AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
RICHARD ALLAN ARONSON: We are faithfully on time on the last day of AMCHP 2006. It’s been a really great conference. I want to thank all of the people who organized this and put this together, our friends at AMCHP at the Maternal and Child Health Bureau and all of you who contributed to it. There are two handouts for today’s session. The two are in the back of the room. The first one has all the slides on it, and the second one is the ten characteristics of Humane Systems for early childhood that we are going to talk about and share today.
I want to start out with this quote: “Injustice anywhere is a threat…” This is not (inaudible). “…Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly affects all indirectly.” That’s from Reverend Martin Luther King, Jr., and it forms the foundation for having humane practices in maternal and child health.
Notice the first slide; you can’t see it as well up there, but you have it in the handout, and the challenge in thinking about humane systems and policies for early childhood and for maternal change—and child health—is to question cultural paradigms, or as we say in Maine “para-dig-ums,” that are so deeply embedded and tied to our society that we take them for granted. And I’m speaking to you in one sense as a pediatrician and a public health practitioner for nearly thirty years, but more importantly—and this is the key—as a person who strives, as we all do, for the one shared profession, the one degree, the one title that matters the most, which is PhB, which stands for “Professional Human Being.” So, when we do humane stuff we aim to let go of the title, the degrees, after our names, and we try to come together as fellow human beings, with our own humility and our own vulnerability, shared—willing to share that. So the goal here is to not necessarily to give you new information today, but to show how this framework is a transformation in the way that we think and do business in public health. In a deep sense it is intuitive, but at time when our national priorities are out of synch with the mission of maternal and child health, in many ways, my sense is that such a dialogue can enrich all of us who care about our efforts in public health.
So, instead of being Richard Aronson, MD, MPH, the only degree I put is PhB, and that should be in process, because we never stop trying to be whole people. And we have a new department of Maine, Department of Health and Human Services. The acronym is DHHS, but when we start to think humanely about the work that we do, that changes, for me it changes to “Department of Healing and Humane Service.” So being humane means trying to change the way that we think about the things that we take for granted. I have always been amazed throughout my entire life that the United States ranks so poorly in health care compared to other countries. When I started medical school in 1969, we were about fifteenth in the world in certain health indicators. Japan was thirtieth or fortieth. Now, in 2006, we’ve plunged further behind to about twenty-fifth in the world, whereas Japan is first in the world in indicators like infant mortality. So the challenge here is to change our culture so that we, so that we are approaching this low ranking in health and unconscionable disparities as a disaster. We talk about disaster preparedness, but we face a disaster everyday in this country which is that we are doing really, really poorly in many areas of health and health care, and that should be treated as a disaster just as much as the traditional approach now of disaster preparedness.
What I’ve drawn on today is experience over my years, which I’m very grateful for, and here are a few examples. The children’s bureau started in 1912, and that took a lot of vision to have a bureau…yeah?
UNKNOWN SPEAKER: (Inaudible)
RICHARD ALLAN ARONSON: …really small.
UNKNOWN SPEAKER: (Inaudible)
RICHARD ALLAN ARONSON: I know. Hold on just a second here.
UNKNOWN SPEAKER: Very annoying… (Inaudible)
RICHARD ALLAN ARONSON: Okay. Okay, the children’s bureau—here are just a few of the sources, and I’m not going to go over this, but I’m going to give you some references here for you. This is where I’m drawing my talk from: The creation of the Children’s Bureau in 1912, which was the start of what today is now the, um, not just the MCH Bureau but a federal presence. The Title Five legislation in 1935, in particular Eleanor Roosevelt, and for her vision which she brought to the agenda of the Social Security Act and many others to include Title Five MCH as part of the Social Security Act. The move toward systems change, a major development in the history, not only of maternal and child health, but in the history of the way we think about the way people coordinate and treat each other. As humans, we have cooperated with each other, tried to cooperate with each other for thousands, hundreds of thousands of years. But it’s only been in the last hundred years that the concept of a system and what a system is has actually been written about and investigated and researched. Remember that. The concept of getting the whole system in the room and always asking the question in MCH: Who else should be at the table? It also means, by the way, removing the tables, because the best dialogues occur when people when people are gathered in circles without tables between them.
