Grace for the Gaps 

grace

noun  1. “unmerited divine assistance”

           2. “approval, favor”….

verb   1. “to confer dignity or honor on”

— Merriam-Webster Dictionary

My niece’s name is Grace. My sister’s name means grace. So did my grandmother’s. A neighborhood cat’s name is Gracie. Within a 15-mile radius of my house, there are eight places of worship, six businesses, and two schools and nonprofits using that name. I am literally surrounded by grace. And sometimes I really don’t see it until it fills in where I am lacking. 

In a recent conversation with three seasoned executive branch state leaders, we dove into how we describe our life’s work in health equity to those who may shut down at the words “health equity.” One of those women quickly identified grace as the defining element of her work in a resonating moment for all of us. To grant someone grace is to give them favor, to fill in the gap, or to confer honor and dignity whether the person on the other end is deserving or not. Regardless of religious background, many of us who have chosen public service do so for this reason.  

Advancing health equity involves using data to find gaps in outcomes and asking how and why some people suffer from much poorer health in nearly every measurement from cancer to mental health to childhood accidents — a point starkly made in life expectancy data. Life expectancy ranges widely by state — by nearly nine years from Hawaii (80.7 years) to Mississippi (71.9 years). Likewise, it varies significantly by gender and race and ethnicity; there is a 21.9-year difference between Asian American women (86.3 years) and American Indian/Alaska Native populations (64.6 years).  

We fill those gaps with core public services — from health care to public health to social services to those that provide economic opportunity — to enable optimal health outcomes for all. Filling the gaps takes a dedicated focus on improving systems that have grown in ways that perpetuate health inequities. It requires tolerating discomfort as we shine a light on our own personal biases and those that come into view in the places where people live, work, shop, educate their children, and seek health care. Health equity work in government is about weaving grace into the systems and programs that affect the lives of millions. It’s about inviting patients and constituents affected by government-funded programs into conversations to build them, even inviting criticism to be able to better see the barriers in our systems.

To stay in the game and make the most of the short time we have in public service, we also must have grace for ourselves. There are decisions that I look back on from my time in public service that were right for short term, for the road we could see at the time, but that were wrong for the long term and will take years to correct. There were conversations I should have approached differently to have changed a key opinion on a decision, which without a doubt would have saved many lives. There are times I should have pressed harder, and I may have done so had I been from a directly affected community. Likewise, there are decisions that I’ve made as a physician that I should have handled differently — prescribing what would have been the right medication had it not been for a rare reaction, delivering news with the wrong tone, skipping advice that I should have given in that rushed appointment, not having the knowledge I needed to make the right diagnosis. Despite a well-developed self-protective ability to compartmentalize, those things keep anyone with significant responsibility up at night.  

It is having grace for ourselves and our colleagues that keeps us going. We must forgive ourselves for human shortcomings and forgive each other in the same way. It might look like getting up the next day to advocate for a bill after media and social media ran with an out-of-context quote. It might look like meaningfully recognizing a team member’s decade of state service in a staff meeting after a high-impact program was defunded the day before. It might mean pushing a conversation to the edge of what the relationship will tolerate to advocate for the benefit of those not at the table. Leaders have to focus on the good being done, as incremental as it seems at times. They must look at themselves and their decisions with honesty and humility, then clear the clutter in their minds and focus themselves and their teams on what needs to be done.   

Finally, we need grace for those who see things differently. With those who do not see the need for the work and those who fight against it, it takes a steady pour of grace to keep trying to have those conversations. It is always easier to preach to people who agree with us than to authentically show up to reason with those who don’t. It is easier to villainize than to hold fast to a belief that people who do not press for the same change we want to see are also humans who deeply value others.  

I invite those who use the words “health equity” and those who don’t to have grace for each other. Make the table bigger. Invite each other into the work. Filling in the gaps and granting favor in hard-to-reach places will require new kinds of thinking and committed leadership from all of us. 

With thanks to Debra C. Farrington, Morissa Henn, and Dannette Smith