[Music] welcome to this special edition of the minor console I recently had the privilege of sitting down with Chelsea Clinton Vice chair of the Clinton foundation and the Clinton Health Access initiative in front of a live audience in addition to reliving memories from our time in Arkansas we discussed pressing Global health issues the critical role of trust and communication in science and the importance of approaching the world with humility empathy and optimism so without further Ado let's g
et into our episode so it's now my pleasure to welcome Chelsea Clinton Vice chair of the Clinton foundation and the Clinton Health Access initiative Chelsea of course has her undergraduate degree from Stanford um and she's been driven by a deep commitment to improving lives and fostering emerging leadership across the United States and around the world her initiatives range from promoting Early Child Development with too small to fail to empowering student leaders through the Clinton Global init
iative University not only is Chelsea a formidable advocate for public health but she's also a celebrated author with her Works inspiring young readers across the globe her dedication to Health Equity and her thoughtful perspectives on global Health Systems make her a Le leading voice on these critical issues as I said Chelsea's academic Journey began right here at Stanford and it's been marked by a passion for Global Health sparked by transformative experiences that she had here as a student an
d in her other educational Endeavors after Stanford Chelsea it's a pleasure to welcome you here great to see you thank you great to see you again I'm happy to be here um it's always uh lovely to be back in the Bay Area um I just want to say thank you to everyone um at the medical school and everyone here at the Ritz for helping us be uh well hydrated and hopefully uh inspired um and informed and activated having uh been on the other side of planning events like this I know they always run the sm
oothest when there's been an extraordinary amount of work so just wanted to start with a moment of um gratitude and also um just to acknowledge how wonderful it is to be here uh with the fellow aranan um and as some of you may know because you may have been on what I still count as the single most spectacular Zoom interaction of my entire life was when we had one of our inaugural sort of advisory Council meetings for uh the public health program uh here at the medical school at the end of the me
eting uh Dean Miner said you know may I have a a personal like moment I said sure I had no idea what he was about to say and he said you know do you remember your uh kindergarten teacher and I said of course Mrs Miner and he said that was my mother and so small world it is a it is a small world um and Mrs Miner does exist in this really special place in my kind of heart and my memory Because by the time I was in kindergarten in the mid 1980s uh in lck the lck school district had grown of so rapi
dly um that there was not enough extant space in elementary schools for kindergarteners and so I actually uh went to kindergarten in a high school at Hall High School and so kind of Imagine This flock of 5-year-olds in this sea of teenagers right and they just just felt big and scary and so I really just have this memory of Mrs Miner kind of as our Good Shepherd in a quite kind of a profound but practical sense so I'm so happy to be here for many reasons but admittedly especially because I get t
o talk to my kindergarten teacher's son thank you well it's it's a pleasure to be back together and um enjoyed our chat in New York and also have some memories of um the first uh Christmas in the governor's mansion after your dad was elected president uh which is quite an exciting time and um I remember our daughter my wife and I's daughter at the time was two and a half and uh we were there mingling you know the governor's Manion in Arkansas is not a big big room and you know it's it's kind of
small actually and uh there lots of people there as you might imagine you were there too um and our daughter had this little doll um that she dropped and like two seconds later there were about a dozen Secret Service agents you know take picking up this doll and checking it and it was indeed a doll so uh we still have the doll by the way and our granddaughter is now uh playing with it so anyway lots of great stories and maybe we'll talk a little bit about Arkansas in the context of our conversat
ion but you know um you were an undergraduate here at Stanford and you've spoken and written about um your experiences here and and some of the readings you did which helped guide your future education and what you've done now in your leadership roles can you tell us about that first of all what were your experiences like here and what was most transformative for you about this environment oh goodness um well I I came to Stanford partly because I had been a little kid in the South and then I'd g
one to high school in Washington DC and I wanted to be in a different environment I wanted to have a different experience I thought that's what we were supposed to do when we went to college um and so I came to California um much to my parents Chagrin um I have really uh Treasured Memories of going on kind of college tours with my mom as we like trundled around what felt like the 28th School kind of in the Mid-Atlantic and Northeast regions as she tried to kind of sway me toward kind of closer p
