We Can Do Better: Global Health as a Lever for Social Change
A Conversation with Stephen Blount
Director, Special Health Projects, The Carter Center
Julie: Steve, it’s great to speak with you today about social justice, compassion, and your spiritual practice. Let’s begin your story by hearing about what inspired you to enter into the field of global health.
Steve: I’m a child of the 60s and 70s. My experience both in the civil rights/black power movement and the anti-war movement broadened my perspective about the world. Health seemed to me like a good lever to transform society, domestically and globally. Global health means seeing our planet and our species as one. What affects anyone in one place affects all of us. During the war in Vietnam, I recognized the link between the need to improve health in this country and the need to address health issues abroad.
Both of my parents were very compassionate people. My mother was a psychiatric social worker and she expressed compassion through her professional and personal life. My father was an electrician. However, during World War II as a conscientious objector, he was interested in health and became a medic. He also had a huge curiosity about the world. My father taught me how to read by reading the names of African leaders during the liberation movements of the late 50s. The combination of their personal values, religious principles, and curiosity about the world infused me, and my sister and brother, with like-minded interests. So, I entered the field of medicine and global health through the lens of social change.
As a teenager, I had an interest in health as a lever for social change, not only in this country but abroad. I began in clinical medicine but my long-term interest was at the community and international level. After finishing family medicine, I knew I wanted to enter the global health field, so I earned a Masters degree in Public Health and studied epidemiology.
My first job was in my hometown Detroit in the late 70s and early 80s. I was the Director of Epidemiology at the Health Department for a few years. Detroit was a difficult city with many disparities. I was interested in social justice problems related to high infant mortality, particularly comparing blacks and whites, and in health disparities among black women with breast and cervical cancer. This was my focus, too, in the Chronic Disease Center at the Centers for Disease Control and Prevention (CDC). After five years at CDC focusing on domestic health, I took a job with the Pan-American Health Organization (PAHO) and spent four years at the Caribbean Epidemiology Center. In 1997, I returned to CDC as the Director of the Office of Global Health to help people who have little voice.
Julie: Based on your extensive experience in the field, what role do you feel compassion plays in global health?
Steve: I’ve wondered about this a lot. The definition of compassion aligns with my deep awareness of the suffering of others and the wish to alleviate that suffering. Global health wishes to alleviate suffering in the world. It could be here; it could be elsewhere. We are bound together by our common humanity and our common desire to be happy and to be free from suffering. Global health helps people improve their health, improve their lot in life, wherever they are. The desire to help those who struggle most to be heard and to help themselves, that to me is the core of global health.
One example of compassion in global health will make you smile, Julie. I first met David Addiss and Pat Lammie in the late 1990s. They were addressing lymphatic filiarisis (LF) in Haiti. I was very much drawn to the culture and the people of Haiti, and to Dave and Pat’s work. Over several trips to Leogane, the epicenter of the LF epidemic in Haiti, I was struck by the deep compassion of Jeannine Coreil, a faculty member at the University of South Florida working at Hopital Sainte Croix, the treatment center for LF morbidity management. She was working with women who suffered from LF elephantiasis. These women were physically disabled and socially shunned. Jeannine focused on the health of these women beyond their infection. She helped them organize a cooperative to develop business opportunities in crafts, jewelry, and clothing. I was so impressed by her compassion in action.
Julie: Where do you see compassion in action in the work that you’re doing now?
Steve: My work at The Carter Center primarily focuses on helping the Ministries of Health in both Haiti and the Dominican Republic to eliminate both malaria and lymphatic filariasis. It’s very fulfilling work because we may actually be able to achieve this goal. Both Ministries have agreed to try and do this by the year 2020. It’s very ambitious. This is the only island in the Caribbean that still has both of these diseases. What’s missing is a national commitment in both countries to provide clean water, sanitation, decent housing, and access to basic medical care for those with the greatest needs. These are health issues, but the solution requires cultural, political, and economic changes, too.
Julie: I’m sure you face many challenges. Any that you particularly want to speak to?
Steve: There is limited political interest in the United States for the issues in global health. Our predominant goal is protecting the United States from infectious disease threats. This scares everybody. We’ve recently experienced fear that the Ebola epidemic might come here. Of course we want to protect ourselves, however a big challenge for those of us who work in global health is that our government defines its interest in global health very narrowly.
For example, the leading cause of death and disability throughout the world remains infectious disease. But in the last twenty years, even in Africa, the burden of chronic disease – such as heart disease, cancer, high blood pressure, diabetes – has risen dramatically. Since diabetes in Africa is not a threat to the United Sates, the political support and funding to work on chronic disease issues just isn’t there. There is little support for environmental health, maternal and child health, or road traffic injuries. These are huge problems affecting particularly poor people abroad, and the suffering is enormous. But that’s not how the US evaluates its interests. Not enough resources are put toward diseases or conditions that do not directly affect Americans. It’s a huge challenge.
Julie: I imagine your Buddhist practice and the Cognitively-Based Compassion Training (CBCT) you lead influence your view of global health.
