From its start in 2014 to its completion in 2020, the 100 Million Healthier Lives (100MLives) global movement fundamentally transformed the way the world thinks and acts about health, well-being, and equity. Grounded in trust, and interconnected in partnership at every level, the initiative explored the relationship between the social determinants of health and well-being and revolutionized how the public health sector works together to scale and sustain equitable outcomes.
Drawing on the lessons learned from 100MLives, this conversation explores the power of trust in fostering collaborations among different stakeholders and outside of conventional siloes, how to contribute to a positive culture of health, and the ways in which organizations can foster a culture of well-being.
Realizing the Need for a Trust-Based System
“During the pandemic, we were seeing communities being hardest hit. … What we realized was that we needed to build a trust-based system to move the money into communities, to trust those who — it wasn’t about asking for trust, it was about giving trust and being trust-worthy, and supporting those who were closest to the problems to lead the solutions. And as we were able to do that, we were able to actually watch in over 500 communities across the country how creatively people solved real problems, improved 100’s of 1,000’s of real lives in their friends, their neighbors, in the most creative and brilliant ways and found ways to build systems that could not just create 5,000 jobs today but create and shift policies like Medicaid expansion in North Carolina, shift the Farm Bill, shift what happens with broad band policies and the conditions that lead to poor health in the long term.”
How do we start?
“It begins by getting in relationships and doing things like mapping trust. We have processes for not just mapping power also understanding that trust is a form of power. It is, in fact, a super power to map who has trust and to invite and get in trustworthy relationships. That often starts not by asking for something but by listening, by understanding. By grounding ourselves and then building trustworthy relationships.”
Data and Trusting Communities:
“We looked at data in a way that was about validating and trusting what communities were telling us and about looking for that… A big part of how we’ve been ahead of the curve is listening to what communities are telling us and… watching what the research follow that.”
Trust is Efficient:
“In the case of Delaware, we had to figure out how to transfer [foster] youth in a way that shifted policies and systems. In the case of Communities Rise Together, it was about bending federal money to the places where people in communities needed it and trusting those communities to be able to mount and lead their own response. It took $30 million dollars of funds in those communities to create those jobs. But part of what we were able to show that trust was efficient. Trust could achieve real abundance, like it could actually shift the needle, and do that in a way that now I think 53 federal agencies are using frameworks developed and contributed to by communities that said what was needed.”
What does it mean for a health system to be trustworthy? What does that look like?
“We’ve been thinking a lot about that… Here are the things we’ve found:
We need to shift ourselves. If we go into the conversation thinking that we’ve got it all right and we’ve got it all figured out and that we haven’t created harm, then we’re kidding ourselves and we can’t even begin to get started. And actually we spend a lot of our time in joy, so I want to say that. We talk about heavy things but in ways that are about freeing ourself from legacies that have weighed us down, and collectively removing and transforming those legacies in a way that creates abundance and joy. And so, I think that that’s really important for people to understand and consider living into…. It’s a faulty diagnosis of the system if we don’t understand how our legacies of racism, of classism, you know, the way we treat people who are in poverty, with mental illness, gender and–if we don’t understand how that affects outcomes and how that affects people, we can’t actually move the outcomes.”
Love in System Change and Solutions Through Relationship
At Cambridge Health Alliance, we created high functioning teams, grew medical assistants and receptionists who could be quality improvement leaders, and relational caregivers and nurses. We built an entire health system that made love and trust property of the system and made the relationship the priority. And as we did that, we found that we could move health outcomes to the 90th percentile while taking 10% of the cost out of the system. But what we couldn’t address just by doing things in our waiting room is that there was a whole set of other solutions that actually required us to get into relationship with people in places that invited us to think differently and gave us many more assets to work with–beyond what was in our waiting rooms–that were actually way more powerful than we had given ourselves credit for.
And if we built those relationships, we could actually find not only that, for example, kids spend a lot more time in schools and schools can be great partners in the work. That there were many more assets in the community, and that it was more efficient to solve problems there. It was more efficient to understand that we had choices about where we hire people from and where we purchase from, how we build small businesses and buy food from in our hospitals.
And suddenly there were all these other partners in the healthcare team that could become part of actually bending the curve on health inequities in the first place, that could start to greenline what had been redlined so that that kid that community had that tax base for good schools and healthy parks and toxic stress would be reduced. We actually could put the supports in place as the health system in Texas did… We could trust community members and families to propose supports for their own lives rather than trying to solve it for them. And we could use our policy and lobbying power and our narrative power through our comms department to change the narrative about why people are poor — why people experience inequities — and to move policies, to bring our power and privilege as health systems, which is considerable, to do things like interrupt the incarceration pipeline and to change contracts between jails and for-profit prisons that incentivize police to do bed-fill rates of 90%.”
And it’s actually to say that we aren’t powerless. That we can be trustworthy to our communities. That’s actually what we found interrupts most effectively that cycle in a way that we don’t exhaust our resources and that we can not only be trustworthy but that we can trust others to have solutions that we need.”
Whole, Unspeakably Abundant Communities
“As resources shrank, people were abundant in offering support to one another. You know when you hold resources in a way that’s trustworthy and everyone steps forward and says, ‘Here’s what we can do. We have something to share.’ That’s what we’ve seen. I’m abundant because I’m part of whole communities that are unspeakably abundant with each other.”
How can small, community-based organizations partner with communities to build a positive culture of health?
If you’re community-based, start by understanding who has trust in the community and form relationships with the people who hold trust. Spend some time getting to know them. We are in relationship with–I’ve peeled potatoes in tiny little churches in Canada North Carolina. The time that I was doing it, they were ranked 100 out of 100 in health outcomes and had been slowly climbing the rankings in a faith community and farm. And it’s all about relationships. To youth in Wisconsin to people who are experiencing graduates of the foster system, a big part of it is getting out of our rooms and asking people to come to us and saying, ‘How do we go to where people are?’ One thing Bryan Stevenson says is ‘get proximate to the pain,’ and I would say if you can get proximate to either the pain or the joy, you can connect.”
. . .
Somava Saha, MD, MS, is the Founder and Executive Lead of Well-being and Equity in the World (WE in the World), and Executive Lead of the Well Being In the Nation (WIN) Network. Dr. Saha has dedicated her career to improving health, well-being, and equity through the development of thriving people, organizations and communities. She has worked as a primary care internist and pediatrician in the safety net and a global public health practitioner for over 20 years. While difficult, she has witnessed and demonstrated sustainable transformation in human and community flourishing around the world. As Vice President at the Institute for Healthcare Improvement, Dr. Saha founded and led the 100 Million Healthier Lives (100MLives) initiative, which brought together 1850+ partners in 30+ countries reaching more than 500 million people to improve health, wellbeing and equity. She and her team at WE in the World continue to advance and scale the frameworks, tools, and outcomes from this initiative as a core implementation partner in 100MLives.
Jessica Perlo, MPH is the Executive Vice President of the ABIM Foundation, a nonprofit focused on advancing medical professionalism and clinician leadership to improve the health care system. Jessica is an expert in workforce well-being, quality, and safety and teaches and coaches around the globe, building individual and organizational capability for improvement and well-being, and has authored publications on these topics.
This video was originally published at https://buildingtrust.org.
- Health Equity Framework (HealthEquity.com)
- We In the World website (diverse resources by sector)
- Improving Health Equity through Asset Based Community Development (Answer & Dwyer-Voss)
- Becoming Trustworthy (John McKnight)