An Open Letter to Healthcare’s C-Suite

I didn’t think I was going write anything more about my cancer experience – at least in the near term. I’m just kind of done with it. I finished my chemo and now I have to conjure up whatever “mind over matter ninja magic” I can to keep it at bay for the foreseeable future. My next blood test is in a couple of weeks and we’ll see how things are, but I don’t anticipate anything negative. Even with a positive result – that’s no prediction of the longer-term though. I didn’t think I’d have to go back through this two years ago after the last set of infusions in 2015. But I did. So now I’m realistic. I’ll do everything in my power and that’ll have to be enough.

This year has been anything but fun. Cancer is just one part of it. Living in a world with Donald Trump, Mitch McConnell and Paul Ryan having anything to do with my well-being has me in constant state chemo-aided anger. My resistance to nonsense is at an all time low. For all my talk of self-efficacy, mine also often wains. Enough of this though. I’m still an optimist and I have to look at 2017 as just another one of those pothole ridden stretches of road to my Perfect World. It’ll get smoother.

What I do want to do is take one last stab (at least for the foreseeable future) at turning this experience into a positive for other people who may be going through something similar as I am. And selfishly so … maybe it’ll help me too.


This is my Open Letter to all those who are tasked, or have made it their profession to be part of our worlds during these precarious times of health we face.

I’ve come to realize that few people outside the “I have or have had cancer” club really have any idea of what the experience is actually like. I assumed the doctors, nurses and administrators in the exalted cancer centers of our community-dominating clinics would. I assumed once you walked past the donor walls you were given membership to some secret society where every one was in the know, empathetic and waiting to literally and figuratively take you the hand as you waded into the deep end of this murky physical and emotional pool. Such is not the case. Having a life-threatening, debilitating disease or not … we’re all thrust into to the same malaise of issues plaguing healthcare in America. Just because hundreds of thousand of dollars and thousands of lost hours of patient productivity are siphoned through the system – we’re all relegated to the same level treatment and customer service. It’s the same experience for everyone. Obviously I’m naive to think it would have been different.

As response to my personal frustration, I have vented over the couple of years through my blog. I’m not going to rehash the content I wrote now. The links are below if you want to yourself. And it wasn’t that things went so bad, even though the chemo treatment didn’t hold the first time and within two years I was back in again for another six month regiment. And it wasn’t any one person. For the most part, the people involved in the treatment regime did what they were tasked with. They did their job. But maybe that’s the problem. My idea of what their job should be and what it is as defined by their employer, my healthcare provider, are two completely different things.

Maybe my problem is that I’m idealistic and see things how they can be not just how they are adhering to the crippling paralysis of the status quo of diminished expectations. Maybe I’m just not tolerant of  organizations who don’t make it their mission to first set the bar as high as they can for the customer. Maybe I just don’t get what health mean in the context of a healthcare provider.

We live in world infected with silos. And I don’t mean silos that hold corn and wheat. The obsession with specialization and being an expert has been thrust upon us for decades now. And it shows no signs of letting up. And no where is this more epidemic than in the medical field. Did you notice I didn’t say health field. When specialization enters the discussion, the two are not necessarily synonymous. For example:

Many young American surgeons have a strong desire to do humanitarian work overseas. But their good intentions usually don’t match up with the skills, such as performing cesarean section deliveries and fixing broken bones, that they’ll need in poor countries. But only 0.1 percent of general surgery residents in the study had been trained to do a C-section. Yet it’s the most commonly performed surgical procedure in MSF projects.

The skills necessary for work in the developing world used to be universally taught in American surgical rotations. But training has changed to reflect increasing specialization. (NPR)

I assumed when I descended down the rabbit hole of a cancer diagnosis I would be enlisted in a collaborative effort to battle this condition. I assumed we’d have discussions about the role I would be expected to play over the next few months during treatment and afterward. I assumed we’d talk about how I could support the efforts of my doctors for my benefit. I assumed we’d have discussions on diet, exercise and mental issues as well as the physical ones. I assumed we’d talk about my life in the real world and the effect the cancer would have on those around me – those expected to provide help as well as those I’m currently providing help to.

I assumed there would be a “we.”

There is no “we.” They was no talk of my life outside the walls of the hallowed halls of the cancer center. Obviously my treatment ends at the bottom on the computer screen containing the results of my latest blood panel. Every doctor visit or infusion session began the same way: “Any pain?” My answer was pretty much the same every time: “No, but I have chemo brain, I’m tired and a I have thermometer as my constant dance partner.” But since my answer didn’t reference to the pain question and wasn’t in the affirmative: it was brushed aside. It didn’t fit into the boxes on the EHR software that operates as the equivalent of a malignant shadow government in most healthcare providers. The interface design of Epic and its competitors covertly dictate our relationships with our doctors, PAs and nurses.

Well, I hope my journey of “Any pain?” questions has come to an end, at least for now. So anything that may come from any of this post will be for the benefit for those that follow me. And I’m good with that. That being said, this is my letter to those in charge of our healthcare system in this country – the ones that run clinics with walls filled with donor boards.

First, quit reflexively calling yourself healthcare providers. This is a title that is earned. Most of you are human body repair shops. Nothing more, nothing less. If something breaks, hopefully you’ll fix it after the fact. At least when it comes to our cars they instill the importance of changing oil and taking other preventive measures. In the six years of attending doctors appointments for either myself or my two elderly parents, not once has the questions of diet, exercise or cognitive stimulation been brought up. What’s the hell is up with that!

It’s bad enough these foundational health and well-being issues aren’t being stressed with my parents, but you’d think they would be with me being a cancer patient and facing the ravishing effects that not only the disease but also the chemotherapy has on me. Shouldn’t there be a concerted effort to attack this with all resources available – especially ones that I may be able to bring to the game. I consider myself pretty tuned into my body and mind and work hard on my self-efficacy. I firmly believe what I do will make a difference in my outcome in battling cancer. I’m not going to sit idly by and think the only component to my success is administered through an IV on the fourth floor of the Billings Clinic infusion center. But what about the other cancer patients who have only blind faith in the bag of chemicals? Will they do anything for themselves to help out their own prognosis? This disease that we’re living with is not yours – it’s ours. We have to be involved in our own future. Our parents and grandparents may have been content with turning over the prognosis of their future to you – but we’re not. This is a collaborative effort and if you as both physicians and the institutions you run aren’t prepared to accept that, relinquish some of the control … get the hell out of the business and make way for some that will. 

And another thing, don’t treat us like victims. We have lives to live that transcend our disease so don’t lump together as just survivors. Survivors are those stakeholders who have lost a loved one. We don’t have any time to relish in the fact that we are still alive. We’re too busy trying to live. And believe it or not, our lives take place outside the walls of where your paycheck comes from. 

If you want to truly deserve the name, “healthcare provider,” come to grips that health means more than what you do for us in your clinic. Get past the body repair shop mentality. If you really want to raise the bar; take a walk around your community, and not just the gated one you live in. Take a walk around the streets where those people who have entrusted their lives with you live. Do you like what you see? Do you see enough parks and places to walk? Do you see playgrounds filled with kids afterschool? Do you see a farmers market down the street from where you park your BMW; or a farmers market where a cancer patient like myself can use a prescription for fresh produce? Do you see opportunities for children and the elderly to serendipitously interact with each other … exchanging stories and dreams; of the past, present and future?

My definition of health is being able to pursue the life I want to live and having an environment that is conducive to it. If my healthcare provider wants to consider itself one in more than just name on a letterhead, it has to lead the charge in the community to make this definition a reality. Not everyone is in perfect shape, especially people who have recently gone through what I have. Help us make a pursuing a good life, or at least a decent one – one that doesn’t involve massive stakeholder preparation or driving endlessly a monumental undertaking. Physical serendipity and engagement is our friend … if not our salvation. A healthcare provider most often has more community clout on several levels than any other entity. You have the stage – use it. If you’re not going to, pack up and make way for someone who will.

I’m sure a lot of you will brag about all the wonderful things you’re doing for the community. Invariable most all have to do with building stuff though. Ribbon-cutting ceremonies generate big press, big donations, names on big buildings and more names on big donor walls. And if it’s not shovels in the ground – it’s technology. A plethora of accounts on my Twitter feed are salivating over artificial intelligence and its possible effect on the healthcare field. But it seems like healthcare is a zero sum game. The more money spent on buildings being built and technology being put in play, the less on human interaction. Investing in caring for people as people is nebulous and hard to quantify going out and especially hard obliquitously coming back around.

