Notes from the Institute for Health Policy and Leadership: In November, 2018, four leaders of Stakeholder Health, a collaborative learning organization of over 50 mission-oriented and faith-based health systems, traveled from San Diego, CA to Wilmington, NC – literally from sea to sea. Their goal was to make careful observations of innovative partnerships of health systems and community organizations dedicated to fostering better health outcomes for whole communities. In the following blog, Dr. Gary Gunderson, one of the founders of Stakeholder Health, offers some reflections on what was learned during that journey they dubbed the “See2See Road Trip.”
Meeting the Nation
One can learn a lot about health policy on a drive from the California fires to the Carolina floods the week after landmark elections. Four of us trundled our way across the country on behalf of Stakeholder Health to find a different way of learning about the things that matter most in health policy and institutional leadership. We have all been victims of the normal way: fly in experts to gather with rows of other experts to stare at PowerPoint presentations in dim rooms for 20 minutes at a time, tweaking a thought that was presented a year before in a similar conference room. Surely we could find a way to learn better and faster. So we tried meeting the nation instead of having a national meeting.
Being Deliberate with Words
The first thing we learned on our 3,200 mile See2See Road Trip was to be careful with our words. They contain us inside professional tribes and often separate us from the very people we care about most.
The language of health policy and leadership is technical, designed for efficient communication among specialists familiar with the long and nuanced developmental process that will bear institutional weight and withstand the conflicted winds of powerful interests. However, the subject of health policy is nothing less than everyone’s life and death—and a fifth of the economic activity of the largest market in the history of our species.
Be careful with our words. And notice the context.
Our very first visit was with what we had expected to be a cardiovascular prevention program in East San Diego. The meeting involved the Heart Association, a group called Be There San Diego, and some local clergypersons - who turned out to the stars of the show. They thought we were public health experts and only wanted to hear about “heart stuff.” So they didn’t even invite us to the anti-violence street fair they were simultaneously running a mile down the street. And they barely mentioned the frozen turkey distribution they were quietly managing around the table by texting. (Of course, a health policy expert might have wondered about the link between a recent recall and the sudden availability of free turkeys.)
Health experts often help community networks find resources, money, visibility and access to political influence. We saw from coast to coast that community level organizations are canny about how they describe their local work, techniques, philosophy and goals, easily giving the elevated experts an answer that fits what is already known. This poses a real risk for the expert, because the quickest path to professional myopia may be a PowerPoint presentation about a group working on something you think you know about—on ground you’ve never visited.
Working Near the Soil
Ground is what we think of as the bottom, at best the foundation on which we raise up the structures and programs that might contribute to health. Ground is actually soil, the infinitely complex living phenomenon from which emerges all life, everything we know and love. On way from El Paso to Lubbock, we swerved up a side canyon to spend a couple hours about seven hundred feet down in Carlsbad Caverns. Only discovered a century ago, they continue a quarter billion years of limestone sculpting drop by mineral-laden drop. If you keep still, you can hear the next drop of a process still emerging.
We stand on mystery and should kneel in reverence. This posture would also get us close enough to notice what is really going on so that we might be wise enough to do useful work.
When we encourage our colleagues working near the soil to speak our language instead of their more complex natural tongue, we lose the nuance and complexity we claim to value. When we ask only about the health prevention technicalities, we lose the really rich story of how a people have found their way to be their own healer, how to nurture their own life and the lives of those who will follow in all the bio-psycho-social—and spiritual richness. If the myopic health policy experts were only dimming our own vision, it would not be such a loss. We mainly talk to ourselves anyway. We separate ourselves from the phenomenon about which we claim professional standing. And we suppress actual story of the community life we claim to serve.
Finding Our Way
Health policy tends to assume that truth lies in generalizable abstractions that can apply across many particular situations. The highest form of policy applies not to just one neighborhood, but all of the aggregated neighborhoods in a place governed by political lines. That is not untrue and not entirely unworthy labor. We need rules. But we need rules—policies—that are designed first to support and protect the ways and means by which life happens in the human networks where it must happen; in particular places capable of finding meaning, acting with kindness and hope and mercy—maybe even justice.
I am not arguing for less policy and leadership, but a more balanced way of finding our way. Begin with the grounded leaders closest to the phenomenon about which we are called to consider. And don’t just listen to the fellow with the microphone. Follow their eyes closely enough to notice who they are listening to. The East San Diego group was blessed with an extraordinary voice and presence in the Reverend Brown, who was comfortable at the head of the table. There were others present. I noticed the elder pastor sitting quietly beside me, Charles Dorsey. A man who grew up in a tiny town a few twists of the river south of Memphis, he now lived to nurture the life of the leader through mentoring, supporting, protecting the leader’s public voice and presence. He was quick to deny his own importance, a bit uncomfortable that I even noticed him. “I’m not the point,” he said.
Not a bad role model for those of us who are called to strengthen the life of the communities God so loves.
Reverend Dr. Gary Gunderson is the Secretary of Stakeholder Health, a learning group of more than 40 healthcare systems. He is also a member of the Advisory Council for the Institute for Health Policy and Leadership. He is known for decades of creative work in the field of faith and public health at the Carter Center and Emory School of Public Health, then Memphis, where his ideas sparked more than 600 congregational partners, to the expansive work in North Carolina.
Dr. Gunderson is the Vice President for Faith and Health at Wake Forest Baptist Health and Professor at both Public Health Science in the Wake Forest University School of Medicine and in the School of Divinity. His current work focuses on helping Wake Forest Baptist Health align its full institutional and human assets with its professed goal of advancing the health of the region.