INTERVIEW

InterviewVIEW The Power

INTER and Possibility of a Healthy World

An Interview with Richard H. Carmona, M.D., M.P.H., FACS, President, Canyon Ranch Institute

also the fi rst Distinguished Professor of Public This is not to say that people who practice Health at the Mel and Enid Zuckerman College healthy behaviors don’t get sick. However, the vast of Public Health at the University of , disease burden that we deal with on a daily basis is and the fi rst Distinguished Professor of Health the result of chronic illnesses such as heart disease, Promotion and Entrepreneurship at The Ohio asthma, depression, and Type 2 diabetes. Take State University College of Nursing. smoking – almost half a million people die from it every year and millions more suffer from chronic ORGANIZATION BRIEF A 501(c)3 nonprofi t diseases like emphysema and bronchitis as a result U.S. Surgeon General Richard Carmona and some young friends public charity, Canyon Ranch Institute (www. of smoking; children develop more ear infections; during a visit to a City school. canyonranchinstitute.org; CRI) catalyzes the and women exposed to secondhand smoke have possibility of optimal health for all people by smaller babies who have a higher incidence of EDITORS’ NOTE After dropping out of high translating the best practices of Canyon Ranch asthma and chronic infections later in life. school, Dr. Richard Carmona enlisted in the U.S. and CRI’s partners to help educate, inspire, and Obesity is another issue: over nine million Army. While serving, he earned his G.E.D. and empower every person to prevent disease and American children are overweight or obese, and went on to become a combat-decorated Special embrace a life of wellness. obesity is the most potent accelerator of chronic Forces Vietnam veteran. After leaving active diseases known to mankind. If you’re obese, duty, he attended Bronx Community College of What is the status of health care reform you are at a much higher risk of getting Type 2 the City University of New York, where he earned today, and are the important issues being diabetes or accelerated cardiovascular disease; an Associate of Arts degree. He then attended addressed? you may have a stroke; and you may develop the University of California, San Francisco, Very little of the substantive discussion other diseases. If you already have diseases, where he earned a bachelor of science degree around health care reform has taken place, at obesity makes them worse. and then a medical degree, graduating at the least in the public forum. Unfortunately, it’s When you list all of the things that we’re top of his medical school class. Trained in gen- been diluted with political extremism. paying for, so much goes back to lack of healthy eral and vascular surgery, Carmona also com- We need to look at our ‘system’ of care. We lifestyle choices and not understanding how pleted an NIH-sponsored fellowship in trauma, don’t really have a health system – we have a these choices impact our quality of life and our burns, and critical care. He was then recruited sick care system; one that rewards providers for cost of care. jointly by the Tucson (Arizona) Medical Center taking care of people who get sick. Incentives Is this a matter of individual decisions and the to start and direct aren’t properly aligned because health profes- or can government regulation play a role? Arizona’s fi rst regional trauma care system. He sionals make their revenue by treating people Can more be done to encourage people to went on to become the Chairman of the State of who have disease. We have a perversely incen- take responsibility for their own health? Arizona Southern Regional Emergency Medical tivized system. We also have the best science That debate goes on in public health fo- System, as well as a professor of surgery, public in the world often delivered in an ineffi cient rums as well as in business circles. health, and family and community at and sometimes ineffective manner. According Mayor Mike Bloomberg tried enforcing it the University of Arizona. Public health came as to the World Health Organization, the United by banning the large cups of carbonated bever- a second career. Carmona went back to school States spends more per capita on health care ages in New York. The question is, where does while working in order to complete a master’s de- than anyplace in the world, sometimes by many the regulation stop? Does everybody have to gree in public health at the University of Arizona. multiples. Yet, depending on the health metric, memorize a manual about what they can and He has also served for over 25 years with the Pima we’re only the 25th to 40th healthiest nation. cannot eat? I understand the intent, but we have County Sheriff’s Department in Tucson, includ- How can that be when we generate the best in- to look at policy realistically. ing as deputy sheriff, detective, SWAT team leader novative products and 80 percent of the drugs Most of my colleagues in public health un- and department surgeon. He is one of the most on the market come from U.S. research? derstand that the best chance of us succeeding highly decorated police offi cers in Arizona. He It’s because the system is ineffective and is to change behaviors and improve the health has served as a medical director of police and ineffi cient, and because the American popu- literacy of the nation so that people understand fi re departments, and is a fully qualifi ed peace lation still practices bad behaviors that result in there are consequences to their decisions. If you offi cer with expertise in special operations and chronic disease and unsustainable health care continue to be sedentary, eat the wrong foods, emergency preparedness, including weapons of costs. Three-quarters of U.S. health expendi- smoke, and engage in high-risk activities, pre- mass destruction. In 2002, he was nominated by tures go toward treatment of chronic diseases – dictably, you will cost society more money and the president and unanimously confi rmed by the many of which are preventable die sooner. Senate to become the 17th Surgeon We spend over 18 percent of our Gross Also, the example you set for your children General of the United States. After successfully Domestic Product on sick care; 75 cents of every and grandchildren will be poor, because they will completing the statutory four-year term of the U.S. health care dollar is spent on treating chronic replicate those behaviors going forward in life. Surgeon General, he was named Vice Chairman disease. Therein lies the value proposition The idea is to take the best science and of Canyon Ranch and President of the Canyon for rightsizing this system: advance health lit- deliver it in a culturally competent, health liter- Ranch Institute Board of Directors. Carmona is eracy, prevent disease, and promote wellness. ate manner so the end-users, all people, are VOLUME 36, NUMBER 4 POSTED WITH PERMISSION. COPYRIGHT © 2013 LEADERS MAGAZINE, INC. LEADERS 221

