garygunderson Blog

Relevant Science, Mature Faith

If we ask the wrong question, our answer won’t matter. Many ask the wrong question about how to resolve the conflict between religion and science. The useful question is more nuanced: how do we embody our most mature faith and the most relevant science to inform the health of whole people? Good question. But you have to see somebody do it to understand the answer.

*John Hatch, Jeremy Moseley and Teresa Cutts asking the right questions.*

Last week about 200 people asking that question gathered in Rocky Mount, North Carolina for the Eighth Annual John W. Hatch FaithHealth Lecture. And to celebrate Dr. Hatch’s 95^th birthday. Not many black men live to be 95, so we should have a party for every one that does and think about how they did so. John began by picking his parents and grandparents wisely. They were fierce for him, believed that he should be a professor (his grandmother even considered his goal of Governor). Just as important, was inculcating him from his earliest age that his life intelligence, energy, courage and heart belong to the people God so loves—all of them. Good pick, John.

Two weeks ago THE American Public Health Association Caucus on Faith and the Public Health honored Dr. John Hatch as the first recipient of the Flame Award, given for a lifetime of keeping the flame of justice, mercy and healing alive in a hard-hearted world. We did that in Atlanta by Zoom, but Barbara Baylor, the chair of the caucus and a student of Dr. Hatch, came to Rocky Mount to give him the award in person.

The interwoven fields of public health and faith have been embodied in many significant lives in the past several hundred years as public health science has emerged.

For example, in 1737, James McCune Smith became the first African American to earn a medical degree, awarded by the University of Glasgow in Scotland. The local schools didn’t admit him, so his church connections found the way. A gifted orator and writer and social entrepreneur, he was also a mathematician. He used his statical analysis to take down Senator John C. Calhoun who was citing the US census to show that poor health of slaves reflected their inferior stock and poor behavior. Dr. Smith’s widely published scientific article showed that comparative data on free slaves and poor whites to had identical outcomes.

A binary star as our North Star—mature faith, relevant science, John Hatch embodies the most relevant science of all, the one that sets people and communities free by undergirding their own power. I’m sure he learned this science from his family example. But as I thought of him, I picked up my precious copy of “Closing the Gap” published in 1987 by Oxford Press. This CDC Conference was the idea of Jimmy Carter and Bill Foege who convened the hundreds of scientists to figure out how many years of premature death could be prevented based on what we already know. There is a lot of confusion about what we already know. Said Carter in the introduction: “This is particularly true for an issue as complex as health. Too often, Americans are confronted by messages about health that leave us with little or no hope…. Frequently, there is no mention of what I as an individual, or what we as a society, can do to arrest this relentless onslaught on our health.” The answer is about what John’s grandmother would have said:
“Approximately two-thirds of all reported deaths can be delayed, which means that 1.2 million lives and 8.4 million years of life can be preserved each year.” That next three decades dramatically increased our preventive knowledge as well as some relatively minor increases in curative science.

But science without hands, feet and heart doesn’t move from the lab to the streets. That takes mature faith, the kind that lets the science flow through generous lives to where it is needed most. Like that of John Hatch.

Shortly after their landmark report on Closing the Gap, Bill and Jimmy convened another meeting of several hundred diverse faith leaders to see if they could grasp the urgent moral moment posed by the prevention science. They also created the Interfaith Health Program with major funding from the Robert Wood Johnson Foundation as well as some from Templeton Foundation. And they hired me. I quickly learned about John Hatch, who knew every bit of this science and carried it with his body into the toughest places that needed it the very most. This included Mississippi, where he and Jack Geiger created the first (or arguably second) community health center that is still more radical than most of the 3,000 that followed. And he came to the University of North Carolina and continued his landmark work with the 1,600 churches of General Baptist State Convention.

When I say “embody” science and faith, what kind of body do I mean? Whose bodies are best suited—let us say designed by God—to be the ideal carriers of this science that could prevent two-thirds of all unnecessary and thus, scandalous, death. Who did God put in the world for that purpose, to save, dare I say, it? Well, your body and mine, of course, just as well as John’s. Why can’t you and I be as brave, smart and fierce?

*Dr. Goldie Byrd of the Maya Angelou Center for Health Equity and Dr. Hatch of the UNC Gillings School of Global Public Health*

But I think there is an even better body designed for this mature faith and relevant science. That is the social body of the church, synagogue, masjid, temple or wherever people gather to be made whole and sent out again. That’s the body that formed John. And that is the body designed to carry the science the world needs. We were, of course meeting in just one such body, the Impact Center and Tabernacle, embodying the saving science and faith in a tough town in a tough part of a tough state.

