3-Path-2 - National Forum



Moderator: Well, thanks everyone for regathering. It's gonna be hard to move above our last panel, but I think we've got a group that's up to the challenge. It was a great start to the day. One thing I want to mention is that Dr. Sidney's work we're referring to in a friendly manner, the Sidney Report, is something that we hope to continue into the future every year, really become a signature report product from the National Forum, something you could look to to understand better the trends in our mission efforts and where we may be having impact, so we look forward to continuing our partnership with Dr. Sidney in that area. So our next pathway to engagement is entitled Engaging More of America and it's moderated by our National Forum executive committee member, Dr. Warren Jones.

Warren is the newly appointed Chief Health Officer at Hampton University, distinguished clinician and health policy expert. He's also past president of the American Academy of Family Physicians. So Warren, thank you for joining us today.

Warren Jones: Thank you very much for that warm introduction, John. Well, good morning, everyone. As you heard John say, wow, what a great start, and it's a wonderful opportunity to be here with you and for you to take this time out of your busy, busy schedules to help us strategize on how we can help make America healthier and help make individuals enjoy the life that they have; not only live longer but put more life into those years. This morning, we're very, very fortunate to have a very distinguished panel, and I guess you might say, well wait a minute. We've got someone from industry, we've got someone from municipal world, and we've got someone from the Department of Defense, and you say, "Wait a minute; how can these three things intersect and why are we talking about health with these components?"

And, you know, that's an interesting question, but when you look at our nation and you look at the composite of what it takes to make America what it is, these are three of the key segments that'll make a difference. So what we want to do today is we want to start off by talking about the kinds of things that are going on our spheres and how we got there, the things we see working and the potential solutions, and we want to engage in crosspollination. We want to find out from you, when we get to the question and answer portion near the end, the kinds of things that are working in your communities and the kind of challenges that you face in order that we can build upon those – the solutions that are here today. So as we go through our panel, I'm going to just give a brief introduction to everyone first and then we'll just go through the panel and we'll see. And our first presenter will be Dr. Shurney, and Dr. Shurney, he confessed to me even though he looks like a nice person he used to be a surgeon.

[Laughter]

Now he's come to his senses and he's in public health and preventative medicine now. So I thank – I was afraid initially. I thought I'd have to move away in case he started throwing instruments, but he hasn't done that and he's calmed down. No, but he has – he's with the – with Cummins Incorporated and he's got a very, very interesting story on the kinds of things that they're doing. And our second presenter will be Command Sergeant Major for the Joints Chiefs of Staff, and that is Sergeant – Command Sergeant Major John Wayne Troxell. Now don't let that boy's face fool you. He's got over 30-plus years of service in the military, he served around the world, and I don't know if you noticed but he is the number one advisor for all enlisted personnel in all of the services to the Chairman of the Joint Chiefs of Staff; not a lot of responsibility.

[Laughter]

But he handles it so, so well and thank you for being here with us today, Command Sergeant Major.

John Wayne Troxell: Thank you, sir. It's an honor to be here.

Warren Jones: Okay. And finally, we go to the municipal sector, and I gotta tell you when I read that our next presenter, our next introductee, was a basketball player, I thought I'd be meeting a little five-foot two point guard. Well no, she ended up being a forward – a power forward, so I had to give her due respect when we got together.

Lydia Mihalik: I was a point guard in my own mind.

[Laughter]

Warren Jones: But no, it's amazing the kinds of things that are being done in innovative ways across our country and municipalities are engaging in many of those innovations. And to have a young bright mind that has the confidence and the status of electability to be able to try new things that will help to bring about successful business in a community, that's what we have in our final presenter today who'll be doctor – excuse me – Mayor Mihalik. And Your Honor, I apologize for making you a doctor too soon, but I'm sure it'll be coming.

Lydia Mihalik: No, it's fine. Yeah. No, that'd be great.

Warren Jones: So in order to get things started, why don't we start off with you, Dexter? If you don't mind, share with us a little about how you guys got to your program, what your intents are, and some of the things that you found to be very, very helpful.

Dexter Shurney: Sure. Well, we really – and when I say we I'm starting – I'm looking – I'm speaking of our CEO, and he really for quite the number of years, even before I joined the organization, had been looking at our healthcare costs in our healthcare and the health status of our organization, and he said, "You know, things aren't getting better. We've been working with a lot of the community health systems and providers, but every year we would see this increase in the healthcare costs, every year we would see the health status of the population really not improve that much." He said, "We really need to do something different." Cummins prides itself as being a company that's very innovative.

Even though we're known for making diesel engines, we're also doing really, you know, cutting-edge technology around fuel cells and new systems in terms of power generation, and so they see themselves as really – as an innovator, and he says, "We innovate in power generation and we do so well there, but for healthcare we really haven't been that innovative." And we always go out – we look for best practice but best practice we found, as we started to do more research, is that everyone's pretty much been doing the same thing. They've been doing the same kinds of things for a number of years. We all, you know, have these programs where we encourage people to know their numbers and to go in for their checkups and to get engaged in different kinds of wellness programs, and yet the numbers don't seem to really move or change; in fact, they get worse.

And so it was really this whole journey of going out and looking at the data to say maybe we should bring this more inside and try to do this, and so one – a couple of the things that we looked at, one is that we were going out to the healthcare systems but when we looked at their own data, the healthcare systems, we noticed that doctors and nurses and the people that were telling us how they could benefit us and show us how to make our populations healthy were not themselves that healthy.

Warren Jones: That's right.

Dexter Shurney: And their health risk assessments were just as bad as ours, and we said, "Well, then there must be something that's missing because obviously these are the most knowledgeable," you know, some of these were with academia, and yet they're not being so successful there either, so something is different. We also are a global organization, and when we look at what's happening to our global population we see changes such as type 2 diabetes in China. So we have over – about 7,000 employees in China, and we looked back several years ago and the incidents of type 2 diabetes in China was very small and now it's almost as much as what we see in the United States. So what has changed in China over the last 15 years? It's not the genetics, right?

Because these people have not changed in 15 years in terms of their genetic profile. The other thing that we noticed is that if we – we started to look at epigenetic studies and if – we saw that when you take identical twins and you put them in different environments, separate them, that they get different rates of chronic diseases, they get different cancers and those kinds of things. And so again, we said, "This says that this is really not genetics." Now genetics plays some role, but to a large part what we were looking at was really lifestyle.

Warren Jones: Yes.

