2014 Commencement Keynote by
Anthony Iton MD, JD, MPH ’97
May 18, 2014
“Thank you so much Jeff [Oxendine]. And thank you,
parents and families, for being here today on the
occasion of your loved ones’ graduation from the
School of Public Health. And greetings to the UC
Berkeley School of Public Health Class of 2014! You
did it! Once they hand you that diploma, NOBODY
can take it away from you…EVER!
“I would like to thank Dean Bertozzi for inviting me to
offer this commencement address and, of course, I
must thank the wonderful and talented faculty of the
School of Public Health, several of whom have been
great mentors and friends to me over my career, they are great thinkers, teachers and
leaders in public health nationally and internationally. When the dean called to ask me
speak to you today, I tried to say no because I am just back from an East Coast trip and
heading off tomorrow to a three-day board meeting in Bakersfield, but the dean was
insistent. He is a seasoned international traveler himself and quickly brushed off my limp
attempt at an excuse. We are obviously lucky to have him, he apparently doesn’t take no
for an answer, a true sign of leadership. So here I am…
“Here I am and I feel extremely privileged to be here. What a unique opportunity. It was
17 years ago that I sat where you are sitting and received my diploma which reads in
part:
The Regents of the University of California, on the nomination of the faculty of
the School of Public Health have conferred upon Anthony Iton the degree of
Master of Public Health, with all of the rights and privileges thereto pertaining,
given at Berkeley, the 24th day of May 1997
“So this degree confers rights and privileges. Of course I am left to wonder what rights
and privileges I acquired on that joyful day 17 years ago. The diploma doesn’t spell them
out so I am left to speculate…I imagine that I have the right to call myself a Master of
Public Health, which sounds pretty intimidating if you ask me. It almost sounds like a
cartoon hero—MASTER OF PUBLIC HEALTH, with one quick glance at an epidemic
curve, she can identify patient zero and stop the evil outbreak in its tracks! That would
be a pretty cool superhero, no? My public health degree has also afforded me the
privilege of working in a field that is populated by so many dedicated and near saintly
individuals who see public health as their calling. So yes, rights and privileges will be
conferred upon you today…but what about responsibilities? Well, more on that later, but
first, I want to speak directly to the parents and loved ones of the graduates.
“Parents and loved ones: One of the graduates sitting in this audience today asked me
if I could explain what public health is to his parents. Many of us in public health have
struggled on occasion to explain what we do to the uninitiated, which is virtually
everyone in the world who is not in public health. You all know what I’m talking about—
that awkward moment when your mom or brother goes to introduce you to someone and
says, “This is Tony. He is a… a… what is it you do again, Tony?” As a Master of Public
Health, I should conceivably be able to explain what we do. So how about this, simply
put, Public Health is medicine, except the community is the patient and the goal is to
anticipate and prevent illness rather than just treating individuals after they get sick.
Public health is concerned with:
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Safe food, inspecting restaurants
Clean drinking water
Control of infectious disease outbreaks and cutting edge laboratory science
International health
Tobacco control and reducing the epidemic of chronic disease
Safer workplaces
Family planning and maternal, paternal child and adolescent health and
Safe and healthy places for children and families to recreate, shop, and thrive.
“Your graduate is entering a secret society of very distinguished gentlewomen and men
who move about virtually invisibly keeping us safe without our knowledge or explicit
request. They are constantly vigilant conducting surveillance, looking for threats. In a
way, they are kind of like the CIA except without guns. So now you know…your kid,
grandkid, spouse, sibling, parent is a spy, only cooler, because they don’t kill people,
they save us. If none of this makes any sense to you, just watch the movie Contagion
with Matt Damon, Kate Winslet, and the guy who played Morpheus in the Matrix series
Laurence Fishburne. They do a great job of acting it out.
“Okay, so back to the graduates…and the notion of responsibilities…I want to offer you
three important themes that have helped shape and guide my public health career and
then I’d like to issue an exciting challenge to you.