The science that saves us—at least 2/3rds of us—is for the world God so loves. It is hard to monetize and turned into money by healthcare organizations, even those trying to use value-based contracts to do so. It won’t put hundreds of billions in the basement or pay big bucks to interventional physicians or those who organize the organizations who so successfully monetize other branches of science. The science that fits mature faith perfectly is that of mercy-making, justice-doing and love that teaches people and communities that God has made a world in which 2/3rds of their suffering is within their control. This science is considered the lowest in the academic hierarchy with a tiny fraction of NIH funding. But it is the highest of all sciences because it liberates, releases and sends out the whole body of faith.

That science is relevant once it finds the right body to carry it to the streets.

The John W. Hatch FaithHealth Lecture is coordinated by Anita Holmes with support from the FaithHealth Division of Atrium Health Wake Forest Baptist. Cosponsors include the Wake Forest University School of Divinity, the General Baptist State Convention of North Carolina, Maya Angelou Center for Health Equity, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Caucus on Public Health and the Faith Community of the American Public Health Association, Community-Campus Partnerships for Health and the National Association of Community Health Associations.

More information at FaithHealth.org or StakeholderHealth.org

Rosalynn Carter

Now that’s how to spend 96 years.

Rosalynn Carter’s life is an extraordinary witness that demands that we pause in respect. But she would know we were not paying attention if we paused longer than that. She was fierce, urgent and tenacious in doing good, especially for those who suffered with any kind of mental or emotional burden. In the book, Everything to Gain, written just after they returned home to Plains from Washington, DC., Rosalynn said, “What I have learned over these years of work and study is that mental illnesses are less understood than almost any other major health problems, and that most people who experience difficulties suffer needlessly. The mystery, stigma, and misconceptions that surround mental illnesses prevent many people in need of psychiatric help from seeking treatment.” I once drafted notes for her to speak at a meeting in Pittsburgh at a Divinity School about the church and mental health. I thought the notes were somewhat aggressive, but she wanted them tougher: “the first word anyone in the church should say about mental health is an apology. The church has been the last bastion of the worst stigmas.” She never gave up on the church but had eyes wide open to the ugly complicity it has with the cruelty experienced by those it finds inconvenient to care about. That stigma is, was and will be the biggest challenge facing those individuals and their families.

If you want to honor Rosalynn Carter today, reach out to one of those you know (you do know more than one) and say you care.

Don’t pause.

Broken Glass

One of 128 stone is a collective sculpture The the young people from Graben who designed this stone wanted to warn and remember:“A raised index finger signals to the viewer that they have to pay attention. It demands attention and urges vigilance. The string on the finger is barbed wire.

I am writing this in one of the small towns in Germany that on October 22, 1940 was among the first to railroad its Jewish neighbors to the Gurs holding camp in southern France and then to their murder in Auschwitz. Today is the 85^th anniversary of Kristallnacht that preceded the deportations in a national attack to break all the glass on Jewish stores and synagogues throughout the country. The death camps, “the final solution,” then ramped up, operating for only a couple years, leaving a bitter stain that will last centuries.

There is never a final solution for incoherent hatred, not in Baden, Gaza, Tulsa or Cherokee land. Hatred replicates, simmers in the hearts of the children watching their parents humiliate or be humiliated. There are few unbroken windows in Gaza.

Germany is the only place I’ve ever seen I’ve ever seen where the people teach their children about their inherited complicity in an attempt to break the cycle. It begins with the churches that have the most reason to hide from that history, as they provided cover for the worst atrocities. I visited a a youth camp in Neckarzimmern where Lutherans and Catholics created an astonishing memorial right next to the basketball courts where the kids couldn’t miss it. Each of the 128 of the local villages from which Jews were expelled created its own unique memorial stone which were then placed in a large Star of David on the campground as a collective sculpture. Artful, honest and stunning.

The website is in German, but google translation works. Go deep enough into the specific village’s monuments (such as Graben-Neudorf, #31 in the opening photo).Each explains how their neighbors where deported on that one brutal night. The monuments were done by students, many by confirmation classes learning the profound truth in the Talmud: “The secret of redemption is memory/remembrance.” At least these kids might not go along with the next hateful frenzy.

Students from the Sandhausen Catholic Community designed a deep crack runs across the memorial stones from Sandhausen. If it weren’t for the Star of David that holds the stones together, they would break apart in half. Tears flow from the crack like blood from a wound. With the inscription “For I weep day and night for the dead” (Jer. 8, 23)

In Germany the memorials are created by the perpetrators, so their children will not repeat the cycle. Kids need grown ups to help them. In Germany, the grown up was the president Weizsaecker who in 1985 took the anniversary of the end of the war to declare the moment of liberation from their past, not capitulation to an enemy. His Historic speech is only comparable to Lincoln’s Gettysburg address, which by comparison was much easier to be a gracious winner. I wish that young Baptists in America were being taught their complicities instead of their parents worrying about hurting their feelings.

