Rosalynn Carter’s life is an extraordinary witness that demands that we pause in respect. But she would know we were not paying attention if we paused longer than that. She was fierce, urgent and tenacious in doing good, especially for those who suffered with any kind of mental or emotional burden. In the book, Everything to Gain, written just after they returned home to Plains from Washington, DC., Rosalynn said, “What I have learned over these years of work and study is that mental illnesses are less understood than almost any other major health problems, and that most people who experience difficulties suffer needlessly. The mystery, stigma, and misconceptions that surround mental illnesses prevent many people in need of psychiatric help from seeking treatment.” I once drafted notes for her to speak at a meeting in Pittsburgh at a Divinity School about the church and mental health. I thought the notes were somewhat aggressive, but she wanted them tougher: “the first word anyone in the church should say about mental health is an apology. The church has been the last bastion of the worst stigmas.” She never gave up on the church but had eyes wide open to the ugly complicity it has with the cruelty experienced by those it finds inconvenient to care about. That stigma is, was and will be the biggest challenge facing those individuals and their families.
If you want to honor Rosalynn Carter today, reach out to one of those you know (you do know more than one) and say you care.
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. Itis striking how littleisasked of these vast organizations.In most every community the healthcare organizations are pretty much busy with running the hospital.The staffmight 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 21st 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 fortransformation, 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.
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.
I walk through morning light among the apple trees to the circle of seven hives as a half-million bees begin a new day. I sit by the small hive over on the left looking for pollen saddlebags on the arriving foragers which will tell me there are babies being fed. This hive is a refugee remnant from one that fell prey to an infestation of wax moths. Many bugs beside bees are attracted to honey and wax—small beetles, ants, “destructor mites” too small to see. And, the most disgusting, wax moths that tunnel sideways through the comb leaving stringy goo the bees can’t remove and can quickly overrun the whole hive.
Bees are NOT supposed to do this, but they were refugees without options, so they build UNDER an empty hive.
The Mother and 6 or 8 thousand sisters abandoned the lost hive, flew 100 feet across the circle and attached underneath an empty box and built comb as if they were waiting for me to do something. This situation is not covered in my dozens of beekeeping books, which the bees don’t read. I was anxious about hurting the already traumatized refugee Mother so I gently picked up the bottom board under which they had attached themselves and put it on top of a small box with their new comb dangling down into a box. I added a bottle feeder to help them settle in.
Mother might have time for two three cycles of babies before frost. The sisters don’t hibernate, but they’ll quite raising babies and push the drones out to save food and bother. The girls form a tight ball to keep Mother warm until February when she’ll rev up again if—a big if—the hive can recover its strength. I’ll always pull for the underbee.
Meanwhile, the other half million sisters around the circle need treatment for those damn mites. This involves a 14 day regime of stinky chemical pads inside their hive which makes them grumpy as I check carefully for other bugs. The only nectar around is goldenrod so I’ll feed them after this treatment with a last shot of formic acid till we tuck them in for the Winter.
We say “beekeeper” but I am the one being kept. Why do all this? Not the honey, although I did harvest 18 gallons from four of the hives this summer; should be twice that If I can nurse these hives along. But the longer I am kept by the bees, the less I think about the honey. These sisters have watched mountains, oceans and glaciers come and go—taking lightly the latest annoyance, we silly humans. I savor being inside their generous circle on a season of their 30-million-year journey.
Moon rising through the Nunnery on Iona.
On every one of those 11 trillion days, they read their environment and adapted to the unexpected. They focuses on the babies who thought only of the babies after them. Bees will let you have honey, but sting for brood. On the other hand (bees have six) their survival depends on radical diversity. Honeybees are impossible to tame; certainly not be me. The mother mates with 10 boys a few seconds each 50 feet in the air. She flies right past the neighborhood boys to those a couple miles away. Her daughters have random fathers so every bee and every hive is a slightly different mix of inherited traits. Don’t worry about their survival; some hive somewhere will have the traits to survive the worst we dumb humans can do. We humans on the hand (we only have two) are far less likely to survive. We don’t think about the babies, resist diversity and have tamed ourselves.
But now and then an improbably wild human hive emerges with traits fit for the future. Last month TC and I took rail, ferry, bus and footpath to the rocky island of Iona on the western coast of Scotland. People have come here for millenia to experience its “thin veil” between human and the Ultimate. The abbey was built 1,460 years ago and Druids worshipped here a thousand before them. Its Christian phase attracted pilgrims and, unfortunately, my ill-behaved Viking kin for centuries until succumbing to the protestants who let the rubble crumble. In the 1930’s until a muscular Presbyterian, George McLead, founded the Iona community restoring the abbey, and more importantly, built a movement for enspirited mercy and justice. My Norwegians gave them the lumber for the ceiling they had burned earlier. Now Iona is a hive of radical spirit. If honeybees invented humans, we would look like the Iona community—women leading with maybe 15% men allowed, as long as seemed relevant to the babies.
