The recent health rankings came out from America’s Health Rankings, which again rated West Virginia pretty low in a number of health categories. This is happening despite the fact that we spend substantially more per citizen on health care than most states.

What is the root cause of this issue?

Well, I will proffer one possibility.

I submit that the underlying issue may be from people not being connected to the greater community of hope, caring and opportunity.

If you look at evolution, we survived and thrived together as a species by creating communities -- helping each other. This is engrained in our DNA and in many ways, our instincts track back to these times.

Successful people and communities develop a sense of connectedness. For example, ask folks in the military at war what they are fighting for and they invariably say their friends that are there. Basic training builds community and unit, training individuals to be part of something bigger to help them survive and thrive.

Emotionally, the most damaging single issue for development is abandonment by parents, from choice, injury or circumstance. This lack of touching and nurturing is critical to development, particularly in infancy and youth.  Similarly, my understanding is that dismissal by another person predicts the end of that relationship, while arguing or fighting does not.

Connectedness counts.

Nick Christakis from Harvard showed that we are more likely to be obese if our friends are obese as opposed our first-degree relatives.

Moreover, sense of purpose is a critical predictor of health in people over 45 years old. We gain a sense of purpose from our meaningful relationships, job and community. Connectedness and hope lead to the vision of abundance and safety, which is typical of thriving people and communities.

Maybe this is a root cause of West Virginia health problems – the lack of hope and connection to possibilities for them, their families and community.

In the famous New Yorker article The Hot Spotters by Atul Gawande, which identifies super-spenders in healthcare (the top 5% of people that spend more than 50% of the healthcare money), the solution by Dr. Jeffrey Brenner in Camden, N.J., was to connect with people personally. As a human, not only as a doctor.

Is it possible that our best solution is foundational to all of us and detailed by Dr. Francis Weld Peabody many years ago, when he said, One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.

We must begin by caring for the people of our state -- by caring about them and empowering our citizens to dream big again.

To be clear, this is not about rescuing people.

Just like the initial misplaced belief that the Wizard of Oz had the answers to get Dorothy and Toto home.

There is no top-down approach that will work.

Instead, it will be human connections and programs that are bottoms up that will help others find their way.

This is what Dino Beckett and his team is doing in Sustainable Williamson. This is what Kate Long and Steven Smith are doing in Try This West Virginia. This is what Dr. Larry Rhodes is doing in Summersville and the WVU doctor-brothers Jim and John Brick are doing in Gilbert.

This is what innumerable people are doing in their own way to make things better for others. And this is the magical formula for us to follow in bringing West Virginia together.

For as complicated as we make things in academic medicine, the answer may truly be simple.

Like Dorothy in the Wizard of Oz who was reminded by Glinda, the Good Witch of the North, that she always had the power to return home, but needed to believe it first.

That is our job in our great state – to connect to our communities and people and help them believe again that they have the power to help WV rise, succeed and become the model for others to follow.

It is good to be back home.