When Tyler Norris thinks about the future of the United States, he envisions an investment and systems strategy designed to “ensure that every kid and their family can thrive, with no exceptions.”
Part of that vision includes reexamining how social drivers—nutrition, schooling, housing, to name a few—build health in individuals and communities outside of the traditional healthcare system, says the former vice president of Total Health at Kaiser Permanente and founding CEO of Well Being Trust. Now a Federal Reserve Bank of New York visiting scholar, Norris sat down with Kana Enomoto, director of brain health at the McKinsey Health Institute (MHI), as part of MHI’s Conversations on Health series. The following is an edited version of their conversation.
Kana Enomoto: Tyler, you’ve worked with hundreds of communities across the country, as well as national and global leaders. What do you define as movement building, and what can we learn from it?
Tyler Norris: When Well Being Trust was initiated in 2017, the sisters of St. Joseph Health and Providence Health & Services challenged us to build a social movement for the mental health and well-being of the American people. We took them seriously and [as a first step], reverse-engineered social movements, starting with abolition and suffrage, environmental [protection], civil rights, all the way to marriage equality.
Movements are very different from campaigns because they’re not time limited and controlled from the center. Rather, they have both collective and distributed properties, so people leading from where they stand, as well as working together. Human capital may be what you can do; social capital liberates what you will do. That is what we’re trying to address—to unleash trapped assets.
All social movements have strong policy apparatus to change federal, state, and local policy; they have strong mechanisms to raise more money and aim it at the strategies that work; they have leadership alignment; they bring great granular data. That informed the kind of investments we made at Well Being Trust to build an ecosystem that was capable of delivering a population health impact, not just doing a few good things around the margin.
Kana Enomoto: What are the outcomes you’ve seen from this effort toward movement building?
Tyler Norris: First of all, the mental health and well-being field was missing a 501(c)(4) to take the gloves off and enforce mental health parity laws at the state and federal levels and move money toward mental health. We partnered with Inseparable [a mental health advocacy organization] to help do that. It has, in the past couple of years, helped pass legislation in eight states, enforcing mental health parity laws, and helped bring $1.2 billion to mental health in schools through the American Rescue Plan and the Safer Communities Act. We built Mindful Philanthropy to help build a philanthropic field to break through the stigma that so many donors and high net worth individuals have about talking about these issues, and then to aim more resources at the evidence base of what works.
Dan Gillison, the CEO of NAMI [National Alliance on Mental Illness], and I cofounded something called the CEO Alliance for Mental Health that brings together 17 of the nation’s leading guilds, associations, and philanthropies focused on mental health to align the field. We invested in partnership with the Kaiser Family Foundation [now KFF] to bring granular mental health data that were actionable at the local level.
Seven pillars to bring about change
Kana Enomoto: Tell me more about the unified vision and its seven pillars.
Tyler Norris: The unified vision with seven pillars begins with “How do you create the community conditions that give rise to mental health and well-being in the first place—that create a sense of belonging, purpose, opportunity for service, for awe and wonder?”—those things that we know strengthen mental health and well-being. We wanted to begin with clarity around that and center equity and social justice.
If you’re an organization—an NGO [nongovernmental organization], a CBO [community-based organization], a philanthropy—you don’t need to invest in all seven pillars. You need to invest where your mission is. But it’s important to see how your investments tie to the greater ecosystem [see sidebar, “Seven critical pillars”].
Kana Enomoto: What kind of investments do you think could lead to meaningful changes in population health?
Tyler Norris: First of all, recognize that 80 percent of what creates health is outside of clinical-care delivery.1 Yet we fail to invest in the fact that 80 percent of what creates health has to do with: the choices we make about how we eat and how we move our body; whether we have access to the conditions that give rise to health in the first place, like living-wage jobs, education, humane housing, nutrient-dense calories, and food environments that support us; and the ability to build our civic muscle in our democracy, in our community, and create a sense of belonging. That’s what actually creates health.