Late summer fields surrounding the Abbey of Iona.
About a mile across the strait from Iona is the pink granite “island of the strong women.” The founding priest Columba shipped the women and cows over there, which didn’t last long as boy energy is too brittle for the harsh climate. Today the spirit and practice of the Iona community is distinctly feminine, unafraid of the bitter winds or the venal proud boys now having their day in so many places around the world. Spirit with sting ,if the babies are threatened. And they are.
Aaryaman Singhal, one of the brilliant young leaders of the Sunrise Movement. Count me in.
Iona tunes my ear for the songs of freedom rising up where you don’t expect it. An unlikely young hive, the Sunrise Movement, rose up in Texas demanding the government to reinvent the depression era Civilian Conservation Corp to fight climate extinction. It is led partly by Aaryaman Singhal, who reads his environment like the a honeybee. After slogging through steaming heat in east Texas and Louisiana, this week he stood by President Biden and AOC announcing the American Climate Corps infuriating the republicans (who rather remind me of the wax moths the way they go sideways). It will set another 20,000 people free to give themselves a chance to give the world a chance.
This is how life works. Hope comes from the edges, from the experiments you’d least expect to work. Look to where the veil is thin between human and ultimate; where you can see the inbreaking of the future.
Standing Cross next to the Abbey of Iona looking across to the Island of Mull.
Did you even know there were boy and girl artichokes? My daughter tells me that this one is a boy.
Bob Matthews and I have shared a friendship for nearly 30 years, dating back to the time I worked with Jimmy Carter. Nowadays, both Bob and Jimmy, along with another close colleague, are on hospice care. Yet another friend depends on an annoying oxygen machine. It seems as if our whole species—humanity—is living in diminishing days.
Bob, who is living with chronic obstructive pulmonary disease, is cared for by his wife Marjorie, his daughter Sarah, and hospice nurses, all blending both skill and humor. A few weeks ago, they hurriedly assisted him as he struggled for breath, to which he responded, “why bother?”
It’s a real question. And as a pediatric chaplain, Bob would know smarmy distraction.What justifies any effort or expenditure—bother—when the recipient can’t give back? Insurance may pay for the oxygen or rent the special bed, but no amount can offset the emotional investment of a daughter, wife, or friend. Why bother?
Bob’s patio blooms with flowers that he nurtured, now with help from his daughter Sarah. Did he earn their blossom? Do we ever truly earn anything? Certainly not through our clumsy endeavors labeled as “work.” Most of the most beautiful things in our lives are unearned and now in threat. The fading redwoods, air itself. Why should we bother?
Weed or miracle? Who cares?
As long as Bob can marvel at the beauty of a single blossom, he is on duty. The world runs on wonder, not mere logic. I suspect the flowers grow towards Bob’s awe just as they do toward the sun.
Later in the day, while in another garden with another daughter, I experienced the astonishing beauty of a raspberry. Can anyone truly earn even one of them? And there, from the same earth, an onion the size of her head emerged, worms wriggling away to prepare another one. Witness the egg laid by a generous hen, young Malbec grapes nearby, their roots digging into the same miraculous soil.
A honeybee paused to watch us. Most honeybees live six to eight weeks in the summer, their wings worn out from countless flights, collectively producing less than a teaspoon of honey. Does any human deserve enough for a single cup of tea?
Stone sober, I felt as high as any Californian had ever been at the audacious generosity of it all.
Most of the most beautiful things in our lives are entirely unearned, but often under threat; the redwoods, air itself. So there’s plenty of urgent work for the young and healthy, and even some for the grey, who can endure policy discussions in closed rooms. But work without wonder is unlikely to heal.
Just last Thursday, I saw half a trillion dollars worth of gold in the basement of the NY Federal Reserve Bank; money isn’tlacking in the world. The upper floors, though, offered something more valuable—brilliant minds, brimming with expertise and energy, contemplating the intersection of climate, health, and community. These minds can envision, then bring to life, things that haven’t existed before. But, why bother?
Some people are willing to give their lives away to the last breath—Jimmy, Bob, Jerry. Why wait to follow what they show us? What about the approximately four thousand weeks most of us get before those final moments? ‘We should begin, not end in wonder and then act. Any tool in a hand not guided by love, is more likely to harm than heal.’
I’ve never been much attracted to contemplation, being busy myself. But I see that worthy labor only grows from a sense of wonder, especially as we grapple with the fear of losing our natural systems and social structures. Fear triggers action, but rarely discernment.
Nobody has ever been busier than Jimmy Carter, who even managed to squeeze in bird-watching en route from the airport during an election monitoring trip to Zambia. The miracles on the wing captivated him, just as the miracle of free voting did. He observed, then he worked.