Salutogenesis, Engagement and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and well-being. And at the center of this is engagement, whether it be personally, socially or civically.

Isolation And Our Nation’s Declining Health

A report came out last week that generated a tsunami of follow-up articles. Julianne Holt-Lunstad from Brigham Young University presented the results of two large meta-analyses on the connection between loneliness and premature mortality at the 125th Annual Convention of the American Psychological Association. 

“There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,” Extracting data on things like social relationships, health status, pre-existing conditions and causes of mortality, the team was able to quantify a difference between socially isolated people and those with stronger relationships. Those with strong social relationships were 50 percent more likely to survive longer than those who were isolated. 

“The magnitude of this effect is comparable with quitting smoking and it exceeds many well-known risk factors for mortality (e.g., obesity, physical inactivity),” they write in the study.”

Being alone, often due to declining marriage rates and fewer children, is literally killing us. We don’t engage with each anymore. Not only have our communities not compensated for these changing demographics – suburban sprawl and the invasion of box stores has added to the problem. The neighborhoods America has always relied on for social support have become the exception not the norm. Rather than walk down to the local park and feed the squirrels or play chess under the oak by the playground – our isolated senior citizens watch Fox News hours on end. And not just our senior citizens, it’s anyone facing months or years of chemotherapy or similar treatment. Have we been relegated to lives of polarizing cable news ideologies or driving to Walmart?


Well-being, Hope, Role of the Healthcare Provider

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a  contradiction in terms.” Wendell Berry

What if we designed our communities around the idea of maximizing engagement. The more engaged our residents are … the more empowered they are and feel they are more in control of their health and their futures. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. And what if opportunities to help others realize the same were part of the fabric our daily lives. And imagine if our storied healthcare providers felt their mission and their duty to be at the forefront of this effort.

What if engagement and well-being was how a community measured itself, not obtuse economic activity often distorted through the one-dimensional filter of irrelevant statistics. What if we fixated on what we “could,” rather than what we “can’t.” And what if getting up in the morning was a chance to nurture our hope … and engage with other to help them do the same. And again what if at the center of this new enlightened measurement were those allegedly in the business of keeping us healthy. Then maybe they would truly deserve the words on their letterhead.

Life doesn’t have to suck just because you have cancer, have any other hardcore disease – or are just getting old. But it sure can be if the so-called leaders or our communities, especially the ones perched in the ivory towers of storied healthcare providers, don’t step up and help us out.

We need you to lobby for our communities to be places that prioritize people and engagement – not cars and box stores. We need you take some of the money you don’t pay in taxes and invest it in community gardens, farmers markets and street fairs that showcase local art that encourage creative engagement. We need you to lead the way on healthy eating by including cooking and nutrition as an integral part of our treatment. And while you’re at it – include our stakeholders. We need you to be advocates for engagement and “getting out of the house.” Communities that encourage something as simple as allowing dogs in parks will boost their residents’ collective health and well-being.

We need you to reach out to us with transportation, especially when we live more than an hour away. I’d like to see how many CEOs go through a twelve-hour chemo infusion session only to drive themselves an hour home to two elderly parents they have to help caregive. Probably not many. The life of a cancer patient is seldom one of a giving extended family waiting at the beck and call. Often it’s flipped. Cancer affects anyone and everyone … regardless of the burden of their obligations and responsibilities.

We need you to be vocal when you see politicians and government not doing what they should to improve the human condition of our communities. You should be a regular contributor in the OpEd section of the newspaper. You can’t hide behind the nonpartisan label just because you’re afraid of losing a few ideological wayward customers. Losing them is nothing compared to losing your integrity and human decency.

Most of all we need you to use your stage for us – not just for the construction workers and contractors you hire to build your buildings. I always say that there are few things worse than being rewarded with a stage, a platform to make a difference – and doing nothing with it. People’s time and attention is the one thing that is scarce and money can’t buy more of it. To squander it is criminal. People not only listen to their doctors and healthcare provider – they often don’t act for their own well-being unless given the go-ahead by them. This is a responsibility you personally shoulder, whether you like it or not. If you’re not up to the job … there are other ways to pay for that BMW. Or even more so … you can trade it in for a Taurus.


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Rebutting the Hysteria: More Thoughts on “13 Reasons Why”

Last week it seemed like I was bombarded by articles on the impending doom descending upon our adolescents due to the Netflix series 13 Reasons Why. Pretty much every article cited a study done by San Diego State University Graduate School of Public Health associate research professor John W. Ayers just published in the scientific journal JAMA Internal Medicine.

Ayers and his team of researchers focused on United States internet searches between March 31, 2017 (13 Reason Why‘s release date) and April 18, 2017 (so queries wouldn’t coincide with the April 19 suicide death of former Patriots football player Aaron Hernandez). Every search phrase included the word “suicide,” omitting the word “squad” so searches for the film Suicide Squad wouldn’t contaminate the results. Then they compared those results with searches and daily trends between January 15, 2017, and March 30, 2017 to get a baseline sense of what those searches are like generally.

The findings showed that after the release of 13 Reasons Why, which follows the events surrounding a fictional teenager’s eventual suicide through a series of tapes she leaves behind, all suicide-related searches were 19 percent higher than expected.

While awareness-related phrases like “suicide hotline” and “suicide prevention” were up 12 percent and 23 percent, respectively, “how to commit suicide” increased by 26 percent, “commit suicide” by 18 percent, and “how to kill yourself” by 9 percent.

That said, it’s unclear if these specific internet searches were definitely related to the show. It also isn’t clear whether those searches actually led to suicide attempts or deaths. But Ayers noted that previous research has found a correlation between increased searches for suicide methods and actual suicides. In other words – Ayers is extrapolating his interpretation to what he thinks is causation – but can’t really show anything but what he wanted to show in the first place.

Studies like this are clickbait shrouded in an academic cloak. First correlation doesn’t prove causation. And second nothing, especially teenagers, operates in a bubble. There is no experiment group vs. control group to compare. Also, even more importantly, one would assume there would be an uptick in internet searches associated a popular teenage series (no matter the content and especially if it has weight). To think this curiosity will cause additional action where there already has been action – is far from conclusive.

In my May 12 blog piece, “13 Reasons Why” … And Why It Matters To Your Community, I made a case why I thought the series was a good thing for our communities, including both adolescents and adults. But I’m not one who thinks we need to shelter our youth from the “monsters under bed.” On the contrary, I firmly believe we should empower our teenagers to develop the skills and self-efficacy to fight back against the aforementioned monsters. For there will alway be monsters under every bed well past the teenage years. The better our children get at fighting them early on … the better off they’ll be later on in life.

What I stressed in my previous piece, and what the pieces based on Ayer’s research didn’t (anywhere) – was what is the role of the community and adults who run them. What role can those living with and around teenagers, not only parents – but mentors, neighbors and civic leaders, play in their mental health? What are these people doing to create environments that dissuade our young from getting to the point of such extreme disenfranchisement in the first place.

In “Why People Die By Suicide” (2005), Thomas Joiner, a professor of psychology at Florida State University, drew on the testimony of survivors, stacks of research and the loss of his own father to upend minds. He recognized the myriad pressures on a suicidal mind — substance abuse, genetic predisposition to mental illness, poverty — but identified three factors present in all of those most at risk: a genuine belief, however irrational, that they have become a burden to those around them; a sense of isolation; and the ability, which goes against our hard-wired instincts of self-preservation.

The question we should be asking ourselves is how should we combat this sense of isolation that breeds within our young people. Whatever the reasons why, the best way of combating destructive behavior, including suicide, is refocusing energy by providing positive outlets and alternatives. If your life has a purpose, you’re much more likely to spend your time and attention on that purpose rather than on self-annihilation. It’s hard to feel sorry for yourself and escape in a bottle of vodka if you’re too busy helping those in an even worse space than you. For example, studies have shown volunteering often helps the person doing the volunteering more than the person being helped.

