Cecile Richards on stage

"Everyone means everyone."

That’s a quote from today’s Opening General Session keynote speaker and Planned Parenthood President Cecile Richards, and it pretty much sums up the overriding message of this year’s APHA Annual Meeting in Denver: That ensuring the right to health means recognizing, acknowledging and speaking out against the systemic social barriers — from racism and sexism to homophobia and classism — that give certain groups a built-in advantage toward healthier lives, greater longevity and greater prosperity.

It was another opening session that sent thousands of public health practitioners and supporters into roaring cheers and furious applause. It was public health passion at its best and most contagious.

The session kicked off with a quick hello from APHA Executive Director Georges Benjamin — who stepped to the mic with a cheerful “We’re baaaaaack!” — and then APHA President Camara Jones took to the stage with a fiery argument for tackling systemic racism as a key step toward healthier communities and achieving health equity. Over the last year, Jones had launched her campaign against racism that’s focused on three main elements: naming racism, asking how racism is operating, and organizing and strategizing toward action.

“It’s not a scary thing to name racism, it’s an empowering thing,” Jones told the opening session crowd.

She said that during her travels around the country as APHA president, she’s learned that achieving health equity will require three steps: valuing all individuals and populations equally; recognizing and rectifying historical injustices; and providing resources according to need. Keeping with the theme of 3s, she said the biggest barriers to achieving that health equity are: living in an ahistorical culture in which the present is disconnected from the past; a narrow focus on individuals, which makes systems and structures invisible; and the cultural myth of meritocracy — in other words, the belief that if you work hard, you’ll make it.

The reality of that last myth, she said, is that we don’t live in a land of equal opportunity, and racism is part of maintaining an unlevel playing field. She explained the myth futher using a story about a gardener with two planting boxes — one with fertile soil and the other with rocky soil. The gardener has two packets of the same seeds, but one will bear red flowers and the other pink flowers. The gardener prefers red and so those seeds are planted in the fertile soil. Generations later, the red flowers’ progeny are stronger and healthier, while the pinks’ struggle to survive. The myth of meritocracy, Jones said, looks at the struggling pink flowers and assumes they simply didn’t work hard enough, forgetting the history of the gardener who laid the groundwork that preferred one group of flowers over the other.

Jones ended her talk announcing the forthcoming launch of a new APHA anti-racism collaborative within APHA Connect that will harvest the knowledge of APHA members toward achieving health equity. She urged everyone to get involved.

“We have to go forward together,” Jones said to applause.

A Mile High view of public health

Next up, Brian Turner, president of the Colorado Public Health Association, talked about his frustration that the fundamental right to health is still facing “opposition at almost every turn.” But he said when he feels the pessimism coming on, he relies on the APHA community more than ever, calling on the audience to “maintain that stubborn positivity.” Fortunately, Turner and his Colorado colleagues have had a good amount to celebrate since Gov. John Hickenlooper began serving in 2011.

Indeed, Hickenlooper took to the opening session stage with an announcement that he’s committed to making Colorado the healthiest state in the nation. And the state seems to be on the right track on a number of health fronts. For example, with $25 million in private funding for reproductive health care, Colorado was able to serve more than 50,000 women through its Title X clinics and eventually cut teen births and abortion rates in half in the span of just five years. That funding ran out and it took more than two sessions of the state General Assembly to get the public funding to replace it, but Colorado plans to continue its successful women’s health efforts.

Hickenlooper also announced that Colorado was the first state to put in place methane emission regulations, reducing air pollution from the oil and gas sector by over 45 percent in last five years. On the issue of legalized recreational marijuana, he reported that, so far, legalization has not resulted in a spike among young people using marijuana, and that millions of dollars in marijuana tax revenue has been directed toward supporting mental health treatment. Also on the topic of drug use, Hickenlooper was proud to announce that Colorado had expanded access to naloxone, which reverses the effects of an opioid overdose, noting that he learned how to administer the medicine and carries a dose of it in his state trooper’s vehicle just in case he encounters someone in need.

