The Paul Farmer Effect: Replicable Tactics for Big Social Change
At the end of February, the world lost someone who was, in the nomenclature of human development, a “purpose exemplar” — Paul Farmer.
Paul’s purpose to deliver quality healthcare to the poor was extremely strong. He effected more social good in a life cut short than most of us do with far more time on the planet.
Because purpose is at the core of what we do at Wayfinder, a start-up in the social emotional learning space — the first curriculum we ever made is all about helping young people cultivate a sense of purpose — his death prompted me, as CEO, to take a step back, look at what we’ve built at Wayfinder, and marvel at just how deeply his work has made ours possible.
Paul Farmer became a household name when the journalist Tracy Kidder published Mountains Beyond Mountains in 2003. That book was a bible for those in my generation interested in social change. I remember reading it in one go on a plane, then reading it again. Then I wanted to meet this guy.
Two years later, I did meet Paul, at a symposium on Global Health hosted by Duke. After his talk, I had the opportunity to spend some time with him. I took it to make a bold ask: could I observe his work in Rwanda the coming summer? He said yes.
Paul was a clinician and deep practitioner of public health via the NGO he founded, Partners in Health (PIH). I never wanted to be a doctor, or even to enter the field of public health. But I was intensely interested in learning from someone engaged in deeply purposeful work, whatever that work may be.
So, for a month during the summer of 2017, I was Paul’s shadow — staying at his house, following him on rounds, and accompanying him to all manner of meetings.
I don’t want to overstate my relationship to him — I spent part of a summer with Paul and emailed back and forth a bit after. I wouldn’t claim him as a mentor, or even really as a friend. But my observations of Paul were deeply impactful. I simply call him an inspiration.
Watching Paul shaped how I work, how I lead, and my definition of a life well-lived. He expanded my sense of how much one human can do to help others. Put another way, he showed me what it meant to embody a life of purpose.
Below are some of the lessons I took away from my time with Paul. They’re invaluable for anyone who aspires to create social change. They might be applicable to you too.
If you aim to help the poor, put them front and center.
The marginalized, the disenfranchised, and the downtrodden cannot be an afterthought to an organization’s mission if that is indeed a population they want to serve. Nor can this population be one you plan to serve “down the line.” PIH’s motto is a “preferential option for the poor.” Paul’s entire organization is dedicated to putting poor and marginalized folks before everyone else. In social change, the idea of benefits “trickling down to the poor” is a myth. If your organization or company claims or aspires to help the poor, that needs to be your first priority, from the beginning.
One of Wayfinder’s accomplishments I’m most proud of is that we serve 55% students of color and 45% poor students at Title 1 schools, each well above the national average of those populations in the United States.
If you’re doing something innovative, you have to go out of your way to access rural and indigenous communities.
Most innovation lands first with two populations: the wealthy and the urban. PIH’s work was originally focused specifically on serving poor communities in rural countries, those with the least access to healthcare. In a for-profit education model (like Wayfinder), rural and native students are usually the last populations to receive innovative services and products because the cost of subsidizing these communities’ access is too high.
To ensure we reach these populations, Wayfinder has a non-profit arm we use to raise and set aside funds specifically to subsidize our program for Native communities in the continental US and Hawai’i, and rural communities around the country. But money isn’t enough to get the job done; you also need a strategy you can execute.
Paul hired locals to act as the community health workers in the poor places he wanted to serve. We took a page directly out of his playbook. Rather than having outsiders introduce our curricula to these communities, we hired people who already had close ties to do outreach that built on their pre-existing relationships. It worked. Today, we have served thousands of native Hawaiian students through our island-led partnerships.
Paul stressed this again and again: if you want to get services to communities that can’t afford them, you must develop specific and actionable strategies.
If you want to enact big change, you have to work within “the system”
Paul’s mission was not simply to serve the poor in poor countries; it was to change the systems of which they were a part. This was a hugely ambitious challenge, but one worth pursuing for anyone serious about social change.
PIH was up against a number of structural challenges: Providing high-quality healthcare in poor places where there were significant resource and structural barriers, disproving the belief that it was impossible to deliver high-quality healthcare to those poor places because of these same barriers, and a shortage of trained healthcare workers in these areas. PIH tackled these issues with a three-pronged solution. First, they created their own training programs, which turned the average local citizen into a public health expert. Second, PIH launched a huge amount of international advocacy and piloting work to prove to the international community this could indeed be done. Finally, they fundraised tirelessly to get money to their clinics and sites around the world.
At Wayfinder, we have a different though no less daunting barrier: the United States’ public education system. But we don’t shy away from it. In fact, we work largely with US public school districts because 90% of America’s students are educated there. In fact, we intentionally work with districts that serve a disproportionate number of low-income students because school is where those students get most of their resources. We push against the notion that high school and secondary education have to be an unengaging rat race. We believe that young people can develop the skills to lead purposeful lives if we provide them the right opportunities and experiences.
Prior to founding Wayfinder, I worked largely in experiential education doing purpose-based education. At these organizations, we did serve a diverse group of students, but we were hitting less than 1% of the US adolescent population.
With Wayfinder, I wanted to reach the most young people possible. The only way to do that was by going into the belly of the beast and scaling in the public school system.
Push back against the assumptions and push HARD.
Paul’s ideas focused on a number of things, but particularly the myths surrounding the ability to deliver world-class healthcare to poor people in poor places. I’ll never forget one meeting we went to with the Rwandan Health Ministry. We were talking about scaling up PIH’s healthcare model to serve the whole country. (A great example, by the way, of Paul’s willingness to enact change from within.)
At one point in the discussion, a World Bank consultant chimed in. “We can’t afford to give all these poor people healthcare for free; they’ll just piggyback on it.” This was one of Paul’s most hated lines of reasoning and he jumped on it, cutting the consultant off. “Let me ask you a question,” he said, “What do you do for fun?”
The mildly confused consultant said he liked to watch football matches, hang out with his friends, and drink a beer or two. Paul then asked, “Do you ever just go to the hospital for fun and ask for unnecessary surgeries?” The consultant said of course not and looked confused. Then, Paul dropped the hammer. “Well, why the hell would you presume that poor people like to just show up at hospitals for no reason?” Then he lit into the consultant a bit more.
On our way out, Paul invited the consultant to join him on a visit to a rural hospital later that day, in case he wanted to meet some actual poor people seeking medical care. On the way out, Paul turned to me. Under his breath, he said, “Nothing like whooping some World Bank ass first thing in the morning.”
Wayfinder’s version of this dynamic centers on the United States’ secondary school system, which is designed not to foster relationships but to foster a race towards extrinsic motivation. We advocate for our belief that young people can learn the skills to develop a sense of purpose and that there’s time in the school day to teach them.
Often the grade 6–12 experience is about an incredibly stressful race towards achievement that feels to many young people like an unengaging slog. Dr. Bill Damon, Director of the Stanford Center on Adolescence, breaks students down into this helpful diagram:
His research shows that about 25% of students fall into each quadrant. Often in education, there are excuses for why a student in the three other quadrants can’t shift into the purposeful one. Just like Paul believed that we can provide high-quality healthcare anywhere in the world once the global health community develops the systems and devotes the resources to do so,
Wayfinder believes all young people have the fortitude and the capacity to move towards purpose; we just need to do a better job of getting them there.
That’s our deepest purpose at Wayfinder — helping kids explore and ignite their own sense of purpose early. And what keeps me going and pushing and advocating is directly linked to Paul. If our curriculum helps even a fraction of our kids grow up to be like him, we win.
