrid models we are not leaning too heavily in one area versus another and you know they have been informing both our policy recommendations but also with some of the north and contract language so our counties deliver much of that funding and sometimes, the way it is used as a line item budget as opposed to a Mission Driven budget, is one of the other areas we are trying to change right now. A one final question. We have time for one more. Please. My name is jr denton i am with the Nova Health Systems and two folks secretary came in datasharing and i am curious what if anything you are working on or would like to see happen in order to address issues with making it appropriately more portable for communitybased organizations and other crosscultural collaborations to be able to complete a research and help in this particular area. I would say, in the Obama Administration we put out guidance particularly for our promised neighborhood communities where they were trying to connect across different sectors we put out guidance for them explaining the rules more clearly and showing people that the degree to which data sharing is possible, under current law, you know, secretary rivera made this point people sometimes over interpret the limitations in hippa and as a result, choose not to share data that could be shared to the benefit of kids in communities, now as an advocate the thing i worry about is how do we balance the desire for good information sharing by Service Providers with parents and legitimate concerns with privacy, and helping to construct good rules that allow the right people to have access to the right information in a secure way, because we do see a lot of states a lot of parents concern particularly when they turn on the cv tv and they see data breaches and companies exploiting their data, they are lightly concerned about what we see in some states, legislators will propose things that are overly broad, and would make it harder for educators and Healthcare Providers to serve as well, to where as advocates we are trying to strike that balance. I have very little to add i will say that the access that was expressed, it is a balancing act, you expose data especially in the area of social services, nonmedical aspects of health data, what you see is the health data is a challenge, in 1998 when we wrote, it still is understanding why, with the ipad and the iphone accumulation of data today, and it is one of the areas that we do have to come back to you know, not to dictate the washing, but the guide rails in terms of just explosion in data which we know has huge power. And with the nova and the large systems have more and have the money to access more healthcare and social determinants data than anybody and so i think your question really is a challenge to all of us, especially to those in washington of the people in this room and we are listening today, to come back and struggle with that balance that the job looks at, i will say the parallel supercomputing more personalized healthcare telemedicine for these technologies were not available five years ago. The data was not available five years ago. And again starting with the Obama Administration, and the chief Technology Officer basically said this is a big deal we have to be careful but we need to release this data and be identified in the first step and i think it is incumbent to put on a policymaker to take the next step for the people like you who are doing systems data, the health data getting involved in the community, looking at the Community Assessment and looking at schools and getting involved can do it inappropriate, ethical, moral, equity sensitive ways, i think it is a fantastic question. Another question but given the time maybe you can catch the speakers on their way out but senator, secretary, any final parting words for the audience about those viewing today . I think we need to take the best of the organizations Like National health that are in this, Health Advocacy and the best of the Education Advocacy wealth and collide them together. And with that good things will happen. Right, right. Secretary. Two things, one is sobering then one more positive so the sobering note is we, this did not come up much, we have to stop doing bad things, folks saw the Washington Post article the last couple of days about School Infrastructure when teachers are cleaning rodent droppings off of the rug where they are teaching reading. That is bad for kids education and is bad for their health, when you have schools in baltimore where the water fountains are covered over with plastic bags because of lead, in the water, and the kids are not Drinking Water during the day, that is bad for kids education and it is bad for health and also send a message to kids about how much the society does or does not value them and their education, so in addition to all the good things we talked about today we also need to stop doing some of the bad things we are doing by under investing. In Public Education including the infrastructure of our schools, on a more positive note, thank you for the opportunity to be here, it is inspiring to share a stage with secretary rivera and these men and it is a sign of what is possible in a world of bipartisan collaboration and commitment to kids first. What the senator has accomplished with tennessees score and the degree to which tennessee has as a state across sectors, business, higher education, political leaders, are committed to educational improvement and have made so much progress over the last decade, it is truly inspiring, secretary rivera, in collaboration first, and working across agencies and so i just it makes me hopeful about the future of our country. First i appreciate the opportunity to be here and share but probably most importantly, to hear the list, of folks whenever i looked over at my colleague they were taking notes, all of your great ideas, so you may be reading about them and i might not give you credit for it so i apologize in advance, but, you know i think more importantly, the opportunity here for us to share and really realize the important fact has been wrought up over and over again, there are many, many good people, good organizations, Good Community members doing Amazing Things for our communities and for our students. The issue is everything is done in silence, sought the end of the day you have fortunate individuals that can utilize them but there are many more individuals that are not using or utilizing any of these services because they just do not have access, they do not have the stamina to access many of these opportunities, or, the system is not set up to serve them and some of the most vulnerable communities so as much as we can. Work together to break the barriers so that we can Work Together to the same end, do what we do well, well you know, serving a population in a real holistic way, you know that is how everyone you know, in our schools and everyone in our community each and every single one of our students, the benefit and can continue to learn and an environment that they are deserving of so being here today and being able to hear but more importantly being able to really hit home with the message that we should continue to do what we do but Work Together. To maximize our impact on our most vulnerable communities. Thank you for being here, thank you for all your leadership. Thank you everybody for being here. Tonight, on cspan three, American History focuses on the holocaust we look at the u. S. Response to the era refugee crisis, then later here real life stories from holocaust survivors. American history tv is tonight at eight eastern on cspan number three. Residential leadership surveys, taken between 2020 17, Grover Cleveland drops from 17th to 23rd place. Ulysses s grant makes the most dramatic rise of all the president s, going from the 33rd to the 22nd spot. Where does your favorite president rink . Learned that and more about the lines and leadership skills of 44 chief executives, in cspan the president s it is great vacation reading, available wherever books are sold or at c span. Org the president s. In 1979, Small Network was an unusual, cspan opens the doors to washington policymaking for all to see making you unfiltered coverage. That big idea is more relevant than ever, on television and online, cspan is your unfiltered view of government. So you can make up your own mind. Brought to you as a Public Service by your satellite provider. The trumpet ministration officials testified at a Senate Agriculture Committee Hearing on how Global Agriculture rockets impact u. S. Farmers. They also talked about the us mexico canada trade agreement and potential trade deals with other countr