Depression: A Silent Global Burden

In twenty years depression will affect more people globally than any other disease, according the World Health Organization. A BBC report points out the prevalence of the disease among the poor and those living with disabilities. The BBC says developing nations spend only 2% of their health dollars on mental health while developed nations spend 200 times more.

However, the persistence of depression in the developed world reveals how difficult it is to treat the disease successfully. In a fairly comprehensive article U.S. News says medications are effective for 30 to 40% of the depressed.

Mental health is a sensitive subject, often misunderstood worldwide. The burden of depression adds to the struggle to survive in places where hardship is daily reality. Yet it’s a silent disease, often untreated and in some areas unrecognized.

The seeds of mental health treatment are being sown in many countries where these conditions haven’t been identified before. But they are very few and of limited scope. Anyone who’s seen people traumatized by war, natural disasters or political oppression, those left vulnerable by physical disabilities and diseases, and those struggling with emotional pain of the daily grind of poverty has also seen how these external conditions exacerbate depression. In most developing nations this includes the majority of the population.

WHO’s identification of the problem is a good first step, but many more steps will be required if the projection is correct.


Having just completed Khaled Hosseini’s novel, A Thousand Splendid Suns, the news of bombing in Kandahar arrives with even more pain than it might otherwise provoke. Hosseini captures the dislocation and deeply human struggle of life in Afghanistan through the fall of the Soviet-backed government, the Taliban years and the early days of the Karzai presidency.

The long-suffering people of Afghanistan continue to dodge bullets, dig their loved ones from the wreckage of bombs and deal with the carnage in hospital emergency rooms. Taimoor Shah’s account in the NY Times yesterday of the bombing of Kandahar reads like a scene from Hosseini’s novel. Shah writes simply and with precision: The bombing deepens the city’s sense of isolation and tips its people in despair (that) anyone has the power to halt the mayhem. In its brevity, it’s one of the most moving pieces I’ve read from Afghanistan. I recommend it.

The people of Afghanistan have endured violence and dislocation for at least three decades. It’s no wonder Shah heard voices of despair. How could they not despair? Between bombs and bullets, the geo-political positioning in Washington or Kabul hardly seems relevant. If you’re standing in crossfire, or digging your children from the rubble as one father who spoke to Shah, it would be demented to not feel anger or despair. It would be less than human.

And the Afghans who spoke to Shah spoke of their own sense of diminishing value, as if they are merely fodder for the bombs and artillery. For we who live far away in safety, their suffering barely captures our attention. Except for the families of U.S. military personnel, it could escape notice in this country altogether. But that would be tragic, for our common humanity is bound up with them. It takes no imagination for a father to identify with another whose children have just been buried in a collapsed building, nor a mother grieving a daughter whose life has ended in a violent cataclysm.

There are no easy answers to this intractable conflict. No way to sum it up with soothing words. As I write, I’m helpless to know what can be done beyond supporting those humanitarian organizations that are at work in the country, supporting the families of military personnel, and working with those who seek to find peace. So I have ideas, but I’m not there on the ground, and I don’t make policy. And given the depth of human pain, nearly all seem inadequate.

The act of writing these words, however, seems like a prayer, if prayer is calling to awareness the tragedy of the human condition and the recognition that when people suffer, the whole of the human family is wounded. Awareness places it before us, and God. Admitting frustration and helplessness in the face of the evil of war is a form of confession, a recognition that we cannot control the destructive forces that we and others set in motion. Humility before God and Creation isn’t weakness, it’s a step toward strength. And having confessed one is called upon to act, to change.

Hosseini has become an ambassador for UNHCR. The challenge we all face is to do what good we can in the face of intractable evil and great human suffering, and not be paralyzed by it, nor give in to the anger and despair. Rather, it is to use the energy that is contained in these emotions to create change, to ease suffering, seek peace and sow the seeds of healing.

Health Care is About How we Care for Each Other

Despite all the talk about costs, the health care debate is about more than money. It’s about how we care for each other. It’s about connection and community. By connection, I mean our recognition that we are connected as a human family and in a social network. We are no stronger than our concern for the most vulnerable among us. By community, I mean the principle that has been a foundation of the democratic experiment: that in addition to individual rights, we have a mutual shared responsibility for each other and this wider social network protects and assures rights for all of us. Civic responsibility and morality. The political posturing that has marked the debate the past few weeks could not be further from this reality and that’s a national disgrace.

Many of the most vulnerable are those with chronic diseases, some of which are untreatable but for palliative care; the poor who cannot afford access; seniors of limited means; children, who by their innocence are dependent upon adults for proper treatment. In a society of abundance, yes, even in the great recession we live abundantly, the idea that we are unable to care for all our citizens is disgraceful. Health care is a measure of what we strive to be, or what we have become. It is a moral issue.

It’s deeply disturbing that living wills and advance directives have been mischaracterized as death panels. I’ve found these to be among the most helpful and comforting tools available when I’ve faced agonizing decisions for which there are no easy answers. In those difficult decisions, I’ve wanted the wishes of a loved one to be followed and the sanctity and dignity of their lives respected. I’ve not wanted others who don’t know them to impose their views or judgments upon them. That’s the value of living wills and advance directives, exactly the opposite of the description of some political operatives today.

