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Monday Mantras

If you open it, close it.

If you start it, finish it.

If you see something that needs to be done, do it.

If you’re anything like me, you’re often running from one thing to the next, being pulled in multiple directions by competing priorities and the persistent feeling that there is just not enough time to do it all. In that environment, it is easy to be swept away as the day goes on. Files that you aren’t working on remain open. Cabinet doors don’t get shut. Applications run idly. The stack of papers that need to be filed grow and grow until your working around them becomes an obstacle.

These mantras remind me to be mindful, to slow (a little), and to focus on what is right in front of my face before I move on to the next thing. They apply to everything from doing to the dishes to leadership and project management. Their simplicity is their power. So, on this Monday:

If you open it, close it.

If you start it, finish it.

If you see something that needs to be done, do it.

Opening Day

Over the last five months, the COVID-19 pandemic has had a tremendous impact on the health of the United States. The latest numbers show the staggering, and escalating, loss of life coupled with dire economic conditions. As efforts were taken to bring the virus under control, we canceled events — parades, concerts, parties, celebrations, and perhaps the most sacred of them all — Opening Day of the baseball season.

As humans, we arrange our lives around seasons, holidays, birthdays, and anniversaries. Some of these are actual things (e.g. the Summer Solstice) while others are add-ons from culture (e.g. Memorial Day), religion (e.g. Ramadan), or the greeting card industry (e.g. Father’s Day). As our ancestors used their observation of nature and skies to know when to plant crops, so too these monuments guide us along our path, providing destination points that psychologically satisfying. This year we lost any of those — including my beloved Opening Day.

I truly adore Opening Day. While my interest in the rest of the season is variable, my attention on Opening Day is unfettered. I’ve taken days off of work. I’ve watched Opening Day games in temperatures below freezing. I even bought tickets to watch replacement players play on Opening Day when the regular players are on strike. Why? I think there are three things that make Opening Day a special time.

1. Opening Day is a symbol of change

Typically, Opening Day is an unofficial start to the spring season, ushering in hope of warmer weather after surviving a long winter. It introduces the vestiges of summer — the hot dogs and cotton candy, being outside together in the sunshine. It marks a new period of time that helps us shift our focus.

2. Opening Day is a symbol of possibility

For at least a few hours each spring, fans of every team can celebrate being in first place. No matter how bad your team was the previous season, you can dream and imagine the possibilities of their team going all the way that year. As the saying goes, ‘Hope springs eternal.’ We have few opportunities like that in life. It’s a reset, a new beginning that erases the past and users us forward.

3. Opening Day is the start of a long journey

It is typical to overreact to the game on Opening Day. While, in a normal season, there are 161 more games to play, that first one seems more important despite its statistical similarity to all other games. Opening Day is like the first step on a cross country voyage. It is an awareness of the long journey that lies ahead, bringing both excitement and dread.

Even though it is late, I am so thrilled to have Opening Day, at last, this year. While it may serve as a welcome distraction for a few moments from the challenges we are facing today, I wonder if it could teach us something about how to handle those challenges. All around us, there are signs of change. Confederate statues are coming down, racist ideas are being challenged, and new ways of pandemic living are being developed.

These changes suggest future possibilities. While it may be hard to see amidst the tear gas, unemployment numbers, and socially-distanced interactions, the situations that we are in are full of opportunity to achieve the future that we want. Yes, it may require a small dose of unrealistic optimism (to be distinguished from willful and persistent ignorance), and we could use that about now. The fact that we are having serious conversations about structural racism, for example, is evidence that a different possible future is out there. The things that we are learning about the disease and our risks open up possibilities to have better health in the future. Hope is springing if you look hard enough.

And — just as the first game in baseball is but a step on a long journey — we must remember that the progress we want to make a society will take time and diligence. We can not solve this with a masterful performance on day one (although there is nothing wrong with that). We have to keep at it, keep grinding every day through the winning streaks, batting slumps, and the “dog days” that lie ahead.

Whether you are an aficionado of Opening Day or not, perhaps we can all embrace the spirit of the day this year — to embrace change, to imagine possibility, and to dedicate ourselves to the long season that lies before us. Play Ball!!!

