faithhealthnc – garygunderson Blog

Honeybee Spirit

I was going to write about Buffalo but then Uvalde happened which I was going to write about and then the NRA with Senator Cancun and the Former Guy happened. I just don’t have any words for the cultural/political dumpster fire. I’m in no mood to pile on to the 19 officers who had no idea what to do. I am curious about how in such a tiny town and such a blazingly screwed up kid, no pastor or youth minister had any idea either. I appreciated President Biden not giving a formal speech. Time to shut up and make something happen as there are a lot of towns like Uvalde. I’m shutting up about it, too.

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Honeybees have a perspective on life we could learn a lot from. They have a fossil record, not a Facebook timeline. They are focused on doing the next right thing and doing it right (paraphrasing Seth Greer’s great song). That makes them lock in on the next generation, which causes them to bring the center of the hive up to 95 degrees in late winter when it is freezing out so the Mother can start laying the eggs that will become the workers and foragers the hive will need when the Maple begins blossoming in early March.

This season I got a nucleus hive in place just before the bloom from John Lineberger, who is also a high end race car machinist. Racing bees! And, indeed, they took off and haven’t stopped even for a pit stop, piling in the honey.

John shakes some extra racing bees into the nucleus hive that is heading to the big city

We’ll have 5 gallons bottled available at the Threshold Retreat and Farms booth at Cobblestone Market Saturday just down the street from where the bees call home. This honey is a single hive vintage, sort of like the single vineyard vintages offered at the high end Round Pond Winery where Kathryn and Fernando work. Their Bovet Cab runs just under $150 a bottle. Our honey, which is technically healthier, will be $12.

This vintage will be bottled as Warthog From Hell Honey, honoring the fierce southern women bees who produced it. TC—untamable herself—suggested the name, thinking of Holly Hunter in Raising Arizona—“give me that baby you warthog from hell!” Mothers of every species are fearless on behalf of their kids. The Uvalde cops had to handcuff a mom; the bees would have approved of the mom and wondered about the drones.

Next month we’ll bottle another 15-20 gallons in a mélange from hives in Old Salem, Hispanic Waughtown, Buena Vista, Clemmons and Yadkin. The friends who work with those hives have sharply different perspectives on nearly everything except bees, but we help each other find our way. Despite politics and theology, if I needed something at 3 am at the very end of my rope and hope, I’d call one of them—probably the one I disagree with the most. That honey will be bottled under the name Honeybee Spirit, honoring exactly that.

Honeybee Spirit is also the name of the workshop I’m doing through Threshold Retreat and Farms next month. We’ll explore what we can learn about human spirit in the presence of bees. We can’t learn from the bees, since they would not deign to teach anyone without wings, antennae and only two feet. They know our species is still primitive, barely emerged from larvae stage. They trace to the wasps, before breaking off 30 million years ago to gather nectar in highly social hives that would give up their lives for each other. We’re more like the wasps, I regret to say—meat eating with limited social skills.

To learn from the bees, one has to slow down and attend. Pay close attention to what they are actually doing. I have a Warre’ hive in the back of our house. It uses a different design than the one my racing bees are growing to ridiculous scale. The Warre’, designed by a French priest to be more like the tree cavities bees prefer, has a Plexiglas window that allows me to watch the sisters build comb, tend to the larvae and even see some chewing their way out of their cell to start working. After three weeks inside the dark house, the bees become foragers, navigating by the light and position of the sun to scour in about a two or three mile radius. They invite us to look as carefully at our neighborhood, noticing what is bloom and where the best pollen is, also the rotted wood piles with the medicinal mycelium.

The bodies of the bees are perfectly evolved to read the reality of their environment and then thrive with what is offered. Every little body part is perfectly adapted. Fred Smith once asked me for what are we humans perfectly adapted? We can’t fly or even run fast; not very acute eyesight—none at all in the ultraviolet ranges bees favor. We can smell ok, but nothing like the acuity that allows bees to find subtle blossoms at distance. We can reason when we choose to, but often choose not to. We can invent entirely new things and then make them be; but often choose the most ancient and crude ways—handguns.

And then we have Spirit. I would not go so far as to say humans are the only sentient creature with Spirit. I’d be surprised if dolphin do not. Golden Retrievers, in my experience, do. And surely in some way we can’t grasp, the hive. But for what do humans’ Spirit perfectly adapt us? Africans understand that every human has spirit energy. Kant believed every human has that and creative freedom, that makes it possible for us to invent entirely new social forms, not just the iPhone and AK-15. We are obviously not going to make it another few generations if we don’t pick up the pace on growing up.

