Senator bill frist, former education secretary john king, pennsylvania education secretary pedro rivera and Healthy Schools campaign ceo Rochelle Davis. This is an hour and 20 minutes. Good morning, everyone. I want to welcome all of you to the Bipartisan Policy Center. Im chief medical advisor here. The title of our event today is education in health, twin pillars for thriving students. Good to see you. For those of you new to bbc, our mission here is to actively seek, to take the best ideas from both political parties, to promote health, security, as well as opportunity for all americans. We drive principles and politically viable policy solutions through the power of analysis, negotiation and advocacy. Todays event focuses on the bidirectional impact of education and health. It is part of a project bpc is engaged in looking at quote unquote health in all policies, the idea that policies outside the Health Sphere in fact have a profound impact on health, and therefore Health Impacts should be a consideration for policy making in these areas. It is increasingly understood that education is an important determinant for health outcomes. In addition, its equally understood that Health Facilitates learning, and thus the Education Sector is equally interested in promoting Healthy Learning environments. Just last week, bpcs Early Childhood initiative hosted an event focused on physically safe and developmentally appropriate child care and Early Learning facilities so children can thrive. We are pleased this afternoon to have an extraordinary set of speakers to discuss todays topic as part of a Panel Discussion. To start us off, i would like to introduce Rochelle Davis. Rochelle is president and ceo of the Healthy Schools campaign. Rochelle will be providing some remarks for all of us. The Healthy Schools campaign is a co sponsor of todays event and has played a tremendous role nationally in leading effective ontheground programs and influencing policy. Rochelle has long been an advocate and leader for childrens health, environMental Health. Earlier in her career and School Health over the last two decades. Following her remarks we will vint our panelists for we will invite our panelists to the stage with a discussion and followed by audience questionandanswer. This event is being streamed live online and the recording will be available next week. We also thank viewers on cspan 2 watching today. Welcome to all of you. With this, i would like to ask Rochelle Davis to come to the podium. She will take us away. Rochelle . [applause] thank you and to the Bipartisan Policy Center for partnering with us and thanks to all of you for being here, both in person, through the web cast and on cspan for this really important conversation. At Healthy Schools campaign, our work is based on the very simple and 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. Healthy 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 prevalence of chronic conditions that impact students ability to be in school and ready to learn, such as, asthma, diabetes, and obesity has doubled from 1 in 8 to 1 in 4 children. And more and more children suffer from a range of Mental Health issues, like anxiety, depression, substance abuse, and adhd. 1 in 5 children has a diagnosable Mental Health problem and nearly 2 3 of them get little or no help. These conditions disproportionately impact low income africanamerican, latino and immigrant children from disinvested and marginalized communities. These children disproportionately suffer from a lack of access to healthcare and attend schools with less access to physical activity, higher exposure to environmental toxins in the air and water and fewer schoolbased health services. Compounding these challenges, many of the same children also live in areas that are 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 healthcare and Supportive School environments reverberate throughout a childs life. A student who is mal nourished or living with unmanaged physical or Mental Health condition will have more problems concentrating in class and miss more school days than a healthy student. Children who are chronically absent, as early as preschool, kindergarten, or first grade are much less likely to be reading at grade level by third grade. And students who cannot read at grade level by the end of third grade are four times more likely to drop out of high school. Research increasingly supporting 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 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 Supportive School climate. 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. These are not things we can take for granted. The school actively teaches students to make healthy choices that allow them to thrive, and physical and mental and behavioral healthcare 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 help 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 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 scalable and sustainable. To do that, we need systems level change, including ensuring 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 system level 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, all state School Report cards must now include chronic absence rates which can be a very powerful proxy measure of Student Health and school wellness. In addition, 36 states have included this as part of their States Educational accountability systems. They are leveraging these new opportunities. For one example since i only have a few more minutes, a School District in tennessee it was hard to pick which one. Okay . [laughter] a School District in tennessee is using funding from essa to