3

Community Power in the Context of Population Health

The second session of the workshop featured a discussion of current community power-building efforts and focus areas for future work. The discussion featured Richard Healey, founder and senior advisor at the

Grassroots Policy Project and chair of the board of the Commonwealth Foundation for Inclusive Democracy, and Jonathan Heller, senior health equity fellow at the University of Wisconsin–Madison’s Population Health Institute and co-founder of Human Impact Partners (HIP).¹ The discussion was moderated by Bobby Milstein, director of systems strategy at ReThink Health.²

Milstein remarked that the workshop was designed to deepen understanding of how to enlist greater numbers of people in community-building work and help them to establish their own roles in building power. Although there are currently great opportunities to change systems and cement new narratives, he acknowledged that those efforts could feel daunting owing to a lack of buy-in. Sharing expertise is helpful in determining how the difficult but healthy work of affirming human value and agency can be incorporated into norms and routines. Milstein noted that collectively, Healey and Heller have 70 years of experience working at the interface of population health and civic life—an intersection where people’s power to shape a common world, as well as their own lives and livelihoods, comes into focus.

SHIFTING DEFINITIONS OF POWER

“The key word for this entire workshop is power, a word that is notorious for wobbly definitions and even outright discomfort in the classical, detached discourse of health science,” said Milstein. However, it is possible to examine the pragmatic experience of building power to identify its features. Referencing Healey’s “three faces of power”—a framework for strengthening movement infrastructure—Milstein asked about the framework’s distinctions between “power over,” “power with,” and “power to” (Healy and Hinson, 2005). He also asked for examples of manifestations of these aspects of power. Healey described community-organizing efforts in Chicago, Illinois, in the early 1970s. He already had years of experience in activism at that point and was drawn to the community-organizing efforts taking place in the city. To be successful, this work involved the organization of both people and money. Thus, their working definition of power

___________________

¹ More information about Grassroots Policy Project is available at https://grassrootspolicy.org (accessed February 17, 2021). More information about the Commonwealth Foundation for Inclusive Democracy is available at https://commonfound.org (accessed February 17, 2021). More information about the University of Wisconsin–Madison’s Population Health Institute is available at https://uwphi.pophealth.wisc.edu (accessed February 17, 2021). More information about Human Impact Partners is available at https://humanimpact.org (accessed February 17, 2021).

² More information about ReThink Health is available at https://www.rethinkhealth.org (accessed February 17, 2021).

became “organizing people and organizing money.” At that time, efforts were constrained to the local level. Often, the work took the form of four or five staff members working to get community members elected to local office and better positioned to advocate for improved conditions for their neighborhoods. While organizers were aware of structural racism and social determinants of health, those concepts were not discussed explicitly at the time. Only recently has the power of narrative—the focus of the previous session—become embraced, he added. Healy reflected that as recently as a decade ago, people threatened to kick him out of community-organizing meetings when he talked about power as narrative, ideology, and storytelling, because it was not viewed as a practical approach.

Healey remarked that although there is no single definition of power, his interest is in expanding the notion of power in ways that enable community groups to expand the tools at their disposal. Over the past 10 years, narrative has been incorporated into the definition of power. The dominant perspective in the past was that people and money were organized locally, but the power of building major, durable alliances has also emerged as a component of the working definition of power. He added that the notion of what constitutes power relates to the tools available to effect societal change.

ADDRESSING POWER DYNAMICS IN HEALTH

Milstein asked how health professionals can create space to consider power dynamics and building power. Heller noted that health inequities received little attention in public health discourse 15 years ago, but more recently, the topic has developed into a prominent narrative theme. These health inequities are largely caused by inequities in the social determinants of health, such as housing, voting access, and income, he noted. Across these areas, people of color with low incomes are generally the most affected, mostly as a result of power imbalances and oppression. Thus, if health equity is to be advanced, power imbalances must be addressed. He added that the field of public health can address issues that communities care about by centering their voices and helping them build power to achieve their goals. This work can involve partnering with community-organizing groups, such as the National Domestic Workers Alliance (NDWA), he continued.

