Please join us on October 14th at the CIGNA Foundation forum on Growing Up Healthy: Raising Children in an Urban Environment at Temple University in Philadelphia. The full-day event (8:00am-4:30pm) will explore what’s required to help kids make healthy choices, and how we can work together to create healthier environments where our children live, learn and play.

The morning session features noted speakers and local examples of what caregivers can do to send a healthy message. The afternoon is dedicated to considering the role of the community — business, health, education, non-profits, government, faith, and caring citizens — to improve the social and environmental conditions that are the major determinants of children’s health.

The afternoon dialogue will be facilitated by Communities of Health, and will bring together multiple perspectives on:

• What determines children’s health in Philadelphia?
• What is making a positive impact in the city?
• What is the best path forward?

We welcome all as we consider the potential of a Communities of Health initiative in Philadelphia. The event is open to the public at no charge on a first-come, first-served basis. Registration is online.

“Studies have shown that when people feel part of a close-knit group they are less likely to suffer heart attacks, more able to cope with stress and better at retaining their memory than people who become socially isolated. A study of 650 stroke patients followed over a period of five years found that those who were part of a close-knit social group were significantly less likely to suffer a second, life-threatening problem over a given period of time.

“‘We are social animals who live and have evolved to live in social groups. Membership of groups, from football teams to book clubs and voluntary societies, gives us a sense of social identify,’ said Professor Alex Haslam of the University of Exeter.  ‘This is an indispensable part of who we are and what we need to be in order to lead rich and fulfilling lives. For this reason, groups are central to mental functioning, health and well-being. The point here is that the drug is us. The drug is the social group. The big question is why has it been ignored for so long given the profound impact that it has?’” — full story in The Independent (UK)

“The Mercy hospital shaman program was designed to strengthen the trust between doctors and the Hmong community — a form of healing in the broadest sense… A turning point in the skepticism of staff members occurred a decade ago, when a major Hmong clan leader was hospitalized here with a gangrenous bowel. Dr. Jim McDiarmid, a clinical psychologist and director of the residency program, said that in deference hundreds of well-wishers, a shaman was allowed to perform rituals, including placing a long sword at the door to ward off evil spirits. The man miraculously recovered. ‘That made a big impression, especially on the residents,’ Dr. McDiarmid said… Social support and beliefs affect a patient’s ability to rebound from illness, Dr. McDiarmid added.” – full story in The New York Times

In his column in today’s The New York Times, “No, It’s Not About Race”, David Brooks tells the story of his encounter with anti-government “tea party” protesters who were mingling with members of a nearby Black Family Reunion Celebration during their respective gatherings in Washington DC last Saturday. Brooks’s examination of the encounter is worth a read, and so is his lesson on “other, equally important strains in American history that are far more germane to the current conflicts.”

Whether “it” is about race or not will be debated for some time (in the flurry of e-mail exchanges I saw today there are important points being made by all sides). It might be that the disconnect is more fundamental than this; that racism is but one manifestation of a way of thinking that flows from seeing the world in terms of ”self” and “other”; a way of thinking that is defined by separation and control.

Brooks ends his column with a quote about the failure of each side to see the other as “legitimate.” That is a powerful idea, and I think the choice of the word “legitimate” is important.

Nobel Peace Prize winner Shirin Ebadi, a courageous voice for women and children’s rights in Iran, reminds us that a society is not free until it sees every citizen as a “legitimate other.” When this condition is not present, the work to be done is to create it, to make it possible, so that we can arrive at a place where real dialogue can occur.

And what is this place? According to Chilean biologist Humberto Maturana: “Love is the domain of those behaviors through which an other arises as a legitimate other in coexistence with oneself. Love entails mutual trust, acceptance – with no manipulation, which attempts to control the behavior of the other by illegitimate means. In this sense, love is not a virtue or something special; it is a biological phenomenon that constitutes trust and mutual acceptance.”

Love.. mutual acceptance… High hopes indeed, and a good way to head into a weekend that marks the beginning and end of two high holy days.

Is it our nature to act in self-interest – or in ways that benefit the greater good? Are these two modes of behavior mutually exclusive – or are they complementary, linked, maybe even synonymous? These questions, wondered aloud among a group of us at last week’s Communities of Health meetings in Michigan, are brought to light in yesterday’s The New York Times Magazine cover story by Clive Thompson, “Is Happiness Catching?”