As you read this thousands of young Jews and their anxious parents pray the Iron Dome protects them from the rockets. And thousands of Palestinian parents parents pray the Jewish rage against Hamas will abate before it shatters every glass in the region. Every rocket and every shell is a seed watered by bitter tears that will bear the fruit of another horror.

The smartest president and First Lady we’ve ever had admitted they couldn’t figure it out. If it’s beyond the Obamas’, I’m not going to have any better idea. But I do know that the first obligation of every parent is to act out of wisdom, not another round of adolescent rage.

It’s about hope

Cast of Time Traveler’s Wife at the Apollo Theater, London.
“Love wins the day.”

It’s about hope, she said, explaining her new musical based on The Time Traveler’s Wife, in London. Almost any play worth staging is about hope; as is every book worth typing, every sermon worth the pulpit, every speech worth giving. But so much of our electronic space seems designed to exaggerate fear, distance, venal irrelevance and disconnection. Even in our highest arts of meaning-making such as the theater, we can forget why we are able to communicate at all, what words are for.

It’s about hope.

The worst of us say that hope is delusion that it’s really all about violence, money and domination. They cower behind a self-serving intellectual laziness accusing us of not knowing how life works.

Nobody knows more about unfair reality than artists, especially those in theater. They are blessed but also cursed by talent that wanted to flow like hot lava their whole life. But they were usually the wrong size, color, sex, pitch of voice, perspective in the wrong town, country and century in front of the wrong casting committee, much less audience, who had someone else in mind. True of the ones’ aiming for the stage and those behind the curtain, imagining the lines, music, set or trying to run the business of the arts. That’s before the professionally unhappy people called critics have their shot. It’s a rare artist with healthcare insurance, savings or rent in the bank or any hope their kids get straight teeth, much less private college.

Artists know all about unfair; always have. And because of that they know that nothing is more important than the words that bring hope to life again and again. You can’t do that alone; you need a congregation a company of friends.

*Cast of The Book of Will, Shakespeare North Playhouse, Prescot, England. Same kind of people who would have been on stage 400 years ago.*

The friends of Shakespeare improbably managed to salvage the scraps of his plays into the collection that are fundamental to English—one could argue human—culture. The Book of Will is the story of those friends, a love letter to all those who find hope in language, especially in really tough places. Prescott is one of those tough places, the second poorest borough in England a long way from the West End of London. The town improbably built the Shakespeare North Playhouse here during COVID. This was the site where some of Shakespeare original actors played those centuries ago long before immunization or modern sanitation. Death and suffering were common around the theater then as they are today in Afghanistan. One of the actual first folios was on display downstairs from where a new troupe of actors took to the stage yet once again giving themselves to raising up the words. Why did Will’s friends speak then? Why do these friends do so now?

It’s about hope.

*Lauren Gunderson, Lotte Wakeham, Laura Collier and Will Shakespeare.*

This is also true of those who use god-talk in a room built much like theaters, though usually with worse acoustics and less comfortable seats. The sister of the director of Book of Will is a vicar in a church in London. Both theater and theology depend on the rich for the bricks, so have had to put up with a lot of people dismissive of their most noble work. The god-places are more likely to have food pantries and clothes closets than bars, but both exist for others, not themselves. They point beyond, within and among those of us hoping for hope.

So when they say that hope is not a delusion, you have to pause.

“All I have is too little time on earth.”

“I should savor all I can.”

“I would stop right now on an ordinary day

And forget about tomorrow.

“I don’t need tomorrow.”

“Measure out these days till they slip away.”

“All I need is this little time on earth.”*

“Make it new.”**

(*On and On, ** Love wins the day. Songs from Time Traveler’s Wife, the musical, Apollo Theater, London. Playbook by Lauren Gunderson.

Potbound

Sometimes a houseplant will get too large for its clay pot. You don’t notice at first but it slows its growth as the roots circle sideways around and around in a futile strangle. Even in a new a new pot the roots will keep circling and hardly notice the new soil. Not really dead; a withered version of itself that lost the plot.

I’m talking about hospitals here, most of which were created a hundred years ago by faith and community groups who saw that the simple science of their time could benefit their communities by providing healing and justice at large scale. Hospitals were uncomplicated enough for church committees by the dozens to consider starting one with donations, led by pastors and nuns, linens sewn by congregations. Today, these roots circle inside massive brick pots, out-scaling every other local non-profit organization by a quantum; way beyond the capacities of pastors and nuns to keep them on task.

Non profit hospitals are supposed to be kept on mission by a legal tool called “community benefit,” which works about as well as a fig leaf in the Arctic. The idea of “benefit” dates from when “mission” meant giving away urgent care instead of the goal of community-scale well-being that health and social science now make possible. A recent report from the National Academies of Sciences makes the missed opportunity painfully clear (National Academies of Sciences, Engineering, and Medicine. 2023. Population Health Funding and Accountability to Community: Proceedings of a Workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/27258).

