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{{TheFWD header}}{{DISPLAYTITLE:59. The Onion and the Satellite - Lucas Gonzalez}}
Many health-care systems, where they exist at all, are being assessed as "unsustainable", with expensive and sometimes even harmful interventions, waiting lists so long they look like rationing, and exclusion from care for a number of people (sometimes many).  If these systems are indeed unsustainable then it follows, with unbelievable logic, that they will fail, crack, morph into something different.


== The onion and the satellite ==
So, what’s next? If there's time, maybe some or all health-care systems can be dynamically redesigned from the core, making use of what’s available in other systems, and thinking in layers?
Author: Lucas González Santa Cruz, aka [[User:LucasG|LucasG]]<br>
Body of article: about 500 words.<br>
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.
We must redesign from the core. Health-care systems' core is the '''bi-cellular seed''' deep inside the system: ''someone who has a health issue'' (a broken bone or a future disease that's preventable) and ''someone who can help''. (You take both roles if you prevent or treat yourself.) 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 in modern warfare: layer upon layer of complexity, helpfulness and failure: '''the onion'''. Sometimes the tail is long and fat, but it's just the tail, intended to help those two people who are at the heart of the onion.


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.
The core and all the layers have basic, and sometimes conflicting, missions. Classically, we deal with death, function and pain (or pain and function), and aesthetics. If aesthetics is “social function” or “social pain”, then it's only '''death and pain/function''', and how we deal with that.


=== Redesign from the core ===
Regarding '''death''', let's face it: 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.


Health-care systems do have a core, the bi-cellular seed deep inside the system: '''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: '''the onion'''. 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.
We start at the center.  We look at the age pyramid of the living and the smaller age pyramid of those who die.  Then, we look at the causes of death for each age group, and delay death there.  This is the business of '''contained or containable mortality''', which we might define as ''the mortality that would emerge or reemerge if rich countries' healthcare systems collapse''. In poor countries, such mortality is simply '''uncontained''' or, if you feel optimistic, "yet to be contained".


The core and all the other layers have a few 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 aesthetics is “social function”? Or “social pain”?  So '''it's death and function/pain, and how we deal with that'''.
(Sometimes we're [https://spreadsheets.google.com/ccc?key=0AhtJz9HHi6yVdHRtcnVYaDhEVl9xUDd6a1poeU5HckE&hl=en#gid=1 ''too good'' at delaying death], if population growth kills the ecosystem, if generations fight each other for resources, or if demographic shift makes the pyramid grow old so that either it shrinks and collapses or younger neighbours feel invited to migrate. It seems there's no failure like success, but that's another story.)


Regarding '''death''', let's face it: 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.
Dealing with death is felt to be most important regarding kid’s lives, whose "potential life-years lost" indicator is greater than their grandparents’.  But, of course, if and when I become a grandparent, my remaining life-years will be 100% of what I have at that point, so I will want my hip-bone replaced so I can learn to play golf at age 97.  See, that's '''pain and function'''.


We could start at the center.  Look at the age pyramid for the living and the smaller age pyramid for those who die.  Then, look at the causes of death for each age group, and deal with thatDoing so, we're dealing with contained or containable mortality, which we might define as the mortality that would appear or reappear if rich countries' healthcare systems collapse.  In poor countries, such mortality is uncontained or, if you're an optimist, "yet to be contained".
Infrastructure stands between us and the universe, delaying our death from the basic six ways to die: too hot, too cold, thirst, hunger, disease and injuryIn health-care systems, it's buildings and energy, staff and stuff, knowledge and procedures ... much of which is paid for with money, which in turn is chronically short for the poor, and may become acutely short for the now-rich.


(We might in some scenarios be ''too good'' at delaying death, 1) if population growth kills the ecosystem, 2) or if generations fight each other for resources, 3) or if demographic shift makes the pyramid grow old and then a) shrink and collapse, b) or bring in younger neighbours. But that’s another story: there's no failure like success.)
If money is short, how do we get the services we need?  Do we look into scalable high technology?  Should we look into permaculture as a design methodology that stresses "relative location for mutual service"?  Could we use and improve the devices and methodologies that are currently being developed for (and by) the poor, thus helping everyone?


Dealing with death 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 97But that's '''pain and function'''.
We want prevention, so maybe we can wash our hands with [http://www.akvo.org/wiki/index.php/Tippy_Tap tippy tap]. For diagnostic devices, we can look at what out-of-the-box designers are doing with, say, [http://www.ted.com/talks/george_whitesides_a_lab_the_size_of_a_postage_stamp.html stamp-sized tests.] For communications that don't scale, but spread, use [http://medic.frontlinesms.com/ medic frontlinesms].  For learning and information, build learning systems like [http://www.khanacademy.org Khan Academy], perhaps using books like [http://www.appropedia.org/Where_There_is_no_Doctor Where There Is No Doctor] and inserting them into [http://www.thewikireader.com wikireader]-like devices.  For communities of mutual help, [http://en.wikipedia.org/wiki/Time_Banking time banks] are being used.  For better thinking and less stress, look into the role of meditation (with as much or as little spirituality as you like)And, of course, in general, contribute to open sources like [http://www.appropedia.org/Category:Health_and_safety appropedia].


