Phillip Summers began working in community development in 2001, teaching health and physical education in Belize. He holds a Master of Public Health from UNC-Chapel Hill. Phillip is interested in social justice, racial reconciliation, and active living by design. He has more than 30 co-authored publications from community-based participatory research with immigrant farmworkers and construction workers. While doing community engaged research public transportation captured his imagination and passion for creating systems that enable health. He lives with his family in Winston Salem, NC, and works as a bus driver for the public transportation system.
Gunderson: This is Gary Gunderson. I’m talking to Phil Summers here, actually in my home. We just had a good lunch, and we’re talking about the learning journey that’s involved in someone who finds themselves caring about community in ways that may begin in a professional identity and then extend beyond that, sometimes go sideways from that. Phil is a friend and a colleague from the beginning of when I came to Wake Forest and the academic medical center. We have a large public health science division with many researchers, and the work of Tom Arcury was well known to me when I came. I fairly quickly learned that Phil was a key researcher in this work. So my first experience with Phil, as someone who was a talented researcher on the younger side, and I’m going to ask you to sort of unpack a little bit of that research first.
Then the middle part of our interview will be focused on beginning yesterday, when I pulled up outside the five million square foot clinical complex of Wake Forest Baptist Medical Center. Phil was next to me, driving bus 103, filled with a number of our patients, and it was actually a research curiosity and deep spirit and heart that is why you were driving that bus and not in my car, about to walk back from lunch into a desk job at the medical center. So there’s a pretty fascinating midpoint in this story, and we’ll want to get to that. But, Phil, let’s start with how you became you. We’ll presume we know who you are, but we don’t really know that. But tell me a little bit about your formation.
Summers: Well, thanks for having me. Yeah. I’m glad to be here. I certainly was doing community-engaged participatory research, community-based participatory research starting back in 2010 at Wake Forest School of Medicine, under Tom Arcury. We were doing occupational health research with farm workers, and that’s a social justice issue that has gone on for a long time, that agricultural workers are treated as less than. They really constitute the kind of bottom rung of the labor force. I, as a research assistant, was brought in under some funding that the Obama administration was using to stimulate the economy, way back in 2010, and we were doing a study on farm worker housing. So it afforded me the opportunity to work in a very productive research enterprise and laboratory that cared about stakeholder engagement. So we had farm workers in our design process. We had community partners. I’ve always been inquisitive, but I certainly learned how to have academic rigor. So if you look up Philip Summers in PubMed, I think I have over 30 publications, and that was just… I only mention that to say I was part of a very productive research job.
But, even before that, I was interested in social justice. I was brought up in a Christian home and have done mission work and really wanted to understand how can we help and engage and show love and demonstrate love to people who are at the margins of society? So I found myself, in 2010, doing that. I think it was in 2012 you joined the medical center?
Gunderson: I came in ’12.
Summers: Yeah. So I don’t know if Gary remembers, but I was one of the first people to email him, because I had read his book Boundary Leaders,how people of faith can have influence in public health when I was in grad school at Carolina. So I was a fan before he came, and I was anxious to get to work with him. So, over the course of my nine years at the school of medicine, we became friends and certainly would overlap in some projects, I can remember. Actually, it would be tonight, if El Buen Camino was happening, but I think it was the first El Buen Camino that you helped sponsor. Really helped lift that 5K. It was a Hispanic community partner that we were working with. Needed some funds, and it was nice that the medical center, through the foundation and some of the dollars that Gary controlled, one of his first moves was able to kind of underwrite an important community partner. As we were looking at immigrant health, the community partner was helping us recruit people into our control group.
So I had a wonderful nine years of really doing community-engaged and stakeholder work. I finished there leading what was called the Program in Community Engagement. So we had money from NIH through their Translational Science Award to do stakeholder engagement. For the last three years, when I was leading that effort I was really enamored with some policy work that we were doing around public transportation. We were advocating and following some of the good public health research that says if you expand public transportation, that’s an important social determinant of health. You’re intervening on people’s ability to get to work, get to faith communities, to take more steps in the day, less pollution.