Kimberly DiGioia, a program officer at the Patient-Centered Outcomes Research Institute, provided an overview of findings from her research on the effects of Medicaid expansion on community benefit (DiGioia, 2022). About two-thirds of hospitals in the U.S. are nonprofits, spending between 8 and 9 percent of their total operating expenses on community benefits, which seems impressive. But she explained that the vast majority of community benefit spending goes toward charity care, and unreimbursed Medicaid services while a small amount of this money goes to community health improvements. This includes educating its own health professionals, subsidized health services, medical research, and smallest portion, cash and in-kind contributions to community organizations.

The passage of the Affordable Care Act, DiGioia said, raised optimism that hospitals would report more revenue and less uncompensated care and thus spend more on community health. Indeed, the evidence has shown that the more Americans are covered, the more hospitals reported increased Medicaid discharges and decreased uninsured discharges. There was indeed a decline in uncompensated care, but this was offset by an increase in unreimbursed costs associated with caring for Medicaid patients. They charged more for less care and as a result, “community health improvement spending did not increase as expected.”

Pot bound.

Instead of growing into the rich soil of community health science, health system roots just circled the pot. This is a failure of hospital governance and timid government policy, not lack of science or administrative skill. Boards never fire a CEO for bad community health; the government settles for health fairs and a mobile van.

Thousands of highly skilled administrators and staff came to the profession expecting to grow like an oak in deep soil (they don’t mention the pot in school). These are honorable people trapped in doing small things. At a recent medical school reception honoring TC and I, Dough Easterling reminded us of when we traveled across the country in a Winnebago testing the idea that “everything we hope for is already happening.” He quoted us back to ourselves:

“We traveled with the sharp awareness that we are among the privileged class, linked to institutions among the most privileged of all—academic medical centers. It is striking how little is asked of these vast organizations. In most every community the healthcare organizations are pretty much busy with running the hospital. The staff might be kind in the ER and diligent on its wards, but not likely to cross the sidewalk in solidarity with the poor and suffering. There are exceptions in every hospital, but as institutions, the expectations remain low for a reason.” (Road Trip, Stakeholder Health, 2019)

Jim, TC and me in Wilmington NC —our 29th stop 2,600 miles after leaving San Diego. Everything we hope for is happening, but often trapped in small pots.

There are three ways to approach this withering, this tragic failure to fulfill our missional DNA.

One is to ramp up community benefit regulations. Not many hospitals have the internal capacity to know how to do that kind of work, so give local public health authorities power to get intimately involved in deploying hospital funds into serious programs of prevention, social determinants and chronic condition management. Don’t count “loss” on Medicaid and Medicare or training their own medical providers. The political screaming will be deafening as the ones that own the pots resist.

Two is to simply let non-profit hospitals remain inside their acute therapy pot, but give up the pretense that their efforts have much to do with community. Treat them like banks with some, but minimal, expectations of community good. Banks have to invest actual cash in the communities they previously damaged by redlining. Hospitals should do the same in the same communities as well as providing decent access for urgent services.

Third, create a special legal category for mission-driven hospitals. The 21^st century work of advancing health at community scale needs a whole new pot. These hospitals would be like Community Health Centers (FQHC’s) that get preferential reimbursement for services that make them sustainable once they are built. Hospitals would need what they once had—preferential and protected access to borrowed capital so they could have modern technology. Treat them like missional utilities with no advertising permitted and community people on their governance Boards. True accountability is needed for meaningful integration with public health and social services, both governmental, private and faith. Restricted pay disparity between highest and lowest staff. Built for mission.

The National Academies report notes that Community Health centers offer much of this logic, but built for primary care, not acute hospital services. But why not? Every one of the major hospital systems have some hospitals they don’t actually want, that won’t ever make much money. Why not flip them to this different model?

We could do so much more with what we have. But our communities have almost given up:

Contrasted with the high enthusiasm when the hospitals were created, “the low expectations of (of hospitals) were striking—maybe for more health fairs, slightly kinder financial assistance policies, or free parking for clergy. We didn’t hear any calls for transformation, hardly any for solidarity. Yet those of us inside the institutions know how much more might be possible.” (Road Trip: Soundings. USA: Stakeholder Press, 2019).

We’ve been circling the pot. We need to break it, point the roots to deep soil and get to work.

Lost bee, found bee

That’s me on the upper right trying figure out how to talk to the guard bee at the entrance.

Forty thousand honeybees live above my parked car, which is often cluttered with beekeeping accoutrement that smells of wax and honey. It is common for a few bees to tag along for the ride. Beyond two or three miles and they can’t find home so they will circle a bit, tasting the air for a waft of nectar, resin, honey from a hive nearby. They can sense a hive vibrating with life that might welcome a lost bee laden with honey or pollen from the back of my car. Honeybees are a practical lot, unlike wasps that tend to chew up visitors.

