boundary leaders – Page 2 – garygunderson Blog

Potbound

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

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

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

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

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

Pot bound.

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

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

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

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

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

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

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

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

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

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

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

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

Lost bee, found bee

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

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

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

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

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

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

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

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

Soul sick

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

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

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

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

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

I am sick to my soul.

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

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

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

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

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

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

Social, now

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

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

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

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

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

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

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

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

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

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

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

That the power of the social.

TGP

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why not you and me?

Love finds a way

Celeste Wray a spirit warrior who belonged to St. John’s United Methodist church in Memphis, Tennessee which has seen its share of evil and evil overcome. She fought every good fight with grace.

On Memorial day we often think of those who gave everything so that others could enjoy the normal pleasures of human life, especially the love of family. It has also become a day when loveless political bullies bluster at some already-stigmatized set of people unlikely to hit back. Their cowardly ugliness hardens our social spaces and hurts people who have already been hurt by their families. It continues partly because they rarely go after groups that can’t easily hit back. They don’t attack older white heterosexual married hospital executives. Or ordained Baptist ministers. Like me. I recently presided at the wedding of two kind women whose hearts had found each other. Why would they be attacked and not me? Because bullies are weak, the kind of people the heroes of memorial day faced down.

I wore the robe and read from the Bible my mother gave me upon my ordination:

“You can see, feel and hear that the whole universe sings, hums, buzzes and claps its hands on this happy day. We signed the North Carolina State marriage license before the ceremony to get the government out of our family affairs. So why do a marriage ceremony at all? The State permits love, but only a sacred event with family and friends cements it.

“We know that some in our hard-hearted world think that these two lovers should not even hold hands, much less be joined in matrimony. So it is important that we support their love for each other from this time forward.

“These two wise and thoughtful women considered their decision carefully; they do not need any wisdom from me about how to live their lives or give themselves faithfully to each other and the world. We can see they know this.

“It important for an ordained minister of the Gospel of Jesus Christ to grant sacred blessing to carefully considered committed love. There are those who would not; those who fear the overflowing love of a wildly abundant God. But if we did not celebrate this love as holy, true and sacred, the rocks, trees and earth would cry out and sing instead. This love and this marriage is of a loving God who has made us to have love and then make commitments and keep them so that love matures over decades as a gift for each other and for each of us who are also blessed by their love.

Reverend Mark Stephenson is the South African Methodist minister who presided over the marriage of TC and me.

Anyone could see their natural kind way in the world. They grow things, repair things, clean things, bring stuff into order. They give themselves in labor and skill. They are thrifty, kind and wise; and better at everything because of their union. This is obviously a union made by God, even if some of the family was still getting used to the idea.

I pronounced them married. What God made One, let nobody and nothing separate, especially some loveless bully who wouldn’t know love if it walked up and kissed them on the lips.

We did the wedding in the backyard of our home shared with six hives of mostly girl bees– 150,000 sisters who provided the mead with which we celebrated over dinner

We need lots of love.

TC and me in the Monadnock Room (overlooking the mountain) the day before the wedding. The actual day was marked by heavy rains which are acknowledge in most cultures as a sign of great blessing.

Last weekend TC and I were in New Hampshire to dance at another wedding. Like most love, it was improbable and inevitable. This woman and man had been so bruised by earlier marriages that they had given up on love entirely. It fell to their children to encourage them to try again. And love found a way! The wedding ceremony lasted at least three hours with all that Irish, Indian, Bhai, and random 21^st century meaning-making had to offer. Fire, flame, music, bubbles, knots, turmeric, dance. We didn’t really need any of it, as there was no possibility of missing the light of love between this man and woman shocked to find themselves loved and cherished by one another. Thank God their kids didn’t give up on them!

There is no way to out-bully bullies. I may be best to ignore them; starving them of the attention and fear they crave. Only their children can reach them, after all.

But it would help for those of us they are not likely to attack, to speak up for love. Especially those of us who they think look like people who agree with them. Instead, we should encourage every bit of every kind of committed love it is possible to nurture, bless and protect.

Love finds a way.

Rev Dr. Christoph Patrick Bounds

The life of Reverend Dr. Christopher Patrick Bounds doesn’t fit in a blog; it hardly fit into Memphis! He and the Bounds brothers once opened for the Temptations on Beale Street and he knew the labyrinth under those streets working with public works department. And, oh my, did he do public work as the soul of the “Memphis Model.” He and Dr. Bobby Baker built a meshwork of trust in a city with almost none, certainly none that crossed over the broken boundary zone between the powers, principalities and structures of faith that kept dreaming of mercy and justice decades after Martin preached his last sermon down the street at Mason Temple.

