Boundary Leaders – garygunderson Blog

Seed after fire

A solitary tree with green leaves emerges from a barren landscape, under a bright sun and pale blue sky, symbolizing hope and renewal. — *Seeds fulfil their role when released by fire. And wise humans can help them. So we learned at the McElvoy Ranch in Montana.*

“The arc of history bends toward justice,” promised Dr. King. I was saved for the church and America by that promise. I had decided as a Vietnam era student at Wake Forest to turn from my military family, suburban Jesus and American war-making when chaplain Richard McBride stopped me. He noted that I was nearly ignorant of my faith tradition beyond the tiny suburban rivulet I had dabbled in till then. He gave me a book by Berrigan and another by King; I am still living out the implications of that intellectual and spiritual metanoia.

But, since I had not grown up Black, I did not know that the bend toward justice would include savage reversals. Tulsa, Wilmington, Emmet Till. King himself spoke as that arc seemed hopeless. It was always faith, not logic, that those without power could hope for justice.

So I am new to cruel men laughing with alligator teeth, ablaze with disdain for the weak, all the time preening about their mean God.
Maybe the arc needs fire to bend.

Maybe without fire nothing changes.

Pyriscence is an ecological phenomenon some plants have adapted to release their seeds in response to fire which can melt the resins that seal seed structures like cones closed. I learned of this in an odd CNN piece about some tech guys that had developed an artificial pine cone that would only signal in the presence of fire to help with early warning. Pine cones figured this out over 300 million years, so we can be forgiven how little we’ve learned in a handful of thousands, much less the paltry 250 of our adolescent nation.

Maybe faith works more like Pyriscence than the gradually bending arc of my moderate hopefulness.

We will see soon, as people like Stephen Miller are busy setting the modern civilized nation state ablaze. Libraries, scientific research, healthcare, citizenship and the statue of Liberty all on fire. No need for white robes. But the ones doing the worst work are ashamed enough to wear masks as they bully their neighbors.

Maybe this is how the arc works. We are the ones fired and bent; our faith released like seeds that need the fire to find the new soil.

Gradual improvement over time makes the tree brittle, prone to storm, wind and then fire. Much of our public and non-profit structure grew more than a bit satisfied with ourselves. It has created an entire class of workers who make more money than those they are serving, setting the kindling for wrong but powerful accusations from those who find all mercy inconvenient and any talk of justice anathema.

Now the fire burns hot and unpredictable. Once alight, it follows wind, not logic. It creates its own storm as we saw in the LA fires, burning the poor and rich alike.

At the very moment the fire is triumphant, we can sense it is melting our resistance to being blown to new soil. We are the seed released by the fire to become our new selves the only way we ever could.

How, exactly? The Germans and South Africans are our best teachers.

The Reich was far more frightening than Mr. Miller’s little band of colleagues could ever hope to be. A sinking plurality supports him and his sad boss which is why they are in such a desperate hurry. In Germany those who resisted by showing compassion for the despised ones are now honored. I have written before about how the children place bronze “stumble stones” marking the homes from which Jewish neighbors were dragged. Cruelty morphed to shame which released the seeds of new generations that honor those who stood for justice. Not fast, but sure.

A stone carving depicting a hand raised with a small star above it, textured surface with moss and lichen. — One of 128 stone is a collective sculpture The the young people from Graben who designed this stone wanted to warn and remember:“A raised index finger signals to the viewer that they have to pay attention. It demands attention and urges vigilance. The string on the finger is barbed wire.

South Africa teaches that it takes more than one fire to forge a new arc. One impossible bend after another. The raw power of the Christian Apartheid state, falling before the peaceful miracle of Mandela, Tutu and Hani. But then pandemic AIDS, and ugly failure of the ANC to prevent the capture of the state (the Gupta family inspiring the Trumpian scourge). And now a bend toward collaborative governance. All while the tiny white minority owns most of the assets, whining all the while. Each fire, another bend, more seeds finding new soil.

But ever fire is different. And the seeds must be many variations on hope. No one seed starts a forest. Most seeds fail entirely. But this is the only way forests happen.

This political fire focuses on immigrants of color, a typical feature in American history. But I think this is the first time featuring people fed to alligators. Evil evolves, so we must, too.

This reign’s attack on the poor, immigrant and dark are a wicked tangle. The evisceration of Medicaid will undermine the capacity of healthcare, community health and public health to provide even the most basic of 20^th century medicine—while forbidding them to track the results. To keep the lights on, hospitals will seek revenue anywhere they can and cut everything without a billing code. Forget chaplains, translators and social workers. Ash on the wind.

