As we look to DC this weekend, it would be good to breathe in and out a few times. And in doing so, pull a bit of the anxiety out of the civic breath. It’s a good time to appreciate the likelihood that the expected storm of angry violence will pass unremarkably like many winter storms do. There are, of course, entire media channels whose livelihood depends on keeping us anxious about storms of various kinds. Let them whip up somebody else. The couple thousand aged-out men (and occasional fading women) with fantasies of overthrowing our government will dissipate now that the US Army has shown up. Let them go back to wherever they came from. Let them chatter among themselves, all couple thousand of them.
The violent ones are tiny fraction of the 74,221,744 (the total voting minus two thousand) who supported our sitting President. Some are mad, some afraid, a large fraction confused, and probably half already gone back to worrying about the kids and dog next door. The 81,283,485 who voted more like me also scatter across the spectrum of elation, but all have also mostly gone back to worrying about the kids and dogs next door. Image both spectrums as one, and I’m pretty sure that the largest glump in middle have anxieties and hopes with very little to do with anything near any capitol. This is good. Democracy doesn’t work well by exaggerating the emotional implications of every twist and turn. There’s a reason bureaucrats are boring; government work is supposed to be boring, clunking along without the rest of us worrying about it.
From time to time, though, it’s not boring. Whatever you think about the election, everyone should pause to lament those dead from a tiny virus that has killed more we lost to the Third Reich. Almost everyone knows a family that has lost a member; I sure do. Focus there. And then focus on getting everyone vaccinated and the deeply bruised institutions back on their feet: the churches, schools and restaurants.
Don’t give any breathe to anyone who wants to talk about anything else, especially if it makes you angry at somebody who has not actually hurt you. If you hear that coming, walk away and find someone ready for actual human words. Don’t argue, instruct, or magnify; for God’s sake, don’t retweet or reply all.
Now is the time for grown-ups, bringing non-anxiety and non-judgement. Counsellors get paid a good hourly wage to do that, but if you’re old enough to read a blog, you’re probably capable of giving away some non-anxiety for free. That’s much more valuable than your reprocessed opinion.
It’s possible that tens of thousands of armed goobers will swarm our streets like killer bees. But probably not. I’m confident the US Army and cops can sort that out. The rest of us should figure out how to share our tiny blue planet with people who do not vote like we think they should.
Pause. Quiet. Listen.
Do it again.
Notice that days have more light. If you look closely, you’ll notice the early buds are getting ready for Spring.
It can all fall apart, this democracy thing. It’s not like gravity that makes rocks fall, even if you don’t believe in it. Democracy only lives in the mind and spirit and evaporates when we forget it. The belief that people can elect people who care enough to more or less do what they said they’d try to do rests on a fragile set of behaviors and values. For instance, that elected ones won’t lie and laugh at the same time. Basic stuff; it’s a low bar but one we have dropped below.
I was on a Delta flight to Denver Wednesday on my way to a meeting of the Stakeholder Health Advisory Council. Trapped in a middle seat between two suits who immediately turned the inflight video monitor on Fox News inches from my face. The guy on my left opened up a vast laptop with a powerpoint about the 10 things you need to know about illegal immigrants, including the “fact” that 79% of food stamps go to illegals. I’m pretty sure that in North Carolina half of food stamps go to Baptists, because half of everybody is a Baptist. I didn’t know how to begin the conversation, so I just turned on CNN. I’ll do better next time.
How do we craft a working democracy again; one where we can talk to each other? In a nation where hardly any of us came from here, you wouldn’t think that would be that hard. We are all a muddle, all some kind of mutt. My last name is Norwegian, but 15/16th is something else. Nobody is the same, even those that think we are. All the Evangelicals and Catholics turn out to have abortions and divorces at nearly the exact rates as the liberals, who are presumed to not be Evangelical or Catholic, even though many are. We are all just doing the best we can to be decent parents, brothers, sisters and citizens, the whole time we know we are not doing a very great job of any of those roles.
Loma Linda University’s San Bernadino Campus includes a community health clinic and a stunning gateway school for high school students to begin their journey into health professions.
In such a motley group, it is important to avoid letting someone else tell you who to be afraid of. This is especially important when by any rational basis you have never actually met one of the fearsome people. I’m thinking, of course, of the many Muslim physicians without whom our hospitals named Baptist would have to close. And the many, kind family-oriented Spanish-speaking men and women who have found refuge in our city, rebuilding the south side of town with an entrepreneurial earnestness. Why be afraid of them? I’m more afraid of the people trying to make me afraid.
Of course, others want me to be afraid of white small town Baptists, who did, admittedly, vote for our current White House occupant, which I find mystifying. In my actual experience, these folks are kind and generous to any request for mercy, willing to drop anything to go build a wheel-chair ramp for a total stranger. The rural churches are naïve about the ecumenical nature of opioids addiction, alcoholism or poverty. If I needed food, I’d head to a church, confident they’d help no matter how inconvenient.
Here in gentle Winston-Salem, we had some very ugly, but predictable, outbreaks of threats against the two Muslim Mosques where our doctors worship. We don’t know who did it; but I’m sure they’ve never met a Muslim. I’m certain that, if we asked the Baptist Men’s groups to turn off Fox News and head over to provide protection, they’d do it. If they brought their wives, everyone would quickly find pull out grandchild pictures and complain about the teenagers. The kids would play soccer together as they do at school.
Sometimes, all it takes is an invitation to do better. Many of those claimed as friends of the mean have simply not been invited by to do anything else than put a dumb red hat. Shame on us for not asking more.
Jerry Winslow is the chair of the Stakeholder Health Advisory Council. He and I were together a couple of weeks ago at Loma Linda University Health’s institute for Health Policy and Leadership. Amid the heavy policy discussion we found some time to turn a gorgeous piece of maple burl and reclaim a piece of chestnut bowl I had managed to turn a hole in the bottom of. Jerry, the son of a German immigrant home builder, has been a master craftsman of wood for decades.
Jerry Winslow, teaching as always, this time at the lathe.
On Saturday Jerry took me over to the 1909 Gamble House, the epitome of “craftsman” architecture in Pasadena. It is a revelation in simplicity. Every single joint, lamp, door, handle, light, stair tread and attic beam was thought about and then crafted to express a perfect blend of form and function. The two architect brothers, Greene and Greene, were part of a vibrant global movement that saw in craftsmanship the hope for democracy, the possibility of a human culture. This was no small thing to believe amid the turn of the raw and violent century where industrial bigots had their way nearly unfettered. Something as modest as a well-crafted cottage might seem hopelessly irrelevant against the unstoppable tide of crass exploitation. But not if that cottage, or chair, or perfectly made lamp is an expression of integrity, consistent with a whole way of relationship to other people and the created order. What if such people outnumbers the mean crass ones? What if they—we—crafted a democracy?
