cognitive dissonance
G L O S S A R Y for H E A L T H C A R E
A CLUSTER of terms and concepts for promoting
a cohesive understanding of our Nation’s
POPULATION HEALTH and its PRIMARY HEALTHCARE
50 pages — 1 —
INTRODUCTION
“If terminology is not corrected, then what is said cannot be followed.
If what is said cannot be followed, then work cannot be accomplished.”
Confucius (551 – 479 BC)
“The whole is more than
the sum of its parts.”
Aristotle (384 – 322 BC)
“The most important thing in science is not so much to obtain new facts
as to discover new ways of thinking about them.”
Sir William Bragg (1862 – 1942)
“In a time of drastic change, it is the learners who inherit the future.
The learned usually find themselves equipped to live in a world that no longer exists.”
Eric Hoffer (1902 – 1983)
Timeless thoughts, spanning 25 centuries, continue to serve our need to think carefully about the alternatives for our nation’s contemporary survival. We face heroic levels of change within the separate, marketplace arenas for our world’s global Resources, Knowledge, and Human Dignity. Arguably, our nation’s dominance of these marketplace arenas may be currently in decline. Our nation’s economic stability will not be assured without, first, a fundamental correction of our nation’s annual deficit by our Federal government. To reverse the worsening dominance of our nation’s health spending within our national economy, we must prevent cognitive dissonance from paralyzing our nation’s discussion about healthcare reform. With a precisely defined and broadly acknowledged agreement about the need for its clarity, the consistent use of this or any other similarly comprehensive “Glossary for HEALTHCARE” could be an important contribution to a widely understandable and supported, national scenario for fundamental healthcare reform.
The smoldering embers of meaningful healthcare reform must not be allowed to die out amidst the paradigm paralysis squeezing out the last vestiges of vitality that still exist within our nation’s healthcare industry. The Knowledge required to promote true healthcare reform already exists. Energized and re-focused based on this Knowledge, a renewal of our commitment to enhancing Human Dignity and to preserving our nation’s Resources should be the underlying focus for goal-directed healthcare reform. A steady self-sustaining improvement of the health care offered within each community to its resident persons should now represent our nation’s Job ONE. A New Strategy will be required to assure that enhanced Primary Healthcare becomes equitably available as well as ecologically and culturally accessible by each resident person, community by community. Concurrently, this New Strategy will also be required to assure that all healthcare is justly efficient and dependably effective for every community’s obligation to each of their resident persons.
In 1960, health spending represented 5.0% of our nation’s economy. For 2019, our nation’s health spending represented 18.0% of our national economy, its gross domestic product. At that time, most of the other 38 OECD nations of the world spent a much lower portion of their economy on healthcare. The portion of their economies allocated to healthcare averaged less than 13.0%. Using 13.0% as a goal for our healthcare industry, the excess health spending for our nation’s healthcare would have represented $1.0 Trillion during 2019. This view of health spending also means that nearly 58% of the Federal fiscal deficit in 2019 occurred as a result of the Federal government’s excess contribution to our nation’s total health spending.
For my compatriot 822,000 citizens of Metropolitan Omaha during 2019, the excess cost of its healthcare was likely to have represented $2.52 billion for my community alone. This is a resource that is unavailable to my community for its economic growth or for the city’s infrastructure and especially for its Survival Commons. Recognizing the excess cost of our nation’s healthcare is made even more relevant when we consider the needs of our nation’s future by the year 2050. The United Nations predicts that the worldwide population will have grown from 7 billion in 2011 to a population of 8 billion in 2022. In effect, we have only 10-15 years to fix our nation’s debtor status made worse by the pandemic in order to prepare for the worldwide population of 11 billion that is very likely to exist in 2050. Adding to the influence of global warming (regardless of its knowable causes), it is possible that international pandemics will become increasingly prevalent. Among all the issues regarding immigration, securing our borders will be a second requirement as a means to shield ourselves from these international pandemics and their associated worldwide turmoil. Recall the inter-national measles outbreaks that ended in 2000 as well as the coronavirus that became a pandemic in 2020.
As of 9-1-20, there are 62 terms and phrases cited below. The LISTING column represents an alphabetic arrangement with each identified as contributing to one of six categories. Each term or phrase has a connection with similar concepts within a category. This Sub-Page of the Blog proposes to use this carefully defined GLOSSARY as the basis for creating an integrated, broadly acknowledged understanding of the specific terms applicable to any discussion about healthcare reform. This GLOSSARY, or any similar effort diligently applied, could also be useful for reducing the cognitive dissonance underlying the conflicting issues associated with healthcare reform. Many of these issues have led to a disconnected collection of reform tactics without any real hope of substantially improving our capability to improve either our nation’s population HEALTH or its healthcare. The 30 terms and phrases that are listed with bolded-italicized letters represent a substantially new formulation for understanding the conceptual origins for the DESIGN EPISTEMOLOGY.
It is likely that there are, and will continue to be, honest differences of opinion about choosing wisely among the alternatives for meaningful healthcare reform. I would only remind anyone who has a connection with healthcare reform that our nation is heading to a disastrous financial crisis, much like Greece, based substantially on the current excessively high level of health spending. During 2019, the cost of our nation’s healthcare represented 17.9% of our nation’s economy. All of the other 37 OECD (Organization for Economic Co-operation and Development) nations of the world have healthcare spending as a group that averages less than 13% of their combined national economies. Using 13% as an initial GOAL, the excess health spending for our nation’s healthcare in 2019 represented $1.008 trillion, of which the federal government paid at least 45% or $454 Billion. With the excess health spending for our nation’s healthcare at $1.008 trillion, it would have represented the annual cost (corrected for inflation) of waging 10 combined Iraqi/Afghanistan wars in 2005, simultaneously. And, the $454 billion excess health spending paid by the Federal Treasury would have been 46% of our nation’s fiscal deficit for 2019. Clearly, our current level of cognitive dissonance and paradigm paralysis surrounding healthcare reform must not be allowed to block a distantly envisioned, long-term plan for healthcare reform.
This GLOSSARY for HEALTHCARE is intended to serve as the basis for a broader discussion of healthcare reform. The thoughts of Confucius, Bragg, and Hoffer cited above should reorient the precision necessary to choose wisely among the options available for healthcare reform. By 2050, our nation’s autonomy within the worldwide community will depend on it.
ALPHABETICAL LISTING (72)
ADAPTIVE SKILLS ————————– FAMILY
ANTHROPOLOGY ————————— FOUNDATION
BASELINE HOMEOSTASIS ————— FOUNDATION
BENEFITS AND OBLIGATIONS ———- OTHER
CARING RELATIONSHIP —————— DESIGN EPISTEMOLOGY
CLUSTER —————————————- FOUNDATION
CLUSTER OF COMMUNITY
CAPABILITIES ————————- OTHER
COLLECTIVE ACTION ———————- DESIGN EPISTEMOLOGY
COMMONS ————————————– OTHER
COMMON GOOD —————————- DESIGN EPISTEMOLOGY
COMMUNITY ———————————- DESIGN EPISTEMOLOGY
COMPLEX ADAPTIVE SYSTEM ——– DESIGN EPISTEMOLOGY
COSMOLOGY ———————————- FOUNDATION
CULTURAL SOCIAL-COGNITION —— DESIGN EPISTEMOLOGY
DEPENDABLY EFFECTIVE ————– QUALITY
DISRUPTIVE PROCESS ——————— DESIGN EPISTEMOLOGY
ECOLOGY ————————————— FOUNDATION
ECOLOGICALLY &
CULTURALLY ACCESSIBLE —- QUALITY
EQUITABLY AVAILABLE ——————- QUALITY
ETHICAL PRINCIPLES ———————- FOUNDATION
ETHNOGRAPHY —————————— FOUNDATION
FAMILY ——–——————————— DESIGN EPISTEMOLOGY
FAMILY CONVOY ————————— DESIGN EPISTEMOLOGY
FAMILY MEALTIME ———————— FAMILY
FAMILY TRADITIONS ——————— DESIGN EPISTEMOLOGY
HEALTH ————————————— DESIGN EPISTEMOLOGY
HEALTH CARE —————————— DESIGN EPISTEMOLOGY
HEALTH CONDITION ——————— PRIMARY HEALTHCARE
HEALTH SERVICE ————————– V I S I O N
HEALTHCARE ——————————– V I S I O N
HEALTHCARE CLINIC ——————– V I S I O N
HEALTHCARE ENTERPRISE ———— V I S I O N
HEALTHCARE INDUSTRY ————— V I S I O N
HEALTHCARE SYSTEM —————— V I S I O N
HEALTHCARE TEAM ———————- V I S I O N
HUMAN CAPABILITY ——————– DESIGN EPISTEMOLOGY
HUMAN DIGNITY ———————– DESIGN EPISTEMOLOGY
HUMAN FETUS —————————- DESIGN EPISTEMOLOGY
INNATE TEMPERAMENT —————- FOUNDATION
INSTITUTION ——————————— DESIGN EPISTEMOLOGY
INSTITUTIONAL CODEPENDENCY — OTHER
JUSTLY EFFICIENT ———————— QUALITY
MANAGING THE COMMONS ——— DESIGN EPISTEMOLOGY
MASTER DISASTER PLANNING
STRATEGY ————————— OTHER
MATERNAL MORTALITY ————— OTHER
MEDICAL TRIAGE ————————- PRIMARY HEALTHCARE
MUNICIPAL LIFE ————————— FOUNDATION
PERSON —————————————- DESIGN EPISTEMOLOGY
PERSONAL SURVIVAL PLAN ———— FAMILY
POPULATION HEALTH —————– DESIGN EPISTEMOLOGY
POVERTY ————————————- DESIGN EPISTEMOLOGY
PRIMARY HEALTHCARE —————- DESIGN EPISTEMOLOGY
PRIMARY PHYSICIAN ——————– PRIMARY HEALTHCARE
PROSOCIALITY —————————— DESIGN EPISTEMOLOGY
QUANTUM SIGNALING BRAIN ——- DESIGN EPISTEMOLOGY
RESILIENCE ———————————- FOUNDATION
RESOURCES, KNOWLEDGE, and
HUMAN DIGNITY —————– FOUNDATION
SALUTATORY GREETING —————- DESIGN EPISTEMOLOGY
SOCIAL CAPITAL ————————– DESIGN EPISTEMOLOGY
SOCIAL COHESION ———————— DESIGN EPISTEMOLOGY
SOCIAL DILEMMA ————————- DESIGN EPISTEMOLOGY
SOCIAL INTERACTION ——————- DESIGN EPISTEMOLOGY
SOCIAL MOBILITY ————————- FOUNDATION
SOCIAL NETWORKS ———————– FAMILY
SOCIAL RELATION ————————- FOUNDATION
SOCIAL RESPONSIBILITY ————— OTHER
SOCIAL STIGMA ————————— FAMILY
SURVIVAL COMMONS ——————– DESIGN EPISTEMOLOGY
VESTING FORMAT ————————- OTHER
TRUSTWORTHY —————————– FOUNDATION
VISIONING STATEMENT and
ACTION PLAN ———————- FOUNDATION
WELL-BEING ——————————— DESIGN EPISTEMOLOGY
NOTE — For the listings above and below, the words or phrases identified by bolded–italicized letters represent the 13 basic concepts and their definitions that are unique to NATIONAL HEALTH and represent an interconnected basis for considering any strategy for our nation’s healthcare reform.