These fires are burning away the vanity of wealthy non-profit healthcare organizations that have treated mission as a hobby. The community expects little of substance from them and will not protect them from the blaze. Instead, community organizations with fiery passion like Action4Equity and Love Out Loud are forming alliances with community health centers and local government networks. You can see this scrappy practicality in Winston-Salem. It works and is attracting national funding, such as the bold Robert Wood Johnson Foundation’s Justice Squared grant. Fire, seed, good soil.

As the LA firest still smoked and smoldered, The Randal Lewis Fellows of Partners for Better Health formed teams to envision a whole new way forward integrating all the assets, public, private, faith and neighborhood grit.

I don’t think the Germans ever had $45 billion dollars to spend on “the ultimate solution.” Mr. Miller does, which is more money than any racist in history; more per deportable victim than is possible to spend. He literally can’t find enough people to be cruel to. So he’ll look silly, which morphs quickly into performative cruelty. Expect horror; it’s the point. People kidnapped at emergency rooms and churches. And the alligators.

What is the opposite of fire? Not water; it is the seed. And what is vital kernel of the fire-born seed? Tell the truth. Which does not mean poking “like” to a Facebook post. It means getting close to reality and then tell the truth with your life. Don’t let evil keep its mask on. Talk to Hispanic pastors. Do what they say will help them.And yes, be generous with cash and time. We are seeing new channels emerge more efficient than the big old non-profits. Intermediary organizations like Love Out Loud and Neighborliness Center are giving shelter to smaller neighborhood scale ministries close to those in most extreme need. This is how TC and I help Una Bendición. Don’t “like”—give cash. All you can.

A sunset view showing the Statue of Liberty silhouetted against a vibrant orange and blue sky, with industrial cranes visible in the background. — *Statue of Liberty which welcomed my ancestors. It has been mocked before and still stands.*

Don’t romanticize fire; a cruel hunter. But we have no reason to fear it. A fire fears itself more than water, for its very nature it to burn out its fuel. In the same way cruelty consumes itself. It builds nothing, plants nothing, grows nothing. Fire falters even in the presence of a shift in humidity. In politics that is sort of like a shift in the polling that we are seeing now. It is realistic to not be afraid of the cruel.

Be the seed after fire. Cultivate your deep kindness, your most fierce love of the truth. You are born for what comes next and you will be ready.

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Live, the People

Historical industrial building at dusk, flanked by greenery and a pathway. — Belle Vue Cotton Mill used to dominate for miles with thread wove of slave-raised cotton. All gone, but the building is good for techies now. Our boat way down in the lower left corner on the canal that used to bring the cotton.

We live only if we are connected.

The FaithHealth networks in Winston Salem were so woven into the neighborhoods that somebody on the team knew every single homeless person by name. And where the Mayor ate lunch (West End Cafe). Thin filaments of trust, subtle as the forest mycelia, threaded every neighborhood including even into the Sherriff’s Office and, yes, ICE. Every now and then we’d host a lunch with ICE agents and Hispanic clergy so that the humans knew each other, not as cartoon characters.

The very first of the Leading Causes of Life is connection because all life flows across relationships, as real as the grittiest street in the toughest neighborhood.

Once, local ICE agents rescued a woman being trafficked and didn’t know where to put her safely. FaithHealth paid for a hotel (I didn’t ask the hospital CFO!). And when we convened the undocumented, we had enough trust to tell the ICE folks which church to stay away from. I am sad for these friends’ as they are debased by venal “superiors.”

Every human structure—church, hospital, university, Marines and ICE exists like honeycomb for the bee to help us attain our God-given capacity to thrive. This behavioral structure is hard-wired in the bees; no queen ever goes rogue to subvert her hive. Humans go rogue all the time debasing themselves and those with less power they coerce. Jonas Salk wrote, The Survival of the Wisest, about how our lack of hard wiring made us capable of adaptive choice. And, of course, it makes possible the corruption of power you can now see at your neighborhood Home Depot. Bees don’t have to think about being true to their purpose; we do.

Walter Wink observed that a) all human structure is designed with a Spirit for good that b) always tends to be corrupted and twisted against good so that c) the work of every human is to redeem and restore the structure to make mercy and justice possible.

When a damaged person obtains power, they can debase structure built for good and twist it to serve perverse ends. Social Security—one of the moral icons of the last two centuries—can be twisted into a weapon against vulnerable working people whose payroll deductions leave a trail. This is what Musk was doing. In the same way, our highest principle of free speech makes it possible for Journalists trained to articulate the truth debase language to confuse, distort and inflame. Marines trained to risk their lives to defend democracy become like Halloween clowns, threatening citizens who are protesting the violation of the Constitution they swore to defend.

