Episode 24: Creating a Culture of Health with Dr. Michael Goldstein

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Transcript

Dr.  Wendy Slusser 00:03

In 2011, Dr. Michael Goldstein began developing and growing a social movement focused on creating a culture of health in the UCLA community called the Healthy Campus Initiative. This initiative was envisioned and supported by Jane and Terry Semel, and embraced by UCLA Chancellor Gene Block in 2013. Today, I chat with Fielding School of Public Health Professor and Medical Sociologist, Dr. Michael Goldstein, about the origins of the Semel Healthy Campus Initiative Center, and what it takes to create long lasting culture change. Keep listening to hear about how social change begins, not with rationality, but through social movements.  Thank you for coming for this interview.

 

Dr. Michael Goldstein  00:47

Oh, well, thank you for inviting me. Wonderful to be here. Great to see you.

 

Dr.  Wendy Slusser  00:51

I don’t really know where to start. Because there’s so many places to start with you and how you have been instrumental in not only creating and starting up this Semel Healthy Campus Initiative, but also your pioneer, and work at UCLA overall. And I’d like to start with the fact that you’re a sociologist, and your career has been in the School of Public Health. How did that kind of intersection occur in your career?

 

Dr. Michael Goldstein  01:25

Well, my interest going back to when I started studying sociology seriously as an undergraduate, and then later as a graduate student, a lot of it focused on two things. One was the role of inequalities in society in determining all kinds of outcomes, one of which was health and health status, about inequalities. I mean, in terms of income inequalities in the society– educational, racial, gender based inequalities. So I was very struck by how those things played out in many areas of peoples’ lives throughout their lives, and one was health. The other thing that I was interested in was the the study of the professions. And because of funding availability, most of the funding that was available to study professions when I was going to graduate school had to do with the medical profession- the health professions in general. So those two areas came together inequalities and the professions. And that’s what eventually led to my being able to get a position at UCLA in the School of Public Health.

 

Dr.  Wendy Slusser  02:40

And that was your first position?

 

Dr. Michael Goldstein  02:41

Well, I had taught for one year in a new medical school at Brown, Brown University was forming a medical school. And that’s where I got my PhD. And when they began it, they only had the first two years of study. And then the students moved on to another medical school. But it was an innovative curriculum. And one of the things that they required, which was very innovative at the time, was a course in medical sociology for all the medical students. And they hired a famous person to come and teach it and eventually lead the program there in social medicine. But as part of his contract to get the job, he got his first year off. And so they needed someone to teach the medical students this required course. And so I was sort of at the right place at the right time. So I taught there for one year. So then when this job came open at UCLA, in those days, it was pretty unusual to find a sociologist who had experience teaching in a medical setting, particularly a medical school. So on paper, it sort of looked like I knew what I was doing. And that facilitated my getting the job here. Really, I had no idea what…

 

Dr.  Wendy Slusser  03:07

In the School of Public Health?

 

Dr. Michael Goldstein  03:52

Yeah, right because I had that medical school experience. So it was a coming together of my genuine intellectual interests with the way the situation was changing in the United States, the availability of funding for these kinds of positions and the growing awareness that things like social determinants of health were really crucial in understanding the health problems of our society.

 

Dr.  Wendy Slusser  04:18

I want to unpack just what you said, because there’s so many pieces that I’d like to sort of explore with you. I think the first question just as a quick follow up is, was this when social determinants of health are emerging as a conversation in the academic world as well as the practice of medicine?

 

Dr. Michael Goldstein  04:36

Well, I think that’s a complicated question. I’m not sure I can give a fully accurate answer. I think the answer is that in the academic world, it had emerged long before. The question was what kind of traction did that get within more of the world of both health education of health professionals and in terms of just general awareness of people who were powerful in the health care system that this had to be taken into account. And I think the way it came together, what would be of interest to us here was the growing interest in prevention as the nature of disease or illness or disability in society came to be so much more based on chronic problems, rather than acute problems- there was a growing awareness of the need to emphasize prevention or that it was going to be much better economically and medically and in every other way to prevent a problem than to try to deal with it, especially when there was no way of dealing with a lot of these problems very successfully.

 

So all of that came together just at a time when there was so much emphasis on the increasing costs of health care. And that prevention then came into prominence.  And that’s what was happening in public health, you know, public health had had a great deal of success dealing with acute conditions, infectious conditions, things like this. And now public health, we’re going back to late 1960s. So it’s a long time ago, there was an awareness of bringing a public health perspective, to what was now seen as the major health problems in the country, things like cancer, heart disease, of course, all the cardiovascular stroke, whatever, hypertension, all of that, and then eventually diabetes. And that prevention was so important, and that the social determinants of health was so important in just knowing where these problems existed in society, and where the emphasis had to be put. So all these things were coming together. So in that sense, it was a good time to come into academia with the interest that I had.

 

Dr.  Wendy Slusser  06:49

So it sounds like from at this point in time, with your interest in inequality, and also, what sounds like the opportunity for funding through the health studies and professional sector that you were able to merge those interest with this emerging translation of what we now know quite well social determinants of health. Well, what did you teach when you had to teach that first year? How did you pull together something with the students at Brown? In the medical sociology? What was that?

