This article is a co-publication of Zócalo Public Square and State of Mind, a partnership of Slate and Arizona State University focused on covering mental health.

In early 2020, weeks before Covid changed our lives, I sat uneasily with a dear medical school friend, listening to a panel of experts discuss burnout, moral injury, and wellness. The speakers focused on categorizing and describing these terms, recited research and data, and prescribed self-care strategies, including a healthy diet, exercise, yoga, and mindfulness. Many colleagues found these sessions helpful. I left feeling even more unwell.

These discussions began sprouting up at hospitals, including my own, well before the pandemic helped propel stress and burnout levels among health care workers to an all-time high. Health care worker burnout has been tied to physician and nurse suicides, depression, and medical error. It impacts cognitive function, patient safety, and quality of care.

My testy relationship with burnout and wellness presentations begins with their dominant focus on data. I don’t need research to explain what I’m feeling. Over three decades, I’ve navigated escalating obstacles to care for patients as an emergency physician in a broken health care system. The past three years, the crushing constraints eroded my integrity as a healer. I knew patients deserved better and could feel their trust slipping away.

I often feel numbed by it all. I want to feel more, care more, and recognize myself again. I want to work with the uncertainty, and understand that burnout can never be fully defined or mastered, only honored and engaged with.

Psychology researchers define burnout as experiencing depersonalization, emotional exhaustion, and a loss of accomplishment or efficacy. Wellness presentations are supposed to address such symptoms. But I’ve found that when interventions oversimplify and universalize complicated feelings under the banner of burnout, they compound my sense of losing control, depersonalizing an experience already marred by depersonalization.

The problem isn’t the message but the framing. Why do hospitals and physicians approach burnout as a problem, and not a mystery?

The French philosopher Gabriel Marcel distinguishes a problem from a mystery in a way that I find helpful. A problem, he writes, is external to us. It’s objective and universal, and its solution is available to everybody. Take a faulty electrical circuit that won’t light a bulb. We troubleshoot the power source, the wiring, even the bulb to figure out how to fix it. The repair process is rooted in a shared understanding of principles, functions, technique, and scientific knowledge.

A mystery, Marcel explains, is “a problem that encroaches on its own data.” We can’t study a mystery objectively because the problem itself is rooted in the person. We can’t lean on a generalizable technique because the individual is involved in the quest. With mysteries, we can’t substitute one person for another, one experience with another, without altering the question itself. The person asking the question matters.

Through a prism of mystery, we thwart the impulse to universalize, to define, to break a problem into its parts and analyze with detachment, which are standard techniques we bring to our study of problems in medicine. Despite the wealth of research on health care burnout, I fear it’s become shorthand for a range of complicated individual experiences that are hard to put into words, let alone define, measure, or master.

The conversation changes when the focus shifts from the occupational syndrome of burnout to the individual, from ready answers to questions about the experience itself.

What if wellness experts spared overworked physicians from their next PowerPoint presentation and instead asked them to come up with their own language to capture their experiences and feelings? Doing so would force us to drill inward, which can be difficult. But the struggle to articulate our stories is the struggle to wrestle control over our experiences.

If I had been asked, in early 2020, what nagged at me, I would have pointed to pointless medical bureaucracy and its torturer’s apprentice, the electronic health record. I would have bemoaned the way the system leans on emergency rooms to solve mental health and substance use problems that community leaders and other institutions don’t or can’t handle.

If you asked me the same question now, I’d say I was stumbling into the post-pandemic normal, concussed by all I’ve absorbed and not fully processed: needless death and suffering; patient anger, insults, and violence against ER staff; degradation of standards in respone to constraints and resource limitations; staff exoduses.

Talking about burnout is easier than talking about being burned out. Physicians and nurses fear judgment and stigma—being perceived as insufficiently smart, mentally tough, or resilient.  To admit my feelings out loud instead of hiding vulnerability—and hear in return how colleagues struggled, too—would acknowledge our range of experiences in all their messiness, and blueprint possible bridges from isolation to community.

