Podcast 24 Lauren Gunderson and Scott Burris

Mar 29, 2020 | Coronavirus, COVID-19 | 0 comments


Lauren Gunderson is a playwright, screenwriter and short story author from Atlanta, GA. She received her BA in English/Creative Writing at Emory University, and her  MFA in Dramatic Writing at NYU Tisch, where she was also a Reynolds Fellow in Social Entrepreneurship. She was named the most produced playwright in America by American Theatre Magazine in 2017 and 2019, was awarded the 2016 Lanford Wilson Award from the Dramatist Guild, the 2016 Otis Gurnsey Award for Emerging Writer, and was awarded the prestigious 2014 and 2018 Steinberg/ATCA New Play Award for her play, I and You (also a Susan Smith Blackburn Blackburn and John Gassner Award finalist) and The Book of Will. That play was an NNPN Rolling World Premiere that started at Marin Theatre Company and has seen over 40 productions nationwide. She is also a recipient of the Mellon Foundation’s 3-Year Residency with Marin Theatre Company.

Scott Burris is Professor of Law and Public Health at Temple University, where he directs the Center for Public Health Law Research. His work focuses on how law influences public health, and what interventions can make laws and law enforcement practices healthier in their effects. He is the author of over 200 books, book chapters, articles and reports on issues including urban health, HIV/AIDS, research ethics, and the health effects of criminal law.  His work has been supported by organizations including the Open Society Institute, the National Institutes of Health, the Bill and Melinda Gates Foundation, the UK Department for International Development, and the CDC.  He has served as a consultant to numerous U.S. and international organizations including WHO, UNODC and UNDP.  He is a founder of Legal Science, LLC, a private company dedicated to the social mission of improving access to legal information and the supporting the practice of policy surveillance. He has been a visiting scholar at RegNet at the Australian National University, and a Fulbright Fellow at the University of Cape Town Law School. In 2014, he was the recipient of the American Public Health Association (APHA) Law Section Lifetime Achievement Award, and was the 2018 recipient of the Jay Healey Health Law Professors award. Professor Burris is a graduate of Washington University in St. Louis (A.B.) and Yale Law School (J.D.).

Interview by Gary Gunderson

Gary Gunderson: So when we put up the podcast, there’s actually a little bit of short bio of each of you, so I won’t have to do that. But let me do it this way. I’ve known Lauren since before she was born. Lauren’s best known around the world these days as extraordinary, most-produced American playwright, a teacher of playwrights, and a teacher of actors and actresses. And so I wanted her to be in our life, in this moment, particularly engaging with Scott Burris, who I’ve come to meet over the last five years, with an extraordinary intellect, and extraordinary capacity as a professor public health law at Temple, but a teacher of lawyers, a teacher of those who craft the policies and craft the legislation that give public health a chance to actually create the channels in which society can flow. And so, ever since I’ve come to know Scott, I thought, “I really wish Scott and Lauren would have a conversation.” And today, finally, I get what I’ve wanted for years, is Scott and Lauren talking to each other about the greatest drama there is, the drama of public health.

Scott, I told Lauren I was so struck when I spent today with you in Philadelphia, and I remember riding from the School of Law to your home, and passing these extraordinary historical landmarks. It wasn’t about the Constitution, it actually was about public health. And so, what would be interesting is for you to tell a little bit about what we were talking about; the story of Philadelphia and Yellow Fever and sort of ease into how the founding stories of Philadelphia informed your experience of being in public health law. And what I’m pretty sure Lauren’s going to hear is… As she said, anytime she’s in any conversation, it makes her want to write another play. And when I was with you, I thought, “Wow. Lauren’s got to write a play about this.” Well, that may come out of this conversation.

Scott Burris: That would be cool.

Gary Gunderson: Tell a little bit about yourself and your work, and where you actually are in Philadelphia. And then Lauren, I want you to do the same and talk about yourself. I’ll help you.