 

Dr. Michael Goldstein  07:23

Well, you’re going back so long, I don’t know that I can really give you an accurate…you know, when you start teaching, in any subject, what you do when you’re teaching in the beginning is you just teach what you’ve been taught. So, I guess what I did is I took my various courses that I had had, that seemed relevant, and, you know, came up with with readings. And what I remember of it is, of course, you know, medical students don’t necessarily take this stuff too seriously. And certainly back then, this isn’t what they saw themselves as doing. So who knows if they did the readings or not, but, you know, we just had a lot of discussions, it was a small program, and did emphasize small classes. So I had a couple of classes of maybe, you know, 15 students, first year medical students, and some of them were very interested in this kind of thing. They weren’t interested in doing the readings, but they’re interested in talking about it because of their experiences or whatever. And some of them, were completely uninterested in it.

 

And that’s the experience that I found carrying through right up until I stopped doing this stuff a number of years ago, that, you know, there are there’s a subset of medical students and medical professionals who are very interested, very aware. And then there’s a much larger group that just don’t see this as relevant for their work. Because most physicians and most health practitioners are not dealing with prevention in terms of what they have to focus on. They’re so overwhelmed with the problems, the real problems that they are seeing in the hospital or in their office or whatever, that prevention is an afterthought. They have so much they have to deal with today. So that’s another set of issues and thinks a little remote from what we’re talking about today.

 

Dr.  Wendy Slusser  09:10

Right, so this focus on prevention, which germinated, it sounds like in this work that you did at Brown and then as you got invited here at UCLA. I’d love to know, you know, as you’ve evolved, and what you’ve taught me over time with the Semel Healthy Campus Initiative work is your ability to not just translate it to perhaps a single group, like a professional group, but your ability to start social movements and community organize. And I’d love to know, if you were to advise someone on, you know, wanting to work like “a culture of health”, for instance, which is really what the movement is now with the Semel Healthy Campus Initiative that you initiated eight years ago? And what did you know? What are these the key ingredients that you have found useful, at least on a campus level that you think would be useful for other people to know about?

 

Dr. Michael Goldstein  10:13

Well, it’s a complicated question. I think some of it relates to my background and the perspective that I had about how social change occurs in a society and in institutions. And that’s where this notion of emphasizing social movements comes from. Because when I looked around, and I saw that American society had been going through and continues to go through a tremendous amount of social change and what was responsible for that, I kept coming back to this notion that it was social movements. When I looked at things like the Civil Rights movement, or changes in the consciousness– all of it, to my way of thinking, there was a social movement behind all those changes.

 

And so when I thought about something like changing the culture of health, it seemed to me that we had a model, an implicit model there of how change could occur in a society like ours, or an institution like a large university, such as UCLA. And that was to take a social movement approach to bringing about change, which was very different than the dominant model that existed in peoples’ minds. Let’s say in the health professions, the notion was that rationality was going to bring change that people, let’s say, if you wanted to get people to stop smoking, or if you wanted to get them to change their diet, or exercise more, there was data that would show that if you did a certain thing that things were going to get better. And people were rational. And if you just showed them that data, you educated them, or you sent them a pamphlet or something, they would, of course, behave rationally. And they would do it and that’s the way change would occur. And that’s not true. But that’s not the way change occurs, right?

 

If you have a population of smokers and today, there are millions of smokers in the United States, I think it’d be pretty hard pressed to find some who don’t know that smoking is bad for their health. You can tell them that over and over, they know that already, it doesn’t change their behavior. And that was the same thing, when we looked at, let’s say, attitudes towards gay people, gay marriage or something. And it wasn’t knowledge or rationality that was influencing people’s behavior was something else. And whatever that something else was, was, it seemed like very hard to change. On the other hand, we saw a change going on around us all the time in society.

 

So when I looked at, well, why is that change occurring? I was led back to this idea of a social movement. So that was really the key thing for me. And social movements are tricky. They’re hard. They’re very broad. They’re very amorphous. And they’re also very much based in conflict. Whenever you have a social movement, it comes out of that there’s a group of people who have a grievance, they have a complaint, there’s something they don’t like, and they want to change that. So it’s really conflict-based. It’s very different than this rationality model, which is, is anti-conflict. The notion is that rationality, there’s a rational answer two things, and that if people know what everyone will agree, once you see the data on smoking, there’s no argument what it is- it is what it is. But that’s not the way change takes place. If you want to get a no smoking legislation passed, if you want to raise taxes on cigarettes, or if you want to have rules that don’t allow cigarettes to be sold near schools, or whatever it is, right away, you’re involved in conflict, in reality. Some people think it’s terrible that cigarettes are available to school kids. And they’re angry about it. They’re furious about it. They see their own kids or their whatever kids they love, you know, smoking, and they’re angry, and they say, who’s doing this who’s benefiting from it.

 

Dr.  Wendy Slusser  14:16

So it’s emotional.

 

Dr. Michael Goldstein  14:17

It’s emotional. But there’s also conflict, because then there are people who are selling cigarettes, and they’re interested in selling more cigarettes. So you can’t just say, well, here’s the data, and then everyone is going to coalesce around that and then say, ‘Okay, we have the data now, and I make my living by selling cigarettes, but I’m gonna stop now I’m not going to, I’m going to toss my income into the garbage can because I see,’ it doesn’t work like that. And for all these things, there’s conflict. So social movements are always built around conflict. I mean, if we talk about the environmental movement, we talk about gay rights, civil rights, whatever it is, it’s conflict isn’t grievance. People are angry about something, something’s wrong and they get together with the idea that’s- we want to change this.

