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Discussion page for this essay: [[Talk:TheFWD_lucasgonzalez_The_onion_and_the_satellite]] | Discussion page for this essay: [[Talk:TheFWD_lucasgonzalez_The_onion_and_the_satellite]] | ||
Health-care systems in many countries seem to be unsustainable: expensive | Health-care systems in many countries seem to be unsustainable: expensive and less-than-perfect interventions, and waiting lists that are long to the point of looking like rationing, when there's no direct exclusion from care for sometimes large numbers of people. If health-care systems, where they exist at all, are indeed unsustainable, then it follows, with unbelievable logic, that they will fail, crack, morph into something different. | ||
So, what’s next? | So, what’s next? Given enough time, some or all health-care systems might be dynamically redesigned from the core, making use of what’s available in other systems, and thinking in layers. | ||
=== Redesign from the core === | === Redesign from the core === | ||
Health-care systems do have a core, the nugget deep inside the onion: there’s someone who has a health issue (a broken bone or a future disease that's preventable) and there’s someone who can help. (When you | Health-care systems do have a core, the bi-cellular nugget deep inside the onion: there’s ''someone'' who has a health issue (a broken bone or a future disease that's preventable) and there’s ''someone'' who can help. (When you prevent or treat yourself you’re taking both roles.) Everything beyond that core - from the assistants who bring the drug or the knife, to the folks who plan world-wide vaccine production - is like the tail of modern warfare: layer upon layer of complexity, helpfulness and failure. Sometimes the tail is long and fat, but it's just the tail, intented to help what goes on at the heart of the onion. | ||
The core and all the other layers have a number of sometimes conflicting missions: deal with death, function and pain (or pain and function), and aesthetics. | The core and all the other layers have a number of sometimes conflicting missions: deal with death, function and pain (or pain and function), and aesthetics. We’ll leave aesthetics out for this piece. Or maybe it’s “social function”? Or “social pain”? So it's death and function/pain, and how we deal with that. | ||
We all die at the end of our life. (Big news, I know.) So health-care systems can't really ''reduce'' death | We all die at the end of our life. (Big news, I know.) So health-care systems can't really ''reduce'' death: all they do is delay it, making room for more life if we live it. This is felt to be most important when we’re talking about kid’s lives, whose “potential life-years lost” is larger than their grandparents’. | ||
(We may in some circumstances be | Of course, if and when I become a grandparent, my remaining life-years will be 100% of what I have at that point, and I’ll want my hip-bone replaced so I can play golf at age 97. But that's pain and function. | ||
(We may in some circumstances be ''too good'' at delaying death, if population growth kills the ecosystem, or if generations fight each other for resources, or if demographic shift makes the pyramid grow old and then shrink and collapse, or bring in younger neighbours. But that’s another story: there's no failure like success.) | |||
Start at the center: | |||
* contained or containable mortality = the mortality that would appear or reappear if rich countries' healthcare systems collapse. | |||
* method: age pyramid for the living, the deaths, then look at causes of death (present or potential) | |||
* ... | |||
=== Use what’s available === | === Use what’s available === | ||
Money has become short for some of the previously rich, and | Money has become short for some of the previously rich, and it was chronically short for the poor to start with. In whatever context, there are already many hints that health-care systems can reinvent themselves using, and further developing, devices and methodologies that are currently being developed for the poor: | ||
* Want prevention? Use tippytap from akvo’s wiki to wash your hands. | * Want prevention? Use tippytap from akvo’s wiki to wash your hands. | ||
* Want diagnostic devices? Look at what out-of-poverty and allies are doing. | * Want diagnostic devices? Look at what out-of-poverty and allies are doing. | ||
* Want communications? Use frontlineSMS-medic. | * Want communications? Use frontlineSMS-medic. | ||
* Want learning and information? Build a learning system a la Khan Academy, use books like "where there's no doctor" and put them into thewikireader. | |||
* Want communities of mutual help? Use neighbours helping neighbours lose weight, walk more, quit smoking, all with help from community currencies (link from davies-coates). | |||
* Want better thinking and less stress? Look into the role of meditation (with as much or as litle spirituality as you like). | |||
We're all part of "what's available" ... '''This needs developement!''' | We're all part of "what's available" ... '''This needs developement!''' | ||
=== Think in layers === | === Think in layers === | ||
Revision as of 10:47, 24 October 2010
The onion and the satellite
Author: Lucas González Santa Cruz, aka LucasG
Body of article: about 500 words.
