Expanding the health care debate

David Suzuki

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Expanding the health care debate - health care should begin in the classroom
Steve L Friesen

Posted on: 17 July 2002
Complex Systems Health: Expanding the health care debate even further.
Vivian S Rambihar

Posted on: 08 July 2002

Posted on: (17 July 2002)

Expanding the health care debate - health care should begin in the classroom
Steve L Friesen, Teacher
Recognizing the role of health education is central to any discussion about the long term sustainability of our health care system.
Many of the diseases which consume millions (billions?) of health care dollars are essentially diseases of choice - diabetes, heart disease, many forms of cancer to name a few - where lifestyle decisions play a vital role. The human and financial cost of inactivity and poor nutrition...
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Recognizing the role of health education is central to any discussion about the long term sustainability of our health care system.
Many of the diseases which consume millions (billions?) of health care dollars are essentially diseases of choice - diabetes, heart disease, many forms of cancer to name a few - where lifestyle decisions play a vital role. The human and financial cost of inactivity and poor nutrition has become staggering.
How healthy are our children? The latest research indicates that children will follow in the footsteps of their parents. Our children are inactive as almost 1/3 of them are overweight or obese. This does not bode well for health care in the future. At this rate, our children will become adults who are as sedentary and disinterested in active living as their parents. In fact, children today are being diagnosed with diseases usually associated with adults - diabetes is an example.
We need to link health care with health education - despite their federal and provincial responsibilities. Think of our children - the 'next generation' if you will - as the link. Imagine if in our schools, health education was a priority. Imagine the opportunity to reach millions of children, at an impressionable age and get them 'hooked' on the benefits of active, healthy living.
For this potential to be realized however, schools must change the way that they deliver these programs to the students.
Many people would agree that health and physical education programs across the country are suffering. These programs are generally not regarded as serious or 'core' curriculum courses by provincial governments, school boards and schools. One of the main reasons for this is because these programs do not place a high enough priority on the actual teaching of the health curriculum. Too many programs are primarily concerned with the delivery and the success of their athletic program (school teams). This is a problem because the majority of students are not athletic. We need to focus on the success of every student, not just the ones who win championships or get scholarships.
This approach is a reason why so many school 'physed' programs struggle. Schools do not provide enough positive 'physical activity opportunities' for students. The majority of these opportunities are geared towards the physically gifted student - athlete. This approach alientates students and reinforces the belief that activity and fitness in general is only for the athletes.
We can reverse this trend in our schools. With about 13,000 schools in Canada think of the impact that can be made with regards to personal health and disease prevention if every student in Canada has a comprehensive daily physed program at his/her disposal.
The financial cost would be minimal because these programs are already in place. The benefits would be felt for years.
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Competing Interests: None declared.
Posted on: (8 July 2002)

Complex Systems Health: Expanding the health care debate even further.
Vivian S Rambihar, cardiologist
Other Contributors:
David Suzuki writes that the health of our citizens is inextricably linked to the health of our surrounding ecosystems (1), in seeking to expand the health care debate to include ecosystem health, with far reaching implications for the future of health care. The more fundamental concept of complex systems health would expand this debate even further to include not only the topics covered by ecosystem health, but all of m...
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David Suzuki writes that the health of our citizens is inextricably linked to the health of our surrounding ecosystems (1), in seeking to expand the health care debate to include ecosystem health, with far reaching implications for the future of health care. The more fundamental concept of complex systems health would expand this debate even further to include not only the topics covered by ecosystem health, but all of medicine, health and everyday living (2-3). Ensuing relevant ideas would include webs of causation, network organization and the contextual nature of evidence (2-5).
The new science of chaos and complexity better and more realistically illustrate how ecosystems and complex systems like health work (2-5), and the derived new meanings, models and metaphors could be used to shape the future of health care and serve as a model for change. Only recently described scientifically, these concepts are enshrined in Eastern and ancient philosophy and cultures and utilized intuitively by wise scientists and Native Peoples, the latter described in Knudson and Suzuki’s book “Wisdom of the Elders.”
We live in a capricious world where events unfold in a somewhat determined and also somewhat uncertain way. There are complex dynamic local and distant interactions with amplifying and attenuating effects where often small unexpected influences change the shape of our future. Our lives and our health, as individuals or populations, are inextricably linked to the complex dynamical systems that ensnare us - our surrounding ecosystems and everything else, the entire internal and external environment.
Ecosystems, as one of the many interacting complex systems that determine health, illustrate the fundamental concepts of chaos and complexity, which could then be used as its scientific base. The novel principles inherent to ecosystems, successfully used in ecosystem health and applied to eco-related health matters (6), could thus be extended to all of health and medicine (2-3). Although ecosystem and ecology are powerful metaphors for health, the more fundamental concept and science of chaos and complexity, applicable to all complex systems, describe individual and population health better.
The centuries-old mechanistic, reductionist and linear thinking which continue to govern medicine, health and health care delivery does nor reflect current reality. Dee Hock, in introducing newer ideas into health care says “there is simply no way to manage the diversity and complexity of 21st century society with 17th century concepts.”
We can not afford to throw old solutions at complex modern problems. The health care debate could be expanded even further by exploring novel ideas from complex systems.
References:
1. Suzuki D. Expanding the health care debate. CMAJ 2002;166(13):1678 -9.
2. Rambihar VS. CHAOS 2000 from Cos to Cosmos: Making a new medicine. Toronto: Vashna; 1996, 2000.
3. Rambihar VS. A New Chaos Based Medicine Beyond 2000: the response to evidence. Toronto: Vashna; 2000.
4. Sardar Z, Abrams I. Introducing Chaos. Cambridge: Icon Books; 1999.
5. Buchanan M. NEXUS: Small worlds and the groundbreaking science of networks. New York: WW Norton; 2002.
6. Rapport D, Bohm G, Buckingham D, Cairns J (Jr), et al. Ecosystem Health: the concept, the ISEH and the important tasks ahead. Ecosystem Health 1999; 5(2):82-90. Available: www.ecosystemhealth.com/ISEHCommentary.pdf
VS Rambihar, cardiologist, Toronto, SP Rambihar, Medical Student, UWO, London, Ontario..
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Competing Interests: None declared.