White Dove, by Jimmy Carter in the Zaban Room of The Carter Center
Jimmy Carter is not dead quite yet. Counting him out was almost never a good idea whether he was running for an improbable office (every one he ever held) or an improbable health goal (guinea worm, polio, smoking or handgun violence). Or embracing improbable relationships—the Allman Brothers Band so key to the first steps of his race for President, Charles Taylor, the Liberian Pariah President or North Korean Pariah President, Kim Jong-un. Carter was able to live across improbable boundaries because he was comfortable with his own complexities and complicities; he knows he is human like all of the 8,018,082,868 of us. And he is clear-eyed about his own death, which most of us ignore until the last final shock.
Carter was always misread as being somewhat simplistic and moralistic. In fact, he worked through his own complexities to still choose to act, speak and do what he thought right. He was not surprised that his relationships sometimes made that harder; he was a loyal to people who made his life more complicated than a more ruthless man would have (thinking of a few bankers and entrepreneurs who clung to him like barnacles). A religious man with eclectic curiosity, he often confounded Baptist Christians who feared the grey areas (most of life). And he confounded secular friends who loved the grey so much they found it odd that a man could choose commitment and follow through. Not satisfied with a simplistic stab at polio, he did the hard work decade after decade after decade. Never satisfied with pontificating in a hotel ball room, he took African presidents to left-behind places in their own countries they had never seen. And then he went back again and again. He knew the complicated reasons for homelessness, but he never failed to pick up his own hammer and build one more home. He loved one woman his whole life, even though he was honest enough to almost lose an election by admitting “lust in his heart” for others. He gave the word “human” a good name.
Like many thousands, my life would be unrecognizably different had it not met his. Not long after he was involuntarily returned to civilian life from the White House, he started The Carter Center as a launching pad, more than a museum. He and Dr. Bill Foege, who had run the CDC under him, held the first global conference called Closing the Gap, even before he had a building. An engineer’s kind of conference, it asked how much of the burden of premature morality could be prevented based on what was already known. What could we actually do with what we already know? About two thirds was preventable back in the 80’s, as your grandmother would have guessed. And who needs to act? Among others, the ubiquitous faith networks who he knew tended to sit around and wait for something terrible to happen and then act surprised at the most predictable things (cancer, war, diabetes, river blindness). Could religious people grasp the vast moral chasm causes by not acting on the patterns we know cause needless suffering? He and Dr. Foege got the attention of the Robert Wood Johnson Foundation and started the Interfaith Health Program, which I ended up leading. Why me, and not some famous academic bishop? Frankly, I’m not sure, but both men had a preference for action over formal qualifications.
The first thing we did was blow up the perfectly respectable grant plan of work, which began with a big formal conference at the new Carter Center. We replaced it with two years of scrappy meetings in dumpy basements and raggedy centers all over the nation (not unlike his run for president, now that I think of it). We asked the leaders actually doing things what they would commend to him as worth replicating. And we asked where they were stumped for lack of a clear vision of what might work. The two lists were identical, of course, which meant that the big innovation was having enough humility enough to realize that somebody down the road had probably already figured out the answer we thought we had to invent. It is actually harder to adapt something as it demands even more intelligence than simply plopping down another idea from somewhere. He called this a “mundane revolution.”
Carter is known for protecting the Arctic reaches of the Alaskan wilderness. I rafted the Canning River which borders that vastness and I was grateful; what other President even knew it was there, or would spend scarce political capital to protect it? It wasn’t just big nature he loved; he never missed participating in the Audubon bird count in Plains. He personally called the American Chestnut Society to get some hybrid seedlings to plant at The Carter Center, where they are improbably growing strong. He accepted some gift of Koi from the Japanese government but refused to purify the pond so people could see them. (A Georgia pond is brown.) Life, even the mundane, is spectacular when you have eyes like his.
My very best ideas are tiny footnotes in the extraordinary legacy left by this special man. These include the “Memphis Model,” emulated by dozens of major healthcare systems all over the nation, the “religious health assets” which paved the way for the WHO into activating faith networks all over the world and, of course, Leading Causes of Life, which I spoke about the first time at a Conference in Milwaukee to which the former President sent me to in his place (imagine their disappointment!). Carter created a physical and a mental space where it seems reasonable to imagine things that had never happened and then try to do them. And then keep trying, maybe even for 98 years.
After decades of one unbearably oafish Christian after another desecrating the very idea of faith, he quietly gave his life as a long gift to his church and all people of faith: an example of sacred dignity and integrity. Not that the oafs understood. When he was gracious enough to invite evangelical leaders to the White House, more than one publicly prayed that he would become a better Christian. However, when my secular friends think that anyone who tries to believe is foolish, I could always say, “No, I mean people like Jimmy Carter.” They had to nod.