I knew only a shred of this great life. Technically, he worked for me as a chaplain at Methodist LeBonheur Healthcare, but I was never confused about who knew what to do and why. He and the Reverend Dr. Bobby Baker once took me to breakfast after the Congregational Health Network was rising up from the delta mud; they told me I needed to hire more white people to balance the risk of the work being dismissed and targeted as just Black: “surely you can find some!” Chris lent his considerable store of trust to CHN, Methodist Healthcare and me. He once took me to preach at the Historic First Baptist Church of Millington (the white people named their later thing First Baptist, too). The congregation had come for church and found me in the pulpit; they were skeptical based on a few centuries of history. Chris explained in his introduction that I talked softly and, frankly a bit oddly about the leading causes of life; but it was worth leaning in and listening.

Dr. Bounds was never surprised by the ugly claws of injustice. He closed the door of my office and told me that while he knew I was a liberal and did not have room for Satan in my cosmology, I was dangerously exposed without some way to understand that chaos fights back when justice and mercy begin to rise up. It did and does.

He was the lead chaplain at University Hospital which put him inside rooms where justice could be carefully titrated and found inconvenient amid the pressures of big time healthcare business. He spoke in clear language that ripped the veil when quality wonks spoke of gross disparities as “opportunities.” We found, somewhat surprisingly, that our data showed equal treatment inside the ER; but that Black men died on the way at shocking rates. And the hospital had trouble keeping track of the ones that survived. Chris said these were his brothers and that they were dead.

It is hard to live with such clear vision and a heart of mercy. He was one of the few Black preachers to preach white funerals, including one for a recovering alcoholic chaplain. Their love for each other was a beacon fire in a dark land.

He spoke life in places that only spoke death. He preached leading causes of life in a funeral that released a family full of repressed anger and grief. The deacons and lawyers had to protect him. He warned me that these leading causes of life were a lot more powerful than they look.

TC and I got married in South Africa but with a blessing of the marriage on Mud Island in Memphis. Chris did the prayer which went on for quite some time. Several minutes into the prayer we realized he had wandered off into supplications for the Affordable Care Act, which somehow seemed appropriate given the many tribes attending. Pastoral love and politics were never far apart in the eyes of Dr. Bounds.

When I think of—dare I say brother—Chris, I can think of many times he spoke the urgency of justice. But I can only remember him with a smile and gentle eyes that did not give up on anyone. We knew when his love Bren passed last year, that Chris would not have much more use for this world. He passed at 10:30 Monday morning in the residential hospice he helped build, surrounded by many whose lives were dignified by his.

Dirty Politics

Rulers have held conferences about food, hunger and health since the land between the Tigris and Euphrates rivers was farmed 11,000 years ago. Now every five years the United States Congress passes a comprehensive Farm Bill in that great tradition of balancing complicated and conflicting ideas about how to feed another generation. Governments have usually gotten their citizens enough calories in the short run, but screwed up the long run, turning farms turning into deserts. Mesopotamia, now Iraq, was “the fertile crescent,” just as northern Africa was the grainery of the Romans, just as Iowa is for us. Doesn’t bode well for Iowa.

At Joe Biden’s White House Conference on Food, Hunger and Health last week I sat behind Dr. Dean Ornish, the cardiologist who was derided for showing that one could reverse heart disease with nutrition, exercise and, even more controversially, social/spiritual support. On my left was the President of American Soybean Association, which has so successfully lobbied for their bean that it is second only to corn syrup as the most common ingredient in the American diet, including many products that are only barely identifiable as food. There were many such ironies in the room: food bankers munching on lunch provided by Google. Hospitals like mine highlighting community food initiatives in the shadow of our massive surgical towers that Dr. Ornish proved unnecessary decades ago. Meals on Wheels executives jostling with Instacart lobbyists. Organic farmers next to pesticide people. Chef José Andrés, the electrifying Puerto Rican Chef sounded the call to simply feed everybody…now; just do it.

The last time food rated a White House conference was under President Nixon 53 years ago when I was in high school. He opened the door to China, just as he opened the kitchen cupboards to food stamps, now called WIC and school lunch programs. He also had Earl Butts as Secretary of Agriculture who considered small farmers a silly distraction in favor of industrial behemoths. The mishmash of noble and industrial programs had all sorts of unintended consequences that their advocates understand need to be corrected. New York Mayor Eric Adams (sitting next to Dr. Ornish) wanted the health experts to be responsible for designed school lunches to be about nutrition, not calories: “we’re just feeding the next health crisis.” Donna Martin, The head of Burke County Georgia school kitchens asked for the same thing: “come to school, work in our kitchens, feed our kids.”

