The following is a conversation between Tyler Norris, CEO of Well Being Trust, and Denver Frederick, Host of The Business of Giving on AM 970 The Answer.



Denver: American lives are shorter on average than those in other wealthy nations, and the gap is growing ever wider according to the latest data released by the Center for Disease Control. In fact, it appears that in 2017, US life expectancy will drop for a third year in a row, an event that hasn’t occurred in over a hundred years. As Americans, we are not faring well. But there’s a young organization that is dedicated to advancing the mental, social, and spiritual health of the nation. It’s called Well Being Trust, and it’s a pleasure to have with us their Chief Executive Officer, Tyler Norris. Good evening, Tyler, and welcome to The Business of Giving.

Tyler: Denver, thanks for having me on. Glad to be here.

Denver: Give us a snapshot of Well Being Trust.  And tell us how the organization came to be.

Tyler: The Well Being Trust is a new national foundation with a mission to advance the mental, social, and spiritual health of the country. When two large Catholic health systems, Providence St. Joseph Health came together two years ago, the executives and sponsors of the organization were looking at the horizon of what is driving poor health outcomes in the country and recognized that unaddressed mental health and substance use issues were not only a leading cause of disability in the United States, but that they were fundamentally undercutting our ability to address other chronic diseases. And so the third largest hospital system in the country made a commitment to really not only transform the way we address mental health and substance use issues, but also to focus on prevention and to go upstream on what creates good health in the first place.

…life expectancy in the United States is decreasing, and issues such as opioid overdose, alcohol-related deaths, and suicides are becoming a leading cause of disability in the United States. It’s the equivalent of nine school buses going over the cliff every single day, and it’s hard as a nation to get our heads around the scale of the tragedy…

Denver: While the dimensions of this crisis are truly staggering, and you have documented the scope in a report you helped to produce called Pain In The Nation, what does that picture look like today, Tyler? And what are the projections for the coming decade?

Tyler: Well, I think the most important thing… and you said it in your opening, is that life expectancy in the United States is decreasing, and issues such as opioid overdose, alcohol-related deaths, and suicides are becoming a leading cause of disability in the United States. It’s the equivalent of nine school buses going over the cliff every single day, and it’s hard as a nation to get our heads around the scale of the tragedy.  We understand; we hear about the opioid crisis, and we kind of wonder what’s really driving it, and of course, recently, some higher profile suicides are pointing, shedding the light on the pervasive rates of suicide, whether it’s our young people or our veterans or aging adults. And I think it’s essentially a clarion call to: One, we need to understand what’s killing us; secondly, that there are things that are working. In fact there’s quite an evidence base around what works to address these issues.  And then, build the community and political will to be able to address these issues in a meaningful way. So that’s what Pain In The Nation was for us– a chance to build awareness, recognize what works, and call for a national resilience strategy.

…a person experiencing persistent and ongoing loneliness is the equivalent of smoking about fifteen cigarettes a day. So loneliness, disconnection, despair, and hopelessness are really upstream from the ways that we are then self-medicating with alcohol, opioids, and other substances, or choosing to take our own lives and die by suicide…

Denver: Well, I know this is a complicated and multi-faceted issue, but what do you think? Why do you think this is happening now?

Tyler: I think it’s a really important question, and one that I’ll try and put some answers towards, but I think needs to be part of the national debate. These so called deaths of despair; alcohol, drug-related, and suicide disabilities and fatalities tie to a great extent to loneliness, to hopelessness, to a sense of disconnection, and are often related to social isolation.  

So even in a period with social media and other ways that we appear to be connected, many of us are feeling less connected to each other than ever. In fact, it’s said that 40% of us don’t have a best friend or a confidante that we feel comfortable going to; the data of which suggests that a person experiencing persistent and ongoing loneliness is the equivalent of smoking about fifteen cigarettes a day. So loneliness, disconnection, despair, and hopelessness are really upstream from the ways that we are then self-medicating with alcohol, opioids, and other substances, or choosing to take our lives and die by suicide. That’s what we think is actually underneath it– a much greater trauma-related and social/cultural issue, not just the prevalence of these substances.

Denver: Yeah, and that seems to be particularly true for men, because I know so many guys who don’t have a best friend; it just seems to be an epidemic almost.

