Love is Not Enough

This guest blog post is by Sue Klebold, passionate advocate for brain health awareness and mother of Dylan Klebold, one of the two shooters at Columbine High School in 1999. She spoke on the TEDMED stage in 2016 and you can watch her talk here.

It has been almost 18 years since my son and his friend killed twelve students and a teacher at Columbine High school, and injured more than twenty others before killing themselves. From the moment the tragedy happened, it seemed to belong to the planet rather than the community. Live news coverage of its evolution reached every corner of the world, and people across the globe seemed to know what was happening in the school before some of its victims did.

At the time of the tragedy, Americans rarely heard about school shootings, and 24/7, on-the-scene news coverage was in its infancy. Social media as we know it today didn’t exist. I didn’t own a cell phone, and I was just learning to use the Internet. I had no idea that my seventeen-year-old son could purchase guns without my knowledge or permission. I believed that suicide was something that happened in other families – not in mine – because I loved my children deeply and I believed that my love would protect them. I didn’t think about homicide because I’d never known anyone who was killed or who had killed someone else.

A lot has changed since the Columbine tragedy, but a lot hasn’t. We hear more about heartbreaking murder-suicide events in the news, but we are just beginning to consider the role suicidality might have played in the incident. Whatever concerns we may have had about youth suicide and teen depression in 1999 couldn’t have prepared us to accept the ongoing increase in these health problems nearly twenty years later. Despite growing efforts to mitigate depression and suicidal thoughts/actions in youth, we have not been able to reverse the rates that continue to inch upward.

As I began a journey of recovery after the tragedy, I tried to find a way to accept the horror my son perpetrated. In my desire to understand, I learned that if my son had gotten effective help in a timely manner, he probably would not have participated in the shootings or taken his own life. My eyes were opened to the extreme costs to society of not providing adequate care in a timely manner. The tragedy itself, followed by my own bouts of panic disorder after the shootings, convinced me that advocating for brain health was the most important work I could do.

Numerous efforts to reduce suicide rates and improve mental health care are in development around the world. Many of these focus on system improvements within schools, hospitals or the military. They rely on research from a broad spectrum of disciplines.

The umbrella of brain health is vast and it’s hard to know where to start. When I am asked what people can do when they struggle with lethal thoughts, the first thing I suggest is to contact the National Suicide Prevention Lifeline at 1-800-273- TALK (1-800-273-8255) or go to the website at The Lifeline provide free and confidential support to people in emotional distress or suicidal crisis all day, every day, across the U.S.

In my own efforts to raise awareness and improve services for those who struggle, I chunk the work into three major areas of focus.

1) We need to remove the psychological barriers that prevent people from seeking help. Too many people fear negative consequences from revealing their pain, or believe that their inability to function normally is a character flaw rather than an illness. Unfortunately, the better they hide their aberrant thoughts, the more difficult it becomes for others to recognize their need for care. (This is what happened with my son.)

2) We need to increase the general public’s knowledge about mental illness and the recognize signs that someone’s brain health may be deteriorating. This includes learning better ways to talk, to listen and to respond.

3) Sadly, those who know they need help can’t always connect with professionals who can provide a continuum of effective, affordable, evidence-based interventions and treatment. Much work needs to be done to educate professionals, and improve the systems in which they work.

The work is there and there is plenty for each of us to do. Let’s get going.

Mending the Strains in our Social Fabric: Protecting and Healing Trafficking Survivors

This guest blog post is by Susie Baldwin, Co-Founder and Board President of HEAL Trafficking and TEDMED 2016 Speaker. You can watch her TEDMED talk here.

January is National Slavery and Human Trafficking Prevention Month in the United States. During his last weeks in office, President Obama proclaimed this month’s commemoration, noting that despite the rejection of slavery by our nation, “Today, in too many places around the world — including right here in the United States — the injustice of modern slavery and human trafficking still tears at our social fabric.”