CATEGORY LISTING
DESIGN EPISTEMOLOGY (30)
CARING RELATIONSHIP, COLLECTIVE ACTION, COMMON GOOD, COMMUNITY, COMPLEX ADAPTIVE SYSTEM, CULTURAL SOCIAL-COGNITION, DISRUPTIVE PROCESS, FAMILY, FAMILY CONVOY, FAMILY TRADITIONS, HEALTH, HEALTH CARE, HUMAN CAPABILITY, HUMAN DIGNITY, HUMAN FETUS, INSTITUTION, MANAGING THE COMMONS, PERSON, POPULATION HEALTH, POVERTY, PRIMARY HEALTHCARE, PROSOCIALITY, QUANTUM SIGNALING BRAIN, SALUTATORY GREETING, SOCIAL CAPITAL, SOCIAL COHESION, SOCIAL DILEMMA, SOCIAL INTERACTION, SURVIVAL COMMONS, and WELL-BEING;
FOUNDATIONAL (15)
ANTHROPOLOGY, BASELINE HOMEOSTASIS, CLUSTER, COSMOLOGY, ECOLOGY, ETHICAL PRINCIPLES, ETHNOGRAPHY, INNATE TEMPERAMENT, INSTITUTION, MUNICIPAL LIFE, RESILIENCE, RESOURCES, KNOWLEDGE & HUMAN DIGNITY, SOCIAL MOBILITY, SOCIAL RELATION, TRUSTWORTHY, and VISIONING STATEMENT & ACTION PLAN;
FAMILY (5)
ADAPTIVE SKILLS, FAMILY MEALTIME, PERSONAL SURVIVAL PLAN, SOCIAL NETWORKS, and SOCIAL STIGMA;
‘V I S I O N’ (7)
HEALTH SERVICE, HEALTHCARE, HEALTHCARE CLINIC, HEALTHCARE ENTERPRISE, HEALTHCARE INDUSTRY, HEALTHCARE SYSTEM, and HEALTHCARE TEAM;
PRIMARY HEALTHCARE (4)
HEALTH CONDITION, MEDICAL TRIAGE, and PRIMARY PHYSICIAN;
QUALITY (4)
EQUITABLY AVAILABLE, ECOLOGICALLY & CULTURALLY ACCESSIBLE, JUSTLY EFFICIENT, and DEPENDABLY EFFECTIVE;
OTHER (8)
BENEFITS & OBLIGATIONS, CLUSTER of COMMUNITY CAPABILITIES, COMMONS, INSTITUTIONAL CODEPENDENCY, MASTER DISASTER PLANNING STRATEGY, MATERNAL MORTALITY RATIO, SOCIAL RESPONSIBILITY, and VESTING FORMAT;
DEFINITIONS LISTING
1. ADAPTIVE SKILLS may be defined as “…practical, everyday skills needed to function and meet the demands of one’s environment, including the skills necessary to effectively and independently take care of oneself and to interact with other people.”
COMMENT This definition appeared in the ABAS II second edition produced by Pearson, Inc., an international on-line learning institution. Their Website was accessed at http://www.parinc.com on 8-23-2020.
2. ANTHROPOLOGY may be defined as “the study of human beings and their ancestors through time and space and in relation to physical character, environmental and social relations, and culture.” (Merriam-Webster 2014)
COMMENT “Anthropology is a comparative discipline, seeking to unravel the complexity and variety of human understanding and human social and cultural life.” (Howell 2018)
During my encounter with various realms of knowledge, this one has eventually led me to a central tenet within this field of study: the ethnography of “human suffering.” Arthur L Kleinman M.D. seems most dominant along with many others as they have described how people have adjusted to their “human suffering” as expressed by a specific social and cultural tradition. This line of thought is applicable to the origins of population HEALTH. For persons who are unable to achieve viable social mobility and whose lives involve perpetual social isolation, their lives eventually become associated with Unstable HEALTH describable as human suffering.
3. BASELINE HOMEOSTASIS may be defined as the “…self-regulating process by which biological systems tend to maintain stability while adjusting to conditions that are optimal for survival. If homeostasis is successful, life continues; if unsuccessful, disaster or death ensues. The stability attained is actually a dynamic equilibrium, in which continuous change occurs yet relatively uniform conditions prevail.” Encyclopedia Britannica accessed 3-13-16.
COMMENT The original concept of homeostasis is attributed to Claude Bernard (1813-1878) in 1865, viz. milieu interieux. Much later, Ashley Montagu (1905-1999) expanded the concept with his aphorism that “Man is the only 70 kilogram (150 pounds), non-linear servo-mechanism that can be wholly reproduced by unskilled labor.” To further expand this fairly narrow view of humanity, he also said, “By virtue of being born to humanity, every human being has a right to the development and fulfillment of his potentialities as a human being.” To be sure, it was a forerunner of the human capabilities concept applied to an advanced definition of HEALTH for this NATIONAL HEALTH proposal.
A person’s BASELINE HOMEOSTASIS forms initially during maternal gestation from the originating cytoplasm of its pre-fertilized female ovum. It is the origin of each person’s epigenetic inheritance. The pre-fertilization sperm is not currently known to contribute cytoplasm during fertilization. The post-fertilization cytoplasm, slowly amended by the post-fertilized genetic capabilities, also establishes in combination with the maternal gestational homeostasis the characteristics that form a person’s INNATE TEMPERAMENT before birth. A well-recognized human characteristic identifies this connection. Some people who experience emotional stress are prone to physiologically mediated intestinal (heartburn) or heart (racing) symptoms. Another person may experience all sorts of emotional or even physical stress without any other effects on their awareness of Well-Being. These attributes form probably from many processes, but they all have their post-conception origin prior to birth and subsequently during very early childhood largely through epigenetic inheritance. Each person’s personality characteristics evolve from their prenatal innate temperament.
4. BENEFITS AND OBLIGATIONS may be defined as the specific services, goods, or community investments along with their accessibility and availability attributes that are offered to a community’s resident persons either as a Common Good or for certain defined purposes originating from among the community’s Clusters of Community Capabilities.
COMMENT For many years, the concept of a community’s safety net has persisted through the combined efforts of public and private institutions at all scales. Unfortunately, the evolution of a community’s safety net has not compensated for the decline in Family Traditions and Extended Family support processes. Most of this is generational in character and has been aggravated by each community’s decline of its social capital. Professor Robert D. Putnam has written several books and documented the decline by the loss of social networks progressively after WWII. (Putnam 1986)
5. CARING RELATIONSHIP may be defined as a dyadic social interaction with a Human Dignity scenario that begins by expressing beneficent respect for each other’s autonomy, thrives when each person steadily renews their adaptive skills, and flourishes from a timely intent to communicate ‘in harmony’ with warmth, non-critical acceptance, congruence, and empathy.
COMMENT This definition clearly begins by acknowledging an age-old adage about relationships that asks the question: who is leading whom and for what reason? The answer within a Caring Relationship for healthcare begins by respecting that the ultimate responsibility for a person’s HEALTH is the person themself. As a physician, I have very important responsibilities. But rarely, and only rarely, should I even temporarily assume the ultimate responsibility for a person’s HEALTH. Similarly, as a parent, your responsibility could be defined as preparing a son or daughter to eventually achieve Stable HEALTH as an Independent Person. As the parenting analogy evolves, the second ethical standard for a parent, after autonomy, is beneficence. Within the healthcare arena, beneficence means “do no harm” as well as “being helpful.”
The day-to-day expression of a Caring Relationship is then most clearly defined by the characteristics long-ago described by Carl Rogers. (1980) Empathy is the preeminent attribute of a Caring relationship. It is also the most difficult to define. Merriam-Webster’s ELEVENTH COLLEGIATE DICTIONARY defines empathy as “the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another either in the past or present without having the feelings, thoughts, and experience being fully communicated in an objectively explicit manner.” The persistent occurrence of Empathy during multiple interactions over time promotes a person’s level of self-esteem that energizes their commitment to act in their own best interests. Their Personal SURVIVAL Plan, acknowledged with various degrees of precision, is necessary as the first step for a person to establish Stable HEALTH. It represents the lynch-pin for unlocking the full benefits of the health care that is available to maintain Stable HEALTH for each resident person within a community.
Rogers defines Congruence as representing a high level of honesty among the expression of a person’s thoughts, words, and deeds. The impact of Congruence is measured by its degree of consistency over an extended span of time and represents the process that ultimately creates trust. It is likely that trust represents a contemporary “Appian Way” from which to construct the community-based collective action required for any enduring strategy of trustworthy healthcare reform.
Non-critical Acceptance represents the most difficult attribute of a Caring Relationship to sustain over time. Amidst a continuing sequence of interactions, a non-critical social interaction may be communicated with the unintended bias of certain ethnic, religious, or political traditions. With the continuing occurrence of cognitive dissonance over time without non-critical acceptance, an evolving Caring Relationship is unlikely to survive.
Finally, Carl Rogers defines Warmth as the non-possessive, positive regard shared by one person for another. The communication of Warmth produces an initial sense of connection, viz attachment, between any two persons of a Caring Relationship. It is the most simple to communicate as in persistent eye contact with a smile, active listening with a nod, or a posture change. Along with trust, it contributes to the eventual level of “attachment” that dominates long-term relationships, ultimately becoming an investment within a community’s Social Capital asset. (Rogers 1980)
Any resident person who is an infant, disabled, or homeless, as well as any woman during pregnancy, should all be acknowledged as qualifying at the highest priority level for the ethnographic access to Caring Relationships offered from within the micro-social networks and Extended Families of each Family as well as their community’s Survival Commons. The timely harmony of a Caring Relationship can speak volumes about the underlying heroic needs of each person’s survival, community by community and neighborhood by neighborhood.
6. CLUSTER may be defined as two or more components that form a sustainable capability when the components paradoxically interact as a result of their respective Quantum-related contributions to the synergy occurring between the components, the affinity between or among the prominent components, and the salutary conditions surrounding the components.
COMMENT Cluster phenomena have been most prominently applied as the basis for biological evolution. Addy Pross, Ph.D. applied thermodynamic analysis to these evolutionary attributes. The initiation of biological evolution may have required a biochemical, cluster phenomenon to preserve its entropy according to Newton’s 2nd Law of Thermodynamics. (Pross 2012)
Imagine that four different gas stations, located separately on the 4 corners of a busy intersection with a stop signal, will each have better business than if they were all individually located separately at various intervals north, south, east, and west of the intersection. All of your major sensory organs are located in your head. They are vision as augmented by depth perception, hearing as augmented by directionality, taste, smell, and balance as in relationship to gravity. These are joined by oxygen detection and certain hormonal control processes. Cluster phenomenon is a recurring, biological theme for understanding the uniqueness of every person’s HEALTH.
For NATIONAL HEALTH, the Cluster concept is associated with the definitions for a person’s COLLECTIVE ACTION, COMPLEX ADAPTIVE SYSTEM, CULTURAL-SOCIAL COGNITION, COMMUNITY, FAMILY, and every community’s SURVIVAL COMMONS. The connections that improve the efficiency and effectiveness of a Cluster are very complex given the dimensions that may coexist. It is probably an underlying factor for the basis of evolution. For the socioeconomic analysis of a COMMON POOL RESOURCE, these non-formalized “elements that mutually interact” are labeled as “idle talk” by Professor Elinor Ostrom.
The use of “Cluster Analysis” as a basis for evaluating various phenomena has increased substantially within the last 30 years. The use of the term “Cluster Analysis” has become increasingly ubiquitous within biologically related research. Strangely, there is no widely recognized definition for a “cluster.” The above definition is intended to be applicable to a wide variety of cosmological, biological, and human suffering phenomena. This definition applies to the frequent application of cluster within the Design Epistemology. Using GOOGLE SCHOLAR and excluding citations or patents, the use of ‘Cluster Analysis’ has resulted in the Citations pattern listed below as of 07-10-22.
1980-81 — 798 2030-01 — 2030-31 —
1990-91 — 2,120 2040-01 —
2000-01 — 7,700 2050-01 —
2010-01 — 33,500 2060-01 —
2020-01 — 47,700 2050-01 —
By 2021, the use of “cluster analysis” and “health” assessed as Citations by GOOGLE SCHOLAR may have peaked-out as compared with chemistry and astrophysics.
7. CLUSTERS of COMMUNITY CAPABILITIES may be defined as each community’s locally originated commitment to provide for the common needs of its resident persons.
COMMENT Historically, the actions of neighborhood micro-networks initially formed their community’s CAPABILITIES that were eventually expanded by the community-wide social and philanthropic networks to support the general welfare of each resident person, as in a “Safety Net.” Eventually, governmental support and regulation became a factor for improving their sustainability. Local collaborating groups continued the process of developing linkage among the various CAPABILITIES expressed by their Benefits and Obligations.