Tyler: Well, it really is, and it’s interesting; I know we’ll spend time talking about the rates of these deaths for communities of color and young people, but it’s fascinating looking at what’s happening to those that we would expect would be doing pretty well, particularly white middle-class men who we would think, with all the privilege, would be doing well.  And the rates in that population are as high as ever, and I think it’s connected to “What’s my opportunity? Am I doing okay? Am I connected to my family? Are my kids going to be better than me?” And in many cases, we’re seeing that many kids born today will not do better than their parents, and I think that’s very difficult across all generations now.

… I think the first thing to recognize is that this is an issue that affects every single one of us, where we live, work, play, shop, worship, etcetera.

Secondly, we have to be able to talk about mental health issues and address our anxiety and depression and thoughts of suicide no different than we would our diabetes or our hypertension or a knee injury. There’s no reason to be ashamed for experiencing these issues.

Denver: Well, there’s so many things to talk about; let’s start with mental health, and there’s some 44 million Americans who experience a mental health issue. How do you believe the national conversation surrounding mental health has to change in the coming years to better address this crisis?  And what role will the Well Being Trust be pursuing to help guide and frame that conversation?

Tyler: Well, first of all, I think the most important point is that these mental health issues: anxiety, depression, thoughts of suicide, and other related issues, substance-use issues, that these issues are all of us; this isn’t just some people in some pockets; these are our brothers and sisters and parents, our kids, our school teachers, our co-workers.  It’s all of us; so we might say one in four or one in five of us are struggling with these issues, but the truth is, it’s all of us because we are all bound up with each other in our families and at work and at school. So I think the first thing to recognize is that this is an issue that affects every single one of us, where we live, work, play, shop, worship, etcetera.

Secondly, we have to be able to talk about mental health issues and address our anxiety and depression and thoughts of suicide no different than we would our diabetes or our hypertension or a knee injury. There’s no reason to be ashamed for experiencing these issues. These are chronic diseases that many of us have, and the first thing we need to be able to have is a conversation about it without the kind of stigma that shuts it down. I think many of us are afraid to talk about those issues, and that’s got to be the beginning: to tell the truth about what we’re struggling with and what our families are struggling with, so that we can begin to show up for each other.

So one, is just being able to have a safe conversation, and that’s what we are really noticing happening right now from our youth, from many influencers, celebrities whose stories are finally coming out and maybe making it safer for most of us to address it. So that’s really the beginning for us, is to change and open the conversation; and then we can start to say what needs to happen in our clinical setting and in school and in the workplace and in our communities.  And there’s an evidence base that we might talk about, but we have to be able to open the conversation first.

So in partnership with media partners, we’ve been beginning a conversation about: “Let’s make it normal to talk about these kinds of issues.”

Denver: Well, I know one of the things you’re trying to do in removing that stigma is conduct a campaign that is targeted towards youth; tell us about a few of those efforts.

Tyler: We decided early on that we were going to focus on tweens and teens. Tweens of ages 9 to 12, and teens, obviously 13, and onto young adults maybe up to 25, as a primary focal point for us. One is that, as all of us know as we approach teenagerhood, there’s more agency, more freedom.  The kids have a cell phone; they begin to have exposure to substances, opportunities around sexuality, etc., and so, the sort of agency and freedom places our teenagers at ever younger ages around choices about how well they address the social and cultural pressures they may face at school. And what are they going to do when they start feeling hurt or bullied or are traumatized by something that happens?  And do they begin to develop patterns of reaching for alcohol, reaching for cannabis, reaching for other substances, cutting, bullying? What is it that young people start to do with these challenges? And so because those patterns are put in place early, and over half of mental health issues later in life become active at around age 14 or 15, we know we need to focus on teens.

So in partnership with iHeartMedia, Buzzfeed, Complex, and other media partners, we’ve been beginning a conversation about “Let’s make it normal to talk about these kinds of issues.” And we’ve even been training DJs to be able to speak during drive time to parents and kids, to be able to open the conversation in the car on the way to school.  

But that’s not where it stops; we want to make sure that every child– and their parents, for that matter– knows how to get help, how to give help, and essentially show up for each other, be good listeners, help our friends get help when they need it and, in fact, make sure that they reach out for professional help.  And third, that they know how to activate; you know, “What can I do to at my school or work or place of worship?” So getting help, giving help, and activating is where we’re going once we’ve built an awareness around these issues, and young people are rising to the occasion all across the country.

