“The Health of a Nation”©
September 27, 2009
By Reverend Sally Hamlin

A long time activist friend recently sent me a couple of Youtube videos focused on health care in the U.S.  The first one I listened to is a song performed by its composer Paul Hipp called “We’re Number 37”.  It has a rockin’ tune, and Hipp plays guitar as he sings….

And our own John Akers, happily, is here to share some of it with us today-  Hit it, John!

<<John Akers sings a part of this song accompanying himself with guitar>>>

In this song, Hipp, of course, is referring to our nation’s status according to the 2000 World Health Organization’s list of each nation’s health care outcomes, by looking at longevity, infant mortality, maternal morbidity, etc.  Our status as number 37 puts us after nations such as Andorra, Columbia, Malta and Oman.  We barely outrank Cuba.  France is number one, as Hipp says in his song. 

This song and its implication regarding our nation’s priorities remind me of an old saying:
“How you spend your money  reveals what you truly value.”   As I said at our leadership retreat last weekend – a fantastic day, by the way, attended by twenty of your devoted fellow congregants and staff and led by our Saint Lawrence District Executive Tom Chulak- I would add two other ways we demonstrate what we value.

I would suggest also that we show what we value by how we spend our time, and, third, by the words we choose -and how we deliver them- when we speak with one another. 

So, our money, our time and our words reflect what we value.

If we use this lens to look at what is happening in the conversation and debate surrounding health care reform, there is no doubt that people feel passionate about this topic.  How we feel about our health care system, how it’s delivered, our providers, the insurance industry, our public health care programs such as Medicaid and Medicare, all evoke strong feelings from both ends of the spectrum.  Whether we value a single payer plan, a public option or, get ready: a form of socialized medicine- ooooooohhhh, scary!- there is no scarcity of opinions to consider. 

Over the course of the past nine months, the number of articles in the New York Times and even the Democrat and Chronicle have become too numerous to count.    

So many words: written and spoken about our current health care system and what is wrong with it, fill the news: print and voice media.  And the words have become more strident. Think about the language heard at the August town meetings.  Think about the signs demonstrators held at public events; think about Congressman Joe Wilson’s outburst: “You lie!” he shouted to our president.  Though Saturday Night Live tried to find a way to try to make this humorous, it seems we have reached a new low in civility when it comes to health care.  One national columnist even went so far as to say that civility has become more important than health care reform, to illustrate her belief that the way we speak with one another has gone beyond the pale, evidence that no other good work can take place until we decide to be kinder with our words.[i]

But here we are, with a proposed health care plan on the table, one as complex as the insert from your latest prescription, and with the original intent so diluted it is difficult not to lose heart.

One recent article I read quoted a professor of health policy and management from New York University’s Wagner School of Public Service, who said rather than look at the World Health Organization’s data, which is already nine years old, it would make more sense to look at a study published just last year in the journal Health Affairs, which still ranks France as number one, and the United States last on the list of the country with the highest number of avoidable deaths. The U.S. has two and a half times the rate of avoidable hospitalizations as France, which can be attributed to access to early diagnosis and management of routine, controllable conditions such as asthma, bacterial pneumonia, diabetes or congestive heart failure.[ii] 

The bottom line: when people have access to preventive health care medicine and a provider who is not dependent upon their ability to pay, their health outcomes improve. 

Not rocket science.  But logic that seems to defy my original premise, which states that how and where we spend our money shows us what we value.

I believe that we cannot be successful at making true change unless we are willing to look at all aspects of health care system: how we deliver it, how we pay for it, and who gets it. 

And bottom line: who benefits from it. 

Should health care be a right? Should it be a privilege?  How do we decide such things without ridiculing others who have different opinions than we do?  What ethics and values apply when deciding such momentous things?

Back in the day before I became a minister, I spent almost thirty years working in our health care system as a nurse practitioner and as a health care administrator.  With the exception of the last three of those years, my career was spent in the non-profit arena, working in two different community health care centers, our federally funded safety net provider for the uninsured.  The last three and a half years I worked for one of the country’s ten largest HMOs.

It is widely understood that over time, lack of adequate primary health care results in higher rates of infant and maternal mortality, low birth weight babies, and fewer childhood immunizations.  In part this explains why the United States is near the bottom of the list when it comes to health care, despite spending more per capita for health care of all other developed countries. 

While disregarding the common understanding of what system creates good health for a nation, we still have upwards of 45 million people without health care in our country.  More than 12 million children live in poverty in the U.S.  Though three of four poor children live in homes where someone works, an American child is more likely to be poor today, than 25 or 30 years ago.  The gap between rich and poor is measured not in dollars alone, but can determine whether the other conditions that allow children to flourish: good child care, eyeglasses for reading the chalkboard, a Little League fee, a musical instrument, will be present.  When parents are stressed by just providing basic needs, the peace of mind that lets them create a warm and nurturing family life free from worry about eviction or hunger is at stake.[iii] 

            Let me tell you a story about one of my patients that illustrates what is needed to make a difference in the life and health of someone who has lived on the edge of our society her whole life. 

