Ebola of Health

Jonas Salk turned 100 Tuesday, his ideas alive, powerful and relevant despite his passing nineteen years ago. Today, a crowded field of health leaders are beginning to realize that wide spread health is possible as a norm, not an exception. The answers, he knew, lay waiting for the questions to be asked by people with enough hope and freedom to align their collective energies. Heather Wood Ion worked with Jonas on this bold idea and now leads a band of colleagues –including me– sharing that vision (epidemicofhealth.com). This has been—obviously—a major influence on our work on the leading causes of life. Heather is a Fellow in that band and guided the design of Stakeholder Health’s summer Chawumba gathering.

Salk’s key insight, hopeful for humans and constantly troubling for managers of institutions, is that health can spread quite like a virus. This makes sense as both health and disease are phenomenon that reflect the biological, social, psychological and spiritual dynamic of human life. That life–our life together–is one. Really. This is not just true in some poetic or metaphorical level that exists above the clanking grind of bones and chemicals and the weirdly mechanical array of programs, interventions, projects. It is….true:; an accurate description of what happens which sets up the possibility of getting the questions right so that we can see the natural possibilities. And then we can get our work right.

That the reality of our hopes for life might spread like our fears of death in a viral phenomenon makes sense. Most of life is viral. Most of our body mass is made up of viruses. There is no such thing as a human digestive system without, roughly speaking, a gazzillion bazzillion viruses. We are them; them are us. Nathan Wolfe, the well known virologist who happens to be married to my well-known playwright daughter, is writing a book “Colonies of Life” to describe this wondrous interweaving. Today we are witnessing in the disease called ebola the grizzly collective cleverness of viral forms perfected adapted to the broken human systems pushing across natural boundaries. AIDS spread because humans are inclined to have sex with each other and do so in patterns that are often fogged with fear and abuse as well as love. Ebola spreads because we touch each other when we are most human; when we care for the ill and bury those we love. The weakest systems most exposed to novel viral forms seem perfectly designed for epidemics most dangerous to the weakest people. But once in full bloom, the viruses don’t pause to notice the “MD” after one’s name, or the stars on the shoulder of one’s uniform.

Could the positive mystery called “health” spread like that, too? Could we create such a rich and inviting set of conditions, so perfectly aligned with human capacities and energies that health would challenge our politics, faith, business and family to keep up with the new reality?

One of the insights I find most encouraging in this line of thought is that no on virus figures it out and then “leads” all the others. Nathan Wolfe once explained to a working group of the Epidemic of Health that viruses thrive because of their “adaptive novelty” that is able to produce constant changes. They do this by literally sharing their essence—their DNA—with each other in ways that are wildly unpredictable, but ultimately adaptive.

I like that a lot.

Today, many organizations, networks, institutions, small groups of fanatic individuals and countless thousands of different faith groups are trying everything they (we) can think of to adapt to the wild winds of the 21st century. Some of us are quite confident we know what everyone else should do, but most of us are just trying to do the best we can to help some people nearby in our little ways. Nobody is or could possibly be “in charge.” Nobody is organizing or could possibly even know what all the adaptive novelties are that are underway already.

Last week Robert Wood Johnson sponsored the National Forum on Hospitals, Health Systems and Population Health: Partnerships to Build a Culture of Health (www.populationhealthandhospitals.com). A number of leaders of Stakeholder Health partners spoke, but we were among a cloud of powerful witnesses to what is emerging. Probably the coolest and most creative thing I heard was by the Tracy Davison, the CEO UnitedHealthcare Community Plan of Ohio which is paying to train felons as community health workers to teach those in and out of the prison how to access the healthcare system. You can listen to this panel and the whole agenda on the website above (I was on the panel with Tracy, Tom Zenty of University Health Systems and John Buford, moderated by Paul Kuenhert). It was full three days of heroes and prophets making up what Dr. Debbie Chang calls “a crowded field.” Sort of like viruses reaching a critical creative mass.

My small contribution to the hopeful stew was sharing the news of the emerging surprises in Winston-Salem where our Supporters of Health are turning social determinants into social variables. Faith doesn’t think anything is determined, especially while people can come into each others’ lives with compassion and hope.

It is likely that all we hope to be possible is already alive among us somewhere, waiting for a few more adaptive novelties to be fully robust enough to overwhelm the forces that appear so powerfully arrayed against health. Some of those forces are armed and angry, equipped with daunting modern tools of violence and intimidation. The awfulness now normal in Syria echoed in places CNN has not yet noticed. We must be as persistently creative as Ebola has been as it tried a billion ways to burst into epidemic spread.

Jonas saw the future and believed that life would find a way. He thought (long, long before more than a handful could even imagine it) that life found its way to Earth on comets. Now we know for a fact that the universe is rich in the ingredients of life riding in comets and floating in clouds at distance and scale far beyond our grasp. It is a much smaller leap of imagination to think that the life already here on earth–so powerfully equipped with the modern human tools of intelligence, faith and radical connectivity–could figure out how to simply spread health that is already possible in many places on earth to the rest of the earth.

Perhaps the idea that it might be possible is the adaptive novelty we need most. Ideas need language, stories, song and poetry to spread among humans. There are humans who live on data, just as there are forms of life that life at the coldest depths of the ocean where light never reaches. But most of us need the power of voices, the touch of hands sharing real work and the light we find in the eyes of colleagues daring to risk for something great. Those are capacities that Ebola can not hope to match and why humans tend to fare well over time even against the most deadly viruses.

And that is why it is likely that we not yet done in our social journey toward health.