For ninety percent of us, we just need someone to talk with and to open a conversation and be able to talk about our struggles.

Denver: Let me ask you a little bit more about that, particularly as it relates to getting help, because, I’ll tell you that what I’ve observed, whether it be in mental health or even addiction, people generally don’t know what to do. They don’t know where to go or how to go about it.  What advice would you give them?

Tyler: Well, first of all, organizations like Crisis Text Line and the hotlines that exist nationally in communities across the country are available as a one-stop shop to be able to get help in a time of crisis.  And so one of the most important things that someone can do who’s struggling, or if you’re aware of somebody who’s struggling, is pick up the phone or pick up the text and dial Crisis Text Line. Or reach out and begin a conversation with a peer supporter on the other end of the line. That, for many people, is the beginning, I think, for about ninety percent of us.  And we’ll come back to the acute, real issues. For ninety percent of us, we just need someone to talk with and to open a conversation and be able to talk about our struggles, etcetera.

So, for many who are not sort of at the edge of doing something, being able to reach to a friend and creating a safe container as a place to begin, or being there for someone is really important.  But otherwise, we need to be able to talk to our primary care physician, or coach, or teacher, depending on the age or where we find ourselves, and ask about where to get help in our community because there are many organizations in every community across the country… which is not to say, there’s not a shortage of providers; there is a shortage of psychiatrists and mental health providers, but there’s much that we can do with peers.  We can be supported by community-based organizations, and then these Crisis Text Lines and other are places to go, when the issues get rough.

Denver: You know how important it is, Tyler, for people to have purpose and meaning in their life, a sense of belonging, contributing. These are so central to a person’s sense of self and to their overall health. What can be done to help provide opportunities for people to connect with these things when they’re absent from someone’s life?

Tyler: Well, first of all, you’re really putting your finger on some of the underlying drivers of the mental health crisis and suicide and substance issues that we’re talking about here. In partnership with the Greater Good Science Center and 19th U.S. Surgeon General, Vivek Murthy, we’ve been working to identify what really are the underlying drivers of well-being.  Or when we talk about resilience, which is sort of the protective factors, what’s there? The first of these is purpose. Someone saying “This is why I’m here; this is what I have to bring; this is my contribution or my gift. ” Particularly for young people, to know what it is they have to contribute and that gives them meaning in life is vital.

Secondly, to have a sense of belonging, like “Who can I trust?  Where do I belong? Where do I feel safe?” Those two are vital predictors of well-being and predictors of resilience.

But also, the third is around awe and wonder. The ability to experience a sense of awe and wonder, like beauty or a conversation or a great meal or a walk in the park in nature, to be able to experience ourselves as part of something greater than just our own mental conversation with our self.

And fourth, the opportunity to give back and to be able to be generous. That virtuous cycle drives well-being and are the predictors of resilience.  So what we’re looking at in schools and in the workplace is helping people connect with their sense of purpose or meaning or what brings them joy; to be able to create safe places to go, to have experiences that give us a sense of connection and how we’re bound up with people around us and meaningful opportunities to give back.  And initiatives in school, and in workplaces, and communities around the country are actually taking up that mantle as a way to address the underlying drivers of our mental health crisis before they become acute and express themselves as significant serious depression or a fundamental substance-use issue.

Denver: Absolutely!  Well, let’s move on to communities, and I think much of the disease in this country is really just not simply from the lack of access to healthcare. It’s also shaped by where someone lives.  And It’s been, I don’t know, maybe thirty years since the birth of the healthy cities/ healthy communities movement in the United States. What kind of grade would you give it after these three decades?

Tyler: My daughter is 23, and she came home a couple of years ago with a report from the Institute of Medicine. It basically said that after the previous century, 20th century, where lifespans expanded over 25 years, in the current decade, many children born today are likely to live five years less than their parents.  And my daughter, wisely, was saying, “Dad, you’ve been working on these health issues with all your colleagues for three decades, and we’re going backwards! What is the matter with us as a country? What have you been doing?”

