News & Events

Dr. Ansley Bacon honored for her work in the field of developmental disabilities

The following is Dr. Bacon's convocation address to the students and faculty of New York Medical College.

I am so honored to be your convocation speaker today. But I do have to tell you that feeling honored was not my first reaction to Dr. O'Connell's invitation to speak to you - my first reaction was shock.

As the shock subsided, I began to ask "why me?" Why was I chosen to be today's convocation speaker? One person suggested that it was because I have so many college titles. I am now one of the oldest Program Directors in our School of Public Health (oldest in terms of years on faculty I would like to add).

Another person said that it was because of my role at the Westchester Medical Center as the Executive Director of the Westchester Institute for Human Development. Perhaps it was partly in recognition of my work on disability policy. Many others thought that I should view it as a reward (of sorts) for all of those years of service on university task forces and search committees? But the best response was from my Dad. In his infinite wisdom, he said, "Well honey, if you stay around long enough, they will eventually get to you."

Whatever the reason, Trustees, Msg. Barrett, Deans, colleagues, students, families and guests, thank you for this opportunity to speak to you today.

The Fall Convocation is a special event in the life of NYMC. It is a time for the entire college community to welcome our new members. So let me add my warm welcome to the Medical School Class of 2006, the new students of the school of public health, including the SLP class of 2004, and the PT class of 2005; and the new BMS graduate students. You are now part of the NYMC family. You will be student members of this community for the next 2, 3, 4 or more years. But, let me warn you, it doesn't end there. This is a lifelong relationship. Once you graduate, you will become an alumni member, hopefully an active alumni member. We will keep track of you and what you do in your careers. Like any good family, we will of course claim credit for all of your success. Any failures or problems will be blamed on someone else, maybe your undergraduate university.

By joining NYMC, you are now connected with a great community. Many things make this a wonderful place to be, but today, I want to focus on what I consider to be one of the most important - our shared, university-wide commitment to the goal of advancing the health of the population.

ADVANCING THE HEALTH OF THE POPULATION

Our mission statement begins with this ambitious goal: " to advance the health of the population." But what does that really mean? What ideas and challenges are embedded in that statement? I will begin by taking a careful look at the meaning of this goal for our university. But as I do so, I hope you will realize the challenges this goal represents because I will be asking you to think about how you can embrace this goal as a student, and in your future professional life.

Advance the health of the population - In the broadest sense, one could say that it means this medical university is committed to focusing its resources and expertise on finding solutions to the many pressing health issues facing our society today. We believe that we have a responsibility to use our knowledge to make a difference and to prepare future health professionals to make a difference in the health of the community and society, but particularly in our own community - the Hudson Valley Region and the NY Metropolitan area. We understand and serve a broad set of community needs. We define ourselves, in part, from the perspective of the people we serve.

HEALTH

The mission statement focuses our attention on our society's health issues. In the United States we spend more on health care per capita and in total than any other country in the world, but-

• there are still over 40 million people without health insurance. And in terms of health disparities, Hispanic families are three times as likely, and African-American families twice as likely as White families to be uninsured.
• More than 18 countries have longer life expectancies than the US for both men and women;
• Infant mortality rates are considered to be one of the most sensitive indicators of the health and well-being of a population, yet the United States has a highest infant mortality rate of any country in the developed world. And the infant mortality for African American children in the US is twice that of white children.
• Over 55% of the US population is obese, and the prevalence of childhood obesity has increased from 5% to over 13% of all children over the last 20 years.
• We do not yet have a comprehensive immunization program; nationally only about 73% of children receive all the necessary shots by the age of 3, but again there are big differences between groups. In New York about 80% of white children are likely to receive all their shots compared with 65% for Hispanic and African-American children.
• 19 million adults suffer from depression, the cause of 2/3 of all suicides. Yet less than 1/4 of adults diagnosed with depression receive treatment

These statistics highlight just a few major health issues. They also tell us that many segments of our population are unserved or underserved and experience significant health disparities that occur by race, ethnicity, gender, education, income, disability, sexual orientation and geography. At NYMC, our mission expresses our direct concerned about these health disparities and about our special responsibility for people who are unserved and underserved.

MULTIPLE DETERMINANTS OF HEALTH

In our mission statement, we also identify many different strategies to advance the health of the population - we form partnerships, educate people and encourage them to adopt healthier lifestyles, treat people in times of illness, and contribute to scientific progress.

All of these strategies are important because we understand that our health and well-being is determined by multiple factors: our individual genetic and biological make up; the lifestyle and health behaviors we choose; the physical and social environments in which we live; and the policies and interventions developed to promote health, prevent disease, and ensure access to quality care. All of these factors work in combination to determine our health as individuals, as communities, and as a nation. Therefore, any serious attempts to address the health of the population must work on many levels.

We have made great progress in the development of new medical technologies, in our understanding of the genetic causes of health problems, in the creation of effective pharmaceutical interventions, and in the development of new cures and treatments for many illnesses. Biomedical research has been very successful and must continue. We have also invested a great deal in clinical approaches to treating health problems. But in order to address some of the most pressing health problems we face today, we need to incorporate approaches that focus on the behavioral, social, environmental and policy factors that play such a significant role in our health.

A recent Institute of Medicine report examined the importance of behavioral and social factors on health. It found that six of the 10 leading causes of death are behaviorally based, or, to put it another way, about ½ of all of the causes of mortality in the US are linked to social and behavioral factors, such as smoking, diet, alcohol use, sedentary lifestyle and accidents.

