Michael Randall: Young Leaders in Public Service

0:00:09.1 DeAndré Calvert.: Good afternoon everyone. My name is DeAndre Calvert, I'm the Community Engagement Manager for the program in practical policy engagement here at the Ford School. I'd like to welcome everyone to our Young Leaders and Public Service event with our special guest, Mr. Michael Randall, who is a senior director of Community Impact for the American Heart Association. Right now, I just want to make sure everyone knows that this event is being recorded, and I'd like to acknowledge Mariam Negaran, who is our administrative assistant and our tech guru, who will be helping behind the scenes, and also our associate director, Ms. Cindy Bank. Right now, I'd like to introduce Michael, he is one of our community partners with the PCLP, the independent study through the program in practical policy engagement. We worked for the last two semesters now, in the spring and in the fall, on tobacco issues within public schools in the State of Michigan. Now, Michael wears many hats, and actually, he was just promoted to this current position, so congratulations on that, but it's been an honor to get to know him, working with our students and seeing all the work that the American Heart Association does. So without further ado, I'd like to introduce Mr. Michael Randall.

0:01:20.6 Michael Randall: Awesome, thank you, DeAndre, and Cindy and Mariam, thank you for having me. It's actually been a tremendous pleasure to be working with the Ford School in this work with tobacco-related issues and vaping issues within our public schools. The American Heart Association for a number of years has had an interest in preventing tobacco usage for obvious reasons, of course, tobacco use is prevalent in individuals who end up leading a life of cardiovascular disease. However, we've seen a resurgence of tobacco usage primarily in our younger population, middle school and high school-age individuals because of the advent and the distribution of vaping products, and so there's been a renewed focus on this issue, and we were blessed and fortunate to be connected with DeAndre through LaSonia Forte, through our connection there, and it's really just been really off to the race as we developed the practicum, we were able to submit that and get some students interested in that, so we're in our second semester. I'm really looking at school policies and how those policies support students in their journey to prevent tobacco usage or stop and create cessation opportunities for students who are addicted.

0:03:01.8 MR: So this is an epidemic that our young people are dealing with, and it's really awesome to have students from the Ford School really help us look at these policies and figure out how to engage K through 12 education when it comes to developing policy that's supportive and not punitive in nature. So once again DeAndre, thanks for having me. I appreciate it.

0:03:30.8 DC: My pleasure. So now at this time, you can take an opportunity to explain your journey, how you got in this position and some of the work that you do with the American Heart Association.

0:03:41.2 MR: Absolutely. So I currently serve as the Senior Director of Community Impact for the American Heart Association, and that primarily covers the entire State of Michigan when it comes to what we call our health strategies work, and that work falls into three buckets, the first bucket is heavily focused on our clinical partners. So we work with large health systems like the University of Michigan Health System, Beaumont, the Hammond Fords of the world. We also work with a lot of small, fairly qualified health clinics as well, free clinics, and other primary care providers as well, and a lot of that work with our clinical partners is focused on improving health outcomes for patients that are disproportionately impacted by cardiovascular disease. So we have several quality-improvement programs that we offer to our clinical partners that are based on The American Heart Association guidelines around cholesterol management, hypertension management, and more increasingly, type two diabetes management. So you probably are familiar with the American Heart Association guidelines 2017, American College of Cardiology, I'm sorry, I was messed up there, guidelines that really help keep guardrails in terms of how physicians and cardiologists are caring for patients that are dealing with these chronic conditions.

0:05:26.1 MR: So I act as a consultant. I work very closely with quality improvement directors, chief medical officers. I'm really looking at those guidelines and creating protocols and algorithms to help improve clinical workflow, create efficiency, and really prevent the misdiagnosis of hypertension and cholesterol and other things. We also work primarily in medication adherence as well, so statins, aspirin, other beta blockers, other drugs and prescription drugs that are used to help individuals that are suffering from chronic conditions like cardiovascular disease and stroke. So that's one bucket. The other bucket really focuses on our community engagement, and so this is where the Ford School comes in. We have several areas that we work in in terms of creating what we like to call, environments that make the healthy choice the easy choice. So a lot of those things are based on policy. Take tobacco for instance, there's laws around age and possession and usage of tobacco that help safeguard industries to prey on young people, to sell cigarettes to individuals that are underage. There's laws that protect against that, so it helps to create an environment that's conducive of lower tobacco usage.