Disparities as Symptoms

Amid all the American fault-lines exposed by the COVID-19 pandemic, none is more alarming than the disparate impact of the disease on racial and ethnic groups. According to the Centers for Disease Control and Prevention (CDC) data, both non-Hispanic black and Hispanic/Latinx Americans have three times the risk of getting COVID-19 than white populations. They are five and four times respectively more likely to be hospitalized, and most alarmingly, the death rates for each group within age categories are at least six times that of the white population. These are not small measures of statistical significance, but huge effect sizes that should alarm and mobilize every one of us.

For those of us who work in public health, while these numbers are tragic, they are not surprising. Decades of research have highlighted disparities in premature death, disease prevalence, and overall well-being based on one’s race/ethnicity and/or neighborhood of residence. The COVID experience is just another piece of evidence that something is really wrong with the society that we have built and maintained. These disparities are not isolated occurrences but symptoms of a much larger problem.

The problem is that we have created a society that limits access and opportunity for many. It starts with something as simple as food. In a New England Journal of Medicine article released this week, Dr. Matthew J. Belanger and colleagues described the connection between nutrition, obesity, and COVID-19. They illustrate the connection between the disease and the society we have created that allows more than one in ten households to be food insecure and many communities in which access to healthy foods is severely limited. These characteristics disproportionately affect people of color. The authors argue:

“The U.S. health care system needs a renewed and increased focus on health inequities, inclusiveness, resilience, and chronic-disease prevention. Public health policies and legislative initiatives that reduce food insecurity and food deserts in vulnerable communities are urgently needed to address the upstream determinants of health”

COVID-19 and Disparities in Nutrition and Obesity. Belanger et al., 2020

Those “structural and social determinants” of health are the subject of an article in the American Journal of Respiratory and Critical Care Medicine, by Dr. Neeta Thakur and colleagues. They identified drivers of these disparities including gaps in risk exposure, access to information, and access to health services. We have set up a society in which Americans of color are much more likely to be essential workers who work in the most dangerous environments during the pandemic. We have set up a society where Americans of color are more likely to live in crowded conditions. We have set up a society where Americans of color are most at risk of losing income during challenging economic times.

All these things are sad but true. Yet, they are grounded in structural systems that were created over many decades. If they are structural, however, it means that that we can tear them down to build something new. We just need the political will to do so. We can create a country in which everyone has access to healthcare. We can create more investment in communities to sustain healthy lifestyles. We can create health systems that prioritize patients over profits. We can create communities where the color of your skin or the neighborhood that you live in do not determine dramatic spikes in your risk of death.

In their Health Affairs post, Leana Wen and Nakisa Sadeghi suggest a series of policy solutions to address these disparities. In the near-term, they highlight the need for an equity lens in thinking about the ways in which testing will be made available, contact tracing will be conducted, and quarantine will be supported with sound information, trusted leadership, and supportive fiscal policies. These should be “no-brainers”, but the lack of coordinated leadership often exhibited throughout the pandemic to date may inhibit these efforts. They also suggest some more progressive ideas by ensuring that healthcare costs related to CVOID-19 are covered. While this would require some significant effort, it is critical as the long-term effects of a COVID-19 hospitalization could be catastrophic– if not for health — for the economic viability of the family

Wen and Sadeghi also correctly point out that we will need longer-term investments in eradicating the conditions that led us to this place. We absolutely need more resources dedicated to social determinants of health and public health in general. They also raise the powerful point that we should attend to equity as we think about how the first vaccine(s) to address COVID-19 will roll out. In a society with unequal access and purchasing power, will we exacerbate these inequalities by settings up inaccessible systems for vaccinating the population, systems that may exclude those most at risk? We must learn from the past and not repeat those mistakes, as they strongly state:

Lack of thoughtful planning will inevitably lead to a situation where those who are well-connected and well-resourced can obtain scarce resources, leaving many others to go without them.

