Natural Fact


Hermit Creek, usually only 2 feet wide, cut its way through solid rock to the Colorado a mile below here.

The Canyon that John Wesley Powell called Grand was thought useless by the first Europeans who were looking for gold. Their Hopi guides did not dissuade them or show them the trails down through the impossible chasm, so it was left unvisited for two centuries until one-armed Powell came back. The Canyon didn’t care. It just went on emerging as it still is, now swarmed by millions of tourists from rim and helicopter, a few thousand who hike and a few who even sleep amid the unthinkably ancient rocks.

Kevin Barnett and I slipped away from a nearby meeting in Phoenix, raced to the rim and down the abandoned trail to Hermit’s Rapids on the western end of the Park. It was the only permit we could get after three tries and were warned by the rangers it was “aggressive.” The email noted that those who tried this one experienced a range of bad things, “sometimes even death.” REI doesn’t have a department for that but we thought ourselves within the range of fitness (and folly), so there we went. It was aggressive, although we should note that two dozen of the three we passed on the trail were….our age. And, we guessed, tough tofu eaters seeking refuge from the trumpian dystopia.


November at the Hermit rapids.

It was on the way back up we learned about nature, beginning in the forty degree blowing morning mist trying to dig a hole in the shale sufficient to poop in. I am hoping that will be the most disagreeable poop of my life.

Nature doesn’t care what humans think, feel or spin. The Colorado plateau rose up, drained an ocean cut a river that still runs deep. The savage economy of water, wind and gravity cut and undercut, carving what to any human with any spirit at all is a cathedral to the endless creativity of time.

But the Canyon doesn’t care about that. It is still becoming.

The rain and wind picked up as we left the Tonto Trail back up the Hermit Rest trail. We left at dawn and slowly noticed the quickly moving clouds, but were surprised by the thunder and even more by the lightening on the plateau high above. Up a thousand feet the hail started and wind went sideways, totally defeating our nifty REI rain gear. The water ran red off the cliffs and coursed down the trail. We could see the creek that we had been able to step across the day before, now surging white and brown, wondering about the couple and their daughter we saw head down that way.


Kevin Barnett, thought leader and hiking friend near the base.

The Canyon is vast but not wild. 12 miles up from where we had slept Horn creek runs radioactive from mining that stopped when I was four years old. It will be dangerous when my grandsons have grandsons. At the river we slept where an orchard had grown once. We knew that every cave, even the ones high on the cliffs hid birds twisted out of wild grass by people whose name we do not know for reasons we do not know; symbols of love or worship? So too it will be with us, our voice and pride.

We picked our way across a ravine where a landslide happened back when Jimmy Carter was elected, which isn’t that long ago geologically speaking. The shards are still sharp and gravel ready to move again, not quite at rest. Far above we could hear other rocks sliding and then, breaking like canon fire when they hit below. One the size of a piano hit a woman a year ago, but the Canyon is a big place so were more worried about the sleet and slippery rocks beneath our feet. We kept going, chewing energy bars and electrolyte things, which seemed to work.

We were strong enough to walk and too cold to stop, so for hours the Canyon taught us about the fragility of humans, our toys and ways. Five hours in the sun broke through, clouds still scudding past, but broken now. We could see the plateau above and, then, ridiculously beneath us in between the couple of miles over to the next butte, what should appear but a rainbow, the curve of which seemed to match the trail left above.

I wondered about the Canyon not caring. Perhaps I was projecting; but I knew that TC had sensed the danger and been praying. I took it as a blessing, but also a warning. Another thunder crack. Three minutes after reaching the rental car, a squall line of snow and sleet whipped across the plateau.

gg-canyon-rainbowx-copyWe were almost afraid to check CNN to find what had happened while we were happily remote. We turned the heater up high and headed back to the city, grateful, chastened; awed again. Don’t worry about the Canyon; it doesn’t care. Mr Trump and his deniers will be gone before another few rocks fall, entirely unremembered before the river cuts another inch from the basalt floor. Natural fact.

The other natural fact is more preposterous; that we care and care for each other. A few days after sleeping on Canyon rocks, I was privileged to be the executive on call in the hospital, spending the weekend with the security guys and nurses and docs pulling the holiday shifts. I like to slip in a prayer on Sundays:

Dear preposterous God,

What could be more obvious than the natural fact that everyone who has ever lived died, felt pain and knew sorrow. We know that, too. And we know that all those we love will learn this, too. So why, against all the force of natural fact, we find ourselves able to heal, to offer comfort with all pills and touch and technology we can conjure, every single day, all around the clock, year after year. Why does the healing never stop? Is this folly, delusion; or are we drawn to something about the world we come closest to when—in fellowship with others—we open ourselves to hope, healing and life? Jesus—a healer who never stopped, even for the Sabbath—said that he only stopped healing when his Parent did. How preposterous; how human, how holy; we don’t whether to laugh or cry. Either way, thank you for bringing us close to that natural mystery of human life.

Natural fact.

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There it is


Looking to the sunrise from Fancy Gap, VA over toward the Sauratown Mountains.

President Obama was right; the sun did rise the day after the election. Since I am still reorienting to a seven-hour time zone shift from South Africa, I can tell you that it is about rise on Sunday, too.

Rev. Bill Torkell was one of the great souls who was a damaged man, but knew it, which made him more whole than most everyone. He had worked many jobs—including chaplain at Methodist in Memphis. He hurt enough people along the way to love clear-eyed and openly all of us. He would say, “There is is. There it is if you like it; there it is if you don’t; but there it is.”

So there it is. Seems pretty perilous to me, given that we’re down to hoping on Mike Pence and four Trump children to keep the nutters away from the red buttons on the dash board. There it is.

Garrison Keillor says it is a good time for us liberals to go for a walk around the block: “The government is in Republican hands. Let them deal with him. Democrats can spend four years raising heirloom tomatoes, meditating, reading Jane Austen, traveling around the country, tasting artisan beers, and let the Republicans build the wall and carry on the trade war with China and deport the undocumented and deal with opioids and we Democrats can go for a long brisk walk and smell the roses. (Her’s his article in SF Gate). In effect, there it is.