It seems likely that we humans will be known only by one of the thinnest layers in the archeological record, facing away before we barely got going. But maybe not. Maybe our capacity for Spirit might allow us to change into something more wise, generative and resilient.

I’m working on a book about all this by the same name, Honeybee Spirit. Should be ready to take wing later in the year. If you sign up for the workshop, I’ll share a working draft of the book with you. And a bottle of Honeybee Spirit honey, too. The workshop is whatever we make of it; the honey is what the honeybees have made and I can assure you, it is for the ages.

Phillip, Mellisa, James, Annie, Clay, Kelly and Linwood spinning the honey from the racing bees.

Adults, flunking

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

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

Adults are flunking adulthood; our children are growing smaller.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Plant

The morning after Ruth Bader Ginsburg completed her journey and handed on her legacy, I picked up six Linden trees from a nursery south of town. The county bee association had arranged a bulk purchase of the trees, known by their “small, pale yellow, fragrant flowers in clusters.” Bees and their human friends like the honey which is “white with a slightly aromatic flavor [and] when fully ripened in the hive it is considered one of the best table honeys,” according to John H. Lovell’s Honey Plants of North America. He states that “hot, clear weather and a humid atmosphere are most favorable for the secretion of nectar. Small drops may then be seen sparkling in the bloom; and the bee may obtain a load from a single blossom.” Worker bees, every one of which are female, would have liked RBG a great deal.

Our local county bee association arranged for us to buy Linden trees as a group. Bees and beekeepers will appreciate this in 10 or 15 years. I bought six to help somebody who will probably never know me.

It is cool here in the Carolinas, which is bad news for drones. Every morning below the hives I find drones that have been escorted from the hive, some with force, as they are no help in the rigors of winter. The girls don’t tolerate big and useless creatures. I think I know how they would vote, especially following the loss of RBG. Maybe I’m wrong. I didn’t ask anyone in my bee Association how they were voting. My closest bee friend is also the man I’d call in the middle of the night, if I needed something. He’s a thoughtful and kind man, whose vote will cancel mine.

The Linden trees will not help my bees today or in their eight-week lifespan. They may not be much help to me either for the similar reason. You don’t plant a tree for today; you plant for the blossoms it will provide to others who may not even know your name. A few weeks ago, we harvested honey from nectar from trees Moravians planted without knowing that me and my bees would thank them someday.

Democracy–fragile, tender and organic–is like that. A group can clear-cut it to make sticks to match their stones and beat those they consider enemies to pulp. Win! Every democracy that has ever been experiences its own failure, sometimes death. But we try to construct agreements to weather the unpredictable fire and storms of human social life. We try to anticipate how our best selves might survive our occasional worst. The young experiment called the United States has done pretty well as these things tend to go considering the potentially fatal compromise at our root—slavery and later toleration of decade after decade of gross disparity.

Some consider those issues to be in our past, exaggerated to make the current administration look bad. Not Black moms with young men for whom they are afraid to jog down the street, drive across town or bird watch. And it is not in the past for any public health department watching the COVID data replicate the pattern of almost every other viral phenomenon from cancer to gun-shots, metabolic syndrome to environmental pathologies. Case and Deaton, in their landmark work around diseases of despair shocked the world by tracing the decline in American longevity rates to working-class white men experiencing structural vulnerability that denied them a way to make an honorable living. Humiliated and trapped, they are experiencing something not entirely unlike the phenomenon common to Black men for four hundred years. As usual, the mostly White elites channel that outrage in ways that seem illogical against the Black and Brown men, not those driving the structural causes. The humiliation is so painful that it cries out for immediate release, logical or not.

Some empathy and respect would help, although likely to be lost in the cacophony of internet-speed clang and gotcha. Empathy develops slow, as slow as the speed of trust.

Another friend, Mike Heisler, sent me a book this week by Timothy Snyder, “On Tyranny.” It is “20 lessons from the 20^th century” about how to live in these times of liquid anger and fragile polity that RBG hoped to outlive. Snyder fears the people Linwood trusts, just as Linwood fears the people I trust. Lesson 12 is “make eye contact and small talk.” Synder says that “In the most dangerous of times, those who escape and survive generally know people whom they can trust. Having old friends is the politics of last resort. And making new ones is the first step toward change.”

