Prescribing Community: Healing Together with Open Source Wellness Leader, Dr. Elizabeth Markle
SHOW NOTES | TRANSCRIPT
In a world where loneliness has become an epidemic and healthcare often feels impersonal, Dr. Elizabeth "Liz" Markle offers a revolutionary approach: prescribing community as medicine.
Dr. Elizabeth Markle, a licensed psychologist and co-founder of Open Source Wellness, challenges traditional healthcare approaches by introducing a revolutionary "Community As Medicine" model. She explores how social connection, movement, nutrition, and stress reduction can heal more than pharmaceuticals. Through Open Source Wellness, Liz has developed innovative group programs that prescribe community support, demonstrating significant improvements in participants' physical and mental health. Join us as she shares with us how community can be the most powerful medicine.
In this episode, we cover:
Benefits of Community-based peer support for Health
The Concept of a Behavioral Pharmacy
Shortcomings of the Healthcare System
Training and Implementation of Community as Medicine
Partnership with low-income Health clinics, YMCAs, and other Organizations to deliver the Community as Medicine Model
Choice of Individual Coaching
Formation of Groups and Group Accountability
Helping people who are suffering from loneliness
Creation of Open Source Wellness and collecting outcomes data
Need for Structural changes to support Social Connection and Well-being in Modern Society
Challenges and Future Directions
Forming Lifelong Connections and Support Networks that Created Sustainable Structures
How to join as a coach
Helpful links:
Elizabeth Markle, Ph.D. Co-Founder, Executive Director of Open Souce Wellness a nonprofit devoted to equitable health and wellbeing. To donate, visit this LINK
Are you interested in being a Health Coach? Apply here
Connect with Liz @dr.eliz.markle on Instagram and on LinkedIN
Bowling Alone: The Collapse and Revival of American by David Putnam
+1-415-471-7010
Founder, Rosebud Woman, Award Winning Intimate and Body Care
Host, The Rose Woman on Love and Liberation: Listen, Like, Share & Subscribe on Apple Podcast | Google Podcasts | Spotify
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TRANSCRIPT
Elizabeth Markle 0:01
And there's this amazing man named Jerry who was so candid with us. He said, I only came to get my therapist off my back. She wouldn't stop telling me, I need to come to community as medicine. And so I said, Fine, I'll go once. And he said, I walked in and I had no idea what was going on. I couldn't tell if this was like a block party, or was this church for health? You know, people were laughing, people were hugging each other, like I just had no idea, you know what this was going to be, or if this was for me. And frankly,
Christine Mason 0:33
Hello, hello. It's Christine Marie Mason, your host for the rose woman podcast. I always love the line from David Whyte's poem, everything is waiting for you, where he says, Put down the weight of your aloneness and ease into the conversation. This line beautifully evokes the invitation to belonging, to release isolation and step into our shared human field. And there's an African proverb that kind of goes along those same lines, that says I am because we are. I remember reading Robert Putnam's book Bowling Alone, maybe 15 years ago, and his central argument in that book is that the decline of community life and civic engagement, the metaphor, obviously, of Bowling Alone is correlated with poor health, diminished happiness and less resilient societies. He talks about social connectedness as one of the most powerful determinants of our well being, and all of that is very supported by research. Things like loneliness and social isolation increase the risk of heart disease by 29% and stroke by 32%
community based peer support for diabetes management works better than medication alone. A landmark meta analysis found that strong social relationships improve the odds of survival by 50% equivalent to quitting smoking, and stronger than many medical interventions. In short, belonging heals and often more powerfully than pharmaceuticals or hospital visits. Today, we're going to talk with a wonderful woman who I was introduced to at the Holo movement conference in Asheville. Holo movement is a movement to say, if you touch the great unity, how might you construct your life, the world we live in differently? So Dr Elizabeth Markle Liz is a clinical psychologist, and she is a founder and executive director of open source wellness. This nonprofit actually prescribes community like you get a little RX for community, and we're going to talk about that. She and her team designed a behavioral Pharmacy, a model that prescribes movement and nutrition and connection and stress reduction, but achieves it not by just telling you what to do by yourself, lonesome, go do this, but to architect deeply human, inclusive group experiences. Over time, they have figured out an ingenious way of carrying these out through primary care providers and YMCAs, and really have some great data on how the program introduces measurable improvements in health and resilience and belonging and creates long longitudinal communities, even far beyond the time the program ends. Now, if you're not getting a prescription from your healthcare provider for community, then I'm going to invite you to self prescribe that as you listen to Liz, consider how you might join or activate more person to person engagement, or cohere a community of your own, or possibly even go take her training and see if there's a way that you can become an agent for hosting these kinds of processes, because there is such a need right now for people to get together in real life and connect human to human. Get out of the digital realm, get out of the abstraction layer and meet the other in a field of ease and comfort and shared goals, particularly shared goals and becoming healthier and clearer in the mind, body and spirit. So I hope you enjoy this conversation today with Dr Liz Markle. Tell us a little bit about your path to healing through community. Sure.
Elizabeth Markle 4:22
You know, there's a professional story to tell and a personal story to tell.
Christine Mason 4:27
You know, which one I want? Oh, you want personal story.
What really moves us to, you know, take, take the roads we take. Yeah, yeah.