Scott Burris: Well, I guess it’s from Anna Karenina, about happy families and unhappy families, and you can say the same thing about pandemics. All healthy cities are different. But all unhealthy cities are the same. The pandemic experience seems to repeat itself again, and again, and again in our history. I suppose Philadelphia has pride of place in the modern American story of pandemic, because in 1793, at the birth of the new Constitutional Republic, Philadelphia experienced its most severe epidemic in its history when Yellow Fever emerged from a particularly hot, swampy summer and spread throughout the city, shut it down for eight months, at a time when it was not just the capital of Pennsylvania, but the capital of the United States. When all our founding fathers were still hanging around, at least at the beginning before they fled. At the time, it was our largest city, our largest port, our national intellectual center. So, this was as if you were looking in England at the plague in London, or at Paris, it was the center of the country being decimated by an epidemic.

What happened from response point of view is also pretty typical of how pandemics have always played out. It started with denial, and people insisting or simply not recognizing it was there. And then in the manner of Camus’ Plague, started to notice something funny going on and started to talk to each other and realize that more people than usual were dying, and they were dying of something that looked the same. So they started to raise the alarm. We had our Fox News of the day suggesting that, really, it’s just the imbalance in the atmosphere and the thing to do is shoot of canons and have bonfires and things like that. And other people suggesting, “Well, maybe it’s spreading from person to person, and maybe we should be actually quarantining all of the new people in town.”

Again, consistent with classic epidemics, there was a bunch of outsiders who had recently come to town, and residents with HIV. They were Haitians. This was the time in which the liberation struggle was going on in Santo Domingo in Haiti, and the French planters had by and large decamped and fled. And so, a whole bunch of them had fled to Pennsylvania and to Philadelphia. So we had a bunch of refugees, who some people were pointing at as being the cause of the epidemic.

This is where the old plague story diverges, we hope, from the new plague story, because in the old, classic plague story, everybody who could, fled. That in this case meant Washington and Jefferson and Hamilton, and the entire federal government, and the governor of the state, and so on. And only those who could not flee remained. Typically, too, the government collapsed, because people didn’t come to work. Not just governors and the senators and congressmen and presidents, but the people who operated city services such as they were, and maintained city government.

In the case of Philadelphia, the mayor didn’t flee, and the mayor went to work. But in order to have a city government, he had to recruit a new government, essentially a junta, from among those who stayed. So a group of Philadelphia’s most courageous citizens, which is to say most of the merchants who didn’t dare leave, because they were trying to keep their businesses alive… They took over the city. And for six months, out of their own pockets, they paid for poor relief, and they paid for something of a hospital, and something of healthcare, and the collection of dead bodies. In the same tradition of rising to meet the civic need, the future bishop of the African Methodist Episcopal Church, Richard Allen, organized the city’s black population to do the dirty work. So, Philadelphia’s African Americans collected the bodies and did the burying in that time.

All around us, all around Philadelphia, the rest of the world drew their lines. So there was essentially a cordon sanitaire around Philadelphia. If you tried to get to New Jersey, you would be fended off by armed guards. In fact, Alexander Hamilton, who managed to get through New Jersey, was denied entry into New York and to Poughkeepsie, and to Hudson. He had to go all the way to Albany to find New York City to take back its favorite son, given that he had come from Philadelphia.

There was this effort of relief, to some degree. The people from surrounding communities would jump off wagon loads of food at the boundary, and then people would come out from Philadelphia to collect it and take it back in. But in spite of that, there was some pretty large scale suffering among the poor, who had no jobs for six months of social isolation and social distancing, no schools. There were orphans to be taken care of, along with the burying of their parents.

And then, as we hope will happen in our story, sometime in the future, the cases started to dwindle. Winter set in, cold weather killed the mosquitoes, and the epidemic was over. By late October, the government was filtering back in. By November, we were, I guess you’d say, back to normal, minus something like 20% of our original population. But you could tell that story if you’re talking cholera in New York in the 1820s through the 1840s. You could tell it, really… Yellow Fever in Atlanta in the 1890s. Even has some resonance for plague in San Francisco in 1900, 1903, 1904. So we’ve always had this problem of being taken by surprise by this disease, by struggling with, even in our highly technical age, struggling with technical questions. How does this one spread? Now, we have the luxury of being, I suppose you could say, befuddled and challenged by creating vaccines and effective treatments, whereas in Philadelphia in 1793, they were challenged by questions of, “What is this? How does it spread? How do you treat it?” Which they never successfully answered.

