100 million lives – garygunderson Blog

Hurricanes

Winston-Salem as the storms of Florence came near.

Things move fast and urgently in an operating room early on a Monday. The churn of events and flood of people in the hallways are wondering why the nurses are standing holding hands right there in the surgery suite. A dozen family members are hoping for comforting words while a dozen feet away across a couple of gurneys, eight surgical nurses have no words at all, struggling to process the loss of one of their colleagues, apparently shot down dead by her husband right there in front of the kids. Feels like a hole in the eye of the circle with enough emotion to swirl a hundred miles out and around. Hurricane, indeed.

Florence ground slowly from the coast across the sandy flats up and through the rolling Piedmont and is now picking up speed on Interstate 81 like a northbound trucker. The winds could have been a lot worse. But this was a post-modern storm following no pattern at all, inexorably overflowing norms, breaking rules and making entire communities uninhabitable.

Hurricanes are about as big a show as nature puts on. What could be bigger? It turns out that jet streams and oceans are; even a tiny twitch in the speed or warmth of either one and you get the deadly meandering of storms like Florence. When the driving currents collapse, the flood isn’t far behind. So why would a hurricane behave in such an odd and deadly manner? Why would a democracy just forget to bother to follow its own rules anymore, chasing its own inevitable slow collapse? Why would we just forget to try to stem the tide of guns, now so over our heads that any pissed-off husband can just blow away the one they probably still loved? Surgery can’t stitch together what’s broken in this world. Hurricanes, all.

What to do?

Don’t look away.

Don’t look for the answer on a screen.

What can a nurse do as their own heart is breaking for a friend they loved? Form a circle, hold hands and feel the blood and spirit pumping. Let a few tears out, have a chaplain murmur a prayer. And then go scrub in to help someone else.

Last week before the deluge, TC and I went by the Forsyth County Democratic Party headquarters where Eric Ellison gave us our street assignment and over the next two hours knocked on 96 actual American doors. Being 2018 we only met 7 humans. One of them had become a citizen after immigrating from Spain two decades ago. Another grew up in the neighborhood 50 years back. We asked our fellow citizens to remember to vote, now in less than 55 days. A few thought they might want to volunteer, too, so we’ll follow up on that. Heading to higher ground door by door.

Anyone with a brain bigger than a 22 caliber slug knows it’s probably too late to stop global warming, the collapse of democracy or gun violence. All the data tell us so. But what parent, brother, or daughter would not try? What sentient mammal would not at least stir and try to get their kids to higher ground?

Our hospital has one of the worst parking lots built since the model T rolled out of Detroit. Dark, low ceilings and always oddly damp. The other day I was hurrying to my car and almost knocked down a woman standing in the middle of a lane looking this way and that, glancing down at the paper in her hand. I asked if she needed help and I thought I saw tears of gratitude. The real problem was that her eyes were dilated and she couldn’t even see the paper in her hand, much less her grey Toyota in the grey parking lot. I could help. In spite of my ordination, she trusted me enough to let me do something and we ended up circling six floors in my Mini Cooper, both squinting until we found the car. Probably wasn’t a great idea to let her drive away!

If you look up from the screen in your hand for a bit, you’ll notice people around you, doing this or that, going about their lives. You can’t know if their house is under water, their best friend dead or scared to go home. You probably don’t even know those things about people you work and walk beside every day. You have to make eye contact.

Last Spring my daughter Lauren, now a mom, watched with us all on live TV as Parkland high school students fled from their building, learning shortly that 17 of their friends were dead inside. She writes plays,“so instead of closing my eyes and thinking back to being a junior and watching the news in horror curing my AP US History class and thinking those poor mothers and please god someone do something about this… I posted a query on Facebook asking for help with this play in the wake of this new violence.” Her friend and fellow theatre activist Christina Wallace reached out immediately, read Natural Shocks, and said “Let’s do this.”

Lauren contradicted Hamlet; “the play is not the thing. You are. Your community, your company, yourself. Any play is just the metal that attracts the lightning. We are the lightning – actor, artistic team, audience, community. We are the undeniable force of nature that will light up this darkness and change it forever.”

More than two hundred theaters of every sort and size did the play, including the very best performance in our own Green Street United Methodist by the brilliant Mellissa Jones. Next month a full production of the play will open in New York, keeping the movement going.

That’s how it works. Most of us are not famous. But when the hurricane hits, we move and don’t quit, not when people we love are in high water.

On November 10th the See2See Road Trip will begin making eye contact with about 3,300 miles of people beginning in San Diego with the 100 Million Healthier Lives annual meeting and then the American Public Health Association with our Public Health Law friends. That afternoon we’ll grab a bite at our friend Heather’s home up the coast, then winding through friends and strangers in San Bernardino, Phoenix, Tucson and El Paso where Dr. Arvind Singhal is teaching his band of positive deviates (seriously, check out his book). Then over to Abilene and Lubbock before landing with the friends at Baylor and Parkland in Dallas. Over to Floyd with the astonishing Redeemed Christian Church ….. and over to Little Rock, a hugely creative node in what’s coming next. Memphis, down to the Delta for a nod to the very first community health clinic and activist Fannie Lou Hammer, over to Chattanooga, Cherokee, Hickory and Winston-Salem. Raleigh for William Barber, John Hatch at Shaw University. We’ll ending our discovery where the surge from Florence met the flooding of the Pamlico Sound in little Washington.

We’ll make eye contact with people finding the way to heal their communities. That’s what movements do: they make eye contact, grab hands and move. That’s how the P2P movement is springing up everywhere, ditto Stakeholder Health.

You could just get on the web and watch famous people saying really smart things about it all. These days nothing is quite so urgent as to look at another human and ask about how they are hoping to heal, themselves and the ones they love. For that matter, why are you still reading this? Go talk to somebody, put your hand in theirs and go find somebody who needs you both.

Finding Our Bearings

mapbig How do we find our bearings when we are so far off the known map? Last week I reflected on how bearings were the things we rest our weight on when times are mean. We humans simply must bear each others’ burdens. This is the essence of being human, rather than some other animal that only hurts, breaks down and takes what they can grab. Those lesser mammals are scary, but easily and always defeated by the kind that bears each other up, that tends to our wounded to inspire confidence and coherence.

Bearing means another thing, also helpful in this deeply confused and anxious time. We’ve lost our bearings, wandered off the map. The mariners drew dragons on the edges of their maps to warn the lost. We can see dragons from where we’ve drifted; just turn on the TV. Where do we find our bearings in these uncharted times?

You wouldn’t think it would be possible to lose our way on such a small blue marble of a planet. The problem is that the planet is so small that we can’t find any place where there are only people like our little tribe and no others. We need to find our way into working relationships with those who do not share everything and that we cannot beat into line.

Billy Graham dedicated his every breath to persuading everyone on the blue marble to agree with what he considered life and death and obvious: Jesus. At the end of a century of very serious effort, he got nearly everyone’s attention, but not their agreement. And many who did agree do not yet show they understood the kind and forgiving Jesus that animated Billy through his years.

People of such certainty as Reverend Graham are like a Rorschach test, telling us more through our response than their own witness. Some remember him helping pay Dr. King’s bail out of the Birmingham jail; others remember his voice like a sledgehammer on their teen ears. Gene Matthews, my health policy lawyer buddy from UNC-Chapel Hill, came from the same place as Billy. His dad knew Billy’s dad and remembers in elementary school in South Carolina that his teacher stopped class and had them put their heads down on the table to listen to the very young Billy on the radio. Gene turned out alright, serving as the General Counsel for the CDC through six Directors over nearly three decades. But many who heard Billy still wince.

I’m guessing that Reverend Graham would be more open and kind than many of the politicians eager for a photo op by his casket. Most religious leaders are more creative thinkers than their followers, especially the ones that turn their ideas into “fundamentals.” Of course, every faith leader should be expected to believe their own stuff enough to want others agree. But every religion has a mean and dangerous side, as well as an attractive and transformative one. Thee Smith, one of my colleagues from Emory, said that one of the key tasks of any religious leader is to try to make their religion safe for the rest of the world who do not share it.

