Cagne Cochrane

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 21st 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.)

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.


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.

Zach Stewart

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 99th birthday.

Why not you and me?


Did you even know there were boy and girl artichokes? My daughter tells me that this one is a boy.

Bob Matthews and I have shared a friendship for nearly 30 years, dating back to the time I worked with Jimmy Carter. Nowadays, both Bob and Jimmy, along with another close colleague, are on hospice care. Yet another friend depends on an annoying oxygen machine. It seems as if our whole species—humanity—is living in diminishing days.

Bob, who is living with chronic obstructive pulmonary disease, is cared for by his wife Marjorie, his daughter Sarah, and hospice nursesall blending both skill and humor. A few weeks ago, they hurriedly assisted him as he struggled for breath, to which he responded, “why bother?”

It’s a real question. And as a pediatric chaplain, Bob would know smarmy distraction.What justifies any effort or expenditure—bother—when the recipient can’t give back? Insurance may pay for the oxygen or rent the special bed, but no amount can offset the emotional investment of a daughter, wife, or friend. Why bother?

Bob’s patio blooms with flowers that he nurtured, now with help from his daughter Sarah. Did he earn their blossom? Do we ever truly earn anything? Certainly not through our clumsy endeavors labeled as “work.” Most of the most beautiful things in our lives are unearned and now in threat. The fading redwoods, air itself. Why should we bother?

Weed or miracle? Who cares?

As long as Bob can marvel at the beauty of a single blossom, he is on duty. The world runs on wonder, not mere logic. I suspect the flowers grow towards Bob’s awe just as they do toward the sun.

Later in the day, while in another garden with another daughter, I experienced the astonishing beauty of a raspberry. Can anyone truly earn even one of them? And there, from the same earth, an onion the size of her head emerged, worms wriggling away to prepare another one. Witness the egg laid by a generous hen, young Malbec grapes nearby, their roots digging into the same miraculous soil. 

A honeybee paused to watch us. Most honeybees live six to eight weeks in the summer, their wings worn out from countless flights, collectively producing less than a teaspoon of honey. Does any human deserve enough for a single cup of tea?

Stone sober, I felt as high as any Californian had ever been at the audacious generosity of it all.

Most of the most beautiful things in our lives are entirely unearned, but often under threat; the redwoods, air itself. So there’s plenty of urgent work for the young and healthy, and even some for the grey, who can endure policy discussions in closed rooms. But work without wonder is unlikely to heal.

Just last Thursday, I saw half a trillion dollars worth of gold in the basement of the NY Federal Reserve Bank; money isn’tlacking in the world. The upper floors, though, offered something more valuable—brilliant minds, brimming with expertise and energy, contemplating the intersection of climate, health, and community. These minds can envision, then bring to life, things that haven’t existed before. But, why bother?

Some people are willing to give their lives away to the last breath—Jimmy, Bob, Jerry. Why wait to follow what they show us? What about the approximately four thousand weeks most of us get before those final moments? ‘We should begin, not end in wonder and then act. Any tool in a hand not guided by love, is more likely to harm than heal.’

I’ve never been much attracted to contemplation, being busy myself. But I see that worthy labor only grows from a sense of wonder, especially as we grapple with the fear of losing our natural systems and social structures. Fear triggers action, but rarely discernment.

Nobody has ever been busier than Jimmy Carter, who even managed to squeeze in bird-watching en route from the airport during an election monitoring trip to Zambia. The miracles on the wing captivated him, just as the miracle of free voting did. He observed, then he worked.

Make haste to wonder.

Forgive anything that distracts from kindness.

Accept the bother of others with grace.

Take “yes” for an answer.

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 21st 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.

Carter, the Improbable Man

White Dove, by Jimmy Carter in the Zaban Room of The Carter Center

Jimmy Carter is not dead quite yet. Counting him out was almost never a good idea whether he was running for an improbable office (every one he ever held) or an improbable health goal (guinea worm, polio, smoking or handgun violence). Or embracing improbable relationships—the Allman Brothers Band so key to the first steps of his race for President, Charles Taylor, the Liberian Pariah President or North Korean Pariah President, Kim Jong-un. Carter was able to live across improbable boundaries because he was comfortable with his own complexities and complicities; he knows he is human like all of the 8,018,082,868 of us. And he is clear-eyed about his own death, which most of us ignore until the last final shock.