roximity uh I am incredibly close to both of my parents and Incredibly uh proud to be their daughter I also wanted to have a different Adventure in life so I came to Stanford and I certainly uh thankfully found that here and have um really just extraordinarily kind of Rich memories of my time um as a as a student and as a person here I have a very strong friendships um I went to my reunion last year and it was so fun to see uh so many of my professors many of whom actually are still teaching um
and to be able to have maintained those uh relationships has been hugely important to me um I think though um de Miner what you might be referencing um is that I I read um infections and inequalities when I was a junior here and I cold emailed Paul Farmer um three pages of you know thoughts questions and critiques as I think only maybe a 20-year-old a institution like Stanford can think is a remotely you know kind of reasonable thing to do um and he wrote me back and we started kind of this pin
pal relationship um I didn't know at the time that my mother actually had already known Paul because she had recruited uh Paul and Partners in Health uh to help support some of the work that she was really spearheading on trying to kind of provide kind of more robust both kind of medical and public health uh support to um countries that were part of the former Soviet Union and so she had gotten to know um Paul through that effectively saying like you're already in Siberia why can't you go to Kaz
akhstan they're like those are aren't close but okay we'll figure it out um and so fast forward um to when my dad was kind of thinking about kind of what to do in his post presidential life and how to kind of take his capacious heart and brain and networks um you know and he asked me and you know others what should he do and I said well I think you know you did a lot of great things uh while you were president because again again I'm like the now the 21-year-old like Stanford grad who thinks I s
hould be able to assess in such a ridiculously uh hubristic way um but I did say like but you you haven't done enough on AIDS and you need to do more and you should start by talking to Paul Farmer and so thus actually began um a really profoundly important relationship uh between my dad and Paul as they would work together over the next you know 20 plus years until his tragic and way too early passing almost two years ago and kind of that that work of understanding kind of what was happening kin
d of around the Hib AIDS crisis uh globally and what wasn't happening you really uh catalyzed what would become the Clinton HIV AIDS initiative and then kind of now today is the Clinton Health Access initiative um because at the 2002 uh Barcelona the international AIDS conference in Barcelona um my father kind of you know had started with Paul but now was talking to lots of other people uh and along with President Nelson Mandela you know decided that they would kind of take the fact that they we
re no longer an official positions of power but still were connected to many who were and that they had you very um kind of deep and Broad relationships with people in the private sector as well as an not for-profit sector you know to tackle the gross in equity which feels like a good segueway from what the previous conversation was of kind of the current uh price Dynamics around anti retrovirals in the global South you so as I'm sure many of you uh know if you were living here in the Bay Area y
ou know 20 one 22 years ago you the odds were that you knew your HIV status the odds were that you were on arvs the odds were that you were in some form of supportive care um community- based probably more likely than not um and if you were in the global self the odds were that none of that was true right in at the dawn of the Millennium fewer than 10,000 people people across UPS Africa alone were on arvs despite the HIV burden being you know close to 25 million people at the time and so thankfu
lly I say as a as a daughter and as a kind of global Health person and as a citizen you know this is where my father along with President Mandela decided to orient kind of their their energies um and so today you know Flash Forward uh what was you know $110,000 per person per year is now less than $60 per person per year and of the 30 million-ish people across the global South who access anti retrovirals um more than three quarters access them through agreements that my father and the chai team
helped negotiate so really um proud of that work and also proud that for my dad that was then just the challenge of what more can and should we be doing and so now you know more than 140 kind of large scale multi sectoral kind of Market shaping agreements have been stewarded um by my dad the tri team on everything from you know lowering uh the cost of point of care Diagnostics to um lowering the cost of uh Rota virus vaccines um to now we're heavily focused on hepatitis um both Hepatitis B and h
epatitis C um because there's just always more to do absolutely what um what are the top issues right now both in chai and Clinton Global initiative uh that you're working on that you're passionate about that you feel like both chai and also those of us in in the academic Community can have an impact on through the work that we do well I do think um you know I was at I guess this is like the week of hanging out around like prestigious academic institutions I was uh at the Harvard Graduate School