Even after we’ve addressed the reasons why and created positive outlets to focus on, we still don’t live in a Perfect World though. The human psyche is vulnerable. The monsters will always be there and no matter how much we try to ignore them … they’re still going to find their way out from under the bed into our minds. Or in the words of John Milton; “turn our heaven into hell.” The question ultimately becomes … how do we deal with them when they do. Do we dive into the bottle or the medicine cabinet – or do we shake it off and put the haze of gloom behind us? How much can we, or in the case of “13 Reasons Why” our kids – take? 

Salutogenesis and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes a health approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. When fighting adversity, self-efficacy is your tool chest. It’s your ability to fight the monsters under the bed. One of the most potent defenses we have is engagement. This engagement can be with ourself, through our minds and bodies, or with those around us in our communities and neighborhoods. “Doing” is a prescription for well-being. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and self-efficacy.

Now as the supposed adults in this discussion (that is highly questionable at times though), isn’t our responsibility to step in and do something other than playing Chicken Little running around screaming the sky is falling. Our kids are fragile, as we are. Sheltering them is not the answer though. Empowering them and giving them access to engagement to boost self-efficacy is.

In the last couple decades we decided that the effective way to bring up our children is to strip them of opportunities to express themselves in benign ways as they wish. At the earliest age possible we relegate them to organized academic activities pounding reading instruction down their throats even in preschool rather than letting them flourish in unstructured play where they self-learn coping and socialization. It’s no wonder when they get into situations later on, outside of the constructs of the classroom, they don’t adapt well.

Even though our adolescents are exposed to the same information we adults are due to technology, we still often view them as less than people. Our teenagers are not the way we were. No matter how much we want to shelter them – we can’t. What we can do is help them acquire the tools to successfully cope and excel. And this responsibility extends well past the walls of our classrooms and even our homes. It lies open with everyone in our communities.

“I believe that the community – in the fullest sense: a place and all its creatures – is the smallest unit of health and that to speak of the health of an isolated individual is a  contradiction in terms.” Wendell Berry

The world we all live in is charging ahead at a speed no one could have envisioned. While we can pull from our experiences of the past – we can’t take them verbatim as the answer for the problems we face today. Our mission must be to use the past and mold the positive value it bequeaths us and let it evolve to a more relevant time of today and tomorrow. And central to this social inheritance is the Middle Ring of our neighborhood and community relationships.

Introducing the ‘Middle Ring”

A few years ago Marc Dunkelman wrote an excellent book on the evolution, or should I say the de-evolution of the American neighborhood, “The Vanishing Neighbor.” In his book Dunkelman introduces the concept of the Middle Ring. The Middle Ring is what Dunkelman calls our neighbourly relationships. This is in contrast to the inner-ring of family and close friends, and the ever-expanding outer-ring relationships fostered by the digital age and social media. Unfortunately the ‘middle’ is not holding, collapsing from pressures on both sides. Social media sites have brought our closest contacts closer and expanded our reach to include ‘weak ties’ that we know only through cyberspace. Compound this with the proliferation of politically and interest segregated cable and internet news outlets, we have little time or attention for anyone else, physically or philosophically. And what suffers are our neighborhood acquaintances, our communities and the memories of what they used to stand for.

There’s been much discussion in the last decade about the decay of the American community as we like to remember it, or as Hollywood portrays it. But really it’s the loss of the Middle Ring we’re seeing. We still have communities, they’re just not inhabited by ‘our neighbors.’

It’s the loss of these neighbors who were physically around that could be counted on (often without even asking) that’s creating a social divide in America. In the past, before World War II, our neighbors were our support. They were the doctors, the midwives and the handymen. They were where we could go to get food when we needed it. It’s what got America through the Great Depression.

We didn’t have to agree with them politically, socially or otherwise, but we knew them and they were still our neighbors. And we could count on them.

But with Roosevelt and the New Deal, the government became America’s support system. The help of your neighbor wasn’t as important. That worked fine, but that reliance on the township, the community, the neighborhood and in turn the nurture of our Middle Ring began to wane. It wasn’t so evident at first. But the chinks in the armour, so to say, were beginning to show, even back then.

And now it seems as if we’ve all but lost our Middle Ring. Maybe not physically. There’s still people who live next door and down the street, but we don’t know them. Maybe we’ve never even met them. We don’t know where they’ve been or where they want to go. And it kind of makes it hard to help them get there.

As a result our neighbors don’t seem to have identities – and neither do our communities. It’s hard to tell one from another. Maybe it’s due to the prevalence of homogenized big box stores like Wal-Mart and Target. Maybe its the MacDonald’s or Starbucks on every corner rather than Joe’s Diner or Martha’s Koffee Klatch. Maybe it’s the gated communities where unless you live in one … you don’t know who or what does. Maybe it’s all of it. But regardless, everywhere kind of seems the same. It’s like there’s planned communities everywhere, except they’re not intentionally planned.

It’s time to re-examine this way of life we’ve created – one that increasingly resolves around isolation not engagement. It this the world we want our children to have? Do we want their only access to the answers they need to grow up being on the other end of the screen of the iPhone? Our lack of attention to the communities we have socially and civically abandoned has given them no other option. It’s no surprise some of the most desperate see suicide as the only option.

Also last week the sentence came down on the “death by texting case.” Michelle Carter received sentence of only 15 months, while the prosecution wanted seven years. The mother of Conrad Roy, the boy who committed suicide at the encouragement of Carter is calling for new legislation to invoke mandatory sentences for future offenders in similar cases. As Bill Clinton once famously said, “you can’t legislate morality.” no politician is going to come to our rescue. Only we, the ones who live in our communities, can create them as we want to.

Since we’ve let our civic and social relationships, especially across generations, decline to the extent it has – shouldn’t we take responsibility, own up to the problem and make efforts right at home in our neighborhoods to fix them. Calls for mandatory penalties are not going to repair the social fabric of our communities, deter anti-social behavior or bring back a troubled loved one – no matter how impassioned they are. Only we, the leaders of our communities, can affect change by encouraging an embrace of empathy and compassion that jumpstarts a collaborative dialogue with our teenagers.

Whether you believe it or not, our children are more capable than we ever were at their age. We just don’t give them the avenues to express themselves to create environments around them to better fit the their social needs to handle the demands of the daily stresses they encounter in a over saturated world. And we’re sure not doing it for them.

“To learn is to accept that one’s growth—the endless process of becoming who they will be—depends on engaging the strangeness within themselves (the part that is perpetually open, unpredictable) as much as interacting with a strange world of knowledge that they can absorb but never know in its entirety on their own.” Maximillian Alveraz

The summer job at the gas station down the street or the pick up baseball game in the vacant lot are gone. We, the adults, have let them go away. We replaced them with Wal-Mart and volleyball summer camps (for our benefit more than theirs). What ever summer jobs might be left are filled by retirees too actively young or financially needing to retire. Cross-generational interaction isn’t based on physical collaboration – it’s from a spectator perspective. Distrust because of unfamiliarity extends up and down the age spectrum.

Our answers lie in inclusion and engagement across all lines. Our young people are assets if we treat them that way. Help them build their own futures rather than create barriers because we think they should act like we did (whether we even did or not). After all the world we’re living in will soon be theirs – and we will be the ones needing their help. The more successful the transition we provide … the better off we all will be.


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“Believe it or not it may not be about you!”

This is one of those “don’t forget this … and share far and wide.”

A few years back I was traveling on Amtrak from Orange County to Seattle to visit Jennifer (you’ll hear more about her down the road). Trains are great … way better than planes and cars. You get to spend hours together with people you’ve never met and probably will never see again. All you have is that single experience.

At the beginning of the trip, I met and sat next to a young man who happened to be a Buddhist. Now he didn’t look like the stereotypical Buddhist; no shaved head, no robe … just kinda look like I looked twenty-five years ago (except probably better looking). For miles we talked, ate and talked some more.

Note: Coincidentally, I did meet two “typically looking Buddhists” the next morning a few hundred miles up the road after being left a train station; That’s different story for different day.


One of topics of our conversation was his girlfriend – who lived with him on a Buddhist compound outside of San Diego. Over the last couple of months their relationship had declined. She would come home from work in a surely mood and stayed that way through the night. “What was wrong and what had he done to cause her malaise.”

“What can I do to make you happy,” was the pretty much how every evening began.

At wits end, my new Buddhist friend went to his monk for advise.

This is it:

“How can you be so arrogant and self-absorbed that you think everything in her life revolves around you and is caused by you.”