Strains in our social fabric not only result from the injustice of human trafficking, but create the problems of human trafficking and exploitation. The conditions that frame our lives— factors known as the social determinants of health— can increase or reduce vulnerability to trafficking. These “upstream” determinants of health include: the availability of resources to meet the needs of daily life, such as safe housing and adequate nutrition; access to education, health care, employment opportunities, and transportation; and freedom from violence, discrimination, and poverty.  Relationships with other people—the presence or absence in our lives of others whom we trust, and who provide us with support or love— are also key social determinants.

cropped-heal-logo-1-e1426167334902 (1)The stories of the trafficked patients I have cared for reveal how vulnerabilities created by the social determinants underlie human trafficking. For example, Olga experienced domestic violence and left her husband. As a teacher in a country that was no longer able to pay its educators, she needed to find a way to support herself. She answered an ad for a job as a housekeeper in the U.S., and wound up a domestic servant. Jaclynn experienced child abuse and neglect at home, where her drug-addicted mom was unable to properly protect her, and found solace in the arms of a man who manipulated her and sold her to other men. Narong wanted to earn a living for his family and came to the U.S. for a job as a welder, only to be trapped working in a restaurant for long hours with barely any pay.

These survivors are the lucky ones— they escaped or were rescued from trafficking and managed to connect with services provided by my long-time partner, the Coalition to Abolish Slavery and Trafficking, including case management and legal services. But as I worked to help my patients cope with the physical and mental health consequences of trafficking, I learned that their struggles to rebuild their lives often hinged on social determinants. Perhaps most critical was their search for jobs and affordable housing that would allow them to achieve and sustain independence. Sometimes, they were re-victimized. Alma, for example, another patient who had escaped domestic servitude, wound up—as a free woman— working as a housekeeper for room and board, without receiving any pay.

Though it wasn’t true in Alma’s case, for many trafficking survivors, a criminal record poses a barrier to gainful employment. Trafficked people are commonly charged with offenses that burden them with criminal records for the rest of their lives, making it difficult for them to find housing and jobs, and unable to access loans and grants. These negative social determinants leave them vulnerable to being exploited and trafficked again.

Fortunately, it doesn’t have to be this way. Bipartisan legislation in the new 115th Congress, called the Trafficking Survivors Relief Act of 2017, would allow courts to erase survivors’ nonviolent federal criminal convictions resulting from being trafficked. While this law only helps survivors with federal criminal records, it provides an important model for criminal justice systems in cities and states around the U.S. To learn more about this bill and express your support for it, please see:

To support trafficked people on their journey to safety and recovery, HEAL Trafficking, the organization I founded with colleagues three years ago, has just released our Protocol Toolkit for Developing a Response to Victims of Human Trafficking in Health Care Settings. This toolkit guides health professionals through the process of mobilizing interdisciplinary responses to trafficked people who present for care. It encourages cooperation with the diverse agencies and individuals who can address the social determinants that put trafficked people at risk, and which can hinder healing of the body and mind. HEAL Trafficking believes that together, we can create conditions and systems that allow survivors to thrive, and that prevent human trafficking in the first place. Please join us.

HEAL Trafficking is a network of over 800 multidisciplinary professionals dedicated to ending human trafficking and supporting its survivors. We aim to heal the world of trafficking by approaching the problem through the lens of public health and trauma-informed care. We work to expand the evidence base, enhance collaboration among multidisciplinary stakeholders, educate the broader anti-trafficking and public health community, and advocate for policies and funding streams that enhance the public health response to trafficking. 

The Missing Piece for Healing Community-Wide Trauma

This guest blog post is by James Gordon, founder of the Center for Mind-Body Medicine and TEDMED 2016 Speaker. You can watch his TEDMED talk here.