0:07:03.5 MR: And what we've seen increasingly is, the vaping industry has taken advantage of loopholes in the laws and created products that are very addictive and are being promoted directly to young people. So we really try to look at policy systems and environmental change, that we can help municipalities and even states, and even on the federal level, help create policies that create environments that hopefully help people make healthy choices when it comes to their cardiovascular health, which we found by science is a proxy for overall optimal health.

0:07:45.2 MR: So tobacco falls into that, we also work a lot in environmental spaces, and so clean water, clean air. We also work with transportation organizations, providing transportation to low-income individuals, we work a lot in that space. We also work in affordable housing because affordable housing also is a proxy for life trajectory and life expectancy. So a lot of our work is focused on that area and really looking at how we can create policies and systems and environmental changes to help improve those environments.

0:08:20.8 MR: And the third bucket really is our volunteer focus. We are a voluntary health organization, so we've been fortunate and blessed to work with fantastic organizations all throughout the world that are interested in cardiovascular health, are interested in overall health, and reducing some of these disparities that we see in this area, again, disproportionately impacting people of color and women and the low-income individuals. So my work in that area is just continuing to harvest and cultivate relationships with organizations that care and understand our mission and wanna help us move forward.

0:09:06.4 MR: So that's pretty much my role at the American Heart Association. How I got to the AHA is an interesting story. I always say that I didn't really choose population health or public health, it chose me. I'm an urban planner by training. Out of college, I wanted to do affordable housing, I wanted to work for a local nonprofit housing developer, or even working in a city planning department or something like that, with a focus on community development and housing development.

0:09:45.4 MR: I had an internship at the Ypsilanti Housing Commission, not too far from campus, and I had my internship, I felt it went well, and I was not offered a job. I was hoping to be offered a job, but I was offered an AmeriCorps position. The actual position was for a health navigator within the Washtenaw County Health Department. And the executive director at the Ypsilanti Housing Commission connected me with that opportunity, and I spent two years as an AmeriCorps worker working within the Health Department.

0:10:23.1 MR: And I primarily worked in benefits access, so I helped people get connected with Medicaid insurance, Medicare insurance, marketplace insurance. This was 2013 and 2014, so this is right when the Affordable Care Act was passed and Medicaid was expanded in the State of Michigan. So as you can imagine, overnight we had close to 25,000 newly eligible individuals in the county. So it was my job to go out in the county and build capacity to get all these people enrolled.

0:11:02.5 MR: And it was a challenge. We had very small mini grants that we can help churches and schools and anyone that would... Anybody, anyone that cared. We would give them small grants so they can buy laptops and printers and scanners so they can assist individuals in the community that needed to be connected with the newly passed Medicaid expansion. It was a very exciting time. And that was my first... That was my first, I would say, engagement when it came to population-level healthcare, looking at counties, not just looking at direct service or point-of-care service, like a nurse caring for a patient or a doctor caring for a patient. We were looking at increasing levels in the tens of thousands in terms of people that were enrolled.

0:12:02.0 MR: And so it got me interested in looking at, what were some of the barriers or what were some of the policies that could be in place to help make these processes more efficient? So I would look at the Michigan Department of Health and Human Services and the role they played. I would look at the County Health Department and the role that they played, and also other social services and the role they played in terms of this ecosystem that was either sometimes very helpful and very useful, but sometimes created several barriers to individuals that were accessing healthcare.

0:12:38.8 MR: So from there, I went to a Medicare managed care provider called AmeriHealth Caritas. It's an integrated care organization, and that was my first introduction to really looking at urban problems. That organization serviced the Tri-County area, so Macomb, Oakland and Wayne County, and most of the patients that were serviced under this integrated care organization were in the City of Detroit, and I once again was a healthcare navigator and I was looking for hard-to-reach patients. Connecting them with services, connecting them with primary care, and also doing social determinants of health screening. So I had patients that were living in very high levels of poverty, individuals that lived in homes with no heat. Individuals that had live sewage in their basement, individuals that didn't have roofs and were using a tarp for a roof. So these were extremely impoverished conditions, and I was tasked to connect them with healthcare. So once again, looking at those barriers and knowing that these organizations were funded by CMS, these were Medicare-funded organizations. However, we were still having issues connecting patients with their health coverage.