Elizabeth Markle 4:36
Well, they kind of go together for me. So I'm a psychologist, and to be a psychologist, you're in graduate school forever and ever and ever. And during that time, I was seeing patients, and I was working in low income health clinics. I was working in emergency departments of giant health systems. I was really in it, and I got so present to. The ways that the health system was with good intention, setting people up for failure. And that happened in little ways, like in primary care, doctors saying things like, you need to exercise more and you need to eat better and you need to reduce your stress, and then saying, Good luck with that, off you go. I remember my co founder and I saying, My God, if we said you need antibiotics, good luck finding them. That would be malpractice, right? We have this whole infrastructure of this whole pharmacy system set up to support people with the delivery of medications, but no behavioral pharmacy, right? No, no community based delivery system for the practices that make people well, like physical activity, healthy food, stress reduction, social connection. And so my co founder's name is Dr Ben Emmer Aronson. And so he and I really said, what would it look like to create a behavioral pharmacy? And I think the other thing that was happening is that we were watching how these structures were setting people up to have an experience of personal failure or to have an experience of shame, especially patients that didn't have a lot of privilege or a lot of financial or social cultural capital, they would say, yes, Doc, okay, I'll do that. And then they would go home, and the circumstances surrounding their lives made it so hard for them to make these changes almost really structurally impossible, and then, and then they would feel like it was their fault. They would feel like, you know, why can't I make these changes? Or there's something wrong with me, or I just didn't have enough willpower, and that that was not the case. So at the same time that we were sort of envisioning, okay, what would community as medicine look like? I had personally discovered living in intentional community. And you know, intentional community can mean a lot of things, but for the purposes of this conversation, I'll just say it was living in community with other adults and and sometimes children and families in a way that was not a commune, right? We didn't have a shared spiritual practice. We shared. We had our own finances and resources, but we set up our lives such that we leveraged economies of scale to make the healthy thing the easy thing. And so, you know, for example, twice a month I would have to cook food for a lot of people, and it took half the day to do it, but the rest of the time I could come home from work and sort of rock up to a really healthy meal and social connection, and all the abundance that living in community could create. And so while I'm super clear that the American Dream is alive and well, and most people don't view living in community as necessarily how they want to move in their lives, when we were creating open source wellness and this community as medicine model, we were thinking, how could we get some of those active ingredients of community, like empathy, connection, validation, support, vitality, joy, play, vulnerability, you know, all of that. How could we bake that into the healthcare system such that it's available for the populations that need it most. I mean, I
Christine Mason 8:01
love the idea of behavioral pharmacy, and I also notice arising in me, when you speak about the difference between, say, antibiotics and get more exercise, that there's a part that arises, like people should know how to do it, you know, like, this is a self bootstrapping nation. Go figure it out. You're not a child. You know, there's a piece. There's a piece in me that I think is a legacy of the toxic individualism that's me like already biasing the question the individualism of the culture that I think got inherited by medicine, yeah, that I noticed that I'm excited about it. It also feels really logical. And then on the piece on Community Living. We have, for the last nine years, hosted a community. We have a farm in Hawaii, and all of those beautiful things that you mentioned also come with, like people not doing the dishes and all these sort of daily irritations that came up and and what I noticed is that one of the reasons people come in and out of community is their own inability to be present with others in difficult emotions. And so there's, there's two pieces that feel even in this sort of intro, of like knowing that it's needed, but that the individualism, the skill sets around communicating and being with other people in a comfortable and being comfortable and being comfortable with that, particularly in conflict, sort of might get in the way. Yeah, oh, there's
Elizabeth Markle 9:26
so much to say here. So first of all, I so appreciate your candor and humility in naming the ways that that sort of toxic individualism is present in your own thinking and that uprising of, can't people just do the right things, or, you know, go, take a walk. Everybody knows. And I think that logic maybe holds when you assume a certain amount of privilege, including inner, invisible kinds of privilege, like nervous system regulation privilege, but if we just zoom out, so let's imagine someone will say it's a woman, a. Living in a neighborhood with that is profoundly unsafe. And we say, like, go take a walk. And it is not safe for her to walk in her neighborhood right there, there. There are areas not far from where I live, where that is the case, where it is the most affordable place to live in Oakland, and it is, it is not safe to go out for a walk by yourself. And then, let's say, just eat healthy food. Everybody knows fruits and vegetables well. You know, this person lives in a food desert, and what she has access to is a convenience store around the corner. And we all know what's in convenience stores. And then we could say like, well, just meditate, just just breathe, just just relax. And you know, anybody who's dealt with significant trauma burden in their lives. Knows what it's like inside a nervous system that doesn't feel safe relaxing, and we say the same thing, well, just just connect. Just connect with a friend. And you know, when we're living with complex developmental trauma, you know, repeated, intimate, relational trauma, it doesn't feel safe either, to be vulnerable, to be connected, to be socially resourced, and so I appreciate that we're really sort of peeling back the layers of that, like just just care for yourself, just do the right thing, kind of thinking, because that can deepen, that can double down on the shame that the medical system can create. And again, it's with good intentions. No doctor comes into the field saying, I want to create shame, right? Like they're doing the best they can with an insane schedule. It's not the provider's fault, but the system can recreate that.
Christine Mason 11:27
And also, to your point about lived experience and empathy, like, if you don't have any reference to I can't go for a walk because I live in a safe neighborhood, you don't even think about that. And you you know that's that's a beautiful example. I would also, another thing that comes to mind is just sheer time. Like a lot of the people I know who are in San Francisco in particular, are working three jobs, you know, just to keep afloat. And there's the time piece of that, right?