But nonetheless, we haven’t licked it, nor have, I think, we’ve licked the tendency for people to conflate their interests and concerns with the wellbeing of the population. We are about to have a big fight over the economy versus people my age, versus those who are more susceptible to death. We have the same kind of arguments over whether we somehow made a mistake to get into this and the failures that have brought us here. We should all be incredibly shocked and troubled that we don’t have a test, that we’re not deploying a test en masse in the way that they have been in places like Korea. We should be pretty shocked that there appears to be not much left of public health middle management in this country, the people who would be figuring out where the masks are, who produces masks, where the government can get more masks, who’s selling the masks. That’s the kind of information that is supposed to be monitored over time, so that when this happens, you can actually make a plan.

We should be troubled that, for whatever reason, the federal government decided they were going to close the borders on a Wednesday… Or they decided on a Wednesday they’re going to close the borders on a Saturday, that come Saturday, nobody was prepared. That people who were at higher risk of disease were actually packed together in tiny airline hallways for several hours where they could practice spreading whatever they had. These are all the kind of questions of readiness that, in modern epidemics, we’ve been more concerned about, and which we have gone backward on in this country.

Gary Gunderson: So, Lauren, you can see why I wanted you to meet Scott, and Scott’s day job is helping draft legislation, train public health leaders, especially those who draft policy legislation and do the kind of blocking and tackling of public health. Most public health folks are not as eloquent and do not have his historical memory. And so, Scott and I have worked, along with Gene Matthews and some others, for five years trying to help public leaders find their voice. Scott, I wanted to talk a little bit, in a bit, about the public health advantage and how we have sort of found our way trying to find our voice to help others find their voice. But when the pandemic started breaking out, and we saw this happening, I thought, “You know, I wonder whether the professional storytellers could help us. I’d never actually turned to you, my daughter, and said, ‘Lauren, can you help us learn how to craft the narrative, craft the story, pay more attention to the whole framework of the story?’ How do we bring the characters, the humanity of this greatest trauma out in this moment so we could all know how to play our role?”

So that’s what I wanted you to engage, and you did a gorgeous job with Gene. I don’t think Scott memorizes volumes of poetry like Gene. Nobody does. But I wanted you to talk a little bit about how you, as a writer and a playwright, engage with this field. And you might mention, at the very moment, tomorrow, you’re going to be teaching hundreds of people on a playwriting workshop on Facebook using these technologies to instruct and help others find their voice. In fact, that’s what I want you to help us do with public health.

Lauren Gunderson: I’m struck so much by the history lesson. I adore history. I write a lot of plays that situate themselves in a critical moment in time, because theater, much like novels and movies, can be a form of time travel. We get to go to that moment and see the more intimate details of a place and a time. And you did that for us in how you described the incredible experience of being at that time during Yellow Fever and all these other moments of plague and outbreak.

What occurs to me is finding the heroes and finding the protagonists of the stories. The protagonist’s obviously the main character of the story. And the reason they are the main character is not necessarily because they are the most “heroic,” or “interesting,” even. It is because it is their action and decision and the consequence of their actions that we’re following. That was propels the story. That’s what drives our interest. So, when you mentioned those shopkeepers and business owners that took over the city when the government left, I want to know who they are. How did they make that decision to go from a business owner to a de facto mayor? I can see a play there. I can see a play in the people who say, “Well, somebody has to bury these bodies. Okay, I’m going to do that.” Who is that person, and what were they doing right before that decision? And what is the consequence of that action? And what did they give up and sacrifice and challenge themselves to do in these times of crisis? That’s what theater loves and needs, and all stories need those kind of people.