Thompson profiles the work of Nicholas Christakis and James Fowler, who say “they have for the first time found some solid basis for a potentially powerful theory in epidemiology: that good behaviors – like quitting smoking or staying slender or being happy – pass from friend to friend almost as if they were contagious viruses.” Drawing on data from the landmark Framingham Heart Study, which has followed 15,000 participants since its inception in 1948, the researchers conclude that “staying healthy isn’t just a matter of your genes and your diet” but also your “proximity to other healthy people.” This influence is true, they say, not just among close friends and family members, but also across “three degrees of influence” (e.g., your indirect connection to your son’s best friend’s mother).

“People are connected, and so their health is connected,” Christakis and Fowler concluded when they summarized their findings in a July 2007 article in The New England Journal of Medicine, the first time the prestigious journal published a study of how social networks affect health, reports Thompson.

And the social effect appeared to be quite powerful. When a Framingham resident became obese, his or her friends were 57 percent more likely to become obese, too… A Framingham resident was roughly 20 percent more likely to become obese if the friend of a friend became obese… Risk of obesity went up about 10 percent even if a friend of a friend of a friend gained weight.

 

A friend taking up smoking increased your chance of lighting up by 36 percent, and if you had a three-degrees-removed friend who started smoking, you were 11 percent more likely to do the same. Drinking spread socially, as did happiness and even loneliness. And in each case one’s individual influence stretched out three degrees before it faded out. They termed this the “three degrees of influence” rule about human behavior: We are tied not just to those around us, but to others in a web that stretches farther than we know.

In the case of happiness, Thompson writes, what’s most important is to have a lot of friends: “The researchers say increased sociability pays off because happiness is more contagious than unhappiness. Each new happy friend boosts your good cheer by 9 percent; each new unhappy friend drags you down by only 7 percent.”

Christakis and Fowler’s critics argue that “ascertaining cause and effect in such complex constructs” is difficult. Indeed, other mechanisms are likely at work, including the shared environment and the tendency of people to gravitate toward others who are like them. Whether or not this specific research proves the point, most do agree that within the complex array of interconnected forces – the ecology of health – human behavior is widely contagious and important. (As someone said in our CoH gatherings last week, there are certain truths we can intuit without exhaustive scientific studies, like the fact that driving with a blindfold on at 100 MPH is more likely to result in a car crash.)

This suggests new ways of thinking about population health improvement, giving due to the power context over individual behavior: “If they’re right,” notes Thompson, “initiatives that merely address the affected individuals are doomed to failure.” For example, rather than dieting alone or with your immediate friends, Christakis and Fowler suggest that dieting with friends of friends – across multiple degrees of influence – could create a “counterepidemic of skinniness.” In fact, using simulation models that measure the impact of healthy behaviors across extended social networks, the researchers demonstrated that obesity trends could be reversed.

Just as interesting and relevant to our CoH work is Christakis and Fowler’s observation that social contagion could even help explain the evolutionary imperative of altruism. Writes Thompson:

Tribal groups that were tightly connected were likely more able to pass along positive behaviors than those that weren’t… If we can pass on altruism to distant points in a network, it would help explain why altruistic people aren’t simply constantly taken advantage of by other members of their community. Last year, to test this theory, they conducted a laboratory experiment in which participants played a “cooperation game.” Each participant was asked to share a sum of money with a small group and could choose to be either generous or selfish. Christakis and Fowler found that if someone was on the receiving end of a generous exchange, that person would become more generous to the next set of partners – until the entire larger group was infected, as it were, with altruistic behavior, which meant the altruist would benefit indirectly.

 

As Fowler pointed out, if you want to improve the world with your good behavior, math is on your side. For most of us, within three degrees we are connected to more than 1,000 people – all of whom we can theoretically help make healthier, fitter and happier just by our contagious example. “If someone tells you that you can influence 1,000 people,” Fowler said, “it changes your way of seeing the world.”

So, whether this is science or intuition (or both), it is increasingly a “truth” we are hearing again and again in CoH gatherings all over the country. And in this, we no longer see a separation between self-interest and the greater good. In this, we see that our hope and our health are inextricably linked to us all.

I had the great fortune of meeting Mary Pierce Brosmer in the way I’d wish to meet everyone: we became a source of listening for each other. This happened a year and a half ago when a colleague brought us together as prospective co-facilitators of a workshop on courage, and because we spent very little time creating content and almost all of our time creating for each other precisely the kind of context we intended to create for those who attended our workshop.

Mary began doing this sort of work 18 years ago when she founded Women Writing for (a) Change, which she describes as a “living system” that inspires women and girls to craft more conscious lives through the art of writing and the practices of community.

I experienced this living system when Mary and her team invited me into a staff meeting, which began with a writing-sharing-and-reflecting practice. In this community, ongoing practices of deep listening are a pre-requisite even for the seemingly mundane tasks of staff meetings and budget reviews. And as a result, this community has endured – and expanded into the relational lives of many thousands of women through a growing number of affiliates around the country – for nearly two decades.