0:14:07.7 MR: So once again, I'm ruminating. I'm in my car in 95-degree weather and I'm looking for hard-to-reach patients and I'm knocking on doors, and I'm thinking like, "What are the systemic issues that are creating this? Like does this individual even know that they've been enrolled into this health plan?" Oftentimes, Medicaid recipients, they get auto-enrolled in their health plan, they don't even know that they have it, and so I would knock on their door and they would say, "Who are you?" "I'm from AmeriHealth." "What is AmeriHealth?" "That's your insurance." "I didn't know I had that insurance. What is that?" They may have went to the emergency room and got connected with a social worker, and the social worker enrolled them in the healthcare coverage. They never followed up, and so the state just enrolled them automatically. So imagine going years without actually knowing you have healthcare coverage and your teeth are rotting now. You're going deaf and you don't have a hearing aid. You're going blind and you don't have glasses, but you've always had this coverage, you just didn't know. These are some of the things that I was experiencing day in and day out.

0:15:16.6 MR: And one day, I just got a call, and it was a woman [0:15:20.3] ____ from the American Heart Association asking me if I wanted to apply for a Community Impact Director position, and I was like, "Absolutely." Because I was familiar with the American Heart Association, I had worked in clinics that were enrolled in some of the quality improvement programs. I really didn't have... I didn't have an extensive understanding and knowledge of what the American Heart Association does, but I knew they focused on a population level, with a bunch of individuals, and they were really heavily focused on advocacy, awareness, and policy, which is where I wanted to go. So I joined the American Heart Association three and a half years ago, and it's been awesome. Taking all of that experience from the front line and then figuring out how we can use the platform of the American Heart Association to reduce barriers. Do the barriers still exist? Absolutely.

0:16:17.4 MR: But I think that organizations like the AHA, which has historically been focused on research, recently has looked at social determinants of health. Looking at these barriers that I experienced on a day-to-day basis in the field, and they're actually looking at ways to solve it. Hiring individuals like me, it was not something that the AHA did, but they're really focused on those social determinants, which by the way, 80% to 90% of heart disease is preventable, and where we see the prevention happening is reducing these risk factors when it comes to that 80% to 90%, and those are the social determinants. The social factors, the transportation, access to food, housing, air quality, water quality, education, things like that. Those are where those 80% to 90% of risk factors live, and so if we're ever gonna stem the tide of the number one killer, which is heart disease, organizations like the AHA, the CDC, WHO, they have to start thinking about these social determinants if we're actually gonna move the needle, so yeah, that's pretty much my story. I was born and raised in Ypsi, so not far from [0:17:36.9] ____ campus, and I've experienced these personally coming from Ypsilanti and working-class background. So it's really cool to bring all that experience and help craft initiatives and policy at the AHA that's meaningful.

0:18:02.1 DC: Thank you so much for that, Michael, and it's so interesting that the journey you take with the specific goal of being able to help those in communities that don't necessarily have the access that others might. So at this point, we'll jump into our Q&A. We want this to be a dialogue, so please raise your hand, ask a question, or you can feel free to type it in the chat, but right now, I see that Nathan has his hand raised, and feel free to ask your question.

0:18:30.0 Nathan: What's up everybody? How's it going, Michael? Nice to meet you.

0:18:32.6 MR: Thanks.

0:18:34.3 Nathan: Thanks for being here.

0:18:34.9 MR: Absolutely.

0:18:35.8 Nathan: Actually, it's interesting, I work in Medicaid right now. I work for the State of Maine, it's a Medicaid accountable care organization, and so basically I'm a payer, and so I hear you saying this... All this stuff I'm interested now from the standpoint of the American Heart Association and your experience in working with managed care. What ways do you think that those two organizations, those two styles of organizations, both involved in healthcare but in different aspects of healthcare, how do you think they can more effectively work together in order to facilitate better outcomes for Medicaid members? I think that's something that I'm constantly trying to figure out, how can we get more of these healthcare stakeholders involved in working in the right direction at the same pace? 

0:19:18.0 MR: Oh man, Nathan. Well, first of all, we need to get you into the AHA, number one.

0:19:22.2 Nathan: I'm into it, man. I'm into it.

0:19:26.5 MR: We need a... It is so funny you ask that, and awesome, ACO's, ICO's, very similar, very similar organizations, and I just had a call today about how we can bridge that gap in terms of the goals of an integrated care or accountable care organization and what the American Art Association does, and I think about HEDIS measures, and CMS star rating and quality improvement goals that oftentimes keep these integrated care organizations or ACO's open. It keeps them in business. Looking at improving their quality of your care. That's how they're able to continue to get funded through CMS and other organizations, so I think that we need more organizations that have individuals like me and you in their organization, if that makes sense.