I can easily see us following Alexander Hamilton. There’s already been a minor musical about Alexander Hamilton. He may not need another one. But I could see him, following him as he’s trying to get back to his home state, and being denied, denied, denied. There’s so many of these things that you just mentioned in your brief historical American pandemic 101. It makes me think of, “Who are those people making the critical decisions that affect a town, a state, a country?” And I think we’re seeing a lot of them, now, certainly in medical workers, but in people who are deciding to make masks. There are fashion designers and theater companies that are turning their costume shops into makers of masks because they want to help. Every manner of person, I think, is trying to find the ways that they can help and act. And that is what I remind people in any sort of storytelling workshop or class is: your main character has to do something, not just say something. And I think that’s what we’re seeing in our history, and what is so interesting and makes me lean in to that historical storytelling is, what are people doing? What is the extraordinary action that they’re taking that this crisis pushes them into?

That’s what I want to investigate, and I think that’s what we can imitate. We can follow those instincts of those protagonists and those heroes and say, “Well, what can I be doing?” I thank you so much for that. There’s about a billion plays in what you just said.

Scott Burris: If Jonathan Demme were still alive, we could pitch Philadelphia: the Prequel.

Lauren Gunderson: There you go.

Scott Burris: Just keep turning out plague movies and stories from Philly. And I appreciate that, and they are wonderful people. There’s a wonderful book, if you want to pursue this, called Bring Out Your Dead, which is written by a historian at Penn, about this. And one of his big characters is Stephen Girard, who eventually… When I think about Stephen Girard and his role, it kind of takes me into the, what I guess I would … Framed from a dramatic point of view, call more of Brechtian mode. One of the features of the Philadelphia epidemic from a social history point of view is that the people who stayed were not the elites. So not only do you think of Richard Allen, the outcast who … he and his fellow African Americans were kicked out of the Episcopal church, because they didn’t want black people in the Episcopal church, so they had to start their own church.

Stephen Girard was a mere immigrant merchant from France, and not part of the Quaker elite that really ran the city. And so, there was this underlying kind of social struggle for power that’s going on. I think, when we look at today, and when we look at what Gary and I and Gene have been working on, there is a real crisis of agency in our own story about ourselves. You do not see readily… I think there’s a real question as to whether the current public health identity is a heroic identity, or whether it’s a bureaucratic identity. Whether is embraces itself as the leader that rises up in the crisis, or it just keeps its head down and does what the politicians say with very limited resources that are left. I guess Anthony Fauci sort of is supposed to represent our heroic public health mold. Within the limits that Trump allows, he’s speaking soft truth to power, I guess you could say, or muted truth to power. But CDC as an agency is silenced. The people who are the actors in this story now are the governors and the mayors. And the people in public health are kind of behind. I don’t know whether that’s a bad thing or a good thing, but it’s very different.

The original board of health … The idea of a board of health came out of stories like Philadelphia, because what a board of health was, though it had some nice, legal form around it, was basically the list of people who could be counted on to stay and not flee. And that group that could be counted on to stay was then given all the powers of government. Their power was to do whatever was necessary to respond to the epidemic, and they were essentially our version, the 18th century version, or 19th century version of emergency power. But it was rooted in the fact that they were going to be those agents that you talked about. They were going to be the ones who took control. And it was that kind of clean story of staying heroically, fighting uncertainty.

I don’t know how we reclaim that clear story now in a truthful way, when the actual life of the public health person and their sense of possibility in agency…. Not to go against that idea. I perfectly love you story, but I feel like this is the challenge. To make this real, somehow we have to have part of that story. Maybe it’s more like Ibsen. There’s this other whole background, right, of where that hero is in a setting that is not set up for heroes.

Lauren Gunderson: I think that, in itself, makes a good story. That’s a perfect hero. If a hero has so much going against their version of right, and they have people who want them to say a different thing than the true thing, or the convenient thing instead of the true thing, that is the medal of most great stories or triumph, is you’ve got to have something to triumph over to triumph at all. So if it were easy, it would not be a very good story. Now, unfortunately, we wish it would all be more easy, since that’s the story we’re living. And I wonder what you think about … What would a heroic public health worker, leader, the middle management you talked about … What would those people do now?

