FaithandHealth-apolozza

Not all the religious nut cases are  running for office. Some of them park their vans across the street from government buildings in Washington. This particular brother (maybe cousin) parked across from the offices of the Health and Human Services where 28 faith-based and community-oriented health systems were meeting to talk about how our faith could drive a deeper and more effective partnership with a government that shares our mission for improving the health and wellbeing of our communities. We were convened by the White House and HHS offices for Faith-Based and Community Initiatives, led by Mara Vanderslice and Alexia Kelly.

What does faith have to do with life? At least four varieties of answers were on view in Washington in the past week. The one getting the most attention was that offered up by the Catholic Bishops whose lawyers would probably want them talking about almost anything other than sex. But they understand their role as laying down their understanding of what religion has to do with condoms and other means of interupting pregnancy, which is to say, life. Life is a non-negotiable good and that's that, no matter that nearly all Catholic women agree with that principle, but do not extend it to cover contraception. Life is simple, say the Bishops. Not quite, say the Catholic women.

Another answer was offered up through the research findings of Gallup, which had a big meeting of academics just down the street. They were exploring the surveys of 676,000 Americans which indicated that Americans who are most religious have the highest levels of well-being. (I'm guessing the guy in the van was not in the survey pool.) The study "does not allow for a precise determination of why this might be the case" and promised to keep working at the mystery. Dr. Ellen of Ilder, now of Emory explored this some years ago making the link between participation in congregational life -- not spirituality--so this is sort of old news. But don't quibble: even with all its obvious ambiguities, religious people have more well-being. (Except for clergy, which have terrible health status. Apparently something like an overdose is possible.)

I returned home to Memphis where today a room full of United Methodist District Superintendents and a Bishop were meeting in the Innovation Studio, working on the future of the Church. The United Methodist Church has lost about 1,000 members a week  for 43 years in a row, so this is daunting labor. You can tell what a person has faith in by what committees they attend, said my Methodist father.  Religious life is about structure, connection, organization and strategy. (Where does Gallup think all those congregations come from?) So they were plugging away with maps, to-do lists and mounds of paper.

A fourth answer was offered up inside the HHS building in the room full of healthcare people. About 80 billion dollars worth of faith and community health assets were learning from each other about how to allow the best 21st century science to liberate their funding from an almost total focus on hospital-based medical care so that we can get at least  tiny portion of those funds onto the streets and into the lives of people who actually need something much cheaper than an emergency room. Over the next few days I'll be posting links to the stunningly smart presentations offered up so faithfully by friends at Loma Linda University Medical Center, Henry Ford Health System in Detroit, Camden Coalition, South Central Foundation in Alaska.

More insights came from the Public Health Institute in Berkley, the Centers for Disease Control (advising the IRS on determining legal rules for community needs assessment) and HHS leaders working to drive innovation, liberate data and, more or less, "do the right thing." For this group, faith is the hopeful energy that embraces uncertainty with curiosity, not fear.

Religion may be the thing that draws lines, points the finger and stirs the anger. Faith is the thing that asks, "why not?" Ethics based on religion tends to be about not doing something. Ethics based on faith tend to be about trying to do something, especially a right thing that has never been done, that lives in the "not yet."

The faithful health systems were sharing how they might do something never done before--achieve a merciful and just community marked by health and wholeness. The dude in the van across the street could only scowl. But amid the data, and amazing tools of GIS mapping, financial analysis, creative clinical management and public scale policy you could feel the spirit of possibility breaking through.

Felt like faith to me.

(Powerpoints should be available online later this week.)

Mercy -- and a hint of justice

The Tennessee Healthcare Campaign alerted that on the 21st of the month for just a few hours there will be a crack in the wall allowing a few more thousand people in the state to get covered under TennCare. From 6pm till 8:30 pm the phone lines will open for the lucky poor who get their call through. Reminds me of the Buffet song about how the whole world lies waiting behind door number three. But this is truly life and death.

