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Hosted by Princeton Theological Seminary President Jonathan Lee Walton, Expanding the Table gathers leading voices in history, theology, and public life to explore questions of faith, leadership, and justice.
Jonathan Lee Walton | 00:06
Welcome to Expanding the Table. A Princeton Seminary series from the Office of the President. I'm Jonathan Lee Walton, the 8th president of the seminary. And at this table, we gather leading voices in history, theology, and public life. And here we explore questions of faith, leadership, and justice. Today's guest is a Harvey V. Feinberg professor of the practice of public health leadership at the Chan School of Public Health at Harvard University. Dr. Howard Koh is a physician and public health leader He has served as the U.S. Assistant Secretary for Health and Human Services for the Obama Administration. As well as Commissioner of Public Health for the Commonwealth of Massachusetts. His work has advanced national conversations on health equity, prevention, and community well-being. And his recent scholarship, highlights spirituality. As a critical determinant of public health. Dr. Cole. My dear old friend, it is so great to have you with us here today.
Howard Koh | 01:17
Reverend, thanks for having me. It's great to be here.
Jonathan Lee Walton | 01:19
Listen, I figured we would just get started by... I'd love for you to share a little bit about your own kind of spiritual life and how that ultimately informs the work you do at the Chan School of Public Health.
Howard Koh | 01:35
Thank you, Reverend. Well, you're looking at a very lucky guy. And when I look back on my career as a physician, Everything that's happened to me was not planned. When you Go to college and dream of being a doctor someday and you have it all. Planned out about what you're gonna do to become quote unquote successful? Going into public health, being a government official, none of that was even on my radar.
So now I'm looking back. Being the state public health commissioner in Massachusetts under four governors, if I can say, through the 9-11 and anthrax crisis, which was... Incredible life experience of being the Assistant Secretary for Health and the Obama Administration through the passage of the Affordable Care Act and the last pandemic, H1N1. And now, Delving into this fascinating and critical intersection of health and spirituality, in discussions like this. Look back and say, was answering a call. This was a call, and the work in public health is very much a vocation, not only for me, but thousands of other colleagues that I've met along the way.
So I think the intersection between faith and health and spirituality is so critical and to talk about it here is very much the definition of expanding the table so thank you for having.
Jonathan Lee Walton | 02:52
Me. And listen I know because I know you that when you're talking about spirituality and faith this isn't just an academic exercise for you right this is just not clinical research this is deeply personal based upon your own kind of spiritual development and faith commitments.
Howard Koh | 03:12
Very personal so a lot of this depends as it is for all of us in childhood. My parents were immigrants to this country from Korea, Searching for the American dream. If I can say, even in tough times like this, Reverend, the American dream is alive and well. And when you're part of an immigrant family, you don't take anything for granted the society. And I'll never forget, even as a young child, my parents, particularly my beloved late father, lecturing to us saying, "You know, we've sacrificed to come here. Life has meaning and purpose, and you're going to study hard and then become somebody and make a contribution to society?" So these themes of meaning and purpose and commitment to a sense of mission were themes I heard about ever since I was a kid. In hindsight, Jonathan, that was the beginning of my spiritual journey.
And then I had the incredible privilege of going to Yale College and Yale Medical School at a time when Yale Chaplain Reverend William Sloan Coffin was there. And Bill changed my life And here I am, a pre-med student, studying really hard, trying to do well so I could get into a good medical school and learning all these things about microbiology and cell cycles.
Jonathan Lee Walton | 04:17
Because... The legendary William Sloan Coffin.
Howard Koh | 04:33
All of that's very important, of course. But when I went to Battelle Chapel on Sunday mornings, Reverend Coffin was thinking about the big picture, about what do we do for humanity? Others in our society, particularly the underserved. How can we make a contribution during our time on Earth, particularly as healers and as medical professionals. He used to Push us and tease us. At Yale. And I can say, since I'm at another Ivy League school, he would... He would really say to us students, "You know, all you guys do is try to study and compete and beat each other out in the rat race, but when you win the rat race, "You're still a rat." Which is the ultimate spiritual question, okay? Which is why, when you're running the rat race and trying to compete, What does it all really mean? In the long run. The spiritual questions for me came All the way back then when I was hearing Reverend Coffin speak. He went on to become one of the big mentors of my life. And a big reason I'm sitting here with you, Reverend, is Because of him, I got to think about the big picture, think about meaning and purpose on the journey that involved in the research apply this to my public service And now be working with colleagues like you.