Nobody—not even Billy Graham—can convince everybody on the Blue Marble to believe anything close to the same thing as long as it keeps spinning. Many religious leaders die at the hands of somebody who agrees with them on almost everything. They die for showing tolerance to somebody slightly more different than one of their own finds tolerable. Jesus, Gandhi, Martin, Malcolm were all killed by people who worshipped the same way. Some Lutheran clergy can still get fired for praying in public at the kind of community events we’ve seen following Parkland horrors.

Religious identity remains a useful blunt instrument with which to pummel others who stand in the way of something some 1% wants. However, we humans continue to diversify even as we become more intimately entangled with each other. We eat food grown by, work on machines made by, drive on highways shared with, fly on planes piloted by and are nursed by those we do not expect to worship like us. Not in 2018.

Foothills Free Clinic in Wilkesboro, NC. About the most mundane place for miracles since the Pool at Bethesda. I think Jesus would have liked that the clinic borrows the Wifi from the tattoo parlor.

These days you just never know whose hands you might find on the the plough next to ours. The Foothills Free Clinic in Wilkesboro, NC is driven by the generous practicality of tough hill people of faith. The key volunteer is Dr. Ernest Cohn, an integrated medicine practitioner and chiropractor who is Jewish. More than a thousand of his neighbors—probably not Jewish—owe their lives to this clinic, now a working partner of the hospital called Baptist that I work for.

Any agency, public, private or faith-based who has a mandate to care for any real place–any real city, any real state, any real neighborhood—must figure out how to make this radical diversity an asset. On the ground where the poor are trying to find any hope at all, the people who care need every type of person of every persuasion to share the care. The practical daily labor involved in advancing the health of that place depends on aligning all the assets of all those motivated to help.

Weaving difference is an essential competence of anyone trying to heal anything more complicated than one organ system on one occasion. Even there you may damage the human involved even as you get the surgery right, if you make unfounded assumptions about who they are. Pause the knife to ask if the person’s faith is an asset or complication in what you are hoping to do with their organ. Do they believe something that will interfere, or perhaps accelerate, the healing modality?

As soon as you try to do anything beyond one event in one organ in one human, you simply must use the arts of collaboration with eyes wide open for the durable complexity of human populations. Here you look for the social structures of faith that mediate the dynamics that might keep us apart. Those social structures of faith—some 300,000 communities of Spirit in the United States alone—not only buffer, but nurture the capacities for collaboration and compassion.

Counsellor Anita Holmes in the main hallway of Leonard Hall, built as a medical school, not the Divinity School of Shaw University.

How do we work with those social structures of faith in collaboration with government and private entities such as hospitals? Good question. That’s exactly the question that the National Academies of Science Roundtable on Population Health is addressing on March 22^nd in a special workshop exploring faith-based assets and population health. The free, one-day public workshop will explore challenges and opportunities for health sector actors that engage with “faith-based health assets.” These organizations and social structures, in the form of congregations and religious community service networks, collaborate with others in communities, including health systems and public health agencies, to improve the conditions for health and well-being. There will be voices of many faiths including Muslim, Jewish Sikh, B’hai and varieties of Christian.

Please visit the registration page to sign up for the workshop or the live webcast and visit our meeting page for more information (additional resources will be posted before the workshop).

Leonard Hall, Shaw University, Raleigh, NC.

Shaw University is the perfect place to explore this beyond the chirpy happy talk that often marks discussions of collaboration. Shaw sprung from the bitterly tough minded hope of the post-Civil War black faith, barely around the corner from slavery at the hands of white Presbyterians. They knew racism of every kind–structural, informal, legal, illegal, cultural, subtle and full-bodied screaming, complete with the strange fruit of lynching. And so they created a school. This included a school for preachers, but those preacher-students helped lay the bricks for a school of medicine. Almost at the same time Harvard did, Shaw had a four year school with a hospital on campus. That school was closed by the Flexner Commission, which was charged with standardizing medical education, but went one lap further, taking the opportunity to scrub out nearly all the annoyingly persistent and impertinent Black schools. Wake Forest, up the road with a far lesser story, made it through, so we have the $3 Billion medical center today, not Shaw. Strange institutional fruit, indeed. Yet Shaw persists in its hopeful work today as the embodiment—not of an institutional lynching—but of tough-minded, “gonna-find-a-way” equipping of the People.

Consider coming to Shaw on March 22^nd. Who knows what will happen? Who knows what we’ll be able to see together? I suspect we’ll help each other find our bearings.

Crafting life together

fullsizerender-8 It can all fall apart, this democracy thing. It’s not like gravity that makes rocks fall, even if you don’t believe in it. Democracy only lives in the mind and spirit and evaporates when we forget it. The belief that people can elect people who care enough to more or less do what they said they’d try to do rests on a fragile set of behaviors and values. For instance, that elected ones won’t lie and laugh at the same time. Basic stuff; it’s a low bar but one we have dropped below.

I was on a Delta flight to Denver Wednesday on my way to a meeting of the Stakeholder Health Advisory Council. Trapped in a middle seat between two suits who immediately turned the inflight video monitor on Fox News inches from my face. The guy on my left opened up a vast laptop with a powerpoint about the 10 things you need to know about illegal immigrants, including the “fact” that 79% of food stamps go to illegals. I’m pretty sure that in North Carolina half of food stamps go to Baptists, because half of everybody is a Baptist. I didn’t know how to begin the conversation, so I just turned on CNN. I’ll do better next time.

How do we craft a working democracy again; one where we can talk to each other? In a nation where hardly any of us came from here, you wouldn’t think that would be that hard. We are all a muddle, all some kind of mutt. My last name is Norwegian, but 15/16^th is something else. Nobody is the same, even those that think we are. All the Evangelicals and Catholics turn out to have abortions and divorces at nearly the exact rates as the liberals, who are presumed to not be Evangelical or Catholic, even though many are. We are all just doing the best we can to be decent parents, brothers, sisters and citizens, the whole time we know we are not doing a very great job of any of those roles.

Loma Linda University’s San Bernadino Campus includes a community health clinic and a stunning gateway school for high school students to begin their journey into health professions.

In such a motley group, it is important to avoid letting someone else tell you who to be afraid of. This is especially important when by any rational basis you have never actually met one of the fearsome people. I’m thinking, of course, of the many Muslim physicians without whom our hospitals named Baptist would have to close. And the many, kind family-oriented Spanish-speaking men and women who have found refuge in our city, rebuilding the south side of town with an entrepreneurial earnestness. Why be afraid of them? I’m more afraid of the people trying to make me afraid.

Of course, others want me to be afraid of white small town Baptists, who did, admittedly, vote for our current White House occupant, which I find mystifying. In my actual experience, these folks are kind and generous to any request for mercy, willing to drop anything to go build a wheel-chair ramp for a total stranger. The rural churches are naïve about the ecumenical nature of opioids addiction, alcoholism or poverty. If I needed food, I’d head to a church, confident they’d help no matter how inconvenient.

Here in gentle Winston-Salem, we had some very ugly, but predictable, outbreaks of threats against the two Muslim Mosques where our doctors worship. We don’t know who did it; but I’m sure they’ve never met a Muslim. I’m certain that, if we asked the Baptist Men’s groups to turn off Fox News and head over to provide protection, they’d do it. If they brought their wives, everyone would quickly find pull out grandchild pictures and complain about the teenagers. The kids would play soccer together as they do at school.

Sometimes, all it takes is an invitation to do better. Many of those claimed as friends of the mean have simply not been invited by to do anything else than put a dumb red hat. Shame on us for not asking more.

Jerry Winslow is the chair of the Stakeholder Health Advisory Council. He and I were together a couple of weeks ago at Loma Linda University Health’s institute for Health Policy and Leadership. Amid the heavy policy discussion we found some time to turn a gorgeous piece of maple burl and reclaim a piece of chestnut bowl I had managed to turn a hole in the bottom of. Jerry, the son of a German immigrant home builder, has been a master craftsman of wood for decades.