So today this is a bit too large of a group, but whenever you have groups of fifteen or less that you are organizing and facilitating meetings, a humane way of doing that is changing the way you set up the chairs in the room, making sure they’re in a circle, making sure that there are no empty chairs; so every chair in the circle is filled. By the way, this is all been researched—this is not just out of my hat. And when a person comes in late, invite that person to join the circle and not have them stay on the outside. So that, what this is all about is fostering the condition for people to be at their best.
Cultural and linguistic competence has had a huge influence on me—and, as well as the research on the social determinants of health. Just a few people here to mention that I think are really important: the Georgetown University, the National Center for Cultural Competence, the Whole Direction of Children with Special Health Needs program, with the leadership from the MCH Bureau over the years in terms of emphasizing cultural and linguistic competence. And the work on social capital, which is very interesting and challenging by a number of people, including Robert Putnam, but also others. The linkage between education and democracy, which I’ll talk about shortly, and the work on resiliency. And the work on the resiliency I’ve drawn over the years from James Garbarino, G-A-R-B-A-R-I-N-O. James Garbarino has been extremely helpful to me. The work of Emmy Werner, W-E-R-N-E-R; first name is E-M-M-Y. She has done great work in the area of resiliency, and there’s a whole body of research. It’s not the research, it’s not the studies, that we in maternal and child health or public health or medicine have been trained in, but it is out there in different disciplines. And so one of the challenges for being humane is to be open to, and include, those who have so much to share from other ways and other perspectives.
I also draw, and am very grateful and glad to see colleagues in the room, on the five guiding principles that we developed in maternal and child health in Wisconsin in 1993, putting the family at the center—and the five principles are Family Centered Care, Outreach, Resiliency, Community-Wide Leadership, and Cultural Competence. And the reason that this was such a exciting effort is that we, as a state and as an MCH program, we said that we would view all of our efforts within the context of these principles. And they’re all trying to change systems. And in Maine I’ve been grateful to be able to focus on specifically early childhood, applying the guiding principles into the early childhood humane plan that we have in Maine.
Now, education in democracy is a really a very interesting and important, for me a very important point that I want to share with you. Just hold on a second. Anyway, I’ve always had trouble with Power Point, and I finally figured out why. The power is not in the point. The power is in the people! And I spent hours last night trying to coordinate this so that I would be able to do it right on in synch—and it’s obviously not working. So this is proof that the power is indeed in the people. And that’s why, if you will bear with me again, I’m going to go back…you have the slides in front of you, right? And then I’m going to be able to talk much more meaningfully.
I’m an alumnus of Amherst College. I have always admired Alexander Micheljohn. How many of you have even heard of him? Okay. He’s an important person for maternal and child health. Why? He served as Amherst President from 1912 to 1924. There is a great book called “Education in Democracy: the Meaning of Alexander Micheljohn.” He went on to start an experimental college at the University of Wisconsin in the 1930s, and then, at the end of his life, he became an eloquent, eloquent advocate for the First Amendment, the First Amendment on free speech. And his vision of education, with which I think all of us resonate here, is that education is a process starting at the beginning of life to equip children and young people with the tools that they can use to build, sustain, grow, and strengthen democracy. And his vision of education that I am so grateful in my life for having been, had the opportunity emphasizes the excitement of learning, the joy of learning, the ability to think with a critical and questioning and skeptical mind, to contemplate in community the timeless, moral human dilemmas that we all ask: What is the meaning of life? Why is there war? How can we make our world safer? Et cetera. Education needs to create the tools for us to be able to ask those questions. And this is a vision that inspires students, whatever age they may be, to develop, number one, a realistic idealism that they can sustain throughout their lives with passion and commitment. According to Micheljohn, the key to keeping democracy alive, and we are at a point in our country where that is very much in the balance. Indeed, the necessary conditions for a thriving democracy lie in education.
Now here’s something interesting about Alexander Micheljohn. As it is with all people I think who approach life with integrity and according to their conscience, and who strive to be humane, in the deepest sense of that word, Micheljohn encountered obstacles and controversies throughout his whole life—one of which was his forced resignation by the board of trustees as the president of Amherst College in 1923. At the time, that was a huge controversy, highly visible. Such tensions are bound to happen when the practice of our ideals clash with entrenched systems that fail shamefully in their capacity to honor our common and interconnected humanity, as I shared earlier with the Martin Luther King Jr. quote. Through these storms, Micheljohn managed to sustain his own dignity as one of the great educators in the history of the United States. His story reminds us that the courage to live up to high human ideals, and to risk the controversy that such courage surely generates, is indeed an important part of what it means to be a healthy person. And this naturally leads us to discover and celebrate the common ground shared by both education and health. And that’s why education and health systems have natural linkage together. I raise his example because I had never heard of Alexander Micheljohn before I went to college, and I certainly didn’t’ learn about him in medical school or public health. But this is an example of how we all, if we’re humane, we can learn from others—and apply it the best we can.
