Monday, October 2, 2017

Be Part of the Conversation: Our Stories, Our Communities, Our Health

The theme of the 2017 Minnesota Community Health Conference was “Be Part of the Conversation: Our Stories, Our Communities, Our Health.” As Commissioner of Health, I welcomed the 400+ attendees and then set the stage for the opening keynote address entitled “Telling Our Public Health Stories” with these words:

Once upon a time, long ago, in a New Mexico pueblo, a wise elder sitting among the people in a council ring 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 evil 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.
You don't have anything
if you don't have the stories.”
(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 help change our perspective. 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, enriches, and adds substance to the stories. That underlying narrative generally embodies the values, principles, and beliefs that a community holds sacred. Stories create, reinforce, and strengthen the narrative, make it more powerful and influential, and help carry it beyond the moment.

Despite what we would like to think, data, information, and even experience are not the things that most shape our behavior. That distinction belongs to the narrative which forms and shapes our beliefs, perspectives, and sense of responsibility and possibilities from which our actions spring. Stories help create and strengthen that narrative which is why they have such incredible power.

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 who molds public sentiment makes statutes and decisions possible or impossible to be executed.”

Stories and their underlying narrative (public sentiment) are powerful public policy tools thus they are also public health tools.

As public health workers, it is crucial that we tell a variety of stories that help shape the overall narrative about what creates health. We should tell stories about bad things that don’t happen because of our past public health investments in protecting people and that those investments have given us a longer and healthier life. We need to tell stories about what bad things might happen if we don’t change our current resource investment strategies which prioritize treatment over prevention. We must especially 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 development, and the quality of communities – policies that have destroyed opportunities and hope for too many people in too many communities.

Public health stories are seldom about heroic actions or ground breaking technologies. They’re not about individuals pulling themselves up by their bootstraps or about short term miracles. Public health stories are about the basic needs of individuals and communities, about the need for a long term vision and shared responsibility for health, and about protecting the “commons” – the public good. Public health stories are about inequities in opportunities to be healthy.

The narrative behind the public health 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 opportunities for populations affected by these policies to make healthy choices which stifles their opportunity to be healthy. That narrative is a social justice narrative.

And, the social justice narrative is really 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 (that health is determined by medical care and personal choices) is overpowering the social justice/public health narrative. That’s why we need to initiate and be part of the conversation about what creates health. That’s why all public health workers need to bring the health equity/public health perspective into those broader conversations. That’s why our stories need to be told in a way that expands our understanding about what creates health and helps create an alternative narrative that can guide the creation of policies, systems, and environments that allow everyone in every community to thrive.

That’s why you need to be part of the conversation that’s going to take place over the next two days – and beyond. Your stories are powerful. They are the best weapon “we have to fight off illness and death. You don't have anything if you don't have the stories.”

The stories I heard over the two days of the conference filled me with hope and convinced me that there are a lot of great public health story tellers in our midst. As they become a more integral “Part of the Conversation,” I’m anxious to see what impact their stories will have on “Our Health and Our Communities” in our state, our country, and the world. Living happily ever after may be how fairy tales end but I hope our real life stories end with everyone living equitably ever after.

Ed