Dexter Shurney: And we said, "What we need to do –" and we came to this big aha moment, and we said, "We really need to focus more – or less on healthcare and more on either public health or population health," as a previous speaker said, and so that really is what started us down this path to say we really need to focus on this population health and it really centers around lifestyle and we need to do this from a business perspective because, number one, obviously the costs are going up. And I work now with a lot of corporations and some of them have healthcare spends from, you know, $200 million to almost $1 billion a year, and if you think about those trends of 9 percent to 10 percent every year, if you're that $1 billion company and your costs go up $100 million, you're saying, "What did I get for that," right? Was there any value to that?

And that's happening year over year. You can start to see why organizations kind of look at that. But the other thing is that it speaks to productivity, and later I can tell you about how we're looking at some of those kinds of things too, but inherently we know that people that feel better, people that are healthy, they show up to work differently than people that are sick. In fact, they show up. People that are sick oftentimes don't even show up, but even when they do they just kind of barely make it through the day. And so we said in terms of engagement, in terms of retention, in terms of the work that we're trying to do, this makes sense.

And again, being a global company, in some of the countries where we operate there is universal healthcare available, and so it's not a cost issue there, right? But yet we're still doing a lot of these programs in those environments as well, because again, it speaks to the core business productivity and those kinds of things as well as accident rates, error rates, and some of those things that I can speak to a little bit later. But that's kind of the mindset that kind of drove us to that and I'll just say one other thing. Looking at the research, you know, going back decades – for example, the Harvard Nursing Study back at the turn of the century, early 2000's, demonstrated or concluded that 90 percent of type 2 diabetes was actually related to lifestyle, so that was another thing that kind of got us there.

DPP was big, you know, back then but yet we're now just getting there, but that involves lifestyle. And so again, those were just some other data points that said we really need to tackle this, and we weren't really seeing this in the healthcare community per se, so we decided to build some programs around this inside the organization.

Warren Jones: That's great. We're looking forward to hearing more about that as we go on this morning.

Dexter Shurney: Okay.

Warren Jones: Okay. Command Sergeant Major Troxell, some individuals will say, "Wait a minute, everybody that goes into the services, they're healthy. Why are we concerned about the health status of the individuals are there and why would it be important for us to take a look across communities to see what we can do to assist you and learn from the programs that you've engaged in within DOD and your partnering organizations to make a difference in the health status of our young people in service?"

John Wayne Troxell: Well that's a great question, Warren, and one of the things we're grappling with now – two things – on the Department of Defense. First of all, I think it's – everybody knows our mission is to defend our homeland, our freedom and our way of life, and over the past 16 years, ever since the rise of violent extremism, our operational tempo has caused our United States Military to be an expeditionary force, meaning we're spending more time abroad defending our interests, assuring our allies and deterring any kind of aggressive from a nation state or a non-state actor like a violent extremist organization. This has caused a lot of time in our operational tempo of our men and women to significantly increase to the point that we're dealing more right now with injured and ill than we are battle wounded.

If you look at the world we live in today, there's 196 countries. The United States Military has troops in 178 of those countries right now, and as something we look at all the time with the people that are in the force is how do we maintain this health and fitness they need for this threat against our country that is not gonna go away any time soon? With all of the tactical successes we have against violent extremist organizations, it's still gonna be a threat to the homeland so we're still gonna have to be an expeditionary force. And over the past 16 years we've seen a decrease in the health and fitness of our force because of this high operational tempo to the point where we have about 200,000 men and women that have medical ailments right now that prevent them from deploying and doing their job.

Then you add to that, and kind of to get back to a comment that Dr. Shurney brought up, is you know, what is society bringing in to us today that allows us to have the requisite capabilities and force levels we need to defend our homeland and our freedom? Right now, in a 2010 study, 27 percent – only 27 percent – of men and women 18 to 25 year old qualify for military service. Their disqualifying reasons were because of medical or fitness or something like that. That number today is under 25 percent. And if the trend continues, in 2030 that number will skyrocket to 64 percent of that pool of men and women that we draw on to join our military will not qualify for military service and that's a serious potential national security risk. So when we look at, one, within our force, how do we continue to get after and get the health we need?

It centers around fitness, it centers around nutrition, and it centers around healthcare to the left of actually providing medical care. So we're trying to create a positive deviance in health and fitness standard to our men and women, meaning if they're sick or ill or injured we're not just trying to get them un-sick or, you know, heal their wounds; we're trying to get them to live a healthy lifestyle within the context of being deployed at about a one-to-two ratio, meaning for every year they're out, two years they're back, which is as very high operational tempo. Now others in our force, like our special operations forces, that operational tempo is really out of whack, but we have to look at it from that perspective, which is why we partner with industry and a lot of things and try to look at what they're doing, and some of the things that the doctor brought up, to see if we can adopt that as practices there, but we also want to share some of the things we're doing. And what I do for my two bosses – that's General Joe Dunford, the Chairman of the Joint Chiefs of Staff, and Secretary Mattis of the Secretary of Defense – is I focus on total force fitness and our healthy-based initiatives that we have on – going on – to get after the health of our force.

But then the other part is when we look at the young men and women we need, we have to have a partnership with the leaders of our nation, like the mayor here, in terms of having a dialogue on what we can do to assist in helping with childhood obesity or any of these other things that get after the health of our force. I think you all know, in every state in the nation and with every country in the nation, there's some form of military presence, whether it's recruiters, whether it's National Guard or reserve troops or whoever it is, they're some kind of military presence and we're trying to leverage that presence to have a better relationship with key leaders out in our communities as well as chambers of commerce and other key centers of influence like educators and things like that, so we can help prepare men and women that want a life of service in the military. So those are the things that we have going on.

But even with the challenges we have, I want to leave you with three absolutes. Even with the challenges we have, our military today can absolutely defend our homeland and our way of life and our freedom. We can absolutely meet our alliance commitments and we can deter any kind of state aggression. And third, we have competitive war fighting advantages in every domain, and the key domain is in the human domain. No one in the world – and I can say this successfully or truthfully because I spend most of my time going from – I just told Warren I was at Navy Recruit Training Center in Great Lakes, Illinois, and three days later I was in downtown Raqq, Syria.

Warren Jones: Yes.

John Wayne Troxell: – watching our troops that were finishing up defeating ISIS there. And I can faithfully say that no one in the world trains, educates, entrusts and empowers men and women like the United States Military. So as we continue to do that…

[Applause]

Thank you very much. As we continue to do that, there is a certain number of our men and women that make this a career.

Warren Jones: Yes.

John Wayne Troxell: I joined the military when I was 18. I'm 53 years old and this is all I know how to do –

Warren Jones: [Laughs]

John Wayne Troxell: – and there's plenty of people out there like that. Warren himself is a Navy veteran of 28 years, so we have to make sure that we're preparing those men and women for a lifetime of health and fitness and self-centered kind of medical focus to make sure that they have what it needs – what we need, the resilience, whether it physically, mentally, emotionally, to deal with a lifetime of defending our country. So I look forward to the dialogue and the discussion today, and again, it's truly an honor for me to be here today. Thank you.