0:20:28.6 MR: I came to the American Heart Association and I would say these things, "We really need to work with more ACO's and ICO's because I see the synergy." And oftentimes it's like, "Okay, now, that makes sense." But sometimes, it may fall on deaf ears of individuals, 'cause I've already said like HEDIS measures, people may not know what that means, but you do 'cause you work in the space, so our goals are very similar, but the lingo and the vernacular and the lexicon is different, so it's gonna take individuals like us to help be a translator, if you will, because the AHA wants people to use their guidelines when it comes to hypertension management, cholesterol management, type two diabetes management, and ACO's wanna close care gaps.

0:21:19.7 MR: So those are the same end goals, just different routes, and so if we work together, sometimes we can even augment our individual's staffing. I always tell quality directors at an ICO or a friendly qualified health clinic or even a health system, "Look at me as an extra set of hands. I can help you reach your goals and you can help me reach mine." And so you said it right. Oftentimes, it comes down to the purse, it comes down to keeping organizations sustainable and keeping them open, and I'm 100% okay with having that conversation, but great question.

0:22:00.2 Nathan: Yeah, I think it's interesting. One of the things that we do, you mentioned HEDIS measures, it's like our organization internally just needs to transition into a more of an outcomes oriented measurement system versus a process oriented measurement system, and I think that that's very clearly... Or I hear that reflected in the same thing that you're saying. It's like, how are we making sure that we're adhering to ACA or AHA guidelines versus just making sure that these processes are done from the standpoint of the provider? It's just an interesting dilemma, and the ability to fix that is so much easier said than done.

0:22:36.4 MR: Oh man. Nathan, it's like you're absolutely in my head right now. You're absolutely right. Oftentimes, payers are just doing things for compliance sake. How can we stay compliant and not end up in a receivership? And so but ultimately, Nathan, and you'll see that as you progress in your career, it sounds like you're going in the right direction, but one you'll see that it's not just payers, our healthcare system as a whole has gotten used to the status quo, "Just keep the lights on, stay in compliance. Keep CMS outta your hair." We have to get out of that. We have to get more focused on and more aligned with better health outcomes. I think that's why we all got into this space. Nobody got into this space to just keep the doors open. We got into this space to help individuals, but it's hard when the day-to-day is just putting fires out, and so at some point during that day, when you're definitely putting fires out, we have to have conversations about how we can work a little bit more upstream to improve better health outcomes.

0:23:49.2 DC: I think Cindy...

0:23:51.6 MR: I think you raised your hand, Cindy.

0:23:53.5 DC: Well, actually there's a question in the chat that we'll go to if you'd like to unmute and ask.

0:24:00.2 Speaker 4: Hi, Mr. Randall, thank you so much for your thoughts. I wanted to ask about the community's response to efforts to integrate care, and especially in terms of the AHA's efforts, because I'm sure there is a sort of gap in knowledge, like understanding exactly especially when it comes to CPR and care that can be provided by bystanders, so if you could talk about that a little bit.

0:24:36.2 MR: Integrated care, yeah, I'll start with CPR, and we've definitely seen an influx in organizations, faith-based organizations, community-development corporations, a more of a shared responsibility when it comes to improving overall outta-hospital cardiac arrest rates. The City of Detroit is almost dead last in the country when it comes to survival rate for outta-hospital cardiac arrests, and so I think that we've been trying to get the awareness out of those rates, and I think that it's done a good job, because we've seen an influx in I would say nontraditional or non-healthcare organizations that are more interested in integrating CPR training and other CPR-related educational opportunities within their organization, but we have a ton of work to do.

0:25:43.5 MR: When it comes to integrating CPR education, we're also integrating behavioral health. We've definitely seen an influx of the need for that especially during the pandemic, so we have a long way to go, but I do think that there's been ground softening that's been happening for the last several years when it comes to welcoming non-medical or nontraditional organizations to the table and really figuring out how we can create more community health initiatives that integrate behavioral health, CPR, and other things that can potentially be administered.

0:26:27.8 MR: We championed, we use that word "champion" a lot, or "ambassadors" in the community. We really, really try to create community clinic linkages that can reinforce care in non-healthcare or nonclinical settings, so it's easier said than done, we have a long way to go, but I've been enthusiastic about the energy and the interest of organizations that are looking to really help facilitate those opportunities in the community.

0:27:09.5 Speaker 4: Thank you.

0:27:10.7 MR: Absolutely.

0:27:12.2 DC: Cindy, you had your hand up.