PERSONAL EXPERIENCES IN POWER BUILDING

Milstein asked about the circumstances that led the panelists, both applied methodologists, to a career path focusing on power building. Healey said he is the third generation of a family of activists who escaped

Hungary. When he was an epidemiologist for the State of Massachusetts, he looked at the environmental causes of chronic diseases. This involved going to cities such as Woburn and Canton to explore possible associations between increased cancer rates and environmental hazards.³ This work led him to think more deeply about the role of power, after state senators and corporations attacked him and the community for discussing environmental causes of cancer because of fears that it would drive down property values. Healy noted that he was often unsuccessful in those attempts to center people, not property values. However, over time, he and others in this field, including colleagues at this workshop, have slowly developed tools of power. Community groups are no longer isolated in advocating for themselves and in fighting forces much larger than themselves. Instead, statewide alliances are developing ever-more sophisticated political and legislative tools. Milstein reflected that behind any environmental, housing, or health crisis, there is a power crisis, and that the people determining the circumstances leading to these crises may not value—and may even actively resist—the idea of making space for everyone to thrive.

Heller commented that his own history of approaching health problems through examination of power dimensions is more recent. Initially, he used his Ph.D. in biophysics in a biotechnology career. However, he was drawn to the health field after witnessing the suffering caused by malaria during his service in the Peace Corps. He came to see that biotechnology was not the best strategy to address issues such as malaria, and he did not feel he was living in alignment with his values. Thus, he shifted to public health, wanting to bring a data lens to creating solutions. Heller recalled, “[I was] naively thinking that if I just did reports, like health impact assessments, and brought data to decision makers, they would change their minds. Lo and behold, more data does not actually change things.” Fifteen years ago he started to understand this when he volunteered with environmental justice advocates who were organizing in West Oakland, California. A low-income housing development for seniors was proposed next to the freeways by the port, and the organizers were concerned about the seniors’ exposure to pollution and noise. During a 3-month process, the organizers held five meetings in which community members discussed the issues surrounding the housing development. Input from those meetings was used to draft a 10-page letter regarding the potential health impacts of locating low-income senior housing next to the freeway and port. This letter, containing both data and stories from the community, was sent to the developers, only to be ignored. However,

___________________

³ Healey and colleagues investigated an increase in the occurrence of childhood leukemia from 1969 to 1979 in Woburn, Massachusetts (Cutler et al., 1986).

a group member had a relationship with a planning commissioner, who happened to be involved in the nurses’ union, and the member sent the letter to that commissioner. A commission meeting was held around the development, and the planning commission asked the developers to work with the community group. “It was not necessarily the data that changed anything,” Heller contended, it was the relationships and power, paired with the data, that resulted in the developers changing their plans and ushering in other changes in Oakland. Reading “The Three Faces of Power” (Healy and Hinson, 2005) helped Heller understand that power was fundamental to all the issues activists address, including housing, incarceration, immigration, and that a shift in power was necessary for change. Health and community organizing fit in that framework, he concluded.

ADDRESSING INTERNALIZED DEVALUATION

Milstein highlighted the key role of power in issues of equity and justice, as demonstrated when the initial efforts of the community organizers were ignored by the developers during Heller’s experience in West Oakland. He contended that the tendency to ignore the needs of devalued people must be met with efforts to gain dignity and respect for devalued groups, just as NDWA and the Black Voters Matter (BVM) Fund are doing. He emphasized that the first step in any kind of move to improve health has to be rooted in the dignity and inclusion of people. He asked for examples of people who were ignored or oppressed yet managed to gain the dignity they deserve in the eyes of those overlooking or devaluing them.