Building a culture that supports well-being is critical, as U.S. Surgeon General Vivek Murthy has noted in his recent call to get to the roots of the health care burnout crisis. System change begins at the level of human interaction. The pressures and waves of disturbances that make a life—different personalities, relationships, previous experiences, and institutions—are complicated and individual. Fostering authentic conversation is a good place to start.

To see ourselves differently, we must slow down and change our angles of understanding, or “make strange,” our previous ways of knowing. This idea of defamiliarization, made famous in a 1917 essay by the Russian literary critic Viktor Shklovsky, builds on our tendency not to notice things we encounter frequently. Our perception becomes habituated. Defamiliarization disturbs all that and forces us to see experiences and objects anew.

Writing and the arts function as a medium for defamiliarization. Critics often perceive humanities and arts-based medical education—from collaborations between museums and medical schools to reflective writing courses—as soft, nice but extra, or as a pill for humanism. But the arts provide rigorous critical thinking skills—they foster perspective shifting, remind us to consider cultural, historical, and social forces, and prepare clinicians for situations that push them outside their comfort zones. In 2020, the Association of American Medical Colleges issued a landmark report recognizing the need to integrate humanities and arts into medical education through writing, visual arts, dance, improvisation, museum-based experiences, and more.

Wellness or burnout initiatives should prioritize exploration and value curiosity and uncertainty. Interventions should regard easy answers with healthy skepticism. An authentic process, even without a “cure,” is an end unto itself. In the “third space” between art and the science of medicine, we can encourage vulnerability and the emergence of different discussions and insights. I find museums, with their quiet rooms and curated art objects, provide psychologically safe spaces for nourishing destabilization. In my experience, dialogue with artists and arts experts seeds different types of questions than typical medical wellness programs. It has forced me to engage with alternative ways of looking at, and appreciating, daily experiences.

The jury is out on the role of humanities and the arts for burnout. The effects of such programs are difficult to measure. Arts-based reflection doesn’t promise answers, or lend itself to data sets. But it might allow each of us room for contemplation, a chance to recover that which is mysterious in our lives, a moment to recognize who we’ve become, what we’ve lost, and what is still within our grasp.

Let’s not forget that we’re talking about human hearts in peril, searching for that ferry from burnout to better. I can’t say what the journey looks like—only that it requires new maps.

The post Are Hospital Wellness Initiatives Making Doctor Burnout Worse? appeared first on Zócalo Public Square.

Then came colic. Night after night, cuddles were met with blood curdling screams, each one more enigmatic than the last.

Yet by all reasonable standards, she was completely fine: her diaper was dry. She just ate. There was no sign of reflux. She’d just woken from sleep. Nevertheless, every night, for weeks, my daughter continued to cry, typically from the hours of 10 PM to 2 AM.

At the time, I was in my third year of my pediatric residency, merely weeks away from becoming a board-certified pediatrician. I felt as though I should know how to comfort my daughter, if not as her mother than as a medical professional, who had dedicated more than a decade toward higher education, and the last three years to pediatrics exclusively.

On my newborn rotations in residency, I regularly counseled new parents on the nuances of infants and provided experienced parents refreshers, both clinical and practical. I recited feeding regimens, skin abnormalities, stooling patterns, and other “basics” with ease. I lived by the five S’s— swaddle, side-stomach position, shush, swing, and suck—introduced by pediatrician Harvey Karp in The Happiest Baby on the Block. Again and again, moms watched in awe as I used these techniques to soothe their babies to sleep after marathons of cluster feeding, and I felt like I was empowering them to do the same.

But all of these methods failed to pacify my own daughter. Her screams were so piercing that one night, I took her to her changing table, completely undressed her, and looked at every finger and toe for hair tourniquets. Finding none, I proceeded to perform a full physical examination, complete with cardiac auscultation and primitive reflex assessment. Everything was normal. I swaddled her up, held her in my arms, and sank deeply into the recliner in her nursery. She screamed herself to sleep, and I felt like a failure.