8. CLUSTERS of HUMAN CAPABILITIES may be defined sequentially for each person as associated with
a. Immature Level of Capabilities that establish the person’s initial level of baseline homeostasis in association with the gestational formation of an innate temperament that enable the initial expression of the survival at birth as a Dependent Person. In tandem, they evolve to eventually form the initial expression of each person’s Mature Level of Functions. The initial enabling baseline homeostasis and innate temperament functions become increasingly complex after birth until 25-30 years of age, especially in association with the development of each person’s personality. In effect, the resilience of each person’s baseline homeostasis and its associated innate temperament at birth then begin a period of variable Stable HEALTH until typically age 25-30 years of age. Subsequently, its decline eventually evolves based on the person’s accumulated encounters with modest and substantial Disruptive Processes. The Basic Capabilities that sustain a person’s Stable HEALTH beginning before birth as a Dependent person may be defined sequentially as:
i. a cardio-vascular Cluster in tandem with a respiratory Cluster of Human Capabilities at birth *) to supply oxygen and remove carbon dioxide for cellular energy transfer AND *) to preserve the gastro-intestinal, genito-urinary, endo-metabolic, immuno-hematologic, dermatologic, musculo-skeletal, and neuro-psychiatric Clusters with a Personal Survival Plan that is gestationally provided before birth and offered immediately after birth by the person’s Family for the person’s RESTFUL Sleep, GOOD Food, Dedicated Exercise, and MENTORED Courage;
ii. Adapting to the occurrence of modest Disruptive Processes that began occurring before birth and continue to occur after birth in various sequences and patterns to temporarily or permanently, with varying degrees of maleficence or beneficence, impact the resilience of one or more than one of person’s Clusters of Human Capabilities unless prevented, mitigated, and ameliorated by the person’s Family gatherings;
iii. Nurturing the person’s sentient Reflective-cognition Cluster of Human Capabilities as a Dependent Person to accrue the adaptive skills and a Personal Survival Plan to restore their resilience following the occurrence of substantial Disruptive Processes;
iv. Learning the adaptive skills for encountering the situational, social interactions of their municipal life with the alternatives offered by their Family’s mentoring Convoy as the basis for becoming an Independent person; and
v. Considering the future alternatives for selecting their own mentoring Convoy as a guide to enhance their Personal Survival Plan for assuring resilient HEALTH upon becoming an Independent Person.
b. Mature Capabilities represent a person’s pursuit of the fullest expression of their Clusters of Human Capabilities as an Independent Person. The Mature Capabilities that guide a person as an Independent Person to achieve Stable HEALTH may be defined as:
i. Preserving the respiratory, cardio-vascular, gastro-intestinal, genito-urinary, endo-metabolic, immuno-hematologic, dermatologic, musculo-skeletal, and neuro-psychiatric Clusters of Human Capabilities with a stable Personal Survival Plan;
ii. Maintaining caring relationships for personal support from within an immediate Family including its Extended Family, micro-social networks, and a mentoring Convoy as a basis for achieving the resilience to survive encounters with modest Disruptive Processes;
iii. Establishing a Family and its attendant Family Traditions, Extended Family, micro-social networks (including a Convoy), and an enduring Personal Survival Plan as a basis for achieving the resilience to survive encounters with substantial Disruptive Processes
iv. Participating in their community’s ecologic and cultural municipal life to provide for their Family’s Personal Survival Plans and a commitment to promote the justly equitable availability of social capital for each of the community’s resident persons; and
v. Supporting a Family oriented, spiritual community as the basis to *) reconcile the alternatives for a personal set of PRINCIPLES, *) adapt to the inevitable rhythms of generational life involving birth, education, marriage, employment, retirement, and death, and *) acknowledge the alternate beliefs and traditions applicable to the ultimate origins of light, life, and love as the ultimate basis for a person’s expression of Well-Being.
COMMENT To honor the character of life within a multicultural nation, the specific attributes of a spiritual community for anyone will vary considerably among the nation’s resident persons. The last provision for a person’s Advanced Functions is not intended to identify the need to choose an institutional religion. We should all recognize the tribal origins of religion as a means to survive human suffering. The value of a spiritual community reflects its ability to benefit from group dynamics as we all encounter the daily barrage of conflicting values afflicting contemporary communities as well as the conflicting values regarding the meaning of life and its agency. Ultimately, a Personal Survival Plan in association with each person’s Family, Extended Family, and Family Traditions will most frequently characterize a person’s Stable HEALTH until survival hopefully ends with a ‘vibrant mind’ and a ‘feeble heart’. [as paraphrased from Ashley Montagu]
9. COLLECTIVE ACTION may be defined as a social interaction involving a cluster of three or more persons who collaborate with sufficient social capital and congruent ethnography to change the beneficence and autonomy of their cluster or another cluster by a. establishing a visioning statement that defines the short-term and long-term measurable goals of the cluster’s collaboration, b. preparing an action plan to achieve the cluster’s visioning statement including, if applicable, the special provisions for managing a common-pool resource, and c. delegating the specific responsibilities for implementing the action plan to either one or more-than-one of the following options: i. the cluster itself, ii. another cluster of persons, or iii. an institution chosen by the cluster.
COMMENT The Community HEALTH Forum Chapter describes a proposal for implementing the formation of a Forum by each community of @400,000 resident persons, nearly 800 nation-wide, as part of the new strategy to improve our nation’s population HEALTH and the level of health spending for its healthcare. These Forums ultimately form the basis of reducing the social determinants of HEALTH for decreasing the need for healthcare and its related health spending. Many communities already have focused efforts to reduce poverty and the lack of employment options. Frequently, these community capabilities develop with collaborative processes similar to collective action, such as collective impact.
There are many forms of Collective Action that arise within the municipal life of each community. This definition attempts to focus the initial efforts to initiate Collective Action based on a derivative form of governance. I discuss this concept further on the Sub-Chapter, OPERATIONAL PRINCIPLES, within the GOALs Chapter. Unfortunately, the definition accepts the possibility that the purpose may be for beneficent or as well as for maleficent effects.
10. COMMON may be defined as “land or resources belonging to or affecting the whole of a community.” (Wikipedia accessed 9/29/17)
COMMENT For the purpose of NATIONAL HEALTH, the COMMONS is represented by the portion of our nation’s annual economy that represents health spending. For a political economist, a COMMONS is frequently referred to as a “common-pool resource” or CPR. For a brief but comprehensive essay as a preliminary understanding of this realm of Knowledge, the following internet site is very helpful. This citation is a relatively brief analysis of how the preserve a commons for preventing its destruction from excessive use. http://www.isusymposium2012paper_tchowbweeden.pdf (accessed 8-23-20)
11. COMMUNITY may be defined as a social interaction involving a cluster of three or more persons with certain uniformly identifiable attributes, most typically recognized as the persons residing within a geographically defined municipality, who share a valued awareness about their interconnected identity that is borne out of the cluster’s daily social interactions and each person’s association of these social interactions with certain memories of their own ethnographic traditions.
COMMENT For NATIONAL HEALTH, the population and geographic dimensions of our nation can be divided into 9 separate Regions of contiguous states (plus protectorates) with an average of 36 million citizens within each Region, using 2016 census data. Within each Region, nine District Coalitions consisting of, on average, 4 million citizens each can also be identified. Finally, each District Coalition would be connected with 8-10 Community HEALTH Forums that each comprise approximately 400,000 citizens each. In effect, nearly 800 communities would be identified nationally as the basis to form locally initiated leadership traditions to guide the resilience of its own Survival Commons. The words of Eleanor Roosevelt apply: “When it’s better for everyone, it’s better for everyone.”
A search using Google Scholar for a broadly recognized definition for COMMUNITY in June of 2018 was “fruitless.” A COMMENTARY by David M. Chavis and Kien Lee that appeared in the May 15, 2015 edition of the “Standard SOCIAL INNOVATION Review: “What is Community Anyway?” was the most succinct of those I found during the search. The Ph.D. thesis of David J. Connell was the most comprehensive, based on complex systems theory. The words above represent a mild adaptation. The definition thus allows for alternate community forms, as in internet, social, employment, or religious “communities.” Finally, the words from a dictionary may be helpful: “1.b: the people with common interests living in a particular area;…” This definition might be the most succinct for a geographically defined municipality. (Merriam-Webster 2014)
12. CONVOY may be defined for sociology as an evolving group of independent persons with whom a person has a mentoring, caring relationship who become available throughout a person’s lifelong survival, especially for certain crisis-related needs early and late during the person’s lifetime.
COMMENT A convoy most often includes family and neighboring relationships but also persons with certain professional skills. The keyword for my own definition is “mentoring.” The paper by Toni Antonucci, Ph.D.and her associates represents a dominant citation for this concept. (Antonucci 2013)
13. COSMOLOGY may be defined as “the branch of philosophy dealing with the origin and general structure of the universe, with its parts, elements, and laws, and especially with such of its characteristics as space, time, causality, and freedom.”
COMMENT One definition (Merriam-Webster 2014) defines cosmology as a branch of astronomy. Certain references have cited the possibility of multiple universes. Our own universe seems to have a specific time and event as a basis for its origin, viz “big-bang.” When I have time, I will invite my “dear readers” to describe for me their understanding of how “freedom” fits within a COSMOLOGY definition.
14. DISRUPTIVE PROCESS may be defined for HEALTH as an entanglement of Cosmological, Biological, and Human Dignity disturbances, each occurring with paradoxical emergence and diversely-intensive, time-course patterns that converge to form a unique Cluster of disturbances which variably interacts with a community’s resident persons to variously alter the current and future, survival resilience of each resident person.
COMMENT The respective phenomena for DISRUPTIVE PROCESSES are further defined on a Sub-Chapter of the EXECUTIVE SUMMARY PAGE. The remainder of this Comment is intended to acknowledge the great unknowns that still exist for understanding the underlying dimensions that generate the characteristics of each resident person’s HEALTH during their lifelong survival.
One change of a person’s survival illustrates the incredible diversity and the current deficits in the KNOWLEDGE that currently exist for understanding the vision capability of each person. This HEALTH Condition is known as “Congenital Strabismus with Amblyopia.” Most people would recognize this condition as an infant with “crossed eyes.” Within a few months after birth, it may resolve on its own. But, if the Congenital Strabismus does not resolve on its own, the brain may progressively “turn-off” the vision in one eye, and this eye may become permanently blind. Early detection after birth and treatment with patching of one eye or surgical correction of the muscular alignment of one eye will usually, but not always, prevent the loss of vision or depth perception. This HEALTH Condition occurs for 1-4% of all newborn children.
There is no current, widely accepted explanation for this sequence of events. Any blindness that occurs is not associated with any other abnormality of the child’s eye or brain. In spite of the underlying complexities for any possible explanation of Congenital Strabismus, the current goals of pediatric healthcare still focus on maximizing each child’s emotional, intellectual, and creative “human capabilities.” Given all of the potential contributing factors, it represents the Great Frontier for maximizing the fullest expression of a person’s HEALTH beginning early in life. Fred Rogers, Ph.D. said it best:
.
“The roots of a child’s ability to cope and thrive, regardless of the circumstances,
lie in that child’s having a small, safe place (an apartment? a room? a lap?)
in which that child could discover, in the companionship of a loving person,
that he or she was lovable and capable of loving in return.”
.
Increasingly, our Knowledge for understanding Disruptive Processes has evolved from the simple recognition of a broken bone during warfare to now include a large variety of traumatic events. Until becoming an Independent person, the occurrence of Disruptive Processes may or may not lead to Unstable HEALTH. The underlying wearing out, steadily increasing after around 27 years of age, aggravates the subsequent occurrence of certain other Disruptive Processes that at an earlier age would have no effects. Bed rest after an injury might require only two to three days to be healed when you are 18 years of age as compared to 5-7 days when you are 60 years of age. The most easily definable factor for Unstable HEALTH is obesity, especially in combination with aging. During a person’s lifetime, the most prominent Disruptive Process occurs as the progressive late mid-life, decline of the person’s sentient Reflective-cognition Clusters of Human capabilities to adequately resolve the daily encounters with Social Dilemmas that eventually represents Senile Dementia.