And I think that’s a great question for this country. What have we been doing that we spend eighteen percent of our national product on sick-care services, and yet our health is declining? A couple of reasons: one is our health system, and this is not a partisan comment, this is just true. Our health system is primarily rewarded for the volume of care that is provided.  And so until, and we can maybe get to this a little later, we actually start rewarding what creates health in the first place and create an incentive around that– our sick-care system, we have to recognize is only ten percent of what creates health, and it is just incentivized to create health; it’s incentivized to create treatment, which is fine, and we all appreciate the care when we need it.

But if it’s only ten percent of what creates health, and we know that sixty percent of what creates health has to do with our lifestyle and our behavior and the socio-economics in which we live, then that’s where the locus of change is.  And it has to do with income and education, and access to safe affordable housing, access to transportation and mobility to be able to get to work or school or to other resources in our communities. It’s essentially these community conditions that give rise to health, not only access to care.

So it is vital that everybody has access to a physician in a medical home; that is critical.  But if we’re trying to improve the health of the country, we need to make sure we’re investing in these community determinants, not only access to sick-care.  And that means that it’s a civic issue where mayors and business leaders and non-profit leaders and public health and hospital leaders, and faith leaders need to come together to address these underlying issues.

There are some large integrated systems like Kaiser Permanente that are an integrated provider and health system, and those kinds of systems that are incentivized to provide high-quality care at the best cost while investing in what produces health in the first place is the future of health in the United States. That is a market that values health, not just a market that values healthcare.

Denver: Let me pick up on both those things. First, let’s start with changing of the mindset, and also, I think, Tyler, the changing of the business model, because you’re saying, if I hear you right, that we have to have a marketplace that’s going to value health outcomes and not the amount of healthcare services that are provided. How do you see such a transition occurring?

Tyler: It’s very challenging because the typical model, where we have our insurance, Medicare, Medicaid, and they basically pay the provider, is essentially a volume-based system that is not inherently wrong, it just doesn’t incentivize health; it incentivizes treatment.  So what we’ve seen is increasing at-risk arrangements… like we see many states taking on with Medicaid, or we see integrated health systems; many of the non-profit health systems that are delivery systems are increasingly offering are health plans.

There are some large integrated systems like Kaiser Permanente that are an integrated provider and health system, and those kinds of systems that are incentivized to provide high-quality care at the best cost while investing in what produces health in the first place is the future of health in the United States. That is a market that values health, not just a market that values healthcare.

We’ve seen others…to pick on one very exciting example in Minneapolis, Saint Paul in the Twin Cities. Over the last few years… with waivers that came from the White House and Congress around Medicaid in the State of Minnesota, Hennepin County took a fixed Medicaid payment from the state for 20,000 of its most high-utilizing patients.  And when they got that big check for the 20,000 individuals or covered lives, that was all that the county’s going to get. So then they started saying “What shall we invest in?” And because many of these people were housing-insecure and food-insecure, were not taking their meds, the leaders in Hennepin County said: “We’re at risk now for health. We’ve got this one check, and we’ve got to care for these 20,000 people.”  They invested in safe, affordable housing; they invested in making sure that people were getting access to healthy, fresh food that might help them address their diabetes or hypertension, and they made sure they were getting case management to be able to take meds and make sure they were working a health plan.

So when you go at-risk for health, it fundamentally changes the incentives.  Then you begin to invest in the community determinant like they did in Hennepin County, Minneapolis, Saint Paul, and as we see examples in Vermont, California, Texas, Red States, Blue States, in conservative communities, and progressive communities, we’re beginning to see a trans-partisan understanding, particularly at the community level, that when you create at-risk arrangements, you begin to invest in what creates health in the first place, not only sick-care services.

Denver: And what was the threat in all of these communities, because, you know, there’s always such a challenge of breaking down these silos, because as you talk about these issues, affordable housing, mobility, education, and access to healthy food, sometimes even the leaders in the healthcare sector are somewhat protective.  How do you get these communities to work together? What’s been the secret sauce to that?

Tyler: First of all, the healthcare providers can only do so much. While in most places among the largest employers and most significant organizations, they can be making sure that they are assessing the issues, that they are investing their community benefit dollars required by federal law to invest in the things that produce health. But for the most part, healthcare providers need partnership with mayors, with business groups, with non-profit organizations, with philanthropy.