Just a few of the billion perfectly crafted details designed into the Gamble House.
In fact, the craftsman movement was a strong signal about what mattered most, a thoughtfulness about how to live a well and worthy life. Frank Loyd Wright (a man of no small number of peccadillos) said of the movement: “Do not think that simplistic means something like the side of a barn, but something with a graceful sense of beauty in its utility from which discord and all that is meaningless has been eliminated. Do not imagine that repose means taking it easy for the safe forest, but rather because it is perfectly adjusted in relationship to the whole, in absolute poise, leaving nothing but a quiet satisfaction with its sense of completeness.” (Architecture and Machine, 1894).
It is time to craft democracy again with the same thoughtful attention to form and function as our earlier teachers lent to working with wood and home. Some of the old tools work fine, if sharpened again. Jerry still uses tools he acquired decades ago, now sharpened to a fraction of their original length. I just bought some 100-year old Sears Craftsman tools on EBay for $25. Old tools still work: Precinct 601 met in the Single Brothers House of Old Salem where democracy has been argued for a couple centuries. We elected a new party precinct chair, Kate Hayden, who looks for all the world like Bernie’s granddaughter, but knows the craft of elections. First job is to get to know each other, have a party for the party, read some books and talk like humans who are capable of caring and thinking about what matters.
I have some very modern carbide tools, too. Likewise, we need to craft to the relational technologies like twitter that are too powerful to leave to the mean and desperate. This is how I think of 100 Million Healthier Lives, the unprecedented collaboration led by Dr. Soma Stout of the Institute for Healthcare Improvement. The craftsman movement has something of the same challenge to figure out what to do with industrial machines; but democracy is played for much higher stakes than any lathe. Respect the medium; watch the density and grain if on a lathe; watch the pattern of need if crafting public policy. If you don’t love the wood or the people, go do something else.
When there was much to fear in a culture gone to mere machinery, the craftsman movement trusted thoughtfulness and beauty from integrity and the life well-lived. These democratic and communitarian values stayed alive in the culture expressing themselves later in the practical compassion of the Civilian Conservation Corps (which turned Jerry’s German immigrant father into a craftsman), Social Security, the policies favoring religious hospitals and non-profit health insurance. They crafted institutions that removed abject fear of penury from aging and made it possible to fight a skirmish, if not war, on poverty itself. Think of it as graceful joinery the Greene brothers would have liked.
Jerry’s old tools fit for the craft. “Life is not a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside thoroughly used up, totally worn out and proclaiming, “wow! What a ride!”
Democracy can all fall apart; But it can also heal and find its heartbeat. I think that is what is happening.
The meanest bully by the beach that we find so shocking today is nothing compared to the raw and untethered industrial power a hundred years ago. We have seen worse bluster fail before well-crafted policies and institutions built by people no smarter than us who wanted their life to simply be good.
They even left some tools behind that just need to be sharpened, put to the grain by hands willing to learn. Find your party precinct meeting, show up and get ready for the next cycle of voting. Make an appointment with your congressman just to tell them what you care about. Take your state representative out for lunch with a couple friends. Volunteer for a church mission committee and go find somebody to help. Plant a couple hundred trees like my brother did at his Presbyterian Church along with some Muslims up the block. Go read a book to a kid. This is how you craft a community, a culture, a life.
Sprouts find their way through the bullet holes in an old refrigerator in North Georgia. Maybe life can sprout after an election, too.
Ninety or so days from now our body politic will be on the other side of the most dangerous passage since the Civil War. (Here’s an exact countdown.) I think that Mr. Trump will have found a way to abandon the process between now and then (he’ll think of it as firing democracy). I’m not interested in what he’ll do on November 9th, but very interested in everyone else in a position of public responsibility and how we play our roles in a bruised and disoriented body politic. Every elected official in every county and town, every public officer responsible for public health or law enforcement, all of us with public roles in key institutions such as hospitals, major companies, press and religious leadership face the question: how do we do public work in a broken public body?
Our social and political body will walk with a limp. We’ll have a split mind with both sides almost incomprehensible to the other; like symbiotic twins of different species unable to find any words or gestures that are not interpreted as hostile. Forty percent of our fellow-citizens resonate to Mr Trump’s views, even if they might hope for better manners. But the intransigence could continue for a long time.
This is why we need to shift our attention from the battle, to how we live together afterward. Nobody has a bigger stake in this—or is in a better position to do something useful—than those of us working health, prevention, public health, healthcare systems. In gross financial terms, we are more than a trillion dollars of the economy, with millions of people working as nurses, janitors, researchers, doctors and the whole panoply of roles across our thousands of institutions. Those of us in faithhealth are even more relevant, because we live across so many boundaries of both faith and health.
Kathryn’s sketch of the many channels the Mississippi cut over time, always finding a way.
There is hardly any more possible diversity of faith and politics than inside one of our institutions, so we don’t have to go looking for someone who doesn’t agree with us. The nature of our work puts us in the midst of the most profound moments of hope (birth!) and shock and lament and sorrow on the human journey. We don’t just see the traumas. We can see many of them simmering in grinding poverty and the brokenness that passes from one generation to the next, the predictable implications of the insults of race, class and stigma.
As health organizations, we find ourselves right in the middle of the most contentious public policy issues. All of the third-rail issues run right through our buildings. We care for the undocumented immigrants (of course, we do) and the beaten up women, and the veterans with all the wounds that you can’t see. We know the eyes of those who can hardly recognize themselves because of addictions and dependencies. We know those surprised by vulnerabilities of age and the disconnections of the 21st century family. Those of us in public health know the streets where all these patterns live and we ache with the knowledge of how much of the suffering could be prevented or buffered.
Sprouts find their way through the bullet holes in an old refrigerator in North Georgia. Maybe life can sprout after an election, too.
We know a lot about bruised and broken people. Now we need to focus on our role in a bruised and broken body politic. To heal that body requires a new humility in our language and a quiet tenacity in our work.
Gene Matthews, now faculty at UNC School of Public Health, spent many years as the General Counsel for the Centers for Disease Control, many of them working for Dr. Bill Foege. I also worked for Bill at The Carter Center, so when I came to North Carolina a few years Gene reached out to me. Gene introduced me to the writing of Jonathan Haidt and his recent book The Righteous Mind, which turns on very bright lights on the way to much healthier public dialogue about the things that matter most. Haidt, a professor of moral psychology, says there are six “moral intuitions” that function like taste buds for all people. Liberals (my people) tend to have a taste for caring and fairness (meaning equality) which we prefer with a touch of liberty. Conservative have a broader pallet, which includes caring and fairness (to the surprise of we liberals). Conservative have an equal taste for the virtues of liberty and also loyalty, respect for authority and “sanctity.” This last one is not just religiosity, but a sense that some things are sacred and deserve protection. Haidt argues that conservatives—and conservative political movements—have an advantage in that they can appeal to all six, while liberals aren’t even trying on three of them. This was true at least until the Democratic convention last week with all the flags, religious singing and Mr. Khan whipping out his pocket copy of the Constitution.
