1a. DESIGN EPISTEMOLOGY

H U M A N S U R V I V A L

AS PURSUED BY A NATION

R E Q U I R E S

A ‘Well-Being’ & ‘Human Dignity’ informed

DESIGN EPISTEMOLOGY for guiding the Global Tasks

of a semi-autonomous institution that is Nationally Chartered

as a Complex Adaptive System with a GOAL for the Nation’s

POPULATION HEALTH and its PRIMARY HEALTHCARE

to equitably achieve ‘Stable Health’ resiliency

by every community’s neighborhood persons, especially when

‘kindness and respect’ permeates each person’s Family and

their Family Culture, Extended Family, and Close Neighbors;

neighborhood-by-neighborhood.

Pages 145 — 1 —

P R E F A C E

“Consideration for others is the basis for a good life, a good society.” Confucius (0551-0479 BC)

“I shall pass this way but once. Any good that I can show to any human being, let me do it now. Let me not defer nor neglect it, for I shall not pass this way again.” Etiene de Grillet (1773-1855)

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou (1928-2014)

“In the absence of justice, what is sovereignty but organized robbery?” Saint Augustine of Hippo (0354-0430)

“The language of citizenship suggests that self-interests are always embedded in communities of action and that, in serving neighbors, one also serves oneself.” Benjamin R. Barber (1939-2017)

“Never doubt that a few committed people can change the world. In the end, it’s the only thing that ever has.” Margaret Mead (1901-1978)

“The central problem of epistemology has always been, and still is, the problem of the growth of knowledge. And the growth of knowledge can be studied best by studying the growth of scientific knowledge.” Karl R. Popper (1902-1994)

COPYRIGHT 2026: PAUL LUTHER LLC

— 2 —

I N D E X

EPISTEMOLOGICAL THEMES: EACH THEME with 6 CONCEPTUAL DEFINITIONS; Pg 03
WELL-BEING: WELL-BEING, HUMAN DIGNITY, CLUSTER, CHAOTIC DISRUPTION, ANTICIPATORILY-CONSCIOUS PROSOCIAL-HUMAN BRAIN, & COMPLEX ADAPTIVE SYSTEM; Pg 09
PERSON: EPIGENETICS, CULTURAL SOCIAL-COGNITION, HUMAN CAPABILITY, HUMAN FETUS, PERSON, & BIRTHING PERSON; Pg 23
FAMILY: SALUTARY GREETING, SOCIAL INTERACTION, CARING RELATIONSHIP, FAMILY CULTURE, EXTENDED FAMILY, & FAMILY; Pg 37
NEIGHBORHOOD: PROSOCIALITY, NEIGHBORHOOD, HEALTH, SOCIAL STIGMA, POVERTY, & POPULATION HEALTH; Pg 55
COMMUNITY: SOCIAL DILEMMA, INSTITUTION, COLLECTIVE ACTION, COMMUNITY, SOCIAL CAPITAL, & SURVIVAL COMMONS; AND Pg 69
NATION: HEALTH CARE, PRIMARY HEALTHCARE, COMMUNITY DISTRICT, MANAGING THE COMMONS, SOCIAL COHESION, & COMMON GOOD. Pg 83
EPILOGUE: REVITALIZING OUR NATION’S HUMAN DIGNITY PARADIGM Pg 93
REFERENCES for the DESIGN EPISTEMOLOGY Pg 123 — 3 —

GETTING STARTED

The Thomas Jefferson Presidential Memorial is located on the Tidal Basin south of the Mall in Washington, D.C. Inscribed inside on the Eastern wall of his Memorial is a quotation from President Jefferson (Jefferson 1816). Within the eighth paragraph of a letter to Samuel Kercheval in 1816, he said:

“I am certainly not an advocate for frequent and untried changes

in laws and constitutions. I think moderate imperfections had better

be borne with; because, when once known, we accommodate ourselves

to them, and find practical means of correcting their ill effects.

But, I know also, that laws and institutions must go hand in hand

with progress of the human mind. As that progresses, becomes

more developed, more enlightened, as new discoveries are made,

new truths disclosed, and manners and opinions change with

the changes of circumstances, institutions must advance also

and keep pace with the times. We might as well require a man

to wear still the coat which fitted him when a boy,

as a civilized society to remain under the regimen

of their barbarous ancestors (Jefferson 1816).”

Thomas Jefferson (1743 – 1826)

COMMENT: The Jefferson Memorial sits prominently with a view of the Washington Memorial to the North and to the Memorials nearby that honor President Franklin D. Roosevelt, The Reverend Doctor Martin Luther King, Jr., George Mason, and Commodore John Paul Jones. I would urge anyone who visits our nation’s capital to plan, at a minimum, for a visit to the Tidal Basin.

QUANTUM PHYSICS: AN EVOLVING PARADIGM SHIFT

“There is no matter, as such! All matter originates and exists only

by virtue of a force which brings the particles of an atom

to vibration and holds this most minute solar system together.

We must assume, behind this force, the existence of a conscious and

intelligent mind. This mind is the matrix of all matter.”

Max Planck (1857 – 1947)

COMMENT With a focus on this 1918 Nobel Prize honoree, we recognize the accrual of new realms of knowledge that had begun to occur after 1850. For health, it was anesthesia for surgery and asepsis for its success. Subsequently, the early application of calculus for celestial physics began before 1880. A 1918 Nobel Prize recognized the discovery of the ‘Planck time-Constant’ by Max Planck. Specifically, it is: t = 5.391247 X 10√-44 seconds.

It is applicable for the evaluation of sub-atomic particle attributes. Soon after 1918, this realm of knowledge was also marked by a Nobel Prize awarded in 1921 to Albert Einstein for his validated theory of Relativity regarding light, mass, and energy (Planck 1959).

ONSET OF THE ‘ANTHROPOCENE’

Unfailingly, it is likely that our nation’s socio-ecologic evolution from the late nineteenth century through the middle twenty-first century has prompted a profound Paradigm Paralysis involving our nation’s Population Health and its Primary Healthcare. Initially triggered by the evolving scientific advances directly and indirectly associated with Quantum mechanics, the steadily evolving cascade of parallel yet disconnected realms of knowledge between the sciences and humanities became more prominent according to Sir Baron C. P. Snow, viz., Cognitive Dissonance. — 5 —

Simultaneously, Thomas S. Kuhn wrote a book about the history of science and its highly complex theories that have a propensity to eventually endure paradigm paralysis from cognitive dissonance, such as Newtonian Physics. As a complex paradigm expands, it becomes so complex that it eventually becomes less useful, viz., paradigm paralysis (Kuhn 1962). Baron C. P. Snow in post-WWII England noted the cognitive dissonance that had occurred between the sciences and humanities (Snow 1959). Together, these authors offer a better view of a Design Epistemology that offers a strategy to prevent, mitigate, and ameliorate the adverse effects of the Paradigm Shift. His book, published in 1962, is recognizable by its title: THE STRUCTURE OF SCIENTIFIC REVOLUTIONS (Kuhn 1962).

I assume that its message is widely understood. If not, I will add Eric Hoffer, who introduced a sentinel book in 1951. Here is its title: “THE TRUE BELIEVER thoughts on the nature of mass movements (Hoffer 1951).” Importantly, a “True Believer” tends to ignore the adverse attributes of a paradigm’s paralytic, conceptual shift.

WHAT IS LIFE ?

The question posed above by the brief header for this paragraph also introduces an article that proposes a currently recognizable answer to the question (Fantini et al., 2024). I cite from its Abstract — “In this article, we focus on the critical parameters such as time, water, entropy, space, quantum properties, and electrostatic potential to redefine the nature of living matter, with special emphasis on biological coding. Where does the DNA double helix come from, how can the reproduction of living organisms occur without mutations, what are the limitations of the genetic code, and why do proteins have an unstable three-dimensional structure? There are so many questions that cannot be answered without considering the aforementioned parameters.” Here is the full title of the article: “What is life? Rethinking Biology in Light of Fundamental Parameters. (Fantini et al., 2024)”

PARADIGM PARALYSIS

As of 2020, it had been 65+ years since Leon Festinger and Baron C.P. Snow initially publicized their conceptual models, which applied then, as well as now, to the future of Human Survival. Professor Festinger, then at Stanford University, finished his book: “A Theory of Cognitive Dissonance” (Festinger 1957). Essentially, this book may be viewed as a systematic analysis of the problems associated with how certain concepts can be viewed by alternative persons with diverse perspectives. In effect, the resulting level of intellectual discordance, ambiguity, and inconsistency prevents a mutually shareable explanation for the original concept. Similarly, Baron Snow described the cognitive dissonance that was occurring between the realms of knowledge involving the sciences and the humanities (Snow 1959).”

Also a physician, the analysis by Baron C. P. Snow of the cognitive dissonance between the humanities and the sciences, viz., THE TWO CULTURES, has prompted a variety of historical reviews (Snow 1959). There were many large worldwide ecological and cultural transitions that began to evolve after WWII. An essay by Guy Ortolano, Ph.D., uses the concept of meritocracy to assess the sociological era surrounding the message of Baron C.P. Snow (Ortolano 2016). Its title will likely prompt your curiosity: “Breaking Ranks: C.P. Snow and the Crisis of Mid-Century Liberalism, 1930-1980.”

DESIGNERLY THINKING

To explore an initial consideration for any Design Epistemology concept, I recommend four concise essays by Dino Karabeg (Karabeg 2005, 2012, 2013, & 2016). Professor Karabeg presented the third essay during an international conference.

More recently, an essay by two newly collaborating authors offers an advanced, philosophical evaluation of the epistemological and design components of a Design Epistemology. Alger Sans Pinillos (University of Pavia in Pavia, Italy) and Anna Estany (Autonomous University of Barcelona, Spain) co-authored their essay entitled “Concerning the Epistemology of Design: The Role of the Eco–Cognitive Model of Abduction in Pragmatism (Sans Pinillos & Estany 2023).” Its authors jointly focused on the Philosophical and Designerly analysis of their essay. The application of an Eco-Cognitive Model for deep computer learning for adaptive hypothetical reasoning is a recent tool to simulate Peircean pragmatic abduction. A colleague of the authors at the University of Pavia, Lorenzo Magnani is prominently associated with this programming endeavor (Magnani 2022). — 7 —

The title of the Sans Pinollos & Estany essay applies to a recently evolving realm of knowledge for reducing the cognitive dissonance associated with refocusing on a Wicked, very complex, adaptive system involving a social-economic problem. The best applicable article (Laursen & Moller, 2019) about Designerly Thinking also reviews the evolution of this concept since 2016. “The shortcomings of Design Thinking when compared to Designerly Thinking (Laursen & Moller 2019)” cites the philosopher C.S. Peirce, who is known for his philosophical analysis of Pragmatism more than 100 years ago.

For the uninitiated, I cite an article from 2023 by Peggy Marshall, entitled: “The role of quantum mechanics in cognition–evolution (Marshall 2023).” The next-to-last paragraph of the Marshal article ends spectacularly with: “If we define cognition as inductive reasoning; codes as computing; and chemistry as physico-chemical laws; it becomes clear that reductionist models for deduction can never solve these problems.” And, the last paragraph ends similarly: “This promises to be one of the greatest discoveries in the history of science, on par with Quantum Mechanix itself, relativity, the invention of the transistor, and the discovery of the DNA helix (Marshall 2023).”

Amidst the recently expanding realms of knowledge associated with evolution, 19 authors have contributed to a ‘newly considered analysis’ for understanding evolution. See their “The Vienna in Theoretical Biology” Gerd B. Muller, Editor-in-Chief. Among these books, I recommend the book edited by Peter Corning: “EVOLUTION ‘ON PURPOSE’ Teleonomy in Living Systems (Corning et al., 2023a).” The word ‘Teleonomy’ has been defined as “the quality of apparent purposefulness of structure or function in living organisms due to evolutionary adaptation (Merriam-Webster, 2014).” I cite two References by Peter A. Corning from his book that contribute to The Vienna Series (2023a) and (2023b).

PARADIGM REVIVAL

Please read again the quotations listed on PAGE 2. As a combination, do you share their view of human life? If so, it’s likely that you may agree with the next sentence. ‘The current national commitment to improve our nation’s Population Health and its Primary Healthcare is not working. Remember that our nation’s personal longevity, as in the average age at the end of life, stopped increasing in 1990.

I propose that a high level of Cognitive Dissonance is occurring between the ‘humanitarian-political-economic’ and ‘positivist-reductionist-scientific’ realms of knowledge within the daily human discourse for health care. By Cognitive Dissonance, I mean that when an isolated, dyadic social interaction involving the health care of another person occurs, one of the social interaction’s persons may be thinking about the wrong person. That level of Cognitive Dissonance is probably rare, but subtle levels of dissonance are likely to be much more common. I refer to Cognitive Dissonance as defined by Leon Festinger (Festinger 1957).

The selection of 36 definitions for a Design Epistemology represents an intent to accommodate the realms of knowledge that underlie the cosmological origins of human evolution, now encompassing 13.8 billion years.

IN TIMES OF CHANGE

LEARNERS INHERIT THE EARTH,

WHILE THE LEARNED FIND THEMSELVES

BEAUTIFULLY EQUIPPED TO DEAL WITH A WORLD

THAT NO LONGER EXISTS.

ERIC HOFFER ( 1902 – 1985 )

————– W E L L – B E I N G T H E M E ————–

# 1 of 6

WELL-BEING HUMAN DIGNITY

CLUSTER DISRUPTION

ANTICIPATORILY–CONSCIOUS PROSOCIAL–HUMAN BRAIN

COMPLEX ADAPTIVE SYSTEM

— 9 —

WELL-BEING may be postulated for HEALTH as:

“…When defined as a person’s eudaimonia,

Well-Being represents Happiness In An

Objectively Worthwhile Life (Badhwar 2014, p 50).”

Neera H. Badhwar, Ph.D. (1955 – )

COMMENT Professor Badhwar validated the particulars of this definition with a philosophical analysis. She applied alternate lines of reasoning that originated from a diverse cluster of authors. She cites Julia Annis, Aristotle, Albert Einstein, Cicero, Victor Frankl, Stephen Hawking, Immanuel Kant, Carl Rogers, and Amartya Sen, among many other scholars. Eudaimonia is an ancient philosophical theory that ascribes personal Happiness as having reached its “…highest ethical goal…(Merriam-Webster, 2014).”

As an aside, the Merriam-Webster Collegiate Dictionary cites 1582 as the year when Well-Being was first used (Merriam-Webster, 2014). It defines Well-Being as follows: “the state of being happy, healthy, or prosperous.” The same Dictionary defines “Health” as Well-Being. My own view is that a person’s Well-Being largely arises from the lifelong Cultural Traditions shared by their lifelong Family, its Family Culture, their Extended Family, and their home’s Close Neighborhood. Population Health Research has affirmed that “self-reported health” and “trust” demonstrate reverse causality with a high level of certainty (Giordano & Linstrom, 2016).

To measure the lifelong impact of a Person’s level of Well-Being, I cite (Zaninotto & Steptoe, 2019) from the University College London in London, England. Using the English Longitudinal Study Of Aging, they had access to 9761 continuing participants from 2002 to 2019. Their analysis focused on disability-free survival after age 64. A High Level of Well-Being at age 64 for women was associated with another 31.4 years of survival, disability-free. The data for the women with a low level of Well-Being was 20.8 years, disability-free (about 10 years less). Men with a High level of Well-Being at age 64 survived for another 20.8 years, disability-free. The same data for men with low levels of Well-Being at age 64 survived 11.4 years, disability-free (almost 10 years less).

To further strengthen my respect for Professor Badhwar’s book, I cite 3 articles. The first originates from London and Cambridge in the United Kingdom by Harry Walker and Iza Kavedzija: Values of Happiness (Walker & Kavedzija, 2015). I would judge this essay as representing a very high level of excellence among the best ethnographic analyses of Well-Being that I have encountered.

The second article expands our understanding of eudaimonia as an attribute of Well-Being, as contributed by Frank Martela of Finland and Richard M. Ryan of Australia.

Its title is: “Clarifying Eudaimonia and Psychological Functioning to complement Evaluative and Experiential Well-Being: Why Basic Psychological Needs should be Measured in National Accounts of Well-Being (Martela & Ryan, 2023).”
From its Abstract: “Psychological Needs as a category provides a parsimonious set of elements with clear inclusion criteria that are strongly anchored in theory and our current understanding of nature – and could thus form a core part of the third, adi dimension of well-being. The needs for autonomy, competence, and relatedness have especially received broad empirical support. Accordingly, national accounts of well-being should include measures for key psychological needs to gain an enriched and practically useful understanding of the well-being of their citizens (Martela & Ryan, 2023).”

Finally, a third article (Fuhrer & Cova, 2022) represents an analysis of the results from 2 studies of volunteers, possibly representing phenomenologically unique cultural traditions. When referring to an “Objectively Worthwhile life” as a “meaningful life,” I cite from this article’s ABSTRACT (Fuher & Cova, 2022): “In study (1), we find that individuals who are successful, competent, and engaged in valuable and important goals are considered to have more meaningful lives. In study (2), we find that the perceived meaningfulness of life does not depend only on its components but also on how its elements are ordered and how it forms a coherent whole (the ‘narrative shape’ of this life). Additionally, our results stress the importance of morality in the study participants’ assessments of meaningfulness (Fuher & Cova, 2022).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) > added feature

Within each Theme of this DESIGN EPISTEMOLOGY, the definitions postulated respectively, for each of its 6 Definitions will also review the applicable ACEs research that is associated with POPULATION HEALTH. This is intended to explore the underlying knowledge and complexity of ACEs.

I now cite a report by three colleagues from the Center for Advancing Population Science at the Medical College of the University of Wisconsin, Milwaukee, Wisconsin. It is titled as follows: “Assessing the Relationship between Adverse Childhood Experiences and Their Satisfaction, Psychological Well-being, and Social Well-being: Longitudinal Cohort 1995 – 2014: (Mossley-Johnson et al., 2019).”

The Background of this article’s Abstract begins: “More than half of the US population has experienced Adverse Childhood Experiences ACEs, which are eventually linked to a person’s physical and mental health issues.” The Conclusion of the Abstract begins and ends with: “In this sample of adults, ACEs were significantly associated with lower life satisfaction, lower psychological well-being, and lower social well-being, especially to those who also report household dysfunction during childhood (Mossley-Johnson, et al., 2019).” — 11 —

With a focus on WELL-BEING, a person’s HEALTH ultimately occurs from their sequential, lifetime encounters involving *) certain adverse cultural and ecological Social Interactions and *) the Chaotic Disruption occurring within their home’s close neighborhood. See the concept definitions within the NEIGHBORHOOD THEME, viz., page 55, and the FAMILY THEME, viz., page 37. Unfortunately, there is a growing concern about the unique harm to infants, children, and adolescents from ADVERSE CHILDHOOD EXPERIENCES, ACEs. This susceptibility is related to the harmful events that damage the brain’s sensory consciousness system during childhood, adolescence, and early adulthood from the occurrence of an ACE. Each early life ACE is known to alter the intuitive, memory processing of a person’s brain. The disabling effects of one or more ACEs on a person’s overall WELL-BEING have become increasingly recognized since 1997.

HUMAN DIGNITY may be postulated for HEALTH as

a Homo Sapiens, gestationally fertilized ovum that

develops in response to their gestational birthing person’s achievement

of sustainable viability before ‘his or her’ birth as a Dependent Person,

acquires developmental differentiation during childhood and adolescence

as occurring from their uniquely-endowed Human Capability

to become a person with free will after adolescence and

survives with diverse self-sufficient attributes representing

Intrinsic Value, Moral Autonomy, and Fundamental Equality.

COMMENT Amidst the 36 definitions of this Design Epistemology, Human Dignity was the most difficult to establish since there is no identifiable heritage for its presence within a philosophical realm of knowledge. To finally identify a frame of reference for understanding Human Dignity, I have resolved this search by locating the constitutional, international legal scholarship that has evolved since 1947. While the United Nations as an institution was forming in 1945, Eleanor Roosevelt also convened a large number of international scholars to craft the UNIVERSAL DECLARATION OF HUMAN RIGHTS. It was approved by the United Nations in 1947. It includes a reference to Human Dignity.

Many nation-states and their associated political subdivisions have added Human Dignity to their Constitutional language. There has been an overriding awareness that our nation’s Bill of Rights implies the attributes of Human Dignity. To date, Montana is the only State to have specifically added a Human Dignity provision to its Constitution. As a US protectorate, Puerto Rico has also.

After 1969, the Human Dignity concept was progressively studied by a group of scholars that includes Myres S. McDougal (McDougal 1969), Oscar Schachter (Schachter 1983), W. Michael Reisman (Reisman 1990, 2012), Stephen J. Wermiel (Wermiel 1998), Johanna Kalb (Kalb 2010), Doron Shultziner (Shultziner 2003, 2017), Vicki C. Jackson (Jackson 2004), and Kai Moller (Moller 2018, 2021).

THE Kai Moller ‘HUMAN DIGNITY’ DEFINITION

“Intrinsic Value” represents each person’s contribution to the Homo Sapiens species. In that role, each person contributes to the survival of their species, no matter how their contribution becomes distinguishable. As a result of this recognition, each person deserves equitably respectful acknowledgment of their personhood. Therein lie the issues that degrade Humanity, viz., slavery, stigmata, social caste systems, poverty, corporal punishment, or substance dependence. The intersection of Human Dignity with the Constitutional provisions for Human Rights can become complex given view that Human Dignity represents the ultimate source of a person’s authenticity. In addition, this attribute is commonly associated with the cultural traditions of a specific ethnic tradition. In a sense, each person’s Cultural-Social cognition (see below) is a God-given capability to uniquely identify each person’s existence among all of the other Hominids and the worldwide biological community. Within that role, every person then becomes responsible, as viewed by proportionality, for maintaining the welfare of all the other biological entities, including their recognition as having lived. — 13 —

“Moral Autonomy” represents each person’s acquisition and subsequent expression of moral reasoning as the basis for achieving their ecological and cultural survival with free will. Before adulthood, this process is dependent on the cultural and ecological traditions within their Family and their neighborhood home’s community to persistently acquire and revise the adaptive skills required for their future survival with free will. Ultimately, each community is obligated to ensure that meaningful options exist for each resident person’s self-sufficient survival given their own community’s ecological and cultural heritage. By doing so, each community and its SURVIVAL COMMONS, viz., augmented Safety Net, becomes responsible to Prevent, Mitigate, and Ameliorate its ecological and cultural heritage that tends to promote congenital disabilities, childhood maltreatment, suicide, addiction, social isolation, poverty, and mid-life depression. Moral Autonomy then implies an obligation to incorporate Human Dignity into each community’s resilience management and its associated social cohesion obligations.

