Jimmy Carter Inches Towards Stunning Accomplishment

The Huffington Post

Jimmy Carter's Fight Against Guinea Worm Approaches Victory

First Posted: 12-25-10 04:56 PM | Updated: 12-26-10 12:03 PM

ABUYONG, Sudan — Lily pads and purple flowers dot one corner of the watering hole. Bright green algae covers another. Two women collect water in plastic jugs while a cattle herder bathes nearby.

Samuel Makoy is not interested in the bucolic scenery, though. He has an epidemic to quash.

Makoy points out to the women the fingernail-length worm-like creatures whose tails flick back and forth. Then a pond-side health lesson begins on a spaghetti-like worm that has haunted humans for centuries.

This fight against the guinea worm is a battle former U.S. President Jimmy Carter has waged for more than two decades in some of the poorest countries on earth. It is a battle he's almost won.

In the 1950s the 3-foot-long guinea worm ravaged the bodies of an estimated 50 million people, forcing victims through months of pain while the worm exited through a swollen blister on the leg, making it impossible for them to tend to cows or harvest crops. By 1986, the number dropped to 3.5 million. Last year only 3,190 cases were reported.

Today the worm is even closer to being wiped out. Fewer than 1,700 cases have been found this year in only four countries – Ethiopia, Ghana, Mali and Sudan, where more than 95 percent of the cases are. The worm's near-eradication is thanks in large part to the efforts of Carter and his foundation.

"I'm still determined to outlive the last guinea worm," Carter told The Associated Press in a phone interview. The 86-year-old set that goal in the 1980s, when his center helped eliminate guinea worm from Pakistan and other Asian nations.

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The Carter Center has battled the worm for 24 years through education and the distribution of strainers that purify drinking water. It has helped erase guinea worm in more than 20 countries, and it believes the worm will follow smallpox – which was wiped out in the late 1970s – as the next disease to be eradicated from the human population.

But Carter staff members say ending the disease in Southern Sudan may prove the most difficult, because of how remote the remaining endemic areas are and the fact that the worm is found in semi-nomadic pastoralists who have little education and low sanitation standards.

Another complicating factor: Southern Sudan is scheduled to hold an independence referendum Jan. 9, a vote that is likely to lead to separation from the Khartoum-based north. The process has been peaceful so far, but any conflict that arises would derail eradication efforts.

As Carter put it: "War and good health are incompatible."

"There's no way we can go into an area that is at war," he said.

Although the Carter Center has been fighting guinea worm in Sudan since 1994, its efforts only made significant headway following the signing of a 2005 peace deal that ended two decades of north-south civil war.

The 20 years of fighting prevented the Carter Center and other authorities like the World Health Organization from conducting a comprehensive assessment of guinea worm here until 2006. Since then, eradication programs have reduced the number of yearly cases by about 90 percent.

The few remaining cases exist in off-the-map places. In many sites, the Carter Center is the only outside presence – no other international or Sudanese organizations have set up shop. Even a government presence is rare.

"We are in the most remote places because that's where the guinea worm is," said Doug Tuttle, 31, a technical adviser with the Carter Center who lives in a tent in the village of Abuyong. He oversees a staff of paid field officers and guinea worm volunteers whom he visits on his motorcycle or by walking anywhere from 30 minutes to two hours.

Reaching Abuyong requires abandoning the dirt road for a narrow path hacked through dense woods that was only forged after the Carter Center moved in. On a recent bone-rattling ride to Abuyong in the center's hulking, Russian-made truck, the vehicle forded flooded ravines as the occasional baboon scampered away.

At the picturesque pond outside Abuyong, Makoy explains to the women that if someone enters the pond with a guinea worm hanging out of a blister, the worm will dump larvae that will mate with the white worm-like creatures – copepods – and render the pond endemic with guinea worm.

Makoy doesn't use the words "endemic" or "copepods" with the women. His aim is to deliver a more pragmatic message: that filtering water is the key way to avoid contracting the disease.

"This work requires a passion inside you to keep you going day after day. Even if you must repeat the same things 100 times to the same person – education, education, education," said Makoy, who works for the Southern Sudanese government's Ministry of Health and has collaborated with the Carter Center since 1996.

Makoy hands both women mesh filters and explains how to use them. Then he repeats a message he has delivered thousands of times – that even one person with a hanging worm who enters a water source can trigger scores of cases in the next transmission season, roughly a year after someone drinks tainted water.

