The Writing on the Wall
About This Episode
“It was an experience that we could never have imagined…”
That’s been a consistent refrain in and around our country since the early days of this COVID-19 pandemic. “I could never have imagined living through COVID.” “I could never have imagined the number of lives that would be lost.” “I could never have imagined the toll this pandemic would take on Black lives.”
And yet, the writing was on the wall. As our world has become increasingly global, the spread of disease has become more likely, and the effects were bound to hit the most under-resourced communities the hardest. Add to that the role that social determinants play in the health of our communities, and we have to ask, “how could we not have seen this coming?”
There’s an old saying that “when white folks catch a cold, Black folks get pneumonia.” It’s often shared in the context of economic health, but in the time of COVID, it is even more resonant. And so this season, we’re digging in to how COVID-19 has affected us; how it’s affected our communities, our relationships, our understanding of the world around us, and of each other.
Along for our journey this season is the brilliant Natalie S. Burke, founder of CommonHealth ACTION and a true equity evangelist. Together, Carrie and Natalie will dig in to issues of public health through the lens of communication, connection, and of course, equity. We’ll explore how COVID has changed us, and where we go from here.
This is going to be a season of perspective-shifting conversations that will touch on faith, media, the economic recovery, and the role of philanthropy. We start this week with a big picture conversation with Natalie.
You won’t want to miss this one.
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Carrie Fox: Hi all, welcome back to Mission Forward. We are so lucky to be joined this season by the brilliant Natalie Burke, founder of CommonHealth ACTION, a longtime mentor of mine, and a true equity evangelist who is doing some of the most profound and important work in equity building, community building, and systems change today. If you are a regular follower of Mission Forward, you know that we’ve had Natalie on a few times in our first season with Mauricio Miller last season to talk about how racism harms all of us and this season, she’ll be joining me in every episode as we bring on guests across industries to take on an intersecting and crosscutting conversation about the future of health, how COVID has changed how we think about health, how we think about ourselves and our society and what we can do to stay focused on our health. Plus where we go from here, we’ll have some powerful and some perspective shifting conversations planned that will touch on faith, media, the spread of information, the economic recovery, the role of philanthropy, but we’re starting today with a big picture conversation with Natalie. So Natalie, thanks for being willing to dig into this with me. Thank you for inspiring this season, bringing me the idea to come together and really go deeper into the conversation that we had last season. And quite honestly, this opportunity to co-create the season with you. I’ve been thinking a lot about how often I have heard folks say in the last year how we could have never imagined living through an experience like COVID, right? And yet in so many ways, the writing was all over the wall. As our world has become increasingly global, the spread of disease has become more complex. And you know this firsthand having been in public health for the majority of your career, and to that, the role that social determinants play in the health of our communities and I think how could we not have seen this coming, right?
Natalie Burke: It’s not so much that we didn’t see it coming. I think that it’s an issue of power more than anything else. So whether or not we engaged in thinking this through in advance had a lot to do with who would be most heavily impacted by it all and who would be least impacted by it. And in fact, there are some people who’ve actually benefited during this time. And so avoiding this was not necessarily a high priority for people who were in power, people who have an economic motivation, but we’re not thinking about it to be really honest with you. And so when you look at how COVID has played out, who it has affected more than anyone else, you’re looking at people of color, you’re looking at communities and populations of lower socioeconomic status. You’re looking at people who work often in service industries and frontline workers, et cetera. And it makes sense to me that there was no one projecting into this space in a significant and meaningful way. And the result of that is really that much more harm was done than [inaudible 00:03:43] was absolutely necessary. I think a lot of lives lost, a lot of illness that has been experienced, a lot of economic loss and hardship that we’ve experienced as a nation. And particularly in communities hardest hit could have been avoided if we had decided that we wanted to value all people regardless of their identities. And in fact, within the context of their identities and where they sit in the world, if we actually chose to say that all people were valuable in the same way, COVID would have played out in a very different way. At least in my mind it would have.