He had little patience with superficial piety. Once he had all of us Directors reflect on whether Newt Gingrich had any good ideas in his “Contract with America.” I choked and noted this was not likely to go down well with the faith people who actually do the work on the streets. He snapped that the churches rarely break a sweat, while the government at least knows where all the poor live.
In the very first article for the Interfaith Health Program he wrote, “We must make the choices that lead toward life.” And who is accountable for those choices? Not just improbable Presidents, but hundreds of thousands of improbable grown-ups doing the right thing when people notice and when they don’t.
This is true, even unto the very end of their days, when the right thing means releasing into the love of one’s family, instead of the normal vain and fruitless medicalized struggle against death. James Carter was proud, but never vain, often overlooked, but few lives bore so much fruit. I hope he lingers in hospice to savor the deep joy of a life well lived.
Rulers have held conferences about food, hunger and health since the land between the Tigris and Euphrates rivers was farmed 11,000 years ago. Now every five years the United States Congress passes a comprehensive Farm Bill in that great tradition of balancing complicated and conflicting ideas about how to feed another generation. Governments have usually gotten their citizens enough calories in the short run, but screwed up the long run, turning farms turning into deserts. Mesopotamia, now Iraq, was “the fertile crescent,” just as northern Africa was the grainery of the Romans, just as Iowa is for us. Doesn’t bode well for Iowa.
At Joe Biden’s White House Conference on Food, Hunger and Health last week I sat behind Dr. Dean Ornish, the cardiologist who was derided for showing that one could reverse heart disease with nutrition, exercise and, even more controversially, social/spiritual support. On my left was the President of American Soybean Association, which has so successfully lobbied for their bean that it is second only to corn syrup as the most common ingredient in the American diet, including many products that are only barely identifiable as food. There were many such ironies in the room: food bankers munching on lunch provided by Google. Hospitals like mine highlighting community food initiatives in the shadow of our massive surgical towers that Dr. Ornish proved unnecessary decades ago. Meals on Wheels executives jostling with Instacart lobbyists. Organic farmers next to pesticide people. Chef José Andrés, the electrifying Puerto Rican Chef sounded the call to simply feed everybody…now; just do it.
The last time food rated a White House conference was under President Nixon 53 years ago when I was in high school. He opened the door to China, just as he opened the kitchen cupboards to food stamps, now called WIC and school lunch programs. He also had Earl Butts as Secretary of Agriculture who considered small farmers a silly distraction in favor of industrial behemoths. The mishmash of noble and industrial programs had all sorts of unintended consequences that their advocates understand need to be corrected. New York Mayor Eric Adams (sitting next to Dr. Ornish) wanted the health experts to be responsible for designed school lunches to be about nutrition, not calories: “we’re just feeding the next health crisis.” Donna Martin, The head of Burke County Georgia school kitchens asked for the same thing: “come to school, work in our kitchens, feed our kids.”
Food doesn’t come from a warehouse or even a kitchen; it comes from soil. The kitchen just links two astonishing complexities, the soil biome and the one in our gut where food turns into…us. We know now that the human gut biome determines much of our resilience and lifespan health. Many even speak of the “gut brain” to describe how the biome shapes our choices, emotions, patterns of behavior. The only thing more complex is soil itself. Bad dirt, bad gut, bad health.
Those complexities of soil and gut are largely shaped by the third, politics. Perhaps as complex as food and soil is the social biome; how the 8 billion of us love, fear and choose over our lifespans. Our social choices emerge from our social soil, not surprisingly these days producing poorly nourished decisions. Our civil society, Congress and courts are like children raised on Twinkies and Red Bull; our democratic process staggers in puff and bluster.
It is easy to be cynical about events like the White House Food, Hunger and Health Conference. But this is how democracies muddle our our way, and nearly infinitely smarter than letting the rich royalty dither. The day before the Conference, the White House released a thoughtful national food strategy with 5 pillars—the first one focusing on economic stability. This thoughtful document is only paper until it gets translated into the 2024 budget and the $1.1 trillion Farm Bill. That legislation will determine how many soybeans get subsidized, what kids get free lunches, what moms watch their kids grow healthy or smaller. As President Joe said, “if a mother can’t feed her child, what the hell else matters?” A handful of contested house seats will decide whether that legislation will will be shaped by the people who put together the White House food strategy or people with no strategy at all. Food policy shapes generations; Wendell Berry thought we should enact 50-year Farm Bill’s to break the dangerously short-term thinking. ( Jackson, Wes; Berry, Wendell (January 5, 2009). “A 50-Year Farm Bill”. The New York Times.)