Carter was always misread as being somewhat simplistic and moralistic. In fact, he worked through his own complexities to still choose to act, speak and do what he thought right. He was not surprised that his relationships sometimes made that harder; he was a loyal to people who made his life more complicated than a more ruthless man would have (thinking of a few bankers and entrepreneurs who clung to him like barnacles). A religious man with eclectic curiosity, he often confounded Baptist Christians who feared the grey areas (most of life). And he confounded secular friends who loved the grey so much they found it odd that a man could choose commitment and follow through. Not satisfied with a simplistic stab at polio, he did the hard work decade after decade after decade. Never satisfied with pontificating in a hotel ball room, he took African presidents to left-behind places in their own countries they had never seen. And then he went back again and again. He knew the complicated reasons for homelessness, but he never failed to pick up his own hammer and build one more home. He loved one woman his whole life, even though he was honest enough to almost lose an election by admitting “lust in his heart” for others. He gave the word “human” a good name.

Like many thousands, my life would be unrecognizably different had it not met his. Not long after he was involuntarily returned to civilian life from the White House, he started The Carter Center as a launching pad, more than a museum. He and Dr. Bill Foege, who had run the CDC under him, held the first global conference called Closing the Gap, even before he had a building. An engineer’s kind of conference, it asked how much of the burden of premature morality could be prevented based on what was already known. What could we actually do with what we already know? About two thirds was preventable back in the 80’s, as your grandmother would have guessed. And who needs to act? Among others, the ubiquitous faith networks who he knew tended to sit around and wait for something terrible to happen and then act surprised at the most predictable things (cancer, war, diabetes, river blindness). Could religious people grasp the vast moral chasm causes by not acting on the patterns we know cause needless suffering? He and Dr. Foege got the attention of the Robert Wood Johnson Foundation and started the Interfaith Health Program, which I ended up leading. Why me, and not some famous academic bishop? Frankly, I’m not sure, but both men had a preference for action over formal qualifications.

The first thing we did was blow up the perfectly respectable grant plan of work, which began with a big formal conference at the new Carter Center. We replaced it with two years of scrappy meetings in dumpy basements and raggedy centers all over the nation (not unlike his run for president, now that I think of it). We asked the leaders actually doing things what they would commend to him as worth replicating. And we asked where they were stumped for lack of a clear vision of what might work. The two lists were identical, of course, which meant that the big innovation was having enough humility enough to realize that somebody down the road had probably already figured out the answer we thought we had to invent. It is actually harder to adapt something as it demands even more intelligence than simply plopping down another idea from somewhere. He called this a “mundane revolution.”

Carter is known for protecting the Arctic reaches of the Alaskan wilderness. I rafted the Canning River which borders that vastness and I was grateful; what other President even knew it was there, or would spend scarce political capital to protect it? It wasn’t just big nature he loved; he never missed participating in the Audubon bird count in Plains. He personally called the American Chestnut Society to get some hybrid seedlings to plant at The Carter Center, where they are improbably growing strong. He accepted some gift of Koi from the Japanese government but refused to purify the pond so people could see them. (A Georgia pond is brown.) Life, even the mundane, is spectacular when you have eyes like his.

My very best ideas are tiny footnotes in the extraordinary legacy left by this special man. These include the  “Memphis Model,” emulated by dozens of major healthcare systems all over the nation, the “religious health assets” which paved the way for the WHO into activating faith networks all over the world and, of course, Leading Causes of Life, which I spoke about the first time at a Conference in Milwaukee to which the former President sent me to in his place (imagine their disappointment!). Carter created a physical and a mental space where it seems reasonable to imagine things that had never happened and then try to do them. And then keep trying, maybe even for 98 years.

After decades of one unbearably oafish Christian after another desecrating the very idea of faith, he quietly gave his life as a long gift to his church and all people of faith: an example of sacred dignity and integrity.  Not that the oafs understood. When he was gracious enough to invite evangelical leaders to the White House, more than one publicly prayed that he would become a better Christian. However, when my secular friends think that anyone who tries to believe is foolish, I could always say, “No, I mean people like Jimmy Carter.” They had to nod.

He had little patience with superficial piety. Once he had all of us Directors reflect on whether Newt Gingrich had any good ideas in his “Contract with America.” I choked and noted this was not likely to go down well with the faith people who actually do the work on the streets. He snapped that the churches rarely break a sweat, while the government at least knows where all the poor live.

In the very first article for the Interfaith Health Program he wrote, “We must make the choices that lead toward life.” And who is accountable for those choices? Not just improbable Presidents, but hundreds of thousands of improbable grown-ups doing the right thing when people notice and when they don’t.