Warren Jones: Thank you very much. Okay. And now, Your Honor, everybody knows that mayor – that cities are not having any challenges in today's world –

[Laughter]

– and that the easiest job other than being a talk show host is to be a mayor of a city.

Lydia Mihalik: Is to be a mayor, right. It's the best job in the world, I know that.

Warren Jones: [Laughs] But can you share with us some of the initiatives, activities, and some of the programs that you've had and some of the successes you've had?

Lydia Mihalik: Sure, absolutely. Well, you know, when I first took the reins of the City of Findlay organization and the community back in 2012, we were like a lot of communities across the country. We were struggling to come out of the recession – a recession – we had issues with our operations, we weren't investing in our infrastructure, we were spending a lot of money on our people, we had cost centers relative to healthcare, so we were having 47 percent increases in our health insurance premiums year over year over year. It was pretty standard for the chief financial officer or the auditor of the city to walk down to the mayor's office and say, "Well, we ran out of money again in the health insurance account. We gotta put some more money in there."

And so we're self-funded, just to give you an idea of how that works for us, and we've got a great plan at the City of Findlay and a lot of communities are like this, but we pay for 90 percent of that premium from the taxpayer's perspective, and then we asked every employee to contribute 10 percent. So a 47 percent increase is a pretty sizeable increase on the 10 percent side for the employee but it's a really tough pill to swallow year over year to the overall city budget. And so when I took the reins we – I said, "Look, we've gotta change this." First and foremost, there's a business case to be made for this and we need to be better stewards of the taxpayer dollar, and so we went to work at evaluating through our employees what it is that we could do to better educate our employees that because we are self-funded our plan doesn't work where you hit your deductible and then everything is free.

You know, once you hit that deductible, every time you go to the doctor or you go to the emergency room for a cold it costs you and me and the other 349 employees at the City of Findlay money, and so we were educating folks on how the plan works, and we had to make some minor structural modifications to the plan but I'm happy to say we were spending over $6 million in 2012 on our health insurance costs, now we spend less than $3 million. So – and a lot of that just went into more emphasis in understanding how the plan worked but then like a true, real wellness program. Like business, like in the military, we need you to be present and productive –

Warren Jones: Yes.

Lydia Mihalik: – in order to properly serve the constituents in your community. And so we made sure that the folks knew that that was important to us. And so when you're constantly sick and you're not there, we're having to fill your spot if we can. You know, obviously police and fire are a little different than our public works guys, but when we have to fill your spot that costs money. And so we continually educate and we just put a larger emphasis on things. And the first couple of years we did some biometric testing and folks kind of got an idea of what their baseline was, whether or not, you know, their BMI was in a good range, what their cholesterol looked like, whether or not, you know, they were prone or had high sugar or low sugar problems, and a lot of folks didn't even know what that number was.

A lot of them didn't take the time to go to get an annual physical every year, and our people are pretty active. I mean they're constantly doing things and, you know, we have quite a few administrative folks but, you know, the people who are – the majority of our people are out and physically working to serve the Findlay community, and so we wanted them to realize that their health was really important to us, but it not only saves the city money but was saving them money as well. So we went – you know, the last few years we've had several health insurance premium holidays towards the end of the year, so we've generated enough money to cover what the costs are of the plan, and once we've hit that reserve and it's fully funded and things are good – 'cause look, bad things happen, right?

I mean they're – that's why you have health insurance but, you know, what was happening over and over again was people were just making unhealthy choices, they weren't aware of how the plan worked, and they didn't realize that there was somebody that actually cared about their own physical health, so we've tried to communicate that to me. So we've had a lot of success in that program. On the opposite side, once we got our own house in order, we've kind of taken it to the street, and so now we're communicating with our community about what public health really is and we've had the good fortune of the last three years being the country's number one micropolitan; the number one micropolitan to bring your business or expand your business in the country. There's 575 other micropolitans and we've been number one now three years in a row.

And we do that because I feel like the Findlay community is a place that wants to be conducive for business and investment, and in order to do that, in order to compete for the top talent that you need to be successful – whether that's in the military, in business or in the public sector – you need to have a great place to live. And so we've continually invested in the space that we're in charge of and we've tried to encourage folks to come to Findlay. We don't have Cummins like Columbus, Indiana does, but Findlay, Ohio and Columbus, Indiana share a lot of similarities.

Warren Jones: [Laughs]

Lydia Mihalik: In fact, I was really excited to see that you're here. We have Marathon Petroleum Corporation and it's as significant as a partner in Findlay as Cummins is to Columbus, Indiana. And they're on the hunt for America's top talent, you know?

Warren Jones: Yes.

Lydia Mihalik: The country's, the world's top talent because they need it –

Warren Jones: Yes.

Lydia Mihalik: – just like everybody else does, and so it's our job from the city's perspective to create that environment that's conducive for investment, that people want to live and raise and work and have a family in, and so we've just tried to focus around that and we've done some things, you know, relative to getting active and –

Warren Jones: Yes.

Lydia Mihalik: – we've gone out to every single city park this last summer. We either played kickball or dodgeball. We played pickleball with our senior citizen population, and we got kids in the neighborhoods – you know, it was really funny. We had some neighborhoods – the very first event we had at one of our parks, and they're like, "The mayor's here to play kickball," and so they all ran door to door and got all these kids to come out and play kickball.

[Laughter]

Well then the fire truck showed up, and they were like, "Oh my gosh, the fire truck's here."

Warren Jones: [Laughs]

Lydia Mihalik: Well then we had a couple police cars show up, and they're like, "Whoa, what happened with the police car?" And I'm like, "No, no, no, no, no, everything's fine. They're just here to play." And so we were encouraging them to get active, and when we finished I said, "You know, you don't need to have us here every day to get out and be active and play. If you want to invite me to come, I'd be happy to," but we used that opportunity not only to play and get active but we also taught them about healthy snack choices. And so we've done that and there are a lot of communities across the country that are doing that because public health is extremely important and I think there's a newfound appreciation for that.

Warren Jones: Yes.

Lydia Mihalik: Because there's a business case to be made for it.

Warren Jones: Well thank you for sharing those insights, and particularly, the next time you get ready to play kickball with the kids, let me know.

Lydia Mihalik: Come on down. We'd love to have you.

Warren Jones: Well one of the challenges that you face, Dexter, is even more complex than some of the others because by you being a global company that's in a competitive environment, you gotta stay a step ahead, and if your workforce globally is not fit enough because of cardiovascular disease and other issues you can't really compete. How – what kind of innovative things have you found to be successful and some of the outcomes that you've been able to find that work for you?