Addressing Racial Health Disparities in COVID-19 Pandemic: Immediate and Long-Term Policy Solutions (Wen & Sadeghi, 2020)

COVID-19 will not be the last challenge we face. We have often not got it right in the past. We should do our best to not repeat those mistakes again in the future and to, at long last, take this time as an impetus for action to reduce these inequities and create communities where everyone has the opportunity to thrive.

Good Trouble

Over the weekend, we lost one of the last icons of the civil rights movement at a time when the energy around addressing structural racism has grown. John Lewis was an icon and a statesman whose legacy should be remembered for a long time. In the plethora of memorial writing that followed the unfortunate news, one quote emerged with the powerful concept of good trouble. Earlier this year, Representative Lewis invoked this phrase in Selma, Alabama.

Get in good trouble, necessary trouble, and help redeem the soul of America.

Representative John R. Lewis

What does it mean to get in good trouble? I think it means to challenge the status quo in pursuit of the values the we hold and the world that we want to see. I think it means having the courage to act when unpopular and the creative audacity to suggest fresh ideas when the same old ones will do. I think it means to embody the playful spirit of the disrupter, the provocateur , skillfully manipulating the conversation to cut to the core of the issue, challenge thinking, and inspire new solutions.

It also occurs to me that the more comfortable we are, the more complacent, compliant, and complicit we tend to be toward the status quo. If we benefit from the system of injustice — as I have and do being a White male — it is risky to stir the boat. We may agonize over oppression in private conversations, attend a rally, or change our Facebook profile picture to display “Black Lives Matter” — but is this really what Lewis would describe as “trouble”?

Of course, this concept extends well beyond racism and civil rights. In every moment, we have the opportunity to either go with the flow or creatively disrupt it. Our business and personal selves could benefit from this willingness to mix things up. It’s a risk, but some things are worth risk for — and it is when we take those risks that we learn new things and accomplish what we previously only dreamed of.

Today, is a great day, in honor of John Lewis and all fellow troublemakers – past, present, and future — to create a little “good trouble” of your own.

The Great Mask Battle of 2020

Our superhero stories are chock full of figures — some heroic, others villainous — that conceal their faces beyond a variety of colorful and exotic coverings. These masks can serve a functional role as a source of protection or sensory enhancement (see Iron Man). They can conceal an identity (Batman, Black Panther) or just hide a really ugly visage (poor Deadpool). Sometimes, they are just a style accessory that completes a look (see Captain America or Wonderwoman). These modern manifestations of superheroes are echoes of centuries of masked figures who live in our myths and legends.

It is remarkable, then, that this simple, familiar piece of equipment has become the source of such ideological battle lines during the persistent COVID-19 pandemic. The President has famously refused — until recently — to wear a mask, ignoring the advice of health experts. Many of Trump’s allies have lined up behind this notion to that point that yesterday the Governor of Georgia mandated that its localities could not mandate masks. (double negative anyone?). While there are real legal questions here about the ability of the government to enforce citizen compliance, it is unbelievable — as cases surge — that this has been perceived as the time to have that fight.

The data clearly show that masks have been accepted by a large majority of the population. The embattled and marginalized Centers for Disease Control and Prevention (CDC), published an article this week highlighting that, in data from May, 76% of a national sample of adults were in favor of wearing masks. A recent Gallup poll showed that 72% of Americans (between June 29 and July 5) report “Always” or “Very Often” using a mask in public, and an increasing number of national retailers are requiring masks to be worn in their stores.

A deeper dive in the Gallup data shows the fault lines in this national momentum around mask-wearing. While 94% of Democrats and 69% of Independents report a high level of mask use, less than half (46%) of Republicans did, with a remarkable 27% of those who identify as Republicans stating that they “Never” wear a mask.

Meanwhile, the hard-earned progress in flattening the curve is being erased with spikes in cases, led by states with higher percentages of Republican-identifying residents. Arizona, Alabama, Florida, Texas and others lead the way with real consequences for real people. While limitations in mask wearing are not fully responsible for these spikes, human behavior in these settings — influenced by the policies and punditry of leaders — has put more people at risk, even to the point where hard-hit New York and New Jersey are mandating quarantine for arriving individuals from almost half of U.S. states.

