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 20th 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.

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.

Honeybee Way

Some of the wayfinding women of Stakeholder Health as we met at Salem College in Winston-Salem Thursday and Friday: Heidi, TC, Dora, Amy, Anya, Somava, Shelly, Lauran, Anna. Women have learned how to do that at Salem for 250 years.

Honeybees are the most successful species of the most recent thirty million years. The honeybee in the fossil record is essentially the same as you can find on your nearest batch of clover. Humans, inexplicably proud of our brief ten thousand years, should pause in wonder. We are doing poorly as a species, unlikely to see more than a few generations. Ironically, is common to read stories on the human internet about the demise of the honeybee! These stories are based on the widespread collapse of commercial hive operations, which often ship hundreds, even thousands, of hives on trucks to pollinate vast almond orchards. The bees die by the billions as disease spreads easily in the unnaturally weakened hives, especially from the dreaded varroa mite—the “destructor.”

Dr. Thomas Seeley notes that in nature, hives are usually dispersed two or three per square mile and seem to be rapidly adapting the behavior to resist the mite. Smart money would be on the honeybee to outlive humans by another several million years.

So perhaps we should pause and ask what we might learn from the bees about ourselves. Bees are highly evolved with every body part honed to perfection. My favorite is the middle leg joint which has a little notch through which the bee pulls the antennae to clean them when they become clogged with pollen. My knees barely permit tennis.

It is not the body parts that teach us; we are stuck with two legs and no wings. In any case, you can’t build a strategy on what we do not have. What do we have?

The main distinctive of the honeybee is not its body, but the wonderous social structure of the hive. The hive—the same 3-pound weight as a human brain—is social, intelligent and highly adaptive. It makes complex decisions, including where and when to send out the mother and half the workers create a whole new hive. For 30 million years in a row they have made that decision with stunning success. Its most experienced foragers switch from looking for the daily nectar to become scouts or, I like to think, wayfinders. They find the way, help the hive decide and then literally lead them. They couldn’t find our home; we need our own wayfinders.

What do we two-leggers have to work with as we face a tougher challenge– finding a new way to live on the one and only planet we will ever have. Despite the fantasies of a handful of delusional narcissists with so much money they can’t think straight, we can’t go anywhere. Mars? No honeybee would think about it for a nano second.

Honeybees have a vast advantage in that their social life emerges from a shared purpose every single bee will give their life for. Just this afternoon I noticed as a bumble bee found its way into my backyard Warre’ hive, which has an observation window that allowed me to watch her being chased by a guard bee a tenth its size. Humans, cursed with social media can no longer distinguish common threats, easily distracted by individualized fantasies and fears. Bees never take their eye off their common future.

Wayfinders! Dr Kimberly Dawn Wisdom receives the first Stakeholder Health Dr. Ruth Temple Award from Dr. Dora Barilla as Dr. Jerry Winslow watches from Loma Linda University (Dr. Temple’s alma mater). All of them brilliant, brave with eyes on the future of us all.

Humans do have Spirit, which some think gives us the capacity for wisdom, social imagination and common courage when facing a true discontinuity as we are now. No hardwired species would have a chance. We still do because we have Spirit, which gives us the subsidiary capacities for lamenting the lost beauties and then deep accountability for making the choices that lead to life. We can do that and have in other times of radical challenge. It is not enough to be homo sapiens, or even as we like to claim homo sapiens sapiens ( the species that knows it knows). Our only hope is to claim our capacity as homo sapiens sanctus-the Spirited species. That one might be capable of metanoia—the Great Turning so obviously required.

A tiny step in the Great Turning happens these next two Wednesdays as some wayfinders gather on Zoom for a workshop based on a book under construction. I’m delighted to be doing this with Threshold Retreat and Farms, itself a worthy harbinger of the possible. We’ll also gather in July at the farm for some in person mingling with the honeybees. We’ll help each other be a little less afraid of our wonderful world and a bit more clear about how we might live with it—especially the magnificent honeybees.

