In a recent discussion I had at a party, someone was arguing quite forcefully about the irrelevance of challenging the infrastructure of social systems, health care in specific, in the United States. Being a public health professional, I was on the opposite side of the debate, stating that systems and institutions, because they are comprised of people, are malleable and are not intrinsically opposed to change. As an individual, I feel as though I can act as an agent to slowly effect positive changes within the systems and institutions I find flawed. This I believe.
Growing up, my family frequently engaged in spirited debates about baseball, politics or the propensity of children to cause stress in their parents’ lives. So I learned that I had to hold my own in arguing about who was the best first baseman of my youth or why voting in presidential primaries mattered. My father was typically the conductor of the cacophony which was my brother, sister and I challenging his premises and generally agreeing to disagree with whatever he was saying. My mother was usually a silent spectator, only chiming in from time to time to bolster my father’s conclusions. In college and after, I became much more cynical about the political process in the United States and kept thinking to myself, with so much wrong, how can I do anything to make it right? And in arguing with my father, I would always trivialize his assertions that small victories can lead to sweeping changes.
Despite my growing cynicism, I decided to go into the field of public health. My purpose was to make a difference. And deep down, I believed that I could play some important role in effecting positive change. Yet, I found the healthcare system much like the political system—robustly resistant to movement in the direction I wanted to push. But every time I would lament to my father about the obstinacy of politicians and healthcare policy makers, he would assuage my panic with pointing out some small, seemingly insignificant change for the better. And I am reminded of Gandalf’s words in The Lord of the Rings trilogy about the Ents: The coming of Merry and Pippin will be like the falling of small stones that starts an avalanche in the mountains. I believe that we are all small stones falling atop the mountain. And who knows which of us will start the avalanche.
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