Jerry Winslow, teaching as always, this time at the lathe.

On Saturday Jerry took me over to the 1909 Gamble House, the epitome of “craftsman” architecture in Pasadena. It is a revelation in simplicity. Every single joint, lamp, door, handle, light, stair tread and attic beam was thought about and then crafted to express a perfect blend of form and function. The two architect brothers, Greene and Greene, were part of a vibrant global movement that saw in craftsmanship the hope for democracy, the possibility of a human culture. This was no small thing to believe amid the turn of the raw and violent century where industrial bigots had their way nearly unfettered. Something as modest as a well-crafted cottage might seem hopelessly irrelevant against the unstoppable tide of crass exploitation. But not if that cottage, or chair, or perfectly made lamp is an expression of integrity, consistent with a whole way of relationship to other people and the created order. What if such people outnumbers the mean crass ones? What if they—we—crafted a democracy?

Just a few of the billion perfectly crafted details designed into the Gamble House.

In fact, the craftsman movement was a strong signal about what mattered most, a thoughtfulness about how to live a well and worthy life. Frank Loyd Wright (a man of no small number of peccadillos) said of the movement: “Do not think that simplistic means something like the side of a barn, but something with a graceful sense of beauty in its utility from which discord and all that is meaningless has been eliminated. Do not imagine that repose means taking it easy for the safe forest, but rather because it is perfectly adjusted in relationship to the whole, in absolute poise, leaving nothing but a quiet satisfaction with its sense of completeness.” (Architecture and Machine, 1894).

It is time to craft democracy again with the same thoughtful attention to form and function as our earlier teachers lent to working with wood and home. Some of the old tools work fine, if sharpened again. Jerry still uses tools he acquired decades ago, now sharpened to a fraction of their original length. I just bought some 100-year old Sears Craftsman tools on EBay for $25. Old tools still work: Precinct 601 met in the Single Brothers House of Old Salem where democracy has been argued for a couple centuries. We elected a new party precinct chair, Kate Hayden, who looks for all the world like Bernie’s granddaughter, but knows the craft of elections. First job is to get to know each other, have a party for the party, read some books and talk like humans who are capable of caring and thinking about what matters.

I have some very modern carbide tools, too. Likewise, we need to craft to the relational technologies like twitter that are too powerful to leave to the mean and desperate. This is how I think of 100 Million Healthier Lives, the unprecedented collaboration led by Dr. Soma Stout of the Institute for Healthcare Improvement. The craftsman movement has something of the same challenge to figure out what to do with industrial machines; but democracy is played for much higher stakes than any lathe. Respect the medium; watch the density and grain if on a lathe; watch the pattern of need if crafting public policy. If you don’t love the wood or the people, go do something else.

When there was much to fear in a culture gone to mere machinery, the craftsman movement trusted thoughtfulness and beauty from integrity and the life well-lived. These democratic and communitarian values stayed alive in the culture expressing themselves later in the practical compassion of the Civilian Conservation Corps (which turned Jerry’s German immigrant father into a craftsman), Social Security, the policies favoring religious hospitals and non-profit health insurance. They crafted institutions that removed abject fear of penury from aging and made it possible to fight a skirmish, if not war, on poverty itself. Think of it as graceful joinery the Greene brothers would have liked.

Jerry’s old tools fit for the craft. “Life is not a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside thoroughly used up, totally worn out and proclaiming, “wow! What a ride!”

Democracy can all fall apart; But it can also heal and find its heartbeat. I think that is what is happening.

The meanest bully by the beach that we find so shocking today is nothing compared to the raw and untethered industrial power a hundred years ago. We have seen worse bluster fail before well-crafted policies and institutions built by people no smarter than us who wanted their life to simply be good.

They even left some tools behind that just need to be sharpened, put to the grain by hands willing to learn. Find your party precinct meeting, show up and get ready for the next cycle of voting. Make an appointment with your congressman just to tell them what you care about. Take your state representative out for lunch with a couple friends. Volunteer for a church mission committee and go find somebody to help. Plant a couple hundred trees like my brother did at his Presbyterian Church along with some Muslims up the block. Go read a book to a kid. This is how you craft a community, a culture, a life.

Let’s do that.

Thanks for the fish

Sunday morning I found myself, an incurable optimist, preaching perched on the chasm of doom, 46 hours into a Trump presidency. Green Street United Methodist is the archetype of the raggedly dogged social action church. The kind that Newt things is dead, when, actually, it’s not even tired. But Sunday was still a tough sell for hope.

The first lectionary text for the day was better suited to the more triumphal congregations; it’s the one from Isaiah, about how the light is now shining out of deep darkness. I skipped that one, muttering. Here’s the thing; nothing in the scripture helps us much right now, if the subject is democratic process. We are way off the biblical map, since the canon closed 9 centuries before the Magna Carta, 13 before European convicts settled the Carolinas, 14 before the Moravians came down the Shenandoah to what is now precinct 601 in Forsyth County. It was 16 centuries before anyone but white men could vote in anything worthy of the name democracy. Jesus didn’t vote and nobody voted for him.

So there is no relevant political guidance to found, although I will point out that there is a lot in the Bible that the absolute rulers found comforting. Every king since Constantine had their very own Christian chapel and Christian chaplain. John Wesley isn’t a lot of help either. He thought his American followers were way off the rails with the democracy thing. He opposed the revolution, supported the King and scolded all of our founding fathers for their childish overreaching.

It’s only quite recently that it occurred to any theologian that people of faith could create a democratic government with qualities of mercy and justice. And they never would have imagined that once we had it, we would let it float away on a froth of nonsense. How has the brief American experiment come to this? Especially now amid a vast tide of rootless suffering on a melting planet. This is simply beyond the imagination of any of the biblical authors except maybe whacked out Ezekiel and the inscrutable dude who wrote Revelations.

I don’t know about you, but I’m attending the Democratic party precinct 601 meeting next month. I’m ashamed to say it will be my first meeting. Perhaps you have many such missed citizen opportunities, too. Quit missing them. Programs and policies laboriously put in place over decades are about to evaporate at the clumsy hands of people who know not much of anything, much less what their actions will do those with the least capacity to absorb one more blow, one more insult, live with one more burden. Put your phone down and show up.

The Bible doesn’t help us know how to fix democracy; but it does have a lot to say about how to live without having power and even more about not needing it.

You don’t need Ezekiel or the Revelations dude at a moment like this. Head for Jesus. Look at what he did right after his mentor John was arrested by Homeland Security. Herod didn’t need to tweet his move; everybody knew his appetites and paranoia; it was just a matter of time till he went after John like someone we know went after John Lewis. Jesus was part of John’s movement, so wasn’t surprised by the arrest. When Herod made his move, Jesus headed for the hills. Then in utter vulnerability he came back down, started forming and collecting his confoundingly unexpected movement. His was not like John’s, except in its radicality. Jesus’ radicality went much farther and in a different direction than your normal righteous protest. It was marked from the first by a ridiculous amount of healing and radical generosity that made no sense. It was almost as if Jesus was declaring an end to religion, not just offering a new flavor. This was confusing from the start and unsatisfying to revolutionaries and rulers ever since.

What did Jesus find in the wilderness? In the second half of my life, I find myself going to the wild places more and more. Two weeks after the election I was in the wilderness end of the Grand Canyon down a mile from the rim near the river. On the way back up, I learned a lot as we were caught in a winter storm.

As we picked our way up the trail, we heard stone move high above us, then bounce once, twice, three times and, after a long silence a swinging sword, a sharp crack more like a cannon far below. Even through the sleet and wind, the sound cut hard with menace even though we knew the Canyon wasn’t thinking about anything but gravity.

Nature and the fundamental drivers of large scale change do not care what humans think, feel or tweet. The Colorado plateau tilted up over millions of years, draining an ocean that cut like a saw through a billion years of rock in what by geologic standards was a relative handful of years. It carved a cathedral. But, I don’t even think the Canyon knows or cares about its own beauty.