of Education yesterday um talking about work that we're doing at too small to fail um with many of the re Searchers at the um Harvard School of Ed on uh trying to better connect uh those of us who are concerned around climate change's impact on kind of pregnant uh people and kind of infants and and toddlers kind of from all the different spheres in which we're kind of doing uh kind of research work practice work and advocacy work um you we're really uh focused on trying to help uh parents bette
r understand kind of why as an example extreme heat is a danger for themselves as kind of pregnant people and their children but also then what can they do about it um because I think particularly uh climate change often seems to be sort of the pornography of Despair right it's just like everything feels so extreme and so overwhelming and then I worry consequently kind of disempowering and kind of pushing people into uh kind of just cynicism and I want people of course to be worse wored because
it is very worrying like every week we have more research it's ever worrying and also to think oh I can um push my local elected officials to think about Porous concrete I can kind of push my local elected officials to prioritize shade as we are kind of updating our playgrounds you know things that might seem incremental but collectively we think have a you know pretty protective effect for kids and families and so we were at this meeting yesterday trying to understand kind of what is working to
help you know parents and other caregivers um kind of best kind of feel as if the science is informative and activating and not kind of disempowering and disorienting and what more can and should we be doing with kind of content creators uh and and people who have very large platforms like the parent influencers or kind of folks in Hollywood to try to embed this message so that it's coming from people who are you know maybe a little less serious than us um but who have kind of Greater kind of n
arrative you resonance so I I share that because I do think um you you ask the question about kind of what is the role here of of academic U medicine and I I worry that because again kind of building off of the last panel's conversation and some of what you know Reika was sharing as her experience that it was such a intense time and that feels like sort of too mild a word for so many of our physicians or nurses or physician scientists over the last few years that there will be this receding from
the public sphere and I think we need actually people to be even more engaged particularly with uh local communities because we are always learning more about kind of how to best kind of protect and promote health and I think it's only through trying to better kind of communicate that at a policy level but also kind of directly to communities to families even to kids themselves that will really start to kind of rebuild kind of the trust that I think all of us probably regardless of where we sit
kind of on the political Spectrum recognize that we desperately need um in our country you've literally written a book on global Health Systems and you think a lot about how impact scales and how we take discoveries how we take advances and get them into parts of the world that traditionally haven't been benefited or only far too late or much later than should they should have been benefited what are what are the take home messages from scaling and in particular how do we here as an academic Me
dical Center you know focused on excellence and research education and patient care how does our work then get Scaled to have the type of benefits that you talked about for example with u HIV therapies and and emerging pathogens but are there some principles that we should keep in mind as as we look at our our work here well you know Dean I think uh I'm less presumptuous now than I was as a student here so I would not tell you kind of what your principles um should be I think you're more well si
tuated to do that than I am I will say though um that I think uh at least you at at the foundation um we try very hard to always kind of design in how we'll hold ourselves accountable um kind of from from the beginning and I do think um more kind of large scale efforts whether from kind of multilateral Institutions or kind of big kind of operating um kind of global NOS like we are um kind of need Partners like you to help us really understand kind of what those metrics should be I mean even our
kind of too small to fail work which you were kind enough to mention earlier where we have really tried to meet kind of parents and caregivers here with the resources that they need to be kind of effective first teachers for their children on kind of early language development early kind of math and numeracy development and also early social emotional development um you we've had now like 16 evaluations on different parts of that project from building uh libraries and laundromats we've built now
more than 600 libraries and laundry mats because low-income families spend two to four hours a week um in laundry mats so DET turn turn kind of wash time into teaching time uh we now have more than 1300 playgrounds that have shade um across the country that prompt parents and other caregivers to turn playtime into teaching time so things that probably all of us because we went to institutions like this or are working at institutions like this no are important you know to talk to our kids around
how many colors do you see on the playground how many times can you swing on the swing like how many shapes do you see to really also help give um parents and caregivers kind of the confidence of starting you know conversations also their multilingual um when that is important in the different places and spaces um we've distributed more than a million books kind of through Partnerships with diaper Banks and so all of these have um really rigorous evaluations alongside them not admittedly with S