support their School Nurses efforts to track why students are absent. This 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, which operates in 22 states, announced that it will require all of its hospitals to include chronic absence in their Community Health needs assessments. Also this year the American Academy of pediatrics released a policy statement highlighting the role that pediatricians can play in addressing chronic absence. With them adding chronic absences into their data systems, we have created a new opportunity for alignment and partnerships. Another opportunity to address a longstanding barrier that schools have faced is some recent changes in medicaid. States now have the opportunity to allow School Districts to be reimbursed for a much wider range of Services Provided to medicaidenrolled students. We are partnering with trust for Americas Health to lead a 15state learning collaborative so that 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 and 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. This event provides an important chance for us to explore how to be successful in building healthy and Supportive School environments so all children can learn and thrive. Thank you. [applause] rochelle, thank you for those opening remarks. I think that sets the stage beautifully for our Panel Discussion today. I do want to take the first maybe couple of minutes and just provide a brief biography sketch of our three panelists that i think most of you know them as public servants, but just so you understand their perspective. To my left center bill frist is a heart and Lung Transplant surgeon and former u. S. Senate majority leader as you know. Senator frist represented tennessee in the u. S. Senate. For 12 years and was elected majority leader in 2003. His service on the Senate Health committee responsible for all federal education policy later inspired him to found score, state collaborative on education to propel tennessee as a k 12 education state. Hes currently a bpc senior fellow and led many Health Initiatives here over the last decade. Thank you for being here. Thank you. John king jr. Is the president and ceo of the education trust, a National Nonprofit organization that seeks to identify and close opportunity and achievement gaps from preschool to college. He served in president obamas cabinet as the tenth u. S. Secretary of education. He joined the Department Following his tenure as the first africanamerican and puerto rican to serve as new york States Education commissioner. He began his career in education as a High School Social studies teacher in puerto rico and boston massachusetts and as a middle school principal. Secretary, thank you very much for being here. And secretary rivera was appointed as pennsylvania secretary of education by Governor Wolf in 2015. Currently secretary rivera also serves as the president of the board of directors for the council of chief state school officers, a Nonpartisan Organization of Public Officials who head state departments of elementary and secondary education. Prior to his appointment to Governor Wolfs cabinet, he served as superintendent of the School District of lancaster. Additionally he was a classroom teacher, assistant principal, principal and executive director for the School District of philadelphia as well as a staff member with the Philadelphia Federation of teachers. Thank you again for all three of you being here. I think you heard from rochelle, her perspective how important this bidirectional impact is between health and education, and i thought it might be helpful to start based on your experiences just to share why is this so important and where are you seeing signs of progress across the country . Senator . Thank you. Rochelle, thank you for your remarks. It really set the stage beautifully. 12 years ago, i was in the United States senate, and after being here for a period of 12 years, and having the opportunity to be involved in no child left behind on the health committee, when i came back to tennessee, i knew a couple of things. This as being a doctor, wearing the doctor hat first, that if somebody has a college degree, four years of continuing education, after the 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 they would have less diabetes, that they would live longer, the five years coming after that, and they would have less heart disease, less diabetes, less obesity, but we didnt know then quite as much but weve developed the Science Behind that gathered the evidence that when you look at health and healthcare, and how long somebody lives, the infant mortality, burden of disease, whatever it is, that it is not the doctor in me or the doctor in you that determines how whatever that measure is, outcome of health, but twice or three times more important than the doctor or the type of insurance or the hospital are these social determinants. What we have learned is that education is a primary social determinant for health. So we have healthcare over here. We have education here. What were talking about today is that nexus of the two. There is not just correlations but there ease causality but theres causality involved. Thats how i got involved initially and weve stayed on it ever since. Great. Secretary . Let me take it to the simplest level of the student. When i was a middle school principal, i recall we had a student who had 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, and when we get a nebulizer set up for him in the nursing home that he could access, he went from missing a lot of school to being in school regularly. His grades went up. He was a happier student. His family was happier, by just having