This is true, even unto the very end of their days, when the right thing means releasing into the love of one’s family, instead of the normal vain and fruitless medicalized struggle against death. James Carter was proud, but never vain, often overlooked, but few lives bore so much fruit. I hope he lingers in hospice to savor the deep joy of a life well lived.


Humans are a very young species so it is hard to tell if the idea of humanity will stabilize or not. It’s not looking good. Jane Goodall writes in the forward to Regeneration: Ending the Climate Crisis in One Generation that “what separates us from our closest living relatives, the Chimpanzees—and all other animals—is the explosive development of our intellect. … How bizarre that we, the most intellectual of all species, should be destroying our only home.

Bees beeing

No honeybee would do something that dumb. I wonder if we can learn from them?

We do not deserve to stand in the presence of such wondrously complex creatures. But they don’t mind as long as we are quiet and let them work. When I do, I can’t help but reflect on our own way and Spirit. It gives me both hope and instruction.

That’s what the workshop is about August 17 and 24th (online). I’m leading it at Threshold Retreat and Farm (here). You might want to join with people who will gather in humble, hopeful curiosity to ask how can we humans might find our way illuminated by the honeybees.

It is worth pausing to study bees carefully because many of the things we think we know about them are exactly wrong. For instance, they are not rigidly organized around a totalitarian leader. They are democrats with no one bee deciding anything, certainly not the queen who is busy laying eggs. When they vote on a new home, they do so in the open, transparently and while dancing. No mean spirited puffery. Good decisions happen.

The honeybees are not invulnerable. Three of my hives died within two weeks when gardeners nearby sprayed poison ivy, which have little flowers the bees like. Nothing bad for bees is good for humans. We breath in the same crap that kills them. Dumb us.

Honeybees remain wild, even after millennia of being managed and robbed by humans. We think of bees as orderly, hierarchical and well-behaved because we steal their precious honey. About four thousand books have been written purporting to teach silly humans how to manage them. And yet honeybees are still untamable for thirty million years and counting,

Honeybees survive because they are wild. They mate high in the wind with six or ten boys not from the neighborhood. It reminds me of my Norwegians who were often led by women as fierce as honeybees, finding mates and raising children across the waves to Newfoundland and down long rivers all the way to Turkey.

Human cultures also find life through shared–not shed–blood. Our story includes violence, often organized and sustained over long period of time. But the species as a whole thrives because of what flows across the boundaries where we find new blended life. Zero immigration adds up to….zero.

Wild works. I’d rather live in the wild USA than teeny weeny Hungary which used to have a diverse empire. Now it is afraid of the world, encouraging us to be afraid with them. Look rather to the honeybees.

Honeybees don’t teach us; they probably think we’re unteachable. They do pose a damn good question: how do we humans remain wild and expansive? How do we remain curious about where love might be found, Spirit unleashed, new songs and vibrations pointing to new possibilities?

We are so young that we are still stupidly proud. Surely it is obvious that every human structure, hierarchy, creed and scientific certainty has passed like the dew in the dawn. Wild, adaptive, ever beginning, ever new–that’s what works. The honeybees have been a stable success for at least 300 times longer than we’ve been painting on cave walls. Generously, they invite us along for the flight.

Register here for the workshop, August 17th and 24th. Zoom, of course. $75 tuition goes to Threshold Retreat and Farm. Participants will receive a PDF draft of a book I’m writing about this. And a real copy when it is published. I’m glad to scholarship a bit, if you’ll give me some feedback. Email me at gary@honeybeespirit.org. Please join us!

Note: The honey from the bees who live with TC and I is called Warthog From Hell honoring the wild untamed nature of southern women. We also bottle honey blended from five other sites to make Honeybee Spirit. Both are available at the Threshold Retreat and Farm booth at the Cobblestone Market in Winston-Salem.

Adults, flunking

“We will live together, or not at all. We will build hope and wholeness, or watch our children grow small, surrounded by ineffective barriers against their fears. We know that acts of compassion, nobility, faithful caring for the earth and her people are all we can do. It was once thought that acts of virtue, conservation and care were only of personal consequence. But surely it is the most fundamental adult responsibility to build and nurture systems that carry our hopes forward. (Faith&Health, The Carter Center 2001).

White Dove. Jimmy Carter, 2012

On national bee day (May 20) twenty leaders from Atrium Health met at The Carter Center to see how we might align our efforts to “To improve health, elevate hope and advance healing – for all.” This is a very large organization—some 70,000 people—serving 400 miles of rough Southern country. If the FTC allows, the circle of care will grow to include even rougher neighborhoods in Chicago and Milwaukee as we combine with Advocate-Aurora. Most of the people work inside traditional hospitals and clinics, but increasingly both science and mission draw us over the sidewalk and into the neighborhoods where elevating hope is like pushing a glacier uphill. Despite superabundant healing science and technology to see disease at the molecular level, the fundamental drivers of ill health remain mired in ugly patterns of race and poverty, often in the very same census tracts for many decades.

