Visionaries of the Meaning Economy is an interview series by Manuel Maqueda that explores how meaning is transforming the economy, and our future. This interview features SVN member, Tyler Norris, Vice President of Total Health Partnerships at Kaiser Permanente.
Tyler Norris is the kind of visionary leader who not only practices, but also embodies his beliefs. Gentle, passionate, mindful, present, physically fit, convivial and joyful, Tyler carries himself in a way that, even when we converse about other topics, is already advocating for what he passionately believes: equitable, accessible and integral health of people and communities. With 25 years of experience in the healthy communities movement, Tyler could be an example of what we could playfully call meaning-driven up-shifters: leaders with conscious boutique careers who decided to go work for large organizations in order to amplify their impact. In Tyler’s case, as Vice President of Total Health Partnerships at Kaiser Permanente, he gets to make sure that the impressive muscle of a 60 billion dollar nonprofit health provider gets flexed in the best way possible. Tyler holds a BA in World Political Economy, is a graduate of Harvard Business School’s Executive Program – and to top it all, he has a Master of Divinity degree from Naropa University, on whose Board of Trustees he sits.
In this interview, Tyler shares with us details about the amazing depth and breadth of his work, but also offers priceless insights about how the health of people is a powerful argument to bring together many diverse voices around social policies.
You are Vice President of Total Health Partnerships at Kaiser Permanente. What does “total health” mean?
Total health for us is three things. First, is that everything we do is addressing the whole health of a person: spirit, mind, body, not just their physical health.
Second, it’s about clinical-community integration and how we leverage our extraordinarily high-quality health delivery system by wrapping around it community assets such as access to healthy foods and places to be physically active, good quality housing and affordable mobility so people can get to places of employment and meet their needs and aspirations. In this way, we are not only able to deliver clinical quality, but also total quality in terms of increasing people’s health and well-being.
Third, total health is about how we bring every asset of our 60 billion dollar non-profit company to bear on the health of people and places. In other words, to leverage our procurement, our hiring practices, our investment portfolio, our facilities and our policy advocacy towards our mission to improve the health of our members and the communities we serve.
How closely related are the health of people and the health of communities?
Well, first we need to talk about what creates health in the first place. Only 10 percent of what creates the health of people has to do with access to medical care. Our biological inheritance, or genetics, is another 30%. Fully 60% of what creates health has to do with lifestyle and behaviors which are mostly shaped by the socio-economic and physical environments in which we live. In other words, a person’s zip code is a greater predictor of their health than their genetic code.
As an integrated health delivery system that offers both health care services as well as coverage through our health plans, we are essentially “at risk” for the health of the population. So, using our procurement, our hiring policies, our facilities, and our investment portfolio to help drive the local economy and create social value is ‘on-mission’ for us, as this approach helps address the underlying determinants of health which contribute to people being healthier. This is especially for vulnerable populations and communities of color, to achieve what we call health equity. In the process, we can reduce unnecessary care utilization, which reduces costs over time, and helps us make healthcare more affordable for all Americans. Affordability is at the very heart of our aspiration.
What tactics is Kaiser Permanente using to impact local community development?
Over the last couple of years we have begun to consider and act on such questions as: are we using our procurement in a way that can help drive the local economy? What kind of companies do we buy from, and how can we increasingly buy from women and minority-owned firms? How can we increasingly buy from the companies that are based in our communities, so that we can spin the local economic flywheel, if you will, of a community– and increasingly invest in companies that are owned locally and then reinvest their wealth in the community? The alternative is buying from companies whose profits are exported out of the community to Wall Street or other distant capital centers.
How do hiring practices support local communities?
We think a lot about how we are growing the workforce of the future. For example, here in Oakland we don’t want to only attract people from across the country, we want to be able to grow the skills and capacities of the local population, especially that reflect the diversity of our city. So we are partnering with the Oakland Unified School District, workforce investment board, community colleges, and local groups to create a more inclusive workforce pipeline, so that un- and underemployed members of the community have an opportunity to access living wage jobs, and so that young people have the opportunity to build the skills and capabilities to realize their full potential and earn a living, family-supporting wage.
Can you give examples of ways Kaiser Permanente helps people make healthier choices in their daily lives?
We have 10.2 million health plan members, and two million of them are in schools every day – children, teachers, and staff. One of the things we’ve been trying to do, through our Thriving Schools initiative, is to increasingly source school food from the local area, as healthy and as fresh as possible, and served through scratch cooking as much as possible. Also, we are looking at the built and natural environment in and around schools, to shape how it can better support the objective of ensuring that kids are getting at least 60 minutes a day of moderate to vigorous physical activity. In other words, we want to create food and physical activity environments that make the healthy choice the easy choice. The arts matter too, so we also offer the largest health educational theater program in the nation, reaching over a million children.
