In Seattle yesterday I was listening to a keynote by Dr. Jack Shonkoff who is a breain researcher at Harvard with an interest in early childhood development. He said an interesting thing about American health care which kind of answers the question for me about what the US is good at.
Many Americans who are opposed to public health care use the argument that people from other countries come to the United States for the world’s best treatment, surgery and acute care. No question that if you can afford it, the USA has the best. BUT – and this was a revelation to me, to hear from a leading doctor – no one moves to the USA permanently for their health. In the case of almost every industrialized country, and several developing countries as well , the USA trails in health promotion. So while people do come for treatment, they go back home to countries that support better overall health.
And insurance based system is to blame for this. Pouring money into insurance means that treaments, including surgery and drugs are developed and widely available because there is an incentive for private companies and public institutions to develop excellent treatment, activities and products that you can charge for. Health promotion is not a profit making venture, so if you choose to put public resources in private insurance, you get private, price based solutions. Building a system that prioritizes prevention, healthy communities, health promotion and safety is the way to reduce the need for acute treatments later in life, but no one can make a profit at it, so it requires a public, social response to build that infrastructure.
So that’s kind of interesting, especially as we hear the debate in Canada clamouring for more private involvement at the treatment end of things.
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Silo busting is a very interesting thing. Everyone knows that systems atrophy when they divide their work into silos. Silos entrench difference and prevent learning across sectors whether we are talking about departments in an organization, or a social system like health care or child and family services.
Silos have limited usefulness. They divide work into manageable chunks. But in general they create reductionist responses to systemic problems and they pose a massive challenge to people working nfor change. If we first have to bust the silos, and only then can we address the problems, how do we know we’ll have energy left for the real work?
So let’s be real. Dr. Rob Anda, who I met this week in Seattle, had a great line when talking about reducing the effects of adverse childhood experiences. “I don’t see silos as disappearing anytime soon, but if we work together in community from common information sources we can make change.”
Great line. Forget about the silos. Bring people together in communities of practice to learn about the information they need and that serves their common purpose, and then engage in the conversations that build network and community around learning about change and enacting solutions that make sense at the community level. Bottom up silo busting. Forget about the structural reforms first. Do the work first and then institutionalize the solutions that work across sectors, disciplines and other silos. Follow the Theory U process: concretize solutions following social prototyping.
And when the silos – the funders, the government agencies, the power brokers and decision makers – come looking for evidence and evaluation, use Developmental Evaluation to tell the story of what is going on across the system.
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I’m at a Casey Family Programs conference in Seattle that is looking at applying science to early learning in kids. The people here are learning about brain science and the results of early adverse childhood experiences and what the science can tell us about how we should react in the policy sphere to create healthy kids, families and societies.
The keynote is by Jack Shonkoff, who is a leading brain researcher in this field and who has been sharing some of the basics of what we know about brain science, relationships and healthy societies. Here are some of his key points:
Experiences build brain architecture. What happens is that neural circuits develop to reinforce behaviours, emotions, motor skills and so on. Babies brains build a basic architecture by forming synapses and then a more complex architecture develops on top of that. For the first three year of life, babies’ brains form 700 synapses a second. Genes provide the template for this work, but experiences turn the genes on and off. So early life experiences are built into our bodies, encoded in our brains – for better or for worse. To promote healthy brian architecture you need language rich environments, supportive relationships and “serve and return” interactions with adults are the three things that promote health brain architecture. Prolonged stress and reduced exposure to supportive relationships – in other words, what are known as adverse childhood experiences (ACEs) – create the conditions for heart disease, diabetes, and other diseases that are a result of disrupted development of organ systems.
Toxic stress derails healthy development. In babies, stress is alleviated by contact with a caring adult. If a child is exposed to stress in large amounts, the brain loses the ability to turn off the stress responses, and the stress becomes toxic. Nurturing, stable and engaging environments are the antidote to stress. It’s interesting that in North America we don’t treat stress with much compassion – “get over it” is a common response. In the USA especially, a hyper individualistic culture diminishes the importance of stress.
Some positive stress is a good thing however – what we call in the facilitation world “The Groan Zone” which helps learning and helps healthy development. There is always stress associated with learning new things or doing things for the first time. In healthy development, adults help kids with this kind of stress and the kids learn strategies for dealing with stress, which amps up the heart rate and blodd pressure and then reduces it. Supportive relationships help children to learn adaptive and coping skills.
Tolerable stress is serious and temporary – death of a family member, natural disasters, war and violence, an experience of extreme despair and other things that can lead to post-traumatic stress disorder. This kind of stress is also buffered by supportive relationships. Families, extended families, friends, neighbours, supported programs need to step in and provide the buffering that reduces stress to baseline levels.