Adults are flunking adulthood; our children are growing smaller.

Many of my best thoughts were born at The Carter when the oak trees were smaller. The very first major project of The Carter Center was called “Closing the Gap” which asked, “how much of the current burden of premature mortality could be prevented based on what we already know.” Turns out the answer is about two-thirds. Who can act on what we know? Formal healthcare and public health are only a small part of the answer. The knowledge must come alive in the hundreds of thousands of non-profits, businesses and….faith networks. My Atrium Health collegues and I have made reducing live expectancy gap by 2030 our top level goal, so I am back face to face with the same great and still unsolved opportunity that started me in FaithHealth, still difficult for much the same reasons. The ideas that grew out of The Carter Center soil, with major help from our partners at Advocate 30 years ago, included the basic ones we are still working with today: strengths of congregations, boundary leadership, leading causes of life, religious health assets and now the prayers of the people. These ideas were like bridges across troubled water.

One idea we had at The Carter Center was “not even one,” the name from Dr. Fred Smith. Simple public health logic matched with fierce faith that refused to look past even one gun death of a child. We thought adults could be organized at the level of their town to investigate where they—the adults—had missed a chance to prevent each young persons’ gun death. It would take a lot of adults talking to each other.

The oak trees are now much larger and I find myself less hopeful than at any point in my life, sobered by war and melting planet and, most of all disabling political vitriol. So it was good to be at The Carter Center where preposterous things are made practical through tenacious and smart work: eliminating polio and guinea worm. Elections in places they are obviously impossible: Zambia, Liberia, Ghana (where I helped once). Again, diligent and non-naïve preparation, training of thousands of volunteer poll-watchers. Work in the service of noble values. Tenacious. Qualities that national Bee Day brings to view.

Yascha Mounk writes in The Atlantic about the doom spiral of “pernicious polarization”—when a society becomes fearful of its fellow-citizens, expecting ill-will and hurtful actions unprotected by law or norms that can interrupt the most ordinary days, say shopping in a neighborhood grocery story. The research indicates that the spiral is only broken by a cataclysm. You’d think losing one million people to a pandemic would do it, but it seems to have only accelerated the polarization.

Who is crazier, the shooter of children or millions of adults who allow themselves to be radically polarized?

Nobody at The Carter Center has ever been naïve about religion as both an asset and profound barrier to boundary-crossing labor. There was a time when religion itself was the agent of polarization, but that seems quaint now, replaced by raw political anger untethered by any traditional norms or rules. Our children grow small. Some are shot.

On National Bee Day, I wondered, “how do the bees avoid our kind of doom spiral?

Thomas Seeley is an impeccable researcher and professor at Cornell who has written graceful books about how bees make decisions. He has focused on the most profound risky decision of all, which is when a hive splits, sends out the current mother/queen with about half of all the workers to form a new hive. In “Honeybee Democracy” he describes in mesmerizing detail how the oldest members of the hive switch from seeking flowers to scouting for a new homesites and weigh the options. If they choose one too small, they won’t have enough honey to make it through the winter; too big and will be too cold to survive. There are six life-death criteria. The bees get it right more than 90% of the time. They have for 30 million years.

We face no less perilous a passage in finding our way toward a new political, healthcare system, economic and, yes, faith systems even as the natural systems writhe, shudder and buck. We can’t get it wrong. Seeley says there are five clues from the honeybees. The scout bees tell the truth about the many alternatives over 40 square miles. The process takes whatever it takes, maybe an hour, maybe three days. No leader warps the process. No bee lies to another.

Bees use their pin-sized brains collaboratively to scout for the alternatives and compare them to make a choice. (p100) It helps that the idea about “good enough cavity” is hardwired into those little brains. And, as in many things bee, there seems to be no detectible pride at the individual bee level. They share, then release, their individual perspective so the truth comes clear. Not shooting grandmothers and children is hardwired into even human brains. So we at least what not to do. Bill Foege, who led The Carter Center and led the field of public health to embrace gun violence as a disease once said that it is easy to have a brilliant idea; think of the dumbest thing possible and do the opposite. How do we choose the opposite?

There is no future when leaders warp our ability to talk to each other. Nothing works, choices become random and disconnected from reality. We cannot see each other or our children. We are absolutely certain to perish.