The next time you beat yourself up over something having to do with somebody else, try empathizing – look at the world from their perspective.

Believe it or not – it may not be about you.


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Staying Strong

Monday morning I got up early and prepared myself for I thought would be my last three-day session of chemo treatments for my lymphoma (Using the word “my” in reference to having cancer seemed odd writing it, but I suppose if I take ownership over it – it won’t own me) . Unfortunately I got bumped. My platelet count was too low and my ordeal is now pushed to next week. In the whole scheme of things this is no big deal – but it’s just another one those straw putting pressure on the proverbial camel’s back. It’s not just the all day infusion sessions: It’s the preparation, mentally and physically that’s a big part of it. Now I’ll have do it all again at the end of this week. Hopefully my blood levels are up so I can get on with this.

Later after I got back home, I check my email and came across an article in my Fast Company feed, “Why Telling John McCain to Beat Cancer Feeds Into a Dangerous GOP Narrative.” All things considered, this piece peaked my interest.

Now for those living under or in a rock and oblivious to current happenings in the world, John McCain was diagnosed with a fast-metastasizing cancer of the brain Glioblastoma to be specific. The outpouring of support was no surprise. And the tone of the support was really no surprise either considering who John McCain is and his personal history. No one is feeling sorry for him. Just the opposite. People are assuming he will fight this with the same tenacity he did as a POW in Vietnam.

Jean Hannah Edelstein, the author of the Fast Company piece had an odd take on the situation. In this brief, maybe 500 word article, she didn’t really talk about John McCain or cancer that much. Instead Edelstein chose to attack the Republican party and their healthcare policies. She also threw Barak Obama under the bus for good measure.

Now I want to pile on the toxic dumpster fire that is the Republican party as much as anyone. But I don’t really see why John McCain’s cancer is the place and time to do it. This isn’t a partisan issue. Access to treatment of maybe – but reaction to it … not at all.  To make it that – is to further feed the fire that has created the toxic political and civic environment we all now inhabit. If anything, McCain who for the most part is not a polarizing figure, may be one of the rare politicians who could generate a common sense of compassion and human decency. That being said, his vote repeal Obamacare yesterday did little to endear him or his situation to me. One would think he would have acquired a new sense of empathy for those less fortunate financially in situations similar to him. But apparently not.

Regardless, that doesn’t change Edelstein’s reaction to the outpouring of support for McCain – which occurred before the vote. She used the situation as yet another opportunity to further the political divide. Rather than encourage people diagnosed with cancer to fight the disease and build their self-efficacy, she thinks we should show them sympathy. To encourage them to fight the disease implies if they give way to it, they didn’t fight hard enough and the outcome is their fault. I suppose I get where she’s coming from. While I’m not against a show sympathy. While not my preferred reaction – it works for some people. But I have real hard time with the view that one’s own efforts have nothing to do with the outcome when it entails a disease. When does self-responsibility and personal power of affecting change come into play in Edelstein’s mind? Does it ever … for anything. Or are we just innocent victims of a predetermined fate – possibly only affected by the efforts of someone in a white lab coat and a fifteen minute visit.

For example she picked a bone with Paul Ryan, who I’m no fan of, and his views of self-responsibility.

Paul Ryan spearheaded the concept of personal responsibility in the context of health care in 2009, when he wrote in his Patient’s Choice Act that a “large percentage of heart disease, stroke, and type 2 diabetes, as well as many cancers, could be prevented if Americans would stop smoking, start eating better, and start exercising.” Health policy should be built, he argued then (and now) to reward people who look after their health—to disincentivize illness, as if people are eager to pursue bad health.

While Ryan’s Ayn Rand extremism is exactly that, extreme … there are things we can take from it. Should we embrace Ryan’s view of “pulling ones self up by the bootstraps” wholeheartedly – probably not. But should we buy into Edelstein’s succumb to destiny and fate – probably not either.

Her views are affected by the death of her father, a non-smoker, of lung-cancer at age 69 (as the article outlines). For good reason, it’s obvious this has had a major impact on her life, specifically her views on healthcare. Her bio even says she’s writing a book on cancer and genetics. In addition, she’s a writer for the Guardian – which has become a go-to anti-GOP media outlet (no judgement intended, but it’s impossible to ignore its left-leaning direction).

Disclaimer: I used to read the Guardian, but can’t anymore. In my opinion, their political views have infested virtually everything they publish – whether the content should be taken as political or not. I suppose they believe they are doing a service. That may be – but they can do it without me. I believe Edelstein’s article in Fast Company follows along with this philosophy.

She takes the opportunity to rally us for a “healthcare for all” policy of government. While a noble cause (and philosophically I agree with – and I have enormous skin in the game) – its implementation is a completely different story. I’ll leave discussions of a single-payer government-run system for a different day and different couple thousand words. Let me just leave it with anyone who has had experience with American Veterans Choice program wouldn’t wish that experience on anyone, friend or foe.

To assume that we turn over everything to the government and expect them to sprinkle fairy dust on every problem we have and make it better, is naive at best and most realistically – pragmatically irresponsible. The government isn’t going to fix healthcare or much anything else – regardless of what party and color clown suit they’re wearing. The governmental apparatus is mired in operational malaise and void of innovative talent. Unfortunately, what our founding fathers created is no match for the complexity of today’s world and the narcissistic political behavior that has manifested in Washington D.C. under the guise of representative democracy.

My journey with cancer over the last two and half years has heightened my obsession with self-efficacy. I have no other option. I have to believe what I do and what I think makes a difference. I’ve never been one to believe in fate – and I sure as hell I’m not going to start now. My way of dealing with this is believing that self-efficacy is my partner in this battle. The stronger it is … the stronger I’ll be and better my prognosis. I’ve even created an engagement bot to help me in my journey – and named it MelvinOf course I have my medical treatments which I anticipate will work, but I don’t have any control over that. What I do have control over the is my attitude during this journey (both during treatment and afterwards) – to help ensure I don’t have to go through this for a third time (or more).

I can be positive and take care of myself; and most of all try to lend support to others by being part of the solution to issues in their lives. I believe looking outwards is a big part of internal healing. We are a function of so much more than just ourselves. We are products and parts (today and in the future) of those around us – in our communities. I’ve taken this stance and made it a cornerstone of my Community 3.0 project, right there next to Rhizomes and Front Porches

That is what I can do … and will continue to do going forward.

My very good friend Bob always tells me to stay strong. It shows he cares. But more than that, it shows he thinks enough of me to believe that my strength and self-efficacy will in some way lead me to a positive outcome. This makes me try harder. And that’s a good thing. How Jean Hannah Edelstein can justify taking that away from me is malignant in itself. I go through my own battle, and yes Jean that is what it is (and I wouldn’t doubt your father considered it the same), with the same passion and drive I’ve put forth towards anything else I’ve done in my life. Only in this case, the stakes are higher. Whoever wants to jump on board and give Melvin, my self-efficacy, a little push … I’m all in.

Battling cancer is so much more than just the end-game. It’s the journey. It’s the side-affects and the treatment. It’s the physical turmoil. And it’s emotional rollercoaster. It’s Chemo Brain and the struggle keeping concentration. And it’s not enough to take care of and worry about myself – it’s the affect my situation is having on those around me? And if I succumb to it, what effect will that have on those closest to me? Will they never be able to let it go – always looking for an answer, dedicating their lives or worse obsessing over of it until it consumes them too? Or will they turn it around and pull strength from it – much like a vicarious spirit of the Phoenix. Personally I want to lead by example, and as Bob says … Stay Strong!

May this post be a message to those close to me, and those close to others with cancer who are battling, often in ways you have no idea of. We don’t need sympathy. We don’t want you to feel sorry for us. We want to know our battle will transcend us as you take the baton our of strength and self-efficacy and carry it forward to use in your own lives – adding to your own personal emotional and mental toolboxes. Make our battle worth more than just the efforts of us alone. Use it fight to fight your own battles too.

You can follow me on Twitter at @clayforsberg and on Google+.