“Fundamental Equality” represents each person’s constitutionally defined Human Rights and each person’s equal standing for their economic and political rights as compared to any other person. Any restrictions or advantages granted to a person must reflect justly applied proportionality, given the circumstances involved. This provision for Human Dignity requires a community-initiated, neighborhood-by-neighborhood strategy to prevent, mitigate, and ameliorate the inequitable ecological and cultural attributes of their own community’s SURVIVAL COMMONS, as defined on page 76.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Here is the Multi-Ethnic Study of Atherosclerosis (MESA) that represents a population-based analysis of Individual and Neighborhood Social Disadvantages and the progression of 11 Cardiovascular Risk Factors over time (Wang et al., 2022). The Study cohort numbered 6,814 individuals, aged 45-84 years, who were recruited from 6 study sites from 07-2000 through 08-2002 located in Forsyth County, NC; New York City, NY; Baltimore, MD; Saint Paul, MN.; Chicago, IL; and Los Angeles, CA. The cohort was chosen to include 4 ethnic participants: White, African-American, non-white Hispanic, and Chinese-American. The study accrued a Socioeconomic data set for each participant that included childhood through adolescent social history and an analysis of their home’s neighborhood.

Each study participant was randomly recruited to fulfill the study’s socioeconomic purpose, with an assumption that their home’s location in a ‘disadvantaged neighborhood’ would involve ACEs with variable intensity. This was an intense project involving 15 co-authors. With the evaluation of 11 Cardiovascular Risk Factors, they were able to support the hypothesis that neighborhood risk factors, as mediated by DNA methylation, worsen any other cardiovascular risk factor (Wang et al., 2022).

CLUSTER may be postulated for HEALTH as

two or more bounded components that form

a uniquely resilient and sustainable survival capability

from their evolutionary interactions involving

the synergy among the components,

the affinity between certain components, and

the salutary conditions surrounding these components.

COMMENT The preparation of this Design Epistemology has encountered many odd issues for which the recognition of a ‘Cluster’ phenomenon is critical. Strangely, there is no consensus as to its fundamental definition, especially for its occurrence as a cosmological attribute OR as a contributing process for biological evolution. And so, the word ‘Cluster’ appears in 14 of the 36 Definitions, viz., 38.9%. It is particularly applicable for the ‘Family’ definition. The initial page of each THEME lists the definitions that are epistemologically cluster-connected. Each of these definitions may be anchored or enhanced as a Cluster definition. If so, it is identified with an underline.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

This represents the second research advisory that informs each of the 36 Definitions associated with the DESIGN EPISTEMOLOGY. Six experts, each originating from a medical school, coalesced to report their research regarding ACEs. When published in 2022, this was its title: “Transmission of the adverse consequences of childhood maltreatment across generations: Focus on gestational biology (Moog et al., 2022).”

I cite from the report’s ABSTRACT (a Latin Language term meaning ‘summary’): “In this review, the current state of knowledge on the intergenerational effects of maternal exposure to ‘childhood maltreatment’ is summarized, and their transmission pathways are discussed. The specifically directed, as well as, indirect pathways involving variation in gestational biology. The review begins with a definition of childhood maltreatment and an overview of the clinical and neurobiological consequences of childhood maltreatment in the exposed and the offspring generation. The intrauterine period and variation in gestational biology are identified as a potential time window and a mechanism of transmission, respectively. Furthermore, a summary of the available evidence supporting both direct and indirect effects of gestationally biological variation on offspring development is included. Finally, knowledge gaps and challenges in the investigation of the role of gestational biological mechanisms in the intergenerational transmission of childhood maltreatment sequelae are addressed and considerations for future, study designs along with experiences from our current studies are provided (Moog et al., 2022).” — 15 —

I also cite a recent report (Ratcliff et al., 2025), entitled “Adverse Childhood Experiences: Increased Likelihood Of Socioeconomic Disadvantages For Young Adults.” It may eventually qualify as a sentinel ACEs study, even though that qualification has already been ‘runeth over.’ From the middle of the report’s ABSTRACT, “After childhood socioeconomic status was controlled for, young adults with ACEs were more likely to have been charged with felonies, have become teenage parents, live in a household with poverty or housing assistance, be enrolled in Medicaid, not employed, and were less likely to be enrolled in an educational institution. These outcomes were most likely among adults with multiple ACEs or lower socioeconomic status (Ratcliff et al., 2025).”

I cite an article from The Milbank Quarterly — “The Perils of Medicalization for Population Health and Health Equity (Lantz et al., 2023)” – especially the report’s first page and its ‘Policy Points’ section. Here is its third of its four comments: “The essential and important work of population health science, public health practice, and health policy writ large is being thwarted by a medicalized view of health and an overemphasis on personal services and the health care delivery system as the major focal point for addressing societal health issues and health inequality (Lantz et al., 2923).”

CHAOTIC DISRUPTION may be postulated for HEALTH as

an entanglement of Cosmological, Biological, and Socio-Ecological

disturbances, each occurring with paradoxical emergence and

diverse time-course patterns that evolve continuously to form

a cluster of disturbances that variously interacts with each person

within one or more of a community’s neighborhoods to uniquely impair

the sustainably resilient Well-Being of these resident persons

within their own so-afflicted neighborhood.

COMMENT A specific Sub-Page (3c) for Unstable HEALTH attempts to identify the commonly recognized disease categories and their identifiable HEALTH CONDITIONS. It may be found on the PAGES List that occurs as a right-sided column of the first two pages of this Design Epistemology. The list of contributing Pages and their Sub-Pages represents partially revised chapters from the 1st edition of BETTER HEALTH FOR AMERICA (Nelson 2021).

The unanticipated occurrence of DISRUPTION within an industrial business institution may occur with any newly planned introduction of a major innovation. This can be influenced by certain adverse effects, viz., chaos. I cite Joshua Gans for this isolated arena of knowledge (Gans 2016). For this Design Epistemology, Chaotic Disruption is also applied to defining the concept of a “CLUSTER” and its attributes that are potentially associated with the initial initiation of the evolution underlying biological adaptive systems, viz., for humans. For a plausible analysis of an initial “biological cluster,” I cite Addy Pross (Pross 2012).

Since @2000, hereditary causes have become increasingly recognizable as the origin of many chronic diseases by their EPIGENETICS. This is the next major THEME category and begins with a general DEFINITION of this disease process (page 23). Recently, this concept has become implicated as an underlying cause of multi-generational poverty. Its increasingly recognizable complexity requires the exploration of its unique, anthropological ethnography.

CONCEPTUAL KNOWLEDGE: CHAOTIC DISRUPTION

“Our article helps innovation scholars disentangle the nature of different types of disruption depending on their primary cause and shows how non-technical disruptions can challenge the incumbent’s status.” I have cited the ABSTRACT’s last sentence from an article entitled: “The multifaceted concept of disruption: A typology (Godart & Pistilli, 2024).” You won’t be disappointed by an effort to access the article’s “2.0 Theoretical Framework” section that begins on its page 2.

Secondly, from a large array of articles focused on CHAOS, I have chosen from a publisher’s Pamflet series of “VERY SHORT INTRODUCTIONS” that has been curated by the OXFORD University Press: its title: “CHAOS A Very Short Introduction (Smith 2007)” – 4 1/4 ” X 6 3/4″ 180 Pages, with a bit of quantum cybernetics. Since a typology could become enshrouded by Chaos, I cite another article entitled “Virtual identity crisis: The phenomenology of Lockean selfhood in the ‘Age of Disruption’ (Deckard & Williamson, 2020).” Here is the first sentence of its article’s ABSTRACT: “From the end of the seventeenth century to now well into the 21st, John Locke’s theory of personal identity has been foundational in the field of philosophy and psychology.”

CONCEPTUAL KNOWLEDGE: COMPLEXITY

From the Complexity Sciences Center and Physics Department at the Univ. of Calif., I quote from their article’s Abstract (Crutchfield 2012): “Quantifying the notion of pattern and formalizing the process of pattern discovery go right to the heart of physical science. Over the past few decades, physics’ view of nature’s lack of structure — its unpredictability — underwent a major renovation with the discovery of deterministic chaos, overthrowing two centuries of Laplace’s strict determination in classical physics. Behind the veil of apparent randomness, though, many processes are highly ordered, following simple rules. Tools adapted from the theories of information and computation have brought physical science to the brink of automatically discovering hidden patterns and quantifying their structural complexity.” — 17 —

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Here is an exemplary report with a focus on the connection between EPIGENETICS AND ACEs. The ‘HAPO Follow-up Study, Cooperative Research Group’ published a report from their institutional collaboration (Perak et al., 2021). From the study’s interim report, I cite the study’s CONCLUSION AND RELEVANCE portion of its ABSTRACT: “In this multi-national cohort, better maternal cardiovascular health at 28 weeks of gestation was associated with significantly better offspring cardiovascular health at the cohort’s age of 10-14 years after birth (Perak et al., 2021).”

ACEs are also known to affect an offspring’s mental health. Up next, here is a 2023 research report regarding a birth cohort of “fragile families” (#3,474) and the occurrence of child Maltreatment (“harsh parenting” or “neglect”). These families were evaluated with a standardized parent-child conflict tactics scale when their children were assessed at ages 1, 3, 5, & 9 years of age and finally at age 15 years of age with an age-related parent-child conflicts scale. The author and co-authors involved 7 colleagues originating variously from the USA and Europe (Dunn et al. 2023). I cite the report’s title: “Sensitive Periods for the Effect of Child Maltreatment on Psychopathology Symptoms in Adolescence (Dunn et al., 2023).”

The authors of the report were seemingly committed to an understandable analysis of their cohort study that had begun during 1998-2000. The families were selected at the time of a child’s birth and were interviewed at the child’s birthing hospital (including 1 of these 20 hospitals located in the USA). With the age-related follow-up, they identified specific gender-related ages for heightened externalizing symptoms: age 5 for boys and age 9 for girls. I cite from the Discussion section of their report: “To our knowledge, this is the largest study to test the sensitive period hypothesis for neglect in children and adolescents (Dunn et al., 2023).”

ANTICIPATORILY–CONSCIOUS PROSOCIAL–HUMAN BRAIN

may be postulated for HEALTH as

the central memory and cognitive functions

of every person’s nervous system that is formed

by ‘his or her’ uniquely-endowed Human Capability

to become a viable Human Fetus and initiate the

quantum processing of ‘her or his’ contextual consciousness and

its clusters of pattern-recognition knowledge for the evolving

predictive resilience required for the developing person’s

innate temperament and baseline homeostasis to become

a viable Human Fetus before birth, a Dependent Person after birth,

and an Independent Person with free will after adolescence.

COMMENT Among the thirty-six concepts encompassed by this Design Epistemology, the ANTICIPATORILY-CONSCIOUS PROSOCIAL- HUMAN BRAIN of each person may be the most difficult to understand or accept. With the advent of quantum mechanics within the last 100+ years, we now encounter a need to use our intuition to understand this newly understood phenomenon. For most quantum dimensions, they are not accurately measurable by direct assessment. Thus, ‘alternate statistical systems’ are required to assess the presence of quantum phenomena. Devising these statistical systems using calculus requires the exploration of alternative models for analyzing the character of predictive neurological processing.

The terms paradigm paralysis and paradigm shift continue to appear with the use of new terms, concepts, and dimensions for which any current Glossary or Unified Lexicon may not be intellectually accessible. The best analysis of this paradigmatic phenomenon would be most widely recognized as described by the book entitled: “THE STRUCTURE OF SCIENTIFIC REVOLUTIONS.” It was initially published by Thomas S. Kuhn in 1962 (Kuhn 2012). It is best complemented by the Eric Hoffer book entitled “THE TRUE BELIEVER” regarding the nature of mass movements (Hoffer 1951). In a sense, an enduring paradigm is maintained by its own true believers who tend to resist accepting new forms of knowledge.

By understanding the historical evolution of scientific knowledge over time, we now recognize the central role of the ANTICIPATORILY–CONSCIOUS SOCIALLY-HUMAN BRAIN and its Cultural Social-Cognition as the basis to understand each person’s substantially unique survival among all the other hominid species. Before and after birth, each person eventually achieves self-sufficient survival with free will. By the continuous acquisition of adaptive skills that eventually include a cultural array of intuitive Social Interactions, moral reasoning, and an adaptive personality, each person’s self-sufficiency achieves ‘Free Will’ or agency. To understand the origins of this ecological and cultural array of attributes, I refer to the career-long research commitment by Michael Tomasello, Ph.D. He has defined each person’s Childhood Development and its subsequent trajectory during their lifelong development. The breadth of this commitment should inform everyone’s knowledge arena for understanding Population Health. Among multiple books and research reports by Professor Tomasello, his keystone book is entitled: “BECOMING HUMAN – A THEORY OF ONTOGENY (Tomasello 2019a).” — 19 —

For the analysis of the various “quantum” attributes that would account for human consciousness, consider the article entitled: “Holographic Brain Theory: Super-Radiance, Memory Capacity, and Control Theory (Nishiyama et al., 2024). For a recent biological review that is Internet open-accessible, consider “Quantum Neurobiology” by Melanie Swan. Her review represents a “common-sense” introduction to the quantum dimensions of brain signaling and consciousness (Swan 2022). And also, Takaaki Musha has recently explained another view of our human holographic memory (Musha,T. 2022).

Finally, I cite three articles for those readers familiar with the Quantum boundaries of knowledge regarding consciousness: by Eric Bond – “Coherence Field Theory: Quantum Coherence as the Basis for a Model of Brain Function (Bond 2022);” by Charles D. Laughlin – “Consciousness as an intelligent complex adaptive system: A neuroanthropological perspective (Laughlin 2023);” and by – Adam Safron – “The Radically Embodied Conscious Cybernetic Bayesian Brain; From Free Energy to Free Will and Back Again (Safron 2020).” – Here is its Abstract’s Last Sentence: “In brief, this manuscript is intended to illustrate how radically embodied minds may create foundations for inteligence (as in capacity for learning and inference), consciousness (as in somatically-grounded self-world modelling), and will (as in the deployment of predictive models for enacting valued goals (Safron 2020).”

PREDICTIVE PROCESSING

I propose the most comprehensive review of this title appearing in 2025, which is also the most comprehensive and accessibly understandable: “(Phillips, M. 2025). THE INTEGRATIVE BRAIN: Functional units in Predictive Processing.” Here are the first four sentences of its ABSTRACT:

“Predictive processing asserts that the brain learns a generative model of the world, which it uses to make sensory-updated predictions about reality. While traditional views emphasize the cerebral cortex, prediction is a fundamental brain principle, which underscores the vital role of older subcortical structures. This view offers a framework for understanding the brain as an integrated system of semi-independent cortical and subcortical units that collectively enable predictive processing. The cerebral cortex is positioned as the primary driver of subconscious predictions, whereas the thalamus, hippocampal complex, amygdala, basal ganglia, and cerebellum contribute critical indirect roles by translating the predictions into conscious, cohesive, and coordinated experiences and behaviors (Phillips, M. 2025).

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Here is a large collaborative study involving 12 separate experts associated with 4 medical centers, each within either Alabama, Illinois, Minnesota, or California. 5115 participants were enrolled for a separate CARDIA study during 1985-1986, aged 18-30 years. A standard protocol called for doing cardiac tests every 3-4 years until 2015-2016. In 2000, a follow-up study involved a questionnaire evaluation among the cohort regarding each participant’s personal history, if any, of one or more ACEs. A standardized questionnaire was used. During the study, they also evaluated several types of DNA, methylation-based measurements known to be associated with increased risks from Coronary Artery Disease (Kim et al., 2023). From the report, I cite its CONCLUSIONS AND RELEVANCE Section of its ABSTRACT: “In this cohort study, ACEs were associated with EAA (epigenetic age acceleration) among middle-aged adults after controlling for demographics, behaviors, and socioeconomic status. These findings of an association between early life experience and the biological aging process in midlife may contribute to adverse (pjn edit) health promotion for a life course perspective (Kim et al., 2023).” This study will likely receive a follow-up analysis within 5-10 years.

A COMPLEX ADAPTIVE SYSTEM may be postulated

for a nation’s POPULATION HEALTH &

its PRIMARY HEALTHCARE as

a minimally nested Cluster involving a community’s

micro-, meso-, & macro- person networks

with a Human Dignity scenario that becomes

locally established and sustained by the collaborative application

of collective action to define, monitor, and periodically revise

each respective community’s Survival COMMONS

that is implemented to function generationally near

the edge of chaos to pursue the GOALS established

by a nationally chartered institution as informed by a

DESIGN EPISTEMOLOGY.

COMMENT To newly establish 810 contiguous Community Districts, each originating with @400,000 citizens, for a national Complex Adaptive System (CAS) of institutions after the COVID pandemic may seem totally unrealistic. Neighborhood by Neighborhood, the CAS would intentionally rebuild our nation’s Social Cohesion by a self-governed, decentralized span-of-control institution involving @2,000 Associates. The Associates would represent the staff of NATIONAL HEALTH and the 900 Members of the 10 Governance Committees for the CAS. Even with a chaotic onset, a broadly shared commitment to assemble a very large set of fully engaged, nationally collaborative social networks would ultimately be required. Left unrecognized, nearly 8,000 members of every local Community’s HEALTH Forum’s governance would also need to be locally promoted. Further analysis and exploration of this concept could at least begin with five journal articles: — 21 —

1. Simon A. Levin. “ECOSYSTEMS AND THE BIOSPHERE AS COMPLEX ADAPTIVE SYSTEMS (Levin 1998);”
2. Kevin J. Dooley. “A COMPLEX ADAPTIVE SYSTEMS MODEL OF ORGANIZATION CHANGE (Dooley 1997);”
3. Ted Carmichael and Mirsad Hadzikadic. “THE FUNDAMENTALS OF COMPLEX ADAPTIVE SYSTEMS (Carmichael & Hadzikadic, 2019);”
4. My M. Sellburg, Allyson Quinlan, Rika Preiser, Katja Malmborg, and Gurry D. Peterson, “ENGAGING WITH COMPLEXITY IN RESILIENCE PRACTICE (Sellburg et al., 2021);” and
5. Charles D. Laughlin. “CONSCIOUSNESS AS AN INTELLIGENT COMPLEX ADAPTIVE SYSTEM: A NEURO-ANTHROPOLOGICAL PERSPECTIVE (Laughlin 2023).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

The importance of a “complex adaptive system” for governance now becomes sacrosanct because of its provisions for supporting community autonomy to design their own SURVIVAL CCOMMONS and its associated Safety Net. As an introduction to this paradigm shift, I cite the ABSTRACT of an article (Guevara 2024) that anticipates the complexity associated with a community’s prevention, mitigation, and amelioration of ACEs.

“… In the United States, communities that have been historically marginalized, including racial and ethnic minorities, are disproportionately impacted by the occurrence of ACEs. This occurs from the systemic inequities and historical injustices, leading to persistent sociodemographic health and social disparities. Recent advances in the ACEs framework argue that the traditional ACEs model inadequately addresses the broader socio-structural, political, and economic contexts that influence Well-Bing within undersourced communities, neighborhood violence, and access to service systems.

As a result, child and family service systems may fail to consider how socio-structural factors may potentially reinforce disparities in services access, delivery, and outcomes. […] By shifting toward this holistic perspective, researchers and practitioners alike can better understand the interplay of systemic inequalities and socio-cultural conditions that shape ACEs exposure. Ultimately, this holistic perspective must inform more effective practices and services that will address both the immediate impact and root causes of embedded adversity as well as ACEs (Guevara 2024).”

————– P E R S O N T H E M E ————–

# 2 of 6

EPIGENETICS CULTURAL SOCIAL-COGNITION

HUMAN CAPABILITY HUMAN FETUS

PERSON BIRTHING PERSON

— 23 —

EPIGENETICS may be postulated for HEALTH as

“… the interactions of genes with their environment,

by which genotype gives rise to phenotype and brings

the phenotype into being … (cited by Lester et al., 2012).”

Conrad H. Waddington (1905 – 1975)

COMMENT The Waddington quotation cited above originates from within the Lester essay that identified Conrad Waddington as having been the first to use the concept of “Epigenetics” in his book entitled ORGANIZERS AND GENES (Waddington 1940a). Specifically, we are considering what occurs to the maternal, male fertilized ova, its DNA, and its RNA as it biologically develops during conception within their Birthing Person to nurture the gestational origins of the fetal person’s phenotype.

Epigenetics influences the expression of a person’s Genes and does not change or alter a person’s originating DNA (without certain very unusual circumstances). Most importantly, Epigenetics should be recognized for its potential effects on the maternal gestational environment. In effect, prenatal epigenetic factors can alter the pre-viable fetal formation of its uniquely-endowed Human Capability. The epigenetically informed, developmental process then continues after birth, especially during the first 1-3 years of growth and development. Remember, the male sperm and its semen are necessary to modulate the ova fertilization process and its subsequent endometrial implantation. Sperm do not contribute any cytoplasm to a fertilized ovum, just its DNA. Apparently, the mitochondria associated with each sperm can influence its conception process.

“Evidence for the multigenerational and transgenerational impact of the environment is described, and the chapter explores the unique routes through which mothers and fathers mediate this generational transmission. We differentiate between germline and experience-dependent epigenetic inheritance and discuss the role of these mechanisms of inheritance in adaptation and plasticity (Curley et al., 2023).” I cited the last two sentences from the article’s Summary entitled “Transgenerational Epigenetics” that represented Chapter 24 in the Handbook of Epigenetics (Third edition) published by ScienceDirect in 2023. This Chapter OF JUST 9 pages augments the related information introduced in the Definition for a BIRTHING PERSON at the end of this PERSON THEME (Curley et al., 2023).

As our knowledge about Epigenetics and its inheritability has become defined, a report (Jones et al., 2019) from the Tulane Brain Institute described their analysis of 67 births. They found epigenetic evidence that several newborns had inherited the attributes during the gestation of their mother’s prior experience of one or more ACEs. Their analysis also focused on “placental aging” and “infant autonomic system reactivity.” I cite the last sentence of the Conclusions section of the report’s Abstract — “These data are the first, to our knowledge, to report that changes in placental TL (telomere length) influence the transgenerational impact of maternal early life adversity on the development of her offspring’s autonomic nervous system (Jones et al., 2019).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Within the last 10 years, the processes that cause “environmental and social” effects on the expression of a person’s Human Dignity have become progressively studied. For this Epigenetic definition, I cite a recent study (Triplett et al., 2022). The research identified 280 infants whose mothers had endured substantial social disadvantage (poverty) with psychological stress before and during their child’s prenatal gestation. The research identified substantially reduced brain volume after birth among many of the study’s infants. The study represented their initial findings as the basis for a continuing follow-up study to further define the prenatal epigenetic effects of poverty on an infant’s nervous system when exposed to ACEs.

This study established the occurrence of a Childhood Adverse Event ACE by using DNA methylation as a marker for an intervening occurrence of the ACE. Three separate blood or urine sampling schedules, along with concurrent family/social history monitoring, occurred for 14,451 children from birth to age 15 years. The study included 19 collaborative participants from 5 separate institutions located in Ireland, the United Kingdom, the USA, and Australia. I cite its published title: “The timing of childhood adversity associates with epigenetic patterns across childhood and adolescence: results from a prospective, longitudinal study (Lussier et al., 2023).” I strongly recommend this study as the basis for grasping the DNA methylation concept. Be prepared to increasingly encounter this concept! — 25 —

CULTURAL SOCIAL – COGNITION may be postulated

for HEALTH as the attributes of

each person’s uniquely-endowed Human Capability involving

Shared Intentionality, Tribal Social Learning, and Symbolic Learning

that are nurtured during each person’s early childhood development

by their Family, its Family Culture, its Extended Family, and

their Home’s close neighborhood, as well as

the Survival COMMONS of their family’s community

for preparing each person’s prosocial contribution

to the generational survival of the Homo Sapiens species..