access to quality healthcare made the difference for his educational outcomes. So the thing im encouraged by is i do think theres a growing Awareness Among states and School Districts that as educators we have to be thoughtful about how we Better Connect kids and families to quality healthcare services. Three quick examples. Theres a partnership between Childrens Defense Fund and the Superintendents Association to use the School Enrollment process as an opportunity to talk with families about their enrollment in healthcare, whether thats medicaid or chip or one of the Healthcare Options on the exchanges or personal health insurance, but making sure that families are attentive to their kids having access to healthcare. Thats one. Two, we see and we heard about this in the discussion of essa, we see states paying attention to chronic absenteeism. Whats encouraging about that is that they are using that data point to translate it into action, not just noticing the data point, whether thats connecting families with Healthcare Providers or addressing homelessness or housing insecurity or addressing Food Insecurity that a family might be experiencing or helping a family strategize around transportation, or whatever issues that are getting in the way of kids missing school. A third example is around food. One of the key things that we know thats made a positive difference in kids lives all over the country is the free or reduced price lunch program. There are many kids where that is their best meal of the day. Many schools have expanded to universal breakfast programs. Thats an important step. Many schools and communities are working harder to make sure kids can access food in the summer. 20 of the kids who access the free and reduced price lunch meals during the school year access meals during the summer, but we can do better. There are some communities that have started doing food trucks in the community so that kids have easy access to food, during the summer. Theres 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 increasing the likelihood that kids have access to quality meals. So theres 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 these solutions. Thank you. I think piggybacking off of what my colleague shared, rochelle did a great job kicking off as well as the senator, with identifying and really recognizing the social determinants of health. I would like to share in government especially now in state government, i have learned we dont always engage in the best ways around pushing initiatives through, but one of the things government does do really well is setting conditions, setting conditions for success, sometimes setting 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, i have been really fortunate that i was able to return and teach in the community in which i grew up. And, you know, i understood that, you know, if i really wanted to help others break the cycle of poverty, education was the key. You know, really being steadfast and focusing on improving the quality of education of the students in my class, building the system and beyond. What i quickly learned was that we couldnt focus on the traditional abcs of learning without really realizing those social determinants of health. Realizing that there are students in our community that, you know, live with Food Insecurity every day. You know, they deal with issues of homelessness, have physical health needs, Mental Health needs. And quite frankly, many of those are in some of our most vulnerable communities lack access to quality supports around, you know, around those needs. So as a teacher, at a real small scale, you know, something as simple as providing laundry cards or providing meals in my classroom or providing tokens for public transportation, you know, i was able to better support, you know, the 100 plus students in front of me each and every day. And i started to really become committed in focusing on those areas. As a School Administrator and then ultimately as a district administrator and now a secretary, continue to look at opportunities to expand that reach, but more importantly, solicit, you know, other partners that can help better serve our you know, better serve our students. As a teacher that may have been a corner store owner. But as secretary, im fortunate it could be secretary of agriculture at the state level, secretary of the department of corrections or labor and industry, what weve been trying to do i know we will get deeper around this but understanding that 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 why we exist, how we should be best serving our communities, focusing our collective impact in terms of mission. You know, to better serve those most vulnerable communities and being unapologetic around the need to focus on equity. You know, and just for the sake of the rest of our conversation today, what weve done in the commonwealth of pennsylvania with support of our governor, we have defined equity by saying it is making the resources, opportunities and supports available to communities when they need them, how they need them. Not when we feel like giving to them but making those resources they need to be successful in the manner they need them. That goes from Educational Opportunities to health and Human Services impact. Great. Education is a powerful determinant of health. Health impacts learning. Areas such as physical activity, nutrition, critical, Safety Environmental conditions in schools, critical. Schoolbased clinics, a lot of good literature there, improves gpa, as well as improves health outcomes. It sounds like we know this is pretty important. Maybe secretary king, when we get to your