Don’t worry about the Canyon. The climate deniers will be long gone before another few rocks fall; we will all be entirely unremembered before the river cuts another quarter inch from the basalt floor. This is the natural fact Jesus would have learned in the wilds east of Jerusalem.

I think Jesus went to the wild places to remember another natural fact more preposterous than all the canyons on earth; that amid all the harshness, fragility and loss, loving kindness survives. Humans care and care for each other, even as blood, race, wealth, politics, religion and ethnicity fall like nameless stone from the cliffs. The rocks fall, the kindness survives.

What could be more obvious than the fact that everyone who has ever lived died, felt pain and knew sorrow. We know it for ourselves and we know it for all those we love, too. Bitter resignation makes sense. But generation after generation, we find lovingkindness.

Life is fragile, short and harsh, THEREFORE be radical in your love.

My Mom died a few days short of 18 years ago. She was a practical person not given to symbol. I’m more of a romantic, so when she was near death, I took her hand and asked her if she had last words for me. She looked at me and said, “no, I think you’ve got it. You’ll remember what you need when the time comes.”

Today is a time for us to remember what Jesus told us. We need it now. Wayne Merritt, a Baptist drinking buddy who taught me Greek, said that Jesus’ message was that you will know the truth and the truth will make you odd.

Jesus came out of the wilderness and gave himself to healing —and never stopped, even for the Sabbath. He said that he would stop healing when his Parent did. How preposterous; how human, how holy; we don’t know whether to laugh at him or cry for how strange that is to us.

And what did he do beside healing pretty much everyone in sight? What does he tell his movement to do? He doesn’t give them a box of tricks to win anything at all, but a way to live; And what a crazy way! How happy are the humble, those who know sorrow, who claim nothing, who are starving for goodness. Here it shifts: How happy are the merciful (not desiring to show mercy, but doing it); and so too those who are actually sincere and those who do the work of peacemaking. And, here it gets even worse: happy are those who suffer persecution for the cause of goodness, especially when people tweet about you and make things up entirely. If you suffer for living a true life of radical generosity, how lucky you are!

This, Jesus says, is what salt is for, what a light is for, what we are for.

He keeps the radical pedal down, which must have been a shock to those just looking for some free medical care or to get some demons released. Jesus said that anger is as bad as murder! Anyone who calls someone a fool commits a serious crime and that anyone who says someone is lost is himself heading straight to the fire. Recently, I happen to frequently call a particular group lost fools, which makes me guilty of both of those. I wish Jesus would be more reasonable and supportive of our movement.

But he didn’t get more reasonable; he just keeps getting worse. Don’t tell people that God will guarantee your promise, no eye for an eye, no hitting back and if the cop makes you do one mile, give them another. And give to anybody who asks anything (I can tell you that’s dumb; that’s why I ended up in the pulpit!).

On and on, page after page, without a single tip about how to beat Herod, his deeply annoying glameroti and his horrible ever-grinning children. “Jesus…..is…..impossible,” every king and king-hater has said for two millennia.

“Comfort my people, for in the darkness we have a seen a great light.” But the light of Jesus is not the light we want. It is not a way out or a way over, but a way through; a way to live day by day, year by year, even generation after generation after generation, if we have to, waiting for the promises of god for mercy and justice to be realized. And what do we do while we wait for the big show? Go do mercy and some justice, that’s what. Jesus’ promise is that you and I can live this way, The Way, the only way which gives life a chance at all.

Come and be part of the end of all fear, especially the fear of all death and all that claims the power to kill. Come and give your body and mind to The Way that leads to life. Give yourself away, every bit and you will feel the life flow where once you held tight to your little fears and hopes. Give it away, every bit. Be part of the healing and don’t start big. Before you make a big holy show of it, think of your brother, sister, former spouse or left-behind friend; go make peace with them first. Come away from the anger and scheming. Quit bargaining and holding your minor gains as if they will last. Live this way now and you will find life flowing freely, abundant, overflowing beyond all measure at all.

You might point out that, technically, it didn’t work out so well for Jesus or those who bet their lives on his words. Herod won without a recount. Pilot, two clicks meaner; he won, too. Most kings do. But take a look at the end of Jesus story.

The story of the boats and fishers is so good that it show up in all four gospels in four different ways. John puts the story in the tender days after the assassination and scattering, when the fishermen went back to fishing for fish. Simon Peter, Thomas, Nathanael, Zebedee’s sons and two other disciples were hiding at the lake north of Mt. Airy. Peter announced that he was going fishing and since nobody wanted to be left behind, they all tumbled in. They stayed out all night, and caught nothing. They headed back in, even more discouraged than when they started, except now hungry, too. Jesus watched from the beach across the early still mist and then called, “children, have you caught anything to eat?” (No, of course.) “Cast on the right side where its deeper and you’ll find some.” They netted so many they couldn’t haul them in. John reports that it was 153, which is like counting the beer bottles left on the lawn after beating Carolina. Peter, sure didn’t count the fish. Naked, he jumped out of the boat, pushing his way a hundred yards through waste-deep water to get to his beloved friend.

Jesus had started a charcoal fire going on the beach, expecting the haul, toasting some bread. “Bring me some of the fish; y’all need some breakfast.”

Listen to the tenderness of the one who calls us into a preposterous Way of generous vulnerability. This is a savior who knows we need to eat as much as we need hope; and that we need hope as much as we need breakfast.

Be as careful with each others’ hearts and spirits in these tender days as Jesus was that morning.

Jesus does not give us a way to beat the mean and violent, but neither it is a counsel to give way to the liars and schemers. He gives us The Way to not be like them. So do not let your fear draw you toward them or their way. They have no power over you and they have no power to stop you from living The Way of Life. Their castles are as froth on the waves. You are drawing from a deeper place, carried by a deeper current, that can cut through stone like the Colorado.

The healer is here among as we fish, and type and give away our lives in healing, or teaching or raising up the voice of hope through art or kindness. Give yourself to life-giving now, not later; save nothing back for a safer or smarter time. The Reign of God is at hand, says Jesus. I think he meant your very fingertips.

“Hey,” says Jesus, “do you want some fish?”

Body politic, limping

Life through the bullet holes — Sprouts find their way through the bullet holes in an old refrigerator in North Georgia. Maybe life can sprout after an election, too.

Ninety or so days from now our body politic will be on the other side of the most dangerous passage since the Civil War. (Here’s an exact countdown.) I think that Mr. Trump will have found a way to abandon the process between now and then (he’ll think of it as firing democracy). I’m not interested in what he’ll do on November 9th, but very interested in everyone else in a position of public responsibility and how we play our roles in a bruised and disoriented body politic. Every elected official in every county and town, every public officer responsible for public health or law enforcement, all of us with public roles in key institutions such as hospitals, major companies, press and religious leadership face the question: how do we do public work in a broken public body?

Our social and political body will walk with a limp. We’ll have a split mind with both sides almost incomprehensible to the other; like symbiotic twins of different species unable to find any words or gestures that are not interpreted as hostile. Forty percent of our fellow-citizens resonate to Mr Trump’s views, even if they might hope for better manners. But the intransigence could continue for a long time.

This is why we need to shift our attention from the battle, to how we live together afterward. Nobody has a bigger stake in this—or is in a better position to do something useful—than those of us working health, prevention, public health, healthcare systems. In gross financial terms, we are more than a trillion dollars of the economy, with millions of people working as nurses, janitors, researchers, doctors and the whole panoply of roles across our thousands of institutions. Those of us in faithhealth are even more relevant, because we live across so many boundaries of both faith and health.

river emergent COVER ART — Kathryn’s sketch of the many channels the Mississippi cut over time, always finding a way.