Toxic stress however is prolonged activation of the stress response in the absence of protective relationships. This includes living alone in violence, or with adults that neglect children or who are unable to care for children because the are sick or depressed. If you don’t have access to caring adults, the stress becomes toxic and the stress system is built into your brain architecture, placing hardship on your organs, your nervous system and your hormones. This is the kind of stress that leads to long term health and development issues.
Neglect can be as powerful as abuse. It doesn’t matter to the baby’s brain whether your lack of relationships come from neglect or abuse. It has the same effect on the brain, and it keeps the stress levels high. Seven hundred synapses a second don’t care what an adult is doing if there are no compassionate relationships. Reducing stress by reducing the numbers and severity of adverse early childhood experiences results in better outcomes. This doesn’t mean that we have to solve poverty and subsistence abuse overnight before we get better outcomes – it means we need to make policy decisions that ask the question about whether we are supporting healthy and supportive relationships. In other words, the social safety net needs to work both at the systemic level to reduce inequalities, and at the acute level to create spaces where people can learn and experience healthy supportive relationships at every age.
I’ve been listening here thinking about the implications for this in organizations and communities. To sacrifice relationships at the alter of work or learning is to not only inhibit the sustainability of what is going on, but also creates the conditions for unhealthy families, groups, communities and organizations.
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From my recent work in the labour movement, a quote to inspire you in your work for social change:
Howard Zinn: ”Ž”To be hopeful in bad times is not just foolishly romantic. It is based on the fact that human history is a history not only of cruelty, but also of compassion, sacrifice, courage, kindness. What we choose to emphasize in this complex history will determine our lives. If we… see only the worst, it destroys our capacity to do something. If we remember those times and places–and there are so many–where people have behaved magnificently, this gives us the energy to act, and at least the possibility of sending this spinning top of a world in a different direction. And if we do act, in however small a way, we don’t have to wait for some grand utopian future. The future is an infinite succession of presents, and to live now as we think human beings should live, in defiance of all that is bad around us, is itself a marvelous victory.”
I’m in Prince George today and tomorrow working with the BC Government Employees Union in a great regional conference that is looking at forging the links between unions and communities. There is much organizing capacity and heart based action in the labour movement and much need on the ground here in the north of the province. Putting one to work on the other is a huge and easy capacity building thing to do.
So today a cafe on where we can go to work in community to make a difference, and tomorrow a short Open Space for people to ground action and make some plans to get out there.
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Running an Art of Hosting workshop this week for employees of the City of Edmonton. We are about 30 people all together looking at the art of hosting participatory process, convening and leading in complex environments where certainty is an artifact of the past.
Naturally because these people work for a municipal government, the conversations we are having tend to be about systems. We are working at the level of what it takes a system to shift itself as well as what it takes of an individual to lead when the answers are unclear.
For me, lots of good insights are coming up. A few that cracked in a cafe conversation this morning included these three:
- The fundamental question facing governments is not why or what or who, but HOW. How can we deliver services differently? How do we change to include more public voice in our work without losing our mandate? How do we cope with the scale of change, chaos, interconnection and complexity that is upon us? These questions are powerful because they invite a fundamental shift in how things are done – the same question is being asked of the Aboriginal child welfare system at the moment in British Columbia, which is looking to create a new system from the ground up. Shifting foundations requires the convening of diversity and integrating diverse worldviews and ideas.
- New systems cannot be born with old systems without power struggle. As old ways of dong things die, new ways of doing things arise to take their place. But there isn’t a linear progression between the death of one system and the birth of the new: the new arises within the old. Transformation happens when the new system uses the old to get things done and then stands up to hold work when the old system dies. While old systems are dying, they cling to the outdated ways of doing things, and as long as old systems continue to control the resources and positions of power and privilege, transformation takes place within a struggle between the new and the old. Ignoring power is naive.
- A fundamental leadership capacity is the ability to connect people. This is especially true of people who long for something new but who are disconnected and working alone in the ambiguity and messy confusion of not knowing the answer.
Its just clear to me now that holding a new conversation in a different way with the same people is not itself enough for transformation to occur. That alone is not innovation. The answers to our most perplexing problems come from levels of knowing that are outside of our current level. The answers for a city may come from global voices or may come from the voices of families. Our work in the child welfare system was about bringing the wisdom of how families traditionally organized to create a new framework for child welfare policy and practice, and that work continues. Without a strategic framework for action, for transforming process itself, mere reorganization is not enough.