Guanxi, social capital, relationships, and health, wealth

INTRODUCTION

If we don't understand the nature of life, we can't possibly reason correctly about the "health" property of it, let alone reason about finding cost-effective interventions to improve or sustain it.

The nature of life is not obvious. I believe we have it all wrong, and as a direct consequence of this we have flawed personal behaviors, corporate behaviors, and a flawed national policy and system of "health care." Until this error is fixed, our efforts to improve "health" will simply fail in baffling ways.

Where did we go wrong?

THE OLD MODEL OF LIFE

Biology 101 teaches us, and we absorb deeply, this model:

1. LIMIT: All life is made of one or more biological cells.
2. LIMIT: Cells are blobs of protoplasm surrounded by distinct walls that clearly separate the inside from the outside. Only cells that touch each other in a more-or-less fixed shape can form "higher" life forms.
3. LIMIT: Although humans and "higher" organisms are both made of cells and have an independent life of their own, even larger colonies or collections of higher life forms cannot and do not form even "higher" life forms with a life of its own.
4. LIMIT: Life can only arise from other life and be "passed on".
   
5. LIMIT: The algebra of living things only includes division -- one living thing can divide to form two living things, but two or more living things don't re-assemble into one living thing. (A notable exception is sperm and egg, which are each separately alive and yet reassemble into a single life form.)
   
6. LIMIT: all life forms die.
   

Although every one of these rules or limits or statements has "exceptions", the model is treated as if it is "essentially correct" and not questioned very much. I will challenge it much more strongly right now, stepping on the toes of tradition and religious faith in the process.

I will propose a much more general model of life that reduces to the above model in the the special case of looking at biological life on the surface of the earth today.


MY NEW MODEL OF LIFE

1. All life is based on processes that have at least one closed feedback loop which is self-aware and self-protective. There is not limit to the special case of biology. A computer network, a family, a corporation, a culture, a nation all are "life-forms" with such loops. One very important class of living entity is called a "relationship" between people. Another class of living entity is the relationship between cells in "an organ" or "a body system", such as the heart or the circulatory system or the digestive system. These are independently alive.
2. A living entity has fuzzy edges which extend outwards, possibly across great distances with gaps in between, to anything else that forms part of its closed regulatory feedback loops.
3. Essentially all living entities are in the middle of a hierarchy of life, encompassing smaller life-forms below, and comprising parts of higher life-forms above, simultaneously. Each "level" has a "life" (closed feedback regulatory loop) of its own, and there are also some loops (lives) which span multiple levels.
4. Life can be created on-the-fly, systematically, on purpose. It is not that hard to create new life. We do it all the time. Various aspects of life can also be extinguished on the fly. It is not that hard to damage or kill life forms. A Life-form becomes "dead" when its primary closed loop no longer functions.
5. Any number of living things can combine, and often are already weekly combined, into larger life-forms with separate independent lives of their own.
6. There is no reason a life form has to die.

So what? WHAT DOES THAT CHANGE?

First, if we recognize that people, corporations, and nations are all linked together into a huge multi-level life form, then we realize that it is not possible to have one part of this "healthy" while another part of it is "unhealthy." We are, basically, all chained to each other and our fates our linked.

Corporations are life-forms, as are nations, but they are not "separate" entities from "people."

It is true, for example that there is a "personal economy" and a "corporate economy" that have separate lives and interests in the very short run, but it is also true but unrecognized that there is a longer-time-span linkage between the two so that destruction of the personal economy in an effort to improve the corporate economy is simply self-defeating and self-destructive.

This means that it is nonsensical for "Public Health" to see corporations as "an enemy". Any solution that deals with personal or family health will collapse if the local economy collapses. Jobs are as important as medicine for personal sustainable health.

Similarly, it makes no sense for corporations to try to build a vibrant economy on the backs of and at the expense of people and the environment -- because, ultimately, they ARE people and if the people or environment are destroyed, the corporate entities and economies will die off as well. It won't work for corporations to try to become computer-based and get rid of all people, for reasons I'll get to later.

Similarly, people do not have "clean edges" where there is "my" health and "your" health. Every day scientists find deeper ways in which the health of "your neighbors" and "your friends" and "your friends' friends" contribute to and often even determine "your" health and "your" behavior. A cell with damaged DNA can go on functioning if it is surrounded by healthy cells that it interacts with strongly. The same is true for people.

