Pitching you a note from Bemidji

Greetings from Bemidji,

Tonight I’m in Bemidji – half-way through my last “Pitch the Commissioner” trip of 2012. Unfortunately, just when I’ve started to get the hang of pitching and have increased my ringer percentage, the weather has intervened to shut me down until next spring. However, Bemidji is the curling capital of the U.S. so tomorrow I will be throwing a 35-pound curling stone for the first time in my life, tutored by an Olympic Curling Champion.  I’m sure there will be a crowd there to “Rock the Commissioner” – an option much better than “stoning the commissioner.”

Today I pitched horseshoes on the Red Lake Nation and was pitched ideas about long-term care, diabetes, nutrition, suicide/mental health, breastfeeding, childbirth in rural communities, and the need for health educators outside of the metro area, among other things. Earlier in the day at the Sanford Hospital in Bemidji I was educated about the hospital’s community needs assessment, an innovative dental access clinic, and a large NIH grant studying social determinants of health among various tribes in Minnesota and the Dakotas. 

Tomorrow I meet with the staff in the MDH District Office, multiple SHIP partners, the Clearwater County Commissioners, and the Headwaters Food Sovereignty Council; bicycle with local supporters of several bike initiatives; and end the day curling. It should be interesting and I’m glad someone else will be driving on our way back to St. Paul. 

As I sit in my room tonight overlooking beautiful Lake Bemidji (I’ll take people’s word for that because it’s too dark to see), I’m remembering all the faces of health that I saw today – faces from hospitals, clinics, dental practices, community organizations, research institutions, tribes, advocacy organizations, government, and schools. Tomorrow, I’m sure I will see many more faces. 

That image of faces reminded me of the welcome that I gave at the Many Faces of Health Conference in Bloomington last Thursday. I’ll close this note with some of what I shared with that group.

I mentioned to the attendees of the conference that the day of the meeting (October 25) was the 50^th anniversary of the announcement that John Steinbeck had won the Nobel Prize for Literature for his works that elegantly and starkly articulated the plight of the poor and dispossessed during the Great Depression. I read part of Steinbeck’s Nobel Prize acceptance speech during which he reflected on the efforts of writers. He said:

“Literature was not promulgated by a pale and emasculated critical priesthood singing their litanies in empty churches--nor is it a game for the cloistered elect, the tin-horn mendicants of low-calorie despair.

Literature is as old as speech. It grew out of human need for it and it has not changed except to become more needed.

The ancient commission of the writer has not changed. He is charged with exposing our many grievous faults and failures, with dredging up to the light our dark and dangerous dreams for the purpose of improvement.

Furthermore, the writer is delegated to declare and to celebrate man's proven capacity for greatness of heart and spirit--for gallantry in defeat, for courage, compassion and love. In the endless war against weakness and despair, these are the bright rally flags of hope and of emulation.”

I then reflected that if that’s the role of a writer, what about all the folks working in community and public health – the community health workers, primary health care and social service providers, sanitarians, epidemiologists, regulators, lab scientists, community organizers, statisticians, policy makers and policy specialists, and many more? 

I answered that question by paraphrasing John Steinbeck’s speech:

“Public health was not promulgated by a pale and emasculated group of naysayers with a defeatist approach to community health -- nor is it a game for cloistered and tin-horn mendicants of despair.

You, public health professionals, are healers and protectors and health promoters and truth seekers creating health -- a cause as old as humanity itself. You are here because of human need and more needed now than ever.

The ancient commission of public health has not changed. You are charged with exposing our many grievous faults and failures, with dredging up to the light our dark and dangerous realities for the purpose of improvement.

Furthermore, you are delegated to declare and to celebrate humanity’s proven capacity for greatness of heart and spirit -- for courage, compassion and love. In the endless war against weakness and despair and injury and disease, you are the bright rally flags of hope and of emulation.”

That certainly describes those who work in public health in Minnesota.

Ed

Symposium on Fragmented Families

Greetings,

A couple of months ago I was invited by Mitch Pearlstein, Founder and President of the Center of the American Experiment, to submit an article for a published symposium entitled “Fragmented Families and Splintered Classes:  Why So Much Churning?  What Can be Done? What Will America Come to Look Like?”  The premise of the publication was that divorce, single parenthood, and out-of-wedlock births were the source of many of the problems facing our society and that we need to do something to address this major problem. 