I suspect that Mr. Keillor is not quite as done as his morning-after comments suggest. And while Mr. Trump’s children are the ones crafting the transition, not me, Garrison, me and you are citizens, connected and responsible for doing what we can in the day that just dawned again. Bill Torkell would say “there it is,” then offer to help move the furniture after the divorce, craft your child’s funeral, get you a bag of food or into rehab. “There it is” was the first, not last step.


Looking South from the Blue Ridge is always good perspective as the Sauratown Mountains preceded the Appalachians. Lots of sunrises.

Life gives us a clue where to look for the many next steps. The logic of the Leading Causes of Life is that we are alive, not just as individuals, but as complex human systems called villages and nations. Organizations (hospitals) and networks (political parties) and movements (100 Million Lives) are also alive. In a practical-as-dirt way, human systems find their life through their connections, through the sense of coherence, through their sense of being able to act, choose, move –agency. And we find our lives acting consciously through the web of generativity flowing from one generation to the next. Finally, life finds life in hope; not optimism, but the confidence that what matters most survives. Life finds a way. This has worked since we started painting on cave walls and is how it will work after the election.

You can analyze political and religious movements locally and globally through this lens and notice that the ones that thrive hit on all five causes. This also warns you that life is not safe without something else—a practical moral compass that always points to the life of the whole complex system, not just one’s tribe, team. And certainly not something as tiny as a self. The Nazi and Apartheid movement were tightly connected, highly coherent, manifested powerful agency with a sharp sense of history and clear hope. Yikes.

No human system lives apart; this is why apartheid was doomed, as is any movement defined by separation. Even when all you hope for is you and yours, it is folly to ignore, much less oppose, the larger systems in which you and yours find life. The logic of the Leading Causes of Life is always to understand the next larger system, as well as one’s own. The idea is to examine ones connections with active curiosity that enables accurate coherence.

img_4600“There it is,” refers to exactly that: making one’s practical moral choice in a clear-eyed understanding of the complex human systems in play. That includes the Chinese, Mexicans, Africans and billions of other fully alive humans, including several down the block who voted—incomprehensibly—for the other person this week.

You can’t vote to disconnect from the world or each other. The event of the election does ask us to look again at those connections for clues to life. What are we going to do with our connections with angry White people? What are angry white people going to do with their connections with angry Black people? What are both going to do with scared brown ones and the billion Indians and nearly billion Africans that didn’t make it into the headlines? Where’s the life in these connections?

The way to use the Leading Causes of Life is the opposite of the medical problem-oriented approach (what’s wrong or missing that we can fix or inject). Life grows from life and along its lines of strength. Ironically, the friction comes from connection; but also warmth and fire. We are very, very connected, even when those connections are deeply confusing, painful and uncomfortable. Ask any Black person if they are connected to white America. Ask any West Virginian if they are connected to the scientists driving the fracking or solar energy roller derby.

Look to the strengths—connections. Revisit your old framework of ideas about those connections to find your choices. Some of the Trump anger was simply cruel and toxic. But listen again to the rage of not being understood, the real vulnerability throbbing in rural, small town and left behind industries that are turning millworkers into Walmart greeters. Of course, these are all victims of the hand of larger systems; but some empathy might turn on some intelligence about what to do. “There it is” might at least offer up something as practical as helping to move the furniture. And it might offer a lot more, if we really took our connections seriously and thought together.

I’m not at the table in DC, but that’s not the only table that matters. Every Stakeholder Health hospital is deeply connected to hundreds of small town and rural communities, but we tend to peer at them through the tiny peephole of our emergency room and only when they are forced to come lacking any other connection to 21st century medicine. We are connected, but have brought little creative moral choices to those relationships. We haven’t even begun to think about it, not entirely unlike the way we tend to avoid the obvious thinking about the minority neighborhoods that tend to surround our urban academic medical centers.

Follow the connections home and then find the thread of coherence that might disclose some real choices.


These ancient “witness stones” were covered over by vines beneath our place on the ridge. A witness I didn’t even know was there.

The name for that work is generation. Generation is what grown-ups are supposed to do. It’s not quite as fun-in-the-moment as procreation, but it has its pleasures.

Generation is also the way we work: with life, hoping and choosing, tending and protecting. Generation draws us to the broken places and wounded connections, but not in hopes of mere restoration. We look to the next sunrise, not the past. Generation is also amount of time it takes for the hope to mature. Decades of sunrises; one every day.

Life finds a way.

There it is.

If you’d like to be in connection with others thinking about the Leading Causes of Life, follow this link:


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Ways and meaning

We met in Cape Town where life always finds a way improbably and impossibly amid the shards and horrors of what humans do to each other. The subject was generation. The Leading Causes of Life Fellows explored the work of grown-ups hoping our life could be about more than our own life; that we could give ourselves to  the phenomenon of generation. Not abstract or innocent, we know how power is held  and it protects institutions, sometimes violently and sometimes on our behalf. Such contradictions and complications. The way is found with others seeking life. That’s what we saw when we looked at our lives, some threads woven across decades.

Here’s a sort of poem I wrote as notes to myself before the African dawn thinking about that.

I thought we were talking about engaging communities of need and vulnerability. Now I am home in my home, my people torn, scarred and scared.  I am reading my notes again and they seem  useful in another place, here.


On the old road over the pass to Paarl.

Question not

What first or


but how with.

Living systems ask

and offer

Acknowledgement of



And possibility.


Seek not first the things to fix.


In Sutherland, the first big telescope in South Africa–only 1 meter. Still useful as old instruments can ask new questions.


How with?


Approach with humility

Earned by you and yours.

Be tender at the




Mind, skin and space.



Massive cork tree at Schoenstatt. Out of Place, peculiar. Still growing.

Seek invitation,

Hope for membership.


First do no more harm.

You, invasive exotic

We, adaptive hybrid.



Your only possible



Offer it.