 

So the notion that I had was, that’s the way change in the health area in terms of prevention would take place. Because it’s a little tricky, because on one level, of course, everybody, if you ask them, are you in favor of health? And would you like to be healthy? Everybody says ‘yes’. But that’s sort of an illusion, because that’s a foolish question to ask people. Because that’s not the way the question exists in the real world. If you ask people, ‘gee, would you like to have a healthy diet?’ Everyone’s gonna say, ‘yes’. But if you ask them, ‘how important to you is it to have a healthy diet if it means giving up the 10 foods you like best in the world?’ Then people are going to give you a different answer. Right? So it’s meaningless to say that, gee, everybody wants to be healthy.

 

In practical terms, most people only want to be healthy if it has no cost. And it usually does have a cost to them. In some way, I saw that I was very conflict-oriented, all my background had oriented me towards conflict in the world. And that progress- things only develop and change through conflict of various kinds. It doesn’t mean violence, but it means there’s all kinds of different ways that conflict can can exist in society.

 

Dr.  Wendy Slusser  16:20

Like, what would be an example?

 

Dr. Michael Goldstein  16:22

Well, just what laws should be passed, legislative conflict, value conflict, different religions, right? They’re often in conflict with one another. Different views about how important things like individual responsibility is for determining where you wind up in life, people just have different attitudes about things. And those, those views some often come in conflict with with other views, right? And that’s the nature of, of what you have. So I was oriented that way from the start. But to get back to social movements. Whenever I saw change occurring in our society, I saw a social movement behind that change. So I saw this idea of a grievance and a group becoming very active and trying to change that grievance, as leading to a kind of collective identity change and collective actions. And that’s how change came about in society.

 

So that was really the model for the Healthy Campus Initiative. At UCLA, as I’m sure other large universities, it’s a very diverse group of people who live and work here. And when I looked around, I saw that there were a lot of groups who wanted all kinds of changes in terms of health, a whole array of different things. And the idea was to mobilize them in terms of some sort of common effort, and to get them to, in a way, share their concerns, or share their grievances, and come together and try and build up a collective identity around that, regardless of how they differed on this on the particulars. Okay, so let’s say and Wendy, of course, you’re more familiar with this than I, there were lots of groups that were concerned about food and eating and diet. But they were concerned in different areas. Some of them were concerned, because there were a lot of homeless students who didn’t have enough to eat. Others were concerned that the food in the dining hall should be labeled with calorie counts, and some people who have more information about what they were eating. And others were concerned that the food shouldn’t be labeled with calorie counts, because we had eating disorder problems on the campus and that would make it easier for people to facilitate their eating disorders.

 

And there were all kinds of people, staff, people, and professors who studied everything for the basic science of food to people who were, you know, training dieticians over the VA, which was part of UCLA. And so there were hundreds and hundreds of different groups concerned with this. And my thought was, well, you want to get those groups together, and just sort of put them together and see what comes out of it, maybe they’ll find some commonalities, because they really do have some things in common. They were concerned about eating and the quality of food and people taking more responsibility for what they eat, knowing more about what they eat, etc. Then there were people who were concerned about the environment and farming and there were all kinds of things. Well, this is the way movement comes together.

 

So really, in terms of forming the Healthy Campus Initiative, that was the model that I had, that you just get these people together and something will happen and that is what happened, and then you just go from there, so that that oversimplifies it a bit. But that was that’s what I was thinking. And I had a very clear model in my mind because what I looked at these other movements or say feminism or civil rights, that’s what had happened there. The people who were part of that movement – they weren’t all interested in the same thing. But they had certain underlying themes in common. And what they had in common was a grievance. They were all angry and upset and dissatisfied with the way, let’s say, people of color were being treated in the United States, what they wanted to focus on what their solution was, across, varied across the map. But it was the grievance that brought them together. And that was a model for the Healthy Campus Initiative.

 

Dr.  Wendy Slusser  20:38

I know in the first two years, in particular, you went and spoke to a myriad of different groups and over 60, 70 or 80 groups over those two years. Was there any thing that you were surprised by in terms of a grievance? Was there anything that you found during your course of sharing this vision of this Semel Healthy Campus Initiative as being the healthiest campus in the country?

 

Dr. Michael Goldstein  21:05

Well, I guess, I was positively surprised by the amount of interest that there was in this, the negative things didn’t surprise me at all, because I began with the notion that the dominant culture, both in the United States and on the campus was either unconcerned or opposed to to health and prevention. So didn’t surprise me at all. And I want to speak to these different groups, most of them, of course, they’re, again, they’re, they’re agreeable, they’re not against health. And they’re not against the people that say, who work in that unit being healthy. But in terms of their, their practical considerations, what they need at the moment, most of them were just unconcerned, because they have other things on their mind, they’re not really interested in being involved. So going around and talking to those people had multiple purposes. One purpose was just to, to let people know what is going on, because it’s a very large campus. And, you know, we’re besieged by these initiatives, right, if you, you know, as a member of the faculty that as a member of the administration now, that you probably get every year 20 emails from the chancellor, or somebody telling you, oh, we have a new initiative for such and such, you never hear about most of them.