We should continue to have a conversation about civil liberties, the role of government, and the breakdown of federal, state, and local responsibilities. These are important topics on which people can reasonably disagree. We absolutely should engage in dialogue to understand why different demographics within this country see things so dramatically different — even on issues with daily-updating line charts. However, now is not the time to usher in further catastrophe to make an ideological argument or try to score points for your team. Now is the time to take a lesson from our superheroes and don a mask in public — for our protection and for the protection of others. After all, “with great power, comes great responsibility”. We each have the power to act responsibly toward our fellow citizens, and we should — by wearing a mask for starters.

The Argument for Holistic Approaches

We like to put things into nice, neat categories. It helps us organize. It allows us to rely on well-honed heuristics that pre-determine assumptions about an idea or an organization. We do this every day in thousands of covert ways to make our lives more efficient and psychologically satisfying.

We also do this with our community change organizations. We have housing organizations. We have mental health organizations. We have civic organizations. We sometimes talk about these as sectors and emphasize the need for enhanced “cross-sector collaboration”. We less often acknowledge that these sectors are in many ways artificial. They were created by us and are maintained by us.

This dividing of the boundaries of helping organizations (and the funding that supports them) often leads us to ineffective approaches in part because they fail to acknowledge that the outcomes we seek — reduced poverty, improved well-being, declines in infant mortality, etc — are all connected on fundamental (and often causal) levels.

I just finished reading a very nice National Bureau of Economic Research paper entitled ‘Poverty, Depression, and Anxiety: Causal Evidence and Mechanisms’. In short, this review highlights something that we all discuss intuitively — poverty and mental health are inextricably linked.

Unfortunately, our social service system is not built to deal with this reality. We have incredible programs (although clearly not enough of them) that connect people to mental health services and supports to prevent and treat adverse symptoms. We have dynamic initiatives that help people emerge from poverty by improving employment, increasing financial skills, and expanding education. Yet, too often, these resources are disconnected across sectors with the assumption being that they are separate issues. While the mental health/poverty dichotomy is poignant, the same could be said in other areas we well.

These lines were created by us and can be changed by us. We need to embrace holistic approaches that don’t do one thing or another — or even take one thing and tack on another — but perhaps combine the efforts, in an integrated and intentional approach that doesn’t see one thing as adjacent to another, but considers them in concert together. This has potential to change how we strategize, how we partner with others, how we distribute funds, and — perhaps — how we structure our organizations as a whole.

We are working hard at this every day at Norwescap, building an integrated system for comprehensive participant support. Follow our journey and leave your idea, question, or comment below so we can learn from each other.

Shifting Perspective

After nine weeks of commandeering my dining room table as a work location, I decided today was time for a change. When COVID-19 struck, my normal work-from-home office was lost by the demands of virtual education, so I shifted operations to a new location. The dining room spot was fine, with a nice view out the window and the thrilling backdrop of my coffee machine enhancing all my Zoom meetings.

Today, I have picked up and moved exactly 15 feet into another room and faced my workstation in the opposite direction. While the geographic dispersal is minor, it feels different. Is it better? I can’t say just yet, but the simple act of shifting perspective presents me with renewed energy and enthusiasm.

This is true in all aspects of our lives. Even when pandemics don’t threaten our public health, we are susceptible to living and thinking into ruts that lead us down well-worn paths. These rigid guardrails are not always bad, but they limit our creativity. In normal times, our work life builds in experiences that challenge these norms — new meetings, new places, holiday celebrations, conferences, travel — but, now all these things — both professional and personal — seem to happen in the same virtual “room” leading to a greater likelihood of falling into the malaise of the comfortable.

Sometimes, we just have to step outside the comfort of these pathways, to shift our vantage point, to listen to a new perspective, to force ourselves to think differently– if even for a moment. We can always return to what was good in our previous location or view. I may find myself back at the dining room table after all (or hopefully steal my office back when summer hits!).

So, if you’re feeling in a bit of a rut, shift your perspective — mentally, physically, emotionally, relationally. It might just be the change that you need right now.