1. What we know, and what we do
“My public health and medical career started in East Baltimore, Maryland, in the 1980s,
when I left Montreal Canada and went to medical school at Johns Hopkins. In East
Baltimore, I was immediately greeted with images of a devastated urban landscape that
took on the appearance of a war zone. I recall feeling confused and disoriented as I tried
to grapple with the living conditions of people in the neighborhoods immediately adjacent
to the hospital. I recall seeing a young boy in clinic one day who had been shot in the
abdomen and had undergone surgery and had returned for follow up. He had been
discharged with a special surgical dressing for his abdominal wound, yet when he came
back to clinic his wound was covered instead with a zip lock sandwich bag because that
was the only thing this 13-year-old could find to cover his wound. When I asked him
where his parents were, he told me that he didn’t know. He said he lived with his
grandmother, but that she was often high on crack and wasn’t able to help him. As I sat
in that clinic with this young man I realized the profound absurdity of the situation. What
this young man needed more than anything else was a support system to help him
survive the devastated landscape of East Baltimore, not just a handful of surgical
2014 Commencement Keynote by Anthony Iton
pg. 2
dressings and instructions on how to apply them. I was being asked to treat profound
social ills with pills, and that made no sense. Since that time, an enormous literature has
sprung up about the social determinants of health and how so many of the root causes
of disease lie in the policies and legacies of past practices that shape living conditions
for low-income people and people of color in this country. Whole journals are dedicated
to this topic and hundreds of conferences are held to explore the science showing the
influence of these root causes. We know this. Yet, what we do with this knowledge is
what is most disturbing. Our public health practice literally ignores this fundamental truth.
In America, when it comes to your health, your zip code is more important than your
genetic code. Right here in Alameda County I can take you to neighborhoods with
average life expectancies in the mid- to high-80s, and then we could walk a short
distance to neighborhoods with average life expectancies in the mid-60s. Twenty years
of life lost in that short distance, the equivalent of having Sweden and Pakistan within a
few blocks of each other. What we do with this knowledge is up to you. We are smarter
than our policies and practices suggest. We need more leadership in public health to
develop and implement a new more muscular public health practice that applies this
science to improving living conditions right here where we sit. Let’s stop just describing it
and do something about it. We have a responsibility to use what we know to design a
public health practice that targets the root causes of poor health. So much of the
scholarship and leadership on these issues is based right here at UC Berkeley. You
have been taught well, now you are responsible for applying what you know.
2. Job vs. career
“A job is something that helps you pay your bills and keep you busy and engaged in
something, hopefully constructive. If you are lucky, you find a job with colleagues whose
company you enjoy, some of whom will become friends and possibly even a spouse. A
career is something different. When it comes to looking for a career, ideally three things
will come into alignment.
1. Your passion: What is it that really gets you up in the morning? What can you talk
about non-stop? What is that thing that you can do with a focus that makes you
forget to eat or sleep on occasion? A career lets you exercise your passion.
2. Your gift: Some of us are very passionate about something, but unfortunately it is
not our gift. That’s the case with me and singing. I love to sing, I love karaoke,
but unfortunately for me, I am not a gifted singer so despite all of my passion, I’m
better off just doing it in the shower where nobody has to be tortured by it. If you
are lucky, your passion and your gift are the same.
3. Is there a market for what you want to do? Is there a likelihood that someone
needs this talent or skill that you have? Is there an opportunity that you can
cultivate?
“A career is where these three things align: your passion, your gift, and the opportunity.
Let me tell you today that I know many, if not all of you, are passionate about public
health; you wouldn’t be here otherwise. Many of you are gifted, after all, you were
accepted into this great citadel of public health. The great news is that there is a market,
a big market and growing for exactly the skills that you have acquired here at Berkeley.
That’s the core recipe for a meaningful and satisfying career. Find and use your gift,
fueled by your passion to take full advantage of the enormous landscape of opportunities
available to you in public health to enjoy a fulfilling career. We are very fortunate people
2014 Commencement Keynote by Anthony Iton
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to be poised to make such a contribution to the well-being of our society. But we also
have a responsibility to use our passion and our gift to seek solutions that address root
causes, not just the symptoms. We have to be passionate about finding the truth.
3. The need for a system of prevention
“When signing the Affordable Care Act, President Obama said the following: ‘Simply put,
in the absence of a radical shift towards prevention and public health, we will not be
successful in containing medical costs or improving the health of the American people.’
“A radical shift towards prevention and public health—a radical shift. He didn’t say a
renewed emphasis, he didn’t say a little tweaking, he said a RADICAL SHIFT! In
essence he is saying that the biggest investment in this nation’s social contract in 50
years will fail…if public health doesn’t step up to this challenge. If that is not a call to
arms, I don’t know what is. Who is the President talking to? He’s talking to you. We are
teetering perilously on the edge of a cliff, with obesity, diabetes, and chronic disease
threatening to push us over. According to the CDC, a child born in the year 2000 has a
one in three chance of developing diabetes in his lifetime, if that child is African
American or Latino it is one in two! According to the Institute of Medicine: ‘For many
years, Americans have been dying at younger ages than people in almost all other highincome countries. This disadvantage has been getting worse for three decades,
especially among women. Several studies are now suggesting that even advantaged
Americans—those who are white, insured, college-educated, or upper income—are in
worse health than similar individuals in other countries.’