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Rebuilding Alexandria

About twenty years ago, my daughter Alex and I were living in Marin County above San Francisco. During this time I became addicted to reading. I don’t know if I was trying to make up for lost time or what; but a pile of five books (all in various stages of completion) became a permanent fixture on my dining room table. At least once week, and more often more than that, I made the trek to my local independent bookstore in Corte Madera down the road to see if there were any new current event titles I could add to my menu of cerebral digestion. Normally a book stayed a couple of weeks until I was done with it – only to make way for another to take its place. There was one book however that stuck around a lot longer. The 100: A Ranking of the Most Influential Persons in History by Michael Hart written in 1992.

Hart’s book was fascinating to me. Since I was in grade school, I’ve been a history buff – even reading the entire encyclopedia sitting on the living room floor when sub-zero temperatures and three-foot snow banks put a damper on outdoor activities (obviously it was a pre-video game era). What intrigued me about “The 100” was that Hart didn’t pass value judgement on whether the influence the person had was good or bad – just that the person had influence. Jesus and Sir Issac Newton figured prominently, but Hitler and Genghis Khan were also ranked. He also went into copious detail on why he ranked them where he did. A lot of the reasons weren’t obvious, but once brought to light – made complete sense. George Washington for example, was ranked in the top 40 not because he was the first president of the United States, but rather because he chose to voluntarily relinquish his office after only two terms, setting a precedent that would remain intact until Franklin Roosevelt 150 years later.

Being immersed in the printing industry as a headhunter, I loved the fact that Johann Gutenberg and his printing press mad the Top Ten. But the one person that took me by surprise was the one Hart ranked as Number 10 overall. That was Euclid. I didn’t know who Euclid was – even with my encyclopedias and three-foot snow banks.

Euclid and Alexandria

Now for those of you who are as uninformed as I was, Euclid is known almost solely for writing the math text, Elements.

Euclid (fl. 300 BCE) was a Greek mathematician, often referred to as the “father of geometry”. He was active in Alexandria during the reign of Ptolemy I (323–283 BCE). His Elements is one of the most influential works in the history of mathematics, serving as the main textbook for teaching mathematics (especially geometry) from the time of its publication until the late 19th or early 20th century.

But the most interesting part about Euclid was that Elements wasn’t really that much of an original text. He didn’t make any groundbreaking revelations like Newton or Copernicus. He pretty much just took the works of other scholars, many of which lived and worked in Alexandria, and synthesized into one book a comprehensive guide to geometry. In summary – Euclid was a curator; and a prolific enough of a curator that Michael Hart had him ranked Number 10 in the list of the most influential persons of history. Holding a curator in such high regard, especially at that time in history where personal contact was really the main way to spread knowledge – brings up an interesting point. Euclid was a product of his geography and those who resident in his civic proximity. Euclid embodied the very essence the of Alexandria, Egypt … the diverse cross-pollinated intellectual melting pot of the world. Rather than beset by religious and societal division, it was a bastion of inclusion and open thought. Thinkers worldwide traveled from afar to participate in the collectivism.

In January of 1989, my wife Mitra and I found out she was pregnant. I vividly remember the discussion of names. Before we knew the baby’s gender, we picked both a boy’s and girl’s name. We didn’t necessarily agree on the boy’s name (which I don’t even remember). The girl’s name was a different story. The decision on Alexandria came quick as our first pick, even though our reasons different. Mitra liked the name itself (as did I). But I really liked what it stood for. It’s hard to set the bar much higher for your child than being named after arguably the most prolific center of learning in the history of the world. If some of that rubbed off on her … all the better.

On October 11, 1989 in Burbank, California – Alexandria Noelle Forsberg was born.

Two years ago, as part of my series on community-based societal evolution, I wrote “Silos.” “Silos” outlines the need for communities to rise above their provincial jingoism in order for them to truly pursue sustainable policies. Cross-pollination; whether its gender, sexual-preference, ethnic, racial, age-based or especially geographic – must be fundamentally encoded in a community’s civic DNA. All to often however, especially where I live, the opposite is often preferred. How far back your Montana roots go back somehow makes you a better person – not more geographically myopic which is actually the case.

Community and the Value of Diversity

Everyday the environment we live in changes. These changes are a response to external stimuli. Darwin’s theory of evolution states that the flourishing and ultimately the survival of a species (or any other anthropological entity) is based on its ability to adapt to these stimuli. Diversity is an advantage if not a necessity. Lack of diversity makes itself open to disease (literally and figuratively).

My daughter Alexandria breeds exotic snakes, specifically Rainbow Boas. She goes to extreme lengths to make sure the gene pool of her breeding stock is as diverse as possible. It may be a lot easier and less expensive to acquire stock domestically – but due to inbreeding (often unintentional) by less diligent breeders, genetically based pathologies often occur. To counter this, Alex has imported snakes outside the genetic pool from Finland and Great Britain. It’s much more difficult and more expensive – but it’s her only option with the bar she’s set for herself and her projects.

Your community really isn’t a lot different from Alex Rainbow Boa community (aside from the preponderance of scales). Any community is the product of its residents. Social inbreeding creates weak species and weak communities; vulnerable to adversaries, internally and externally. Inbred societies rely on decision-making and responses founded in a narrow historical perspective – severely limiting its response to challenges and opportunities.

The fact is that if you want to build teams or organizations capable of innovating, you need diversity. Diversity enhances creativity. It encourages the search for novel information and perspectives, leading to better decision-making and problem solving. Diversity can lead to unfettered discoveries and breakthrough innovations. Even simply being exposed to diversity can change the way you think. This is not just wishful thinking: it is the conclusion I draw from decades of research from organizational scientists, psychologists, sociologists, economists and demographers. Scientific America

A community is the collective sum of the value of its individual inhabitants multiplied by the community’s ability to synergize these individual parts (by curating organized and random encounters). Every encounter or engagement has an opportunity to be a synergistic one. Empathetic cross-pollinated engagements are the key. The city of Alexandria during the time of Euclid was a perfect example of this. Even though there were organized discussions and forums, just walking down the street could lead to a serendipitous encounter that might result in a groundbreaking discovery.

Every member of your community is unique and adds to its fabric. Everyone has something to offer and everyone should be heard – no matter their age or social standing.  It’s up to us to find it and help them see it. The more expressively diverse a community is, the more resilient it is and more potential it has to invoke change – both inside and outside its walls. Our focus must actively be on inclusion, not retreat into personal protectionism and paranoia of those different from us. We must resist the temptation of the comfort of “sameness.” Nothing happens in our comfort zones. If we don’t venture into the land of unease … we’ll never see, let alone realize the possibilities life avails to us.

Designing for Serendipity, Synergy and Collaboration

Cross-pollination doesn’t happen easily though. People of different fabric may inhabit the same locale, but that doesn’t mean their views and ideas will synthesize and your community will be built on Alexandria-type collaborations. You have to reach out and try to understand these people not like you. You first need to empathize with them. The most effective way to do that is through shared actions – specifically shared community-beneficial actions. For example, building a school playground with your neighbors of different ideologies can bridge chasms that would otherwise be uncrossable. It’s amazing what work for the common good can do. This is what happens in disaster relief efforts. I doesn’t matter if you’re a Republican or a Democratic, everyone bands together to help rebuild the town they all live in. We just have to not rely on disasters to bring us together. Community commonalities are everywhere. We just have work to create opportunities for everyone to share in them.

From these opportunities and resultant actions will come serendipitous relationships; relationship that can create synergies that move your community ahead in ways no one envisioned. That being said, we have to design environments; physical, social and personal so that these opportunities, actions and relationships become baked into our society. In business applications we strive for economies of scale. These efficiencies are mainly mapped on vertically axis or are niche based. Building for serendipity takes community economies of scale and expands their opportunity on the horizontal axis across defined multiple niches and focuses. This solution thinking stemming from diverse thought breaks through conventional siloed vertical constraints.

Imagine if your community had a Department of Horizontal Integration, where its primary role is to break apart the silos of the status quo power structures and connect dots from the pieces. This department wouldn’t need to be housed in the government. In fact it would be best if it wasn’t – for obvious hierarchical reasons. It could rely on your community’s true assets; its people and where they congregate, the Front Porches of the small business network.

Rather than abide by a top-down governance model run by those embedded in the status quo of mediocrity – we must create a platform of serendipity where matchmaking happens organically through interaction uncovering commonalities between the participants. Think of a synergistic mixing bowl of opportunity; obliquitous, indirect, organic relationship building.

