TEDMED knows theater and impact. Really. Last year they kicked off the 3.5 day conference with a stirring talk from Bryan Stephenson, a lawyer (of all things!) and Director of the Equal Justice Initiative. Bryan's TEDMED talk is now required viewing for my community health nursing students each semester. This year, TEDMED introduced us to America Bracho, MD, MPH and Executive Director of Latino Health Access. Her talk will now also be required viewing for my students, and should really be required viewing for anyone who cares about health in a meaningful way.
I Tweeted yesterday that if you closed your eyes during America's talk, you would hear the voice of Paolo Friere as if he was in the room with you. Friere's work, especially his masterpiece text The Pedagogy of the Oppressed, serves as an invitation and guide for the most vulnerable among us to claim power and improve their lives. Although often associated with 'revolucion' and challenges to status quo power structures, Friere's work is really an opportunity for all of us to recalibrate our power positions in order to claim a quality of life which is rightfully ours.
What does this mean for health? At TEDMED on day 1 I met about 11 people who were desiging iPhone apps to empower patients. ELEVEN (11) (10+1). These apps do everything from recording biometric data (what is your posture? did you sleep well last night?) to connecting you with your doctor so you can ask questions. Arguably these applications position patients to receive and analyze data, a potentially important aspect of empowerment. But these apps, even if they become powerful adjuncts, can never substitute for human empowerment based on dignity and respect. This was America's core message: our patients are the experts in their care and we must partner with them to co-create the health we seek. All of that sounds great, of course, until you get to the next part: to be effective we must unveil power structures and acknowledge our own role as oppressors of patients. The term "oppressor" is likely to lead to jeers from some readers, but we aren't talking (necessarily) about despotic physicians and nurses who adopt paternalistic attitudes. We are really talking about systems of care that are built around models of intentional disempowerment. For example, we maintain primary care models that rely on appointments - a convenience for the practitioner which can be very difficult for low-income patient due to transportation and work concerns. When our low-income patients "no-show" for their appointments, or seek care in the emergency department (where no appointment is necessary) we get frustrated, lament the impact on health outcomes and decry the financial impact on our healthcare system. In response, we invest millions of dollars in 'patient engagement' strategies that will prompt patients to arrive on-time, discourage them from using EDs, etc... What we often fail to do is recognize that our system of care itself is fundamentally flawed. It isn't built around our communities and patients - it is built around healthcare providers. This is the very definition of insanity. There isn't another industry in the world that could make money by creating customer experiences that don't serve the basic needs of the customer.
It turns out that Freier's "revolutionary" concepts, articulated and implemented by visionaries such as America Bracho, are having an impact on a few in healthcare who seem to get it. And these folks aren't your likely community health heroes. I had the opportunity to run this morning with a healthcare executive at a major retail corporation in North America. Listening to him talk about serving patients and creating health, he could be mistaken for a Community Health Center leader in a major metropolitan area. He spoke eloquently about creating environments of health for customers and explained how retail intuitively understands how to make customers the center of the experience. Guess what? When patients are placed at the center of the enterprise, they are engaged and empowered.
We can learn a lot from executives like the one I ran with this morning and from public health heroes like America Bracho. In their programs and ideas (some for-profit, some not-for-profit), we can hear the not-so-faint echoes of Paolo Friere reminding us that empowerment is at the core of all that we hope for. Now THAT is a way to start TEDMED 2013.
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