This happens. Most of us just didn’t think it could happen in the constitutional democracy of the United States. At least most of us who are white. I don’t know anyone Black or Hispanic who is even surprised by the amoral vacuity of Musk/Bannon/Miller/Marco, serving a guy who hasn’t even read the constitution, much less a whole book about it. They have seen this for centuries.

This happens. But it never sticks.

TC and I live for now, for a season, in northern England on a canal dug by shovel 250 years ago by poor people who were valued little more than the sheep shorn for wool. The workers were guided by exquisite engineers working for rich families. They were digging for the same reason the container ships come to LA and deliver all the Chinese tools and Canadian lumber to the Home Depot that is put on shelves by people who mostly speak Spanish. I doubt if anyone in the White House has ever shopped in one personally. But they might wonder where their golf balls come from. Same ship.

It was—always has been—one world. But in the last two hundred and fifty years, the pace and scale has escalated profoundly. Even in those simpler times the relationships were woven in cotton and tobacco. Slave grown cotton from the Carolinas traveled to Liverpool on the same ships that had brought them from Africa to work the clay soil. Just west of Winston was the largest plantation in the state developed by British bankers from Liverpool. Our canal is known as Leeds to Liverpool, but it really runs to the hot fields of the Carolinas, across the South to Mississippi. A Manchester cotton company still owns thousands of acres of cotton land surrounding where TC was born, including the barn where Emmett Till was killed by some thugs way down the debased food chain of power.

A Venn diagram illustrating the concept of 'LIFE' at the center, surrounded by five overlapping circles labeled 'connection,' 'conference,' 'agency,' 'blessing,' and 'hope' in varying shades of orange and yellow. — *Leading Causes of Life leads with connection. If you want to kill something–say, a democracy–disconnect it.*

We grow ever closer to each other, which makes some afraid and thus easy for those who twist power to inflate those fears. LA shows us one structure of power in a last desperate ill-considered rush to hold on to its privileges, debasing all and everyone to the very last Marine.

Webs of power never last because the soil wears out or some technical gizmo changes everything again. The Belle Vue Cotton Mill behind our boat dominated everyone for miles around, spinning slave cotton into thread that was shipped around the world, even unto India where they conspired to make it illegal to spin cotton themselves. The rich built big houses thinking they would be lords of industry forever but did not imagine Gandhi who taught the people to spin for themselves and be free. Today the mill is full of flats and offices with people wearing shirts made in Vietnam spinning little bytes around screens built in China.

Human structure dissolves when it ceases its proper work and is bent to evil. The Marines pointing guns against citizens violate their own oath and become something else, sadly. Many in my family took that same oath, some buried at Mt. Vernon. They swore to serve only the People. So did all the people in Our White House, but you expect more from a Marine.

Why such a rush to scour the Home Depots anyway? There is more violence at an average English soccer league game. The desperation is so obvious as to be sad. They have already lost when they have to pretend that Home Depot needs the Marines.

Statue of Liberty illuminated at dusk, holding a torch and a tablet, with a sunset background. — *Stand strong lady in the harbor. We will not debase you.*

They have to finish their debasement quickly before the People can vote again. Once we get within a year of voting, even the most emasculated Republicans will hesitate to risk everything for a 79-year old lame golfer. So they are right to hurry. It is said that if you go at the King, you must kill him. And what if the wanna-be king goes after democracy? He must kill it, too; and so completely that we will not remember it. Our job is to follow the Constitution and make it clear that the only insurrection is the one behind the Resolute Desk in the People’s House.

Things that cannot continue don’t.

But they do until people look up from the screen, move into the physical world and behave differently. Find your local Interfaith Alliance witness and act like a citizen.

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If you or a family member are in the National Guard or active-duty military and you believe you are being ordered to violate the constitutional rights of U.S. citizens, call the GI Rights Hotline for advice and support, at 877-447-4487.

Boss power

An abstract painting featuring vibrant swirls of colors including blue, green, yellow, red, and purple on a white background. — *The many paths of the Mississippi North of Memphis. Drawn by Kathryn Gunderson for the Cover of Religion and the Health of the Public (Cohrane and me, Palgrave).*

How does power work in a time of no boundaries, rules, or words that mean anything?