There is hardly any more possible diversity of faith and politics than inside one of our institutions, so we don’t have to go looking for someone who doesn’t agree with us. The nature of our work puts us in the midst of the most profound moments of hope (birth!) and shock and lament and sorrow on the human journey. We don’t just see the traumas. We can see many of them simmering in grinding poverty and the brokenness that passes from one generation to the next, the predictable implications of the insults of race, class and stigma.

As health organizations, we find ourselves right in the middle of the most contentious public policy issues. All of the third-rail issues run right through our buildings. We care for the undocumented immigrants (of course, we do) and the beaten up women, and the veterans with all the wounds that you can’t see. We know the eyes of those who can hardly recognize themselves because of addictions and dependencies. We know those surprised by vulnerabilities of age and the disconnections of the 21^st century family. Those of us in public health know the streets where all these patterns live and we ache with the knowledge of how much of the suffering could be prevented or buffered.

mandela cave — Sprouts find their way through the bullet holes in an old refrigerator in North Georgia. Maybe life can sprout after an election, too.

We know a lot about bruised and broken people. Now we need to focus on our role in a bruised and broken body politic. To heal that body requires a new humility in our language and a quiet tenacity in our work.

Gene Matthews, now faculty at UNC School of Public Health, spent many years as the General Counsel for the Centers for Disease Control, many of them working for Dr. Bill Foege. I also worked for Bill at The Carter Center, so when I came to North Carolina a few years Gene reached out to me. Gene introduced me to the writing of Jonathan Haidt and his recent book The Righteous Mind, which turns on very bright lights on the way to much healthier public dialogue about the things that matter most. Haidt, a professor of moral psychology, says there are six “moral intuitions” that function like taste buds for all people. Liberals (my people) tend to have a taste for caring and fairness (meaning equality) which we prefer with a touch of liberty. Conservative have a broader pallet, which includes caring and fairness (to the surprise of we liberals). Conservative have an equal taste for the virtues of liberty and also loyalty, respect for authority and “sanctity.” This last one is not just religiosity, but a sense that some things are sacred and deserve protection. Haidt argues that conservatives—and conservative political movements—have an advantage in that they can appeal to all six, while liberals aren’t even trying on three of them. This was true at least until the Democratic convention last week with all the flags, religious singing and Mr. Khan whipping out his pocket copy of the Constitution.

It’s not a perfect book. Haidt wanders off the rails in his description of religion as a kind of social Elmer’s Glue. As much as he values sanctity, he left the whole field of faith somewhat less than sacred. And he takes some odd detours to pick an argument with Kant. You can skip those parts. But don’t skip his core gift to us, which is a hugely helpful framework that helps us see and talk across our otherwise impossible divide.

Haidt argues that we humans are prewired for righteousness so deeply that we can sense these six moral flavors intuitively way before we shape logical moral arguments. This is basic to how we humans form highly complex social bodies far beyond the simple ties of blood and clan. And this is also how we can map the pattern of traumatizing bruises which mark our body politic today. And this is how we can see the need for urgent humility by which those of us in positions of influence in our complex human body can create a new pattern of deep listening and dialogue about the things that matter most. Haidt begins and ends his remarkable book by quoting Rodney King’s immortal question, “can’t we all get along?” Less quoted, but not overlooked by Haidt, was King’s follow-up counsel: “we’re all stuck here for a while, so let’s try to work it out.”

Some think our only common language is money—what things cost and who should pay. I’ve even watched churches collapse under the heavy and highly visible hand of economics squeezes the air out of otherwise adult discussion: “be realistic and act like a business.” Health organizations often succumb to this even though our daily life is filled with evidence that when life hangs in the balance, money often matters the least. What we actually have in common is not money, but the human journey of health, frailty, dependence, pain and the fear of pain, loss and the fear of loss. What we actually know is how our life is shaped by those we share it with, those who care despite all boundaries of blood and coin. This is why I think those of us in the health fields–including the massive number of community and faith partners—are in such a profoundly key role in this moment when our body politic suffers so deeply. We can understand each other because we are all on the same short and fraught journey.

SONY DSC — The first celebration of July 4th was held in Old Salem while George Washington was passing through. It’s reenacted every year as a service of prayer for peace.

One thing health people know is that words are not enough. Words are not even the beginning and they are hardly important at all at the end. We may need Haidt’s counsel to talk among ourselves and then again when we have the chance to explain ourselves in public. But most of the time our eloquence is quiet. We keep our doors open to anyone all day and night. Despite the fabulously expensive technology and astonishingly prolonged training of thousands of staff, every non-profit and faith health system gives away tens of millions of dollars of care every year on purpose. We are required to do so as part of public trust, but most everyone of us goes well beyond the minimum bar. This passive waiting in readiness kind of witness is part of the glue that holds society together, that defines us as a moral people at all. It is good, indeed very good. And it is not enough for this broken moment. For we know we can be proactive with our mercy; we need not wait, we know better.

The Stakeholder Health book, “Insights from the New Systems of Health,” looks like a kind of textbook based on our collaborative learning; and it is. I expect dozens of courses to use it in the next few years (TC and I will be teaching one ourselves at Wake). But more than a textbook, it is a collaborative witness that is map for healing out social body. Its 44 authors wrote about the social drivers that shape the health of people and neighborhoods. They wrote of population health as the common ground for those professing public health and those running healthcare organizations and hospitals. The book did not quite say the obvious and most profound thing. The social body itself is bruised, but resilient. The social body itself is defined by biological, psychological, social and spirit aspects, inseparable as the facets of an emerald. The social body itself cries out for the practical, on-the-streets intelligent love found in the daily walk of community health workers. The social body itself thrives when generosity is humble and smart.

This is already happening all over the nation and world everywhere I look. The wild organic sprawling testimony of 100 Million lives is hitting on all six of Haidt’s cylinders. There was not a syllable in the Stakeholder book that you could not go and see on Monday morning. We were describing, not imagining.

Even in fractured North Carolina the heart of the body politic is beating even as the political bruising continues. Every single day I see a truly astonishing level of serious collaboration quietly crossing over all the supposedly impossibly treacherous chasms. Competing hospitals share data and teach each other about how to come alongside the poor. Black, white, liberal and conservative Baptists are working together on the meanest streets–some paved, some not. Republican sheriffs and way liberal Hispanic activists are quietly helping each other keep faith with all six of Haidt’s moral intuitions. With just a little bit of humility and decency very different kinds of people find a way when the work is about real people. That’s the NC Way.

Haidt would ask us to describe our work and witness not just in the liberal flavors of care and fairness (as we usually do). We could—and thus should—embrace a more robust and compelling witness that resonates with the broader values that honor the sense of loyalty so typical of healthcare teams, the sense of respect for authority of many kinds that govern the practice of medicine and public health.

And we should claim in humility our deepest intuition that our work is sacred because we humble ourselves before the ultimate human mystery of life and death and the life of the common body that goes on beyond us all.

Dawn over Winston-Salem. It happens every day, if not always this pretty.

New systems of health

Sometimes when you’ve been walking a long time you forget how far you’ve come and far you can see from the crest. This happens more in the folded and forested Blue Ridge than in the wide open west. But even there above the tree line where it seems you can look right around the curve of the planet, you still have to remember to look up and notice the view.

That’s what I felt when I held the new book Stakeholder Health, Insights from New Systems of Health. It is collaborative learning at its best, edited by Teresa Cutts and Jim Cochrane, two synthetic thinkers who make everyone around them smarter. They were surrounded by 44 authors who were already pretty smart, but together the voice is brave and sure.

Dr. Teresa Cutts at the Rolling Release of the book at Chicago Theological Seminary.

In a time of fear and anxiety, Stakeholder Health writes with collective confidence that we—a very big we—are already well on the way to being new systems of health. We are certainly far enough along the way that we can see what we have to work with: a deep well of tested intellectual tools, street-smart tools for mapping community assets, clarity about the powerful integration of body, mind, spirit and social.

