A powerful story and beautiful music reflect the complexity of our world.

Sometimes things come together in unexpected ways and help us to see connections we were not aware of before. It can be thrilling when this happens: a flash of insight that is hard to articulate to others in a simple way or a glimpse of something that one senses is important and meaningful but remains a bit elusive, as if it were still around a corner…

This happened to me last weekend as I sat in the Kimmel Center here in Philadelphia, behind the stage right above the timpani and the harps, listening to another beautiful performance of the great jewel of our city that is the Philadelphia Orchestra. The conductor was the renowned Essa Pekka Salonen and the piece was The Miraculous Mandarin Suite by Béla Bartók. 

The Miraculous Mandarin is a one-act pantomime ballet based on a story by the Hungarian writer Melchior Lengyel. The story involves three tramps, a girl, two poor men (an old one and a young one), and the Mandarin, a wealthy Chinese man. The story is rather truculent and involves the tramps forcing the girl to dance seductively in order to attract men for money, the rejection of the first two men by the tramps because they refuse to pay, and a final confrontation with the Mandarin who is viciously attacked by the tramps, but ultimately comforted by the girl as he tragically dies in her arms. 

This is the explicit and literal story of the ballet (and the suite derived from it that I listened to). It is captured in beautiful and colorful music with great energy and inventiveness. But the underlying text to the story, and what motivated my insight is the conflict between the chaotic city and the natural world, reflected in the tramps and the Mandarin, who battle for dominance, with the natural world tragically perishing. 

The whole day of the concert, I had been working on a book chapter related to the links between cities and planetary health. I had been thinking and reading about the ways in which city living and the lifestyles encouraged by urbanization affect our natural environment. Growing urban footprints linked to urban sprawl threaten natural ecosystems by reducing biomass (with implications for climate change) and biodiversity. Cities are major sources of energy consumption, greenhouse gas emissions, and air pollution. City dwellers often consume high amounts of processed foods and meats and produce extraordinary volumes of waste with major impacts on the environment. Cities are home to inequities, injustice and social conflict. Yet at the same time cities have enormous potential to create efficiencies and promote health, social justice, and environmentally sustainable consumption patterns.

I had been struggling with this idea, with the conflict between cities and the natural world and with what we can do about it, all day. And that evening, as I sat there in the conductor’s circle at the Kimmel Center, I heard it — indirectly of course but still powerfully captured — in the beautiful music of The Miraculous Mandarin Suite. The Miraculous Mandarin has been described as “a disturbing parable of modern urban existence and the ceaseless power of materialism.” But it offers hope through the redemptive power of love, as reflected in the girl’s final embrace of the dying Mandarin. 

Today, with the help of many collaborators, I finished up the chapter on urban places and planetary health. We tried to end the chapter on a positive note with illustrations of what some cities are doing to promote both population health and environmental sustainability: advocating for more compact urban development, discouraging automobile use, promoting walking and cycling, encouraging consumption of locally produced fresh fruits and vegetables, consuming less energy and producing less waste. Urban places can be chaotic and violent and polluted, but they can also be welcoming and inclusive and health promoting and green. This is perhaps our greatest challenge and our greatest opportunity in public health today: acknowledging and leveraging the inextricable connections between human health and the environmental future of our planet. And cities are, and will be, a big part of that.

This tension between our built urban world and the natural world, and the possibility of resolution, was my insight that night. Somehow, most likely because I was primed by what I had been reading and writing all day, this was prompted by meditating as I listened to Bartok’s lovely piece. I know this connection may seem like a stretch (someone whose opinion I value very much told me that this was like mixing tuna with fruit salad…) but perhaps there is something there… In any case, and public health reflections aside, I encourage you to spare a few minutes to listen to The Miraculous Mandarin, not because of any hidden planetary health messages it may contain, but because of its musical color, inventiveness, and simple beauty. 

Listen here. Enjoy!

Ana V. Diez Roux, MD, PhD, MPH
Dean and Distinguished Professor, Epidemiology, Dornsife School of Public Health