COMMENT A detailed analysis by Professor Tomasello of the historical progress of the Homo Sapiens species indicated an evolutionarily sudden transition 150,000 years ago. This transition included an expanded set of human attributes definable as Shared Intentionality, Tribal Social Learning, and Symbolic Learning. These skills promoted our species’ worldwide migration and its eventual tribal agrarian survival. The eventual transition to larger community-based survival began 12,000 years ago (Tomasello & Call 1997; Tomasello 2019a; and Tomasello 2019b). The transition began at the end of the last global ice age, the Holocene.

Shared Intentionality represents “…the ability to participate with others in collaborative activities and shared goals…(O’Madagan & Tomasello, 2021).” In comparison to empathy and its mutual awareness of emotional states of mind, Shared Intentionality implies a natural predisposition to cooperatively contribute to mutually beneficial social interactions. It becomes developmentally observable by 12 months of age.

Tribal Social Learning may best be viewed as occurring among a cluster of 153 persons, aka, a social network. This number is recognized as the mean number, aka the Dunbar Number, of persons within a natural social network (Dunbar 2020). This social network, alias tribe or close neighborhood (including “dependents”), then becomes the essential origin from which daily routines involving Social Interactions are acquired, learned, and generationally revised within a neighborhood’s “social network” and secondarily by its surrounding community. The learning micro-events of this process are delightfully described by a somewhat sardonic, ‘easy-to-read’ essay by Erving Goffman: “THE NATURE OF DEFERENCE AND DEMEANOR (Goffman 1956).”

Symbolic Learning refers to the capability of communicating from within a complex cluster of knowledge systems, such as music, language, geography, flowers, and mathematics. These structures of knowledge then mediate how a given tribal unit’s cultural traditions and knowledge are generationally accrued, memorized, and shared over time, or not, with other Tribes.

To further inform the structures of knowledge, I introduce Andras Angyal, M.D., Ph.D., who was the Resident Director of Research at the Wooster State Hospital, Wooster, Massachusetts, from 1937 to 1945. Born in Hungary, he obtained a Ph.D. in psychology (1927), and an M.D. along with his Psychiatry residency (1932) in Austria. He emigrated to the USA at the end of 1932. His first book, published in 1941, carries this title: “Foundations for a Science of Personality (Angyal 1941a).” On Page 111 of this book, we encounter the following two sentences: “Physiological psychology takes into consideration some of the physiological functions, namely, the sensory processes. In modern quantum physics, the role of the subject, the observer, is considered a rather important factor (Angyal 1941a).” His use of the word “quantum” for the human brain may be the first. It is Peircean abduction at its best.

To view this analysis with perspective, Dr. Angyal’s theory of personality is about how a person acquires and refines the social scenario memories for building the intuitive character of their prosocial personality. Given the required memory dimensions, we can only imagine the recall capabilities required for each person’s Anticipatorily-Conscious Socially-Human Brain. I suggest that Doctor Angyal may have been the first to understand the memory processing requirements for a person’s intuitive participation during the diversely discordant, Social Interactions encountered daily, during early life.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

From an article written by Andrea L. Roberts and 6 associates, I cite a background statement in the article’s first paragraph: “US national surveys report high lifetime occurrence of childhood physical abuse (18.1%), emotional abuse (23.9%), and sexual abuse 26.6% for females & 5.1% for males (Roberts et al., 2022).” The Nurses Health Study II was the focus of the Study. It included 116,429 female U.S. nurses in 1989 who participated in a biennial questionnaire for data acquisition. A violence questionnaire occurred in 2001. This Study represented a follow-up analysis of the 2001 survey respondents, numbering 14,151.

I cite the last sentence of this article’s Abstract: “Childhood abuse should be investigated as a potential risk factor for cognitive decline and dementia in old age (Roberts et al., 2022).” For a very thorough analysis, it announces a certain degree of deep resignation given its prevalence among our nation’s resident persons. We must do better! — 27 —

HUMAN CAPABILITY may be postulated for HEALTH as

each person’s epigenetically & genetically, uniquely-endowed

ANTICIPATORILY-CONSCIOUS PROSOCIAL-HUMAN BRAIN

that emerges during its initial Human Embryo, Preparatory Phase;

begins to promote harmony between its innate temperament and

its baseline homeostasis to become

a biological ‘female or male’ Human Fetus and

configures ‘his or her’ Cultural Social-Cognition to become

a pre-birth viable Human Fetus for initiating the person’s

eventual pursuit of ‘her or his’ Human Dignity;

initiates their consciousness at birth; AND

promotes their adaptive skills during:

i. the person’s sequentially nested, cognitive development throughout

early childhood when nurtured by the Caring Relationships originating

before birth from within the person’s Family, its Family Culture,

its Extended Family, and their Home’s close-neighborhood; AND

ii. the person’s situationally socialized, cognitive development

throughout ‘her or his’ childhood, adolescence, and early adulthood

to achieve Free Will after adolescence when

the person’s Cultural-Social Cognition begins to merge the fluency

of their personality, moral reasoning, and self-esteem while

acquiring the intuitive spontaneity to apply prosocial norms

for resolving the human-dignity-related, discordant social interactions

they encounter within the civic life of their Family’s community,

especially when these discordant social interactions also receive

‘timely mentoring’ by the Caring Relationships originating from within

their Family, its Family Culture, their Extended Family, and

their Home’s close neighborhood.

COMMENT The original conceptual exploration of “Human Capabilities” is primarily attributable to Martha Nussbaum and Amartya Sen (Nussbaum & Sen, 1993). They had proposed a set of lifetime capabilities and their respective aspirational functionings for each person. These “Human Capabilities” then formed the social justice requirements for a social-choice-based democracy. This expanding philosophical exploration has now been somewhat codified by its designation as “the human capability approach” (Robeyns 2005).

In contrast, the future of a NATIONAL HEALTH tradition begins by defining each person’s uniquely-endowed Human Capability as forming the developmental origins for their ANTICIPATORILY-CONSCIOUS PROSOCIAL-HUMAN BRAIN. It is also recognized as a Social Brain that humanity has evolutionarily acquired to become socially self-sufficient among the Homo Sapiens species as substantially separate from all the other biological species (Dunbar 1992, 1998, 2003, 2007, 2009, 2016, 2020a, 2020b & 2024). “Thus, human reproduction is defined by high failure rates (viz., periodic ovulation) but also good cumulative success rates, reflecting against low-fitness offspring (Brosens 2022).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

I propose that the analysis reported in 1997 by two faculty members at the University of British Columbia in Canada has a special honor for shepherding the socio-ecological Human Dignity arena now recognized as ACEs (Power & Hertzman, 1997). Here is its title: “Social and biologic pathways linking early life and adult disease.” Beginning in 1974, Canada reorganized its healthcare into a Federally managed system. As a result, they encountered the phenomenon now recognized as Population Health, especially for the health of children. As a Pediatrician, Professor Hertzeman was prominently active in this public health arena until he died in 2013.

Here is the last sentence of the 1997 report’s ABSTRACT: “Thus, it is argued that adult disease will be more fully understood when account is taken of the combined effects of social and biological risk occurring at different life stages (Power & Hertzman, 1997).”

HUMAN FETUS may be postulated for HEALTH as

identified by the occurrence of a fertilized ovum

of the Homo Sapiens species through its initial gestational survival

during an initial 8-week Stage involving conception,

uterine implantation, germination, and embryonic phases

to finish a 20-week, pre-viable Human Fetus stage that

incorporates its generationally genetic and epigenetic origins

for endowing its individually unique Human Capability

to become a post-birth, viable Human Fetus as enhanced

by the resilience of its mother’s pre-gestational Health and

a perinatally co-occurring Birthing Convoy originating from

within its gestational parents’ Families, their Family Culture,

their Extended Family, and their Home’s close neighborhood.

COMMENT: Each resident person of every community should have a regular “nudge” that this phase of every person’s future survival hinges on the unique juxtaposition of multiple generational cultures that coalesce for every Human Fetus. A sustained Birthing Convoy is beneficial for nurturing the Birthing Person’s prenatal “gestational” survival with anticipatory courage and enduring hope, despite the physical and emotional risks that are not ultimately manageable by any “medical model.” This Human Fetal stage begins a quest to gradually acquire a new beginning for its Family and their commensality needs. — 29 —

During conception, the fertilized ovum becomes implanted within its gestational endometrial surface to form an embryo. The ultimate paradox of feto-maternal, immunological tolerance then begins. I cite the PERSPECTIVE article by Gabrielle Rizzuto and Adrian Erlebacher for a baseline description (Rizzuto et al. 2022). The profound complexity of this immune paradox begins during implantation. Its most important transition occurs 16-20 weeks after contraception when post-birth viability develops. As of 2022, there are no physiological resiliency tests that will reliably identify when the onset of birth viability by a Human Fetus has already occurred, or when it will eventually occur.

The Human Fetal stage ends at birth after the onset of the rapidly evolving and complicated reversal of the maternal, immune-tolerant gestational status has occurred to induce the onset of labor. At birth, the infant is suddenly exposed to a very cold environment that initiates a crying response (driven by evaporating amniotic fluids) that is necessary to open the respiratory passages for obtaining oxygen. In addition, the infant’s uterine birthing sequence may have initiated a “splitting” headache as well as their innate rooting reflex.

Simultaneously, the person’s mucosal surfaces are being colonized with their own bacterial “biome” to modulate their initial immune system (Panthee 2022). And just as suddenly, their ANTICIPATORILY-CONSCIOUS PROSOCIAL-HUMAN BRAIN awakens its consciousness with the flood of newly encountered sensory and homeostatic signaling information.

As a result, each newborn dependent person begins to interact with their new environment to achieve many changes that are most obviously marked by a doubling of their weight and a 27% increase in length during the next five months. If you started today at 150 pounds, a similar weight gain would represent a weight of 300 pounds, five months later. Remember also that within 4-5 months, each newborn will be able to quickly recognize their parents and smile when viewing their faces, maybe with a bit of cooing as well. Unfortunately, maintaining an awareness of this child’s daily developmental needs as a prelude to their character differentiation as a 16-year-old adolescent becomes steadily more difficult to anticipate.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

In 2021, Andre Bussieres and 12 colleagues reported the results of their analysis of ACEs during childhood and the occurrence of chronic pain as an adult (Bussieres et al., 2021). Their research accessed data from 70 observational studies involving 826,452 persons, each person living in either Canada, Australia, Denmark, Hong Kong, or the USA. From the ABSTRACT of the report, I cite its Background statement – “Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.” and from its Objectives statement – “This systematic review and meta-analysis aimed to evaluate associations between ACEs and chronic pain and pain-related disability in adults (Bussieres et al., 2021).”

For the study’s results, I cite the ABSTRACT’s Conclusions: “Single and cumulative ACEs are significantly associated with adult reporting of chronic pain and pain-related disability (Bussieres et al., 2021).”

PERSON may be postulated for a NATION as representing

a Human Fetus that achieved birth viability and survival at birth to

*) become a Dependent Person within ‘his or her’ Family;

*) become a person with Free Will during and after adolescence,

unless interrupted by an identifiable interval of Dependency

according to the Human Dignity proportionality of their Nation;

*) maintain their own, Family-initiated, Personal Survival Plan;

*) sustain their human survival as supported

by their community’s Survival Commons;

*) support their community’s Community HEALTH Forum and

its Survival COMMONS for their SAFETY NET; AND

*) promote their nation’s equitably available, ecologically &

culturally accessible, justly efficient, and dependably effective

participation in the international marketplace arenas of their nation’s

Resources, Knowledge, and Human Dignity.

COMMENT As anyone might observe, this collection of concepts is developmentally defined and may be viewed as overly convoluted. In response, the concept of cognitive dissonance needs further recognition. If we are all mutually committed to improving each community’s Social Cohesion to reduce its prevalence of poverty, then we will ALL need to understand how human development occurs. Otherwise, it would be very difficult to prevent, mitigate, and ameliorate each person’s developmental encounters with modest as well as substantially discordant, social interactions and the resultant moral fatigue. The resultant occurrence of entrenched poverty explains why it becomes generationally sustained as a result of its social, economic, and epigenetic perpetuation. — 31 —

Within the intellectual arena that focuses on a “Person,” I found a collection of essays for a book written by Andras Angyal, M.D., Ph.D., as most engaging, viz., its title: FOUNDATIONS FOR A SCIENCE OF PERSONALITY (Angyal, 1941a). To advance this diverse heuristic, it is important to distinguish an ‘independent person’ from a ‘dependent person.’ For daily discourse, the single word “person” is usually understood as an independent person. This level of complexity is further clouded by each State’s legislation and any National legislation for defining these terms. And finally, it becomes even more complicated as each community attempts to manage the free will of its resident persons who are affected by a debilitating, chronic mental illness, viz., pedophilia.

Eventually, the issue of Free Will, viz., agency, and its associated moral reasoning becomes important to consider when evaluating the effects of certain addictions that can degrade any person’s willfully authentic choices. As additionally identifiable in conjunction with Dr. Angyal, I recommend a sentinel essay written by Professor Harry G. Frankfurt, which appeared in The Journal Of Philosophy: “FREEDOM OF THE WILL AND THE CONCEPT OF PERSON” (Frankfurt 1971). This essay analyses the issue of a person’s Free Will when they are under the influence of mood-altering substances.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

From (Zarei et al., 2021), here is a report with the following title: “Adverse Childhood Experiences Predict Common Neurodevelopmental and Behavioral Health Conditions among U.S. Children.” I quote from its Abstract, “Objective: Adverse childhood experiences (ACEs) can have a significant but variable effect on childhood neurodevelopment. The purpose of this study was to quantify and compare the associations between “household challenge” ACEs and common childhood neurodevelopmental and behavioral health conditions, using nationally representative data.” … “Results: Down Syndrome, Tourette Syndrome and cerebral palsy were not associated with household challenge ACEs, whereas behavior/conduct problems, depression, and substance abuse were strongly associated…” “Other neurodevelopmental conditions not traditionally associated with childhood adversity showed moderate yet robust associations with ACEs including autism…, learning disability…, and attention deficit hyperactivity disorder…,” “Conclusion: We found significant dose-dependent or cumulative associations between ACEs and multiple neurodevelopmental and behavioral conditions (Zarei et al., 2021).” The report also confirmed the widespread population-related incidence of ACEs.

BIRTHING PERSON may be postulated for HEALTH as

a gestationally-capable, independent person who

revises her own ‘Personal Survival Plan’ to

form a Birthing Convoy while planning and anticipating

the occurrence of conception to form a Human Embryo;

completes the gestational conception of this Human Embryo

to eventually achieve ‘its’ post-birth viability as a Human Fetus;

nurtures their Human Fetus to secure post-birth viability; and

endures the miraculous birth of this Human Infant who survives

‘his or her’ birth as a Dependent Person with Human Dignity.

COMMENT Our contemporary customs may prefer to use the term Birthing People and its connection to their biological gender identity. This Design Epistemology prefers a basic commitment to support a uniform definition and heuristic for the use of the word PERSON. As conception eventually develops one, or more than one, Human Embryo, each Birthing Person then accepts the privilege of contributing to the evolution of Human Survival, especially by their contribution of a Human Fetus who has achieved ‘his or her’ post-birth viability. As such, the intentional termination of any post-birth viable Human Fetus then becomes a Human Dignity dilemma. From an ethical morality standpoint, any such intentional termination also becomes a national socio-political “Social Choice” issue. Incest, rape, maternal Well-Being, and congenital anomalies, such as anencephaly, may also be involved.

As a contribution to social cohesion, a biologically precise ability to identify the fetal transition to post-birth birth survivability would promote the evolution of a broadly accepted accommodation of abortion and its ethical morality. Putting aside the ultimate issues of fertility, the Well-Being Survival of each Birthing Person within the 21st Century has become the most disgraceful attribute within our global saga of Human Survival. It is second only to the continuing level of civilizational genocide and climate-related starvation. — 33 —

Within the USA, the frequency of women who die in association with a pregnancy has worsened annually since @1975 (Singh 2021). Furthermore, the maternal mortality rate has especially worsened since 2020, and no one seems to know why! By comparison, we would need to reduce our nation’s maternal mortality rate by 60-70% to achieve maternal survivability at the level of ‘the Scandinavian nations’ and, by 40-50% to achieve the maternal mortality incidence of ‘the 5 other English-speaking developed nations’. This problem represents the Keystone issue for our nation’s POPULATION HEALTH. Reducing maternal mortality would likely resolve many of the other quality of Health and cost problems of our nation’s POPULATION HEALTH, including our nation’s exorbitant annual health spending, viz., “Capability Traps.”

ALLOSTATIC LOAD

The worsening incidence of our nation’s maternal mortality is likely explained by the allostatic load that each birthing person experiences before and during a pregnancy and the occurence of low birth-weight newborns. The inclusion of a Birthing Convoy represents a recognition of the uniquely worsening allostatic load that occurs for a birthing person before and during a pregnancy. “Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk (Richardson et al., 2021).”

The definition cited above represents the first sentence of the ABSTRACT from an article with the following title: “Social status differences in allostatic load among young adults in the United States (Richardson et al., 2021).” There are many attributes of this article that bear a connection with this Design Epistemology. For Birthing Persons, I cite this sentence from the article’s ABSTRACT: “We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates.” Ethnic Latina, Birthing Persons have a US maternal mortality incidence that is actually lower than for US White women. To understand this social dilemma and its socio-ecological implications, it may be that a nationally sanctioned and locally governed improvement of each community’s Survival COMMONS must be generationally required, neighborhood by neighborhood, to significantly reduce the Allostatic Load for ALL gestational Birthing Persons.

“GRANDMOTHERS MATTER”

“Biomarkers of pre-pregnancy allostatic load and subsequent adverse birth outcomes” represents the title of a report by Megan C. Barry (Barry et al., 2022). It used a unique survey-based, initial teenage population (1994-5: 20,745) with four subsequent follow-ups for 23,000 ending in 2016-18. I cite the last two sentences of its #5. Conclusion: “Despite the study’s holistic approach and design strengths, we did not identify consistent patterns that could be used as key markers for prevention purposes. Additional work is needed to expand on the content and lived experiences that affect women’s health and birth outcomes (Barry et al., 2022).” The underlying Human Dignity of this author’s report no doubt reflects her character as well as her University of North Carolina colleagues, especially her Co-Authors.

“Grandmothers Matter: How Grandmothers Promote Maternal Perinatal Mental Health and Child Development (Riem & van der Straaten, 2024),” represents the title of a report from the Netherlands. Given the uniquely anthropological role of a maternal grandmother, ‘her role’ may even have contributed to humanity’s evolution. With the seemingly tragic dissolution of sustainable families during our Anthropocene Era, we may need only to view the Scandinavian nations’ very low maternal mortality incidence to understand the basic function of her Birthing Convoy.

From the report’s closing Discussion section, the authors state: “Although there is a lack of attention to the role of grandparents in perinatal research, studies conducted so far suggest that grandparents can directly promote better child development in the case of maternal mental illness, by offering love and support to the child, or indirectly, through reduced maternal prenatal and postnatal caregiving stress. In particular, support from the maternal grandmother is a protective factor against the development of perinatal depression, and associated parenting difficulties and risks for the developing child (Riem & van der Straaten, 2024).”

EXCLUSIVE BREASTFEEDING

The definition of a Birthing Person includes a reference to a Birthing Convoy. For nearly 30 years (Antonucci 2019), Toni C. Antonucci has pursued the value of a Personal CONVOY, viz. Personal BOD (board of directors). Sociologically, we might view a Birthing Convoy as a cluster of Caring Relationships that form for a person with the purpose of preventing, mitigating, and ameliorating the person’s fearful isolation associated with a Birthing Person’s first-term pregnancy.

This becomes especially important as a basis to support Exclusive Breastfeeding for at least 3-9 months (Soegaard et al., 2024). The Denmark study involved a total of 309,473 children who were followed between 1 year and 14 years of age from 2005 through 2018. A total of 322 children had either a blood or a solid organ cancer. 37% of these children had a blood cancer. I cite from the RESULTS section of its ABSTRACT: “…exclusive breastfeeding for 3 months or more was associated with the infantile risk of developing a certain cancer, which was largely attributable to a decreased risk of BCP-ALL…” BCP-ALL means B-Cell Precursor-Acute Lymphoblastic Leukemia. The incidence of all the other childhood cancers was NOT affected. — 35 —

Given this “Headlines Suitable” report, another study underlies the importance of a Birthing Convoy (Isiguzo et al., 2022). Here is the study’s title: “Stress, Social Support, and Racial Differences: Dominant Drivers of Exclusive Breastfeeding.” And, here are the last four sentences of their report’s Abstract: “…Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding. However, breastfeeding support directly increased the likelihood of exclusive breastfeeding for 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer their stress.”

Another attribute associated with breastfeeding may be the most important. I refer to the brain-to-brain synchrony that occurs, as shown by their mother and child electroencephalograms, viz., their interconnected brain wave attributes. This theme is best understood by a research report from Yaara Endevelt-Shapira and her three associates (Endevelt-Shapira et al., 2012). I cite from the seventh page of the report as follows:

“We show that maternal presence experienced only through her smell increased the infants’ visual attention to social skills, augmented positive arousal, improved safety during interaction with a stranger, and enhanced inter-brain synchrony in this specific connectivity. Infants require their mother’s presence for growth, soothing, and survival, but the two must be present at the same place and time for this presence to be felt. The unique properties of olfaction, which preserve the maternal presence in her absence, can assist infants in transitioning to social groups, exploring new environments, and communicating with unfamiliar partners, augmenting their social repertoire toward greater survival and thriving (Endevelt-Shapira et al., 2021).”

GENDER BIAS

“A feminine advantage in the domain of harm: a review and path forward” is the title of a BIOLOGIC LETTER from ‘THE ROYAL SOCIETY journal (Graso & Reynolds 2024). I cite the last three sentences of its Abstract: ” …Our view aims to complement the existing literature on gender biases by presenting a balanced view that acknowledges men and women face unique challenges. By understanding these biases, we hope to foster a more equitable discourse on gender and harm, encouraging empathy and validation of suffering irrespective of gender. This holistic approach aims to de-escalate gender-based conflicts and promote effective interventions for both men and women (Graso & Reyholds, 2024).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

A similar study was published the same year by the California Maternal Quality Care Collaborative and its key stakeholders (Johnson et al., 2023) entitled: “Addressing Adverse Childhood and Adult Experiences During Prenatal Care.” The report describes the implementation of a prenatal endeavor to explore the maternal previous occurrences of ‘ACEs’ and the current attributes of maternal adversity or mental trauma, viz., Allostatic Load. This broad review includes care-planning options before and after parturition. As of a May 2025 Google Scholar review, this report represented the only article of its kind.