Steve: They do. I was raised as a Christian and both my parents were spiritual people. My father and his father were deacons in the Baptist church. My mother’s grandfather was a minister in the African Methodist Episcopal denomination. The interest I have in helping others stems from the Christian tradition. My mother saw herself as practicing one of many viable faith traditions. When I became more interested in Buddhism, part of the attraction was that it was consistent with how I had been raised. I didn’t draw a firm line between Christianity and Buddhism. The emphasis on compassion and caring within Buddhism fit very well into my worldview.The link between compassion and my professional work drew me to study CBCT. I entered the first class that Geshe Lobsang Tenzin, a faculty member at Emory, taught four or five years ago. I was also in the first cohort of teachers he trained, and last year I had a chance to teach my first CBCT course for the Deans at Emory’s medical school. The school is now offering an elective in CBCT to first and second year students. This is not a requirement, but the students are strongly urged to take advantage of the course. Chris Larsen, Dean of the medical school, tells his students, “You’ll be a better person. You’ll be a better member of your family and community. You’ll be a better doctor. I’m sure some of you are wondering, I have all these required classes. Do I have time to take another course? Do I have time to meditate? I think you do. You all know I’m a transplant surgeon. I’ve published 300 articles. If I can take 30 minutes out of the day to meditate, you can, too.” There are only a few places that offer this kind of opportunity to students. It’s fabulous.
I’ve been teaching CBCT to both first- and second-year medical students and it’s been a wonderful experience. The students love it. A room has been set aside on campus from noon until 1:00 where anyone can meditate. One day during the week we offer a guided meditation. Soon they will dedicate a room for meditation at any time. It’s not limited just to the daily afternoon mediation. CBCT has caught on. Anyone can come. It’s pretty exciting. And this is in a medical school!
I’ll also be teaching CBCT to veterans from Vietnam who suffer from post-traumatic stress disorder. Forty years after the Vietnam War and they are still struggling. Who knows what they have seen, heard, and maybe done? Imagine carrying around this burden for so long. They’re coming because they think that something in CBCT will be helpful. I hope so.
Julie: Could you envision at some point CBCT being offered at CDC?
Steve: Yes. It could be offered as an elective as we do at the medical school. There are so many groups at CDC that come together for all sorts of things: because they like to cook together or hike together or something. A CBCT meditation class could be organized in the same way. I believe it would be very valuable for many people at CDC. Compassion arises at the individual level. People feel better being with others who have similar values. I think it would be wonderful.
Julie: Our Center for Compassion & Global Health is working toward developing a conference that would bring Buddhist leaders and global health leaders together into conversation about compassion in action.
Steve: His Holiness the Dalai Lama speaks about secular ethics. CBCT is based upon a Buddhist practice, but we’re not teaching Buddhism to these students. The benefits of CBCT – such as love, compassion, treating people the right way – cut across all faith traditions. Such a conference might examine the ways in which faith traditions understand our deep connections that emerge from, what I call, “the well” that each of us has. “The well” is our core source of love and compassion that doesn’t run out. It is a deep connection can be broadened to people who are like us – our friends and relatives – but also to strangers and the entire world. That’s what CBCT is trying to teach – expand our circle of love and caring to embrace the world.
None of us would be here unless one person had cared for us when we couldn’t care for ourselves. The biological basis for our continuity as a species is love and caring in a selfless way. We all have that. We’ve all seen that. We can tap into how we have benefited from someone else loving us and expand this circle of care and compassion outward. Every major faith tradition speaks to exploring these feelings.
Global health is a platform, and an opportunity, to practically apply care and compassion to the world, to entire populations, because of our focus on social justice. Global health moves beyond “aspiration” compassion – “I wish it could be better for everyone” – to “engaged” compassion, as does the teachings of the Dalai Lama. Engaged compassion links Buddhism and global health together. I think such a conference would pack the house. Emory would be a great place to hold it.
Julie: What is it that sustains you personally in your work and your life?
Steve: My sense of compassion and caring. I identify with the people who don’t have a voice, who are invisible. I was taught, “to whom much is given, much is expected, much is needed.” This still drives me. Also, working with others who share my values and drive to do this kind of work – what I call melancholy optimism – sustains me. This is an optimism that things can get better, but melancholy because so much more is needed. This is not the best of all possible worlds. We can do better. That keeps me going. Everybody gets discouraged from moment to moment, and then I just keep going.
Stephen Blount, MD, MPH, joined The Carter Center as director of Special Health Projects in 2013. In this role, he oversees the Center’s work to intensify binational coordination between the Dominican Republic and Haiti to eliminate malaria and lymphatic filariasis on the island of Hispaniola. Prior to this role, Steve spent 25 years at the U.S. Centers for Disease Control and Prevention (CDC) in a succession of leadership positions, the last of which was as associate director for global health development. He earned his Bachelor of Science in psychology, his medical degree from Tufts University, and his Master of Public Health Degree from the University of Michigan (1980).