0:27:13.9 Cindy: Sure, Michael, it's just wonderful, and your passion for what you do really comes through, and I was really struck by you talking about how public health found you, and it's a great example and something I often tell students about, "Walk through that open door, you don't know what's gonna be in there, and you gotta try it out, and even if it's a little bit different than what you think you're going after, you never quite know where it's gonna take you." So thank you for sharing your story. My question is more on, many years ago, before I started working for the university, I was working for a government contractor that did a lot of work for the Center for Substance Abuse Prevention, we did a lot of work on alcohol, tobacco, and other drug prevention. And back then, and this is mid-'90s or early '90s, it was like we really had a hard time pushing the idea of prevention because it was... I mean, well, people sort of understood it, and I think we all understand if you prevent something from happening, it's a good thing, and that happens with heart disease certainly, but because we really couldn't put a dollar amount on it, it was a hard sell. So do you have a sense in the policy world now of, is the prevention argument stronger or being heard and being acted on? 

0:28:37.9 MR: Well, certainly in heart disease, it's really, really hard to fundraise on research when the entire research community says that about 80% to 90% of heart disease is preventable, and so you gotta work in prevention when it's just overwhelming in terms of the risk factors that lead to cardiovascular disease and stroke, and looking at diet and sodium levels and exercising, the impact that that has on your cardiovascular health. So we've seen a lot of funding in the prevention side, I pretty much work in the prevention side, a lot of the work that we do in the community around policies, systems, and environmental changes are geared toward prevention. So I do see a number of opportunities in that space, and I think that the community has got with the program, if you will, on prevention when it comes to funding for that. For tobacco and substance abuse, it's difficult, it is really difficult, it's extremely political, it's extremely political when it comes to choice and preference. We're seeing that in vaping as well, you may have parents who say, "Hey, at least they're not smoking a pack of Kools," so is vaping a form of prevention for more traditional tobacco usage? 

0:30:16.1 MR: And so I guess when I say political, I mean it falls into two polarizing schools of thought, so it's difficult to fund things around prevention when it comes to that if it's such a hot-button item and it's very contested, that can really mess up a grant cycle. You know what I mean? You're putting in a narrative to get this program funded and then you're having people even on the planning committee that have these very polar viewpoints, and that's what my experience has been. I was just thinking about DARE, I'm a kid of the '90s, and so I believe that DARE was very effective. I remember my DARE classes, I remember the sheriff department coming into our classroom and giving us those DARE bumper stickers. I never used those type of drugs. I think it was very effective. It wasn't like those drugs weren't available, but I remember those DARE classes in there. I recently just looked up an article, and they were like, "DARE was 100% not effective, in some instance, that increased the usage of it."

0:31:30.6 MR: So again, it's a very polar experience that they're... And all of it is qualitative. Everybody was like, "Well, did it work? 

0:31:41.6 MR: I don't know, what are the numbers?" And so that's something, that's a challenge that we've had. We have fantastic partners like the CDS Foundation, who just believes in this, they remove tobacco products from their stores and their stock price went up. And so what we've been seeing is organizations like "I'm gonna take a leap of faith because I just know that this is probably what we should be doing," and CDS has been one of those partners that said, "Look, we're just gonna do this because we know that this is the right thing to do." So I don't know the answer to your question exactly but that's been my experience and... Yeah.

0:32:26.0 Cindy: Yeah. No, I appreciate that, and I just want to make one other comment, there's somebody very close to me who was a recovering alcoholic, was well into recovery from alcohol, and then gave up smoking. He said to me it was far more difficult to give up smoking than alcohol to show just what a strong drug that is, so.

0:32:49.2 MR: Absolutely, and that's what we're seeing, look what the vaping industry has done, and we would do... Before covid, we would do community conversations at some of the largest schools in the state, and we would have people outside protest, protesting the right to consuming substances. So it's a very interesting space to work in and navigate.

0:33:23.8 MR: And your story about your friend. Our stories that we typically use when it comes to working with Lansing and maybe doing phone calls to lawmakers and galvanizing some of our volunteers, we typically don't go to charts and pie charts and graphs, we use stories like that. We use these very personal anecdotes that help to potentially usher in funding and resources to help create opportunities for prevention.

0:34:02.8 Cindy: Keep up the good work.

0:34:05.1 MR: I'll let you know how it goes, I'm in the fight.