What is new about the new systems? Nearly everything. The new systems are marked by realizing they are systems, not just structures. And we are systems of systems interwoven in complex ways that are impossible to map neatly. But the chapter by Maris Ashe describes the tools we are finding useful in living into such complexity. The next chapter (not as smart, but not bad)(I led the writing team) describes the new ways of leading rapidly emerging in the upper reaches of hospitals today. The next, led by Dora Barilla and Eileen Barsi dives deep into the electronic connectional apparatus, which is how these sprawling systems find coherence and get work done at very large scale. Information technology (IT) is giving way to Relational Technology (RT), which changes everything.

Kirsten Peachey, of Advocate Health Care, outlining the chapter on Integrating Care to Improve Health Outcomes: Trauma, Resillience and Mental Health

The next three chapters are a sweet suite on intellect and testimony vibrating with hopeful, practicality. Nancy Combs of Henry Ford Health led the chapter looking through the lens of community navigators and the radicalizing affect they are having turning the new systems of health inside out. Teresa Cutts (“Dr. Honey” in our home) led a global quality team laying out the extraordinary depth of logic and practice allowing up to map community assets with as much rigor as we’ve long had to map needs. This chapter by itself will change the future of “community benefit” and its tame model of Community Health Needs Assessment. The chapter on integrating trauma, resilience and mental health, led by Kirsten Peachey, will likewise radicalize the thought and practice of “integrated health.” The three chapters together are positive bombshell with energy and intelligence released because of who is in a position to act on the new synthesis. It is profoundly good news, except for the old in-bred guilds trying to hold their power.

Kevin Barnett led the team building the case for a new financial accountability; indeed, a whole new financial logic that synthesizes all of the above so that we are a whole new business—health, and at large scale. This is taken to another radical edge by Doug Easterling and Alan Smart’s chapter on philanthropy. Between the two chapters, we can for the first time see the flow of money at the level of the whole system called health. We can begin to see how the old patterns of tame complicity can be cracked open to let the money flow through to the biggest opportunities.

Jim Cochrane led the writing for the chapter that puts all this American chatter into global context and thus accountable to world class intellect and practice. So much of what is old and creaky in our systems is peculiarly American; so much of the new now emerging is global. This sets up the chapter led by Jerry Winslow – a global citizen who happens to live in California—on mission and the heart of healthy community. Every bit of the book is a call to bold mission, not because of who started them, but because of who needs them—the world that God so loves. All the science, technique and technology fit the work of mercy and justice. Let it roll down.

Even the appendices have some bright lights where you wouldn’t expect them! The first appendix lays out the learning journey of Stakeholder Health, which began in a blizzard in Memphis, turned into the Health Systems Learning Group and found our way through an extraordinary array of learning experiences. I don’t think any of us realized how many steps we had take to the get to the the view (hence the mountain metaphor above). Appendix two is a rich collection of population health screening tools, sure to help many hospitals—and no small number of graduate students. The last appendix has numerous mission and vision statements new guiding hospitals and religious bodies in the field.

The book is in a “rolling release” in Chicago, Winston-Salem and next Tuesday in Oakland. Each bounce gives voice and visibility to the local authors and engages the networks most relevant to the local institutions. You can track it all, of course, on the stakeholderhealth.org website.

Most of the authors work for one or another of the new systems of health, so there is optimism but no happy talk. Most of the new systems are surprised to learn they are new because all of us spend the vast majority of our working days engaged in very old problems. Even when you are near the clearing at the summit with the great view, you have to watch where you put your feat rock by rock or you’ll hurt yourself. I happen to know that is true. The caution is not the whole story, however. It is significant that those of us inside the beast(s) can see the new emerging.

The book will be available for free download chapter by the chapter on July 1, which makes it a kind of textbook likely to be integrated into courses of many disciplines. And it is also available now to purchase on Amazon for $19.95. Just click here. Today.

CS010816-050 (1) — Rev. Francis Rivers, the Faith Health Division’s lead organizing an Identity card drive for the Hispanic/Latino community. Part of what is very new in our New System of Health

The cover picture was taken on a chilly morning in Winton-Salem where one of the New Systems of Health—our own little Wake Forest Baptist Health—found ourselves in the position of having done something really smart and right. We had lent our name, presence, religious voice and political weight to a program offering validated picture ID cards to hundreds of undocumented Hispanics. They were part of the new system of how our city works and who mattered. They honored us by trusting us enough to show up. We were helping each other find our way into the future we were already partly living in.

That’s why that gorgeous picture is on the cover: we are far enough along that we can learn from the journey, pause and testify that we’re on the right path.

Runaway heart

My daughter Lauren is about to give birth to my second grandson, which, with her sense of dramatic timing will probably happen on Mothers’ Day. This also kicks off Nurses’ Week in hospitals. My wife and my (now former) first wife are both clinical professionals and moms. Most of my staff in the FaithHealth Division are women and the men are in touch with their feminine side or they couldn’t do their work of care for the bio-psych-social-spiritual dynamics of the thousands about whom we care. For ninety years our largest partner–the NC Baptist State Convention–uses Mothers’ Day to collect an offering for our most vulnerable patients.

So I’ve been thinking about the expansive caring going on; and the unknowable, but real limits to our reach.

Last Saturday it was my turn to lead the Medical Center’s daily “safety huddle”—the mundane miracle in which every operating unit of the health system from chief medical officer to security to food services and everything in between gathers to report on whether each of us has an event, concern or need to report. Even if we don’t, we have to say so out loud to our colleagues. Usually it moves fast, but sometimes it just stops the heart. Someone reported a situation with a runaway kid who had been compelled to come to the ED by her mom, who promptly run away herself, leaving the kid in our care. Except then the kid ran away from us, too. Everyone hurt hurt. We all dealt with our sense of profound limitations even when the 14,000 hospital people were multiplied by the police and social services. I couldn’t get it out of mind, so the next morning slipped in a prayer amid all the operational chatter:

As Jerry Winslow has noted, it takes a lot of sawdust to find the second life of a tree.

“Mother God, we pray today with thanks for the big heart and strong muscles you have given us so that we might be healers amid so many lives. Every morning we see how big a family of colleagues we have that is constantly present to do what is possible for all who come. Today we pray for all events that raise our concerns for all the needs we cannot satisfy that we cannot get out of our minds, hearts and bones. The runaway kid from yesterday with the runaway mom who left her. All the husbands without words sitting next to their wives with cancer about to leave the whole world behind. All the people who have lost their way to any hope except for the medical miracles that lie beyond us, too. Keep our hearts tender like a mother for all that love lets in. But keep it beating and open for each other and your great spirit so that we might be smart, gentle and kind for this one more day.”

The first cut through the pith lays open the astonishing grain of the burl.

The British Medical Journal has been thinking about this, too, although in grim language of “multimorbidity:” “Across the world healthcare systems are struggling to cope with increasing demands and costs. Rising life expectancy has been accompanied by an explosion in the prevalence of long term conditions and multimorbidity.

“Clinicians are working within legacy systems that were developed to deal with 19th century problems—they provide specialised responses to acute illness and infection. At the same time daily practice is strongly influenced by an ever expanding array of disease centred guidelines that don’t map neatly to the realities of clinical practice, in particular the ubiquity of multimorbidity. The result is fragmented, poorly coordinated health services for those most in need—vulnerable patients with multimorbidity. Today’s healthcare professionals are faced not only with rising disease-disease, drug-drug, and disease-drug interactions in multimorbid populations but with the increasingly evident consequences of socioeconomic disadvantage.

The rough and twisted bark hints at the pattern.

“Meanwhile, patients, their families, and their extended social networks experience not only the burden of symptoms but the burden of treatment. This is an emerging but underi-nvestigated phenomenon. It has received increasing attention recently, and interest has been growing in how to define and better understand the concept.” ( (BMJ Published 10 November 2014)

We could join the public chorus of complaint and rage about what the world is doing to us and demanding of us, as if expanded life span were a mean trick on all of us. Or we could work on what lies between us, the weak ties that could be strong, the empty spaces that could be filled with compassion and carefully tended connections. Even in our mean and stupid time, we are witnessing the dramatically hopeful emergence of webs of trust where you’d think they would be impossible—North Carolina, where you can’t even pee without the government telling you how or where. Good grief. But even here—maybe especially here, where powerful elites have told stigmatized and despised people where they could drink water and pee for generations—webs of compassion spring up on the bitter soil like desert blooms in random rain. Don’t ever be surprised by what a privileged but anxious elite will do badly. And don’t ever be surprised by the fruits of compassion, either. That’s what we are coming to call the North Carolina Way and it is big, strong and unafraid of tough neighborhoods and runaway everything.