First described in 1954 by physician Morris Wessel in a paper describing infants who cried excessively, colic stems from the Greek “kolikos,” which means “relating to the colon.” Wessel and others suggested that colic stems from gastrointestinal issues, but modern medicine has not pinpointed an exact etiology. To meet the definition, an infant must cry for at least three hours per day for at least three days per week for at least three weeks without an otherwise identifiable cause. Approximately 20 percent of newborns, like my daughter, are subject to this phenomenon, primarily from 3 to 12 weeks of age. But few research dollars are allocated to the condition, because it is self-limiting: In other words, curing colic “just takes time.”

But I wasn’t ready to hear that yet. I’ve always believed that mothers and doctors fix things; we clean up the scrapes and bandage them up. And if we cannot cure the ailment, we give comfort. Finding myself in a situation with my own daughter where I could provide neither my confidence in my abilities as a parent and medical professional plummeted.

In the following weeks, I received a lot of well-meaning advice from friends and family who wanted to help ease the burden. I leaned into my own medical background, as well, reading what little else I could find on the subject: Some parents find comfort in giving their newborns mylicon drops, a medication advertised to relieve the bowels of gas. Others change their infant’s formula or their own diet if they are breastfeeding. I gave my daughter a probiotic, Lactobacillus reuteri, the only medication studies show to have mild benefit.

In my line of work, I have fought harder battles than an infant with colic. During this global pandemic, I have treated patients dying in pediatric intensive care units, unable to be surrounded by their family or friends. Now as a pediatric hematology and oncology fellow, I regularly tell mothers and fathers their child has or is dying from cancer.

But this was my daughter, and her pain penetrated my heart in ways I’ve always hardened myself against while at work. In short, I lost sight of one of the most basic tenets of medical ethics: you do not treat your family.

I was reminded of this at her three-month check-up, when her pediatrician (also a friend from residency) assured me that I was not overlooking any aspect of my baby’s health. This affirmation gave me a new sense of resolution and confidence. Yes, she’s uncomfortable, but I was doing everything in my power to ensure that she’s healthy and loved. With that realization, I started to trust myself as a physician again and recognize that I needed to give myself the space to be her mom first and doctor second. In that space, I found new conviction in the cure for colic: time.

I started to take each day hour by hour, diaper by diaper. And sure enough, like clockwork, around 13 to 14 weeks, the nonsensical crying ebbed almost as quickly as it washed over us.

Relief was an understatement. Seeing my daughter through colic was a singularly terrifying and exhausting experience, one that jettisoned me into the realities of motherhood. There is a helplessness that nobody warns you of as you celebrate the birth of an infant. How somehow your own heart has left your body, and survival, both yours and theirs, is dependent on their wellbeing.

The experience has also lent me a new understanding to each patient encounter. In the moments where I recognize the same of loss of control in new parents that my husband and I went through, I bypass the five S’s and remind them to trust themselves and give it time.

Time is the most contentious medicine. Glance around the waiting room the next time you are at the doctor’s office. I imagine you will find most engrossed in their phones, trying their best to pass the time. We all want something active to help us feel engaged, most especially when there is nothing to do.

But take it from a pediatrician who is also a mother, your child will grow faster than you can possibly imagine. You will be thankful for that some days. Other days you may wish to stop blinking all together, if only to slow down the changes happening right in front of you. But that is not how time works.

Right now, I am enjoying my daughter’s cries of excitement as I walk through the door after a day at the hospital. And I am hoping that one day soon she will sleep through the night. Fingers crossed.

The post Curing My Daughter’s Colic appeared first on Zócalo Public Square.

Our friend, a physician, had just witnessed the death of a 27-year-old man with no chronic conditions. In his hospital, doctors were already making decisions about who to put on ventilators. “It’s a mess and there’s no help,” he told us. The young residents—doctors in training—were completely disillusioned; one of them told him, “When this is over, I don’t want to do this anymore, if this is what our health care system has come to.”