Change is difficult here. As someone who comes from a pastoralist tribe, Makoy knows that cattle herders on the move don't think twice about drinking from a brown puddle. In a place like Abuyong, where the few water hand pumps each cost thousands of dollars because water lies so deep under ground, accessing any water – infected or clean – is a blessing.

By January, the cattle camp next to Abuyong will have cleared out and the large pond dry. The 500-plus cattle and their keepers will move to the Nile River, where they will remain for the blisteringly hot dry season.

It won't be until May that some begin to notice red puffy blisters developing on their legs and feet, the sign of a soon-to-emerge guinea worm.

That's what 7-year-old Ajak Kuol Nyamchiek had to deal with a couple weeks ago as a worm exited her foot at a Carter Center clinic in Abuyong, where worm victims stay while the worms make their painful exits. Nurse John Lotiki slowly pulled the thin, white worm out of the girl as Ajak looked on with pain – and appreciation.

Pulling a worm out is a weekslong process of rolling out the worm by coiling it on a pinkie-length stick, about an inch (2.5 centimeters) a day. Aside from surgery, this centuries-old extraction method is the only way the guinea worm can be removed safely.

Carter, whose center began working in Sudan in 1987, said he knows the people appreciate the work his team does.

"They know we're working for freedom and they know we're working for peace," Carter said. "And they know that we are there to end the plight of diseases that they should not still have."

___

On the web:

The Carter Center: http://www.cartercenter.org/health/guinea_worm/mini_site/index.html

Humanists Find Meaning in Christmas

John J. Dunphy

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The following article is from the Secular Humanist Bulletin, Volume 22, Number 4 (Winter 2006/2007).

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People often ask me if I, as a humanist, celebrate Christmas and, if so, why. After all, they point out, Christmas is the observance of the birth of Jesus, the Christian savior who is son of God. Don’t I, as a humanist agnostic, feel more than a bit awkward at this time of year?

They seem genuinely surprised, even astonished, when I reply that I feel perfectly comfortable joining in this annual celebration, since there was a Christmas long before there was a Christ.

Humanity has celebrated a winter solstice festival virtually since the dawn of our species. Our primitive forebears rejoiced that the menacing tide of increasingly short days and long nights had at last ceased and that the newly reborn sun would continue to grow more powerful with its promise of renewed life for all on earth. As civilization advanced, so did the nature and sophistication of winter-
solstice festivals. The Romans, for example, observed the Saturnalia celebration from December 17 to December 24.

But how, I am frequently asked, did December 25 come to be recognized as the date of Jesus’ birth? Is it clearly designated as such in the Bible? Alas, the answer is no!

Luke writes that the savior was born in Bethlehem while shepherds were “keeping watch over their flock by night.” In that area of the world, this would have occurred from mid-March to mid-November. Shepherds would never have had their flocks out during the cold midwinter.

The earliest Christians did not observe Jesus’ nativity on December 25—or any other date, for that matter. They believed that the celebration of birthdays was a decidedly pagan, secular custom.

Mithra, the Persian god of light and embodiment of the sun, was said to have been born out of a rock on December 25, and that date was recognized as an important festival in the religion of Mithraism. In the third century, the Roman Emperor Aurelian, who had embraced that religion, established December 25 as Dies Invicti Solis—the Day of the Invincible Sun—and Mithraism became the official state religion of Rome. When Christianity supplanted Mithraism in the fourth century, pragmatic Christians chose to transform the Day of the Invincible Sun into the day of the son of God’s birth, since December 25 was so firmly entrenched in the popular mind as a festival date.

Through the centuries, any number of Christian sects, uncomfortable with the pagan origins of Christmas, have sought to ban the holiday. Puritans in early America fined anyone caught celebrating Christmas, and the holiday remained forbidden in much of New England until the mid-nineteenth century. Cromwell’s England actually tried to ban Christmas from that nation by an act of Parliament.

Regardless of its non-Christian genesis, Christmas will always be exalted as the birth of the Christian savior, a truth that brings us back to the matter of why a humanist such as myself has no reservations in joining with my Christian friends to celebrate Christmas. How do I find meaning in this Christian holy day?

For me, this beautiful season is a joyous paean to life and love, a time that reminds us that, beneath the veneer of race, religion, and nationality, we are all members of a universal family. I celebrate Christmas as the victory of light over darkness, not merely the defeat of the winter darkness by the waxing sun, but the triumph every person of good will feels when our innate warmth and compassion rout our tendencies toward selfishness and malice. I celebrate Christmas as the resurgence of that sacred flame that dwells within every woman and man. I celebrate Christmas not so much as the recognition of a divine child’s birth but as the recognition of a divine essence in all of us.

