Select Page


The awakening at the confluence of Stewardship, Leading Causes of Life, and Positive Deviance


(Long Read)

By Gary Gunderson with Arvind Singhal, Jim Cochrane, Teresa Cutts, Bobby Milstein and Somava Saha*

Back before COVID we had planned an UnConference on the campus of University of Texas El Paso to explore how the Leading Causes of Life and Positive Deviance could undergird a new level of effective work in advancing the health of communities served by Stakeholder Health partners. Today the hospital across the street from where we would have met is full of COVID patients with treatment tents in the parking lot. Some of those who would have gathered instead wrote the profound Springboard document that maps the way forward out of COVID and onward to the work of equity and wellbeing for all. And instead of a three days UnConference, we did three UnZooms that now tightly edited and available on a new YouTube channel, Flip to Life. The first 7 minute video clip by Gary Gunderson and Jim Cochrane introduces the Leading Causes of Life. The second 10 minutes by Arvind Singhal introduces the Positive Deviance approach.

The two basic competencies of community, much less hospital leadership, are knowing how life works and what to do with it. This is a good start to remember what you already know.

There is an awakening going on amid the troubles and turbulence in the lives of many thousands of people working with new commitment and energy to give themselves to the work of advancing the wellbeing of their neighbors. Bobby Milstein of ReThink Health calls these people Stewards. You see them by the thousands in the work inspired by Somava Stout of 100 Million Healthier Lives and We in the world. A new essay offered here describes this awakening in the social body as a kind of healing that we see in our own bodies after suffering a trauma or wound. The heroes of healing are the humble, ubiquitous fibroblasts that, like the Stewards—are already present, rushing to the work of healing even before we call out for help. This paper puts the new You Tube offerings in context: Stewards as Vital Deviants.

This, and probably the next few weeks, are going to be a wild and disorienting. Pray to God—but row toward shore. Where’s shore in the wind-blown fog? Head toward the Leading Causes of Life, grab an oar and row with the other Stewards. The tools of Positive Deviance will tell you how.

Stewards as Vital Deviants

Within a few weeks we will likely see the passing of a toxic growth from our global body politic. We’ll begin the work of crafting our future, probably looking over our shoulders, a bit disoriented by the opportunity. There will be enough venom still leaking from the wound to remind us of what not to let happen again. The work ahead is quite different and, in many ways, more challenging. The human systems of government, faith, health, neighborhood and many facets of non-profit labor can rebound with great generative energy. How do we rise to become the tens of thousands of stewards our world needs?

The little fibroblast fellow above gives us a hopeful metaphor I’d like to unpack a bit. I learned about this especially handy body part when I inadvisably leaped and then awkwardly landed on a tennis court. I tore my tendon entirely off my bone, feeling helpless and frustrated in June 2016.

The ER doc suggested ibuprofen until TC pointed out to her that I could not stand up. The MRI pointed me toward a surgeon who explained the two different paths that might get me back on a bike, hike and court: he could cut and sew, or we could wait for the body to secrete an epoxy-like goo to hold the tendon. Dr. Martin recommended the second path, noting that the possible nerve damage of the surgery could disable me permanently. TC gave me a book—Job’s Body by Deane Juhan– to read about the fibroblasts so I could learn how to be a good partner with my body.

“Of all the cells in the body, these fibroblasts are the only ones which retain throughout our lives the unique property of being able to migrate to any point in the body, adjust their internal chemistry in response to local conditions, and begin manufacturing specific forms of structural tissue that are appropri­ate to that area. No other cell exhibits this wide range of regenerative activity, and this makes the fibroblasts the key element in wound healing of all kinds; scar tissue is new collagen that has been secreted by fibroblasts which have migrated to the injury.” (Juhan, p. 66)

Just like neighborhood volunteer organizations or congregations, “when they settle in a particular area, they begin manufacturing and secreting collagen chains, which then respond to local chemical properties and specific stresses in the area to form the appropriate kind of fibers and arrangements—sacs around the muscles, ligaments across the joints, the walls of blood vessels, the cornea of the eye, and so on.” (Juhan, p. 66) Fibroblasts are alive and generative, but the connectional substance is not.