We should all be afraid about that reaction to COVID-19. If this pandemic can be compared to a war, we have sent our soldiers—our medical professionals—to the front lines without the protection and protocols they need to survive. Physicians, nurses, and other hospital workers are overwhelmed by endless streams of patients, the extra-long hours, and the deaths they see all around them. Scared and confused, they fight on. We should expect that when their duty is done, some of our best and brightest will decide never to return to the battlefield again.

In this respect, this pandemic is an extension of the ordinary. The United States routinely neglects the needs of one of its most vital workforces. If COVID-19 has any silver linings, the most important one will be its exposure of the fault lines in American healthcare, including the fact that even before the epidemic hit, healthcare professionals were suffering from toxic levels of burnout that hampers their ability to care about their patients.

More broadly, this epidemic shows that many aspects of the way we speak and think about healthcare, and the way we provide it, need to be reconceived and redesigned. To do that, we need to listen to doctors, nurses, and other healthcare professionals.

Despite the health risks of treating COVID-19 patients and the lack of masks and basic protection in many hospitals, healthcare professionals are not running from the challenge. Instead, they are building their own masks out of office supplies, coming out of retirement to offer aid, and isolating themselves in garages and trailers to protect their families.

Such commitment is particularly impressive when you consider that even before COVID-19, a significant proportion of them were unhappy in their jobs. According to research from the National Academy of Medicine, between 35 percent and 54 percent of U.S. nurses and physicians feel substantial symptoms of burnout, including exhaustion, depression, and emotional numbness. For medical students and residents, the prevalence of burnout ranges from 45 to 60 percent.

Our caregivers are not just tired or stressed—they are experiencing “moral injury.” The term moral injury was coined in 2009 to describe how soldiers’ mental health suffered from having to act against their own moral compass in times of war. Dr. Simon G. Talbot and Dr. Wendy Dean applied this term to the healthcare setting to describe the “suffering, anguish, and loss” clinicians feel when they cannot deliver the care patients need in our profit-based healthcare system.

In our profit-based healthcare industry, billing is king, and clinicians bear the brunt of the busy work that’s required. According to an annual survey conducted by Medscape, an online medical news outlet, the most common contributor to moral injury is the absurd number of bureaucratic tasks healthcare workers now do. For example, a 2016 study found that physicians in four specialties spend about half of their work day filling out electronic medical records and paperwork. Family physicians spend another 1 to 2 hours at home after work doing coding and billing in the electronic medical record.

Another casualty of profit-driven healthcare is the time doctors get to spend with patients. More patients per day means more billing opportunities, and many clinicians are pressured to fit as many patients in their schedule as possible. The “15-minute visit” in primary care has become routine. Many physicians barely have time to listen to patients’ concerns before sending them for one test or another. This diminished time with patients gives doctors and nurses the feeling that they are mere cogs in a computerized system that cares little about people and their health problems.

This is not what most practitioners signed up for, and the mismatch between the ideals of medicine and the reality takes a high toll. Physicians in the U.S. have the highest suicide rate of any profession. That statistic may reflect the fact that physicians are stigmatized and sometimes punished for seeking mental healthcare.

Of course, the COVID-19 pandemic has reinforced the sense of purpose driving many medical professionals. But as they’re putting themselves in danger, and their mental health is suffering as they watch patients and even colleagues die. For many, including our friend in Queens and his colleagues, the crisis has already inflicted a devastating emotional impact.

In order to retain health professionals after this epidemic, we must do more than recognize their sacrifices, or address their current anger. We must answer their long-held concerns—and involve them in charting new policies and ways of keeping them healthy enough to tend the sick. Call it the GI Bill for Healthcare Professionals, if you will.

Some of these new policies should be financial. Nursing and medical students often leave school with thousands of dollars in debt, and the mental stress that accompanies it. Educational debt also adds pressure for doctors to choose a high-paying specialty rather than primary care and geriatrics, where the need for a larger workforce is most urgent. Steps can be taken to address that: Erase all health professionals’ school debt to help those already in the field. In addition, medical, nursing, and physician’s assistant training should be free for all low-income students, to encourage more people from disadvantaged neighborhoods and regions to pursue these necessary careers.

