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Radical Redesign and the Door to Transformation By Jamie Harvie P.E.

I’m a believer in synchronicity. For that reason, I’ve been thinking about two recent Huffington Post blogs which appeared within the span of a couple weeks. The first was one by John Weeks, editor of the Integrator Blog entitled “Hooking Up: Don Berwick, Integrative Medicine and His Call for a Radical Shift to 'Health Creation'". The other was written by retired Bay Area Physician and Soda Tax Champion Jeff Ritterman, “Can a Hat Trick Reverse Obesity?” I was intrigued, because through my lens, these blog posts were intimately connected. At one level, Ritterman’s article highlighted the Commons Health Hospital Challenge, a project initiated by the Institute for a Sustainable Future, and strongly supported by integrative clinicians referenced in Weeks’ post.  More deeply, I was excited because together they begin to frame the necessary new narrative about health, connection and relationship.

Weeks’ wonderful article highlighted the important and foundational role of the integrative health community in health creation and captured how a huge door to the transformation of our health system is swinging open. This past November, another door of transformation opened at the 2013 ABIHM (American Board of Integrative Holistic Medicine) review course, when  ABIHM President Mimi Guarneri announced the formation of the new Academy of Integrative Health & Medicine.  The Academy will be an umbrella for licensed health practitioners who will be, according to Dr. Guarneri “standing together in the name of health, not only of people, but of communities and the planet”.

This united front of clinicians may be one piece of the “radical” Don Berwick was referring to in his remarks at the recent Institute for Healthcare Improvement Annual Conference  (and highlighted in Weeks’ blog) where he suggested that, "The pursuit of health, the creation of health, may require something even bolder. The redesign we need may be even more radical than we have imagined."

My guess is that for many in the highly specialized bio-medical model, the notion of physicians, nurses, naturopaths and other providers working together is radical. Moreover, the idea that the health of individuals, community and the planet are somehow connected is equally radical. However, this concept appropriately acknowledges that our health is influenced by factors outside of hospital walls. More importantly, implicit in this emerging model is the vital importance of “power within,” social relationships, connection, openness rather than hierarchy, control and power “over.”

I think this is really what Berwick was referring to when he referenced how the  redesign we need may need to be more radical—perhaps this is because we have built western medicine on a top-down hierarchical worldview.  It IS radical because instead of a redesign, we appear to be in need of a fundamental shift in operating principles with a narrative built upon a new consciousness.  And that consciousness is embedded within the truth of the interconnections between health, individuals, community, and the planet that most of us can intuitively recognize.

Among our major collective challenges then, is how we tell this new story together. This question was raised in the recent JAMA opinion, Finding the Role of Health Care in Population Health, in which authors Eggleston and Finkelstein remind us that “the increasing inclusion of a population perspective is not a natural evolution for the US healthcare system. In fact, it is counter culture in a society that values personal independence and is often mistrustful of the centralized efforts of large organizations, public or private.” This “truth” is reinforced daily through our culture’s promotion of material gratification and through pervasive advertisements that reinforce the notion that material goods bring us love, happiness and satisfaction.

Also prevalent in the popular culture is the primacy of the “quick fix” and the promise that technology and science (the false promise of GMO’s) hold the answers to humanity’s ongoing problems, rather than the equally important exploration into relationships, connection, intuition, and the arts. This concept is captured brilliantly in Annie Leonard’s Story of Stuff.

A strategic approach to support this radical redesign must then include the construction of an alternative public narrative. One that connects us in a vision that allows us to wake up, each day with purpose. This new narrative will necessarily highlight connections, networks, collaborations and the ability for each of us to affect change. Perhaps that is what I saw in Ritterman’s blog, which tells us that there are often interrelated solutions which offers success and hope when we become “agents of change” working together. 

Threads of this narrative are elsewhere. Consider the increasing coverage and appreciation for the benefit of health care teams in media such as the Wall Street Journal. Or  the idea of teams and collaborations though a different, but equally important lens. The Evergreen Cooperatives, a partnership of the Democracy Collaborative and Cleveland anchor institutions including the Cleveland Clinic and University Hospitals, have together helped create a laundry, solar panel business and one of the largest urban green houses in the country, all new worker-owned collaboratives, in one of the poorest zip codes in the country. These are all exciting, successful health creation models. Finally, we see other threads through the partnerships and collaborations of labor, environment and clinicians providing necessary transparency to support safer chemical policies, through clinically relevant data bases such as  ChemHat, the Pharos Project  and the Collaborative on Health and Environment Toxics Database.

We are at an exhilarating moment when opportunities allow us to strategically seize and advance a culture of health creation. Issues such as climate change, toxic chemical and body burden and food systems inform us about the connection between human activity and the resultant influence on people, the planet, and health. Similarly, rising inequity, health disparities and adverse childhood experiences have invigorated a focus on the social determinants of health. These offer us both a reminder that health is created in community and an opportunity to acknowledge and address the role of race, class and gender hierarchies and institutional racism in health inequities.   

If we are wise, we should think about how to weave and embed these strands together and cultivate an alternative narrative in our collective work, allowing a new consciousness to arise. It will have to reinforce how we succeed through cooperation, connection, collaboration and relationship. It will include transparency, the power of agency, and the ability to affect change. Finally, it will embody humility and importance of loving and valuing everyone equally.   

At a local level, this movement will require community organizations--those working on issues such as affordable housing, food access, and livable jobs--to tell the story of their vital work through the lens of health creation, rather than charity and service. It will support inclusion of health affected communities as partners in decision making through Community Health Needs Assessments and development of  Accountable Communities. And finally, it will require us to invite our local hospitals to collaborate, rather than compete. As Dr. Guarneri astutely stated in the Academy announcement, “We don’t need more pretty green buildings competing against one another.”

The principles upon which the integrative health community are built are ideally aligned with this broadly focused narrative. I’m eager to explore how the many allies in this work connect with this wisdom as we co-evolve a shared new consciousness and open the door to transformation. I’m equally excited to hear what ideas you might have for this 'radical redesign'.

(Originally posted here on the American Board of Integrative Holistic Medicine website on March 10, 2014).

Jamie Harvie P.E. is the Executive Director of the Institute for a Sustainable Future and co-creator of the Commons Health Network


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