in Benin City, Nigeria,

some 30-odd years ago,

I was drawn to help people live full lives.

But often, I found myself feeling impotent.

Here I was, a brand-new doctor with all these skills,

but I couldn't cure my patients who had chronic diseases --

illnesses like heart disease, asthma, diabetes --

and needed more than just handing them a prescription

or providing grief counseling in the office to get the job done.

Fast-forward 15 years later:

I'm in Atlanta, Georgia;

it's a different world,

but it was déjà vu all over again.

As doctors, we see our patients who have chronic illnesses

in an episodic way.

In between,

the patients have to learn how to make a lot of decisions for themselves.

I'll give you examples.

If you have medications you're supposed to take every day,

what do you do when you're sick?

Are you still supposed to take it?

How do you recognize a complication when it happens?

How do you recognize a side effect when it happens?

What do you do with it?

In addition to all of this,

they're dealing with the inevitable loneliness, isolation and anxiety

that people who have chronic illnesses deal with.

In the US alone, six in 10 adults have a chronic illness.

That's 125 million people.

A recent report from the Robert Wood Johnson Foundation

showed that health habits account for 50 percent

of the health outcomes that people experience,

while medical care only accounts for 20 percent.

In fact, the Centers for Disease Control

says that if we could eliminate smoking,

physical inactivity and poor nutrition,

that we can prevent 80 percent of heart disease,

80 percent of type 2 diabetes

and 40 percent of cancer.

But we also know

that changing health behaviors is very difficult.

So we asked the question:

What if we could create a resource

that could motivate people to change health behavior?

The truth is, there are a lot of these resources out there

that help people acquire these so-called self-management skills.

But many a time, they're not easily accessible or relatable,

particularly to individuals within minority and underserved communities,

who face bias in addition to barriers like language and culture

and inadequate health insurance coverage.

And so in the last 12 years,

my colleagues and I at Morehouse School of Medicine

have created a technology-based application

to assist with chronic illness care.

It's freely available on the web

and as an app.

And what we do is get people to track variables --

blood pressure, blood sugar --

and then report it back to them in a color-coded format.

So green would indicate a healthy range,

and red would indicate a problem that needs something done about it.

We link these stats to a curriculum.

The curriculum helps the individual learn about their health condition,

whatever the chronic illness is.

They also work with a health coach

to learn self-management skills,

skills that'll help them prevent complications of their illness.

In order for the coach to be successful,

they have to be able to gain the trust

of the individual that they're working with.

We tested this application

in clinics, where the health coaches were medical assistants,

and in a large urban church,

where the health coaches were volunteers from the health ministry.

A year later, a third of the participants

were able to acquire three new self-management skills

and maintain them to the extent that it was able to improve

their blood pressures, their blood sugar

and their exercise.

Now, what was simple yet fascinating to us

was that the group from the church did just as well or even better

than the group that were under purely medical care.

And we wanted to learn why that was.

So we looked a little further into the research --

400 hours of recorded conversation --

and what we learned was that the coaches from the church

did have more time to spend with the patients,

they had access to the patients' families,

and so they could figure out what people needed

and provide those resources for them.

My team and I call this "culturally congruent coaching."

To illustrate this concept of culturally congruent coaching,

I want to tell you about one of our patients.

I'll call her Ms. Bertha.

So Ms. Bertha is an 83-year-old lady with diabetes and hypertension.

She was assigned to Anne, her health coach in the church.

Anne also happened to be a family friend to Ms. Bertha for many years,

and they were fellow congregants.

Anne observed after the first few visits

that even though Ms. Bertha faithfully recorded her stats,

they were all showing up as red.

So she probed a little deeper

to try to understand what was going on with Ms. Bertha,

and Ms. Bertha gave her the real-real.

(Laughter)

She told her that there were times

when her medications made her feel weird,

and she wouldn't take them the way they were prescribed,

because she thought it was due to the medicines

but she didn't tell her doctor that.

She also skipped out on some doctor appointments

for a variety of reasons,

but one of them was she wasn't doing better

and she didn't want to make her doctor mad,

so she just didn't go.

So Anne talked to Ms. Bertha

and asked her to bring her daughter in for the next visit, which she did.

And at that visit,

Anne was able to print out a log of all these stats

that Ms. Bertha had been collecting,

gave them to her and encouraged them to go see the doctor together,

which they did.

With that information,

the doctor was able to make changes to Ms. Bertha's treatment.

Within three months, Ms. Bertha's numbers were all in the green.

No one was more excited or surprised than Ms. Bertha herself.

Now, Anne was successful as a health coach

because she cared enough to go below the surface

and probe Ms. Bertha's deep culture

and was able to reach her at that level.

She knew how to listen,

and she knew how to ask the right questions

to get to what was needed.

We all have deep unconscious rules

that drive the way we make our health decisions.

That's our culture.

The relationship and the conversation between Anne and Ms. Bertha

illustrates what's possible

when we have conversations with our patients,

our friends and our neighbors

on a deep cultural level.

And personally, I'm beyond excited

to think that with this simple concept of culturally congruent coaching,

we could change the lives of 125 million Americans

and many others across the world

that are living with chronic diseases.

Thank you.

(Applause)