Not celebrate Christmas because I am a humanist? I celebrate it because I am a humanist.

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John Dunphy is a writer and bookstore owner. His essay “A Religion for a New Age” was the basis for the Religious Right’s charge that secular humanism was invading public education. This essay was originally published in The (Alton, Illinois) Telegraph on December 24, 1995.

Published on Thursday, December 23, 2010 by YES! Magazine

10 Most Hopeful Stories of 2010

There was plenty of disappointment and hardship this year. But the year also brought opportunities for transformation.

by Sarah van Gelder

It was a tough year. The economy continued its so-called jobless recovery with Wall Street anticipating another year of record bonuses while most Americans struggle to get work and hold on to their homes. The wars in Iraq and Afghanistan continued, and spilled over into Pakistan and Yemen, and more American soldiers died by suicide than fighting in Afghanistan. And it was a year of big disasters, some of them indicators of the growing climate crisis.

World leaders, under the sway of powerful corporations and banks, have been unable to confront our most pressing challenges, and one crisis follows another.

Nonetheless, events from 2010 also contain the seeds of transformation. None of the following stories is enough on its own to change the momentum. But if we the people build and strengthen social movements, each of of these stories points to a piece of the solution.

1. Climate Crisis Response Takes a New Direction. After the failure of Copenhagen, Bolivia hosted a gathering of indigenous people, climate activists, and grassroots leaders from the global South—those left out of the UN-sponsored talks. Their solution to the climate crisis is based on a new recognition of the rights of Mother Earth. Gone are notions of trading the right to pollute (which gives a whole new meaning to the term "toxic assets"). Instead, life has rights, and we can learn ways to live a good life that doesn’t require degrading our home.

The official climate agreement that came out of Cancún was weak and disappointing, although it did represent a continued commitment to work to address the challenge. But the peoples' mobilizations, and the solutions born in Cochabamba, continue to energize thousands.

Meanwhile, Californians voted to uphold their ambitious climate law, despite millions spent by oil companies to rescind the measure in November's election. And cities—Seattle, for one—are moving ahead with their own plans to reduce, and even zero-out, their climate emissions.

2. Wikileaks Lifts the Veil. The release of secret documents by Wikileaks has lifted the veil on U.S. government actions around the world. While the insights themselves don't change anything, they do offer grist for a national dialogue on our role in the world—especially at a time when our federal budget crisis may require scaling back on our hundreds of foreign military bases, our protracted overseas wars, and our budget-busting weapons programs. Likewise, the traumas inflicted on civilian populations and on our own military are spurring fresh thinking. We now have data points for a bracing, reality-based conversation on the future of war—the kind of conversation that makes democracy a living reality.

3. Momentum is Building for the Abolition of Nuclear Weapons. The ratification of the START Treaty is an important step in the right direction. And the National Council of Churches, the U.S. Conference of Catholic Bishops, the U.S. Conference of Mayors, and others from across the political spectrum have joined UN Secretary-General Ban Ki-moon in calling for an even more ambitious goal: the end of nuclear weapons.

4. Resilience is the New Watchword. As familiar sources of security erode, people are rebuilding their communities to be green and resilient. Detroit, a city abandoned by industry and many of its former residents, now has over 1,000 community gardens, a six-block-long public market with some 250 independent vendors, and a growing support network among small businesses. Around the country, faith groups and others are forming Common Security Clubs to help members weather the recession and consider more life-sustaining economic models. Communities are becoming Transition Towns as a means to prepare for breakdowns in society that may result from any combination of the triple crises of climate change, an end to cheap fossil fuels, and an economy on the skids.

5. Health Care—Still in Play. The passage of the Obama health care package seemed to lock us into a reform package that maintains the expensive and bureaucratic role of private insurance and props up the mega-profits of the pharmaceuticals industry. But the story is not over. The decision by U.S. District Judge Henry Hudson to strike down the individual mandate in the health care reform may begin unraveling the new health care system.

As insurance premiums continue their steep climb, some are advocating expansion of Medicare to cover more people—or everyone. Thom Hartmann points out this could be done with a simple majority vote in Congress—expanding Medicare to everyone was what its founders had in mind in the first place, he says.