It’s not a perfect book. Haidt wanders off the rails in his description of religion as a kind of social Elmer’s Glue. As much as he values sanctity, he left the whole field of faith somewhat less than sacred. And he takes some odd detours to pick an argument with Kant. You can skip those parts. But don’t skip his core gift to us, which is a hugely helpful framework that helps us see and talk across our otherwise impossible divide.
Haidt argues that we humans are prewired for righteousness so deeply that we can sense these six moral flavors intuitively way before we shape logical moral arguments. This is basic to how we humans form highly complex social bodies far beyond the simple ties of blood and clan. And this is also how we can map the pattern of traumatizing bruises which mark our body politic today. And this is how we can see the need for urgent humility by which those of us in positions of influence in our complex human body can create a new pattern of deep listening and dialogue about the things that matter most. Haidt begins and ends his remarkable book by quoting Rodney King’s immortal question, “can’t we all get along?” Less quoted, but not overlooked by Haidt, was King’s follow-up counsel: “we’re all stuck here for a while, so let’s try to work it out.”
Some think our only common language is money—what things cost and who should pay. I’ve even watched churches collapse under the heavy and highly visible hand of economics squeezes the air out of otherwise adult discussion: “be realistic and act like a business.” Health organizations often succumb to this even though our daily life is filled with evidence that when life hangs in the balance, money often matters the least. What we actually have in common is not money, but the human journey of health, frailty, dependence, pain and the fear of pain, loss and the fear of loss. What we actually know is how our life is shaped by those we share it with, those who care despite all boundaries of blood and coin. This is why I think those of us in the health fields–including the massive number of community and faith partners—are in such a profoundly key role in this moment when our body politic suffers so deeply. We can understand each other because we are all on the same short and fraught journey.
The first celebration of July 4th was held in Old Salem while George Washington was passing through. It’s reenacted every year as a service of prayer for peace.
One thing health people know is that words are not enough. Words are not even the beginning and they are hardly important at all at the end. We may need Haidt’s counsel to talk among ourselves and then again when we have the chance to explain ourselves in public. But most of the time our eloquence is quiet. We keep our doors open to anyone all day and night. Despite the fabulously expensive technology and astonishingly prolonged training of thousands of staff, every non-profit and faith health system gives away tens of millions of dollars of care every year on purpose. We are required to do so as part of public trust, but most everyone of us goes well beyond the minimum bar. This passive waiting in readiness kind of witness is part of the glue that holds society together, that defines us as a moral people at all. It is good, indeed very good. And it is not enough for this broken moment. For we know we can be proactive with our mercy; we need not wait, we know better.
The Stakeholder Health book, “Insights from the New Systems of Health,” looks like a kind of textbook based on our collaborative learning; and it is. I expect dozens of courses to use it in the next few years (TC and I will be teaching one ourselves at Wake). But more than a textbook, it is a collaborative witness that is map for healing out social body. Its 44 authors wrote about the social drivers that shape the health of people and neighborhoods. They wrote of population health as the common ground for those professing public health and those running healthcare organizations and hospitals. The book did not quite say the obvious and most profound thing. The social body itself is bruised, but resilient. The social body itself is defined by biological, psychological, social and spirit aspects, inseparable as the facets of an emerald. The social body itself cries out for the practical, on-the-streets intelligent love found in the daily walk of community health workers. The social body itself thrives when generosity is humble and smart.
This is already happening all over the nation and world everywhere I look. The wild organic sprawling testimony of 100 Million lives is hitting on all six of Haidt’s cylinders. There was not a syllable in the Stakeholder book that you could not go and see on Monday morning. We were describing, not imagining.
Even in fractured North Carolina the heart of the body politic is beating even as the political bruising continues. Every single day I see a truly astonishing level of serious collaboration quietly crossing over all the supposedly impossibly treacherous chasms. Competing hospitals share data and teach each other about how to come alongside the poor. Black, white, liberal and conservative Baptists are working together on the meanest streets–some paved, some not. Republican sheriffs and way liberal Hispanic activists are quietly helping each other keep faith with all six of Haidt’s moral intuitions. With just a little bit of humility and decency very different kinds of people find a way when the work is about real people. That’s the NC Way.
Haidt would ask us to describe our work and witness not just in the liberal flavors of care and fairness (as we usually do). We could—and thus should—embrace a more robust and compelling witness that resonates with the broader values that honor the sense of loyalty so typical of healthcare teams, the sense of respect for authority of many kinds that govern the practice of medicine and public health.
And we should claim in humility our deepest intuition that our work is sacred because we humble ourselves before the ultimate human mystery of life and death and the life of the common body that goes on beyond us all.
Dawn over Winston-Salem. It happens every day, if not always this pretty.
Sometimes when you’ve been walking a long time you forget how far you’ve come and far you can see from the crest. This happens more in the folded and forested Blue Ridge than in the wide open west. But even there above the tree line where it seems you can look right around the curve of the planet, you still have to remember to look up and notice the view.
That’s what I felt when I held the new book Stakeholder Health, Insights from New Systems of Health. It is collaborative learning at its best, edited by Teresa Cutts and Jim Cochrane, two synthetic thinkers who make everyone around them smarter. They were surrounded by 44 authors who were already pretty smart, but together the voice is brave and sure.
Dr. Teresa Cutts at the Rolling Release of the book at Chicago Theological Seminary.
In a time of fear and anxiety, Stakeholder Health writes with collective confidence that we—a very big we—are already well on the way to being new systems of health. We are certainly far enough along the way that we can see what we have to work with: a deep well of tested intellectual tools, street-smart tools for mapping community assets, clarity about the powerful integration of body, mind, spirit and social.
What is new about the new systems? Nearly everything. The new systems are marked by realizing they are systems, not just structures. And we are systems of systems interwoven in complex ways that are impossible to map neatly. But the chapter by Maris Ashe describes the tools we are finding useful in living into such complexity. The next chapter (not as smart, but not bad)(I led the writing team) describes the new ways of leading rapidly emerging in the upper reaches of hospitals today. The next, led by Dora Barilla and Eileen Barsi dives deep into the electronic connectional apparatus, which is how these sprawling systems find coherence and get work done at very large scale. Information technology (IT) is giving way to Relational Technology (RT), which changes everything.