point about barriers. We might see pockets of success here and there, but what are the Biggest Barriers whether youre a state or School District or Health Provider or Health Insurer in terms of collaborating, you know, bringing education and Health Together . Are the barriers funding . Is it accountability . Is it data . Culture . You know, can you go through and maybe what are the most important barriers as to why these two sectors given that we know that its important. We know that bidirectional i will probably be reflecting or will take the stand on reflecting the health part of the health and education part. I think you just saw we can get programs in there, but how do you take them to scale . Scale is going to be an alignment around common goals. I will let my colleagues talk about the pure education, but on 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 policy, but at the state level, state budgets are set its really security, safety, it is health, medicaid and education. You have to balance your budget. So if you put more money in education, health comes down. You put more money in health, education comes down. We have information since the 1960s to show that. I will speak from the Health Perspective because it is a parallel to what healthcare used to be ten years ago really before president obama began to really put together valuebased healthcare spending, not just fee for service, not just more mris you do, the more you get paid or the more primary care visits or the more heart surgery, but to reimburse for not Just Healthcare, which that is fee for service, but more health and well being, the sort of words that sort of in the introduction were used. The outcome for both is well being, is fulfillment, is productivity. If healthcare whats happened, a fee for service system, were moving again with leadership of the past administration and being supported by the current administrations value based care. If you look at the value for the care, and outcome, and its well being, then you immediately go to not the fee for service, but you go to reimbursing for things and we will probably talk about medicaid, it was introduced earlier. That sort of funding. If you Want Better Health well being, not Just Healthcare and you go to value, and a major determinant is the education itself. So right now for the first time, medicares beginning to reimburse for social determinants and food which again were talking mainly food and getting people moving in schools and then the School Nurses with the delivery system, all of a sudden were beginning to reimburse here in washington, d. C. Of medicare, not medicaid, of things like food and transportation and even housing. That needs to come down to the medicaid level and they will be looking for science. Again, it is the common goal, the common alignment about well being of health that will drive it. One last thing, at the state level, the budgeting is siloed, and the budgeting is education and youre focused on education. Youre fighting for every dollar and you have to balance the budget, and it is health. Not until we bring those committees together, at the state level and at the federal level, around these common goals, and just jumping to the very end, the end way you do that is at the local community level. We will come that eventually, i believe. Thats great, senator. Secretary . I agree with everything the senator said. A couple things i would add. I think we have political will challenge, administrative will challenge and a culture challenge. The political will challenge, one example, the states that have done Medicaid Expansion see Better Health outcomes for their children. Now, the Politics Around that are complicated and the senator knows more about that than probably anyone else in the room, but at the end of the day, we know 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 through chip or other programs, they are more likely to participate in their parents are able to access medicaid through Medicaid Expansion. If youre going to the doctor and taking care of your healthcare, you are more likely to make sure your kid getting regular access to healthcare. Thats a political will problem. The administrative will problem is we put out 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 School Based Health services in schools that are serving large numbers of low income students. It is a hassle. It is a bureaucratic hassle. In many states, the rules are quite complicated. The result is that people dont follow through in creating those schoolbased health opportunities, and so it is a lost opportunity for kids and families. We just know people are more likely to Access Healthcare if it is immediately available to them at the school site. The culture problem, i will give you one example that troubles me a lot. Johns hopkins did this study in baltimore, fascinating study, they looked at kids and reading outcomes. And they found shockingly that if you cant see the board or read the book, you do worse in school. I know its a shocking finding. [laughter] 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, but it is an important study, but whats frustrating is the result wasnt that every School Started making sure that every kid had vision screening and had the access to appropriate vision care. There are kids who are being held back. Theyre being told that they are not good at reading, they cant read because of something thats so simple, just untreated vision care. Thats a culture problem. Weve got to get much better at understanding the intersection between health and education. You know, speaking from the state perspective, and really taking into context what