Ten years ago, I moved with my family to our present home in Mountain View, California. Mountain View is the home of Google, in the heart of Silicon Valley—two towns over in one direction lies Stanford University and Facebook, and two towns in the other direction lies Apple.
We moved because of a job offer for me, but we had other reasons for moving, too: we had always wanted to try living in a completely different environment than the East Coast. I felt compelled to take on an elevated leadership and management role at my new job. And our kids were juuuussst young enough to make the transition from our friends and our extended family members a little less frightening.
In moving to California, I left what turned out to be my most beloved work situation; ten years at the Robert Wood Johnson Foundation, working in communications. During my time there, I worked on an amazingly rich array of subject matter—uninsured Americans, supportive services for older people, unacceptable inequities in how groups of color accessed healthcare services. And every day was a learning curve, when it came to understanding the content I was communicating about (nostalgia alert: that used to be considered an important attribute of being an effective communicator, and someday, I hope it will count again).
To boil down what I learned: pretty much everything can have an impact on your health. Where you live, the educational backgrounds of your parents, your cultural beliefs and norms, whether your community has access to fresh fruits and vegetables, whether you have insurance, whether you have enough insurance, whether you can access care in a doctor’s office or hospital, whether the care you receive is the right care for your issue, and is delivered in a empathetic, culturally sensitive way, whether you can master new routines and behaviors related to a chronic disease—everything, literally everything matters. And at Robert Wood Johnson Foundation, we actually worked on almost everything. About the only thing we didn’t work on was genetics—i.e., the hereditary blueprints we inherit from our parents and ancestors.
Now: communicating about these issues was not easy. I don’t think communicating about any massive social challenge—like improving education, or the criminal justice system—is easy. After spending some time communicating about these social challenges, I’m pretty sure I would find it far easier to communicate about, say, a new brand of ice cream. So when it came to communicating about complex social challenges like a person’s health or healthcare—well, let’s just say that we had to pick our shots and constantly figure out where we were in the lifecycle of people even understanding why something mattered. Like: it sometimes felt hellishly tough to communicate about the challenges faced by people lacking health insurance, simply because for the people who DID have insurance, they often couldn’t be bothered to care about the literally millions of other people who didn’t.
(This, by the way, is one of the truly sad and peculiar quirks about American culture: we don’t seem to understand that when we help everyone, everyone benefits. An oft-used cliché we used to explain this: “A rising tide lifts all boats.” Unfortunately, many Americans have adopted a different motto, especially under Trump, which is, “F–k everyone who doesn’t have a boat already.”)
Facing communication challenges like that, we often had to, as I said, pick our shots and also, stage things carefully. So first we had to determine: where are people at when it comes to their awareness that this issue is a problem? (The answer is almost always, by the way, COMPLETELY CLUELESS.) And if we were dealing with a low awareness of the problem, then we’d have to define the problem, and find emotional, engaging ways to communicate both the research that demonstrated the extent of the problem and also, the very real, heart-wrenching, human stories at the heart of the problem.
So, to take my earlier example on uninsured Americans: we communicated about research that illuminated the challenges uninsured Americans face. We also shared stories of the incredibly brutal economic choices faced by hard-working Americans who worked three jobs, yet still couldn’t afford treatment for cancer. (Thus debunking the common message from conservatives that people who lack insurance are somehow “lazy.”) We built coalitions across political lines (nostalgia alert: it was a time when one could still do that).
I look back on this time with RWJF and I feel like I had the opportunity to learn the most and do some of my best work as a communicator, then. But despite feeling proud of the impact that my colleagues and I helped to create, I still look back on the communications challenges I and others worked on and wonder: were we too focused on the problems? Did we spend too much time communicating, over and over again, about the extent of the problem and who was suffering the most? Did we not focus enough on communicating about the possible future we were hoping to create?