A person might well ask, what can be done to survive the constant threat of near-daily exposure to Disruptive Processes. Over a person’s lifetime, the true benefit of an enduring Family is its ability to offer the immediacy of their caring relationships. This becomes protective when associated with an Extended Family that participates together for maintaining a set of Family Traditions. In addition, the Family’s micro-social networks assist with a connection to the larger community and its Survival Commons. Finally, a connection with a spiritual community further broadens’ a Family’s adaptation to the inevitable life-cycle of birth, unstable HEALTH, family, and death.
15. ECOLOGY may be defined as “…a branch of science concerned with the interrelationships of organisms and their environment.” (Merriam-Webster’s 2014)
COMMENT Typically, ecology is viewed as a subset of biology. Traditionally, the word ‘ecologic’ was paired with ‘cultural’ to describe the traditions that form the social determinants of health (SDOH). For NATIONAL HEALTH, the word ethnographic seems the most appropriate.
16. EQUITABLY AVAILABLE may be defined for HEALTH CARE as the goods and services that are offered fairly to each of a neighborhood’s persons within a community.
COMMENT If the community represents 5 thousand persons living near each other in a remote location, a clinic located in the center of the community would represent an ideal location for equitable availability for non-emergent Primary Healthcare. For a more robust characterization, another term is usually associated with Equitably Available, as in Ethnographically Accessible. The second term then contributes ‘ecologic’ and ‘cultural’ factors that define a host of factors that can affect the acceptable availability of healthcare.
17. ETHICAL PRINCIPLES that are most applicable to preserving a resident person’s HEALTH may be identified as AUTONOMY, BENEFICENCE, and JUSTICE.
COMMENT The concepts of equitable availability, ecological accessibility, justly efficient, and reliably effective define the attributes of how healthcare should be offered to a resident person for and during a healthcare encounter at a given point of time. Given the complexity and interacting effects of each resident person’s daily encounter with Disruptive Processes, competitive ethical principles frequently co-exist. How these underlying issues are reconciled, when occurring, represents the ultimate social dilemma underlying each person’s healthcare. Trust, cooperation, and reciprocity for healthcare become the social capital norms for establishing trustworthy health care. Along with altruism and excellence, five PRINCIPLES should form the bedrock foundation for each healthcare institution with a commitment to its Social Responsibilities. They are Altruism, Trust, Cooperation, Reciprocity, and Excellence.
Two references stand out: Bernard Lo. RESOLVING ETHICAL DILEMMAS: A Guide for Clinicians. Now in its 5th edition since its 1st Edition in 1994 (Lo 2013); AND Tom L. Beauchamp and James F. Childress. PRINCIPLES OF BIOMEDICAL ETHICS. Now in its 7th edition since its 1st Edition in 1997. (Beauchamp & Childress 2013) Both of these references are clearly venerable.
18. ETHNOGRAPHY may be defined as “the study and systematic recording of human cultures : a descriptive work produced from such research “. (Merriam-Webster 2014)
COMMENT Alternatively, I recommend the following: “…the recording and analysis of a culture or society that is usually based on participant-observation and resulting in a written account of a people, place, or institution”. (Simpson & Coleman 2017) Most relevant to NATIONAL HEALTH, the declining character of traditional Family Traditions, especially for Families with a dependent person, is possibly the driving institutional change underlying our nation’s Social Determinants of HEALTH.
An underlying theme within the ethnographic analysis of certain cultural and social scenarios would involve the characterization of how human suffering is accommodated. I have chosen this attribute as the core problem of how individuals survive and their communities evolve.
19. ETHNOGRAPHICALLY ACCESSIBLE may be defined as an evolving social interaction between a person and members of a Healthcare Team that evolves to form a trustworthy interaction based on reconciling the levels of health literacy among the participants and the person’s healthcare scenario events prior to a first encounter, especially from the person’s ecologic and cultural heritage formed by human suffering.
COMMENT It is likely that the character of a Healthcare Team for Primary Healthcare should be different as compared to Complex Healthcare. The trustworthy character a Primary Healthcare Team may be most precisely successful when all of the team members share first contact responsibility. Some members would have enhanced skills for engaging the broad spectrum of those who seek healthcare. Physicians would accept after-hours patient contact and mid-level practitioners might take on occasional home visit duties. Weekly staff meetings then bring an enhanced level of personal expertise to better respond to the unique moments they encounter involving human suffering. As a result, these weekly gatherings convinced me about how little we actually knew about the ethnographic character of our patient’s family traditions.
The cumulative experience of health care visits following a first visit should set the basic foundation of trust that is necessary for both efficient and effective healthcare. Two vignettes can tell the story. Following the completion of medical training, I had a military service obligation. With a combined pediatric and medicine post-graduate residency, I was first assigned in 1973 as a pediatrician at an Army installation in the Washington, D.C. area. Most of the assigned personnel had highly technical assignments and frequently had multiple dependents. I was always amazed at their skills for quickly deciding during an encounter whether or not a trustworthy relationship existed with me. Appropriately, it was never absolute.
During a 15-year association with a capitated, 50% risk (stop-loss protected) all other risk-pool, gatekeeper/capitated HMO, my associates and I noticed that the employer-plan group of patients took about 9 months to “buy-in” and the medicare group of patients took about 18 months to adjust. The variety of strategies used for managing their healthcare within and between the two groups was often fairly inscrutable. For a well-written formulation of ethnographic research on similar albeit diverse scenarios, a key reference would be ETHNOGRAPHY Principles in Practice Third edition by Martyn Hamersley and Paul Atkinson. (Hamersley & Atkinson 2007)
20. EXTENDED FAMILY may be defined as a group of independent persons who each had a caring relationship with each member of an instituted Family and gathered together with the Family’s persons support the evolution of their Family Traditions, especially in association with adapting to transitional events occurring during their generational life-cycle.
COMMENT Currently, the most common description of an Extended Family still defines its members as being genetically related to one or more of a Family’s persons and live within or close-by the Family’s immediate neighborhood. Now, we live during a time for which family units are smaller, less connected with biological relatives, and the character of their Family Traditions has become less reflective for each person’s search to find a uniquely sustainable niche. Furthermore, the traditions of mutual support during episodes of suffering become less of a duty for each Family’s identity over-time.
Is it possible that the decline of Extended Family cohesion among its members actually contribute to our nation’s social determinates of HEALTH? And if so, might it also contribute ultimately to the turmoil within our nation’s large metropolitan cities?
21. FAMILY may be defined for HEALTH as a social interaction involving a cluster of two or more persons that
I. Configures itself with a goal to preserve each other’s HEALTH by the spontaneous immediacy of their communal caring relationships;
II. Institutes itself within a community to sustain the cluster’s configuration for a generational cycle of its originating independent person or persons when
A. two originating independent persons express a lifelong commitment to sustain their caring relationship as affirmed by a marriage certificate or
B. one originating independent person who is not married, has a caring relationship with a dependent person, and accepts custodial responsibility for this dependent person as an additional dependent person;
III. Engages their community by offering a greeting social interaction to the other persons that the cluster’s persons safely encounter during the municipal life of the cluster’s community, irrespective of the social stigma possibly represented by themselves or any of the other persons; AND
IV. Assembles a constellation of Family Traditions to form the cluster’s shared identity and to guide the responsibilities of the originating independent person or persons for their duties to:
A. Establish a household within a neighborhood of their community, their Home, for enriching each person’s resilience with joy and courage;
B. Select a convoy of mentoring persons who each maintain a caring relationship with at least one of the cluster’s persons that
1. begins by coalescing any pre-existing convoy(s) of the cluster’s originating independent person or persons and
2. evolves over-time during the cluster’s sentinel transitions, especially in association with unstable HEALTH;
C. Promote gatherings of the cluster’s persons within their Home
1. for a weekly pattern of Family mealtimes to share with each other the dietary, emotional, and spiritual nutrition that ameliorates each person’s daily encounters with social dilemmas involving modest disruptive processes,
2. with the persons from within their Extended Family to enhance the ethnographic character of the cluster’s Family Traditions, especially in association with the sentinel transitions occurring throughout the cluster’s generational cycle, and
3. with the persons from within their micro-social networks who share mutually-supportive attributes of the cluster’s Family Traditions, especially those persons residing within the cluster’s immediate neighborhood;
D. Define a Personal Survival Plan for each person of the cluster and, when appropriate,
1. prevent, mitigate, or ameliorate each person’s encounter(s) with a substantial disruptive process,
2. adapt the residential capabilities of their Home, and
3. arrange for the situational needs of each person’s HEALTH, especially their Restful SLEEP, Good FOOD, Dedicated EXERCISE, and Mentored COURAGE;
E. Accept an additional independent person into their Home, if either the additional independent person becomes an originating independent person through marriage with a cluster’s sole originating independent person OR the additional independent person
1. has the consent, preferably written and notarized, of the current originating independent person or persons that is dated 01 to 28 days before the date of the additional independent person’s initial residence within their Home and
2. has a written Personal Survival Plan or its next-of-kin approved equivalent that preferably includes
a) provisions to manage the additional independent person’s HEALTH in the event the additional independent person becomes, or is possibly becoming, a dependent person who would not qualify as an additional dependent person within their Home and
b) a notarized Will, power of attorney, and medical power of attorney with provisions for an advanced directive; AND
F. Accept an additional dependent person into their Home, if at least one current originating independent person has an established custodial responsibility for the additional dependent person as defined biologically through birth, child, or sibling OR legally through adoption, guardianship, foster care, or divorce.
COMMENT It is likely that a lifelong cascade of social interactions that begin after conception is the subsequent basis for a person’s Stable HEALTH during their lifetime. Of course, there are a variety of Disruptive Processes that each person encounters. Underlying the occasional occurrence of substantial (i.e., life-threatening) Disruptive Processes, there is a constant barrage of modest, low-level Disruptive Processes that continually form an interactive repetitive, stress injury to a person’s resiliency. The continuing degradation of this resiliency eventually leaves a person with less capability to survive a substantial Disruptive Process.
This Family definition offers a plausible strategy for the reform of population HEALTH and its healthcare. Simply stated, by reducing the annual increase in health spending to a level that is less than economic growth, our nation will have the resources for each community to assure that its Survival Commons promotes the social capital for indirectly or directly mentoring every Family before and after the birth of their children as well as later during their early childhood and adolescence.
22. FAMILY MEALTIME may be defined as each person’s daily nutritional needs are wholely or partially consumed during a social interaction involving at least one other member of their immediate Family according to their Family Traditions.
COMMENT There is very little reported research, if any, reported according to Good Scholar. A brief search on 9-1-2020 revealed 187 citations for 2020 to date. The only possibly significant finding seemed to be its possible role in preventing pre-adolescent obesity. The sentinel number was 5 Family Mealtimes occurring weekly. My own bias is that Family Mealtimes represent the best long-term stress-management strategy for a Family’s members, especially if at least one Family Mealtime is scheduled at the same time weekly.
23. FAMILY TRADITIONS may be defined historically as a person’s immediate Family and its Extended Family that provides the person with economic survival, security, religious faith, education, and social status. (Curran 1983)
COMMENT Dolores Curran summarized her book entitled “Traits of a Healthy Family” as follows: a Family “…communicates and listens, affirms and supports one another, teaches respect for others, develop a sense of trust, develops a sense of shared responsibility, teaches a sense of right and wrong, respects the privacy of one another, values service to others, fosters family table time and conversation, shares leisure time, admits to and seeks help for problems.” (Curran 1983) I ask, rhetorically, whether or not our nation’s population HEALTH problems would disappear if every person’s Family attempted to follow these traits? Our nation’s core cluster of population HEALTH problems may be stated as follows: worsening maternal mortality, childhood maltreatment, pre-adolescent obesity, adolescent adjustment disorders (suicide, homicide, pregnancy, substance abuse), mass shootings, homelessness, mid-life disability/depression, and pre-senile dementia.