I’ve also learned by visualizing and viewing maternal and child as making community happen, and it takes a village to raise a family, not just a child, but to raise a family. And we need to create systems to do that. I’ve also drawn heavily on the future search conference principles. We had a great session on that, Saturday. And…you were there, right?
UNKNOWN SPEAKER: I wasn’t.
RICHARD ALLAN ARONSON: You weren’t. But who, somebody was…uh, Mary was there. Thanks. Do you want to share? Since we have a pretty small group, do you want to just share briefly what you got out of that session about Future Search in terms of how it might apply? These are the principles…the principles are: Get the whole system in the room, Experience the whole before you act on any one part, Focus on common ground rather than problem solving and conflict resolution, and Emphasize self-responsibility, share responsibility, and self-management. Any sharing?
UNKNOWN SPEAKER: Well…
RICHARD ALLAN ARONSON: Would you introduce yourself, too. Mary?
MARY: I’m Mary (inaudible)…Minnesota. Well, I actually walked into the session feeling fairly downtrodden, and I actually thought that the Future Search model has a lot of potential in these fairly difficult times where I think, I sense that, I sense that there’s a lot of personal below the surface angst and rage, and what to do with that. And I think that the Future Search sort of give a way for people to channel what they’re thinking. We were looking at early childhood systems and what kind of training in any given place are impacting that…so that it’s not going forward but could be going forward. And from what Richard shared about using this up in Maine, I do think that it gives you an opportunity to bring the spirit philosophy together; because there is room in the process for people who haven’t (inaudible). And I don’t know that we always do that so well.
RICHARD ALLAN ARONSON: Especially now when, as you say, Mary, there is underlying throughout this conference, although it hasn’t been explicitly expressed as much as I personally would like it to be, there is an underlying sense of profound sadness, of profound disillusionment—a profound sense for me personally that all of the dreams and hopes that I had when I was a young person, the ideals that I had, are getting taken away from our country, and that we’re losing it. And I’m very sad about that, and I think that’s a tension that occurs in our work every day. And I think the courage that what I’ve learned from Future Search is that it is okay to bring that to the surface and share it, but not in a spirit of us versus them, not in a spirit of more polarization, because that’s the last thing we need in this country. We need, and we need in maternal and child health, to be leaders that rise above that, and that move on from those very strong feelings that Mary expressed that I have and many of us have to move on to a higher ground—to be idealistic but also to be realistic: to go from a sense of profound pessimism to one of hope, and that’s what this conference is all about; that’s what MCH is all about, that’s what our leadership is all about…is moving onto that level.
Another thing about Future Search is that the premise behind Future Search is that you can’t change behaviors in people. No way. But you can change the conditions through under which people interact with each other. Going to move on here. Appreciate the comments as we move on.
Now I’d like to share with you these ten characteristics of humane systems and humane policies for maternal and child health. I offer this as a work in progress. I do so because we have done, I think, we have articulated cultural competence; we articulated family centeredness. We are articulating, I think, increasingly community-wide leadership. But I think that our systems need to be more than just evidence based. They need to be evidence based; they need to show best practices, absolutely. They need to be productive and efficient and effective, but we need to also remember the term “humane.” And we’ll find that if we really apply “humane” all of those other characteristics will happen as well. So I’m just throwing this out to you, and I’m giving you one or two comments with each of the ten themes, except for language which I want to dwell on more deeply with you all.