Elizabeth Markle 11:51
There's time and transportation and childcare and getting basic needs met, and how are we going to keep the lights on? And when those things are top of mind, you know, fortunately, there can be a compounding effect where, like, we know that level of chronic stress leads to physical health problems, right? And then we have chronic pain, which makes it harder to move, which creates more fear and stress. And so, you know, you know that these knots can kind of tighten, and so we need structural, affordable, accessible ways that start to loosen that sort of snowball effect of physical and emotional unwellness.
Christine Mason 12:25
This is where I found your work so beautiful, because you these are all conceptually great. I think everyone will agree that these are healthy, but you actually put them in a structural container with open source wellness. So can you talk a little bit about that? Yeah. So
Elizabeth Markle 12:40
we started in 2016 with the idea of designing a behavioral pharmacy and our universal prescription, we abbreviate, move, nourish, connect and be so that's physical activity, healthy nutrition, social connection and stress reduction. And we came to that on the realization that whether a patient is struggling with diabetes or depression or hypertension or anxiety, this sort of fundamental trans diagnostic prescription is the same, right? So we said we're going to move away from disease specific groups like a depression group and an anxiety group, and say, Hey, this is a group for human beings who, by our nature, have strengths and challenges with our well being, right? We're all working on something and so, so we designed these groups to be trans diagnostic, and we designed them to be experiential, meaning we're not going to just talk about wellness. We're not going to just sit in the circle and tell each other what we do or what we should do or what we're going to do. We're going to actually do them together. So if you came to visit an open source wellness group, or what we now call a community as medicine group? You would see a predictable arc of activities or a ritual. And we start with a welcome and quick agreements and an icebreaker, and then we dive right into physical activity, and somebody is leading playful, interactive, friendly, fun movement that doesn't feel like exercise, right? It's not about getting the reps in. It's really about laughing and connecting and moving in a way that brings joy. And then we transition into a little bit of mindfulness practice. So this is really brief. It's dogma free. It's like a sampler platter every week of different different ways to bring our autonomic nervous system down and practice intentional regulation, we then have what we call a spark, which is like an interactive learning or lesson topic of conversation for a week. So it could be something like grocery shopping on a budget, or it could be like setting boundaries in relationships, right? Like, how do we how do we figure out what we're a yes to and what we're a no to, and how do we communicate? Those boundaries? Then that large group, which could be up to 25 people, breaks out into small groups, and in every small group, there's one coach and five or six participants, and this is where the deep dive happens, because people share. They share about. Health and their well being, but they also just share about their lives and their dreams and their hopes and their traumas and their families and what they're working on. And over the course of 12 weeks, where this group meets every week, they form this really beautiful, supportive environment for people to start to gain traction on making and meeting the goals that matter most to them. And so some people might be working on nutrition, and some people might be working on social connection and physical activity, as relates to working with their depression or their substance use. And it's really a place where we're cultivating a culture where even the coaches are working on something, right? Everybody's working on something with their well being. It's not a matter of experts telling patients what to do. It's it's creating a community where we can, we can dissolve shame by being candid, vulnerable, playful and working on it earnestly together.
Christine Mason 15:55
It also sounds lateral like you're respecting the wisdom in the group and letting them teach each
Elizabeth Markle 16:00
other. I mean, that's the beauty of coaching, rather than education. Right? Education says, I have information for you. You take it in and hopefully apply it. And coaching says, What would make a difference in your life? What's the next right step? If there's information you're missing, I'll try to help you with it. But, but it's really about honoring people's autonomy and their wisdom to know the right thing that's next for them given their lived circumstances, like we talked about earlier, it's not saying you should eat kale and quinoa. It's saying like, okay, let's talk about what's working and what's not working in your nutrition plan. You know, what would be the baby step you'd be interested in trying this week?
Christine Mason 16:38
And who are the coaches? What's their professional background? What are they drawn from? We have a
Elizabeth Markle 16:43
health and wellness coach training program. It's called the community as medicine health coach training program, and it's aligned with the standards of the National Board of Health and wellness coaches. There's really an exciting movement where it used to be that anybody could say, I'm a health and wellness coach, because I say so. And now there is national board certification at it's an 80 hour live virtual training that includes basic health and well being competencies. But in our program, we're focusing on cultural humility, right? So those things that we started our conversation with trauma informed coaching, right? How do we respect what's happened in people's nervous systems and help them find those sort of ways towards safety inside and group coaching, because individual coaching, which is the sort of the basis of most health coach training programs, is one thing, and then facilitating a group to create that culture of support and intimacy across difference, right tremendous demographic diversity within these groups, that whole other skill set that we're trying to really uplift in this training program. So the community
Christine Mason 17:47
of medicine programming is both designing, creating a framework, helping develop coaches, and then offering that out into the world, but you're also going for grants and directly providing coaches to organizations. Are some I kind of remember that from your talk, yeah.
Elizabeth Markle 18:03
Great question. When you say we're offering into the world, yes. And what's, what's important about this model is that we are, we are committed by the mission of our organization to generate health, well being and human connection, especially for those who've been historically excluded and marginalized. And so what this means is it can't just be for people who are seeking health already, who are hiring a private health coach. The way we set up the community as medicine model is that about 90% of our participants come to us via a prescription from their primary care doctor, right?
Christine Mason 18:35
They're actually getting a prescription like all right? Community, you really did it?