john shared, i think what ive noticed over the past few years in observing some of the systemic barriers that exist in local government right now is this far too often weve 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 have engaged thousands of stake holders from everything from essa to our school improvement, you know, focus and opportunities. And what we realize is that in many instances, there could be minor tweaks to language, that would allow a classroom practitioner, a building practitioner, you know, a district leader to utilize resources or time or even relationships differently, you know, to build in high you know, health care into a School System or into, you know, the traditional block of time. You know, looking at dental care and looking at, you know, hearing, you know, and other, you know, types of support services, but what has happened over the course, 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 on the areas that would better serve students and communities holistically. Whereas we have 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 not more energy to reprogram or deprogram some of the old, you know, misnomers, what had always been assumed around a language of law, the language of policy or the responsibility of a system to allow them to think of the care, the community, the client first. test. To build infrastructure and to allow funding for system that could to keep them that are accessing federal, department of agriculture. Programming go program. So schools were able to utilize that federal funding because they didnt have the tools for that. Why not invest a few Million Dollars to build an infrastructure in the school. Pedro rivera we work with the department of corrections to build resource centers. When family comes in, to visit, a mother that happens to be incarcerated, with have the same access to information where we are not, compensation for teachers leadership, we expect so much that by marrying those two together, its a clearcut alignment infested toxic start there. Then we can get appropriate access to healthcare. We can look at things like medicine and technology. They are not thinking creatively and out of the box where we can take these out there but youve got to be able to change that. Now we have the evidence and data to do that. I dont mean to advertise but altogether, 500 people, thats why cspan is important. Its a better help and better learning, a statewide grasp Roots Organization that works with leadership, political advocacy and other partners with that was called national help, totally independent group but looking at the wellbeing of the community, of what health and wellbeing is all about. You take a hospital in the last six or seven years, they look at assessments of the community as part of their nonprofit status. They have to do it because of the policy. They look at what is actually working and they said yes, it makes sense. Our hospital should get involved in our community and adopt schools. Our hospitals should have a program like in tennessee where they put money into education. He looks at the activity and 100 million, physical activity the teachers use through videos. And thats where the intersection goes. Theres a lot of leadership and campaign scores, i want to ask all of you to put your Public Sector hat back on. How difficult is it to promote these partnerships . You talked about when you were with help in Human Services, you were able to do something, you talked about having monthly meetings. Im curious if it was more thought norm or exception. How difficult is it to get folks who are interested in education and help them understand how their policies impact the other sector . What is some advice you have for your current and former colleagues, either on the hill or at the federal level or state level, how they come together and work to bring and make these sectors connected . Then the fresh credit, how do you deal with things like the National Breakfast program, 30 million kids in the School Breakfast program, the jurisdiction over them, at the department of agriculture. Sometimes youre dealing with department well beyond health and education. Talk to us about what the advice is that you have to ensure and promote departmental partnerships to really integrate these . I think trust and collaborative habits are a big challenge. Sometimes you have one organization around one particular organization and then something else. You have to have a regular partnership, often by how then start ongoing collaboration and trust building. There are things policies can make that easier, data sharing easier, that is often a big obstacle. We can improve the training of professionals. Look at most principal training programs, there is discussion of healthcare turnout the intersection between health and education. The impact it has on young people longterm health so we can do training better, data sharing better and then we can break down some of the silos. There are these budgets and they feel like they are mike dollars, and happy to collaborate with you, dont take my money. There are committee oversights, silos and legislature. So we have work to do to break down some of those silos so that people have a sense of shared responsibility. I think first and foremost, it is recognizing that one collaborating and being transparent and trying to be clear in terms of what youre hoping to accomplish, physically deal of vulnerability. Thats the world we live in. Its like being a superintendent in the middle of a snowstorm and deciding whether or not to. They hate the superintendent and make a decision or not those. If theres any advice, we have to be explicit