Good morning, everybody. Good morning. How you feeling? Good. Good. It's a great crowd. Thank you all for coming. on behalf of Black Doctor, we are excited to be here. thank you to our partners at USA Today and all of our pharma partners, our community partners, and each and every one of you for attending today. So today, we're really here to talk about a system, right? A system that, has perpetuated, or developed, inequalities that have really impacted, the community that we serve in terms of communities of color and more specifically, the Black community. And we're here to explore this concept and this notion of generational health, and what does that really mean?

How does that translate from generation to generation? And most importantly, what are the health outcomes and the impacts that we can drive by implementing a, a generational health framework that allows for better health outcomes? So I am, on this panel and, here with Dr. Aluko, to explore this and to kick off the day for us, and, hopefully you all find our conversations throughout the day very insightful, and meaningful, as you all go back to your, corners of the world and continue to do this work. So good morning, Dr. Aluko. Good morning. How are you? I'm doing well. Good.

Good. Good. So, can you walk us through and kinda tell us more about yourself, and what you've been focused on since leaving, Ernst & Young and, and also give us a little bit more about your background and, what brought you to this work and, and so forth?

Thank you very much for this invitation, and, welcome to everybody. I wanna congratulate you and Black Doctor for the very important work that you do. I am a cardiologist. I practiced cardiovascular medicine in Charlotte, North Carolina for twenty-five years up until about nine years ago. I, I ran a heart and vascular institute across a fourteen ho-hospital health system in the southeast USA as the medical director of the heart and vascular institute. I joined EY nine years ago, and this was just before, maybe a few years before COVID, and I was chief medical officer at EY.

I was also the inaugural founder, the founder of the Center f- EY Center for Health Equity and the inaugural director for the Cen- of the Center for Health Equity. I retired from Ernst & Young in June last year with very deliberate intentions to focus on the more macroeconomic issues that drive the health industry, a focus on two audiences in particular. One was a health consumer audience, all of us are health consumers, if not now, will be, as well as the health executive audience. trying to bridge the upstream connectivity with the downstream, downstream manifestations.

I formed my own company now called Aluko Advisors, seeking to provide, insight and optimization across that spectrum. Fantastic. the work you've done is been tremendously important in terms of the clinical work. how has that translated, in some ways, if you don't quickly mind kind of giving us some ideas, how has that translated into the work that you're doing right now at Aluko Advisors?

it has prepared me for what I'm planning to do. Yeah. it has helped me understand the complexity of the health industry itself and the multiple sectors within it, and very importantly, the fragmentation of the industry, the lack of accountability of the industry, and the architecture itself, and to realize that the outcomes that we see today in, coming out of the health industry are not accidental. They're a function of the fundamental design. Great. So let's move on a little bit and talk about generational health. And so when you hear the phrase generational health, what does that mean to you?

S- good question. And let me start by saying that the term generational health is somewhat a recent context in popular discourse- Mm-hmm probably over the past five to six years. But the genesis of generational health actually dates back to around the nineteen eighties, and it was informed by what was then called the Barker hypothesis that demonstrated through research that human health is impacted by early life's exposures to certain, adverse or enabling social determinants. This was mainly within a s- research context, but most recently, this is now becoming an important public conversation.

it is driven by accumulation of health opportunity or health risk that permeates through one's life in a generation and is transmitted through successive generations. So it is the contemporary context of generational wealth.And as you well know, generational wealth, doesn't happen accidentally. Similarly, generational health is not an accidental construct, and it is very important and opportune that we are now beginning to understand that health risk doesn't begin when a diagnosis is made, that it is driven in the first twenty years of one's life by accumulation of health risk that may be driven by multiple structural forces, which we'll probably talk about.

Absolutely. No, that's, that is a, a very helpful kind of articulation of what generational health means. When you talk about structural forces, what structural forces tend to compound across generations? What are you referring to when you say that? so I'm referring to structural forces which are broadly referred to as the political determinants of health, and the political determinants of health such as judicial orders, executive orders, state legislative orders, an example of which would be the acceptance of the Affordable Care Act or not. That local state decision impacts access to healthcare for millions of people.