So what we see in the communities that are working are three things:  one is they are taking a multi-sector approach, recognizing that it will take business, government, non-profits, everyone working together to address these complex issues, particularly if you understand that it’s housing and income and education and jobs and all those things that are actually upstream. Secondly, that we need to create a much greater system of accountability, to measure what matters, and not only do good things, but to ensure that there’s a civic commitment across those sectors to address these issues over time.  And that, essentially, is a functioning of our democracy of essentially building the community and political will to make the long term investment.

Listen, these increasing rates of deaths of despair, and diseases of despair, and the turnaround of lifespan… that didn’t happen overnight. Those are your generational investments that have landed us where we are.  So the civic leadership we’re seeing in, again, red and blue communities, red and blue states across the country, they’re taking a comprehensive approach to what creates health; they are building partnerships; they are taking accountability, and they’re taking a long-term view just like we do with our kids. Raising a family is 20, 25 years at least, minimum. You don’t just say:  “Well I read to them at fourth grade, you know, I did it for 2 or 3 years. What’s the deal?” No, we take a generational approach, and the communities that are taking a generational approach to improving health are the ones where we see the greatest outcomes. Not just 2- and 3-year quick projects that come and go.

… we start to see the connection between the things that improve health in the first place and the driving of the local economy. That is a place where the localism movement in the United States meets what produces health in the first place.  Those are very virtuous, positive strategies that we see growing in communities in the country.

Denver: They also really rely on their anchor institutions, don’t they?

Tyler: Yes, absolutely, and you put your finger on a real opportunity right now, particularly for hospital systems, universities, city governments, and businesses that really feel rooted in their communities. These organizations can hire local and build workforce pipelines, partnering with community colleges, and high schools and universities to hire more from the community, and make sure that we’re growing a pipeline of communities, particularly from… pipelines for jobs, particularly from disadvantaged communities where kids see the opportunity.

Secondly, these big anchor institutions can buy more local. There’s a lot of pressure to source nationally and globally to get the best price.  So when you buy from local companies that are owned locally, you essentially spin that local economic flywheel… what a Chamber of Commerce would call “multipliers.”  When you buy from large national firms, profits leave town. That doesn’t mean we should stop trading with every large company we know in the country. But we need to recognize that when you hire local, when you buy local, when you invest local, that wealth will circulate locally rather than being pumped out to profit centers and capital centers like our big cities in the U.S. and around the country.  

So that’s what anchor institutions can really be doing, and these anchor institutions can also not only use their own purchasing power, hiring power, and investment portfolios differently, but they can also help drive the civic conversation that says: This is what creates health; we need long term commitment and be part of anchor strategies to create jobs. One real specific example of that is around treating people with diabetes or hypertension who we know need to eat healthier. Many of these individuals are also food-insecure, so there are growing movements for growing local healthy fresh food that grows green local jobs in the community that can essentially fulfill food prescriptions for people who are needing healthier food to manage their healthcare.

So with these at-risk arrangements, you start to see places where we meet people that need access to healthy, affordable fresh food, and there are business opportunities for local companies to be growing that food, fixing and preparing that food, serving that food.  We start to see the connection between the things that improve health in the first place and the driving of the local economy. That is a place where the localism movement in the United States meets what produces health in the first place. Those are very virtuous, positive strategies that we see growing in communities across the country.

…we’re focusing on the whole person: spirit, mind, and body. “How are you doing? What matters to you?” And those kinds of questions are not only what changes how we begin our meeting, the way we take breaks, what we try to eat and serve, that we take a walk during our breaks to get some fresh air, but particularly, we’re investing in asking our employees and our team “What brings you joy?  What brings you happiness? What do you care about?”

And then with small dollars, but I think very significant, being able to invest in each of our employees to be able to put a small amount of money in the things that bring them joy and well-being, because we know that if we invest in their well-being, they’re much more likely to bring their best to the job and to attract the kind of workforce that we need.  

Denver: They sure are. Let me turn a little inward for a moment and speak about Well Being Trust. You’re a very young organization, founded just last year.  Share with us, Tyler, your thinking about how you create a healthy and wonderful corporate culture that’s going to attract and retain the very best talent to take on this daunting challenge.

