Practicing health in a broken world
By Rebecca J. Vander Meulen '99

 
Rebecca Vander Meulen ’99 was the student commencement and diploma ceremony speaker at the Rollins School of Public Health at Emory University in Atlanta, Ga. Vander Meulen worked as a legislative specialist for Bread for the World immediately after graduation from Calvin. She then attended the Rollins School, where she earned her master’s degree in public health. This is the text of her commencement speech.
 
Rebecca Vander Meulen
Rebecca Vander Meulen '99 reminds her fellow graduate students to continue to listen and continue to learn.

Asking a public health student to give a speech without using PowerPoint is a little like asking Dean Curran to talk to prospective students without describing Atlanta as “the public health capital of the world.” But I’ll do my best. It’s an honor to stand here before you today, before all of you who have stood by us and behind us and who have brought public health to life.

We are being commissioned today to practice, promote and investigate health. That mandate may sound fairly simple, but I get a little apprehensive about this charge when I remember that the World Health Organization defines health as a “state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.” Complete physical, mental and social well-being? By that definition, I doubt any of us are healthy.

We are practicing health in a broken world, where the problems are complicated and often paradoxical. Consider this: In Africa, more than 30 million people are living with HIV, and fewer than 30,000 are receiving anti-retroviral drugs. Things are not perfect in the United States, either. According to the World Health Organization, although the United States spends more on health care than any other country in the world, it ranks only 37th in health care performance. Or consider this: While more than 10 percent of households in the United States regularly wonder — because of poverty — where their next meal is coming from, 21 percent of us are also obese. And this is up from 12 percent just ten years earlier. Meanwhile, a chocolate company is aiming to tackle obesity by giving sports equipment to schools when children buy chocolate. (You biostatisticians could calculate the average number of hours of pick-up basketball that will be necessary to counteract the four million pounds of fat in these chocolate bars.) Each of you can give examples of paradoxical problems from your own fields of study. But in the midst of this mess, we somehow say we still want to practice public health.

We want to practice public health because we believe that complete physical, mental and social well-being is a goal worth our effort and that our efforts can somehow make a difference.

Solutions to public health problems can also be paradoxical. Take the example I know best: latrines. Around the world, a child dies every ten seconds due to diseases associated with inadequate water and sanitation. However, although human waste currently destroys health, it has the potential to improve health by increasing agricultural productivity. As long as feces are treated properly to kill pathogenic organisms, they can be enormously beneficial to farmers around the world. It is projected that agricultural production must double in the next two decades to meet basic food needs. And every day each one of us excretes 13 grams of nitrogen, a gram and a half of phosphorus, and three grams of potassium that we flush or throw away — nutrients that our soil desperately needs! This is the solution Mozambicans shared with me during my summer practicum. I could talk forever about how poo matters and that urine is liquid gold, but that would be a thesis defense, not a graduation ceremony.

So back to the idea of paradoxes. Perhaps the biggest paradox of public health is that the most fundamental public health skills we need are the ones we began to cultivate even before we paid our Emory application fees. Although the Emory deans are sanctioning us to go and practice public health, what will make us great public health professionals is not the extent of our knowledge, but our ability to continue to learn. Although we have magnificent skills in epidemiology and community health promotion, we cannot practice health with these skills alone.

In the context of terrorism, of anthrax, of war and of SARS, the term “public health infrastructure” now rolls easily off Tom Brokaw’s tongue, and we have an audience. But having gained an audience, we must not stop listening — including to those who may not have medical credentials, like the people who open the office mail or who repair hospital ductwork. We must understand how people generations ago addressed similar problems without our textbooks. So whether our goal is to educate or analyze or manage or treat, if we don’t listen, we won’t do a very good job. We need to listen so that we don’t miss important clues or redundantly reinvent solutions.

Most importantly, we need to continue to learn by walking beside people. We must immerse ourselves in the problems to help develop real solutions. And nothing motivates us into action like bearing witness to hopes and despairs. There is risk involved — the risk of despair because so much is broken in the world. But there is also great joy. Without working and living with Mozambicans, I never would have been so happy to receive the picture I received from Mozambique recently. It showed corn growing in soil supplemented by natural fertilizer reclaimed from latrines — and this corn is growing well, even though much corn in Southern Africa is failing because of drought.

Author and theologian Neal Plantinga describes this health we’re pursuing as shalom: as “universal flourishing, wholeness and delight — a rich state of affairs in which natural needs are satisfied and natural gifts fruitfully employed.” We might not achieve global physical, mental and social well-being. But sometimes soaring, often trudging, despite our failures, despite our successes, we must continue onward in our effort to help people, communities, states and nations flourish. We see signs of hope along the way, and continue towards this vision of abundant life. In the process, may we take delight in the journey’s small steps. Onward, my friends, onward.