Robert Reich, who is normally pretty smart, said the other day that power is a zero-sum struggle; that is, if someone has more, the other has less. There is a limited amount of power; the only issue is who has it. This is a mistake as it turns our attention to taking power instead of making power. Generals usually prepare to fight the last war, unprepared for the one they are in. So are social change-makers. It focuses us backward, thinking we need the kinds of power that created the mess instead of building the strength to subvert or bypass with new power. Even the Mississippi River, when confronted with a new barrier erected by some foolish human, goes around or under it, leaving it behind as a monument to folly.

There is no taking back the money Trump and his awful dependents have stolen. But how many gilded hotels can a family rent to how many bit-coin suckers? Who is going to stay in Trump Gaza for $1,000 night? The stuff stolen is mainly circulating among other thieves, so let them stay in each other’s hotels, fly on jets and swap wives, too.

The techno-poofs of Amazon, Apple and Meta didn’t become big by preying on whales. They want to be whales by consuming teeny krill like you and me one download at a time. They are mass market consumer companies just as vulnerable as Tesla has been in the face of global revulsion against its owner.

Tim Cook, Zuckerberg and Bezos have surely joined millions of their customers in downloading Springsteen’s meteoric hit recorded live just days ago in Manchester, England about 50 miles south of where TC and I are at the moment. I ran into a woman at a Skipton store yesterday. She was SO disappointed that I was an American but I assured her I was a Springsteen patriot not, well, you know. “Oh, she said, I heard about his Manchester concert…..”

Download his four-song set from pretty much anywhere and thrill to the “sound of freedom ringing.” You’ll be reminded “it’s going to be a long walk home.” He is as vivid as Dr. William Barber: “the world’s richest men are taking satisfaction in abandoning the poorest children to sickness and death.” You’ll find courage as he quotes James Baldwin “In this world there isn’t as much humanity as we would like.” And you’ll probably follow him as he urges us to pray as a bridge into “this train.”

It’s not his best music, but surely his best speech. (The speech is My City of Ruins (Introduction) [Live in Manchester, May 14, 2025])

I believe when the Boss says that we’ll survive this.

But how? The Don taunts the courts and those who hope law prevail, “whose army will enforce your judgements?” Good question. Can new power be created enough to turn over a lopsided accumulation of old power?

You’ll be watching the answer happen June 14^th, which is when we’ll see two kinds of power face off—62,000 soldiers embarrassed to be disgracing themselves in the Don’s silly parade dwarfed by 6 or 10 million disgusted citizens. First time we’ve ever seen president with such weak self-esteem that he needed such a ridiculous thing; soldiers are for fighting not fawning. So even the soldiers will be be humming Springsteen, not Kid Rock. The organizers are calling this “no kings day,” which is really not fair to actual kings, which have agreed to submit themselves to the Law and the People for a thousand years.

Many, many of the citizens will be signing songs forged in the long walk to freedom of the Black Church. If you are of the faithful persuasion, you can register here to find the Interfaith Alliance march closest to your church.

Aerial view of a winding river with vibrant blue hues, showcasing its curves and natural patterns. — Landstat image of the Mississippi’s wandering ways–never ceasing to power around, never through.

Last month I noted a new song by my friend Sally Morris whose new hymn makes the same point as Springsteen (and millennia of saints): “These simple lessons are the teachings of God. Diverse and Equal and Included by God, we rise to righteous calls

each time we topple walls.”

You can listen here. My earlier blog has the words. Here’s the link to the full sheet music so your choir can sing it Sunday, if they can’t do Springsteen.

Is there new power in the world or are we left to scrape and struggle for scraps of the old? Jesus laughed at those who thought that God had already spent all the creative energies there were in the world. God can raise up new children out of dry stones (Matthew 3:9). And if children, why not citizens?

Bees politics

TC and I arrived in Skipton, Yorkshire (UK) Tuesday to live for a while near her twin sister Lisa. On Thursday an urgent pounding on the door revealed an anxious Royal Mail man gingerly holding a box of 10,000 loud bees that we had ordered from Abelo in York. He did not stay for the congratulatory selfie.

A person wearing a beekeeping suit and veil smiles for the camera, with a beehive visible behind them, nestled in a lush hawthorn hedge. — *Buckfast Bees nestled into the hawthorn hedge by the Leeds and London Canal.*

We introduced the bees into their box nestled into the hawthorn hedge bordering the canal behind Lisa and David’s home. The honeybees were a nucleus 5 frame hive of Buckfast bees, a distinctive species developed at Buckfast Abbey by Brother Adam after many years of careful breeding.