This is our version of Medicaid, the government program for the poor, but you have something similar--and similarly restricted-- where you live. The brutality of the vulnerability is simply medieval. 

Wealthy politicians swagger and blather about how we should quite worrying about the the poor. So it is helpful to look at how vulnerable you have to be to get covered: You must be either 65 or officially disabled AND have medical bills about the same size as you monthly income AND have no more than 2,000 savings (3,000 if married).  The phone lines are expected to jam within an hour as thousands of people fitting that profile in just one state compete with each other to get through the eye of a needle.

It is not surprising that someone with an account at Tiffany's or the Cayman Islands may be a bit out of touch with the fact that there are so many people like that. But you'd think they'd at be curious about it.

This is the human reality behind the accountable care act that President Obama has brought to life in the face of rabid opposition. Granted this is not artful legislation. It was a highly compromised before it was even submitted and getting more compromised as it is written into rules and then into real programs on the streets. It is not beautiful, but don't imagine it is not necessary.

The political dwarves are too easy to criticize; they can't help themselves. The fact is that I can't relate much better than Newt to this desperate vulnerability. If you are reading this on your home computer, you are probably out of range of understanding their reality, too. But the poor are not from another planet; their lives are knowable by anyone who cares to know.

This is much on my mind as 28 health systems with a high level of care for the poor will be gathering under the auspices of the White House and HHS offices for Faith Based and Community Initiatives later this week. Every one of us carries tens of millions of dollars of cost for providing care to people who have no money and no coverage for their care. This is for people who don't even qualify for TennCare--another whole notch more vulnerable.

Systems like Methodist Healthcare provide mercy and are proud to do so. But often the request for mercy is so delayed that the care is too late to be effective or very useful. We know that what we give is rarely given at the time that 21st century medical science would want it available. And the poor tend to get their mercy, such as it is, at the Emergency Room, which is the opposite of a sustained relationship with a medical provider trained to manage care over a lifespan.

 Most of the "emergencies" we treat are entirely predictable, if not preventable; they are usually conditions that have a long trajectory easily managed with modern science--but through regular access to a medical provider and access to pills and supporting services. In our weird economy those things are quite simply out of reach of millions of people unless they are covered under a decent insurance program (such as TennCare). 

It is amazing to me that two-thirds of those asking us for mercy last year only needed it one time. The poor are tough and proud.The Tennessee Healthcare Campaign wages a daily, grinding struggle to help our democracy do the right thing for people who need mercy even if they cannot really hope for justice. Your state almost certainly has a similar band of prophetic mercy-makers and justice-seekers. If politics permits and the accountable care act survives somewhat intact, in a bout a year a half there will be millions--not just thousands--of people able to get covered under some level of insurance. That process will be ragged and difficult, too. But don't imagine that it will not be live-saving.It is not even close to justice, but it is a start toward decency.

Flashlights and hammers

 What counts matters, but not everything that matters gets counted. Just ask any United Methodist pastor these days. That denomination is under storm warnings after losing roughly 1,000 members a week for 43 years (I am not making that up). Even though there are still 7 or 8 million United Methodists on the rolls, that steady decline matters. But what exactly would you count if you wanted to map the opposite of decline? What would you measure if you were interested, not in pathology, but  vitality? What is the arithmetic of life?

Counting can feel like a flashlight or a hammer depending on who is counting and whether they are trusted. If you are a pastor and the your are asked by a  Bishop, Board or big deal committee, the counting can feel like a hammer, with you being a nail. This is exactly what is happening today in the denomination. The the ones wanting the numbers are not trusted by the pastors because the clergy don't think the people on the committee understand the parish reality enough to understand the numbers. The numbers are more likely to hide reality, than disclose it. They like to say that a parish is not like a corporation, so one can't count in the same way. But a parish is not the only organized entity where complex intimacy is the norm. Hospitals are, too.