Humans do have Spirit to work with, which seems like a slim reed on which to lean. Since we have little hardwiring to move us toward common purpose, we can only hope Spirit is stronger than venal stupidity. We do have a few mature humans, so we know it is possible. But it seems like a slim hope amid the manipulated deluge of divisiveness.

The oaks at The Carter Center grow a little each year. About 15 years ago the Carters planted a small grove of American Chestnut hybrids selected from among the tiny handful that have not succumbed to the blight that wiped out millions. Real science. Tough hope. Carter—then 80 years old–knew he would not see if the experiment “worked” to again blanket the Appalachians. None of us can know any more about the seeds we are planting with our lives.

He is 95 and the trees are still growing. Listen to the man: “I have one life and one chance to make it count for something… My faith demands that I do whatever I can, wherever I am, whenever I can, for as long as I can with whatever I have to try to make a difference.”


I rocked back in my chair as Becky brought the prayer to life in her voice. I actually heard my own prayer as if for the first time. We had gathered on a gorgeous Connecticut afternoon at Round Hill UCC using my book God and the People as a magnet. A dozen of us had convened to talk about “prayer as if for the first time.” Although mostly life-long church folks, everyone was more than a bit curious and wary of this talking to God thing. Becky read my prayer, “between clarities,” which in her voice was like opening a Springtime window: “Ever unfolding one, We live between clarities about the most important things. It makes it hard to pray. We are not clear if You invented us to have some to talk to or if we invented you for the same reason.”

That’s not something that would happen with a bowling team. Probably not many of the ten million “nonprofit organizations” in the world, either. Congregations are different social beasts. Their DNA holds distinctive strengths to find, form and express Spirit. Staggering out of COVID amid a European war, with dozens of other countries including our own simmering at the civil boiling point… we need prayer. Not religious chatter. No abstractions. Certainly not just about certainties. Prayer as honest dialogue, listening more than talking. Together.

Congregations have eight strengths which have long held my interest and kept hope alive in my life. I wrote about this nearly a quarter century ago at The Carter Center in Deeply Woven Roots, still in print and used in multiple seminaries. I name the eras of my life by the names of the congregations that held me: Milford Mill, Knollwood, Oakhurst, St John’s and Green Street. I usually sat near the door with friends outside wondering what I was doing within; and those inside wondering why I was not further in. My best thoughts grew here as doubts matured into commitments that have endured woven like threads into fabric.

Ed, Shannon, TC and Gary in the sanctuary of Round Hill Community Church

The idea that congregations have strengths is surprising to some (especially clergy!). On this side of COVID we are remembering that we have more than Zoom and social media to work with. We have things that bring humans together, woven like roots too hold us up and find nurture. We—together—have strengths. And those strengths are adequate to the vast challenges of our melting contentious planet.

These eight strengths have been tested for nearly a quarter century in many communities and congregations of many varieties and traditions. They are there for hard work, built for heavy lifting of entire neighborhoods. The National Academies of Sciences Roundtable on Population Health used this model to help grasp the role of faith-based health assets in communities. The logic of strengths is the taproot of the Memphis Model, which is about congregations, not the hospital. The strengths are the foundation of the large scale faithhealth ground game growing in the Carolinas. They are the positive power of the social determinants.

The strengths of congregations mainly function on the other side of the sidewalk from the hospital. This is why the FaithHealth Division of Atrium Wake Forest Baptist Health is part of the population health group, not solely in the clinical hospital group. We have superb chaplains who are there in the radical crises of the hospital and the poignant times of transition. But most of the time, Spirit and the congregations that nurture and express Spirit flex their social strengths in the neighborhoods where life is happening. This is why the videos based on those strengths are on the FaithHealth.org website that drives our broad “ground game” improving health.

A quarter century after discovering the framework of the eight strengths and writing Deeply Woven Roots, we’ve put up a short set of videos to help you discover your strengths and your roots. The videos are edited so you can take in the logic, or focus on each strength that seems most relevant. Prayers strengthen Spirit; the strengths give the Spirit form, sinew, muscle.

Round Hill Community Church on strong Greenwich Connecticut rock

My experience has mostly been among those trying to follow the Way of Jesus, but it turns out that the strengths are present in any temple, mosque or ashram. They are, I think, the way God has made us strong when we are humble enough to gather as we understand ourselves in the presence of the Ultimate.

We—together—are strong enough. Let me know how your strengths are expressing in the neighborhoods you love. Drop me a note at gary.gunderson@gmail.com