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The Onion and the Satellite - Lucas Gonzalez

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This is an entry in The Future We Deserve - a collaborative book project about the future. See all the entries or talk about this entry.

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, long waiting lists, less-than-perfect interventions, and 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? Some or all health-care systems might be dynamically redesigned from the core, and in that redesign we will all make use of what’s available in other systems, in layers.

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 help 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. Sometimes long and fat, but it's just the tail.

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”.)

We all die at the end of our life. (Big news, I know.) So health-care systems can't really reduce death, but they can delay 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.

(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 old and then collapse. But that’s another story.)

Use what’s available

Money has become short for some of the previously rich, and it’s chronically short for the poor. 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.

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.