The Keys to Driving Generational Health, Well-Being, and Justice

MARTIN:
I am Drew Martin. I am the Director of Strategic Partnerships, here at WE in the World, and I live in Champaign, Illinois, beautiful part of our state.

SOMAVA SAHA:
Hi, Drew, it's great to see you again. I’m Somava Saha, President and CEO of Well-Being and Equity, of WE in the World, and I'm joining you today from Pelham, New Hampshire.

So, Drew, we just finished an amazing gathering, that brought together just about everybody you could imagine, youth and people who are young at heart. We had community members including barbers and farmers and health system leaders. We had federal agencies and funders, and we had community organizers and computer science geniuses. Like, it was probably one of the most diverse rooms I've been in.

And I'm just wondering, as you were going around talking with people, what were some of the things that people were saying that stood out to you? And what were some of the questions that are still circling around for you?

MARTIN:
Sure. I think that one thing that stood out directly are people are ready to move. They're ready to see their communities transform.

They are no longer accepting the status quo. I was moved by the amount of coordination amongst people, you know, different political views, ideologies, ages, and socioeconomic status as well. It felt like a true, true community. It felt like a true movement, as well, as we, you know, look at, you know, like our, you know, as we look to be better ancestors, as we look to leave, this planet as work, and better hands.

We received it so maybe I may not see it, but for sure, maybe my son, my ten-year-old boy to see a world that's, you know, truly just. And, you know, made for him so, yeah, I was moved by that. I was inspired, you know, I think people used that word, I was inspired, and I was really inspired.

Like, I feel like this, this time for real, we're ready to see transformation, but we do.

SAHA:
Yeah, there were so many moments that were, that people described as like, changing, and I know, I just felt that, you know, when we talk about being better ancestors, you know, some of what I think about is how do we, as ancestors, how do we understand what's happened seven generations in the past that got us here?

And how do we look forward seven generations in the future to build the world that we want to see? Like, what does it mean for us, for you and I in this moment and for all of our colleagues in public health and communities, everybody who's working to build health equity and well-being, for everyone, to create a world where everybody can thrive.

How do we, how do we look back at the past to understand where we are and look at the present and look in the future? And one concept that I think has really been moving for people is this concept of the vital condition, this idea of a set of things that are not about what they need over there, but about what we all collectively need, together, grounded in, at the at its heart, in belonging and civic muscle and equity and justice as a poor.

And then around that the things all of us need and really in a way, whether communities have those things or not, has a huge impact. We've learned on our health and well-being, whether you live in or and grow up in a community that has enough humane housing or has or gives us, access to meaningful work and wealth through which we can afford and access our basic needs for health and safety and food, whether we have access to lifelong learning to breakthrough generational cycles and a sense of grounding in our community and culture and that thriving natural world, whether we have access to reliable transportation to visit one another or to get to work and whether we are able to, you know, have digital equity. These are all things that matter in terms of people being able to live a good life, to be able to be in community together and to be able to contribute toward our world. And I just wonder, as you heard people, in this gathering, what were people thinking about as it related to the vital conditions.

MARTIN:
I think once again, they saw that as a pathway to justice, as one of the pathways to justice as well.

People saw it as, because of the diverse group, everyone was able to hold on to it, which mattered as well, like it felt more community and less individual. It felt, like, more interconnected. and you know, as well, but the one question that people get hung up on sometimes, our acronyms. Right and sometimes the terms, so there were people that were correlating social determinants of health with vital conditions and I've learned recently that there is a clear difference between the two.

So for the audience listening in or who will listen, who may have that same question, what is the difference between what we see as social determinants of health, versus, vital conditions?

SAHA:
Yeah, and I think that, you know, there are so many ways in which they are, in fact, incredibly similar, especially in their purest form.

But I think in answering that question, I'd say it, is two things. One is the frame. The social determinants of health was used by public health professionals to communicate with one another, to advocate for the idea that health is not just about medical care, it's about all these other factors that have to do with whether people have the conditions they need to thrive.

Things like food and housing and transportation and access to like, lifelong learning. In some ways, that sounds a lot like those vital conditions. But because the the goal was to communicate to other public health professionals and others in the field, it didn't take well into account for community residents who are experiencing those things might feel in hearing that term.

And the first critique that I've heard from community residents is you're saying that it's a determinant of health. That means I don't have a choice versus a driver of health. And that which is, of course, how it's intended. So the idea was, you know, can we initially that, you know, these things to drive your health outcomes? We need to stop blaming individuals and instead start accounting for all the other ways in which their health is defined more broadly.