0:34:07.1 Lasagna: Michael, I had a question for you. I was wondering how do you navigate equity in the State of Michigan? I'd like to joke around that it's pretty much one giant farm surrounded by water with a baker's dozen of cities, half of which are very suburban, and the other half are very urban, very black. When you are faced with different health issues, do you run into any barriers trying to have specific focus in these communities, or how does the... You and the organization navigate the different spaces within our state? 

0:34:43.7 MR: Absolutely. Great question. I'll start with personally. So personally, I'm a black man, so anytime I come into the room, I bring myself with me 100%. "I'm a black man, I come from a primarily African-American community, and I've lived these barriers myself." So you cannot tell me what someone is experiencing or what you think someone is experiencing until you've lived it. I've lived it, so I bring those experiences with me and I would encourage anyone that's on this call or is gonna view this call to do the same. You have to bring yourself into conversations, especially when it comes to your profession, your specialty, and where you work in your focus area, and that goes for African-Americans. That goes for other minorities, LGBTQ, women. You have to bring that experience with you because you are an advocate for said community, period. So I really, really strongly advocate for that.

0:35:47.6 MR: When it comes to healthcare, quality of care, and health outcomes, it's absolutely in health... Is absolutely an health equity issue. The numbers do not lie. Individuals and certain demographics and populations and geographical areas are disproportionately impacted by chronic disease. It is that simple. And so if we want to target a focus group or a specific area, geographical area, we're using the data. The American Heart Association is a science-based organization. We've funded research close to $5 billion for the last 90 to 100 years, and so the things that we do in terms of initiatives and focus area is very seeped and rooted in science and data.

0:36:43.1 MR: So if I work with a fairly qualified health clinic in the City of Flint, and their population health data shows that they have a hypertension control rate within this clinic of 30%, and I also look at their demographic, and their demographic is 80% African American, then we need to go into that clinical partnership with an understanding of how hypertension impacts our African-American energy, period. What me and Nathan were talking about in terms of improving quality of care and care gaps. So now you overlay that with social determinants and you look at the education level, you look at their access to transportation, you look at their housing. You have to take those factors into consideration. You have to or you're not gonna improve those care gaps. If you have community health workers that are on your staff that aren't familiar with these barriers, the population is being disproportionately impacted by these chronic conditions.

0:37:43.0 MR: If you don't look at the social determinants, you're not gonna be able to treat them, period. So that's working way, way, way upstream, but you have to approach these things with an equity lens, and it's about looking at the science and about looking at the data. So that's how we navigate. I think the America Heart Association's doing a tremendous job, there's areas where I'm critical, when it comes to this, I think that we're doing a tremendous job because we're letting the data drive our initiatives, our resources, and our focus area. And I cover the entire State of Michigan, so looking at county level, city-level data to figure out where to pinpoint initiatives and where to solve problems.

0:38:34.7 DC: Thank you for that. I was wondering, does... Oh, we have another question, if you'd like to unmute.

0:38:43.3 Cindy: Sorry. Following that last point, I just wanted to ask, has there ever been an instance where there was a need or a desire for a certain kind of intervention or effort, but there wasn't enough data to support that, but you probably have input from the community or from experts that this is something we should try? 

0:39:10.3 MR: So not really in my purview, the American Heart Association... What I will say is that we're very focused, and so we have certain areas that we want to influence and impact, and so there may be an instance where individuals may want the American Heart Association to do specific things, and what we do is we try to look within our goals as an organization, look at our impact goals when it comes to increasing life expectancy by 2024. You have to be extremely focused and disciplined if you are going to get to those goals, right? And so we might have an organization that might come to us and say, "You know what, Michael? I want the American Heart Association to do a health fair in my community." We have to look at those initiatives and really figure out if it's going to move us forward in terms of increasing life expectancy, which is the overall goal.

0:40:20.9 MR: So could that health fair, where we're doing blood pressure screening... Absolutely, that could definitely make an impact, micro impact in our that community, more people are screened for blood pressure, and then more people are connected with primary care, or we can take a step back and we can work with the local health system to create a continuing screening opportunity for all patients under a certain demographic or income level, that they can get those screenings for free year round. So now you've gone from the 20-30 person impact to 20-30,000. That's how we have to look at opportunities. So I will say that there has never been instances in my tenure that we've not had the data to support a certain initiative. Wherever you see people, you'll see heart disease, and so we're needed everywhere, but we have had to take a very focused approach to our 2024 impact goal, really looking at a population level and figuring out how we can best serve the needs of our partners.