Inconsequential and



Your stuff and power

Weighed in the savage

Economy of another.

But usually life finds life

Practical as dirt.




Yellow Wood Tree, 400 or so, growing in place in the Company Gardens, Cape Town.

As for faith,

Have some.


As for hope,

Have some.



Less than love

Which lasts

the only way;




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North Window of St. George Cathedral in Cape Town, South Africa. Where Archbishop Tutu prayed for a non-violent revolution. The prayers worked.

I was flying over Libya from  South Africa when I watched the elections unfold last night.  KLM now has wifi that even reaches the African desert. The pilot shared the news to gasps. I am as heartsick and afraid to my bones as all the Trump folks would have been had the election turned out as predicted. This will take some digesting, but let me share a few thoughts as we head to a home I hardly recognize and maybe never knew.

Between TC and me we have four daughters and two grandsons. I am thinking of them and the wild uncertainties facing them as they will find their way in this unhinged world. They have been raised to respect faith and logic times art and science and the truth that emerges from all four. They have lived among people of difference in culture, race, language and nation, so watching a victory that looks like the opposite of all that is a deep shock.

We were in South Africa  meeting with the Fellows of the Leading Causes of Life, most of whom were formed in life, character and work by the horrors of apartheid and the traumatizing  uncertainties of resistance. TC and I went by St. George’s Cathedral where Archbishop Tutu galvanized the improbable non-violent movement of Spirit that surprised everyone with a peaceful transition to a new democracy. Amazing things happen sometimes. We lit a candle at the Shrine of the African Madonna for our fragile nation. I’d ask for our money back for the candle since the prayers didn’t work.  But  maybe the work is ahead.


TC lighting a candle for the fragile USA democracy at the Shrine of the African Madonna. Didn’t work out so great. So far.

Politics is not the entertainment channel. Different votes change the flow of power, money and legal authority to set the rules for love and marriage, work and free voice. It matters and will change more than many of the Trump folks understand. Politics is not about sending a message; it is about putting people in charge of governing. We just elected people who have shown not the slightest interest in the actual work of governing, so we have no idea at all what happens next. Nor do they.

I’ve been confused about how my country works ever since Reagan won so others will have to sort out the politics. I have long been especially saddened as a Christian, although there the South Africans give me a clue.  The radical  apartness of South African  rested on Christian language and logic, all in the service of the Boer people who saw themselves a special people in the world constantly reinforced by a theological and cultural backbone. When threatened and afraid, they prayed but not for understanding. In the end, it all collapsed as any tribal in-turning does on our round globe.. For many reasons Apartheid could not last, but one of them was the energy and intelligence of Christian resistance sustained through very dark years which offered little rational path forward against raw state power .It’s theological foundation was a sand castle exposed not by the secular intelligentsia, but by other Christians. This had many witnesses, but turned when a small group published the kairos document declaring Apartheid a sin and the failure to name it as such heresy. (Jim helped write it.)

Not all the blood lust  is aimed at the poor. In fact, I don’t think that Mr. Trump cares one way or another about poor people. I don’t think my side lost because we are for mercy and justice. A lot of anger  is aimed at those of us who claim to be helping the poor while benefiting ourselves. Bill and Hillary offered spectacular targets with an FBI bullseye as a last impression.


Image of the moon shot on my Iphone through a telescope on the Karoo. I like that it shines despite all the craters.

My simple point is to not reject the language of faith just because of the weirdly constant Evangelical support for anyone who fights against what they fear even if the candidate so clearly do not share the faith. I can sort of understand the alt-right folks with all the guns and unhinged conspiracy ideas. But I don’t understand  my Christians who have lent the cross to Mr. Trump.  I wonder who they’ll get to pray over it all and what they’ll say.

I know this is the time to speak  in the language of faith, but of the kind of faith that welcomes the stranger, sides with the poor and seeks mercy and justice. As in South Africa, such faith finds common cause with people of many other faiths.

Don’t give up the big words, ideas and durable truth. But put your body where it matters, too. Let me be explicit about Muslims and Hispanics, the two groups singled out for special fear. Mr Trump has telegraphed the punch. South Africa 101: make sure white Christians stand so close that we get hit, too.

I work in the broad field of health science, including hospitals and all the institutions relevant to the health of the public. Nobody has any idea what Mr. Trump’s election will mean for the policy frameworks of our work, because there has been no thought about it. There has never been any serious alternative proposal other than resistance to President Obama. I suspect there will be lots of change in language and show, but not much  fundamental changes in the basic policies. Obamacare is really just the inexorable advance of science shifting the balance from expensive treatment to long term management and prevention. It decenters the privileges of the hospital specialists  in favor of the simpler mundane things that make and keep people healthy. Much of the current problems result protecting the role of the insurance companies who have no interest or even curiosity about poor or working class people. Now that the Republicans—or whoever they are—go to governing, I will be surprised if they don’t reinvent Obamacare which was just reinventing Romnycare.



The Leading Causes of Life Fellows talking through the work of generation amid broken societies.

Academic Medical Centers are a whole different  negotiated set of compromises and protected privileges all built on the sanctity of science. Mr. Trump seems more inclined to go to Mars than invest in hard science relevant to health.  But who knows what exactly will be undone, redone and replaced? We’ll see.

This is true for nearly every single area of civic life—not just health policy–where government policy intersects with fluid culture and moving technology. Who knows? If Mr. Trump chooses some people who actually want to undo privilege on behalf of making things better, there could be some ground to work on once they get over whooping it up over The Obamas.

Before we go into hard core resistance mode, we should listen carefully to the fear and sense of loss that was strong enough to overlook the obvious lack of decency. While it is hard to overlook the hot froth whipped up around  race and gender we just don’t know how much was also about the loss of moral credibility of the privileged. We just elected one of the most weirdly privileged insiders of them all, but I know that’s most of his supporters were certainly not. We won’t get anywhere if we don’t listen.

