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Science & Environmental Health Network - The Networker: The Deep Music of Democracy January 07
   The Deep Music of Democracy - January 2007
The Networker
I. The Deep Music of Democracy Nancy Myers
II. Boston Consensus Conference on Biomonitoring: What's Music Got To Do With It? Madeleine Kangsen Scammell

  I. The Deep Music of Democracy   TOP
By Nancy Myers

Last month, a representative group of Boston-area residents issued a sophisticated and nuanced statement on the complex topic of biomonitoring. While the 8-page document endorses the practice of using the latest scientific tools to measure even minute quantities of alien chemicals in human bodies, it also raises thoughtful questions. The statement addresses the gamut of issues--how biomonitoring surveillance should be done responsibly, how the information should be used, and what people should be told about the results. The statement could well serve as the basis for guidelines on the newer and still controversial applications of this practice.

How did "lay" people as opposed to experts come up with such a statement? The article that follows tells that story. Madeleine Kangsen Scammell, a Ph.D. student in environmental health at Boston University School of Public Health and a SEHN board member, describes the "consensus conference," conducted over three weekends, in which ordinary Bostonians became a jury on biomonitoring.

Consensus conferences were developed by the Danish government and have been used by that government and others to stimulate informed social debate on complex issues and help shape legislation and policy. Madeleine wrote about consensus conferences in our first book on the precautionary principle1. You can learn more about these and other tools for democracy in our latest book, Precautionary Tools for Reshaping Environmental Policy2.

The consensus conference process is hard work, but true democracy is also a thing of beauty. When former strangers become a community of purpose and diverse opinions merge into consensus, some mystery is involved. In Madeleine's experience the art of deep democracy became connected with the art of music. We asked her to report how that happened, because we believe such boundary-crossing, heart-and-mind-engaging creativity is exactly what we need to build a better world for future generations.

The project is described at www.biomonitoring06.org. The final consensus statement is at http://biomonitoring06.org/uploads/Main/Consensus_statement_final.pdf


1. Sclove and Scammell, "Practicing the Principle," in Raffensperger and Tickner, eds., Protecting Public Health and the Environment: Implementing the Precautionary Principle (Island Press 1999).
2. Pellerano and Montague, "Democratic Tools: Communities and Precaution," in Myers and Raffensperger, eds., Precautionary Tools for Reshaping Environmental Policy (MIT Press 2006).


  II. Boston Consensus Conference on Biomonitoring: What's Music Got
      To Do With It?
  TOP
By Madeleine Kangsen Scammell

I do not know why I am spending so much time burning CDs. It is late at night. I am missing sleep and have more important things to do. Just the same, this evening I went to Micro Center to buy CDs, labels, and "jewel" cases to make presents of music for 14 people I hardly know. My sisters will be lucky if they get as much from me at Christmas, but for a group of relative strangers, I am preparing as if for a holiday celebration.

As I begin to write this, it is the eve of the third and final weekend of the Boston Consensus Conference on Biomonitoring. I will try to make sense of my actions, linking the music I've included on the CD with the biomonitoring consensus conference.

A friend once mistook the music on the album South African Freedom Songs: Inspiration for Liberation (2000) for church music, perhaps because of its harmonies. In fact, the Xhosa song Welele is a cry for help: "Mandela don't let the whites undermine us. Help! People are dying. We sleep in the mountains." Historians have suggested that apartheid in South Africa would not have ended without music. Music and song with their messages of revolution and change joined people in a movement. This was also true in the United States. Slave owners often did not recognize the meaning of the songs or drums that carried messages of freedom from slavery and ignored them. Sometimes, however, drumming and singing were considered an overt threat and banned.

Five years ago I wrote a proposal to the National Institute of Environmental Health Sciences that included, as Aim 3: "Conduct a Danish-style consensus conference to provide in-depth education and understanding of the ethical and scientific issues in conducting community environmental health studies." The proposal was a collaboration of university researchers and community organizations.

When we learned our proposal had been funded, we had our work cut out for us. According to the Danish criteria, the topic must be 1) complex enough to require scientific expertise in the education of panel members; 2) clearly delimited so that panel members understand their charge and have a reasonable chance to learn what is necessary in a short time; and 3) related to pending legislation or policy where citizen input is likely to have an impact.

From the beginning, our project team was very good at finding ideas that filled the first criterion, but the second two were more challenging. Our original idea, "community environmental health studies," was too vast. None of us doubted that members of a lay panel could come up to speed on an issue and offer meaningful opinions, but we needed a hook. How would lay panel findings have an impact? For the first three-and-a-half years, we more or less avoided Aim 3 and focused on other project activities.

