Wednesday, October 21, 2015

Public Health Healers

What matters is the presence of healers in all walks of life – the teacher, the doctor, the rabbi, the family member, the friend.
                        Margaret Mahoney (October 24, 1924 – December 22, 2011

While at the Carnegie Corporation in the late 1960s, Margaret Mahoney realized that effective health leaders of the future would need health policy, health services research, and public health expertise in addition to their clinical skills. That vision came to fruition as the Clinical Scholars Program (CSP) when Margaret Mahoney moved to the newly established Robert Wood Johnson Foundation in 1972. 

I was privileged to be a CSP fellow in the earliest years of the program – an experience that helped shape my professional career.

I’ve been thinking about the CSP and Margaret Mahoney as I prepare to attend and present at my first CSP annual meeting in 35 years. I re-read several of the essays written by Ms. Mahoney that focused on the key roles required to bring about social progress. These essays were titled: Doers. Inspirers. Communicators. Healers. Builders. Innovators. Trustees. Mentors. Leaders. Partners. Heroes. 

Given that many of my recent presentations start with the World Health Organization (WHO) definition of health, I was particularly interested in her essay on “Healers” since both “health” and “healing” come from the same Old English word root hal meaning whole. To be healthy is to be whole. To heal is to be made whole. Healers help to make things whole. 

As I read her essay on “Healers,” I became more convinced than ever that healing is the primary task of public health. Because being whole includes both personal integrity/well-being and communal belonging/social connectedness, our healing efforts as a public health agency must encompass not only individuals but also the communities in which they live and the systems that affect them. 

In order to be effective, I believe healers must possess some specific characteristics.

¨      Healers must be patient. Healing takes time and we must accept the natural course of healing.  It’s okay to try to hurry things along but as Shakespeare said:“What wound did ever heal but by degrees?” Healers must take a long-term view and accept long term responsibility for results.  Being a healer is a lifetime job.
¨      Healers must be risk takers. Sometimes healers need to confront and educate those in power who may not embrace a healthful vision for our society. Healers are not always popular or welcomed. 
¨      Healers must work together. Healers must be confident and self-assured but must also be integrated with other healers. No one has all the skills or energy that is needed to foster all the healing that needs to be done. Healers are more likely to be successful if they are organized and working together.
¨      Healers must be compassionate and forgiving. Blaming those who make unhealthy choices is misdirected. Choices are made in the context of people’s environments and we, as members of this community, have in many cases helped create those environments. We all share the responsibility of making this a healthier community.
¨      Healers must be passionate. To be a healer, one needs to be firmly committed to improving the health of people and the community. 

Healing in this sense resonates with the Institute of Medicine definition that public health is what we, as a society, do collectively to assure the conditions in which people can be healthy. To make our communities healthy or whole we need the entire community to be healers. We need to have healing become a community responsibility.

This means that we all need to become healers and take a broader view of health so that healing can include the body, mind, and spirit of individuals and the community.

Using the clinical lexicon, we must first make the right diagnoses if we are to become individual and community healers. We must be able to identify the healthy state and any divergence from it.  Recognizing that most of the things affecting our health and the health of our communities are not medical conditions but social and economic conditions, we need to begin to make the right diagnoses related to things like violence, incarceration, discrimination, working conditions, structural racism, and community values. 

As I thought about healing, I realized that health and health equity require all of us to develop the capacity and skills to be healers. As Margaret Mahoney said: “Whether the healer is helping an individual or a community – family, neighborhood, group, or indeed the nation – the objective is to heal the rifts that lead one person or one group to misunderstand, even disdain, another. The goal is to recover friendships, rebuild self-esteem, and cement understanding.”  Healing is the only way to achieve health equity and optimal health for all. We all have a responsibility to be healers and we must take that responsibility seriously.