Mind the Gap: Learning on the Way to Wellville

Contributors: Rick Brush and Jeff Doemland
To learn more about Rick and Jeff, click here.

 

Screen_Shot_2019-10-15_at_10.09.24_PM.pngFirst, a bit of background: Wellville is a national non-profit project to improve equitable well-being in five U.S. communities over 10 years, while sharing what we learn as a path toward national change.

Founded by angel investor Esther Dyson, Wellville supports its communities like a business accelerator helps start-ups: We provide dedicated advisors who work with multi-sector teams in each Wellville community; we ask lots of questions; and together we learn through the thinking and actions of hundreds of local people and institutions collaborating with thousands of community members to make life better in the five places they call home.

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One of the most notable facts about Wellville is that it is a 10-year project. (The end of 2019 marks the midpoint of the Wellville project, which ends on December 31, 2024.) Working together over a decade frees teams to do things that wouldn’t otherwise be possible, like reshaping community conditions that cultivate (rather than compromise) our collective well-being.

Stepping Back
This timeframe allows Wellville teams to look beyond the typical 1- to 2-year grant cycle and imagine a better future. While each Wellville community has a different aspiration, all are aiming for meaningful change that is unlikely to happen without disrupting the status quo. Therein lies the challenge and the opportunity.

Creating a better future means breaking from business as usual. This is only possible when we: 1) step back to think about our current reality and what led to it, 2) step forward with new insights and new hypotheses to put into action, and 3) repeat. As we are learning with our Wellville communities, this cycle of stepping back-stepping forward doesn’t typically happen alongside our normal course of work. It requires intentional, ongoing, collective practices that become “the work.”

These practices can take many forms, like the multi-day facilitated working sessions we conduct at our 4_Photo_of_Action_Lab_at_Wellville_Gathering.jpgannual Wellville Gathering (see photo). Or they can be simple conversations that uncover thinking and clarify the path forward. 

What follows is such a dialogue between two members of the Wellville National team: Rick Brush, Wellville’s CEO and advisor to Wellville community North Hartford, CT and Jeff Doemland, Wellville advisor to Spartanburg, SC. It’s our hope this brief example offers a glimpse into why Wellville has identified short-term, self-interested thinking as the problem that needs our attention, and how we’ve begun to dive into it.

The Dialogue
Jeff Doemland (JD): Let’s start by reflecting on the work the communities have done in the first five years and what they’ve learned.

Rick Brush (RB): From the start, our communities realized that Wellville was about learning their way forward; there isn’t a roadmap to Wellville. This can be unsettling, but also energizing. In coming together to imagine a different future, communities have built strong, trusting relationships among diverse stakeholders – health systems, local government, community organizations, residents, and others. This in turn has led to joint efforts, even combining budgets in some cases, to address community health needs that are bigger than any one entity could tackle alone.

To date, the Wellville teams have advanced a number of significant community health initiatives (similar to efforts profiled here in this publication’s Mind the Gap column). To name a few: passing Tobacco 21 legislation, expanding the Diabetes Prevention Program, improving access to healthy food, integrating clinical and social services, and building systems to increase resilience while reducing the incidence and harmful effects of trauma and poverty.

So, one thing they’ve learned is they can accomplish more by working together. They’re also learning how difficult it is to shift focus – and funding – to “upstream” solutions that address the causes, and not just the consequences of deteriorating health.

JD: Recently, Wellville National made a pretty dramatic shift in its own thinking. This caused us to question, and, ultimately, change our stated mission, which had been to “demonstrate the value of investing in health.” What led to this change?

RB: Our revised strategy is a result of some strong “advising” from our Wellville Advisory Board. One of their pushes was that if Wellville spends 10 years proving that health is worth investing in, we will have repeated what public health has been doing for decades. 

Is it a lack of evidence that prevents the U.S. from investing differently? (Our evaluation and learning partner, Kathleen Brady, has cautioned us about the “impotence of proof.”) Or is it something else?

When we stepped back to consider what’s fundamentally constraining progress, we came up with a different diagnosis: We’re addicted to short-term thinking. This thinking has resulted in people, institutions, and systems that too often pit their immediate self-interest over the long-term, equitable well-being of all.

This plays out in all sorts of places: how healthcare makes money, how politics work, how funders fund, and how individuals make choices. What’s needed is a shift in thinking that prioritizes the future for the common good.

We’re betting this is where Wellville can be most valuable: helping our communities make this shift, measuring the impact, and documenting the process.

JD: In a recent email I sent to our team, I suggested we might want to inquire into thinking itself. After all, it’s something like the keystone of our strategy. My suggestion considers the possibility that thinking is a peculiar phenomenon. And if we presume to understand it — as we might be doing when we diagnose “short-term thinking” as the problem Wellville is going to address — we might not really be thinking. We should want to be careful that as we address the problem we aren’t falling prey to it.