Kirsten Peachey, of Advocate Health Care, outlining the chapter on Integrating Care to Improve Health Outcomes: Trauma, Resillience and Mental Health
The next three chapters are a sweet suite on intellect and testimony vibrating with hopeful, practicality. Nancy Combs of Henry Ford Health led the chapter looking through the lens of community navigators and the radicalizing affect they are having turning the new systems of health inside out. Teresa Cutts (“Dr. Honey” in our home) led a global quality team laying out the extraordinary depth of logic and practice allowing up to map community assets with as much rigor as we’ve long had to map needs. This chapter by itself will change the future of “community benefit” and its tame model of Community Health Needs Assessment. The chapter on integrating trauma, resilience and mental health, led by Kirsten Peachey, will likewise radicalize the thought and practice of “integrated health.” The three chapters together are positive bombshell with energy and intelligence released because of who is in a position to act on the new synthesis. It is profoundly good news, except for the old in-bred guilds trying to hold their power.
Kevin Barnett led the team building the case for a new financial accountability; indeed, a whole new financial logic that synthesizes all of the above so that we are a whole new business—health, and at large scale. This is taken to another radical edge by Doug Easterling and Alan Smart’s chapter on philanthropy. Between the two chapters, we can for the first time see the flow of money at the level of the whole system called health. We can begin to see how the old patterns of tame complicity can be cracked open to let the money flow through to the biggest opportunities.
Jim Cochrane led the writing for the chapter that puts all this American chatter into global context and thus accountable to world class intellect and practice. So much of what is old and creaky in our systems is peculiarly American; so much of the new now emerging is global. This sets up the chapter led by Jerry Winslow – a global citizen who happens to live in California—on mission and the heart of healthy community. Every bit of the book is a call to bold mission, not because of who started them, but because of who needs them—the world that God so loves. All the science, technique and technology fit the work of mercy and justice. Let it roll down.
Even the appendices have some bright lights where you wouldn’t expect them! The first appendix lays out the learning journey of Stakeholder Health, which began in a blizzard in Memphis, turned into the Health Systems Learning Group and found our way through an extraordinary array of learning experiences. I don’t think any of us realized how many steps we had take to the get to the the view (hence the mountain metaphor above). Appendix two is a rich collection of population health screening tools, sure to help many hospitals—and no small number of graduate students. The last appendix has numerous mission and vision statements new guiding hospitals and religious bodies in the field.
The book is in a “rolling release” in Chicago, Winston-Salem and next Tuesday in Oakland. Each bounce gives voice and visibility to the local authors and engages the networks most relevant to the local institutions. You can track it all, of course, on the stakeholderhealth.org website.
Most of the authors work for one or another of the new systems of health, so there is optimism but no happy talk. Most of the new systems are surprised to learn they are new because all of us spend the vast majority of our working days engaged in very old problems. Even when you are near the clearing at the summit with the great view, you have to watch where you put your feat rock by rock or you’ll hurt yourself. I happen to know that is true. The caution is not the whole story, however. It is significant that those of us inside the beast(s) can see the new emerging.
The book will be available for free download chapter by the chapter on July 1, which makes it a kind of textbook likely to be integrated into courses of many disciplines. And it is also available now to purchase on Amazon for $19.95. Just click here. Today.
Rev. Francis Rivers, the Faith Health Division’s lead organizing an Identity card drive for the Hispanic/Latino community. Part of what is very new in our New System of Health
The cover picture was taken on a chilly morning in Winton-Salem where one of the New Systems of Health—our own little Wake Forest Baptist Health—found ourselves in the position of having done something really smart and right. We had lent our name, presence, religious voice and political weight to a program offering validated picture ID cards to hundreds of undocumented Hispanics. They were part of the new system of how our city works and who mattered. They honored us by trusting us enough to show up. We were helping each other find our way into the future we were already partly living in.
That’s why that gorgeous picture is on the cover: we are far enough along that we can learn from the journey, pause and testify that we’re on the right path.
This palm was planted at the Garfield Park Conservatory in 1926. It takes time and tending over generations to get something like this.
Between Pope Francis and the nine Charleston “Saints” whose deadly witness held us just as rivited a few months ago it is obvious to all that faith is not synonymous with stupid, mean and irrelevant. They are helping us see through the stars, bars and blather to something real. If you need forgiveness, intelligence, mature compassion, it is a reasonable idea to look toward an institution where faith has been nurtured over a few centuries, or, in the Pope’s case, millennia. If something lasts longer than one lifetime, or even a season in one lifetime, it is likely that there is a tradition involved, ecology not just of one, but many institutions. The Pope, for all his evident virtues, did not invent or elect himself to the role of Pope. The very institution that has been so egregiously, yes, criminally, complicit with some of the worst imaginable abuses of power and privilege turned around, found its best possible self and—who could imagine it—found a guy to fill the role that has electrified the nuns, nones and nearly anyone with a heartbeat. The Saints of Charleston who died–and the hundreds more that lived to forgive–were not a random gaggle of what really good people, but a fellowship born and formed with those easy-to-dismiss rhythms of bible study, song and prayer that turned out to be—when tested on a horrible afternoon—to be stronger than speeding bullets.
The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabius, CareNet and Ron Manderscheid on integrating Spirit into Population Health.
On Wednesday a small group of experts in behavioral and population health gathered at The Carter Center (named for a Baptist deacon who knows about formation even unto the edge of death). The “we” included Ron Mandersheid and Ray Fabius, who has literally written the textbook on population health (second edition!) before most of us heard the term at all. He was with us after gaining specific permission from his mom so that he could travel on Yom Kippur, a day held sacred across not two, but four millennia and counting. Why? Because the subject was how to integrate the sacred, the Spirit, into the work of behavioral health as it is integrated into large-scale population scale programs. One of the questions alive in the room was how to accelerate and shift “health” from being all about disease and preventing toward the positive dynamic we hope for.
What does “faith” know about that, given that from the outside, the institutions of faith seem to be mostly about not doing things? What does faith know about life that could be integrated into—maybe even illuminate—population health? The answer isn’t in the tricks of faith-based behavior modification that drizzle a bit of ritual razzle-dazzle over the dreary goop that “wellness” programs use. It is about the practices, disciplines—traditions—that shape we humans over the complexities of life together on this spinning and wobbly planet. Those traditions help us adapt to unpredictability, with a huge toolbox relevant to failure, forgiveness, resilience and hope. And the traditions themselves adapt—as Pope Francis is modeling in real time brilliant humility.
Dr. Kimberly Dawn Wisdom of Henry Ford Health System is one of the springs of intelligence within Stakeholder Health.
