BEGINS BY
^
Respecting the Caring Relationships that originate
for each person from within their Family, its Family Culture,
its Extended Family, and its Close Neighborhood
for mentoring ‘his or her’ lifelong prosociality;
^
Promoting each person’s Well-Being and Human Dignity
for honoring a Design Epistemology as a shared guide
to improve our nation’s Population Health and
its Primary Healthcare within ‘her or his’ community,
neighborhood-by-neighborhood; AND
^
Chartering a Complex Adaptive System to ensure that our nation’s
health care is equitably available, ecologically & culturally accessible,
justly efficient, and dependably effective for every person,
neighborhood-by-neighborhood.
6 pages — 1 —
INTRODUCTION
“There is no matter, as such! All matter originates and
exists only by virtue of force. We must assume,
behind this force, the existence of a conscious and
intelligent mind. This mind is the matrix of all matter.”
Max Planck (1857 – 1947)
“Never doubt that a small group
of thoughtful citizens can change the world.
In the end, it’s the only thing that ever has.”
Margaret Mead (1901 – 1978)
“It’s better for everybody when
it gets better for everybody.”
Eleanor Roosevelt (1884 – 1962)
“I’ve learned that
people will forget what you said,
people will forget what you did, but people
will never forget how you made them feel.
Maya Angelou (1928 – 2014)
“To create long-lasting change, organizations and
the programs they create must, in one way or another,
become embedded in the local community (Nee 2016).”
Eric Nee (1953 – )
THE ONSET OF MODERN HEALTHCARE
Before 1850, health care usually occurred within the home of each person’s Family. Historically, any exception to this tradition occurred in association with hunting/gathering, wartime, or poverty. After @1850, health care began to occur more frequently at centralized locations within a community. Initially, the need for anesthesia during surgery required this change. By 1870, the recognition of infection risks became more widely acknowledged as a basis for the sanitation requirements necessary for this surgery.
Nearly 175 years later, health care has increasingly become the responsibility of caregivers who have only a cursory ecological or cultural connection with any resident person as a patient. The decreasing interconnectedness of healthcare is notable primarily by the absence of an intuitive, responsive awareness about a person’s Family, their Family Culture, their Extended Family, or the close neighborhood of their Family’s Home. Simultaneously, this social attribute of healthcare has been accentuated by each family’s instability related to its sentinel events, such as unstable employment, unaffordable housing, neighborhood violence, parental cognitive fatigue, health disabilities, lack of regular family mealtimes, and each family’s survival requiring two wage earners.
In effect, the historical evolution of health care and its healthcare mirrors the increasingly fractured ecological and cultural traditions within our nation’s communities, viz., their declining social cohesion. Amidst many social, political, and economic changes, the occurrence of these evolving changes has decreased the expression of trust, reciprocity, and cooperation within the municipal life of every community. The subtle decline in the shared expression of prosocial norms then fragments each community’s SURVIVAL Commons and their locally augmented Safety Net. Among many contemporary distractions, it is way past the time to renew our recognition that we are all better off when we mutually express the ‘shared intentionality’ that binds our mutual obligations to care for and about each other. — 3 —
THE ORIGINS OF ITS PARADIGM PARALYSIS
The onset of two progressive problems associated with our nation’s Population Health and its Primary Healthcare is difficult to pinpoint meaningfully. Two attributes are clearly of great concern. First, our nation’s health spending represented 5.0% of our national Gross Domestic Product (GDP) in 1960. By 2019, it was @17.8%. The increased health spending had occurred at an annual rate that was slightly higher than our nation’s yearly economic growth, viz., on average + 0.5% annually higher than GDP growth.
Using data compiled by the Organization for Economic Cooperation and Development for comparison (OECD.Stat 2024), the mean 2019 Health Spending as a portion of their GDP by each of the ten Scandian and non-USA, English-speaking nations was 9.4% (S.D. 1.33) during 2019. The USA Health Spending within that data set was 16.7%. The difference between 9.4% and 16.7% for the USA gross domestic product (GDP) of $21.4 Trillion during 2019 represented $1.2 Trillion more than the mean health spending of the other English-speaking and Scandian nations.
Second, our nation’s maternal mortality rate (pregnancy-related deaths per 100,000 live births during a calendar year) was 21.0 in 2019. Among the Scandian and the other English-speaking nations in 2019, the mean maternal mortality rate was 3.1 . Comparing 21.0 with 3.1, the excess pregnancy-related deaths for our nation may have represented nearly 700 women during 2019. There is no reason to believe that our nation’s current priorities for improving our nation’s Population Health or the quality of its Primary Healthcare will eventually improve our nation’s maternal health OR its annual health spending. A Benjamin Franklin aphorism probably applies as well to this NATIONAL PROSPECTUS.
“We must, indeed, all hang together
or most assuredly, we shall all hang separately.”