around what we are looking to address and what goal we are hoping to accomplish. Just to pick one specific instance, when we were looking at summer, one of the obstacles we faced was some of our rural communities. Some of the rural communities, we needed to bring the population together in order to use some of the funding to provide those options. So we had to bring partners together from both the community and across agencies to find a way to provide opportunities in some of our most vulnerable dispersed communities. Everything from communities create the equivalent of a school lunch truck, for example, they have outfitted full transportation to serve as it congregates feeding locations. We work with our Church Partners to provide those services. By not bringing everyone together, we would never have been able to tackle that issue. Now we interpret take the lead and the fix in reviewing language. Many of the conversations, we are extremely passionate and everyone had an opinion and everyone understood their role to be as it could be. By not coming together and addressing the vulnerabilities and focusing working through thus, we would never have found a way to serve those communiti communities. I think it is a every level. What we need in terms of leadership and having people at the top, basically said this is a priority. Now we have the data to show why its such an important priority. If you look at the primitives we are talking about, there are programs that show people do better on tests and so up for school on time, you put the data out for the health committee, it is clear cut overall. There are other things, much as today which are killing our kids, at the federal level, they are adding sugary beverages. Those are battles that have to be fought. But ultimately, it what is going into our body is what gives us health. Its hard because the government can create problems. Not intentionally but the idea that we are in the world of education, all of which is really important, that was part of the no child left behind. Then that is translated to the individual teacher but i will solely be judged on these expectations in terms of scores, i had to discipline a student, i will take away what they love and not be counterproductive. Execution can actually happen then. I would like to make some final comments. There was be some questions the audience. We have roaming microphones on both sides. Please raise your hand and introduce yourself please. Is working. Thank you very much for the talk ive realized of course i was in an International Economist and an educator as well. So i can see a lot of things here on what youre saying, is being very important. I realize that you havent mentioned the very important stakeholder in the system. Its not just the people at the local level and the state level but what about the farmer and actually doctor fritz you can talk about this than i can. For example, learning and thinking of as far as the education and healthcare, our children who have dyslexia, they are in the schools and they are in the normal classroom. They have a lot of problems and the problems are not just in the schools but also at home with the parents who dont know how to treat them. One of the big problems of course, is the big farmer that does not provide for anything that helps the students without making them as, the bad person in the classroom. Of course our teachers are not prepared to deal with the brightness of the 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. The proper medication but also can they make these medications los expensive. Dr. Bill frist first of all i love your question. But im not going to be able to answer. [laughter] i think that you bring up the. That there is a huges stakeholders and you brought up one that i didnt mention. They are outside of the normal purview of the true experts. We learned in education. Now is the time to open up our spirit to reach out and educate them in any political pressure and expose them in certain ways. I make sure that i mentioned sugar beverages and thats the kind of thinking that i dont know exactly how to get the big pharma involved but i think its a wonderful idea. People in the schools or by telemedicine, accessible to people so its not the teachers that it falls upon in the principles that oppose a upon in this something that when you talk about telemedicine and Virtual Health and hospitals reaching out and doctors reaching out and, should all be a part of that equation. And, is such a big issue. If you guys have anything to comment on that. You click you touched on the dyslexia aspect. We also have a real gap in access to reading specialists and some of the schools. We both are identifying kids early enough who have dyslexia. And we arent necessarily providing the kind of support they need. Some students are misdiagnosed and prescribed medication. What they actually needed was good reading instruction in the first place. That is a real problem and there are some states that are working hard on improving the screening for dyslexia in the training of administrators and teachers around this. We are one of the states is actually now just completing dyslexia project where we have tracked a number of identify classrooms and students and have been comparing the reading levels in the reading attainment levels of both of the understanding and growth. On the parallel end of that starting so in turn we support the advocacy of those programs. Im going to be really honest though, the first half is if it works, its great. I cant give you the forecast of what the studies are going to show then i have to put on my financial administrator had and say how are we going to move forward. Those programs are extremely well done and they work and we have to find the funding. Greater think there is a question here in one of the middle here. My name is anna and i am actually with the school appliance. Within the last month we released census that study across the country. I just want to give a quick number 6. 