A honeybee shares a mother with thousands of sisters with a random assortment of absentee sperm accumulated on mom’s one big day on the town. A bee is so fully integrated into the superlife of the three-pound hive that a solitary bee can hardly be thought to be imagined unless they accidentally drive away in a car. The bee has a tiny brain devoted to life and death issues such as where the nectar is, what the hive box looks like and her immediate job at hand. No brain synapses to waste on lingering affections, so in about three days she will not remember her sisters. The new sister will learn to dance among thousands of new kin until her her wings wear out in a month.

A worker bee lives about eight weeks collecting a twelfth of a teaspoon of honey. You and I live 4,750 weeks often, without producing anything as helpful. Humans exaggerate what can be done in a season, while cynical about longer transformations. Impatient foundations often force recipients to promise transformation in three years while cynically avoiding commitment to the city-sized transformations that could be realized in a half generation. Ask any bee.

I found myself thinking about these issues when I noticed that a bee was riding with me on the four-mile drive from the hospital where I used to work to my new home on the Wake Forest University. This was my hive once—I can see my freshman door room out my office window. And while academic guard bees notice my hospital scent, I do carry the equivalent of pollen for the young ones (a new course on Leading Causes of Life). And friends from South Africa, Germany, Texas, California and even Finland with sweet nectar (ideas) that might help the hive. Here’s a link to the Baobab conference we just hosted. I’m already forgetting the old ways.

Bees don’t try to teach humans anything, given our short and unpromising evolution. But they allow us to observe and notice their practical balance between intense selflessness and short term memory. We humans exaggerate our individualism, thinking that the skin-bag holding our squishy parts and three-pound brain is a functional whole. And, opposite of bees, we nurture unhelpful affiliations long after they are are relevant to our future. A bee forgets in three days; about five years for humans. This may be a bit quick for our species.

Bees are a bit ruthless in their commitment to the future, but we should also focus on the neighborhood in which we now live and the people with whom we might thrive. I’m thinking of the tortured shore east of the Mediterranean. The sad futility of my dad’s old political party. The pathetic rending of old religious groups voting about other people’s sex. Hospital systems tethered to old therapeutic techniques instead of modern population health science. Seminaries teaching the same stuff they did 180 years ago. Universities organized the way they were when I was a freshman; for that matter, when my father was a freshman and his dad, too.

(Don’t mention these last two to my new guard bees; winter is coming and I need a hive.)

Soul sick

Lisa Lumb, artist. In dialogue with her twin sister.

I am not sick to my stomach. I am sick to my soul.

The first job of any religious person is to try to make their own religion safe for the world. Every religion has a dangerous side which has at various times in the evolution of the tradition provided cover, sometimes even encouragement, to the most obviously horrible facets we humans are capable of doing to each other. Every king, thug, despot, gang leader and e-gazillionaire has a chaplain willing to cheer them up when they are sad and encourage them when angry. Every castle had a chapel, even when it did not have flush toilets.

As a follower of a Jewish man named Jesus, I am sharply aware that people have done, in the name of my religion, some of the same repulsive things done in Israel this week. Hamas didn’t do anything that the Crusaders hadn’t wraught a millennia ago on the very same land.

My daughter is married to a Jewish man, with both my grandsons raised to respect and participate in the rituals of Jewish life. We just built a Sukkah shelter together that we bought on Amazon. They are San Francisco moderns, sophisticated and proud of lots of things no longer believed. They let a Baptist sit in the Seat of Elijah for the circumcision. And those kids are more likely to go to Burning Man or a trance music festival in Israel one day than church.

I am sick to my soul.

This weekend a couple dozen authors and scholars from Africa, Europe and the US will gather at Wake Forest University to blend our thinking toward a book published next year about religion and health. We meet in sharp awareness that many would wish for no religion at all.

I can’t blame anyone who looks at history and concludes that we should try a culture with no religion of any kind. I thought we were heading that way, as rational secular science-based logic was all the rage way back at the end of the 20^th century. It turns out that there is something in the human being that simply must tether beyond ourselves to ultimate meanings. Call it Spirit. Homo sapiens spiritus. We all have an ember that will flame for good or evil beyond all imagination.

Any of us brave enough to accept identity with one of the great traditions is responsible to see that the others of that tradition do not use that religious cover for heinous actions toward people of other religions; or those who are simply going about their life down the street in Hroza, Gaza or Winston-Salem. We say clearly that any religion—especially our own–that is comfortable with gross inequity in the distribution of things God intends for everbody should be rejected by the larger world as fraudulent. If one’s religion is not good for the whole world it obviously is not linked to the God who created the human species with nearly infinite variations of thought and imagination. Any religion that is not good for the whole world is dangerous to our small planet. Let us not leave that to secular people to say; it is our responsibility.