Carrie Fox: If we think about it, if we zoom way out well beyond the country that we sit in today and think about how COVID was managed and contained in other parts of the world, what sticks with you as you think about how other countries addressed this issue?
Natalie Burke: This was definitely a learning on the job type of situation because the science had to catch up. So being realistic about that, but I think that messaging and narrative driven by leadership in different countries had a lot to do with how effective or ineffective government response was to this pandemic and the ability to tone set and to help the public understand how health happens, how a virus like this spreads, but also what our individual and collective responsibility is. What is my responsibility to my neighbor? What is my responsibility to other people in society? And what can I do to contribute to health, well-being, and quality of life as opposed to really contributing to illness, disease and early death, right? And I think the nations that did better had more of a collective consciousness and were less focused on individualism. I, me, mine, personal Liberty and those types of things, but really saw it early on as a collective effort that would lead to a collective benefit. And I think the United States didn’t get there. It just, we just didn’t get there. I still don’t think we’re actually there. I think there are some parts of the population, yes, and other parts absolutely not.
Carrie Fox: Trust comes to mind too, how much we perhaps learned about how much people trust or don’t trust one another, how much we trust society, how much we trust the news, how much we trust what is shared with us in those messages. And we’re going to touch a lot on that over the course of the season, but that’s sticking with me too that United States has so far to go to build trust and earn trust, right?
Natalie Burke: Mm-hmm (affirmative).
Carrie Fox: With communities that probably never had trust.
Natalie Burke: Well, it’s interesting because I think there are a number of different layers to that. So part of it is about building trust. The other is not eroding trust that is actually there. So there is for many people and in many communities and with many populations, there are certain segments of our society that have an assumed trust, right? That people automatically because there is an authority figure, because they have a title, et cetera, they are then trusted. And I think it’s not just that we haven’t built trust. I think we have undermined trust over time. And it’s so interesting because there are some things for which we have a very long memory and other things that our memories are incredibly short. But I think part of it has to do with this idea of narrative and the flow of information, the speed of information, the injection of misinformation and disinformation which is really intentional. All of that has kind of factored into who and what we trust and who and what we don’t trust. And I think confirmation bias absolutely has been a part of this whole thing around trust as well. People seeking out the information that is going to reinforce what they already want to believe is true.
Carrie Fox: I’m going to timestamp this episode and I’ll ask you to fact check me. Hopefully I’ve gotten this right in terms of the numbers, but here we are early May, we’re at about 43% of the US public vaccinated. We are still seeing a COVID crisis, deep, deep happening in other parts of the world and very specifically in India as so many countries try to figure out how do they get what they need to actually address and attack the virus. I think it’s part of that, that we wanted to come together to dig into because as we sit here as noted in May, more than a year after COVID first showed up and changed the way that so many of us think about life and one another and the systems that we’re part of, that we are still processing a lot of this experience that we’re in.
Natalie Burke: I think we’re processing. And again, I think this is around the issue of connectedness and relationship. So the United States then experience this in isolation, we experience this as a global community. And so the issues in the pain and the suffering and the loss and in the confusion that’s taking place in India right now has real implications even for the United States. And I think that there’s a lot of work for us to do to figure out what does it mean in the United States to be good citizens, good neighbors. And I think it also means what is it … It requires us to think about what does it take for us to be good global citizens and good global neighbors. So this issue around the availability of vaccine, right? We have a responsibility to step forward and play a role in developing nations, having the vaccine supplies that they need, and being able to distribute that and disseminate that as needed because we experienced this as an entire planet, as a world community. And as long as plane travel is a part of reality, this has implications and impacts for us, if you want to get that transactional about it to some degree. But I just think on a very human level, human suffering should matter, right? And the fact that we can do some things to help, we have to step forward to do those things because ultimately, there will come a time when we will need the help of our global neighbors for other things as well. So we’re in this together and I think that we have to begin to shift conversation and narrative in individual and localized ways, but also in very global ways.