So, in some ways, I kind of fell in love with the idea that expanding public transportation was the first community intervention that had all this promise. My dad is in drinking water, and I know you public health thinkers out there will have your own bias toward different public health interventions. I know drinking water’s an important one. I mean, vaccines. I think maybe we all fall in love with our different idea of how to use a system to improve health. But, locally, when I was doing stakeholder engagement, I realized we have a lot of great things in this community, but they’re not very well connected, and the tragedy there that we see is that it has a legacy of segregation and concentrated poverty around race lines.
So you have your hospitals and your grocery stores and all these health-producing assets on one side of town, and you have all your concentrated poverty on another. As I’m trying to intervene on health disparities, I’m thinking, “What can bridge that?” To me, time and again, it came down to access. But not access in the “Let’s create some sort of fancy model to get them there.” It’s like, no, physically, they need to get there. We have a great Goodwill program. We have community colleges. We have all these things, but if you can’t get there, day in and day out, how are you supposed to avail yourself of them, or how are you supposed to take advantage of the resources?
So, for three years, we really worked on policy. And I couldn’t let it go. I think sometimes there’s a life cycle to things, and it’s like, “Okay, Philip, you have to stop talking about it. We’ve got to move on.” It’s like, “But I can’t stop talking about it.” I think there are other seeds in my life, like my undergraduate degree is in physical education, so I love to watch people move around. I love to move around myself. I’m a bike rider, so I think maybe it was kind of a calling away from the office setting to just observe people. I like to watch people. Gary and I were joking at lunch.
Sometimes being a bus driver is people-watching overload, though, because you’re doing it eight hours of the day, and sometimes, especially when you have public health sensitivities, you want to look away. I was reflecting on the other night, I drove by this race track and, as a public health figure, you’re grieved when you see overweight people, when you see people smoking. We want better for them. So sometimes, when you’re driving by something that maybe is not necessarily health-producing regularly, and you’re really confronted with the status of health in the US. I can remember…
Gunderson: So, Phil, wait a minute.
Gunderson: I want to interrupt, because I suspect, at this point in the interview, some of the stakeholder health folks listening to the interview are saying, “Wait a minute. You’re actually driving a bus, not writing a paper about people who are driving buses, and you’re actually on the bus, watching human beings for eight hours a day, not reading about people writing about people riding a bus?” So walk us through this process. How did you become a bus driver? So you decided, “Okay, it’s not enough to be a researcher. I actually do love the community, and, as we all know, sometimes love makes you crazy.
Gunderson: Well, so your love is you’re driving a bus. How did that happen, and what’s it mean? How do you become one?
Summers: Well, I’m so glad you asked that. I think love is the reason. I can remember, when I was interviewing for the job at Wake to be a researcher, Sara Quandt said to me, “Now, you know we’re not doing service. We’re not doing direct service. You seem to really want to help people. We’re doing research.” She helps a lot of people. Their work is cited, and I was glad to do it. But I think there became a calling to want to do some more direct service and, in some ways, apply all the things that I know. So what I’m telling you, as a bus driver, I feel like a one-person intervention. I know what a lay health advisor is, so when … I’m like a lay health advisor to the fellow bus drivers.
So I don’t feel like I gave up those other aspects that are important, and the last thing I want to do is diminish any of that work. I just kind of walked into a new chapter. And love is the exact right word. As I was reflecting on, “What should I say in this interview?”, I should say that my family intentionally lives in some of these concentrated poverty reasons. So, for nine years, I had been seeping and knowing and steeping in the lived experiences of my neighbors.
So I would ride the bus to work at the Wake Forest School of Medicine, and I would befriend coworkers at the medical center. I would befriend neighbors. Their time on the bus enriched my life, or those relationships, and then wanting to understand their experience more fully. So if you want to find maybe an academic analogy to what I’m doing, Seth Holmes has done some great work out in California. He went with migrant farm workers and illegally crossed the border. So, in some ways, I’m really just trying to embed myself to see how I can best intervene. When we were doing policy work, I had a feeling that there was…
Gunderson: You’re not riding alongside a bus driver. You’re…
Summers: Sorry, I keep missing that point.