Practically, only a Christian can engage a dangerous Christian. Same for every other religion. This is not without risks, as some of the most virulent emotion is between people who share the same religious identity. But only an older white male Baptist can deal with the leadership of the minority group of older white male Baptists showing dangerous tendencies in public toward people within punching range. No Muslim, Jew or Sikh can sort out a crazed Baptist. That’s on us Baptists. And I’ll count on y’all to keep your extremists away from my grandsons.

The heinous savagery degrades all religion. Every faith favors humility, hospitality, kindness, generosity and peacefulness—especially toward strangers. And every religion violates every one of those time and again when it fails to hold itself accountable to its own teachings.

Today a kind of prayer beyond words lives in my soul, sick with sorrow.

Social, now

The top floor of Baylor Scott and White hospital is dark wood, deep carpet and lots of glass, out of which one can see Dallas stretching to the dusty horizon. A physician noted that the people visible to the southeast near the Ferris wheel tend to die about 12 years sooner than those on the other side the same distance from the hospital. This is why I was there talking about the “social determinants” of health and what religion has to do with them. You’ll notice the phrase has two problems, “social” (when it really means “non-medical”) and, worse, “determinants” (when it really means variables). Hospital leaders hear about these factors a lot these days, but nearly all the problem and possibilities called social lie on the other side of the sidewalk outside their control.

The school is way more important than the hospital. Two scholars (Case and Deaton) sifted life expectancy data to clarify that people who don’t graduate from college tended to die 8 years younger. It’s not because the books would have taught them health-related tips. College is a social marker, mainly about one’s parents social position which is a big boost toward the student’s. Hospitals are pouring money into new IT to see what social determinant things such as food and short-term housing that their patients need. That is nice but misses the point. And it misses where to work.

It may surprise the well-educated, but not those on the downside of the data. The two thirds of Americans who did not go to college know all about early death; no wonder they are angry and vote with fury.

Social is the thing that happens when people talk to each other. In this case, at Tova Coffee House in Lubbock, TX

In 2008 the World Health Organization commissioned a global study on these poorly named factors, led by Dr. Marmot, who was famous for noticing that life expectancy decreased in a step-wise factor with each click down in social position within bureaucracy. The 2008 report said sharply that “social determinants can be more important than health care or lifestyle choices in influencing health.…studies suggest that SDH account for between 30-55% of health outcomes. ….the contribution of sectors outside health to population health outcomes exceeds the contribution from the health sector.” We’ve wanted to blame the doctors and the hospitals when the problem falls on all the rest of us.

The critical role of social drivers has two inconvenient implications for hospitals and one for people of faith. Hospitals have been happy with the assumption that they are the key to extending the health to everybody who can see their large buildings. Modern healthcare is mind-numbingly expensive. The business model draws from a deep well of borrowed money from nervous bankers requiring vast reserves to ensure they are paid back. The weird irony is that hospitals look like they have a lot of money, but it is reserved for the banks, not the neighborhoods. Everybody hates this.

Hospitals are legally obligated to provide “community benefit” but nearly all of it pays for expensive free care offered inside their tall buildings. Some count medical education (of doctors, not the patients). In some states they count the loss between what government pays for Medicare and Medicaid and the actual cost. Less than a nickel of every community benefit dollar goes to anything in community. Everyone involved hates that, too.

We should release the hospitals from the unrealistic expectation they can do what they’re not designed to do. They deserve tax benefit for giving so much care to people who can’t pay. We don’t want citizens dying, writhing on the streets. But—and this is the inconvenient part—we should no longer pretend that hospitals can solve what all the rest of us need to be accountable for. If hospitals can’t do it, they shouldn’t get political credit for pretending to try. Let the money follow the science to where health is created: especially the schools, social supports and public health that advances the health of everybody.

The day after speaking in Dallas, I was on a Stakeholder Health Zoom, a sophisticated group that knows all about this cruel reality. We we talked about how to get the money and attention out the door and into the streets. One promising clue is the rapid spread of communities using the Vital Conditions and the Thriving Together document to approach the radical complexity of assets in community. This has already sparked an extraordinary 53-agency Federal Working Group to advance health for “all people, no exceptions” at that level. We just have to do the same at the local level.

As I was preparing for the Dallas lectures, I came across a note that President Carter sent me when I was leaving his Center to go over to Emory University. He was not impressed. And he would not be any more impressed with my recent move to Wake Forest University Div School.

He hates needless theory when there is something practical to do. And he hates pretending that someone else should do what we can do any Saturday. Science says that health comes from people being in the right relationship to each other. It always has.

That the power of the social.