Food doesn’t come from a warehouse or even a kitchen; it comes from soil. The kitchen just links two astonishing complexities, the soil biome and the one in our gut where food turns into…us. We know now that the human gut biome determines much of our resilience and lifespan health. Many even speak of the “gut brain” to describe how the biome shapes our choices, emotions, patterns of behavior. The only thing more complex is soil itself. Bad dirt, bad gut, bad health.

Those complexities of soil and gut are largely shaped by the third, politics. Perhaps as complex as food and soil is the social biome; how the 8 billion of us love, fear and choose over our lifespans. Our social choices emerge from our social soil, not surprisingly these days producing poorly nourished decisions. Our civil society, Congress and courts are like children raised on Twinkies and Red Bull; our democratic process staggers in puff and bluster.

It is easy to be cynical about events like the White House Food, Hunger and Health Conference. But this is how democracies muddle our our way, and nearly infinitely smarter than letting the rich royalty dither. The day before the Conference, the White House released a thoughtful national food strategy with 5 pillars—the first one focusing on economic stability. This thoughtful document is only paper until it gets translated into the 2024 budget and the $1.1 trillion Farm Bill. That legislation will determine how many soybeans get subsidized, what kids get free lunches, what moms watch their kids grow healthy or smaller. As President Joe said, “if a mother can’t feed her child, what the hell else matters?” A handful of contested house seats will decide whether that legislation will will be shaped by the people who put together the White House food strategy or people with no strategy at all. Food policy shapes generations; Wendell Berry thought we should enact 50-year Farm Bill’s to break the dangerously short-term thinking. ( Jackson, Wes; Berry, Wendell (January 5, 2009). “A 50-Year Farm Bill”. The New York Times.)

The food conference should make everyone uncomfortable a half century after the last one. Different decisions could help our community systems produce much more health. But we have to include capital investments on the screen, which is especially sensitive for hospitals and industries such as soybeans and food chemicals. Once you’ve built something, you have to pay for it. Better scientific critique would prevent us making extravagant and unfounded investments that produce little real gain in health. Our non-profit industry has shielded our capital investment side from visibility to the community benefit legislation, so I don’t sense we have a lot of moral high ground on the soybean people. Like fixing the food stamp and school lunch programs, the hungry would have us fix community benefit legislation, too.

President Joe Biden bringing the word: “if a mother

Most politics is mostly projected out of the past, not the future. The arguments focus on keeping privileges, not getting new ones. That’s how the 3/5th of a citizen idea got into our founding documents: it kept slavery and made inevitable the Civil War. This is also how the subsidies for cotton, sugar, soybean and petrochemical industries end up the Farm Bill cycle after cycle. I was representing Stakeholder Health which has dozens of healthcare non-profits, so I was not comfortable about our illogical privileges, too. We give away a lot of free care. But we could be way more scientific about our investments, including the vast sunk cost of buildings. If we stacked all our bed towers next to all the soybean silos, I think ours would be higher, more expensive and harder to defend.

The day before the White House Conference I was part of a workshop convened by the Stand Together Foundation—a child of the Koch Brothers Foundation. It would have been easy to be cynical about this one, too. But the invitation was just as hard to turn down as the White House Conference, as the subject was just as fundamental: “social dynamics of health.” The two were windows on opposite side of the house peering into the same phenomenon.

The link between the tiny San Diego workshop and massive WH Conference is hard to miss as both events raise fundamental issues of how to achieve fundamental public good. One of the big changes since the last WH Conference is the huge expansion in the non-governmental non-profit sector, especially in healthcare. Neither meeting was about more charity. Rather, the issue is how to appropriately recognize our part of the community systems that create the population scale patterns of health. Whether we are big hospitals or soybean farmers, we should thoughtfully subjecting all of our community-facing policies to basic science critique, especially procurement and capital planning.

The place to start is the same place as doctors do, “first, do no harm.” Wendell Berry was a young man during the Nixon Conference. He was already famous for taking on the agro-industrial machinery that found small farmers so inconvenient and illogical. “What I wish to speak for here is the discipline in the Human character that makes him able to forebear and restrain himself when he’s doing obvious damage to other people.”

Bad food and bad food policy comes from ravaged social soil. Ours is worse than depleted; actively poisoned. Carpet bomb spraying of pesticides makes it impossible for bees to fly or think. Anyone who would do that has drunk their own poison. Dirty politics? I only wish that politics were as healthy, resilient and self-cleansing as dirt.