I work for—have long worked for—agencies of great privilege and oddly complicit wealth. Emory floats on Coke, Wake Forest on tobacco and  Methodist LeBonheur Healthcare plantation cotton. I am among the privileged elite that the Trump movement has found so deeply unworthy of trust. I’ve long found financial support among Foundations that are even more privileged. All of these privileges rest on the moral claim  that the poor and the vulnerable benefit from the array of programs to advance public health and healing. This moral claim is part of what is rejected, along  science itself. Its not just evolution and climate change, but pretty much the whole idea of scientific ideas. But clearly, those of us with science at our side have not always used that science to pursue the needs of the poor. Large fractions of nearly all budgets end up flowing toward the professionals.


Schoenstatt retreat center near Cape Town where we met. It has been a Catholic training center back into the anti-apartheid days.

Part of modern health policy is an enhanced focus on Community Benefit, driven mostly by Senator Grassley. The point is to force non-profit hospitals to prove how we are fulfilling our social contract—and earn our tax privileges. Wake Forest Medical Center just last week approved a pretty good Community Benefit Plan. It is a legal document but also a moral one. By hospital standards it is progressive and almost bold. But it is hardly sacrificial. I suspect the average Trump supporter would find it less than compelling.

The point is that we—every privileged institution–will have to do be worthy of trust and continued support of a deeply untrusting body politic. The vote does shown they are willing to throw out any traditional allegiance they sense is part of the general betrayal they are feeling. Real work that provides real value to normal people at a fair cost is how trust grows. Obviously, this is exactly where the focus of Stakeholder Health, 100 Million Lives and FaithHealthNC are focused. In this fractured moment, we must do it, and not just say it.

I expect to spend more time in big public demonstrations  protecting the rights of the most vulnerable and stigmatized. But we also have to show up at the committee tables where the boring work of governance is figured out.

A little humility will go a long, long way in these days.

And bring all the scraps of faith you can find, too. Maybe we should have lit another couple candles to see the way.


Chapel at the Schoenstatt Retreat Center. I’m glad it is alarmed. I am, too.

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finally, we vote.

Science, faith, the english language, decency, and democracy seem to be hanging by an unraveling thread. Scant comfort to know other democracies are off the rails, too. We are on the way to South Africa, one of the few democracies more imperiled than my own troubled USA. I voted before leaving, of course, finding peace in the ragged assortment standing in the long line at the library. One of my tennis friends was handing out reminders to vote for his wife who is running for judge. Seems like a good person, so I hope she gets to serve. Same for The woman further up the ballet.

And I found hope early Sunday morning in Denver as I met with the leaders of the American Public Health Association a group torn by its science-based hopes for widespread health and its profound sense of how much those opens rest on the partnership with the raggedy, mess of humans called “the public.” Like anyone who can read, they were worried. But they—we—had no other plan than to hope and keep on working out of that hope.


35,000 public health professionals gather at APHA every year.


I work for a hospital these days, but think entirely like a public health person. I came to the field of public health at The Carter Center, which was led by two laypeople who expressed their faith through public service—Jimmy Carter and Bill Foege, a former President and Director of the Centers for Disease Control and Prevention (CDC). The first major conference President Carter convened after graduating from President to Citizen was called, Closing the Gaps in 1986 which was a cooperation between the CDC and The Carter Center. The meeting illuminated the huge prevention opportunity in the fact that 2/3rd of all death before age 65 could be prevented based on things we already know. He and President Carter, another practical person of faith, then held a meeting of interfaith leaders to see if they knew that and could act on its moral implications. They didn’t know it, but rang like a bell when they saw it as evert religion thatt gas ever been places prevention of suffering on a higher moral plane than after-the-fact response. So the InterfaithHealth Program was born at The Carter Center and Bill asked me to help lead it. I noted thatI didn’t know anything about Public Health to which he said (I swear), “you’ll pick it up in no time.” Of course, he wasn’t talking about epidemiology, which is harder, but the ground game of public health of aligning the medical and community assets once science knows that is something to be done.

Before I took the job, I borrowed the pulpit at my beloved Oakhurst Baptist church to see if I could preach a public health sermon. It was easy to find relevant religious texts almost anywhere in the Bible you’d want to put your finger in, so it wasn’t hard. It was a pretty good sermon for a white guy. I’ve been a practitioner of public health ever since. I am proud to hold the title of Professor of Faith and the Health of the Public at the Divinity School at Wake Forest University while also being Professor in Public Health Sciences at the med school. I’m all in.

I later came to understand that our entire field of public health and our many institutions at county, state, national and global level were born out of the very same optimistic democratic rational engineering kind of hopeful politics that in the religious field is known as the Social Gospel. That fertile identical spirit also bore the fruit of most religious hospitals, which, like my Baptist hospital in Winston-Salem, were explicitly built in response to what we now call social determinants. You can google it.

I don’t know how the elections will turn out Tuesday; whether I’ll need Rauschenbusch’s muscular progressive Christian hope, or Bonhoeffer’s dark counsel of resistance. Either views the work of faith in the world as sacred because God so loves that world, the one we live in, the only one we have to hope for.


The abortion protesters outside probably don’t know there is a Faith and a health caucus in APHA with hundreds of members.

What both faith and public health view as sacred, blessed, honorable, worthy or praise and sacrifice—are the practices, behaviors, choices that lead to life, protect it, enhance it, extend it and spread its blessings widely across the people. The Hebrew prophets always meant the whole public whenever they said “people” and never meant selected individuals. There can be a lively dialogue between public health and faith because we are family; both optimistic about the future. We don’t think God is done; and we don’t think science is done. There are things to do worth doing together (even when some of us don’t care about God and others don’t care for science).

The health sciences have often been terribly disrespectful of people who are ill and vulnerable. The early history of public health is full of paternalistic, often racist, rant disparaging of those who live in horrible housing deprived of any decent education or sanitation. Hospitals continue to speak of “super-utilizers,” “non-compliant” patients and “frequent flyers” that produce “financial drag” on our business models, as if being sick was a recreational sport. I am trying to train our clinical and finance people to speak instead of JFP’s—Jesus Favorite People. They’re not all pitiful; they’re just people.