Healey remarked that he first recognized this needed shift toward dignity while advocating for a living wage for hotel service staff. He witnessed that many of these low-paid workers had internalized a low sense of self-worth in response to “the dominant, neoliberal⁴ narrative that you are worth what you are paid.” Thus, the starting point must be helping people understand that all humans have equal value, regardless of wealth or fame. Identifying allies who validate that sense of self-worth, such as ministers and city councilors, is part of the process. Healey noted that public health professionals are well positioned to serve as validators. The dominant narrative in the United States has long been that those not earning much money are at fault for their circumstances and, in turn, they are blamed for not getting more education or training. In contrast, he suggested, the narrative that should be strengthened is that working people are worthy of the right to earn a living wage and that their children

___________________

⁴ See https://plato.stanford.edu/entries/neoliberalism for a definition of neoliberalism.

are worthy of receiving good childcare. Healey said the struggle with the political conditioning and the internalized dominant narrative is “a crucial piece of this puzzle.”

This approach aligns with HIP’s work and focuses on the concerns of community members Heller described. Instead of coming into communities and telling residents why they should be concerned about an issue, HIP listens to community members about the issues that are important to them. Partnering with community-organizing groups, HIP assists with the issues the community members have prioritized. For example, if members are concerned about housing, HIP works with organizers on rent or other housing-related issues. While avoiding forcing a health perspective on community members, HIP pulls from the considerable research available around housing and health, a research area that has been growing in the past 20 years. Heller noted that the scientific perspective on research can be limiting; input from community members is valuable data that should be incorporated. For instance, in conversations with communities in Minnesota around access to education, critical race theory was raised, alerting HIP that the research literature was limited in terms of adequately describing the experiences members were sharing. By bringing the community voice alongside the published research and government data, HIP simultaneously filled a gap in the research and demonstrated to community members that their real-life experience is valuable and needed. After HIP issues a report, they work with the community to convey the contents of the report to city councils, state legislatures, or other advocacy avenues. Heller emphasized that the entire process is focused on validating community concerns, bringing the voices of the community together, and helping community members build their power to tackle issues affecting their lives.

COMMUNITY-BUILDING INFLUENCES

Milstein commented that lifting up human dignity and helping people change the circumstances of their lives requires a shift or evolution in how knowledge is pursued. He asked the panelists about influences on their practice of science centered around human dignity and the narrative of people’s agency. Healey replied that he was influenced by activists and radicals in his family, and also by the work of Stuart Hall, a Jamaican sociologist, activist, and theorist of narrative and cultural strategies. Providing a public health example of such strategies, Healey said the dominant (cultural) narrative of individualism is tied to white supremacy and ignores collective struggles. Within this narrative, focus is placed on promoting oneself while competing with everyone else and treating health as a commodity that individuals seek out, while dismissing socialized

medicine as an impractical framework. Over decades, this narrative has led to the devaluation of public health and other public agencies, making health something that can be attained if one can afford it. In turn, Healey asserted, poor people, and particularly people of color, are excluded from access to health care. The health conditions on reservations for Indigenous people in the United States reflect this exclusion. Healey suggested that a new collective narrative is needed for examining public versus private health at the intersection of race and individualism. Furthermore, community groups, public health groups, and trade unions should seek to ensure that the narratives of their respective organizations are addressing questions of white supremacy and individualism. He added that public health is particularly well positioned for this work.

Heller shared the insights about power he gained from Healey’s framework. Initially he was dismissive about ideas of power until “The Three Faces of Power” provided him with an understanding of how the pieces fit together, Heller described. He described Jamaican-British sociologist Stuart Hall as a key influence on the topics of narrative and cultural strategies. Community organizers such as Deepak Bhargava from Community Change,⁵ Doran Schrantz from ISAIAH,⁶ and others were instrumental in helping Heller shift from a perspective of hard sciences to a focus on relationships and organizations. In applying public health ideas to community organization, he built on the foundation laid by such leaders as Tony Iton, senior vice president of programs and partnerships at The California Endowment (TCE),⁷ Jeanne Ayers of VoteSafe Public Health,⁸ and others who have long been advocating for health equity. Heller said he melded the ideas learned from these experts with community-organizing principles to inform the way he analyzes the world and approaches his work at HIP and the University of Wisconsin.