Untitled-1 2 7/17/2013 9:02:32 AM impacted by that message in such a way that they other specialties. What we really need is to in- leaders in health and wellness. They said, we change their behaviors in a sustainable way – centivize all of our health professionals to start want to make sure those who can’t come here that they start walking every day; they never focusing on primary care and prevention. get the benefi ts of what we have developed. smoke; they eliminate high-risk activities in their If we continue to argue the politics of I was asked to be Vice Chairman of the daily endeavors and they educate their children health care and who pays, that won’t address corporation and to help with business, but also to be discriminate in how and what they eat, and the issue. If we don’t do something, we know to be the President of Canyon Ranch Institute kids remain physically active. the costs will continue to rise. to make sure the knowledge they had accu- We have the science and knowledge to be Finding the best path forward is what we mulated over decades – on how to keep people successful. The translational element is so dif- need to do, devoid of the political rhetoric and healthy and well in a sustainable manner – fi cult because we’re a heterogeneous society: focused on substantive discussion of what will could be shared with underserved communi- there is no such thing as the ‘average’ American. work, based on evidence and best practices. ties all over the world; this appealed to me. We must embark on this journey of improving Overall, we are seeing a brain drain and I kept my academic credentials, but work- the health literacy of the nation, which we do at exporting a signifi cant amount of our master’s ing with my colleagues and our partners at the Canyon Ranch Institute, and in doing so, we will and doctorate students to other countries to Canyon Ranch Institute gave me a platform and start to affect a cultural change where people compete against us. a universe of intellectual property to dissemi- start to accept some of the responsibility. In minority populations, as many as a third nate through all of the partnerships that our Government has a responsibility to provide of U.S. students drop out of high school. How team has created. information and programs to incentivize people can we hope for a diverse workforce in health We have proof of concept now, data that to make healthy choices. But, the government professions when we can’t get a third of these has been generated over the years to show that can’t do it alone. The government has to meet kids out of high school? we can build sustainable programs within some the public halfway and help those who of the most economically challenged don’t understand that there is an op- communities, improving health met- portunity for each of us to be individu- rics and empowering people to make ally responsible for our health through healthier choices for themselves and the decisions that we make every day. their families. With health may come We can’t underestimate the chal- a better chance of being employed lenges we face such as the fact that 20 and staying out of the hospitals, and percent of children grow up in poverty. children having a better chance of By the time they’re in adolescence, al- graduating and enjoying successful, most half of the children in the United productive lives. States are in some type of support pro- How do you evaluate success gram, which is embarrassing for the when you have such a lofty goal? greatest nation in the world. We pay Can you put metrics in place to the consequences because later in life, track impact? those social determinants come back At Canyon Ranch Institute, we to haunt us as those children get older, were determined to distinguish our- practice bad health habits, and become In October 2009, Canyon Ranch Institute (CRI) and Urban Health Plan (UHP) cut the ribbon selves in several ways. We hold our- to open The UHP-CRI Health & Wellness Center in the South Bronx, New York. The center is a societal burden. the home base for the CRI Life Enhancement Program at UHP. Pictured left to right: UHP CEO selves out to be thought leaders who Do you feel it is possible for and President Paloma Izquierdo-Hernandez, M.P.H., M.S.; Richard H. Carmona, M.D., M.P.H., are