Thursday, September 13, 2012

Greetings from Austin, Texas

One of the slogans that the locals in this city use is “Keep Austin Weird.” You see it in many of the gift shops, clothing stores, bars, and live music venues throughout the downtown area. I can’t say whether or not the slogan has been successful in keeping this place weird but the city (13th largest in the country) certainly has managed to keep the feel of a college town that also happens to be the state capital – think Madison. You decide if that is weird.
One thing I do know for sure is that the things covered in today’s ASTHO meeting were anything but weird. In addition to the numerous topics covered in our Prevention Policy Committee, of which I’m a member, the agenda today covered 3 major topics: the Integration of Public Health and Primary Care, Working with Hospitals to Improve Prevention, and Making the Case for Prevention. Superb presenters from the Institute of Medicine, the Catholic Hospital Association, and the Robert Wood Johnson Foundation (among others) made the day rich with information and new ideas.
I learned a great deal from the sessions but the thing that struck me most was a passing reference to the writings of psychologist Justin Menkes. This was mentioned in the context of the challenges facing public health today. In his book “Better Under Pressure,” Menkes writes that people who maximize their own potential and the potential of their colleagues and their organization embody “three essential capabilities or drivers:
  • Subservience to purpose,
  • Finding order in chaos. and
  • Realistic optimism and sense of agency.
The first two are somewhat self-explanatory. Dedication to a purpose gives people the drive to realize their potential and that of their organization. For the sake of a larger good, people who demonstrate this quality put the mission of their agency or organization ahead of their own personal interests.
Finding order in chaos means being able to see the opportunities that crises provide, which sets the stage for the possibility of tremendous progress. This requires clarity of thought and the drive to solve the puzzling problems that arise every day.
“Realistic optimism and sense of agency” is a bit more complex. In the face of today’s multiple challenges and unpredictable circumstances, successful people display a sense of that the future can be better and thus are willing to prepare for whatever comes their way. “Realistic optimism” helps people minimize constraining fear and maximize their odds of success in a world of overwhelming ambiguity. A person’s “sense of agency” is the single most important factor in being able to cope with all these multiple challenges and unprecedented change. According to Menkes, a sense of agency is “the degree to which people see their circumstances and the outcomes they experience as within their control. For people who look outside themselves for explanations, long-term success becomes much more difficult. For those who look inward, learning and adaptive behavior come more readily.”
This brief reference to Menkes in today’s opening session struck me because it seemed very relevant to the situation of public health in Minnesota and to the Minnesota Department of Health. I have never been in an agency that is so mission-driven as MDH. Staff are experts in their fields but also dedicated to the mission of improving and protecting the health of all Minnesotans. I am confident that, as an agency, we possess the first characteristic. I think we are also looking to find order in chaos. There are great threats that face us but our current situation also contain great opportunities. I think we have the clarity of thought and desire to solve these puzzling problems for us to legitimately claim that we possess the second characteristic.
That brings us to realistic optimism and sense of agency. This is an area on which those of us in public health need to focus. We (myself included) often complain about the paucity of funding, invisibility because we prevent things from happening, the lack of understanding by policy makers of the importance of public health, the short-term focus of budgets, and the dominance of the medical care system. We need to learn that we can’t look to others to take the lead in advancing public health. We can’t be victims and succeed. We have to recognize and believe that the future of public health is really within our control. That realistic optimism and sense of agency will foster creative thinking, increase comfort with risk-taking, and create a confidence to move forward a programmatic and policy agenda that breaks new ground for 21st century public health.
The longer I’m at MDH, the more I’m recognizing that we do possess realistic optimism and a sense of agency. We are an agency poised, in this time of chaos, to take advantage of some unique opportunities to improve the health of all Minnesotans in both the short and long-term. I am confident that we will not only do “Better Under Pressure” but we will actually do great under pressure.

9/11 Reflection

On this morning’s flight to Austin, Texas for the Association of State and Territorial Health Officials (ASTHO) annual meeting, I was able to complete my yearly 9/11 ritual of reading Seamus Heaney’s “The Cure at Troy” which is his 1991 version of Sophocles’ 5th century BCE “Philoctetes.”  The story is one of a wounded man rejected by society, abandoned, and terrorized by enemies who see ends justifying means.  The story shows Philoctetes overcoming his hatred and distrust of his enemies to return to society for healing and ultimate victory over his foes.  The play highlights the conflict between personal integrity and political expediency.  It also explores how the victims of injustice can become as obsessed with their wounds as the perpetrators are to the justification of the harms they have done.  It’s a poignant 9/11 story – it’s also an everyday story. 
I particularly appreciate the fact that Heaney sets the stage for the play with this W. H. Auden poem:
‘O look, look in the mirror
   O look in your distress;
Life remains a blessing
   Although you cannot bless.
O stand, stand at the window
   As the tears scald and start;
You shall love your crooked neighbor
   With your crooked heart.’
and ends the play with these words from the Chorus:
Human beings suffer,
They torture one another,
The get hurt and get hard.
No poem or play or song
Can fully right a wrong
Inflicted and endured.
History says, Don’t hope
On this side of the grave.
But then, once in a lifetime
The longed-for tidal wave
Of justice can rise up,
And hope and history rhyme.
So hope for a great sea-change
On the far side of revenge.
Believe that a further shore
Is reachable from here.
Believe in miracles
And cures and healing wells.
Call miracle self-healing:
The utter, self-revealing
Double-take of feeling.
If there’s fire on the mountain
Or lightning and storm
And a god speaks from the sky
That means someone is hearing
The outcry and the birth-cry
Of new life at its term.
To me, “The Cure at Troy” is also a public health story.  It recognizes the fact that the lives of many in our world are negatively affected and terrorized by the same attitudes and dishonesty that confronted Philoctetes.  Yet, the story reminds us that there is always hope that with the right circumstances and with the right support, healing can occur for both individuals and society.
Let us hope that the lessons of 9/11 can teach us the lesson learned by Philoctetes and expressed in his last lines in the play:  “I feel I’m a part of what was always meant to happen, and is happening now at last. Come on, my friends.”