Vermont is exploring instituting a statewide single-payer healthcare system. The United States may wind up following Canada’s path to universal coverage, which began when the province of Saskatchewan made the switch to single-payer health care, and the rest of Canada, seeing the many benefits, followed suit.

6. Corporate Power Challenged. Small businesses are distancing themselves from the Chamber of Commerce, which promotes the interests of mega-corporations over Main Street businesses. And there are more direct confrontations to corporate power. The citizens of Pittsburgh, Penn., passed a law prohibiting natural gas “fracking,” and declaring that the rights of people and nature supersede the rights of corporations. Other towns and cities are adopting similar laws. The biggest challenge will be undoing the damage of the Citizens United decision, which opened the floodgates to wealthy special interests to spend what they like on elections. Groups around the country are gearing up to take on the issue, with a constitutional amendment just one of the potential fixes.

7. A local economy movement is taking off as it becomes clear that the corporate economy is a net drain on our well-being, the environment, communities, and even jobs. A “Move Your Money” campaign inspired thousands to close their accounts with predatory big banks, and instead, to open accounts at credit unions and locally owned banks. Schools, hospitals, local retailers, and families are increasingly demanding local food. Farmers markets are spreading. Independent, local stores have huge cachet as people look local for a sense of community. And the experience of one state with a budget surplus and very low unemployment is capturing the imagination of other states—North Dakota’s state bank is creating a buzz.

8. Cooperatives Make a Comeback. A new model for local, just, and green job creation is gaining national attention. Leaders in Cleveland, Ohio, created worker-owned cooperatives with some of the strongest, local institutions (a hospital and university) promising to be their customers. The result: formerly low-income workers now own shares in their workplace and earn family-supporting wages. They can plan for their families’ futures, knowing that their jobs can be counted on not to flee the country. The model is spreading, and people now talk about how to bring "the Cleveland model" to their cities.

9. A Turn Away from Homophobia. The revoking of Don’t Ask, Don’t Tell is just the most dramatic sign that the country has turned away from homophobia. A widespread anti-bullying campaign sparked by the suicide of Rutgers freshman Tyler Clementi led to an “It Gets Better” campaign with videos created by celebrities and others.

10. Social Movements Still Our Best Hope. Thousands gathered in Detroit in June for the second US Social Forum, an event that galvanized grassroots social movements from across the United States. In Toronto, the meeting of the G20 was greeted by thousands of protesters, many of whom were subjected to police beatings and gassing. The Cancún climate talks brought caravans of farmer/activists and global justice activists as well as greens to press for a meaningful response to the climate crisis. Social movements are alive and well, even though they are disparaged or ignored by the corporate media, which choose to instead shower attention on the well-funded Tea Party. And movement leaders are connecting the dots between Wall Street’s plunder, growing poverty, and the climate crisis, and setting priorities instead for people and the planet.

The turbulence of our lives is increasing, spurred by the crises in the economy and the environment, growing inequality and debt, military overreach, deferred peacetime investments, and species extinctions. Turbulent times are also times when rigid belief systems and institutions are shaken, and change is more possible. Not automatic, and definitely not easy, but possible. The question of our time is how we use these openings to work for a better world for all life.

Sarah van Gelder is co-founder and executive editor of YES! Magazine, a national, independent media organization that fuses powerful ideas with practical actions for a just and sustainable world. Sarah is executive editor of YES!

YES! Magazine encourages you to make free use of this article by taking these easy steps. This work is licensed under a Creative Commons License

Published on Saturday, September 26, 2009 by CommonDreams.org

Medicare for All: Yes We Can

by Holly Sklar

More Americans die of lack of health insurance than terrorism, homicide, drunk driving and HIV combined.

Grandma could be dead from lack of health insurance before she turns 65 and gets Medicare - 80 percent of first-time grandparents are in their 40s and 50s.

America is the only country that rations the right to health care to those 65 and older.

Lack of health insurance kills 45,000 American adults a year, according to a new study published in the American Journal of Public Health. One out of three Americans under age 65 had no private or public health insurance for some or all of 2007-2008.

You can't go the emergency room for the screening that will catch cancer or heart disease early, or ongoing treatment to manage chronic kidney disease or asthma. And even emergency care is different for the insured and uninsured. Studies show uninsured car crash victims receive less care in the hospital, for example.

Even with health insurance, many Americans are a medical crisis away from bankruptcy. Research shows 62 percent of all bankruptcies in 2007 were medical, a share up 50 percent since 2001. Most of the medically bankrupt had health insurance - the kind insuring profits, not health care.