 

So after that, so that’s the, that’s the reality. So when most people heard about the Healthy Campus Initiative, they thought, ‘well, that’s nice, you know, so what?’ So, one task was just to make people know that this was a real thing, and it was going to happen. So the more people you talk to the better whether they’re involved or not, they know who you are, the initials HCI, means something to them in the back of their mind, they’ve heard it and whatever, just by the fact of going to them, because you know, so many of these initiatives get started and then people never hear about them. No one ever visits, all the different schools, there’s something like 128 departments on this campus.

 

So just by going around, that’s important in itself, the other thing I was trying to do is to get something going, it didn’t really matter what the important thing is, I’d say a year later, that you can write a report and say, well, we did these five things, because that right away sets you apart from these other initiatives. So if you can show people that you’ve actually done something doesn’t matter what you did, and that more people are involved at the end than at at the beginning, right away, people see whether they agree with what you’re doing or not, they take you more seriously. So that was the goal at the start. And it’s just to stay in people’s minds and to get anything going. Because whatever you get going, it’s going to lead to something else.

 

Okay, and you saw that yourself with what we call the, you know, the the EatWell pod- you get people together, and you throw them in a room and 20 ideas come out and 19 of them die on the vine, but one of them leads to something and that leads to something else that leads to something else and then at the end of five years, you’ve done 10 different things. And each of them has a core of people, there’s some people involved in all 10, but most of them are just involved in one or two. And then you really have accomplished something there. And they all know each other. And the whole culture starts to change on the campus, in terms of eating. And then you look at all the things that that the Healthy Campus Initiative has done in terms of whether it’s the gardens or the dining halls, or where they haven’t been the sole force involved, but they’ve been an element of it. And that’s, that’s the goal. That’s the power of it. Not that you do these things by yourself, but that you’re involved in all of these other things. And then all of them lead to other things. So you’re growing all the time, and it’s everywhere. Eventually, that’s the goal to be everywhere. And that’s the way these other social movements, you know, you couldn’t imagine an institution or society of business, for example, beginning these days without being cognizant of diversity issues. Doesn’t matter what it is that mentality has now- it exists throughout the culture. So that’s the goal here in terms of health and prevention.

 

Dr.  Wendy Slusser  25:21

And so yet that you mentioned how there are groups of people within the health care field that still don’t consider prevention as a priority for lots of competing reasons. And I see it also on our campus.

 

Dr. Michael Goldstein  25:36

Sure.

 

Dr.  Wendy Slusser  25:37

In terms of the health sciences, in particular, the medical side of our enterprise so to speak, they tend to, even when they hear the word help, think of it in terms of medicine, not in terms of prevention, what would you recommend on how to crack that nut? Because that’s a tough one.

 

Dr. Michael Goldstein  25:57

Well, you always– I mean, and I think by this point, this is pretty well established in public health, you have to start with people are. So if you go into a community, let’s say, and you say, oh, gee, I know what the problems are in this community, it’s diabetes. And so we’re going to get people together. And we’re going to give information about this and that diabetes and screening and changing your diet and get the people together. And they’re not concerned with diabetes, they’re concerned with the fact that their kids are unsafe walking home from school? Well, so then you’re in a situation there you have a decision to make, do you go with how they define what’s going to make them healthy now? Or do you say, in essence, look, I know better than you. Trust me, it’s not your kids coming home from school being unsafe, it’s diabetes, you’re at high risk for diabetes, and your kids are high risk. So that’s not going to work. Right? You have to start with where people are.

 

So if they feel that way, you find out what they want to do about it. And you try to facilitate them accomplishing that. And hopefully, after a while, if they’re successful, and there is some change, it doesn’t mean that that everything magically is going to change about their kids being safe coming home from school, but their success and the structures that develop out of that and your feeling of collective efficacy, because they’ve done something. Some of them may decide, well, we want to talk about eating in the community, they may not talk about it in terms of diabetes, but they may talk about it in terms of food deserts, or talk about it in who knows what- the quality in the vending machines at school or whatever.

 

And you go where people are, again, and so there’s so there’s two points. One is that’s the way other social movements that have been successful, have developed over time, and you take a less professionally dominated approach, it gets back to some of the things we were talking about earlier- you don’t assume that you know more than the people know about what their needs are and what they want. You may know more about them, and the in terms of what the risk factors are for diabetes, but that doesn’t mean that you know what they want, and what they feel they need now, and it’s very hard to do. But you know, people in the health professions sort of develop this idea that they have rationality, they have more rationality than other people do. And so therefore, they’re willing to impose that rationality on other people.

 

I think a better way to think about it is that everyone feels that making rational choices. And if you understood how that person perceived the world, you would understand that the choices they are making are rational for them. So in the diabetes example, a person might think, yeah, I don’t want diabetes, and I understand that I’m at risk for diabetes. How important is that? And the doctor told me, if I don’t change my diet, I’m gonna have diabetes. And for this good year chance in a few years, I’m gonna have diabetes. But I have these three kids coming home from school, and one of them was bullied and beaten up, and then there is no traffic lights. And, again, that’s my worry today. And you know, the safety and well being in my children are more important to me than the chance that I’m going to get diabetes in five years. Well, is that irrational? Maybe it is for you if your job and your salary depends on getting people to be screened for diabetes, but it’s not irrational for a person to have that, to have that response.