24. HEALTH may be defined for a Nation as a resident person’s daily experience of Well-Being which occurs when the resident person’s lifelong survival has been
^
A. Endowed by the prenatal, parental Family Traditions that undertake an adjustment soon after conception to newly prioritize the ‘shared intentionality’ among their Family’s caring relationships for mentoring the maternal formation of synergy between the person’s innate temperament and baseline homeostasis to achieve sufficient resilience for the fetal person’s survival immediately after birth and vitality thereafter from a parental-originated Personal Survival Plan as a ‘Dependent Person’ with Stable HEALTH;
^
B. Nurtured by the person’s caring relationships that originate initially before birth from within the person’s Family, their Extended Family, and their Home’s close neighborhood during their Early Childhood with a goal to enrich the person’s search for the broadest portrayal of their uniquely-endowed Human Capability while becoming a joyful ‘Dependent Person’ and subsequently during their Late Childhood, Adolescence, and Early Adulthood with a goal to mentor the person’s cultural social-cognition for the broadest portrayal of their unique-endowed Human Capability while becoming a courageous, sustainably self-sufficient ‘Independent Person’ after adolescence;
C. Challenged by the person’s daily encounters with disruptive processes involving discordant social interactions that begin before birth, occur as interacting combinations and patterns, and cause variably-reversible beneficent and maleficent changes to the adaptive resilience of the person’s Quantum Signaling Brain as variously prevented, mitigated, and ameliorated lifelong by their Family Traditions, by the courageous caring relationships originating from within the person’s Family^ their Extended Family^ and their Home’s close neighborhood, by their Personal Survival Plan, as well as by the Survival Commons of their Home’s community;
^
D. Matured by the person’s episodic encounters with substantial disruptive processes involving diversely-complex traumatic events that begin before birth, occur as interacting combinations and patterns, and cause variably-irreversible, maleficent changes to the adaptive resilience of the person’s uniquely-endowed Human Capability including its innate temperament and baseline homeostasis as prevented, mitigated, and ameliorated lifelong by their Family Traditions, by the courageous caring relationships originating from within the person’s Family^ their Extended Family^ and their Family Home’s close neighborhood, by their Personal Survival Plan, as well as by the Survival Commons of their Home’s community; AND
^
E. Sustained by the person’s Family Traditions, by the hopeful caring relationships originating from within their Family^ their Extended Family^ and their Home’s close neighborhood, by their Personal Survival Plan, and by the Survival Commons of their Home’s community until eventually the entropy-laden resilience of the person’s uniquely-endowed Human Capability is no longer sufficient to maintain the person’s survival from their lifelong encounters with disruptive processes.
COMMENT For context, the Preamble for the Constitution approved in 1948 for the WORLD HEALTH ORGANIZATION defines Health as follows: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” It is likely that every physician alive today, including this author, would think of good health as primarily the absence of disease. The real issue, of course, is that a person’s obligation to maintain their own “absence of disease” during a lifetime also includes an obligation of the person’s community, their extended family, and their Family’s micro-social networks as a contribution to this “absence of disease.” The character of each person’s life can be largely affected by their community and the social norms characterizing the social interactions that are prevalent within this community, “neighborhood by neighborhood.”
The key phrase for this advanced definition of HEALTH is the term Human Capabilities. As of 2018, I am not aware of any attempt to apply this phrase within a definition of HEALTH even by its most recent originator Sridhar Venkatapuram. The basis for this term is extensively analyzed by his book: HEALTH JUSTICE. (Venkatapuram 2011) So, I have started.
The essential supporting evidence takes several forms. Broadly, the analysis of a national company that offers actuarial consulting services, MILLIMAN, has published this analysis for the general root-causes of disease: Social determinants 40%, Behavioral 30%, Quality of healthcare 20%, and Genetics 10%. The origins of the above DEFINITION of HEALTH began with a definition for a Person as defined beginning before birth, a Dependent person after birth, and eventually when capable of sustaining their own Personal Survival Plan, as an Independent person. This life-cycle definition of HEALTH represents the basis for a pre-modern era regarding a person’s HEALTH that began to change about 1860. The Personal Survival Plan definition includes a provision to maintain access to HEALTHCARE. It is also referenced as a responsibility of the Head-of-Household person or persons for their respective FAMILY members. Finally, the stability of a person’s Personal Survival Plan becomes a community responsibility within its Survival Commons for disaster mitigation and its related “safety net” provisions.
25. HEALTH CARE may be defined as the preservation of a person’s Stable HEALTH by a specific health service along with any other activities necessary to improve the precision of this encounter.
COMMENT The distinction between HEALTH CARE and HEALTH SERVICE may seem artificial. Their separate use implies an underlying perspective involving the attributes of a Caring Relationship for HEATH CARE. I describe a situational scenario to illustrate.
During the spring of 2015, I received a call at around 2:00 A.M. from my answering service that was “on the line” from Hawaii. They wondered about transferring it to me. I recognized the person’s name, and I said “yes.” My last contact with the person’s family had occurred about three months earlier during their first child’s 6-month check-up. Learning of their impending military-move, I had encouraged both parents to call me at any time including “the middle of the night” if they had a need to talk with a doctor they already knew and trusted. At the time of the call, they were sitting in a military hospital’s emergency room (in Hawaii) as a result of their child’s febrile seizure. Very frightened, we talked for about 20 minutes to carefully review the events that prompted the trip to the hospital. Then I reviewed the research by a Swedish group of physicians that had been done to predict the lack of danger from an isolated febrile seizure for a healthy child. We also talked about what should occur (and not occur) in the Emergency Room to be sure that a treatable bacterial infection had not occurred. They seemed deeply appreciative and relieved by our conversation. I reminded them to keep calling, assuring them that they were “gifted parents.” They had called with a discerning ability to access trustworthy healthcare, almost 1/2 way around the earth. I had not received any further calls from them by the time of my retirement 1 1/2 years later.
Believe it or not, other than calls from a hospital’s inpatient unit, I only received a middle-of-the-night call about once every three years from the nearly 3,000 patients of our group-practice patients. The point of the Story, of course, is that the phone call represented health care but not a health service. At that time, a phone call was not a covered benefit by ANY source of health insurance.
26. HEALTH CONDITION may be defined as a change in a resident person’s HEALTH for which the person, or when applicable their responsible independent person, would contact medical TRIAGE from their Primary Physician or relevant Specialist Physician, e.g., Hospital Emergency Department. The change in HEALTH may have occurred in the past, could be occurring now, or could occur in the future. The HEALTH CONDITION may be further defined as Emergent, Urgent, or Expectant as follows:
a. Emergent HEALTH CONDITION may be defined as a sudden or unexpected HEALTH CONDITION that is usually associated with one or more of the following new, or newly excessive, signs or symptoms: i) shortness or trouble breathing, ii) loss of consciousness, iii) pain that interferes with breathing or walking, iv) active bleeding, OR v) the sudden onset of the inability to speak, walk, breath, or eat with no apparent cause. An Emergent HEALTH CONDITION requires an immediate decision by or for the person to i) go immediately to the nearest Hospital’s Emergency Department, ii) call “911,” OR iii) call the person’s Primary Physician for further medial TRIAGE.
b. Urgent HEALTH CONDITION may be defined as an unexpected HEALTH CONDITION that possibly represents an Emergent HEALTH CONDITION but the person, or when applicable their responsible independent person is reasonably convinced that it does not require an immediate trip to a Hospital’s Emergency Department. This Urgent HEALTH CONDITION warrants, at least, an immediate call to the person’s Primary Physician for medical TRIAGE. Depending on the circumstances, the situational scenario may require an ASAP clinic or urgent care facility visit or a Primary Healthcare Team call-back within 24 hours arrangement.
c. Expectant HEALTH CONDITION may be defined as an unexpected HEALTH CONDITION that does not represent an Emergent or Urgent HEALTH CONDITION and the person, or a responsible independent person, is convinced that a Healthcare Clinic encounter is not required. However, the person believes that an action plan involving medical TRIAGE by their Primary Physician or a Specialist Physician is appropriate.
COMMENT Please note the emphasis on medical TRIAGE for any new HEALTH CONDITION as occurring through contact with a person’s Primary Physician or their Healthcare Team. Most persons with a change in Stable HEALTH do not even think about contacting a doctor when they a “bad cold,” another migraine, or “a backache after mowing the lawn.” Also, some persons who experience a new HEALTH CONDITION will contact a specialist directly even though they do not have a HEALTH CONDITION that is related to a previously established COMPLEX HEALTHCARE NEED. Unfortunately, many persons have a Primary Physician but perceive they have a more trusting relationship with a Specialist Physician or Extended Family member with whom they prefer to contact for medical TRIAGE.
The definitions proposed above emphasize that initial medical TRIAGE is the fundamental responsibility of a Primary Physician. In the near future, our nation’s healthcare industry should promote HEALTH SECURITY certified Primary Healthcare for the medical TRIAGE for any new HEALTH CONDITION, community by community. This scenario represents the lynchpin for achieving substantial “downstream” efficiency and effectiveness of our nation’s healthcare.
27. HEALTH SERVICE may be defined as uniformly identifiable interaction between a person and a State’s licensed member of the health professions. A uniformly identifiable interaction qualifies as a HEALTH SERVICE unit when it has attributes consistent with the professional standards applicable for its financial reimbursement and, similarly for its use in education and research.
COMMENT A “uniformly identifiable unit of service” is usually described and codified for physicians use by the most recent edition of CURRENT PROCEDURAL TERMINOLOGY (CPT). It is published by the American Medical Association.
In addition, Medicare has its own supplementary list of codes for the reimbursement of certain physician services, durable medical supplies, ancillary health services, pharmaceuticals (not including Part D benefits), and hospital charges. Also, individual states may have their own special codes for Medicaid. In addition, each payer may or may not bundle together certain groups of charges as in maternity care. Finally, any one code or group of codes may have pre-authorization requirements, especially for Worker’s Compensation.
28. HEALTHCARE may be defined as multiple episodes of HEALTH CARE that occur over shorter or longer periods of time for a person during their lifetime involving variously either or both BASIC HEALTHCARE NEEDS and COMPLEX HEALTHCARE NEEDS.
a. BASIC HEALTHCARE NEEDS may be defined as:
i. the ethnographically accessible and equitably available medial TRIAGE at any time for the occurrence of emergent, urgent, or expectant HEALTH CONDITIONS and, when applicable, referral to a Specialist Physician for further HEALTH CARE;
ii. the diagnosis and treatment of I) any urgent or expectant HEALTH CONDITION possibly indicating a disease for which its timely treatment would improve the preservation of the person’s HEALTH, II) any new or recurring HEALTH CONDITION possibly associated with a disease for which the person’s HEALTH would be especially preserved by its early diagnosis and treatment, OR III) any unchanging or uncomplicated disease for which a person’s HEALTH would be improved by its regular reassessment; AND
iii. the periodic reassessment of a person’s overall HEALTH as the basis for determining the person’s priorities for defining a comprehensive plan to maintain Stable HEALTH, including any Specialty Physician needs, and the provisions for a Personal Survival Plan.
COMMENT “…the periodic reassessment of a person’s overall HEALTH..” could represent a wide variety of recommended schedules and content. I propose an appropriately age-related schedule for which the content could reasonably accommodate a minimum schedule for biological as well a preferred male or female persons including early detection, minimum random screening, and prevention (especially immunization) in association with any periodic review of a person’s comprehensive health plan. A representative lifelong schedule might occur in association with attaining a certain age: birth, 5 days, 1 month, 2 months, 4 months, 6 months, 9 months, 12 months, 18 months, 2 years, 3 years, 5 years, 8 years, 12 years, 16 years, 22 years, 29 years, 35 years, 40 years, 44 years, 48 years, 51 years, 54 years, 57 years, 60 years, 62 years and every two years thereafter. Interval “HEALTH MAINTENANCE” follow-up exams can be scheduled as well for certain early detection screening needs.