Health insurance executives don't worry about going bankrupt from getting sick. Forbes reports that CIGNA's CEO made $121 million in the last five years and Humana's CEO made $57 million.

We're harmed by health industry and political leaders following the Hypocritic Oath: Promise a lot, and deliver as little as possible.

Wendell Potter, CIGNA's chief of corporate communications until quitting in 2008, testified to Congress, "The status quo for most Americans is that health insurance bureaucrats stand between them and their doctors right now, and maximizing profit is the mandate." He said, "Every time you hear about the shortcomings of what they call 'government-run' health care, remember this: what we have now ... and what the insurers are determined to keep in place, is Wall Street-run health care."

Premiums for employer-sponsored family health insurance jumped 131 percent between 1999 and 2009 - from $5,791 to $13,375 - hurting businesses, employees and families.

Contrary to myth, the United States does not have the world's best health care. We're No. 1 in health care spending, but No. 50 in life expectancy, just before Albania, according to the CIA World Factbook. In Japan, people live four years longer than Americans. Canadians live three years longer. Forty-three countries have better infant mortality rates.

One or two health insurance companies dominate most metropolitan areas in the United States.

Health industry lobbyists and campaign contributors have gotten between you and your congressperson so they can keep getting between you and your doctor. There are 3,098 health sector lobbyists swarming Capitol Hill - nearly six for every member of Congress.

As Business Week put it in August, "Health insurers are winning." They "have succeeded in redefining the terms of the reform debate to such a degree that no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable."

President Obama should listen to his doctor. Dr. David Scheiner was Obama's doctor for 22 years in Chicago. On the July 30 anniversary of Medicare, Scheiner said, "I have never encountered an instance where Medicare has prevented proper medical care ... Insurance companies frequently interfere and block appropriate care."

Scheiner belongs to Physicians for a National Health Program, which, like a majority of Americans, favors Medicare for All - 58 percent favored "Having a national health plan in which all Americans would get their insurance through an expanded, universal form of Medicare-for-all" in the July 2009 Kaiser Health Tracking Poll, for example.

Tell President Obama and Congress, Yes we can have Medicare for All. Rep. Anthony Weiner's amendment would substitute the text of the Expanded and Improved Medicare for All Act (HR 676), which has 86 co-sponsors, for House legislation HR 3200. Like the even worse Baucus bill in the Senate, HR 3200 would feed for-profit insurers more customers without providing the universal health care Medicare could provide at much lower cost.

It's time to stop peddling health reform snake oil.

Medicare for All won't kill Grandma, but it may save her children and grandchildren.

Distributed by McClatchy-Tribune News Service

© 2009 Holly Sklar

Holly Sklar is co-author of "Raise the Floor: Wages and Policies That Work for All of Us" and "A Just Minimum Wage: Good for Workers, Business and Our Future." She can be reached at hsklar@aol.com.

Single-payer Everywhere! To members of Progressive Democrats of America

Conor Boylan September 2 at 12:20am Reply

Leaders in the movement for the only real solution for health care reform—Medicare for All—met in the Medina, Ohio, at the home of PDA member, supporter, and always gracious host, Dave Kelley for strategy sessions and a panel discussion on August 23-24.

Joining members of the PDA national team at the weekend gathering were Rep. Dennis Kucinich, community organizer and legislative advocate Donna Smith of the California Nurses Association, Healthcare-Now’s assistant national coordinator and “Baucus 8” arrestee Katie Robbins, and the tireless executive director of HealthCare4AllPA, Chuck Pennacchio. Dozens of members of Single-Payer Action Network of Ohio (SPAN Ohio) also attended the weekend events, along with Midwest PDA leadership, to organize future plans. Read the full report here

http://pdamerica.org/articles/chapters/oh-2009-08-27-11-21-59-chapters.php

Watch Dennis Kucinich speak http://www.youtube.com/watch?v=kVHNz03qQp8#, and check out some photos from the eventhttp://www.flickr.com/photos/pdamerica/sets/72157622131060114/

And, there are more events coming up in which PDA national team members will be particpating--please try to attend:

On September 12, Tim Carpenter will be a panelist at the Fighting Bob Fest VIII. https://www.thedatabank.com/dpg/309/mtgdetail.asp?formid=meet&caleventid=15426

On October 20, join us at the Single-Payer Rally in Harrisburg, Penn.https://www.thedatabank.com/dpg/309/personalopt1.asp?formid=meet&c=9799962

Keep an eye out for the Mad as Hell Doctors Care-a-Van coming to a city near you. https://madashelldoctorstour.com/Our_Route.html

We're in constant communication with our friends at California Nurses Association, Healthcare NOW!, Physicians for a National Health Program and the member groups of the Leadership Conference on Guaranteed Healthcare as we follow the healthcare reform debate, and the progress of the Kucinich and Weiner amendments. We'll keep you informed!