————– F A M I L Y T H E M E ————–

# 3 of 6

SALUTARY GREETING SOCIAL INTERACTION

CARING RELATIONSHIP FAMILY CULTURE

EXTENDED FAMILY FAMILY

— 37 —

SALUTARY GREETING may be postulated for HEALTH as

a person’s steadily renewed ‘adaptive skill’ for offering

a brief gesture of Kindness and Respect to any person

who is safely encountered while participating

in their community’s daily civic life, especially if this person

*) is recognizably parenting an infant or toddler

who may also share eye contact with a brief smile,

*) is disabled or possibly homeless, or *) lives within the

close neighborhood of the person’s Family home.

COMMENT Encountering another person can begin with a communicative display of briefly combined combinations of eye contact, facial contortions, hand gestures, verbal phrases, or just a nod. Oh – yes, and here is a reference (Caruana et al., 2021) involving authors who originate from Australia. Here is its title: “Gaze facilitates responsivity during hand-coordinated joint attention.” And, here is the last sentence of its Abstract: “These results indicate that humans attend to and process gaze information to facilitate joint attention responsivity, even in contexts where gaze information is implicit to the task and joint attention is explicitly cued by more spatially precise and visually salient pointing gestures (Caruana et al., 2021).” I practice these skills as often as possible, especially during visits to my neighborhood’s chain-managed, grocery store. Remember that “joint intention” skills begin to develop for each person at 9 months of age (Tomasello 1999).

When expressed frequently within your Family, Extended Family, and your Home’s close neighborhood, the persistent sharing of Kindness and Respect with your neighborhood’s resident persons promotes their community’s mutually recognizable trust and its associated social cohesion. Improving a community’s social cohesion then promotes every person’s healthy survival, viz., self-reported health, during the bad times as well as the good times (Giordano & Lindström, 2016). Importantly, every person needs to steadily revise their adaptive skills while encountering the municipal life of their own, increasingly complex, civic society. Social stigmata must never be allowed to disturb our mutually shared expressions of Kindness and Respect for each other. Now, you will understand why a serious commitment is necessary to steadily improve the spontaneity of every person’s ‘Salutary Greeting’ skills while participating in their close-neighborhood’s municipal life. A final reminder, a person’s adaptive skills should include regularly adequate sleep. See the article by Professor Simon (Simon et al., 2022). Its Abstract about sleep could be described as startling.

Remember that close neighborhoods become possible for every family when ‘Kindness and Respect’ are mutually shared daily with and among each other’s neighbors, ALL TOGETHER. To inform this priority, an unusual form of research regarding ‘mindful awareness’ applies. I will cite a portion of a study with the following title: “TRAIT-MINDFUL AWARENESS PREDICTS INTER-BRAIN COUPLING BUT NOT INDIVIDUAL BRAIN RESPONSES DURING NATURALISTIC FACE-TO-FACE INTERACTIONS (Chen et al. 2022).”

Here is a portion of its Abstract: “In recent years, the possible benefits of mindfulness meditation have sparked much public and academic interest. Mindfulness emphasizes cultivating awareness of our immediate experience and has been associated with compassion, empathy, and various other social traits. However, neurological evidence pertaining to the prosocial benefits of mindfulness in social settings is sparse. In this study, we investigate neural correlates of trait-mindful awareness during naturalistic dyadic interactions, using both intra-brain and inter-brain interactions […] with a portable electroencephalogram (EEG) device …”
And, here is the end of its Abstract: these “…findings underscore the importance of conducting social research in ecological settings to enrich our understanding of how (multi-brain) correlates of social traits, such as mindful awareness, manifest during social interactions (Chen et al., 2022).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

ACE phenomena have been codified under variously defined epidemiologic criteria. A report by 6 co-authors (Surtees et al., 2003) cites @80 ACE’s reports since the (Felitti et al, 1998) sentinel article. It may be the best systematic review of research reports published using the ACE concept. Note, a Canadian Pediatrician published an ACE-related Population Health study before 1998 (Hertzman 1994).

SOCIAL INTERACTION may be postulated as

a single encounter, or a variously connected series of encounters

involving two or more persons who recognize each other’s

‘shared intentionality’ about the occurrence of a situational scenario,

assemble for its purpose, and participate in this situational scenario

based on each person’s understanding of its likely

purpose, rules, and time course.

COMMENT This definition represents a contemporary adaptation of the sociological concept originated by Erving Goffman (1922-1982), who initiated the field of study known as micro-sociology. Briefly considered, a Social Interaction refers to those actions within a social scenario that a person initiates with another person who responds in turn. Social Interactions apply to a very large array of human behavior (that may begin without an initial Salutary Greeting) and can be viewed as representing the cursory events occurring between two or three persons during their community’s municipal life. The analysis of Social Interactions became a fixture within Sociology after the publication of Professor Goffman’s book entitled: “THE PRESENTATION OF SELF” (Goffman 1959). — 39 —

“Seeing social interactions” is the title of a scientific report with a focus on the cognition that occurs at the beginning of a Social Interaction (McMahon & Isek, 2023). Here is the first and last sentences of its Abstract: “Seeing the interactions between other people is a critical part of our everyday visual experience, but recognizing the social interactions of others is often considered outside the scope of vision and often grouped with higher-level social cognition as in a theory of mind.[…]We propose a computational framework for how this process is carried out in the brain and offer directions for future interdisciplinary investigations of social cognition (McMahan & Isek, 2023).”

Within another humanitarian arena, Philosophy uses the term Social Relation instead of Social Interaction. Since the growing use of Social Interaction, it seems as if social relation usage has become overall less common. This may be rebalanced by the burgeoning use of Social Relations within the humanitarian arenas of social capital, social dilemmas, and social cohesion as promoted by Professor Elinor Ostrom (E. Ostrom 1990) and others for the analysis of Common Pool Resource management. (See Page 88 of the Design Epistemology )

SOCIAL INTERACTION FOR LEARNING NEW KNOWLEDGE

I cite a portion of the Abstract from an article by 4 colleagues from the United Kingdom (De Felice et al., 2022): “…The focus of past research on learning has been either exclusively on the learner or (less often) the teacher, with the primary aim of determining developmental trajectories and/or effective teaching techniques. In fact, Social Interactions have rarely been explicitly taken as a variable of interest, despite being the medium through which learning occurs, especially during childhood development, but also in adulthood. Here, we review behavioural and neuroimaging research on social learning, especially focusing on cognitive models of how we acquire knowledge from and with others, and include both developmental as well as adult work. We then identify potential cognitive mechanisms that support social learning, and their neural correlates. The aim is to outline new directions for experiments investigating how knowledge is acquired in its ecological niche, i.e. socially, within the framework of the neuroscience approach (De Felice et al., 2022).”

From the LAST PARAGRAPH of the same Article (De Felice et al., 2022), I cite from its final summary: “In conclusion, we presented studies to show the role of Social Interaction in the first years of life for optimal cognitive and brain development, and demonstrate that Social Interactions boost learning in adulthood too.[…]Taken together, these suggest that learning via solitary action may not be enough, while learning during social interaction with others may be a key factor supporting the acquisition of new knowledge in the real world.” [Note: italics by its author]

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Here is a study about the ACEs that occur during the childhood of birthing persons who then become an actively gestational, Birthing Person. Apparently, the maternal neurological ACEs residual is epidemiologically passed to this child, who passes it on to her own children. Its principal author is Andrea L. Roberts (Roberts et al., 2015). I cite the last sentence of the study: “Conclusions: As offspring exposure to abuse and maternal mental health accounted for more than 50% of the elevated risk of high depressive symptoms among the offspring of women who experienced abuse, improving maternal mental health and parenting practices may reduce offspring risk for depressive symptoms in these families (Roberts et al., 2015).”

CARING RELATIONSHIP may be postulated for HEALTH as

a dyadic Social Interaction occurring within a Human Dignity scenario,

that begins with kindness and respect for each person’s autonomy,

thrives when each person steadily renews their adaptive skills, and

flourishes from a shared obligation to communicate in harmony

with warmth, non-critical acceptance, congruence, and empathy.

COMMENT Caring for, by, and about another person seems to be a psychological tradition that became initially denominated by Carl Rogers, Ph.D., after WWII. His research defined the interactional congruence necessary for therapeutic counseling to be effective. Eventually, Rogerian therapy became a recognized skill for which its interactional priorities reflected:

*) warmth (viz., non-possessive positive regard);

*) non-critical acceptance (viz., ecological and cultural dimensions);

*) congruence (viz., coherent ‘actions, thoughts, and feelings’); and

*) empathy (viz., the most difficult to define) (Rogers 1995).

CARL E. ROGERS

Remarkably, the Editors of “The Personnel and Guidance Journal” eventually added a comment to its online version of an article they had published entitled “The characteristics of the helping relationship (Rogers 1958).” Here is the Editor’s Comment: — 41 —

“This article, written in 1958 by Carl Rogers, is his most quoted and reprinted article. It has been republished in sourcebooks, the Harvard Business Review, and many other publications. It helped introduce a profound change in the way people look at professional relationships. The Article’s ripples still affect us today. It includes Roger’s famous 10 ‘CAN I’ questions.”

STEADY RENEWAL

What may be new for our definition of a ‘Caring Relationship’ is its inclusion of the phrase ‘shared obligation to communicate in harmony’. In effect, a Caring Relationship represents the continuing ability of two persons to interact with a spontaneously affirming acknowledgment of what the other person may be thinking, feeling, and needing, viz., their shared intentionality. We all might recognize such an event as occurring within a close friendship or an immediate family relationship. Recently reported research has shown that your brain’s electromagnetic energy patterns may become coupled with another person’s electromagnetic wave patterns to mutually focus each other’s intellectual and emotional cognition, viz., in harmony.

Importantly, every infant’s brain requires it to develop normally after birth. Here is the evidence. I cite from Yaara Endevelt-Shapira & Ruth Feldman and their 2023 report regarding dual-electroencephalogram recordings: “Mother-Infant Brain-to-Brain Synchrony Patterns Reflect Caregiving Profiles.” Here is the last sentence of the report’s Abstract: “Our results support the perspective that inter-brain synchrony is a mechanism by which mature brains externally regulate immature brains to social living and suggest that one pathway by which sensitivity and intrusiveness exert their long-term effect may relate to the provision of coordinated inputs to the social brain during its sensitive period of maturation (Endevelt-Shapira & Feldman, 2023).”

“THE MORAL PSYCHOLOGY OF OBLIGATION”

By 3 years of age, every young child will demonstrate obligation with peers with a special force and social structure. Michael Tomasello compiled his own core article (Tomasello 2020) with 32 Commentary responses for an ‘Open Peer Commentary’ article that included his own responses to the commentaries. The title for the Tomasello article represents the Header for this paragraph. As a result, the word ‘obligation’ has been added to the Caring Relationship definition.

At the time of birth, each person’s Anticipatorily-Conscious Human Brain initiates the person’s consciousness and its lifelong learning process for informing their survival. Given a basic framework for acknowledging each person’s prenatal innate temperament and baseline homeostasis, each person’s consciousness steadily informs their intuition and social-cognition knowledge from experience, viz., Lifelong Learning. With a focus on Design Epistemology, I surreptitiously encountered a book with the following title: “Epistemologies and Ethics in Adult Education and Lifelong Learning (R. G. Bagnall & S. Hodge, 2018a).” Its 7th Chapter is remarkably applicable to this Design Epistemology. Here is its title: “Design Epistemology and Ethics in Lifelong Learning (R. G. Bagnall & S. Hodge, 2018b).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Remarkably, here is a complex (ACEs) related study, (Houtepen et al., 2020), who analyzed their eventual connection with adolescent educational success and family socioeconomic attributes. Within the article’s ABSTRACT, the authors end with a sub-section with the following header: “What do these findings mean?”

“People who experience ACEs have, on average, lower educational attainment and higher risk of depression, drug use, and smoking; these factors were not fully explained by family and socioeconomic factors.
“We did not find strong evidence of associations between ACEs and either obesity or alcohol use.
“Our findings imply that interventions that focus solely on ACEs or solely on socioeconomic deprivation, while beneficial, would miss most cases of adverse educational and health outcomes, suggesting that the intervention strategies should target a wide spectrum of relevant factors, including ACEs, socioeconomic deprivation, parental substance abuse, and mental health. (Houtepen et al., 2020)” — 43 —

FAMILY CULTURE may be postulated for HEALTH as

a cluster of adaptive skills that a Family

acquires to perpetuate their shared identity,

applies to the daily encounters involving

their caring relationships, and periodically

adjusts to enhance their generational traditions

of mentoring each other’s Personal Survival Plan.

COMMENT Dolores Curran (1932-2022) found herself having been appointed to coordinate the Family Education program within a Catholic parish that she and her family had joined in Denver, Colorado. With her, then recent, post-graduate education for an M.S. in Journalism, she began a national research project to define what was known about how Families function to best prepare their children for becoming self-sufficient independent persons. As described in her book TRAITS OF A HEALTHY FAMILY, an extended national survey analysis led to the list cited below (Curran 1983). Now, some 40+ years later, her list of TRAITS still represents the Gold Standard for defining a FAMILY CULTURE. Written with a warm-hearted hint of Irma Bombeck, it remains remarkably current. The TRAITS are:

“1. Communicate and listen;

2. Affirm and support one another;

3. Teach respect for others;

4. Develop a sense of trust;

5. Have a sense of play and humor;

6. Exhibit a sense of shared responsibility;

7. Teach a sense of right and wrong;

8. Has a strong sense of Family in which rituals and traditions abound;

9. Has a balance of interactions among its members;

10. Has a shared religious core;

11. Respect the privacy of one another;

12. Value service to others;

13. Foster family mealtimes and conversations;

14. Share leisure time together; and

15. Admit to and seek help for problems.”

Dolores Curran (1932 – 2022)

When questioned about how many of the Traits are required for a Healthy Family, she refused to answer when asked, and even refused to study such a goal. In essence, she did not want these Traits to become socially observable currency. She claimed that none of the traits were absolutely required and that no sub-cluster of traits was possibly more important than any other sub-cluster of traits. Importantly, her list of traits is rank-ordered based on how frequently they were cited during her survey research.

She also proposed that “Family Traditions may be defined historically for the members of a family as their treasured legends and characters, their gathering persons and places, their gathering rituals, their shared past as a link to the future, their positive regard for infants and elders, and their shared priority to actively attend and participate in their gatherings (Curran 1983).” Her view of Family Traditions, from my perspective, has defined Family Culture with succinctly accurate precision. Her book continues to be published by her family.

A succinct analysis and literature review with a focus on “…Food Makes Family…” recently appeared. Mealtime gatherings are described in all their commensality complexity (Ee 2023).

MAPPING PLACES OF ENCOUNTER

“Meeting places are an important element of social integration and sense of place in both urban and rural areas. Generally speaking, face-to-face encounters can be considered a prerequisite for building local communities that constitute a “lubricant” for social contact and contribute to personal well-being and identity formation. Weak ties, such as with a greeting or making ‘small talk’ with neighbors, can reduce the social distance between social groups. This adaptive skill may occasionally be converted into “strong ties” depending on 1) time spent together, 2) emotional congruence, 3) mutual trust, and 4) certain types of reciprocal assistance (Spenger et al., 2023).” Meeting Places involve their survival needs, as in favorite locations for their grocery store (especially for produce), post office, gas station, bus stop, restaurants, bakery, and hardware supplies. The Spenger reference expands the character and integrated inclusion of favorite family places, for a family’s sources of communal identity, including a church or synagogue for their spiritual traditions. Finally, a family will also include special locations for a work site, schools, health clinics (medical & dental), as well as community parks for exercise and blue-sky awareness. — 45 —

For a family with 2 or more children, the daily routine can become very “chaotic.” So, the location of their family home, mealtimes, and respective schedules become a daily challenge. Eventually, a balance of paternal and maternal Gatekeeping becomes a choreographic challenge. An article by Tina Miller (Miller 2018) describes the importance of mutually balancing their parental responsibilities. I cite the last sentence of her article’s Abstract: “This paper urges a more critical examination of practices of maternal and paternal gatekeeping as parental choreographing of caring practices and responsibilities unfold (Miller 2018).”

MULTI-GENERATIONAL FAMILY COMMUNICATION

Given a Family of 3-4 persons, its Extended Family, its close neighborhood, and its social networks distributed within their community, we might encounter, on average, approximately 153 participatory resident persons. This number represents the Dunbar number (Dunbar 2020) for whom a family of 6-10 persons would have intermitant continuing contact, viz., their social network. Importantly, this would likely involve three generations. I cite another investigation involving the analysis of interpersonal brain-coupling, viz., tri-generational (Dikker 2024).

From this report, I cite its Abstract: “The simulations suggest that grandparent-child interactions may be paired with higher inter-brain coupling than parent-child interactions, raising the possibility that the former may be more advantageous under certain conditions. Critically, this enhancement of inter-brain coupling for grandparent-child interactions is more pronounced in tri-generational interactions that also include a parent, which may speak to findings that grandparent involvement in child-rearing is most beneficial if the parent is also an active household member. […] We advocate for a community neuroscience approach in developmental social neuroscience to capture the diversity of child-caregiver relationships in real-world settings (Dikker 2024).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

A rapidly evolving, newly advanced conceptual strategy for the analysis of Human Survival eventually yields a wide variety of research traditions. You may have anticipated that, in due time, these studies would lead to reviews of reviews. Here are four examples:

(Lorenc et al., 2020) Its five contributing authors originated from the United Kingdom. Here is its title: “Interventions to support people exposed to Adverse Childhood Experiences: a systematic review of systematic reviews.” Here are the last two sentences of its ABSTRACT’s Results: “The strongest evidence is for cognitive-behavioral therapy for people exposed to abuse. We included reviews with a summary quality score (AMSTAR) of 5.5 or above.”
(Cibralic et al., 2022) Its eleven contributing authors originated from Australia. Here is its title: “Utility of screening for adverse childhood experiences (ACE) in children and young people attending clinical and healthcare settings: a systematic review.” Here is the last sentence of its ABSTRACT’S Conclusion: “As the evidence stands, widespread ACE screening is not recommended for clinical use.”
(Tzouvara et al., 2023) Its six contributing authors originated from Northern Ireland. Here is its title: “Adverse Childhood Experiences, Mental Health, and Social Functioning: A Scoping Review of the Literature.” Here is the last sentence of its ABSTRACT’S Conclusions: “Future research should implement robust methodologies to provide evidence that could be used for developing evidence-based interventions.”
(Gautschi & Latsch, 2024) Its two authors originate from Switzerland. Their article represents a broad review of its realm of knowledge. Here is its title: “The Effectiveness of Interventions to Prevent and Reduce Child Maltreatment in high-income Countries: An Umbrella Review.” As such, here is the only sentence in its ABSTRACT’S Conclusions: “We suggest several measures to improve the quality of research and call on practitioners to be persistent in developing more effective interventions.” — 47 —

EXTENDED FAMILY may be postulated for HEALTH as

a cluster of persons assembled by a family,

commonly involving 2-4 persons per family member, for whom

each member of this cluster maintains a caring relationship

with at least one family member as a variably-close connection that

forms initially with the selection of close, biologically related persons

of their Family to enrich the ecological and ethnic

continuity of its generational Family Culture;

includes persons residing within the close neighborhood of their home

who share mutually reciprocating, helpful accessibility;

selects persons who offer situational, wisdom-guided mentoring

for the family members, such as Godparents;

evolves periodically from the replacement of certain persons

according to the family’s needs for prosocial adaptive skills,

contact frequency, or nearby closeness; and

revises as the social network’s membership changes with the occurrence

of sentinel events that substantially affect the Personal Survival Plan

of a specific Family member.

COMMENT Beginning many years ago, the concept of a personal micro-network as a support and mentoring source of caring relationships continues to be revisited by Toni Antonucci, Ph.D. Some 25 years after initially assessing the close Convoys of an investigational cohort, she again assessed the same cohort and their Convoys. She noted that their Convoys had remained largely intact (Antonucci et al., 2019). Presumably, this combined version of a Convoy for each parent would then prepare their children’s adaptive skills for eventually maintaining their own personal Convoy, particularly for Birthing Persons.

For this Design Epistemology, an amalgamated version of a Convoy might be useful. The inclusion of a mentoring contribution to each Family member’s Personal Survival Plan recognizes the value of the Convoy tradition. Suffice it to say, the use of the Extended Family concept has had many models, historically as well as currently.

The occurrence of a large number of persons who are genetically related and live within a given neighborhood may have been common before the 20th century. But, it virtually disappeared during the first half of the 20th Century. I would ‘venture to say’ that it is currently an extremely rare occurrence within any of our nation’s 810 District Communities.

The historical occurrence of Extended Families applies to the kindred early-adult children or grandparents who live with a classic Family of mom, dad, baby Jane, and toddler Joe. This was prominent during the final quarter of 1800-1899 in England (Ruggles 1987). And, the nuclear family seems to have been applied to a triadic Family of mom, dad, and toddler Jane. Finally, a complex family cluster applies to a mom and dad who each may have custodial responsibilities for children from a previous marriage as well as their own marriage, viz., a blended family.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Chaotic Disruption may be acknowledged as the evolutionary forces that disturb the ecological and cultural attributes of a community’s Population Health. As encountered by a community’s Survival Commons, an underlying theme will involve the dimensions of Prevention, Mitigation, and Amelioration. Given the potential for a lifelong impact from ACEs, the complexity underlying their occurrence should prompt a focus on prevention. Ten contributing authors originating from the University of Manitoba in Canada have collaborated to offer a sentinel proposal (Afifi et al., 2021). What follows is a supplement to the Afifi article and reminiscent of the book written by Doloris Curran: “Family Traits of Healthy Families.”

Afifi Protective Factors For Adolescents

“Individual-Level – a) Identifying with a culture or language, b) Becoming excited about the future, and c) Visualizing one’s future;
Family-Level – a) A trusted adult in the Family, b) Being hugged by a parent or guardian, c) Being told “I love you” by a parent or guardian, d) Eating regular meals with an adult family member, e) Supportive relationship with a mother or mother figure, and f) supportive relationship with a father or father figure;
School-Level – a) A supportive relationship with a peer at school, b) a trusted adult at school, and c) A feeling of belonging at school;
Community-Level – a) A trusted adult in their community, b) Volunteering in their community, c) Feeling involved within their community, and d) Feeling motivated to help and/or improve their community (Afifi et al. 2021).”