0:41:27.2 Cindy: Thank you.

0:41:29.6 MR: Lasagna? 

0:41:31.1 Nathan: Okay, I got a question along this line... Oh, sorry, Lasagna.

0:41:34.5 Lasagna: That's alright.

0:41:36.1 Nathan: Go for it. I already asked a question, I'm good.

0:41:38.3 Lasagna: That's okay. I think about your role at the American Heart Association, and I think about how does the American Heart Association define success for you and your team, and then what are the challenges that you face with achieving? And then the third part is, how can the University of Michigan resources help you to achieve that? 

0:42:03.0 MR: The last one is a easy one, so I'll start with the hard one. How do we define success? So, we've been blessed with a tremendous brand, so people know... They see the heart and torch, they know what the American Heart Association is, they pick up a box of Cheerios, they pick up a tin of almonds, and they see a little heart check. We have a tremendous brand, but because we have a tremendous brand and tremendous awareness of who we are, it comes with a huge responsibility. Heart disease is still the number-one killer. I've been with the American Heart Association for three and a half years, it was the number one killer three and a half years ago, it still is today, even among the global pandemic. So defining success in my opinion is looking at those three buckets that I mentioned in my introduction, supporting our partners, supporting our clinical partners, supporting our community partners, and supporting our community initiatives and engagements. If I've covered those three areas and my team as well has covered those three areas, you can sleep well at night. Heart disease is gonna be the number-one killer tomorrow morning but we've definitely moved toward more individuals leading longer and healthier lives free of chronic conditions.

0:43:34.2 MR: Now, some of the reciprocity comes in on the patient level, and Nathan probably will appreciate this because he gets to connect directly with patients, I don't get that as much anymore, but when I do, you really see the work in motion. We do a lot of education modules with patients that... Of our FQHC partners, our clinical partners that are looking to reduce their... They've gotten diagnosed hypertensive and they're really trying to work to reduce that reading, so we give them nutrition support, we give them education. So sometimes, I'm able to do those, and that's really awesome, really being able to see their reciprocity on that level, on the patient level, really taking ownership and agency of their health, but personally, that helps me, that gives me some reciprocity that I know that we're moving in the right direction. When it comes to success, again, piggybacking off my previous point about population level and AHA being very focused, we have very specific goals every single year in terms of our number of engagements, what we're focusing on in terms of policy systems and environmental changes, and how we're improving the clinical experience for patients no matter where they come from, walk of life, ethnicity, gender, whenever you enter the clinical setting, and if you're diagnosed with a chronic condition, you should receive the best care possible.

0:45:09.8 MR: And we can actually track that. We can look at our health outcomes and we can look at levels and blood pressure readings and figure out on a population level if your patients are getting healthier and improving their health, and so we have mechanisms in which we can track that with our clinical partners to see if they are adhering to these guidelines, and that that those guidelines are actually improving people's health outcomes. So that's how we measure success on a year-to-year basis. To the question about how the university can be involved, this is fantastic. I feel like I really cracked the nut. I mean there's been years of... And Lasagna, we've talked about this. There's been years of reaching out to the university, and I feel like I just met the right person, that I met the right person again, and now we're here, so I think that continuedness is extremely important.

0:46:16.7 MR: We do have shared values, we do have shared goals, and we have a fantastic awesome health system through the University of Michigan that has several clinics all throughout the State of Michigan, that has some of the best researchers in the world, they have some of the best faculty in the world. The impact that we can make from Southeast Michigan can have a global impact, I mean we have the shared network and awareness and resources to actually have a global impact from where we are, and so we need to continue to grow this relationship from where it's at with that understanding that we can have a very catalytic impact on the rest of the world. And I forgot the third part of your question.

0:47:18.2 Cindy: That was it, the third part was about how the university could...

0:47:21.3 MR: Okay. Awesome.

0:47:24.2 Cindy: Thank you.

0:47:26.5 MR: Yeah.

0:47:28.5 DC: Nathan, if you'd like to circle back.

0:47:29.9 Nathan: That's part of my... That's actually perfect. Part of my question anyways, I got those notes down perfectly.

0:47:41.7 DC: Do we have any more questions? It's been a great conversation. I would like to give a shameless plug for our work through the PCLP and everything that we've been able to do, and hopefully it's been a big benefit to the AHA and the communities that you are representing, if you don't mind, would you mind just giving a brief description of what you've we've done and the work that you hope that our students' research will help spur? 