In solidarity,

Tim Carpenter, National Director,

Laura Bonham, Deputy Director,

Conor Boylan, Field Coordinator.

Published on Wednesday, August 26, 2009 by YES! Magazine

Upgrading the Way We Do Politics

by Sandy Heierbacher

Town hall meetings being held on health care legislation across the country are exploding with emotion, frustration, and conflict. Citizens are showing up in throngs to speak out, and sometimes to shout, about health care—turning the meetings into a vivid demonstration of what's missing from American democracy.

Many of the most vocal protesters at town hall meetings are motivated not by the legislation itself, but by their fears and sense of exclusion from the process. The health care debate has illustrated the need for a better method of public input–not only to help prevent those feelings of alienation, but also to produce legislation that actually meets the needs of citizens.

At the National Coalition for Dialogue and Deliberation (NCDD), our members are involved in a flurry of discussion about how we can encourage public engagement that’s more participatory and more productive than what we’ve seen in the news lately.

Scrap the typical “town hall meeting” format

"The term 'town hall' conjures up images of townsfolk gathering in some New England hamlet, writes deliberative democracy scholar Jim Fishkin. But today's typical "town hall meetings" don't live up to that tradition. They don't allow citizens to feel they've been truly heard, or to discuss issues in any depth. Like public hearings, town hall meetings tend to largely be gripe sessions, where the most passionate and bold attendees take turns giving three-minute speeches—usually after enduring long speeches from the front of the room.

Arkansas Senator Blanche Lincoln, one of the members of Congress who did not plan a large town hall meeting during the recess, has suggested that the raucous nature of the town-hall-style sessions has made them counterproductive. “If people genuinely wanted to have a constructive conversation, then that would be a different thing,” she said. “But that has not been what we’ve seen.”

She's right on one count: the town hall design sets the stage for activist groups and special interest groups to try to 'game' the system and sideline other concerned citizens in the process. As Martin Carcasson, director of Colorado State University’s Center for Public Deliberation, recently pointed out, “the loudest voices are the ones that get heard, and typically the majority voices in the middle don't even show up because it becomes a shouting match.”

False accusations and misinformation have certainly played a role in fueling the furor, but they might not be as effective if people hadn’t already felt cut off from the process. As Tom Atlee, founder of the Co-Intelligence Institute noted, many of the recent town meetings were originally organized to promote the Democratic health care agenda, not to provide opportunities for real dialogue with and among citizens. “So in a sense they invited disruption from those who felt unheard,” he said. And when a person or group feels ignored, their frustration often shows up later “with increasing and often dysfunctional energy.”

Upgrade to higher-quality meeting formats

So how can officials hold more effective open-to-the-public meetings with their constituents? Dozens of effective public engagement techniques have been developed to enable citizens to have authentic, civil, productive discussions at public meetings—even on highly contentious issues. These techniques have names like National Issues Forums, Study Circles, 21st Century Town Meetings, Open Space Technology, and World Cafe, to name just a few.

When done well, these techniques create the space for real dialogue, so everyone who shows up can tell their story and share their perspective on the topic at hand. Dialogue builds trust and enables people to be open to listening to perspectives that are very different from their own. Deliberation is often key to public engagement work as well, enabling people to discuss the consequences, costs, and trade-offs of various policy options, and to work through the emotions that tough public decisions raise.

Skilled facilitation is key to almost all forms of dialogue and deliberation. Alexander Moll, who is facilitating a health care deliberation using the National Issues Forums method in Washington, D.C. later this month, describes his role this way: “My job is to elicit the best ideas from each of you, regardless of ideology... I do not ask 'leading' or 'loaded' questions that bias the conversations; instead I'll ask questions like, 'Why do you believe this to be true?' or 'Can you explain your position further?’” Skilled facilitators know how to translate conflict and anger into specific interests, needs and concerns so that what's behind the emotion can actually be understood and addressed.