What I have learned from Mary and WWf(a)C is that healthy, sustainable community cannot rely on a single “grand idea.” It requires ongoing practices, rituals, and care of the details: what Mary calls an “operating system” — reliable and replicable for continually inviting people into more conscious community. She shares how this has worked within WWf(a)C in a recent talk, and offers more details in her forthcoming book.

Today the Institute of Medicine (IOM) released a 106-page report outlining actions for local governments to prevent childhood obesity. (Coverage in USA Today.) Among the recommendations: Create incentives to attract supermarkets to underserved neighborhoods… Require menu labeling in chain restaurants… Keep parks and playgrounds safe and attractive…

A colleague, who has been doing remarkable work with a group of women in Hartford, CT — they call themselves, Sisters in the Spirit of Health — said she was amazed to read that many of the recommendations were similar to those her group came up with. Yet, while there may be some overlap, the biggest difference is the way in which the recommendations came about.

On the one hand (IOM), an expert panel publishes a comprehensive set of policy and structural changes to be implemented by government and local authorities.

On the other hand, a group of moms and daughters, friends and neighbors begin a conversation, take a look around their own community, and share their highest aspirations for change — in words, drawings, and a powerful video montage and theme song!

We are optimistic that the IOM report might lead to new conversations and maybe even investment in a broader approach to health. Mostly, news like this seems to make even more urgent the need for ongoing community dialogue that explores what led to current conditions in the first place.

Meanwhile, the Hartford women are manifesting new sources of food in the city, and, just as important, sisterhood, as they continue to come together to consider what matters most and what might be possible working (and singing) together.

Even in community, there is conflict. Our Communities of Health (CoH) work is not immune to this. In large and small cities around the country, our work plays out in personal, interpersonal, and systemic relationships. And, as our psychologist friend Lou Cox, PhD, reminds us: “Human systems are made up of imperfect people, i.e., us … people developed in some ways, and undeveloped in others. They are created in our own collective image, and reflect our best and our worst.”

Most of the conflicts we’ve encountered (and, by definition, been part of creating) have been resolved in ways that allow the work to flow forward. Indeed, in many cases, stepping into conflict and seeing our way through together has changed the path in profoundly better ways, for those of us directly involved and by extension for the many intended to benefit from our work.

Not resolving conflict, or refusing to see it in the first place, can be poisonous, particularly for a team intending to create healthier communities. We cannot bring to others what we are unwilling to acknowledge, confront and heal in our own relationships.

The practices for seeing and freeing ourselves from conflict have existed for thousands of years. They are simple and sincere forms of dialogue. Inclusive, ongoing and deeply reflective. (We practice these forms of dialogue in our CoH gatherings, and from time to time will offer ideas here — so please share yours with us.)

A particular quality of dialogue, what Dr. Lou Cox calls “conscious conversation“, is necessary for any meaningful shift in relationship or system. Without it, we play at the surface; we may do great things together for a time, but if we have not agreed how we will handle conflict — or if we tell ourselves we can simply “skate over” it — we may get derailed at the first signal that all is not as harmonious as we thought. In our CoH work, a team of would-be-interveners not consciously communicating would harbor the very seeds of disconnect we seek to remedy in broken communities.

Rather, when we see ourselves and our relationships as ongoing practice fields for the work, we can begin to see together that what creates conflict is a kind of fear. We can name it as such. And in this understanding we find commonality, we find hope, and a way forward together. We come to see that this matters in every relationship that we extend into the larger communities, systems and world we are connected to.

Thanks to Mary Pierce Brosmer for this post, and in particular for her question, asked here in the context of the health reform dialog: What kinds of spaces make a different quality of language, and learning together possible? We’d like to hear your thoughts. Comment (below) or send us a post.

…………………………………………………………………………………………………………………………………………

Creating spaces series:  Discussing health care reform

By Mary Pierce Brosmer – August 11, 2009

If you don’t know the kind of person I am

and I don’t know the kind of person you are

a pattern that others made may prevail in the world

and following the wrong god home we may miss our star.

—William Stafford from “A Ritual to Read to One Another”

“In a neighborhood served by 26 liquor stores but only one grocery, a community group is peddling fresh fruits and vegetables like ice cream. Five days a week, the Peaches & Greens truck winds its way through the streets as a loudspeaker plays R&B… Experts call Detroit a food desert: More than half of its residents must travel at least twice as far to reach the nearest grocery store as they do to a fast-food restaurant or convenience store. Other cities also are struggling with obesity, diabetes and other illnesses tied to diets high in calories and sugar. They’re trying a variety of ways to solve the problem…” — The Associated Press story continues.