Fibroblasts are not solitary or heroic. They are common, dis­tri­buted, adaptive, responsive, connectional, humble smart things. They are already every­where in the body, not dispat­ched by some computerized healing elite. They were mov­ing toward my torn tendon even before the EMS team loaded me in the ambulance.

They quietly do such exqui­sitely tender work, it seems they are moved by love. Of course, love does not wait for injury to ex­press itself. Life works that way at every scale present to every tear and wound, just as it nurtures every hope and possibility.

The most extraordinary characteristics of fibroblasts and stewards is that they are already where you’d want them to be in a crisis. It takes a brilliant surgeon to hold back from drastic and dangerous mechanical intervention. “I can do that same surgery in a month or two or three,” he said. “Let’s see what the body does and if we’re needed.” I started physical therapy with the same energy that we’re now pouring into our grassroots civic structures. We may be too late, of course. Every individual organism, person, family and political order has a lifespan. But life expresses astonishing generative and regenerative capacities as long as you don’t kill the very last one of the species. Ask the condors, the fish in the Hudson and Cuyahoga or the members of that church you thought was closed. Those are not miracles; that’s life happening.

Do we have anything like fibroblasts in our sprawling, bruised and anxious human systems today? You can see where to look through the lens of a most remarkable document: Thriving Together: A Springboard for Equitable Recovery and Resilience in Communities Across America ( This document emerged in astonishing speed from a broad community of thinkers and doers, writing amid the wreckage of the catastrophic American experience with COVID-19. Given that our civic response was worse than almost every other nation in the world, we must look beyond the wreckage into a decade of work leading to broad, distributed well-being. But that is just what they did when asked by the CDC Foundation for a practical vision. Far beyond fixing healthcare and repairing public health, the writers saw the possibilities of a stunning alignment across multiple other domains including housing, food, finance. Not just the “social determinants”; all of the determinants aligned and convergent, undergirded by a way of understanding evaluation and accountability, so the ensemble could stay together across the years needed to deliver on the promise.

Two critical turns of thought quietly carried the effort to a new place. First, was a single graphic by Bobby Milstein, that for the first time got the work of healing the suffering onto the same logic map as the work of wellness. They are often seen as such different kinds of work, approached with such different language and funding, that they are entirely disconnected. At the very best, they compete for funding and creative attention, which in practice pits the urgent work of mercy against what seems an unfair list of things we might want to do when we get into better shape. Should we put out the burning house, or paint it, maybe add a porch? In bitter reality, when we constantly avoid the generative work of strengthening the vitality capacities of our institutions, neighborhoods and political life, we find our capacity to respond even to the most grievous crises lacking. The deaths of despair are fractal; we lose the plot amid the overlapping pandemics. Bobby’s graphic lets us see those often-separate choices as one body of stewardship, making us accountable for wisely balancing the works of mercy and well-being.


The second remarkable move within the writing takes the document from being a long list of things to do and turns our attention to the people needed to do the work. After being put to the side of many such comprehensive strategies for at least several decades, the Springboard vision speaks to the need for “civic muscle.” It avoids the magical thinking that the broad and long-term collaborative labor can simply be purchased or, worse, “incentivized.” The grown-ups will have to develop qualities of wisdom, commitment, selflessness and tenacity that we have almost forgotten was possible. We need what Bobby calls “stewards” who would find their life through giving it to the life of the whole.

Many of the organizations involved in the Springboard visioning are actually networks and, in some cases, far more like the connectional tissue created by the body. One remarkable example is the complex and sprawling networks of 100 Million Healthier Lives, now moving into a phase chance as the WE In The World movement. Dr. Somava Saha authored the section of the Springboard on metrics and measuring, which points the entire logic toward the Healthy
People 2030 well-being goals. This includes, for the first time in such a document, Leading Causes of Life. Somava’s energy level goes way up when the subject shifts from metrics to the thousands of people—many young—around the world galvanized by the vision of unleashing their lives in service of their communities. At that level the webs of high-energy boundary spanning action is palpable. In COVID many of these networks turned in real time to the fundamental labor of food and medicine distribution for the most isolated community members. These were people who were exactly where they were needed—and they knew it, claimed their agency and purpose by expressing their healing work in the moment with skill and, often, panache.