Summers: I am a driver.
Gunderson: It’s like a really important point.
Gunderson: You’re driving a bus.
Summers: Getting too philosophical. Well, I wanted to know what it was like, and turns out they need a lot of bus drivers. So if you apply, they’ll hire you. You go through two months of training, and you get your commercial driver’s license. You’re really an independent operator. They give you a schedule, you show up, you drive your bus. You talk to people. You interact with other bus riders. You learn the scheduling.
So you have to make a living, and so I realized, “Well, they’ll pay me to do this, and I’ll get to keep working on the issue.” I don’t think I could’ve written a proposal… I guess maybe as a master’s level researcher, I couldn’t figure out how I was going to write a proposal to keep working on the issue. I think, in the clinical setting, we want to find clinical answers, and, ultimately, I wanted to find primary prevention answers.
That’s where it gets back to this issue of love. My neighbors, who I love, I saw how changes in the bus system negatively impacted their life or positively impacted their life. I wanted to understand, how can I be of resource to more and more of my neighbors by continuing to improve and study the issue of public transit? There’s a lot of great literature out there that says that it helps people, and I wanted to understand that, not just from reading it, but by doing it.
Gunderson: So, on Mondays, you drive 107. That goes to both major health centers in Winston. What do you see?
Summers: So you see a flow. You see, early in the morning, the contract workers and the housekeeping staff are going in to work. You get to know them. You get to kind of understand how contractual relationships keep people in poverty, right? These are the same people who are riding the bus. You grieve the fact that they don’t enjoy all the economic prosperity or advancement that certain people do.
So, again, I always revert back to these social justice terms. It colors what I see. I see me, the one white guy, driving a bus full of minorities to low wage jobs, and it feels like they’re trapped in that. But there’s a lot of joy, too. I mean, it’s life. I know you’ve written about this whole idea of life is this interesting paradox, where it’s like it’s not stopping. It’s abundant. It’s there. So there’s this wonderful community and camaraderie on that 6:30 bus, because we’re going to work. And I know where they want to get off, because I’ve been driving them for a month, and I’ll hopefully drive them for several more months or however long I’m called to be there.
So that’s kind of the inflow, and then the sad thing is you start to know your patients… or patients, sorry, your riders who some of them turn out to be patients, and you say, “Hey, you ought to talk to the FaithHealth people, now that you’re telling me you’re having an asthma attack and can’t afford your $300 inhaler. There are probably people there that would keep you from going to the ER,” as the guy’s wheezing and saying, “Hey, drop me off at the emergency room.”
So you really do get to take people to the emergency room. I mean, I can remember driving the 107 at midnight and this guy twitching and scratching at things and obviously having some sort of mental break. Gets off of my bus right at the emergency exit at the other hospital. So there’s a little bit of fear around that, too. I think what I’m doing is radical, because it’s so terribly vulnerable. I mean, I’m right on the front lines. I’m a minority in a setting where there’s not a lot of master’s trained white guys driving buses. I’m a minority in that respect. But I’m certainly from the majority culture, and so that has its own baggage and privilege, too. So I just… I get to see people. I mean, I don’t want to shorten that answer, because I get to see people in mobility devices. That means I’m loading their wheelchairs and strapping them down. That means you’re pretty close to them, and you’re smelling their unwashed skin. You’re helping elderly people. You’re kneeling the bus so elderly people can get on.
I have a blog. It’s blindspot.city and I’m right now drafting a post about movement. One of the things about public transit is you walk more. Well, I get to see people running to catch the bus. They don’t want to miss the bus, so you see people on a walker pick up their walker and start running with it. They’re like, “Hey, don’t leave me behind. I don’t want to wait for the next bus,” and we wait. Then they scold you, “Now kneel the bus,” and you’re thinking, “You just ran here, and you need me to kneel the bus for you?” But you do. You’re trying to give good customer service, but there’s just things like that that are really amusing, day in and day out, as people are getting off and on your bus.
Gunderson: So I’ve never ridden the bus to my own job at the medical center that you drive past every day. I don’t know… I function, and I suspect most folks listening to this podcast function at a level in their institutions that they probably don’t ride a bus, either. How would we understand our work differently?