Now imagine organizing set gatherings where this serendipity is on the menu. While there’s no guarantee your group will change the world – increasing that chance through proximity of diverse thought and motivation sure increases its chance. And what if the overarching goal of your gatherings was to improve the human condition in your community. How this is accomplished would be determined by those in the room not by a top-down bureaucracy mired in inefficiency and out-dated procedures. Everyone is here for the same reason and they are here because they WANT to be … not have to be because of an overriding need to fuel ego. 

For arguments sake let’s call your gathering, Serendipity. Serendipity could be a petri dish for how to solve civic and social problems directly rather than through government. It would be the platform for inclusion and experimental benevolence. The bar would be set so that no area of community need would be untouched. If something needed to be fixed, or something needed to be done – there would be no questions and no siloed jurisdictional squabbles … it would just happen.

In 1986, John Gage, then of Sun Microsytems, organized NetDay in California. NetDay was historic grassroots effort in the classic American barn-raising tradition. Using volunteer labor, their goal was to install all the basic wiring needed to make five classrooms and a library or a computer lab in every school Internet-ready. If the same work was financed by taxpayers, it would cost more than $1,000 per classroom. Volunteers from businesses, education, and the community acquired all of the equipment and installed and tested it at each school site. As a result 20,000 volunteers helped to wire 20 percent of California schools to the Internet. In addition, by bringing together these diverse elements, NetDay established a framework for lasting partnerships among business, government, educational institutions, and local communities provide ongoing support for the schools to this day.

What if we designed our communities around the idea of maximizing engagement from those in the streets? The more engaged our residents are … the more empowered they would be. They would feel more in control of their health and their futures. Imagine if a chance to engage, whether it was physical, mental or social was just around the corner. What if our physical security and well-being was not dependent on government assistance or the whims of a fickle market driven economy. What if our neighborhood was our safety net, a safety net that knew best in our time of need. What if the streets of our community became melting pots of diversity-driven serendipity – places where curiosity was bred. What if engagement, well-being and self-efficacy was how a community measured itself, not obtuse economic activity often distorted through the one-dimensional filter of irrelevant statistics. And what if getting up in the morning was a chance to nurture our hope … and engage with others to help them do the same.

Building Your Own Alexandria

It’s obvious the human species must evolve. The ascent of Donald Trump to the forefront of our attention has presented us with some hard facts. We all have to take look in the mirror and ask ourselves how we got here. We will have to change our thinking – or maybe just start thinking. Instead of relying on past expectations, and cultural assumptions and metrics as our guides — we have to envision what could be, not just what always has been.

But vision is only part of the journey. We have to look past how things in past have been done. No longer should government and traditional institutions be looked at as the first line defense … rather should be looked at only as a last resort. Our reaction should be to assemble our friends and neighbors at our local Front Porch, organize and do what has to be done — developing self-efficacy along the way. And we best accomplish that by inclusion and reaching out to those around us who normally we may feel uncomfortable doing so. These outliers of our social circles may be the exact people who ensure the very survival of those social circles.

We can make the change we need — but it won’t be by thinking the way we’ve always thought and doing what we’ve always done — the way it’s always been done.

If you’re interested in moving on from the status quo that will inevitably take anyone and anything down with it … please check out Community 3.0, my vision of an evolved society where self-efficacy and the well-being is priority. Or even better email me, at and we can set up time to have a conversation.


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Why Amazon’s Whole Foods Acquisition Will Revitalize Rural America

Friday, July 16 sent seismic shock waves through the grocery industry, as well as any other company on its peripheral. Grocery stocks plummeted and Wal-Mart heirs lost over billions. Friday, July 16 was the day Amazon announced it was buying Whole Foods, regulatory hurdles notwithstanding. Arguably the world’s most intimidating company has just gotten a whole (pardon the pun) lot scarier.

Amazon and its “anything you want you can get delivered to your door – with free shipping” is now about to add 450+ brick and mortar stores in prime (again pardon the pun) locations to its arsenal. The pontifications by pundits have spanned the gamut of views from outright alarm to guarded optimism of the opportunities that may arise.

Whole Foods organic

The Fallacy of Amazon as the Bad Guy

The chicken littles of the world will prophesize that Amazon will destroy what’s left of America’s Main Street small businesses – using the book industry as an example. What they won’t say is that since Amazon has entered the market, independent book stores have actually done better – the main causality of the Amazon’s online surge being chain stores like Barnes and Noble, and the dead and buried Borders. These two corporate piranhas were on a Sherman’s March to the Sea destruction plan of the industry before Amazon blew up their plans. We can never go back to the days of fifty years ago when independents were the only players in the game. But people will always go to physical bookstores – just not in the same numbers. Clearing out the homogenized corporate boxes like Borders help ensure those numbers flow to independents.

When we talk about small businesses it’s easy to myopically look only at retailers and resellers. What about the entrepreneurs that create the products sold in those stores? What about the writers that supply the bookstores? Under the corporate chain model, independent writers and other small batch producers have no chance of getting their work any shelf space. With Amazon – you, I or anyone else can write a book and sell it worldwide through their ubiquitous online distribution channel. Even with independent book stores we can’t do that; locally probably yes … nationally or worldwide, no. It’s easy to pick and choose the facts to back up our preconceptions and worldviews – but seldom are things so cut and dry. Whether they produce the product or sell it on the street corner or Main Street – entrepreneurs both produce and sell, and we must support the entire independent channel … even if not all parts of the channel are independent.


Over the past two or three months I’ve been on a crusade of self-efficacy. The return of my lymphoma has put me in a “what I do matters to my very existence on this planet” mentality. While I have faith in the conventional chemotherapy treatment that has been prescribed to me (more or less) – I feel it’s my own efforts; whether it be nutrition, exercise and especially attitude, are going to be what makes or breaks the state of the journey down the road to my Perfect World.

In America the healthcare industry spends very little time, energy and resources working with patients to raise their level of self-efficacy. Even with overwhelming proof – discussions of diet, exercise and attitude are seldom raised, let alone made a priority. I don’t know if this is intentional, or just lack of training. It’s hard to believe it could be the latter since even the mainstream media has been covering the research ad nauseam. Whatever the reason – too many of us put way too much faith in “the man on the white horse and man in the white hat” and their ability to fix all that ails us (literally and figuratively).

Amazon and Whole Foods

This brings me to Amazon’s acquisition of Whole Foods. In American culture, Whole Foods is emblematic of healthy food – often overpriced health food … but healthy nonetheless. A trip through the isles of Whole Foods is not one populated by the brands normally seen at a Kroger’s, Albertson’s or other grocery chain. The shelves are filled with foods from providers and farms (all organic) that you wouldn’t otherwise find. Many of them sourced locally. Unfortunately Whole Foods is located in primarily in upscale areas, relegating those who often could benefit from healthier food choices less-than-optimum options

With Whole Foods, the hope is that through their ubiquitous distribution network; Amazon will not only find another piece to their puzzle of being the “everything store” – they’ll make the Whole Foods catalogue available to a wider less-affluent demographic. How this hope plays out, we can only wait and see. America is firmly rooted in an epidemic of obesity and bad food choices. Moving the dial away from the inevitably of chronic health conditions that result from these choices could go a long ways toward creating a society focused on well-being; rather than just the after-the-fact fixes that has immersed our country in the healthcare crisis we’re currently warring over. And that’s just the demand side of the Amazon/Whole Foods equation. The supply side offers up another set of possible variables and effects.

Current State of Affairs in Farming

For several years now I’ve lamented about the farming situation where I live in southern Montana. The climate is moderate and the land is irrigated. Most any type of food can be grown here – yet the only things that are; are sugar beets, feed corn and barley contracted by multi-national beer conglomerates. Ironically our farming community doesn’t grow food. It produces components for manufacturing processes –  beer, processed sugar, cattle or ethanol for our car’s gas tanks. The produce I buy at the grocery store is trucked in from hundreds if not thousands of miles away. The only local food I have access to in this farming community comes from the garden in my backyard.

What this type crop selection has done (along with other factors) is decimate the population of farm-supported small towns. Fewer people are needed to produce small-margin crops like corn. Automation and standardization has replaced craft labor and unique crops options – often those seen on the shelves at Whole Foods. We bemoan the decline of rural of America, often affixing blame on liberals living in the coastal urban areas – when short-sided business decisions by rural areas may very well be main causes. We’ve turned our food supply over to multi-national conglomerates on Wall Street and abandoned local businesses in favor of box stores; and the farms and small towns traditionally supported by food production are the ones suffering most from it.