Dexter Shurney: So we've done a number of things, but at the very foundation what we've tried to do, again it's about lifestyle, it's about changing behaviors. And so we weren't the first to come up with this idea but we put a framework around it that we call MC2. And so M is for motivation, and we want this to be intrinsic motivation, so instead of just giving people money to do things, really finding out what motivates them and what are the things that they're trying to do for themselves, right, this intrinsic motivation because that's far more sustainable. So for example, we knew that people were out there spending billions of dollars on nutraceuticals, they're spending money on books on, you know, how to lose weight, how two, you know, live longer and all those kinds of things, they watch shows like Dr. Oz and The Doctors, and yet when we give them money [laughs] inside the organization to be healthy, they don't want to participate.

Warren Jones: Right.

Dexter Shurney: They don't want to engage. And so we said, "You know, we need to look at this a little differently; how do we engage people on the things that they're already trying to do?" So instead of just coming up with these programs ourselves, we said, "Okay, what do you want to do? Do you want to lose weight, you want to live longer, you want to decrease your risk of type 2 diabetes, you want to decrease your risk of erectile dysfunction, you want to decrease your risk of dementia? Then what are the programs that we can do for you to help you reach that goal?" You choose what you want to do."

And again, all of these things are – have a lifestyle foundation, but that's how we're starting to engage people and then providing them the help to do that. And if they engage and if they start to show improvement then that's a good thing, we all start to win, but they're doing it for themselves. And then the first C is competencies, what we call lifestyle competencies, and they're really built around something – I think Steven mentioned seven healthy levers or seven healthy habits, we have something called seven healthy levers, and it's around, you know, proper nutrition, it's around physical activity – we don't call it exercise – physical activity, sleep, tobacco, stress – right? – resiliency, those kinds of things.

And so we have seven of those, and so basically we're saying is once you become motivated, how do we teach you the competencies, evidence-based science that says if you are trying to lower your cholesterol what are the healthy things that you should do to do that, right? And so depending on what you're trying to do the levers might change, right? You know, if you're trying to do one thing it might be more heavily based on nutrition. If you're doing something else it might be more heavily based on physical activity or sleep or whatever, and also we just –we help you determine where you are on those levers.

So we know, for example, that everyone is supposed to get 150 minutes a week of, you know, moderate exercise and we know that no matter what we do we can only move about 20 percent of the population on that. So instead of beating them up on that, we say, "Well, what – could you just stand more, you know?" And so for each of these levers, what we've done is we've developed these baby steps, kind of like – some of you are familiar with Dave Ramsey's Financial Well-Being, and he has these baby steps to financial health. Well we have these baby steps to physical and emotional health built around these levers. So for physical activity, if you stand more, boom, you get a – you know, that's more than what you were doing before, right?

Warren Jones: Yes.

Dexter Shurney: You can go for a walk. Well you'll get credit, even if we can't get people to engage in the marathon running and all that kind of stuff. But those who want to, we encourage that, too. So that's the first C; what's the evidence around, you know, healthy lifestyle – what's gonna actually get you the results? Because the other thing is that – as someone mentioned before – there are a lot of myths out there. People go on the internet, they do fad things, they work really hard, and then because it's not based on evidence and science they don't work, you know, or you get them doing things that aren't gonna really show outcomes they become discouraged. They actually become demotivated versus motivated.

So we want to give them the things that are actually going to work for them and motivate them. And then the second C – and I think this is really what this panel is about in this session – is really community and culture. Because we did some talking to other people in business – Whole Foods was one of those organizations and talking to their senior VP over there that's in charge of their health and wellness – they, for a number of years, have been sending people to residential lifestyle treatment programs where they would spend anywhere from ten to four weeks in a residential program and they would actually be able to reverse type 2 diabetes based on those seven levers. And so people would go in on medications, they would come out and they were actually off their meds.

But what happened is when they brought them back into the community they would revert and go right back to having type 2 diabetes because the family, the church group, whomever, the workplace, just wasn't helping them. It's like putting – it's like someone going through AA and then they come back and they say, "Okay, I'm gonna let you work at a bar, you know, and surround you by people drinking all day." And so that was what their experience was, and we said, "We have to do something so that that doesn't happen to our people as well," so the community is really important. One of the things that we did around community is that we've developed our own onsite, near site clinics, and so we incentivized the doctors to actually share decision-making process with the patients and the clients in terms of the things that they're trying to do based on our incentive and benefits program and what the doctors are then incentivized to do – and the doctors are actually paid based on moving the health status of our employees and not how many procedures and referrals they can do.

And so – and they're actually incentivized to have those conversations because what we were finding is that when people would come in and say they had an issue with sleep they would, you know, just hand them the Ambien or the pill and not really say, "Well, how much sunlight are you getting, how much exercise are you getting, what's your level of hydration?" All those kinds of things and what are the mechanisms that might be keeping you from getting a good night's sleep versus just going straight to the medication? So we had to train the doctors. I didn't get this in medical school – most doctors don't – but we trained the doctors in terms of how to have those conversations.

We trained the coaches on that. We've gone out into the community, so we have rotating doctors. We just don't hire all the doctors in our clinics. We actually rotate and have doctors in the community and the local hospitals because we need to broaden this and spread this beyond that. We have a teaching kitchen, and so one of the things about that is that people think that healthy food has to taste bad, and that's not sustainable. You know, we can show you 50 different ways to prepare eggplant, and I bet one of those ways you'll really like, you know?

If you don't like every way that, you know, someone might cook chicken, right, but there's one way that you might like and so it's the same kind of thing. So you show people that healthy food can actually taste good, healthy food doesn't have to be very expensive and costly if you know how to shop for it, if you know how to purchase it. It's something that you can do; so again, it's hands on, show people how they can do it. One of our most popular programs where we show people to come in and they do five meals for a family of four, costs them $40 and mainly they're paying for the ingredients.

They take it home, they put it in the refrigerator, they put it in the freezer, so when they get home from work and they're tired they just pull it out, put it in the microwave and they have a healthy meal, 'cause that was one of the things – well, I don't have time to do this and it's gonna take a lot of time. And then the other thing, again, is that it's easy to prepare and that they can actually do that. So that really helps there. We also have another program – and this'll be the last thing I'll say for now, is that going out into the community is that we're piloting a program where people can come to a workplace site and actually pick up a dinner that they can take home at the end of the day.

Now we did one version of this where we actually worked with our cafeteria provider to do this but their heart wasn't really in it and the food didn't taste very good, and so even though people did it, it really didn't, you know, blow our socks away. So we said, "Okay, the next version we're gonna do, we're gonna go out to the community and we're gonna contract with restaurants." So, you know, Mr. Thai restaurant, you're Monday, Mr. Italian restaurant, you're Tuesday, and you see what I'm saying, right?