My position borrows from 20th Century German philosophy, which offers a particular critique of the Western philosophical tradition that underlies all conventional notions of thinking. In fact, one of the principal voices of this critique, Martin Heidegger, argues that what in our time passes for thinking is not thinking at all. With our diagnosis maybe we’re stepping toward thinking. However, Heidegger would caution that without a rigorous inquiry into the question “what is thinking,” nothing prevents us from doing the kind of “thinking” we’re calling short-term thinking. Can you help me understand how our efforts will elude the seductions of short-term thinking if we don’t cultivate a disposition for persistent inquiry into the “what is thinking” question? 

RB: Thinking determines “what’s so” for each of us. It’s how we make sense of the world and our place in it, and, in a more pragmatic way, it’s how we move about the world to survive and get things done, for example by finding food or staying away from what we perceive as dangerous. 

This is always a product of our own particular and ever-evolving socio-historical context; we assign meaning to experience based on memories, norms, structures, and relationships that form the backdrop of our lives.

Unchecked, thinking also is limiting. We come to believe that what we think is what is real, nothing more and nothing less. Everything we do is guided, and then interpreted, by our thinking. So, this inquiry into the question “what is thinking” – and, I would add, “how is thinking influenced” and “how does it influence us” – seems essential to any real change in course. 

JD: Heidegger sees thinking as an activity that is an end itself, that is, not especially pragmatic. He associates it with wonder, which seems like a pre-condition for learning, especially in complex systems, which describes all of our communities. How are we seeing the socio-historical context getting in the way of this kind of “thinking as wonder”? 

RB: On a recent visit to one of our communities, a local leader asked whether our diagnosis was pointing to an immutable fact of human nature: perhaps we are predisposed to short-term, self-interested thinking. (She might also agree with Heidegger that learning – in this case, learning our way to Wellville – requires “wonder,” though she might not use that term.)

The deleterious effects on our nation’s health might seem obvious. It’s easy to point a finger at personal behaviors, like overeating and under-exercising, that put short-term desires ahead of long-term well-being. And we can see it, too, in the structures that influence our behaviors, like payment systems, politics, and profit-seeking, that keep us focused on the next cycle rather than the next century. 

Are these the “natural order,” or preoccupations that keep us from properly diagnosing the problem? 

JD: I wonder if there aren’t some parts of the health “ecosystem” that don’t see the problem in the same way. For example, in some of our communities, the health systems don’t see the nation’s healthcare crisis the way we do. After all, they have a business model that depends on people walking through their doors needing the services they offer. Working to change the “socio-historical context” isn’t in their interest.

RB: One of the more insidious effects of our fixation on the short term is that it gets in the way of thinking about our thinking. Hospitals, like most institutions, are pragmatic; their survival requires it. But let’s change the frame (aka, our thinking).

In the long run, short-term thinking serves neither individual nor shared interests, because it compromises our collective potential and causes us to spend more of our nation’s resources to remediate problems (like illness, crime, and poverty) rather than investing over time to promote greater well-being. Conversely, we all benefit from a healthy country where everyone can reach their full potential and contribute to building a better society.

We believe that if we encourage institutions and individuals to take the long view, we’ll change the conditions that underlie so many of our big, intractable-seeming problems (see “Shifting Our Thinking” chart).

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JD: But is “the long view” just another symptom of socio-historical understanding of thinking? Back to Heidegger: he ties thinking to language, and in language he recognizes its innate ambiguity, its capacity for conveying a multiplicity of meanings. So I’m interested in institutions that have changed to a way of thinking that cultivates wonder and learning. 

Take philanthropy, as an example. This is a field undergoing a fundamental re-thinking of its role and function. We’re seeing in our communities, where local philanthropies traditionally operated within what could be called a very pragmatic frame. They funded specific programs hoping for specific outcomes. They were less concerned with learning about how the programs actually worked, how program staff did the work, and how the programs fit into community settings. Recently, some have begun making investments focused on understanding the community context rather than paying for program implementation. And they seem to have a genuine sense of wonder – eager to understand the communities within which they exist.

RB: We can see similar shifts in other places as well. The Rippel Foundation’s FORESIGHT project is using an “emergent process” to answer the question, “What is the future of health?” This builds on their other work, such as the ReThink Health Dynamics Model, which lets people test the potential impact of 25-year community health investments. Outside of health, there’s the Long Now Foundation, which aims to “foster long-term thinking and responsibility in the framework of the next 10,000 years” and the Long-Term Stock Exchange, the recently SEC-approved platform for investing in “companies that operate with a long-term mindset.”

JD: Are these examples of a new socio-historical context? Are they examples of thinking that’s long-term and shared? Are they the dawn of some mode of thought that’s at the same time aware of the prevailing socio-historical context and capable of transcending it?

RB: That’s where this cycle of stepping back-stepping forward – this interplay between thinking and doing – takes hold. Because ultimately the collective and cumulative thinking of any group is reflected in the structures they create, in the form of culture, norms, policies, institutions, and systems…which in turn influence the thinking and actions of the group. As Winston Churchill said: “We shape our buildings, and afterwards our buildings shape us.” 

 

Contact Rick at:
rick@wellville.net

Contact Jeff at:
jeff@wellville.net