While the Pope was doing his best to tend to America’s soul one Speaker at a time, the leadership of Stakeholder Health was working in Chicago, where the FaithHealth movement was born, reborn and reborn many times, with another FaithHealth infant in the birth canal as I type. Stakeholder Health is a learning group of those who are living institutional lives, trying to find the shared intelligence, courage and community needed to nurture another round of transformation. What we want to learn the most is how to find and release the deep practical nobility found in the birth story of these hundreds and hundreds of faith-inspired healthcare organizations. Stakeholder Health includes a number of institutions that are not faith governed. Some of those, like Henry Ford and Nemours, spring from the social conscious of a vastly wealthy industrialist; others like ProMedica, MultiCare or Kaiser, express another community of social imagination. But all of us know we are drawing on more than our own toolkit of techniques and clever people. And we know we are doing so for a greater purpose than ourselves. All of us have an ear for the inconvenient cries for mercy rising up from the streets and neighborhoods we were born to serve. We know—as does anyone who has ever attended a church committee—that our institutions are deeply complicit with the banal evil of every status quo. Yet, we also know they are capable of nobility and of giving the moral energy of thousands of employees and their partners a chance to express itself at a scale unimaginable by one, two or a group of individuals.
Levon Stone is what a man looks like: paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: “don’t tell me you’re too tired.”
We heard about the miracles born of wrenching change—the closing of Advocate Healthcare’s Bethany Hospital—with angry wounding community protests about broken trust. Out of which came the Advocate Bethany Community Health Fund, structured for transparency and partnership, to steward a million dollars a year into carefully defined West Chicago neighborhoods to strengthen the non-profit and faith organizations closest to those tough streets. We heard the radical simplicity of CeaseFire Chicago, which blends the power of ER chaplaincy (embodied by Richard James) with the brutally won integrity of one who has lived the life of violence and its paralyzing fruits (embodied by LeVon Stone). The “golden hour” is that which follows the bullet’s impact, doing all to break the cycle of retribution. If not forgiveness, maybe grace, at least resilience. It doesn’t always work; but it is almost the only thing that does work.
Dr. Carrie Nelson and Dr. Bonnie Condon unpack the complexities of aligning thousands of physicians for the health of the community.
And we learned from Dr. Carrie Nelson of the mammothly hopeful and excruciatingly complicated task of turning 4,500 Advocate Health physicians toward the work of health in exactly the same way that got Ray Fabius on the plane to The Carter Center. How exactly does that come to be, not just outside the walls of the hospital, but also outside the doctors’ exam rooms and maybe even on the streets in between?
We learn of each other’s best attempts, still caught and partial, filled with frustration and inertia. We become braver, not just smarter. We look at our little lives and decide to risk our reputations as professional grown-ups on things that have never yet worked before. So, all across the vast warren of Chicagoland streets, dozens of hospital are working together to coordinate their community health needs assessments, struggling with the insane arcana of cleaning and aligning data so it can be made coherent at large scale (sort of like making oil and watercolors blend in one painting!). It seems just impossible. But then it is possible, at least enough to encourage those in the heart of it to try a bit harder, to invite a few more partners (let’s paint with acrylics, too!). It isn’t smart enough, yet. But certainly wiser than anything ever before.
Even naming a collaborative learning document with seventy authors is hard! Stakeholder Health will find a way.
There are some thing that one can absorb by listening and others that only become known through the laborious process of writing. And some by the even harder process of collective writing. Stakeholder Health is working on a second “collaborative learning document” that can help us name and claim the land we are in now. We wrote the first before the Affordable Care Act had passed through the valley of shadows known as the Supreme Court. We are in a truly new place drawing hospitals over their institutional moat and public health into partnerships only dimly imagined (with hospitals????). Stakeholder Health knows that one of the greatest and most hopeful unknowns is whether and how the quiet innovations among congregations and faith networks can be woven into the fabric. Like weaving behavioral health and Spirit (surely, we can do this!), weaving congregational intelligence and energy looks obvious until one tries. Even in Memphis where it has been nearly institutionalized, it has failed to become adapted across the full spectrum of competing hospitals (or competing faith ministries!). We need to learn more and far more quickly about integrating the full spectrum the hopeful arts of faith and health. So we are writing a not-book quickly emerging from the field, ready for the field with ten (or is it 11) chapters marking our learning edges.
This is holy and profane work, the only kind we get to do on this planet. It is the only kind any humans have ever hoped to do. We think in these days of Dr. King’s hopeful counsel about the arc of history bending toward justice.
Martin Luther King as a potential student to Colgate Rochester Seminary, long before he came to know of arcs of history and mountaintops.
Gene Matthews, who was the General Counsel for the Centers for Disease Control ended the recent meeting of the NC Citizens for Public Health with the quote behind Dr. King’s quote. Among his genius was King’s eye for the shards of wisdom born of previous battles, this one given in 1853 by Theodore Parker to a Congress on Abolition, an earlier chapter of the work still calling us beyond disparities: “I do not pretend to understand the moral universe;
The arc is a long one, My eye reaches but a little ways; I can not calculate the curve and complete the figure by experience of sight; I can divine it by conscience.
And from what I see, I am sure it bends toward justice.
The Surgeon General of the United States explains why his four biggest opportunities to advance health need relational infrastructure built on faith and community partners.
On Wednesday and Thursday this week, a wildly diverse group of leaders met in the White House to explore how to accelerate the growing alignment so necessary to advancing health and well-being of communities. Surgeon General Murthy laid the foundation with a sketch of a framework he will unwrap later this week in detail. But you could guess the outlines, which are pretty much the same priorities John Wesley laid out in his book, Primitive Physic, years ago, written before germs were invented. The reason this is new today is not because we have a new machine, but because have the possibility of new relationships of high capacity, capable of operating at scale. Keep saying that: building capacities for scale. They require what is now possible; rich interconnection between systems for food, mobility, the more complex systems of legal and illegal substances and the almost infinite array of systems relevant to emotional and mental balance. Oh my!
The challenge is the opposite of what you’d think: too many partners, not too few.
A trellis fits the plant it is intended to help find the light. Plants just need old sticks.
Tom Peterson tells me there are at least five million non-profit organizations in the world today, most of them created in the last half century, and almost every single one formed to do something somebody thinks useful for improving their community. It’s worse than that! Many more millions of for-profit companies have been formed in this same time, hoping to make money, but also to do something good in the process. Just check out kickstarter.com to get an idea. The ecology of human forms of association is rich, complex, interconnected and adapting at the speed of electrons. This is terrific if you need lots and lots of relationships. It is daunting if you think someone should be in charge of organizing them.
The Surgeon General does not aspire to organize 5 million of anything. But he does hope they (we) can organize ourselves in ways that can make it more likely that 21st century science (including, but far beyond everything Wesley knew about) can get into the lives of people and neighborhoods.
Many trellis builders think a lot more about their wooden art than they do about the plants.