TGP

There are two reasons for grown-ups to avoid church. First, they’ve never been. My grandson once asked me with innocent curiosity what that building is with the “t” on top. Many others have been and see no reason to come back. The experience may have been repellent, demeaning or embarrassing. When you hear the worst people in public life explain their ugliness with faith, sensible people back away and keep the kids out of earshot. But it is far more likely that the church was inoffensive– less interesting than another cup of coffee, a walk around the block, tennis or whatever.

By Zach Stewart ( (a heck of a TGP) originally drawn for the Barefoot Guide book on Generative Leadership.

I’m speaking of church, but I’m guessing something happens like this in other religions, too.

I have found my closest working partners in two groups. The first are inside the church, but near the back door ready to get back on the streets. The second are already on the streets surprised to find themselves friends with a religious guy like me. We share the energy, joy and pathos—but not “god-talk.”

Next week twenty authors from Africa, Europe and the United States will gather at Wake Forest to blend our thinking on a book on religion and health to be published next year by Elgar Press. The intellectual sausage is still in process, so it’s premature to share detail. I mention it because most of the authors are in the two groups—some surprised to be invited to anything religious and all surprised by the creative energy released.

I am trying out the name “theogenerative practioner” for those propelled by an experience that feels ultimate and urgent, not just dutiful or godly. TGP for short. They are everywhere which is why I can’t despair. When Stakeholder Health gave Soma Saha and Ji Im our Jerry Winslow and Ruth Temple Bell Award in June, I called all of them that. Legendary practice; the theo signals the well from whence comes the imagination and resilience.

Writing in a more academic manner about “theogenerative practice” for the book I had to deal with “theo.” Jim Cochrane pointed me to Rev. Dr. Ted Jennings, our late friend from Chicago Theological Seminary, a TGP who wrote a wildly generative book, Beyond Theism, in 1985 (out of print, but available used on Alibris). He said we had been suckered into defending an abstraction called God—and the dangerous claptrap of theism. We misplaced the real mystery, that we humans experience God more like a verb than a noun. Ted did not care about God as an abstract ultimate cause that lends itself to authoritarianism. The abstract god justifies structures of religion, culture, politics and practice whose inertia robs the poor of hope for change and, risks the extinction of us all. A Christian theologian, he cared less about God as creator and more about the liberating Spirit. And he cared about the itinerant carpenter who was killed by the twisted authorities of religion and empire for proclaiming justice and mercy. Count me, in Ted.

Although TGP’s are often not religious, we find “god-talk” helpful as we talk to each other about the experiences of being drawn, called, called out, confronted by the deeper currents of life. Ted was careful to note that a lot of non-religious people experience this even when they don’t have “god-talk” to explain it: activists, artists, care-givers and healers. Maybe you and me.

I think of Brooks Hays, Jimmy Carter, Bill Foege, Jim Curran, Howard Koh. And John Lewis, of course, who became an icon of generative public justice-making. He was raised in the church; long called him “preacher” for his earnest way of preaching to the chickens under his care. (Read Walking in the Wind right away!). But his life changed when,

“on a Sunday morning in early 1955, I was listening to our radio…as always, when on the air came a sermon by a voice I’d never heard before, a young minister from Atlanta…. But even more than the voice, it was his message that sat me bolt upright with amazement….This was the first time I had ever heard something I would soon learn was called the social gospel….I felt that this man—his name was Martin Luther King Jr.—was speaking directly to me.” (Lewis, p. 56).

He was transformed forever; following, following, following and in then leading, leading and leading. This was an event that opened the possibility that oppressive political realities could be disrupted, too.

We may never have another John Lewis or Jimmy Carter. But we may never have another you or me, either. It is entirely normal to have one’s life disrupted by events and inbreakings that release us for what we are made to be, made to do. Ted would say the work of theology begins with these events, not the old dry abstractions of theism. God is not done. What?!?!?!

Don’t skip over “generative.” This is the quality we recognize in God and the people. And not just practice which is nice, kind or proper. This is what makes God disruptive and impossible to tame by human systems. And this is why generative theologians scare defenders of the old ways.

A critical role for TGP’s who are religious like me is to defend theogenerativity against authoritarian religion in the public square. We needed this in COVID when religion was used to undermine public health. And, sadly, we see it in the most ironic place—love and the wonders of sexuality. Amid so much hurtful blather, we have to say clearly that God delights in generative relationships; you can’t have too much love across the whole fluid alphabet of sexual identities. God loves love.

By Jimmy Carter. Hanging in the Zaban Room of The Carter Center

We need tens of thousands of theogenerative practioners. And I think we have them. We have twenty-five new ones starting at our School of Divinity. Jerry Winslow is still disruptively typing at 78. I promise you that Jimmy is doing something theogenerative on his 99^th birthday.

Why not you and me?