Scott Burris: What do we want? Detailed operational plans prepared months in advance. That is another part of this story, right? That epidemic… Maybe the testing story is the right story. That’s a wonderful story to tell, because that was the failure. So, if you imagine… That horrible, bloviating idiot, yesterday, in his Castro-like performance, kept saying, “We didn’t know, we didn’t know, we didn’t know. The Chinese, they’re … We call it the Chinese Virus because they kept it a secret.” Reuters reported yesterday, although, the press didn’t ask him about it, that we had a CDC person embedded in China CDC until last summer, when that position was eliminated because of budget cuts. So, that’s the beginning of the story, when we just don’t even care enough. We just let that go. We let the capacity disappear. We let those people evaporate, and all their links and networks.

And then you get to December, and we know. People look at these things. CDC people were surely saying, “This looks worrisome. Any one of these could jump, and this is already starting to jump in China, so we better get going. We’re going to need a test.” And somehow, I don’t know why, how it was that the whole concept was so limited. “We ourselves are going to produce in-house, something that will be good for a few hundred tests …” What a catastrophic… That was. And one wants to know why did someone fight against it? Did someone warn that this was an error? And then of course, whatever it was that… You can imagine, if it was a movie, you’d say, “Well, we’d better go to the lab and work on the test,” and somebody would open it up and the door would creak, and there’d be dust all over it, and half the bunsen burners would be inoperable. “Oh, gee. I wonder if we should’ve kept this up a little better.”

Gary Gunderson: So, Lauren, Scott mentioned Ibsen and we’d been in Norway. And the thing about Norway is, the national theater is right between the palace and the parliament. And it sort of speaks everything about the role of story in a democracy, and helping a free people find what to do in a moment. Talk a little bit about that, and then I want to come back to Scott and talk a little bit about where you might be seeing some unlikely heroes within the networks that you’re aware of. But, Lauren, follow that Ibsen lead.

Lauren Gunderson: I do love an Ibsen. Yeah, it is. That’s one thing that I was pleased to find, and kind of affirmed what I believe story to be, which is the way we process our conscience, the way we do a group thought experiment that asks us all to align with a hero and say, “Well, what would I do in that situation? Would I behave as Hamlet did, or Lear did, or Peer Gynt did? Or Antigone?” Those great plays are about things more than just personal. They are about political. They are about country. They’re about community. And in effect, those plays want us to ask ourselves, “What is it to be a citizen?” Because those plays are also not in isolation. They are about community. They’re about the action of a person affecting a community, which could not be in more of a public health metaphor if you tried.

So I do think there is a responsibility for plays to continue to ask us those questions that they’re never not going to ask those questions. That’s the DNA of how they are created, how they breathe and walk about. When writing the play, you have to figure out who the hero is, what they want, do they get it, and what’s in their way. And also, at what cost? Do they either get, or lose the thing that they want?

So, since we are in the midst of this thing, we are talking about plays written a long time ago, while we are in the midst of this play. To kind of reframe the question: what are the elements of a good change maker? A protagonist that we can leave the play going, “Yes! They did the right thing. I don’t know if I would’ve been strong or brave enough to do that, but I’m glad they were?” And I don’t know if that hero is more likely to be a politician, or a ER doctor, or this out-of-work middle management public health person that knows where the masks are. I don’t know if it’s journalists. I don’t know if it’s the parents staying at home trying to keep the kids and the grandparents safe, or if it’s all of us. But I wonder if we could follow that one person.

Going back to Ibsen, I think of his play “Enemy of the People,” which is about a government… It’s about hidden truth and people denying things, and what it takes to tell the truth on a larger scale.

So all of those questions are in my brain right now as we try to figure out who’s the hero we can follow, knowing that of course plays don’t always tell you the right thing, or show you the right thing to do. They often show you the mistakes that you should not imitate. So we all don’t want to end up like Lear or Macbeth, and those plays tell us, “Yeah, maybe don’t follow the greediest instincts in yourself. Maybe listen to your daughters, Lear.” So yeah, it could be an example of how this fails, but I honestly feel like we are in the middle of an example of how it fails, so maybe we don’t need another example of that. We need an example of how you triumph, what we need to be saying, how we need to be taking care of each other and what to fight for, and all of those civil pieces.

