My Commencement Address to the Graduates of Columbia University’s Mailman School of Public Health

It was a privilege to speak to the next generation of public health leaders at the Mailman School of Public Health at Columbia University in New York. Our country and our world face challenges today that these graduates will take on tomorrow — I cannot wait to see what they do!

Here are the words I shared with the 600+ master’s and doctoral public health graduates today.

Thank you, Dean Fried and Dean Goldman.

Congratulations to all of you, Mailman Class of 2016! Watch out world! You are great — and you look beautiful from up here. For some of you, this is your second or even third graduation ceremony. So from someone who barely got an undergraduate degree, congratulations on this tremendous achievement. And parents, families, loved ones — nice job!

I always feel a bit of an imposter at graduations since I missed my own. During my time at Brown University, we were organizing to end the school’s investment in South Africa during the apartheid regime. So when commencement rolled around, someone had to unfurl the protest banner from a second story window during the ceremony — and I figured, why not me?

My first lesson: Working for social change doesn’t always lead to quick success.

But Brown did eventually divest — and it was very gratifying 30 years later to return to the Brown commencement when Nelson Mandela was awarded an honorary degree.

So, my message is: Hang in there!

You are all here at Mailman because you’ve chosen to apply your brilliance and energy to public health — which is by definition social change. And in my book, there’s nothing in the world more noble than that.

If there is one piece of advice I can give you today — it is that to do this well — to disrupt the status quo — you are going to have to get in trouble.

“Get in good trouble,” as the great Civil Rights leader Congressman John Lewis would say. The education you’ve had here, the work you’ve done already here and around the world gives you the chance—and the skills, and (I hope) the attitude—to be the kind of troublemakers that change lives.

In the years ahead there are going to be days when you wish you had taken on something easier or less controversial — take it from me. But the day of your orientation at Mailman you took an oath. You committed to defending health care as a human right. And for too many people in power, including here in the United States — that is still a radical idea.

In the years ahead your oath will be challenged by the inequities in who gets care, and the quality of that care. It will be tested by the obstacles of gender, race, geography, sexuality and income — and many more reasons.

In places like Flint, Michigan — where families are denied their right to clean water. In places like my home state of Texas, where those in need of an abortion are forced to drive hundreds of miles to access safe and legal care. And all over this country, where millions of immigrants are daily denied health care access every single day. In places like sub-Saharan Africa, where treatable, preventable diseases like AIDS, TB, and malaria too often can be a death sentence.

All these inequities exist, not because we don’t know how to solve the problem. They exist because too often people in power haven’t cared enough to or haven’t been pushed enough to solve the problem. You are the ones that care enough, and will agitate hard enough, to demand more and demand better. That is the work of public health.

As you have learned in your time at Mailman, to change health outcomes, you have to change health systems. You will be called upon not only to use research to diagnose the problem but also to use activism and advocacy to provide the cure — which 100 percent means there are times you are extremely unpopular.

The entire 100 year history of Planned Parenthood and the fight for reproductive health care has been about standing up for what’s right, even — or especially — when it’s unpopular. We started 100 years ago when a young nurse named Margaret Sanger — not only did she hand out pamphlets about how to prevent pregnancy, which was completely illegal—the great thing is, she was busted by an undercover cop posing as a mother. She was carted off to jail where she taught her fellow inmates about birth control. And a movement was born!

And since then, every single advance for reproductive health has been a struggle.

Take birth control.

• In 1957, the FDA approved the pill… only for ‘menstrual disorders.’ But, it came with a big warning label that it could prevent pregnancy… and suddenly an unusually large number of women reported severe menstrual disorders…

• It took Estelle Griswold getting arrested for giving out birth control at Planned Parenthood in Connecticut that the Supreme Court made birth control legal in 1964 — but only for married couples.

• And even though birth control is used by 98% of women at some point in their lives, just a few years ago, we had a knock-down, drag-out fight to get it covered under the Affordable Care Act. We had to endure an all-male panel of ‘birth control experts’ in Congress explaining why women did not need birth control… We had to deploy students across America dressed as giant birth control packs to agitate on campus… And bring thousands of people to Washington to lobby and rally Congress.

Finally after two years of activism — we were victorious: every single method is covered under no cost for women in America. And that was worth fighting for!

Today Guttmacher reports that we’re at a 30-year low for unintended pregnancy, and that didn’t happen because people quit having sex.

But one thing is clear: It’s young activists, thinkers and leaders — like you — who will carry this fight for health equity throughout this century.

I have read about such incredible work of Mailman students:

• Your work in the Congo, to ensure contraception and post-abortion care is available to all women.
 • Your work with young and expectant mothers in the Dominican Republic on everything from safe sex to breastfeeding.
 • And your work in Laos, Uganda, and Jordan to combat HIV, improve conditions in refugee camps, and improve sanitation.

And many of you, throughout your education, have been activists and troublemakers and for that I thank you. So a special shout out to the graduates here in pink. Thank you for being loud and proud leaders for Population and Family Health! And I saw the sashes as we walked in — so want to give a really big shout out to those who have led the fight for the Black Lives Matter Movement here on campus!

It matters because there are policy decisions and political decisions being made every day in legislatures and in Washington DC which will have as much impact on access to care as the 2.5 million patients we will provide care for at Planned Parenthood this year.

Ironically, in the face of the attacks on reproductive health care, we have seen a resurgence of activism and it is heartening! At Planned Parenthood, in 10 years we’ve gone from 3 million supporters to 9 million — which just so happens to be twice the membership of the National Rifle Association.

As for our future: The number one goal for our second hundred years is health care equity. Because a right to reproductive care doesn’t mean much if you can’t access it.

To get true equity we have to fight for culture change, and take on the stigma and shame that is keeping people from accessing reproductive health care in America. And we are seeing this happen slowly but surely.

More and more doctors are now speaking publicly and openly about providing abortion care — bringing women’s health care out of the shadows and into the light. They deserve our support and thanks. They are doing their part to change the system. And you can too.

I’m telling you this not because I’m trying to recruit you… Though you are welcome to see me later… I’m telling you this because I want you to know that change on this scale can happen — and has to happen! Yes, it takes time. Yes, there are setbacks. But it is worth the fight!

Not everyone has to be unfurling the banner. You can be the advocates who combat ignorance with science. You can be the innovators who get the latest advances to people who need them.

You could’ve gone somewhere else to make a comfortable living. You could’ve let the public health in places like Flint, or West Texas, or sub-Saharan Africa be someone else’s problem. But that’s not what you signed up for. That’s not what you decided when you dedicated your life to public health.

I don’t know how you’ll choose to make your mark. But whatever you do, I hope you do it on the front lines.

Every graduation speech is supposed to have some pearl of wisdom, so mine comes from my mother, the late Governor Ann Richards from Texas — a troublemaker in her own right.

Mom went to a Baptist school, and said everything they did there was more fun because it was either against the rules or a sin. Anyway, mom had a lot of good advice, but the most memorable for me was that public service was a noble calling. She told me, “You could go somewhere else and make a lot of money, perhaps with less stress. But you will never have the kind of reward you get when someone looks you in the eye and says ‘Thank you for making my life better.’”

So Mailman graduates, find your place in the fight. And do it with the understanding that you are part of a much broader effort — united by the oath you took, the values we share, and the core belief that health care is, was, and always will be a basic human right.

Thank you. And congratulations, Class of 2016!

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