Justices Ginsburg and Scallia were friends who enjoyed each other’s company enough laugh. My daughter Lauren had dinner with Rex Tillerson at the opening of one of her plays (he, a great patron of theater!). Linwood and I will plant Linden together 44 days before the election. I’ll cheer for his daughter’s basketball team, even if I don’t for his candidate. In a sense, that makes no sense. But democracy is not about logical sense—certainly not about winning. It does help messy humans live in between clarities when the best we can hope for is non-violent compromise. It good for muddling our way when nothing can make complete sense. Good for these times.

I feel exposed by the loss of a tiny 87-year old justice in the same way I did with the loss of John Lewis two months and two days ago. They deserve to rest in peace, honored by grateful generations. We haven’t earned that peace or honor, but there is still time. Can anyone be confused about how to honor them? Respect the structures of legal process, support social institutions, the dignity of professional ethics, the essential decency of labor serving the good of all people. Have faith. Vote.

And embrace the process of planting for others to harvest. I gently free the Linden from its plastic container, tenderly loosening the roots. I put my hands into the soil of the hole I’ve dug so it can welcome the roots home. I am not the Linden, or the soil, much less the rainfall or sun. Just one human grateful to have a chance to give life a chance.

Four trees in a trunk, two more in the passenger seat. Planting for the future sometimes requires looking a bit silly today. I’m okay with that.

Drive

I didn’t know there was a Winnumeuca, Nevada, but less an East and West one, too. People live there.

Six thousand miles through and around fires, hurricanes, political conventions and seven shots in the back. Red states and red parts of blue states in a Mini Cooper with a “Make America Kind Again” bumper sticker. I drove and pumped gas next to several thousand pick-up trucks through Tennessee, Arkansas, Oklahoma, Texas, Arizona, Nevada, Utah, Colorado, Kansas, Missouri, Illinois, Kentucky and West Virginia. I was taken by what did not happen and what I did not learn.

You’d think somebody somewhere would have at least muttered something. I never saw two hands on the wheel, so there was plenty of opportunity for gestures. I’d be an easy target and, well, sort of deserved it, what with my bumper sticker. Nothing. Not a peep or cross-eyed glance. I saw a couple dozen Trump/Pence signs—about one every 200 miles and maybe 6 for my guy. Hundreds of signs for citizens running for Sheriff and county commission. A few for Senate hopefuls who had lost in the primaries. More COVID signs than all of these combined.

People are sick of political sugar and spit. Maybe ready to stop shouting, go vote, do what we need to do to beat the virus, teach our kids and go back to work.

I-80 could be named for its average speed. 15 seconds equals a day on foot.

When I was planning the trip, I had, well, overlooked the nearly thousand miles of Utah and Nevada. To dodge the fires I ended up crossing their former ocean basin on US 50, the “loneliest highway in america.” From 37,000 feet in years past I had liked to pick out the Grand Canyon and been curious about the the tiny bright green dimes surrounded by brown rock to its north. Through my windshield I could now see that the pivot irrigation machines making green hay as well as rainbows in the morning light. But I would have to stop to learn anything about the people who tend them, what they hope or fear, where their kids are and how many cows the hay will feed. Driving back on I-80 I found myself following the California Trail which one wind-blown Nevada rest area explained was a walking path for thousands. Why would someone would walk Nevada with their kids? What were they leaving or seeking? How could I say anything about Nevada until I walk, too?

Ruby Mountain near the border of Nevada and Utah. Up close it is many colors, a rock rainbow.

US 50 road goes through through St. Louis and across the Mississippi, though no longer a lonely road. I had forgotten Illinois and the beautiful rolling forests gifted by glaciers on both sides of the Ohio. I jotted down the names dozens of museums I hope to stop at someday, constant reminders of the thousands of miles of things I did not know.

Sutro Tower out Charles and Asa’s bedroom windows. It ain’t fog. Smoke.

I did learn a lot about smoke. The brown acrid smoke of the Haight in San Francisco persisted in clouds, high haze and columns of fire till east of Denver. A continental-sized phenomenon that literally took my breath away. Not a thousand mile wall of flame, but the drifting smoke is clarifying things in the minds of people you might not expect. YHWH promised Noah no more floods; he didn’t swear off smoke.

On the high plains Sequoia-sized turbines are spinning by the thousands with hundreds more under construction. In the Kansas night they blink in unison from one horizon to the other, blades nearly touching. Only nimble birds make it to Canada and back and those only if they avoid looking into the glare of the solar arrays. Don’t buy oil stock. And don’t let them drill the arctic for oil we won’t need.

