All of my theoretical models lead to the same conclusion - the field of "public health" cannot really do their job well until the needs and interests and realities of multi-human meta-organisms are included as well.
In English, that means that we ARE what we are PART OF, which is increasingly clear in public health studies of the impact of social connectivity on physical and mental health.
But it also means that the internal life of corporations, cultures, and nations, as well as the entity called "the public", are all very real systems that behave as if they were separate biological goal-seeking, energy-consuming, adaptive, reactive, self-protective organisms.
It also means that it just doesn't make any sense to evaluate the impact of different interventions in the health of people without, at the same time, evaluating the impact on jobs, employment, and the health of corporations and business and the business community.
The physical health of people in a community or nation is very directly influenced by the "health" of the community or national economy. If the economy or businesses crash, it will show up "under the skin" very rapidly.
The failure of many in public health to have a wholistic approach that includes BOTH people AND corporations reduces the credibility of public health. If there is one lesson "systems thinking" teaches, it is that the word "OR" is vastly over-used. We shouldn't be thinking that EITHER we can serve people OR the public - we need to lead the way in serving BOTH. And, similarly, we need to get corporations realizing that they can't survive if the workforce they draw on, and customer base they need in this country collapse. We need each other. We are each other, in some very real ways, and our respective "health" depends on each other in a feedback loop, either for better or worse.
Similarly, it makes no sense to me that "Republicans" should be fighting for the interests of "business" and "Democrats" for the interests of the "people" - because there is only one, multi-leveled complex life-form on this planet, which includes "cells", "people", "corporations", "cultures", and "nations."
We are all in the same lifeboat. At this point if the people all die off, so do the corporations. If the corporations all died off, so would almost all the people. Get over it.
If we're upset that corporate or national planners don't include "human factors" in their planning, we shoudn't also assume it's because they refuse to -- it is, in my experience, more that they are clueless as to how to do that.
If public health wants to change that equation and interaction, great, pick up that heavy burden and figure out how to include humans in the equations and not make them indescribably difficult to solve. If corporations can get better bottom-line performance by doing better planning including more of reality in the plans, they'll do it, but someone has to show them how that would work and make a convincing case that it does work.
That gets down to that messy problem of "profit." As the Ross School of Business here in Michigan says "Non-profit is a tax strategy, not a business strategy."
Or, as one sister from Trinity Health Care's catholic leadership put it, "No margin, no mission."
Health is intimately tied to growth and life which are intimately tied to "wealth."
That component sub-systems decay and die is a given; what's up for grabs is whether there's a balancing source of regeneration and growth, which requires that actions result, ultimately, in absorbing more energy than is spent in getting there.
In other words, in the larger accounting scheme of life, public health interventions have to "pay off" or they will simply "die off." This is a schitzohrenia that both clinical health and public health seem to have - the idea that making money is intrinsically bad or a dirty concept.
Yes, obsession with short-range, stupid strategies to make money at the expense of life, health, and stability are indeed stupid. On the other hand, there is no such thing as a long-range strategy of losing money each year.
The most important distinction is that wealth, and health, are not zero sum, and are based heavily on interactions across levels of the MAWBA beastie.
Health can, in fact, be created out of thin air.
Wealth can, in fact, be created out of thin air.
BOTH of these, health and wealth, cross-support each other.
Being "rich" and "dead" is not a winning strategy.
Some balance is required.
Public health has an opportunity to teach the principles of SUSTAINABLE GROWTH, which means sustainable rates of return on investment. Business owners hate that venture capital firms and stockholders expect them to operate to maximize profit this quarter, at over 27% a year annual rate, but to keep operating in the long run.
Those are incompatible goals. With the exception of discovering gold or the equivalent, healthy businesses probably grow at 10% or less, maybe as low as 2% per year. If public health would show CEO's how to keep stockholders from jumping ship if the companies invested more internally in people and showed such "small" profits, the CEO's would love public health. Everyone knows this is an absurd demand that's killing off healthy, stable business as "not up to par."
These problems cause each other. People are stressed out because the businesses they work for are stressed out. Businesses are stressed out because they don't know how to tap the healthy creative power of people at a sustainable rate. They are different views of the very same, multi-level, MAWBA problem.
If 30% of the humans died or were seriously put out of commission for 2 months by something like avian flu, at least 30% of the corporations would crash and burn as well, because they are riding very close to the line on being as short-staffed as they can be right now. The crash would cascade, as suppliers of key components failed. The interests of public health and "big business" align when it comes to stopping global pandemics.
This fact is maybe less visible because of the invisiblity of the details of the roles of people on "the bottom" in keeping corporations operating. My guess is, after the last round of layoffs, that more than half the large corporations in the US are vulnerable to crashing and burning if 30% of their Information Technology staff were to abruptly be incapacitated on the same day. All meta-life involves a constant battle between natural collapse and regenerative efforts, which may "look like" nothing is going on and all is "well." Remove those people who are holding everything together, and it will suddenly become apparent that maybe they were doing something after all.
Other areas of "infrastructure" are similar. We have huge reliance on armies of people doing low-visibility or invisible jobs, without which the wheels of commerce would cease turning in a cross-cascade, house-of-cards type collapse.
It is a mistake to think that pulling out the "safety net" has "worked." It hasn't been tested on a full-scale pandemic yet. The effect of having almost 50 million people in the US without health coverage will have the same effect as having a basement filled with gasoline-soaked rags would have on a small house fire. These are things you really do NOT want to give a running start on you.
---------
(This was originally published 11/21/06 on my weblog "might as well be alive" at http://mawba.blogspot.com)
No comments:
Post a Comment