I noticed some difference from my Italian-Americans in the Carolina’s. My home bees dispatch a line of sentinel bees to the opening, lift their rear ends high in the air and fan the scent of the hive to help its missing members find their way home. The Buckfasts maintain a very British dignity with no anal display at all. But within an hour all the bees that had been in the delivery box were enjoying their spiffy new hive with lots of room for new sisters and, eventually honey.

As if to welcome us and the bees, David Attenborough posted the very same morning about the ancient practice of “telling the bees.” He noted that “beekeepers in 18th and 19th century Europe and America believed that bees were not just insects—they were members of the family, messengers between this world and the next. And like any family member, they deserved to be told when something significant happened.

“When a loved one died, got married, or even when a child was born, the head of the household—or more often, the “goodwife”—would walk solemnly to the hive, knock gently, and whisper the news. They’d say the name of the person who had passed or wed, and even drape the hives in black cloth during mourning. Why?

“…it reflected a powerful belief that bees could feel joy and sorrow, that they needed to be included in the life of the household. The practice likely finds its roots in Celtic mythology, where bees were seen as spiritual couriers, able to travel between the worlds of the living and the dead. Seeing a bee after someone passed away was interpreted as the soul in flight.”

A close-up of a green box containing live bees, with a warning label stating 'Live Bees', 'Handle with Care', 'Do not expose to Direct Sunlight', 'Do Not Drop', and 'Do Not Shake'. — *How would YOU like to the mail man delivering 10,000 bees?*

I’m a Baptist-Druid, which rounds out to being Celtic, so this all makes perfect sense to me. It is why a friend suggested I should tell the bees that the young experiment with democracy in the Colonies was dying.

The bees already know. For what democracy could survive in a culture willing to poison itself? The bees are not the vulnerable species here. They’ve survived many, many times longer than humans and seem certain to last millennia beyond us.

They are an untamable species without rulers, which is why they are smart. Dr. Tom Seely, the epic honeybee scientist from Cornell wrote Honeybee Democracy that documented how all major honeybee decisions are made after transparent deliberation of comparative data. (Here’s his great lecture.) Seely says that there is no boss bee expected to know everything. Male humans back to Aristotle thought the biggest bee ruled the hive who they assumed to be King. She is not a King or, really a queen. Despite her size and crucial role (birthing babies) she makes no more decisions than anyone else in the hive. It is a pure democracy so sophisticated we lesser species can’t figure it out.

No bee would imagine a process as flawed as American “democracy” in which fear of one deeply flawed person disables the thinking of millions so that he would not just be obeyed, but enriched with more honey than 1,000 hives could ever consume. They bees don’t need to be told about the death of this dumpster fire; they have seen it coming.

Not many humans in this part of England need to be told, either. They have seen actual kings, not the trashy American knock-off. They, like the bees, know about the certain suffering that follows from elevating one human so far above the others, wrapping them in layers of stultifying privilege and then letting them decide anything. They become stupid and then dangerous. The one in the gilded bubble inevitably make horrible decisions that damage and impoverish everyone. And then they, of course, go down, too as the consequences of their folly roll out.

View of a canal lined with boats and greenery, including a hedge, in Skipton, Yorkshire. — *The Buckfast Bees love the gardens but love the corridor of canal wildflowers even more.*

The English Magna Carta and closely linked tradition of habeas corpus were evolutionarily necessary for the human species to survive. They first established that nobody—certainly not the king—was above the law. The second established that no human could be judged without a fair trial. No human society that violates these can survive. Trust dies first, then facts, marked by random decisions that fuel greed, fear and loss of every certainty. There is no way to navigate or talk: nothing but raw violence as the single ruler and the tiny group he depends on run us all off the cliff.

It would be so convenient if it was possible for one person or a tiny group to manage all the vast interwoven complexities of life on this wild earth. Democracy is messy, inefficient and slow. But letting one person, especially a man decide things is dumber than any insect could survive.

The English figured this out about a thousand years ago, so this can’t be considered a “secret sauce.”

We don’t have to tell the bees. We should ask them.

Potbound

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

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

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

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

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

Pot bound.

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

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

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

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

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

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

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

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

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

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

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

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

Lost bee, found bee

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

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

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

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

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

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

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

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

Social, now

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

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

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

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

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

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

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

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

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

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

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

That the power of the social.

TGP

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why not you and me?

Love finds a way

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

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

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

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

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

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

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

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

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

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

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

We need lots of love.

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

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

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

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

Love finds a way.

Rev Dr. Christoph Patrick Bounds

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

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

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

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

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

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

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

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