Carrie Fox: Actually in one of the episodes coming up, we’re going to be talking about the role of our American democracy and how we sit in the bigger picture of the world. And there was some new research that was released just a couple of weeks ago around the lack of trust that our greatest allies have in our nation, that people in our closest allied nations see the United States as a threat to democracy.
Natalie Burke: Here’s the thing and it’s been very interesting for me certainly over the last four or five years to recognize that this is a period of time that has tested many of our assumptions. So these things that we talk about as norms, these unspoken agreements, it’s like when you’re driving down a highway and there’s a double yellow line, there’s a car coming towards you doing 70 miles an hour, and you’re doing 70 miles an hour. There’s an unspoken agreement. You’re going to stay on your side and I’m going to stay on mine. There’s so much within American society even when you look at how the constitution was written, that there are assumptions in there about the goodness and the integrity of human beings. And I think that what this time has taught us is that some of those assumptions were wrong. There are some things that we need to get clearer about in our democracy that requires legislation and structure and guard rails. But I think at the same time, and I’m hopeful that we are demonstrating that our democracy has been tested, but it actually is demonstrating resilience. We’re not over the hump by any stretch of the imagination. And I actually think that there are some more things that will rise to the top, to the forefront that may not be pretty, but there are things in a sense that have to come to the top to be cleared away. And I would like to believe that when all is said and done in a few years, we’ll be able to look back at this time and recognize that this was the time when we actually strengthened our democracy because we tested it as it has never been tested before.
Carrie Fox: And I agree with you. If I think back a year to when we were asking ourselves in large part in response to George Floyd’s murder, are we witnessing a moment or are we witnessing a movement that in a lot of ways, not always, but in a lot of ways it does feel like it is more than a moment and maybe it’s even more than a movement. It is a need to dig deeply in as you said to the systems that have so long run our lives and our societies. What can we use this moment to change?
Natalie Burke: I’m careful about the word movement for a lot of reasons. It comes with its own brand baggage and a host of other things. And I do think it’s important and serves a purpose in a role. When I look at this period of time, I don’t really think of it as a movement time. I do think of it as a period of evolution that is happening differently than other periods of evolution. Because with evolution, you don’t normally see the change happening and then all of a sudden the change has happened. I think that this is in a sense, almost like a mixture, maybe of evolution and revolution that we’re seeing it, but it’s happening in a way. And over a period of time that’s a bit of a mixture of both. And within that, I think that there are movements, plural, that will inform the evolution and revolution so that we come out to be whatever our next iteration is going to be. I think of it in that way in my own mind. Movements are fueled for that evolution in that revolution. And I think that that’s what we’re seeing. It’s not one big movement, lots of small ones where remarkable people are stepping forward to test assumptions, to lift up and create space, to give voice, to issue challenges, to actually say that certain things are not going to be acceptable and willing to take the risk associated with that. And that requires a level of bravery that I think we haven’t seen in a long time.
Carrie Fox: That is so well said and it makes so much sense because you’re right. All of those moments put together, all of those movements put together, that’s progress.
Natalie Burke: It is. It may not feel like it, sometimes it’s hard. I got to think it like this, but it’s like when you’re on a diet, and you’re down seven pounds and you’re feeling great and then you had that one weekend and you get on a scale and you gained back three. How did I do this? It took me six weeks to lose seven and in one weekend I gained three. Right?
Carrie Fox: It’s true, yeah.
Natalie Burke: I do think that that is the nature of our society. And it is the nature of how we’re in relationship, because this is all about relationship. So we know that part of, and social psychologists tell us this that part of what we do as part of our social identity is to organize into these groups where we identify with people who share things that we have in common. And then we categorize ourselves and make sure that we identify in similar ways. We may wear the same clothes, we may have something very much in common. So when we see folks who are like us and in our group, we can nod our heads like, "Yeah, you’re one of us." Type of thing. But in that process of identifying group, what we’re doing is creating an ingroup and an outgroup and we’re assigning value to one another differently and I want my group to be valued and valuable. So guess what? In the process of trying to elevate my own value, my own prestige and my own power, I am devaluing other people and other groups. This period of time is very much about how we choose to be in relationship with one another, how that connects to in many ways our identities, and what does that actually mean when we think about how we value some people and we value other people much less.