FAMILY may be postulated for HEALTH as

a cluster of two or more persons that

I. Configures itself with a goal to encourage the broadest expression of each other’s uniquely-endowed Human Capability and to sustain each other‘s survival by the daily immediacy of their communal caring relationships, especially when an ‘originating’ independent person is also a Birthing Person;

II. Institutes itself with a social gathering to jointly affirm the expression of ‘shared intentionality’ by its ‘originating’ independent person or persons when

A. Two ‘originating’ independent persons express a lifelong commitment to their caring relationship as affirmed by a marriage certificate OR

B. One ‘originating’ independent person who is not married, has a sustainable 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 Salutary Greeting to every person that each of their Family’s persons safely encounter during the municipal life of the Family’s community, irrespective of any ecological or cultural stigmata possibly represented by either a member of the person’s Family or the other person (Goffman 1963); — 49 —

IV. Accepts an ‘additional’ dependent person into their Family, if at least one current ‘originating’ independent person of the Family has an established custodial responsibility for the ‘additional’ dependent person as defined:

A. BIOLOGICALLY through birth, biological child, or sibling OR

B. LEGALLY through a divorce, adoption, guardianship, or foster care by a judicial decision;

V. Assembles the traditions of their Family Culture to form the communal identity of the Family’s persons and to guide the responsibilities of the ‘originating’ independent person or persons for their duties to:

A. Establish a household, viz., a Home, for their Family within a neighborhood of their municipal or rural community for the purpose of promoting the resilience of each person’s uniquely-endowed Human Capability;

B. Identify an evolving group of independent persons who would function as the household’s Extended Family who would respectfully nurture a caring relationship with at least one household person involving varying degrees of closeness that

1. initially forms by consolidating any pre-existing Extended Family of the cluster’s ‘originating’ independent person or persons or custodially related dependent person or persons,

2. evolves over time as the persons of the Extended Family variously contribute to the family gatherings involving its Family Culture with an intent to enrich its cultural heritage of the family’s communal identity, and

3. offers courageous mentorship when requested during a substantial Disruptive Process affecting the survival resilience of a household person, especially during and after adolescence;

C. Promote gatherings of the Family members within their Home:

1. for a weekly pattern of at least 3-5 Family Mealtimes to promote a communal responsibility for each other’s biological, emotional, and spiritual nutrition to prevent, mitigate, and ameliorate their daily encounters with disruptive processes involving discordant, social interactions,

2. for the recurring events involving close persons of their Extended Family to enhance the ecological and cultural character of the household’s Family Culture, especially in association with the sentinel transitions occurring throughout the household’s generational cycle, and

3. for the episodic events involving persons from within their Extended Family who share mutually supportive attributes about the household’s Family Culture, including those persons residing within the family’s close neighborhood (Goffman 1963);

D. Define a Personal Survival Plan for each person of the Family to:

1. arrange for the daily residential needs of each person’s Stable HEALTH, especially for their Restful SLEEP, Good FOOD, Dedicated EXERCISE, and Mentored COURAGE,

2. prevent, mitigate, or ameliorate, when possible, each person’s encounter with a discordant or traumatic disruptive process that includes a dedicated connection with Primary Healthcare, and

3. adapt the residential capabilities of their Home, when required, for the Personal Survival Plan of each household member; AND

E. Accept an ‘additional’ independent person into their home, if either the ‘additional’ independent person becomes an ‘originating’ independent person through marriage with a sole ‘originating’ independent person of a family OR the ‘additional’ independent person

1. has the authentic consent of the current ‘originating’ independent person or persons that occurs 01 to 28 days before the first day of residence by the ‘additional’ independent person within their Home and

2. has an authentic Personal Survival Plan, or its next-of-kin approved equivalent, that includes:

a. provisions to manage the ‘additional’ independent person’s HEALTH in the event that 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, including its provisions, for an advanced directive.

COMMENT If you find this definition somewhat inscrutable, I would respond by saying: “So do I.” Intentionally, it describes the ecological and cultural requirements for promoting each resident person’s lifelong Stable HEALTH. For continuing Human Survival, each Family will most commonly include a person who either will be, is now, or was previously a ‘biologically capable’ Birthing Person. — 51 —

The traditions of each person’s ecological and cultural ‘civic-heritage’ are now withering under a contemporary barrage of discordant Social Interactions. More than ever, we all need a very clear basis to reinvigorate the sustainable resiliency of every community’s Safety Net, viz., Survival Commons within their own community. Repeated multiple times, remember that POPULATION HEALTH is ultimately about each person’s Family, their Family Culture, their Extended Family, and their Home’s close neighborhood as sustained by their community’s Survival Commons, viz., its augmented Safety Net.

“Section III.” of the Family definition draws special attention to stigmata phenomena. It is very important to realize that a person may have an internalized sense of living as a stigmatized person. Even if not at all noticeable by anyone else, they are substantially affected by someone becoming aware of its presence. A person who has well-controlled epilepsy might well apply. An essay by Lawrence H. Yang, along with 5 other authors representing public health, sociology, anthropology, and psychiatry, best amplifies the dimensions of Stigma Theory (L. H. Yang et al., 2007).

One wonders why there is no substantial arena of anthropological research for a clearly understood and recognizable ethnography about the functional dimensions of a Family. Even the occurrence of Extended Families involving adult children was only identifiable during a short sociologically discrete period of time in the United Kingdom by the census-analysis community (Ruggles, 1987).

HOME

To access an all-inclusive awareness of the importance of a person’s home for their health, several realms of knowledge come to mind. Anthropology, human ecology, home economics, human adaptability, ethnography, and social epidemiology come to mind. After a sustained effort over several hours, serendipity won out with my eventual discovery of a concisely edited series of small handbooks published by the OXFORD University Press, Oxford, UK. The series is labeled as such: VERY SHORT INTRODUCTIONS. From the list of nearly 500 titles, there is one entitled simply ‘HOME.’

It is written by Michael Allen Fox (2016), who was then a faculty member of the University of New England in Australia. It represents a collection of short essays. One of the essays was ‘New to me,’ not all languages have a word with a meaning similar to our Anglo use of the word ‘HOME.’ Here we go, the eight Chapters cover 122 pages, and the first paragraph begins “Homes have always been gathering places (Fox 2016).” The Chapter titles attest to the book’s underlying dimensions. They are:

1st The many faces of home, 5th People, Objects, and identity,

2nd The importance of place, 6th Home politics,

3rd Dwelling and dwellings, 7th Homelessness and uprootedness, &

4th Remembering, Imagining and other Mindwork, 8th The future of the home.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Referring to (Hege 2020), this study of an initial cohort involving 13,500 adults in North Carolina from 2012 through 2014 who had experienced frequent ACEs during their own childhood. Another cohort was selected, and their children were screened for possible ACE-associated, long-term adverse health. With ‘Population Health’ related, cohort survey analysis, I cite the first three sentences of the report’s Abstract: “Adverse childhood experiences (ACEs) are a critical determinant and predictor of health across the lifespan. The Appalachian region of the United States, particularly the central and southern portions, experiences worsening health outcomes when compared to the rest of the nation. The current research sought to understand the cross-sectional relationships between ACEs, social determinants of health, and other health risk factors in one south-central Appalachian state (Hege 2020).”

Using a ‘Population Health’ study’s analytic process, the initial study’s cohort who had experienced 4 or more ACEs also experienced a significantly higher prevalence of smoking, heavy alcohol consumption, obesity, frequent mental distress, and food insecurity. The study’s Abstract ends with the following sentence: “Developing programs and implementing policies aimed at reducing the impact of ACEs could improve social determinants of health, thereby helping to reduce health disparities (Hege 2020).”

In effect, there is no basis to assume that the generational effects of ACEs would respond to a medical-model strategy, viz., 3.8 million USA births annually. Plainly, if a person has developed a Borderline Personality disorder from the incessant occurrence of near-daily childhood maltreatment, we need to accept the maddening reality of its intransigent social cognition deficits. In effect, our nation’s Population Health has become paralyzed by the effects of an overwhelmingly dominant CAPABILITY TRAP (Landry & Sterman, 2017) that has developed neighborhood by neighborhood within every community.

As a Wicked Problem (Gamberini et al., 2022), a complex-systems strategy will be required to promote the natural health of every newborn and their mother. Quoting Eleanor Roosevelt: “It’s better for everybody when it gets better for everybody.” With this prompt, it is likely that a nationally chartered and community-focused institution will be required. To prevent, mitigate, and ameliorate every community’s socio-economically driven CAPABILITY TRAP (Landry & Sterman, 2017), a complex adaptive-system strategy must ensure the lifelong ascendancy of every resident person’s Human Dignity. To focus on the prevalence and immediacy problems of our nation’s CAPABILITY TRAPS, I recommend a 2022 report from the NATIONAL BUREAU OF ECONOMIC RESEARCH (Kennedy-Moulton et al., 2022). — 53 —

“MORAL LEARNING and DECISION-MAKING ACROSS THE LIFESPAN”

The above heading is the title of an Annual Review of Psychology (Lockwood et al., 2025) published by ANNUAL REVIEWS. The article begins with a sentinel Abstract herein cited:

“Moral learning and decision-making are crucial throughout our lives, from infancy to old age. Emerging evidence suggests that there are important differences in learning and decision-making across the lifespan, and these are underpinned by co-occurring changes in the use of model-based values and theory of mind. Here, we review the decision neuroscience literature on moral choices and behavioral moral learning, considering four key concepts. We show how in the earliest years, a sense of self/other distinction is foundational. Sensitivity to intention versus outcome is crucial for several moral concepts and is most similar in our earliest and oldest years. Across all ages, basic shifts in the influence of the theory of mind and model-free and model-based learning support moral decision-making. Moving forward, a computational approach to key concepts of morality can help provide a mechanistic account and generate new hypotheses to test across the whole lifespan (Lockwood et al., 2025).”

Of the extensive list of references, my preference is the one by Professor Lockwood. The author team of the Abstract originates from Western Europe and has described the most current status of Moral Learning. This is the development setting that is so harmfully disturbed by the ACEs phenomenon, which is prominently cited in this Design Epistemology.

Oddly connected, I cite a new sentinel article by Professor Tomasello entitled: “An agency-based model of executive and metacognitive regulation (Tomasello 2024).” Here is its Abstract:

“In the context of agentive decision making and action, both executive and metacognitive processes serve self-regulatory functions–just on different hierarchical tiers. In the agency-based model proposed here, executive processes monitor and control action and attention from an executive tier of operation, and metacognitive processes monitor and control those executive processes from a second-order tier of operation–both with the function of facilitating effective and efficient behavioral decisions. Each is best conceptualized as comprising three key components: (i) what is regulated, (ii) how, via what processes, is it regulated, and (iii) where, in what cognitive workspace is it regulated–either in individual or shared agencies. Developmentally, evidence is presented that executive processes for regulating both individual and joint agencies emerge only after 9-12 months of age, and metacognitive processes for regulating both individual and collective agencies emerge only after 3-4 years of age. Cognitive flexibility, as an important outcome, derives from the child’s attempts to metacognitively regulate differing social perspectives within shared agencies (Tomasello 2024).”

——– N E I G H B O R H O O D T H E M E ——–

# 4 of 6

PROSOCIALITY NEIGHBORHOOD

HEALTH SOCIAL STIGMA

POVERTY POPULATION HEALTH

— 55 —

PROSOCIALITY may be postulated for HEALTH as

Social Interactions that are formed by various Scenarios

involving volunteerism and altruism

by one or more persons for improving the Human Dignity

of another person or persons as guided by certain:

*) Principles, e.g., Autonomy,

Beneficence, Non-maleficence, and Justice;

*) Interpersonal Rules, e.g., Veracity,

Confidentiality, Privacy, Fidelity, and Respect;

*) Action Ideals, e.g., Forgiveness, Generosity,

Immediacy, Compassion, and Kindness; AND

*) Social Norms for Collective Action, e.g.,

Trust, Reciprocity, Cooperation, and Idle Talk.

(as adapted from Beauchamp & Childress 8th Edit, 2019)

COMMENT During the transition from early to late childhood, each person normally begins to engage more closely with their home’s close neighborhood and the municipal life of their community. As the encounters with discordant social interactions begin to acquire a widening array of deference and demeanor skills, each person’s personality and moral reasoning begin to intuitively acquire the spontaneity for maintaining their self-sufficiency. A positive connection with a father helps their children manage their male Social Interactions. Similarly, the same connection occurs for the female children with their mother and her female Social Interactions.

Beforehand, this Design Epistemology included a definition for an Extended Family and its role in promoting contact between adolescent family members and familiar adults to mentor their prosocial behavior (see above). Lost in all of this, there is no intentional strategy to encourage locally-specific, norms of deference and demeanor for a community’s traditions of prosociality (Goffman 1956). Ultimately, High Schools, Vocational certification schools, and Colleges that grant Baccalaureate Degrees may be the best institutionally sponsored sources to guide or sponsor this priority within the civic affairs of their associated community.

Importantly, the Social-Cognition underlying the human attribute of “Human Sociality” begins before the onset of late childhood (Tomasello 2020). I cite another article by Michael Tomasello, especially given his analysis of the current status for the social development of each person’s Prosociality during early adulthood (Tomasello 2019b): “THE ROLE OF ROLES IN UNIQUELY HUMAN COGNITION AND SOCIALITY.”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Karen Hughes and her Co-Authors reported an extensive analysis with an article entitled – “Health and Financial Costs of Adverse Childhood Experiences in 28 European Countries and North America: A Systematic Review and Meta-analysis (Hughes et al., 2021).”

I cite a sentence from its Findings — “Harmful alcohol use, smoking, and cancer had the highest ACE-attributable costs in most countries. The ACE-attributable costs ranged from $0.1 Billion (Montenegro) to $129.4 Billion (Germany) and were equivalent to between 1.1% (Sweden and Turkey) and $6.0% (Ukraine) of their nation’s Gross Domestic Product (Hughes et al. 2021).”

And from the article’s Interpretation — “Millions of adults across Europe and North America live with the legacy of ACEs. Our findings suggest that a 10% reduction in ACE prevalence would equate to an annual savings of 3 million DALYs or $105 Billion. Programs to prevent ACEs and moderate their effects are available. Rebalancing expenditure towards ensuring safe and nurturing neighborhoods would be economically beneficial and relieve pressures on a nation’s health-care systems (Hughes et al., 2021).”

NEIGHBORHOOD may be postulated for HEALTH as

a cluster of 2 or more persons within a community that

reside within a variously identifiable section of their community,

share certain cultural traditions within their social networks,

bound caring relationships with their close neighbors, and

initiate collective action, when necessary, to augment

the public symbols required by their section of the community.

COMMENT Like so many of the other concepts of the Design Epistemology, this definition is another concept characterizable by the iconic rubric for quality, viz., “I know it when I see it.” As a result, I prefer to use the same concept of a Cluster for defining a Neighborhood. A cluster (see page 14) may be defined as “two or more bounded components that form a uniquely resilient and sustainable survival capability from their evolutionary interactions involving the synergy among the components, the affinity between certain components, and the salutary conditions surrounding these components.”

For a Neighborhood, there are TWO communitarian components for every neighborhood: the PUBLIC obligations and the PRIVATE obligations. Each community’s municipal, county, & state PUBLIC obligations encompass roads, public transportation facilities, utilities, primary & secondary education, public & fire safety, parks & recreation, historical monuments, libraries, post office, public health & especially its Primary Healthcare, as well as Safety Net resilience, disaster preparedness, community sustainability, and promotion of its Social Cohesion. These PUBLIC obligations should also include their respective Justice and Fiscal responsibilities. — 57 —

The PRIVATE obligations then are generally related to the support of higher education opportunities, employment alternatives, household shopping accessibility, diverse fine arts & their performance/exhibition facilities, philanthropy, ecological & cultural heritage, and social capital. For a common-sense reference, the MODELS OF NEIGHBORHOOD CHANGE essay by Kent P. Schwirian still retains its stalwart level of sensibility (Schwirian 1983).

Of interest for this concept, most research focuses on a neighborhood’s adaptability to endure ecological and cultural change. Gentrification, racial & ethnic evolution, climate change, longevity & homicide, social isolation, and poverty are among the most prevalent arenas of knowledge warranting continuing sociological research. For a neighborhood, its sustainable attributes are then associated with its geographic location, especially as it becomes affected by its surrounding historically associated ecological and cultural identity.

Recently, a new arena of research has focused on neighborhood social networks with data from internet social networks. For one example of this research arena, I cite Dounia Mulders: “INFERENCE OF NODE ATTRIBUTES FROM SOCIAL NETWORK ASSORTATIVITY (Mulders 2020).” For an institutional tradition of research, I cite Robert J. Chaskin and his summary about the Chapin Hall Center for Children at the University of Chicago: “LESSONS LEARNED FROM THE IMPLEMENTATION OF THE NEIGHBORHOOD AND FAMILY INITIATIVE: A SUMMARY OF FINDINGS” (Chaskin 2000).

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

We are now increasingly aware of the perinatal epigenetic factors that affect early childhood, neurological development. Here is a report on the use of a maternal Mediterranean-style diet (MSD) to prevent the occurrence of autism or hyperactivity during childhood (NDD). It represents a study by 7 University-associated, Co-Authors originating from either Maryland, Massachusetts, or Illinois (Che et al. 2023). The results identified a reduction in the incidence of NDD by 26%, especially for birthing persons who were overweight with and without diabetes.

HEALTH may be postulated for a nation’s COMMON GOOD

as the experience of Well-Being that occurs for each

of its resident persons when their lifelong survival has been

A. Endowed by a Family Culture that originates

before ‘his or her’ birth to promote a communal identity

among the caring relationships involving their Family,

Extended Family, and Close Neighborhood to sustain

the synergy between the person’s innate temperament and

baseline homeostasis for building resiliency

during the fetal person’s survival immediately after birth and

for ‘his’ or ‘her’ stable vitality thereafter from their parent-originated,

Personal Survival Plan to become a happy ‘Dependent Person;’

B. Nurtured by the person’s Caring Relationships that originate

from within the person’s Family, its Extended Family, and

their home’s Close Neighborhood 1) during Early Childhood

with a goal to enrich the person’s search for the broadest

portrayal of their uniquely-endowed Human Capability to

become a happy Dependent person AND 2) during

Late Childhood and early Adolescence with a goal to mentor

the person’s cultural and social-cognition for the broadest portrayal

of their uniquely-endowed Human Capability for becoming

a courageous Independent person with Free Will

within their Home’s community after Adolescence;

C. Challenged by the person’s encounter with Chaotic Disruption

involving discordant Social interactions that begin before birth,

occur daily as interacting combinations and patterns, and cause

variably-reversible, beneficent, and maleficent changes to the

resilience of the person’s Anticipatorily-Conscious Human Brain

as variously prevented, mitigated, and ameliorated lifelong

by the person’s Family Culture, by the courageous

caring relationships originating from within ‘his’ or ‘her’ i) Family,

ii) Extended Family, and iii) Home’s close neighborhood as well as

by their Personal Survival Plan, and

by the Survival Commons of their Home’s community;

^ — 59 —

D. Matured by the person’s encounter with Chaotic Disruption

involving diversely complex, traumatic events that begin before birth,

occur episodically 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 Culture,

by the courageous caring relationships originating from within

‘his or her’ i) Family, ii) Extended Family, and iii) Home’s

Close Neighborhood as well as by their Personal Survival Plan, and

by the Survival Commons of their Home’s community; AND

E. Sustained by the person’s Family Culture,

by the hopeful caring relationships originating from

‘his or her’ i) Family, ii) Extended Family, and iii) Home’s

Close Neighborhood as well as

by their Personal Survival Plan and

by the Survival Commons of their Home’s community

until the entropy-laden resilience of the person’s

uniquely-endowed Human Capability is no longer sufficient

to maintain ‘his or her’ survival as a result of their lifelong

encounter with Chaotic Disruption.

COMMENT Milliman is a nationally recognized consulting company with periodic business connections involving the actuarial consultation needs of various health insurance companies. They have publicly reported their analysis of the basic causes of Unstable Health. They are: Social Determinants – 40%; Behavioral – 30%; Healthcare Quality – 20%; and Genetics – 10%.

Given the Milliman findings, it is unlikely that the character of our nation’s Population Health will improve with its medicalization strategy that is currently focused on its market share status. Remember that our nation’s maternal mortality incidence has worsened nearly every year since 1975. Every year, there are nearly 300 Birthing Persons who likely die in association with pregnancy just because they were not living in a ‘Scandinavian’ nation at the time of conception.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

In 2021, the JAMA Pediatrics|Review published a report by Lucinda R. Grummit and 5 associates. The Co-Authors variously originated from Australia as well as from New York and Massachusetts. Here is its title: “ASSOCIATION of CHILDHOOD ADVERSITY WITH MORBIDITY IN US ADULTS a Systematic Review (Grummitt et al. 2021).” Here is the last sentence from its “CONCLUSIONS AND RELEVANCE. The prevention of Childhood Adversity and Disruptive ACEs that link these experiences to elevated disease risk must be considered a critical public health priority (Grummitt et al., 2021).” I would add: nationally, community by community.

SOCIAL STIGMA may be postulated for a PERSON as

an isolated social interaction involving 2 or more persons that

occurs unexpectantly for a variable interval of time,

involves a ‘loss of Human Dignity’ scenario, and

eventually excludes one or more of the participating persons

based on the perception of “Spoiled Identity”

by one or more of the other participating persons.

COMMENT This concept has many dimensions that inform the Chaotic Disruption concept underlying a person’s Well-Being during their lifetime. Most importantly, Erving Goffman Ph.D. laid the groundwork for recognizing Stigma phenomena (Goffman 1963). Obviously, I cited his last book entitled “STIGMA Notes On The Management Of Spoiled Identity.” The definition given above uses the template of SOCIAL INTERACTION as developed by Professor Goffman and included within this Design Epistemology. Human Dignity is also defined herein by Kai Moller, Ph.D. Eventually, this COMMENT will lead to citations that reflect current dimensions for understanding Stigma and its effect on a community’s level of prosociality. — 61 —

“CONCEPTUALIZING STIGMA”

We begin by citing an article, so named, from an Annual Review of Sociology (Link & Phelan, 2001). 15,571 Times since 2001, it has been cited by another article as of July 1, 2025. From its Abstract, I cite its first and last two sentences: “Social Science research on stigma has grown dramatically over the last two decades, particularly in social psychology where researchers have elucidated the ways in which people construct categories to stereotyped beliefs. […] Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people’s lives, stigmatization probably has a dramatic bearing on the distribution of life chances in such areas as earnings, criminal involvement, health, and life itself. It follows that social scientists who are interested in understanding the distribution of such life chances should also be interested in stigma (Link & Phelan, 2001).

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

“The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Action Center” represents the title of a report by 17 co-authors (Dannefer et al., 2020). I cite from its Abstract: “Interviewees felt that collaboration, being responsive to community needs, and being community-based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members’ expectations and hopes for the East Harlem Action Center were consistent with the overall vision for the Action Centers, which may facilitate implementation (Dannefer et al. 2020).”

POVERTY may be postulated for a Community as

the cognitive fatigue of a person’s Human Quantum-Cognitive Brain

that occurs from the incessant Chaotic Disruption associated with

the hypervigilant expression of ‘his or her’ adaptive skills

during the discordant Social Interactions occurring while

the person encounters their community’s Survival COMMONS

to obtain its survival-related, Benefits and Obligations AND

during the discordant Caring Relationships encountered

while marginally maintaining their close neighborhood’s home

for sustaining their own Personal Survival Plan and, if any,

the additional resident persons of ‘her or his’ Family.