“The truth is, we have studied the heck out of this. We know what is happening. This
didn’t sneak up on us. So how are we going to take up this challenge? What does a
radical shift look like? I don’t know, but I can tell you this…we are going to have to build
a system. These kinds of changes don’t happen just because we want them to. A
mechanism has to be built. When we became concerned about landfills overflowing and
garbage islands floating around our oceans, we didn’t just talk about how bad that was,
we built a recycling system; because we knew that we needed to change the incentives
in the system and bring various interests into alignment. When we became concerned
about climate change, Californians recognized that to begin tackling it we need a
system, so we built a carbon credit trading system, again to bring varied interests into
alignment and create a new market.
“To achieve a radical shift in prevention, we’ll need to build a SYSTEM OF
PREVENTION. That system will have to realign incentives in the health care system and
key community systems like land use, education, and criminal justice. We’ll need better
data systems and data sharing, new financing mechanisms and behavioral disincentives
(soda tax? Marketing restrictions to children?). The point is, this will not happen unless
people in this room make it so. That is our responsibility. Sitting in this room today are
the architects of that system, look around you, there are radicals amongst you who you’ll
be reading about in the years to come. We can’t do this alone in public health but the
leadership must come from public health. We need this system of prevention, and we
need it soon.
2014 Commencement Keynote by Anthony Iton
pg. 4
Finally, a challenge:
“When I go back East to meetings and conferences, I like to tell people that I am from
the future. Why? Because I am from California, and California sets the agenda for
America. We are witnessing a huge technology revolution here in both computer and bio
tech, we are tackling climate change, we are investing and innovating in green energy,
we are producing the cars of the future, we are implementing the Affordable Care Act
and showing the rest of the country that it works. We are witnessing an enormous
demographic shift with an emerging brown majority. California is the future. We are the
future. With that comes an enormous responsibility. We have a responsibility to lead in
public health. The eyes of the nation are on us.
“So how will we lead? Will we continue to build a California with haves and have-nots,
will we sideline enormous human capital in communities with failing schools, poor
housing, poor jobs. Will we continue to waste people by shutting them out of opportunity
pathways? Or will we build an equitable and sustainable California. A place where every
child has access to high quality health care, high quality education, and a ticket to
participate in the 21st Century economy?
“Today in the Eastern Coachella Valley, California children are living in trailers without
potable water. Up north along the Klamath River there are Native American communities
without electricity. Throughout the state there are communities where only 20% of 3rd
grade children are reading at grade level. And, strangely, the only thing that many
communities are building is PRISONS! The challenge I put to you today, on your
graduation day, is that as we bring what we know and what we do into closer alignment,
as you stake out your careers by aligning your passion, your gift and the demand for
your skills, and as we take up the President’s challenge to make this radical shift
towards prevention and public health and build a sustainable system of prevention, that
we be that generation of Californians that recognizes that its ALL OF US, not just some
of us, belong in the mainstream of society. That includes the formerly incarcerated, our
LGBTQ brothers and sisters, our undocumented neighbors. It’s ALL OF US, all of us. An
equitable society demands that all of us have a voice and no one is relegated to the
margins. There is no better group of people prepared to lead on this issue than the
brilliant, gifted and committed practitioners of public health. What does that leadership
look like?
“‘Leaders are called to stand in that lonely place between the no longer and the
not yet and intentionally make decisions that will bind, forge, move and create
history. We are not called to be popular, we are not called to be safe, we are not
called to follow. We are the ones called to take risks, we are the ones called to
change attitudes, to risk displeasures, we are the ones called to gamble our lives
for a better world.’
–Mary Lou Anderson, Maryland House of Delegates (1970)
“UC Berkeley School of Public Health Class of 2014, I am proud to welcome you into
our ranks of public health leadership. Congratulations to all of you, to your parents,
siblings and families. Thank you for choosing a career in public health…and thank you
for the privilege of speaking to you today.”
2014 Commencement Keynote by Anthony Iton
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