How many such people does the world need? Thousands, tens of thousands, millions. Paul Hawken wrote of the quiet emergence of 2 million non-for-profit organizations in his book, Blessed Unrest. And then more recently, Drawdown, about the array of needed choices to turn the planet back toward health and sustainability. He was able to write optimistically about the vast and intricate scale of the needed work precisely because he knew the social body was rich in the stewards in positions to make those decisions with the energy and confidence to do so. Like fibroblasts, they are already in place and at work before the “higher” consciousness even feels the pain and worries about dispatching some remedy.

One place to find such stewards is within the “faith-forming entities” that. like fibroblasts, are already present in every tough neighborhood, speaking every dialect anywhere within the body politic. Of course, all of our institutions of human service and health are tended by, often, generated by, some meaning-making group. Most are not exotic imports; about half of bothpatients and providers within our hospital are … Baptist. It is predicted by those who know such things that perhaps 20% of the roughly quarter million faith organizations in the United States will be lost to the economic ravages of COVID. Whether that reflects the shedding unneeded skin cells or load-bearing bone mass will be seen. Early evidence suggests that the congregations that survive and thrive will be those most relevant to the social networks that need them and that call out for their capacities amid the crisis. The institutions themselves are stewards who find their life by giving it away, by letting vital capacities pass through them as a kind of dissipative social system.


One can organize the complicated story of the people called Americans by its wars and civic meltdowns. One can also see it through the lens of its great revivals. Those have been largely understood as Christian, because most people in most parts of the States are some amalgam of Christian. While that is already a very broad stream with many complex currents, Americansociety today now flows beyond the banks of Christendom, indeed beyond the channels of modernity itself. At some grand intervals, we can see four or five truly profound “awakenings” that shape culture and thus politics, each spanning some decades and planting the seeds of the next.

  • The first—from 1730 to 1830–may have created the nation itself as it undermined the prevailing thought that humans were predestined to whatever they found themselves experiencing. Instead we are capable of creative freedom and thus accountable for the circumstances we choose. This one was seeded from European “enlightenment” thinking, which found the American soil rich.
  • The second, spanning most of the 1800’s, overlapped and then extended the revolutionary Spirit, most obviously in the moral ferment that split the nation apart. Slavery was not the only oppression and the five early years of the 1860’s were not the only ones of violent conflict. Presbyterian pastors wrote in defense of slavery while Quakers spoke as if from a different Bible. The Klan gathered around a burning cross; opposite social movements emerged with tenacious energy.
  • The third great phase saw the massive changes of the later 1800’s pitting conservative evangelical revivals, entirely divergent from the liberal “social gospel” movements that created the progressive era politics of public health, unions, healthcare and early environmentalism. Some think we are still in this one.
  • Most see a fourth great awakening marked by the highpoint of religious attendance in the postwar 50’s when a quarter of all American were Methodist. This sparked two highly divergent streams of experience, with the 60’s expressing all the iconic cultural resistance at the very time the “moral majority” began to assume political power and influence. The end of this phase is marked by the end of the common American experience, acerbated greatly by internet technologies that permit radical tribal separation. Even while politics amps up the voice of the evangelical, every single religious body except the Black Church is in sharp numerical decline.

An awakening is more than its political agenda, especially the list of things it is against. And it is more than the institutions to which it gives birth. An awakening is a movement of energy and consciousness that makes possible entirely new ideas, networks, structures and social scale choices. The Springboard document is only one such emergence; but the fact it was able to find coherent form amid the most confusing early 3 months of COVID suggests that something had been percolating already.

One can see the outlines of an awakening emerging in the lives of tens of thousands of Stewards just among the hundred organization aligned with the Springboard movement. It will be visible in the thousands of religious congregations finding themselves relevant and vital in their COVID plagued communities. No small number have found themselves in the huge groundswell of political energy. Much of that is driven by anxiety and fear, but some is positive and actively hopeful.