Among the things I know I don’t know is how to live our human lives when our machines are so powerful. My Mini gets 47 miles to the gallon, but still sucking my grandsons’ future from their air. Greta is right: we’re not trying hard enough. Get out of the planes and not because of the virus.

Charles in “school.” Easier to find Waldo than the teacher.

School was pretending to open as I drove. I watched my way-too-smart grandson try to pay attention to a screen on a wall, picking out the teacher’s voice amid a cacophony of chattering kids. It’s easy to say the kids aren’t learning much. I’m sure the adults are no better picking out the lessons from noise. Our kids watch as we pretend to notice the screams of our burning planet.

We’ll have lost about a quarter million Americans by Election Day. And a few more cubic miles of Greenland ice. And a few million acres of trees, including bristle cone and sequoia that finally met people too dumb to survive.

“Go back to your screens and don’t bother us,” our kids see us say. They notice. COVID invites some adult behavior.

Door hangers! Not much help, this democracy stuff. But our best and only hope.

Saturday morning after I got back a handful of citizens met at our garage door over a precinct map and box of election door hangers. Some of us headed to the apartments near the highway, another and his two grandsons headed to Washington Park. It went quick without the door knocking and conversations. We had instructions to only poke the Democrats awake, but we think everyone is paying enough attention to remind them to act like citizens. It is possible that all the wheels will fall off our cultural wagon; that we are too late with too little wisdom to make the choices that give life a chance. But maybe cultures and democracies, like ecosystems, rebound when the grown-ups show a tiny bit of respect for each other and their place.

Another thing I did not see in 6,000 miles of American pavement: “Jesus is coming back; prepare to meet your doom.” But maybe Jesus is already back, teaching us steps one and two of Shalom: Don’t shout at people you don’t know. And don’t give up on the world that God so loves.

Tender

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

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

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

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

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

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

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

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

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

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

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

God, our simple prayer; keep us tender.

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

Crafting life together

fullsizerender-8 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 15/16^th 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.

Let’s do that.

Body politic, limping

Life through the bullet holes — 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.

river emergent COVER ART — 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 21^st 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.

mandela cave — 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.

SONY DSC — 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.

New systems of health

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.

CS010816-050 (1) — 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.

Runaway heart

My daughter Lauren is about to give birth to my second grandson, which, with her sense of dramatic timing will probably happen on Mothers’ Day. This also kicks off Nurses’ Week in hospitals. My wife and my (now former) first wife are both clinical professionals and moms. Most of my staff in the FaithHealth Division are women and the men are in touch with their feminine side or they couldn’t do their work of care for the bio-psych-social-spiritual dynamics of the thousands about whom we care. For ninety years our largest partner–the NC Baptist State Convention–uses Mothers’ Day to collect an offering for our most vulnerable patients.

So I’ve been thinking about the expansive caring going on; and the unknowable, but real limits to our reach.

Last Saturday it was my turn to lead the Medical Center’s daily “safety huddle”—the mundane miracle in which every operating unit of the health system from chief medical officer to security to food services and everything in between gathers to report on whether each of us has an event, concern or need to report. Even if we don’t, we have to say so out loud to our colleagues. Usually it moves fast, but sometimes it just stops the heart. Someone reported a situation with a runaway kid who had been compelled to come to the ED by her mom, who promptly run away herself, leaving the kid in our care. Except then the kid ran away from us, too. Everyone hurt hurt. We all dealt with our sense of profound limitations even when the 14,000 hospital people were multiplied by the police and social services. I couldn’t get it out of mind, so the next morning slipped in a prayer amid all the operational chatter:

As Jerry Winslow has noted, it takes a lot of sawdust to find the second life of a tree.

“Mother God, we pray today with thanks for the big heart and strong muscles you have given us so that we might be healers amid so many lives. Every morning we see how big a family of colleagues we have that is constantly present to do what is possible for all who come. Today we pray for all events that raise our concerns for all the needs we cannot satisfy that we cannot get out of our minds, hearts and bones. The runaway kid from yesterday with the runaway mom who left her. All the husbands without words sitting next to their wives with cancer about to leave the whole world behind. All the people who have lost their way to any hope except for the medical miracles that lie beyond us, too. Keep our hearts tender like a mother for all that love lets in. But keep it beating and open for each other and your great spirit so that we might be smart, gentle and kind for this one more day.”

The first cut through the pith lays open the astonishing grain of the burl.