When we could no longer put it off, we revisited the consensus conference idea. Jessica Nelson, a fellow doctoral student, suggested the topic of human biomonitoring for chemical exposures. California had legislation pending to establish a statewide biomonitoring surveillance program, and our own State of Massachusetts had applied to the US Centers for Disease Control and Prevention (CDC) for funding to create a biomonitoring surveillance program. The grassroots Massachusetts Alliance for a Healthy Tomorrow had highlighted results of biomonitoring studies to draw attention to chemical exposures (such as persistent pollutants in breast milk), and the media had covered the topic both locally and nationally.

We settled on this topic and Jessica, who had finished her coursework, agreed to spend the next seven months as consensus conference coordinator. We assembled a steering committee and signed a contract with Kagan Associates, the professional facilitation team that would create the space and framework for a lay panel to learn and develop a final consensus statement. There was no turning back.

It's coming from the sorrow in the street,
the holy places where the races meet…

To the Shores of Need, past the Reefs of Greed,
Democracy is coming, to the U.S.A.

I'm stubborn as those garbage bags that time cannot decay,
I'm junk but I am still holding up this little wild bouquet:
Democracy is coming, to the U.S.A.

-Leonard Cohen, Democracy, More Best of (1997)

With high hopes for what such a process might accomplish, I wanted to talk with someone with experience. I sought out Ned Crosby, co-inventor of the Citizen Jury, a concept trademarked by the Jefferson Center in the late 1980s. It seemed an American twin to the Danish consensus conference, and I noticed that the description of the consensus conference process on the website of the Danish Board of Technology had recently changed to resemble the Citizen Jury even more closely. Was this coincidental or the result of collaboration?

Dr. Crosby was not aware of changes in the consensus conference process. Convinced that the U.S. government does not care for deliberative democracy, he and his wife had changed focus and were concentrating on getting a version of citizen juries enacted into law in Washington State as a way to evaluate statewide initiatives. After decades advocating participatory forms of public policy making, the Jefferson Center in Minnesota had released its staff. While this democracy guru was kind, supportive, and full of valuable advice, this was not what I wanted to hear. If I had spoken with Dr. Crosby several months earlier, we might not have gone ahead with the consensus conference. But we continued forward.

With high hopes for what such a process might accomplish, I wanted to talk with someone with experience. I sought out Ned Crosby, co-inventor of the Citizen Jury, a concept trademarked by the Jefferson Center in the late 1980s. It seemed an American twin to the Danish consensus conference, and I noticed that the description of the consensus conference process on the website of the Danish Board of Technology had recently changed to resemble the Citizen Jury even more closely. Was this coincidental or the result of collaboration?

Dr. Crosby was not aware of changes in the consensus conference process. Convinced that the U.S. government does not care for deliberative democracy, he and his wife had changed focus and were concentrating on getting a version of citizen juries enacted into law in Washington State as a way to evaluate statewide initiatives. After decades advocating participatory forms of public policy making, the Jefferson Center in Minnesota had released its staff. While this democracy guru was kind, supportive, and full of valuable advice, this was not what I wanted to hear. If I had spoken with Dr. Crosby several months earlier, we might not have gone ahead with the consensus conference. But we continued forward.

Nomathemba is Zulu for hope. It is performed by Themba Mkhize on his album Lost & Found.

Random Digit Dialing is good for reaching upper-middle-class white people but not many others. We recruited lay panel members via fliers posted in neighborhoods, postcards handed to people in busy areas downtown, newspaper ads, and Craig's List. After approximately 300 pieces of mail, 50 short telephone interviews, and several long meetings of our project team, we arrived at our final 15. A very diverse group on paper, they nearly matched the demographics of the City of Boston in income, age, ethnicity, and gender. We made sure to include some parents of young children.

This summer and fall, I listened to almost nothing but the One World, Many Cultures CD, released by Putumayo in 2006. It features collaborations of artists from over a dozen countries and cultures who sing together on the same tracks in different languages. They make the music work despite their diverse backgrounds and musical genres; it is perhaps because of these differences that the tracks are so great. Included is a Willie Nelson song, Still is Still Moving to Me, performed with the reggae band Toots and the Maytals. Nelson, champion of the Farm Aid concerts and organization, is no stranger to music with a cause. Reebee Garofalo's chapter, "Making Music/Making Bread: Charity Rock for Social Change," in the book, Farm Aid: A Song for America (2005), describes the essential nature of music in struggle.

Weekend one

In October the lay panel met for the first weekend. To begin, the facilitators asked members to state their names and tell what kinds of music they enjoy. I heard Jazz, Gospel, Blues, Rock, Hip-Hop, African music, music without words--and knew I really liked this group. I wanted to connect with them.

