Tuesday, December 23, 2014

Moving Beyond Checkmate

It was 60 years ago this month that I learned how to play chess.  Although chess has brought me some enjoyment over the years, the process of learning the game brought me some much more important life lessons.  

As the 1954 December holidays approached, the demand for the new board game “Scrabble” was exceeding supply so, when my last-minute-shopper parents got to the local department store on December 24th, none were to be found.  Looking around at the mostly empty shelves in hopes of finding an overlooked “Scrabble” game, my mother noticed a few chess sets.  On the boxes was the inscription “Chess, the Game of Kings.”  My mom thought “If it’s good enough for kings, it should be good enough for my children.”  

Neither of my parents had ever played chess so on that night before Christmas while the rest of the family was nestled snugly in bed, my mother read the rules and taught herself to play chess.  The next day when the hubbub of present opening was over and the dinner dishes had been washed and put away, my mom took my two older brothers and me aside and taught us how to play chess.  

My brothers learned the game very quickly and soon were teaching their friends how to play.  For the next couple of weeks we had a steady stream of neighborhood kids coming over to play chess.  Because of the fun they were having, many of the kids used their Christmas money to purchase chess sets while their new “Scrabble” games sat idle – at least for a while.

I learned a bit more slowly but within a week I had mastered the basic concepts of the game.  When I was finally able to call “checkmate” on my mom, she smiled and said that I was now good enough to play with the older kids and teach the younger siblings how to play when they were ready – which I dutifully did.

Over the next 51 years of her life, I never saw my mother play another game of chess.  I suspect that once she was confident that all of her children would learn how to play chess she felt it more important to move on to teaching them other things.  

About the same time that my mother was teaching me to play chess, Geoffrey Vickers was educating people about public health’s role in the “continuous redefining of the unacceptable.”  I frequently use that definition when I talk about public health.  While that definition highlights the importance of focusing on the problems we face in our society, I now realize that it provides a one-sided view of public health and its goal to protect and improve the health of all people.  As I look back to Christmas 1954, it’s evident that my mother was giving me a perspective that could balance and complement that of Vickers.  Although she was focusing on a relatively small population (her family), she knew what they needed to optimally grow and prosper.  In addition to addressing deficits, she was modeling another necessary component of the definition of public health as the “continuous redefining of the opportunities.” 

Public health needs to function as the conscience of our health system by continuously defining what’s unacceptable.  Public health also needs to lead the way to eliminating those unacceptable conditions/situations.  But of equal (if not greater) importance is the need for public health to identify the opportunities for all of us, as a society, to optimally grow and prosper.  Geoffrey Vickers and my mother helped me see and understand that continuum. Together they taught that once we checkmate today’s public health problems, we need move on to the next challenge and opportunity.  


Monday, December 1, 2014

Who will be stirring the public health pot?

In 1997 I played hooky from the morning sessions of the American College Health Association annual meeting in New Orleans to get a different view of the Crescent City than I was getting from inside the convention center. I remember that it was a moderately hot and humid day in a city not known for its moderation. I also remember that it was raining intermittently and that one of the rain showers forced me to seek shelter in a near-by French Quarter building – the Jackson Brewery which no longer housed a brewery but rather a spate of trendy boutiques and gift shops.

Since shopping is not one of my favorite pastimes, I looked for a place to pass the time while waiting for the rain to stop. On the far end of the building I noticed a sign for the New Orleans School of Cooking. The sign announced that there was still space available in a class that was just about to begin. Without a second thought, I signed up.

Within minutes I was in a “teaching kitchen” surrounded by a jumble of aromas and jars and bottles of colorful spices and cooking ingredients. The teacher/chef informed the “class” that we would be making Cajun Gumbo, Creole Jambalaya, Bread Pudding with Whiskey Sauce, and Pecan Pralines. Since the class would end at lunchtime, we would have the opportunity to eat the results of our cooking. Given that the class was taking place in an old brewery, the teacher/chef thought a few glasses of beer for the students would be appropriate. He thought it might even help with the cooking – or at least make the class more enjoyable. None of the students objected.

Over the next three hours we mixed, seasoned, stirred, sautéed, boiled, baked, tasted, sipped, and laughed. Using the “be’s right” method (cook it until it “be’s right”), I learned the importance of cooking something “until it looks pretty.” I was introduced to the Louisiana “Holy Trinity” of vegetables: onions, bell peppers, and celery. I discovered that rice is a staple in the New Orleans diet because it is the only grain that can grow in wet climates. In the process I was also given a lesson about the geographic, historical, social, and cultural influences that have shaped Louisiana and its cuisine.

The class went quickly and all of the recipes worked perfectly. As we sat around the table enjoying the results of our efforts, the teacher ended the class with this observation: “A regional cuisine is the product of geography and history. Geography determines what goes into the pot and history determines who stirs it. The geography remains relatively constant but the history is ever changing and evolving; so is the cuisine.”

I thought of that experience a couple of weeks ago when I was back in the Big Easy for the annual meeting of the American Public Health Association; my first trip back since 1997. Much had changed in 17 years. One noticeable difference was that, as health commissioner, my time at this meeting was tightly scheduled and I had very little free time to explore the city. There was no time to play hooky because in the course of a couple of days I had to give three presentations, participate in several meetings on issues related to MDH initiatives, and “meet and greet” people at a couple of receptions while trying to earn a few CME credits. No need for pity though; I was still able find time in the two evenings I was there to visit a couple of noted New Orleans restaurants and sample the local cuisine. It was during these outings that I noticed the more global changes that have occurred in NOLA.

In 2005 Hurricane Katrina devastated the city. Physically and economically, most of the tourist areas have bounced back but the recovery of the rest of the city is uneven. While some neighborhoods are struggling to recover, other neighborhoods are rapidly gentrifying. But the most notable change is the demographics. Many who left after the storm have yet to return. Many who came to help with the clean-up and rebuilding have stayed. The racial and ethnic make-up of the city has changed dramatically on both ends of the socio-economic spectrum. You can see it among the cab drivers, the airport and hotel workers, the wait staff, and on the streets outside of the French Quarter. You can also see it in the clientele of trendy restaurants.

I could even taste the demographic change in the food that was served; it had more of an Asian and “Tex-Mex” flavor than I had noted in 1997. As I looked at the menu that listed “Vietnamese Blackened Catfish Tacos,” I thought of the statement by the teacher/chef from the New Orleans School of Cooking; “Geography determines what goes into the pot and history determines who stirs it.” It was obvious that New Orleans and its cuisine were evolving because of its changing history.

But New Orleans is not alone. It struck me that Minnesota is also evolving. Despite climate change, Minnesota is still dramatically influenced by the geography that has remained relatively unchanged, a geography that definitely contributes to what goes into our pot – not just our culinary pot but all parts of our socio-economic and public health pots. Conversely, the history that determines who stirs our pot is changing in a much more dynamic way. The changing demographics of our state guarantee that the people stirring the public health pot in the future will be markedly different than in the past. Just as the New Orleans diet evolved from the blend of French, Spanish, Mexican, Indian, Cajun, Creole, Asian, and African influences, our socio-economic and public health systems will evolve from the influences of the new and varied residents who now and in the future will make Minnesota home. Our history and who stirs the multiple Minnesota pots is changing. And like New Orleans cuisine, Minnesota society will be constantly evolving. As health commissioner, I can’t wait to sample and taste our future public health system’s complex and robust flavor.