COMMENT A person and their Family including its Family Culture, Extended Family, and their close neighborhood, viz. tribal unit, thus becomes the anthropologically fundamental unit for evolutionary human survival. The increasingly rapid worldwide population growth since 1800 has encountered a steady increase in the cultural and social complexity occurring within the civic life of every large city and its densely populated neighborhoods.

Each of these communities struggles with the complexities of housing needs, food insecurity, neighborhood safety, educational needs at a variety of levels, and the resultant complexities of their Population Health. Increasingly, Families need both parents to work for their Family’s survival. Even so, poverty afflicts too many families, especially when encumbered with parental responsibilities. ‘Lap time’ for children contributes substantially to parental cognitive fatigue. Fred Rogers and this aphorism are cited within the article by Louisa Davidson (Davidson 2015).

“The roots of a child’s ability to cope and thrive,

regardless of their circumstances,

lie in that child’s having had at least a small, safe place

( an apartment? a room? a lap? ) in which,

in the companionship of a loving person, that child could discover

that he or she was lovable and capable of loving in return.”

Fred Rogers, Ph.D. (1928 – 2003)

Considering the effects of cognitive fatigue on parents who are coping with poverty, it is likely that 30-40% of all children may have missed the developmental process described above by Fred Rogers, Ph.D. That is, learning how to be lovable is the basis for acquiring the skills necessary to love others. Importantly, the intuitive character of these skills then underlies the caring relationships that are required within every Family. These adaptive skills then ameliorate the occurrence of cognitive fatigue for anyone. — 63 —

Importantly, cognitive fatigue is known to degrade a person’s moral reasoning processes while also responding to complex social interactions involving multiple alternatives for deciding what is best to do. This concept is more thoughtfully explored by Shane Timmons and Ruth MJ Byrne (Timmons & Byrne, 2018). Ultimately, the complexity of POVERTY is immense.

Remember now, the potential benefit of frequent mealtimes is to manage the stress related to a family’s Poverty endurance (Ee 2023). I cite the last sentence of the ABSTRACT from Ashley Teoh Synn Ee’s report: “This study offers an extension to the current literature by examining the role food plays in family culture development (Ee 2023).”

TAXPAYER RELIEF ACT OF 1997 Expanded Child Tax Credit Act 1997 (“CTC”)

“Since 1997, the original CTC benefit had been decreased prior to the COVID-19 pandemic spread to the USA (Robert Hovey 2024, p.590). In response to the COVID-19 pandemic and the economic downturn that followed, the federal government passed the American Rescue Plan Act (“ARPA”) of 2021. Under ARPA, the government used the tax code to provide benefits to struggling families with children by temporarily expanding the Child Tax Credit (Robert Hovey 2024, p.590). Here is the title of the Robert Hovey citation: “A Road to Recovery: Why the Expansion of the Child Tax Credit Should Be Permanent.”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Research reports that evaluated the occurrence of ACEs on lifelong mental health began to occur around 30 years ago, viz., 1997. A Reference published in a 2008 review listed the prior research articles regarding this problem (Afifi et al., 2008). As of January 2024, it had been cited 701 times. Here is the Abstract of the Afifi report: “Conclusions: The estimated proportion of poor mental health outcomes attributable to adversity were medium to large for men and women. Prevention efforts that reduce exposure to adverse childhood events could substantially reduce the prevalence of psychopathology and suicidal behavior in the population.” The American Journal of Public Health published the report. Since 2019, a similar population analysis involving ACEs and diverse lifelong outcomes has been published on multiple occasions. I have cited two:

Danielsdottir, Hilda B. (2024). Its title is: “Adverse Childhood Experiences and Adult Mental Health Outcomes.” This study focused on 25,252 adult twin pairs aged 18-47 years with a birth year between 1959 and 1998. The data was analyzed from April 2022 to November 2023. The occurrence of ACEs was subsequently associated with family violence, emotional abuse & neglect, physical abuse, sexual abuse, rape, hate crime, and correlated with the occurrence of depression & anxiety, alcohol or drug misuse, or stress-related disorders. The analysis took full advantage of its twin-pair (identical & fraternal) study group.

Harter, Cynthia L. & John F. R. Harter (2022). Its title is: “The Link Between Adverse Childhood Experiences and Financial Security in Adulthood.” A financial well-being study framework had been established by the Consumer Financial Protection Bureau. In addition, data was used from within a survey begun in 1984 by the Centers for Disease Control, viz., its Behavioral Risk Factor Survey Alliance System (BRFSS). With 400,000 interviews annually, it represents the largest health survey system in the world. The initial sentence of the Conclusion states: “Having experienced more ACEs is correlated with having more financial stress in adulthood as measured by food security and housing security.”

POPULATION HEALTH may be postulated for a NATION as

each community’s neighborhood-related

patterns of Unstable HEALTH that occur

among the community’s resident persons as a result

of their community’s neighborhood-related encounters with

emergent Chaotic Disruption, which variously disturbs the resilience

of each resident person’s Stable HEALTH and may require

a collaborative obligation by their community’s Survival Commons

to prevent, mitigate, and ameliorate the harmful effects caused

by these recurring Chaotic Disruptions, and thereby minimizing their

disturbance to the continuing resilience of each neighborhood person’s

innate temperament and baseline homeostasis for Stable HEALTH.

COMMENT Prior to the above definition, there has been a fitful effort for 20+ years to define POPULATION HEALTH as an independent phenomenon. As yet, there seems to be minimal progress toward achieving any converging consensus. An initial surge of multiple proposals by pre-eminent scholars occurred 15-20 years ago to explore a robust conception. These eminent scholars included Barbara Starfield (Starfield 2001), Sandro Galea (Galea et al. 2005), David Kindig (Kindig 2003 & 2007), and A DICTIONARY OF EPIDEMIOLOGY by Miquel Porta (Porta et al. 2014). — 65 —

During 2021-22, another effort by several scholars suggested an even wider consideration for defining Population Health. I recognize the contributions from C.J. Peek (Peek et al.. 2021), Mark Fineberg (Fineberg et al., 2022), David Kindig (Kindig 2022), and Craig McEwen (McEwen 2022). The definitions proposed herein attempted to encompass the Cosmological, Biological, and Human Dignity dimensions of every community’s resident persons within their nation.

Most succinctly, an article appeared in the 2023 edition of The Milbank Quarterly (Lantz et al., 2023). Using a medicalization theme for understanding the perils underlying the pervasive cost and “health equity” problems afflicting our nation’s Human Dignity (Lantz et al., 2023). It summarizes the paradigm paralysis underlying the institutional preoccupation with market share priorities within every community, especially our Nation’s maternal mortality rate.

SURVIVAL COMMONS AND CHILDHOOD DEVELOPMENT

The POPULATION HEALTH definition, cited above, refers to a Survival C.OMMONS. Its full definition is on pages 62-64. The Survival COMMONS concept represents a definition that proposes to formally establish each community’s responsibility to assess and refine the resiliency of its own SAFETY NET. Since the generational heritage of each community is unique, its own Survival COMMONS would identify the uniquely evolving occurrence of individual and family needs, especially with a focus on early childhood development.

ADOLESCENT DEVELOPMENT

The complexity of this definition for “Population Health” may be most fully appreciated by a citation that refers to the lifelong career findings of Murray Bowen, M.D. (1913-1990). Some will remember his development of a Family Systems Theory. I have chosen a citation from a book written by his associate C. Margaret Hall, Ph.D. (Hall 1991) entitled BOWEN FAMILY SYSTEMS AND ITS USES. Here is a citation from pages 36-37 of her book:

“One of the most important premises of Bowen’s theory is that a family is the most tightly bonded emotional system an individual participates in for an extended period of time. Not only do family relationships, for most people, largely define a person’s life situation at birth and in the years of early socialization, but they also strongly affect an individual’s behavior at all stages of life. Even though family members may be widely dispersed geographically or separated through institutionalization or death, some degree of emotional “bondedness” persists, especially in relation to their family of origin.

The emotional intensity of a family system increases during its relationship crises such as birth, abortion, loss, sickness, marriage, divorce, separation, institutionalization, or delinquency. According to Bowen’s theory, it is more difficult to be a self in a family than to be a self in comparatively transient groups, which make fewer and less persistent demands. A related hypothesis is that self can be differentiated more effectively in an individual’s family, as other social contexts do not provide a sufficiently challenging, lasting, and reactive arena for this difficult sequence of behavior.

Effective differentiation of self generally creates a crisis in the emotional relationships of the differentiating person’s family. Differentiation of self may also consist of planned responsible behavior in major crisis, such as death of a significant family member. Some preconditions appear necessary for successful differentiation. Only if relationship issues are dealt with in an emotionally reactive system that will not easily disband, can an individual respond fully to the feedback needed for long-term emotional maturation or differentiation. Only in a family network, can solid self most meaningfully encounter and deal with ingrained patterns of behavior which were and continue to be intimately related to self (Hall 1991).”

NOTE: As an aside to the above, I recommend a ‘scoping review’ article that focused on the current Bowen ‘Family Systems’ Theory (Calatrava M et al. 2022). It also has a focus on the ‘Differentiation of Self’ developmental transition.

COMMUNITY BY COMMUNITY

As a model for substantial change, the 63rd Congress passed the Smith-Lever Act in 1915 to establish the Cooperative Extension Service in connection with each State’s federally supported College of Agriculture. “Extension” developed an intentional connection between the College of Agriculture and its state’s farmer-operated food production. Thus, the “Ag Colleges became more familiar with their unresolved problems, and the farmers learned more precisely about newly evolving farming methods. As a result, our nation’s farming industry represented approximately 60% of national total employment during 1930. By 2020, it was 1%. No other worldwide nation even approaches that level of efficiency. Argentina is the only nation that comes close at around 50% as efficient compared to the USA.

The same 63rd Congress also passed legislation to authorize the formation of the Federal Reserve. It functions as a semi-autonomous Federal institution with the responsibility to stabilize the value of the dollar within the international exchange of monetary assets. As a result, the stability of the US Dollar remains the essential basis for the international transfer of economic assets. — 67 —

Obviously, we should not want for possible models to improve our nation’s Population Health. Noteworthy, our nation’s maternal mortality incidence has worsened steadily since 1975, especially since 2019. There is a very large commitment to improve the “quality” of maternal healthcare. However, there is essentially no pervasive evidence that it has or will ever be substantially successful. An “antibiotic model” for identifying a positivist, reductionist model to reduce maternal mortality is unlikely to succeed, especially for certain ethnic Birthing Persons. This result has not occurred because of a lack of focus, commitment, or urgency from within our nation’s healthcare industry regarding this devastating loss of Human Dignity. A nationally sanctioned, Complex Adaptive System will be required to apply a Population Health strategy with a generational, neighborhood-by-neighborhood focus.

To add a strategy for selecting a measurement typology for maintaining a population science analysis regarding stress measurement, I recommend pages 163 and 164 of the 2018 report by Elissa S. Epel and her seven associates (Epel 2018). Any effort to implement a Complex Adaptive System to guide the justly efficient and predictably effective attributes of our Nation’s Stable HEALTH will require, presumably, 810 District Communities. Each will establish, regionally publish, and regularly refurbish their own Survival Commons and its monitoring strategy.

Given the early-century, paralysis afflicting our nation’s Federally centralized and autocratic government, we will eventually need to consider a State-by-State, strategic process. Ultimately, the State-by-State strategy must begin simultaneously within a 3-year “starting gate” by each of 810 contiguously connected, Community Districts. These Districts would, on average, encompass 400,000 resident persons. Each Community District would promote the formation of a Community HEALTH Forum to reduce the incidence of neighborhood-related Poverty and its Population Health associated deficits.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Historically, Canada was the first nation to be faced with online access to Population Health data for its citizens, soon after 1975. This occurred after their healthcare system was financially nationalized in 1973. As a result, the Canadian Minister of National Health and Welfare initiated an analysis that was released in 1974. viz., the Marc Lalonde Report: “A NEW PERSPECTIVE ON THE HEALTH OF CANADIANS a working document” (Lalonde 1974).

Subsequently, three reports focused on the occurrence of ACEs. First, I cite Clyde Hertzman who may be the initial pioneer for recognizing the critical developmental transitions that can be damaged by co-occurring events. With several related articles, I cite his most important: “The Lifelong Impact of Childhood Experiences: A Population Health Perspective” (Hertzman 1994). Second, I cite an article that may represent the first evidence to verify the relationship between low birth-weight at birth and maternal socioeconomic disadvantage. Here is the article’s title: “Birth weight and later socioeconomic disadvantage: evidence from the 1958 British cohort study” (Bartley 1994). And finally, here is a report from an economist at the University of Toronto, Daniel Trefler: “Looking Backward: How Childhood Experiences Impact a Nation’s Wealth (Trefler 2004).”

———— C O M M U N I T Y T H E M E ————

# 5 of 6

SOCIAL DILEMMA INSTITUTION

COLLECTIVE ACTION COMMUNITY

SOCIAL CAPITAL SURVIVAL COMMONS

— 69 —

SOCIAL DILEMMA may be postulated as

a Social Interaction involving two or more persons,

who assemble for a ‘collective action’ scenario

involving the distribution of a public good

within a mutually acceptable time dimension,

for which one or more persons may choose

to acquire a short-term benefit for themselves rather

than expressing the prosocial norms that are necessary

for all the persons to receive the most equitable benefit.

COMMENT: Imagine an event involving four cars that arrive at a four-way, stop-sign-regulated intersection at about the same time. The first arrival, not fully stopping, goes first. One of the remaining three cars suddenly goes next, followed sequentially by the other two cars. The cars following the first and second cars are susceptible to an accident amidst this suddenly evolving “Social Dilemma.” This represents a classic, public goods event in which there was a conflict between the individual and the collective interests involving the requisite expressions of trust, cooperation, and reciprocity among the participants.

Collective action situations have been studied extensively. The results generally indicate that some participants are more likely than others to intuitively apply trustworthy, cooperative, and reciprocal ‘prosocial norms’ for resolving a Social Dilemma encountered within a research study. They do the same while participating in the municipal life of their own community. Increasing each community’s expression of ‘prosocial norms’ then becomes the basis for enhancing the resilience of their Survival COMMONS for the community’s POPULATION HEALTH. As defined earlier, ‘prosocial norms’ are considered the basis for each community’s level of Social Capital, viz., as noted on page 64.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Here is a review by a collaborative ‘cluster’ of 11 persons representing diverse academic pursuits within Australia (Mehta 2023) and its title: “Child Maltreatment and Long-Term Physical and Health Outcomes: An Exploration of Biopsychosocial Determinants and Implications for Prevention.” From the review’s Abstract, I cite the following: “The review takes a systems approach to child maltreatment outcomes through its focus on the overall burden of disease, gene-environment interactions, neurobiological mechanisms, and social ecologies linking maltreatment to mental ill-health (Mehta 2023).” This may well represent one of those sentinel articles about mid-life mental health that will continue to be cited after 2034.

From the January edition of HEALTH AFFAIRS in 2025, a group of representative scholars from the Census Bureau, Centers for Disease Control (CDC), and the University of Michigan contributed a collaborative article entitled: “Adverse Childhood Experiences: Increased Likelihood of Socioeconomic Disadvantages for Young Adults (Ratcliff et al. 2025). Here are the 2nd, 3rd, and 4th sentences of the article’s – ABSTRACT – “For this study of 930,000 children born during the period 1999-2003, we used linked administrative, survey, and criminal justice data to measure the association between ACEs (parental death; separation; incarceration; or criminal charge for intimate partner violence, substance use disorder, or child sexual or nonsexual abuse) and socioeconomic disadvantages at ages 18-22 during 2017-2021. After childhood socioeconomic status was controlled for, young adults with ACEs were more likely to have been charged with felonies, have become teenage parents, live in a household with poverty or housing assistance, be enrolled in Medicaid and not be employed, and were less likely to be enrolled in an educational institution. These outcomes were most likely among young adults with multiple ACEs or lower childhood socioeconomic status (Ratcliff et al., 2025).”

Within the text of the article, two prominent by-lines appeared: “Analysis of cumulative ACEs supported previous studies documenting a dose-response relationship between ACEs and harmful long-term outcomes.” AND “Evidence on the long-term socioeconomic burden of childhood adversity is essential to increase understanding of the value of investments in prevention studies (Ratcliff et al., 2025).” — 71 —

“INSTITUTIONS

are the prescriptions that humans use to organize all forms

of repetitive and structured interactions including those within families,

neighborhoods, markets, firms, sports leagues, churches,

private associations, and governments at all scales.

Individuals interacting within rule-associated 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, the benefits they obtain or are excluded from, and

how they reason about the situation are all affected by the rules or the

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 the collective-choice rules used to structure their deliberations and

decisions. If the individuals who are crafting and modifying rules

do not understand how particular rules affect actions and outcomes

in a particular ecological and cultural environment, rule changes may

produce unexpected, and at times, disastrous results (E. Ostrom, 2005).”

COMMENT The definition above can be found within the first paragraph, page 3 of the book entitled: “UNDERSTANDING INSTITUTIONAL DIVERSITY (E. Ostrom 2005).” This book probably represents the most important accomplishment, among many, of Elinor Ostrom. I cite her reasoning for the purpose of this book from page 29: “Without the capacity to undertake systematic, comparative institutional assessments, recommendations of reform would be based on naive ideas about which kinds of institutions are “good” or “bad” and not based on an analysis of performance.” This book laid out a comprehensive structure, the IAD Framework, as the basis for analyzing complex socio-ecological problems. Here is a commonly cited reference by Professor Ostrom for an application of the IAD Framework (Ostrom 2007). I quote the last sentence of its Abstract: “The framework is intended to be a step toward building a strong interdisciplinary science of complex, multilevel systems that will enable future diagnosticians to match governance arrangements to specific problems embedded in a social-ecological context.”

Historically, she had cited a reference to Douglas C. North (North 1990) and his view of the distinction between an institution and an organization. The Ostrom definition cited above for an institution ends with a curious admonition. It ends with a sentiment that was also voiced by Thomas Jefferson regarding our nation’s governance (see the Preface, page 4). As voiced by an unknown author, “If you do what you’ve always done, you will get what you’ve always gotten.” See the website “Quote Investigator” for its analysis of the “unknown author.”

As defined by Douglas C. North, “Organizations include political parties (Political Parties, the Senate, a City Council, a regulatory agency), economic bodies (firms, trade unions, family farms, cooperatives), social bodies (churches, clubs, athletic associations), educational bodies (schools, universities, vocational training centers). They are groups of individuals bound by some common purpose to achieve their objectives. Modeling organizations is analyzing governance structures, skills, and how learning by doing will determine the organization’s success over time (North 1990, p. 5).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Herein, I cite another study from the Federal government’s Agency for Healthcare Research and Quality involving its long-standing, nationally representative MEPS study group of @10,000 households (Decker 2024). On page 4, I cite the first sentence under the Discussion paragraph header: “Using nationally representative data, we found that in 2021 42.8 percent of US children lived in a household with an adult who had experienced four or more ACEs. […] Fewer than one-fifth of children lived in families whose Adult or Adults had not experienced any ACEs (Decker 2024).” This study added further analysis to the ACEs socio-ecologic, dose-response character.

COLLECTIVE ACTION may be postulated as

a Social Interaction involving an initial cluster of three or more persons who collaborate with diverse combinations of ecological and cultural congruence and their attributes of Prosociality for achieving a Goal to improve their status or the status of another cluster by:

1. formalizing a Visioning Statement to achieve the initial cluster’s Goal, especially when acting on behalf of one, or more than one, social network;

2. preparing an Action Plan for achieving the initial cluster’s Visioning Statement, especially when this Visioning Statement requires a set of Specific Tasks for managing a Common Pool Resource; and

3. delegating the Action Plan responsibilities to one, or more than one, of the following three options: a. the initial cluster itself, b. another cluster of persons, or c. an incorporated private or public institution selected by the initial cluster.

COMMENT Mancur Olson, Ph.D. wrote the sentinel reference for collective action, viz., its title: “THE LOGIC OF COLLECTIVE ACTION Public Goods and the Theory of Groups (Olson 1965).” Importantly, the definition for Collective Action given above describes the importance of a defined Visioning Statement (viz., Vision, Mission, Principles) and Action Plan (viz., Strategic Development Plan). It also alludes to alternate types of collective action, as in the collective impact model.

The steady development of collaborative processes, community by community, to manage their own Survival COMMONS in association with their contiguously adjacent communities is likely to represent a highly diverse occurrence of ‘fits and starts.’ At least 810 Community HEALTH Forums would be contiguously formed nationally with population clusters involving @400,000 resident persons. Each Forum would manage the sustainable resiliency of their own community’s Survival Commons in association with their contiguously adjacent communities within each State. — 73 —

This Design Epistemology includes a definition for each community’s Survival COMMONS (See page 76). Locally initiated and supported, each Community HEALTH Forum could then become eligible for nationally instituted certification to receive technical support from NATIONAL HEALTH. Grappling with adverse, locally entrenched ecological and cultural traditions will require a substantial effort within every community. It is likely to represent the linchpin strategy for ultimately improving our nation’s social cohesion for its Population Health.

As a reminder, collective action by itself does not automatically achieve a positive goal that promotes caring relationships and Social Capital. Only one question would accurately measure the Collective Action occurring within a community that augments its Survival Commons: “To what extent does each of a community’s neighborhoods share their own resident persons with each other’s Extended Family?”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Three collaborating authors applied evidence from a population birth cohort study that focused on child abuse, presumably well within the realm of ACEs as we currently acknowledge them (Pereira et al. 2021). Importantly, the self-report of abuse after age 16 years that had occurred during earlier childhood was evaluated. I cite the study’s Conclusions: “In a population cohort, adult retrospective report of child abuse was associated with several harms, prospectively measured from childhood to adolescence, providing support for the validity of retrospective report-based research. Findings suggest retrospectively reported child abuse is not biased by depression in adulthood (Pereira et al. 2021).”

COMMUNITY may be postulated for POPULATION HEALTH as

a cluster of persons, most commonly recognizable as the persons residing

within a municipality’s geographic border AND characterizable

by the unique history of its ecological and cultural heritage,

who participate in more than one social network of the cluster

to obtain certain prosocial benefits from each network’s

intuitive spontaneity and to acquire a valued awareness

from their identity with these social networks that is borne out

of their social interactions occurring within these social networks and

each person’s cumulative association of these social interactions

with the memories of their own ecological and cultural traditions.

COMMENT This definition originated from A COMMENTARY essay written by David M. Chavis and Kien Lee for the Stanford SOCIAL INNOVATION Review (Chavis & Lee 2015). It has been augmented to account for the large variety of social networks occurring within most communities. The prosocial evolution of these social networks then augments their community’s social capital and its annual contribution to offset the entropy-laden depreciation of their nation’s Social Cohesion.

