Perhaps my favourite sound bite was "middle-out". The impressive John Vu of Kaiser Permanente offered it as we discussed how to engage communities in order to activate their assets and build resilience. I have long worried that medicine - and especially public health - is a top-down, patriarchal, almost condescending profession. At the same time, given how complicated health care is it's hard to see it ever becoming bottom-up. John said that Kaiser is experimenting with what he describes as "middle-out" ways to engage with local communities. Fascinating.
I have other reflections to share, but these are the ones that have stayed with me. One meta-reflection, though, is the US' willingness to think, and think big. It's a deep privilege to spend three weeks engaging with such thoughtful and purpose-driven people. As I have reflected elsewhere, I have a deep concern that Europe has stopped thinking, busy enforcing austerity that may make the continent more competitive in the long-run but may stall - if not completely kill - the engine in the short-term. I won't argue about whether we need austerity, but even if we do we also have to find new value, especially in health and health care. The US seems to get that.