The food conference should make everyone uncomfortable a half century after the last one. Different decisions could help our community systems produce much more health. But we have to include capital investments on the screen, which is especially sensitive for hospitals and industries such as soybeans and food chemicals. Once you’ve built something, you have to pay for it. Better scientific critique would prevent us making extravagant and unfounded investments that produce little real gain in health. Our non-profit industry has shielded our capital investment side from visibility to the community benefit legislation, so I don’t sense we have a lot of moral high ground on the soybean people. Like fixing the food stamp and school lunch programs, the hungry would have us fix community benefit legislation, too.
President Joe Biden bringing the word: “if a mother
Most politics is mostly projected out of the past, not the future. The arguments focus on keeping privileges, not getting new ones. That’s how the 3/5th of a citizen idea got into our founding documents: it kept slavery and made inevitable the Civil War. This is also how the subsidies for cotton, sugar, soybean and petrochemical industries end up the Farm Bill cycle after cycle. I was representing Stakeholder Health which has dozens of healthcare non-profits, so I was not comfortable about our illogical privileges, too. We give away a lot of free care. But we could be way more scientific about our investments, including the vast sunk cost of buildings. If we stacked all our bed towers next to all the soybean silos, I think ours would be higher, more expensive and harder to defend.
The day before the White House Conference I was part of a workshop convened by the Stand Together Foundation—a child of the Koch Brothers Foundation. It would have been easy to be cynical about this one, too. But the invitation was just as hard to turn down as the White House Conference, as the subject was just as fundamental: “social dynamics of health.” The two were windows on opposite side of the house peering into the same phenomenon.
The link between the tiny San Diego workshop and massive WH Conference is hard to miss as both events raise fundamental issues of how to achieve fundamental public good. One of the big changes since the last WH Conference is the huge expansion in the non-governmental non-profit sector, especially in healthcare. Neither meeting was about more charity. Rather, the issue is how to appropriately recognize our part of the community systems that create the population scale patterns of health. Whether we are big hospitals or soybean farmers, we should thoughtfully subjecting all of our community-facing policies to basic science critique, especially procurement and capital planning.
The place to start is the same place as doctors do, “first, do no harm.” Wendell Berry was a young man during the Nixon Conference. He was already famous for taking on the agro-industrial machinery that found small farmers so inconvenient and illogical. “What I wish to speak for here is the discipline in the Human character that makes him able to forebear and restrain himself when he’s doing obvious damage to other people.”
Bad food and bad food policy comes from ravaged social soil. Ours is worse than depleted; actively poisoned. Carpet bomb spraying of pesticides makes it impossible for bees to fly or think. Anyone who would do that has drunk their own poison. Dirty politics? I only wish that politics were as healthy, resilient and self-cleansing as dirt.
The maven at the heart of the San Diego meeting was Tom Romeo, VP of the Charles Koch Foundation. Tom had gathered a group of thinker-doers working with the homeless, in public housing developments, with police and troubled kids and two surprisingly cheerful economists. Tom gifted the participants with copies of Ivan Illich’s 1973 book, Nemesis and Deep Economy by Bill McKibben. The third hand-out was a paper TC, Jim Cochrane and I wrote for the National Academies of Sciences about “the health of complex human systems.” These are not what you’d expect of a Koch workshop; a signal that something very basic is changing in the idea soil out of which grows the social dynamics.
Illich, McKibben and my team argue that we have to see human health as the fruit of nested complex systems, just related as soil and gut. This is not a metaphor; this is why things happen as they do. It is why the planet is melting, bees dying and neighborhoods go hungry. If we do not think, analyze and dialogue in the complexity of the nested systems, we will break those systems. The farms will turn to desert and our children will grow small, theirs smaller still.
The data say that we are well beyond the tipping point and that we should despair. However, the natural systems testify that they rebound once the poisoning stops. The ozone hole we thought our doom two decades ago, is already half healed. The Monarch and the Honeybees will thrive too, as will all that comes from healthy soil, meadow and forest. The only question is whether our grandchildren will be here to enjoy it.
Winston Churchill used to say that you can on Americans to do the right thing…after we have exhausted all possible alternatives. Surely we have arrived at that place now since there is still a chance for the children. Bill McKibben, in his latest book, The Flag, the Cross and the Station Wagon notes that there aren’t many things an old person can do better than a young one, except getting arrested on behalf of their grandchildren. We have to try, take risks, be bold for those we love.
Trying in complex human systems means grown-ups talking to each other, especially those expecting to disagree. That’s why I reluctantly went to the San Diego conference and found myself among new friends. Trying means thousands of committees, some dealing with the trillion-dollar Farm Bill, some about the neighborhood school kitchen, some with the homeowners’ association figuring out how to stop spraying dumb chemicals.
Complex human systems seem overwhelming. But they invite us to be part of the complexity because everything matters. Just as every quart of poison spray matters, just as does every choice, every vote, every conversation with someone you thought opposite. Every kindness is honored; no love wasted, no healing intention lost. Chef Andreas is right; we have all the ingredients; we just have to try.