Stewards, like fibroblasts, express their connectional purpose by giving form to the muscles of the body, and shape to what would otherwise be a bag of sea water that is most of our body. “All in all, this stringy, gooey stuff provides us with a remarkable array of necessities and advantages; it is the container that allows us to take our precious sea water with us wherever we go, and that keeps our organisms intact in the midst of the many dispersing forces around and within us.” (Juhan, p. 87)

Any one action by any one Steward is not likely to dazzle, may seem mundane. But in combination they give substance and form, allowing the civic muscles to lift, move, and express agency and intentionality. When the broad array of systems of networks are connected and find common form, they have agency far beyond what one might anticipate. The humble structures of collaborative work—even the mind-numbing committee, much less Zoom—begin to find themselves awake.

An awakening is carried by more than anxiety or excitement about winning some tactical goal, no matter how compelling or smart. An awakening comes from within the life of the Steward and from within the life of the webs of Steward networks. Walter Wink writes of human organizations having a Spirit within them. To speak of “having” a Spirit misses the nuance; the Spirit has us as individuals and as social bodies. We awaken when we realize we are moving because of something within, around, beneath and yet still before us. We might call that enveloping energy Life. And we might find the simple language of the Leading Causes of Life helpful in bringing to focus what would otherwise be mysterious. This is the difference between waking up, startled by a dream, and finding oneself awakened to the possibilities now visible in the broad day experience of the social body.

Stewards find themselves awake to clarity about their work, labor, intentionality. Visioning, not dreaming mist; awake to purpose, not dull and adrift. Capable of logic, reason, analysis and collaborative agency—all the highest capacities of homo sapiens sapiens. Some think the second sapiens is earned by our knowledge that we will die. Perhaps we earn it because we are capable of awakening to life and our capacity to participate beyond our own skin to be generative of the social whole. Stewards of the vital capacities only express themselves when held in right relationship to generative potentials; stewards of possibilities are only capable as properties of an emergent complex systems. Stewards of life.

No one Steward is a very big deal; but bonded into social move­ments, there is little they cannot imagine and cause to be. I think of my brother Ron, here planting a Linden tree that I gave him. I got it from my local bee associa­tion in hopes that in a decade or so it would grow to feed my honey­bees. Ron doesn’t have honeybees; he is steward of two acres of formerly overrun scrub forest that his Presbyterian church had left fallow. It is two of two million acres in the Chesa­peake Bay watershed that teeters on the brink of collapse because of many decades of pollution and poison. Ron’s wood plot is now the daily delight of urban families whose kids are meeting natural flourishing as if magic. The rainwater goes into the ground or runs clean into the creek that leads to the Bay. It’s not magic; it’s life. But it needed a Steward.

The Bay needs a million more, but Ron’s witness is so positive and vital that anyone who has experi­enced it finds themselves looking for their two acres in which to invest some years. That’s how Stewards emerge, called out by the generative lives of existing Stewards who express vital capa­cities, which turn out to be infinite when drawn from the deep well of awakening. Beekeepers love to be around other beekeepers, especially when they can get a hundred linden trees in the ground for bees they will never know. They know they won’t know these creatures—they love doing things that nurture possibilities beyond themselves.

The logic of the Leading Causes of Life is well suited to our post-Christendom, postmodern, liquid network culture. It explains without con­taining, illuminates without blinding, opens the complexity without the anxiety that more rigid ways of thinking are prone to do. Pastor Crivens, the dean of working pastors in the neighborhoods of south Memphis, preached a sermon series based on them. Chaplains at the hospital used the frame­work in funerals. Interfaith and Interdenomi­national groups find the language to be a working bridge between otherwise unintelligible tribes. It is the most common denominator language scaffolding for public health and healthcare organizations to craft community collaboration. In the language Stewards not only find themselves, but each other. It invites without prescribing, integrates without dominating. Sort of like life.

The framework of five causes protects dynamic complexity without forcing it to collapse into a linear causal order. It is built in anticipation of the vital disruptive nature of living systems. An adaptive post post-modern philosophy is more than a brittle creed, while the Leading Causes of Life compel Stewards to going deeper into themselves while propelling them across boundaries into alignment with other Stewards. The Leading Cause of Life are helpful in knowing how to find the life in a system where others find merely a nest of problems. Look for the five causes: the connection, the coherence, evidence of agency, a generative heartbeat and signs of hope.