Elizabeth Markle 18:39
Yes, yes. And we started by partnering with the low income health clinics in our area. So we're based in Oakland, but we're increasingly national, and we train those providers to say something like this, I'm going to write you a prescription, but it's not for medication, it's for participation in a community, and if the patient is interested, then we get their name and phone number, and we call and we get them enrolled in a group. And most of our groups are just led by these health coaches in teams of coaches, and some of our groups actually have a primary care provider integrated into the group so that they can address some of those top of scope things. And we've been doing this in partnership with these low income clinics in the Bay Area now, since 2017 and the really exciting move that's happening the last couple years is that we are partnering with YMCAs and clinical healthcare organizations nationally to train them to deliver the community as medicine model. So we're happy to continue delivering it with our coaches. But there are amazing, culturally relevant local talent all around the country that are really beautifully poised to be delivering this and part of our vision is that anywhere in the country, if someone starts to look like they might be developing prediabetes or they're struggling with some depression or some social isolation, that their primary care doc can prescribe them into this model. Know, happening at the YMCA at a religious community, you know, any number of sort of late, safe and familiar and welcoming community
Christine Mason 20:09
environments. Can we have a little sidebar on the why? Yeah. So, for those of you who aren't y literate, you said something about how many people, like 80% of the population, live within a certain radius of the Y
Elizabeth Markle 20:21
Yeah, I think it's like five miles. 80% of the people within the United States live within five miles of a YMCA branch. What that's
Christine Mason 20:29
crazy? I mean, they really have mastered the art of, like, finding where people live, you know? So I that that's just another learning in general around not reinventing the wheel and trying to find ways to leverage other people's expertise. And if you're going to place an entire fitness and health center close to population base, what a great idea. Whoever came up with that partnership is really a genius. Well,
Elizabeth Markle 20:51
here's what's exciting about it is that, you know, the YMCA used to be the only swimming gym in town, right? Used To Be it, and now we have 24 hour fitness and Planet Fitness, and for 20 bucks a month, you can have a gym membership. And so the YMCAs are needing to reinvent themselves. They're needing a new identity. And some of the really big, strong, progressive YMCAs that we're working with are claiming that they are moving beyond just physical fitness and into community well being, which aligns beautifully with that move, nourish, connect, be framework that we're offering. And so some of these y leaders have said things like, what if we were the trusted partner to the healthcare delivery system, that the clinicians would know that if they send someone to the Y they're going to get trauma informed, culturally humble, linguistically appropriate. All you know that coaching approach, rather than sort of a top down personal training or health education framework, I had 1y leader say, what if the YMCA were the extension of the primary care office? And that is an exciting vision that we are committed to helping them amplify.
Christine Mason 22:03
I love this so much so the participants, do they pay a participant fee? Or are they on a
Elizabeth Markle 22:07
sliding scale? Or is it free? Most of our participants, 90 some percent, pay nothing.
Christine Mason 22:12
Do you think the model could be extended to people who are just generically lonely, and it's not like coming through healthcare. I mean, the idea of an implementation partner in behavioral health that's free and local, I imagine, like there's often a lot of compliance problems in taking your medicine. You know, like getting people to take their antibiotics all the way to be in. Do you have compliance problems, or fall out? Or, once people get into it, is it like they just, they just show up? Yeah.
Elizabeth Markle 22:46
I mean that word compliance with the whole what I tell
Christine Mason 22:54
you, yeah, patriarchy, top downness, exactly. Yeah. And
Elizabeth Markle 22:59
so this is where, again, we're sort of stepping out of that sort of, you know, healthcare specialization, education mode and into that coaching role. And I think part of what we find is that when people find that something is of value to them, they keep doing it. And so part of our job is to sort of stay in that coaching seat and be asking people, What hurts? What do you need? What would make a difference for you? What's the right next step for your life? Rather than saying everybody needs to eat this and everybody needs to work out like this and everybody should meditate like this. So of course, it's true that, you know, it's not the right fit for everybody. And we do offer individual coaching for patients who say, for whatever reason, hey, the group thing isn't for me. Whether it's they don't want to travel, they can't make the internet thing work. They're really just saying, I need a one on one conversation. We're happy to start there
Christine Mason 23:58
with people. Yeah, I feel that sometimes the groups are overwhelming, yeah, and sometimes
Elizabeth Markle 24:02
people start in a one on one coaching context. You know, we always start with a one on one phone call with a coach that helps them build that relationship, helps them, like, understand what the heck is this community as medicine thing in the first place? And from there, they can opt into joining a group. So
Christine Mason 24:16
what do you find like when people move into group for the first time. I mean, so many people come in with ideas about how they belong. Yeah, you know, whether it's body shame or it's their isolation, or will they be liked? Will they be included or welcomed as they are? Do they have to put on a mask? And so I'm kind of wondering how group formation happens?
Elizabeth Markle 24:39
Yeah, we just spent the weekend recording some training videos for our partners, and so we had a bunch of our participants, and we invited them to share about their experience. Like, what was it like when you first came to group? Why did you come to group? And there's this amazing man named Jerry who was so candid with us. He said, I only came to get. My therapist off my back, she wouldn't stop telling me, I need to come to community as medicine. And so I said, Fine, I'll go once. And he said, I walked in and I had no idea what was going on. I couldn't tell if this was like a block party, or was this church for health, or like, you know, people were laughing, people were hugging each other, like, I just had no idea, you know what this was going to be, or if this was for me, and frankly, I wasn't sure. And the punchline, of course, is it's six years later, and he's still involved with our community as a peer leader and supporting, you know, the next generation of participant. But I do think people, people have connotations about what healthcare looks like, right? That healthcare is sterile, it's it's sober and a little scary. There's a lot of white coats and tons of privacy, anonymity and confidentiality. And I just want to say I understand why all the privacy, anonymity and confidentiality, exists, right? It exists for good reasons, and it can inadvertently reinforced shame and isolation and leave people feeling like I have a problem. It might be my fault. I have to fix it alone, and this is going to be really hard and scary and and part of what we're doing at community as medicine is is sort of myth busting that and saying, Hey, we're all working with something, whether it's physical or psychological or social, and whether we're just lonely or we have a major diagnosis, we can be supported in that we can speak our truth about what's going on and be received with more than just clinical respect. We can be received with empathy and care and inclusion and belonging.