If there was an imbalance going on—in communicating too much about the problem and not enough the solution—perhaps it was because the future somehow didn’t feel real enough. That we didn’t know how to cross the bridge from the data and the stories we knew we had to communicating a storyline about all the TBDs of a better future. I read a lot of sci-fi fiction, and many sci-fi fans often critique a narrative based on how well the writers did the “world-building” part—meaning, how believably and thoroughly did they create a completely fictional world that felt authentic and real? What details did they sow in the narrative that felt like a departure from the present and yet, somehow utterly plausible?
I think in ALL of the communication efforts I’ve worked on, but especially health and healthcare, I could’ve done a much better job at world-building. I know this because when we moved out to California, all of the issues that I worked on at RWJF suddenly became more real. I was amazed, absolutely gobsmacked, to encounter actual manifestations of so many things we had hoped to make happen through grantmaking from RWJF. Things like:
–Built environments that supported healthy behaviors. You can walk everywhere in my area, even on the busiest of commercial thoroughfares, and bike most places too.
–Access to fresh produce. There are three farmers’ markets we can access with ease, and the supermarkets have gorgeous produce departments, too.
–Electronic health records. It blew my mind when we signed up with our new health care system and they were all like, no big deal, let me record your health history, track your appointments, and dispense prescriptions straight to your pharmacy.
–Doctors who understood the fundamental relationships between health and healthcare. At our kids’ first appointments with their new pediatrician, we were gently quizzed about our habits outside of the doctor’s office—whether we ate dinner together, our levels of physical activity, etc. We were all asked about our mental health. None of this happened in our East Coast experiences.
–Healthcare experiences that were supportive, patient-centered, and respectful of any cultural preferences we might indicate.
–Community supports for health, like school communications that encouraged healthy behaviors, and lots of restaurant options that served healthy foods.
I’ll stop there, but you get the picture. What I want to convey, most of all, is how weird it was to spend ten years communicating about health and health care improvements at RWJF and then move to a place where many of these things were suddenly….true! And the benefits of having these things were immediate, and real, and not abstract.
Why am I mentioning all of this now, when we are in the midst of a true health and healthcare crisis related to COVID-19? Aren’t we just trying to survive this, somehow? Well, yes. But also: some people have been bold enough to step forward and say: maybe this crisis affords us the opportunity to do better.
I applaud the people who are asking these questions, and I don’t think it’s at all premature to be asking them. But I have a few big questions to noodle over, even though almost every part of me wants to enthusiastically join the future-forward thinkers, the visionaries, the ones who will dream the best and the brightest and the healthiest possibilities for our future. Questions like: how do we re-make a healthier future while accounting for the wealth inequality and racial/ethnic injustices that have been baked into our policies, practices, and behaviors? I did not note all of the health and healthcare wonders of California without a keen awareness that these wonders are not available to everyone. Silicon Valley is soaked in wealth and privilege, but the area lacks leadership when it comes to paying attention to the huge inequalities that prevent many working people from accessing the same health benefits as others. The New York Times put forward a powerful statement about America’s equity challenges today: that yes, we can use this crisis as opportunity, but only if we tackle the glaring inequalities in our government institutions and health systems head-on.
And finally, I return to the question that I think I’ve been struggling with throughout the writing of this piece, which is: how do we do a better job of communicating about a healthier future for us all in a way that makes it feel more real, more achievable, and more motivating for people to work towards? How do we do the world-building, so we spend less time communicating about the problems (and being weighed down by despair about our current problems), and more time sharing the thrilling stories of what could be and what is already happening, in places already showing signs of being early adopters of health and justice principles and practices?
I don’t know, but I have some ideas. First and foremost, I think we will need some powerful creative talent to communicate in this way. Not just the communications people who carefully research and focus-group every single message that gets put out there—don’t get me wrong, those communication experts have their purpose, but not so much for this communications task. I’m talking about the people who can do the world-building, right down to the smallest design detail, for a future that feels both healthy and just for us all, and then share those stories about that future with us. In ways that make the future feel real.