Each of the specified age-related exams could be associated with its own pre-designed, age-related visit format including its association with any health literacy teaching needs and updating a HEALTH MAINTENANCE flow-sheet, especially for vital signs, screening results, and immunizations. The overall plan would represent a life-long perspective for each of its health care encounters. The EMR should offer each individual clinic’s physician group the opportunity to tailor the documentation format for their own preferences, including its associated flowsheet.
b. COMPLEX HEALTHCARE NEEDS may be defined as
i. the diagnosis and treatment of emergent HEALTH CONDITIONs and
ii. the diagnosis and treatment of any new or previously established HEALTH CONDITION requiring the skills of a specialist physician.
29. HEALTHCARE CLINIC may be defined as the physical location where the members of one or more outpatient Healthcare Team members interact with a commitment to achieve “high quality” as the attribute of the individualized health care they offer to any resident person.
30. HEALTHCARE ENTERPRISE may be defined as one or more health systems within one institution that offers healthcare in two or more states.
31. HEALTHCARE INDUSTRY may be defined as all of a nation’s HEALTHCARE SYSTEMS that collectively “organize systems, pursue ‘vision’, build community, manage resources, and develop skills” for offering healthcare to the nation’s resident persons.
32. HEALTHCARE SYSTEM may be defined as one or more institutions that collaborate to use multiple inpatient and outpatient healthcare teams for offering healthcare to the resident persons of a community.
33. HEALTHCARE TEAM may be defined as a cluster of persons, each licensed as a healthcare professional, who share a common VISIONING STATEMENT and PLAN as the basis to offer: a. health care to any person for their BASIC or COMPLEX HEALTHCARE NEEDS, b. a persistent effort to assist the person resolve discontinuities between their Comprehensive Care Plan and their Personal Survival Plan, c. a caring relationship as the basis to minimize the risk of unintended ethnographic cognitive dissonance during a health care encounter involving a person and a healthcare team member.
34. INNATE TEMPERAMENT may be defined as the measurable attributes of a child’s expressive disposition at birth and its connection with the child’s baseline homeostasis after birth, the child’s sentient Reflective-cognition Cluster of Human Capabilities, early childhood Family traditions, and early childhood encounters with disruptive processes that ultimately shape a person’s lifelong personality.
COMMENT It is likely that the person’s baseline homeostasis is epigenetically formed at the same time as a person’s innate temperament. A person’s innate temperament and baseline homeostasis are substantially formed during the first trimester of maternal gestation. As a consequence, they likely form a dynamic inter-connection to mediate their epigenetic origins for a person’s development, especially the person’s resultant personality. This may be highly speculative for now, numerous observations support the contrary.
The attributes of an infant’s temperament have been defined and described long ago. (Thomas Chess & Birch 1970) They are activity, rhythmicity, distractibility, approach/withdrawal, adaptability, attention span/persistence, intensity of reaction, sensitivity, and quality of mood. Many of these terms would also define a person’s physiologic patterns for other bodily functions, particularly the ones that are related to maternal epigenetic inheritance. A Disruptive Process for a child’s personality might also be related to birth order. A first-born child has certain typical emotional attributes as compared to a second or third born, as in higher IQ.
35. INSTITUTION may be broadly defined as “…the rules that humans use to organize all forms of repetitive and structured interactions including within families, neighborhoods, markets, firms, sports leagues, churches, private associations, and governments at all scales. Individuals interacting within rule-structured situations face choices regarding the actions and strategies they may take, leading to consequences for themselves and for others. The opportunities and constraints individuals face in any particular situation, the information they obtain or are excluded from, and how they reason about the situation are all affected by the rules or absence of rules that structure the situation. Further, the rules affecting one situation are themselves crafted by individuals interacting in deeper-level situations. For example, the rules we use when driving to work every day were themselves crafted by officials acting within collective-choice rules used to structure their deliberations and decisions. If the individuals who are crafting and modifying the rules do not understand how a particular combination of rules affect actions and outcomes in a particular ecological or cultural environment, rule changes may produce unexpected and, at times, disastrous outcomes.” (45)
COMMENT From this definition of an “Institution” and a view of our current time in history, one could conclude that our world-wide community is in the midst of a colossal paradigm shift. This event has occurred as a result of our world’s institutions having exhibited a pervasive, wide-ranging, and relative decline of their self-governance in the presence of the growing complexity of social, economic, and political interconnections. And, by the way, what will all of that mean as our world’s population increases from 7 Billion in 2011 to 10 Billion by the year 2050?
Professor Elinor Ostrom proposed this definition for an institution during her academic career. It replaces, for superior specificity, the more commonly used term “organization,” for which the origins and pervasive prevalence of its currently prominent use remain unclear to me. ]
36. INSTITUTIONAL CODEPENDENCY may be defined as a relationship between one institution and one or more other institutions within an industry that eventually reduces the autonomy of each institution participating in the relationship to respect their social responsibility on behalf of their stakeholders and constituents.
COMMENT Most prominently, we identify CODEPENDENCY as a secondary attribute of a person’s substance addiction that occurs among the person’s Family, Extended Family, and micro-social networks. The addicted person’s loss of autonomy and beneficence severely impairs their capability to sustain caring relationships and, in turn, the caring relationships of these persons that extend to others from within their own Family, Extended Family, and micro-social networks.
Similarly, the lack of transparency between a state’s private health insurance institutions and the state’s healthcare institutions to manage their respective market-share participation has produced a steadily increasing capability of the providers for a person’s COMPLEX HEALTHCARE NEEDS to excessively negotiate for its increased reimbursement (to the exclusion of BASIC HEALTHCARE NEEDS). The result nationally has led to an annual increase in health spending that is annually larger than economic growth since 1960. It now represents an excess of more than $3,000 per citizen per YEAR. It is unlikely that current national health reform proposals could change this institutional codependency without greater centralized and coercive control (as in Federal price controls).
37. JUSTLY EFFICIENT may be defined as a nationally structured, community nested, and collaboratively managed financial-risk process involving all payors and providers of the healthcare that is offered to each resident independent and dependent person for their BASIC HEALTHCARE NEEDS and COMPLEX HEALTHCARE NEEDS.
COMMENT In reality, two factors are missing regarding any ethical discussion regarding each person’s Stable HEALTH and the current financial assets available for the healthcare that is offered for each resident person’s needs. First and most prominent, we have no nationally promoted strategy to manage the upstream, community origins for the social determinants that underlie each person’s Unstable HEALTH. A list of core attributes regarding the population HEALTH of our nation would include maternal mortality (worsening for >30 years), infant mortality under one year of life, pre-adolescent obesity, adolescent adjustment (suicide, homicide, & substance addiction mortality), homelessness, mass shootings, mid-life disability and its associated preventable deaths, and stagnant longevity at birth since 2010.
Second, we have no nationally promoted monitoring system that is community nested to evaluate the distribution of resources by all payers for the financial reimbursement of healthcare. The nested process could begin with Primary Healthcare as a basis for improving its “capitalization.” Alternate sampling reports could indirectly measure changes in the level of a community’s social capital assets, such as the number of hospital days consumed per resident person monthly and reported as a one-year rolling average. Correspondingly, a similar reporting scenario could be applied to a state’s maternal mortality. Finally, I note the National, Iowa, and Nebraska mortality from COVID-19 as determined by their total deaths (reported 9-4-20 in my city’s Omaha World-Herald) per citizen estimated by the Census Bureau for mid-year 2020 (National and Nebraska) and reportable as deaths per 100,000 citizens: 56.4 for our nation and 22.4 for Nebraska (60% less than National). As an aside, the July unemployment rate for Nebraska was 4.8%, second-lowest nationally behind Utah at 4.6% (national 10.2).
Ultimately, each independent person with or without a Family designation should be able to obtain alternate forms of healthcare insurance that is respectful of their disposable income flexibility. This observation should assure that the insurance coverage meets nationally coordinated and State by State adjusted coverage along with various levels of stop-loss risk management. Unexpected Family health spending should never cause the need to declare personal bankruptcy.
38. MASTER DISASTER PLANNING STRATEGY (MDPS) may be defined as a community’s annually revised summary of the prevention, mitigation, and amelioration preparedness for minimizing the effects of certain disasters the would reduce the capabilities of a substantial number of its resident person to sustain their Personal Survival Plan.
COMMENT The Community HEALTH Forum for each community, as designated by NATIONAL HEALTH, would be responsible for this commitment including the choice of specific disasters for the MDPS. Each MDPS would represent one of three sections within a Community HEALTH Plan. After several years of preparing these PLANS, each Regional Council may choose to prepare their own guidelines for assessing their content. Likewise, the Board of Trustees may be encouraged to guide regional collaborative processes to improve national preparedness. Ultimately, collective experience may indicate which disasters chosen for preparedness are the most helpful for managing certain unpredictable disasters. It is important to acknowledge that disaster planning and preparedness has a return on investment that is generally found to be 4:1.
The second of the three sections within the Community HEALTH Plan would require an analysis of the community’s Primary Healthcare availability. Specifically. its overall adequacy. Is there enough? And secondly, is the availability equitably located? Finally, is there any evidence regarding the responsiveness of this availability, specifically its medical TRIAGE? The initial annual report should be directed at mobilizing a community’s awareness about the equitable availability of is Primary Healthcare for serving the community’s Basic Healthcare Needs.
The last section within each Community HEALTH PLAN should analyze the community’s collective action strategies currently in place to ameliorate the upstream Social Determinants of HEALTH (SDOH). This analysis should evaluate the current status of efforts to collaborate with the community’s adjacent communities for the Common Good, viz. national social cohesion.
39. MATERNAL MORTALITY RATIO may be defined as the number of deaths related to a pregnancy per 100,000 live birth occurring in the same year among the women of a specified nation or its geographic subdivisions.
COMMENT For many years, Maternal mortality has been reported for research using RATE rather than RATIO. In addition, whether or not a pregnancy directly caused a maternal death has led to variably reliable reporting. Standardizing the death certificates among the 50 states has also been slow. Our nation’s reporting of maternal statistics has not been systematically reported by the CDC since around 2005. There has been steady improvement since 2010 when AMNESTY INTERNATIONAL USA published its analysis of USA maternal mortality in 2010, entitled DEADLY DELIVERY.
In spite of many national, state, and local public and private institutional commitments, our nation’s maternal mortality continues to annually worsen as it has since around 1970. The mortality disparity between African decent women and White decent women is probably the most telling statistic regarding our lack of knowledge about any possibly definable tools for amelioration. The level of collaborative efforts to more reliably manage knowably manage certain causes will have a beneficial effect. It is likely that an epigenetic process that aggravates the risks associated with any pregnancy is involved. And, as identified by the AMNESTY 2010 report, our nation’s lack of a systematic implementation process for high caliber Primary Healthcare in every community, neighborhood by neighborhood, will require deep-seated remediation.
The World Health Organization (WHO) defines Maternal Death and Live birth ( ___, WHO 2020) as follows:
A. “A Maternal Death is a death of a woman while pregnant or occurring 42 days of a pregnancy’s termination, irrespective of the duration or site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.”
B. “A Live Birth refers to the complete expulsion or extraction from its mother of a product of conception irrespective of the duration of the pregnancy, which after such extraction, breathes or shows any other evidence of life — e.g., beating of the heart, pulsation of the umbilical cord, definite movement of voluntary muscles — whether or not the umbilical cord has been cut or the placenta is attached.”
40. medical TRIAGE may be defined as the evaluation of a person’s prior, current, or prospective information regarding a HEALTH CONDITION (typically recognizable as a “Chief Complaint” by healthcare standards) for which an emergent, urgent, or expectant level of recommendations for action would be negotiated with the person by a qualified Registered Nurse (in association with immediate Physician review given the presence of certain information).
COMMENT Many sets of algorithms exist for the initial decision processes related to a person’s new HEALTH CONDITION. Typically, each Primary Healthcare Clinic would employ B.S.N. level nurses with home care or medical ICU experience to offer medical TRIAGE during a Primary Healthcare clinic’s Office Hours and the clinic’s Primary Physicians or Mid-level practitioners would offer the medical Triage after hours. During the clinic’s weekly Staff-Meeting a schedule of written algorithms would be regularly reviewed annually, especially those associated with certain attributes (such as evaluating chest pain or a new breast lump).