The British Medical Journal has been thinking about this, too, although in grim language of “multimorbidity:” “Across the world healthcare systems are struggling to cope with increasing demands and costs. Rising life expectancy has been accompanied by an explosion in the prevalence of long term conditions and multimorbidity.

“Clinicians are working within legacy systems that were developed to deal with 19th century problems—they provide specialised responses to acute illness and infection. At the same time daily practice is strongly influenced by an ever expanding array of disease centred guidelines that don’t map neatly to the realities of clinical practice, in particular the ubiquity of multimorbidity. The result is fragmented, poorly coordinated health services for those most in need—vulnerable patients with multimorbidity. Today’s healthcare professionals are faced not only with rising disease-disease, drug-drug, and disease-drug interactions in multimorbid populations but with the increasingly evident consequences of socioeconomic disadvantage.

The rough and twisted bark hints at the pattern.

“Meanwhile, patients, their families, and their extended social networks experience not only the burden of symptoms but the burden of treatment. This is an emerging but underi-nvestigated phenomenon. It has received increasing attention recently, and interest has been growing in how to define and better understand the concept.” ( (BMJ Published 10 November 2014)

We could join the public chorus of complaint and rage about what the world is doing to us and demanding of us, as if expanded life span were a mean trick on all of us. Or we could work on what lies between us, the weak ties that could be strong, the empty spaces that could be filled with compassion and carefully tended connections. Even in our mean and stupid time, we are witnessing the dramatically hopeful emergence of webs of trust where you’d think they would be impossible—North Carolina, where you can’t even pee without the government telling you how or where. Good grief. But even here—maybe especially here, where powerful elites have told stigmatized and despised people where they could drink water and pee for generations—webs of compassion spring up on the bitter soil like desert blooms in random rain. Don’t ever be surprised by what a privileged but anxious elite will do badly. And don’t ever be surprised by the fruits of compassion, either. That’s what we are coming to call the North Carolina Way and it is big, strong and unafraid of tough neighborhoods and runaway everything.

When I hurt myself last June, I was drawn into being a partner in the healing of my own body. I have been learning in wonder how we – even me!—are made for healing. Of course we are, since we are also made to be bruised, wounded and broken. All of us, sometimes at others’ hands, but usually a mélange of our own mistakes along the random human way. (That dumb overreaching tennis decision wasn’t my only one!). I’ve been learning to turn wood on a lathe as I healed and found myself drawn to the wonder of hardwood burls, the growth that emerges where a tree has been broken or violated with some sort of trauma. The wood in the burl has a weirdly complex grain pattern, twisty, dense and wondrous. The mysteriously beautiful grain reduces me to respectful awe as the smooth cherry takes a beeswax polish. I think, of course, of Lauren’s pain and that of every woman in my life, of every nurse in every hospital, of every broken heart that manages to stay tender to the pain of the world.

No mom I know stops at the pain. They lend their life and every fiber to what remains possible for those they love. They never cease forgiving and hoping. They teach us not to stop at lament even though so much of what we see is deeply lamentable. They teach us that compassion is the heart of prophesy, of lovingly holding up what remains possible for each person, neighborhood and peoples alive.

The burl is what grows around the trauma experienced by the tree.

Mainsail

Charlie Wolfe, among my very favorite humans. His future is not determined, especially by any of the other 7 billion.

Perhaps you’ve met a human. You have noticed that we can be hard to help. Perhaps you’ve been to a planet like Earth and noticed the same thing, except 7 billion different ways. How do you help something with 7 billion moving parts be healthier?

Advancing population health depends on understanding not just the medical problems, but the drivers of health ….at community scale …over time. Those drivers are largely social and they are not determinants because none of the 7 billion of us humans are determined. Words guide our imagination, shape our ability to talk about what to fear and what to hope for. So it is a big deal to see the 100 Million Lives Campaign “determinants” for “drivers.”

It important for every grown up in any position to influence a single life to talk about life as changeable and chooseable—but shaped by power drivers that have to be confronted. This is especially true for the grown-ups in positions to influence the big social structures like hospitals or faith networks. Monday in Washington DC the Association of Academic Health Centers met to explore how their huge organizations can align themselves wit the leading edge understanding of the social drivers of health. This is a huge shift for them (us, as I am a VP of one….). They brought in the big voices including none other than Dr. Michael Marmot the author of the stunningly powerful studies of social position over time (The Health Gap.). And our friend Dr. Denise Koo one of the principle forces behind the new array of useful tools emerging from the CDC such as the Community Health Improvement Navigator. (http://stakeholderhealth.org/cdc-community-health-improvement-navigator/).

salamis The closing panel of the whole conference was our “ground game” in Winston-Salem. This was explained AND embodied by Jeremy Moseley our Director of Community Engagement and Annika Archie the lead Supporter of Health, with Dr. TC laying down the data beat like a bass player in a jazz ensemble. I had two minutes at the end to set a metaphor like a sail to catch the wind of the spirit moving where you wouldn’t expect it.