This does not bode well for upcoming generations wanting to farm either. Small rural towns have made themselves unappealing socially and economically to the very talent they need to sustain themselves. Instead of nurturing young farmers and their fledging families, they sell out to factory farms furthering the cycle of rural exodus. Multiple generations need to evolve together, leveraging the traditions of the past while being willing to reshape them for the needs and wants of today’s generations. Simply expecting young people to fit into the world of their parents not only isn’t fair – it’s not practical as they’ll just abandon it, leaving the old world to simple fade away.

Amazon and the Opportunity for Small Towns

We can look at the Amazon acquisition of Whole Foods as bad for small towns and their local businesses, as many naysayers have. We can ready ourselves to play the blame game – even before-the-fact. Or we can look deeper, past the surface of a ninety second news segment or 400 word blog piece.

I see the acquisition as potentially empowering local producers with a new distribution channel they wouldn’t otherwise have. No matter how the media tries to compare and pit Amazon against Wal-Mart – they are nothing alike. First and foremost, Amazon is a distribution network of hundreds of thousands of suppliers – the vast majority of them small businesses. I see no reason this wouldn’t extrapolate to farms and the small-batch food industries. Rather than large corporate farms producing pesticide-ridden components for a manufacturing process – what if small plot farmers focused on producing food that can be processed and sold locally or through the Amazon/Whole Foods platform. My expectations are that Amazon, gravitating from the Whole Foods brick and mortar network of stores (present and future), will spur the increased demand needed to tip farmers to refocus their efforts towards growing actual food.

Organic farming

But we shouldn’t assume that this extrapolation of healthy food is automatically going to happen just because of Amazon has entered the market. It’ll be up to farmers and small local producers to take advantage this opportunity. It’ll be up to farmers in areas like where I live in Montana to decide to break from sugar beets and feed corn and venture into the unknown land of organic small-batch farming. This transition will be as much cultural as it is economic or logistic. Most farmers are not only economically conservative – they’re politically conservative. Irrationally so, organic food is too often tied coastal liberals and all they represent. For example, kale (my garden’s most abundant crop) embodies all that’s wrong with America to many people in the small town I live in. 

Demand dictates supply, but let us not forget supply also dictates demand. If the product isn’t there; no business, Amazon and Whole Foods included, will make efforts to market and sell it. I want to believe farming groups in locales such as mine can literally create demand for their product by simply making supply more readily available. And by coordinating efforts, they can make their voices heard and their product more competitively available. Imagine local coops acting as a logistical go-between and marketing arm for farmers and small-batch producers. And taking it one step further – these coops can unite creating an even more powerful presence.

Wal-Mart, Costco and the other box stores don’t source locally. Amazon, having the technical backend to do so combined with the Whole Foods small-batch organic focus – most likely will. Farmers will have to break free from their comfort zone and become creative in their crop selection. They will need to maximize local resources (geographic and economic) by identifying the assets of the area and leveraging them rather than just doing the same thing they did last year … worse yet a decade ago.

Building a Sustainable Community Around Healthy Food

Wherever possible rural areas must nurture an environment of craft and small business by taking advantage of local organic food production. With this should be a rebuilding of Main Street – not only as a center of economic activity – but one of civic engagement: all revolving around collective community well-being originating from the production and consumption of healthy food. I envision a societal momentum moving to a healthier, organically based food supply – and an emphasis on health, self-efficacy and well-being. Food (selection, production and distribution) should be the catalyst in all community health efforts. Without it the effort has little chance of sticking, let alone being built on.

None of this is going to happen on its own though. It’s going to take creative thinking, breaking free of “what is normally done.” Ironically it will be a return to our grandparents’ and great-grandparents’ time when farmers grew food for their table and that of their neighbors. Only we’ll be able to utilize the production and distribution technology and processes of today. This cross-generational synthesis will anchor the revitalization of rural America. Growing corn for ethanol and relying on Wal-Mart for our (sourced from god only knows where) is what has put rural America in the dire straits its in now. Now is time to break the cycle of the destruction of our well-being.

Whether the catalyst to a movement of collective well-being turns out to be June 16, 2017 – the day Amazon announced they would purchase Whole Foods, only time will tell. Regardless what’s not to say it can’t act like it is? What’s not saying we can’t our societal norm one of collaborative self-efficacy where our neighbors and our neighborhoods are center to the solution, rather than just afterthoughts at best.

Remember; “The man in the white hat, the man on the white horse” …

They still aren’t coming.


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“13 Reasons Why” … And Why It Matters To Your Community

I watch Netflix – as I’m sure quite a few of us do. A couple of months I was looking at their original section and I noticed “13 Reasons Why.” I had read about it and thought about watching it … but no matter how intrigued I was, I couldn’t get myself to dive into a series about adolescent suicide. On the surface it looked too much like the plethora of other young adult series you find on Netflix … only with a more ominous premise.

But then after a few weeks I noticed “13 Reasons Why” was starting to get a lot of buzz in the mainstream media, but not because it so good – but because many parents and the mental health profession considered it too controversial. The book it was based on was even appearing on banned book lists. This peaked my interest. 

A few years ago, Harvey Weinstein and his brother, Bob, of the acclaimed Weinstein Films produced a topical film about teenage bullying aptly named “Bully.” While not entering the territory of being banned, the Motion Pictures Association of America (MPAA) gave it an R rating; even though its target audience was high school kids and it confronted an issue too often ignored in our schools. Apparently the colorful language of real life in high school was just too much for the virgin ears of teenagers to hear on the screen. Outraged and standing behind their film and its significant societal benefits, the Weinstein brothers circumvented the MPAA and re-released with no rating (NR), leaving it up the each individual theatre to make the call who could see it.

I couldn’t get “Bully” out of my mind every time I thought of diving (or not) into “13 Reasons Why.” Much of the exact things overprotective parents, however well-meaning they may be, want to shelter their kids from are the exact things they encounter everyday at school. As with bullying – suicide, whether carried through on or just contemplated, is real their real world. And our reluctance as parents and adults to see this and confront it head on can have catastrophic consequences.

“13 Reasons Why”

“13 Reasons Why” revolves around a high school student, Clay Jensen, and his friend Hannah Baker, a girl who committed suicide after suffering a series of demoralizing circumstances brought on by select individuals at her school. A box of cassette tapes recorded by Hannah before her suicide details thirteen reasons why she ended her life.

As I mentioned above, the series was not without controversy. It seemed to initiate a united global front from psychology and psychiatric organizations. The outcry centered on the series’ over-simplification of the reasons behind suicide. Much of the focus of “13 Reasons Why” was put on the bullying Hannah had to endure. This reaction is not surprising. After all, the value of their profession is predicated on the assumption that our psychological maladies are rooted internally – and not fixed simply through external adjustments.

In Montana where I live, the state legislature meets for one three-month session every two years. Being heavily conservative, they don’t really do much of anything that involves spending money. They’re big on trying get more guns everywhere, restrict abortion and rid the state all that evil liberal stuff like environmental regulations. But spending money … not so much.

About only thing that both parties could agree on was a mental health and suicide prevention bill. Or at least that’s what they called it. The legislation established that insurance companies that operate in the state must cover mental health on the same level as physical health (welcome to the 21st century). It also dedicated a whole $1 million for local communities, school districts and tribes to develop their own suicide prevention programs. $1 millions doesn’t go far. That’s about one dollar for every person in the state – what a MacDonald’s double cheeseburger on the dollar menu used to cost when there was such a thing.  I suppose we should happy in the Big Sky Country they even did that, since about their only other accomplishment was to add a couple extra judges to deal with all the meth cases that have been piling up.

However well-intended this legislation is, it’s still after-the-fact. Granted, maybe more counseling will help persuade a disenfranchised kid to not take that final step; but anyone who has or has had teenagers knows, probably one of the last places they’re going to go to talk about suicide is to an office that sits down the corner from the principal. The risk of being on the principal’s radar, for whatever the reason, is too much  of a deterrent. School architects don’t think about these things. However, aside from where the counselor sits – too much of the time, the effort is put in is still after-the-fact.

