Text: Health Care Ethics USA

Authentic Development: Encouraging a Culture of Care

Summer 2015
By: Elizabeth Keene and Kirsten Walter

Elizabeth Keene
Vice President of Mission Integration
St. Mary's Health System
ekeene@stmarysmaine.com

Kirsten Walter
Director of St. Mary's Nutrition Center
St. Mary's Health System
Lewiston, Maine
kwalter@stmarysmaine.com

Pope Francis' encyclical letter, Laudato Si', is a profound example of the prophetic voice of the Church, calling us to convert our hearts and our behaviors in order to establish a culture of care. In a recent article in The New Yorker, activist Naomi Klein wrote that at the recent Vatican gathering entitled, "People and Planet First: The Imperative to Change Course," Cardinal Peter Turkson of Ghana noted that the word "stewardship" appears in the papal encyclical twice but the word "care" appears many times. He interprets that to mean that stewardship correlates to a relationship based on duty, but "when one cares for something it is something one does with passion and love."1

For the Catholic health ministry, the bridge from stewardship as a duty to that of a relationship of care is ingrained in our history. Stewardship is a constitutive element of the Shared Statement of Catholic Identity and one of the core values at St. Mary's Health System in Lewiston, Maine. For us, stewardship involves "taking good care" of our resources (including human, material, financial and environmental resources.) A culture of care includes our mandate to provide holistic care — care attuned to physical, spiritual, social and emotional well-being, care that moves beyond duty.

In Section III, Pope Francis stresses this holistic approach while reflecting on the ecology of daily life. Author Kevin Clarke distinguishes that for Catholics: Authentic development extends a "holistic understanding of the interaction of economies and rights and dignities of people. Authentic development includes attending to the spiritual and material fulfillment of the primary focus of economic systems, the human person and his or her dignity and full self-expression."2 This mirrors the philosophy that St. Mary's incorporates into our commitment to the community and our approach to population health.

Just as the poor are disproportionately affected by climate change, so they also experience health disparities. As noted in the encyclical [147], the setting in which people live their lives influences the way they think, feel and act. It also affects their health. It is documented that clinical care accounts for only about 20% of the factors that contribute to health outcomes; the physical environment accounts for 10%, health behaviors (such as tobacco use, diet/exercise and alcohol use) account for 30% and socio-economic factors (employment status, education level, income level, social support, etc.) account for 40%.3 In our urban community of 60,000 people, the downtown urban core has poverty rates as high as 60%.4 Recognizing the impact of socio-economic factors, along with the identified health needs of the area we serve (chronic diseases, obesity, mental health, and substance abuse), St. Mary's has established a Nutrition Center that aims to strengthen community by improving access to good food. Located in the heart of downtown Lewiston, The Nutrition Center includes an emergency food pantry, a demonstration kitchen for cooking classes, community gardens and farmers' markets.

Since 1999, the Nutrition Center's Lots to Gardens program has transformed over a dozen vacant neighborhood lots into thriving community gardens where more than 500 people of limited income build self-reliance and grow food to meet their nutritional needs. The gardens are located primarily in low-income neighborhoods, contributing to vibrant city neighborhoods and removing barriers for underserved people in accessing healthy foods. On the surface, one of the primary objectives of the gardens was to create access to healthy food in the midst of an impoverished community. But in addition to vegetables, other things have also flourished: a communal gathering place for native Mainers and new Mainers, opportunities for shared learning, and the creation of a sense of pride and accomplishment — all elements of well-being. Hands-on garden activities create opportunities for participants to connect with the natural world in meaningful ways as part of their regular life, cultivating an environmental ethic and a more active and engaged population.

Just as Pope Francis cites in paragraph 213 of the encyclical, "Good education plants seeds when we are young, and these continue to bear fruit throughout life," we believe that fostering a sense of stewardship (based on a relationship of caring) at an early age will lead to a greater appreciation of the environment later in life. Through exploration of their food systems, youth learn about how energy use affects the environment and food production; how inequitable access to food leads to malnutrition and hunger; and how institutionalized structures of oppression relate to the mistreatment of farm workers as well as the existence of food deserts. This allows youth to have a better understanding of the connection between what they eat and the environment and encourages them to think critically about how to explain these connections to others.

In addition to participating in workshops, youth work in urban gardens located throughout Lewiston, visit local farms, and participate in cooking and nutrition classes. By being outside, connecting with local farmers and learning healthy, tasty recipes, youth develop a broader understanding of how the environment affects the food system and form deeper connections to the land and cultivate a sense of place. One of our youth gardeners reports, "I came to the United States from Congo. I moved from place to place and had a hard time meeting people. But I loved to cook for my family. It made me happy. Then I moved to Lewiston. It was hard to make friends at first. When I started working at Lots to Gardens, my experience changed. I have closer friends now for the first time since I was in Congo; I am digging in the dirt, growing food, eating it and working. That makes me really happy."

These words and this approach exemplify what Pope Francis refers to "bonds of belonging and togetherness" that enable an "experience of community in which the walls of the ego are torn down and the barriers of selfishness overcome" [149]. St. Mary's is part of Covenant Health in Tewksbury, Mass. It is fitting that the name of our system refers to the "covenant" between human beings and nature that God established. Our goal as a health system is to be a visible sign of hope and the promise of God's care in a broken world, whether we are protecting vulnerable people or this fragile planet.


  1. Naomi Klein, "A Radical Vatican?," The New Yorker, July 10, 2015. http://www.newyorker.com/news/news-desk/a-visit-to-the-vatican
  2. Kevin Clarke, " 'Laudato Si' Joins the Tradition of Catholic Social Teaching," America, June 18, 2015. http://americamagazine.org/issue/laudato-si-joins-tradition-catholic-social-teaching
  3. Bridget Booske et al., "Different perspectives for assigning weights to determinants of health," County Health Rankings Working Paper, February 2010. http://www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf
  4. John Richardson, "Navigating the Poverty Line," Portland Press Herald, November 5, 2011. http://www.pressherald.com/2011/11/05/navigating-the-poverty-line_2011-11-05/

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