Summers: That’s a great question. When you ride the bus, you get very close quarters. There’s a guy out of Atlanta who talks about the three-foot challenge. I’m forgetting his name, but you get really close to the problem. So if there was a call to action from this podcast, it might be try public transit. Now, there might be people listening who ride the subway in New York, and they understand. You’re going to bump into a homeless guy. You’re going to run into people who don’t look like you. But that really embraces this idea of diversity.
I guess… I’m 40 years old. I was probably brought up under this idea that diversity really does matter, and I wanted to live into that more. So when I use languages like minority and majority, I understand that it’s my privilege to give up some of my privilege to go take a job like being a bus driver. I understand that I’m exercising privilege there. But what it affords me is getting to see people that are otherwise kind of cloistered away. So if you’re looking for creative ways to break down some of those barriers, just simply riding the bus on a commute one or two times a month or a week would give you insight into some of the populations that you very well could be trying to design programs for or create relationships with…
Gunderson: I know when Russ Howerton heard about your work—he’s our chief medical officer for the medical center—and you probably created the opportunity that he took advantage of. He’s the kind of guy who also follows his curiosity where it leads, and he rode the bus. He still talks about it. This was some years ago, but he still talks about it. It’s so impactful to have even a tiny slice of reality of the lives of the people who normally you relate to as patients. Kind, thoughtful, decent, every kind of high, noble aspect of being a medical provider, doing the right thing. I’m speaking of Russ, but he had not experienced the actual life, even a tiny bit, and that tiny slice impacts him now, years later.
Summers: Well, and you hear… If you want to read academically about… Some of the bike advocates will talk about how cars give you this false sense of power and autonomy. You’re going so fast. So you really are humbling yourself when you’re waiting on a bus, when you’re walking up to the bus, when you’re not able to go 60 miles an hour, when you’re not able to leave a destination when you want. Those were values that I was also trying to live into as I was a bus rider. So I was a rider long before I became a driver. If you go to the blog… we created a movie through… Thurgood Marshall gave Winston-Salem State some money, and it’s called Bus Stop Jobs. It’s a ten-minute documentary. I was so enamored that… The two characters end up being the passenger and the driver. I was so enamored with the driver, because these things kind of work in your heart and mind and take some time.
I didn’t just wake up and say, “I’m going to become a bus driver.” I was looking around and thinking, “What do I want to be when I grow up?” I think what I realized is that I want to continue to follow this one calling. I don’t know if I’ve reached what I want to be, but the point is this character in this movie that you can watch on YouTube, Bus Stop Jobs, she’s so winsome, an I realized, in some ways, she’s like Mr. Rogers. Mr. Rogers had this TV ministry where he was just trying to be kind to people. I know from being a rider that some of our drivers just lacked kindness, and I wondered why. I wondered what their life was like, and I wondered if I could go and be kind and be civil. Because I’d already done the hard work, or maybe not hard but the easy work of reading and understanding this is important work. We’re getting people to jobs. We’re getting people to healthcare. This is important.
So I had brought with it some high ideals. I wanted to see if I could, day in and day out, live into those. So that was part of it. You’re using the right language of I was curious. I was wanting a change. I think it’s a local problem. Stakeholders had told me it was a local problem, and I thought, “Why don’t I volunteer to try to help?”
Gunderson: So we’ll have a link to “Bus Stop Jobs” with the podcast so folks will be able to follow that link right to YouTube and follow your counsel there. In a few minutes left, I want you to be the advisor of our board of directors, the advisor of our senior leadership. We’ve just completed a budget cycle. We’re tuned, with no small level of anxiety, to the financial challenges of population health, transformation of Medicaid, vulnerable moms, vulnerable kids. That’s underway in the period of months. Not just Wake Forest, but many of the institutions that we work for are making fundamental institutional adaptations to community realities. You’ve been on the institutional side, understand how that works a little bit. Now you’re on the reality side. Speak a little bit to institutional implications of what you’re learning. We’re going to talk to you again in about a year, and you’ll have probably even more insightful knowledge. But even two months of driving the bus probably gives you some valuable counsel. So imagine yourself speaking to our board of directors. What would you want them to take into account?