The first one is honoring the dignity of all people and cultures. And here are a couple of things that I have taken from my years in working maternal and child health. The first thing is that cultural and linguistic competence applies to all people; so you take a state like Maine, and when you start talking about cultural competence in Maine, people start…the immediate reaction is, “Well, that doesn’t really apply to Maine, because we have an entirely white population—almost entirely white population in Maine.” So, you know, “this doesn’t really apply to me.” Cultural and linguistic competence affects all of us; we all have our cultures from which we come from. Our own families, our own communities, our ancestors, whether they be in Africa in Europe or China, those are all cultural. We all have our language. We all have a way of looking at the world, which is very important and very unique. And so cultural competence applies to all of us. The urban, people who live in cities, have a different culture from those who live in rural environments. People in their twenties have a different culture from those who are in my age bracket.
The second thing I want to share with you is that there is more heterogeneity, there’s more difference within a particular group than between groups. And that’s why it’s so important when we try to include more and more people and to get voices to the table that weren’t there before. It’s very easy to say, okay, this is the Native American with whom I have worked in the past, we’re going to invite that individual to our meeting. We never, never can expect one person ever to represent a group of people, to represent a culture. First and foremost they are human beings. I we really want to get the Native American population in concert and in partnership with us in maternal and child health, we have to do a lot more than just inviting some people to a meeting.
The next one is everyone as an expert. That’s the second principle here for the humane…uh, in 1900 in the field of Organization Development or OD, as they call it in their field, the big thing then was that you bring in experts to companies like Bethlehem Steel was their example in the early 1900s. You bring in a consultant. The consultant tells you what’s right and what’s wrong with your organization. The consultant writes up a report and then the organization, and then the organization tries to figure out ways to fix the problem. The paradigm--the para-dig-um, for humane systems is that everyone is an expert, because everyone has something to contribute to enriching and strengthening the world for children and families.
The third one I want to share with you involves families and communities at all times. The couple of things that I want to share from that is, it needs to be from the start and all the way to the finish. So many times I’ve made the mistake of bringing in family scholars, and I consider family scholars, because parenting is the number one occupation. Jaclyn Kennedy did say, if you bungle raising your children, nothing else in life really matters very much. Again, if you bungle raising your children, nothing else in life matters very much. And that’s not just having your own being a parent and being an aunt and uncle, a grandparent, a teacher, all of us, all of us who interact with children, if we bungle that in our own lives, nothing we that we do in this professional world of MCH matters very much. Everyone’s an expert in all families and communities draw on strength. And resiliency literature is fascinating. We need to figure out ways to integrate resiliency at all levels into our MCH systems. An example of that would be…a typical example is that children who feel, who have at least one adult in their life that cares about them, that loves them in a continuous way throughout their life…that child is much more likely to do well in life than the one who does not have that constant, unconditional loving presence. You know, we know all this intuitively in MCH; now the research shows it, so we can get out the research to show it.
Data. I think the key to data is not only that it should be honest and clear, but that we should have the courage to acknowledge limitations in data, and when we think…when the public perceives data in a way that is not faithful to our own expertise, and that’s an expertise, in that area, we need to be…go out there. For example, infant mortality in (inaudible); if it goes down one year, okay, and there are articles in the papers about infant mortality is down, that’s great. What is our job in maternal and child health, if we’re truly humane? One year…one year’s worth of data showing a drop in a high infant mortality…how do we as MCH-ers respond to that? What do we have to get the message out? I’m sure there are folks here that…
UNKNOWN SPEAKER: That’s only one year’s worth of data…
RICHARD ALLAN ARONSON: Right.
UNKNOWN SPEAKER: …in that, you can always (inaudible) may not represent our training rules…true change (inaudible).
RICHARD ALLAN ARONSON: Right. So our job is to get those, that kind of message out clearly and to say, you know, for example, when you look at youth suicide in a particular state or community, the numbers are too few to even state a rate. Okay? And we have to have the courage to do that. The culture, the media, will want to jump to conclusions and judgments.
The sixth one I want to share is to always be faithful to the purpose of public health as defined by the institute of medicine in 1988. And that definition is: “The purpose of public health is to foster the conditions that enable the whole population to achieve optimal health.” And we need to pay attention to several words in that definition and keep on coming back to it, Foster, Conditions, Enable, Whole, Population, and Optimal Health. It’s not our business to make people healthy. It’s not our business to empower people. It’s not our business to intervene in their lives. It is our business to equip people, and to inspire people, with tools and hope so that they can, they can become healthy and whole; they can raise their children to feel special and loved and caring and dignified. The power of empowerment comes from within; so when we say programs that empower communities, communities say, “I don’t want you to empower me; the power is right here in my community.” And also remember that in order to be public health practitioners we have to pay attention to our own health first. And I confess of not having done a good job of that over the years, but trying. We’ve got to do that first.
