It was at the third assembly when Toke Møller, an Art of Hosting practitioner who was invited to host the gatherings, asked Phil if he had ever been involved in a conversation about the purpose of the healthcare system. Phil’s response, as Toke recalls, was a great surprise:
Phil said, “In all the forty years I’ve worked within the healthcare system, I’ve never been in that question, and I’ve never heard anyone ask that question.” I said, “Are you telling me that you’re spending $7 billion a year in healthcare—if you count all the activities —and you guys have never talked about the purpose of what you’re doing?” And he said, “I’m ashamed to realize that we’ve never talked about it. It’s about time.”
This was one of the most profound large-scale assemblies I have ever been part of. We had a four-hour World Caféaround the question, “What should be the purpose of the healthcare system you want and need for this city and its future?” We had 120 people rotating through 25 tables. At the end of the Café, we put a microphone into the center and invited people to share one sentence about what the healthcare system should be. I thought five to seven of them would speak. But one after another, they came to the microphone—we couldn’t stop them! They were all saying the same thing: We want optimal health.
Optimal health, as this group defined it, is about being as healthy as you can be, given what you’ve got—your individual physical, emotional and mental abilities. That means that optimal health is different for everyone—and utterly attainable for all. But optimal health is not the purpose of our current healthcare system. “The system that we’ve known has been built on the wrong platform,” Phil explains. “It’s been built on a sick platform. As long as it operates on a sick platform, it will be unsustainable. When it’s built on a sick platform, you’re engaged in a zero-sum game: a fixed amount of resources are divided across sickness.” (Watch Phil and Toke explain this in a workshop in Nova Scotia). In Franklin County, that zero-sum game is abandoning 12.3 percent of the population, more than 134,000 people who are without healthcare—despite spending more than $6.4 billion annually on healthcare services.2 In Columbus, community members have agreed that the platform needs to shift from being built on sickness to being built on optimal health. “Like life,” says Phil, “there is no zero-sumness to health. There are millions of ways—infinite possibilities for how we can support each other’s health.”
Marc, the physician, explains, “We’d been looking at how to change the sick system and not at how we promote wellness within our community so that the rescue system doesn’t have to be as huge. Everybody is talking wellness. It’s sort of one of those duh! type of things. But this time, the whole community came to it together. Producing wellness becomes a personal responsibility. It’s not how am I going to make you well. It’s how are you going to make you well.”
Our Optimal Health is inviting citizens to explore ideas around a new and different system of healthcare in Franklin County. Here’s just one example: In Clintonville, a neighborhood of Columbus, residents are seeking to organize their own parallel healthcare system. “They’re saying, ‘To hell with the healthcare system!’” Phil says. “‘If we can attract five family practice physicians and five nurse practitioners, we’ll build our own primary care system and make it available to everyone in our geographic community.’ They’re not there yet, but I think that’s where they’re going to end up.” The Clintonville Neighborhood Initiative is experimenting with Health Block Watches, a riff off Crime Block Watch, so that neighbors pay attention to one another’s well-being, inviting each other into local walking clubs, spreading the word about yoga classes and nutrition events, and checking in on seniors and homebound residents. They are recruiting local dentists to provide free care to neighbors who can’t afford it. And they are enrolling volunteers in transporting people in need to medical appointments.
For Dr. Marc Parnes, “Clintonville is a microcosm showing what’s possible,” he says. “A group of people are saying, ‘We can do this. We don’t have to wait for it to trickle down.’ I am so frustrated with our government and all the talk and effort being made to reform healthcare. In this short period of time, we’ve done much more exploring than I know them to have done. The only way I know to change the national conversation is to experiment with it locally and invite others into the conversation.”
Which is exactly what happened to the conversation around homelessness.
A National Conversation on Homelessness
It was the summer of 2009 when Barbara Poppe got a call from the Obama administration. Housing and Urban Development Secretary Shaun Donovan needed to present a new national plan to end homelessness to Congress by May 20, 2010, and was tapping her to head up the United States Interagency Council on Homelessness. By the time she was hired, Barb had a month left to tie up loose ends at the Community Shelter Board in Columbus before reporting for duty in Washington, DC, on November 16. Her mandate is to get federal, state, local and private agencies working well together and innovating strategies that finally will bring homelessness to an end. Once in office, she had ten days to come up with a framework for Secretary Donovan and the White House. With that kind of time pressure, she turned to what she already knew: the Art of Hosting.