Register here. The $75 goes entirely to Threshold Retreat and Farms, of course. I’ll even sweeten the offer by making sure that anyone who registers gets a pound of the wonderful single hive vintage honey from Warthog From Hell Honey—made by fierce southern Italian bees on our porch. If the registration keeps you away, let me know and we’ll find a way, of course.

In humans even drones can help! Arvind, Rick, Ed and Terry lend energy as we met in the Innovation Quarter .

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 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


Winston-Salem as the storms of Florence came near.

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

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

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

What to do?

Don’t look away.

Don’t look for the answer on a screen.

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

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

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

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

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

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

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

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

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

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

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

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

Speak Life

Oh, it’s available on Amazon for $15. Here.

I wish I was handing you this in person in a decent restaurant with a bit more ceremony involved. But I didn’t want to wait to get my new book in your hands.

Speak Life: Crafting Mercy in a Hard-Hearted Time, is written for you, who have given your life to advance the health and well-being of the places and neighbors you love. Like you, most of the people captured by such a movement persist year after year for decades sustained by shared spirit, intelligence and sweat. I hope this new book will deepen and strengthen your energy for that movement.

Speak Life is being released in Orlando June 20th at the Distinguished Lecture Series sponsored by Florida Hospitals, one of our Stakeholder Health partners. Most of the speakers and all of the audience are distinguished by their people and places they care about and the Spirit that carries them. If you’re anywhere nearby, please come (You can register here.)

If you’ve read my other stuff, you’ll recognize echoes of Boundary Leaders and the earlier Deeply Woven Roots. And of course, Leading Causes of Life and the Fellows Jim Cochrane leads. Speak Life is a more radical take on both leadership and Spirit. I’m quite sure you’ve experienced the same dramatic move yourself in these hard-hearted times.

Thank god for critical readers, editors, fact-checkers and proof-readers! Ray Tetz’s amazing team led by Alberto Valenzuelea and Becky De Oliveriera and our home team, especially Tom Peterson, Jim Cochrane, Maria Parries and, of course, TC. 

Speak Life is published by Stakeholder Press and all the profits go to Stakeholder Health. This is a learning group tracing back ten years to the tough streets of Memphis, Detroit, San Bernardino, Bithlo and several times at the White House (back a couple of years). Speak Life is, in a sense, a radical view of the life of leaders that undergirds our earlier book, “Insights from New Systems of Health.” Nearly all of those practices demand grit and courage to cross over many lines of discipline and institutional politics.

The learning is accelerating: we will be releasing a third in the Fall that is more technical exploration of how the Leading Causes helps us understand how to organize and set priorities for our work in community. And then we really do put the pedal down in November in a bold “See2See Road Trip” traveling from San Diego to Raleigh: the move in movement.

Jerry Winslow, the Chair of the Stakeholder Health Advisory Group, writes in the forward: “From one perspective, the movement might appear to be merely the sharing of smart approaches to what is now called population health. But a more careful look, with focused attention to the spirit of the work, reveals something deeper and more lasting. It is life-giving joy in the hard work of the journey toward social justice. The real fuel for this movement is the conviction that together we can build communities in which every person counts, where no one is left out, and no one suffers needlessly because of institutionalized unfairness. To speak life, then, is to adopt the ways of life so that every person is celebrated by a community that genuinely cares.”

Rev. Larry Pray, the prophetic genius of Big Timber. He taught me that life has a language, which he is still speaking in his hardest of all days.

I want you to see Speak Life in the light of all of that highly collaborative learning. Writing is about the least impressive—undistinguished—thing you can do with a large number of hours. It is typing, often with a lot of silence between the clicks. When I slowed down, I thought of all the astonishing people who were generally not typing, but lending their lives to the urgency of mercy and justice. I tried to see what matters most through those many eyes.