We also need to ease some of the burdens of daily work life. Electronic health records, as currently configured, are primarily tools for maximizing billing. Beyond the time required to fill them out, they create all kinds of headaches for doctors and nurses, who find them incredibly frustrating to use. These record systems need to be redesigned into one single, easy-to-use platform, with the primary purpose of improving care. A committee of healthcare workers should be the principal advisors in this endeavor.

We also need to adjust regulations to make it easier to deliver care to patients. In this state of emergency, the federal government has eased regulatory requirements to allow increased flexibility in where and how patients are treated. For example, Medicare is now paying clinicians for a wide range of telehealth services. We have heard from frontline clinicians that the reprieve from many regulatory and administrative burdens has reminded them of how much better it feels to devote time to caring for patients, rather than navigating paperwork and rules.

One primary care doctor told us that before COVID, she would have to see patients in person to determine that they did not need to see her for in-person visits. Now, she is encouraged to care for patients virtually whenever possible, without an unnecessary in-person visit beforehand. Common-sense policy changes like these should be made permanent if possible, with recommendations from healthcare workers helping to drive decisions.

Unfortunately, it isn’t enough to make health jobs easier and more patient-focused. After this pandemic, doctors, nurses, and other healthcare workers will need to recover from what they’ve recently experienced. Hospitals should expand access to counselors and other mental health services we need, and teaching hospitals must do the same for trainees. Health professional schools should follow the example of Weill Cornell Medicine in offering free mental health counseling for all students. Mental health services should be accompanied by safe and confidential screening services for depression, PTSD, and other mental health issues, to reduce barriers to access.

Finally, in the wake of COVID-19, the U.S. public health response to pandemics will have to be re-evaluated and overhauled. One priority must be to make sure healthcare workers are never forced to beg for masks and other basic protections again. To that end, we should establish a Clinician’s Affairs agency within the Department of Health and Human Services with representation from nurses and doctors. By putting clinician representation at HHS, and also at the Department of Homeland Security, it would position healthcare professionals to give direct input on national health and security policies.

For years, Americans have stood by as the healthcare system pushes our doctors and nurses to the breaking point. Now, our need for them is as great as it’s ever been, and we are pushing them further. World War II veterans got the GI Bill. Clinicians today deserve the same assurances. We need a Healthcare Professionals Bill that eases their educational debt and also includes them in redesigning multiple aspects of our broken system.

The post What Do We Owe Doctors and Nurses? appeared first on Zócalo Public Square.

Those panelists—including top researchers and journalists—offered multiple examples of ideas that originated in immigrant communities that have made us healthier—from diet to exercise to an emphasis on family and social relationships. But they all pointed to one overarching conclusion: Immigrants often approach health together, with the participation of relatives and neighbors, instead of alone, as too many native-born Americans do.

In the foreign cultures, “there’s this continuity and connectedness that’s fundamental to your being. You are never alone,” said UCLA medical anthropologist Marjorie Kagawa-Singer. “We’ve lost that here” in the U.S.

The moderator, CALmatters health and welfare reporter Elizabeth Aguilera, began the event, held in the library at the Mechanics’ Institute in San Francisco, by asking what has been learned and adopted from immigrant cultures.

Journalist Claudia Kolker, author of The Immigrant Advantage, answered by citing a host of ideas. She said immigrants had taught Americans about the importance of post-partum care (which has been a higher priority in other cultures than in the U.S., where pre-natal health gets more emphasis), better ways of eating (she noted that Vietnamese culture makes meat a condiment, not the main course), and about seeing loneliness as a threat to health. “These are now medical ideas,” she said.

Asked by Aguilera how we might change our approaches to health from the lessons of immigrants, Kolker pointed to two. First, she suggested thinking bigger and having bigger life goals, as many immigrants do, which may explain why immigrant groups in the U.S. have measurably better mental health. Second, referring to research from Rice University professor Utpal Dholakia, she suggested that thinking of your life as less of a highway and more as circle contributes to better planning and even more saving of money, which in turns aids health.