Gary Gunderson: So Lauren, could you write a play about when most of the important people may be failing, may not be succeeding, may not be doing the right thing, but on the edges, there’s heroes who you wish would be in more power? That was actually sort of the seed of where I was asking Scott. Where do you see some of the unlikely voices within public health who, in this moment, are actually finding their voice? You helped initiate and get a letter of hundreds of public health legal leaders to write one of the very first, large scale letters to Mike Pence when he was given that authority to charge them with… “Well, if you actually want to do the right thing, here’s a memo. It went on for pages. It wasn’t dim and metaphorical; it was really precise.” But who are the heroes that you see right now?

Scott Burris: I am trying to kind of get into the story mode, here in my head and think of stories. I can’t remember the name of the screenwriter, but there was a famous guy who said there’s only four stories, and everything can be reduced to these four stories. So what are some archetypal stories here?

And one, as you talked about, is sort of the crusader for truth. In our story, a great candidate is this guy named Gregg Gonsalves at Yale that you might want to talk to. He’s got a modestly interesting pedigree that starts with being the world’s youngest AIDS activist at GMHC, and moving on, quitting school as a young gay man, high school, and going out in the world and making his way, and then working for years in Africa for human rights and HIV. Then coming back to Yale and starting his education over and ending up with a Ph.D. in Epidemiology and a MacArthur Genius Grant, and becoming this sort..

In this group of people who were working on that letter, and generally, he’s kind of this voice for epidemiological passion and truth. He’s been all over the media, trying to talk about what needs to be done about social justice. But he’s not going to win. So that’s one story, but he’s going to fight.

Then we have the story of like, Mr. Deeds goes to Washington, or Meet John Doe, or something like that, the kind of classic… Let’s face it, in the 30s and 40s, we were afraid of totalitarianism and the power of big business, and the neglect of the little person. And whether it’s Sullivan’s Travels, or a Meet John Doe, there’s somehow this story of the person is going to sort of speak for the true interests of the people, and somehow we hope, get the people to see, the blinders to fall off, and realize that they’ve been lied to and they can take control again. That’s another story, which we desperately need.

There’s the kind of story of Louis Pasteur story, the bio.. Where it’s a question of somebody like Anthony Fauci, somebody who runs a lab, somebody who’s trying to get to the next scene and bring the tech fix. I suppose the challenge of this story, to me, is that it feels like the thing we need is less like any one of those little snippets than some great think like “How the West Was Won,” or something like that. You know, 10 stories, each of which is trying to capture some different aspect, because no one aspect is going to save us. Gregg is not going to win. Fauci is going to get fired. The vaccine is going to come too late. We’re not going to become completely united. But if, somehow, all those different pieces in some way get just far enough that most of us are okay and most of us see the light, and we get pretty good responses .. And the vaccine comes eventually and it mostly works, that’s sort of the… But there’s all these pieces. I guess that’s what I’m getting at. I don’t see a single story that captures the dimensions of our fix.

Lauren Gunderson: I actually love that, because another thing that I tell writers is: if you make everything to perfect at the end of your story and everyone got what they wanted, it feels completely false and unbelievable. So, the truth is, of course, things go unfinished and we help a little. And that little is still worth doing, and ultimately, that’s a lot of the end morals of story are. You’re not going to get all that you want. You may not get almost anything that you want, but if you still made a little bit of a difference, if you still did one thing, if you are a part of something bigger than yourself, that leans towards justice and health and civility. That is a good use of your life and time. And sometimes that’s all we can hope for.

I think every public health story is a story of failure. We’ve failed those people who have already died. We’ve already failed, and yet we haven’t. If you change the definition of failure, then you change the definition of success, and we still have that to fight for.

Scott Burris: There’s also the whole aspect of who’s…  I think there is a crisis of agency in public health, but even there, we’re the favored ones.

Lauren Gunderson: Yes.

