AAM Pre-Publication Version 1 Chapter 28 THE WATERSHED OF LIFE: A RIVER RUNS THROUGH IT Gary R. Gunderson Teresa Cutts James R. Cochrane This is a draft chapter/article. The final version is available in Handbook on Religion and Health: Pathways for a Turbulent Future, edited by James R. Cochrane, Gary R. Gunderson, & Teresa Cutts, published in 2024, Edward Elgar Publishing Ltd. https://doi.org/10.4337/9781802207996.00041 It is deposited under the terms of the Creative Commons Attribution- NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non- commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. Why public health needs to be saved from two things it gets fundamentally wrong so that it’s extraordinary strengths can help save us all. It should be clear throughout this handbook on “religion and health” that when we speak of linking “what was known as” 1 religion to health, we mean the health of the whole public. The discipline of public health is critical to the whole process but, like “religion,” it also needs a fundamental reorientation. We argue that the field has in crucial respects lost its way, but that the way may be found with two moves we invite. The first is to abandon the cripplingly simplistic metaphor of “upstream” and “downstream.” Public health language regularly speaks of going upstream toward the virtue of prevention, as opposed to the inefficient downstream medical interventions needed to deal with the disease and injury that landed people in the stream in the first place. This would be helpful if the metaphor invited us into the actual complexity of streams, but it almost always stops, like a simplistic morality tale, without considering the complex, multi-factorial living phenomena of real streams. Why it matters is our first point of reorientation. The second is to turn the whole field around from death to life or, said otherwise, from the obsession on the leading causes of death (which are rather simplistic) and ancillary metaphors such as “burden of disease” or “morbidity and mortality,” toward the leading causes of life. More years of healthy life is the whole point of the field by its own reckoning. Yet nearly all the analytic processes of public health focus on the dying rather than the living, shaping the job descriptions and daily labour of millions of public health workers to focus on the secondary issue (death) instead of the primary one (life). Life, by which we mean more than biological or material existence, is something public health with all its analytics almost entirely fails to even describe, much less measure. In pursuing these two themes—a misplaced metaphor, and a misdirected orientation—we also