Kolker also said that living with your grandparents, which is common in immigrant families, has cognitive benefits for children. And she said that understanding the importance of human touch is vital now, since Americans “as a society are touching each other less and less.” Many elderly patients are not touched at all, she said, even though we know from research and from other cultures that touch is good for our health.

Dr. David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA School of Medicine, argued that more attention must be given to the health advantages of immigrants and Latinos. He talked extensively about what he called the “Latino epidemiological paradox”—that even though Latinos often have less access to care than other Americans at the same income level, Latinos have fewer heart attacks, fewer cancers, drink less and smoke less, and live 3 and a half years longer. “If everyone in the United States had the same profile” as Latinos, “250,000 lives would be saved,” he said.

Hayes-Bautista has been investigating myriad possible reasons why Latinos do better—social networks, family, community support, diet, and even dance, music, and spirituality. But, he cautions, instead of doing more to understand these advantages so they might be applied to medical care and training, the medical establishment has largely ignored diversity issues.

Medical training, he said, is based on “a bunch of stereotypes” about immigrants or Latinos as unhealthy, rather than as sources for ideas about health. And public health programs often exclude undocumented immigrants and recent immigrants, even though their participation in the health system might make us all healthier.

Kagawa-Singer, the UCLA medical anthropologist, said modern medicine doesn’t encourage doctors to listen to people from different cultures. And the U.S. system ends up dividing mental health and physical health, even though the experience of other cultures teaches us that mental and physical health are closely tied together.

“Modern medicine,” Kagawa-Singer said, offers “a very mechanistic view of the body isolated from the spirit, the family, and the community… And if there’s an immediate infection, biomedicine is great. But if you’re talking about chronic issues and mental illness, you have got to put the whole person back together again.”

During a wide-ranging question-and-answer session, audience members posed queries about the history of immigrant health and whether immigrants might bring a more open attitude and less costly interventions to medical care at life’s end. Panelists also suggested that the experience of immigrants who come from countries with universal health care might inspire the embrace of “Medicare for all,” especially in California, where political leaders have supported the idea.

In response to one query, panelists noted that immigrants may be healthier because people willing to leave their countries may be more adventurous and robust.

“There is evidence that families make the decision about who is the smartest and who is the least prone to being sick” when they decide who might immigrate first, Kolker said, “because he’s the person who is going to take care of us. So we get these extraordinary people coming here.”

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Why is that? And what are individuals, organizations, and government doing to improve Los Angeles communities? These were a few of the questions tackled at the downtown Los Angeles panel titled “How Do You Fix a ‘Bad’ Neighborhood?”

Zócalo editorial director Sara Catania, the event’s moderator, opened by asking Los Angeles City Councilmember Marqueece Harris-Dawson, who represents South Los Angeles and grew up there, to explain why his family left the neighborhood.

Harris-Dawson explained that their move coincided with larger American trends—urban deindustrialization and the crack cocaine epidemic. “A place that was safe and was nurturing became completely unsafe, unstable, and downright destructive,” he recalled.

UC Irvine criminologist Charis E. Kubrin said her research has shown that large-scale structural changes in cities such as the ones Harris-Dawson mentioned shape local neighborhoods. “I’m interested in why crime clusters where it does, why it occurs where it does,” she said. “To understand that you have to know how neighborhoods are shaped by larger social forces.”

That holds true for St. John’s Well Child and Family Center/Harbor-UCLA Medical Center pediatrician Chris Mink. “You think one child, one doctor in one office,” she said. “I am one-on-one with the child, but everyone in the community is there with me.” An obese child may be living in poverty, for example, with food insecurity Mink explained. To combat that, she added, you need a grocery store where the family can buy good food, a parent with a job to buy that food, and a park that’s safe for the child to go out and play.