tanford but with uh NYU with Emory with rice with Harvard with others um and so I I say that because I think it's something that we're highly focused on and I think sometimes others are not yet but I think with Partners you know like Stanford very much could be and I do think too um we're trying to do more in New York City um while I'm very uh grateful for growing up in Arkansas and loved my time here in the Bay Area I've lived in New York longer than anywhere else uh in my life uh by a signific
ant margin it very much feels like home it's where you know we are raising our three kids it's where the much of the kind of core Foundation Team Works although 95% of the people who work with chai kind of work in the countries where they're from um sort of like the back office uh Corpus is in is in New York um and the kind of coordinating mechanisms often for building and trying to Shepherd these big Partnerships through CGI and otherwise and so we had this kind of Reckoning candidly like we ha
dn't really tried to do anything in New York City and so now uh we're one of the core partners of the New York City birth Health Equity initiative um that the mayor and commissioner fan our local Health commissioner started um as any of you who you know are New Yorkers or may have spent time or pay attention to New York we have particularly deplorable um kind of uh maternal mortality rates in New York um and while you know on a national average you know a black mother is three times as likely to
die as a white mother giving birth in New York is actually nine times so we like to think of ourselves as like this Bastion of like you know liberal Progressive policies we have the health and hospitals Corporation we ostensibly have like a very robust um kind of health safety net we have some of the most quote unquote generous kind of Medicaid coverage although I always loathe when generous is used we're talking about Medicaid because it always feels like we're not even scraping what I think t
he bare minimum should be and yet yet we have really terrible on an absolute and relative basis kind of um maternal mortality rates and not surprising our infant mortality rates have been going up in the last couple of years so when we've partnered kind of with the city to help bring together again this kind of um large kind of um set of different organizations who either could be or should be working on these um challenges and we're starting in Brooklyn with a goal of trying to cut um maternal
mortality in half with a real emphasis on helping better support kind of black birthing people you know by by 2030 and we have more than 40 Partners everyone from like the local Catholic Church um to our big Hospital Systems to the city you know to kind of doula and midwife organizations and so I share that because we are really trying to um kind of have the humility of like what have we learned has worked around on the world that really can and should be urgently kind of um at least attempted t
o put into practice you know here um here at home and so I would hope too that kind of similar kind of questions and conversations could be happening you know across you the Stanford landscape given all of the extraordinary work that is often happening elsewhere you know but could have applicability you know in our own ZIP codes closer to home I think that's such an important message and it it comes out in in your writings and of course the the work of the foundations and just in what you've sai
d and that is um a focus really on on looking forward on optimism and on that key concept of humility and empathy how do we how do you think about you know those attributes in in a fairly polarized world today and what do you think you what keeps you going and the people that work with you and chai and other initiatives um in the face of some pretty daunting challenges is well I'll start um kind with the end of your question and then go back to the beginning um Jim Kim one of you know Paul Farme
rs Partners in in starting Partners in Health and then later the head of um of Dartmouth and then the head of the World Bank you know has said something that I've heard him kind of say in different settings that I just think is a better encapsulation than kind of any any words that I could put to this sentiment um ethos and sort of at least kind of the prerogative of how I try to lead my life that optimism is a moral choice and and I I believe that um very deeply um that it is a more moral place
to be to think about how we can always be kind of building a more Equitable more sustainable kind of more inclusive more joyous world than kind of just accepting the status quo um and so I I start with that because whenever I start to feel um like the edges of Despair I think like is this productive like who is is this help like I'm do I want to just be depressed or do I want to think like what can I do with my experience what I know the people I know the platforms that I am um lucky and humble
to have the kind of sense of we can always hopefully be doing more like do I want to do I want to live with that or do I want to live with like the proverbial or the actual covers over my head and and I think too as a parent of three kids it makes it easier for me to be optimistic I think for some people it actually makes it harder but for me it makes it easier because I just think well I want to be able to tell them what I did today that hopefully was generative and positive and productive ins