Christine Mason 26:39
Yeah, one of my favorite things when you do big conferences or group events or programs is when the facilitator says, How many of you think you're too much? How many of you think you're not enough? How many of you have questions or confusions around love like you start to watch like these questions and one after the other, you look around, you're like everything that I held as unique to me, my own unique suffering as a universal human condition, and just how that transparency alone gives you permission to open up. I love that you brought that. And then the other thing is the grimness, which also goes for exercise, right? Like you're standing in the gym and you're like holding the muscle, the muscle machine is very, very hard, and you're imagining you're becoming a superhero. You're just like, or, or I went to some kind of, like, Bikram yoga, and as a woman who's like, she's just like, yelling at us the whole time, and everybody's really, really serious, and I'm like, wait a minute, this is like, supposed to be softening and inviting openness and the balance of strength and suppleness, but not a smile in the place. So if you, if you walk into the idea that that's the way exercise is going to be, or, worse yet, running, no, sorry, I'm sure you might be a runner. So I didn't mean, don't mean to diss that for all the runners out there. But you know, if you walk in with that idea, and then someone challenges you and says, Hey, we're going to dance, we're going to move, we're going to do things in this way. And it suddenly must be a really big eye opener. It
Elizabeth Markle 28:07
is, you know, it's a funny thing and how we're training coaches as well. You know, we sometimes find folks who've been trained in a very sort of earnest, precision nutrition methodology, and they have a very sort of serious idea about how coaching is, and part of how we hire coaches is, we say, come visit a group. We'd like you to just come participate and see what it's like and and you know, they're joining in physical activity, and they're participating in the conversation, and they're seeing that people are laughing and they're crying, that there's this funny thing where if you create vitality, right, you create safety for human expression, you're also starting to create permission for vulnerability, right that they, the two, can kind of go together, that it's okay to express our joy and it's okay to express our grief, our loss, our fear, our shame, that there's space for all of that. And we're really training coaches who can hold all of that and then very gently guide people towards a conversation about creation or about empowerment. There's something we do at the end of every group where we have these little physical prescription pads, and everybody gets a prescription pad and we say, what are you prescribing for yourself this week? It's not the coach, it's not the doctor. It's the individual saying, Okay, I'm going to take that walk around the block, or I'm going to try one new vegetable, or I'm going to reach out to that friend that I lost touch with. And that is sort of the creative power of declaration, of saying, I give my word to this thing. And then participants are on a text thread with their coach and their small group. And so you can bet if the group is Tuesday night, Wednesday morning, people are going to say, snap a photo from your walk, or, you know, tell us how that vegetable went, or how did it go, reaching out to your friend. And that's the power of the group accountability. I
Christine Mason 29:54
like you being your own doctor, writing your own prescriptions. I think anybody can do that right now. You guys. Just listen, in your in your journal, you can write yourself an RX for the day.
Elizabeth Markle 30:04
Totally, yeah, you know, if we were gonna, if we're gonna do a tiny, tiny, microdose of community as medicine here, with our with our listeners, I'd say step one is about just speaking the truth, right? So, so whether you write it down, you know, how can you tell yourself the truth about some domain of your well being. And that could be like, You know what? Like, I got really close with the couch and the pandemic, and I haven't really, I haven't really gotten off it. Or that could be like, hey, this nighttime pint of ice cream habit, like, it's gotten a little out of hand. It's not working for me anymore. And when we can find a way to tell the truth and know that everybody out there listening, this is also speaking some truth. Like I say I meditate and I haven't done it in two months, like we can take the shame out of it. So that's step one. It's just speaking the truth. And then step two is about desire. And this is where we ask ourselves, what do I want? Seriously, I had a teacher who said desire is the only power source potent enough to affect change. It's not guilt, it's not fear, it's not shame, it's desire. So what is something that you want? I want to feel good in my body. I want to be able to keep up with the grandkids. I want to I want to be able to say I meditate and know that that's true for me and I'm living that value. So that's step two. And then step three is that, that creation piece, that empowerment piece. So if you were going to write a prescription for yourself this week, find something to write it down on. I prescribe two walks a day. I prescribe three text reach outs this week to people I lost touch with. I prescribe, you know, going to the YMCA and check it out, membership options, whatever it might be for you.
Christine Mason 31:44
Well, I have so many ideas about where like what I would prescribe, but I also noticed that I have a lot of ideas about what I would prescribe for other people. I want to talk a little bit about loneliness as a precursor to other illness and as an amplifier and tools to interrupt that cycle, like what gets in the way and what can we take away from the community of medicine model to help people who are suffering with loneliness?