Warren Jones: Yeah.

Dexter Shurney: So every day of the week we would partner with a certain restaurant to provide food that's healthy and tastes good and affordable, right? And what that does is now when those – our employees go out to the community to have dinner with their friends, they can go to that Thai restaurant or whatever and they know that there will be things on that menu that are healthy, that taste good, and now they can be social and be with their friends and start to really imbue this into the community, and we've done some programs like that with the hospital too in terms of some of the things incorporating that as well. But just one item that in terms of how we spread this into the community and really kind of involve a larger group.

Warren Jones: Thank you very much for sharing that. And Command Sergeant Major, one of the things that defines all of the different components of the young men and women that you support in representing their interests is the sense of communities, and promoting wellness within those communities as a part of their readiness, as you said, is your major challenge. But you've also got another challenge with the citizen soldier who's been a part of the reserve force integration and the wellness that you have to ensure that they have as well as the fitness and the capability of being deployed, and plus some of the success stories that you have with some of the individuals. Would you share some of those things with us?

John Wayne Troxell: Yeah. So it's a great point, great question, Warren. So one of the things that we've really been trying to focus on is we look at total force fitness as, yes, our active duty folks have to be fit, but we also have our component two and three, our National Guard reservists who have civilian jobs –

Warren Jones: Yes.

John Wayne Troxell: – but also their operational tempo is pretty high.

Warren Jones: Yes.

John Wayne Troxell: We leverage our National Guard and reserve forces a lot for missions in the Middle East or to do things in the Pacific, like exercises and things like that, or in South America to do humanitarian assistance and disaster relief. So more and more we've brought in key leaders from those components, the National Guard Reserve. So we're looking at this from a total force concept on total force fitness. The other thing we're doing in terms of communities, as we look at the men and women that are looking for to join our enterprise, is more and more our recruiters and our personnel out in the communities that every day are on the streets in places like Findlay, Ohio and things like that, that they're doing things before men and women access into the military to come, like doing volunteer fitness sessions –

Warren Jones: Yes.

John Wayne Troxell: – or volunteer nutrition kind of sessions.

Warren Jones: Yes.

John Wayne Troxell: Now this has caused us to make an investment in those people to make sure that they have a good understanding of where we're going with fitness, where we're going with nutrition and as well as healthcare as well, but we're trying to do that. So they're more – they see what life will be like once they enlist and they raise their right hand and they move on to their training and then their schooling and then eventually on to their home station where they probably won't be very long before they're out somewhere in the world defending the homeland. So we're looking at this from a total force concept perspective to get after all of our components, but we're also looking at this as how do we better partner with our communities out across the United States to assist in developing that kind of talent that we need to join our ranks?

Warren Jones: Yes, sir. And one of the things I was thinking about, I understood that there was a success story that you'd wanted to share with us today and one of your members that you wanted to have a dialogue with us.

John Wayne Troxell: Yeah. Do you know who we're talking about here, Rob? I've got a lot of success stories.

[Laughter]

So I will tell you, what I see as I – you know, with the job I have, it allows me to see everything associated with our Defense Department.

Warren Jones: Yes.

John Wayne Troxell: But I talk about things first and foremost about how do we set the best example for the young men and women we want here?

Warren Jones: Yes.

John Wayne Troxell: So regardless of who we are, whether it's me or the chairman or it's the lowest-ranking tactical leader, we have to validate our credentials to lead these men and women as they come in.

Warren Jones: Yes.

John Wayne Troxell: But we also have to set the best example. You know, General Dunford's 62 years old, he's been in the Marine Corps 40 years but he just ran the Boston Marathon in under five hours.

Warren Jones: Yes.

John Wayne Troxell: You know, so and I – every day – I'm kind of a CrossFit, high-intensity interval kind of guy – every day I'm punishing myself by joining these 20-year-old folks and doing the kind of PT they like to do. As a matter of fact, I just conducted a seminar down in San Antonio, Texas for three days where I partnered with athletic trainers from professional sports teams and also our world class athlete program in the United States Military that routinely puts out Olympic-level athletes, and we brought in a bunch of young service members to show them what right looked like. So I think – the success stories I see is when the clearly-obese young man or woman walks into a recruiting station and they say, "I want to join the United States Military, I want to serve my country," and our men and women that are out there, our young NCOs, our noncommissioned officers, that are out there doing that recruiting duty, take time out of their own schedule to get this man or woman down to the requisite physical level –

Warren Jones: Yes.

John Wayne Troxell: – they have to be to join in. Those kind of success stories happen all over the country, and that's really the story that needs to be told is that we're not out there just trying to say, "Here, sign up, join the military," but we're talking about what a life in the military can do for someone. And so when I go around the country, I share my story. You know, I grew up in Iowa. You know, when Ohio State plays Iowa, you know, we'll have a discussion then on that there.

[Laughter]

But I was a good student when I played football and I wrestled, but outside of those sports I really didn't apply myself, and I joined the military and I found purpose, motivation and direction.

Warren Jones: Yes.

John Wayne Troxell: I also found a wife, which led me to have kids and now I have grandkids, and I went from barely graduating high school to where, you know, I've achieved my master degree now in strategic leadership, what I'm doing right now. And I attribute all of that to leaders at all levels showing me the example of what right looks like and embedding in me this ethos that every morning I gotta get up, I gotta think about my fitness and my health, and especially in the job I'm in now and the high operational tempo and traveling three weeks out of the month all over the world, that if I'm not looking out for that then potentially one of my team here is applying first aid on me here. But too, that I'm setting the example that every young man and woman should follow in terms of being fit, eating right, and living a healthy lifestyle. So these kind of stories are just all over our Defense Department and every service has these good news stories.

Warren Jones: Well, I have to think back and shudder when I think that I was 54 years old still trying to run that mile and a half –

[Laughter]

– and I'd say, O-M-G.

[Laughter]

So I gotta salute to you, General, for getting out and doing what he's doing.

John Wayne Troxell: But you know the point there, Warren, is that you went out and did it, you know?

Warren Jones: Yes.

John Wayne Troxell: We can't run as fast as these young men and women anymore.

Warren Jones: No.

John Wayne Troxell: That ship sailed on me 25 years ago, you know?

[Laughter]

But if I'm gonna ask those young men and women to go out and have a healthy lifestyle then I at least ought to be out there with them doing that and showing them that, hey, I'm getting after my own fitness.

Warren Jones: And there's another area of integration that occurs here. If you look at what goes on in our communities, our citizen soldiers – the Reserve and Guard component – they work for industry and they live within municipalities.

John Wayne Troxell: Yep.

