Begins at Home!

National Leadership Award, presented to Jim Felsen by his peers in 1972.

The four pieces of turquoise represent  important spiritual

foundation of Native Americans -the fourdirections and earth,water, wind, and fire.

The cross depicts the spiritual culture of missionaries who introduced Western medicine to Native Americans.

The eagle feathers are a sacred symbol of Native American healing power and the cadueses represents Western medicine.

The broken arrow depicts the ending of hostilities between two different cultures.

The peace pipe represents the honor, mutual respect, and, most importantly, trust, which must exist to assure the success of any agreement and interaction.

The Big Picture & Why I Do This Work

Over 40 years ago, I abandoned plans for a career in orthopedic surgery, family practice, or emergency room medicine when exposed to the enormous power of community public health. I first learned to respect, and then admire, the skills of public health practitioners to blend adeptly the biological, social, and political sciences within a community to realize huge improvements in the human condition.

What hooked me was the staggering potential of public health and the most mindboggling potential of the new emerging capability to integrate and weigh all relevant and contributory information for each patient, community, or subpopulation. This information could then be used to determine, prioritize, target, and coordinate the most effective and efficient risk identification, clinical (i.e., screening, prevention, diagnosis, therapy), educational, promotional and environmental practice interventions.

Although the information technology to support such integration has continued to rapidly advance in sophistication and capacity, the process has stalled for a variety of political, economic, and related reasons. In many respects, the fragmentationand associated ineffectiveness, inefficiency, and waste of local health care systems have increased.

What I am hoping to stimulate through this forum involves issues of respective roles, propriety, and balance in order to assure each community can most effectively and efficiently deploy the contributions of experts. The role of the expert, as contrasted with the local integrator, is no better or worse; it is simply different.  Within the United States, the expanding plethora of “scientific” health intervention options and wealth mesmerize us. We have eliminated many environmental hazards and experienced a marked increase in many favorable indicators of health status. However, we have been spending “like a drunken sailor”.  Most of us concede that we do not see how we can continue upon the current path. Yet, we are very distrustful of any entity that proposes to limit our choices or dictate the process by how we decide which services to deliver.  The solution seems too difficult and complex. As a nation and a community, we have become impotent, unable to envision any way out of this conundrum.

My book, De-spamming Health, describes a rather simple, inexpensive, and incremental approach by which the empowered leadership within a local community can regain ownership of its health care system and drive the agenda. It’s definitely not an easy or direct process. But the insights within the book, combined with active discussion and sharing on this website, provides opportunities to test new ideas, seek support and consultation, and build on improving our system of care for all Americans.


James D. Felsen, MD. MPH