So it's a gift. It's a.
Jonathan Lee Walton | 05:59
Gift. It's a real gift to have you here with us. As you move from medicine to public health leadership, how did that inform and begin to inform your view of faith as it relates to medicine? Public health and overall well-being.
Howard Koh | 06:17
So, Jonathan, you're looking at a guy who went to medical school and started training determined to be the best cancer doctor in the world. I was going to cure every patient put before me because I worked so hard and was so knowledgeable and cared so much. But at a very young age as a young physician, I learned that All that knowledge and all that studying was not enough. My patients were suffering and dying way too early. Because of completely preventable reasons. One of the reasons For me, that was...
So overwhelming to witness was tobacco addiction and drug use. And so that started actually a lifelong journey in tobacco control work. We had a tobacco tax campaign in our state of Massachusetts some 30 years ago, led by the American Cancer Society. I got very involved in that. And Jonathan, it was a great conversation. Way to channel my frustration as a clinician because I just saw too many people under my watch die way too early, And they didn't get to appreciate the gift of health.
You know, there's an incredible saying by the World Health Organization, that the highest attainable standard of health is one of the fundamental rights of every human being. And I find that a spiritual statement. Because as Reverend Coffin used to say, The glory of God is a human being Bully. Alive. You ever hear this booming voice? Yes.
So when we all get to appreciate the gift of health and live it to its fullest. And that's not just physical health, but Mental health. Spiritual health If you get to live that gift fully, then you are fully alive, and that's what spirituality and faith is all about.
So all those themes came forward for me as I got involved in this tobacco tax campaign. That was my beginning of public health work and running press conferences to talk about the importance of tobacco control in public health?
And then just by sheer Serendipity, I guess, the governor of Massachusetts, who I did not know. Noticed me and plucked me out and appointed me the state health commissioner. This is back in 1997 now.
So he changed my life. And it was one example of these unbelievable moments that you cannot plan. Where something happens, in this case, I'M GOING TO TALK ABOUT THE change the course of my career. For good And got me on the path of a bigger, broader way of looking at health through government service.
So that's why I'm.
Jonathan Lee Walton | 08:58
Here. So when I hear you talk about the fullness of life, I think of so many researchers and public health officials have talked about leading causes of death. I think of our dear friend Gary Gunderson and his phrase, the leading causes of life. Absolutely. Life and human flourishing. Absolutely. And so for you now, what's been the connection and some of your research findings as it relates to spirituality? Being a leading cause of life.
Howard Koh | 09:30
Yeah, beautiful. Yeah, we talk so much in medicine about the leading causes of death. That's really important.
Yeah. But when you wake up in the morning, every person thinks about How's my day going to be? How is my family? Am I leading? The life I'm supposed to be living Does my life have meaning and purpose? Do I have connection to the people I love and to my community? Those are the things that people think about. Now, when you go see your doctor, they're checking things like, you know, your blood pressure is normal. That's great. But that's not a leading cause of life. It's absence of disease or infirmity, as the World Health Organization would say.
So we're trying to switch more to an assets-based approach. - Asset space. - Asset space, human assets, faith assets, Reverend Gunderson, who I admire so much, has really changed that vocabulary, which we should all adopt. And so Drilling down on this conversation really helps in terms of Patient care, for example, But when a patient comes into a doctor's office, that patient wants to have their spiritual lives respected by their clinicians and by their providers. They want to be viewed as a whole human being, not just as this organ part or another organ system, for example.
Some of the frustration, a lot of the frustration with the health system right now is that people don't feel like they're being viewed as whole human beings by their doctors and health providers. So this Intersection is critically important.
And then Jonathan, you have alluded to the fact that I've been very lucky now since coming back from Washington to join a group called the Harvard Initiative on Health, Spirituality, and Religion. Some key members of that group, Drs. Tracy and Michael Balboni. Dr. Tyler VanderWiel. And so our group has now published several, a number of major publications showing that spirituality is associated with very important positive outcomes You mentioned some of them. It's Very good.
Jonathan Lee Walton | 11:46
Been designated as a social determinant of health.
Howard Koh | 11:50
Yeah, it is a determinant. It is a determinant of health.
Jonathan Lee Walton | 11:52
Faith. Participation or spirituality, belonging to a community of.