Suicide is an effect of the circumstances thrust upon us by the current society we live in. For the most part it’s a reaction one has to the stresses of their lives, like doing drugs or drinking alcohol – only much more extreme. Granted some methods of coping are a lot more self-destructive than others – they are still all ways to psychologically vent, opening our steam valve. Releasing this pressure is going to have to happen one way or another. The question is how.

I believe how and when this release happens is a function of three components. These act in concert and the result of this interaction can often dictate whether someone lives or dies. Our goal as communities must be to sway these factors in as positive direction as possible.

  • What are the external factors that contribute to the pressures one undergoes in their lives (financial issues, bullying, academic pressures, etc.)?
  • What outlets are available, adolescent or adult, to release this pressure (sports, work, drugs, hobbies, etc.)?
  • How mentally strong is the person (level of self-efficacy) and how much pressure can they take?

It’s easy to simplify the phenomenon of adolescent suicide, as “13 Reason Why” was criticized of – by saying much of its root cause is bullying. Or we can blame parents – whether being over-protective, demanding of even just being indifferent. Or we can blame it on society as a whole by saying it’s just damn unjust and too many of our kids have poverty ridden upbringings (even though poor kids don’t kill themselves any more than rich ones do). Regardless, pinning the blame on external factors, whatever those may be, address only one of the contributing components. Unfortunately, no matter how much we try, there are always going to be reasons why; there’s always going to be monsters under the bed – no matter how well-feathered that bed may be.

Whatever the reasons why, the best way of combating destructive behavior, including suicide, is refocusing energy by providing positive outlets and alternatives. If your life has a purpose, you’re much more likely to spend your time and attention on that purpose rather than on self-annihilation. For example, it’s hard to feel sorry for yourself and drown yourself in a bottle of vodka if you’re too busy helping those less fortunate than you are. In fact volunteering often helps the person doing the volunteering more than the person being helped.

“The mind…can make a heaven of hell, a hell of heaven.” ― John Milton

Even after we’ve addressed the reasons why and created positive outlets to focus on, we still don’t live in a Perfect World. The human psyche is vunerable. The monsters will always be there and no matter how much we try to ignore them … they’re still going to find their way into our minds. Or in the words of John Milton; “turn our heaven into hell.” The question ultimately becomes … how do we deal with them when they do. Do we dive into the bottle or the medicine cabinet – or do we shake it off and put the haze of gloom behind us. How much can we, or in the case of “13 Reasons Why” our kids – take. 

Salutogenesis and Self-Efficacy

Salutogenesis is a term coined by Aaron Antonovsky, a former professor of medical sociology in the United States. The term describes a health approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the “salutogenic model” is concerned with the relationship between health, stress, and coping. Antonovsky’s theories reject the “traditional medical-model dichotomy separating health and illness”. He described the relationship as a continuous variable, what he called the “health-ease versus dis-ease continuum.”

In 2008 Scotland, specifically Chief Medical Officer Sir Harry Burns, adopted salutogenesis as national public health policy. Burns helped Scotland conceptualize health improvement differently, being aware that the small gains that resulted from a range of interventions can add up to produce significant overall improvements. Much of these interventions were and are aimed at empowering the populace through engagement with their own health outcomes.

Engagement creates agency and self-efficacy. Self-efficacy is defined as the extent or strength one believes in their own ability to complete tasks and reach goals. The more a person believes their actions will help their situation, the more likely they are to try. When fighting adversity, self-efficacy is your tool chest, or for those in Montana, your ammunition stockpile. It’s your ability to fight the monsters under the bed. One of the most potent defenses we have is engagement. This engagement can be with ourself, through our minds and bodies, or with those around us in our communities and neighborhoods. “Doing” is a prescription for well-being. The more a person does, the more they’re likely to do. And the more they do, the more they feel what they’re doing is helping … creating a cascade of positive results and self-efficacy.

Now back to “13 Reasons Why.” Let’s assume that the story of Hannah was not fiction; what could those thirteen people have done that would have changed the outcome? But even more so, since the reasons why are just one variable, one factor in the suicide equation – should this even be the question we’re asking? Ultimately suicide is still a personal decision. If there’s a complaint I have with the show, it’s that it portrays Hannah too much as the victim; just a pawn of the external circumstance swirling around her, the poor girl at the peril of the “monsters under the bed.”

That being said, external factors can’t ignored. In fact external factors play prominently into all three of the components I’ve referenced above. What could have these thirteen people have done to create a community that was designed around positive engagement opportunities for young people so they their reaction to stress wasn’t addictive substances and self-destruction? What could they have done to nurture their young people so they could weather storms like these – because there will alway be storms in their lives, whether it be today or in the future? These are the questions we should be asking ourselves. We can’t restrict our focus to efforts after-the-fact … after the damage is so severe that whatever hole is plugged today is only going to reappear tomorrow or the next day. 

We have to wake the hell up otherwise our kids are going to kill themselves. It may not be one thing, but the accumulation of things that add up that gives them the feeling of inescapable hopelessness. Engagement refocuses and helps them break free of the downward cascade. It’s a positive release … and with this release comes hope.

Confederate flags
Livingston, Montana High School

The Failing of a Town and Creating Hope in Yours

Last year I wrote about a suicide that occurred in Livingston, Montana – down the road from me here. In The Failing of a Town, seventeen year old Deon Gillen committed suicide after years of being bullied. His plight was no secret though. On numerous occasions his mother brought it up with school administrators. When a Billings Gazette article came out detailing the incident, the public outcry was harsh – so harsh that the high school shut down their Facebook page, attempted to discredit the report and enacted a locked door policy during school hours. Just the time they have should embraced taking responsibility … they circled the wagons. This was not unexpected though.

I wish that was the end of the story however. It wasn’t though. Not even two weeks after Deon’s tragedy, two more people in Livingston (pop. 7000) committed suicide. This time it was two adults and they received barely a footnote in the paper. Not only had Livingston failed its youth, it failed its adults as well. In a separate article, I read that Park County, of which Livingston is the county seat, has the highest suicide rate in the state (in a state that has the highest rate in the country). And this was calculated before the latest rash of incidents. This dubious distinction is no small feat, but probably not one they’ll include in Livingston Chamber of Commerce’s next promo brochure. What the hell type of a place is this that access to engagement and positive outlets to stress release is so limited that the accepted alternative is to kill yourself.

“Leave every person, every place and everything better off from you being there.”

It’s everyone’s responsibility to make their community better for all its residents. We can’t push off this responsibility to only politicians and social workers. And that doesn’t mean just low taxes and more box stores. It’s up to all of us to contribute – not just take and lobby for our own interests. Helping others is not only the right thing to do … in the long run it’s a prudent economic strategy for a community to take. Going around proclaiming how great your town is when people have few opportunities to engage, reach out and be touched is hypocritical and will eventually be self-defeating.

Too much of the time we assume legislation is the only way to fix our societal ills – like here in Montana with the suicide prevention bill. In reality it’s just the easy way out for us adults to say we’re doing something – giving us an excuse to say we’re actually doing something for our kids. Bill Clinton once said “You can’t legislate morality.” No truer words have been said.

For two years I’ve stood on my soapbox and preached the need for us to rebuild the relationships with those around us in our physical neighborhoods. I’ve stressed focusing on our commonalities not our differences. These Middle Ring neighborhood relationships and the actions that come from them are what are going to determine the personality of where we live. It will determine what we do when someone, say one of our children like Dion, is in trouble. It’s how we raise them and whether we teach them to be empathetic and compassionate. It’s whether we view hardened ideology as a virtue or an obstacle. It’s whether NIMBYism is the norm or a condemnable exception. It’s whether we confront someone for bigoted talk and attitudes … or we just let it slide. These are the socially accepted attitudes and norms that determine what we do when it matters most. They determine our communities’ character.

It’s not easy to make the effort to do the right thing – especially if runs contrary to community norms.. It’s easier just to go with flow and expect someone else will take the chance and do it. But normally no one does. Be the one that does. And who knows … maybe someone else will start doing the right thing too.


Melvin is a customer engagement platform that enables small businesses to combine their loyalty marketing efforts with messaging designed to improve the well-being of their community. This messaging is designed to combat mental, physical and social isolation through community and civic based engagement and volunteer activities. You can find out more about the Melvin Initiative and Community 3.0‘s efforts to improve the human condition at the initiative’s dedicated site here.


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