The social drivers engage the role of an hospital not just as a provider of therapies, but as a social presence—usually the very largest social/political/economic structure in a community and region. This requires us to see ourselves from a community perspective: inside out and upside down. In Memphis we found ourselves in a covenant relationship with more than 600 congregations that pulled us inside out. In Winston-Salem we have followed the deeply grounded intelligence found in some of our lowest wage workers into relationships that are not just inside-out, but upside down or, better, right side up. We were steering toward life, not just away from death.

Proactive mercy is way cheaper than reactive charity. That’s the whole and complete logic of “population health management.” But if you don’t understand the humans, you can’t expect to be proactive. Being proactive depends on the intelligence about– and trust with– the neighborhoods where the costs of reactivity are concentrated. This requires not just the preeminent brilliance of our surgeons, but of all 14,000 humans on the team. Dr. McConnell and Annika Archie embodied this new deep discovery in the video interview he did with her (and me) last week (click here).

That’s what works.

It is new for big organizations to hold ourselves accountable for social factors. That has always been on the side, a by-product, an unintended consequence. Now it is central. Some say we should think of ourselves as “anchor institutions,” but that image reinforces our worst habits of domination. What could be worse than focusing on anchors of determinants? I’m depressed just typing it!

krusenstern_mainsails — The mainsails are the ones low and large. You leave them up so the ship can keep moving even in heavy seas.

We should be mainsail organizations.

The mainsail is the large sail on a clipper ship low and strong that you leave up even amid the heaviest weather and hardest storm. This includes the storm-tattered neighborhoods you can see outside the windows of urban medical center. You leave the mainsail up because in deep and heavy water you have to keep going or the waves will overwhelm you. The last thing you need is to drop an anchor. That’s what you see in Annika, Jeremy and TC and their hundreds of colleagues setting themselves to catch the same wind of Spirit– surgeons, nurses, social workers and revenue cycle VP’s– that share a hope and mission.

You can even hear it now from some our community partners, glad that we have finally joined them in their journey toward health. They don’t want an anchor; they want to go somewhere new.

Last Saturday our own Rev. Dr. Francis Rivers received the major award from the Hispanic League of Winston-Salem honoring him (and the FaithHealth team) for leaning way into the heavy seas of anti-immigrant venom surging currently in North Carolina in creating the ID Drive. Francis’ award honored him, but also his mainsail organization–and not just the tiny part of it called FaithHealth. The medical center put up a big sail amid very heavy seas that helped other key institutions do their critical work. The Sheriff, police, DA, a network of churches called Love Out Loud, many Hispanic organizations and Que Pasa media). And don’t forget the most important FaithAction—the small faith-based organization that does the actual work of validating identity so that an ID card can be issued and trusted.

ship A fully rigged sailing ship is a very complicated thing with many sails and miles of rigging. So, too, is any network of partners committed to helping their community move away from the rocks and into a safe harbor. But none of the partners could have stepped into the heavy wind themselves, much less alone. That role was for the mainsail and a ship built for deep water.

You might be so embarrassed by all the mean hateful things religious people are doing these days that you want to stop the metaphor right there. But you’d be leaving out the most interesting part of sailing—the wind. The sail doesn’t have any power; it only catches the wind. Greek traces the same word for wind to breath and… Spirit.

We know in North Carolina that the Spirit can blow toward or away from the rocks; it depends on the skill of the sailors and the courage of those who climb up the rigging and set the sails. These are days filled with stupid religious venom, so I don’t blame anyone who wants to move culture and institutions and society without faith. But nothing at cultural scale ever happens without Spirit blowing really hard. You can stay below decks and hope for the best. Or you can find someone who know how to set a mainsail and head to deep water. Francis, Annika, Enrique and the others on the edge, live way up in the rigging where the wind blows with raw power. They teach us to its respect power, but not to fear.

Dr. King spoke realistically when he said “the arc of history bends toward justice.” It is a slow bending curve, more tectonic than sharp. We don’t choose this way or that, but lend our days to the slow bend, helping each other keep courage for the long turning. We set our sails for heavy seas and a long arc toward a horizon worth the journey.