We count many many things in hospitals every day, with greater and lesser usefulness. Mostly we count process markers so we can good quality from bad quality. And we count money pretty carefully. And we know that the things that matter most occur in the intimate human spaces where metrics are crude by comparison to the complex wonders that take place. Healing actions and saving behaviors cannot be compelled with anything like a hammer. But it is possible to hold a flashlight to help see whether the good intentions actually do result in good work. That's what matters. 

Pastors, nurses, physicians, teachers all tends to be suspicious of data, trusting the high bandwidth of stories instead. The human mind is tuned that way. One of my senior colleagues' mom is in the hospital right now and he has noticed that even with the vastly detailed electronic medical record the staff still seem to lose track of what is actually going on with her--her real story.

Until a leader sees a pattern, they are powerless to do anything but react out of fantasy or fear. Their action is arbitrary or random. Even success is dangerous because it will result from action that is disconnected from reality.  They can kill the ducks and grind the gears.

Good data helps sensitive leaders find the true patterns in the stories. Good stories help sensitive leaders find the true story in the data.

I used to work as a carpenter and had a toolbox filled with all sorts of tools. Sometimes in a hurry I'd grab anything I could reach and use it to pound something into place. Even a flashlight can be a hammer, if you hit hard enough. Bishops and executives do that, too.

Don't make the metaphor do all the work here. Member and patients are far more complicated, confounding and nuanced than a gaggle of french ducks. And any denomination or hospital is a far more intricate mesh of moving parts than any mechanical gear. Grab a flashlight, turn it on and pay attention.

 

Red Boots in a Biker Bar

Winter woods are my favorite because you can see the ground, the old roads, the contours of what used to be fields. And you can see that even in the cold days of January, Springtime life is finding its way. A couple of years ago on New Year I walked the woods near the cabin, slipped and fell in the deep leaves. I noticed, laying there, tiny little red flowers growing up out of some moss on an old stump. They seemed outrageously out of sync with Winter, like bold red boots in a biker bar. Life works that way.

This is a dreary and desperate time in public caught between strands of cynical incivility. I'm not sure which is worse, the candidates or Marines.

But life pops up amid it all, patiently breaking through the drifts of waste.

Last week I was honored to be included in a meeting of orthodox jews talking about how we could make Memphis a magnet for medical students, residents and faculty by carefully constructing "Sabbath friendly" residency programs. This mainly means scheduling so that the orthodox residents are not required to work between sundown friday and sundown saturday. That's a lot trickier than you'd think, but is possible if everybody wants to figure it out. And we do. I love that a hospital with a seven story "Methodist" topped by a two story cross would would do that in collaboration with the University of Tennessee. So gloriously out of sync with the intolerant times!

This week the Agency for Healthcare Research and Quality turned on the lights about what a tiny fraction of the population incur so much of the overall cost of healthcare: 10% of us account for nearly two thirds of all the cost. They (it should be "we") run up about $24,000 each, while everyone else costs almost nothing. The costly 10% are sixty percent women, with the same percent under 65 and 80% white. Only one in five of the costly citizens remains in the category for two years in a row--they die or get their conditions under control.

I don't know why this is newsworthy. It is like saying that 1% of the cars on the road cause 90% of the repair bills (the ones that get into wrecks), or that the .1% of luxury cruises result in 99% of the deaths (the ones that run aground on rocks and flip on their sides). And really sick people cost more than people who aren't.

It is more helpful to know that year after year the same neighborhoods have the highest concentration of very costly--which is to say sick--people. Our hospital is interested in that kind of knowing for two reasons. Those neighborhoods are where a very large amount of care we provide is not paid for by anybody. And that is another way of saying they are places that need a lot of mercy usually as a last resort.