I met one of Jesus Favorite People on the way over from the Sheraton to the Conference palace we were meeting in. He almost bumped into me spinning out of the 7-Eleven with a couple boxes of Krispy Kreme’s (made in Winston-Salem, by the way). He was frumpy enough to be a public health guy, but the donuts made me guess “semi-homeless.” I asked him for directions and walked a few blocks, asking where he was going with all the carbs. He said he was taking them to some homeless friends, because he didn’t want to forget where he came from. “Wow!,” I said; “Are you a religious guy?” He said he grew up with an alcoholic Baptist for a mom and still didn’t know what that was all about, so he was an agnostic. But he admired Jesus. “Me, too,” I said; thinking Jesus would like this guy. He might have a career in public health (minus the donuts).

Hospitals have lots of people who are a complicated mess and we sort of muddle through. We recently had a different kind of story because two Spirited people engaged with creative freedom to see another way. The individual was a classic JFP, living with his mom in a trailer without plumbing or any way to clean his catheters, so a recurrent visitor to the ER for sepsis. He was running up north of $29,000 in costs just for the hospital until Helen and Jeremy invented a whole new way out of no way. Using all the skills of social and hospital systems, multiplied by the persuasive powers only found in a preacher’s wife and man of Spirit, they made the impossible irresistible: they man is out of the trailer and into an apartment, still in a tough life, but not involving the ER much.

Hospitals tend to see them as individuals hoping for mercy. Mercy is a lot to ask, so don’t under value the miracle of one guy out of a no-plumbing trailer. The Randolph case demanded far more than technical skill and dropping the financial policies. It demanded audacious imagination and the high arts of spirited persuasion. It did produce a good financial and medical story. The person was costing the hospital $29,000 and now is in his own apartment; not cured and still costing $1,300 or so. But how to describe one life turned around, reclaimed, dare we say, saved? Public Health knows there are entire neighborhoods of such folks. It hopes for more than one-off acts of mercy. Hard enough to speak of one miracle. How to speak of a pattern?


Lines to see Hillary and Michelle in Winston Salem.

The humanity of the story—and its outcomes—rests on Spirit and specifically the intertwining spirits of two key professionals. The story created many unlikely heroes including a landlord, pharmacists and churches who went way beyond their normal boundaries on behalf of someone with whom they had no relationship and could never repay them. They showed evidence of loyalty to someone who didn’t deserve it. This is common among mammals, which Haidt undervalues. Healthcare talks about dual eligible (those who qualify for both medicare and medicaid—the older poor) but this story is about a triple eligible, one qualified pretty much only because they are a human. This takes the creative moral freedom and spirited imagination. It’s hard and it often doesn’t work in terms of outcomes or savings. But its not supernatural; it’s part of human complexity, what Rev Joseph Lowery called good crazy. He said the love makes you crazy, which can be good crazy and bad crazy. Spirit makes you crazy, too.

My counsel to our beloved field of public health is to NOT stop talking about facts, analytics, determinants, vectors, patterns and predictors. But we must ALSO talk about our crazy love for the people–the public. And we talk about why we continue to hope for better, hope for more and simply won’t quit hoping no matter what. You can take our money, put us in the dumpiest offices and cut our staff. You can treat us as pitiful, hardly even as honorable as a primary care doctor, which in hospital world is hardly on the map. We won’t quit. Why? Because we are in a lovers quarrel with the public we love.

If you are a public health professional and cannot profess love for the public, I’d recommend that you take your high end analytical tools and move on down the street to do hedge fund manipulation, which is not played for life and death stakes. If you don’t love, you’re a danger to the public and the rest of us in the field of public health. Don’t even tweet.

By the way, we see this phenomenon in religion too. It is quite common that professionals—the preachers and the teachers of theology—do not love the church, synagogue or mosque. It has come to annoy and disappoint them to the point where they cannot abide its failings. They speak of change, but longer out of love. They are too far along in their lives, maybe have a kid in college or alimony, so they stick in the business, but without spirit, hope or love.It is worse than worthless, for they do delete the spirit of themselves and the institutions the people need.

Whatever happens Tuesday we can be assured of a hot stew of angry bitter vitriol. I will be very afraid for all that I value in the Republic, if the slick realtor wins. And I will totally understand the mind-boggling fear of those on the other side who have come to believe that my candidate embodies the corrupt cynical elitism they blame for so much gone wrong.


Why I vote.

This is the time for those who just can’t stop loving the messy, disappointing, ever-muddling gaggle of humans called “the public.” We are in JUST the right work at just the right time. While others rant, we must speak out of that love. Bring our facts and laptops, as we know that science is a friend of humans and what we are possible of. But we must speak out of love first, especially in public, especially with the public, especially about the public.

In the meantime, vote.

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Championship Spirit


Celeste Wray, a spirit warrior who belonged to St. John’s United Methodist church in Memphis, Tennessee. She had seen her share of evil and evil overcome. She fought every good fight with grace. She knew right from wrong. Picture by Collins Dillard,same spirit.

You can no longer watch championship basketball in North Carolina because of a political train wreck involving sex, bathrooms and religion. In spite of some of those same politics,  this is a great place to watch something more important, a championship enrollment campaign. This may sound as exciting as an hour of Dean Smith’s four corners offense (ask someone from the ACC, if that doesn’t instantly make your eyes glaze). If so, you’re not one of the 613,000 North Carolina citizens who signed up for coverage under the Affordable Care Act last year, the vast majority receiving significant financial help to do so. Only four states have seen more people sign up, all with much greater population. This is an improbable success against all odds in an impossibly hostile arena.

