Chronic disease affects one in three Americans. The Institute for Integrative Health in Baltimore, USA, believes that the path to improving health should involve not just medicine but an understanding of all the dynamic processes that contribute to wellbeing: economics, nutrition, work, relationships, the environment. In this article, founders Brian Berman and Susan Hartnoll Berman explain how they hope their approach can help reverse this health crisis.
The Institute for Integrative Health (TIIH) is a non-profit charitable organisation aiming to create a wellness model that shifts the focus of healthcare from managing disease to a more holistic approach of lifelong health. By bringing together researchers and students from many disciplines, and through a range of demonstration programmes, TIIH aims to empower individuals and communities to imagine and build a brighter future for themselves and others.
Research Features caught up with Brian Berman, Founder and President, and Susan Hartnoll Berman, Executive Director and Co-founder, to find out more.
What is the mission of The Institute for Integrative Health?
At its heart, the Institute is a think tank with an activist approach. We seek to improve the health of individuals, communities and the planet. Our vision is to ignite an epidemic of health, a place where as many people as possible live as healthily as possible for as long as possible. Our mission is to catalyse new ideas in health and healthcare, and to better understand all the factors that are interrelated to create and lead up to influencing health, and then to take all that information and use it to promote the health of individuals, places and communities.
With a focus on ‘Integrative Health’, your organisation funds research into various topics that influence health, ranging from social values to education to local policies. How would you define Integrative Health, and what are the benefits of this holistic approach?
It is an approach that embraces a wider whole person view of medical care as well as all the many factors that influence health. There’s an emphasis on self-care, on food as medicine, on stress management, relationships, and then the interplay of mind-body-spirit. It takes the discussion of health and wellbeing beyond what occurs in the doctor’s office. It takes into account the complex interplay of economics, social factors, the environmental determinants of health, equity issues, as well as healthy lifestyle choices.
Do you have a strategy for addressing factors that promote health inequality, such as poverty, access to medical care, local and national policies?
The first thing we say is that we need to take a step back and think about, how can we imagine a brighter future for everyone? What kind of a world do we want to live in? Rather than rushing into it, what’s the strategy? For individuals, that process can heighten our awareness and shift attitudes and perspectives. It can enrich people’s purpose, which can help to increase fulfilment and improve our physical health as well as our mental and spiritual resilience. For groups, a process like this can really help to magnify this change. It’s almost like a contagion that occurs, creating a shared purpose and getting people enthused about making the changes that are necessary. Putting some of the power back into us as individuals and communities is really important; by changing our thoughts, we can reshape our future. We are at a point of transition where we can really change how we do things. By taking that step back at first and imagining what kind of world we want to live in, the strategies will fall out.
We bring together thought leaders from very diverse backgrounds through our Scholars, Fellows, and Visionaries programme. There are no simple answers to these very complex problems, and we need to look at it from a complex systems approach in order to address what’s going on. We hold forums and then we also have demonstration projects.
Can you tell us more about ‘Building Bridges, Defining Metrics’?
Some of what we are doing is grassroots community-based, like our demonstration projects in Baltimore. Usually, there are many stakeholders from diverse backgrounds, all pulling in the same direction in terms of wanting kids to lead healthier, more fulfilling lives, but also with somewhat differing agendas: for example, the principal of a school’s ultimate goal is that his kids successfully graduate. ‘Building Bridges, Defining Metrics’ is an example of the multidisciplinary forums that we organise to look at sticky issues and come up with innovative answers. At this event, we brought people together and asked them to leave their name badges and titles at the door to create a safe and trusting space for open, honest discussion about challenges. At the same time, we looked for that spark of new ideas and solutions. By having a graphic artist there to capture these ah-ha moments, we were able to use visual arts to also facilitate the conversation and connect the dots. ‘Building Bridges, Defining Metrics’ culminated in a report (available on our website) with recommendations and strategies both on programme implementation and the types of research that would answer the questions that are meaningful to all involved.
Which kind of communities do you work with?
We are based right in the heart of inner-city Baltimore; it’s very important to us to connect to our community, even as our work and network extends globally. Baltimore is like a microcosm of the rest of the United States, a wonderful city but with all the problems that result from years of terrible racial injustice and social inequities. We work on a ‘train the trainer’ type model to give people the tools to help themselves and then spread it to others. For example, one of the big challenges in disadvantaged neighbourhoods is the ability to eat healthy, affordable food. We invite people into our teaching kitchen, we go out into their communities, and we work with an urban farm teaching experiential cooking classes that help people prepare healthy meals on a very limited budget. It creates a community while we’re doing it, and at the same time allows us to train the people there to go forth and spread it.
