There is a story that has been told for years in many different settings. Two people are walking along the beach and come across a large group of starfish that have washed onto the shore. One person begins to pick up a starfish and toss it back into the sea. The second person questions the value of the effort in making a difference, as there are clearly many more starfish that need to go into the water than the person can manage. The star fisher thrower responds as he/she tosses in another starfish, “it mattered to that one”.
While this story is often used to inspire staff that may often feel overwhelmed by the work ahead, it is a story that needs a new ending in my opinion. Perhaps this is a bit sacrilegious but I just need to say it. Yes, it absolutely is important when our actions can make the difference in a person’s life. But this story largely reinforces a focus on the individual (saver and saved) – the current framework in health care, social work and often even in public health. If we wish to make larger change, saving one starfish at a time is no longer adequate. Looking at this from an equity frame we might consider the possible bias of the starfish thrower. Is he/she selecting starfish randomly or perhaps unconsciously being drawn to the more colorful starfish or the bigger starfish, and picking those up first to save? From a prevention-focus the person could ask why the starfish are washing up on the beach in the first place? Is there a problem in the water? Are they escaping from a big predator? Or, it an unfortunate combination of sand erosion and wave pattern? Until that problem is addressed the few starfish being tossed back just might end right back up on shore! From a consumer perspective it might make sense to ask the starfish if they want to be thrown back. Perhaps they all wanted to be on the beach to enjoy the sun or stars.
Finally, thinking about collective impact, if getting those starfish back into the ocean is essential, then call out for partners. Get shovels. Get boogie boards. Rally other beach goers to lend a hand. In truth, ALL the starfish on that beach matter. Small victories are critical for helping avoid burnout and to know we are making a difference in spite of big odds. But there are many forces out there that have also made this THE time to think about prevention and population health. It is time for a new story.
Sarah Verbiest, DrPH, MSW, MPH is the Director and Co-Founder of the Every Woman Southeast Coalition. She is also the Executive Director for UNC Center for Maternal and Infant Health and the CDC Senior Consultant to the National Preconception Health and Health Care Initiative.