Two citizens, Dr David Beckman who led Bread for the World. And me, from Precinct 601 in Winston-Salem NC.
Some of the wayfinding women of Stakeholder Health as we met at Salem College in Winston-Salem Thursday and Friday: Heidi, TC, Dora, Amy, Anya, Somava, Shelly, Lauran, Anna. Women have learned how to do that at Salem for 250 years.
Honeybees are the most successful species of the most recent thirty million years. The honeybee in the fossil record is essentially the same as you can find on your nearest batch of clover. Humans, inexplicably proud of our brief ten thousand years, should pause in wonder. We are doing poorly as a species, unlikely to see more than a few generations. Ironically, is common to read stories on the human internet about the demise of the honeybee! These stories are based on the widespread collapse of commercial hive operations, which often ship hundreds, even thousands, of hives on trucks to pollinate vast almond orchards. The bees die by the billions as disease spreads easily in the unnaturally weakened hives, especially from the dreaded varroa mite—the “destructor.”
Dr. Thomas Seeley notes that in nature, hives are usually dispersed two or three per square mile and seem to be rapidly adapting the behavior to resist the mite. Smart money would be on the honeybee to outlive humans by another several million years.
So perhaps we should pause and ask what we might learn from the bees about ourselves. Bees are highly evolved with every body part honed to perfection. My favorite is the middle leg joint which has a little notch through which the bee pulls the antennae to clean them when they become clogged with pollen. My knees barely permit tennis.
It is not the body parts that teach us; we are stuck with two legs and no wings. In any case, you can’t build a strategy on what we do not have. What do we have?
The main distinctive of the honeybee is not its body, but the wonderous social structure of the hive. The hive—the same 3-pound weight as a human brain—is social, intelligent and highly adaptive. It makes complex decisions, including where and when to send out the mother and half the workers create a whole new hive. For 30 million years in a row they have made that decision with stunning success. Its most experienced foragers switch from looking for the daily nectar to become scouts or, I like to think, wayfinders. They find the way, help the hive decide and then literally lead them. They couldn’t find our home; we need our own wayfinders.
What do we two-leggers have to work with as we face a tougher challenge– finding a new way to live on the one and only planet we will ever have. Despite the fantasies of a handful of delusional narcissists with so much money they can’t think straight, we can’t go anywhere. Mars? No honeybee would think about it for a nano second.
Honeybees have a vast advantage in that their social life emerges from a shared purpose every single bee will give their life for. Just this afternoon I noticed as a bumble bee found its way into my backyard Warre’ hive, which has an observation window that allowed me to watch her being chased by a guard bee a tenth its size. Humans, cursed with social media can no longer distinguish common threats, easily distracted by individualized fantasies and fears. Bees never take their eye off their common future.
Wayfinders! Dr Kimberly Dawn Wisdom receives the first Stakeholder Health Dr. Ruth Temple Award from Dr. Dora Barilla as Dr. Jerry Winslow watches from Loma Linda University (Dr. Temple’s alma mater). All of them brilliant, brave with eyes on the future of us all.
Humans do have Spirit, which some think gives us the capacity for wisdom, social imagination and common courage when facing a true discontinuity as we are now. No hardwired species would have a chance. We still do because we have Spirit, which gives us the subsidiary capacities for lamenting the lost beauties and then deep accountability for making the choices that lead to life. We can do that and have in other times of radical challenge. It is not enough to be homo sapiens, or even as we like to claim homo sapiens sapiens ( the species that knows it knows). Our only hope is to claim our capacity as homo sapiens sanctus-the Spirited species. That one might be capable of metanoia—the Great Turning so obviously required.
A tiny step in the Great Turning happens these next two Wednesdays as some wayfinders gather on Zoom for a workshop based on a book under construction. I’m delighted to be doing this with Threshold Retreat and Farms, itself a worthy harbinger of the possible. We’ll also gather in July at the farm for some in person mingling with the honeybees. We’ll help each other be a little less afraid of our wonderful world and a bit more clear about how we might live with it—especially the magnificent honeybees.
Register here. The $75 goes entirely to Threshold Retreat and Farms, of course. I’ll even sweeten the offer by making sure that anyone who registers gets a pound of the wonderful single hive vintage honey from Warthog From Hell Honey—made by fierce southern Italian bees on our porch. If the registration keeps you away, let me know and we’ll find a way, of course.
In humans even drones can help! Arvind, Rick, Ed and Terry lend energy as we met in the Innovation Quarter .
“We will live together, or not at all. We will build hope and wholeness, or watch our children grow small, surrounded by ineffective barriers against their fears. We know that acts of compassion, nobility, faithful caring for the earth and her people are all we can do. It was once thought that acts of virtue, conservation and care were only of personal consequence. But surely it is the most fundamental adult responsibility to build and nurture systems that carry our hopes forward.(Faith&Health, The Carter Center 2001).