Our friends in Camden New Jersey examined their data on most costly patients and it led them to large public housing sky-scrapers. Here in Memphis it leads us to streets with bad single homes, often broken up into duplexes. What kind of knowing would help us know how to do a better job at mercy. It is obvious that mercy delayed is mercy denied, or at least provided with far less quality that 21st century science permits. Especially when in these neighborhood are so dense with our congregations, we know somebody who knows them. Why wait for people to stumble into the emergency room in acute pain when we can pretty well guess what street they live on?

The question is so out of synch with the cold times. Doesn't everyone know there is not enough to go around, that we must distain the poor for being so inconveniently needy?

Spring begins when a tendril starts to feel its way toward the sun. And it begins when a question of mercy starts to feel its way toward the light that data, logic and science sheds on the neighborhoods. You can feel Spring on the way.

 

 

Unlikely Webs of Trust

Note: this was originally posted yesterday as a column in the Faith Matters section of the local Memphis newspaper, edited with his usual graceful touch by David Waters.

EAST JERUSALEM -- It seems naive to speak of “religious health assets” here in a place where religion has caused so much damage to health and well-being.

But that is exactly what a group of leaders of faith-based health care systems came to this sacred and tortured rocky hill to discuss, traveling from Taiwan, India, Zambia, Norway, Germany, Kenya, South Africa -- and Memphis.

We had no illusion of understanding how to bring shalom or salaam to this troubled land, but we were curious about how we might learn how to do that in our own troubled homes.

I was here to talk about the Congregational Health Network -- Methodist HealthCare’s coalition of about 400 congregations, community health centers and privately funded clinics to promote public health in underserved communities. We call it the Memphis Model.

I always feel naive to talk of building a web of trust among hundreds of congregations on the same Memphis streets where Dr. Martin Luther King Jr.’s blood flowed. Putting trust and faith in the same sentence attracted even more curiosity in Jerusalem than it did a few weeks earlier when I was at the White House.

But the Memphis Model offers a tantalizing vision of linking comprehensive technology -- such as that offered by the West Clinic -- with hundreds of volunteer caregivers and prevention experts (mostly grandmothers) in the neighborhoods. The entire CHN network costs less than one mid-range linear accelerator, used for radiation treatments, but probably extends the lives of hundreds of people that will never need one because their church helped them to quit smoking.

This sort of faith-based, trust-building approach to medical care was lauded at the conference by Dean Pallant, head of external relations for the Salvation Army, which has 134 hospitals around the world, mostly in places far more troubled than Memphis on a bad week. Pallant suggests that faith-based systems should focus on conditions that need longer term relationships of trust -- addiction, depression or chronic conditions such as diabetes, AIDS, or sickle cell.

Such trust-building turns our attention away from the fantastically costly technologies. Science actually points in the same direction as the greatest gains in life span come from the relatively simple management of conditions over decades, not the heroic and often futile interventions near the end.

We saw similar examples here. We met in the Augusta Victoria Hospital on the Mount of Olives. The hospital had just installed a mid-range linear accelerator. Hospital officials also have also worked with the Council of Imams to get people immunized; rates improved from 20 percent to 90 percent.

The Memphis Model is being adapted even here in the bitterly tough streets of East Jerusalem.

In a city of walls and a world of need, it might be shocking to think that religion can help to create pathways for people to get health care and attention they need when they need it. But it is happening. The faith and health communities are learning from each other.

One morning, I watched the dawn light up the ancient stones and wondered how many layers of civilization lay beneath the ones I could see. Then I noticed that I was sharing the view with a young Muslim couple trying to balance their camera on one of the stones, setting the timer so they could both be in the picture.

I dropped my weighty deliberations and offered to help. I clicked and then we all stared at the back of the camera and declared it good. Maybe that's the point; to look around and notice who else is looking at the same past, present and future and help each other get it in focus.