From a work-place view-point, the periodic assignment during weekly Office Hours to medical Triage represents a dessert-island assignment. The decision to call a doctor’s office is, more often than not, is laced with either anger, anxiety, or fear. Having a person answer the phone with a kind voice, in effect, can paradoxically aggravate the pent-up emotions. If there is any possibility that the use of profane language is unlikely to quit and the person is known, we always recommended an announced hang-up and a note left in the chart. With continued contact by most persons, such interactions disappear. If not, we send them a certified letter, return receipt requested, with a clinic discharge in 30 days. Just to make sure they received the letter, we also sent a copy of the letter in a standard office envelope.
The importance of a qualified nurse for medical TRIAGE can not be over-emphasized. If a person calls about a new breast lump (male or female), it takes a nurse to understand how to sympathetically arrange for them to come to the office immediately. Research has verified, long ago, that when first reported, the identification of a breast malignancy and its initial treatment should begin within the next 14 days to prevent the time interval from having an effect on the long-term outcome. In addition, the initial diagnostic sequence forever improves the person’s confidence in the accessibility of their Primary Healthcare (along with all the members of their Extended Family and micro-social networks).
41. MUNICIPAL LIFE may be defined as the ordinary life of a community’s resident persons as distinguished from the civil, military, legal, or ecclesiastic ethnography for daily life.
COMMENT As opposed to Municipal Life, Civil life is more often used in relation to a person’s functions occurring in association with the various public institutions with a responsibility for the SURVIVAL COMMONS of their community. Municipal Life reflects a connection to the underlying responsibility of each community’s resident persons to be active among the networks or associations occurring within their community. This connection was described originally by Alexis de Tocqueville. The resilience of this community attribute contributes to the stability of its Social Capital.
The historical precedent for the use of MUNICIPAL LIFE occurred originally within the communities of the United Kingdom. An internet search revealed documents with dates of origin coincident with the Magna Carta of 1215. It represents another aspect of our nation’s heritage that we owe to the United Kingdom.
42. PERSON may be defined as a fertilized ovum of the species Homo Sapiens with its own individually-unique Clusters of Human Capabilities that survives embryonic transformation during maternal gestation to form its own unique innate temperament with sufficient resilience for survival at birth.
a. Dependent person may be defined as a person who survives i) until age 19 years OR until age 16 through 18 years when becoming emancipated by military service, marriage, or the occurrence of a biologically related child or ii) the occurrence of a disruptive process that occurs after age 18 years for the Basic or Advanced Functions of their Clusters of Human Capabilities and that substantially impairs, as justly determined either temporarily or permanently, the person’s performance to plan, implement, and finance the requirements of a Personal Survival Plan for their own sustainably Stable HEALTH.
b. Independent person may be defined as a person who was and who is currently no longer a Dependent Person as a result of i) age of more than 18 years, ii) age of more than 15 years and legally emancipated through military service, marriage, or the occurrence of biologically related children, or iii) a judicial declaration.
COMMENT For HEALTH, the common use of the word PERSON linguistically refers to either an Independent person or a Dependent person. When used in a context with the words “Dependent person,” the use of the single-word term “Person” would imply an intent to use its meaning as associated with an Independent person. Complicating the use of “Dependent” is that it is commonly acknowledged in situations that may be viewed as temporary, such as, a person’s Unstable HEALTH occurring in conjunction with a surgical procedure or temporarily decompensated mental health. Legally sanctioned by a judicial determination, COMPETENCY, refers to restrictions of a previously functioning Independent person that are based on the person’s worsening capability to fully and knowably contribute to the stability of their own HEALTH with a Personal SURVIVAL Plan. When a member of a person’s Extended Family has legally justifiable cause to recognize the occurrence of a persisting “dependent” status for the person, a legally defined “Competency” hearing would permit a standard judicial process to determine whether or not the person is or has been reliably unable to maintain the requirements of a Personal SURVIVAL Plan for themselves or are at high risk for endangering the safety of the Personal Survival Plan required by another person. Finally, a partially “Dependent person” status may be recognized for a person, after age eighteen years, who lives at home or qualifies for a parent’s health insurance while attending advanced education until age 26 years.
43. PERSONAL SURVIVAL PLAN may be defined as an independent person’s fundamental requirements for managing their HEALTH in association with their Family, Extended Family, micro-social networks, and community’s Survival Commons that provides for Restful SLEEP, Good FOOD, Dedicated EXERCISE, and Mentored COURAGE.
COMMENT If every “accredited” hospital used the same basic format for structuring a Discharge Plan at the end of any institutionalization, would this possibly help to reduce our nation’s annual hospital, nursing home, juvenile detention, jail, or penitentiary utilization?
44. PRIMARY HEALTHCARE may be defined as health care that is offered to a resident person by a Healthcare Team for their BASIC HEALTHCARE NEEDS and for the coordination of these needs with any healthcare that is required for COMPLEX HEALTHCARE NEEDS.
COMMENT This definition differs from its WHO definition by its emphasis on the complexities involved with the health care of any person who may soon acquire or already has COMPLEX HEALTHCARE NEEDS. The WHO definition, originating in 1975, describes a greater emphasis on a social contract as the basis for a nation’s healthcare. It is as follows:
- “Primary health care is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community can afford. It forms an integral part of both the country’s health system of which it is the nucleus and of the overall social and economic development of the community.” (WHO 1975)
As our nation continues to evolve fully within the 21st century, the WHO definition serves to remind the USA that our nation’s healthcare industry does not function to the exclusion of the world-wide community. This connection is now visited on us by the COVID 19 pandemic. The need to collaborate with the worldwide community has now become not just a hypothetical concept.
45. PRIMARY PHYSICIAN may be defined as a licensed medical doctor or osteopathic doctor with full post-graduate residency training in Family Medicine, Pediatrics, or General Internal Medicine (or related combinations) who is a member of a Healthcare Team as the basis for offering Primary Healthcare.
COMMENT For those physicians who remember, with a certain memory of angst, their experience with the original gatekeeper HEALTH MAINTENANCE ORGANIZATIONS (HMO) from 1980-1997 as a PCP, will remind everyone that PCP did not mean “primary care physician.” It meant a “primary care PROVIDER.” In respect to the unintended derisory label, I have chosen to simplify it and strengthen the term to emphasize its importance.
46. RESILIENCE may be defined as the attributes of a person’s recovery from the occurrence of disruptive processes that maintains a person’s continuing survival with or without, irreversible changes in the continuing endurance of the person’s HEALTH.
COMMENT As a basis for defining the “root causes of Disease,” there is a Sub-Chapter DISRUPTIVE PROCESSES in addition to this GLOSSARY for HEALTHCARE Sub-Chapter that introduces this concept. Typically, RESILIENCE is most often associated with emotional recovery. Any person who suddenly experiences the death of a parent, spouse, or child will have long-lasting effects from these events, usually labeled as permanent. I have chosen resilience rather than resiliency to broaden our understanding of traumatic events, physical or emotional.
The occurrence of ‘interacting patterns’ and ‘combinations of interacting patterns’ involving the various Disruptive Processes for NATIONAL HEALTH rings the disaster BELL for our nation’s survival in the 21st century. We need a renewed understanding of how to manage the HEALTH of each citizen. Much remains to be clarified. I have begun with an advanced definition for HEALTH and its community-based Survival Commons.
47. RELIABLY EFFECTIVE may be defined as the acceptably offered and accurately provided patterns of healthcare known to improve substantially Unstable HEALTH.
COMMENT As a quality attribute of health care, the ethical standards of autonomy, beneficence, and dignity frequently apply to the daily contact with patients by a Primary Physician given the level of uncertainty the underlies the daily stability of each person’s HEALTH. The ethical standards provide a frame of reference to prevent the occurrence of codependency, especially considering healthcare relationships lasting 20+ years. To generate the daily creativity and commitment as a basis for a career as a Primary Physician, our nation’s healthcare industry must incorporate career development strategies to attract and retain a vibrant, courageous, caring, inquisitive, and inspiring physicians for every community. With this view, it is likely they will spontaneously appear. With visit encounters, correspondence, consultation results, and phone calls, my associate and I estimated that we each managed nearly one million contacts during our professional careers of 41 years.
48. RESOURCES, KNOWLEDGE, and HUMAN DIGNITY may be defined as representing the basic assets that characterize the transactions occurring among the worldwide community of nations.
COMMENT Throughout known time, the occurrence of an imbalance of these transactions has often been associated with the use of military force between nations and occasionally within a nation as well. Increasingly, the occurrence of international discord has changed from a focal point of only one type of asset to all three. As a result, the associated levels of cognitive dissonance among the competing interests prevent collaborative resolution and produces ever-increasing levels of complexity associated with Machiavellian tactics.
HUMAN DIGNITY may be defined as a person’s or a group of persons’ sense of *) self-respect and self-worth, *) physical and psychological autonomy, and *) empowerment. Human Dignity is the most important of a person’s fundamental rights and from which all the other fundamental rights are derived. This expanded definition for HUMAN DIGNITY is an adaptation from the Duhaime.org website and its Legal Dictionary accessed 9-28-17.
49. SOCIAL CAPITAL may be defined as the spontaneity occurring among a community’s resident persons for using the norms of trust, cooperation, and reciprocity to resolve the social dilemmas they encounter daily that becomes more readily expressed by the community’s resident persons when multi-generational caring relationships increasingly permeate the community’s social networks.
COMMENT This definition of Social Capital for NATIONAL HEALTH is unique among the definitions that have appeared during the last 20+ years. First, there has been a vague tendency to associate Social Capital and Social Cohesion as alternate expressions of the same phenomenon. It is likely that Social Capital is a necessary ingredient for the improvement of a community’s Social Cohesion as well as its Survival Commons. However, Social Capital alone will not establish the basis for the availability, accessibility, efficiency, and effectiveness of a community’s Survival Commons, especially its Benefits and Obligations. Second, the definition proposes a strategy to improve a community’s social capital asset for the benefit of its Families. This nuance implies that it requires a regular investment for its continued value to the community and that it must be widely initiated from among the Family units of a community. For Social Capital, the use of the word ‘capital’ implies that it is characterized by depreciation, i.e., wearing-out. Third, there has been a tradition that separates the context of Social Capital as having separately different means of testing, evaluation, or renewal. The separate contexts refer to a person, Family, neighborhood, and community. The key to all of this is related to the Municipal Life of a community as its resident persons interact with each other in a manner that approximates the attributes of a robust definition for a Caring Relationship (see above). In so doing, the benefits to a community’s Survival Commons become magnified as Social Dilemmas are resolved with the long-term benefit of the community rather than the immediate benefit of one or more participants within a Social Dilemma event.
The definition for Social Capital described above has two other attributes that are requirements for its success. The first attribute is plainly described and attempts to emphasize the extended period of time required for it to become clearly meaningful, “enduring.” The second attribute is less obvious. It begins within the definition of a Caring Relationship. This definition has two ethical standards and a communication standard that are important ingredients for the occurrence of “trust.” The standards for “trust” are beneficence and autonomy. The communication standard is honesty. Honesty is most easily recognized as the expression of a person’s words, thoughts, and actions that together communicate a single coherent message, viz. congruence. When Caring Relationships are expressed as described repeatedly over time, they build TRUST.
At a community level, the wide-spread prevalence of TRUST is exceedingly important. When a Social Dilemma occurs for two persons within a community that represents options of combined protection or individual self-protection, each person is more likely to choose combined protection to the extent that they experience TRUST ~ RECIPROCITY ~ COOPERATION. For the advancement of a community’s Survival Commons, the strength of its Social Capital is highly related to the underlying prevalence of mutually experienced Caring Relationships characterized by TRUST. Ultimately, the benefits of health care are dependent on it, especially for maternal healthcare and early childhood development.
50. SOCIAL COHESION may be defined for a nation as a general expectation among the resident persons of a nation’s communities that the resident persons of each other’s community are trustworthy and that the prevalence of these trustworthy persons improves when every community persistently collaborates with their adjacent communities to support each other’s Survival Commons with mutual contributions of social capital.