Not long ago, a revered Lakota elder told me that our work at the Center for Mind-Body Medicine’s (CMBM) was “the missing piece” for his people and indigenous people everywhere. He and other elders have said that we’re giving them the practical, scientific tools to help a severely traumatized people restore balance to their minds and bodies. As they work with us they’re realizing their capacity to live in the light of traditional wisdom as they meet the challenges of the modern world.

Working with Pine Ridge.
Working with Pine Ridge.

Their experience reflects the impact our work has had over the last 25 years. We‘ve seen it in some of the world’s most troubled places – in Bosnia, Kosovo, Gaza, Israel and Haiti, with Syrian refugees in Jordan as well as here at home: among our veterans and first responders; with the homeless as well as the privileged; for the desperately ill as well as the highly functional but highly stressed.

Everywhere we’ve worked the model of self-care and group support has been embraced. The tools we teach – meditation, guided imagery, biofeedback, yoga, self-expression in words, drawings, and movement, and genograms (family trees) – had been easy to learn and use to reduce stress, improve mood, and enhance hope. Our small group model has been welcomed and recognized as a powerful and nurturing context for healing.

The Pine Ridge Indian Reservation in South Dakota has been one proving ground for our approach, for the way we work collaboratively to bring healing and hope to a long traumatized community.

Working with Pine Ridge.
Working with Pine Ridge.

Located in one of the most impoverished counties in the United States, the proud and determined Pine Ridge community suffers from economic devastation, violence, self-destructive behavior, and demoralization. Pine Ridge has 8 times the national rate of Type 2 diabetes. 80% of the population is affected by alcoholism and 85% are unemployed. In the year before we began our intensive training program, 20 young people committed suicide and 200 more attempted to do so.

In 2015, after the 20 young people had killed themselves, Basil Braveheart, a Lakota elder and other community leaders, told us of the urgent need to develop a reservation-wide program for healing the community’s trauma. With generous support from the Swift Family Foundation, Battery Powered, Open Road and Administration for Native Americans, and US Department of Human Services, we were able to bring our comprehensive program of self-care and group support to 70 elders, clinicians, teachers, and youth activists. The training featured the seamless integration of CMBM’s evidence-based model and traditional Lakota ceremony led by participating tribal elders.

We were able to touch hearts change the lives of these community leaders. “Amazing” said Cindy Catches, an elder, “The trust, the love, the tools that were given… I saw the beginning of a real healing.” “Life-changing” said Lisa White Bull, a counselor at the Little Wound School, “I believe our prayers for help have been answered”.

We gave these 70 leaders tools they were then able to share with troubled young people and their families. In the 15 months since that training there have been no youth suicides.

Mind-Body Skills Groups at Standing Rock.
Mind-Body Skills Groups at Standing Rock.

The success of the program inspired the US Department of Health and Human Services to award a grant to the Little Wound School to bring the CMBM model to every child in all 7 of the reservation’s tribal schools, and to all the children’s families and all their teachers.

Committed to bringing this missing piece to the Standing Rock Reservation and other indigenous communities, to Syrian refugees throughout the Middle East, and to communities in the US which are severely challenged economically, and divided by racial mistrust, I believe that our model of providing community-wide trauma relief is needed more than ever. We invite you to become a part of our work and to support it – to join our healing community.

James S. Gordon MD, a psychiatrist, is the Founder and Executive Director of The Center for Mind-Body Medicine, a clinical professor of psychiatry at Georgetown Medical School, and author of Unstuck: Your Guide to the Seven-Stage Journey Out of Depression. He will also be leading trauma workshops in February and July at the Kripalu Center for Yoga & Health.

The Center for Mind-Body Medicine is expanding their professional trainings to meet the needs of all those who want to serve their communities. You can find out more about their upcoming US trainings on our website. On the website you’ll also find articles and videos that feature their work with population-wide trauma – from The New York Times, The Washington Post, The Atlantic, and CBS 60 Minutes – as well as other information about their global trauma-relief programs.

Lessons From The Pandemic Frontline

This guest blog post is by Jeremy Farrar, the Director of the Wellcome Trust and TEDMED 2016 Speaker. You can watch his TEDMED talk here.