Warren Jones: And guess what else they do? They also are part of the volunteer fire department, they also are first responders. So the health and wellbeing really does cross all of these sectors, and so what we've gotta do is think about ways of leveraging all of those different aspects and working together as a team to help to make sure that we can be as responsive as possible to the needs of our communities and the needs of the individuals. Is it okay with you guys if we open up for some questions?

John Wayne Troxell: Absolutely.

Lydia Mihalik: Absolutely.

Warren Jones: Why don't we try that. Any of you have any questions, suggestions or ideas that you'd like to dialogue with us about?

Audience: Hi, good morning. I'm Candace DeMatteis. I'm with the Partnership to Fight Chronic Disease. We saw in the '80s, I guess, more – a lot of models of partnership between employers and schools about what do we need, what skills do we need, and we saw a lot of growth in STEM, a lot of emphasis on that type of education. I haven't seen as much in terms of the health of the future workforce, and are there opportunities? It sounds like all of you are doing things individually, but is there an opportunity for employers to get together and talk to schools and say we need a fit workforce, too? We need to focus on health.

'Cause we see PE programs being cut and things like that, so I'd love to hear your comments about that.

Warren Jones: By all means, by all means.

Lydia Mihalik: So great comment and amazing question. So – uh oh. It is working now? [audio cuts out]. In the last couple of years, particularly in the State of Ohio, there's been this workforce skills gap that has existed, and I think for a good couple of decades now – maybe almost three – we have looked to education to try and tell business what they need and there's been little interaction where business actually communicates with education and education is intentional about providing business with what they really need, and I think that goes from not everybody has to go to college – you know, that conversation needs to happen and it's starting to happen I think, which is a good thing. I mean I've got a line – so we have Whirlpool dishwashers with Whirlpool Corporation in Findlay, Ohio. They make more dishwashers in Whirlpool – or in Findlay than they do anywhere else in the world. We make a lot of dishwashers.

[Laughter]

Well, 40 percent of a particular line at Whirlpool is getting ready to retire in the next five years and that's a severe issue for us. And so I think the more we can have conversation with our private sector partners and listen to what they need the more our educational institutions will be able to provide our communities ultimately with what will be successful.

John Wayne Troxell: If I could add on to that. So over the course of – since 9/11, the actual definition of combat hasn't changed, but the character of conflict has changed a little bit. The threats to our nation have become more asymmetric in terms of terrorist kind of attacks, but also terrorist attacks in terms of cyberspace and then competition short of conflict in places like space and the nuclear domain. So as we continue to move in the future here, we're looking for the talent from our nation that can assist us to get better in the cyberspace arena, to get better in the nuclear domain and in space and things like that.

But the bottom line is the definition of combat will not change; it's a fight of wills against two set – certain sets of people. And so the things that traditional Army and Marine-type troops have to do, which is move over rough and uneven terrain for an extended period of distance with 60 to 80 pounds of kit on and then have the physical reserve to defeat a threat on the objective – that won't change – or the need for our sailors to be able to do damage control and firefighting in times of emergency at sea where they have to have the physical, mental, and emotional skills and resilience to potentially get incapacitated shipmates out of an engine room of that ship and get them up to safety. So all of those things mean we have to continue to focus on that baseline physical fitness, mental fitness and emotional fitness required for this enterprise that we're involved in that is very unforgiving and brutal. But also, we have to look at what our potential adversaries are doing in these asymmetric domains and continue to look and make sure that we're getting after those skills we need to be able to combat those kind of threats in whatever that asymmetric threat might be, like cyber. So I hope that addresses the question. Thank you.

Warren Jones: And if I may just add one thing, I think there really are great opportunities for business and industry and municipalities to partner along with the Department of Defense, and I think a good target area would be look at our middle and high schools. If we can keep our young people moving and engaged it'll make a big difference, because when they're moving and engaged they actually learn better. In my daughter's high school right outside of Jackson, Mississippi, 85 percent of the students participate in high school – interscholastic sport – 85 percent, okay. They also had five perfect ACT scores this past year, okay, and they tend to go to schools around the country.

Why do I say this? Not because it's that exemplary a place; it's because there's been buy-in by the community, buy-in by the faculty, buy-in by the students, and a healthy body and a healthy mind can achieve so many things and they're on the road to wellness. So I'm saying to you that we can do this, Nemo, if we just go back to our communities –

[Laughter]

– and partner together. So, excellent question. Yes, ma'am?

Audience: This is Sunita Dodani. I'm from Eastern Virginia Medical School. Thank you very much for such lucid presentations and sharing your excellent models of lifestyle management and different modalities. I work – my team has been working with communities, primarily ethnic racial communities, in developing programs _____ diabetes prevention program, making it evidence-based, group-based, faith-based programs, and now we are running a hypertension control program in 36 churches back in Jackson and now I'm going to move it to Virginia because I just recently moved to Virginia.

My question is, yes, these models are very successful. However, what we have been grappling for so long is sustainability of these models. We developed soup kitchens, we have the exercise, we have partners with the YMCA, we partner with the food trucks, especially many of these churches in the African American communities that are in the food deserts area so we contracted, you know, farmers markets, you know, come to the churches, give the fresh produce to these communities. As long as you are there the program is there, but when you look at the behaviors – they stay there but they are not continued.

Monetary services work for some time. Food stands, if you provide them some tickets – because we were funded by NIDDK on an R18 grant which was translating diabetes – DPP into a fit body and soul faith-based program. But the challenge has been the program was done, the behaviors came back. So how – do you want to put some light on those and how we can sustain these programs, Dr. Shurney?

Dexter Shurney: Sure. I'll take the first stab at it. You know, what you're saying and really what the problem is, is that it's not part of our built environment, and so what you're trying to do is you're trying to artificially adjust something for a period of time and then once that adjustment goes away then everything reverts back to normal. I mean even the question about education, right? It used to be that we had physical PE, we used to have, you know, home economics where people could learn to cook, we used to have health classes where people would learn those kinds of things. As that infrastructure and that built environment changes and goes away, we don't have safe places for everyone to walk, we have food deserts and those kinds of things, then these, you know, fix-for-the-day kind of program du jour isn't going to work, isn't going to be sustainable.

We have to really as a society, as a community, come together to say how do we build this into our infrastructure and then it will start to change, but a lot of that has just kind of gone away and evaporated and that's what we struggle with.

Audience: And what do you think would be the ingredients for that change?

