The US News and World Report recognized our little hospital system in Memphis as the best in the region for the second year in a row, a fact which makes us very proud. The list of specialties in which we excel runs down the side of our largest hospital for four stories, as you can see. But if you look closely, “improving the health of the community” is not on the list. And it would not be on the list of any of the other hospitals the magazine honors. It is simply not something that anyone expects a hospital to be good at, much less excellent. But back a hundred years ago when our (and most every other) faith-based hospital was founded it was assumed that a great hospital would in fact, inevitably lead to a healthier community. It turns out to be harder than that.
The idea was that government would take care of public health prevention and surveillance (watch the movie Contagion, if you are wondering whether you need that….). And faith and non-profit agencies would get tax breaks to provide charity care. Nobody imagined it was possible to make a profit running a hospital and even it it was possible, it was a bad idea to try. Until this past year it was childishly easy to pretty much make up numbers proving that the tax waiver was justified, so gradually there emerged a whole category of hospitals that should be called Not-Not-For-Profits but Senator Grassly largely closed that loophole. Last month the State of Illinois, not known for its virtuous government, took away the tax break for a number of hospitals that were simply beyond the pale.
But nobody quite knows what to ask of the hospitals in terms of their role in generating the health of the community. The hospitals don’t really know what to ask of themselves beyond taking care of a lot of people who can’t pay. Should they also be expected to be a creative partner in advancing community health? How exactly would they do that and how would anyone know if they were good at it?
On Tuesday The White House and Department of Health and Human Services will convene a small group of health organizations to explore how communities are crafting partnership and programs that work for the good of the whole. The meeting is organized by Mara Vanderslice, Director of the federal Center for Faith Based and Community Initiatives (hhs.gov/partnerships/). The Center has a long bipartisan history, officially created by President W Bush and tweaked under President Obama. But the faith-government partnership has been gathering steam since Carter, Bush 1.0 and Clinton. Once could argue it has been in and out of fashion for 250 years, an acknowledged part of how America works since de Tocqueville wrote in 1835 (pictured).
The current meeting has blended DNA, part of which traces to the Interfaith Health Program at Emory (ihpnet.org) and its long work with the Centers for Disease Control and Prevention. They jointly hosted a meeting at The Carter Center on the role of the “strong partners” years ago. It was curious about the role that faith-based hospitals (and the foundations that were sometimes created when they were sold) could more systematically contribute to the health of the public–not just their patients. That was the first time the phrase “religious health assets” was coined. And the meeting noted that “If you follow good science to the root causes of disease and injury, you will find more than a long list of individuals awaiting admission: you will find yourself struggling in a community with social incoherence.” (“Playing to Our Strengths,” Carter Center 1995)
The idea of religious health assets was later elaborated and deepened by the scholars of southern Africa, especially the late Steve DeGruchy (pictured) and Jim Cochrane, then the World Health Organization, especially Canon Ted Karpf and then hundreds of others, even in Memphis.
The other streams of DNA of the current discussions trace through the many particular histories of the hospital systems and the different way that science, faith and human communities combine and morph along their journey. Neither personal or organizational DNA is destiny, however. Genes are triggered by environment and in this case leadership, community and family. Sometimes a gene can be recessive for generations and then find its time has come. I think that’s what happening Tuesday. The small set of hospitals coming to the White House Tuesday have in common the fact that are not afraid of the flux and tumult of our time, they are expressing their deep DNA. They are strong and while challenged, led by people who want their systems to fulfill the promise their founders–and their governmental partners–intended.
To do that the hospitals will need to learn from each other and government experts, as both also learn from the communities about what works and what is possible. That won’t all happen in six hours, even at the White House. But in this mean and bitter time in Washington, it signals that it is a bit too early to give up hope that we can be the people our communities need us to be.
– Posted on the journey