Working through an epidemic of an untreatable disease is the most frightening thing I’ve ever experienced. As a doctor, there is no worse feeling than telling a patient you have no treatment, but this was exactly the degree of helplessness felt during SARS and in West Africa during the Ebola epidemic.

Thankfully, with trials now confirming the 100 per cent efficacy of the rVSV Ebola vaccine, such fears surrounding the disease are beginning to subside. We should now be able to contain Ebola – at least if we can get the vaccine to those that need it. But these positive results shouldn’t stop us from taking stock and questioning what needs to be done to prepare us for the next emerging infectious disease, whatever it may be.

The Ebola vaccine trials were of course a remarkable success, and not just because of the numbers. They showed that, by working collaboratively across international borders and sectors, we can develop and test vaccines rapidly. The global coalition that worked on the vaccine achieved in a year what would normally take decades and, uniquely, developed a vaccine within an epidemic. That is something that has never been accomplished before, and a testament to what can be done when we collaborate.

So when Ebola next reappears – and it will – we will be ready. But we must remember that we weren’t ready last time. Because we were reactive, we were far too slow, too late. Over 11,000 people died in West Africa, and the economic cost to the countries affected runs into billions of dollars.

It’s important too to remember that the partnership that delivered the vaccine – involving pharma, philanthropic organisations, governments, regulators and NGOs – was an ad-hoc one, hugely reliant on the goodwill of those involved. This way of working, while inspiring, is neither reliable nor sustainable in the long term.

The partnership’s success was also based on having Ebola vaccine candidates ready to be tried in humans at the beginning of the outbreak. For MERS, Zika and many others, there are not yet such candidates.

We must start developing tools to fight these diseases now, and set up the permanent partnerships and systems necessary to do so. Progress is being made. The WHO has drawn up a blueprint for R&D to prevent epidemics and a new global public-private coalition – CEPI – has been established to advance the development of new vaccines for epidemic diseases so that we have candidates ready to test when an outbreak occurs.

But preparedness doesn’t end with the development of vaccines. While in 2016 many were watching the Zika emergency unfold, in central Africa another great but under-reported crisis was emerging: a large outbreak of yellow fever. It began months before the alarm was raised, gathering momentum in Angola and the DRC while diagnostic tests on its first victims were still being run in foreign labs, as there were no suitable facilities close by.

Once the magnitude of the outbreak became clear, it was quickly understood that the world’s emergency stockpile of the yellow fever vaccine would be insufficient – and likewise its capacity to manufacture new doses in time. Ultimately the outbreak was contained: other countries donated their vaccine stockpiles, doses were diluted to spread coverage, and a huge immunisation campaign was implemented – all thanks to a well-coordinated collaboration between the WHO, governments, health authorities, NGOs and volunteers. But again we were lucky.

If the stories of these two outbreaks seem largely doom and gloom, they shouldn’t. They show us what amazing things we can do when we work together, against what at times may seem like long odds. And they show us that, despite what the cynics and scaremongers say, we do have the ability to prepare for and fight against emerging infectious diseases. If we don’t yet have the tools, we can make them. We have the ability to make the world a safer place.

And in showing us our shortcomings, the histories of these outbreaks show us the way forward. If we want to make the world safer, we cannot be passive bystanders. We must be proactive in the face of health challenges in order to be a step ahead, or else expose ourselves to vast risks – and the dreadful consequences that can accompany these.

In a world of denser cities, increased international travel, migration and ecological change, the ability of emerging infectious diseases to spread and cause devastation is increasing. That’s not going to change, which means we have to. We’ve shown already that we can respond effectively to epidemics. Now we need to demonstrate that we can prepare for them effectively too.