The inaccuracies and outright misrepresentations about reform add to the concerns and emotional burden of people who are already living in a vulnerable state. The harm done by introducing the fear they will lose even more of their access to health care is too high an emotional price to pay for political maneuvering. Many have already experienced significant cuts. Fortunately, some religious leaders in the mainline denominations and progressive evangelicals see it in this way. They are speaking out and organizing. This is as it should be.

If the religious community were to remain silent on this issue of civic responsibility and morality, it would risk betraying fundamental values about the dignity of human life and the value of our connection in community. The real cost of our uncivil debate on health care and our failure to reform, is not the loss of dollars but the loss of connection and community.

About That Free Content

I’m thinking a lot these days about how to generate revenue for content. Even non-profits have to do that in this climate. Our organization creates content and gives it away free because we are supported by the generosity of people in the pew. Others take that content, re-package it and sell it. The gratis model of content is under stress because costs continue to increase as income stabilizes. The non-profit economic models from the past aren’t working any better than the model for commercial journalism.

Moreover, the charitable giving model of non-profit support is changing. Younger people give differently than their elders. For example, compare the One Campaign to One Great Hour of Sharing. One is a campaign model in contrast to the institutional model of One Great Hour of Sharing. Very different. Young people give to campaigns but not to institutions. That’s part of the background.

Another part is the way content is being created today. Anyone who wants to jump in, or happens to be in the right place at the right time can participate and publish. Citizens with cell phones are documenting airplanes landing in the Hudson or crashing into each other over the river. Spot news coverage is changing.

Individuals are publishing blogs, open source communities are creating content and anyone who wants can upload video to YouTube. The list goes on and you know it as well as I.

Changing media use is yet another reality. Media on screens, on demand and personalized to individual interests is also creating great change.

So, that’s the background I had in mind when I read that the photo cooperative Gamma has filed for bankruptcy. This underscored the changes once again. Gamma, as other photo coops, serves the mainstream media. It represents top tier photographers. According to the NY Times, the contraction in mainstream media is affecting photographers just as it affects writers. Fewer assignments coupled with the use of images provided by citizens with cellphones are making it hard for photographers to survive.

If the trend continues it presents a basic question: how writers, photographers and other content creators make a living and continue to practice their trade. The expectation that the Internet is a free repository of the world’s content makes the issue even more complicated. A recent report on the movement away from print textbooks to digital carried a striking statement. One interviewee asked why anyone would pay $100 a pop for a textbook when they could get the content in digital form for free? Why indeed?

The Internet has created an expectation, perhaps even a sense of entitlement, that content should be free. It’s a great idea. I support it. But, at what point does the free part of that question result in the end of the content being refreshed, renewed, or even written because those who create it can’t make a living? And if the charitable model doesn’t work anymore, or if it works but not adequately enough to underwrite ongoing services, where do the service providers turn for additional income?

As I said, I’m doing a lot of thinking about revenue generation these days.

Refocus and the future: reaching young people with the Gospel

I want to be candid with you about measures we are taking at United Methodist Communications to address what I consider urgent concerns for The United Methodist Church. Since entering the ministry in my youth, I have always felt and believed proclamation of the Good News an urgent calling. Today it’s more so than ever.

The culture of materialism attempts to redefine the biblical witness of the sacredness of human personality. Today, each of us is defined as a consumer of products and services. Even in its most innocuous usage, I find it unacceptable. In my opinion, the values that arise from it create a void that only the embrace of a caring community living in the embrace of a loving God can fill.

If we do not enter into this world with messages that counter this definition of humanity, I believe we fail the Gospel of Jesus Christ. And we fail future generations. The church in the United States and Europe must reach younger, more diverse people who have been formed in this culture with the gospel message.

On the face of it, it’s a big challenge. It’s made more difficult in the midst of an economic crisis that reduces our capabilities and requires us to pare down even more. In the past year at United Methodist Communications, we have slashed some of our largest line items – travel and related expenses, and printing. Recently we’ve taken the difficult step of laying off good people.

These have been difficult steps, a sentiment that I’m sure would be shared by all manner of organizations and businesses today. But they have been the right ones. And they are enabling us to absorb a deficit and keep with our high levels of plans and programs for now.

However, the economy isn’t the driving force, it’s the precipitating factor. We are focusing on younger, more diverse audiences. The driving force is the Gospel and the demographic realities. It’s the imperative to be disciples of Jesus Christ inviting people to a new way of life, a valued way of living. Discipleship reminds us that we are valued by God and we are called to value each other.

I don’t seek commendation. In fact, we are doing precisely what we should do in a situation like this. The difference is rather than only talking about these details at private board meetings, I’m sharing them here. United Methodist Communications is steadily walking into a new kind of openness and two-way communication about what we do and how we operate because we believe it is right and appropriate in these times.

Your comments are welcome as always. Please keep in mind our policy on being constructive.