Summers: Well, thank you. I wonder about the idea of freeing people up, of really seeing their value, of trusting people to do the right thing. I think we posture very defensively and we protect our own self-interest. When I say we started doing policy work, we were exploring the idea of fair free transit, reducing barriers to people going anywhere they wanted in the community, whether it was to see a friend or to go to work.
And I’ll tell you, as a bus driver, I take up fares. It’s a little bit of a hassle, but there’s a lot of people, like little old ladies, who will take the bus up the street to the community garden and back. It’s like you can’t see where you sit that little old ladies are going to take a bus to a community garden and back, but I’ve witnessed it. It happens, and maybe out of fear, you don’t want people coming across town and to the nice, walled-off neighborhoods, but if you just trust that they’ll take the bus and do the right thing and get to work and get to medical appointments, we really have to figure out how to break down barriers to people doing the next right thing in their own life, and we have to trust them. Unfortunately, because of income inequality, there are people who don’t have fare to take that next ride, to go to the social support service. They don’t have the fare to go to that primary care appointment, right? So they put it off, and they go to the ER.
I think people know that. They know it in a sense that it’s out there in the literature, but it really is happening every day. I want us to be more creative about how to enable people to get to where they want to go and where we all want them to be, as opposed to them figuring out what their kind of last-ditch effort is. So I am still just as in love with the idea of helping people who can’t afford cars get places. I think the system should be so good that people who have cars want to abandon their cars because they get to interact with people on the bus. They get to walk through communities, as opposed to speed through them. They get to reduce pollution. So all these noble things.
To me, it really is primary prevention, which is, I think, where population health needs to go. Population health really needs to go towards primary prevention, and so we need these out-of-the-box, big picture strategies that are going to enable diabetics to go to Hanes Park because you told them to walk anyway, but they didn’t have that dollar to get to Hanes Park or wherever. Let’s figure out ways to creatively subsidize the whole community to do active and healthy things, without it being so hard, without it being so prescriptive. It’s just free. You ride the bus because it’s fun.
Gunderson: As you speak, I think TC and I were just in Scotland for ten days with her family, and we didn’t have a car. We used public transportation everywhere, and the entire culture was tuned to be respectful of… As TC said, “People here are kind to old people and dogs,” and I suspect if we were on different bus routes, we would’ve seen them being kind to vulnerable moms and vulnerable kids, too. But the entire culture was tuned to allow inclusion and access and participation across the culture to anybody who wanted to do it.
Now, I know for a fact the studies and literature you probably are familiar with, healthcare, the combined costs of healthcare, social services, and transportation, you put all of that together in one big bundle. It’s no more expensive than our clutter of non-connected systems. It’s just coherent, and it’s embedded in a culture of inclusion. But it’s no more expensive. That’s sort of what I’d say to our board, that what we actually want is in the little town where we’re the largest business in should be tuned to an inclusive culture. It would probably work better, and it wouldn’t cost any more.
Summers: Well, I think it’s looking for those creative benefits that enable people. So it would be a creative community benefit that would have impact on population health. So one of the things that I’ve thought about is this idea, with how much is given, there’s much responsibility. So, as healthcare continues to grow, our burden of responsibility is so great. So how can we, in some ways, instead of going for the big innovations, look for the small innovations that are really at that primary prevention level?
Gunderson: I think that may be our “amen” moment. Phil, I know you’ve got to get back and ride your bike across town. I’m going to go back to the medical center. But you’ve changed my life in the last couple of months. I never drive by a bus without looking to see who’s driving and who’s on it, and so you’ve already been an influence on this one person. I know there are a lot of folks who are very curious about whether or not we might be brave enough to follow the thread of our curiosity into some part of the community we love in the way you have. So I honor you for what you’ve done, and I’m a little afraid of what you’ve done, for fear of what it might make me brave enough to do, too. So thanks for being with us here.
Summers: Oh, I appreciate your example as well, and God bless all those listeners.
Gunderson: Thanks. Thanks a lot.