“Ground rules” or “agreements” are also par for the course in dialogue and deliberation. Typical agreements establish a kind of golden rule for everyone present, asking people to treat each other as they would want to be treated. By refraining from interrupting each other and by listening with the intent to understand rather than to seek points to argue with (two typical ground rules), participants are more likely to be heard and to hear each other.

To involve a broader representation of the public, events should be publicized widely and thoughtfully enough so a variety of people attend (not just the usual suspects). Furthermore, it’s helpful to organize participants into smaller groups (fewer than 10 at a table is ideal) to ensure each person gets the chance to speak and to make it less likely that one individual or interest group will dominate the whole meeting.

No matter what technique is used, legislators can help all attendees feel heard by diligently recording what citizens say, and being clear about how they plan to use the information gathered (perhaps to share with other constituents or with fellow legislators). Another proven strategy is to “reflect back” the concerns, values, and desires they are hearing. Ideally, public officials join in the dialogue as participants, after which they can publicly reflect on some of the things they've heard. The more thorough and authentic they are in doing this, the more impact it will have on those attending.

Reflecting back, using ground rules, working with facilitators, and having people engage with each other in small groups are all basic but critical elements of quality public engagement. To allow people to deliberate, or wrestle with the complexities of the issue, some important work must also be completed before the public meeting. Balanced information must be provided about the issue at hand, and a fairly-framed spectrum of possible policy choices can be put on the table for attendees to discuss.

Perhaps most importantly, the legislator hosting the meeting must genuinely be open to learning from what his or her constituents think should be done to address the issue at hand. One major barrier to putting these ideas to play right now is that public input should be requested—and heeded—much earlier in the policy-making process. Now that there are draft bills floating around, citizens (rightly) would not trust that their nuanced input would have much impact on what happens in Washington. At this point in the policy process, loud voices and outrageous accusations actually are more likely to impact health care policy—but not necessarily in a productive way.

Atlee observed that “when people are only invited to participate when there is a final battle between (for example) Republican and Democratic proposals for health care, this fact alone invites polarization. When an issue is in crisis mode, it is easier to manipulate people with fear and extreme language and imagery; there is less time to get information and issues clarified; there is less patience on all sides to delve into the actual complexities; and nonpartisans get the sense they are being sold false alternatives.”

One NCDD member recommended asking two legislators from different parties to co-host deliberative events on contentious issues like health care reform. Many citizens on the right distrust politicians on the left—and vice versa. A joint deliberative forum held early in the decision-making process can help build trust beyond party lines, and help legislators get a sense of what their constituents are willing and unwilling to support, and why.

It is also vital to find ways for attendees to wrestle with the trade-offs inherent in all complex policy issues. As President Obama said at a town hall meeting in Grand Junction, Colorado, “there is no perfect, painless silver bullet out there that solves every problem, gives everybody perfect health care for free. There isn't.” Americans need to discuss the trade-offs involved (in the proposals as well as the current system) with each other and with policy-makers, to clarify the values that are embodied in different approaches to health care reform, and to identify the needs that are most important to them. Legislators need to trust us enough to listen.

Most Americans feel strongly that the voice of the people should have an influence on public policy and that the right to speak up and dissent is anything but “un-American.” A recent joint statement by several leading organizations in the field of participatory democracy noted that “beyond simply having a voice, people should have a chance to be informed, to hear each other, to work through tough decisions with each other and their elected officials, and to use democratic processes to figure out how to solve the problems that face us.”

Though it may not seem like it when we watch clips from health care town halls, the truth is that people can come together to have a positive impact on national policy, not only in spite of our differences, but because we can use those differences to make better decisions. It is my hope that what may have seemed like a utopian ideal a few weeks ago—democratic debate in which the people are informed and involved from the beginning—may now seem like a necessary but long-overdue upgrade in the way we do politics.

Sandy Heierbacher wrote this article for YES! Magazine. Sandy is the co-founder and director of the National Coalition for Dialogue & Deliberation (NCDD), a network of 1200 groups and professionals who bring together Americans of all stripes to discuss, decide and act together on today's toughest issues.

This work is licensed under a Creative Commons License

Campaign for America's Future

Making It In America

By Robert Borosage

Washington's special genius is for gridlock. As we're seeing in the health care debate, the entire system is designed to frustrate action — even when Democrats have a popular president, 60 votes in the Senate and a large majority in the House. Moneyed interests trump party loyalty. Partisan politics trumps national purpose. Congressional rules and egos favor dithering and delay.