Scott Burris: And so there’s this whole story of the people who are delivering your toilet paper for you, via Amazon, and going to the factory and people doing sort of this Steinbeck story of the people who are just suffering and who see all this from the bottom. And this goes to sort of the crucial story here, which is that somehow, we have this epidemic and people say, “Oh, we have to make sure that people have healthcare and food and housing and a decent income — now.” Why? If it’s a basic necessity today, it must’ve been a basic necessity yesterday, too, and it’s going to be a basic necessity when this is all over. What’s the reasoning that says, “Well, just for now?” I mean, the whole idea of, “We’re going to postpone evictions. You don’t have to pay your rent this month. We’re not saying your rent is waived. We’re just saying, when everything’s better, we’ll throw you out of your house.”

Gary Gunderson: So, Scott, you took me exactly where I was about to… Lauren, Scott was on sabbatical last year for part of the year, and I was fascinated. He chose, as a leading internationally known public health legal expert, he chose to focus sabbatical on what the social determinants of health have to do with informing policy. So, he was actually alluding just a smidge of that right now. But Scott, go directly to that. Unpack a little bit about how you see the story of this moment informed by what we’re coming to understand to be the more fundamental constant determinants.

Scott Burris: When we look at inequality, that’s the sort of … When we think of social determinants, it helps to … Sort of the big proxy, the thing that gives you your quickest swab of the nose of a society is the degree of inequality. Pretty generally, the greater the inequality, the greater the distance between the poorest and the richest. The more other things have gotten stretched thin, as you’ve pulled the social fabric like this. And so, you start to disinvest in public goods. Your roads aren’t as good. Your schools aren’t as good. You don’t care so much about healthcare access, or the quality of your hospitals, you public health system. Who cares if… We tend to become a place where people feel like they’re on their own, and they get what they can buy, and everybody else is left to their own devices.

And that’s sort of what’s become of us. If you want to think of it as a life story, when I was born … when, I guess, all of us guys here were born, American was at about the peak of its socioeconomic … Well, its economic equality. There was relatively little distance between the top and the bottom. Now, there’s a lot of gender and racial inequality that we hadn’t dealt with, that’s a lot better. But that economic structure was pretty homogeneous. And in just one lifetime, and in fact just the second half of my lifetime, just from the Reagan era on we have become the most unequal we’ve ever been. And it is hard to imagine that the United States of the 1970s would have been in a situation in which we weren’t showing the world how to respond to this epidemic. And now, we’re looking to Singapore, or Korea, which has got its own problems. We’re just kind of bumbling through, because of the extreme degree of disinvestment in the people and resources of response, basically, in government and public services.

Tto answer your question, Gary, the social determinant… When you start to neglect the idea that we’re all in this together, and that we all have basic entitlements to the decent conditions necessary for life, and the services necessary for a decent life, then everybody suffers. The rich are also now locked into their houses. They may be able to take a private plane somewhere, if they feel they’re going to rusticate in their plague-proof country house, but they’re still stuck. They’re all suffering.

Gary Gunderson: So, Lauren’s going to go towards Walt Whitman, I’m guessing, since you’ve raised this. But Lauren, I expect we could go on at some length, and if there’s a way to drink wine over Zoom, I think we’d really get somewhere. I happen to know, because I’ve drunk wine in both of your homes. Talk a little bit as a crafter of narrative and voice… Imagine the public health director in a county most people have never heard of, in some state that you fly over, who may be listening to this podcast and thinking, “Boy, I wish I were as eloquent as Scott. I wish I were as creative as Lauren. Then maybe I could craft the story that my county needs to hear.” What would you say to that person?

Lauren Gunderson: I would say that every great story is about only a few things. It’s about the revelation of truth, fighting for that truth. It is about justice, and about love. Those are the things that almost every great story, either in some combination of those three things. And in a lot of Shakespeare’s plays, it is highborn people fighting for those things. It’s Romeo and Juliet, it is Hamlet. And in a lot of Eugene O’Neill’s plays, it is not terribly highborn people. The same with Tennessee Williams. But it always comes back to these … August Wilson is such a beautiful example of incredible era-defining characters. And that’s what they’re fighting for all the time. Lorraine Hansberry’s characters, it is justice and truth and also a kind of individual agency. But why I bring that up is because, for that person, in whatever small town, small county, is dealing with this, to Scott’s point, is the same thing that the people in the San Francisco high rises around me are dealing with.

