Commencement 2017

July 2017 Vol 10, No 5 - Editorial
David B. Nash, MD, MBA
Editor-in-Chief
American Health & Drug Benefits
Founding Dean
Jefferson College of Population Health
Philadelphia, PA
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Despite having attended or participated in nearly 30 commencements in my role as a father and a Dean, I’ve never received an honorary degree until this year. I was thrilled to give the commencement address at Salus University in Philadelphia, PA, and receive an honorary degree for the first time.

Salus traces its roots to 1919, when it was originally founded as the Pennsylvania College of Optometry. Today, it is a specialized graduate health professions university that currently enrolls more than 1100 students in its 4 colleges and 13 graduate and professional degree programs. This is a setting that I am very comfortable in. What follows is an edited version of my commencement address at Salus University.

I have been a part of higher education my entire life. And I have had the privilege of being in school well past my 30th birthday.

During my tenure at The Wharton School, I had a great professor who had many pithy sayings. One in particular is germane today. Dr William Kissick professed to have a secret recipe for any speech and for any occasion. His recipe had 3 ingredients—“point with pride,” “view with alarm,” and “end with hope.” I’m going to follow his recipe today.

Point with Pride

Most of all, I join your faculty and family members in being proud of all of you and your accomplishments. The 4 colleges and 13 graduate and degree programs of Salus are widely envied and imitated. You have all worked incredibly hard to get to this point today. Your families have worked right alongside you. I am basking in your reflective glory, and I feel your “mojo” all the way up here on stage!

You have all chosen to enter the healing professions, with a legacy that stretches back centuries in time to Hippocrates and Maimonides. I am proud of each of you and the potential for good that you represent.

However, there is regrettably much to “view with alarm.”

View with Alarm

Let’s start locally and build upward from there. Our town—this great metropolis, founding city of our nation, and birthplace of American medicine—is a city where the average annual income places us at the bottom of the list. In other words, of the nation’s top 10 cities, by population, we are number 10 in income.1 What does this mean? It means that poverty is the single most important predictor of health and wellness.

Poverty is the key social determinant of health. This means that more than one-third of our public school students, those in grades kindergarten through 12th grade, are obese. What will this mean for our collective future? We know that the most important number we need to predict your life span is not your cholesterol level or blood sugar level: instead, it is your zip code. A child growing up in Society Hill has a life expectancy of 88 years, whereas just a few miles northward, across the street from one of our academic medical centers in Philadelphia, the average life expectancy is 68 years.

At the national level, this situation is dire indeed. Despite spending more on healthcare than any other nation in the world, where do we rank? According to the National Academy of Medicine, we are number 17 in the world.2 Our system is characterized by waste, inefficiency, and danger. Yes—danger! Preventable medical mistakes remain the third leading cause of death, and experts agree that nearly 1 in every 3 tests and procedures is unnecessary and potentially harmful.

Finally, regardless of what your politics are, the proposed budget cuts for the National Institutes of Health funding, Medicaid, and the Agency for Healthcare Research and Quality are of grave concern and alarm to the health policy community. Hence, there is sadly much to “view with alarm.”

End with Hope

And yet, as promised, despite all these alarming developments, locally and nationally, I will “end with hope.”

First, remember that in spite of our political differences, we are all privileged to live and work in the greatest country in the world.

Second, you will all help to shape a future healthcare system characterized by precision medicine and population health. The future healthcare professionals assembled here today will be the first generation to capture the now 20-year-old promise we made when we broke the human genome.

Third, thankfully, most of you will be paid based on your contribution to the well-being of the patient. Imagine that, colleagues. At our college, we call this hopeful strategy “no outcome, no income.”

Fourth, you will embrace those social determinants of health and recognize their critical role in promoting a just and moral society. You will help us to realize a new meaning and a new vision for that ubiquitous blue hospital sign, the famous “H.” Your “H” will mean health, healing, and a holistic approach to the patient.

Finally, like Maimonides, you too will embrace what the ancient Hebrews first articulated in Hebrew as “tikkun olam”—to repair the world. Now, go forth and make this real. Godspeed, Salus graduates.

Well, there you have it. Certainly this is not my last commencement address, but it is the first one associated with the receipt of an honorary degree, something that I am incredibly proud of.

If you had the opportunity to address the future leaders of our healthcare system, what would you tell them in this time of such great uncertainty? As always, I am interested in your views, and you may reach me via e-mail at This email address is being protected from spambots. You need JavaScript enabled to view it..

References
1. Nash DB. My kind of town. Am Health Drug Benefits. 2015;8(8):409-410.
2. National Research Council; Institute of Medicine. Woolf SH, Aron L, eds. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington, DC: National Academies Press; 2013.

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