Discussion page for this essay: Talk:TheFWD_lucasgonzalez_The_onion_and_the_satellite
Health-care systems in many countries seem to be unsustainable: expensive and less-than-perfect interventions, and waiting lists that are long to the point of looking like rationing, when there's no direct exclusion from care for sometimes large numbers of people. If health-care systems, where they exist at all, are indeed unsustainable, then it follows, with unbelievable logic, that they will fail, crack, morph into something different.
So, what’s next? Given enough time, some or all health-care systems might be dynamically redesigned from the core, making use of what’s available in other systems, and thinking in layers.
Redesign from the core
Health-care systems do have a core, the bi-cellular nugget deep inside the onion: there’s someone who has a health issue (a broken bone or a future disease that's preventable) and there’s someone who can help. (When you prevent or treat yourself you’re taking both roles.) Everything beyond that core - from the assistants who bring the drug or the knife, to the folks who plan world-wide vaccine production - is like the tail of modern warfare: layer upon layer of complexity, helpfulness and failure. Sometimes the tail is long and fat, but it's just the tail, intented to help what goes on at the heart of the onion.
The core and all the other layers have a number of sometimes conflicting missions: deal with death, function and pain (or pain and function), and aesthetics. We’ll leave aesthetics out for this piece. Or maybe it’s “social function”? Or “social pain”? So it's death and function/pain, and how we deal with that.
We all die at the end of our life. (Big news, I know.) So health-care systems can't really reduce death: all they do is delay it, making room for more life if we live it. This is felt to be most important when we’re talking about kid’s lives, whose “potential life-years lost” is larger than their grandparents’.
Of course, if and when I become a grandparent, my remaining life-years will be 100% of what I have at that point, and I’ll want my hip-bone replaced so I can play golf at age 97. But that's pain and function.
(We may in some circumstances be too good at delaying death, if population growth kills the ecosystem, or if generations fight each other for resources, or if demographic shift makes the pyramid grow old and then shrink and collapse, or bring in younger neighbours. But that’s another story: there's no failure like success.)
Start at the center:
- contained or containable mortality = the mortality that would appear or reappear if rich countries' healthcare systems collapse.
- method: age pyramid for the living, the deaths, then look at causes of death (present or potential)
- ...
Use what’s available
Money has become short for some of the previously rich, and it was chronically short for the poor to start with. In whatever context, there are already many hints that health-care systems can reinvent themselves using, and further developing, devices and methodologies that are currently being developed for the poor:
- Want prevention? Use tippytap from akvo’s wiki to wash your hands.
- Want diagnostic devices? Look at what out-of-poverty and allies are doing.
- Want communications? Use frontlineSMS-medic.
- Want learning and information? Build a learning system a la Khan Academy, use books like "where there's no doctor" and put them into thewikireader.
- Want communities of mutual help? Use neighbours helping neighbours lose weight, walk more, quit smoking, all with help from community currencies (link from davies-coates).
- Want better thinking and less stress? Look into the role of meditation (with as much or as litle spirituality as you like).
We're all part of "what's available" ... This needs developement!
Think in layers
Many of those technologies look very ... uhm ... local, don’t they? What about factories that make antibiotics and pain-killers for millions? Don’t they have an essential role in health-care systems? Some may hate Big Pharma, but aren’t they useful? Well, of course they are. They are part of the picture, and we need to look at the full picture.
Health-care swadeshi helps in looking at how layers might interact. You can't make vaccines for family. WHO directors can't wash your hands. Maybe use a variation of SCIM with the specifics for healthcare systems? This needs developement!
In short, we need both: the onion and the satellite. And everything in between.