Benjamin Franklin (1705 – 1790)
As they were about to sign our nation’s Declaration of Independence in 1776, we can only imagine the profound level of resolve among the members of the Second Continental Congress. The meaning of the words, spoken then by Benjamin Franklin, eventually became oddly prophetic. Amidst our rapidly evolving and tumultuous era, known as the Anthropocene, we must also stand together or “hang separately.” In view of this imperative, a certain recently-evolving concept will be most helpful for guiding a precisely defined strategy to achieve three national GOALs.
I propose that a Design Epistemology will be required to reconfigure the complex priorities for improving our nation’s Population Health and its Primary Healthcare. With a 15-year strategy, this reconfiguration would have three GOALs: 1) decrease our nation’s annual maternal mortality by 70%, 2) decrease our nation’s annual, health spending as a portion of our national economy from 17% to 13%, and 3) acquire a participatory commitment by each State to promote their own community by community, collaborative acknowledgment of a nationally Chartered DESIGN EPISTEMOLOGY for improving our nation’s Population Health and its Primary Healthcare.
DESIGN EPISTEMOLOGY — AN INTRODUCTION
Most applicable for the complexity of Population Health as considered by its applicable Primary Healthcare, I cite a RESEARCH ARTICLE with a focus on Epistemology for the health professions (Teal et al 2024). Here is its title – “What you think you know shapes what you see: How epistemology shapes curriculum, teaching, and learning,” and here is its Abstract –
- “This article describes the need for health professions educators to consider their own versus all the others’ epistemologies. It introduces four categories of epistemic beliefs and discusses common topics and their relationships to epistemological traditions, including how they conflict with one another. It also suggests a mechanism for surfacing and managing epistemological tensions (Teal et al. 2024).”
Remarkably, the lack of clarity applied by the article’s authors to the resolution of any epistemological tensions is apparently delegated to others. Ultimately, cognitive dissonance may be an underlying barrier.
Within the realms of knowledge that may be applicable for improving a nation’s Population Health and its Primary Healthcare, I am most indebted to having identified the concept of a Design Epistemology as formulated initially by Professor Dino Karabeg, Ph.D. Amid a substantial professional academic career beginning shortly before 1990, two papers stand out among many as the basis for originating this HEALTH PROSPECTUS PAGE.
Of the references applicable to a NATIONAL HEALTH Proposal, these two articles by Professor Karabeg offer a sentinel beacon for paradigmatic healthcare reform (Karabeg 2005 & 2012). From the “Karabeg 2012” reference, I cite one sentence from its page 3: “When, for whatever reason and in whatever domain, tradition is no longer a reliable way to wholeness (e.g., when changes become too large and rapid to be assimilated through tradition), design must be practiced and relied on.” Given the VINTAGE TRADITIONS of our nation’s Population Health and its Primary Healthcare, we will need a DESIGN EPISTEMOLOGY as a broadly applicable reference to guide the breadth of progress for enabling the solutions required by a Complex Adaptive System to align all of the critical, linchpin components. — 5 —
“WICKED PROBLEMS”
Given the intractable characteristics of Health Spending and Maternal Mortality, I refer to the sentinel article that defined the occurrence of problems for which their resolution represented unprecedented difficulty. Here is its title: “Dilemmas in a General Theory of Planning (RITTEL & WEBBER 1973).” Of note, this article had 30,179 citations as of 12-30-2025.
- I cite its Abstract: “The search for scientific bases for confronting problems of social policy is bound to fail, because of the nature of these problems. They are wicked problems, whereas science has developed to only deal with “tame problems.” Policy problems cannot be definitively described. Moreover, in a pluralistic society, there is nothing like a public good, where there is no objective definition of equity, policies that respond to social problems cannot be meaningfully correct or false, and it makes no sense talk about “optimal solutions” to social problems unless severe qualifications are imposed first. Even worse, there are no “solutions” in the sense of definitive and objective answers (RITTEL & WEBBER 1973).”
To guide the reconfiguration of our nation’s Population Health and its Primary Healthcare, I offer a 36-component DESIGN EPISTEMOLOGY. It may be found as a Sub-Page of this HEALTH RENEWAL PROSPECTUS PAGE. See the Site Directory for the Sub-Pages of this PAGE listed below. Any of the other PAGES OR SUB-PAGES may be accessed by using your computer’s cursor to locate the Subject Title and double-click on it. Located on the right-hand edge of the screen, the entire list of subject PAGES and their SUB-PAGES is available on the first and second printed pages of each respective essay.
Overall, the DESIGN EPISTEMOLOGY only briefly refers to our nation’s annually worsening Maternal Mortality and Health Spending, So identified as “WICKED PROBLEMS” since neither has a currently feasible solution, a separate Sub-Page (viz. see below) proposes a long-term solution for improving our Nation’s excessive Maternal Mortality AND Health Spending.
This page has the following sub pages.