The next one is advocacy. And the reason advocacy is so, so important is that we know…we have this knowledge in maternal and child health…we’re out there leading, but unless there’s the political will at the federal, the state, and the local level to truly invest in children as our most precious resource, regardless of everything we do, it will all lead to nothing. So we have to be strong advocates all of the time and have to realize the connection between public health—maternal and child health, and advocacy.
The next one is non-judgmental. Families do not want to be viewed as bundles of respecters. They don’t want to be seen as morbidity in mortality; they don’t want to be seen as cases to be managed rather than people to be cared for. They don’t want to be described as clients or consumers or whatever we use. They want to be described as human beings and people.
And then the ninth one is relationship-centered care—that we need to put more of our systems, organize our systems, to measure and to emphasize the relationships between people, because we now know that the extent to which people and children feel connected in the positive loving way to each other is one of the most determinants of their health. So we need to create systems in MCH like home visitation, and when we design home visitation, we design it in ways that enrich the trust between the home visitor and the family being visited.
And now I want to talk about language for a bit, and then I want to have a dialogue among all of us. And I want us…I want to cite a couple of some folks in the room here that have helped me with this on language. Chris (inaudible) back there. Chris, um, it was actually six years ago, six years ago at AMCHP in the year 2000 that Chris and I took a long walk and talked about our concern, our concern about the language of public health and the need to look more closely at the way we communicate in both written and verbal discourse. So I want to share with you some of the thoughts that have evolved over these past six years, the work that Chris and I and others have done and the support that many of you have given to me in particular.
Basically, language is…what is language really all about? Our use of words defines how we approach the world, how we think about life. It reflects underlying values. It determines the way we receive and process interpret and provide, output for our thoughts and importantly for our actions. And our concern is that the widespread use in our profession of nonsense, bureaucratic jargon, complex technical terms, epidemic acronyms, military and violence related metaphors permeate our language of public health, including MCH. It appears everywhere in our discourse, written and verbal. We target just about everything and everybody and everywhere—most of whom do not take kindly to the idea of being targeted. We design public health programs and services to combat domestic violence. And if there ever were an oxymoron, that to me would be one, to combat violence. We fight poverty. We design interventions on people and communities for efforts to attack high rates of asthma and its triggers. We describe people as high-risk cases to be managed, rather than to be cared for as people.
We fill our grant proposals and our electronic mail everyday with bulleted talking points and confusing and often bizarre and often obscene sounding acronyms, like BMS for Bureau of Medical Services. Okay, there is humor to that; so, guys please feel free to laugh and play with this. I’m playing with it; I’m enjoying it. Do the same. We identify babies who fail, quote fail a hearing screen, as having a birth defect. Families don’t like to hear that their child had negative test and they’re defective, when in fact in the hearing…in the deaf population there’s a culture to be very proud of in that. We use the epidemiological meaning of surveillance every day, but in the post 911 era such a word is widely perceived in a much darker context and linked to real war. And, of course, we thrive on building infrastructure, whatever that means to the public, trying often in vain to understand what we actually do in maternal and child health. Here are the military metaphors, and actually this is not yet even a…my problem with Power Point, I couldn’t get the notes off of the screen, and that’s why you’re seeing it, but anyway Chris and I have recently…and a couple of other colleagues…have recently submitted a…I won’t put this on very long here…we recently submitted an abstract APHA, which emphasizes how the widespread use of military metaphors, and we looked at the American Journal of Public Health…we looked at the abstract in four, uh, five years of issues of the American Journal of Public Health, and we looked at ten words that were military metaphors, and we found that those ten words were used several thousand times, just in the abstract, just the abstract. And the reason it’s important is because, you know our written literature communicates our values, and when the words go against our purpose, because we are deeply invested in safety, in non-violence, you know, preventing child abuse, preventing domestic violence, solving conflicts non-violently. When we put out that military metaphor, it unconsciously, unintentionally, for sure, but it unconsciously, it has an impact on the way we are perceived and the way we perceive ourselves.
