May 24, 2024

a vision for the future

a man pointing to circles on a chalkboard
image caption: a still image from a scene in the movie ‘Born in Flames‘. an undercover police detective describes the decentralized leadership structure of the subversive Women’s Army. the drawing depicts a series of small circles connected to each other in a large circle, with leadership roles shared and rotated among members of each cell. i once described this structure to my colleagues (“it should look like a daisy”) as my dream public health organizational structure. when i saw this image in the movie 5 months later, i yelped.

For the last year I worked on the local health department’s COVID-19 vaccine strategy. This is the third pandemic I’ve worked at a public health agency, and I’m grateful to have taken part in the effort. I’m very proud of the work that my colleagues and I did. The strategy they and we deployed over the past two years was very effective. We have one of the highest rates of vaccination in the country. I’m honored to have experienced it, first as an outsider and then as an insider.

I’ve always liked working in systems where we can imagine the big picture. But sometimes the picture is too big! If you zoom out, the people go from looking like people to looking like ants. Zoom out too far and they disappear from view. Our region starts to look like the war maps on parchments that nobles once carried into battle. What happens when the people get too small? What happens when we make plans for our region and not for our neighbors? I’ve found that mistakes get larger when the people get smaller. It’s too easy to miss something critical.

I started my public health career during the George W. Bush years. Government agencies were already reeling from years of doing more with less and less. The permanent jobs were already filled as contract and temporary jobs became the only way to get a foot in the door. White-dominant culture centralizes decision-making into the hands of a select group of people. These are men, sometimes women, almost always white. With such a limited worldview, it’s hard to decide with any accuracy what is important and what is not. Especially in a crisis, the important is what’s familiar to us. The unimportant risks becoming what other people say they need.

We risk our communities when we create solutions that will work for “most” people. When people are dots on the map, it’s easy to create plans to deal with the rest later. We even have a few euphemisms for what we disguise as rational decision-making:

“Finding the low-hanging fruit” means the higher-up fruit will have to wait. To extend the metaphor, we discard fruit that’s not deemed worth harvesting. We ignore what’s already fallen off the tree.

“Moving the needle” means the people closest to needle will have their needs met first. People who are further from the needle may have difficulty reading English. They may have more than one health issue that can make it harder for social programs to reach them. They may be taken in by health programs that advertise themselves as free. The small asterisk next to “free” is available for people who can read English in fine print. The fine print says they need to bring their insurance card or pay cash.

What I find frustrating among senior leaders is a failure of the imagination. Leaders in recent years are getting better about listening to their constituents. But where are their ideas based on the input they receive? They wield enormous power. Yet so few can articulate a clear vision for how to fix the racist organizations they inherit.

By some accounts, people are getting meaner. Every day, the ice sheets melt a little more. Every day, white supremacists march in american streets and preside over legislatures. Every day, anti-LGBTQ+ celebrities and politicians make trans people’s lives a little harder. The half-measures and incremental progress might have worked decades ago. We don’t have that kind of time left.

I still see possibility amid all this stress and heartache. We live in a world that changes every day. Time changes even when nothing else seems to. And with time, people can change too. Circumstances change. Leaders change. We have to be ready. If we keep our focus on people in every community, dreaming together as equals, we will be.

my name is josh martinez. i have always loved trying to understand systems, and the systems that built those systems. i spend a lot of time thinking about how to get there from here.

i own and operate a consulting practice, Future Emergent.

say hello: josh[at]