Locally Vocal

Over the past week, we have seen the energy around the tragic death of George Floyd sweep across the world. Thousands have protested in large cities and small towns. Many more have voiced their sympathy, outrage, and distress on social media. The solidarity is powerful, even if the core message is threatened by cooption from all sides. We absolutely need collective voices to be raised to create the world we want.

As I navigated the long lines of cars in the protest in my town this weekend, I felt challenged to take the same level of energy and passion that we apply in response to a tragic national story and apply it every day to our local concerns. The core systemic issues behind the deaths of George Floyd and countless others are not isolated to those circumstances or communities but exist in every community across this country. It is true that some places have embraced equity more fully than others, but nowhere (yet) has inoculated itself against the ubiquitous underlying racism, inequity, and power imbalance that continues to haunt this nation.

What if I/we poured more energy into pursuing local anti-racist policies every day — at every School Board and Town Council meeting — with our neighbors and friends right here in the places where we live? What if we don’t wait until the next tragedy — cop killing, school shooting, racist Federal policy comes — but mobilize continuously? What if we avoid getting sucked into the soap opera of the incident and focus on the root causes that produce these incidents perpetually? What if we stop over-focusing on the drama of the players on a national stage — expressing our undying appall at what someone says or tweets — and shift more of that attention to what is going on right in our backyard?

We can do this — here, now, together.

I know there are many who do take this approach every day. I certainly do not claim to be an expert at this type of local engagement and acknowledge that I approach this topic from a place of privilege. I am humbled by all this and tempted to not click “Publish” to unleash my musings to the world, but I have to be committed to the hard work ahead. I am ready to be more locally vocal starting now. Will you join me?

Are you someone actively shifting your energy and engagement to local issues? Leave a comment below with your perspective. I’d love to learn from your experience and collaborate on creating the world we want to see, where everyone has the opportunity to thrive.

Digging Deeper

This morning arms, back, and shoulders are reminding me how I chose to spend my weekend. For about nine hours, the family and I created a fence enclosure for our new garden. This required digging three, four-foot deep holes for the main poles. The work was as exhausting as advertised.

As the hole went deeper, for a while I would occasionally set aside the post-hole digger and reach deep into the hole to scoop out the wet clay with my hands. It was a welcome occasional shift of muscle energy until at one point I thrust my hand down into the hole — and couldn’t reach the bottom!

When we dig deeper, we enter the unknown. The brute force that we could get by with in shallow ground no longer works. New tools and techniques are needed to reach our goal. The first time we push into that dark unknown it is unsettling, but the more we familiarize ourselves with the deep, the more adept we become at pushing further.

We live in unprecedented times when each of us are called up to exercise our muscles in new ways. We need deeper insight and compassion. We need to plumb the depths of our desire for social justice and community well-being. If we stay in the shallow end, I fear that we will just turn over the same dirt that we have before. Let’s dig deeper than we ever imagined.

Reshaping the Clay

In my work, I spend a good deal of time creating and analyzing logic models. These charts — most often oriented in a series of columns- are designed to give a snapshot of a program or initiative that aligns the inputs (resources involved) and activities (actions taken) with the anticipated outputs and outcomes (or results). Logic models are mandated by many funders to force their grantees to think sequentially, to act strategically, and to (theoretically) measure what matters. I find them generally to be useful tools, except for one small thing:

The world has a way of screwing up our perfectly-crafted logic models.

The clear lines of a logic model between “do this” and “accomplish that” make sense in a vacuum. In a sterilized laboratory, we can isolate the input variables and control for the outcomes. We can set a goal and take an action with minimal fear of contamination.

Most of us, however, don’t work (or live) in laboratories. Those of us dedicated to long-term community change find an ever-evolving cacophony of inputs, unforeseen assumptions, and winds of change that often take our pretty logic and scatter it haphazardly across the front lawn. These disruptions are often frustrating. They can lead to tough questions and feelings of failure. Yet sometimes they lead to better things than we had originally imagined. As painful as it is, disruption can create opportunities and open new doors of possibility that were inconceivable in our initial thinking.

The trick here is to recognize the disruption as the norm and the logical order as a useful illusion. It is to think of our models as an artist, who when the fancies change, takes the ball of clay and reshapes it into what it must be here and now.