Howard Koh | 11:59
Faith. Absolutely, yeah. And you know why this... Intersects so beautifully now is over the last decade or so, Everybody in medicine now understands the so-called social determinants of health. Which can be defined in many ways.
Jonathan Lee Walton | 12:13
But... Education, social determinants of health, education, housing, food. Help me out. I'm a theologian. I'm hitting my limits.
Yeah, part.
Howard Koh | 12:24
Well, the spiritual Yeah, and...
Jonathan Lee Walton | 12:26
And now spirituality.
Howard Koh | 12:29
So I like to say. That health doesn't start in a doctor's office, health starts where people live, labor, learn, play, and pray.
Jonathan Lee Walton | 12:40
Live, labor, learn.
Howard Koh | 12:43
Live, labor, But the prey part is very important because The spiritual part of who we are is essential To health.
Jonathan Lee Walton | 12:44
Learn, play, and pray. Play and pray. I love that. I made that up, so I'm very proud of it. I love that. I love that.
Howard Koh | 12:59
And for whatever reason, we just don't talk about it. And in medical schools and public health schools where I teach, Talking about your faith and the why, and what gives you ultimate meaning and purpose, somehow we don't talk about that when we do our studies. We talk about what we're doing, how we're doing it, but not necessarily why we're doing it, which is out. Why your efforts here at Princeton Theological Seminary, Reverend, are so important.
Jonathan Lee Walton | 13:28
So, Dr. Cote, give us a little bit of insight into the history of this.
I mean, when we think about faith-based hospital systems, right? I mean, when we think about the history of hospital systems and care, right? They were tied to... Faith traditions, denominations, churches. - Excellent point.
Somewhere along the lines, it seems that there was a rupture. And so we know what we've been doing here on the theological side, right? But as a medical professional, I mean, what were some of the... Reasons or rationale for kind of excising or undercutting any kind of faith commitments. Well there.
Howard Koh | 14:10
Was a transformation in our society which I think in hindsight was not a positive one where these sectors and silos got created and medicine and public health was all supposed to be about rational decision-making and evidence, which is all critically important, of course, But the body and soul somehow got disconnected here. Because of the work we're doing at our initiative at Harvard because of the work you're doing here. We're trying to bridge that disconnect between body and soul because We're all spiritual human beings. And You know, we have our... Physical health issues and we have our emotional health issues. But fundamentally, it's the spiritual underpinnings of who we are that make us who we are, right? I.
Jonathan Lee Walton | 14:59
Remember seeing – to that point, I remember seeing a – I think it was a study that the Cancer Institute did that they said three-quarters of people who receive – negative news from a doctor do not distinguish between the physical and the spiritual.
Howard Koh | 15:18
Yeah, sure.
Jonathan Lee Walton | 15:20
And this study was done in New England. Nobody necessarily thinks about New England as a kind of a hot house of religious piety.
So I could imagine the other parts of the country that probably the rates are even higher than 75% in terms of people who do not distinguish. And I guess to your earlier point, that's why people are looking for more integration from their healthcare providers.
Howard Koh | 15:47
Absolutely. Yeah. And we all know that At times of serious illness, that's when people really become very overt. About thinking about their faith and asking for help from chaplains or others in their lives that give them spiritual support.
So that's a window that everybody appreciates. Palliative care, for example, that spiritual support is hugely important. I think that's great, but why aren't we talking about throughout the lifespan through health and illness.
Jonathan Lee Walton | 16:17
Not just at the end of life.
Howard Koh | 16:19
Exactly. And that's what public health is all about. We should be talking about this every day. And because it gives meaning and purpose to all of us.
And then Reverend allows connections to be built like this. I love your... Expanding the table. Title because we need everybody around that table to talk about how Health starts where people live, labor, learn, play, and pray.
So that's what we're doing today.
Jonathan Lee Walton | 16:46
Live, labor, learn, play, and pray. So I'm learning. We're learning now. Our listeners are learning. New things about the field of public health, right? Particularly how spirituality is a social determinant of health.
Howard Koh | 17:03
What are.
Jonathan Lee Walton | 17:04
If you might address what are other some misconceptions? About the field of public health, right? That maybe communities of faith need to get beyond so that we could actually really expand the table and have more conversations like this in our communities of.