May it be so.
Direct link to the Commercial Appeal website:
http://www.commercialappeal.com/news/2011/dec/31/guest-commentary-web-of-trust-can-lift-up/

Look at all the stars

Last week I was in Philadephia speaking to a conference sponsored by city's department of behavioral health and intellectual disabilities which has developed an interfaith collaboration across all sorts of lines which are supposed to be impossible to cross. A number of those involved in the conference would be thought of as 

"consumers" in other places, a term that implies several steps down from "citizen" or "human." But in this city of brotherly and sisterly affection, the generative swirl sweeps up and transforms everyone.

I wore my Van Gogh tie for the occassion, commenting that he would have been at the conference himself, if he had lived in Philadephia in 2011. The tie include a pretty significant piece of his painting "starry night" which is on the bright and garrish side for a side. But those stars to pop out to be visible even from the back row. The outrageous size and almost pulsating energy of Van Gogh's stars was part of what got him classified as deranged back then. But the fact is that Van Gogh's stars look WAY more like what we now understand stars to be like today. Anyone who thinks that stars are teeny weeny little bitty dots of pale light is danerously detatched from reality. They are all--including our little sun-- impossibly vast, distant, wild pools of energy throwing light and energy beyond our capacity to measure all across the universe. 

The universe itself is sort of like that, too. Stable, contained, predictable and cold are qualities only appropriate for minds and spirits untuned to the reality of the jumping universe. Anyone who has really paid attention to a neighborhood, much less a city, much less a region, or country knows that is true, too. But little minds like to think of all those things as stable, contained, predictable and cold, too. They are, well, crazy. How much they miss of what is possible!

Bill Mallonee and Muriah Rose (above ) opened our Innovation Studio last Winter with brilliant lyrics and deeply felt voice. They just released a set of songs for the season called Wonderland ( http://billmalloneemusic.bandcamp.com/album/wonderland ). This is from their WPA series which are more like a live performance than polished studio work. There is a painfully smart song "the king will see you now." This the only christmas song I've ever heard from Herod's cynical point of view, which helps retrieves the holiday from religious smaltz. But the song you need to get you through the next couple weeks is, "look at all the stars," which Bill wrote thinking of his dad, (but I think of Van Gogh).

My father often brought me here; 

I loved to see him smile 

it was hard to tell which one of us 

was the little child 

he would stretch his arms out wide; 

he would hold me to his heart 

he’d say, “Hey, look at all the stars!” 

he’d say, “Hey, look at all the stars!” 

Life is n’er a path that’s straight; 

there’s so much gets in the way 

from here to Kingdom Come 

there’s so much to make you numb 

still I always had that light 

forever etched inside my heart 

I would tell myself at night 

as I stood out in the yard 

“Hey, look at all the stars!” 

I’d say, “Hey, look at all the stars!” 

This has everything to do with what moved the men called wise across the desert to the garage where Mary rested. And everything to do with with the man who did not listen to his friends and renounce her. His friends surely thought he was, well, crazy. 

For the next few days at least, don't pay attention to anyone who tells you to act like a stable, predictable, contained and cold adult. The world is made for surprise and hope. Don't miss it.

Majestic

A couple weeks ago I was in Washington DC and had a few hours before my plane, so I walked the Arlington Cemetery and then to the airport along the Potomac. I had walked that cemetery nearly forty years ago one Winter and remember reflecting deeply on the thousands that gave their lives for others in some brutal, violent and painful way, mostly dying far younger than I am today. From the hill through a gap in the trees you can see the Capitol in the distance. I don't get the impression that many people who work over there make it up the hill to where are the young men are buried. They may vote for the monuments and puff and rant as if they themselves would sacrifice, but its been a while since they actually did anything selfless, much less sacrificial.