Finding Time to Recharge and Reconnect

The ending of one year and the start of another lends itself well to reflection and reconnection.  Like so many of you, the TEDMED team values this time of year because it allows us to reconnect with friends and family while also taking time to be thoughtful about the year to come. As this year draws to a close, we look forward to unplugging and spending quality time with family and friends, writing down reflections of the past year and intentions for the new one, spending time outside in nature, and finally reading that book we picked up at this year’s onsite bookstore.

As we prepare to take some time off, we were curious to know how some members of the TEDMED community rest and recharge their minds and bodies as they enter into the New Year.  In response to specific questions, Jim Gordon, Lucy Kalanithi, Mark Zhang, Sarah Outen, and Sharon Terry shared with us the ways in which they recharge this time of the year.  We hope you find their responses as inspiring as we do and hope they are helpful as you think about how you will spend this time of year.

The first question we posed was: How do you use this time leading up to and entering the New Year to unwind or reflect?”

In their responses, these community members explain that they use this time as an opportunity not only to reflect and recharge, but also to “rebalance,” as Sarah Outen edsc_9130xplained. In the wake of what Sarah describes as a “full on year with its own storms and mountains” she plans to increase her time meditating and exercising as she “reflects on the past year and looks ahead to the shape of the next year.”  As we each reflect on the various storms and mountains unique to the past year of our own lives, we might benefit from what Jim Gordon describes as “going inward.”  Jim shares that “this will be, as the season urges, a time for me to go inward, to appreciate my connection with nature, and also to become aware of and let go of attitudes, worries, concerns, and recriminations that no longer serve me, if they ever did.”  

Part of this process of going inward involves meditation and reflection, something that Sharon Terry plans to spend extra time jh1_7100doing in the coming weeks.  She shared with us that her method for reflection “is a combination of writing, reading, and engaging in wonderfully deep conversation with family and a few close friends.” Similarly, Lucy Kalanithi unwinds and reflects by focusing on “mindfulness meditation, reading books and getting enough sleep!!” Lucy adds that exercise, family, and friends help to keep her going throughout the year.  Sleep seems to be an important component of this time of the year for all.  As Mark Zhang put it, “The holiday season is my time to enjoy time with my son, good food, and even better naps.”

We also asked: “In what ways will you be connecting with loved ones and yourself over the next few weeks?”

Connection with family and friends was top of everyone’s list for the coming weeks.  Lucy looks forward to celebrating Christmas with family in Southern California, which she explains that, after growing up in cold-weather climates, “still feels weird, and it still feels like a huge treat.”  Jim uses the time to call his brothers, children, god-children and, “any man or woman who has a speciimg_5275al but not recently visited” place in his heart, adding that he feels “a palpable joy in each of the connections and in the web that links all of us.” Reconnecting with family and friends is important to Sarah who, having recently completed her nearly 6-year London2London journey around the world, says that “after so many years away I am really glad to have time ahead with my family and friends.” Mark also plans on spending quality time with family, specifically by “reading more Richard Scarry books with my son!”

The usual time spent with family over the coming weeks will include some new themes for Sharon. She and her husband plan to have a “deep dive conversation” with their 2 children and their spouses, specifically discussing their plans for 2017, asking “how will they make space for the things that nurture them and their dreams,” and what Sharon and her husband can do to help. Sharon and her family will also be engaging in a conversation about end-of-life and death, something that was explored throughout TEDMED this year.  She will be having what she describes as “a death dinner!” during which she and her husband will share what they want the end of their lives to look and feel like, and ask that their family and close friends commit to making that happen. At TEDMED, we love this idea of a “death dinner,” which reminds us of Michael Hebb’s 2013 talk, “What happens when death is for dinner?” Sharon said that this dinner may seem sort of odd, but she loves the idea of communicating their decision with family and friends, adding that “they are up for it! They are used to how weird we are!”  

Finally, we wanted to know, “What are you looking forward to most in 2017?”

