Monday, July 28, 2014

The Power of Stories and Narrative

Since most religions or faith-based organizations are concerned about physical and emotional health in addition to spiritual health, I occasionally get invited to speak at a church, mosque, meeting house, or synagogue. When my presentation is temporally related to their prayer service, I try to link my public health message with their theme of the day.

Today I was invited to speak at a local church whose readings revolved around parables, simple stories used to illustrate a moral or spiritual lesson. Since we’ve been working on the narrative about what creates health and because stories and parables help create and support a narrative, I saw this invitation as a good opportunity to talk specifically about the power of stories and narrative.  

Here is part of what I shared with the congregation.

Once upon a time, long ago, in a New Mexico pueblo, an elder sat among the people and began to speak:

“I will tell you something about stories,
They aren't just for entertainment.
Don't be fooled
They are all we have, you see,
all we have to fight off illness and death.
You don't have anything
if you don't have the stories.
The evil in the world is mighty
but they can't stand up to our stories.
So they try to destroy the stories
let the stories be confused or forgotten
They would like that
They would be happy
Because we would be defenseless then.”
     
From Ceremony by Leslie Marmon Silko, a Native American from the Laguna Pueblo in New Mexico.

The wise ones then and the wise ones now recognize that stories are powerful tools. They are powerful because stories are hypnotic. The Laguna people start each story with the phrase, “Humma-hah,” meaning long ago. We often start our stories with “Once upon a time.” Just saying those words puts us in a different mindset, one where we suspend disbelief and become more open to new ideas, different ideologies, and foreign notions. Stories can get us to think and act in different ways.

Besides being interesting, enjoyable, and effective in transmitting information and ideas, stories are also powerful because they link people to a broader more expansive narrative that underlies and adds substance to the stories. The underlying narrative generally embodies the values, principles, and beliefs that a community holds sacred. Stories reinforce and expand the narrative, make it more influential, and help carry it beyond the moment.

Even more powerful is the use of stories to create a narrative because it is known that it’s not data, information, or even experience that most shapes our behavior. That distinction belongs to narrative because a narrative shapes our beliefs, understandings, perceptions, and our sense of responsibility and possibilities. Stories and parables help create and expand a narrative. That is where the real power of stories lies.

Whether a story is fact or fiction, accurate or erroneous, or for children or adults is irrelevant in its relationship to the underlying narrative. Every story helps create or support a narrative. You can see why the Laguna elder stated, stories are not just about entertainment. They are all we have to fight off illness and death. That’s why stories are so powerful.

In fact, stories are so powerful that Plato warned "Those who tell the stories rule society,…so we need to carefully control who tells stories.”

Abraham Lincoln sounded a similar theme. He said, “Public sentiment is everything. With public sentiment, nothing can fail; without it nothing can succeed. Consequently, he who molds public sentiment goes deeper than he who enacts statutes or pronounces decisions. He makes statutes and decisions possible or impossible to be executed.”

Stories and their underlying narrative, or public sentiment, are powerful public policy tools.

You hear lots of stories every day. Some recent ones you’ve probably heard are about the Israeli and Palestinian conflict. There is probably truth behind each of the stories yet the stories are often conflicting. That’s because the message of the story and how the story is told is influenced by the narrative that underlies the story; the narrative that reflects the perspective and core beliefs of the teller.

Similarly, the narrative influences the stories about the unaccompanied children showing up on our southern border, about the ACA, and about taxes, minimum wage, and jobs, to name just a few. Ask yourself, what’s the narrative behind those stories? What values, principles, and beliefs are they trying to convey?

As health commissioner, I hear a lot of stories about health. For example, at a recent celebration of major historical milestone of a large health care organization, I heard wonderful and very emotional stories about how people’s lives were saved by ground-breaking research, heroic surgical procedures, and a medical staff focused solely on the welfare of their patients. In fact, they now have a website devoted specifically to the telling of these stories.

A major medical device manufacturer has a similar website dedicated to personal stories about how technology has saved and improved the lives of many people from around the world.

All of these stories are true. And behind each of these stories is the narrative that it is the medical care system that is responsible for our health. Each story reinforces the narrative that, if everyone had access to and was able to use our medical care system, health would be assured.

Another set of stories that I hear takes a more negative and judgmental perspective. I hear stories about babies being born prematurely because their mothers smoked or used drugs. I hear stories about how obesity is increasing because people are making bad choices about what they eat and because they are spending too much time in front of one kind of screen or another. And I hear stories about kids not doing well in school because parents aren’t attentive to their needs or didn’t spend enough time reading to them when they were younger.

Again, these stories are probably true. And behind these stories is the narrative that a great deal of our health is determined by the choices that individuals make. If we just ate well, exercised, avoided drugs, and read to our kids, everything would be better.

Combined, these two narratives have formed the dominant public narrative that it is medical care and personal choices that create health.

I tell different stories. I tell stories about bad things that don’t happen because of our past investments in protecting people and that those investments have given us a longer and healthier life. I tell stories about what bad things might happen if we don’t change our current resource investment priorities. Mostly, I tell stories about disparities that have been caused, not by the lack of medical care or because of poor personal choices, but by policy decisions that affect income, education, housing, economic opportunities, and the quality of communities.

My stories are not about heroic actions or ground breaking technologies. They’re not about individuals pulling themselves up by their bootstraps or about short term miracles. My stories are about the basic needs of individuals and communities; about a long term vision and responsibility, and about protecting the “commons” and the public good.

The narrative behind my stories is that health is created in communities, by communities, and that health is determined mostly by socio-economic circumstances and environments that have been created by public and private policies. Too often, these policies systematically disadvantage some population groups and communities and limit the opportunity for disadvantaged populations to make healthy choices and limit their opportunity to be healthy. This is a social justice narrative.

Because social justice is about assuring that the basic needs of everyone are met and that no one benefits at the expense of someone else, the social justice narrative is also the public health narrative. Bill Foege, former director of the Center for Disease Control and Prevention (CDC) reinforced that notion when he said, “The philosophy behind science is to discover truth. The philosophy behind medicine is to use that truth for the benefit of your patient. The philosophy behind public health is social justice.”

Sadly, from my perspective, the dominant public narrative about what creates health (medical care and personal choices) is overpowering the social justice/public health narrative.

So what does this have to do with the parables in your readings today? I’m not a theologian so I’m not going to interpret those parables. Instead, I ask you to focus on the narrative behind the parables. What are the values, principles, and beliefs behind those stories and parables? What is the narrative that the parables create and support? How does that narrative help create health in your community? And, do these stories align with your narrative about how you should live your life?

I leave the answers to those questions up to you. But I certainly resonate with the narrative in a couple of your readings today. That narrative is about the wisdom to lead, it's about the needs of the community, it's about connections and all of us working together, it’s about social justice.

I like that narrative because that's the narrative needed to create health in our society and build the kind of society every faith-based group would love to see on this earth.

That’s my story and I’m sticking to it.

Ed