INSTITUTIONALIZING POWER BUILDING

Milstein thanked Heller for sharing that he had previously dismissed the role of power in public health, noting that many people do not fully understand the meaning or gravity of power. He asked what actions could be taken to help institutions incorporate the value of working from

___________________

⁵ More information about Community Change is available at https://communitychange.org (accessed March 19, 2021).

⁶ More information about ISAIAH is available at https://isaiahmn.org (accessed March 19, 2021).

⁷ More information about The California Endowment is available at https://www.calendow.org (accessed March 19, 2021).

⁸ More information about VoteSafe Public Health is available at https://www.astho.org/votesafepublichealth (accessed March 19, 2021).

an understanding of power so that these efforts are not dependent on individual personal transformation. Milstein said methodologies such as community-engaged research and health impact assessments have a role, and Healey has referred to the pivotal role of organizers in mediating relationships necessary for instigating change. How can the importance of power be brought to bear on institutional priorities, Milstein asked. Healey replied that an organization’s understanding of how it can build its power and its working definition of power inform where that organization will invest its resources. An organization that invests all its resources in building its own internal work may find this to be effective, Healey noted, but he has focused his work on putting resources into deeper, more powerful alliances—in a sense, organizing other organizations. For example, he has worked on multiple projects linking community organizers with local health departments. This enterprise is challenging, considering the varied missions and internal cultures community organizers and state health departments have. These organizations are constrained by the political bodies they report to, and their immediate mission is different than that of community organizations. Healey said his work has been developing approaches to advance beyond these challenges to the deeper issues of human value and dignity addressed in the previous session. This involves allocating resources into relationship-building efforts between different types of organizations to build a larger institution. Building an infrastructure requires uniting various parts, each carrying out different tasks, around the mission of changing society. The operative question then becomes how an institution decides to put resources into a broader mission, Healey suggested.

Heller added that this is the type of work HIP began 3 years previously, through funding from TCE, to bring together health departments and community-organizing groups to work collaboratively. A HIP pilot program identified five health departments in California, then matched each county health department with a local community-organizing group. The county health department agreed to help the community-organizing group build power by working on the group’s focus issue. The community-organizing group agreed to work with the health department and bring a health lens to organizing work. Building relationships was a crucial step that took place over the first year, Heller explained. As these organizations have different missions and their approaches vary from one another, building relationships was fundamental to the process. The pilot began with a 2-day meeting in Oakland, California.

Heller noted that after the first day of programming, participants from the Santa Barbara Health Department and its community partner, Central

Coast Alliance United for a Sustainable Economy (CAUSE),⁹ went out to dinner together. The experience of sharing food initiated a relationship between the organizations, a shift that was apparent to Heller the next day as the groups ate breakfast together. This relationship enabled the organizations to collaborate effectively on an issue of focus for CAUSE’s members: conditions for farm workers. Their workers did not have access to toilets, which is a basic, fundamental health issue. Using the power of the Santa Barbara Health Department, the partnership was able to elevate the importance of this issue in the county over the course of a year. Furthermore, Heller has seen ripple effects of these efforts. For example, organizing groups working with farm communities have reported that many undocumented workers lack trust in their health departments and therefore have uncertainty regarding recommendations related to the COVID-19 pandemic. In contrast, the relationships established in Santa Barbara have built trust; Heller was hopeful that this trust has translated to mitigating the impact of COVID-19 on the undocumented farm-worker community in that area.