The second part of that has happened, so for communities that sometimes felt limiting, in addition to that, and it failed deterministic or even more than limiting, and it gave people a sense that they don't have a choice of how they are or aren't able to be in a different circumstance. More importantly, what it left out because the frame wasn't how do we create the conditions that all of us need to thrive. It didn't include things that communities said were absolutely critical, which is the sense of belonging and justice and civic muscle that is at the heart of our culture and community now. No framework or term is perfect and, you know, fragile conditions themselves are part, are just one way of seeing the world.

And, I don't know, it alone, is it speaks about if you especially if you only look at the graphic, what it does beautifully is center things like belonging and civic muscle and equity and shows that the other things are connected to one another. It's powerful to represent it that way, when it, of course, really begs the question.

I often think of them as pupils of an eye. What it doesn't include is how did we get here? To some people in some groups, some places, having all those vital conditions, they might need, or many of them and others being categorically left out of many of them or having insufficient resources. What we know is that is an accidental that that's defined by past and present choices and, that we make about policies and investments and systems.

That leaves some people out, that leaves people in under conditions of adversity rather than having those final conditions. We all need to thrive. And so I think, one of the ways in which it's it's useful as a frame is to help challenge the system that is or isn't creating those special conditions for everyone. John Auerbach and Brian Castrucci, did something really helpful in the field.

They actually differentiated social needs, which is about what an individual might need and efforts to help connect people to an individual, to food or housing or even a family, to food or housing or transportation with what's needed to create the conditions for communities to thrive. And they called those social determinants. So there's been some effort to even clarify social determinants further into social needs and those community conditions.

We find that vital conditions just help to differentiate that in a way that really gives it lift and it rather than focusing on that distinction, it helps us ask, why are these community conditions not in place and what would it take for that to change?

MARTIN:
I'm glad you said that last part, because I think that helps me as well. You know, when we look at our pathways to population health equity and we see our balanced strategies, you know, the physical and mental health and the social, spiritual well-being and how we see that as improving the health and well-being of people.

But in order to have that balanced strategy, you look at the right side of around, you know, these vital conditions and, you know, eliminating those root causes, that's, not allowing us to have, you know, true justice, you know, where we live, and how that improves the, the well-being of places, and environments as well.

So looking at it as both improving the well-being of people, but at the same time improving the well-being of, of communities. So seeing I could see as well, seeing using those social determinants of health and seeing as a, as a part of social needs, which is a vital condition as well can you just maybe talk about that just a little bit more or maybe further explain it?

I want to make sure I capture that right. When you're saying social determinants of health and those when we look at vital conditions as a whole and we see social needs, as well.

SAHA:
So I think social needs are social needs. So when an individual needs for their mental and physical health, their social and spiritual well-being, one person at a time, that's what we would describe as portfolio one is mental and physical health, and portfolio two is social and spiritual well-being.

The real issue, Drew, is that people get it confused all the time, which is why we develop pathways to population health. Like we just to make it a little clear that, you know, here are these portfolios we need to take care of people who are experiencing harm after a hurricane, or if they're in a community which doesn't have a lot of housing.

People might be experiencing homelessness or food insecurity. Those are things that connecting a person to those things is addressing their social needs, making sure there's enough food in the community, and that's affordable and high and healthy for you, making sure that, community has enough affordable housing and enough access to meaningful work and ways to build generational wealth for you to not just be able to afford that food and housing today, but to be able to build, a cushion, to be able to pass on something to future generations that can help them ride out, challenging situations.

Those are all things that we call those vital conditions. And that's portfolio three, those community conditions that everybody needs. And embedded within that area is the ability of a community to take stock of itself and work to improve it. And that sense of belonging and civic muscle, this idea that we belong to one another and together we have enough.

Individually, we might not have enough, but collectively we can actually change this system and change our communities for the better, to change or transform our nation in a way that builds justice for the long term. That and in a way that addresses those root causes. That's what we call portfolio for in pathways to population health equity. That doesn't just say is there enough housing, but asks why did we not have housing in the first place?

And how can we shift policies and investments to do that? All of that requires that sense of belonging and civic muscle. It requires a different social contract with one another, and it requires us to know that that equity is a pathway to abundance.