tead of just thinking like I stared at a wall all day and like thought about the recent like ipcc report and the world's on fire and there's nothing we can do like that's not a great answer to my four-year-old who's like I learned how to read spot today and I'm like I stared on a wall and I was depressed today no like that's I want to say like actually no I like spoke to the people at the World Health Organization about the 75th Anniversary which is coming up in May and how there needs to be bot
h like the storytelling of all that wh has done that I candidly don't think it's ever gotten enough credit for and also so like what should the next 75 years look like or I want to say like actually like here's what we're trying to do here at home in New York City like we're working in Brooklyn like you have friends that live in Brooklyn like let's talk about that like that's the world that I want to live in but I I think you ask it another question which is how do we um try to kind of tell stor
ies that are rooted in kind of evidence and science um that help more of us feel that way and more of us feel like we are kind of in the work of building a a better world for our children um kind of together and and I think about this again a lot as a parent and I was actually thinking about this in the previous conversation when kind of raika made her off-handed comment about bleach because like I was aware of the antivaccine movement and I was aware of kind of the profit motives behind it um b
ut I hadn't really paid a lot of attention to it until I was pregnant with um my first child like 2014 and it was after the third person came up to me because like I live in the world of New York City I've have like no interest in living like in a hermetic sea old box take the subway I'd walk a lot I take the bus it's like I live in I live in the world so after the third person came up to me with just fervor and said you know Chelsea I watched you grow up like I I love your family and I just lik
e I hope you're not going to vaccinate your child I was like so the first time I was like oh that's kind of odd and the second time I was like well that's a little worrying and the third time I was like Wow there is some and this like there is something that has percolated without enough like perception to it that is deeply worrying because I was I would think like if if trust it's kind of it's either like clean water and sanitation or vaccines right if trust in like the greatest Public Health a
chievements and I love Alexander Fleming so I'm not nothing against like antibiotics but if we look at just like the raw numbers of like whose lives have been saved right if if trust in that has been broken I was like what else is going to come and I tried to talk to people about it and maybe the moral is I should have been talking to kind of more people in places like this about like why I was so worried I was like I was like this is a Harbinger like what and and I couldn't get anyone really to
pay attention they're like oh like Chelsea it's just idiosyncratic to you people come up and talk to you about all sorts of things that is true people come up and like like talk to me about why they're frustrated with the MTA and I'm like I have no power over the MTA like I don't know right I mean I people people come up and talk to me about all sorts of things I was like no I was like there's something different there's something different there's something different here and we saw what happe
ned obviously in 2015 um in Texas and elsewhere and and clearly um there is so much you know Miss and disinformation much of which I do believe has its origins in kind of somewhat nefarious or certainly not kind of public good um ground and so I'm going to kind of segue back to what I started with either we can think like this is so depressing oh my gosh like why do so many people believe things that there's no evidence for like there's no Public Health evidence there's not even really anything
they can point to as like anecdotal like does anyone know anyone who can actually say like yes like bleach cured me from covid right so it's an odd dynamic because there isn't a tether to a story really it's a Feeling and it's probably actually lots of feelings so we can either think oh my goodness like how did we get so decoupled from the broad-based understanding of one of the greatest like public health achievements of all time in human history and untethered from the stories like my grandmot
her I remember my grandmother with whom I was very close talking about how she waited in line for six hours to get her kids vaccinated against polio and how excited you was that my mother and her brothers could now safely swim in the pool in the summer I like so I was like what happened to these stories that probably were being told in lots of families so it's like not the evidence and it's not the stories but thankfully there are a lot of smart people who can try to help us move forward again t
o a place where we have a common appreciation for what actual evidence is and how we should think about applying it to our lives and a common sense of actual lived stories in our own lives and in our families so I can either think oh my gosh like this is so depressing and sometimes I do but then I pick myself up and I'm like that's not productive I think about well what can we do to try to learn from the people who are kind of at the Vanguard of understanding what types of stories and what types
