A health breakthrough that depends on people, not drugs

Meet the system stewards, people from every walk of life who improve Americans’ well-being by tackling the deeper causes of disease and despair.

SOURCEYes! Magazine

A surprisingly effective way to help improve Americans’ health can be found in a place you’d least expect—the Woodhill Homes public housing complex in Cleveland.

That’s where I meet Marilyn Burns in the lobby of a community center the day after she hosted an arts festival for neighborhood children.  She recounts the highlights: African drummers, a DJ, a performance by actors from the Cleveland Public Theatre, storytelling sessions, finger painting, a stash of hula hoops—plus a unicorn walking around to entertain the crowd. 

“It all makes kids happy, it makes them smile, it makes them share with others,” says Burns, a certified community health worker.  “My work is to encourage them and be uplifting. That’s good for their health and for the health of the community.”

Marilyn Burns showing a collective artwork project of children’s handprints made at the festival she sponsored the night before at public housing community in Cleveland. Photo by Jay Walljasper.

A Woodhill Homes resident herself, Burns seeks to promote healthy lifestyles and forge stronger social connections in this lower-income community by partnering with arts groups and health organizations to put on events. She also organizes regular Zumba and yoga classes, rustles up winter coats for kids in need, and simply listens to their stories. “Sometimes I go home and cry,” she admits. “But I also keep the children accountable for what they do in the neighborhood, and remind them how they can serve others.”

Burns is just one of many Americans who play a critical—yet often unrecognized —role in helping communities become healthier and more resilient. They are part of a resurgent movement of innovators known as system stewards who understand that our personal health and well-being is fundamentally linked to everyone else’s.

System stewards aim to make good on American ideals of democracy and community self-reliance by pursuing common-sense solutions to health, economic, environmental and social challenges. It’s not a new phenomenon—but an essential part of the fabric of human civilization that has sustained us for centuries.

As a society, we tend to ignore crucial activities for which there is not a word.  Take “entrepreneur,” which was seldom heard in the US before the 1980s when it became a full-blown buzzword honoring innovators who drive economic growth.

ReThink Health, a national advocacy and research organization, has embraced system stewards to highlight the work of people like Marilyn Burns who seek ways to ensure well-being for all. System refers to the entire web of actions and interactions (think ecosystem) that sustains us. And to be a Steward means taking care of the things we value—for ourselves and for generations to come. 

Stewards from across the U.S. gather in Seattle at a national meeting to explore aspirations for the future of health. Photo from ReThink Health.

“Anyone or any organization in any setting—from a small neighborhood organization to a global socially responsible company—can be a system steward, just so long as they are ready to work with others to expand the vital conditions we all need to thrive,” says Bobby Milstein, director of system strategy for ReThink Health, an initiative of the Rippel Foundation. Rippel invests in initiatives that address a range of health concerns.

Cooperation is the active ingredient that makes system stewards powerful. Improving health for everyone depends on a vast number of factors across many fields—ranging from medicine and public health to education and business.  No individual or organization can make a huge impact just by themselves.

A quick tour through American history offers ample evidence for the success of the interdependent approach: indigenous healing traditions; the movement to abolish slavery; widespread improvements in public sanitation; the public outcry that led to the Pure Food and Drug Act; the creation of Social Security, Medicare and Medicaid; the movement to care for those living with HIV/AIDS.

System stewards enlarge our vision of what creates well-being. It’s not just what happens inside the walls of clinics and hospitals—it’s the result of sound policies and smart decisions carried out by people from all walks of life.

ReThink Health has profiled 237 “multisector partnerships” in 49 states that pursue this broader vision of health. Marilyn Burns serves on the steering committee of Health Improvement Partners – Cuyahoga (HIP-Cuyahoga), one such partnership in the Cleveland region. It is a stewardship-focused coalition of more than 100 organizations ranging from public agencies to businesses to grassroots community groups. 

Stewards explore ways of better reallocating resources to improve the health ecosystem for all residents of their region. Photo from ReThink Health.

“We connect people who are experts on many issues with people who are experts about life in their own communities,” says Greg Brown, an economic development consultant and co-chair of HIP-Cuyahoga.

Despite the presence of the world-renown Cleveland Clinic, the region faces acute health challenges, including levels of maternal deaths similar to developing countries and rates of children’s lead poisoning twice that of Flint, Michigan. 

“If you look at our poverty map, it’s almost the same as maps for infant mortality, early mortality, lead poisoning and asthma,” says Dr. Heidi Gullett of the Case Western Reserve University Medical School. She notes that poverty also corresponds to the map of historically segregated African-American neighborhoods. These stark realities prodded HIP-Cuyahoga to take the bold step of targeting structural racism as one of its four chief priorities.

System stewardship is also being supported by nationally focused research centers, advocacy organizations and health care companies, says Gary Gunderson, who co-founded one such effort called Stakeholder Health. The learning collaborative involves more than 40 health care national organizations that are working to better understand the social determinants that affect America’s health.

Seeking to connect with stewards across the country, Gunderson and colleagues hit the road on a 3400-mile trip from San Diego to Winston-Salem, North Carolina, where he is VP for FaithHealth at Wake Forest Baptist Medical Center.

They visited Indian reservations, inner-city neighborhoods, local congregations and wellness clinics. “Everywhere we looked, things are happening because people pulled together and got to work,” Gunderson says. “It starts with a local hub offering free clothing for kids or making peanut butter sandwiches for hungry people—and it keeps going from there.” 


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JAY WALLJASPER writes, speaks, edits, and consults about creating stronger, more vital communities. He is a Senior Fellow at Project of Public Spaces, editor of the Blue Mountain Center Commons, and author of The Great Neighborhood Book and All That We Share: A Field Guide to the Commons. Walljasper is a YES! contributing editor.