willing to tackle the most compli- real change to occur or is it tough FACS; UHP Founder Richard Izquierdo, M.D.; and CRI Executive Director and Board Member cated public health issues in the world. to remain optimistic? Jennifer Cabe, M.A. We have built a board and team of Real change can happen and I’m those thought leaders with the intellec- optimistic. This is our mantra at Canyon Ranch It’s critical that we make sure we have sys- tual capital that we need to make these changes. Institute: The Power and Possibility of a Healthy tems in place that give all students a chance to We run all of our partnerships and programs in World. reach their fullest potential, even if they are liv- an academic fashion; and at the onset of every It means that we have to engage the ing on the margin. single program, we determine the community American public – all 320 million of us have to It’s extremely important that we under- health needs and how we will measure sustain- understand that there is an element of personal stand the social determinants of health. The best able change and cost effectiveness over time. responsibility. Government does have a role to predictor of health status and one’s success or To be considered thought leaders in this educate the public where necessary and put failure is socioeconomic status. space, we needed to publish, so every one of programs in place. It’s clear, based on the trajec- We have to make sure that we’re not con- our programs eventually has papers written and tory we are on today with spending over $2.8 tinuing to disadvantage people because they presentations given about it. trillion on health care, that if we project into the start in a disadvantaged way. If we want a As a result, our leadership has been invited next decade, we’ll be spending 25 percent of healthy workforce, and we want these children to join committees that are developing policy our GDP or $5.5 to $6 trillion. It’s breaking the to become assets to society and not liabilities, for the nation and the world related to health bank already. We can’t afford this any longer. we have to ensure that they get the appropriate and wellness. Everything we have accomplished Eventually, we’ll be forced to do the right education and encourage many of them to get has come from a prospective plan. thing for economic reasons, although we should into the hard sciences, because this is where we We want to build and grow an organization have been acting incrementally over the past need to continue to innovate and where the that is recognized as a credible source of informa- decades when this scientifi c information be- money will be in the future. tion on its own, which has demonstrated through came available. When your term as U.S. Surgeon its programs that it can affect sustainable behav- Do young people still desire to enter General ended, what excited you about ior change, resulting in improved quality of life the health care industry and will we have leading Canyon Ranch Institute? and decreased cost. Our programs are evidence the talent in health care that we need going Even as U.S. Surgeon General, I always based; the metrics are there. We simply start off forward? used the best practices of Canyon Ranch as an defi ning what must change in order to help us For a while, the applications to medical example of the right value proposition: pursu- defi ne success. This can be economic change, school and some health professions dropped, ing optimal health and wellness for all. health change, community improvements, and so but they’re back on the rise. In a resort setting, it is limited to people much more. We set high standards because we However, we have young professionals who can afford to come. What appealed to me is recognize that Canyon Ranch Institute must lead coming out of medical school with debt that that the owners and founders desperately wanted through innovation, which means both applying exceeds $150,000. Many are forced to go into to export the intellectual property they had de- and developing the best available science to meet professions that will pay more, like surgery and veloped over 30 years of being the preeminent our important mission.• 222 LEADERS POSTED WITH PERMISSION. COPYRIGHT © 2013 LEADERS MAGAZINE, INC. VOLUME 36, NUMBER 4