"Our" health is not somehow contained within the boundaries of our skin. Things can go wrong with our health that are outside that boundary, and things can go right with our health that are outside that boundary. This is a cruicial fact!

It has been shown that, for an 60 year old American, making a new friend has a stronger impact on their survival rate and than dealing with smoking, drinking, exercise, and nutrition. This should not come as a surprise, with the new model of biology and life.


WHAT ARE THE IMPLICATIONS FOR NATIONAL HEALTH CARE POLICY?


I think it is evident that a set of interventions that improved interpersonal relationships ( life forms) would have more of a beneficial effect on our lives, morale, and "physical health" than most other interventions we can imagine (such as reduced drug costs or new insurance mechanisms.)

In other words, humans are part of a meta-biologicial ecosystem where the health of the relationship-entities sea that we swim in determines, effectively, the health of the protoplasm units we wear (our bodies.)

Similarly, in the business world, the sea of relationship-entities ("guanxi" or "social capital") is as important, or more important, than the individual roles and positions people have in determining the "health" of corporations and the regional and national economy.

Even on the departmental or work-team level, the relationship-sea, the ecology of life forms that occur "between" people is as important, or more important, than individual "skills and experience" in determining successful perception of direction and accomplishment of objectives.


CONCLUSIONS / RECOMMENDATIONS

Any strategy for personal health, corporate success, or a thriving national economy is doomed to failure unless it attends to the needs of the inter-entity life-form community as well.

"Relationships" are not just something that people "are" or "do" -- they are independent living entities that must be nurtured and which have their own "health care" needs and interests.

This is a much stronger mental model that can direct the attention and focus of policy in ways that will be much more successful at building a sustainable world than the old model.

Wade

Institute for the Future

The Institute for the Future has an interesting weblog at http://future.iftf.org/. Two pieces I found in the current posts relating innovation, competitiveness, and operational structure are these:

Forward Thinking Cultures quotes a study by Mansour Javidan in the Harvard Business Review

In our study, Singapore emerged as the most future oriented of cultures, followed by Switzerland, the Netherlands, and Malaysia.

Interestingly enough, I heard about the Netherlands in a different context on my last trip to Johns Hopkins -- apparently US males are no longer the tallest in the world, and the average male in the Netherlands is almost 2 inches taller than the average in the US. That's probably related to other statistics showing that the USA, with less than 2% of its health care expenditures spent on prevention, has such generally poor health that the top quartile of Americans have worse health than the bottom quartile (by wealth) in the UK.
(see a related post by Ian Morrison of the IFTF, on US vs England comparisons here.)

I was also impressed many years ago, 1989 I think, when I met the head of healthcare IT (at a place called BAZIS) for the Netherlands (Mr. Bakker?) at a SCAMC meeting in San Francisco and we had a chance to chat at lunch. They tend to have a few very large hospitals by US standards there, with 2,500 beds for example. Their health care IT system for the hospitals was available free for anyone who wanted to translate the documentation. It ran on some tiny Digital Equipment Corp. box, something like a MicroVax. We were astounded, both that they had operational hospital systems completed, and that they could run on a small box instead of some huge IBM behemoth. What was the secret? Well, he confided, they did have to rewrite the operating system from scratch, because VAX VMS was trying to be all things to all people, and was so top heavy that it could be close to nothing for anyone anymore.

Wow, I think, just like Microsoft Vista today! To go to Hopkins I needed a cheap laptop in a hurry, and bought a $300 Dell with Vista pre-installed. The Circuit City salesperson told me I needed to drop another $50 for a memory upgrade first, because Vista would just barely fit in the 512 Meg it came with. So, I upgraded to 958 Meg of RAM. It comes with a 1.80 GigaHertz processor.

Let me put this into perspective. In 1990, as I recall, the only computers outside secret government facilities with 1 GHz processors were the ones on nuclear subs that decoded sonar signals. So I have here a computer with almost twice the processing speed of those incredible computers. How fast does it operate? Well, when I click on an application to open it, after a few seconds I often have to click again to get some idea whether it ever heard me or not.