Healey commented that the decision to have dinner together is contingent on having the resources available to do so. Community-organizing groups are perpetually resource constrained, both financially and in staffing. Resources provided by TCE enabled Heller and HIP to allocate time to facilitating relationships. Not only can philanthropy enable organizers to spend time with the community members they are serving, but it also enables organizers to work with legislatures, forming connections and highlighting the value of the efforts being made. Such relationships can be protective in establishing defenders should an organization make controversial moves toward change. When community organizations, trade unions, health departments, and legislatures work together, it shields people from attack, enabling them to work beyond their usual comfort level without fear of being fired. Creating this type of space and security requires resources, which gives philanthropy an important role to play in community organizing, Healey concluded. Milstein remarked that it can seem like resources are the constraint, but it is possible to view resources as abundant if they are invested into building wider relationships.

OBJECTIVITY AND RELATIONAL WORK

Given the norm of detached objectivity in health science, Milstein asked how a commitment to this type of relational work can be approached alongside objectivity and scientific neutrality. Healey replied that science

___________________

⁹ More information about CAUSE is available at https://causenow.org (accessed March 11, 2021).

tells us that racism and white supremacy have had a destructive effect on people of color and on white people in the United States. “That is good science … not bias,” he commented. Structural income inequality and social determinants of health are objective facts. He suggested that people who are interested in improving human health should leverage the scientific knowledge that is available to advocate for changes to the political, social, and economic structures that perpetuate health inequality, such as racial segregation and mass incarceration. Healey remarked that this can be done “objectively and passionately, because science is on our side.”

Heller remarked that this question of objectivity is one he has considered at length. When he came into this work, he thought data alone could solve problems in public health. He quickly realized that this is not possible and came to understand that the concept of objectivity in this context is false. Everyone has values, including scientists, and these values influence the research questions asked, the answers received, how results are presented, and which research gets funded. Given the extent to which values and beliefs shape the research process, the idea that science is purely objective is a false narrative, he asserted. However, public health departments can take advantage of that narrative by validating community concerns, giving them scientific language, and including them in scientific publications. He added that the community-organizing groups he works with are often viewed as political and biased. When he and his team conduct health impact assessments, collecting data through focus groups and scientific methodology, they can report data in a way that is more palatable to decision makers than messaging from community-organizing groups. Thus, the perception that public health is objective can be used to present data in more effective ways to certain groups that might otherwise dismiss it, he said.

Healey highlighted the need for careful consideration about what is construed as objective knowledge, because it is not limited to expert knowledge or results of the scientific process—“tacit knowledge or experiential knowledge is absolutely crucial.” People with lived experience have knowledge that is critical to incorporate.

EQUALITY IMPROVEMENT CONDITIONS

Milstein echoed Iton’s statement, made earlier in the workshop, that although health is often seen as a technocratic enterprise it would be better framed as a democratic enterprise. He noted that “equality improvement” has become a watchword in health care, and he reflected on the circumstances that are needed to engage greater numbers of people in a joint, orchestrated enterprise that establishes conditions in which everyone can thrive. He asked the panelists to discuss ways to mobilize enough

engagement in such an enterprise to ensure that the people affected are determining the opportunities for action—rather than funders or organizations—if the field shifts away from its current reliance on experts and institutions to do this work alone.

Healey responded that those in power are often wary when people organize, because democracy can be a threat to the status quo. Once people experience organizing around an issue, they may expand to other issues. He said the founders of the United States were afraid of democracy and thereby created a relatively weak government, as a true democracy could result in property being shared, white supremacy being overturned, and people speaking for themselves and working together as they realize their larger self-interests. Continued efforts to disenfranchise people stem from fear of democracy, he added. Isolated people “often feel like they have no power, and in some sense, they do not.” When individuals are brought into larger structures by groups such as the BVM Fund and NDWA, they often discover that it makes sense to be engaged in the public sphere. As an isolated individual, it can be difficult to see the difference one can make; in being part of a larger group, the value of engagement and participation becomes more evident. Healey suggested that continued investment in “down-home organizing” could help local people to understand their stake in an issue and feel more confident that they will get a return on their participation in efforts to achieve change.