I want to single out a couple of terms. One is “target.” And that term suggests to the general public and we don’t realize this, because we use it everyday—that the meaning of that mostly, in the popular culture, is being fired at or picked out for an attack of some nature. So I’m not saying not to use it, but think twice, think twice it’s all right. It’s all right to think twice, okay? So, instead of saying “target” say “serve” or “focus” or “emphasize” or “feature” or “choose” or “concentrate” or “select” or “specify” instead of using “combat,” use “reduce” or “address” or “prevent” or “minimize the impact of.” Instead of using bulleted bullets, when you write your grants and do your email points, use hearts. You know, you can do that in Microsoft Word easily. Use hearts and talk about hearts, and say please prepare for me hearts of the key points in your paper. Or, if you don’t want to be that valentine-ish or whatever, you can be, you can use point or dot, but you know, he who risks and fails can be forgiven; he who never risks and never fails is a failure in his whole being, so take those risks and use hearts and replace hearts replace bullets with hearts. Instead of fight use a concerted effort to act against or an organized effort to counteract or prevent with a comprehensive systems approach. That’s the beauty of the MCH bureau, because they’re giving us money to do systems change, and to do it creatively, and to do it in a way that enables us to, to do this. This talk today would not be possible without people at the federal level who have hung in there all of these years, almost a century now, to help us. Instead of trigger talk about a causative agent or a initiator or an actuator. Instead of a battle, talk about a struggle. Instead of an attack, talk about work on or address or approach or precede against or work against. Instead of cohort, which I didn’t realize it until we started working this, cohort has an originally military meaning. Chris, do you recall what that was? That (inaudible)…?
CHRIS: (Inaudible)
JOHN ALLAN ARONSON: Yeah. But you just look in the dictionary, and you’ll see that the origin of the word “cohort,” which we use all the time in public health with good reason…I’m not saying that to use it, but realize that it does have…and originally it had a military connotation. This is a good one, because it does show, you know, that you know people, people if they’re targeted, it doesn’t really uplift them too much. And it can be from the front or it can be from the back. Either way, it doesn’t really feel too good.
And the next word I want to talk about is “surveillance,” and surveillance in public health is important. We need to have surveillance; we need to have ways to collect and analyze and keep track of data about the occurrence of diseases and adverse health outcomes. We do a good job at that; we should strive to do better, but again we don’t think twice about it. For families and communities, especially in the post 911 era, especially in this time of warrant less surveillance…the word surveillance immediately brings to mind to the public a sense of suspicious, of being continuously watched and tracked without our knowledge and consent of using hidden and secret techniques and is commonly associated with wiretaps and bugging. So…and the point is, that’s the reality of our world; that’s the reality of the world, when we have to accept that. So if we’re going to use the word “surveillance,” we need to use it very cautiously and very specifically to the public health definition, but if we’re truly inclusive and humane and involved in multiple partners, especially people who have not been to the table with us before, if you start using “surveillance” they’re not going to want to stay at the table. They’ll leave. And that’s the last thing we want. So a couple of visual expression of “surveillance”.
And then finally the acronyms. Here’s a good thing that I’ve found helpful and funny is whenever you facilitate a meeting, at the start of the meeting make a couple of comments about language. Say, for example, that if you’re going to use an acronym, realize that there are, probably, likely going to be people in the room who do not know what your acronym means. Or, they will interpret that acronym differently; so instead of American Dental Association for ADA, they may think of Americans for Democratic Action or the Americans with Disabilities Act. So, say at the start of your meeting that your facilitating, saying, if you’re going to use an acronym, please define what the acronym is, even if it’s something like AMCHP, okay to the…we’ve got some people that are computer geeks and they hear AMCHP, you know chips and am (inaudible)…that’s a different meaning for them. So that helps. And then create an atmosphere in you meeting and say so people, if during this meeting you hear words that you don’t understand, don’t make sense to you, please speak up. Some people may not feel comfortable doing that; so then give them the option of make some index cards and hand them out and you can have them (inaudible), and say okay if you…if you don’t understand what somebody’s saying, hold up your red card. That’s a non-invasive, a gentler way of doing it, but it creates a tone at a meeting. Also stop using the term “meeting,” because people feel like they’ve been meeting to death. Use more interesting terms than “meetings” like “dialogue”…you know, the unexamined life is not worth living. That was the first thing I heard, the first thing in college from Plato, Socrates, in my humanities course: The unexamined life is not worth living. So be sure to use…you know, so set those ground rules about, you know, the language that we use, etc. And the other thing is, if someone uses a technical term that you don’t understand, also encourage them to share that.
