ALL for the Love of Alice.

We are all in this together. Living a beautiful life takes courage to contribute to a “culture of health”.

Dr. Carol Ash with “Alice Collage on Wood” by Isabella Huffington

I don’t know when I started questioning the purpose of being a physician. Caring for others had always brought me such joy. But not lately. So when Arianna Huffington invited me to attend her daughter’s art exhibit I was thrilled. It was an opportunity to change my focus, and experience something new. The event was a celebration of women, creativity, diversity, and a successful young talent. 
 
Unlike traditional paintings where colors are blended together, Isabella’s art is contemporary pointillism. Tiny images as dots of paint thoughtfully placed to create a bigger picture. Move in close and you see the individual images. Like members of a community, each with their own spectacular color and story. Alone they don’t accomplish as much. Stand back and a bigger pattern emerges from the mutual influence and contribution of the collective whole. The entire process creating reflection based on the emotions evoked.
 
The gallery director explained the work. “Portraits of an Intellectual, Collage on Wood” combined materials to create an image that was organized and structured. Closer inspection revealed the foundation upon which Intellect was built. Tiny pictures of Arianna Huffington, nurturer, educator, and supporter for all that Isabella had become. Then there was “Alice”. 
 
I don’t recall what it was. Maybe something the gallery director said as he described Alice. A brilliant blue and white canvas of diamonds and pearls cooperating to connect with delicate white flowers, and beautiful yellow roses gathered in an embrace. It was new, fresh, and innovative while including images of value from the old. Was it the ambiance in the room of diversity and support, or the lyrics of a Prince’s song now in my head? If I could give you the world diamonds and pearls, as a reminder of what it meant to be loved? As I gazed at the canvas my eyes welled up in tears. It was one of those Oprah moments that releases the secrets of the soul. I knew Alice and I understood. Alice was a call to action.
 
You see Alice lives in my home and in my neighborhood. Just as words and names escaped Dr. Alice Howland played by actress Julianne Moore in “Still Alice”, my husband, a retired Naval commander, is dealing with early dementia. He would give our son and me the world. He will soon forget his own name and ours as well. My life has been in chaos and it has been tough. 
 
In my personal and professional life I have experienced firsthand the hardships created by a troubled health care system. Difficulty with access, overuse and underuse, services not aligned with evidence-based practice or patient’s preferences are all symptoms of something is wrong with healthcare. Despite all the accomplishments of modern medicine, many physicians feel increasingly powerless, vulnerable, and alone. It has been a challenge for me. For America’s poor and middle class the experience can be rough. 
 
ALICE a United Way project, first initiated in my home state of New Jersey, represents the growing number of families and individuals unable to afford the basic necessities including housing, food, and child care. The acronym stands for Asset Limited, Income Constrained, and Employed. ALICE is a part of the framework of society. Helping to shape our communities values and shared meaning. They are the people we rely on every day for success. When ALICE has fewer opportunities it increases stress. That leads to diseases such as obesity, diabetes, heart disease, depression, and even addiction. It takes a terrible toll on ALICE and we all suffer. 
 
Poor health, disparity, and inequality lead to greater use of healthcare services. The consequences are higher taxes, costs for insurance, and an unhealthy workforce for all of us. Studies show countries with the greatest income inequalities have the lowest life expectancies. Americans are dying at younger ages than people in almost all other wealthy countries, and the overall health status of our populations is getting worse. For the first time in our history, according to the Robert Wood Johnson Foundation (RWJF), a five-year-old has less of a chance at life than a ninety-five-year-old when compared to life expectancies in other countries.
 
The RWJF describes a “culture of health” that addresses the way the US culture plays a role in the life expectancy rates falling short of other wealthy countries. Culture is the set of shared values and beliefs that create cohesion and guide change. It is who we are and the way we solve problems. A “culture of health” is a powerful long-term strategy that recognizes we are all in this together and part of a dynamic ecosystem. It fosters co-existence, diversity, partnerships, and caring. Standards and protocols are the rules necessary to create quality at a reduced cost in a mechanical world. They create the understanding of how we do things and the measures for performance. Economies and societies are less like machines and more like ecosystems. Reducing a complex social ecosystem to understandable terms and applying rules too rigidly can cause us to miss the color spectrum of solutions from everyone involved. A focus on performance, not purpose and what matters to us deeply becomes about looking good instead of doing well. Subgroups in control use the resources to compete. We are less likely to find common ground or care about each other. Life becomes ruthless and cold. We are paralyzed to proceed. 
 
A “culture of health” aligns us behind a common purpose, not individual performance. Like good art composition, if we actively work together we can create a greater degree of brilliance. We can change the environment for patients and communities reducing disparities and inequalities. We all do well. Society is more vibrant as a whole. As healthcare providers we start to realize, the most important question we can ask our patients is where do you live. For the love of ALICE, this is just what needs to be done.
 
Translating the RWJF “culture of health” into action will not be easy, but lives and our economic security are at stake. It demands that we adapt and respond outside our usual procedures and performance to close gaps that exist between our operations and our aspirations. I learned at Dartmouth never be complacent and settle for this is the way things have always been done. We have to let go of the values and practices that feed the status quo. Manage the present, and nurture delicate flowers so future gardens can grow. The keys to that secret garden and execution of the plan are: 
 
Align behind the mission, not individual performance. When rooted in principles of action, accountability, and authenticity, it gives us the framework necessary for decision making and problem solving so people can understand their connection, feel deeply engaged, and valued unleashing human potential. We all do well. We reduce disparities and inequalities. Society is more vibrant as a whole.

Leadership so power is used not for personal gain, but for social good. This will ensure that the resources are thoughtfully placed so everyone has a fair chance to compete and be healthy. Leaders who value a system that includes wisdom, self-control, justice, kindness, and courage are less likely to reduce a complex systems problem to a set of rigid rules.

Learn so you can become your best self. Then you will be in a position to connect dots, innovate, and solve problems that will contribute to society. 
 
And ALL for the love of Alice, be a genuine source of good.

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