Colorado has made a lot of progress, but it still faces challenges, the governor said. For example, Colorado has the seventh-highest suicide rate in the nation — last year, more than 1,000 Coloradans died due to suicide. Among the responses to the problem is the Colorado Gun Shop Project, which engages gun stores and shooting ranges in promoting suicide prevention and addressing the role of firearm access in suicide risk.

“All the great successes have always been based on many, many previous failures or setbacks,” Hickenlooper said. “The key is not to give up.”

He looked out at the crowd of public health practitioners and said: “You guys are gonna save the world.”

Cecile Richards: ‘Public health matters’

Then came the session’s main event — Planned Parenthood’s Cecile Richards, who announced that the organization had just turned 100 years old and took the audience back to its founding.

The story of Planned Parenthood began in 1912 when a woman in New York named Sadie Sachs had tried to perform an abortion on herself. A doctor and a nurse named Margaret Sanger were called to her bedside. As Sachs began to feel better, she begged for information on how to prevent pregnancy, but the doctor said nothing could be done. Three months later, Sachs died. For Sanger, Richards said, Sachs’ death was a “deciding moment” and the event that eventually led her to launch the modern birth control movement and eventually found Planned Parenthood. (Even more perspective: Richards noted that in 1916, the two most common reasons for women’s deaths were tuberculosis and complications from childbirth.)

Today, Planned Parenthood is in all 50 states and across the globe, serving 2.5 million patients every year in the U.S. Planned Parenthood is also the largest provider of sex education in the U.S. and for many patients, the only medical provider they see. Still, as is painfully obvious these days, maintaining access to comprehensive reproductive health care remains a challenge.

For example, Richards reminded the audience, supporters had to fight to include maternity care and contraception coverage in the Affordable Care Act. Today, fortunately, the ACA requires insurers to cover all forms of birth control with no co-pay — a legislative victory that Richards called “revolutionary.” She noted that in the first year of ACA birth control coverage, women saved $1.4 billion.

“We can invent incredible birth control and improve outcomes, but we won’t have equity unless we end stigma around sex, sexuality, birth control and abortion,” Richards said. “We need culture change and we need a national movement that ends the judgment and shame around reproductive health care.”

Even though the country has made great progress in abortion care and birth control, “that progress is extremely uneven,” Richards said, noting remaining gaps in access and affordability. And perhaps there’s no place where such access has been in the spotlight like Texas, where legislators shut down the state’s Women’s Health Program and enacted strict abortion facility regulations that effectively shuttered women’s health clinics across the state. Richards told a story about being in the Texas capital of Austin when residents traveled from around the state to protest the legislative actions. There she met a mother and her young son, who was holding a sign that said: “I still have my mom thanks to cancer screenings at Planned Parenthood.”

“His mom started to cry and said ‘thank you,’” Richards remembered.

Three years later in the face of overwhelming evidence that the laws were harming women’s health, the Supreme Court ruled that the Texas abortion facility laws were unconstitutional. Regarding winning at the Supreme Court, Richards said “that’s what never giving up looks like.”

Still, in the last 16 months, Planned Parenthood has sustained some of the worst political attacks in its history, Richards said. But in the midst of those attacks, Planned Parenthood has gained 600,000 new supporters. Today, the organization has 9 million supporters in the U.S alone. That’s one-and-a-half times the membership of the NRA, Richards noted, adding that it shows that “public health matters and it matters to people.”

Richards ended her address with the story of a woman named Jessica who she met in Macomb County, Michigan. Jessica told her she became homeless at age 13 and said she wouldn’t have survived those years without the support and care she received at Planned Parenthood. Today, Jessica is paying that forward, helping to empower others through voter registration efforts.

“She’s working to create a future in this country where no one has to question whether they will be able to get the care they need,” Richards said. “That is what we are working for. That is why we are here. One-hundred years into this work, I feel we are just getting started, but I’ve never been prouder to be on the side of public health.”

Unable to make it to Denver? Participate in the APHA Annual Meeting and Expo virtually with APHA Live. View top sessions, including the Opening General Session, via live streaming or on-demand video. You can also earn continuing education credit.