3 Million Students currently have access to healthcare nationwide. One of the tours that we then seeing over the last five or six years is the emergence of telehealth. Its really in rural areas and medically underserved areas. An easy telehealth struggling with education in the coming years. Again all of my experts and colleagues in education, i am in evolved very heavily with tele dock. Within eight minutes, we can reach 3 Million People every year at a very low cost. Forty dollars to talk to a boardcertified physician. I mentioned that because tele dock shows reach, we had the infrastructure and 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 it is. Theres a huge impact with technology, it simple and its inexpensive. Ill take it from there but in terms of access, were not going to be able to flip and put this in every school. We need a nurse or Health Personnel with that expertise when 25 percent of the population have some basic health need every day they come to class. Telemedicine to me and i am off to make steak in many ways is a huge opportunity with barriers at the state level have been broke down last year and the federal have been broken down. They have been used in east tennessee. The foundation has used not tele medicine but tele delivery of health in the schools with huge success and again is one of those areas that now the ecosystem has lowered the barriers, i think it can expand greatly. Most of you probably do have experience with telehealth. The thing i would say is as a way to address some needs but obviously cant address all needs. We need to have a greater sense of urgency around meeting the Health Care Needs of rural kids. I think not just about access to nurses and doctors but access to dental care. To go back to the. About medicaid. What we have seen we have Medicaid Expansion. The survival of rural hospitals where as in states that have not expanded medicaid, many of those hospitals are closing. There is a real urgency around directing resources to rural health. For s our department of Human Services and department of education have been convenient especially in our rural areas. With the practice can look like it does look like, not only for our traditional our medicine but Mental Health services as well. In working with our superintendent and their teams, then understanding what their needs are, how they have been most successful in how we have been able to utilize some type of hybrid model so we are not leaning too heavily in one area versus another. Theyve been informing other policy recommendations but also with some of the contract language. So our county knows and does much of that funding is sometimes dispute is alondra item budget instead of a Mission Driven budget is one of the areas we are trying to change right now. One final question. My name is jr. Im without assistance. There are two folks secretary king mentioned data sharing. What are you working on or would like to see happen in order to address issues with hipaa, portability and actually making it appropriately more affordable for organizations another Cross Cultural cross sector collaboration to complete research and help in that particular area . I would say in the Obama Administration, without guidance particularly for our promise neighborhood communities where they were trying to connect the process sectors. We put up Guidance Forum explain the rules more clearly and showing people a degree which dan is sharing is possible under current law. Secretary rivera made this. People sometimes over interpret the limitations and have back in for back in as a result, choose not to share data that could be shared. To the benefit of kids and communities. Now as an advocate, one of the things i worry about is how do we balance the desire for good information sharing service providers. With parents concerns and privacy in helping to construct rules that allow the right people to have access to the right information in a secure way. We do see a lot of states, particularly when they see on the tv that they see news reports about data breaches are about companies exploiting their data, they are rightly concerned. What we see in some states that legislators will propose bills that are overly broad. It would make it harder for educators and Healthcare Providers to serve kids well. As advocates, were oyster to strike the right balance. The i will say that the access has been expressed perfectly. It is a balancing act. Especially in the area of the social services, nonmedical access of health data, plus what you say is that health data is a challenge. 