of messaging and who the right story tellers are to try to lend like our platform and our ecosystem not only here in the United States but around the world because this is also clearly a global Challenge and so that's the solution space because I do think it is the more moral space in place that I want to operate in maybe please do think of questions we'll open up for question but I have one one point on that thread that love to get your thoughts on how can we as as a place that does science an
d and at a high level U publish everyone in this room is publishing paper papers and high impact journals and doing other work and yet I have this sense that we're not really communicating it or not communicating it PR as effectively as we could or not partnering with organizations foundations like yours in order to get the message out because like you said um there are so many things that for which there is just no evidence uh but I have the sense that that we like so many other institutions ha
ve on many levels lost trust so how do we rebuild that trust how do we become more effective not in a poic way but just communicating what we know and perhaps equally importantly what we don't know when we don't know something I think in some ways you the answers are embedded you know in the way that you asked the question um I think there is I think there there's a a few challenges um historically that I think we saw kind of acutely um in the ways in which kind of the the incentives in the cult
ure of AC emia were arguably like not well suited to kind of the the moment that we live through in the last few years right I think the just that the and I haven't really thought about this so forgive me if it's a bit of a ramble um but my visceral reactions are you know are a few fold you know one um the sense of kind of you do you do work you submit a paper for publication and then you're on to the next thing instead of thinking like how do I more broadly communicate you know what we now have
a good evidence basis for but I'm sure the way most of your kind of kind of lab or practice funding works is like you're so oriented to the next thing so trying to understand I think that that time Dimension I think too um in a wonderful way uh I I saw one of my really good friends um last night who is a researcher at Harvard um runs a big lab and she spent so much time telling me like what she didn't know it's understandable like part of what you do is to be mindful of what you don't know to h
opefully ask like better questions you know over the next Horizon but I think when we're living in a moment of like 15c sound bites it's something like you know teenagers the alpha generation you know are willing to watch um things of like 22 second duration you if the Preamble is all of like what we don't know all they think is like well you don't know anything instead of saying well here's what we know and here's what we don't know and here's how we think it applies to your life like I'm trust
ing you like you know to be able to use this information in whatever way you think applicable to make the decisions for yourself and your family but I think there is the sense of like oh my gosh we don't know so much because I think you're always focused on like what is the like how do I narrow the space of what I don't know so I I think I would hope maybe you could think about that and and the third thing I would say too is you know respectfully Dean Miner like you just talked about like all of
the really prestigious places where like your colleagues are publishing and clearly that's important like I believe in the peer review model I believe in the ways in which kind of the artifacts of knowledge help again like build the kind of you know the skeleton of us hopefully ever better understanding ourselves and our world but we should also have incentives recognitions in place for people who publish in Parents Magazine sure or the ARP magazine which is still the most widely read magazine
in the entire world did you know that it is if you are a member of ARP you get in the mail a copy of the magazine and I was just with the ARP policy team last month it is true that they think millions of ARP members read the magazine cover to cover every issue and that tens of millions of readers read at least one article so I think we just have to think about how we hopefully celebrate people who are helping us better understand our world help the rest of us better understand ourselves and our
environments as they are today and what hopefully can help us all be kind of healthier and better off in the future but I think that has to come probably from the top great when you asked absolutely great Chelsea thank you so much for sharing your wisdom your optimism your vision for the future my honesty Dean Miner to you thank you thank you so much everyone it's great thank you you so great this is wonderful thank you for listening to the minor consult with me Stanford School of Medicine Dean
Lloyd Miner I hope you enjoyed today's discussion with author and Global Health Advocate Chelsea Clinton please send your questions by email to the minor consult at the minor consult.com and check out our website the minerc consult.com for updates episodes and more to get the latest episodes of the minor consult subscribe on Apple podcast Spotify or wherever you listen and if you enjoyed today's episode please rate the podcast five stars your feedback helps make this podcast happen thank you so
much for joining me today I look forward to our next episode until then stay safe stay well and be [Music] [Applause] kind
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