One idea that has been popular, but rarely successful, is forming a backbone organization to achieve “collective impact.” I think it’s the wrong body part for the job, preferring something more like the intelligence of the liver or gut. But it is often useful for relatively small problems with simple answers, such as building a lot of homes in a particular city. When used for big and complex challenges, the backbone is often overwhelmed by all the partners and ends up simplifying things by leaving new ones out. The backbone’s limited number of vertebrae is the same list of privileged partners that always end up around the table. The idea of a table at which things are decided is part of the problem: you can’t fit 5 million people around any table.
On Thursday we tried on a different mental model better suited for organic complexity: the trellis. A trellis is not a miracle; it’s just useful to support the miracles of photosynthesis so that plants do what they want to do—bear fruit. The gardener (and the movement organizer) trusts the process, but doesn’t make the process do all the work. I like wine, and know that good wine needs just the right soil (developed over many thousands of years) and just the right rain (which depends on picking just the right valley and sun, not too hot and not too cold), so that magic happens. But it helps if the vines don’t just run every which way on the ground, so they have developed a near science of trellis design to fit different grapes.
Some trellis are built for the decades the vines mature through.
A movement is more complicated than grapes—and right now we have vines running every which way. It would help if we did the humble work of building some trellis on which could grow a rich array of relationships to bear the fruit the Surgeon General imagines possible. There are four main kinds of trellises:
Conceptual. Stakeholder Health emerged as a learning group, which collectively created a monograph to map the conceptual trellis on which healthcare systems could fulfill their missions. It is really good, but like other kinds of conceptual trellises, it needs to be rebuilt for a new season of work (stay tuned on stakeholderhealth.org). The learning community will need to be much larger and even more interdisciplinary than the intellectual gaggle that did the first one. It will need a relational trellis on which grow (and prune) those fruitful concepts.
Programmatic. The Surgeon General’s call for broad activity is not a call to do 10,000 different things, but to find alignment around four that could be transformational. Thousands of us can find a coherent role in food and we can understand our work as linked. Nobody is exactly in charge of it, but a well-built programmatic trellis helps us we can find power and meaning in contributing to a very large collective change.
Institutional. The YMCA is 3,000 local organizations, which have changed quite radically from the original shelters for young men to today’s iconic role as suburban fitness conglomerates. Now it is changing again, to embrace its extraordinary role very aligned with the Surgeon General’s vision. There are many other examples of old structures finding new relevance. But in every case, it is tough work. The 3,000 Y’s have 900 local Boards!
Some plants (like some types of congregations)(yours, Michael Minor!) are so smart they can grow up a string. But the string still needs some support.
Michael Minor is the midwife of the National Baptist Convention’s 60,000 congregations move toward health; but every one of them has its own Board of Deacons that will need to catch the same wind of the Spirit. So, too, the 33,000 United Methodist churches, hundreds of Jewish Community Centers and dozens of faith-based hospitals. “Can dry bones live?” asked Ezekiel. Can an old trellis bear new fruit?
Narrative. We humans live by story, far more than objective data. A movement with capacity and scale needs a narrative trellis, so that each of us, in our many roles as members, leaders, citizens and healers, can locate our personal story in the thread of a great story. We need the bards, writers and artists to help us tune ourselves to resonate to a greater tone.
Community Health Assets Mapping, here led by Teresa Cutts, makes visible the assets already alive in a place–the stuff that wants to grow. This enables the community leaders to imagine a new kind of trellis of relationships. And then they can build it.
We watched the video of the murmuration of the starlings, a mesmerizing image of complex beauty (here). Are we like starlings? They dance in the sky forming patterns beyond words. But they are all starlings and know how to act with each other. We are not alike (Kirsten Peachey said the group is more like a dozen starlings, and a hawk that eats starlings, and a horse, pig and potato). Not as pretty in motion. Or maybe it just takes time to find our common energy. The International Science Times, reflecting on the video, says that the way the birds dance is managed “by constantly avoiding collision. Generally, they were taking their lead from the bird directly in front of and below them, rather than the birds to the sides or above.” If you can’t understand how that metaphor applies to humans, you have never tried to lead a committee.
And we watched a YouTube video about how reintroducing the wolves in Yellowstone are changing not just the wildlife, but birds, berries, beavers and the flow of the rivers—the whole ecology (watch it here). Maybe we can change more than we think! So we howled (literally, we howled, which may be the first time that’s happened in White House since Andrew Jackson let in the rabble from the streets!).
Arvind Singhal used his many creative meeting structures to unleash a torrent of transparent brilliance. This is the “fishbowl” with healthcare providers in the middle. Pretty smart, but the questions from the outside were the real brilliance.
Or maybe we are just human grown-ups influencing our own complex systems as we try to live our way into the new possibilities. Many of us this week find our story in the Great Story of faith; we think we are agents of a redemptive process that has never quit, despite entire centuries of bleak reversal. We think that God is not quite done with our tiny planet or even with us, flawed and tiny people.
As we were meeting, astronomers were reporting more evidence that the ingredients for life are astonishingly abundant in places beyond counting at distances beyond imagination. The vast reaches of reality are swirling with the ingredients of life. The places once imagined as impossibly cold and hostile are just waiting for the right relationships to emerge. “Life finds a way,” said Jonas Salk, who was one of the first who thought that life rode into Earth on the comets.
Life is still finding a way—even in the hostile barrenness of Washington DC. It turns out there is a richer array of the basic ingredients than we’d been led to expect. But don’t make the process do all the work, unless you have a few million years worth of patience to move at the speed of stars.
I turn 64 Monday and need to pick up the pace a bit. It is very good news that we don’t need to invent the life. But we do have to thoughtfully craft the trellis. Let’s get on with it.
Sprouts find their way through the bullet holes in an old refrigerator in North Georgia.
Hearts break today in North Carolina.
I think of atheists as slightly over-educated modernists who are harmless, almost quaint, in their ardent non-belief. It had not occurred to me that non-believers were inclined to shoot people over parking slots. But now the Associations of Non-Believers have to explain, just as we Baptists have had to do for centuries, how their style of belief in UnGod can make one mean enough to be kill.
Of course, Atheism doesn’t make you mean any more than Islam, Christianity, Bhuddism or Hinduism. But every one of those structures of meaning have given harbor at some time to dangerous people who kindled the energy of belief into the fire of violence. Belief—and unbelief—can warm or burn.
Someone who believes in nothing is indistinguishable from one who says they believe in God but who do not believe in what that God tells them to do toward others. Groups of people, whether Islamic or Christian, can claim to follow God, but actually believe in their guns, banks, drones or grinding, blinding anger.
No French cartoonist, or student trying to park their car can be entirely safe from delusional nutters. Mental illness often hides in the fog of ardent belief and unbelief. It deserves pity, prayer and, often 21st century pharma. Turning this man’s delusions into a reason for religious or anti-religious rant only serves the demons.