MARTIN:
Just, just to be clear, when we're talking about conditions, because I've heard different numbers, and different levers, we're talking about the seven levers here, meaningful work and wealth, reliable transportation, lifelong learning, belonging and civic muscle, humane housing, basic needs for health and safety. And then a thriving natural world and belonging and civic muscle, you’ve mentioned a few times, always sits in the middle of those kind of vital conditions.

Well, and it reminded me of, of a well-being survey that was done, with central Wisconsin, pretty diverse area of Wisconsin by 3000 respondents, 50% of them, you know, described themselves as struggling, or not thriving. But when they, you know, ranked what vital condition hinders their community the most, 35% of them said belonging and civic muscle.

Why is that so important? to the overall bottom conditions when we're, you know?

SAHA:
It's the thing that gives you what you need to move all the others. That's why it's so important. It not only is a sense of belonging that is essential for your own health. It turns out that if you experience discrimination four or more times in a year, it takes five years off your lifespan to experience signs of racism, experiences of, class inequality, but experiences of discrimination because of a mental health condition, your weight, whatever that might be.

If you feel discrimination or that you don't belong, then you. It directly hurts your health. But more importantly, if you and I don't feel like we belong to one another, like if I don't feel like you belong in this community, or you don't feel I belong in this community, then not only might we not work to create a community where we can have a fair chance for everybody, but we might work actively to exclude one another from that fair chance, right from the opportunities that we might each need.

And even more importantly, if we even, if we believe we, belong and or if we're not just belong to one another but are interconnected, even if we believe that you have an essential gifts that this community needs, and you believe I have, that if we can't bring those gifts together to create a community that is going to work for, not just us, but for our children or grandchildren and seven generations to come.

That's civic muscle. Civic muscle is our capacity to organize our resources, our assets, our ingenuity, our ability to think and our commitment to a just community and a just nation. It's our ability to organize all of that in a way that changes our community and our nation for the better. That creates the conditions for everyone to have that fair chance at well-being.

And to me, that's I think the reason people value that is because we know that if you live in a community where people have lost hope, that's actually where people have high levels of deaths of despair. They no longer believe it's solvable, and they may be much more prone to someone promising them something. Whereas if you believe that you, as an outside solution, versus being able to understand what it looks like for a community to come together to move something.

Whereas if you if we know you and I know that was not actually intended as a political statement, just to be really clear, if you and I, because this work has resonated in communities all across the country of every different political type that one could imagine, if you and I believe that we can solve our problems together if we come together first, belonging and civic muscle tells us that we are more together than we're apart.

And it tells us that by creating the conditions for us to put those pieces together, we can achieve more and not just something that we say. It's something that you and I know we've seen live many, many times. Drew what are some of your favorite stories of seeing some of that?

MARTIN:
I know that's going to I just want to ask if you wanted to, I want to play a game with you.

I want to talk about a community in Illinois that is a bright spot, that is doing unbelievable work to, for there for individuals, and their community to thrive. And I would love to pass it to you, Somava, to see what it would look like for them, to look seven generations, for them to create conditions for their children and their grandchildren to thrive.

And is there a community in this country that lives in that, along the same, and while they're both trying to solve the same, the same barrier in a lot of ways. So, this community is Will County, Illinois. It's, made up of two coalitions that we have the privilege of working with, with one of our projects called Arise.

And in Will County, you have a community, Senator Warren Sharp, that, was developed, donated a plot of land right next to that community center and had a dream of building or having a garden. the city condemned that, or soils that the soil wasn't suitable, to grow. So a volunteer, heard the story. He happened to be a trained chef that just retired and decided to build raised bed. and now they have a thriving garden with 20 elementary and middle school students, as gardeners and learning, getting foods, you know, learning, understanding food certifications and, understanding, you know, a better way of growing, and, you know, nutrition. and obviously this garden is, is expanding, you know, other entities around the neighborhood would like to have the same thing.

And it's truly they're truly seeing what belonging and civic muscle can do. And then you have also, you know, the health equity team at the Will County Public Health Department, that decided that they're just the traditional food pantries were not enough. They weren't open on certain days. They weren't 24 hours and you never know when someone is in need of food, when someone is in need of toiletries, or things like that.

So, they started developing, micro pantries, and started having community partners like churches and other, businesses offer up, you know, a piece of their property to build these, micro pantries where, people in need of food or people in need of, bandages or anything like that, or this resources will be able just to open up this door.