Carrie Fox: That’s the perfect segue into where we go next which is you just touched on it quite a bit, but this idea of our social identities and how we socialize with one another and how COVID has changed everything about that, about how we are together. I wish I could be in a room with you right now. We’ve made it work, right? But we don’t need to be, but as we are now thinking about returning to work, returning to school, how this time has changed everything about how we pray, how we come together, how we learn, and most importantly, truly how we are in relationship with one another. So I’m curious what you see. If you want to dig into that more as you look out across this society, trying to figure out how to come back together. What do you see?
Natalie Burke: First of all, again, I think this is a period that has tested assumptions. So there were things that we said about education could not be done. And in fact, we found that some things absolutely could be done. And at the same time, we had to recognize what we’ve lost. I think the same thing applies, whether you’re talking about education, whether you’re talking about the workplace. So employers have really big questions they should be asking right now about how do they re-establish culture. We curate culture. Culture doesn’t just happen. We make decisions even if it’s to not do anything, you’re curating a culture by not doing something. And so employers are going to have to really stop and think about, and some of these are employers who before said, "No, you can’t work from home." Or people can’t be trusted to be productive at home and so on and so forth. We’ve now demonstrated in so many different ways that that is possible and it is feasible. It may not be optimal. And so what is the balance? What does it look like to strike a balance? I think the other piece with regard to workplace is to acknowledge that people are not coming back as the same people they were a year ago or a year and a half ago. And so we have to figure out how to rediscover one another in the newest version of who we are coming out on the other side of COVID and that means that we’ve got to spend time listening to each other. I just asked our team yesterday and I said, "Look, I think we need to survey staff. I think we need to ask them what they think and feel about being in person with each other and how important that is and how that then fits into their lives because their lives have changed." People have gotten used to doing laundry while they’re on their conference call. It’s very different. And I also think even things like retail and commerce, our relationship to things has shifted and changed in ways that I don’t think that we really understand yet. So what I hope and what I encourage people and other leaders that I’ve been talking to from all different sectors and who do all sorts of things is to really go into a mode, a period of time. And I’m thinking at least for the remainder of this year that is about listening, learning and remaining flexible. So even if Washington DC is going to open up completely June 11, right? Just because Washington DC opens up completely on June 11, it’s not like somebody pushes a reset button and everything just falls back to the way it was.
Carrie Fox: Right.
Natalie Burke: That’s not going to happen. And I think on one hand, there are some things that we’ve lost that I’m sad to see that we’ve lost. But I also think that there are opportunities to do some things differently that could actually allow people to stand in their own humanity differently in professional environments and professional relationships. So hopefully we can find the opportunities in this as we recalibrate, as we decide to curate the cultures that we want to see moving forward as we figure out what it means to be in relationship in ways that are three-dimensional as we figure out how to touch and how to hug. And I never thought I would say this, but I actually want us to go back to shaking hands. There is something to be said for that.
Carrie Fox: It will take time for folks to feel comfortable again and I’m seeing it in my children, in the anxiety that my children are having, going back into places where there are even small crowds because for so long, they’ve been told, "Keep your distance." Now that our children are just naturally conditioned now to be apart from one another, that breaks my heart, right? To think that kids are always the best place to look for the best of humanity, right? So we want them to feel strong and comfortable and able to come back together. And so I think that there’s going to be, and actually, we’re not touching directly on mental health so much in this season, although maybe it’s one of the things we should on what we know is coming down the road that hasn’t even really revealed itself.