Tyler: It is an inside job, so I really appreciate you going there. Here we are as a national foundation; we’re focused on clinical transformation and community transformation, a major policy agenda to implement evidence-based strategies, social engagement strategies and metrics. We need a world-class team as a small organization.  And so we need to be able to walk the walk.

So first of all, in our conversation; in fact, today’s a major meeting with our team, we’re focusing on the whole person: spirit, mind, and body. “How are you doing? What matters to you?” And those kinds of questions are not only what changes how we begin our meeting, the way we take breaks, what we try to eat and serve, that we take a walk during our breaks to get some fresh air, but particularly, we’re investing in asking our employees and our team “What brings you joy? What brings you happiness? What do you care about?”

And then with small dollars, but I think very significant, being able to invest in each of our employees to be able to put a small amount of money in the things that bring them joy and well-being, because we know that if we invest in their well-being, they’re much more likely to bring their best to the job and to attract the kind of workforce that we need.  So we pay attention to well-being, we get creativity, we get loyalty, and we get a culture that brings the best that we can bring to the workplace.

…not only can we turn to one another to meet much of what ails us, but that we can engage in our democracy, in our communities and in our states in a national environment.  And particularly when it feels like toxic partisanship is pulling us apart as a nation, these issues can bring us together and remind us that whatever may divide us, that which connects us is greater still.

Denver:  You’ve got a culture that reflects the work that you do day in and day out. Let me get you out on this, Tyler. Boy, there is so much to do, and you’ve stated it beautifully, and the urgency of all this cannot be overstated, but the organization has limited resources and limited bandwidth to take on all these challenges. What are your priorities and what critical areas will Well Being Trust focus on in the next couple of years in order to optimize your impact?

Tyler: As the largest national foundation focusing on mental health in the country and being new, really five areas are most important for us. One is clinical transformation. Our resources came out of the healthcare sector, so first, we’re focused on making sure that a whole person’s spirit, mind, body approach is in place in primary care settings, in the emergency department and acute care.  So we’re really leaning back into the healthcare sector that we came from to make sure that care addresses the whole person.

Secondly, as we’ve been talking about, much of this call, we’re partnering with community organizations across the country to ensure that the conditions that give rise to intergenerational well-being; again, income, education, transportation, housing, that communities are making commitments.

Thirdly, we have a major commitment to policy and advocacy. We are blessed to live in a democracy that is capable of looking at what works.  And because we’re seeing such a red-blue trans-partisan work on the ground around that, we’re committed to building the community and political will to make the investments in what creates health. That’s a big focus for us.

And then in opening the conversations.  And Denver, the great questions you’ve asked and what you’re doing in the dialogues that you’re creating is a big part of what we care about which is opening the conversation in the country.  And then we want to measure what matters, so that we are assuring that we are, one, focusing on the places where there’s the greatest need, and making sure that what we’re doing is adding up to impact.  

So that’s really what our agenda is, but we can’t do that alone. Everything we do, we need to do through partnership. We have a mantra: Do what we do best, partner for the rest. And that recognizes that to create essentially a social movement about what creates well-being is a distributed job. We can only do so much, so our job is to be able to help individuals ask questions “What can I do about my own well-being?  How can I support the well-being of my family and friends at work and school, etcetera?” And really take a distributed approach to what creates health, and recognize that not only can we turn to one another to meet much of what ails us, but that we can engage in our democracy, in our communities and in our states in a national environment. And particularly when it feels like toxic partisanship is pulling us apart as a nation, these issues can bring us together and remind us that whatever may divide us, that which connects us is greater still.

Denver: Well, Tyler Norris, the Chief Executive Officer of Well Being Trust, I want to thank you so much for being here this evening. What is your website, and what information will visitors find on it?

Tyler: Well, thank you. Go to www.wellbeingtrust.org to learn more about not only what Well Being Trust and our partners are doing, but what you can do in your own household, or place of work or worship or school to help drive the change. We welcome your partnership and thanks for this conversation tonight.

Denver: And thank you, Tyler. It was a real pleasure to have you on the program. I’ll be back with more of The Business of Giving right after this.


The Business of Giving can be heard every Sunday evening between 6:00 p.m. and 7:00 p.m. Eastern on AM 970 The Answer in New York and on iHeartRadio. You can follow us @bizofgive on Twitter, @bizofgive on Instagram and at http://www.facebook.com/BusinessOfGiving

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