The report concluded that, in terms of improving the health of the population, we need to balance clinical approaches to disease, with a new agenda that emphasizes effective intervention strategies that address the social and behavioral determinants of disease, injury and disability.

This broader approach to health makes sense. But, very few of us will have the depth and breadth of expertise to combine these approaches and address the multiple determinants of health simultaneously. I guess we could all pursue combined MD, PhD and Masters of Public Health degrees. (I think I just heard some of the parents gasp and put their hands over their wallets.) Another approach is to look at this agenda as an opportunity to form collaborative partnerships with colleagues from other disciplines. Long-term, interdisciplinary strategies involving the basic sciences, medicine and the range of public health disciplines are increasingly the most effective approach to addressing the complex issues that determine health.

DISABILITY

The NYMC mission statement is carried out many different ways throughout the college community. Let me give you an example from my own work with a specific population - people with developmental disabilities. Talk about an unserved population! If you look up unserved in the dictionary, you will find a description of people with lifelong disabilities, like mental retardation, cerebral palsy, autism, and other significant disabilities.

What do we know about their health needs and health disparities? We do know that there is lower life expectancy, but beyond that, the data are limited, especially population data. But some studies have found high rates of obesity, low levels of physical activity, and high rates of smoking, all of which are major risk factors for serious health problems. Other studies have shown significant oral health problems, a high prevalence of MH needs.

In some ways, not so much different from the general population. But one of the major differences is that they lack access to high quality health services.

• There are insurance/reimbursement issues, because the majority of adults with developmental disabilities have Medicaid as their primary insurance so reimbursement rates are low.
• Health professionals often lack the training and experience and often, there is fear and prejudice.
• Serving individuals with developmental disabilities can be time-intensive and challenging because of communication barriers, making it difficult to get a good medical history, and to identify and treat health problems. And the provider must play an active role in coordinating care between primary care and specialty care, as well as coordinating with all of the other community service providers in the person's life.

In most parts of the country, because of these issues, access to care is very limited.

It is ironic that as we have found ways to support people with disabilities so that they can live more independent lives in the community, work at real jobs, and be contributing citizens, we haven't been able to find ways of providing access to adequate health care.

And effective health promotion strategies for this population are almost non-existent. At our Institute, we are just beginning to look at innovative strategies to promote healthy lifestyles. A new program, called Best Buddies-Health, matches of young adults with disabilities with medical students and graduate students. The buddy pairs get together on a regular basis and engage in activities to promote health. It might be going to a health club, going for a walk or a bike ride, joining weight watchers, or some other activity related to improving health. The intent is to encourage the young adults with disabilities to adopt healthier lifestyles. I am pleased to say that 16 of you have signed up to be part of this exciting new program.

There are many challenges in the disability field but there is some good news. The major health issues faced by people with disabilities are finally receiving significant national attention. Our country's national initiative to promote health for the entire population, HP 2010, has as one of its major focus areas, a goal related to the health of people with disabilities. The goal is to:

• Promote the health of people with disabilities, prevent secondary conditions, and eliminate disparities between people with and without disabilities in the U.S. population.

This goal is very significant because it represents a change in the way disability is viewed by the public health community. Until fairly recently, the primary public health focus with regard to disability was prevention of disability. Disability status equaled health status. The disability itself was viewed as a health problem to be prevented. This "misconception" as HP 2010 calls it, meant that there was very little focus on health promotion strategies, and no emphasis on the many secondary conditions that people with disabilities are likely to experience.

The new view recognizes that people with disabilities have increased health concerns and susceptibility to secondary conditions. Having a long-term condition increases the need for health care, as well as health promotion strategies that address medical, environmental, social, and access issues.

With this new goal, the disability community and the health community can come together around a common agenda.

THE CHALLENGE

So what about my challenge to you to embrace the College mission and think of specific ways in which you can make a difference in improving the health of the whole population? You are the ones who will make the difference. The skills, attitudes and values you take from this Medical University will have a more profound impact on the future health of our population than almost any other policy or organizational change you can imagine.

You will have many opportunities during your time here to experience the power of building relationships with colleagues from other disciplines as the key to solving the health care problems within communities; you will have opportunities to both mentor and be mentored by individuals and families who live daily with the impact and consequences of chronic illness and disability. Some of these experiences should be humbling, all should be enlightening: because what we need you to become is an advocate -

• an advocate for public policies that will promote and protect the health of communities; and
• an advocate for public policies that will provide you, your professional community and family partners with the resources necessary to develop responsive approaches through which you can achieve the mission the College has set before you.

Don't be overwhelmed by the enormity of the task. We can all make a difference in big way and in small ways: Marian Wright Edelman said "we must not, in trying to think about how we can make a big difference, ignore the small daily differences we can make." There is a Swahili proverb that says the same thing in a different way; "If you ever think that you are too small to make a difference, try spending the night cooped up with a mosquito."

Find your niche, your passion and let it guide your work here and your future career. There are many, many needs and so many opportunities waiting for you. Once you find that niche, use the goal of advancing the health of the population to make a commitment to make a difference in big ways and in small ways.

By doing this, you will be contributing to the health of the population and you will have found a life-long source of professional satisfaction.

Thank you for having me as your speaker today.

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