Seismic Shifts Blog

Natalie Burke

Natalie Burke

As a change strategist, Natalie makes unique connections between people, information, and ideas.  For more than a decade, she has lead CommonHealth ACTION on its journey to create seismic shifts in sectors, institutions, communities, and people.  As a student of all things, she is an information junkie seeking ways to make the world a better place.


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In response to the heartbreaking events in #Charlottesville, people have asked #CommonHealthACTION how to create space for their staff to talk about it -- as a way to manage stress and support mental health. After the spate of shootings last year, several organizations reached out to say they noticed their co-workers were either stressed or grieving. They wanted to talk about the violence but didn't know how. We shared a voluntary process that worked for our organization and for others. While we went into greater detail while assisting them, here is a simple explanation for how to create a space for your team to talk. While it will be challenging, it will likely be helpful for your #workplace. The feedback from last year is that it was helpful. If you have questions, let us know at info@commonhealthaction.org. Feel free to share the video with others.
Tuesday, September 1, 2015

Dear Public Health...

I think we need to talk. 

Over the last 20 years we've had a wonderful, although at times challenging relationship.  I'm not saying that I want to break up, but I do think we have some things to work on.  I know that I'm partly responsible for the state of our relationship so I decided to write this letter because sometimes when I talk, I don't feel like you really listen. 

Not long after we got together, you decided that everything in this relationship was going to be about the social determinants of health (SDOH), the big picture.  You were always talking about policies, systems, institutions, and communities—housing, education, transportation, structural racism, and employment.  While I understood why, I had some concerns and I think I even voiced them at the time but that didn’t make a difference.  I could have openly disagreed with your focus but I followed your lead because I thought that within a few years, you'd open up and find ways to connect personal health behaviors to those systems and institutions.  

Now don't get me wrong, you definitely bring up the role of individual health behaviors and choices every now and then--but let's be honest, I'm just not feeling a strong enough connection based on the things you say and do.  Personally, I can get people to understand the relationship, but what happens when I’m not around?  Too many times, I’ve walked in on conversations about us and the people talking (who think they know us or are our friends) either don't really understand what we do or they immediately point to what's missing between us.  They’ll even go so far as to say that we’ll never last if you won’t open up and make space for lifestyle and personal behavior in the relationship--  not just when you’re talking about health education and direct services, but also when you’re developing models, designing programs, and evaluating impact. 

So here’s the good news… I’m still invested in this relationship and I know that you are too because recently, I’ve seen some important changes in the things you say and do.  You’ve started to open up and talk about the connection between lifestyle and determinants of health in more specific ways; the relationships between employee wellness and community conditions; the importance of developing cultures of health everywhere people live, work, and play; and that while all roads lead to health, one of those roads is paved by the choices people make every single day.  I’ve decided to be patient with you Public Health.  I know that change takes time and that perspective transformation requires changes to the head and heart.  When you know and believe something different, you will decide and act differently.  I believe you just might be transforming.

No relationship can be one-dimensional and successful over the long haul.  Every good relationship requires balance.  Yin has Yang, Abbott had Costello, Beyoncé has Jay-Z, and social determinants of health have personal health behaviors.  For all of them, talking about one without the other just doesn’t seem right and communicating their connections and roles validates them both.

So Public Health, while things between us might not be perfect, I am hopeful.  I believe that if we continuously communicate the connections between SDOH and health behaviors, strive for authenticity and transparency during your transformation, and seek balance in all that we do, we’ll be together for a long, long time.


As I speak to corporate and organizational leaders around the country that operate outside of the public health sector, it is clear that the nation’s innovators switch from being innovative to being linear thinkers the second I mention the word health.

They struggle to understand -- and at times they outright reject -- the idea that health is actually produced by society and that regardless of their sector, they play a role in that production. For public health, this one-dimensional approach to health is the death knell to multi-sector solutions to the nation’s public health problems.

Years ago we use to say that we needed to give communities and other sectors a seat at “the table” of public health. The truth is that the public health “table” is actually in a conference room in Silicon Valley where they are discussing workforce diversity. The “table” is at the county board of education meeting where they are rethinking a policy regarding student discipline. The “table” is at the community meeting where developers present their plans to build a retail and entertainment complex that will create 1,000 jobs, displace 200 families, and eliminate 1,700 trees. “The table” is in the boardroom of a major retailer that has decided to create family-friendly work environments with the addition of breastfeeding rooms and onsite child care centers. “The table” is at the department of public works where they are increasing lighting on walking paths between train stations and the surrounding neighborhoods.

To improve the public’s health, Public Health has to find seats at the real “tables.” Once seated, we have to observe and learn from innovators in other sectors. We need to master their language and understand their bottom line, their agenda, what drives them. Then and only then can we begin to share the message of public health in ways that are meaningful and relevant to this “lay public health workforce.”

The concept of “the table” has been a part of CommonHealth ACTION since its inception; when Vinny (Vincent Lafronza) and I sat at my kitchen table envisioning ways to embody so many dreams and ideas. They were a reflection of the wisdom of our elders and communities that allowed us to be students of their realities. Ten years later, CommonHealth ACTION continues to dream and to have new ideas about what we can do to contribute to the production of the public’s health.

You will notice that in honor of our 10th Anniversary we have a refreshed logo. The logo has five elements linked together; each one is a different color. Those elements are people. They are communities. They are sectors. They are policies. They are the interactions and interplay of enumerable factors that create the conditions within which we live our lives and make our decisions. They are the determinants of health, equity, well-being, and quality of life. They represent the interconnectedness that makes American society great and at the same time calls upon all of us to understand that the nation’s greatest production is the health of its people.

As we mark our 10th year, CommonHealth ACTION will continue to seek and fill seats at new tables, participating in unexpected conversations, exchanging knowledge, and steadfastly looking for ways to ensure that all people achieve their best possible health.

Be Healthy. Stay Well.