For this Design Epistemology, each District Community, viz., page 86, would represent, on average, 400,000 resident persons within the border of any State as primarily defined by each Community HEALTH Forum’s, contiguously connected counties. Any District Community with a low-density population must be comprised of at least 100,000 resident persons. The community median for resident persons would evolve every 10 years based on the distribution of Community HEALTH Forums individually accounting for a number of resident persons above and below the median size.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Ultimately, every person’s experience of sustainably resilient Well-Being is dependent on their housing stability. The occurrence of being evicted from a person’s home was the subject of a classic book about homelessness by Matthew Desmond (Desmond 2016) entitled: “EVICTED Poverty and Profit in the American City.” It represents a chronology of events that degrade the home life that is critical for any person, especially if they are responsible for a family. To understand the effect of Housing Instability on children, I refer to a report from Katherine Marcal (Marcal 2018) entitled: “The Impact of Housing Instability on Child Maltreatment: An Investigation.”

From the Marcal report’s Abstract, I cite its last two sentences: “Families experiencing housing problems likely have a range of needs that require earlier, targeted intervention to mitigate the consequences of poverty, domestic violence, and maternal depression. Child welfare services should invest resources in housing assistance programs in-house as well as through partnerships with local public housing authorities to stabilize families, reduce housing-related strain on caregivers, and promote family preservation (Marcal 2018).” — 75 —

SOCIAL CAPITAL may be postulated for HEALTH as

the intuitive immediacy for offering a Prosocial Greeting when

encountering another person within their community’s municipal life that

becomes increasingly prevalent among the community’s resident persons

when multi-generational, caring relationships progressively populate

the community’s micro-, meso-, and macro- social networks.

COMMENT This definition of Social Capital is uniquely phrased for this Design Epistemology. It reflects an emphasis on the character of the social networks within a community and how they do or do not maintain caring relationships among and between their micro-, meso-, and macro- social networks. For a uniquely comprehensive bibliography and periodic analysis of Social Capital, Tristan Claridge, M.S. initiated, long ago, an online Institute for the diverse phenomenology associated with the concept of Social Capital (Claridge 2005). Notably, he lives in New Zealand.

Ultimately, the prevalence of each community’s prosociality and its steady improvement over time contributes to their ‘appreciation rather than depreciation’ of their nation’s Social Capital and its associated Social Cohesion. It is likely that our nation’s locally prevalent social determinants of health will not be resolvable without a nationally sanctioned and locally driven strategy to refurbish every community’s prosociality, neighborhood by neighborhood, and viz., its related Capability Traps (Landry & Sterman 2017).

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

Assuming that a child’s development encounters a steady exposure to ACEs while his or her family survives amidst pervasive poverty, what might be his or her lifelong disability? I cite the ABSTRACT of a collaborative report by 6 Co-Authors from New York, Michigan, and Texas (Perkins et al., 2024). Here are its Abstract’s first and last sentences: “Childhood poverty is related to deficits in multiple cognitive domains including adult function. […] Childhood poverty disrupts language processing neural networks in adulthood, after controlling for phonological awareness, suggesting that poverty in childhood influences the neurological basis for language processing in adulthood. (Perkins et al., 2024).”

SURVIVAL COMMONS may be postulated

for POPULATION HEALTH and PRIMARY HEALTHCARE as

an evolving Cluster Of Functionings for a community (Sen 1994)

that are intended to prevent, mitigate, and ameliorate

the neighborhood-related Unstable Health occurring among

its resident persons from the continuing occurrence

of Chaotic Disruptions for which the Cluster is:

A. Assembled in accordance with their nation’s laws and regulations,

at all jurisdictionally nested scales applicable to the public and

private institutions within their community for promoting

a resilient SAFETY NET for its resident persons;

B. Enhanced by the daily greetings of Kindness and Respect occurring

within the municipal life of their community’s resident persons,

especially when each resident person safely offers

a Salutary Greeting to each person they encounter and

each of these persons responds with an appreciative gesture;

C. Offered by each municipal community to its resident persons

who each may select from among their community’s

Cluster Of Functionings, those Benefits and Obligations

most suitable for the needs of their own and, if any, the needs

of their family’s Personal Survival Plan(s) which are offered

from within their community’s Ecological and Cultural traditions;

D. Improved by each municipal community’s volunteer, resident persons

who become aware that their community’s SAFETY NET

requires the resolution of certain discontinuities with an

equitably available, ecologically & culturally accessible,

justly efficient, and dependably effective Vision and Action Plan;

^ — 77 —

E. Augmented by the collective action strategies originating from

within each community’s private and public institutions, as well as,

its social networks to prevent, mitigate, and ameliorate any

‘newly recognizable adversity’ encountered by its resident persons

that is related to a locally prominent discontinuity among

the community’s Cluster Of Functionings or

its associated Benefits and Obligations, especially

if the ‘newly recognizable adversity’ is associated with

a birthing person, homelessness, poverty, or ageism;

F. Protected by the community’s Master Disaster Planning Strategy

that is reviewed and revised annually to prevent, mitigate, and

ameliorate the Chaotic Disruptions occurring locally or

may occur in the future to affect

the neighborhoods of the community’s resident persons and

their ability to maintain their own Personal Survival Plan, especially

for those resident persons afflicted by social isolation or the loss

of Human Dignity in association with Human Trafficking; AND

G. Supported by the community’s reciprocating collaboration

with their contiguously adjacent communities and

by their nation’s expression of social cohesion when interacting

within the worldwide marketplace arenas for every other nation’s

Resources, Knowledge, and Human Dignity.

COMMENT Assuming that Congress will charter the formation of NATIONAL HEALTH, each of its nationally recognized District Communities would form a Community HEALTH Forum. Each Forum would pursue certain responsibilities as defined for this recognition, such as the community’s support for locally sustainable collaboration to maintain their District Community’s Survival COMMONS. This phenomenon, viz., an augmented safety net, has already been variably formed, community by community, to manage a variety of problems related to a family’s socio-economic status (SES), especially its maternal mortality. Ironically, it is now 60+ years since President Lyndon Johnson initiated his “War on Poverty” in 1964.

National Health Spending continues to increase faster than our nation’s economic growth, and our nation’s annual maternal mortality rate continues to worsen, as it has since @1978. Both of these phenomena represent the underlying and unabated upstream problems that occur within the neighborhoods of every community. Developing a Survival COMMONS within every District Community will be very important to resolve the CAPABILITY TRAP that underlies ACEs and their occurrence for children and adolescents.

Among many others, I cite a research article by Vahid Fafhihi, Amy Kin, and David Ford that was published in 2023. Here is its title: “Designing Sustainability Programs to Escape the Capability Trap (Fafhihi et al.).” Remarkably, a report by two engineers (Landry & Stermin, 2017) represents the best analysis of the ‘Capability Trap’ phenomenon. It is likely that a Congressionally Chartered, thinly nested, and regionally decentralized institution with a fixed budget will be required. Both citations are easily downloadable from Google Scholar.

Every community’s SURVIVAL COMMONS specifically depends on the prevalence of its resident persons’ Volunteer commitment. Fostering this community attribute promotes its SOCIAL COHESION which directly boosts the prevalence of its Prosocial Norms within its community’s Families. An article that appeared in 2024 attests to this phenomenon (Davies et al., 2024). Here is its title: “The Causal Relationship Between Volunteering and Social Cohesion: A Large Scale Analysis of Secondary Longitudinal Data.”

FUNCTIONINGS

Amartya Sen apparently helped to originate this odd concept with his prescient analysis of poverty many years ago (Sen 1994). FUNCTIONINGS referred to the poverty-associated personal adaptive skills that were deficient for pursuing the Global Goals related to ‘his or her’ Well-Being capabilities and their Functionings related to survival. The capabilities terminology eventually received considerable attention from Martha Nussbaum and her connections with other philosophers. Their articles eventually became mutually associated with a “capabilities approach” genre. In effect, a community’s SURVIVAL COMMONS would currently become a community’s institution for arranging the local array of FUNCTIONINGS as the Benefits and Obligation applicable for every resident person’s ‘Safety Net.’ — 79 —

STRONG NEIGHBORHOODS

I propose that the ultimate key to achieving Well-Being for every resident person will NOT be possible without substantially resolving the existence of poverty, neighborhood by neighborhood in every community. During my continuing search for meaningful reports, I heartfully recommend the Special Report by Seth Kaplan at the MERCATUS CENTER, George Mason University, Arlington, Virginia. I cite the last two sentences of its ABSTRACT: “The role of institutions is key to reviving a neighborhood. The way these institutions structure — or fail to structure — relationships at the neighborhood and inter-neighborhood level affects the vitality of each locale and the Well-Being of everyone living there (Kaplan 2022).”

Tara Mahoney and her associates have compiled a similar report. They hail from Simon Fraser University in Vancouver, British Columbia, Canada. I cite from their Introductory Page regarding its regional impetus: “Our aim is to act as an infrastructure for community-engaged research rooted in values of reciprocity, collaboration, equity, justice, and social transformation (Mahoney et al. 2021).” Their SFU Community-Engaged Research Institute (CERI) retains the copyright.

FAMILY RESILIENCY

To begin, we might view biological survival as an innate cluster phenomenon that is initiated from within the Quantum Physics of matter, viz., Max Planck’s definition cited on Page 6.

And, to continue, a family tipping point might be best identified by a father’s, steadily literal and salutary presence for his child’s mother. I fully recommend the analysis of this family tipping point by 5 Co-Authors from the University of Rochester in New York (Alio et al., 2013).

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

A uniquely formed research group {representing University de Montreal (Canada) and the University of Edinburgh (United Kingdom)} assembled to study the ‘Growing Up in Scotland’ birth cohort data and an annual assessment through 7-8 years of age (Blair 2019). The report’s Abstract for their research began with its “Objectives – To assess what proportion of the association between low income and the incidence of adverse childhood experiences (ACEs) would be eliminated if all households had access to housing, transportation and childcare services, breastfeeding counseling, and parks (with a <10-minute proximity).” The initial cohort was N=5217 and ended with N=2816 and 7 total data sets.

I now cite from its: “Results – The protective effects of resources were heterogeneous. Only access to transportation was associated with lower ACE incidence in both low- and higher-income households. If all households (my edit) had access to transportation, 21% (95% CI 3%, 41%) of the income-based inequality incidence of 3 or more ACEs could be eliminated.” Finally, I cite its: “Conclusions – While second best to the elimination of child poverty, measures to improve families’ access to community resources such as transportation may mitigate the effects of poverty on ACEs incidence (Blair 2019).”

NEXT, I just now this afternoon finished reading a report published in HEALTH AFFAIRS this month, August 17, 2024: (Thomas et al 2024). All four of its authors hold positions at the Agency for Healthcare Research (AHRQ) and Quality in Rockville, Maryland. Here is its title: “Adverse Childhood Experiences: Healthcare Utilization And Expenditures In Adulthood.” Its ABSTRACT begins as follows: “Adverse childhood experiences (ACEs) have been shown to be strong predictors of socioeconomic status, risky health behaviors, chronic health conditions, and adverse outcomes. However, less is known about their association with adult healthcare utilization and expenditures.”

“We used new data from the 2021 Medical Expenditure Panel Survey (aka MEPS). Compared to demographically similar adults without ACEs, those with ACEs had substantially higher utilization and 26.3 percent higher health expenditures. The aggregate spending difference across the 157.6 million US adults with ACEs was $292 billion in 2021. We also found associations between ACEs and a range of adverse adult circumstances, also newly measured in the 2021 MEPS, including financial and housing problems, social network problems, little or no life satisfaction, stress, food insecurity, verbal abuse, physical harm, and discrimination (Land et al, 2024).”

As an aside, the AHRQ group has been in existence for many years. The MEPS study is a major research project at AHRQ that represents an annual survey of some 10,000 adults who are periodically, individually replaced to maintain a nationally representative, non-institutionalized study group. The MEPS reports have been published annually for more than 20 years. This study is probably the best for an annual evaluation tool to monitor the status of our nation’s socio-economic CAPABILITY TRAPs (Landry & Sterman, 2017) that variably exists, neighborhood by neighborhood, in every community. — 81 —

HOMELESSNESS

It seems as though the lifelong outcome of a person’s social interactions with *) Chaotic Disruption involving ‘his’ or ‘her’ uniquely-endowed Human Capability, *) the absence of an enduring Family, AND *) their community’s lack of a sustainably resilient ‘Safety Net’ may interact to eventually cause a person’s HOMELESSNESS. I cite the most recent Literature Review of Homelessness that is entitled: “Homelessness and nature across landscapes and disciplines: A literature review (Land & Derrien 2025).” Within a theory of philosophy, it might be described as a typology.

From a 5-Author collaboration originating from the Western and McMaster Universities in Canada (Plett et al., 2024), I cite its title: “Belonging through meaningful activity in the transition from unhoused to housed.”

I cite its Summary Abstract:

“BACKGROUND Belonging is closely associated with well-being, yet individuals with experiences of being unhoused are likely to experience social exclusion and challenges with developing a sense of belonging. Engagement in meaningful activity has been linked to belonging; however, there are no focused studies exploring experiences of how engaging in meaningful activities influences belonging. Meaningful activities are things we do that bring value to our lives.
PURPOSE To explore how engaging in meaningful activities may influence experiences of belonging following homelessness through a secondary analysis of qualitative interviews.
METHOD Using interviews conducted in a community-based participatory action study exploring the transition to housing following homelessness (n = 19), we conducted a thematic analysis using the method described by Braun and Clarke. Participants were recruited through communication with local organizations supporting individuals with lived and living experiences of being unhoused as well as through presentations at drop-in organizations. An intentional effort was made to recruit diverse participants regarding housing status, age, and gender. Inductive analysis was used to conduct initial coding, focusing on belonging and engaging in meaningful activities. We then analyzed the codes abductively, using Bourdieu’s Social Capital Theory to inform this analysis.
FINDINGS The overarching essence generated in our analysis was: “I don’t feel like I belong…everything in the world is not for me…it’s for people wirh…enough money to…enjoy those things.” Within this overall essence, we generated three themes: 1) Human connection: “being where I am with people who care about me, I actually feel good”; 2) Social Exclusion: being a “regular member of society”; and 3) non-human connection: “my cats…are like my kids to me.” Participants described numerous contextual factors that challenged them as they sought belonging following homelessness, including financial limitations and other societal factors.
CONCLUSION Our findings suggest that meaningful activity was an important pathway to belonging for the participants in this study (Plett et al, 2024).”

————– N A T I O N T H E M E ————–

# 6 of 6

HEALTH CARE PRIMARY HEALTHCARE

COMMUNITY DISTRICT MANAGING THE COMMONS

SOCIAL COHESION COMMON GOOD

— 83 —

HEALTH CARE may be postulated for HEALTH as

the preservation of a person’s Stable Health

by a specific health service encounter that is

recognized by its designation as a uniformly identifiable unit of

health services for research, professional, or institutional reimbursement;

provided during a social interaction involving

a caring relationship with a professionally licensed person; and

defined as HEALTHCARE, when it is characterized

by two or more continuing HEALTH CARE encounters,

occurring over a variable period of time.

COMMENT Both ‘Health Care’ and ‘Healthcare’ usually involve unpredictable professional activities to improve the precision of Health Care for promoting a person’s Stable Health. With frequent shifts between alternate diagnostic hypotheses and their associated deductive or pragmatic reasoning processes require extended periods of study and experience, e.g., 8-10 years, for a physician to acquire the adaptive skills for managing the pattern recognition scenarios required by their professional Cultural-Social cognition.

BASIC HEALTHCARE VS COMPLEX HEALTHCARE

It is best to differentiate Basic Healthcare Needs for Primary Healthcare as compared to Complex Healthcare Needs, as follows.

a. BASIC HEALTHCARE NEEDS may be postulated as the prosocial opportunity to mentor a person’s priorities for preserving their uniquely-endowed Human Capability and any supportive COMPLEX HEALTHCARE NEEDS by offering the following:

i. the equitably available as well as ecologically and culturally accessible medical TRIAGE that is telephonically offered to a person continuously for the occurrence of any emergent, urgent, or expectant HEALTH Condition involving a potential requirement for Health Care, especially for a HEALTH Condition possibly requiring referral to a Specialist Physician;

ii. the diagnosis and treatment of *) an urgent or expectant HEALTH Condition possibly representing a disease for which its timely treatment would improve a person’s Stable Health, *) any new or recurring HEALTH Condition possibly associated with a disease for which the person’s Stable HEALTH would be more likely preserved by its situationally-timely diagnosis and treatment, and *) any unchanging or uncomplicated disease for which its regular reassessment would likely mitigate and ameliorate its effects on the person’s Stable Health; and

iii. the periodic reassessment of a person’s overall Stable HEALTH as the basis for determining the person’s priorities for defining a Comprehensive Care Plan a) to sustain their Stable HEALTH, b) to coordinate this Care Plan with any co-occurring Complex Healthcare Needs, and c) to support the provisions for the person’s Personal Survival Plan (see essay 6a).

b. COMPLEX HEALTHCARE NEEDS may be postulated as

i. the diagnosis and treatment of emergent HEALTH Conditions &

ii. the diagnosis and treatment of any new or previously established HEALTH Condition requiring the skills of a specialist physician including the coordination of any immediacy that may be

required.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

An article (Austin et al., 2023) reported that “States in the US have the option to eliminate the asset test and/or increase the income limit for SNAP eligibility under a policy called broad-based categorical eligibility (BBCE). Given associations of economic hardships, including food insecurity, with child protective services (CPS) involvement, state adoption of these policies may be associated with changes of their CPS-investigational rates.” From the article’s CONCLUSIONS AND RELEVANCE, here is its first sentence: “Results from this cross-sectional study suggest that state expansion of SNAP eligibility […] may contribute to decreases in rates of CPS-investigational reports (Austin et al., 2023).”

PRIMARY HEALTHCARE may be postulated for a NATION as

the HEALTH CARE for each of a community’s resident persons

that its municipal leaders and stakeholders promote to ensure that

equitably available, ecologically & culturally accessible,

justly efficient, and dependably effective HEALTH CARE

exists for the ‘Basic Healthcare Needs’ of each person and

the coordination of these ‘Needs’ with any HEALTH CARE

required for a resident person’s ‘Complex Healthcare Needs.’

COMMENT This is a very compact definition for which several other definitions are required: PRIMARY HEALTHCARE TEAM, HEALTH Condition, medical TRIAGE, and PRIMARY PHYSICIAN. They are defined within the GLOSSARY For HEALTHCARE of the book entitled: BETTER HEALTH FOR AMERICA (Nelson 2021).

The first appearance of Primary Healthcare within a glossary or lexicon would most likely be attributable to a definition established by the World Health Organization in 1975 (WHO 1975). Cited below, it ascribes more clearly to an emphasis that Primary Healthcare is necessary for honoring a nation’s social contract, viz., its Common Good. — 85 —

“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.”

As our nation continues to survive within the 21st century, the WHO definition for Primary Healthcare should persistently remind us that the Population Health of each community’s resident persons evolves within the context of their Nation’s Common Good. The need to improve the international prevalence of Social Cohesion will not occur for Stable HEALTH without the annual collaboration between each Nation and its bordering associated nations that is focused primarily on Social-Ecological strategies for improvement.

< ADVERSE CHILDHOOD EXPERIENCES >

I cite what is likely the first reported analysis of ACE phenomenon in 1994 by a Canadian pediatrician at the University of British Columbia (Hertzman, 1994). Here is its title: “The Lifelong Impact of Childhood Experiences: A Population Health Perspective.” Canada had nationalized its healthcare system in 1974. Suddenly, the prospect of a very large accumulation of data represented an opportunity to assess broader phenomena. This led to the establishment of the Canadian Academy of Health Sciences Expert Panel’s report: “EARLY CHILDHOOD DEVELOPMENT: ADVERSE EXPERIENCES and DEVELOPMENTAL HEALTH (Boivin & Hertzman, 2012). As a model for a Pediatric, Population Health Plan, it is outstanding.

COMMUNITY DISTRICT may be postulated for HEALTH as

one of the 810 separate clusters of resident persons that

respectively encompass, on average, 400,000 resident persons

who contiguously reside within one, or more than one, county

of a Region’s State as the basis for establishing a

nationally sanctioned Community HEALTH Forum.

COMMENT The Congressionally Chartered provisions for the national governance of NATIONAL HEALTH forms a triadic structure. The top level of Governance would reflect the formation of 9 Regions involving one, or more than one, state to achieve a nearly equal population of citizens at the last census. The 9 regions collectively achieve a mean of 37 million citizens. Each Region would be initially responsible for appointing one MEMBER to the Board of Trustees as defined by its Congressional Charter.

The top level of governance would represent a Board of Trustees involving 1 Member selected by each Region according to the Congressional Charter for NATIONAL HEALTH. As defined by the Congressional Charter, each of the Regions would form their own Board of Directors and function in a Consulting relationship between their own 90 District Communities and the Board of Directors. The Regions can be identified as follows (based on their 2020 regional census population) for a grand total of 335,410,000: — 87 —

Region 1 CENTRAL EAST population 33.52 million – Pennsylvania, New Jersey, Maryland, Delaware, & District of Columbia with our Atlantic ocean Protectorates;
Region 2 NORTH EAST population 34.47 million – Massachusetts, New York, Connecticut, New Hampshire, Rhode Island, Vermont, & Maine;
Region 3 SOUTH EAST population 36.69 million – Georgia, Virginia, South Carolina, North Carolina, & West Virginia;
Region 4 CENTRAL MIDDLE population 36.16 million – Kentucky, Tennessee, Ohio, Indiana, & Missouri;
Region 5 SOUTH MIDDLE population 37.19 million – Louisiana, Mississippi, Alabama, Arkansas, & Florida;
Region 6 NORTH MIDDLE population 37.68 million – Illinois, Michigan, Iowa, Wisconsin, & Minnesota;
Region 7 CENTRAL WEST population 39.54 million – California;
Region 8 SOUTH WEST population 42.37 million – Texas, Oklahoma, New Mexico, & Arizona; AND
Region 9 NORTH WEST population 36.95 million – Oregon, Kansas, Nevada, Nebraska, Colorado, Montana, North Dakota, South Dakota, Washington, Wyoming, Idaho, Utah, Alaska, & Hawaii with our Pacific Ocean Protectorates.

Within each Region, the State with the best Social Mobility is bolded. Lawrence M. Eppard and three associates reported a unique in-depth study entitled: “Obligations to the Future (Eppard et al., 2020).” In effect, it reports many attributes of our nation’s sociological ecology. On page 18, a list of the county-by-county average of each State’s Social Mobility are listed, from 2020 Data. The State within each of the above Regions with the best Social Mobility is bolded above. This will be useful for the selection process underlying the selection process of an initial Board of Trustees for an instituting NATIONAL HEALTH the subsequent evolution of its membership.

The initial governance for NATIONAL HEALTH would begin with the selection of its Board of Trustees. Presumably, each of the 9 regions would be given a unique selection procedure by the Congressional Charter: the overall process would select three (3) Primary Healthcare physicians, Two (2) physician Specialists, and Four (4) non-physicians, each with a certain professional skill-set — such as: mental health; public health; anthropology; and socio-ecological economics (See PAGE 4c. INITIAL GOVERNANCE concept) .