In terms of investments, we need to make sure every mother and child has everything they need to flourish; let’s invest in a nurse–family partnership and other things we know are important. Ready to read. Ready to learn. Universal pre-K. The nurturance early in life. Relationship care. All the way from that first thousand days2 to ready to be in school, to ready to enter the workforce. And I believe it’s very important that we do what Governor Wes Moore in Maryland is calling for right now, which is a service year [for high school graduates] so that every young person has an opportunity to serve [their communities] for nine, 12, 18 months and earn college credits.
We have a growth-oriented healthcare delivery system. Resources need to be put upstream into what creates health in the first place. That’s the investment strategy we’re calling for in my projects with the Federal Reserve Bank of New York.
What we’re talking about here is an investment and systems strategy that centers a pathway for potentiation to ensure that every kid and their family can thrive, with no exceptions. It is time that we solved the wrong-pocket problem and put the cash up front in what creates well-being, since we know what the evidence base is, and then hold ourselves accountable for outcomes, and use financial mechanisms to deliver reduced utilization of healthcare.
That is inviting healthcare to move beyond its anemic community benefit investments, to be the anchor institutions they are, and to be accountable for the outcomes of young people. The sector should move from doing good things to being accountable for community outcomes.
It is not pragmatically feasible for us to do well as a country unless we take a life span approach for our young people.
Spiritual health and ‘community as medicine’
Kana Enomoto: At MHI, we look at health through four dimensions—physical, mental, social, and spiritual. As someone with a master of divinity degree, and a champion of these issues throughout your career, what does spiritual health mean to you and how does it play a part in driving change?
Tyler Norris: Thanks for the question about spiritual health. We are in an era of “polycrises”—an economic crisis, political crisis, climate, continued race challenges. Underneath all of those crises is a spiritual crisis, a crisis of “Who really are we?” Am I just a white male in this body, or am I a spiritual being who is deeply connected with everyone in my community in shared fate, including those who may not look like me?
I draw on my own Abrahamic faith tradition that teaches us to love one another as we do ourselves. Not in some transactional way. But as ourselves. And recognize the intimacy of who we are, for, and with, each other. Outside of that understanding of our fundamental human connection with each other, we’re bereft. It is not surprising that outside of that, trying to find other layers of our identity, we find ourselves more anxious, more depressed, separate, with more suicidal ideation.
One in three young girls has seriously considered suicide. Three in five are persistently sad or in despair. That’s a spiritual crisis. Yes, we need to provide more access to mental healthcare, but we’re not going to get to transformation by more apps and profitable start-ups. We’re going to get it by people connecting and being able to turn to one another and listen to one another. That is a spiritual act, to create a safe space for someone to share their struggles and joys.
How do we create a place where people have a sense of purpose and a place to express themselves fully? I think that’s what spirituality and health look like—belonging, a place to express purpose, the ability to experience awe and wonder, and to serve. To bring back who we are in a meaningful way to our community. This is upstream from our mental health and well-being, and as we address our mental health and well-being, we’re going to get at the chronic disease that’s, frankly, killing this country and is expected to soar because how we eat, how we move, how we manage our stress is held in place by an underlying mental health crisis in this country that is rooted in the need for us to appreciate the community that we already are. We’re already connected. The spiritual question is, will we allow ourselves to be connected with one another and stop the “othering” that’s not only killing us, but is undercutting the United States of America.
Kana Enomoto: I love how you talk about allowing ourselves to be connected to one another, and to the world around us. Community as medicine, and nature as medicine. Could you speak more to that?
Tyler Norris: I think “community as medicine” is recognizing that we are here to be for, and with, one another. Places to be real with each other, to be vulnerable, our women’s groups, our men’s groups, our book clubs, our places of worship—they allow community to be the healing balm. Every major faith tradition reminds us of the power of the community.
And “nature is medicine” because we too are nature. We were created in and with nature, so that walk, that bathing in nature, that ability to appreciate the changing color of the sky or the clouds or the trees, that wander through the park, or the beauty of a grandparent walking along with a child gives us a chance to remember what’s most important. The data are extraordinary around what being in nature does, to not only change our cortisol levels and reduce our stress but to help us know that we’re more OK than we may think we are.