Isn’t it amazing that the US being so wealthy and having so many cutting edge medical facilities lags so drastically behind other developed nations in health indicators? Why do you think that is, and how can we change it?
Despite the fact that the US spends a higher percentage (18%) of our GDP on health care than most developed nations in the world, we don’t have the population health outcomes to show for it – to a great extent because we are not investing in the underlying determinants of health to the same degree that many other developed nations are. We know that a living wage income, education, access to healthy foods, safe neighborhoods, quality housing and transportation are among the underlying determinants of health. And as a nation we are underinvesting in those factors, especially for disadvantaged families and populations. As a result, despite massive spending, we find ourselves in the lowest tiers among developed nations when it comes to children born with a low weight birth rate or child mortality. We also have higher rates of many chronic diseases such as diabetes, hypertension and certain cancers, as well as high rates of domestic violence, substance abuse and other preventable factors that impact the health of the community.
In sum, the United States has an extraordinary opportunity, indeed an imperative, to look at how we will begin to invest more fully in what creates health in the first place, and not in just sick care services.
Total health seems such a powerful argument for social policies, and yet we rarely see it used in the social and the political discourse. Why do you think that is?
Well, it’s been slow in coming. Different from Kaiser Permanente, with our model of care combined with coverage, the business incentive for most US health care providers is to benefit from increased treatment services and procedures, rather than producing health. It’s a perverse incentive for the nation to pay providers for volume, not value. Kaiser’s model sets the direction for the nation for rewarding improved health status.
Sounds like this argument could rally many people around these themes.
There is a growing understanding in the United States that many of the drivers that create population health and those that create equitable economic prosperity are the same. This is causing business leaders, public health leaders, elected leaders, community grassroots activists and leaders across the sectors to understand that even though they may have different objectives – e.g. creating jobs, or improving health, or addressing social justice – that the strategies to deliver on those are pretty much the same. The understanding that placemaking, when we create places that are magnetic, that draw people together, that get them physically active, where we share food and we connect with each other – that’s actually what creates health. It’s also what creates great places that people want to be and live in, and locate their businesses and raise their families.
What is the thread of passion that led you to this visionary work?
For the past 25 years or so I’ve been engaged in creating healthy cities and communities that lead to healthier people and equitable prosperity. This approach seeks a more inclusive and vibrant nation that creates opportunity for all Americans to thrive, not just the fortunate. This is essentially a community-based approach by which business, government, nonprofits, faith communities and community residents come together to articulate their vision of a healthy community, and then engage the diversity of the community in identifying priorities and building the community will and the political will to make the investments, and the public policy and organizational practice changes that can bring about a healthy community.
I have had the chance over the years to work in about 400 cities in the US and globally. In a way, it’s the finest form of citizen democracy, of civic engagement: communities organizing themselves to express their aspirations, solve problems, bring together assets and implement solutions — and then hold themselves accountable for the outcomes. So we are engaging the diversity of the community to essentially ‘own’ their well-being – to be part of the solution, not just pointing fingers at others.
How important is emotional and spiritual health of people?
Not only in health care systems, but also in schools and in the workplace, the question is increasingly being asked: how can we increase overall well-being? How can we best cultivate mental, emotional, physical and spiritual well-being? We are encouraging practices such as meditation and mindfulness, and teaching ways of calming anxiety that are supportive of human flourishing. Especially with chronic illness, if an individual has a poor sense of self, or is feeling isolated and disconnected from the community they live in or the people they love — it’s very difficult to sustain the behavior changes to improve their physical health.
So we see social and emotional wellbeing not only as an end in itself for human flourishing, but also as a means to helping people make and sustain the behavior changes to improve their overall wellbeing – and to activate around the wellbeing of their families and communities.
So being meaning-driven is good for your health?
Meaning matters. Interestingly, when people have a strong sense of purpose and belonging, a sense of connection to those around them, that’s actually health-producing in itself. So having a sense of meaning, belonging and making a contribution, and doing that with people we care about – and who care about us – is by very definition health-producing and it also builds personal and community resilience. Meaning is at the heart of the future of health and well-being.
Manuel Maqueda is an economist, a social entrepreneur and the author of the forthcoming book The Meaning Economy. Visit www.meaning.ec for more interviews and for the whole audio of this interview.