Elizabeth Markle 32:14
Well, as a society, we are getting lonelier, and we can track all the ways that functions of privilege, right? A house with a picket fence and DoorDash that brings groceries to us, rather than us having to leave the house to go get anything, and working virtually, and, you know, engagement with our phones and technology in ways that can kind of feel like pseudo connection, but actually aren't connection. We have. We have painted ourselves into a little bit of a corner in that, in the name of convenience, we've created structures that don't bake social connection into the fabric of our lives anymore, right when, when we when we went to work, when we did the did the washing out in the community, when we had to go get water, when we were working out in agricultural communities, social connection wasn't something we had to structure in. It was baked in. And now we have to, we have to bake it in, just like we have to bake in physical activity in a way that we didn't have to before. And so, you know, if we go back to that, move, nourish, connect, B framework, suddenly we are having to to swim upstream to make them happen. That's tough right now, busy families with kids and homework and multiple jobs, and maybe they do or don't have a car for transportation, more things to bake in. Is a very, very heavy lift. So I want to start by just acknowledging how hard it is right now and then. I want to say there's this function by which shame thrives in isolation right as soon as, as soon as the the light of of contact and truth telling and being received, sort of touches shame. It evaporates on contact, but, but isolation can create shame, and when we're feeling shame, we we are very motivated to continue isolating, and that's kind of the downward spiral that we gotta find ways to interrupt in ourselves and that community as medicine, we're very committed to interrupting that but, but even on our own, we can notice where is the place where I'm feeling shame, what is the thing that I think I need to hide? And then, if we cannot make it a should not make it like I shouldn't feel shame. I should. But if we can just have compassion for like, Oh, honey, I get it. Of course you're feeling worried that this is something you've done wrong, or there's something wrong with you that's causing you to sort of lock down in that shame pattern, then we can get curious about about where it might let us wiggle free. Like, is there one person that I could tell right? Is there one person who I think might. Might get it. And the upward spiral works exactly the same way, that as we connect with a human being about what's happening for us, the shame starts to lighten, which gives us permission to connect more. And that spiral that, if we can find it, it can have have tremendous impact on our lives,
Christine Mason 35:17
like a virtuous cycle, yeah, exactly. And that choice, that encouragement just to double click and land on that, is to make one small outreach and let that amplify, and then watch how another doorway and another opportunity appear from that. Just do one thing you don't need to build out a whole year plan
Elizabeth Markle 35:35
Absolutely. Yeah, what's the one text you could send? Beautiful, what's the one thing you could do today or tomorrow that would put you in contact with another human being? Thank
Christine Mason 35:47
you. So one thing I'm also interested in is, you know, the the name used to be open source, and for people or you were using that terminology, and for people who don't know that term, I think it originates from software that, like you, share the code so that everyone can critique it and develop it and then carry it out together and build extensions off of it together, and that open source is a sharing mentality. It's a sharing model in general. So I'm wondering how, in addition to the direct client base, like the why and stuff like that, how is the data that you're gathering and the information you're gathering being held, shared, distributed so that others can model their programs off of it or learn
Elizabeth Markle 36:29
from it? So yeah, open source wellness is still the name of the nonprofit organization that's the backbone structure that created the community as medicine model. And yes, we get that question all the time, like, Are you a tech company? What's your platform? Why is it called open source? And we chose that name for a couple of reasons. First, that what we're doing is based on one universal prescription, move, nourish, connect, be, there's nothing rocket science about that. And and while I think precision medicine is moving in amazing directions, and the boutique wellness industry has a lot to offer. There's so much to gain in terms of an 8020, split here on getting these fundamental move, nourish, connect, be basics in our lives. And so, you know, the open source wellness is sort of a return to that, and that name is also a nod to that it is a coaching and sharing model, that it isn't like we have the branded workout plan or the nutrition or the supplement brand that's going to change your life. We're saying, hey, human beings seem to have some hardwired needs for physical activity, stress reduction, social connection and healthy food and no technology in the world is going to change right now that we have those needs, and so let's bring some kind attention to crowdsourcing and sharing, how we're meeting those needs, supporting them in it. Now you asked about data. We are absolutely collecting outcomes data. We've been doing that since 2016 because my co founder is a researcher and statistician, and now we, for the first time, have data not only on how our program participants are doing, but now how our YMCA partner participants are doing, and so we're seeing, you know, I can, I can share the actual data with you, but we're seeing massive increases in physical activity, in fruit and vegetable intake. We're seeing drops in depression, anxiety and loneliness. We're seeing reductions in emergency department visits, and that's the data that is getting insurance companies, payer partners on board with
Christine Mason 38:30
this. Tell me those stats on ER, again, yeah.
Elizabeth Markle 38:33
You know, in one study, we showed a 77% drop in emergency department visits and unplanned hospitalizations. 77 that's a massive number. You know, I can't promise that that will hold at a larger sample size, but, but even some reductions in acute care utilization makes a huge difference for the insurance company behind
Christine Mason 38:54
it, there's some design question that's coming out as you were saying that the world itself has gotten more structured towards isolation. I remember a book maybe in the late 90s, early 2000 Bowling Alone. Oh yeah, Robert Putnam, very seminal work around the changes in culture, with the disappearance of community organizations, of churches as a centrality with commuter society. I'm trying to remember all of the things he was pointing to, and then you pointing out early on your own choice to return to an investigation of communal living at some point. Do you feel this like open source wellness and the experience that people have in these groups will create a collective wake up to restructuring the underlying design of the societies we're living in?
