OAKLAND -- Poverty is the main obstacle to improved global health, Dr. Helene Gayle, CEO and president of CARE USA, said Saturday during the Barbara Lee & Elihu Harris Lecture Series at Parks Chapel AME Church.

Gayle sat down with Lee, a Democratic congresswoman from Oakland, to discuss "The State of Health in America," but the bulk of their conversation called for local "street heat" to light the path to better access, delivery and understanding of health care.

Gayle arrived with youthful energy belying her résumé as a longtime leader in humanitarian advocacy, global disparity issues and, specifically, the fight to eradicate HIV/AIDS. The Buffalo, N.Y., native spent 20 years with the Centers for Disease Control and Prevention; directed the Bill & Melinda Gates HIV, STD and TB Prevention program; and has made long-term empowerment of women and children core components of CARE's global aid imprint.

Lee avoided deep inquiries into specific public health issues. Instead, the conversation skipped rapidly along the barriers: poverty, discrimination, public perception and politics.

"Every issue is political," Lee said. "To see the rollout of the (Patient Protection and Affordable Care Act) and make sure it happens properly, we're really going to have to raise some Cain. Engagement and activism is so critical."

Lee expressed pride in the 13th District's "think local, act global" history and pumped up the audience by referring to her district as "the leader in progressive politics."

Even so, continuing educating was Gayle's unannounced mission as she picked up the "leader" lob and aimed her words at what she believes is the number one obstacle to improved global health.

"Poverty," she said. "I started out as a pediatrician, now I head an organization focused on global poverty."

While working to stem the AIDS epidemic in the 1980s, Gayle had a revelation: Underlying social issues like poverty, racial discrimination and gender bias led to higher health vulnerabilities than medical factors. And treating lack of access required more than handing out meds; it meant "moving upstream."

Ironically, a lack of resources -- a common problem for global health initiatives -- led to innovative, "upstream" solutions.

"We had limited access to medicine," she said. "We had to ask, "What are the supporting structures so we can make healthy behaviors become the norm? What are the needs, and who is able to take care of health information and services?'"

A key factor, she said, was entering communities in ways that didn't impose the programs but provided enough ownership through decision-making to empower a population. Training rural workers to make services available to outlying communities increased program efficiency. And micro-financing shored up local resources for supporting structures like housing and job training.

Lee called attention to the Affordable Care Act's similar provisions for training community level heath care workers.

"I hate to think of this as an industry, because I think of health care as a right," Lee said, "but this bill is going to be a huge job creator."

Gayle said empowering women first and "bringing men along, because you can't focus on just half of the population" constituted CARE's most vital efforts.

"If you can educate a girl, you start that girl's life on a different trajectory.

We focus on women saving and pooling their resources to give loans. With small amounts of money, we have seen women develop self-confidence and stature," she said.

Both women agreed that increased financial stature for women leads to new family dynamics and has a ripple effect, reducing domestic violence and thus, society's health care costs.

Lee said her conversation with Gayle -- and ones like it happening all over the world -- bring back the message: "Peel back reasons, give someone options, change the situation."

Addressing a common misperception that the U.S. devotes tremendous percentages of its GDP to global health issues, Gayle said less than 1 percent of the federal government's budget goes to foreign assistance.

And the misinformation causing most people to guess that the figure is closer to 25 percent can best be fought with citizen advocacy or local information sharing.

Lee said resources directed to impoverished, unstable countries was in our best interest because "terrorism is bred in despair. We know that poverty introduces conflict."