Howard Koh | 17:20
Faith. Public health, despite The incredible challenges of COVID. People still don't quite know what public health is. And what public health does is to protect The gift of health for all of us 24/7. And extend our lifespan but our health span. One misconception is that you have to be a doctor or have medical training to be in this field. That's absolutely not true. And I can say that as a doctor and a former clinician. The more I do this work, the more we have interdisciplinary partners, non-traditional partners, The faith-based partnership is essential, and the more we do it, we can bring more people around the table. And expand what public health is all about. Another major group in our society that we're trying to bring more strongly into the conversation is the business world. If private business can be involved in that, and they got devastated through COVID, of course.
So You can't do anything unless you're healthy. And Health is defined in the broadest possible sense, a state of complete physical, mental, and social well-being, spiritual well-being, and not merely the absence of disease or infirmity. And that's what the WHO has said.
Jonathan Lee Walton | 18:38
We'd love to hear some examples. Of what it looks like. You said you need faith communities involved in this work, right? Faith community, faith leaders could be involved in public health. I wonder what that looks like. Do you have any examples or concrete examples of some robust, healthy partnerships that have been formed? -.
Howard Koh | 18:57
Absolutely. Interesting. Grew when I was assistant secretary for health in the Obama administration at the Department of Health and Human Services, HHS. And when I got there, I was stunned to learn that under President George W. Bush, a office of faith-based partnerships was established not only at the White House, but at every federal agency.
So our department of HHS, Health and Human Services, had a little office of faith-based partnerships. So that means whenever any faith-based group came through Washington to work with us on issues like health insurance, the Affordable Care Act, vaccinations, cancer screening, I was usually trotted out. To welcome them, to talk about how important these partnerships were. They did it so often, Came up with an opening standard line, which is, you may think I'm a doctor, but I'm actually a frustrated minister. I've know, our friend Reverend Gunderson, who you've already met, has done work in Memphis, Tennessee, and joining faith-based groups.
Jonathan Lee Walton | 19:56
Heard you say that before. You know, we have your application material. And, you.
Howard Koh | 20:11
Groups and when their parishioners are admitted to the hospital, tracking them through the hospital, making sure their spiritual needs are supported, getting people onto health insurance, Medicaid through outreach, through faith-based groups. He and his colleagues think the two fields, faith and health, are so critically important. He puts them together in one word. - Faith Health. - Faith Health. - Faith Health, that's what he calls it. The thrill of doing this work is you get to meet colleagues like you and Reverend Gunderson and others who are thinking about health in the broadest sense and saying, I can contribute. I may not have gone to medical school or public health school, that's In fact, it's more important to have somebody who cares deeply about making their communities healthier. - The country's healthier, the world's healthier, have as broad a vision as possible. And I think that's what you're trying to do with podcasts like this, Jonathan.
Jonathan Lee Walton | 21:04
Exactly. I mean, when we talk about going back to, I mean, or tying to the social determinants of health and faith being a social determinant of health and some of these healthy, robust partnerships, I mean, some of the evidence that you've been able to identify at the Harvard Flourishing Project, I think it If I'm right, it has to do with being a part of a community and the kind of interconnected nature. It helps with your, in terms of people taking medicine, having regular schedule, knowing that there you have transportation, all of these effects of just being part of a kind of a robust community that already engages in volunteerism at higher levels.
Howard Koh | 21:50
You know, it's fascinating to track the history of the leading causes of life. In the midst of writing something with Reverend Gunderson on this. Let's see if we can get this out and publish soon. But you know, over the last several decades there's been more interest in happiness and positive psychology and psychological well-being. Now colleagues like Dr. Martin Seligman and my wonderful colleague, Dr. Tyler VanderWiel, are talking more about flourishing. Dr. VanderWiel has a so-called flourishing index where you can grade yourself on a scale about not just your physical and mental well-being, but sense of meaning and purpose in life, whether you feel a sense of mission in your life, whether you have social connections and social coherence. All those things weave together to form support of the flourishing aspect of who you are. And when you do, You are then. Fully alive.
So he's tracking this now in some 22 countries. And Jonathan, this is really important after COVID, where everybody is struggling to find a new normal after COVID, even now. And the social bonds have been really... Fragmented, as you well know, and we do a lot of work online now, and the human connection, which has never been easier to make, is getting even tougher.
Jonathan Lee Walton | 23:17
So they described the anti-social century.
Howard Koh | 23:19
It's been called. Yeah, it's tough.