1998 when we wrote it still is just standing but that was before the iphone and the accumulation of data today. It is one of the areas that we do have to come back to. Not to dictate from washington but set some guide rails in terms of aches lotion and data which we know has huge power. You have a large systems and you have more money to access more healthcare and social deterrent data than anybody. I think your question really is a challenge to all of us and especially to those in washington of the people in this room who are listening today to come back and struggle with the balance that you looked at. I will say supercomputing and more personalized healthcare and tele medicine, these technologies were not available five years ago. The data was not available five years ago. Again it started with the Obama Administration. The chief Technology Officer said this is a big deal we have to be careful but we need to relieve this data and see whether it was the right first step. We need to look at the policymakers to take that next step. People like you who are doing youre getting involved in looking at all of the schools and getting involved in doing it on and appropriate, ethical, moral and equity sensitive way. I think its a fantastic question. Given the time, you may be able to catch the speakers on the way out. Do you have any final parting words for the audience those viewing today. I think we need to take the best of organizations Like National health that are in the self at infancy. The best of the education and at the state as well. Glide them together. With that good things are going to happen. Two things, one suffering and then one more positive. The sobering notice this doesnt come up this much. Folks thought the post on the washington article about poor infrastructure. When teachers are claiming rodent droppings off of the rug where they are teaching reading. That is man for kids education and bad for their health. We have schools in baltimore where the water fountains are covered over with plastic bags, because of lead, kids arent during cooking water during the day. Thats bad for kids health and bad for the overall look of that the kids see that is no one values them. We are under investing in Public Education including the infrastructure of her schools. On a more positive note, thank you for the opportunity for me to be here. It is inspiring to share a stage with all of you as a sign of what is possible in a world of bipartisan collaboration and commitment to kids first. What we accomplish with tennessee score and the degree which tennessee is a state across sector business of our entire education committed to education improvement. Has made a lot of progress it is truly inspiring. In collaboration first, working across agencies and so it makes me hopeful about the future of our country. I appreciate the opportunity to be here and share the probably most importantly, to hear that we learn lots of folks his ideas. Were always taking notes to steal all of your good ideas. You may be reading about them and i might not give you credit for it. So i apologize in advance. [laughter] more portly, the opportunity here for us to share and really realize an important fact thats been brought up over and over again. There are many good people good organizations and Good Community members and have done Amazing Things for us and our communities. The issue is everyone is doing them in silence. At the end of the day you have some very fortunate individuals who can utilize them as a superuser but there are many more individuals were not using and who are not utilizing any of these services because they dont have access or they dont have the stamina to access many of these opportunities or the system is just not set up to serve them and some of the most vulnerable communities. As much as we can, Work Together to break the barriers so that we can Work Together to amend and do what we need to do and do it well. While serving a population in a very holistic way, thats how everyone in our schools and everyone in our communities in each and every one of our students will benefit and can contain and learn in an environment that there are deserving of. Being here today and being able to hear but more importantly to be able to purely at home with the message that we should continue to do would be due Work Together to maximize our impact on our most vulnerable communities. Thank you for your leadership and for being here. Makes for all of your efforts. Thank you everybody. [applause] [applause] [inaudible conversation] [inaudible conversation] [inaudible conversation] todays theme is political history. Authors include Mitch Mcconnell and jared cohen. Hater historians and contributors to cspan the presence book consider the strengths and what weaknesses of all us chiefs and commanders. You can watch that beginning at 830 here in cspan two. Enjoy the tv and every weekend on cspan two. Also tonight and 930 eastern, about the future of Representative Democracy and relations between legislative branches. Speakers include carl grove, former House Majority eric cantor and former governors give hodges of South Carolina and george allen of virginia. Again you can watch a 930 eastern on cspan. On cspan three we are featuring American History programs. We are showcasing our weekly lectures and history series. Taking her to College Classrooms around the country. Tonight we focus on native americans. He can watch it tonight starting at eight eastern and enjoy American History tv every weekend on cspan three. Tonight on the communicator, cnbc cybersecurity reporter kate panini on her book, kingdom of life. Its about the world of cybercrime. If you want to understand what all of these things are happening to us, whether it is the exploitation of the algorithms that run twitter and facebook in order to help the russian intelligent agencies influence an election. Or things that have taken down big cities like baltimore and atlanta, we have to understand the people so behind these things and all of them are different. Tonight at eight eastern on cspan two. Next, the Senate Agriculture committee looks Agricultural Research in the status of the abutment taken the 2018th our bill. Witnesses include deputy undersecretary for research, scott hutchins, who answers questions to address concerns regarding the relocation of research service. The National Institute for food and agriculture