PROGRESS IN POWER BUILDING

The infrastructure that enables people to engage in organizing is grounded in being relational and engaged, rather than observational and technocratic, Milstein commented. He asked about progress toward facilitating the power shift necessary to center people’s voices and create an infrastructure that can make this practice routine. Healey remarked on the substantial progress in this direction since he began this work in the 1970s in Chicago. At that time, modern community organizing was in its infancy and was competitive, with groups attacking one another for resources and encouraging funders to stop funding other groups. The idea that community organizations could work together was inconceivable, he said. In the years since, national networks of community organizations have formed and ties have been established among community organizations, trade unions, and religious and civic institutions. However, in spite of this progress, the infrastructure remains insufficient, Healey emphasized. Only in the past few years have community organizations become meaningfully involved in electoral politics, for example. The accomplishments of LaTosha Brown, co-founder of the BVM Fund; Stacey Abrams; and other Black women in Georgia illustrate the shift from the antipolitical notions

of community organizers of the 1970s to the recent emphasis on entering electoral politics as a legitimate arena of power.¹⁰ Healey described this as an exciting change but noted that much work remains to be done.

Healy also remarked on the current lack of a common narrative—around race, gender, capitalist institutions, individualism, and white supremacy; there is no shared narrative across the institutions of public health, community organizing, and organizing around workers, housing, low-income people, and the unemployed. A unified message is needed to effectively communicate across institutions and across the country. Healey said that fragments of this narrative are commonly known, with white supremacy being a major issue and dog-eat-dog capitalist competition playing a role, but work needs to be done to accomplish change in bigger terms.

Heller agreed on the need for a new narrative and new infrastructure to further the participation of the groups listed above and others. Collaborating with Ai-jen Poo, co-founder and executive director at NDWA, and others through the Always Essential campaign, he is currently facilitating an alternative type of worker organization tailored to nonunion worker groups that have formed around issues related to the COVID-19 pandemic and the essential worker framework. Although this is an example of certain infrastructure pieces coming together, those elements also need to be strengthened, Heller said. In addition to the contributions of community-organizing groups, the health sector also has a large role to play in this infrastructure, as do governments and other institutions. Public health agencies and hospitals have relationships with other institutions and with individuals that they can bring to this growing infrastructure. Organizers are excited about working with public health agencies because of their relationships with planning departments, public works departments, and other governmental agencies. In giving community-organizing groups access to these governmental relationships, public health agencies can support power building through establishing power-sharing infrastructure, added Heller.

___________________

¹⁰ Stacey Abrams and LaTosha Brown led efforts to address voter suppression and engage Black voters. Record turnouts of Black voters have been credited for democratic wins in Georgia in the November 3, 2020, presidential election and two U.S. senate runoff elections on January 5, 2021.

THE EFFECT OF NARRATIVE ON THE COVID-19 PANDEMIC

Milstein raised the issue of the various social dynamics at play in the COVID-19 pandemic, which have underscored the extent to which population health and community health are underfunded relative to health care. The social context and interdependency of our lives are highlighted during times of crisis and often ignored in ordinary times, he said. Organizational efforts toward dignity, inclusion, and conditions for all people to thrive are going largely unnoticed by institutions, with hospitals and public health partners unaware of community groups that have been working in their own neighborhoods for decades. He added that targeted disinformation is tearing at people’s sense of belonging, connection, and dignity. Bearing these social dynamics in mind, Milstein asked whether there is a way to spring forward from the current crisis into a renewal of civic life.