So much of what each community member is looking forward to in 2017 connects back to family, but also to their work, which is a source of great purpose, passion, and fulfillment to each.  The organization Sharon founded, Genetic Alliance, is marking its 30th anniversary, and she and her team are excited for what the future holds.  She told us that they have spent nearly 6 months “in profound contemplation” of what they want to be in the world, animg_3513d they discovered that their “heart and soul is in enabling a path for people to be authentically involved in all aspects of health – at home, in health care services and in biomedical research.” Mark shares that he and his colleagues at Cake are “excited to be in the inaugural cohort of companies participating in PULSE@MassChallenge in 2017” and that they will be rolling out new features to Cake.  We look forward to following the increasing impact that both Genetic Alliance and Cake are sure to have for those who are in search of better health.  

Lucy shared that in 2017 she will continue speaking about her late husband’s memoir, When Breath Becomes Air, while also prioritizing advocacy “for patients, caregivers, and for all those who need compassion from us and from our new President.” This intention to work for greater compassion and understanding in the wake of 2016’s tumultuous election is shared by others.  Jim explained that for him the election was a wake up call and a “summons to reach out to and find common ground with people who appear to look at the world very differently” from him.  Sharon commented that “as we enter 2017, America is not a predictable place, nor is the globe.” One of her intentions for 2017 is to explore the questions: “How can we love each other amid the massive strife on the planet for plants, animals and people? How can we love each other in our differences?” adding that she looks forward to the “joy and the pain in the undertaking” of finding the answers.

img_4632In 2017, these community members also intend to deepen their connections with family and continue what Sharon refers to as “inner work.”  For Lucy, 2017 will be filled with the joy brought by her growing toddler, Cady, who is “talking up a storm.” Jim is looking forward to watching his 14 year old son “drive to the basket” and also to “exploring the world with the little children” in his life.  For Sarah, the transition back into life at home following her London2London journey has been challenging at times, so in 2017 she is aiming for balance, “hoping to find increasing peace,” and looking forward to spending more time with loved ones. Sharon will continue to be deeply committed to her inner life work and growth as a path to serving the world. She shared with us that she will be entering a long-term study program called Gestalt Practice, “the aim of which is unfoldment, wholeness, and growth” that will, she explains, help her to follow and trust her own process, adding that, “it will help me get out of the way of meaningful growth.”

We hope these thoughts and reflections from some members of the TEDMED community have inspired you as you enter into this holiday season, bid adieu to one year, and welcome in a new year.  
From all of us at TEDMED, we hope you have a very happy and healthy holiday season. We look forward to collaborating with you in the year ahead!

WHAT IF you made earning a college degree a community goal?

This post is tenth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

What does a college degree have to do with health? Quite a lot, says Mary Gwen Wheeler, executive director of 55,000 Degrees. Her organization has an audacious goal: see to it that at least half of adults in Louisville, Ky., have an associate degree or higher by 2020.

People with college degrees enjoy higher average incomes, are less likely to have ever smoked or to be obese, have fewer divorces and are more likely to exercise compared to those without a degree.

“We set this goal because we saw it as a proxy for increasing quality of life,” Wheeler says.

The dozens of business, education and community-based partners that launched 55,000 Degrees in 2010 have witnessed significant progress. The number of high school students who graduate with the skills to attend college and start their careers reached 63 percent last year, compared with 45 percent in 2012. The number of college students completing degrees has gone up at 4-year institutions, even as enrollment has gone down.

“We’ve been able to move all populations, but we haven’t been able to close the gaps” between white and minority students, Wheeler says. “That led us to the mayor’s Cradle to Career initiative. We understood we needed to start much earlier.”

Now 55,000 Degrees is one of four organizations with lead roles in a continuum of programs that begin with preschool and bolster education and training for Louisville residents beyond their high school and post-secondary graduations.