I agreed to be part of the symposium because I thought a public health perspective was needed in the discussion. I thought you might be interested in what I wrote. The article can be accessed at: http://www.americanexperiment.org/issues/culture-religion/fragmented-families-and-attribution-errors

Ed

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 (13^th 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 21^st 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.

Ed

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’ 5^th 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.”

Ed

Greetings from Moorhead, Minnesota

“I hear and I forget. I see and I remember. I do and I understand.” Confucius – Chinese philosopher – born August 27, 551 BCE

As you know, I’ve been going around the state having people pitch me ideas about what Minnesota needs to do to regain its stature as the healthiest state in the nation. I have those discussions before, during and after pitching horseshoes in a local park. This afternoon I stopped in Ottertail County to talk with a group of local and state elected officials, health care workers, local public health, community organizations, Area Health Education Center staff, educators and other interested citizens. I was also pleased that some of our district staff was there. Tomorrow I’m in Clay and Becker counties interacting with similar groups of people. Tonight I’m in Moorhead.

This is my fourth “Pitch the Commissioner” trip but the first one that has required an overnight stay, so this is the first opportunity I’ve had to let you know what I’m hearing, what I’m seeing and what I’m doing.  I’m hoping that those three things lead to some understanding as outlined by Confucius.

What I’m hearing is that communities across the state are looking for continued partnership with MDH.  They speak highly of the help that has come from all divisions within MDH. It may have come from the district nurse consultant who has helped with an MCH issue; a sanitarian who has helped with a pesky water quality issue; a nursing home inspector who has helped improve the quality of care; a health economist or statistician who has provided some useful information to a hospital administrator, or a grants manager who has helped an agency work through a tough problem – to name just a few. I’m certainly hearing a lot about the value of SHIP and how it’s changed the conversation and relationships in communities. It has had an effect more powerful than I had imagined. Mostly, I’m hearing that people throughout the state see us as good partners in creating healthy communities. 

I’m also hearing that there are some acute needs in most communities. The public health infrastructure is weakening, and it’s becoming increasingly difficult to maintain the high level of service that local agencies have provided.  I hear about creative and unique ways of making do but the lack of resources is starting to take its toll. I hear about changing demographics that are challenging the communities, and I hear about many of the specific acute and chronic problems that are present in every community.

What I’m seeing in these communities is amazing. I see a pride in what these communities have accomplished and a desire to do even more.  I see partnerships, affiliations, alliances and collaborations that have been established and solidified and are having a huge impact on the health of these communities. People are anxious to work together to improve their communities. I see the huge impact that small investments in prevention can make. I see things that make me feel proud to be a Minnesotan and proud to be part of a public health system that helps make these things happen.

What I am doing – besides listening and looking – is asking questions about the needs and strengths of communities and what help they would like to get from the state and MDH. I must admit that I also do quite a bit of advocating for creating a public health framework for health reform, rebalancing funding for medical care and public health and integrating medical care and public health. But mostly I advocate for how we can create healthy communities where people have the opportunity to be healthy and where health disparities are eliminated. The points of those presentations will have to wait for a later note.

Confucius said, “There are three methods to gaining wisdom. The first is reflection, which is the highest. The second is imitation, which is the easiest. The third is experience, which is the bitterest.” I hate to disagree with a noted philosopher on his birthday, but the experiences that I’m getting through my visits are certainly adding to my knowledge and understanding of the needs of the state (I can only hope that they add to my wisdom) and they are far from bitter. They are rich and flavorful experiences that fill me with hope for our state. 

As I go around the state and talk with people, they often wonder if those of us in the metro area or working at the state level know what the local folks are doing and if we understand its importance. I can’t speak for everyone, but I’ve certainly come to see them as an integral part of the public health enterprise that’s so essential if we are to be the healthiest state in the nation. They give credence to what Nobel Peace Prize winner Mother Teresa (BD 8/27/1910) said, "What we are doing is just a drop in the ocean. But if that drop was not in the ocean, I think the ocean would be less because of that missing drop.”

Ed