 

So, you know, it’s not that I’m anti-rationality, but I don’t think- when it’s over emphasized in terms of certain types of policies, it doesn’t lead to what we want. And it doesn’t, it’s not the way change occurs. So we’ve just seen that, you know, people, progressive people are always saying they can’t understand why people don’t vote and act in their own self-interest. But sometimes they don’t really have an understanding of how people themselves perceive their self-interest. So, when we’re talking about a culture change, I think those are the kinds, that’s what it comes down to. And so that’s one thing I always emphasize with the Healthy Campus Initiative is, let’s not be a South Campus. In other words, at UCLA, the health sciences are all centered on the southern part of the campus. Let’s not be South Campus oriented. That’s not what we’re trying for, that’s going to lead us in the wrong direction. As you yourself said, most of the people down there are not concerned about prevention. They’re not concerned about the issues we’re talking about. Let’s be focused where the need is, and where a lot of desire for change is. But it’s not among health professionals. That’s a hard thing for people to hear, for some people to hear. But that was the perspective. I brought to it. And I think that’s a public health basic public health perspective.

 

Dr.  Wendy Slusser  31:25

So distinguishing, of course, between the school, the students themselves, and the health professional students versus the practitioners because I think that there is hope for the students.

 

Dr. Michael Goldstein  31:37

Well, I think it’s the same thing you start with where the students or the way you describe it, I’m not intimately familiar with it or familiar with it at all anymore- the situation down there. But again, somebody seems to feel that we know what their problem is.

 

Dr.  Wendy Slusser  31:52

Yeah.

 

Dr. Michael Goldstein  31:52

So we’re going to design a program, oh it’s going to be a great program, but we’re going to require you or pressure you go to the program. You start with where the students are you bring them together, and what do they want, right? And then you go, you go from there, and don’t worry if it’s not what you want. One of the things that they want, in fact, is to have what they want, not what you want, regardless of whether it’s the right thing or the wrong thing. And by by telling them, ‘Oh, no, we know better what you want them what you yourselves want.’ You’re putting them down, you’re telling them that their thought process is irrational, right? It’s just what doing with that woman with diabetes, right? You’re saying, ‘you don’t really know. You think you know, but I know better than you what you yourself want.’ And that’s probably not going to work out well. You know, so that’s why I say people, if it’s gonna work, people have to come together around a grievance. And you know, what your grievance is, I can’t tell you what your grievance is.

 

Dr.  Wendy Slusser  33:00

Yeah,  that’s really good advice. I think that says a lot about the sort of important strategies about community organizing and social movements. And I’m wondering, before I move on to a sort of bigger, broader question about how do we keep the momentum going, which is, I think, really important. Where did you see some of the obstacles? And what were some of the ways you overcame obstacles or hurdles as you moved through developing this social movement of the Healthy Campus Initiative at UCLA?

 

Dr. Michael Goldstein  33:34

In terms of the Healthy Campus Initiative, I think, when obstacles came and those obstacles were almost always that some group of people were opposed to what we thought should be done. Of course, sometimes the obstacles are insurmountable. But I think the general approach would be to try to incorporate those people into whatever the group is. So even people with very different views. So there was a time when we had some conflict with people who do physical planning on the campus. You know, the architects, the sort of urban planner types. Well, we were fairly successful in some ways, we’re getting those people involved. Instead of saying, gee, your values are different than ours, we’re not gonna have anything to do with you. Say, you know, gee, we need your perspective right here on the on this group in this pod, which is the language we use in Healthy Campus Initiative.

 

Dr.  Wendy Slusser  34:34

In the BEWell pod.

 

Dr. Michael Goldstein  34:35

Right, so let’s, let’s bring you in. It’s crucial that you’re here. You know, will you come, wil you join the pod? And they’ll speak and let and don’t impose, I think the key to any kind of administrative success if you’re a person like yourself, or I was who’s charged administratively with running these programs is, is the old Zen adage which is not to become attached to any particular outcome. In other words, you may have an idea about what the right thing to do is, in terms of, I don’t know, Healthy Vending machines or some particular thing. But if that’s going to become something that’s really dealt with, and the vending people are going to be involved in the people who run, the stores are going to be involved in the transportation people, and God knows who else has to be involved in this kind of thing. You know what you want, but whatever comes out, it doesn’t really matter what comes out, as long as there’s movement in the right direction. And if people’s consciousness is raised, because even if you don’t get the outcome that you think is the right outcome, and people in the group are annoyed, that’s okay. That just means that they learn more about the grievance, and how, how resistant the culture is to changing things, and what has to be changed, and that maybe it’s not possible to change some things and why. So, once you become attached to a particular outcome, I think that’s that’s very, that’s not a good thing in terms of what we’re talking about here.

 

Dr.  Wendy Slusser  36:11

So really, using the strategy of not becoming attached will help you deal with hurdles.

 

Dr. Michael Goldstein  36:18

Right. Yeah.

 

Dr.  Wendy Slusser  36:20

And also increase engagement.