It’s adaptive emergent strength is also its limit. Stewards do more than think (although doing is a kind of thinking, and thinking a kind of doing). Stewards are agents of generation and regeneration. Humble as fibroblasts, they act, choose, move, do, risk, try. They find power from within, illuminated by the Leading Causes of Life—often by finding new dimensions to systems of faith and meaning they had become to find dead.

Ideas need stewardship, too, as crafting better ideas is a kind of doing, a craft. Since 2012 the Leading Causes of Life Initiative(LCL-I) has created an interdisciplinary fellowship drawn from a number of nations and perspectives to do that. The ideas which emerged from one mind evolved like viruses do by blending the essence of other minds. Not really authorized by anyone, or ever actually assembled at one time or place, the Fellows created intellectual connectional tissue that allowed the ideas to find form and purpose for a time such as this. The LCL-I has been quietly moving amid the connections of Stakeholder Health and dozens of learning hospital systems, honing relevance in the work in Memphis and FaithHealthNC. It has been tested by the crisis of public communications led by the Network for Public Health Law, and more recently in the exploration of the National Academies of Sciences Roundtable on Population Health, struggling to understand how to strengthen community power for health. Few of the many thousands of stewards noted above will want or need to know any of that. But they will sense whether the movement of the Spirit calling them beyond themselves rests on solid foundations of thought and logic.

Positive Deviance

But what does one … do? For that we need a third tribe, the Positive Deviants, a very particular line of Stewards living very illuminating kind of lives. More discipline than philosophy, Positive Deviance is a set of tools with which one may approach almost any complex social problem. If one is drawn to engage malnutrition among Vietnamese villages, violence among Palestinian children, failed schools in Britain or women missing mammograms, the first step is to scour the data for evidence of positive outliers among those least likely to have solved the problem. Every child who hails from a poor family isn’t hungry; every resource-poor school is not failing. Show discipline in not leaping to explaining why not. Separate the positive behavior from the often-compelling story of the heroic deviant. We don’t want the hero; we want to isolate the choices driving the deviant pattern. They are usually minor, even mundane. One mom mixes the green leaves of sweet potato with the pho and hand feeds her child. One principal pries loose time to call the parent when their kid does something right. Isolate the choice driving the deviation. And then figure out how to invite (not compel) others to adapt it into their family, network or organization.

The process of spreading a vital deviation is easier when one understands one is working with living systems. One family is alive, as is one school or neighborhood, as is the Chesapeake Bay Watershed. If the key discipline in Positive Deviance is to slow down before the complex wonder of a single deviation, the key discipline to spreading the positive is to be humble before the complex living system to which it might be relevant. How do you make anything more alive? That’s the task and it rests on humility.

Humility should not make one passive; it should make one reach for the Leading Causes of Life to help understand the vital logic of living system as it already is. Then one might see an appropriate way to enter into relationship with it to strengthen it, help it become more vital.

  • What Connection might be the best bridge of relationship across which new ideas might be received? A daughter is better than a researcher if the audience is a mom.
  • What might be the existing web of beliefs and thinking the system finds coherent that might resonate with the new practices? In South Africa HIV and AIDS medicines were taken as part of evening prayers, grounding them as evidence of God’s love.
  • What existing agency could be strengthened with the new insights? Sharpening a tool is better than switching to a whole new skillset.
  • What generative relationship would be strengthened by the positive practices? A school raising up more of its students AND the families of the students taps into a deep well.
  • What hopes does the deviation now make possible to imagine? What is the opposite of malnutrition, the opposite of despair?

The Leading Causes of Life can become as dead as any other framework of values and faith. And it can be captured into the service of tribal and exclusive groups. Born among people working on the Mississippi Delta and Apartheid South Africa, the Leading Causes of Life language always felt dangerous precisely because of its power to drive social choices. And social choices can calcify into a bounded defensive identity against others, in service of ours alone, serving not life as a whole only, but our particular lives, excluding and harming others in the process. Christian history is littered with bodies of martyrs and enemies who felt that power in violation of the obvious witness of One who died on a cross erected to protect a failing set of religious leaders. If Stewards can be understood as expressions of the social immune system, we must pause to remember that immune systems fail when they turn against their own vital processes.