White Dove. Jimmy Carter, 2012
On national bee day (May 20) twenty leaders from Atrium Health met at The Carter Center to see how we might align our efforts to “To improve health, elevate hope and advance healing – for all.” This is a very large organization—some 70,000 people—serving 400 miles of rough Southern country. If the FTC allows, the circle of care will grow to include even rougher neighborhoods in Chicago and Milwaukee as we combine with Advocate-Aurora. Most of the people work inside traditional hospitals and clinics, but increasingly both science and mission draw us over the sidewalk and into the neighborhoods where elevating hope is like pushing a glacier uphill. Despite superabundant healing science and technology to see disease at the molecular level, the fundamental drivers of ill health remain mired in ugly patterns of race and poverty, often in the very same census tracts for many decades.
Adults are flunking adulthood; our children are growing smaller.
Many of my best thoughts were born at The Carter when the oak trees were smaller. The very first major project of The Carter Center was called “Closing the Gap” which asked, “how much of the current burden of premature mortality could be prevented based on what we already know.” Turns out the answer is about two-thirds. Who can act on what we know? Formal healthcare and public health are only a small part of the answer. The knowledge must come alive in the hundreds of thousands of non-profits, businesses and….faith networks. My Atrium Health collegues and I have made reducing live expectancy gap by 2030 our top level goal, so I am back face to face with the same great and still unsolved opportunity that started me in FaithHealth, still difficult for much the same reasons. The ideas that grew out of The Carter Center soil, with major help from our partners at Advocate 30 years ago, included the basic ones we are still working with today: strengths of congregations, boundary leadership, leading causes of life, religious health assets and now the prayers of the people. These ideas were like bridges across troubled water.
One idea we had at The Carter Center was “not even one,” the name from Dr. Fred Smith. Simple public health logic matched with fierce faith that refused to look past even one gun death of a child. We thought adults could be organized at the level of their town to investigate where they—the adults—had missed a chance to prevent each young persons’ gun death. It would take a lot of adults talking to each other.
The oak trees are now much larger and I find myself less hopeful than at any point in my life, sobered by war and melting planet and, most of all disabling political vitriol. So it was good to be at The Carter Center where preposterous things are made practical through tenacious and smart work: eliminating polio and guinea worm. Elections in places they are obviously impossible: Zambia, Liberia, Ghana (where I helped once). Again, diligent and non-naïve preparation, training of thousands of volunteer poll-watchers. Work in the service of noble values. Tenacious. Qualities that national Bee Day brings to view.
Yascha Mounk writes in The Atlantic about the doom spiral of “pernicious polarization”—when a society becomes fearful of its fellow-citizens, expecting ill-will and hurtful actions unprotected by law or norms that can interrupt the most ordinary days, say shopping in a neighborhood grocery story. The research indicates that the spiral is only broken by a cataclysm. You’d think losing one million people to a pandemic would do it, but it seems to have only accelerated the polarization.
Who is crazier, the shooter of children or millions of adults who allow themselves to be radically polarized?
Nobody at The Carter Center has ever been naïve about religion as both an asset and profound barrier to boundary-crossing labor. There was a time when religion itself was the agent of polarization, but that seems quaint now, replaced by raw political anger untethered by any traditional norms or rules. Our children grow small. Some are shot.
On National Bee Day, I wondered, “how do the bees avoid our kind of doom spiral?
Thomas Seeley is an impeccable researcher and professor at Cornell who has written graceful books about how bees make decisions. He has focused on the most profound risky decision of all, which is when a hive splits, sends out the current mother/queen with about half of all the workers to form a new hive. In “Honeybee Democracy” he describes in mesmerizing detail how the oldest members of the hive switch from seeking flowers to scouting for a new homesites and weigh the options. If they choose one too small, they won’t have enough honey to make it through the winter; too big and will be too cold to survive. There are six life-death criteria. The bees get it right more than 90% of the time. They have for 30 million years.
We face no less perilous a passage in finding our way toward a new political, healthcare system, economic and, yes, faith systems even as the natural systems writhe, shudder and buck. We can’t get it wrong. Seeley says there are five clues from the honeybees. The scout bees tell the truth about the many alternatives over 40 square miles. The process takes whatever it takes, maybe an hour, maybe three days. No leader warps the process. No bee lies to another.
Bees use their pin-sized brains collaboratively to scout for the alternatives and compare them to make a choice. (p100) It helps that the idea about “good enough cavity” is hardwired into those little brains. And, as in many things bee, there seems to be no detectible pride at the individual bee level. They share, then release, their individual perspective so the truth comes clear. Not shooting grandmothers and children is hardwired into even human brains. So we at least what not to do. Bill Foege, who led The Carter Center and led the field of public health to embrace gun violence as a disease once said that it is easy to have a brilliant idea; think of the dumbest thing possible and do the opposite. How do we choose the opposite?