And, you know, and, kind of improve their health for that, for that, period of time, you know, and both of these are expanding, once again, the entire county is seeing, record numbers and people come and go and health fairs, record numbers and donations of food and, and clothing, so that they're starting to see what it looks like to have that belonging a civic muscle, the seven generations ahead.

What does it look like where my food pantries and, you know, embrace, small plots of land is now fields and fields, of land where people are growing and thriving? Somava, you have a story of what that may look like. for a community like Wheel County.

SAHA:
Oh, my gosh Drew, I have gotten to see I have a front row seat to some of those stories, and one in particular really stands out, in Canadian, North Carolina, where, under the leadership of Reverend Richard Joyner and an entire incredible group of leaders in that community, who began not even from a health perspective, they began from a place of not wanting to do funerals anymore for people in their 30s and 40s. They were watching their children and their youth were losing hope. All they really wanted was to have their families there to watch them graduate from high school. And that, you know, when we really translate these numbers that we look at in public health to real lives, that's what it means to have a community where the life expectancy is ten, 20, 30 years slower is that kids don't have their parents reliably around to watch them graduate.

And so when we think about that and think about what the implications are, they could see that people were diabetes that were dying from things like diabetes and heart disease. And of course, they did things to help educate people. But what they began doing is saying, you know, what could we do that brings hope and agency back? And what they began with the small community garden, just like you're talking about in Illinois, all those years ago.

And as they grew that community garden rather than just using it to grow food for health effort, they used it to grow food to create wealth and well-being. They created agro businesses that could help young farmers and young beekeepers, some starting at the age of five, to begin to grow a sense of agency and hope to begin to grow their own health and wealth together.

And as they began to do those things together, they began bringing lots of other people along faith communities that began growing, first, using their assets of land in black churches to begin to grow wealth that is now not only have they then connected that with health education and, you know, tele visits and all of those things to connect people to health.

But they were able to get people, get youth to get familiar with those vegetables and fruits to delight in not just growing them, but eating them and addressing things like mental health and trauma. Something that turns out that reconnecting to land is a powerful way of beginning to do. And so, what you see over the course of the next 20 years is a community that used to be one of the worst food deserts in the country, now become a food oasis that is growing, food that is growing, community that is growing that sense of hope and possibility.

Back in the nation. 90% of people in Canada turn out to vote. It's because they believe their voice matters. And regardless of what they choose in their votes, what matters is they're a community that knows that their voice counts and that together they can begin to solve real things. That is now shifting to a model where health systems and others are partnering with Canada and other black farmers across North Carolina, like Operation Spring Plant and Glow House to begin to say, how can we as health systems not just treat people after the fact?

Addressing their downstream medical needs or educating people, but how can we be part of interrupting these generational cycles in a way that builds these vital conditions? And one of the biggest things that health systems can do, and public health systems can do, is buy food from generational small farmers like black and indigenous and Latinx, farmers, too, and small, farmers, as they buy that food, those folks are then able to stabilize, their land and their use of land.

They're investing in regenerative farming practices. And as they're doing that, they're doing farming in a way that's better for the environment. They're creating generational wealth. And as they do that, they begin to create new legacies that are not just breaking a generational cycle in one's own health, but in building new generational cycles. That creates abundance. Because Drew, it turns out that if we keep paying for the cost of diabetes and heart disease at their current rate, we will go from health care, going from 18% of our gross domestic product to 100% of our gross domestic product by 2064.

We can no longer afford, as a society, to leave inequities and to leave poverty unchecked. Healing. These generational cycles are truly about creating the conditions for all of us to thrive. And if we we have to this moment, we have this opportunity to go from people who have been taking away from the earth, taking away from one another's health, to creating the conditions of being a people that belong to one another, that belong and can be restorative in ourselves and be restorative in our earth.

And I think that the best invitation in these opportunities is to know that we could, these aren't just negatives, spirals. They can turn into massively positive spirals of well-being and equity and hope. If we give ourselves permission to ask how.

MARTIN:
Yeah. Thank you so much, Somava. That was an unbelievable story of transformation looking seven generations ahead and the wonderful work that's happening in, East North Carolina.

That's I believe what I'm seeing now is, is motivating the country as well as a story is being told. If you want to hear more about, Canada or, any of our other available partners that's transforming our country, for the better please, check us out at weintheworld.org.

That’s W-E in the World dot org, and more information. We mentioned things about pathways for population health equity and our balanced strategy framework. You can see that and learn more at publichealthequity.org. Once again that's publichealthequity.org.