The most dangerous nutters are the ones who gain control over the instruments of state power. The mentally ill man who shot three students in Chapel Hill is not as scary to me as the elected wackos 25 miles away in Raleigh where an unhinged legislature is considering a bill to prevent Muslims from imposing Sharia Law on the good Christians of Northern Carolina. These guys have a whole police force, not just some guns in a closet. They don’t want your parking place; they want the whole enchilada.
We Baptists remember times when we were strangers in this land, too, and know to fear any government that thinks it is holy enough to know who to punish on behalf of God. The first duty of any Christian—or believer of any other faith—is to work to make their own faith safe for the world and especially for anyone who does not share your faith. You or your children might be a refugee someday, too. This is why every religion that lasted longer than a few seasons raising high the priority to care for the stranger, the weak, the poor, the widow or motherless child.
The actual followers of Islam who pay taxes here are mostly students and a previous generation of students now serving as our doctors, nurses, dentists, computer programmers and anchors of our civilized way of life. There is no clinic or hospital in the entire state (or any of the other United States) that could operate an entire week without the medical professionals from many faiths well beyond my own Christian circle. Our community strategy of “proactive mercy” depends on the powerful faith of saalam-seeking healers of Islam. So our grief extends to the families and friends of the UNC students in a double portion because we share their commitment to the healing arts their entire family so obviously embraced.
I’m a Christian, trying to follow Jesus. He said that God would sort out the right and wrong, sheep and goats later on. The twisting plot of the story made clear God’s decision would surprise everyone involved. Don’t guess God. In the meantime, love mercy, do justice and walk humbly.
Cry with us and lend us with your prayers of mercy.
Carolos Latuff, one of hundreds of visual jounalists speaking into the horror of Paris.
Every religion is dangerous. Like fire, wind and water, religion is a fundamental element of human life that can drown, blast and burn. Religion guides our fear and frames our shame. And it can also strengthen our capacity for the courage shown in generosity, compassion, kindness and decency. It can be a wicked brew and also be like warm French cider on a bitter Winter day.
What are those of us who find our hopes in faith to do this week? What do we do when faith has been the language for nearly unspeakable acts? Do we just huddle behind the soldiers, or is there any place for our own actions to be as brave and relevant as the cartoonists like Carolos Latuff poking his pencil into the muzzle of terror?
Can mercy be brave as violence?
Although it filled up the CNN cash register this week, violence between religions is relatively rare and getting more unusual year by year. I’ve quoted the finding of Daniel Pink in earlier blogs, but worth remembering that all forms of violence continue to decline year over year over year. Most religious violence is between those who share a religion but find its variations deeply threatening.
While dozens died in Paris because of their secular differences from Islam, hundreds, probably thousands of moderate Muslims died last week because their 1,500-year-version of Islam embodied the radical hospitality, kindness and sacrificial generosity that fills up the pages of Islamic sacred writings. This is true of every religion. John Calvin burned–literally set fire and watched die–Christian theologians that it would take another theologian to figure out the minor differences in doctrine they were arguing about. He killed Christians not Muslims. I’m a liberal protestant writer who not have survived a week in Geneva. I thought about this when worshipping down the hill from Calvin’s towering grey church with an ecumenical gaggle of english-speaking Christians last July. He would have locked the doors of the World Council of Churches, torched the whole place and everyone in it….and than sung a hymn about it. And Presbyterians are relatively nice people. I’m a Baptist…….which I’m just guessing is more common among the Klan than their up-market Christian cousins.
It is always safer to have a radically different idea about god than a moderately different one using the same language. ISIS kills many more moderate Muslims more eagerly than Christians or those who believe in no god at all but humor. Every now and then they may travel to Paris for some especially flamboyant act of horror. But their every day killing is focused on the vast majority of fellow Muslims they find nearby who understand Islam as a faith of mercy and healing.
There is not much a Christian can do about radically violent Islam. But it would help to avoid accidentally strengthening the most despicable by implying they know anything about Islam. The “terrorists” aren’t radical about Islam, which is a religion of hospitality and charity; they are radical about their own projected fears, insecurities and delusions which are then wrapped in a weird and horrible way in the vocabulary of Islam. Christians know all about this process. Christian politicians are masters at wrapping their reptilian greed with Jesus’ words. But we don’t say of our nutters “those folks who blew up the Federal building in Oklahoma sure were radical about following Jesus!”
Do something to strengthen the moderate Muslims, for whom this is a special time of danger, not only from their traditional nut-cases on the far boundaries of Islam, but now from those of other faiths, including secularity, that will fear anyone they think is a Muslim no matter where they’re from (including Sikhs who stupid Americans confuse with Muslims all the time because of their turbans)(Oh, good grief…..).
Sprouts find their way through the bullet holes in an old refrigerator in North Georgia.
TC and I took a check over to our friends at the Muslim Free Clinic on Waughtown Street that I’ve mentioned in my blog before. They were today, as they do twice every month, caring for whoever walked in from the neighborhood that needed healthcare, medical counsel or a clue about where to their pill prescription renewed. It is very mundane, as most mercy tends to be. The physicians and volunteers show up and do it because their faith has thought them to do so. They aren’t aiming for martyrdom; just happy to settle for basic grown-up integrity. They are, as a Christian philosopher once said, “grabbing the near edge of a great problem and acting at some cost to themselves.” It is all a Christian, Muslim, Jew, Sikh, Bhuddist, Zoasterian or cartoonist can hope to do with their lives.
Do this.
Soak in the TV, then turn it off and go find someone who isn’t of your tribe, class, color, faith or opinion and be kind to them in some practical way.
Do this.
And the God known by every name any human has ever uttered in hope will heal your fears and count you among the living.
Six decades later I can still hear the screaming whine of this saw as my dad crafted cabinets with it.
I peered through a hole in our basement wall into a cloud of sawdust where my father fed a piece of wood into the spinning blade. The sound was painfully high loud and powerful, such that I can still hear it, now almost six decades later. I was two or so and learned later the wood was pine, as was all the rest of the cabinets in the home I grew up in, crafted with a mixture of love and parsimony by Dad. The saw, made by Rockwell, eventually became mine and used for most of my adult life as I, too, ripped, spliced, joined and paneled every place I’ve landed. The saw was a primal link to Dad, but over time whined, smoked and wobbled more and more. Once, back when I was earning my living with it doing remodeling, I was moving it from a job site when it bounced out of my nearly-as-old pickup truck, breaking on the pavement. Ken Sehested, knowing my despair, found a friend to weld the key cast iron gear back together, so it lived to wobble on in my life. But eventually the damn thing could no longer hold an angle, sometimes cutting a perfect 45, but more likely 50 or, the other day, 60 degrees. This makes very ugly joinery.
Now wobbling, smoking and whining, the saw prevents, not enables, good work. Dad would not be happy.