Okay, so the conclusion to this part is that the uncritical, the unexamined, the unquestioned, and the ubiquitous use of words and terms in public health, though largely unintentional…and one could argue that maybe I’m making too much of this, maybe, but I don’t think so. Contribute to cultural norms that undermine the purpose and ideals of public health and the quest for a culture of non-violence and peace and justice, which are at the heart of what we do. People in communities cry out to be honored and respected, included, affirmed in the practice of public health, but our dominant communication patterns have the opposite effect of exclusion. The challenge that we face is to change our language and the culture of our language so that it explicitly embraces things like social support and non-violence in justice. And explicitly invites people to share honestly about tensions that are simmering on a particular issue, but are not being talked about.
And I guess that’s kind of the conclusion of this…of this talk…is that the challenge in public health is to…is basically to create and sustain systems both formal and informal that are humane and that inspire hope and resiliency in children, families, and communities. The traditional and conventional approaches to improving the health of people have relied too heavily upon pathology and risk. We’re not saying to do away risk and pathology and morbidity in mortality, but we need to also include the opposite, the other things. It wasn’t until the 1980s that people started…talked about protective factors. Our job is not only to reduce risk factors but increase protective factors. But that didn’t get written about in literature until the 1980s. Negative life styles and individual level risk factors have been documented and studied to death for decades. I can’t stand the term “single parent” as a risk identification term, because some of the most courageous and incredible people that I have met during my life are…were, or have been or are, single parents, because they have the courage, the courage, literally the courage, the bravery, to get out of abusive relationships which were damaging them and their children. So when we use terms like “single parent” or “crack babies”…remember the term “crack babies” in the 1980s? A whole generation of infants got labeled “crack babies.” It got on the Time Magazine and Newsweek, and it turns our, if you read an article in Pediatrics, I think a couple, a year or two ago, the literature has shown that the neurological effects from exposure to cocaine in euro are low and minimal compared to the impact of alcohol and cigarettes and tobacco and other drugs. So that turned out to be not true, but these kids continued to be labeled “crack babies.” And they’ve grown up, and I’ve read some of their reflections, and they express pain and humiliation of being seen that way in school and their communities from day one.
And then, finally, realizing that research does affirm, does show, that the extent to which we feel loving and peacefully connected to each other and to our communities is a powerful determinant of health, and we have the (inaudible) the Adverse Childhood Experience Research…which is another important body of research that I draw on in my work. It’s called Adverse Childhood Experiences; the original article was by Vincent Fellitti, I think it’s spelled F-E-L-L-I-T-T-I. Just look in, just do the search in the computer for Adverse Childhood Experiences. That’s very powerful research.
So, I think I’m going to…I’m going to close right there. I well end with a couple of quotes, because I always like to do that. With respect to how we’re feeling right now, I turn to Harriet Beecher Stowe, who said…to take the power away from the PowerPoint; I’m going to close this out. Which is great. Harriet Beecher Stowe, she said, uh, sorry about that…let me get my glasses are get: “When you get into a tight place and it seems that you can’t go on, hold on, for that’s just the place and the time that the tide will turn.” Harriet Beecher Stowe.
The next one: “We must accept finite disappointment, but we must never lose infinite hope.” That’s from Martin Luther King, Jr. “We do not know how high we soar…we are until we are asked to rise.” Anybody know that one? “We do not know how high we are until we are asked to rise.” Another connection to Amherst for me, which you’re always looking for. That’s Emily Dickenson. And then, of course, the one that you’re all familiar with is “We must become the change we want to see in the world.” That’s Mahatma Gandhi. But a couple of others that may be less familiar to you all…”When power leads man toward arrogance, poetry reminds him of his limitations. When power narrows areas of man’s concern, poetry reminds him of the richness and diversity of his existence. When power corrupts, poetry cleanses.” Anybody know where that one’s from? That’s from John F. Kennedy, speaking at the dedication of the Robert Frost Library at Amherst College in 1963. And then finally a poet and someone who has had a deep, deep influence and inspiration on me: “May your hands always be busy; may your feet always be swift; may you have a strong foundation when the word (inaudible)…when the wind of changes shift; may your heart always be joyful; may your song always be sung; and may you all stay forever young.” Thank you.