  • The United Way will spearhead work to get more children into quality preschool programs and prepare more than three-quarters of students for kindergarten by 2020, compared to about half today and a little more than one-third a few years ago.
  • The school district aims to have every student reading at grade level by the end of third grade. By 2020, it plans to raise the number of students who graduate from high school to more than 9 in 10 and ensure that 85 percent of high school graduates enroll in college, using steps such as summer coaching to keep new graduates on track.
  • The nonprofit KentuckianaWorks offers training and programming to give working-age residents the skills to get jobs and succeed in the region’s manufacturing, tech and healthcare sectors.

Taken together, these efforts will ultimately give more Louisville residents a chance at obtaining a degree—and a better life.

WHAT IF you used a land trust to build a grocery store and a movie theater — and give residents a greater sense of social connectedness and well-being?

This post is ninth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

With just four screens and an unassuming Art Deco marquee, the 24:1 Cinema in Pagedale, Mo., may not seem like much to an outside observer. But to Alderwoman Marla Smith, the one-year-old movie theater’s lights are “eye candy” and a herald of the renaissance she fervently wants for her city.

“When I was a little girl, Pagedale was popping,” says the 44-year-old mother of three. People owned their homes and lived in them in this small municipality that is one of two dozen northwest of St. Louis, Mo., known collectively as the 24:1 Community. Big employers such as the Lever Brothers soap factory and the Stix, Baer and Fuller department-store warehouse anchored the community.

But by the mid-1980s, many Pagedale businesses were in decline or had shuttered. Unemployment rose, and X-rated movies were showing at the Olympic Drive-in. There hadn’t been a grocery store since the 1960s. Houses went dark when homeowners lost their jobs and mortgages.

In the 1990s, Mayor Mary Louise Carter and the neighborhood development group Beyond Housing began working together to replace dilapidated homes and vacant lots with affordable housing. Then about 10 years ago, they began meeting with residents to ask what else would make their lives better.

“Everybody agreed that a grocery store they could walk to and get fresh fruits and vegetables and get healthy meals was one of the first things they wanted,” Carter says.

It seemed a simple enough wish, but enticing a developer to build a store in a low-income community proved challenging. In the end, Beyond Housing financed construction with local taxes, and discount supermarket chain Save-A-Lot agreed to run the store, which opened in 2010.

A flurry of other development projects aimed at making Pagedale more livable and walkable has since brought in senior housing, a bank, and the cinema—all within a few blocks of each other. The city has used grant funding to repave the formerly uneven, unlit sidewalks near the theater and supermarket and has added streetlamps. A barbershop, health clinic, and county social services center will open next to the theater this year.

Because the cinema and supermarket are owned by a community land trust, their profits fund neighborhood development, which is a boon for Pagedale and the surrounding municipalities.

Though it might take some time, one of Smith’s biggest hopes is to attract a family restaurant to downtown Pagedale.

“Who wouldn’t want to go have dinner and go to a movie?” she says.

WHAT IF you turned fire stations into intake centers for people addicted to opioids?

This post is eighth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

A bad month for opioids in Manchester, N.H., meant 30 overdoses when Chris Hickey first started working as a paramedic in the city 15 years ago. These days, the emergency medical services officer says Manchester’s emergency responders see 60 to 70 suspected overdoses each month. More than a half dozen of those are fatal, which represents a nearly 12-fold increase in the city’s overdose deaths between 2003 and 2015.

The spike mirrors a national trend, with opioid prescription drugs, heroin and illegally manufactured fentanyl fueling a 137 percent increase in deaths from drug overdoses between 2000 and 2014, the most recent year for which statistics are available.

“You have people of all backgrounds, of all ages who are all overdosing,” Hickey says. And those are just the emergency cases, he says. “We know that we have a large group of the population who are functioning addicts.”

How does one reach those who are addicted before they overdose? A small piece of the answer appeared to Hickey this spring when another firefighter’s stepbrother—homeless and struggling with heroin addiction—posted suicidal messages on Facebook and his family sent him to the fire department for help. It was the first time Hickey had encountered an addict who really wanted to take the first steps to get better. The two drove in Hickey’s pickup to Hope for New Hampshire Recovery, an organization that helps people overcome addiction. Three days later the man was in an inpatient treatment program, and Hickey was writing a proposal to Manchester’s mayor to turn fire stations into intake centers, where people could come without fear of being arrested.