The problem was that during meals and breaks, when we might have sat and talked, members of the panel were talking about chemicals, pollution, causes of disease, and issues related to biomonitoring. While we organizers needed be there to answer questions, provide information, and separate fact from false statements, we did not want to taint the process by injecting our own opinions. Feeling constrained, I tried hard to think of other ways to relate to the panel members. In this group, music seemed to be a safe topic. As a result, I couldn't help thinking about the participants, their music preferences, the consensus conference, and biomonitoring while I listened to music over the following weeks.

A hundred years from now, who'll be left to say…
What's the truth and what are lies?

-- Gigi, Utopia, One World, Many Cultures.

The first weekend the lay panel crafted a set of ground rules for communication, agreeing to focus less on opinions or positions and more on understanding concerns. The group also spent nearly two hours defining the meaning of consensus. When the group needed to make a decision the facilitators would present a statement and, with eyes closed, people would raise 1, 2, 3 or 4 fingers. Four fingers meant, "I can't live with this decision and I will block consensus." Three fingers meant, "I am not in full agreement with this decision but I have voiced my concerns, feel I've been heard, and will trust the wisdom of the group." Two fingers meant "OK" and one finger was a resounding "yes."

During the first weekend the lay panel also heard from two experts who presented information that we and the project's steering committee felt was essential to understanding biomonitoring. The panel learned about various routes of human exposure to chemicals, what happens with different types of chemicals once they enter the body, and why biomonitoring is used in studies of the association between chemicals in the environment and human health. Some members of the lay panel were surprised to learn that chemicals are present in their bodies and may have been there for years. They were concerned for future generations. I have often heard that concern and share it, but hearing it from a great-grandmother was different. The messenger does convey the meaning.

Bob Dylan is one of my all-time favorites. I like his voice and I love his lyrics. But some lyrics I know by heart sound new on A Reggae Tribute to Bob Dylan (2002). Various artists perform on this CD including Jamaican reggae singer Don Carlos, who sings Blowin' in the Wind.

How many times can a man turn his head and pretend that he just doesn't see?
How many ears must one man have, before he can hear people cry?
How many deaths will it take till he knows that too many people have died?

By the end of the first weekend we were inspired and excited by the lay panel and the questions they asked. We also wondered how everything was going to unfold. The panel had far more questions than could be answered in three weekends. Obviously, the professional facilitators were essential to the process. The task of our team was to find the themes in the panel's questions and identify experts who could address some of them in weekend two.

After living 40 years in exile, Abdullah Ibrahim returned to his home in South Africa to establish a school for musicians. The school also educates students on health and nourishment of the body and soul. Music, Ibrahim says, has the ability to transcend both its practitioners and its audience, sending them to places they could scarcely imagine.

Weekend two

After three intervening weeks, all but one member of the lay panel, who was kept away for family reasons, returned for the second weekend. We felt the loss. Without realizing it, the group of 15 had developed an identity. It was a rough start to the second weekend, and the third and final weekend suddenly seemed uncomfortably close.

Two more experts gave presentations to the lay panel on questions related to biomonitoring surveillance programs, and the panel began to prioritize their areas of interest. Participants then worked in smaller groups, hashing out the concerns and potential benefits associated with each area. By Sunday noon, every bit of wall space in the large conference room was covered with paper and words. Everyone was feeling a little overwhelmed. With sticky papers and 3 x 5 cards, people added more words, "Agree" "Disagree" "Idea"--all headings for more thoughts.

That afternoon, when everyone was tired and ready to go home, one young member of the panel announced that he had something to share with the group. He stood in the center of the room and fiddled with a newfangled cell phone until the sound of a drum mix came from its speaker. The cell phone became an instrument. The panelist began rhyming about biomonitoring, about the group coming together to learn about the science, and having a voice. By the end of his brief performance I had crawled out of my head. Feet tapping, heads nodding, parts of our selves neglected all weekend were now involved in a biomonitoring rhyme that was off the chain.

Although a few artists recognize Hip Hop as a potent vehicle for social change, Hip Hop in the U.S.A has more often been associated with "bling," "gangsta rap," and misogyny. However, Hip Hop is popular among youth all over the world. Beyond the Ocean is the title of Tasha's piece on the Global Soul CD (also released by Putumayo, 2003), and Tasha is apparently the rage in Korea. Half Korean, half African American, Tasha is one of many youths using Hip Hop to communicate about issues of universal importance. In a documentary illustrating the role of Hip Hop in the HIV/AIDS crisis, a musician with the Kenyan group Do Klan Revolution describes Hip Hop as medicine. Hip Hop has the ability to unite people and carry positive messages about prevention. It is also an outlet for creative energy and expression by youth.