As president and chief operating officer of the Gang Reduction & Youth Development Foundation (the GRYD Foundation), Adrienne Newsom is trying to combat some of these issues through programs like the Summer Night Lights series. Summer Night Lights keeps the lights on at parks in neighborhoods dealing with gang-related violence and also creates events and programs (from sports and food to gardening) for the entire family after hours. The program, said Newsom, is about taking people who live in areas where it’s hot during the summer and who feel cooped up inside, and giving them the chance to come out with their families and enjoy themselves.

“How do you take an example like that where you see success with a program,” Catania asked Harris-Dawson, “And translate that into action on your end?

Harris-Dawson, who was involved in the beginnings of Summer Night Lights as a community organizer, said that it’s two-fold: People and organizations talking to neighborhood residents first, then doing things with the community. Summer Night Lights “created a platform for connection,” he said. “No one knows more than the people living in a block, or a neighborhood, what it takes to bring that place to the next level.” It’s not just poverty but disconnectedness, from both your neighbors and the police, he added, that causes crime.

Kubrin said that communities with less crime have a very close relationship with their police force. “There’s communication, there’s trust,” she said. It goes both ways, too, she explained. People feel they can go to the police if they have a problem. And “the police rely on the community members to help do their job.”

Harris-Dawson pointed to the LAPD’s Community Safety Partnership Program, which places officers in a specific neighborhood for a five-year period and evaluates them not on arrests, but on participating in community activities as a successful way of building such relationships. “Residents know police, and police know residents,” he said.

Resilience and grit have become buzzwords for talking about individuals who rise out of difficult circumstances, said Catania. “Can a community have resilience? Can a community have grit?”

Yes, said the panelists, but they can’t do it without having support from beyond their communities in fixing structural disadvantages and providing necessary resources. “You can have all the grit you want” in a struggling neighborhood, said Kubrin, but “you are from behind at the start.”

Harris-Dawson said that it has to start with creating “a situation where people’s basic needs can be met,” like having the time and money to cook healthy meals. Too often, we marvel at the rose that grows through the concrete. “I’m like, break up the concrete, there are a bunch of flowers under there,” he said.

So what can be done to transform a “bad” neighborhood?

“I think one thing would be to have some type of town forum, so to speak, where we can actually hear from residents what their perceptions are of their neighborhood and what they think are some of the solutions,” said Newsom. It’s more than that, however. “There needs to be a mindset change, too,” she said.

For Harris-Dawson, it comes down to kids. “Every child has to have their basic needs met. A caring adult in their life. Something meaningful to do. And someone to love,” he said. “I think if you do those things, almost every problem’s solved.”

Mink said that we know what a good neighborhood looks like: “It’s safe, loving, and nurtures growth for everybody,” she said. “There are so many things we need to do and we know how to do” to make those neighborhoods happen. “We just have to get people invested.”

That takes resources. “Where does that money come from?” asked Catania.

The money is there, the panelists agreed. Unfortunately, most of it is going into what Kubrin called “back-end criminal justice solutions” rather than “front-end prevention.” The state, she said, spends $60,000 per year to house a prisoner.

What, asked Harris-Dawson, would happen if you spent that money paying people decent salaries instead?

In the question-and-answer session, audience members asked for advice on dealing with problems in their communities, how the panelists tackle various challenges, and their takes on a few different programs.

“If an inner-city residential neighborhood had a pocket park within a quarter mile of every resident, how valuable would this investment be?” To put a pocket park in every six to eight blocks, he said, would take just 1.2 percent of L.A.’s annual budget.

“It would help with health and wellness and stress relief,” said Newsom.

However, Harris-Dawson cautioned against parks without programming. “The park is identified as one of the most dangerous places” in many neighborhoods in South Los Angeles. A football league in the street, run by adults, is more beneficial to the community than a park without the type of programs GRYD runs, he said.

Another audience member asked what she can do to educate her neighbors about resources available to them, and get the community connected, even as she feels unsafe on her neighborhood’s streets. “What’s the first step?”