Natalie Burke: Oh, it started revealing itself. There’s not a question in my mind. So when you look at the spate of gun violence that we’re seeing, I do think it’s an outgrowth of this entire experience, I really do. And I think more broadly when I think about it, I think that we have to look at, and in some ways learn from the bookends of our society, babies and elders. So for people who’ve had babies in the last year, they’ve had this really interesting challenge of babies learn facial expressions to talk and communicate in that first year in so many different ways that require this. And they’ve been doing that with masks on. And so what does that mean even for them and their socialization and what does that look like? Because quite frankly, I don’t think it only applies to babies. I’ve realized as I’m wearing my mask when I’m out in the world, sometimes I’m smiling at people and I’m like, "Let me make sure I’m smiling the whole way to my eyes so that they know that I’m actually smiling."
Carrie Fox: That’s true.
Natalie Burke: And then I think for elders, I think that they have become incredibly aware of their own fragility from a medical standpoint. And I think for many of them, it has manifested in their spiritual lives, new and different considerations and explorations for seniors with whom I’ve been speaking, we’ve talked about not just worship in a traditional sense, but really a spiritual awakening that this period of time has made their mortality very present for them. And that, that has really serious implications for them. But also the question of re-entry, what does it mean for them to re enter socialization and connecting with people and so on and so forth? So I think we need to take our time, Carrie. We can’t jump into this. Nobody knows exactly how to do this. There will be some trial and error. And my hope is that we can extend grace to one another.
Carrie Fox: No, I know you’re an avid reader as I am in one of the books that’s on my mind, especially as you’re talking is Atul Gawande’s book Being Mortal. And he talks a lot about the systems of putting our elders in nursing homes and what that changed about society going back to when there was never a thought that we would put our elders in a nursing home. They would age in place with their children, and then thinking about COVID, again, it’s a system that will be good to watch and see how it will evolve, creating more space for our elders to stay in place, to stay in their homes and to think about how that family unit stays together when it can.
Natalie Burke: I think in many ways, relationships with elders that have been taken for granted, I think people now recognize the value of our elders and a new way in a different way. And I know families are having different conversations. There’s not a question in my mind, and I’ve had a lot of folks to reach out and a lot of conversations with different groups about this, that families are having those different conversations. That’s why I’m saying this is a mixed bag. In the midst of disconnecting from each other in some ways, I think we have connected to one another in other ways. And I think the key is to figure out how to make the best of that, how to amplify that and how to make that increase in value over time. I’ve never seen the inside of so many people’s homes, so many pets and children, and it’s been wonderful in that regard because I think particularly in a professional sense for those of us who had the blessing of being able to work at home, people were humanized. When you’re in the middle of presenting an Amazon delivery, first, it comes to the door and you’re trying to ignore it. And people are like, "No, just go ahead and answer the door." It’s this recognition that life continues. And I hope that we remember that even in the midst of so much loss.
Carrie Fox: This is such a small example, but for 20 years now or so, I’ve run my own company and I’m not sure I ever took a lunch break in that 20 years. My idea is I work through, I work as efficiently as I need to because I want to get home and be with my family at the end of the day. But here I am now working from home with my children in the next room and I take a lunch break every day to be with them, in large part to make them lunch, but also to take a break.
Natalie Burke: Yeah.
Carrie Fox: And so there is something you’re right, there are things that then I hope we hold on to that I know I will hold on to on being more aware of my pace, the pace of the work, the pace of our society and how we … That is in our control to slow that down.
Natalie Burke: Absolutely. But, and I think it speaks to you doing that, speaks to the fact that you have to be present in order to be in relationship. It doesn’t happen otherwise. And so I think I know personally as it relates to my family and particularly as it relates to my parents really pushing and saying, "I’m not just going to send a text, I’m going to call, I’m not just going to call, I’m going to FaceTime." To reach beyond the boundaries of what would have been normal and acceptable before and to say, "I need to push to make sure that we’re connecting." It’s important and I don’t think, I know for me it’s not going to go away and it’s not going to go away quickly. And I think that’s something that I can say, "Okay, I’m thankful for this in the midst of everything that we’ve experienced."