 

Dr. Michael Goldstein  36:22

Right. Exactly. Again, having a model of these other social movements in the back of your mind, I think, is useful, because when you think of another social movement, right away, you see how broad and amorphous it is. And you realize that in terms of the big change, it doesn’t really matter. The best thing for the movement, let’s take a look at something like the environmental movement or something, the best thing for the movement is simply that it grows. And more and more people adopt the perspective. And if people within the movement disagree, they’ll form segments and groups, and there’ll be a million different groups, and they’ll be at odds. But that’s, it’s sort of like the image should be like a big cloud of gas enveloping, you know, and it doesn’t really matter that it goes in this direction first, or whatever. But you just want people to have this basic feeling that they’re connected, that the role, pretty much want the same thing to happen. And let 1,000 flowers bloom. You know, if you think gardens are the right way to go, some people are gonna think gardens are so important. Other people you think gardens are the last thing that– it isn’t a matter of proving to ones that oh, well, you’re right, we’re going to have these gardens. No, the anti-garden people won. And that’s it when let everybody go to do their thing. That’s what the movement is- that it’s not a set of specific things that we must have.

 

Dr.  Wendy Slusser  38:03

So what I’m hearing and sort of is answering some of the question that I was going to pose next, which is about how do you maintain momentum for an initiative that now has evolved to be a center. And I’m hearing that a strategy for engagement is to not have an attachment to any particular outcome. And at the same time, also, working in a bureaucracy, you need to be cognizant of agreeing, but agreeing with your vision in mind as you move forward, and how do you maintain a momentum? What are your thoughts about how to maintain momentum in general, and then more specifically to the Healthy Campus Initiative since this is sort of the case study we’re talking about as a social movement? Right?

 

Dr. Michael Goldstein  38:47

Well, that’s a very good question. I guess, it seems to me, there’s no shortage of issues that people want to be involved with on the campus. And it’s just a matter of making sure that the Healthy Campus Initiative is involved with with those groups. So you’ve mentioned a good deal of the time, in terms of mental health needs for different groups on the campus. So there’s a lot of concern, whether it’s, you’ve talked about medical students, but of course, there’s similar concerns with with graduate students of all, you know, shapes and persuasions. So that’s one area. You know, there are specific issues. I mentioned things like traffic patterns and things that that some people are going to be very concerned with. There’s all kinds of disability issues. Obviously, Me Too movement is huge and has a million different repercussions or tangents that go off from it in terms of various types of sexual harassment and retaliation and things like that. So that’s, that’s an area I imagine there’s much emphasis now on the digital world, and sort of the health consequences of that in terms of information, or supposed that information that’s available. And some of it is good information. Some of it is not such good information. So curating that- there’s a lot of ideas there. You talk to staff people, and they have organizations and you see what they want to do. And then what’s the most important thing for them? And then you just read the LA Times. And you you go from you go from there. That’s, you see, what is hot, so to speak? I mean, you’re very sensitive to, to those kinds of things. And I think that’s great. I think that’s one of the real strengths that you bring to the, to the HCI.

 

Dr.  Wendy Slusser  40:47

Those are great ideas and I see what you’re saying is that in order to keep momentum, part of it is just being keeping yourself relevant to what’s on people’s minds, and what are the sort of conflicts that are going on…

 

Dr. Michael Goldstein  41:01

And what they’re complaining about.

 

Dr.  Wendy Slusser  41:02

And what their concerns are.

 

Dr. Michael Goldstein  41:04

And their grievances.

 

Dr.  Wendy Slusser  41:05

Yeah. Okay, that’s very, that’s very wise information and makes it relevant in terms of any university movement has to be really homegrown, because every university campus will have different…

 

Dr. Michael Goldstein  41:20

Absolutely.

 

Dr.  Wendy Slusser  41:21

Priorities, different challenges, and so forth. So on a larger scale going back, I’d love to talk a bit about your influential book you wrote on the origins and ideologies of three crucial health movements in our country: dieting, exercise, and non-smoking. It’s called The Health Movement: Promoting Fitness in America. And what is so important about these three health movements?

 

Dr. Michael Goldstein  41:46

Well, of course, I wrote that book a long time ago. So I think, to my mind, they’re all just different aspects of the same underlying movement, which I call the health movement there. Well, first of all, throughout American history, there’s been a waxing and waning with concern, the kinds of things we’ve been talking about today, concern for health and prevention, and being healthy. And what does that mean? And whenever those concerns have been high, those three things have been together, the idea of eating in a more healthy way, whatever that means, being physically active, and eliminating contaminants from the body. And, of course, people of different times, people concern with different contaminants, but tobacco has been in American history, very, very important. So those three things have always, always come together.

 

And I saw them as related to each other in that sense, historically, because they concern with them comes from a shared set of values that people have. And that’s really what that book is about, as I remember it, my memory may not be completely accurate. So let me speak very briefly about those values, because there’s a whole bunch of them. And it gets back to a lot of the things that we’ve been talking about here about the healthy culture. The first one is that this idea of wellness or what some people refer to as high level wellness, and I think the key thought there is that wellness is not simply the absence of a diagnosis or symptoms. But wellness is something else. It’s independent. You can have a diagnosis of whatever and your wellness is independent of that. You can have low wellness or no wellness, or you can be…

 

Dr.  Wendy Slusser  43:41

Social well-being for instance.