Elizabeth Markle 39:39
Oh my goodness, that is big picture, isn't it? Here's what I'll say, is that what part of what we see happening in these community as medicine groups is that people build skills for connection. I think that's a really big deal. That when we meet people our you know, our coaches meet people from the minute they walk in the door or sign. On zoom, with generosity, with welcome, with care, with respect, with inclusion and and sometimes people are a little taken aback by that, right, that that can be new. But then, because the culture of the group is built in such a way that even across tremendous demographic differences, right, we have differences across race, across politics, across age, across gender, across occupation. You know, you couldn't get more different groups of people together if you tried, people can start to have the experience that they can be nourished by connection. You know how there's, you know, you're in the healthcare realm. So there's, like, nutrient deficiency because we're not taking it in. And then there's nutrient efficiency because we can't absorb it. I think the same thing happens around social connection, beautiful, yeah, there's loneliness because we're just not around people. And then there's loneliness because we don't yet quite have the skills to absorb the nutrients of connection, and that is an important psychological muscle to build is to create enough safety, enough skill, enough recovery from interpersonal trauma, so that we can be nourished by the connections in our lives, and that we can start to regeneratively nourish each other. You
Christine Mason 41:12
know, in yoga, I teach a lot of physical embodiment practices, and I can always tell like the level of receptivity in a person, like how much they can receive by their inhale, and that it's like a parallel a lot of people are okay with, like, oh on the side, but the inhale stops sort of at the rib cage. And that this is seems to be similar to this emotional state. Like, how much connection can you absorb? How much can you let down to receive, open your heart, all those words of saying that, like, if the world hasn't been a safe place, it's pretty hard to relax into receiving another praise or blame or even offers of help.
Elizabeth Markle 41:48
Yes, and what you did there was such a brilliant pivot. You said, if the world hasn't been safe then, of course, it makes sense that people would be closed and defended and self protective, and that's how we get out of the the victim blaming here, or the non compliant, or why are you so closed? Or any of that, right? That's how we get out of that sort of toxic individualism. And we say, ah, the world hasn't been safe for a lot of people, physically, nutritionally and particularly around human connection, right? If we've had experiences where, whether it's individual level trauma or social and structural trauma, which is happening all the time for groups of people, then we come at creating safety and support from a totally different lens.
Christine Mason 42:28
Yeah, having another thought about the food desert thing, and potentially there's a whole bunch of urban gardening and urban farming co ops where people are teaching how to turn your lawn into a free food Bonanza through community organizations. Ron Finney, I think, in LA, in every major city, and I'm wondering how these groups might pair up or partner on some of these more structural questions, where you still keep the community aspect and the movement and the try and the dyadic or triadic small group stuff, all the things that you've proven to work. I mean, just as a comment, yes, people can get together, but the way that you have described the design of the group, the warming up, the movement spaces, the getting in the body, the broader conversation, the smaller conversation, like all of those things, are actually like a very deep design into how we open and connect. It's a very beautiful wave function that you've laid out. And so within the context of that, some of these larger structural things, like not having access to food, could actually be another partnership element that could be one of the main activities that the group is doing. Yes.
Elizabeth Markle 43:43
So here in Alameda County, we've been delivering the community as medicine model in partnership with a food as medicine model since 2017 it's been so exciting. It's this model called recipe for health that provides a food pharmacy. It's actually doorstep delivery of regeneratively grown produce, plus community as medicine, or the we used to call it, the behavioral pharmacy, plus healthcare provider training on how to use food as medicine, how to, how to, you know, involve that in their practice. And that has been so exciting, because, yes, you know, even if you're online with people, if everybody's gotten a bag of the same produce, then you get to have a conversation about, what the heck do we do with beets, right? What do they look like? How do you cook them? How do you eat them? How are they tasty? Et cetera. So yes, we love food as medicine partnerships, and would love to do more of
Christine Mason 44:33
that. So I'm going to make the assumption that all of healthcare is going to fully embrace community as medicine. Hallelujah. What are the structural barriers you guys have as an organization to getting it into everyone's hands, and how can we help?
Elizabeth Markle 44:45
Oh, goodness, thank you. Well, we are a nonprofit, and as an organization, we're about 50% revenue based and 50% philanthropically funded, and over the last two years, we've really been making a pivot as an organization. We were predominantly. Eminently a direct services organization where we employed a lot of health coaches to deliver this model. And we're still doing that, but we are now building this whole other arm of the organization dedicated to training and licensing, YMCAs, clinical organizations, community organizations, employers, even to deliver community as medicine on their own, and that is an organizational infrastructure build to have the team, the technology, the learning and the infrastructure in place to support you know, now we're up to seven. I think in the coming years, we will, we will crack 20 different organizations around the country delivering this model. And there are all these questions that come up, like, how do we balance fidelity with flexibility, right? How do we keep it, you know, coherent as community, as medicine, but allow local flavor and cultural adaptation to come through? And so these are all the things that we are building our staff for, that we are building new partnerships for and all of that takes funding. So if any of you listeners know the individual philanthropist, the family out Foundation, the big grant making foundation that would support this, you know, that's really part of what's needed to make this possible. I generally
Christine Mason 46:14
try not to get too political. But do you think this Maha movement thing is part of a good thing for you? Or, like, how does that fit? Oh, it's, isn't it that like, a crazy irony of, like, all the nutsy stuff and then on top of it, but then suddenly it's like, no seed oils. Sure, we can, we can abuse the whole population, but no seed oils.