Heller remarked that many of the dominant narratives have led to dynamics present in the current crisis. These include the narrative that the government is incapable of doing anything right, that the free market is able to solve our collective problems, and that the government should thus be decreased in size. This line of thinking has led to underfunding public health for decades, resulting in the complete lack of preparedness for the current public health crisis, he maintained. Another dominant narrative is “pull yourself up by your bootstraps” individualism. COVID-19 is a collective issue, intertwining the health of individuals with one another; still, the response has been grounded in individualism. For instance, people have been told to stay at home and take care of themselves. Collective responses, such as paid sick days, are not being used. Heller stated the individualistic narratives need to change, and noted that messages such as “we are all in this together” are emerging, but are not yet universally embraced. The crisis of the pandemic, Heller asserted, has revealed the degree to which the United States is ill prepared, that corporations do not have all the answers, and that a collective response in the form of government is needed. The government has failed many people for centuries, but the collective response to the COVID-19 pandemic has underscored that failure in a dramatic way. Echoing Healey’s earlier call for a shared narrative, Heller said a compelling and consolidated narrative is needed in order to prepare for the next public health crisis.

Healey offered an example of the work that remains to be done from California, a state that appeared to have a strong health system, with good hospitals and quality of health care. However, over the past 20 years, hospitals have been decreasing bed numbers to save money. Profitability,

resources, and disinvestment have been taken for granted, even in a nonprofit setting, with profitability serving as the dominant narrative. During the COVID-19 pandemic, the lack of redundancy has translated into a lack of buffers and resiliency because of a failure to appropriately prepare for long-tail probability events. He said that in the short term, allowing for redundancy does not seem smart or efficient. However, COVID-19 has shown that tethering health to profitability can be hugely detrimental for individuals. Referencing Brown’s earlier talk about centering human value in decision making, Healey emphasized the need to move away from the narrative of profitability of health and determine other types of criteria for health decisions.

VALUES OF PEOPLE AND MONEY

Milstein referenced the recent release of the Surgeon General’s Community Health and Economic Prosperity report, which established that healthy communities are needed to prosper economically, and an inclusive economy is needed for everyone to be healthy.¹¹ Without both community health and economic prosperity in place, society can spiral into adversity; when they work in tandem, opportunities arise for both to grow simultaneously. Although the language of the political left and of the right can be further explored, Milstein remarked that neither Healy nor Heller is suggesting these issues stem solely from a red–blue partisan divide. He also noted a recent Harvard Business Review article that showed that 9 out of 10 Americans would be willing to receive less pay in order to do more meaningful work (Achor et al., 2018). He asked whether this desire to be a part of something bigger than one’s private paycheck and family resources is a signal that unifying American society is possible.

Healey replied that when he talks with people in small groups about issues that matter to them (e.g., the meaningfulness of work), the distinction between right versus left politics tends to evaporate. In holding such discussions around the country—including in rural, predominantly white areas—he has heard white people talk about health care in terms of not wanting the wages cut of people caring for family members and not wanting profit to be considered above whether somebody lives or dies. Healey stated that there is something “wrong with thinking about profit and loss in health care” and noted that health has a special role in framing these issues in human terms, rather than in political terms.

Heller noted that personally, he chose to take a decrease in income

___________________

¹¹ The report is available at https://www.hhs.gov/sites/default/files/chep-sgr-full-report.pdf (accessed February 17, 2021).

in exchange for more meaningful work. Biotechnology pays far more than the nonprofit world, but Heller said making the change was the best decision of his life. It gave meaning to his life, made him a happier person overall, and was the right thing to do, he reflected. More broadly, Heller said he sees the future of work in the United States changing—for example, with increased automation and companies like Amazon surveil-ling their workers,¹² there is potential for harm until the narrative changes around what is allowed. Heller suggested that the fundamental question is which is more valued: people or solely profits. A shift will have to take place to create the kind of world in which everyone can thrive, Heller said, and it is that shift that community organizers are driving toward.

___________________

¹² See, for example, https://www.openmarketsinstitute.org/publications/eyes-everywhere-amazons-surveillance-infrastructure-and-revitalizing-worker-power (accessed February 21, 2021).

This page intentionally left blank.