 

Dr. Michael Goldstein  43:41

Or your well-being, your ability to function, your happiness, your whatever, resilience, whatever you want to call it, whatever the components are, that wellness is separate. It’s not just, you know, in the medical people you’ve been talking about, they understand health, in what I would call a residual way. They have a bunch of tests and a bunch of questions that they ask you and if the answer is no for all of them, and all the tests come back negative, you’re healthy. Health is the absence of symptoms, it’s the absence of a diagnosis. That’s not what this movement is about. Wellness is different than the absence of symptoms. It doesn’t mean we don’t want to reduce symptoms, we don’t want to, but it’s something different. So that’s, that’s one thing. So what is wellness, then, that brings us partially to the answer of your question, why those three things are together? Okay, so that’s one aspect of it.

 

The other another thing, and this is a very complicated area, we don’t really have time to get into a detail, that all of these things emphasize is personal responsibility. In some way, you have to eat better, you have to exercise. I can’t give you a pill that is the equivalent of you exercising, you know, if you’re going to stop smoking or stop drinking or whatever it is, you have to do it you have to be responsible for actively doing something. And again, that’s one of the things tensions with health professionals, health professionals tend to do things to you, they give you a prescription, they do an operation, they perform an operation, they whatever. With wellness, you’re doing it yourself in some way. You are responsible for doing it. A third thing is the interplay between mind, body and spirit and these things that, you know, we can talk about in terms of the work that you did so well and continue to do with the Healthy Campus, the food part of the Healthy Campus, where there’s a notion, there’s a biological part about what you put in your body, but there’s a motivational part. And more and more, there’s a kind of spiritual part in terms of for some people as being a vegetarian, or being vegan, or supporting local farms, or just the effect of having the gardens down at the hospital has on people, that these things all come together in some way. And the mind, body and spirit are seen as interpenetrating each other, and all can be causal in terms of the other two, any one, one can has causal implications for the other two, and is also a response, therefore, to the other two, okay, so. So that interplay of body, mind and spirit.

 

And another aspect of it is that to be healthy, or to be well means living in harmony with nature, whatever that means. But there’s clearly not, let’s say, on this campus, been a huge affinity between the people who are concerned with environmental issues and sustainability issues, and health issues. That that is, is there. There’s also a real ambivalence towards science, technology and medicine. They’re not against these things, but they’re ambivalent about if you’re feeling as if there’s too much emphasis on that it goes against these other things. And, you know, the nonprofessional the emphasis on non professionals, that’s been an undercurrent in the discussion here. So that’s tied up in all this. And then a whole set of values around what I call in the book, as I recall, prevention, vigilance and restraint. The idea that to be healthier to be well, you have to cast a middle ground balance, which means if you like something, you got to put some limits on it, that even if it’s a good thing, if you do it too much, it’s not going to be good.

 

And you have to sort of watch out, you have to be vigilant, the thing about being healthy. And this is what stops a lot of people, let’s say to eat a healthy diet. If you eat a healthy diet on Monday, that’s great. But when Tuesday comes, you still got to eat the healthy diet. So it’s this idea of vigilance. So you have to, you know, and those values go against the values in our culture, the values, our culture is, hey, if this is good, and you’re like this on Monday, on Tuesday, you’re going to do it again, if you went to Starbucks, and you had a whatever, this whatever thing they’re offering today, and that’s great. Well, the fact that it’s great means you just want to do it again, right? And so there’s a different set of values. And that gets back to the question you asked about diet, exercise, and the smoking business, all these values are in there. And they all come together in this what I saw as a health movement. And that’s a different angle of what we’ve been talking about here. But one of the problems in our society is that when things are developed, that are good for people, they immediately become unrestrained, because we have this notion that we just want to make more and more money out of things. So if I’m providing the service to get you to your class quicker, and it’s really good, and you’re really useful it, it calms you down so you don’t have to be so anxious- ‘gee, I’m not going to get to my exam on time and all of that.’  But somehow what comes out of it at the end is you want to do that every time, three times a day, back and forth. It ends up being unhealthy for you, you know, you don’t exercise, the traffic is clogged and all the things we talked about. So you have this idea of moderation in all these things.

 

Dr.  Wendy Slusser  49:17

Balance.

 

Dr. Michael Goldstein  49:18

Balance and all of this. So those are the values in the health movement. And those are not necessarily the values in our society. Tolerance, things like that are very important, but we’re getting away from that. And I think one of the things that’s attractive to people about it and one of the things that the Healthy Campus Initiative should be focusing on in my view, although it’s very hard to specify this, is this idea of balance and moderation, right. And that’s so important to people, and yet so much in our society pushes us away from that. It isn’t that there’s anything wrong with with drinking a little bottle or a little glass of Coca Cola. What’s wrong is when all of a sudden, every fast food place is advertising for the same price as that little thing will give you a bigger and bigger and bigger and bigger and you can have 64 ounces for what you’ve just paid for eight ounces, then somehow things have gone sort of crazy. And everybody knows it’s no good. But everyone wants it at the same time. So that’s sort of a little disjointed answer…

 

Dr.  Wendy Slusser  50:43

Well, I think that it’s sort of answers the question I was going to ask you Next, which was what? What do you think the most pressing health issue of our society faces today?