“It’s one slice at a time,” said Mink. She works with many foster children who face a number of different obstacles. Her hospital has tried to deal with these obstacles individually: A fundraiser for buying pajamas first, then one to provide lunch in the summer, and finally to buy backpacks for the school year. “Just one slice of the pie at a time,” she said.

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Four panelists, each involved in different Inland Empire communities, shared their diverse perspectives on this topic at the Zócalo Public Square/The California Wellness Foundation event “Will the Inland Empire’s Sprawl Create the Community of the Future?” in front of a full house at the Riverside Art Museum.

The evening was framed by findings from The California Wellness Foundation’s Advancing Wellness Poll, which found that residents of Riverside and San Bernardino counties endure some of the nation’s dirtiest air and longest commutes. These communities also deal with low wages, which means they often work more, making it difficult to spend time with friends, family, and neighbors. Nevertheless, the evening’s spirit was one of hope from the beginning, when moderator and New York Times reporter Jennifer Medina asked the panelists how optimistic they are about the region’s future and why.

“I’m very excited about our region’s job prospects,” John Husing, a research economist, answered. He said the Inland Empire has added approximately 235,000 jobs recently, bringing the region to a total of nearly 100,000 more than before the recession.

Luz Gallegos, who works with the region’s immigrant population as community programs director at TODEC Legal Center, was also optimistic. She said she’s seen the immigrant community “wake up” and become politically engaged. “We’re very hopeful because at the end of the day that’s how you see change,” Gallegos said.

Medina pressed the panelists to consider one of the Inland Empire’s greatest challenges: How do you engage the community when it’s so widespread and disjointed?

“It’s one community at a time … If change is going to happen, you must start with the indigenous people,” Rev. Samuel J. Casey, executive director of Congregations Organized for Prophetic Engagement and a pastor at New Life Christian Church in Fontana, said. The other panelists agreed, emphasizing the importance of building relationships between individuals as well as across different organizations.

Greer Sullivan, a professor of psychiatry and the Founding Director of UC Riverside’s Center for Healthy Communities, pointed out that it’s not uncommon for people to feel like they don’t know their neighbors or like there is no “community” to begin with. But she had an idea for change: “I think the solution is to start small and build from there.”

Gallegos agreed, saying she’s seen the firsthand benefits of grassroots organizing. It helps to “get in the trenches” in order to know each community’s individual needs. Coachella, for instance, is very different from Riverside, she said.

“There are 4.4 million people in the Inland Empire spread across two counties,” added Husing. “There’s no center to it.” This disjointedness can make it challenging to deal with big problems. “In San Bernardino, 27 percent of children and 18 percent of all people are living in poverty,” he said. “These are catastrophic numbers.”

Sullivan said that there’s a link between poverty and health, and she has been encouraged that this is becoming more widely known and researched. However, the Inland Empire needs to address both at the same time. “Research shows that having close friendships, having close family or friends, is really critical,” she said. “Exercise is really critical. If you don’t have a safe neighborhood, you may not feel safe exercising.”

Gallegos agreed that paying attention to wellness is a necessity for positive community growth. “We live such fast and crazy lives; we are running from taking kids to school to trying to get to work. There’s really no time for wellness,” she said. “How can we work together as a team that will continue empowering the community—not only for our generation, but for future generations?”

The audience question-and-answer period also looked ahead in order to deepen the discussion. One audience member asked: How can people in the Inland Empire get better access to education?

Casey said there are two issues that need to be addressed. First, high poverty areas sometimes lack teachers with the training needed to address students who come to school hungry, or are suffering from PTSD. “The reality is that teachers are walking into classrooms trying to engage students that they are not prepared to engage,” he said. Second, he said, more attention needs to be given toward not just education but jobs in order to put an end to “the school to prison pipeline.”

Still, several of the panelists said they have seen improvement at schools where parents become involved at school board meetings. Ultimately, that’s the kind of action that all four panelists agreed can improve the region’s communities—a perspective best summed up by Gallegos’ closing remark. “By working together,” she said, “I think all of us can really make an impact in the Inland Empire.”

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