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
Health-care systems in many countries seem to be unsustainable. It shows because there are expensive and less-than-perfect interventions. And because waiting lists are long to the point of looking like rationing, when there's no direct exclusion from care for sometimes large numbers of people. Thing is, 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 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, 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. 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.
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 could start at the center. Look at the age pyramid of the living and the smaller age pyramid of those who die. Then, look at the causes of death for each age group, and deal with that. 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 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) 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 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 learn to play golf at age 97. But that's pain and function.
Use what’s available
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. Money, chronically short for the poor to start with, is too becoming short for some of the previously rich.
So the question is for all of us: 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?