That is one thing that public health reminds us. it forces us to acknowledge that we are all made of the same stuff. It is often accident and genes and strange fortune that separates us. It is not inherent better-ness on a cellular level. Of course, it’s not. AIDS will strike whomever it can, and so will COVID, so will the Coronavirus. So I do think that is one thing that these kind of situations do bring out, is our sameness.

And also, of course, if we have this sameness that the virus is striking the president of Harvard as it is striking the immigrant at our border who has nothing, why are our social structures the way that they are? That is a truth that is becoming very apparent. Why do we have a president who will not say the thing that the people who know are telling him to say? Why is science ending with a question mark instead of an exclamation point?

So these things are what great stories are made of. They are the person saying, “No, I will fight for the truth. I will insist that we only tell the true thing, not the convenient thing for the markets. I will fight for those people. I will fight for love. I will work hard for my family, the people I love and the people that I learn to love, because we’re all in this together.” It can sound rosy-eyed and like everyone ends up with a unicorn at the end of the story. But the truth is that those are the things that have always been worth fighting for, and I think that’s part of what we have to tell each other again and again now.

I keep going back to finding those heroes that people can understand and get behind, and say, “Wow. What a brave choice,” and “Would I do the same thing in that situation? And maybe I should.” I don’t know exactly what story unites us all, except that the same stories have always been told, and we find the same things heroic over and over again, and it is along those lines. So, how can we remember that we all have someone in our life to love, and we all have someone in our life who might die from this. And how does that change our mind?

We all have the same sense of, “Is this just? Are we in a just nation?” Of course not, spoiler. “How can we fight for that justness now?” And truth. We have to be able to fight for that, among almost everything. What else do we have if science can’t be agreed upon? Anyway, that’s what’s in my mind. It’s hard to find a perfectly clear answer, but that’s what the great stories of old tell me.

Scott Burris: You make me think of the story that might feel, to me, to sum up this in a positive way, the inspirational way. What would the story be that we want someone to be seeing in Kansas? I’m trying to think exactly of an example, but it’s the story of a group of people in a desperate situation who have to find a way to trust each other, to work together, to learn together, and overcome something that they cannot overcome individually. Because that’s really our fix. We don’t actually know. We can say we believe in science, but at this point, science is more firewood than it is a house. We’ve got to burn it to make some heat and light, because we do not know the answer now. It is not our shelter. It’s just one of the things we can draw on.

Gary Gunderson: I think the story actually comes out of the first few minutes of the conversation with Gene in our first podcast when he quoted Yeats and, of course, that’s one of the most quoted poems in a crisis, especially a polarizing one, all about how the center does not hold. And Gene said, “No, the center must hold. And the center of the center that must hold is actually those of us charged with the good of the public.”

Tom and I and others here work for a national network of healthcare systems that, in this very moment, are sort of remembering who we are. We were founded mostly 100 years ago, very frequently by people of faith, or like Henry Ford, people of enormous community commitment, not unlike Stephen Girard, who, in the moment when a creative act was necessary, they did the right thing and they created a structure. So we called these podcasts “The Center Holds,” not just optimistically, because that’s what we see in real time is people standing in the center remembering who they are and doing that. And both of you have helped us enormously in this conversation, helping those in the center remember their voice, too. Not just their actions, but their voice so that the rest of us can find our role in this great drama.

I do wish we were having wine together, and I look forward… I look forward and whenever this pandemic breaks, to doing that. I promise I’ll buy the wine.


Podcast 23 Lauren Gunderson & Gene Matthews


Books from Stakeholder Press

Books about Transforming Health

Join the Community!

Sign-Up for the Latest News.


Submit a Comment

Your email address will not be published. Required fields are marked *