Monday, December 2, 2013

In dreams begins responsibility

I met Senator Edward Kennedy only once, in the fall of 1983. The occasion was a hearing on “Hunger in America” that the Senator held at the Plymouth Congregational Church in Minneapolis. I was asked to provide testimony on the nutritional status of children in urban areas. 
To set the context before expounding on the data garnered from the WIC program, food stamps, homeless shelters, and food shelves, I read a passage from Michael Harrington’s book “The Other America.” 
“There is a familiar America. It is celebrated in speeches and advertised on television and in the magazines. It has the highest mass standard of living the world has ever known… but, there (is) another America. In it (dwell) somewhere between 40,000,000 and 50,000,000 citizens of this land.  They are poor. 
To be sure, the other America is not impoverished in the same sense as those poor nations where millions cling to hunger as a defense against starvation. This country has escaped such extremes. That does not change the fact that tens of millions of Americans are, at this very moment, maimed in body and spirit, existing at levels beneath those necessary for human decency. If these people are not starving, they are hungry, and sometimes fat with hunger, for that is what cheap foods do. They are without adequate housing and education and medical care.”
When I finished my prepared remarks, Senator Kennedy thanked me for my presentation of the statistics that “underscored the need to address hunger in America” and then began to reflect on Michael Harrington’s book. As best I recall, his words were “Thank you for reminding me of Michael’s book.  My brother Jack read that book, so did I. It was an important book because it made Jack more acutely aware of the suffering in our country and prompted him to propose some of the programs that were subsequently implemented and which made a huge difference in people’s lives. Too bad we’re back to where we were twenty years ago.”
The fiftieth anniversary of President Kennedy’s death prompted me to recall not only where I was when I heard the news of his assassination but also the hearing with his brother twenty years later. It also provided an opportunity to reflect on the legacy of JFK through a public health lens. 
Although implementation fell to his successor, much of the “War on Poverty” and “Great Society” programs were built on the framework laid out by President Kennedy. Even a partial list of accomplishments is impressive: Civil Rights Act of 1964, Voting Rights Act of 1965, Immigration Act of 1965, Office of Economic Opportunity (which led to Community Action Programs and Neighborhood Health Centers), Medicare, Medicaid, Head Start, food stamps, Elementary and Secondary Education Act, Higher Education Act, Work Study, Peace Corps, VISTA, Job Corps, environmental protection, first nuclear test ban treaty, and expansion of Title V of the Social Security Act. 
The impact of these programs was also impressive. Poverty rates dropped dramatically among all population groups but particularly among the elderly. High school and college graduation rates improved as did economic and health disparities. Unfortunately, many of these trends were not sustained when support for some of the “Great Society” programs was lessened or eliminated in the 1980s. For the last 30 years, we’ve struggled to recapture that lost momentum which offered so much hope and promise. Sadly, Michael Harrington’s words in “The Other America” are as true and accurate today as they were when they were written in 1962. 
Still, there is reason to be optimistic because some of the same conditions that existed in the early 1960s are present today. From my perspective, there were three things that prompted JFK’s actions for social change: data, community engagement, and a sense of optimism - a belief that we could do better. The data compiled and summarized in reports and books like “The Other America” and “The Silent Spring” by Rachel Carson were compelling and helped inform our country about its unacknowledged problems. The Civil Rights Movement and the nascent environmental movement used these data and personal experiences to create a narrative that supported the need for change and pressure Kennedy to act to protect and improve civil and human rights and our environment. And, as the Baby Boom generation was moving into young adulthood, there was a sense that not only could we do better but that we needed to do better and that we had the energy to make change happen. 
Today, we also have data that powerfully show growing disparities in all sectors of our society - that there are many people “without adequate housing and education and medical care.” We have research that demonstrates which programs and policies work in improving the quality of life for everyone and those that don’t. This information is ripe for a communication vehicle to help stimulate action. We also have a growing number of community-based organizations who are beginning to use this information and community experiences to create a quality of life narrative to pressure program administrators and policy makers to address the needs of all people in communities throughout the country. While we don’t have another Baby Boom generation, we do have a rapidly diversifying population that recognizes that we can and must do better. From this is emerging a sense of hope and optimism (combined with a sense of urgency) that we have untapped potential and unlimited opportunities. 
John Kennedy’s idealism has been recently criticized for giving people unrealistic hopes. But history shows that the idealism and dreams of the Kennedy and Johnson administrations led to some profound and positive changes in our country. Many of these changes are now an ingrained part of our culture. Given the problems we face, the risks are too great to abandon as unrealistic the current dreams for a better and healthier world. 
JFK addressed those criticisms directly. The problems of the world cannot possibly be solved by skeptics or cynics whose horizons are limited by the obvious realities. We need men who can dream of things that never were.”
His brother, Ted, reinforced this message. “For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”
As workers in the field of public health where we are striving to eliminate health disparities and achieve health equity, the words of John and Ted Kennedy should challenge us to persist in our efforts. Our efforts may be labeled quixotic but it is more important now than ever to work to make those dreams for a healthier and more equitable world come true. 
In dreams begins responsibility.”  - William Butler Yeats

Ed