 

Dr. Michael Goldstein  50:53

Well, I think the the issue is clearly access to healthcare, which is different than what we’ve been talking about. That’s number one. But the other thing is, and this will take us back to the very first questions that you asked. Inequality. That, you know, when I started being interested in these things, let’s say in the mid 1960s. Okay, so that’s, that’s a while ago. And at that time, I and everybody I knew had this image that yes, social change was taking place much too slow. But it was taking place and we were moving in a good direction, there was no question that in 10 years, things would be better than they were, let’s say, 1975, they’d be better than they were in 1965. And in 1985, they’d be better than… things were slowly going to get better. That was inevitable, right? I don’t think we have that image now. And I think one way we can see that is in terms of basic inequalities in a society, that inequality in the United States has gotten much worse, between 1965 or 1970.

 

And today, and in some respects, inequality in health, and education just reflects those inequalities, those more basic economic inequalities. So that’s really the major issue. And for me, the whole notion of the health movement are changing, making it a healthier culture, is that in some way that will contribute to reducing these inequalities, whether we’re looking at some specific health related goal, depression, or you know, diabetes, or any of these, any of these things, or smoking or whatever. And also reducing those will foster a reduction in those basic economic inequalities, as well. If people are healthier, especially young people, they will be able and willing to have better education. And that will lead to them being able to have more productive lives and have better jobs and have more money, when, etc, that all these things are part of the broad structure of society. So that’s really…but  inqualit and access, of course, is just one aspect of inequality. That’s the major issue that in my mind that we face today.

 

Dr.  Wendy Slusser  53:18

So in essence, your journey of reducing inequality by improving the culture of health on a campus and now, thanks to your vision, and Jane and Terry’s, it’s really transformed UC wide; different cultures, different places, but feel that that’s a step forward.

 

Dr. Michael Goldstein  53:40

Right. I think, of course, it hasn’t gone nearly as far as you and II would like it to. The first step in this is just an awareness. And, you know, for the most part, people don’t have an awareness that just about every decision that is made, let’s say the campus is going to build a new building, that that decisions gonna have an impact on the health and well-being of the people who work in that building, the students who study in that building, the people who work surrounding it. Is it going to block all the light that we have? We’re sitting here in your office- wonderful, natural light, but there’s a parking lot out there. And that’s been part of the problem, right? The noise from the parking lot? Well, what if they say we’re going to get rid of that parking lot, but we’re going to build a huge structure, huge building there, and then there’s no more natural light here. Well, the first step, I’m not saying they shouldn’t build that building, but I’m saying the very first step is there has to be an awareness that all these decisions impact people’s well-being people should be thinking about this. So that’s, in that sense, I think we’ve made some baby steps forward. But they’re just baby steps and they can be wiped out in an instant. And we see right now politically in this country, how and just the the space of a couple of years how much consciousness has has changed about this, and that these gains that we thought were irrevocable, they’re not irrevocable.

 

Dr.  Wendy Slusser  55:11

Right.

 

Dr. Michael Goldstein  55:11

And we look around the world and things that we saw- breaking down of barriers and borders doesn’t mean that they disappear, but interchange between people, it seemed like that was that was a good thing, and that etc and cultural diversity and all of that, it’s under attack in very basic ways. And it doesn’t, it doesn’t have to be that way. In other words, in my mind, it comes back that conflict that, that people have to assert their vision, and they have to be willing to fight for that.

 

Dr.  Wendy Slusser  55:50

And be vigilant.

 

Dr. Michael Goldstein  55:51

And be vigilant about it. Otherwise, these gains will disappear very, very rapidly. So in a way, maybe that’s a negative message. Because the image about health at least used to be that oh, you know, once we cure these diseases, we’re not going back. But we see now even here in California with something as fundamental as the measles and the vaccine, it’s very easy to go back and people… It’s really, it’s a constant struggle.

 

Dr.  Wendy Slusser  56:26

Yeah. So I think that well, to wrap up, for anyone who sees an issue and wants to do something about it, what would your advice be to them?

 

Dr. Michael Goldstein  56:35

To get involved, doesn’t matter. That the thing is to be involved and because that will do something good for you. It may not be what you expected to do, like, Oh, I’m going to be involved in the issue is going to be resolved. But just involvement and engagement in the world is a good thing. And to do it in a way that reflects what you think is the best version of yourself, the values that you hold to be true to you. And to just do that. So I think that’s what, what, what people have to do. And, you know, if it’s a health related thing, that’s great, but whatever it is, that’s, that’s just just do it. And to understand that when you do things like that, you know, it’s not just that you’re doing things for other people, but you’re doing something for yourself. And just to try that and then see, I think people will see that that is that is true, or at least most people will.

 

Dr.  Wendy Slusser  57:38

Michael, well. you do it all the time. You’ve been an incredible leader, not just in the Healthy Campus Initiative here at UCLA. You’ve resolved a lot of challenges on this campus and thank you so much.

 

Dr. Michael Goldstein  57:52

Oh, you’re very welcome.

 

Dr.  Wendy Slusser  57:56

Thank you for tuning into UCLA LiveWell. For more information about today’s episode and the resources mentioned, visit our website at healthy.ucla.edu/livewellpodcast. Today’s podcast was brought to you by the Semel Healthy Campus Initiative Center at UCLA. To stay up to date with our episodes, subscribe to UCLA live well on Apple podcasts, Spotify, or wherever you listen to podcasts. Get to know us a little better and follow us @healthyucla. If you think you know the perfect person for us to interview next tweet your idea to us, please. Have a wonderful rest of your day and we hope you join us for our next episode as we explore new perspectives on health and well-being.