When I hurt myself last June, I was drawn into being a partner in the healing of my own body. I have been learning in wonder how we – even me!—are made for healing. Of course we are, since we are also made to be bruised, wounded and broken. All of us, sometimes at others’ hands, but usually a mélange of our own mistakes along the random human way. (That dumb overreaching tennis decision wasn’t my only one!). I’ve been learning to turn wood on a lathe as I healed and found myself drawn to the wonder of hardwood burls, the growth that emerges where a tree has been broken or violated with some sort of trauma. The wood in the burl has a weirdly complex grain pattern, twisty, dense and wondrous. The mysteriously beautiful grain reduces me to respectful awe as the smooth cherry takes a beeswax polish. I think, of course, of Lauren’s pain and that of every woman in my life, of every nurse in every hospital, of every broken heart that manages to stay tender to the pain of the world.

No mom I know stops at the pain. They lend their life and every fiber to what remains possible for those they love. They never cease forgiving and hoping. They teach us not to stop at lament even though so much of what we see is deeply lamentable. They teach us that compassion is the heart of prophesy, of lovingly holding up what remains possible for each person, neighborhood and peoples alive.

The burl is what grows around the trauma experienced by the tree.

Mainsail

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. (http://stakeholderhealth.org/cdc-community-health-improvement-navigator/).

salamis The 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!

krusenstern_mainsails — 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.

ship A 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.

Faith with

Across the street from The Garfield Conservatory, a block away from the L, a gaggle of geese find their away amid the urban mysteries. — Across the street from The Garfield Conservatory, a block away from the L, a gaggle of geese find their way amid the urban mysteries.

There were years when I was across the ocean that I would tell people I was from Canada to avoid explaining US politics. People in more normal countries dumbfounded my people would be found dumb enough to vote for a California actor obviously reading someone else’s lines to fill the most intellectually demanding job in history. Some Americans still talk of him with reverence, which is hard to explain. But since we elected our Harvard lawyer, it’s been a lot easier to travel.

Its not any easier being a Christian than an American. I work in fields with lots of science going on so am occasionally held to account for my faith. Nobody cares enough enough to hurt me for it, as in olden days. But for those who otherwise like me (sometimes including my children), it bears explaining how an apparently intelligent person would identify as a member of Jesus’ or any tradition of faith. Like claiming Canada next door, it is easier to say something vaguely ethical rather than saying I go to that most odd of all human assemblies, a church.

Francis has helped. But even in a week in which it would really hard to screw up being a Christian, we have had nutters from Arkansas chattering away near microphones embarrassing generations of Christians. If Francis watched any TV while he was here last week, he probably thought about taking his robe off to just blend in with the homeless.

We think of programs as independent and accountable, but actually they weave, influencing each other and shaping the whole. — We think of our traditions and learning groups as independent and accountable, but actually they weave, influencing each other and shaping the whole.

I think of our traditions—mine being Christian—as learning groups more than knowing groups. My most powerful relationships are like that, such as the Africa Religious Health Assets Program (ARHAP) led by Jim Cochrane, Steve DeGruchy, Paul Germond and now Jill Olivier. A whole literature has emerged from its thoughtful journey, now thousands of pages. Groups don’t learn in a straight line and sometimes wander into dead ends (especially when they put on conferences with papers). But if we keep our learning grounded, we can find our way back out. AHRAP accumulated epic stories of finding, naming and mapping. But its most useful tools are those for optimistic searching (such as the assets mapping now about to be trusted by hospitals, public health and community partners in Tacoma).

That curious community spun off another one pursuing just one of its questions, about the Leading Causes of Life. Those Fellows cross the strangest boundaries of intellect and miles, as great questions always have and will draw us.

Stakeholder Health was originally the “Health Systems Learning Group” and remains useful when in learning mode. We’ve are drawn to the questions that lie in between hospitals and their neighborhoods, borrowing and bending the language of clinical, public and population health. The questions look technical, but draw us into deeper waters.

Technical kinds of answers are not the most interesting or obvious thing being learned. Along the way we have been learning about the defining characteristic of our group—most of us as both individuals and institutions were of faith. But not all of us are officially faith-ish, which is what makes the whole group so interesting. We’ve talked and sometimes argued about whether Stakeholder Health is “based” on has “faith.” What we mean by those words? Is it important? Does Henry Ford Health System have enough to count just because it has among the very largest network of faith community nurses in the nation? It reflects the man named Henry Ford, not Jesus, but sustains an often sacrificial mission finding innovations where a mere corporation would flee. What’s the name of that driving spirit? Most hospitals with religious names on their buildings don’t think or act any differently toward their patients, neighbors or employees—and many much worse—than massively profitable Cancer Centers of America. But some do find the wells of compassion to give their life away decade after decade. Iconic little Bon Secours in West Baltimore sure does and, yes, those are nuns all over that history, just as surely as the Pope is Catholic.

Many of our organizations are now merged and morphed—Brooklyn Lutheran part of staunchly secular academic NYU. The blended hospital and medical school called Wake Forest Baptist Medical Center will discover the cure for cancer before we figure out what to do with that middle word in our name. These complicated relationships are being carried by what we are learning, not by what we are based on; faith more like a sail to catch the spirit than anchor to hold us back.

We are who we walk with along our learning way. (Kevin, TC and me. Jim Cochrane holding the camera.)

People from outside hospitals notice that interesting things are happening inside. Peter Berger edited a special edition of “Society” looking at the complicated dynamics of faith in modern hospitals. Some of the pieces are not brilliant, even borderline snarky. But Berger’s introduction is tantalizing as he speaks of those of working inside the places: “They cope with reality in both secular and religious terms and they find ways (not necessarily coherent theoretically) of applying the two discourses in different parts of their lives. Is that feasible? We already know it is. The interesting question is how it is done! The question suggests a fascinating research agenda.” (Society, October 2015, Volume 52, Issue 5, pp 410-412)

Last week the learners of Stakeholder Health convened in the Garfield Conservatory in West Chicago, which for more than a century has protected space for the flowering of learning about plants. Its human story is as exotic as the plants, especially how they won’t quit when surrounded, literally, by gangs or rapacious politicos. Or when only a year after the massive dome was built, thousands of panes of glass protecting the tender palms had to be replaced because the wood frames were rotting (cheap wood). You’d think God would protect arboretums along with fools, but it turns out not.

It often takes a learning community decades to flower, especially when the questions outlast the curious. Jerry Paul, who led Deaconess Hospital in St. Louis and then its equally faithful foundation, formed when the hospital was no longer needed and lent his intellect to the founding of ARHAP, died suddenly in May of fast-moving cancer. Steve DeGruchy died in fast moving water before he even wrote his real book. Larry Pray has lived through another and then another and another stroke stealing his memory even as his spirit is defined by poetic appreciation for life. I’m not so young myself.

Faith is a fellowship, not just a bundle of ideas; marked more by with, than what.

We find life in the questions that outlive our answers.

We are defined by those with whom we seek.

We are what we find in each other.

We are what we think about and how we help each other learn.

We are what we ask of each of other.

We are what we notice in other groups also finding their way, by how we lend and borrow.

We are not the first or smartest humans to do all this.

We find nobility in humility before faith and its mysteries, complicities and community formed and still forming across the years.

It’s Sunday morning after the two big storms have passed; I think I’ll head up to church.

Improbable Lessons

This palm was planted at the Garfield Conservatory in 1926. It takes time and tending over generations to get something like this. — This palm was planted at the Garfield Park Conservatory in 1926. It takes time and tending over generations to get something like this.