=== Use what’s available ===
Some of the above technologies look very, erm, local, don’t they?  What about expensive factories that make inexpensive antibiotics and pain-killers for millions?  Even if you dislike Big Pharma, don’t they have an essential role in health-care systems?


Infrastructure has been defined as "that which stands between us and the universe, delaying our death from the basic six ways to die".  In health-care systems, it's buildings, experts, energy, stuff ... and much of that is paid for with money.
Well, of course they are ''part'' of the big picture, which includes all the layers, from "self", sitting at the center of my world, to "mom" to "neighbour" to "satellite".  Simply because I can't make vaccines for my family, and WHO directors can't wash my hands.


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:
So we need to look at how layers define themselves, and how they interact. Maybe use a variation of Simple Critical Infrastructure Maps [http://butteredsidedown.co.uk/scim.html SCIM] with the specifics for healthcare systems? What would that look like?  How can we use both, the onion and the satellite, and everything in betweenWork in progress!
* 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 helpUse neighbours helping neighbours lose weight, walk more, quit smoking, all with help from community currencies (link from davies-coates).
* Want better thinking and less stressLook 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!'''
{{TheFWD references}}


=== Think in layers ===
[[Category:TheFWD]]
 
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.

Revision as of 00:50, 9 February 2015

Many health-care systems, where they exist at all, are being assessed as "unsustainable", with expensive and sometimes even harmful interventions, waiting lists so long they look like rationing, and exclusion from care for a number of people (sometimes many). If these systems are indeed unsustainable then it follows, with unbelievable logic, that they will fail, crack, morph into something different.

So, what’s next? If there's time, maybe some or all health-care systems can be dynamically redesigned from the core, making use of what’s available in other systems, and thinking in layers?

We must redesign from the core. Health-care systems' core is the bi-cellular seed deep inside the system: someone who has a health issue (a broken bone or a future disease that's preventable) and someone who can help. (You take both roles if you prevent or treat yourself.) 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 in modern warfare: layer upon layer of complexity, helpfulness and failure: the onion. Sometimes the tail is long and fat, but it's just the tail, intended to help those two people who are at the heart of the onion.

The core and all the layers have basic, and sometimes conflicting, missions. Classically, we deal with death, function and pain (or pain and function), and aesthetics. If aesthetics is “social function” or “social pain”, then it's only death and pain/function, and how we deal with that.

Regarding death, let's face it: 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.

We start at the center. We look at the age pyramid of the living and the smaller age pyramid of those who die. Then, we look at the causes of death for each age group, and delay death there. This is the business of contained or containable mortality, which we might define as the mortality that would emerge or reemerge if rich countries' healthcare systems collapse. In poor countries, such mortality is simply uncontained or, if you feel optimistic, "yet to be contained".

(Sometimes we're too good at delaying death, if population growth kills the ecosystem, if generations fight each other for resources, or if demographic shift makes the pyramid grow old so that either it shrinks and collapses or younger neighbours feel invited to migrate. It seems there's no failure like success, but that's another story.)

Dealing with death is felt to be most important regarding kid’s lives, whose "potential life-years lost" indicator is greater than their grandparents’. But, of course, if and when I become a grandparent, my remaining life-years will be 100% of what I have at that point, so I will want my hip-bone replaced so I can learn to play golf at age 97. See, that's pain and function.

Infrastructure stands between us and the universe, delaying our death from the basic six ways to die: too hot, too cold, thirst, hunger, disease and injury. In health-care systems, it's buildings and energy, staff and stuff, knowledge and procedures ... much of which is paid for with money, which in turn is chronically short for the poor, and may become acutely short for the now-rich.

If money is short, how do we get the services we need? Do we look into scalable high technology? Should we look into permaculture as a design methodology that stresses "relative location for mutual service"? Could we use and improve the devices and methodologies that are currently being developed for (and by) the poor, thus helping everyone?

We want prevention, so maybe we can wash our hands with tippy tap. For diagnostic devices, we can look at what out-of-the-box designers are doing with, say, stamp-sized tests. For communications that don't scale, but spread, use medic frontlinesms. For learning and information, build learning systems like Khan Academy, perhaps using books like Where There Is No Doctor and inserting them into wikireader-like devices. For communities of mutual help, time banks are being used. For better thinking and less stress, look into the role of meditation (with as much or as little spirituality as you like). And, of course, in general, contribute to open sources like appropedia.

Some of the above technologies look very, erm, local, don’t they? What about expensive factories that make inexpensive antibiotics and pain-killers for millions? Even if you dislike Big Pharma, don’t they have an essential role in health-care systems?

Well, of course they are part of the big picture, which includes all the layers, from "self", sitting at the center of my world, to "mom" to "neighbour" to "satellite". Simply because I can't make vaccines for my family, and WHO directors can't wash my hands.

So we need to look at how layers define themselves, and how they interact. Maybe use a variation of Simple Critical Infrastructure Maps SCIM with the specifics for healthcare systems? What would that look like? How can we use both, the onion and the satellite, and everything in between? Work in progress!

Template:TheFWD references

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