This seems to be the corporate model in America that has gone from a philosophy and practice in the culture to actually being hard-wired "under the skin" of the latest computers. Let's make the beast so top heavy, so unwilling to say "no" to anything, that it can no longer say "yes" to anything because there's no room left to operate. Sleek and lean it is not. Shades of the entire US business model -- so preoccupied with fist-fights in the cockpit that no one is even looking out the plane windshield any more, having forgotten the original mission.

So, anyway, the tiny Netherlands, not laden with our historical success, saw fit to throw it all out and rewrite from scratch to do one thing extremely well, and it worked.

A second piece at IFTF that caught my eye was this:

Medical innovation: Could the U.S. slip?

The Washington Post's Amar Bakshi writes about the Artemis Medical Foundation, an about-to-open clinical research center in India. It's an interesting piece for two things. The first is its blunt critique of American medical research: Artemis founder Kushagra Katariya (formerly a professor at the U. of Miami) declares, “Opportunities to develop cutting edge [medical practices] are fast disappearing in…the United States."

The rest of the Post article quoted more or less describes the same congestion effect I refer to above.

Slip, by the way? "Slip?!!" Pfizer just closed it's doors in Ann Arbor. Fall and crash its skull open is more like it.

Actually, I recently wrote about Little's Law here in an analysis of why so many planes are so late these days. Pretty much all these three situations - computers, US research, and US airlines share the property of systems that throughput drops rapidly towards zero if you try to jam too much stuff into the box, then try to make it go by whipping it harder. Then you get a vicious death spiral - as the cartoon Dilbert says "the whippings will continue until morale improves." The less comes out, the more management tries to jam into every remaining opening. Well, see my causal loop diagram for how that simply cascades itself to death.

It's not a new problem - I believe the Old Testament in the Christian Bible warns land owners against gleaning to the very edges of their fields, or basically, taking all the slack out of the system. So, sorry Futurists -- this isn't a future problem , or even a current problem, it's a very old problem that we are really, really good at putting off.

What we need in many ways is less "news" and more "olds." I guess that's much of what my weblog here is about - lessons from religion that we keep on trying to reinvent the hard way, and botching.

If my primary assumption is right, that we're in a scale-invariant hierarchical organization of Life, then evolution is carrying us around a helix or spiral, back to the same "point" each pass, but shifted in a perpendicular direction upwards each pass a little more. We're "turning the screw." In that case, it's easy to predict the future (although not the timing) -- just assume that we will keep on running into the same damn organizational problems at each new scale of size until we wise up and solve them generically. Them is us. Then is now. We're traveling in our own prop-wash.

Each of us is a walking testament to the fact that 6 trillion cells can work together as one emergent larger entity, so we know that this problem has a solution. Why don't the cells just rip each other apart, or go their separate ways, or compete to see who will be the king cell of the body and get to rule all the others and own all the energy supplies?

Getting N+1 units to operate together and produce an output superior to what N units alone can do is one of those core problems that scales up symmetrically. We keep on trying to put off dealing with that problem, ascribing the failure of "committees" to this or that thing, and never looking at this core problem. What are we doing wrong? This is important. If we solve this, we just increased mankind's innovative power by a factor of about 6 billion, or maybe 6 billion factorial, but in any case, way more than 25%.

We don't know how to share. We don't know how to play together nicely. These are not just "children's problems." These are make-or-break it problems. While our scientists peer into deeper microscopes, their social base and funding is unraveling, because this "little" problem has not been solved. I'll assert that the whole "war on terror" wouldn't have come to 9/11 attacks if we had solved this problem in the Mideast. There's a trillion dollars right there.

And health care costs? Amid the arguments about how insurance happens, we've lost sight of prevention, which only matters because it's way cheaper than repair. Maybe 100 times cheaper. But, prevention may require people to work together, whereas repair only needs one doctor. Since we refuse to address the working together problem, we're stuck with the repair problem.

Then, miracle of miracle, along comes Toyota discovering "lean" principles which, at their core, are pretty basic religious teachings of honesty, integrity, transparency, working for the long run, caring about each other and working together. To quote another cartoon, "Doh!" How could we have known? I doubt that the little Andon cords and colored cards matter so much as the "care about each other" part. Maybe "competition to the death" is not our best strategy.

As T.S. Eliot, in the Four Quartets , said

We shall not cease from exploration
And the end of our exploring
Will be to arrive where we started
And know the place for the first time.

Wade