Dad would have hated the crappy quality the saw made inevitable and surely would have found any link with him something of an insult. I finally had to distinguish between clinging to nostalgia and actually honoring my Dad’s woodcraft. So I went to Lowe’s, channeled his spirit, and bought a solid Kobota table saw. I’m in the last stages of a new bathroom in TC and my condo near Old Salem and now have a chance at doing the finish work in a way that the Moravians and Dad would find acceptable.
Our lives are filled with the artifacts of those in whose shoes we walk, feeling our feet slightly too small for the journey. Just before Christmas I met with the ethics committee of the medical center, which had been established by the iconic surgeon, Eben Alexander, decades ago (he’s the dad of the recently famous one who wrote about “proof of heaven.”) The committee he started is still appointed by the chief medical officer, also a surgeon. Although medicine and the health sciences are less and less about what happens inside the medical hotel called “hospital,” the focus of the ethics committee continues to be almost entirely at the surgeon’s elbow. It thinks mostly about what the doctor should do or stop doing. Our current model of bioethics is not looking at the CFO’s spreadsheet, or COO’s deployment plans, or the Board’s capital decisions voting millions to build another office in the burbs, even those decisions shape the life and death for thousands of people over time. One can imagine Dr. Alexander shouting, “I started it; you go the next step!”
Surely dad is glad I finally put down the nostalgia and picked up a decent tool for work that honors him.
Every nook and cupboard among the health field is filled with guilds, national associations (with local chapters!), honoring this and that habitual practice and committee that made some sense long ago. They all have founders and officers—and sometimes even endowments(!)—but have long lost their capacity to cut cleanly or make useful connections. They have not moved with the science that gives more and more power to the integrated strategies managing conditions over time outside the professional enclaves. We live a long time now mainly because of better food and pharma not because we get surguries frequently. So there are way more ethical implications in the price of drugs than when or whether a surgeon does a procedure. They obstruct and no longer aid the joining of good science to good intentions. We need to honor our moral legacy with a new set of intellectual tools nearly as much as I needed a new saw.
We honor those who have given us life by acting with the creative courage they showed in their time; not by doing the same things their courage demanded then, but doing what courage demands now. We grown-up humans build things out of brick and steel. And we craft habits and patterns of power that guide the flow of money and time to the new glass towers. All these artifacts look solid and lasting, but they are as blowing sand at the beach.
Twice a day the tides wash the in-between land of the marshes.
I am typing this at St. Helena Island, South Carolina watching another morning tide move another day’s load of sand a few feet up the shore. These are called barrier islands because they protect the vital salt marshes which the tides wash twice a day, nurturing its wildly generative life. Very little important happens on the beach; all the life stuff happens in the muck and goop where the shrimp and a zillion other things are born and nurtured before heading to sea. The sand islands protect this vitality because they constantly move and adapt dynamically to the next big storm and even the next shift in climate rising the level of the seas.
Old maps tell the tale: the beaches move; the marshes live on.
In the handful of centuries white humans have settled here, the islands have moved miles. From the top of the 132 foot high light house you can see a few miles to the waves north east where the old one once stood. This new one (1889) is built to move again. Geologists know the whole chain of islands have moved back and forth for millennia. They last because they are dynamic; they serve life because they change. They are like tools built for a season of good craft.
The scope points 8 miles away and a quarter mile off shore where the lighthouse once stood.
Those of us holding positions of influence in institutions like to think our work and our organizations are the key to the life of our communities. Smart people at Stanford play to this pretense by suggesting adaptive change is dependent on “collective impact” organized by “anchor institutions.” These ideas are not just wrong, but dangerously misleading. Living communities don’t need to be impacted, but nurtured; they don’t need more anchors but heart, muscle and guts that serve movement. They do need protection from the raw tides, heavy winds and bitter storms, but protection in the service of change, not protection from it.
What else does any leader have to do that protect the creative energy so that it generates life? Do we have something better to do than that. Whether we are stewards of a church or hospital or public health agency or community health center, the life does not come from the edges, but the heart. I learned in Memphis that if I could protect the creative space for those who usually don’t have much power, they would craft beautiful and useful structure perfectly joined to the possibilities the neighborhoods needed. That process is the “Memphis Model” not the specific apparatus that emerged at that point in time. Don’t confuse the craft (mercy and care) for the cabinet (the structure) and certainly not the wobbly saw (me).
Leaders give life a chance by protecting the generative spaces in which life emerges, especially when those spaces need the complex processes over time. Any human community is way more complex than any salt marsh.
This is almost exactly the opposite of the role big institutions want to play. The leaders of the big things like hospitals can always rent consultants who are happy to tell us to tell the neighborhoods how they should live and how they should change, not us. The model for this is the old way that beach engineers tried to build concrete barriers to stop the tides and the natural shift of the sand (sort of like the one now under 40 feet of water a quarter mile from shore). The more we think like anchors, the more we’re in the way of life, which will most certainly have its way with us.
Roots are a kind of anchor that serve for a time and then not.
This is why I find surprising hope in the small stirring of faith and faithfulness in the faith-inspired healthcare systems of Stakeholder Health. Just about the time when you think smart and cynical are the same thing, along comes life to surprise us. In reality sometimes, large institutions such as foundations and hospitals can provide some shelter amid the raw power of the market forces (the “hurricane” in my extended metaphor). We can be barrier islands against the forces of raw money power, preserving the neighborhoods’ function as the salt marsh where life flourishes and creates the next generation. It actually does happen sometimes. It could happen more.
Francis Rivers Meza, one of our faculty in the FaithHealth Division, shared an article by Patricia Fernández-Kelly (2012): “Rethinking the deserving body: altruism, markets, and political action in health care provision,” in the journal Ethnic and Racial Studies. (click here for the article). She explores the way that religious organizations, including the huge ones such as hospitals, sometimes choose to act against the logic of the capital markets, providing crucial buffering for neighborhoods of poor and often stigmatized people. And they do this on purpose with craft and skill year after year. The authors cite one of our stakeholder health friends, Baptist Healthcare of South Florida and their long term work in Homestead Florida, a place that knows all about the need for barriers against storms.
Life finds a way, Jonas Salk liked to say. Jason McLennan, writing in Yes! Magazine this month says, “If there is one thing that’s certain, it’s that the future hasn’t happened yet.” Bingo! Honor both past and future by helping life finding its next way, not by protecting our old way.
The lighthouse just across the inlet above the gull. Everything moves; life finds a way.
It can all fall apart, this democracy thing. It’s not like gravity that makes rocks fall, even if you don’t believe in it. Democracy only lives in the mind and spirit and evaporates when we forget it. The belief that people can elect people who care enough to more or less do what they said they’d try to do rests on a fragile set of behaviors and values. For instance, that elected ones won’t lie and laugh at the same time. Basic stuff; it’s a low bar but one we have dropped below.