But for the last 18 months we--the citizens of this nation--have actually been able to watch a civil servant at work, Dr. Don Berkick. The mean and dumb politics under the Dome ground succeeded in preventing him from holding office as head of the Center of Medicare and Medicaid Services more than that short time, but he has used every minute. And, judging from these excerpts of the speech he gave to the Institute for Healthcare Improvement right after leaving town, they did not manage to take away his spirit for the majesty of the work of government. I urge you to read the whole speech (  ). But a taste is attached here:

"Inscribed on the wall of the great hall at the entrance to the Hubert Humphrey Building, the HHS Headquarters in Washington where my office was, is a quotation from Senator Humphrey at the building’s dedication ceremony on November 4, 1977.  It says: 'The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.'"I believe that.  Indeed, I think that Senator Humphrey described the moral test, not just of government, but of a nation.  This is a time of great strain in America; uncertainty abounds.  With uncertainty comes fear, and with fear comes withdrawal.  We can climb into our bunkers, each separately, and bar the door.  But, remember, millions of Americans don’t have a bunker to climb into – they have no place to hide.  For many of them, indeed, the crisis of economic security that we all dread now is no crisis at all – it is their status quo.  The Great Recession is just their normal life."The rate of poverty in this country is rising. Over 100 million Americans – nearly one in every three of us – is in poverty or near-poverty today – 17 million of them children. I will tell you – state by state, community-by-community, and in the halls of Washington, itself – the security of the poor – their ability to find the health care they need, and the food, and the housing, and the jobs, and the schools – all of it, hangs by a thread.  The politics of poverty have never been power politics in America, for the simple reason that the poor don’t vote and the children don’t vote and the sickest among us don’t vote.  And, if those who do vote  do not assert firmly that Senator Humphrey was right, and if we do not insist on a government that passes the moral test – the thread will break, and shame on us if it does.

"The choice is stark: chop or improve.  If we permit chopping, I assure you that the chopping block will get very full – first with cuts to the most voiceless and poorest us, but, soon after, to more and more of us.  Fewer health insurance benefits, declining access, more out-of-pocket burdens, and growing delays.   If we don’t improve, the cynics win.

"On my last night in Washington, I visited the Lincoln Memorial again – standing at the same spot that I had stood at as a twelve-year-old boy 53 years ago.  The majesty was still there – the visage of Lincoln, the reach of the Washington Monument, the glow of the Capitol Dome.  It was still unbearably beautiful.  Still majestic.  

"But, there was one change. Chiseled in the very stone where I was standing is now the name of Dr. Martin Luther King and the date – August 28, 1963, when he gave his immortal 'I have a dream…' speech.  

"When I first stood at that spot, the Montgomery Bus Boycott was only three years in the past, and Dr. King’s speech lay five years in the future.  Rachel Carson’s book, 'Silent Spring,' was four years in the future.  And it would be six years before the phrase, 'Women’s Liberation,' would first be used in America.

"I thought, standing there, of something I once heard Dr. Joseph Juran say:  'The pace of change is majestic.'  And I mused about that majesty, and its nature.

"It occurred to me that the true majesty lay not just in the words – not just in the call – but also in the long and innumerable connections between the ideas that stir us – the dreams – and the millions and millions of tiny, local actions that are the change, at last.  A dream of civil rights becomes real only when one black child and one white child take one cooling drink from the same water  fountain or use the same bathroom or dine together before the movie they enjoy together.  An environmental movement becomes real only when one family places one recycle bin under one sink or turns off one unneeded light out of respect for an unborn generation.  Women’s rights are not real until one woman’s pay check stub reads the same as one man’s, and until my daughter really can be anything she wants to be.  The majesty is in the words, but the angel is in the details.

"And that is where you come in. Here is the lesson I bring you from 16 months in Washington, DC.  Your time has come.  You are on the cusp of history – you, not Washington, are the bridge between the dream and the reality – or else there will be no bridge.  Our quest – for health care that is just, safe, infinitely humane, and that takes only its fair share of our wealth – our quest may not be as magnificent as the quest for human rights or for a sustainable earth, but it is immensely worthy.  You stand, though you did not choose it, at the crossroads of momentous change – at the threshold of majesty.  And – frightened, fortunate, or both – you now have a chance to make what is possible real."

Thank you, Dr. Berwick. May  it be so.