0:48:16.2 MR: For sure. For sure. So it's definitely been a breath of fresh air, a really jolt of energy, getting the students involved, Karina and Sharon are doing an amazing job really helping us define how students... Well, how faculty in public school can help support students when it comes to this issue of vaping. So the first semester, Bria and Aaron did a great job really looking at how we can look at public records and public data, and create a scoring system for where schools were in terms of their level of punitive behavior, if you will, within those policies.

0:49:15.9 MR: The American Heart Association doesn't believe, and again, the data and the science backs it up, that punitive measures will help prevent tobacco usage, it just doesn't, if you kick a kid outta school, they're more than likely to continue to use if not increase their usage because now they're at home, now they're dealing with disciplinary issues with their parents, and now they're either kicked off the football team, the basketball team, the cheer squad. So that doesn't help, and then also they're getting further and further behind in their studies, which also doesn't help because now they're academically performing poorly, and it just compounds and exacerbates, but you get the drift.

0:50:03.1 MR: So what Aaron and Brenda were able to do was help us define a scoring system of school policies and really figure out where they were, and how we could potentially engage based on that score, so if they scored low in terms of their punitive measures, then the AHA could potentially come in and help craft policy, that helps support that school if they're not doing punitive measures first, not kicking kids out of school on their first or second possession charge. If they scored higher on that scorecard, those schools probably were very punitive in nature, and the AHA potentially would have to work through several conversations with school leadership and staff to really figure out where there may be some synergy or some areas that we may be would able to redirect and help define a policy and craft a policy that's more supportive to students. So that was the first iteration of students. Now we're working with Sharon and Karina, and they're really helping us craft ways in which to engage school staff.

0:51:19.0 MR: So Karina is a registered nurse, so we're really excited to have her aboard because what they found in their research is that school nurses are typically the individual within a public school that are spearheading anti-vaping campaigns within their student population, and also figuring out ways to help craft policies and school policies that are more supportive in nature. So with that finding, we are approaching schools, hearing them out, and then developing strategies not only on the policy side, but also on the student engagement side, working with the National Honor Society, working with other national student body organizations to really figure out how we can create awareness campaigns with students along with crafting that policy.

0:52:19.5 MR: So it's been amazing, like DeAndre said earlier, I wear several hats, and so having that additional brain power and charisma around these issues is really, really, really valuable, and I think that this year, having the students a little longer, we're definitely gonna be able to make some more headway. My goal within the practicum is for us to actually change policies within the time frame that we have. I want students to come in and leave, and being able to put a feather in their cap and saying like, "Hey, we were able to actually craft policy that was enacted, and as a result of my work, students are being more supported." So that's a little bit of what we're doing. It's a little bit more detailed than that, probably, but it's 5:30 and it's late, and it's dark outside.

0:53:19.9 DC: No, understandable. I think that's the best way to end this off. Thank you everyone so much for attending and all your wonderful questions, this has been a great dialogue. If everyone can unmute and join me in thanking Michael for his time, really appreciate that.

0:53:35.0 Cindy: Michael, this was great. Thank you.

0:53:36.9 Speaker 4: Thanks, Michael.

0:53:37.5 Nathan: Thanks, Michael, appreciate it. This has been good.

0:53:39.5 MR: Absolutely. Absolutely, thank you, and this was great.

0:53:41.2 Cindy: Thank you for being... Just to say, also thank you for being such a wonderful partner.

0:53:46.4 MR: Oh no, thank you all. This is absolutely... This is definitely a result of several years of cultivating a relationship with the University of Michigan. Definitely wanna say thank you to you all as well, and DeAndre, Cindy, LaSonia, Mariam, all you... This is fantastic, it really is, and I also wanna thank Linda Lawrence, who's the Chief Operating Officer of Michigan Health System. She's been awesome as well. So I'm really encouraged by this partnership, I'm really looking forward to the work that we're gonna continue to accomplish in the years to come.

0:54:27.1 DC: Awesome. Well, as Marian put in the chat, please look out for our next Young Leaders, that will be on the 16th with Andrea LaFontaine, the Executive Director for Michigan trails and Greenways Alliance, and a former state legislator. So P3E is always trying to offer as many opportunities as we can for our students and be a resource to everyone. With that being said, I would say have a great day, but by looking outside, I guess I should say have a great night.

0:54:53.6 Cindy: Yeah.

0:54:54.4 MR: For sure.

0:54:54.7 Cindy: Good night, everyone.

0:54:55.2 MR: Thank you all. Take care.