| Line 6: | Line 6: | ||
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]] | ||
Many health-care systems, where they exist at all, are said to be unsustainable, with expensive and sometimes even harmful interventions, waiting lists so long they look like rationing, and exclusion from care for sometimes large numbers of people. If they 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? If there's time, maybe 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 | 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 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, intended to assist what goes on at the heart of the onion. | ||
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. | 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. I've decided to leave aesthetics out for this short piece, or maybe aesthetics is “social function” or “social pain”. So it's '''death and function/pain''', 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. | 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 | 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 deal with them. Doing so, we're into the business of '''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 simply '''uncontained'''. Or, if you're an optimist, "yet to be contained". | ||
(Footnote: We might | (Footnote: We might ocassionally be [https://spreadsheets.google.com/ccc?key=0AhtJz9HHi6yVdHRtcnVYaDhEVl9xUDd6a1poeU5HckE&hl=en#gid=1 ''too good'' at delaying death], if 1) population growth kills the ecosystem, 2) generations fight each other for resources, or 3) demographic shift makes the pyramid grow old and then a) it shrinks and collapses, b) or younger neighbours are invited by the situation. But that’s another story: there's no failure like success.) | ||
Dealing with death is felt to be most important | Dealing with death is felt to be most important regarding kid’s lives, whose "potential life-years lost" is greater 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 learn to play golf at age 97. See, that's '''pain and function'''. | ||
=== Use what’s available === | === Use what’s available === | ||
Infrastructure | Infrastructure stand 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 ... 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: | We want: | ||
Revision as of 12:42, 6 November 2010
The onion and the satellite
Author: Lucas González Santa Cruz, aka LucasG
Body of article: about 945 words. needs tightening
Discussion page for this essay: Talk:TheFWD_lucasgonzalez_The_onion_and_the_satellite
Many health-care systems, where they exist at all, are said to be unsustainable, with expensive and sometimes even harmful interventions, waiting lists so long they look like rationing, and exclusion from care for sometimes large numbers of people. If they 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 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' 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 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, intended to assist what goes on at the heart of the onion.
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. I've decided to leave aesthetics out for this short piece, or maybe aesthetics is “social function” or “social pain”. So it's death and function/pain, 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 deal with them. Doing so, we're into the business of 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 simply uncontained. Or, if you're an optimist, "yet to be contained".
(Footnote: We might ocassionally be too good at delaying death, if 1) population growth kills the ecosystem, 2) generations fight each other for resources, or 3) demographic shift makes the pyramid grow old and then a) it shrinks and collapses, b) or younger neighbours are invited by the situation. But that’s another story: there's no failure like success.)
Dealing with death is felt to be most important regarding kid’s lives, whose "potential life-years lost" is greater 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 learn to play golf at age 97. See, that's pain and function.
Use what’s available
Infrastructure stand 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 ... 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? We can wash our hands with tippy tap.
- diagnostic devices? We can look at what out-of-poverty and allies are doing. Stamp-sized tests.
- communications? Use frontlineSMS-medic.
- learning and information? Build a learning system a la Khan Academy, use books like "where there's no doctor" and put them into thewikireader.
- communities of mutual help? Use neighbours helping neighbours lose weight, walk more, quit smoking, all with help from community currencies (link from davies-coates).
- better thinking and less stress? Look into the role of meditation (with as much or as little spirituality as you like).
airtight links needed
Think in layers
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 hate 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 "swadeshi" and "globalisation". Everything from "self", sitting at the center of my world, to "mom" to "neighbour" to "satellite". 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 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?