So those are structural, examples. And those political decisions, determinants, result in the social determinants. The social determinants manifest as where do you live? What access do you have to amenities that provide enablement of healthy decisions, such as access to education, good education, access to transportation that can get you to a farmers market or a grocery store that sells healthy food? And the access to education is critical because it drives health literacy. and also what is not very well understood is environmental exposure. It's been published for at least fifty years that as a consequence of redlining, Black and brown communities tend to, over generations, live in environmentally toxic, more toxic areas than otherwise.

And these all result in compounded risk such that at the time of diagnosis, a person who has this, these types of environmental exposures has more advanced disease at the time of diagnosis than would otherwise be the case.

That is incredibly powerful. when you break down the structural forces, it makes me think back, one of the things you, you said was around the educational piece, right? And so when I think about access to education, access to information, I think that that is one place that Black Doctor really steps in, and we try to step to the forefront, which is democratizing this education, right? Making it so that people can access content, information, and so forth in a digital fashion, such that no matter where they are, they can, they can have access to, to that information and learn about certain conditions, learn about certain environmental and, and societal stressors that then lead to these compounding factors that, that you just referenced.

So with that, how does generational health, or, or should I say, how does generational burden really become a biological reality? How does it manifest biologically? So generational, generational, exposure to health risk is what you're describing as generational burden. Manifests in a, in different ways. Stress is one, and with chronic stress, you have an easier, more likely trajectory towards cardiometabolic disease, primarily hypertension. And with hypertension, all the secondary complications that might arise from that. In addition to poor eating habits, there's a thing about eating because of stress.

And if fundamentally your eating habits are not good, then there is an up-- there's a, a, a downstream impact of predisposing oneself for, for diabetes and cardiometabolic disease.

So these manifest within the biology and physiology of a person that drives early onset of illness. You're all aware, I hope, that, that, overweight states in the Western world have reached pandemic proportions, particularly in people under the age of eighteen. Under the age of eighteen. And that is accelerating the onset of the typical cardiometabolic illnesses that one would ordinarily have seen in the sixties to now being seen in the mid-thirties to the forties. So how do we address that? You know, we, we've got this notion of generational health. We have an understanding of what the burdens are, what the structural forces are.

And kind of going off script here a little bit and kind of throwing you a little bit of a curveball, um-How do we address that, as a community, right? So this is a convening of not just, physicians, this is communi This is a convening of the community, right? We have pharma stakeholders here, we have physicians, we have health equity advocates, we have community partners. y- can, can you articulate a couple of potential, you know, solutions or paths that we could, we could follow, to, to really start to bring this generational health concept, to fruition? So that's a very complex question, and I think it does start with the awareness.

The awareness that we are living in the United States in the most complex health industry in the world. We have the most advanced economy, the strongest military, and we have very sophisticated health system. But all Americans, not just Black and brown Americans, as healthcare consumers are at risk because this health system is actually, in my opinion, not a health industry, it is an illness industry.

So we need to understand that these, th- the cards are stacked against us as Americans because the system we live in is one that is designed to react to disease, to illness. And we have to remember that, that disease doesn't start with a diagnosis. By the time the diagnosis is made, risk has been built up. So what do we need to do? We need to have that macrosystem awareness that the system is really not protecting you and providing you with health. That's number one. And number two, I would say that health literacy is key. It is an important driver of beginning solutioning, and this is driving down the responsibility to the individual.

When I mentioned that I was going to focus on two, two platforms, one would be the health consumer, it's for this reason. Nine percent of Americans, all Americans, are proficient in health literacy. Nine percent. And about two to four percent of African Americans are proficient. Now, that's the highest level of proficiency. there's, moderate prof There's proficiency, moderate proficiency, and low proficiency. But if you understand that two to four percent of African Americans and nine percent of Americans at large are not proficient in health literacy, it tells us that the whole context of population health does not exist.