Final weekend

The third and final weekend of the Biomonitoring Consensus Conference had arrived. In the three-week break (one week included Thanksgiving, so call it two), our project team managed what seemed like a speed dating/matchmaking frenzy and found appropriate experts to respond to the specific questions of the lay panel's priority areas. Each expert was given about six questions and allowed a total of 20 minutes to respond. Some were already aware that they might be asked to do this, but several knew nothing about the consensus conference process or the events leading up to the final weekend. For them, this was quite a specific request at very short notice. Also during the three weeks between sessions, the facilitators and members of our team summarized all the notes from the walls on both weekends and put them into a single document that would provide the framework for the consensus statement.

Oliver Mtukudzi, from Zimbabwe, writes many of his songs about AIDS, poverty, and other social problems of our time on his album Tuku Music (1999). Wake Up, sung in Ndebele and English, calls upon all listeners to unite and defeat hatred and jealousy. "Time is against us."

On the final Saturday, the lay panel and public audience heard from six experts. Ted Schettler, MD, MPH, who was on the expert panel as well as the steering committee, was asked to respond to the suggestion that biomonitoring studies conducted by NGOs are done for political purposes and are alarming to the public. Dr. Schettler said that his answer would depend, in part, on what is meant by alarm: "If you mean ‘alarm' as in ‘the alarm clock just went off and it's time to wake up', then alarm may be exactly what is needed."

After a day of presentations the lay panel met in a private room and reviewed their summary document from the weekends before. They wrote on the document new opinions or ideas, highlighted statements with which they agreed or disagreed, and inserted other comments for group discussion the following day. Late that night, the facilitators, Leslie Kagen, Karen Nell Smith, and Beverly Prestwood-Taylor, compiled all the comments into a single document.

Sunday morning at 8:30, the lay panel convened to discuss the previous day and craft the final consensus statement. In a large circle the group went through the document with all comments included and discussed each point. One finger? Two fingers? Three fingers? Four? This was difficult. Single words mattered. Everyone's voice had to be included, and if one person didn't agree the group refused to move forward. While other lay panels may have acted differently, this group would not have been satisfied with a document that simply identified areas of disagreement.

I was on the edge of my seat while the lay panel deliberated. Who held on to what and why, and who let go, was always a surprise. I watched with bated breath each time they held up fingers on a decision. Many times I was glad not to be a member of the panel. Would I be as respectful? Would I know when to speak and when to hold my thought? They always seemed to arrive at the right decisions for the group, even though I might have decided differently. I realized that by then many of the lay panel knew as much about biomonitoring as I did, and their questions surpassed my imagination. The educational objective of this exercise, at least, had been accomplished.

By 6:00 PM the lay panel had reached the end of the decision process. All the pieces were there (on different flipcharts, laptops, and papers), and all that was left to do was weave the statement together. The group identified speakers and planned for the following day's public presentation of their statement.

I had hoped that the young spoken-word artist might perform his biomonitoring piece for the final event, the public presentation. I had it in mind when I started burning the CD, and the piece seemed to be an integral part of our time together. At my request, the facilitators presented this suggestion to the group. After a slightly awkward discussion the group concluded that he should not perform at the public event. I was sad but understood. They had worked hard to arrive at the consensus statement, and the decision on how to present it was theirs, too. I noticed how easily the performer went along with this decision, how gracious he was. He offered to give the group a private performance the following morning, before the public presentation.

At 6:30 PM, the group broke up for the night. Several lay panel members stayed later, some until 10:30 PM, when the final statement was assembled and formatted.

Monday morning, 8:00 AM, we convened in our conference room for the last time. Everyone looked sharp and complimented each other. After reading the statement, all participants offered their last comments for the group. This was very moving. A panelist suggested they share contact information and meet again, and nearly all agreed. Finally, in the last moments, with cell phone playing a beat (interrupted only once by an incoming call), we heard the biomonitoring rhyme and rhythm once again. The performance was a gift. Then the group headed to the hall.

Press, staff from state legislators' offices, research scientists, students, and representatives from community and environmental health advocacy organizations had gathered to hear the statement. Members of the lay panel took turns reading different sections of the statement. The performance, without music, was perfect. I was glad to have left that decision to the wisdom of the group, and I wondered if they had any idea how much I had learned from them.

As for any remaining questions about what music has to do with biomonitoring and democracy, I'll leave it to Louis Armstrong, who closes the CD with an old Gospel tune…

Bye and bye, when the morning comes….
We'll understand it better bye and bye.

--Louis Armstrong, Bye and Bye, Gospel 1930-1941 (2002)


[Acknowledgements: Thanks to the members of the lay panel for their work, Kagan Associates, Rebecca Gasior Altman, and the BUSPH project team that made the consensus conference a reality: Jessica Nelson, David Ozonoff, Raphael Adamek, Traci Bethea, and Tom Webster. Thanks to Muna Kangsen and Daniel Baker who got me thinking about music more seriously, and to Carolyn Raffensperger who challenged me to write this piece. MKS]




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