Dexter Shurney: Well, you know, there are some places that have actually – someone mentioned the Blue Zones before. So again, if you look at the Blue Zones, the original Blue Zones, those places, it was part of the built environment. They moved more, they ate the right things, they were social, and so we've tried to replicate that. Dan Buettner and his folks have tried – or they've started replicating that, and so basically what they're trying to do is build those kinds of societies here in the United States and they've had some success, so that might be one place to look. There's another group that works with smaller cities called Healthy Communities or Wellness – I might be getting the name wrong – but there's some folks that are out there trying to do those kinds of things and so those kinds of partnerships seem to have some promise.

John Wayne Troxell: That was a great question, ma'am. You know, we focus a lot on the requisite amount of aircraft carrier strike groups or expeditionary strike groups in the Navy we would need to deter a near-peer kind of threat or the number of fighter or bomber squadrons we would need to deter that threat or Army brigade combat teams or Marine regimental combat teams we would need, but sometimes what gets lots is that all of these systems that we have that allow us to have competitive advantages are manned by people.

Warren Jones: Yes.

John Wayne Troxell: And the first and foremost we have to invest in people. And so when I brief the Chairman and the Secretary of Defense about the number of non – medically non deployables we have or the number of clinically obese service members we have and what that price tag is in terms of the billions of dollars of healthcare it costs on that, that kind of gets their attention, you know? A lot of people don't like to hear those kinds of things because we focus more on the things that they – those people man as opposed to the people themselves. So we're really focusing back on this to make sure that the programs we have are enduring.

Out Defense Logistics Agency that provides the food for all of our services; when I started this healthy-based initiative total force fitness concept – well, when I was directed to start it – I brought those folks in, and what I learned is the food menus that we had there were the same food menus in 1982 when I was an 18-year-old private.

[Laughter]

And –

Warren Jones: That's right.

John Wayne Troxell: And because of the cost of the food there, commanders were still buying the same Salisbury steak that I was eating in 1982 when really we hadn't adjusted the menu to more healthy choices that are at a reasonable cost, so we're looking at it from that perspective. The other thing we're doing is we're taking our world-class medical providers and we're decentralizing them more. Instead of being in a hospital on a military installation, we're getting them down at the brigade squadron formation so there's more dialogue between medical professionals and commanding officers in terms of the care of their men and women. Obviously, not violating any HIPPA laws or anything, but if Private Troxell goes to the doc and says, "Hey, my back hurts," the doc probably would want to have a good dialogue with the commanding officer on Private Troxell and say, "What is on your schedule coming up, are you due for deployment, how can we work together to get Troxell back so that he is a productive individual within your organization?"

That has helped us immensely by putting those medical providers at the organizational level to get after this, but we have to keep beating the drum on these programs to make sure they don't lose steam. And any time a North Korea does a missile test or there's a terrorist attack in Mogadishu, Somalia or wherever it's at, in some ways that may take our attention off of this kind of stuff because we think what are the things we need to deter a North Korea? What are the things we need to do to help the country of Somalia to get better? But in the end, it all boils down to our people and we have to have these enduring programs to make sure we have the requisite force necessary to defend our homeland and those of our partners across the world. That's how we're getting after it.

Lydia Mihalik: From the community perspective, what I can say is and what I've been able to see – I'm now in my second year of my second term – continuity counts for a lot.

Warren Jones: Yes.

Lydia Mihalik: And continuity and just leadership in general, and I think if you can utilize, at least from a leadership perspective, the time that you have to help develop the culture so that regardless of who is calling the shots at the top, it's just known that this is what we do and these are healthy activities and this is why it's important and these are the benefits and this is the value proposition and, you know, as long as they understand that and it's – whether that's within an organization, whether it's local government or, you know, in the military, in the Department of Defense, I that leadership has a lot to do with it, but if you can get the right leadership for a specific amount of time where the culture is changed – so it doesn't matter who's up here calling the shots – they're like, "Look, this is important to us and we're gonna get this done." And I think, you know, it's the same in the neighborhoods and the communities that you're talking about. When it becomes, you know, as natural as buckling your seatbelt – you know, I mean we've been drilling that into people for years and years and years and now we do it, right? When it becomes that natural and people just –

Warren Jones: Yes.

Lydia Mihalik: – they create that habit, then I think it just makes sense, and so that's at least – hopefully at the end of the day when I'm done with my service to the City of Findlay, that I have helped create a culture that has some lasting significance on things that our employees and our organization can control and our neighborhood and our overall community can have control of, and I think ultimately that's, you know, the way to go about it.

John Wayne Troxell: I think that's a great example, Mayor. Within my office alone, we have this healthy tension, I call it, in terms of how we and what we do, and so, you know, I'm constantly ribbing my team, you know, if they say, "I'm going to get something to eat," and I'm like, "What are you gonna go get, a Denver omelet or something, you know?"

[Laughter]

Or if someone walks in with something that doesn't look healthy, they kind of get a healthy ribbing about it. Now nobody likes Five Guys Burgers better than me, you know, but in moderation, you know? But I think that's a great point, yeah.

[Laughter]

But I think it's okay to have, you know, that kind of healthy tension within an organization and a culture that we're all about fitness, 'cause in the same breath as I – you know, I ask my team, what did you do for PT today, you know, or they're asking me what did I do for PT today or how did I get myself better, you know, and I think that's a great way to get after this, you know?

Lydia Mihalik: Yeah, I think you can lead by example. I mean I kind of was chuckling to myself when you were talking about, you know, running marathons and how you want to, you know, make sure that your own personal health is a good example to the rest of your organization. Look, we could solve a lot of public policy issues if we could just play one-one-basketball all day.

[Laughter]

I'd be good. So I just continually sharpen those skills, sharpen that saw, so that if one day I get called I'll be ready.

John Wayne Troxell: I'm good for five personals or two 59:44, ma'am.

Lydia Mihalik: Yeah, right. Yeah.

[Laughter]

Warren Jones: But, you know, one of the things that you're concerned about with communities like the one you described is we have research fatigue or funding fatigue. Funding comes for a five-year cycle. You spend a year and a half setting up, a year and a half working on something, a year and a half assessing what you do and then a year reporting on what you think you did.

Audience: That is one _____, when the funding is gone _____.

Warren Jones: Well, many times the nature of the funding is that it's targeted to a specific activity that someone at a distance thinks is important and it may not have the same degree of importance to the community. So one of the things we're gonna have to do is be creatively defiant, is what I like to call it. Describe what we do in order to get the funding but be defiant enough that we can do what we know the community needs, and as long as you can build a bridge between what you requested the funding to do and your positive outcomes you can always justify that. But I can tell you, I lived in Mississippi where I've lived for the last 15 years. I mean that is really the epitome of the cycle, because everyone wants to use the Mississippi Delta and the data out of that is – and I'm telling you, institutions from all over the country are lining up to the come to the Delta, to use those data.

