Friday, November 4, 2016

Poetry and Public Health

I am fortunate to have the opportunity to speak often to groups of people with varied interests, backgrounds, and expertise. In just the last several weeks I’ve presented to county commissioners, urban planners, transportation engineers, hydrologists, air quality specialists, National Park supporters, American Indian tribal leaders, psychologists, and data analysts among others. While I tailor my presentations to the specific interests of each group, my basic message is always the same – “you have an important role to play in creating healthy communities and advancing health equity.”

That message emanates from the Institute of Medicine’s definition of public health: “what we do collectively to assure the conditions in which (all) people can be healthy.” From that starting place I use the Triple Aim of Heath Equity to frame how people in all sectors and disciplines could do their work to advance health equity and optimal health for all. The Triple Aim of Health Equity consists of three “simple rules” for addressing complex situations like health equity:
Expand the understanding about what creates health,
Implement a “Health in All Policies” approach with health equity as the goal, and
Strengthen the capacity of communities to create their own healthy future.

The aims are unified around the core value of social cohesion which recognizes that health, well-being, equity, and thriving communities can only be accomplished in partnership and by collective action – action that requires the efforts of all sectors and disciplines.

I had the Triple Aim of Health Equity in mind recently as I prepared to speak to a group of psychologists and social workers. While formulating my talking points, I remembered a lecture in one of my undergraduate psychology classes given by Harry Harlow, a psychologist at the University of Wisconsin who studied social behavior and development and was best known for his maternal separation and social isolation experiments with monkeys. In his talk Professor Harlow outlined how he had worked to transform the field of psychology so that the notions of love and affection were “deemed worthy of psychological study.”

As an English major who was taking a pre-med curriculum, I was particularly struck by one of his comments: “So far as love or affection is concerned, psychologists have failed in their mission. The little we know about love does not transcend simple observation, and the little we write about it has been written better by poets and novelists.” That statement reaffirmed my decision to major in English rather than the more customary pre-med disciplines of biology, chemistry, or mathematics. A mere 50 years later, his lecture about transforming a field and that particular statement encouraged me to quote a passage from the Romantic poet John Keats in my speech to the psychologists and social workers: “Many have original minds who do not think it -- they are led away by custom.” I used that passage to make the point that we often fall victim to the custom of following our usual and long-standing ways of doing things even when they are not achieving our aspirational goals. To illustrate, I noted that our reliance on our traditional medical care and public health practices are not moving us closer to the achievement of health equity and that a transformation of our work is necessary for that change to occur.

Coincidentally, two days later, as I was preparing to talk to a group of data analysts, I came across a statement by Karl Weierstrass, a 19th century German mathematician who (according to Wikipedia) is known as the "father of modern analysis" for his work that led to the modern theory of functions. He said: “It is true that a mathematician who is not somewhat of a poet, will never be a perfect mathematician.” That quotation made me wonder if “It is (also) true that a (public health worker) who is not a poet, will never be a perfect (public health worker).” It didn’t take long to realize the truth of that paraphrase.

In growing our understanding about what creates health, we’ve come to realize that health is determined by much more than just medical care and personal choices. It’s particularly influenced by the social and economic circumstances in which people live, work, worship, and play. And those circumstances/living conditions are dramatically affected by the presence or absence of music, art, theater, dance, and literature of all types.

Consider how poets and novelists have expanded and enhanced our view of relationships, physical and social environments, transportation, housing, agriculture, business, education, and the importance of community. Imagine how different the peace, civil rights, women’s rights, and environmental movements of the 1960s and 1970s would have been without the musical soundtrack laid by the Nobel Award winning lyrics of Bob Dylan and the powerful tunes of Motown. Ponder the emotions and the questions raised by a stimulating works of classical and modern art within and outside of galleries. Contemplate the expanded understanding of culture transmitted by dances and dancers from around the world. Reflect on the questions raised about our place in the world by theatrical works like “Death of a Salesman” and “A Raisin in the Sun.” Just envision the sterility and blandness of a world without the ability of people to creatively express their joys, sorrows, fears, hopes, and dreams.

Literature, art, music, dance, and theater significantly influence the conditions in which people live, work, worship, and play. Their influence underscores the need to include them in the transformation of the work we must do in public health to advance health equity and optimal health for all. Arts and poetry broaden our thinking and help us see the reality of other people’s existence. They also allow us to imagine how the lives of our fellow citizens can be improved. There is no doubt in my mind that “It is true that a public health worker who is not a poet, will never be a perfect public health worker.” Seeing the everyday impact of these creative forms of expression gives credence to the statement of physician and poet William Carlos Williams,

“It is difficult/ to get the news from poems/ yet men die miserably every day/ for lack/ of what is found there."

Ed