Halting Malawi’s Nursing Brain Drain

I was pleased to get an email from Christine Gorman telling of the posting of her story on nurses in Malawi and pointing to a video she produced. Christine is a Nieman Fellow in Global Health at Harvard. She also writes for TIME and is an adjunct professor in journalism at NYU.

Malawi is attempting to address the “brain drain” in medical personnel–the outflow of qualified doctors and nurses to higher paying countries. One solution is to “top off” existing salaries with additional funds from outside donors to encourage workers to stay in-country. Christine reports that Malawi’s experiment is working, but it has its own pitfalls.

She profiles two nurses and their supervisor at a mission hospital in Malawi. The multimedia package demonstrates not only reports on the effort to reverse the brain drain, it takes us to Embangweni Mission Hospital in northern Malawi.

Christine also demonstrates how journalists are adapting to the use of digital media to complement and enhance traditional writing and print skills. The media package is below:

Could U.S. unemployment reach 10%? The people hunger for hope

If the recession is easing, as this morning’s headlines suggest, we still have a long way to go. Today, I read that U.S. unemployment is on the rise yet again. Columnist Bob Herbert recently wrote the effective unemployment rate–counting those who’ve given up seeking work, those working part-time but seeking full-time jobs, and those recently laid off–could be as high as 16.5 percent. Staggering.

If the official rate reaches 10 percent, which is possible, it could set off yet another economic contraction. Anxiety is high. People seek sources of hope.

At the 2008 General Conference, Bishop Mary Ann Swenson called The United Methodist Church the “cup that runneth over.” As people hunger today, are we sharing our bounty of hope? The hope we know in Jesus Christ? Are we going out into our communities to reach people who fear the worst, to be the community Jesus calls us to be even amid despair?

As everyone knows, church membership in North America is in decline, and spiritual seekers are looking elsewhere. It is a trying time for we who hold dear the Wesleyan principles. But it’s also a time of opportunity. We must seize this as an opportunity to do what God calls us to do … to leave our church buildings and go to the people who hunger for hope.

United Methodist Communications is trying to do our part. We have invited the people of The United Methodist Church into a conversation to Rethink Church. Its goals include gaining the attention of spiritual seekers, to engage, invite and offer the message of hope that United Methodist Christians believe in.

If unemployment worsens, people will be desperate for connection, community and, perhaps, evidence that God is present with us, and that this makes a difference. In community we embody that hope, and through community we live the evidence. How might we share it?

A Good Week

It’s been a good week. I traveled to Geneva with United Methodist, Lutheran and United Nations Foundation colleagues to meet with staff of the Global Fund to Fight AIDS, Tuberculosis and Malaria. United Methodists and Lutherans are partnering with the United Nations Foundation and the Global Fund to raise funds to eliminate malaria. The conversation was stimulating and exciting. I have more hope that the world can conquer malaria than I’ve ever had. The goal is 2015, a date called by UN General Sec. Ban Ki Moon. It’s great to leave a meeting feeling more excitement and hope than when you began.

Sen. Bill Frist and Larry Hollon A day after this, Sen. Bill Frist and a colleague came to our offices. Along with two of my staff colleagues, we had a very hopeful conversation about common concerns in global health. Since leaving the Senate he’s devoted his time to global health and poverty. We discovered several places where our interests intersect. And I learned that he played a key role in creating the Global Fund. Along with him, I believe the Global Fund is one of the greatest hopes the world has for significantly reducing the human toll of these three major diseases.

We also discovered we share relationships with people and organizations working on health and communications. The role of communications is often overlooked in addressing poverty and disease. But the challenge of getting life saving information to people, especially in underserved remote, rural regions where poverty is endemic is a function that deserves our careful consideration. I’m glad we were able to talk about it.

All in all, at week’s end I looked back and reflected; it was a good week.

Video update from Global Fund Summit


The power of partnership


As I fought off jet lag this afternoon, my mind raced with ideas. The meeting with executives from the Lutheran denominations and the Global Fund to Fight AIDS, Tuberculosis and Malaria was more stimulating than even I had expected, and I was hopeful going in.

The whole day was a lesson in the effectiveness of partnership. Together we can make good things happen. We can save lives. In Global Fund lingo, it’s about scale. Combine resources and skills with a strategy for national coverage and you can make a dent, a significant dent, in the diseases of poverty.

Ethiopia has reduced mortality from malaria by 50 percent in a just a few years with national bed net distribution. Other nations are seeing similar dramatic life-saving change. This happens when resources and skills are aligned, a national plan is created by those who will implement it, and adequate funds are made available. When this happens at scale, the effects of the diseases of poverty can be reduced, if not eliminated.

United Methodists and Lutherans bring much to the table. We are present in remote areas far beyond the end of the road. We’re in rural, under-served villages that lack financial resources but have deep community connections. The people in these villages, our brothers and sisters, are United Methodists and Lutherans. They are us, and we are them. One global community.

I was reminded of this system we United Methodists call our connection. And I kept thinking about what a transforming potential it holds. When we align, focus and partner with others at scale, we can change the world. Even if you’re addled by jet lag, that’s exciting to consider!