Elizabeth Markle 46:33
Yeah, it is a, it's a. It's an excruciating time, really, for community based organizations that have devoted themselves to creating equity and are watching progress being stripped away. I think we have a lot of discernment to do about how we uplift and align with the aspects of Maha around addressing chronic disease that that that do serve the population as a whole, while being very clear about our commitment to equity, to the well being of the communities that are not poised to benefit from a lot of what Maha is doing. So I think we need to be really thoughtful about it, and really true to our ethics and identity and mission as an organization. There's
Christine Mason 47:16
such beautiful nuance even in the way you're first of all, I appreciate that about you in general, the way you respond to questions and present information is very nuanced. And yeah, it's really, it's really a beautiful way of seeing that, and we could parse that out more like, what is, what are the parts that are healthy, and what are the parts that are like, not really showing empathy for the actual people in our communities and in our lives that are suffering? So beautiful. On a closing note, are there any more stories that you'd like to share from things that have really delighted you in the work, or places that you've taken joy and seeing it
Elizabeth Markle 47:53
roll out? Part of what's a dream for me is watching what happens when people complete the community as medicine program. So most of them are prescribed 12 weeks, and after 12 weeks, some folks are just done. They're complete. They're like, that was great, thanks. And some folks have said, like, No, you can't kick us out of group. Like, we're not we're not stopping coming to group every week. And so we created a peer leadership program that allowed them to stay engaged. But a group of our alumni created a group that they call OSW x. So, you know, OSW stands for Open Source wellness. You know how there's TED Talks and then Ted, you know, OSW x is going to be the peer run, independently organized graduates group, and so we have a group that meets every week. There's a group that meets in English and a group that meets in Spanish, that some of them have been doing this for five or six years, and some of them, you know, just graduated, that get together to practice, move, nourish, connect, be, and they're groups that meet online, and groups that get together in person when they're able. And that brings me tremendous joy that for some folks, this has been an on ramp to a sustainable, you know, lifelong, ongoing path to well being. And part of my hope with these YMCA partnerships is that after people have been coming to the Y for 12 weeks, they've made some friends there, they're comfortable in the space that whether they stay on as y members, or they now have a pod or a group of people that they're practicing these, these well being basics, with that this, this creates a lifelong pathway. We also have a few folks who graduate the program and then complete coach training and then join our staff as coaches. And that just feels like such a dream to me, because we now have the capacity to deliver in English and Spanish and Cantonese and and now Farsi. We have, we have a couple Farsi speaking coaches. And I just think if we can really create communities of well being that are that maybe started in healthcare, but now have created sustainability structures. Hers then, then it's all worth it. That's the dream. I
Christine Mason 50:03
love that. And if you were someone out there who was interested in becoming a coach or learning about doing that part of the program, Who's your
Elizabeth Markle 50:10
ideal candidate? Ah, great question. You know, we have such a diversity. We have folks who just graduated as a participant and have no professional background in wellness or coaching. We have folks with a like a community health worker background. We have some folks that have a master's degree in some health related field, or are an RN, or are a physician, but want the coaching skills, so the community as medicine health coach training program we we applications are open pretty much year round. We have a group that starts in usually February, and a group that starts in August, so folks can apply on the website and and we're so excited to welcome the next generation of diverse allied health professionals that
Christine Mason 50:51
is so great, particularly with this rollout coming up. Yeah, I want to say a huge thank you to you for your work. Oh, the idea that you've been at this for what, nine years now, nine years? Yeah, nine years. And look at, look at how much time and longitudinal attention it takes to build something and to get to the kind of impact you have. So just want to compliment you on your tenacity and the vision and staying with it this long.
Elizabeth Markle 51:17
You're so kind. Thank you. And I'll just say it really is a team now, right? There are many, many people now who are committed to this vision and just pouring energy into it. It seems so logical.
Christine Mason 51:28
Yeah, okay, well, we are going to step it up here for open open everything source, I think in French, la surf is the well and well, literally well in German, Creel like this idea that open source well is like where we're all drinking from, we're all being nourished from. So even beyond the catchy software reference, it just has a beautiful sense of we're all looking into the same place and being nourished together. So thank you very much.
Elizabeth Markle 51:56
I love that. Thank you so much.
Christine Mason 51:59
Well, here are some takeaways from me, just to remember how much belonging actually heals us, that humans are wired for connection, and yet much of modern life has structured it out of reach in the West, at least for many. I want us to remember also how toxic individualism can shame people for failing to achieve well being in an isolating system that we can step away from that and design community back into healthcare. I want us also to know that community as medicine works. It reduces ER visits, improves mental health and fosters sustainable well being. The skills of connection, receiving and giving and absorbing are as vital as any nutrient, and that small steps, a single text, going to a group, can spark an upward spiral out of isolation and shame just to take a small step. So you can try it yourself, write your own prescription this week for movement or connection, or nourishment or mindfulness. You can support the movement, you can learn more or donate at open sourcewellness.org you can see about bringing community as medicine to your organization, whether you're a business or a Y or a community group, there are many ways to actually activate this in your community and then challenge toxic individualism in yourself and your circles. Notice where you might unconsciously blame people for structural barriers, or not have empathy for how people get to the place they are in their lives. Open the heart a little bit. And then finally, if you like this show, if you like this episode, if you think it has a message that might benefit someone, then share the link and let people know. Liz has done some beautiful work in the world, and we want to amplify and uplift her and her team and her organization as much as possible if you've gotten this far, thank you for listening. Please visit rosewoman.com for reverent body support, topicals for intimate care, body love, content and things that can help bring us into more wholeness inside of our own body, particularly at the point of integration of embodiment and sexuality. I'd also like to tell you that my course is live for the fall. We start September 16, six weeks online living Tantra. I would love it if you would join me that at christinemariemason.com if you'd like to learn more, so I will see you online or in the next episode. All love all the time. You