And making healthy choices is driven by health literacy. If we compare generational health as a context to generational wealth, which is more evident to us today, and we have example, the, the, the prime example that comes to mind is the Walton family.

And in the 1990s when Sam Walton, passed on, he had about $100 billion, but it started with one small store in Arkansas, and today it's worth about $520 billion. That didn't happen by accident. It happened by intention, with financial literacy and intentional investments. The parallel needs to be drawn for generational health. We do have some examples of generational health in the world before we actually coined the term. Multiple studies have been done in the 1980s to 2000s in Sweden that has shown about 15,000 people across multiple families have demonstrated longevity, and there are some drivers that are common across those families.

And we are lucky to be familiar with the Blue Zones, cities in the world, I believe there are five Blue Zone cities, where people live to, to their 90s and 100s. Okinawa, Japan, Loma Linda in the United States, Ikaria in Greece, s- there's one in somewhere in South America, and another one I don't remember. But there are some commonalities. There is a prioritization on healthy habits, a prioritization on community connection, and habits that drive good health choices. So for us to begin to benefit and plan for generational health in a similar manner, it needs, it has to be done with intention.

First of all, the awareness, and secondly, the willing to invest in one's current health and transmit that, that down to successive generations. As a cardiologist, I've often heard, patients tell me that I have a family history of heart disease. I'll also say that I- I've been on TikTok for about four weeks.

Five weeks. Yeah. I have a TikTok page, and one of my messages on TikTok-And again, this is part of my broader strategy to be able to reach potentially a global media about health education. and one of the things I said on TikTok was that patients have told me that they have, "I have a family history of heart disease. My father died when he was fifty-five. I'm fifty-four. I'm scared." And my response was always that most of my patients who have heart disease don't actually have a family history of inherited conditions, but what they may have is a family history of poor choices and bad habits, such as doctor's visits that just didn't take place, doctor's orders that weren't followed, healthy choices that were not developed, stress that was left ignored.

Those are not genetically transferred. Those are habits that can be transferred by observation from one generation to the other that results in the accumulation of health risk. No, I, I think you just hit the nail on the head, which is this is a lot of this is, is learned, is habit, right? I think there's a stat, something like eighty-five to ninety percent of disease is preventable. and what happens is we develop habits, unhealthy eating habits and so forth, that then lead to these diseases taking place, and then we look back and say, "Well, my grandfather died of it, my grand you know, my father," so forth and so on.

It's like, well, it's not exactly something that's inherited, but it's more about bad habits. we've got about two minutes left, and, don't wa- wanna make sure that we, give you a chance to, to, to say any parting words.

But would love to kinda hear where you would like to see this, this movement go, and, and what you would like to see Black Doctor specifically, being a convener of all the various stakeholders, do, going forward, to promote generational health. and then you can leave everybody with your, TikTok hashtag, TikTok at name- so they can follow you. great question. So I've been fortunate in my career, and most of this wasn't planned, to be honest with you. I have been at the bedside, and I've had physician executive leadership opportunities as well as health system leadership opportunities, and I have been exposed to big business and corporate America and large employers that drive, health budgets.

And it has led me to understand that the, we need to un- to, to realize the macro systems that we live in. Once we do that, we also need to understand that we must make a decision as to what are we going to take forward within our own family units. disease is not, disease is not destiny. Disease is an output of our personal decision-making as well as the complexity of the industry within which we are exposed to. So with Black Doctor, I'm very proud with the, with the increasing visibility, the increasing, enterprise approach to becoming a relevant health media organization.

You are a convener. you are also dis- a disseminator of health information. But because this is a macro problem, you can't do it alone, and the problem you're trying to solve is an American problem, not just a Black problem.

If you have a problem, if you can solve the Black problem, you're going to also be solving the American problem. So those are my parting words, that you need to engage with multiple stakeholders so that you can create a tsunami of opportunity. Fantastic. Well, can everybody give a round of applause for Dr. Luco? Thank you very much.