So on health care, Republicans have lurched into partisan opposition, hoping that obstructing change will lead to Obama's "Waterloo," and they can replay 1994 and take back the Congress. Blue dog Democrats remain lap dogs for special interests, blind to the fury that they will face if reform fails.

But at least on health care, the administration is leading the charge. We haven't even begun an adult conversation about the fundamental question of America's global economic strategy. What is the economy we will build out of the ashes of the old?

Obama has raised the subject. He understands that we can't go back to the old economy — and shouldn't want to. We can't go back to borrowing $2 billion a day, largely from the Chinese, to serve as consumer to the world. We can't go back to an economy in which finance captures 45% of the nation's profits. We can't keep shipping good jobs, technology, and manufacturing capacity abroad and expect to sustain a broad middle class at home. We've got to start making it in America again. As Obama has declared, "The fight for American manufacturing is the fight for America's future."

As Louis Uchitelle in the New York Times reports, the United States now ranks behind every industrial nation except France in the percentage of overall economic activity devoted to manufacturing. We've been shedding manufacturing jobs for years, and the recession has been brutal, with nearly two million industrial jobs disappearing since it began.

But we haven't even begun a serious conversation about what it would take to revive manufacturing in a global economy. The president's trade representative, Ron Kirk, seems clueless, intent on passing free trade agreements with Panama, Columbia and South Korea that are but tribute to the old unsustainable ways. The president calls sensibly for investment in education and training, in 21st century infrastructure, in research and development — but his budgets project reducing domestic expenditures to levels lower as a percentage of GDP than the early 1960s. And conservatives in both parties say that isn't low enough.

Obama has suggested that America must lead in the green industries that surely will grow in the future — new energy, more efficient appliances, more sophisticated building efficiencies — and the supply chains associated with windmills, solar cells, batteries, fast trains, electric cars and more. Yet, Obama opposed the weak "buy America" provision put into the stimulus bill. His energy bill contained no serious effort at insuring that these products would be built here. Amendments designed to help manufacturers here were introduced into the bill in the dead of night because the administration needed the votes of industrial state Democrats to pass it. And because Ohio Senator Sherrod Brown and the Apollo Alliance had put together elements of a new energy industrial policy that House members could elbow into the legislation.

Contrast that with China. China has determined that new energy will be one of its strategic industries. It is now the largest manufacturer of solar panels — exporting 95% of its production, largely to Europe and the US.

While Obama felt it necessary to distance himself from the "buy America" provisions put in the stimulus bill, China has no such compunctions. As the Times reports, "when China authorized its first solar power plant this spring, it required that at least 80 percent of the equipment be made in China. When the Chinese government took bids this spring for 25 large contracts to supply wind turbines, every contract was won by one of seven domestic companies. All six multinationals that submitted bids were disqualified on various technical grounds, like not providing sufficiently detailed data."

The European companies weren't exactly foreigners. They had built turbine factories in China to meet the government's requirement that the turbines contain 70 percent local content. But having no doubt benefited from that transfer of technology and engineering experience, the Chinese contracted with home—grown companies, rejecting the bids of the Chinese based European companies while approving those of Chinese companies that had never built a turbine before. European wind turbine makers have now stopped bidding on Chinese contracts, concluding that their bids had no chance.

China is intent on dominating the new energy markets of the future. If its past practices are any indication, it will subsidize exports, manipulate its currency, buy China at home, force multinationals to transfer technology and partner with Chinese companies, and engage in industrial piracy to make its way.

If the US wants new energy to be the centerpiece of a new economy in which — in the president's words — the US "consumes less and produces more," then it will have to have an industrial strategy. It doesn't have to mimic the Chinese, but it has to respond to them, rather than invoking old shibboleths about "free trade," and ignoring the reality of the world marketplace.

A new book issued by the Alliance for American Manufacturing with the ungainly title of Manufacturing for a Better Future for America shows how China is not alone, detailing the practices that our trading partners use to sustain their industrial capacity and export markets.

A new global strategy is essential. But getting there won't be easy. Just as the insurance companies impede sensible reforms in health care, and big oil and coal block vital changes in energy, and Wall Street guts vital reform of finance, global corporations and banks will spend a lot of money to defend the unsustainable trade policies of the old economy.

This can lead to cynical resignation or to fury. But one thing is clear. Little will get done until Americans show politicians that while the lobbies can pay for their campaigns and provide employment in retirement, they can't defend them against the justified anger of a citizenry no longer willing to put up with gridlock.