I’m like one of the nameless grey neurons way back behind the eyeballs trying to connect the signals those many eyes are seeing. I’m not qualified to do very much useful most days, but I am privileged to work among wide extended webs of those who know what to do in the middle of the night standing with the First Responders at a suicide with weeping parents, who build a school for young women in the fire and dust of Kabul, who do surgery, administration, therapy, research and discovery into the mysteries of molecules and neighborhoods. Some of those agents are named Big Dog (the benevolent gang leader in 38109 of Memphis) and R. Ernest Cohen, the Jewish Integrative Medicine Chiropractor who runs a free clinic in Wilkesboro so frugal it borrows its Wifi signal from the tattoo parlor next door. Richard Joyner with his anointed prophetic tractor, the weekly amazements of Oakhurst and Green Street and so many more. You can get a sense of this in the new article about Soma Stout 100 Million Lives, which NewsWeek is smart enough to cover, too.

Taize France, early on the morning when Jim Cochrane, TC, Masana, Shingai and I spoke life.

Through this collective eye we can see life, tenacious and fiercely protective of its most tender edges.

And together we find the words to Speak Life.

I hope you like the book. Oh, it’s available on Amazon for $15. Here.



Finding Our Bearings

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Leonard Hall, Shaw University, Raleigh, NC.

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

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





Charlie and Asa doing what kids do.

Things are seen in in the terrible intimacy of the ED every day that should not happen once in a thousand years. Except they happen in entire zip codes, too; the same damn ones for decades. This morning I presided over our hospital “safety huddle” where we report to each other about events, concerns and needs, often using abreviations and acronynms for highly technical and fraught things that happened; “peds abuse procotol” instead of whatever the true story would be in the life of a child hurt by whoever was supposed to protect her. Those break this grandfather’s heart (Charlie turned 3 yesterday).

Last week I was in Atlanta at the advocacy leadership table of the American Public Health Association—the health colleagues at the exact opposite end of the professional continuum from the two child abuse cases reported out in our hospital safety check-in today. Last week John Lewis opened the APHA with words both fierce and tender about justice and kindness as the zillionaires try to walk off with another trillion or two.

Big numbers and repetition can make us hard and dull; but they don’t have to. We live in such a hard-hearted time. Today the sharp edge of medicine was felt by a nurse who is also a mom with a high school son taking chemo. Later at Green Street church, we lifted Aaron up even as we were still wordlessly aching for Cole, our six-year-old who died only last Sunday. How can we can we keep our heart from closing down?

Cole Weaver’s friends decorated the church in his honor.

In my Christian tradition, we have Paul’s words on love, written to the contentious gaggle in Corinth. These are mostly wasted on romance when we need them in the bitter struggles to give hope a chance one patient and a neighborhood at a time.

“If I speak in the voice of powerful people or spirits but do not have loving kindness, I am only a distracting noise. If I have predictive data and interdisciplinary analytics that give me confidence to move mountains of poverty, but am not kind, I am nothing. If I proudly commit to radical levels of community benefit and take on huge obligations for the health of the public, but am not humbled by love, I do nothing.”

“The love that life needs is patient and kind. It does not envy others’ projects, it does not boast of our own skills, it is not proud. It does not dishonor others, it is not self-seeking, it is not easily angered, it keeps no record of who got more. Loving kindness does not delight in anyone’s failure but rejoices with the truth. It always protects, always trusts, always hopes, always finds a way.”

“Love never quits. Where we have predictions and projections, they will cease; where there are speeches, they will be stilled; where there is knowledge, it will pass away.”

“For we know in part and we predict in part, but when living complexity becomes visible, what is partial disappears. When we were young in our work we talked like beginners, and thought like beginners, reasoned like a students. When we became a grown-ups, we put the ways of childhood behind.”

For now we see only dimly as if looking through a smoky haze; then we shall see it all directly. Now we know a bit; then we may know fully, even as our own lives will be fully known.”

“For only these three remain in life: faith, hope and love. But the greatest of these is love.”

God, our simple prayer; keep us tender.

Kathryn (my kid) shows Charlie (Lauren’s kid) his cake that she crafted  .