Carrie Fox: All right, we’re coming to the end of our first show. So let’s paint a picture for folks of what is coming up. And what I don’t want to step over to quickly is the role that social determinants of health will play as a thread and an undertone to this entire season. And so I wonder first, if you’ll just give a little bit more about what are social determinants of health, what do we mean when we say that to make sure that the folks who are listening to this season have that grounding and that knowledge.
Natalie Burke: Well, it’s interesting because it connects to the very first question you’ve asked around how did we not know that COVID could happen, how were we not prepared? And it connects to the response that I actually gave with regard to these issues around power. So the reality is your health is not an accident, it’s a production of society. It’s about 10 to 20% genetic, 30 to 40% based on your personal behavioral choice, do you eat right, diet, exercise, engage in risky behavior, wear a seatbelt, wear a condom, your hands, wear a mask, right? But the other 40 to 50% is really determined by the systems and the institutions that create the context and the constructs within which we live our lives and make our decisions. And those are things like housing, education, transportation, structural racism, built environment. These are the things that are around us, employment. These are the things that are around us every single day that determine what choices are available to us and what choices are not available to us. And the choices available to us have a lot to do with whether or not we have the opportunity to be healthy. And so if as a society we are committed to the health of all people, it then requires us to change those systems and institutions in ways that are equitable and fair so that people have those opportunities to get to their best possible health. That means that housing inequities need to change. That means that inequities in education need to change. That means that wage inequities need to stop, and all of this ties back to what does it mean to value people and to be in relationship. The reality is those systems and those institutions are not an accident. They are actual products of decisions that have been made for generations. And so what does it mean for us? How do we change the narrative and how do we change how we value one another so that different decisions are made, so that different policies are set forth, so that we have systems and institutions that are equitable and create conditions where health is a real possibility and then the rest can be left up to an individual. But the reality is if I don’t have certain things available to me because of where I live, if I am exposed to lead in my water or poor air quality. If I don’t have access to K-12 education, my earning power will be decreased. If I don’t have a good federally qualified health center in my community, what’s going to be the quality of my primary care? There’s all kinds of things like that, that every single day determine whether or not people have the opportunity to be healthy. And so the conversations I think that we’ll have this season time and time again, we’ll go back to this thing around social determinants of health. And even if we don’t use the jargon, it’s still there. These are the structures that create opportunities for health, well-being, and quality of life, or the structures and institutions that create illness, disease, and early death.
Carrie Fox: And what I want folks to hear who are listening is that if we’re talking about phrases like systems change, what does that really mean? That as we’ve talked about before, that really what it comes down to is that’s human change, right? It is in each one of our positions in the design that we make and the decisions that we make to contribute to a healthier society. And so I want folks listening to understand that every decision they make can contribute towards a more healthy society, whether they realize it or not. And I think that a lot of the conversations we’ll have this season if we’re talking about what we read, where we put our dollars, where we shop, where we support, how we think about supporting our colleagues and our employees, every single one of those is an action and a lever that we can pull to drive towards more equity.
Natalie Burke: We have way more choices available to us than we actually exercise. And it was interesting the other day I was looking into policing and policing models in different countries and so on and so forth. And one of the things that I read they were talking about in a recent survey of police in Great Britain, they found that 90% of them still don’t want to carry a gun. Their model of policing, their tenants of policing, if you read what they say about the relationship between police and community and the role of police as members of community, the tone is completely different. And so using just policing as an example, we have an opportunity to change the culture policing in such a way that police are trained and socialized to be guardians of communities as opposed to being warriors in communities and that’s a choice, it’s a choice that we get to make that can be effective and it’s about changing how people are in relationship with one another and how they value one another and about power.
Carrie Fox: Oh, I feel so incredibly lucky to get this time with you this season, to be able to share, listen to and learn from your insights and share them. So thanks Natalie for taking this time and looking forward to all of the episodes we have coming up.
Natalie Burke: Same here, thanks for having me Carrie, and more for the next time.