            Lanel[iv] first came to me as a thirteen year old, seeking birth control.  Because she was seeking to avoid an unplanned pregnancy, her high degree of autonomy was clear, I thought.  However, Lanel was sullen in her interactions with me, and gave the impression of indifference, shrugging her shoulders and muttering a ‘whatever’ when I told her she would need a physical exam to receive birth control pills.  She refused to make eye contact with me, but as our conversation continued, I realized she was terribly shy, and very nervous, despite her outward appearance of being tough and confident.  When I sat with her and explained that I had no intention of doing a physical exam without her full consent, and that I would not accept a ‘whatever’ as consent, she finally looked my way.  I wondered then, if Lanel had ever had the opportunity to give her permission to be touched, but I made it clear that I was willing to wait however long it took, and that we could talk about anything she wanted to.  After about twenty minutes talking about school- she loved reading- and where she lived – with an aunt and her six cousins- Lanel finally told me she was ready for her physical. This young woman needed to be given time to locate her integrity within her body.  That self-knowledge was a critical component over the next eight years that Lanel was my patient.  Her first visit lasted well over an hour.  Good health care takes time to deliver.

            Well, was Lanel a success story?  Did she use her birth control and keep an unplanned pregnancy at bay? Well, no she didn’t. Six months later, Lanel appeared back on my schedule, this time with a positive pregnancy test, and with plans to become a mother.  But she had come to us for care early in her pregnancy.  She kept every appointment, and gave birth to a healthy full term baby who she took very good care of. 

Here is a little background on why I read Lanel’s story as a successful one. It was going to take a lot to improve the harrowing health outcome statistics found in the census tracks of my patients’ neighborhoods.  We served areas and zip codes with teen pregnancy rates higher than those in New York City.  We had infant mortality rates ten times that of the nation for some of our neighborhoods, and the low birth weight rates mirrored some of the poorest countries of the world. 

After several maternal deaths of thirteen year olds, and too many pregnant eleven and twelve year olds, I made some changes in our clinics, knowing full well that it would be years before we saw any significant shift in outcomes.  I was not sure we would be successful, but there was too much at stake not to try.  The payoff came several years later when we looked at our overall numbers and saw that we had reduced the rate of low birth weight babies born by our patients by half, and had reversed the skyrocketing infant mortality rate in the neighborhoods we served. 

            Well, what does this story have to do with us, a mostly white liberal religious community coming together on a Sunday morning in September for worship? 

            The current situation of health care for the uninsured is worse than it has ever been, and it calls us to action, calls for us to respond to the question of how we care for the least among us.  As Unitarian Universalists, we say we affirm and promote the inherent worth and dignity of every person.  This guiding principle of our tradition asks us to examine whether our words are in line with our actions. But where do we start, where can we begin? 

First of all, we find a way to work for a community wide, national solution that lifts all boats in the rushing water. 

The water is wide, and the boat is so small….and we are so busy!

Theologian Paul Tillich says this about the hazard of having lives too busy to respond deeply to our world.  “Most of our life continues on the surface. We are enslaved by the routine of our daily lives, in work and in pleasure, in business and in recreation.  We are conquered by innumerable hazards, both good and evil.  We are more driven than driving.  We do not stop to look at the height above us, or to the depth below us. We are always moving forward, although usually in a circle, which finally brings us back to the place from which we first moved. . . . . we miss, therefore, our depth and our true life.”

            We are at a critical crossroad in this country.  Our national health care system is in the I.C.U.  It is on critical life support, nearing its last breath.  We must find a way to have civil conversations about this with one another.  We can and must choose to listen carefully to one another.  But it is not just the words we use that reflect what we value.  Coretta Scott King has said that “the greatness of a community is most accurately measured by the compassionate actions of its members, a heart of grace, and a soul generated by love.”  May we find a way to live the one precious life we each have and make it be an authentic reflection of our understanding that to become a truly healthy nation, we must protect the least and most fragile among us first, and that how we choose to speak with one another on the way to getting there is not incidental, but will be predictive of a healthy outcome for all.

May it be so.  Blessed Be. Amen.

[ii] Interview with Victor G. Rodwin, The French Are Superb, New York Times, Sunday, September 13, 2009, p.33.

[iii] Homily Notes on Children, from My Boat is So Small, Creating a Safe Harbor of Hope and Health Care for All Children, published by the Children’s Defense Fund, the Reverend Walter J. Burghardt, S.J., p. 84-5.

[iv] Not her real name.