There is no future when leaders warp our ability to talk to each other. Nothing works, choices become random and disconnected from reality. We cannot see each other or our children. We are absolutely certain to perish.
Humans do have Spirit to work with, which seems like a slim reed on which to lean. Since we have little hardwiring to move us toward common purpose, we can only hope Spirit is stronger than venal stupidity. We do have a few mature humans, so we know it is possible. But it seems like a slim hope amid the manipulated deluge of divisiveness.
The oaks at The Carter Center grow a little each year. About 15 years ago the Carters planted a small grove of American Chestnut hybrids selected from among the tiny handful that have not succumbed to the blight that wiped out millions. Real science. Tough hope. Carter—then 80 years old–knew he would not see if the experiment “worked” to again blanket the Appalachians. None of us can know any more about the seeds we are planting with our lives.
He is 95 and the trees are still growing. Listen to the man: “I have one life and one chance to make it count for something… My faith demands that I do whatever I can, wherever I am, whenever I can, for as long as I can with whatever I have to try to make a difference.”
It was such a mundane miracle that nobody thought to take a picture: a handful of straw by a 2” cottonwood sapling at the bottom of a dry arroyo. Hope in shades of brown.
I didn’t take a proper photo, either. My ipad scrawl, instead,
The straw had not randomly blown against the sapling. Larry McEvoy thought hard enough to place the straw precisely to protect its young roots from the hot afternoon sun. The dirt took years more thought and a lot more sweat. The arroyo had once been a creek until a bulldozer turned it a county road that quickly degraded into an impassable rocky sluice. The other five square miles was variations on the same short-term idiocy. Larry and Ankie bought the broken ranch a quarter century ago with young sons. Who else could look at it and imagine Elk sipping out of the creeks that used to be there. They brought in their healing bulldozer wielded like a scalpel to build check-dams in the arroyo to catch enough run-off silt. Cottonwood became imaginable, plantable and now worth protecting against the summer blaze. Here stands a sapling, someday a tree that will protect the creek yet to come.
TC and I don’t live on a ranch, but think the five square miles of lost children of Winston-Salem with streets like dry ravines with little soil for young roots. But they once grew healthy children and can again if some grown-ups would see them like Larry saw the Cottonwood. Some see the run-off from COVID recovery funds as a chance to do the right thing. So it might happen.
Kids don’t grow any quicker than Cottonwood. They need vaccinations, books, safe places to study and oatmeal just as saplings a handful of straw against the sun. Kids need grown-ups to pay taxes to pay teachers and businesses to pay a living wage to their parents.
Tears for what is lost. And a few decades of thoughtful sweat.
Last night we had dinner with two grown-ups who still have tears for the children: Ray Chamberlain was the UMC Bishop of Virginia, now the cook, and Martha, an author who has played many roles around the world. They were celebrating God And the People: Prayers for a Newer New Awakening. Martha’s favorite prayer: For Children Old Too Soon:
God on the run, of parents who ran to safety when the soldiers came. Fled the garage as the shepherds left. Crossed the desert wastes to give your life a chance.
Your mother without a husband,
your father without a story, refugees against an empire.
You knew early and at every step along the way how fragile and fraught the journey without help.
You must weep for others even less likely to find one.
Be with the children on their own.
They listen in the silence for the next blow to fall. Listen for the cold weight of anger from one supposed to protect, they wait for the punch on the way. Listen for the scurry of the vermin and the scatter in the dark. Listen for the parent who is working instead of tending. Listen to the names of shame and stigma. Listen for someone to say their name in kindness.
They are watching for a crack and the slight light. Watch the flow of the day and what comes next. Watch for kind eyes and an open hand. Watch for something to eat and drink. Watch for a safe place to wash.
Child God, the human one, bring us to the children on their own. May we listen and watch for them. You know their lives; teach us as would be with them. Each child a savior of us all.
Give us eyes to see the child old too soon. And eyes for pattern of the ten, hundred, thousand and million as clear as one child’s cry. Strengthen our hearts and sharpen our eyes to see the utterly predictable processes and places bereft of justice, even the shreds of mercy.
How do You stand it, God? What holds back your wrath and vengeance on all of us who care so little?
Tear away the hiding place from the ugly shadow of our lazy charity, of kindness held small. Give us no mercy and make us fear justice.
As a child, come to us and wake us up.
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God and the People: Prayers for a Newer New Awakening, published by Stakeholder Press. Available on Amazon here.
Larry McEvoy’s book, Epidemic Leadership: How to Lead Infectiously in the Era of Big Problems, is here.