The Leading Causes of Life are protected to some degree by being undergirded by deep foundation in The Human Spirit: Groundwork. This is a book by Drs. Cochrane and McGaughey who were asked to do that work precisely to protect the ideas from dangerous underpinnings made possible by the lack of precision in the language beneath the philosophy of the Leading Causes. That work led to a fusion of the African understanding of Spirit as the energy within every human being, the Kantian focus on the universal creative freedom of every human being and the call to take moral responsibility for what we do with that freedom.

Stewards are free.  They are free to imagine things that have never happened in the history of the species. They might fall into the same tribal traps that plague us; but they might choose to find another whole way. They can imagine—and bring to be—whole new political structures, even those stronger than the careening internet. Stewards are free to serve their own company or religious group; and free to transcend them in service of a large vitality. They can ask why not, just as others might be trapped in “why.” This is what boils deep inside the Stewards, driving their desire to be deeply accountable for this extraordinary, if universal, capacity. This is what they are waking up to as they notice they are not alone; they are part of an awakening.

The point of this essay is not to suggest how to harness the awakening for purposes and goals we already have. Like every other great one, this awakening will change what we imagine, give us new language as we need it to express things we have not thought before so that we can do things we did not see. A movement that wakes to its Spirit creates its own wind that needs new sails set away from our old shores. Who knows what might happen? In earlier awakenings there was some confidence to be found in repurposing older Christian language for new demands. Walter Rauschenbusch wrote a book of Christian prayers for the “social awakening.” While this author does attend a church that traces to those prayers, the new awakening needs broader and yet more vital language and logic. Not less Christian, but more than Christian in the same way that Jesus was himself literally rose above religiosity to proclaim its end.

The role of Steward, the undergirding logic of the Leading Causes of Life, the tools of Positive Deviance and the deep accountability to our creative human freedom give us the choice of living lives in service of the large life of the planet. And just in time. Indeed, part of our urgency is that we may not be in time. We may be a generation that paused too long, fiddling with our minor possibilities so that we fumbled away the life of all those to come. Our stewardship is painfully urgent because we know so much more about the fraught and fragile nature of the systems of life. This is awakening of faith that is the opposite of magical thinking. We must be stewards fully conscious of why we must risk all that we have for all that might be.

Fibroblasts are wondrously clever and powerful in their ubiquity. There are entire worlds as wonderous and ubiquitous, scattered throughout not just our world, but across every reach of the knowable galaxies. We have only recently come to understand that every single place we look there is life or the elements of life. It is not rare, fragile or unlikely. Rather, life is everywhere strong, creative—impossibly creative.

Life finds a way, even if it has to ride on an asteroid to a new home on a tiny wet rock in a minor solar system as ours. Almost all of the truly unlikely things have already happened to get us to our human plight, now some 13,700,000 years after the impossibly big bang. All we need is a generation of Stewards to wake up to their life and their possibilities. Given all the unlikely things that have already happened, that movement seems almost certain.

Painting by Lisa Lumb

*  Rev. Gary Gunderson, DMin is VP FaithHealth at Wake Forest Baptist Medical Center and Secretary of Stakeholder Health. Arvind Singhal, PhD, is Professor of Communications at University of Texas El Paso. Dr. James Cochrane, PhD is Professor Emeritus of the University of Cape Town and Coordinator of the Leading Causes of Life Initiative. Teresa Cutts, PhD is Research Asst. Professor of Wake Forest University School of Medicine and coordinator of Stakeholder Health. Bobby Milstein, PhD is Director, System Strategy of Rethink Health and Visiting Scientist, MIT Sloan School of Management. Somava Saha, MD MS (aka Soma Stout) is Executive Lead of the Wellbeing In the Nation (WIN) Network and Founder and Executive Lead of Well-being and Equity (WE) in the World. All the contributors are Fellows in the Leading Causes of Life Initiative.