COMMENT Of all the definitions cited in this GLOSSARY, this one has the least degree of agreement of how to configure the contemporary origins for its trustworthy affirmation about a nation’s resident persons. In a sense, this definition draws on the level of cooperation that tended to occur among certain agricultural rural communities involving emigrants originating from disparate foreign nations. They all survived better by helping each other during the times of a family’s encounters with disasters.
51. SOCIAL DILEMMA may be defined as a social interaction involving two or more persons that commonly occurs as a public-goods scenario with a brief time-interval for which one person or small group of persons may choose to acquire a short-term benefit for themselves rather than choosing to join the other person or persons participating in the encounter even though that is required for all of the persons to receive a long-term benefit. (Pavitt 2018)
COMMENT Imagine, three cars slowly reach a four-way intersection at about the same time. So, certain rules usually apply. The first arrival, not turning, goes first. If one of them has a red light flashing, they go first and so on. But, if they all start out at the same time, one could get through but two might not. Thus a Social Dilemma is a collective action situation in which there is a conflict between individual and collective interests among the participants. Collective action situations have been studied extensively. The results indicate that participants are more likely to make cooperative decisions during a collective action situation when they more commonly express “trust, cooperation, and reciprocity” within their daily municipal life. This tendency is usually labeled as Social Capital. The most recent research on disaster recovery indicates that communities with higher levels of Social Capital recover more quickly and completely than communities with lower levels of Social Capital.
There is a wide variety of Social Dilemmas that are associated with research to demonstrate their operating conditions and outcomes. See www.socialdilemma.com
52. SOCIAL INTERACTION may be defined as a social relation involving a single encounter or series of encounters by either two persons or more than two persons who assemble for a purpose, accept their underlying ethnographic diversity, recognize the occurrence of a situational scenario, and participate based on each person’s understanding of the scenario’s purpose, rules, and likely time-course.
COMMENT This Definition represents a contemporary extension of the concepts originated by Erving Goffman (1922 – 1982) who initiated a field of study known as micro-sociology, aka social interaction. His book, “Presentation of Self in Everyday Life” initially published in 1956, initiated his lasting influence within Sociology. (Goffman 1959) Briefly considered, social interaction refers to those acts within a social scenario that a person performs toward another person who responds in return. Social interactions include a very large array of behaviors that are typically viewed within sociology as divided into five categories: Exchange, Competition, Cooperation, Conflict, and Coercion. The attributes of the social interactions that participate in a community’s level of Social Capital were not widely recognized until 1990 when “Governing the Commons” (Ostrom 1990) appeared. It represented the first of many publications by Professor Elinor Ostrom until her death in 2012.
53. SOCIAL MOBILITY may be defined as “The ability of individuals or groups to move upward or downward in status based on wealth, occupation, education, or some other social variable.” (Dictionary 2018)
COMMENT The most common description of this phenomenon is the drastic decrease in Social Mobility that began to occur within our nation between 1950 and 1960. It is most commonly described as the loss of upward mobility from a lower socioeconomic status during childhood to a higher socioeconomic status as a mature adult. For a thorough understanding of this phenomenon, I would recommend the two books written by Robert D. Putnam: BOWLING ALONE 2000 and OUR KIDS 2015. In addition, the Brookings Institute located in Washington, D.C. has periodically published data on this subject, especially from the research of Raj Chetty and his associates. The latest of these reports occurred in January of 2018.
54. SOCIAL NETWORKS may be defined as the social relations among a community’s resident persons that form major-, meso-, and micro- network groupings of these resident persons to achieve separate goals with various levels of bonding, bridging, and linking inter-connections.
COMMENT Simply stated, a social network is a community without a fixed geographic household boundary. From a social interaction view-point, major- and meso- networks involve multiadic phenomena; and the micro-networks involve dyadic and triadic relationships, i.e., Families. For NATIONAL HEALTH, the generational caring relationships that originate from each Family to form bonding and bridging connections with their community’s meso- and major- networks will form the energy to enhance the community’s social capital.
A Google Scholar search on September 7, 2020, using “social networks” “bridging, bonding, and linking” revealed a nearly logarithmic increase in publications within the last 5 years. Of variable significance, I first learned about the “Dunbar Number.” I also learned there were now micro-social network, cell-phone apps named MONARA, DEX, COCOON, and BASEMENT for small network networks, some limited to less than 15 friends.
55. SOCIAL RELATION may be defined as an interaction between living biological organisms, usually inferring persons.
COMMENT Typically, this term is interchangeable with Social Interaction. I suspect that separate intellectual cultures preferably use Social Relation solely because Social Interaction may have originated from newly formed ontological traditions.
56. SOCIAL RESPONSIBILITY may be defined as “The responsibility of an organization for the impacts of its decisions and activities on society and the environment, through transparent and ethical behavior that: *) Contributes to sustainable development, including health and welfare of society, *) Takes into account the expectations of stakeholders, *) Is in compliance with applicable laws and consistent with international norms of behavior, and *) Is integrated throughout the organization and in its relationships.” (ASQ 2018)
COMMENT ASQ is an international organization with Regional Centers in North Asia, South Asia, Latin America, and the Middle East/Africa. It has origins beginning before WWII, and its home office is located in Milwaukee, Wisconsin. It develops various standards for manufacturing and a certification process for business quality leaders. Their ISO 26,000 guidance for Social Responsibility is copyright restricted as indicated on their website.
The NATIONAL QUALITY FORUM represents the current arbiter for defining quality standards for our nation’s healthcare industry. (NATIONAL QUALITY FORUM 2020) They have become more active in defining discrete measurement since 2010 when hospital reimbursement processes became increasingly tier to quality outcomes.
57. SOCIAL STIGMA may be defined as “…an attribute that is deeply discrediting, but it should be seen that a language of relationships, not attributes, is really needed. An attribute that stigmatizes one type of possessor can confirm the usualness of another, and therefore is neither creditable nor discernable as a thing of itself.” (Goffman 1963)
COMMENT The continuing analysis and commentary about social stigma remains rooted in the systematic exploration described by Irving Goffman, especially from the book he wrote cited above. I add a clarifying paragraph from the same citation (pages 2-3). “Society establishes the means of categorizing persons and the complement of attributes felt to be ordinary and natural for members of each of these categories. Social settings establish the categories of persons likely to be encountered there. The routines of social intercourse in established settings allow us to deal with anticipated others without special attention or thought. When a stranger comes into our presence, then, first appearances are likely to enable us to anticipate his category and attributes, his “social identity”– to use a term that is better than “social status” because personal attributes such as “honesty” are involved, as well as structural ones, like “occupation. We lean on these anticipations that we have, transforming them into normative expectations, into righteously presented demands. Typically, we do not become aware that we have made these demands or aware of what they are until an active question arises as to whether or not they will be fulfilled. It is then that we are likely to realize that all along we had been making certain assumptions as to what the individual before us ought to be.”
What complicates social stigma phenomena is the speed by which the human brain recognizes a “social scenario” as having certain attributes of “these categories.” It is less than one second.
58. SURVIVAL COMMONS may be defined for a nation’s communities as the Clusters of Community Capabilities that each community sustains to protect their resident persons from the sudden or sustained occurrence of certain disruptive processes WHEN these Clusters of Community Capabilities are
A. Instituted by each community of the nation to “…promote the general Welfare…” of its resident persons according to their nation’s laws and regulations that concurrently apply to the community’s private and public institutions, at all scales;
B. Enhanced by the expressions of kindness and respect among the community’s resident persons during its municipal life, especially when one person safely offers a greeting social interaction to another person who responds with an appreciative gesture;
C. Offered by the community to each of its resident persons who may select, from among its Clusters of Community Capabilities, the specific Benefits and Obligations most suitable for the needs of their own Personal Survival Plan within the ethnographic traditions of the community;
D. Improved by the community’s volunteer, resident persons who become aware that their community’s Clusters of Community Capabilities may have certain deficits for which a collective action strategy may be required to improve their over-all equitable availability, ethnographic accessibility, just efficiency, and reliable effectiveness;
E. Augmented by the collective action strategies that originate from within the community’s institutions and social networks to prevent, mitigate, or ameliorate any “newly recognizable adversity“ encountered by its resident persons from a locally prominent discontinuity among their community’s Clusters of Community Capabilities or their specific Benefits and Obligations, especially if the “newly recognizable adversity“ reflects either a deficiency of equitably available, Primary Healthcare or a deficiency among the Benefits and Obligations currently promoting improved social mobility and reduced social isolation,
F. Protected by the community’s Master Disaster Planning Strategy that is annually revised to prevent, mitigate, and ameliorate the effects of certain locally-predictable disasters, especially when their resulting disruptive processes would cause impairment of the capability to maintain a Personal Survival Plan, especially by a vulnerable portion of the community’s resident persons; AND
G. Supported by the community’s public and private institutions at all scales and their nation’s level of autonomy within the worldwide, marketplace arenas for its Resources, Knowledge, and Human Dignity.
COMMENT It is likely that the resident persons who are infants, disabled, or homeless, and women before-during-after a pregnancy, as a GROUP, should have the highest priority for access to the caring relationships that a community’s Survival Commons offers. A more systematic process for the identification of resident persons who qualify for inclusion in this GROUP will be more responsive when focused at the local community level, neighborhood by neighborhood.
59. TRUSTWORTHY may be defined as “worthy of confidence : DEPENDABLE”. And TRUST defined as “assured reliance on the character, ability, strength, or truth of someone or something”. (Merriam-Webster 2014)
COMMENT The definition of a Caring Relationship has the attribute of “Congruence” for its communication ‘harmony’. Briefly, this implies that a person’s words, feelings, and actions together have the same meaning and intent, viz. honesty. Ultimately, the trustworthy attribute increases with time when caring relationships have high levels of consistently expressed congruence. The same reasoning applies to public and private institutions as well as associations, leagues, and networks.
60. VESTING FORMAT may be defined as the means to assess the appropriateness of a possible nominee to serve as an appointed nominee for a Member of either the Board of Trustees, Regional Council, or District Coalition.
COMMENT Presumably, the initial Vesting Format would follow the one used by the office of the President. It would be most applicable to the Members of the Governing groups. Separate Vesting Formats might apply to Associate employees and Advocates for Community HEALTH Forums.
61. VISIONING STATEMENT may be defined as the ‘ V I S I O N ‘, MISSION, and PRINCIPLES for an new institution. The ‘V I S I O N’ represents an over-the-horizon aspirational goal for the affairs of an institution, especially when it is initially constituted or subsequently redirected. Secondarily, the MISSION describes the fundamental operational character required to achieve the “V I S I O N’ . The PRINCIPLES are a set of terms by which the instituting, the initial cluster uses to define the social responsibility attributes for the institution’s operatal PRINCIPLES. Importantly, they define the applicable attributes for a Task is required for which their is no applicable Operational Statement. or conflicting Operatinal Statements exist that require an unspecified Task for their reconciliation.
COMMENT A VISIONING STATEMENT should promote an initial operational trajectory for a new institution’s formation of its daily operational norms. An ACTION PLAN may also be included with a VISIONING STATEMENT for a comprehensive Strategic Development Plan for the institution’s first and fourth years of operational esistence. This would particularly be required if a new institution would take on the responsibility for managiing a COMMON-POOL Resource. The Design Principles defined and validated by Professor Elinor Ostrom (Ostrom 2005) would apply.
62. WELL-BEING may be defined as “…happiness in an objectively worthwhile life.” (Badhwar 2014)
COMMENT Professor Badhwar validated this definition with a philosophical analysis using alternate lines of reasoning.
A Merriam-Webster dictionary (Merriam-Webster’s 2003) cites 1582 as the origin of this word and defines it as “the state of being happy, healthy, or prosperous”. Of note, the same dictionary defines HEALTH, in part, as “flourishing condition: well-being”. My own bias is that Well-Being and a person’s trustworthy perception of their community’s municipal life are inexorably connected. Population HEALTH studies have shown them to demonstrate reverse causality. (Giordano & Lindstrom 2015)