The maven at the heart of the San Diego meeting was Tom Romeo, VP of the Charles Koch Foundation. Tom had gathered a group of thinker-doers working with the homeless, in public housing developments, with police and troubled kids and two surprisingly cheerful economists. Tom gifted the participants with copies of Ivan Illich’s 1973 book, Nemesis and Deep Economy by Bill McKibben. The third hand-out was a paper TC, Jim Cochrane and I wrote for the National Academies of Sciences about “the health of complex human systems.” These are not what you’d expect of a Koch workshop; a signal that something very basic is changing in the idea soil out of which grows the social dynamics.

Illich, McKibben and my team argue that we have to see human health as the fruit of nested complex systems, just related as soil and gut. This is not a metaphor; this is why things happen as they do. It is why the planet is melting, bees dying and neighborhoods go hungry. If we do not think, analyze and dialogue in the complexity of the nested systems, we will break those systems. The farms will turn to desert and our children will grow small, theirs smaller still.

The data say that we are well beyond the tipping point and that we should despair. However, the natural systems testify that they rebound once the poisoning stops. The ozone hole we thought our doom two decades ago, is already half healed. The Monarch and the Honeybees will thrive too, as will all that comes from healthy soil, meadow and forest. The only question is whether our grandchildren will be here to enjoy it.

Winston Churchill used to say that you can on Americans to do the right thing…after we have exhausted all possible alternatives. Surely we have arrived at that place now since there is still a chance for the children. Bill McKibben, in his latest book, The Flag, the Cross and the Station Wagon notes that there aren’t many things an old person can do better than a young one, except getting arrested on behalf of their grandchildren. We have to try, take risks, be bold for those we love.

Trying in complex human systems means grown-ups talking to each other, especially those expecting to disagree. That’s why I reluctantly went to the San Diego conference and found myself among new friends. Trying means thousands of committees, some dealing with the trillion-dollar Farm Bill, some about the neighborhood school kitchen, some with the homeowners’ association figuring out how to stop spraying dumb chemicals.

Complex human systems seem overwhelming. But they invite us to be part of the complexity because everything matters. Just as every quart of poison spray matters, just as does every choice, every vote, every conversation with someone you thought opposite. Every kindness is honored; no love wasted, no healing intention lost. Chef Andreas is right; we have all the ingredients; we just have to try.

Two citizens, Dr David Beckman who led Bread for the World. And me, from Precinct 601 in Winston-Salem NC.

Team Sport

Even an electric vehicle depends on the kindness of strangers now and then. Good thing there are always kind strangers. In this case it was Mike Carnett, a car salesman in Wytheville, Virginia, 90 miles from home when we only had 78 miles of battery life.

Nifty charger at Pipestem State Park. VERY handy.

TC and I had enjoyed the glories of Pipestem State Park in West Virginia, which overlooks the ancient Bluestone Gorge. And it has a modern little free charger for both Tesla and our union-made Chevy Bolt. (I love to park next to Tesla’s who paid three times what I did for our 250 miles of range.)

We decided to take the long way home down the New River as my EV app told us about a charger in Blacksburg. From there we would have plenty of electrons to get home to Winston. We travel these days guided by clever iPhone Apps and the scattering of charging stations in in Walmarts, shopping malls, gas stations and the occasional city hall parking lot.

Even the cheapest EV (mine) has more than 200 miles of range, which is a lot more than I can go without stopping to pee. I’ve put just under 20,000 miles on my Bolt ranging from Atlanta to Cincinnati to DC with only flutters of anxiety.

But you still have to get the electricity into the battery. Our Bolt would not accept the charge at the EVGo charger in Blacksburg even after 45 minutes with a very helpful young man on the help line. No problem as we had plenty of juice to get down to Wytheville as a gas station where we had charged the day before. But, it wouldn’t charge there either, even after an hour on the phone with another delightful lady. We were now 12 miles short of the 90 to get home.

The Nissan Leaf was one of the first legit EV’s so every dealer has a free, but really slow, charger. We drifted slightly nervously across town to Dutch Miller Nissan. It almost worked. Out walked Michael Carnett, who poked and joked as salesman do. He noticed that the charge nozzle didn’t seem to be quite seating correctly. So I stuck my naked finger into the gizmo and dislodged a little chunk of plastic that was wedged in, probably broken off from an earlier session. A teeny-weeny trickle of electrons began to move. It was like watching a bucket of water heated by a match. So we went back to the fast Electrify America and ate ice cream as the big wire poured in 100 miles in 25 minutes. Home by dinner.