Safe Station, as the initiative is called, launched in May 2016 in Manchester’s 10 fire stations. Within the first four months more than 420 people had sought help and been referred to treatment. Twelve people came in on Father’s Day, the program’s peak day. “They wanted to get better to be with their kids,” Mayor Ted Gatsas says.

Stephanie Bergeron, interim CEO of Serenity Place—a nonprofit treatment center in Manchester and a Safe Station partner—says all involved want to make the model as easy as possible for other communities to replicate. For her part, she would like to ramp up Serenity Place’s staffing on the weekends to accommodate Safe Station patients any time of the week.

“You want to catch people right at that moment when they’re ready to come in,” she says.

WHAT IF you used art as a tool for promoting better health?

This post is seventh in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

“I don’t think art in and of itself can do anything,” says Theo Edmonds, artist and co-founder of IDEAS xLab, an artist innovation company in Louisville, Ky. “But I think artists can change the world.”

More specifically, the former healthcare executive says artists can impact health in surprising ways. He’s found believers across Louisville, from the mayor’s office and local foundations to the area’s healthcare institutions and the University of Louisville. Together, they’re out to do transformative things across the city:

A vacant lot in the Smoketown neighborhood will become the venue for a drum circle as part of Project H.E.A.L., a five-year effort that will employ the arts to help residents look for solutions to community health needs.

This fall, a former liquor store will become home to the printmaking and bookbinding activities of Steam Exchange, a free after-school arts program.

A photovoice exhibit, featuring the photographs and written observations of West Louisville residents, will set the stage for a community meeting to pinpoint ways to start taking action to reduce violence in their neighborhoods, which have among the highest violent crime rates in the city.

Roots & Wings, a performing arts group made up of nine young adults of African descent, is addressing community violence, black identity and other topics in neighborhood workshops and main stage performances. They hope to get people talking and thinking about what they can do to level the playing field in Louisville and give everyone a fair shot at success.

In these projects and others, art has become a vehicle for change.

“The power is in the people,” says Hannah Drake, a poet and lead artist for Project H.E.A.L. “But sometimes you have to show people they have the power to change anything they want to.”

WHAT IF you created a wellness coalition to ensure health equity?

This post is sixth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

Under a century-old wood canoe suspended by wire from the ceiling, seven people sit at a round table with a full agenda of health matters to discuss for the next hour. But first, Charlene Nelson, chair of Washington’s Shoalwater Bay Indian Tribe, asks everyone to pause.

“Take a deep breath,” she says. “Let it happen. Take joy in what we’re doing.”

Once a month, the Pulling Together for Wellness group meets to discuss ideas for improving the tribe’s health and well-being. The American Indian Health Commission for Washington State—which works with all tribes in Washington—launched the initiative. Shoalwater tribe members were among the first to adopt the model, says Jan Ward Olmstead, a public health specialist for the commission.

Three years ago, the tribe formed a wellness coalition, creating a framework to discuss physical, emotional, spiritual and social health. “It’s where conversations are starting,” says Jamie Judkins, a member of the group.

Before drafting an action plan, the coalition enlisted teens to conduct a health survey. The move was intentional: Tribal elders wanted younger members to feel as if they, too, had a stake in their community’s future. Pairs went door-to-door to interview families about tobacco use, physical activity and access to nutritious food. The teens reported their findings at a community dinner and were asked for their ideas. They suggested ways to improve and link pathways for walking and biking and advocated for policies to prevent tobacco use.

“The challenges of the community were illuminated, and they could see themselves in that data,” Olmstead says. “It really set a clear path as to what direction the coalition would want to go in terms of their strategies.”