Charlie Wolfe, among my very favorite humans. His future is not determined, especially by any of the other 7 billion.

Perhaps you’ve met a human. You have noticed that we can be hard to help. Perhaps you’ve been to a planet like Earth and noticed the same thing, except 7 billion different ways. How do you help something with 7 billion moving parts be healthier?

Advancing population health depends on understanding not just the medical problems, but the drivers of health ….at community scale …over time. Those drivers are largely social and they are not determinants because none of the 7 billion of us humans are determined. Words guide our imagination, shape our ability to talk about what to fear and what to hope for. So it is a big deal to see the 100 Million Lives Campaign “determinants” for “drivers.”

It important for every grown up in any position to influence a single life to talk about life as changeable and chooseable—but shaped by power drivers that have to be confronted.  This is especially true for the grown-ups in positions to influence the big social structures like hospitals or faith networks. Monday in Washington DC the Association of Academic Health Centers met to explore how their huge organizations can align themselves wit the leading edge understanding of the social drivers of health. This is a huge shift for them (us, as I am a VP of one….). They brought in the big voices including none other than Dr. Michael Marmot the author of the stunningly powerful studies of social position over time (The Health Gap.). And our friend Dr. Denise Koo one of the principle forces behind the new array of useful tools emerging from the CDC such as the Community Health Improvement Navigator. (

salamisThe closing panel of the whole conference was our “ground game” in Winston-Salem. This was explained AND embodied by Jeremy Moseley our Director of Community Engagement and Annika Archie the lead Supporter of Health, with Dr. TC laying down the data beat like a bass player in a jazz ensemble. I had two minutes at the end to set a metaphor like a sail to catch the wind of the spirit moving where you wouldn’t expect it.

The social drivers engage the role of an hospital not just as a provider of therapies, but as a social presence—usually the very largest social/political/economic structure in a community and region. This requires us to see ourselves from a community perspective: inside out and upside down. In Memphis we found ourselves in a covenant relationship with more than 600 congregations that pulled us inside out. In Winston-Salem we have followed the deeply grounded intelligence found in some of our lowest wage workers into relationships that are not just inside-out, but upside down or, better, right side up. We were steering toward life, not just away from death.

Proactive mercy is way cheaper than reactive charity. That’s the whole and complete logic of “population health management.” But if you don’t understand the humans, you can’t expect to be proactive. Being proactive depends on the intelligence about– and trust with– the neighborhoods where the costs of reactivity are concentrated. This requires not just the preeminent brilliance of our surgeons, but of all 14,000 humans on the team. Dr. McConnell and Annika Archie embodied this new deep discovery in the video interview he did with her (and me) last week (click here).

That’s what works.

It is new for big organizations to hold ourselves accountable for social factors. That has always been on the side, a by-product, an unintended consequence. Now it is central. Some say we should think of ourselves as “anchor institutions,” but that image reinforces our worst habits of domination. What could be worse than focusing on anchors of determinants? I’m depressed just typing it!


The mainsails are the ones low and large. You leave them up so the ship can keep moving even in heavy seas.

We should be mainsail organizations.

The mainsail is the large sail on a clipper ship low and strong that you leave up even amid the heaviest weather and hardest storm. This includes the storm-tattered neighborhoods you can see outside the windows of urban medical center. You leave the mainsail up because in deep and heavy water you have to keep going or the waves will overwhelm you. The last thing you need is to drop an anchor. That’s what you see in Annika, Jeremy and TC and their hundreds of colleagues setting themselves to catch the same wind of Spirit– surgeons, nurses, social workers and revenue cycle VP’s– that share a hope and mission.

You can even hear it now from some our community partners, glad that we have finally joined them in their journey toward health. They don’t want an anchor; they want to go somewhere new.

Last Saturday our own Rev. Dr. Francis Rivers received the major award from the Hispanic League of Winston-Salem honoring him (and the FaithHealth team) for leaning way into the heavy seas of anti-immigrant venom surging currently in North Carolina in creating the ID Drive. Francis’ award honored him, but also his mainsail organization–and not just the tiny part of it called FaithHealth. The medical center put up a big sail amid very heavy seas that helped other key institutions do their critical work. The Sheriff, police, DA, a network of churches called Love Out Loud, many Hispanic organizations and Que Pasa media). And don’t forget the most important FaithAction—the small faith-based organization that does the actual work of validating identity so that an ID card can be issued and trusted.

shipA fully rigged sailing ship is a very complicated thing with many sails and miles of rigging. So, too, is any network of partners committed to helping their community move away from the rocks and into a safe harbor. But none of the partners could have stepped into the heavy wind themselves, much less alone. That role was for the mainsail and a ship built for deep water.

You might be so embarrassed by all the mean hateful things religious people are doing these days that you want to stop the metaphor right there. But you’d be leaving out the most interesting part of sailing—the wind. The sail doesn’t have any power; it only catches the wind. Greek traces the same word for wind to breath and… Spirit.

We know in North Carolina that the Spirit can blow toward or away from the rocks; it depends on the skill of the sailors and the courage of those who climb up the rigging and set the sails. These are days filled with stupid religious venom, so I don’t blame anyone who wants to move culture and institutions and society without faith. But nothing at cultural scale ever happens without Spirit blowing really hard. You can stay below decks and hope for the best. Or you can find someone who know how to set a mainsail and head to deep water. Francis, Annika, Enrique and the others on the edge, live way up in the rigging where the wind blows with raw power. They teach us to its respect power, but not to fear.

Dr. King spoke realistically when he said “the arc of history bends toward justice.” It is a slow bending curve, more tectonic than sharp. We don’t choose this way or that, but lend our days to the slow bend, helping each other keep courage for the long turning. We set our sails for heavy seas and a long arc toward a horizon worth the journey.

About garygunderson

Professor, Faith and the Health of the Public, Wake Forest University School of Divinity. NC Certified Beekeeper Author, Leading Causes of Life, Deeply Woven Roots, Boundary Leaders, Religion and the Heath of the Public, Speak Life and God and the People. God and the People: Prayers for a Newer New Awakening. Secretary Stakeholder Health. Founder, Leading Causes of Life Initiative
This entry was posted in 100 million lives, Beloved Community, boundary leaders, leading causes of life, Wake Forest Baptist Health and tagged , , , . Bookmark the permalink.

2 Responses to Mainsail

  1. paulrholley says:

    Thanks Gary. Agree 100% that we should avoid the language of determinants. This implies a powerlessness amongst persons in community to influence the health of themselves and their neighbours. Perhaps it is more attuned to the interests of public health professionals to justify their roles? Also found encouragement for those of us clergy who are struggling still in the rigging to catch that breeze…

  2. Verizon says:

    Thanks! Interesting analogy to move from “anchor”, with the image of stability, to “mainsail”, with the emphasis on foundational power to move forward! Love it. As usual, you provide both a challenge and the optimism of hope-full looking ahead.

    Ron Sent from my iPad


Leave a Reply