Underbee

I walk through morning light among the apple trees to the circle of seven hives as a half-million bees begin a new day. I sit by the small hive over on the left looking for pollen saddlebags on the arriving foragers which will tell me there are babies being fed. This hive is a refugee remnant from one that fell prey to an infestation of wax moths. Many bugs beside bees are attracted to honey and wax—small beetles, ants, “destructor mites” too small to see. And, the most disgusting, wax moths that tunnel sideways through the comb leaving stringy goo the bees can’t remove and can quickly overrun the whole hive.

Bees are NOT supposed to do this, but they were refugees without options, so they build UNDER an empty hive.

The Mother and 6 or 8 thousand sisters abandoned the lost hive, flew 100 feet across the circle and attached underneath an empty box and built comb as if they were waiting for me to do something. This situation is not covered in my dozens of beekeeping books, which the bees don’t read. I was anxious about hurting the already traumatized refugee Mother so I gently picked up the bottom board under which they had attached themselves and put it on top of a small box with their new comb dangling down into a box. I added a bottle feeder to help them settle in.

Mother might have time for two three cycles of babies before frost. The sisters don’t hibernate, but they’ll quite raising babies and push the drones out to save food and bother. The girls form a tight ball to keep Mother warm until February when she’ll rev up again if—a big if—the hive can recover its strength. I’ll always pull for the underbee.

Meanwhile, the other half million sisters around the circle need treatment for those damn mites. This involves a 14 day regime of stinky chemical pads inside their hive which makes them grumpy as I check carefully for other bugs. The only nectar around is goldenrod so I’ll feed them after this treatment with a last shot of formic acid till we tuck them in for the Winter.

We say “beekeeper” but I am the one being kept. Why do all this? Not the honey, although I did harvest 18 gallons from four of the hives this summer; should be twice that If I can nurse these hives along. But the longer I am kept by the bees, the less I think about the honey. These sisters have watched mountains, oceans and glaciers come and go—taking lightly the latest annoyance, we silly humans. I savor being inside their generous circle on a season of their 30-million-year journey.

Moon rising through the Nunnery on Iona.

On every one of those 11 trillion days, they read their environment and adapted to the unexpected. They focuses on the babies who thought only of the babies after them. Bees will let you have honey, but sting for brood. On the other hand (bees have six) their survival depends on radical diversity. Honeybees are impossible to tame; certainly not be me. The mother mates with 10 boys a few seconds each 50 feet in the air. She flies right past the neighborhood boys to those a couple miles away. Her daughters have random fathers so every bee and every hive is a slightly different mix of inherited traits. Don’t worry about their survival; some hive somewhere will have the traits to survive the worst we dumb humans can do. We humans on the hand (we only have two) are far less likely to survive. We don’t think about the babies, resist diversity and have tamed ourselves.

But now and then an improbably wild human hive emerges with traits fit for the future. Last month TC and I took rail, ferry, bus and footpath to the rocky island of Iona on the western coast of Scotland. People have come here for millenia to experience its “thin veil” between human and the Ultimate. The abbey was built 1,460 years ago and Druids worshipped here a thousand before them. Its Christian phase attracted pilgrims and, unfortunately, my ill-behaved Viking kin for centuries until succumbing to the protestants who let the rubble crumble. In the 1930’s until a muscular Presbyterian, George McLead, founded the Iona community restoring the abbey, and more importantly, built a movement for enspirited mercy and justice. My Norwegians gave them the lumber for the ceiling they had burned earlier. Now Iona is a hive of radical spirit. If honeybees invented humans, we would look like the Iona community—women leading with maybe 15% men allowed, as long as seemed relevant to the babies.

Late summer fields surrounding the Abbey of Iona.

About a mile across the strait from Iona is the pink granite “island of the strong women.” The founding priest Columba shipped the women and cows over there, which didn’t last long as boy energy is too brittle for the harsh climate. Today the spirit and practice of the Iona community is distinctly feminine, unafraid of the bitter winds or the venal proud boys now having their day in so many places around the world. Spirit with sting ,if the babies are threatened. And they are.

Aaryaman Singhal, one of the brilliant young leaders of the Sunrise Movement. Count me in.

Iona tunes my ear for the songs of freedom rising up where you don’t expect it. An unlikely young hive, the Sunrise Movement, rose up in Texas demanding the government to reinvent the depression era Civilian Conservation Corp to fight climate extinction. It is led partly by Aaryaman Singhal, who reads his environment like the a honeybee. After slogging through steaming heat in east Texas and Louisiana, this week he stood by President Biden and AOC announcing the American Climate Corps infuriating the republicans (who rather remind me of the wax moths the way they go sideways). It will set another 20,000 people free to give themselves a chance to give the world a chance.

This is how life works. Hope comes from the edges, from the experiments you’d least expect to work. Look to where the veil is thin between human and ultimate; where you can see the inbreaking of the future.