So that's why these conversations are so important. If I could say, in a time of tremendous polarization in our country, which is so difficult to watch, if you share your sense of meaning and purpose and your why... At the very beginning in an authentic way, You can perhaps connect to somebody who may not share your political beliefs, you know, and say, okay, well, we may not agree on everything, but I'm going to respect who you are and why you think you're on this earth and what you're trying to do. And those are all sacred conversations.
Jonathan Lee Walton | 23:54
- I have a friend, they are friends, they are restaurant owners in New Orleans. And before the pandemic, 0% of their business. Was take out. Whether through DoorDash, Uber Eats. Now it's over 50%. Of their business, where even the bar and the restaurant has now become a kind of to-go staging area. That's, we know, evidence and symptomatic of the kind of fracturing of society.
So you named you know, this kind of antisocial tendencies that are not just what I think it's Albert Camus said, it's not what a pandemic does to a society, it's what it reveals about a society. Boy, that's powerful. And just kind of, it hastened some trends. And so we see that in kind of antisocial fracturing, alienation. We see it in, as you named, hyper partisanship and political polarization.
So these are all the things that we're fighting against. I was wondering if you could tell us. What should we be fighting for in your view as a professional? What does a healthy society look.
Howard Koh | 25:19
Like? Well, I hope we have a future healthy society where we're talking about health more broadly than we have before. Most of the conversations about health are really focused on our physical health, which is fine.- More now on our emotional well-being, which is really important. But I think we've got to go further, which is our spiritual well-being, which involves not only ourselves, but our families, our loved ones, our communities, our country, the world. And that gets down to the question of ultimate meaning and purpose, that's the key phrase in the definition of spirituality that we often use, that was pioneered by my colleague, Dr. Christina Puhowski from George Washington University. If we share that and say, okay, we only have a limited time on this earth, We have a journey. That we are trying to navigate. We are trying to find our calling. And if you do, you can be more fully alive and feel like this is what you are meant to do. All of us raise kids and grandkids and a lot of them struggle along the way.
You know, I'm not sure I'm doing exactly what I'm supposed to do it. I don't feel really fulfilled. If you can help. Them reach a better state of understanding about what their calling is and what gives them a sense of meaning and fulfillment, that's gonna make our society healthier, in my view.
And then if you share that with people who may not agree with you politically, You know, you may not. Go forward politically aligned, but at least you can respect them for their fundamental roots of faith. And so that's, I think that's what we're trying to do through this initiative, both in terms of research and education and outreach.
Jonathan Lee Walton | 27:01
I think it was Emerson that said the two most important days in one's life was the day one is born, the day one identifies the reason why they were born. I love that. It's this meaning and purpose, finding one's sense of call, the sense that God's call on one's.
Howard Koh | 27:18
Life. I love that. And to end at the beginning, I mean, I didn't discover public health until I was in my mid-40s when I got appointed by the state health commissioner. And all along the way, I was doing what all my medical mentors told me I should do. You should go into academic research and you should focus on one small area, which I did. Get promoted, which I did. But there was something missing along the way. I was really getting restless, you know, and I'd say to my wife, is that why I've studied like this for all these years? And so I could keep giving the same talk over and over again about the same subjects, you know. And just as I was getting really restless... The governor appointed me state health commissioner and it's changed my life. And so this has been going from something very narrow to incredibly broad, which I love, which this is who I am.
And then to make new colleagues like you and faith-based leaders, it's so thrilling. And it's so exciting. It's expanding the table at its very best.
So I think that's about it. Make our society healthier if we all reached out and tried to extend ourselves and learn a little bit more from people outside of our worlds of expertise.
Jonathan Lee Walton | 28:31
Well, you described yourself as a frustrated minister, and I can speak on behalf of all of us who've answered this glorious call that God has placed before us. We're all frustrated ministers trying to live right, love right.
So welcome to the family, you for joining us for Expanding the Table.
Howard Koh | 28:46
My friend. Thank you, Reverend. You're the best. You're the best. Thank.
Jonathan Lee Walton | 28:53
A Princeton Theological Seminary series from the Office of the President. These conversations are one of the ways we live into our mission. Cultivating leaders shaped by faith, scholarship, and compassion. And as well as opening our community to the world. On behalf of all of us at Princeton Seminary, thank you for being a part of this gathering. May you continue to find ways to expand the table in your own communities. With faith, integrity, competence, compassion, and joy. One love.