Piece of plastic in the wrong spot prevented the charger from seating correctly. Who knew? Note I still have all my fingers even after fishing it out from amid the electronics.

Electric vehicles are still vehicles with thousands of moving parts. There is no oil to change or engines to pour gas in. But EV’s are still complicated machinery built to ride up and down mountains at high speed. Stuff happens in the real world.

I can’t wait for the deluge of charging stations after Senator Coal Mine (a compliment in West Virginia) changed his mind and permitted the future to edge into our lives last week. I don’t know how our Nissan friend votes or what he thinks of global warming. I know I was grateful for his practical curiosity and kind spirit. It’s gonna take all us strangers showing a little kindness to get to the future.

Sunset at Pipestem was still worth all the adventure.

What the Past Gets Wrong

These days I tend to forget how much we know about finding our way through really difficult, depressing, anxiety-fomenting, soul-sucking, hope-chilling stuff. I wrote Speak Life: Crafting Mercy in a Hard-hearted Time in 2018 before COVID, Ukraine, the 2020 election and insurrection and falling glaciers. This section, from pages 182-3, 196 helped me today.

The past deceives us by asking us not to take the possibilities of our one life seriously.

In anxious times, we listen too carefully to all that the past teaches us about what has not worked. The past hides the most important things in plain sight, including the simple fact that history doesn’t repeat. It happened, but it isn’t destiny. It circles, as does the hawk above me as I type this; once, twice, then another six times, but never in quite exactly the same way. Finally, having seen enough, it lets the breeze over the ridge carry it down and away into another life. History is not a circle but a spiral, never quite repeating.

The challenge for us short-lived ones is that some life les- sons take more than one lifetime to clarify. This is especially true for the bad things. Wrong can triumph for a long, long time, far beyond what you’d think possible. Bad people often get away with things for pretty much their entire lifetimes. Sometime their kids pick right up where the parents left off and they get away with bad things, too. But Dr. King wasn’t delusional when he saw the arc of history bending toward justice.

Sometimes it takes more than one lifetime for even the most obvious good things to mature. All my life it seemed obvious that the sun was giving us plenty of energy every day, beyond any possible amount that could ever be needed. That could be enough for billions of trees to grow and trillions of plankton to feed all the fish in the swirling oceans. Or surely enough to warm our little human houses and to allow us to move around without bothering the horses. It was always out of reach, the iconic tree- huggers’ folly. Until in a blink it wasn’t. And in another blink the Peabody coal train was the folly. China—no country of tree huggers—cancelled a hundred coal-burning power plants and started covering desert sands with silicon wafers. Some dreams long deferred are just waiting for the converse to emerge.

This is not just true of technology, which is created by small groups of people acting ahead of what seems possible at any given time. In recent decades millions of wholly new organizations have been invented for the purpose of doing something new, usually intended for some sort of good. These groups compete with each other in some sense, always prompting someone to complain about innovation clutter. But mostly they compete with the past and almost always win.

Love sees most clearly in the aftermath of loss, betrayal and pain, when the cynical smirk seems most appropriate. Love does not always see how to restore that which is broken, but it always has eyes for how life can find a way. Love in the aftermath of loss is tuned with the sensitivity of a bruise.

I tend to hang around with groups of people with hopes verging on grandiosity. On many days we actually do think about world peace, saving the planet, and about the least of these. This is good; what else should grownups think about? The challenge is that we are deceived into thinking that the hero of the story always tends to be…us…because we can see the possibilities and those possibilities tend to be extrapolated from our kinds of skills. We can see the future and it looks like more of us at an even larger scale: Health insurance for all (so that everybody could come to our great hospitals!), public health unleashed to prevent everything possible to prevent, education so wide- spread and enlightened that nobody would ever do anything dumb again.

History exaggerates what has happened and undervalues what could have happened just as easily. And it says little about what is possible, what has not yet happened. Emmanuel Kant insisted that the possibilities are just as real as the actualities (McGaughey & Cochrane, 2017). The possibilities are all we can do anything about.

The point is to give our life to the possibilities that allow life to emerge with the most mercy and justice possible. History also exaggerates the power of boundaries and differences, projecting today’s identities inappropriately backward across time, giving them far more power than they deserve. The actual testimony of life is all about dissolving boundaries, especially the ones in our head.

Love sees the unpredictable consequences of life more accurately than history because it knows that the future is not determined yet. The most important thing about the future is that it comes out of the utterly unpredictable expression of collective creative imagination.

Nothing ignites the imagination like love.