We have also been working to improve knowledge about food and healthy eating among medical students who in the future will be able to pass this knowledge onto their patients. Nutrition education in medical schools everywhere is sorely lacking. Working with the University of Maryland School of Medicine, we have helped bring experiential “food as medicine” courses into the required medical school curriculum. Our emphasis is on a whole foods approach, that at the same time teaches the students to discern for themselves the pros and cons of the many types of diets that may be popular. Word has spread quickly, and many of the other professional schools, not just medicine, want their students involved!
We partnered with a local international business, McCormick Spice. We got funding from them and worked with a local inner-city school; we had the kids cooking and spicing the food. The USDA, which is the government organisation in the United States that has control over things like the National School Lunch programme, were tearing their hair out because even though they had a free food programme for kids in schools, kids were chucking the food into the bin. We published a study where we saw how much food the kids chucked out after they had spiced it and found it was a lot less. We’re able to impact policy with these kinds of relevant and rigourous programmes.
Are there any ongoing research projects you’d like to tell us about? What visionary research are you most excited about?
I would like to tell you about an exciting new endeavour called Project Earthrise that we launched last December at a virtual conference of the same name, co-sponsored with an interdisciplinary group called inVIVO. With Project Earthrise we’re going back to a sense of awe and wonder and calling on the best of human nature to overcome our greatest challenges. We have to fundamentally question what kind of values we want to base things on. It is inspired by the earthrise photograph taken by Bill Anders from Apollo Eight in the 1960s. As the head of NASA said, we spent billions and billions of dollars on this project and the most impactful outcome was a 19-cent photograph. At a time of great social unrest as well as concern about the environment, much like today, it captured from afar all the beauty of Earth. It inspired Earth Day and the whole environmental health movement. Project Earthrise is going to be an inspirational networking project that will bring people together. It will be a research project to ask people what kind of world they want to live in, and to inspire a more global conversation about flourishing.
Another new project that we’re passionate about is the Communications Hub. It’s an online platform building off some of the work that we started doing with the online conference as well as over twenty-five years of working with Cochrane – an international network of health professionals and researchers, patients and carers – to gather, evaluate and disseminate healthcare evidence. It allows people to exchange ideas and discuss their early-stage research and to get feedback from others. It’s going to be carefully curated and have various different threads. A lot of good ideas get killed at an early stage, before they’ve had a chance to develop; this a way of disseminating in a much more dynamic and organic way. I should also mention that, initially, the hub will have a large focus on mental health. Whatever area we’re talking about, we want to point out that there’s also a mental health view that needs to be considered.
Who do you support through your Scholars, Fellows, and Visionaries Programme?
The scholars are people who have successful careers and are leaders in their particular area. But we’re giving them a little tap on the shoulder and asking: What would you do if you had some resources? What would really make your heart sing? And would you be willing to play together in the sandbox with other scholars from very different disciplines? Would you be willing to mentor some of the more emerging visionaries, the upcoming fellows? We try to offer researchers the freedom and encouragement to really go for it and draw inspiration from Albert Einstein’s quote on knowledge and imagination: “Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, all there ever will be to know and understand.” We want researchers to think from that ‘Einstein space’ between knowledge and imagination.
Is there anything else that you would like our readers to know?
We have a lot of projects, but ultimately, I want to share a message of hope. These are dark times in many parts of the world right now; there is a lot of fear and uncertainty. There really are ways out of this, and it’s within us. The whole mystery of life, and hope and healing can absolutely occur. So just join in and stay tuned for things that are going on! There’s room for everyone who wants to be involved.
Back in 2015, the Baltimore uprising following the death of a young black man, Freddy Gray, at the hands of the police shone a light on the cracks in the system, the incredible inequities in our city and society. We worked with a local young man, Devin Allen, a talented, self-taught photographer who had gone out in the middle of the uprising, taking photographs that became a whole body of work called ‘A Beautiful Ghetto’. It captured the extreme emotions of the uprising, but it also expressed the beauty of the community. Our headquarters are in an old warehouse building and we put his work up on the walls. We invited the community in, and we just let them do artwork to respond to it. It was inspired by our Scholar Paul Dieppe’s work where he asked people to draw what healing meant to them. We had art materials out on tables, and people could draw on these and answer the question, “how are we healing?” We created this whole exhibit within an exhibit. We held yoga classes, we held poetry writing sessions, we had children come in from schools. We had activists come in and talk about what they were trying to do. Conversations went on between people who had never met before, standing in front of these works of art and all these photographs and discussing how they felt. This taught us that, yes, things look bleak, but we are connected. And we can overcome. And we can create a better world.