But then they run away at the end of the three to five-year period and the people there are saying, "What next?" So I would hope that leaders like you and others that have the skill set would find ways to be creatively defiant and work with communities to have them tell you what the outcomes are that they desire and then you'll have the longitudinal support you're looking for. Okay, all right. Yes, ma'am?

Audience: Good morning. Thank you so much for the presentation. I'm Calondra Tibbs from the National Association of County and City Health Officials and our focus is on local community, so very happy to hear that, and what I heard from this presentation is that places matter, right?

Warren Jones: Yes.

Audience: So the place where the person lives, works, plays, it matters, and so I wanted to kind of hear a little bit of how the investment in the place, not simply or only the investment in the person but the investment in the place, because what we're hearing from a lot of our communities or through our nearly 3,000 local health departments is that there's not always that place where someone feels that they can go buy fresh fruits and vegetables, they can access places for physical activity or just play or walk in safety. So can you talk a little bit about what is the investment needed to create the place such that these healthy behaviors can be initiated and sustained? And I think that goes a lot to when we're talking about sustainability, it's great. You're in a perfect model and all that but then you're returning to your community and that place or the scientific experiment [laughs] has changed, and so how do you deal with that? So I just want to hear a little bit more.

Lydia Mihalik: So I thoroughly believe that government's role, local government's role, is to create the environment that's conducive for, you know, prosperity, investment, healthy living, et cetera, and I think, you know, there are communities across this country that are doing amazing work in that area and we are a little far behind, and a lot of it revolves around just the traditional values in Northwest Ohio. I mean we're fairly conservative, we only do what government needs to do and nothing more. And I think I was joking around earlier in that, you know, we're just getting into the whole bike lane, share a lane, bike path, jogging path, parks program and, you know, turns out it's a really cool thing and it actually incentivizes people to want to be in your community

But before, people were like, "Why would you want to spend money on that?" And I think that the more communities are intentional, and not just saying, "Well, we're gonna build a bike path," but intentional about encouraging that type of investment and that spend because we all have a finite amount of resources, and so we have to try and prioritize what those resources are gonna go towards and, you know, I think there needs to be a healthy recognition of the impact of, you know, community markets and places where, you know, we can have access to fresh food and a farmer's market isn't just a social thing to do, you know, once every Thursday, you know, once a week. We should be doing it a lot more than that and promoting bike programs and healthy activity and those types of things out of your recreation department – we need to do that.

And what – the communities that recognize that and do a good job of promoting it are gonna win, and as we all compete for talent and we all compete – you know, we – there's this book on the – you know, When the Boomers Bail, right? And so the communities that figure out how to actually attract people or retain people are gonna win and those that don't, and they don't change with the times, they're gonna fall behind.

Warren Jones: Yeah, I think – I'm sorry.

Dexter Shurney: I'm sorry.

Warren Jones: Go ahead.

Dexter Shurney: I was gonna say that organizations can do a lot as well, and so as lot of organizations have foundations and those foundations can make investments into the community. So we've done the things like the bike paths, the bicycles, Columbus Bike and things like that, but what I would also say is that we've done a lot around the physical – if you think about those seven levers that I talked about, we've done a lot about the physical lever; we haven't done enough around those other levers. And so if you think about a plant that you're growing in your garden and if you give it the right nutrition, the right nutrients in the soil, you give it enough water – not too much, not too little – and the right sunshine, you get a healthy plant and the whole plant thrives. The roots are good, the stem is good, the vegetables are good.

And if you overdo one or neglect something then you don't have a good, healthy plant. And so what we've done – if you think about the seven levers of health, we've overemphasized to some extent the physical activity, which is good, but we've neglected the sleep and some of those other things, and so what I would say is that organizations could probably do a lot more – and I know Cummins is one of those organizations that can as well – in terms of work/life balance so that people can actually get enough sleep, right? Because we're a global corporation, you have meetings that are occurring at all different hours of the day and those kinds of things. So all this is to say is that there's a lot organizations can do, there's a lot that organizations have been doing, which is really good, but we need to be more broad in terms of what the possibilities are.

John Wayne Troxell: I was just gonna add or personify or magnify your point, Doctor. We use an acronym REST, which means read, exercise, sleep and think, especially on extended deployments. The other thing we've taught in our teaching our men and women is to think unconventionally in terms of what you can do for fitness, and I've kind of lived this lifestyle for 15 years. When I look in this room in here, I see a fitness center and there's several ways that I could get strength and conditioning or a cardio workout in here. And in 2007, during the surge in Iraq as a brigade CSM, I went to one of my combat outposts in the Northern Baghdad belt and the leaders on the ground said, "Sergeant Major, we don't have anything to work out with out here." Well, there just happened to be where a precision-guided munition had took down a building. All of these 60 to 80 pound pieces of cement laying around.

[Laughter]

And I said, "Well, looks to me like you got a fitness center right there. Let's take our blouses off and let's go over here and I'm gonna show you the fitness you can get out of it." I never got a complaint about not having _____ and everything, but again…

[Laughter]

But the point being is getting men and women to think outside the box on what is traditional workout equipment. When you look at a bench, weights, and stuff like that, that all adds up to a cost, when I can buy a total body resistance exercise system that is a third of that cost and can get a lot more health benefits out of it.

Warren Jones: Yes.

John Wayne Troxell: The other thing we've done is taken food from our initial time after 9/11 on deployment where it was really kind of comfort food, you know? So men and women could go in and you would see the troops lined up at the burgers, dogs and chicken wings line, and then you'd have this little line of healthy stuff and generally us old people would be in there.

Warren Jones: [Laughs]

John Wayne Troxell: Well, we've kind of reversed that, you know, that you don't have a lot of options with unhealthy food. You have options with healthy food now, and we're trying to change that culture that, okay, yeah it's dangerous in the place we're in right now but we gotta make sure we're prepared every day and to change that kind of thinking and that culture of, you know, we don't need comfort food, we need food that can fuel us for the fight and we gotta be able to use the existing resources we have to get after our fitness programs. That's how we're getting after it.

Warren Jones: And we've heard wonderful ideas today from this panel and we've heard excellent questions from you. I'd like to ask those of you that are in communities where you're dealing with issues like that to get together with your academic partners and have them have – help them – have them help you develop some models that you can use to influence policymakers in helping make those decisions. For instance, if you took ArcGIS and you took the locations of healthy foods and the locations of unsafe neighborhoods and you put a graphically on a sheet, suddenly when they're talking about resources and access it makes a difference because it's real. Those are the kind of partnerships that help you make a difference. I want to thank the members of the panel for an outstanding presentation today and I want to thank you for being a great audience and I hope I didn't talk too much.

[Laughter]

Thank you everyone.

John Wayne Troxell: Thank you, sir.

[Applause]

[End of Audio]

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