Between Pope Francis and the nine Charleston “Saints” whose deadly witness held us just as rivited a few months ago it is obvious to all that faith is not synonymous with stupid, mean and irrelevant. They are helping us see through the stars, bars and blather to something real. If you need forgiveness, intelligence, mature compassion, it is a reasonable idea to look toward an institution where faith has been nurtured over a few centuries, or, in the Pope’s case, millennia. If something lasts longer than one lifetime, or even a season in one lifetime, it is likely that there is a tradition involved, ecology not just of one, but many institutions. The Pope, for all his evident virtues, did not invent or elect himself to the role of Pope. The very institution that has been so egregiously, yes, criminally, complicit with some of the worst imaginable abuses of power and privilege turned around, found its best possible self and—who could imagine it—found a guy to fill the role that has electrified the nuns, nones and nearly anyone with a heartbeat. The Saints of Charleston who died–and the hundreds more that lived to forgive–were not a random gaggle of what really good people, but a fellowship born and formed with those easy-to-dismiss rhythms of bible study, song and prayer that turned out to be—when tested on a horrible afternoon—to be stronger than speeding bullets.

The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabious, CareNet and Ron Mandershieim on integrating Spirit into Population Health. — The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabius, CareNet and Ron Manderscheid on integrating Spirit into Population Health.

On Wednesday a small group of experts in behavioral and population health gathered at The Carter Center (named for a Baptist deacon who knows about formation even unto the edge of death). The “we” included Ron Mandersheid and Ray Fabius, who has literally written the textbook on population health (second edition!) before most of us heard the term at all. He was with us after gaining specific permission from his mom so that he could travel on Yom Kippur, a day held sacred across not two, but four millennia and counting. Why? Because the subject was how to integrate the sacred, the Spirit, into the work of behavioral health as it is integrated into large-scale population scale programs. One of the questions alive in the room was how to accelerate and shift “health” from being all about disease and preventing toward the positive dynamic we hope for.

What does “faith” know about that, given that from the outside, the institutions of faith seem to be mostly about not doing things? What does faith know about life that could be integrated into—maybe even illuminate—population health? The answer isn’t in the tricks of faith-based behavior modification that drizzle a bit of ritual razzle-dazzle over the dreary goop that “wellness” programs use. It is about the practices, disciplines—traditions—that shape we humans over the complexities of life together on this spinning and wobbly planet. Those traditions help us adapt to unpredictability, with a huge toolbox relevant to failure, forgiveness, resilience and hope. And the traditions themselves adapt—as Pope Francis is modeling in real time brilliant humility.

Dr. Kimberly Dawn Wisdom of Henry Ford Health System is one of the springs of intelligence within Stakeholder Health.

While the Pope was doing his best to tend to America’s soul one Speaker at a time, the leadership of Stakeholder Health was working in Chicago, where the FaithHealth movement was born, reborn and reborn many times, with another FaithHealth infant in the birth canal as I type. Stakeholder Health is a learning group of those who are living institutional lives, trying to find the shared intelligence, courage and community needed to nurture another round of transformation. What we want to learn the most is how to find and release the deep practical nobility found in the birth story of these hundreds and hundreds of faith-inspired healthcare organizations. Stakeholder Health includes a number of institutions that are not faith governed. Some of those, like Henry Ford and Nemours, spring from the social conscious of a vastly wealthy industrialist; others like ProMedica, MultiCare or Kaiser, express another community of social imagination. But all of us know we are drawing on more than our own toolkit of techniques and clever people. And we know we are doing so for a greater purpose than ourselves. All of us have an ear for the inconvenient cries for mercy rising up from the streets and neighborhoods we were born to serve. We know—as does anyone who has ever attended a church committee—that our institutions are deeply complicit with the banal evil of every status quo. Yet, we also know they are capable of nobility and of giving the moral energy of thousands of employees and their partners a chance to express itself at a scale unimaginable by one, two or a group of individuals.

This is what a man looks like, paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: "don't tell me you're too tired." — Levon Stone is what a man looks like: paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: “don’t tell me you’re too tired.”

We heard about the miracles born of wrenching change—the closing of Advocate Healthcare’s Bethany Hospital—with angry wounding community protests about broken trust. Out of which came the Advocate Bethany Community Health Fund, structured for transparency and partnership, to steward a million dollars a year into carefully defined West Chicago neighborhoods to strengthen the non-profit and faith organizations closest to those tough streets. We heard the radical simplicity of CeaseFire Chicago, which blends the power of ER chaplaincy (embodied by Richard James) with the brutally won integrity of one who has lived the life of violence and its paralyzing fruits (embodied by LeVon Stone). The “golden hour” is that which follows the bullet’s impact, doing all to break the cycle of retribution. If not forgiveness, maybe grace, at least resilience. It doesn’t always work; but it is almost the only thing that does work.

Dr. Carrie Nelson and Dr. Bonnie Condon unpack the complexities of aligning thousands of physicians for the health of the community.

And we learned from Dr. Carrie Nelson of the mammothly hopeful and excruciatingly complicated task of turning 4,500 Advocate Health physicians toward the work of health in exactly the same way that got Ray Fabius on the plane to The Carter Center. How exactly does that come to be, not just outside the walls of the hospital, but also outside the doctors’ exam rooms and maybe even on the streets in between?

We learn of each other’s best attempts, still caught and partial, filled with frustration and inertia. We become braver, not just smarter. We look at our little lives and decide to risk our reputations as professional grown-ups on things that have never yet worked before. So, all across the vast warren of Chicagoland streets, dozens of hospital are working together to coordinate their community health needs assessments, struggling with the insane arcana of cleaning and aligning data so it can be made coherent at large scale (sort of like making oil and watercolors blend in one painting!). It seems just impossible. But then it is possible, at least enough to encourage those in the heart of it to try a bit harder, to invite a few more partners (let’s paint with acrylics, too!). It isn’t smart enough, yet. But certainly wiser than anything ever before.

Even naming a collaborative learning document with seventy authors is hard! Stakeholder Health will find a way.

There are some thing that one can absorb by listening and others that only become known through the laborious process of writing. And some by the even harder process of collective writing. Stakeholder Health is working on a second “collaborative learning document” that can help us name and claim the land we are in now. We wrote the first before the Affordable Care Act had passed through the valley of shadows known as the Supreme Court. We are in a truly new place drawing hospitals over their institutional moat and public health into partnerships only dimly imagined (with hospitals????). Stakeholder Health knows that one of the greatest and most hopeful unknowns is whether and how the quiet innovations among congregations and faith networks can be woven into the fabric. Like weaving behavioral health and Spirit (surely, we can do this!), weaving congregational intelligence and energy looks obvious until one tries. Even in Memphis where it has been nearly institutionalized, it has failed to become adapted across the full spectrum of competing hospitals (or competing faith ministries!). We need to learn more and far more quickly about integrating the full spectrum the hopeful arts of faith and health. So we are writing a not-book quickly emerging from the field, ready for the field with ten (or is it 11) chapters marking our learning edges.

This is holy and profane work, the only kind we get to do on this planet. It is the only kind any humans have ever hoped to do. We think in these days of Dr. King’s hopeful counsel about the arc of history bending toward justice.

Martin Luther King as a potential student to Colgate Rochester Seminary, long before he came to know of arcs of history and mountaintops.

Gene Matthews, who was the General Counsel for the Centers for Disease Control ended the recent meeting of the NC Citizens for Public Health with the quote behind Dr. King’s quote. Among his genius was King’s eye for the shards of wisdom born of previous battles, this one given in 1853 by Theodore Parker to a Congress on Abolition, an earlier chapter of the work still calling us beyond disparities: “I do not pretend to understand the moral universe;

The arc is a long one, My eye reaches but a little ways; I can not calculate the curve and complete the figure by experience of sight; I can divine it by conscience.
And from what I see, I am sure it bends toward justice.