But that was last season. Another season of enrollment kicks off in November, which you may have noticed is hyper-polarized and almost numb with clanging public din. So it was a good time for faithful people to gather at Fountain Baptist Church (“where God’s blessings never stop flowing) to pray and preach and study so that we are ready when enrollment opens up in November. Basketball is a complicated game, especially when strong tall people are determined to stop you from scoring. That’s nothing compared to helping someone buy insurance : Bronze, silver or  gold? From who? With what money? Oh, I might get a subsidy? How much? When? From who? Why? It all makes my stomach hurt. Once someone screws up the courage—or desperation—to ask for help and actually gets in front of a trusted person, the conversation usually takes a bit less than an hour. But who to trust and how to find them? That takes a campaign. Simple steps done at exactly the right time in the right way–six hundred thousand times.


The championship team behind the Interfaith Health Summit at The Fountain of Raleigh Fellowship, September 13th.

Teams that win aren’t perfect. They are carried beyond themselves to give everything for something greater than themselves. Even teenage boys bouncing a rubber ball can sense when the Spirit is present, moving and alive. That’s why we were at The Fountain. We need blessings to flow in a desert. We saw it flow last year 613,000 times. Could it flow again? It depends on why.

Johanthan Haidt, author of The Righteous Mind, says that we humans are born with six kinds of moral intuition. There are so many decisions to make that it would be impossible for any of us to rationally think our way through to the right thing even in the course of a normal Fall day. The human race would never have made it out of the caves into large groups of organized social life, if we had only reason to work with. We don’t. We come with six intuitions which Haidt says operate as quickly as does our ability to recognize a face (even if we can’t remember the name). There’s a lot to recognizing a face and at least six kinds of things involved in recognizing the right thing to do. Haidt thinks we recognize and instantly weigh any moral choice as to whether it is fair and caring, but also whether it resonates with liberty, authority, loyalty and sanctity. The first five are social, relational—human—but frankly, also found by Jane Goodall among the gorillas. This last one rises and raises to another level. The one that makes us truly human is called sanctity. Can organized public action be Right with a capital “R”? That’s what you’d be looking at last week at The Fountain.


Rev. Graylin Carlton, Chaplain found near the Emergency Room and the homeless of Wake Forest Baptist Medical Center.

Basketball prayers work better on behalf of tall fast people. But if you’re playing for high human stakes in which victory depends on trusted teams in Wilkes County or Lumberton, you’d better be praying on behalf of more traditionally shaped men of Spirit like Leland Kerr and Dean Carter. Rev. Paul Anderson is a wee bit short to be picked for a basketball team, but you sure want him on your team, if you’re trying for a movement. And you’d better be praying for the women of Spirit like Anita Holmes, Willona Stallings, Angela Cameron, Dianne Horton and Charlotte Leach. Give them the ball and your prayers are half answered because they’ve been formed in the Spirit for decades.


Rev. Dean Carter, Chaplain at Southeastern Health System in Lumberton, NC. He led the champion enrollment program last season.

While the championship coaches at Enroll America told us the game plan for the enrollment campaign, I sat thinking about my small offering. I’m usually asked to give game plan type speeches, but this time I was asked to close with “why.” I thought this would be a good time to speak to Haidt’s “sanctity.”  I had been reading about another improbable story told with hilarious detail in the book of Acts.  This early Christian story—like the early stories of most movements of the Spirit—is one surprise after another involving one unqualified person after another. The heroes are in and out of jail because of all kinds of behavior wildly  disrespectful of the dominant order. The story of Spirit rings most of the bells of Haidt’s five obvious moral values. everybody in the Empire then and since knew the Jesus movement embodied practical care (#1), especially for the most vulnerable, such as the widows. This was fair (#2) but only in the radical new perspective of God’s presence (hence also clicking off Haidt’s values of loyalty and authority. The story is all about the new freedom (click off  #5, “liberty”). This did not from the human campaign design,  but from the deep sense this was the unplannable inbreaking of God. It was a witness of something sacred: #6.


Reverend Richard Joyner on the right. You’d want him to have the ball if you were hoping to plant a thousand cabbage plants–or grow a movement in a tough state.

You see in Acts that the Spirit can move ahead of the understanding of the people involved. In chapter 12,  Peter was once again in jail because of his long public sermons. Just make sure, he was sleeping in between two armed guards with another at the locked door. An angel lit up the room, but still had to nudge him awake, tell him to get up, put on his robe and then sandals and follow him outside. Peter did so. And then comes the punch line: “He didn’t realize the angel had actually done all these things; he thought he was having a vision!” Holy crap! So he walked down the street to where the Christians were busy praying for him and knocked on the door. Second punch line: the woman who came to the door recognized his voice and was so overcome by joy that she ran to tell everyone. She forgot to let him in. When the Spirit moves the ones most surprised are often those who think they’re praying for it. The Spirit isn’t something we use, it is the thing using us.

The law that resulted in the loss of good basketball in the state was  cleverly designed to ring the sanctity bell of North Carolina religious voters, most of whom have never met a transgendered person. But they somehow sensed it was just out of kilter with everything else they knew of sanctity. There are things (not many) above basketball. I do know some trans people and so have more moral intuitions to work with, including loyalty to them. But I can understand why many of my Baptist friends are willing to watch basketball on TV instead of giving in to arguments that ignore their sense of divine order. An intuition about sanctity comes from and is reinforced by one’s experience.


Rev. Dr. Leland Kerr has played every role there is in Baptist life, now the man building the relationship between Wake Forest Baptist Health and its birth mother, the NC Baptist Convention.

An important clue to those who wish to use sanctity like a blunt club for their political purposes:  if it is of God the campaign will likely resonate with the other five values, too, as you can see in Acts. When the Spirit breaks in, compassion breaks out, new loyalties form in light of new understanding of authority. New experiences happen, even to Peter.

More than six hundred thousand people in this nutty state managed to enroll in insurance. That’s not a vision; it happened to everyone’s surprise. But hundreds of thousands more are still knocking. This is not the moment to celebrate answered prayers, but to go open the door for those still outside.

Many of the heroes of Acts would today look a lot more like Mr Trump’s supporters than my medical center colleagues. This is true, except for the fact that the Spirit of the Living God didn’t make them angry, scared and mean; it transformed them into a community known two millennium later for its boundarylessness hospitality and mercy. That’s what liberated sanctity looks like. It’s not just raw energy; it is energy formed into a body that does what God would do. That’s what makes the work sacred and what makes sacred moral. This is why the humble, almost pedantic work of an insurance enrollment campaign is sacred labor.

Early in Acts the scale of constant compassion needed to be organized, so new roles were invented called deacons. That’s one way of understanding all the detailed new roles involved in the enrollment campaign. The community in Acts needed to manage food distribution; now we need to manage getting people connected to another kind of sustenance, full inclusion in 21st century care systems. That takes insurance, so we’re inventing mundane new roles to channel the spirit so we can do another 600,000 things correctly at the right time.

Acts tells an astonishing story of hospitality and mercy that emerged through the life of a despised religious gaggle that was almost too small for the Empire to crush. Open handed mercy was its miracle. The networks present in The Fountain this week are not like that. The North Carolina Baptist Convention has 3,600 congregations, the General Baptist State Convention another 2,000, the United Methodists another 2,000,  while dozens of other faith networks have hundreds. More than 1,900 clergy are registered at our one hospital in Winston-Salem to visit our patients. What if the Spirit blew through all that? What if the that massive social reality developed a sanctified moral intuition that understood that the authority of God asked not just to love mercy and walk in humility, but to do justice?

I preached at the Fountain as a Christian because I am one. But the Spirit blows where the Spirit cares to go. One of my teachers is the long and just witness of the Community Development Resource Association in South Africa,  Doug Reeler. They publish the Barefoot Guides, including one built on the book  by Jim Cochrane and I about mobilizing Religious Health Assets. They are way beyond smart, built to catch and be carried by the wind of the Spirit blowing in some of the toughest places on earth. You’ll find this poem by Christopher Fry on the CDRA website.

A sleep of prisoners
The human heart can go the lengths of God.
Dark and cold we may be, but this
Is no winter now. The frozen misery
Of centuries breaks, cracks, begins to move;
The thunder is the thunder of the floes,
The thaw, the flood, the upstart Spring.
Thank God our time is now when wrong
Comes up to face us till we take
The longest stride of soul men ever took.
Affairs are now soul size.
The enterprise
Is exploration into God.
Where are you making for? It takes
So many thousand years to wake,
But will you wake for pity’s sake!

Could the wind of the Spirit move us beyond free clinics and insurance toward the partnerships with public health and the things that make for health? Maybe we are not having a vision. Maybe we are being nudged awake.


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Martyrs Park on the bluffs of Memphis. Sculpture by Harris Sorrelle, honors those who remained in Memphis, TN during the Yellow Fever epidemic. The plaque reads: “In grateful memory of the sacrifice of the heroes and heroines of Memphis, in the 1870’s, who gave their lives serving the victims of yellow fever.”

Important things slip past amid the superficial chattering glances of our news cycle. August 13th deserves more.

Only a hundred and thirty eight years ago, Kate Bionda died of Yellow Fever in Memphis after William Warren jumped off a quarantined steamboat and ate at her restaurant. This wasn’t the first epidemic to hit the river town, which was why the city had blocked traffic coming up river from Vicksburg where the fever had broken out. By this time, a week later, 138 year ago twenty five thousand people—half the city—had fled, leaving the blacks and the poor or stubborn whites behind. Soon 200 of them were dying every day, making partners of the prostitutes and priests who stayed to care. The epidemic ended with the first frost in October after 20,000 had died, many buried in the mass graves of Elmwood Cemetery. The whites had almost no immunity, so they died fast, often tended by those of African descent whose blood had long ago acquired some protection. Half of all the doctors died trying their best with almost nothing but good intentions to work with.

At the time they didn’t even know to fear the mosquitoes—same as us with Zika. Fearing is less complex than hope; it takes more time and thought to figure out what is possible. But our first hope is makes everything else possible: we hope someone will show up. That part of the Memphis story is almost impossible to comprehend. People of faith—different faiths and races—showed up from across the nation, rushing into a pestilential horror they did not understand to give what they could to people they did not know.

The highest point in Memphis overlooking the still-flowing Mississippi is Martyrs Park, honoring those who came at the worst possible time to give their best.

People still do that. People are on the highways to flooded, mudded, Louisiana as I type.


Kinshasa, Congo where Yellow Fever is exploding today. Even when you know about mosquitoes, you still have to remember buy the drugs.

Mosquitos still do their thing, too. Today in Kinshasa, Yellow Fever is erupting, finding the puddles and sewage neglect that it loves so much to take down those left behind. No lack of knowledge here. Shamefully, many of the early cases were missed as basic diagnostic supplies were missing, allowing the epidemic to blow up. Global politics has brought 100,000 Chinese rail workers to the Congo these days who have as little immunity as did the white Memphians. When they head home, some ill, and get bit by the Chinese mosquitoes, the Fever could explode to a scale to which Memphis would be a tiny footnote.


The Lorraine Motel a few blocks from the Mississippi where Dr. King was assassinated while defending the sanitation workers of Memphis.

The answer to Yellow Fever in Memphis and Kinshasa was and is sanitation, sewage and clean water. Take out the trash, then bring in the scientists. Scientists in Memphis risking their lives and reputations to figure out the mosquito linkage, fighting their way through a swamp of controversy and stubbornly opinionated ignorance. Engineers invented a revolutionary system of handling water: one pipe for the sewage, one pipe for the rainwater runoff. Memphis was first on the planet with that idea. Treating the sewage before dumping it in the Mississippi came quite some time after. The man who invented the Memphis pipes died in Havana—of Yellow Fever—designing their system. Organized trash collection became nearly obsessive and turned Memphis into the nation’s cleanest city (for a while). Those sanitation workers, responsible for the very life of the city, themselves were denied a decent life until they drew another man of faith to show up amid fevered virulent racism, Dr. Martin Luther King.

Kinshasa, Baton Rouge, Milwaukee, Orlando and Dallas. Deadly fevers flourish when good people look away, walk away and don’t show up.


Devonne at IOM

Devone Boggan of AdvancePeace speaks to the Roundtable on Population Health Improvement about “transformational opportunities” for young men involved in gun violence.

A couple months ago a committee of people showed up in a small Lutheran church in Brooklyn to figure out what to do about community violence. The National Academies of Science Roundtable on Population Health Improvement left our marbled environs in DC to get nearer to the contagion, so that we could have a more informed grasp of what to fear and what to hope. Our fears were jangled by the massacre in Orlando only days before. But we were drawn to less dramatic violence; the daily grinding kind that made a walk to the grocery fraught with fear, the kind that nearly every young black man knows. How do we drain that swamp of appropriate fear? What can we do to make hope from being happy talk? Different things are learned in churches than academies of science, even when the subject—violence—is the same. Faith folks think about life and death a lot. A guy hung on a cross 70 feet from the microphone which stood in front of a quilt the kids in the church had made in hopes of peace. So even when you have the same world class scholars critically engaging each other’s rigorous piles of data, they think differently when they show up near the street.

You can skip CNN for a couple of hours to watch hope emerging from the fear in the roundtable’s deliberation. (Click here for the videos.) If you look closely, you’ll see some tears, which doesn’t happen very often in DC. What you’ll learn that the most important thing to do in our epidemic of violence is to show up. There is a lot more to do, but somebody has to move toward the fear. Devone Bogan brought testimony (double meaning intended) from Advance Peace in Richmond California about the most revolutionary, if obvious, idea: go talk to the one doing the shooting. It turns out that about 100 people were doing the vast portion of the killing. This wasn’t a cloud of millions of mosquitoes, but a handful of knowable people who could be sought out and talked to. Granted they were heavily armed, but they had had mothers. They were invited to city hall and offered a vision that only a human could offer; a path out of gang violence based on radical relationship. And concentrated daily engagement, coaching, social services, mentoring, stipend and exposure to bold alternatives. Radical to the extent the killers were offered a chance to fly to Robben Island to see where Mandela made the decisions in prison to give his life away to something great. Radical. It’s not that hard to find someone and shoot them dead; it takes a real human to find someone and love them to the point they change. The whole story of Richmond is astonishing, but not unique any more than volunteers driving into the floods of Louisiana is. People do this kind of thing all the time. The little church we met in had been doing that kind of thing for a century or so.

Webter IOM

Daniel Webster of Johns Hopkins speaks at Good Shepherd Lutheran Church in Brooklyn about the effectiveness of community based efforts.

We learned from Dr. Daniel Webster of Johns Hopkins that the most mundane things—cleaning up the neighborhood—make a huge difference to the scale and pattern of violence, just as it does with other contagions. Violence is much lower in blocks where the vacant lots have been planted in grass and gardens, especially when the people hired to do the cleaning live there. Normal people know this kind of thing already. You could carpet bomb the rough neighborhoods; but it works better to pick up the trash. Our friends at Bon Secours learned this when they asked their neighbors what they needed most to improve their health—help us pick up the trash (Baltimore Grit).

Follow your heart, but bring your brain.

Recently some of us hospital executive types were meeting to brew a plan for managing hundreds of thousands of Medicaid members in North Carolina. There are billions of dollars in motion, and we have computers, so anything seemed possible. But people with computers can lose many hundreds of millions of dollars selling naively crafted insurance policies to previously uninsured people whose lives they knew nothing about. Ask Aetna. And it’s not Obama’s fault that insurance companies had never met poor people. Is there a way to do this well?

A wise physician from Sentara has done Medicaid work for three decades. He counselled us that the challenge isn’t medical as much as it is social and emotional. It’s humans, not the microbes. The evening before we had talked about our FaithHealth ground game that is so excruciatingly mundane and practical. He got a bit carried away when he described the work of FaithHealth as a “silver bullet.” Silver bullets were once thought to be only way to kill a werewolf, but the wicked tangle of poverty and health is harder.

Memphis didn’t need a bullet. It needed plumbing. Until the Fever and the fetid water decimated the city, they didn’t realize the city sat on “the Memphis sands” which held the largest most pristine source of water in the nation. So what? You still need plumbing. In every community there is a social acquirer of people glad to help others in practical ways. So what? We need social plumbing—roles and relationship and values—to connect the compassion to those who need it.

You can’t shoot bullets at mosquitos and you sure can’t shoot bullets at Medicaid. But you can show up. You use your brain (and computers) to build patterns of relationship systematically street by street, neighborhood by neighborhood, county by county, region by region. Those relationships are the trellis on which our most relevant science grows into the lives of human communities year over year that tends toward mercy and maybe even justice. The trellis is very carefully crafted with the intelligence of those that know those streets. The Supporters of Health were former environmental workers at the hospital not unlike the heroes Dr. King gave his life for in  Memphis. The Connectors are even closer to the ground—they come from and work in the neighborhoods and networks most predictably in need one or two days a week. They show up systematically, methodically, consistently in a pattern of organized compassion.

Show up. Then ask what’s possible and follow that thread and weave it with another and then another and then do it again. That’s what works when you see that your thread is part of a pattern, and it is the pattern of hopes and fears that matters.

A hundred and thirty-eight years ago was like another world but it’s really not that long ago. My parents were married on August 13th 85 years back, closer to the days of yellow fever than to my daily work. They stayed married until dad passed nearly 23 years ago. Neither they or any of their children were without flaws, but life grew up around them year after year.


Rev. Dr. Bobby Baker of Memphis and the Congregational Health Network.

The Martyrs of Memphis are alive in another generation of heroes who have not left the poor and wounded behind. “The Memphis Model” –the Congregational Health Network–inspires people from around the nation to travel to see the plumbing of compassion looks like when you get 600 diverse congregations working as one.

Something about a fever, yellow or the blinding rage of violence, brings out the best in us. It activates the whole body; the social body, too. Without the plumbing of well-built relationships science has nothing to grow on. Today we have lots of science but a paucity of relationships. It’s also easier to go buy some science, software and clever gizmos than it is to win the trust block by wounded block. But we can do it.


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