Conceiving our nation’s annual health spending as becoming defined as a portion of our nation’s overall economy, viz., Gross Domestic Product (GDP). This may strike most people as representing a strategy involving rationing by a centralized bureaucracy. The research of Professor Ostrom (E Ostrom 1990) establishes a cooperative process among payers, providers, and recipients of healthcare for it to become equitably available, culturally & ecologically accessible, justly efficient, and dependably effective.

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

The next report may represent the broadest impact for informing our Family Culture anthropology (Helle et al., 2024). A cluster of six colleagues who diversely collaborated from universities located in Finland, Australia, New Zealand, and Canada. Here is the Article’s Title: “Investment by maternal grandmother buffers children against the impacts of adverse early life experiences.” Yes, they use (AELEs) rather than (ACEs). I cite the last three sentences of the article’s abstract: “When children had faced multiple AELEs, the investment of maternal grandmothers reduced, but could not fully erase, their emotional and behavioral problems. No such result was observed in the case of the investment of other grandparent types. These findings indicate that in adverse environmental conditions, the investment of maternal grandmothers, or a surrogate, can improve child wellbeing (Helle et al., 2024).”

MANAGING THE COMMONS may be postulated

for POPULATION HEALTH as

the application of the Design Principles associated with the

successful management of a Common Pool Resource that represents

a guide for the formation of a national Primary Healthcare Efficacy Plan

for achieving a budgeted portion of a nation’s Gross Domestic Product

that is annually allocated to its health spending that originates

from within HEALTH SECURITY certified Primary Healthcare

offered within every Community District (viz. E. Ostrom 2009 or 2010).

COMMENT Professor Elinor Ostrom, Ph.D. compiled her 2009 acceptance presentation upon receiving her Nobel Prize for Economics (E. Ostrom 2010): “Beyond Markets and States: Polycentric Governance of Complex Economic Systems.” The overall presentation best describes her research for the validation of the Design Principles, listed below, associated with the successful management of a Common Pool Resource (CPR). A video URL for the presentation is internet youtube accessible. It may represent the best introduction to this far-ranging concept. Notably, she was the first woman to be awarded a Nobel Prize in economics. I recommend an article by Michael Cox for an in-depth review of the Design Principles (Cox et al., 2010) entitled: “A Review of Design Principles for Community-based Natural Resources Management.” This article describes the Design Principles as understood at the time of Professor Ostrom’s death in 2010.

As a basis for understanding the dimensions applied to managing a Common Pool Resource, I cite the 1-8 numerated Design Principles associated with a successful Common Pool Resource (Cox et al., 2010):

1. Clearly Defined Boundaries;

2. Proportional equivalence between benefits and cost;

3. Collective-choice arrangements;

4. Monitoring;

5. Graduated Sanctions;

6. Conflict resolution mechanisms;

7. Minimal recognition of rights to organize; and

8. Appropriate coordination among relevant groups.

Conceiving our nation’s health spending as limited to a certain portion of our nation’s overall economic activity, its Gross National Product, may strike most people as representing a strategy that involves rationing by a Bureaucracy much like the Extension Service, viz., for Agriculture. The research of Professor Ostrom establishes a cooperative process among the payers, providers, and recipients of healthcare for it to become equitably available, culturally & ecologically accessible, justly efficient, and dependably effective. — 89 —

SOCIAL COHESION may be postulated for a NATION as

the expectation among the resident persons within each

of its municipal communities that the resident persons

within all the other municipal communities are trustworthy, and

the continuing prevalence of these trustworthy persons

is sustainably enhanced when each municipal community

continuously collaborates with their adjacent communities

to annually enhance each other’s Survival Commons

by their reciprocating investments of Social Capital.

COMMENT Fundamentally, it is possible to construe an analysis that our nation has endured a decline in our social cohesion since the Civil War and especially, since WWII. This trend represents the fundamental cause of the stress that each resident person encounters daily within their community’s municipal life. The definition above would not be recognizable by most Population Health experts. Of many thoughtful efforts to define Social Cohesion, I prefer this essay entitled: The Essentials of Social Cohesion: A Literature Review (Schiefer & van der Noll, 2017).

No matter how it is construed, this Design Epistemology for improving Population Health as well as its Primary Healthcare would likely fail without a strategy to intentionally engage the close neighborhood of every person’s home. A nationally sanctioned, locally self-sustained, and nationally committed strategy will be required to rebuild our nation’s social cohesion for every community, neighborhood by neighborhood.

To substantiate the promotion of Social Cohesion, I refer to a recent study from Sweden by Professor Giordano and his associates who are known for his career-long studies of trust and self-reported health as an attribute of a nation’s Population Health. Here is the study’s title: Trust and all-cause mortality: a multi-level study of US General Social Survey Data 1978-2010 (Giordano 2019). Here is its ABSTRACT’s Conclusion:

“High levels of individual and contextual generalized trust protect against mortality, even after considering numerous individual and socioeconomic conditions. Its robustness among both conditions hints at the importance of psychosocial mechanisms, as well as a trustworthy environment. Declining trust levels across the USA should be of concern; decision-makers should consider direct and indirect effects of policy on trust with the view to halting this decline (Giordano 2019).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs)

Here is a study that directly evaluated, what likely represented, the largest number of participants among the ACEs related research studies. Cynthia Harter and John Harter published the results of their study in 2022 with this title: “The Link Between Adverse Childhood Experiences and Financial Security in Adulthood (Harter & Harter, 2022).” A financial well-being study framework was established by the Consumer Financial Protection Bureau in 1984. The authors also retrieved correlational data from the Centers for Disease Control (CDC) and its Behavioral Risk Factor Survey Alliance System (BRFSS). With 400,000 interviews annually, it represents the largest health survey system in the world.

From the study report’s CONCLUSION, I cite its initial sentence, “Having experienced more ACEs is correlated with having more financial stress in adulthood as measured by food security and housing security (Harter & Harter, 2022).” — 91 —

COMMON GOOD may be postulated for a NATION as

the cooperative obligation of every Nation

to sustain their own prosocial, institutional responsibilities

for promoting the broadest expression of each resident person’s

uniquely-endowed Human Capability and also

to sustain the annually reciprocating exchange of social capital

with their contiguously adjacent nations to improve

the occurrence of Stable HEALTH

for every worldwide community’s resident persons.

COMMENT Following WWII, Eleanor Roosevelt Chaired the United Nations Commission on Human Rights. Renne Cassin, from France, is recognized as its originating author. Since then, no individual person has been recognized as the principal author of the UNITED NATIONS’ Universal Declaration of Human Rights, eventually adopted on December 10, 1948. Worth noting, the UNITED NATIONS has adopted several other related Declarations, e.g., the Rights of a Child (UN 2022). In 2016, the Declaration of Human Rights became a United Nations Declaration. In effect, the change represented a process to exercise Treaty provisions for UN member nations. Given the options for this process, there were initially 196 nations for partial or full participation (UN, 2016).

The international law community of attorneys has maintained a continuing commitment to define Human Dignity as the basis for preparing certain international treaties. See page 12 of this Design Epistemology for details.

The “Universal Declaration for the Common Good of Humanity Project” may represent the most concise, comprehensive statement, viz., constitution, for achieving a worldwide GOAL of the COMMON GOOD, nation by nation (Linder 2012). Its origin can be traced to a proposal initiated by the 2012 World Forum for Alternatives in Rio de Janeiro and presented to the 2013 World Social Forum in Tunis, Tunisia. I cite a retrospective analysis of this international scenario as attended by a participant from Germany (Schroder 2025).

“Health and inequality” (Currie 2024)

For 22 years, Janet Currie has focused on the dynamics of early childhood development. I cite the “ABSTRACT” from her most recent study:

“Poorer people tend to have worse health and shorter lives than richer ones, which raises the question of whether the relationship is causal. Does bad health lead to economic inequality or vice versa? And is increasing inequality responsible for widening socio-economic disparities in health status? What policies can break these links? This commentary assumes the positive relationship between health and income as a given and explores what is known about these questions. I conclude that bad health causes economic inequality, but whether economic inequality harms health depends on the policy environment. There is much that governments can do and have done to improve the health of the poor and flatten the relationship between income, income inequality, and health (Currie 2024).”

< ADVERSE CHILDHOOD EXPERIENCES (ACEs) >

A Canadian economist, Daniel Trefler, wrote a pivotal article published in 2004 with the following title: “Looking Backward: How Childhood Experiences Impact a Nation’s Wealth (Trefler 2004).” I cite the last two paragraphs of its Final Comment:

“Many polemicists have argued that no successful strategy can reconcile the business and social agendas that have polarized Canadians. They are wrong. Canada can have both, but to do so, we must clearly articulate this as a goal, and we must set about identifying the policies that will take us there. We need a pragmatic business strategy that promotes both beauty and brains, as well as caring and prosperity.”

“The question is not about sacrificing our social programs on the altar of competitiveness and prosperity. Rather, it is whether a strategic use of our social programs, especially programs that invest in children, is the best, most cost-effective way to promote productivity growth and prosperity. The answer to this question is a clear and unequivocal – Yes (Trefler 2004, pg. 27).”

————– E P I L O G U E ————–

REVITALIZING our NATION’S

HUMAN DIGNITY PARADIGM

— 93 —

INTRODUCTION This EPILOGUE explores 5 REALMS of knowledge for guiding a Nation’s application of the DESIGN EPISTEMOLOGY to improve our Nation’s Population Health and its Primary Healthcare. Here are the 5 REALMS: ANTHROPOCENE, ANTHROPOLOGY, PRAXIS, PUBLIC CHOICE, & EMERGENCE. Each REALM introduces several interrelated citations. The final REALM introduces the ultimate ‘Human Dignity’ deficit of a nation’s Population Health.

Each REALM cites several references for which an alphabetically listed, author Bibliography exists at the end of each respective REALM.

^^^^^

ANTHROPOCENE – ONE

“Our future in the Anthropocene biosphere” is the title of an Article (Folke et al.,2021) written by Carl Folke and 21 Co-editors who became contributors after they had attended an online convening April 26-28, 2021. The convening was arranged by the Nobel Foundation for Nobel Laureates, prominent scientists, and other worldwide thought leaders for: THE FIRST Nobel Prize Summit — Our Planet, Our Future.

Professor Folke and his 21 co-editors, as a group, originated from scientific institutions located in Australia, Sweden, Germany, United Kingdom, the Netherlands, Canada, Germany, AND the USA.

I cite from the Article’s (Folke et al.,2021) Abstract:

“The COVID-19 pandemic has exposed an interconnected and tightly coupled globalized world in rapid change. This article sets the scientific stage for understanding and responding to such change for global sustainability and resilient societies. […] Taken together, human actions are challenging the biosphere’s foundation for a prosperous development of civilizations. The Anthropocene reality- of rising system-wide turbulence -calls for transformative change towards sustainable futures. Emerging technologies, social innovations, broader shifts in cultural repertoires, as well as a diverse portfolio of active stewardship by human actions in support of a resilient biosphere are highlighted as essential parts of such transformations.”

From the Article’s CONCLUDING REMARKS, I cite its final paragraph:

“There is an urgent need for people, economies, societies and cultures to actively start governing nature’s contributions to wellbeing and the building of a resilient biosphere for future generations. It is high time to reconnect development to the Earth system’s foundation through active stewardship of human actions into prosperous futures within planetary boundaries (Folke et al. 2021).”

^^^

“Navigating the polycrisis: assessing the adequacy of adaptive and transformative capacities for addressing Anthropocene traps” is the title of an article from Peter Sogard Jorgensen and 5 other colleagues (Jorgensen et al., 2024). They are connected by an academic connection, among other connections, with the Stockholm Resilience Center, Stockholm University, Stockholm, Sweden. Essentially, it represents a Typology analysis of the Anthropocene Traps.

Here are the first three and the last two sentences from its Abstract:

“Social and environmental challenges are combining to form a polycrisis with the potential to delay or reset many sustainability efforts. These risks raise questions about what capacities will be needed for advancing sustainability during a time of interlinked crises. Here, we evaluate the adequacy of adaptive and transformative capacities for navigating the polycrisis. […] Importantly, transformative and adaptive capacities complement each other in the types of Anthropocene traps they most frequently address, with transformative capacities targeting global traps and adaptive capacities the emergent structural traps related to connectivity and rate of change. We end by proposing five unifying processes that can serve as an organizing framework for consideration of other sustainability and crisis capacities (Jorgensen et al. 2014).”

^^^^

ANTHROPOCENE – TWO

“The Clash of Civilizations?” entitles a 1993 essay by Samuel P. Huntington that by 1-13-2024 had been cited at Google Scholar 47,957 times. I cite its first and second Paragraphs: “WORLD POLITICS is entering a new phase, and intellectuals have not hesitated to proliferate visions of what it will be — the end of history, the return of traditional rivalries between nation states, and the decline of the nation state from the conflicting pulls of tribalism and globalism, among others. Each of these visions catches aspects of the emerging reality. Yet they all miss a crucial, indeed a central, aspect of what global politics is likely to be in the coming years. It is my hypothesis that the fundamental source of conflict in this new world will not be primarily ideological or primarily economic. The great divisions among humankind and the dominating source of conflict will be cultural. […] For the relevant future, there will be no universal civilization, but instead a world of different civilizations, each of which will have to learn to coexist with the others (Huntington 1993).”

^^^

Thirty years later, a cluster of 13 colleagues prepared an article in 2023 that became part of a journal’s theme issue: ‘Evolution and sustainability: gathering the strands for an Anthropocene synthesis (Jorgensen et al., 2023).” Here is the article’s title: “Evolution of the polycrisis: Anthropocene traps that challenge global sustainability.” — 95 —

And, here is its Abstract:

“The Anthropocene is characterized by accelerating change and global challenges of increasing complexity. Inspired by what some have called a polycrisis, we explore whether the human trajectory of increasing complexity and influence on the Earth system could become a form of trap for humanity. Based on an adaptation of the evolutionary traps concept to a global human context, we present results from a participatory mapping. We identify 14 traps and categorize them as either ‘global,’ ‘technology,’ or ‘structural’ traps. An assessment reveals that 12 traps (86%) could be in an advanced phase of trapping with hard-to-reverse lock-ins and growing risks of negative impact on human well-being. Ten traps (71%) currently see growing trends in their indicators. Revealing the systemic nature of the polycrisis, we assess that Anthropocene traps often interact reinforcingly (45% of pairwise interactions), and rarely in a dampening fashion (3%). We end by discussing capacities that will be important for navigating these systemic challenges in pursuit of global sustainability. Doing so, we introduce evolvability as a unifying concept for such research between the sustainability and evolutionary sciences (Jorgensen et al., 2023).”

^^^

An article from two authors, each associated with academia in Bratislava, Slovakia, offers a unique typology for designing a Research Agenda during the Anthropocene. Here is its Title: “POLYCRISIS IN THE ANTHROPOCENE AS A KEY RESEARCH AGENDA FOR GEOGRAPHY: ONTOLOGICAL DELINEATION AND THE SHIFT TO A POSTDISCIPLINARY APPROACH (Matlovic & Matlovicova, 2024).”

Here are the last two sentences of its Abstract:

“The main idea of this paper is that an ontologically highly complex and hybrid object of research, such as a polycrisis, provides an opportunity for a shift from the subdisciplinary fragmentation of geography to the application of a postdisciplinary perspective. The main research motivation is to strengthen the social relevance of geography in the context of the quest for global sustainability (Matlovic & Matlovicova, 2024).”

^^^

ANTHROPOCENE – THREE

Len Fisher from the School of Physics at the University of Bristol (UK) and Anders Sandberg from the Future of Humanity Institute at the University of Oxford (UK) collaborated for a remarkable essay (Fisher & Sandberg, 2021).

Here is its Abstract: “The world faces a multiplicity of global catastrophic risks (GCRs), whose functionality as individual and collective complex adaptive networks (CANs) poses unique problems for governance in a world that itself comprises an intricately interlinked set of CANs. Here we examine necessary conditions for new approaches to governance that consider the known properties of CANs — especially that small changes in one part of the system can cascade and amplify throughout the system and that the system as a whole can also undergo rapid, dramatic and often unpredictable change with little or no warning (‘viz., Black Swan,’ ed.) (Fisher & Sandberg, 2021).”

From the article’s second paragraph, I cite its entirety:

“Our argument is developed in four steps: 1. A brief review of global catastrophic risks (GCRs) and their governance, 2. Conceptual framing of our social-economic-ecological world and the threats that endanger it as complex adaptive networks (CANs), 3. Analysis of the necessary conditions for the effective governance of the GCRs as CANs, and 4. Evaluation of different proposed forms of governance in terms of those necessary conditions (Fisher & Sandberg, 2021).” — 97 —

^^^

Some three years later, in 2024, twenty-two authors representing eleven nations collaborated to author an intensely focused article entitled: “The planetary commons:A new paradigm for safeguarding Earth-regulating systems in the Anthropocene (Rockstrom et al., 2024).”

“I cite its Abstract: [Whoa! ]

“The Anthropocene signifies the start of a no-analogue trajectory of the Earth system that is fundamentally different from the Holocene. This new trajectory is characterized by rising risks (viz., Black Swans) of triggering irreversible and unmanageable shifts in Earth system functioning (ed. viz., tectonic shifts). We urgently need a new global approach to safeguard critical Earth systems, regulating functions more effectively and comprehensively. The global commons framework is the closest example of an existing approach with the aim of governing biophysical systems on Earth upon which the world collectively depends. Derived during stable Holocene conditions, the global commons framework must now evolve in the light of new Anthropic dynamics. This requires a fundamental shift from a focus only on governing shared resources beyond national jurisdictions, to one that secures critical functions of the Earth system irrespective of national boundaries. We propose a new framework — the planetary commons — which differs from the global commons framework by including not only globally shared geographic regions but also critical biophysical systems that regulate the resilience and state, therefore livability, on Earth. The new planetary commons should articulate and create comprehensive stewardship obligations through Earth system governance aimed at restoring and strengthening planetary resilience and justice (Rockstrom et al., 2024).”

^^^

During 2016, the loss of ozone protection over the polar regions suddenly became a worldwide calamity. The Montreal Protocol successfully banned the worldwide use and production of ozone-depleting substances. The northern Arctic ozone variability is more unstable than the southern Antarctic ozone. From the Massachusetts Institute of Technology, Peidong Wang and 7 associates, each involving 7 other related institutions, described their assessment for a continued improvement of the bi-polar ozone holes (Wang et al., 2025).” Here is its title: “FINGERPRINTING THE RECOVERY OF ANTARCTIC OZONE.”

I cite the first 3 sentences and the last sentence of the article’s ABSTRACT:

“The Antarctic ozone ‘hole’ was discovered in 1985, and man-made ozone-depleting substances (ODS) are its primary cause. Following reductions of ODSs under the Montreal Protocol, signs of Ozone recovery have been reported, based largely on observations and broad, yet compelling model-data comparisons. Although such are highly valuable, they do not provide rigorous statistical detection of the temporal and spatial structure of Antarctic ozone recovery in the presence of internal variability. [,,,] Our results provide robust statistical and physical evidence that actions taken under the Montreal Protocol to reduce ODSs are indeed resulting in the beginning of Antarctic ozone recovery, defined as increases in ozone consistant with expected month-height patterns (Wang et al., 2025).”

^^^^

Fisher, Len (2022) & Anders Sandberg. A Safe Governance Space for Humanity: Necessary Conditions for the Governance of Global Catastrophic Risks. Journal of Global Policy, 2022, 13:792-807. DOI: 1111/1758-5899.13030 [Note: This article represents a subject typology.]

Folke, Carl (2021), Stephen Polasky, Johan Rockstrom, Victor Galaz, Francis Westley, Michele Lamont, Marten Scheffer, Henrik Osterholm, Stephen R. Carpenter, F. Stuart Chapin III, Karen C. Seto, Elke U. Weber, Beatrice I. Crona, Gretchen C. Daily, Partha Dasgupta, Owen Gaffney, Line J. Gordon, Holger Hoff, Siman A. Levin, Jane Lubchenco, Will Steffen, and Brian H. Walker. OUR FUTURE IN THE ANTHROPOCENE BIOSPHERE. The Royal Swedish Academy of Sciences, Ambio 2021, 50:834-869 https://doi.org/10.1007/s13280-021-01544-8

Huntington, Samuel P. (1993), THE CLASH OF CIVILIZATIONS. Foreign Affairs. 72(3), pp 22-49 http://www.jster.org/stable/20045621

Jorgensen, Peter Sogaard (2023), Raf E. V. Jansen, Daniel I. Avila Ortega, Lan Wnag-Erlandsen, Jonathan F. Donges, Henrik Osterblom, Per Olson, Magnus Nystrom, Steven J. Lade, Thomas Hahn, Carl Folke, Gary D. Peterson, Anne-Sophie Crepin. EVOLUTION OF THE POLYCRISIS: ANTHROPOCENE TRAPS CHALLENGE GLOBAL SUSTAINABILITY. Philosophical Transactions of Royal Society B. 379: 20220261 https://doi.org/10.1098/rstb.2022.0261

Jorgensen, Peter Sogaard (2024), Louis Delannoy, Sofia Maniatakou, Carl Folke, Michele-L Moore, and Per Olson. Navigating The Polycrisis: Assessing The Adequacy Of Adaptive And Transformative Capacities For Addressing The Anthropocene Traps. doi.org/10.31235/osf.

Matlovic, Johan (2024), & Kvetoslava Matlovicova. POLYCRISIS IN THE ANTHROPOCENE AS A KEY RESEARCH AGENDA FOR GEOGRAPHY: ONTOLOGICAL DELINEATION AND THE SHIFT TO A POSTDISCIPLINARY APPROACH. FOLIO GEOGRAPHICA, 66(1), 2024, pp. 5-33

Rockstrom, Johan (2024), Louis Kotze, Svetlana Milutinovic, Frank Bierman, Victor Brovkin, Jonathan Donges, Jonas Ebbesson, Duncan French, Joyeeta Gupta, Rakhyun Kim, Timothy Lenton, Dominic Lenzi, Nebojsa Nakicenovic, Barbara Neumann, Fabian Schuppert, Ricarda Winkleman, Klaus Bosselnan, Carl Folke, Wolfgang Lucht, David Schlosberg, Katherine Richardson, and Will Steffen. THE PLANETARY COMMONS: A NEW PARADIGM FOR SAFEGUARDING EARTH-REGULATING SYSTEMS IN THE ANTHROPOCENE. PNAS, 121(5) e2301531121 https://doi.org/10.1073/pnas.2301531121 ISSN ISSN 2454-1001 (online)

Wang, Peidong (2025), Susan Solomon, Benjamin B. Santer, Douglas E. Kinnison, Qiang Fu, Kane A. Stone, Jun Zhang, Gloria L Manney, and Luis F. Millan. FINGERPRINTING THE RECOVERY OF ANTARCTIC OZONE. SPRINGER NATURE, pp 1-8 & attachment https://doi.org/10.1038/s41586-025-08640-9 — 99 —

#8 of 42 ^^^^

ANTHROPOLOGY – ONE [ A CLASSIC ]

We begin with an essay (Maturana et al., 2015) entitled: “Cultural-Biology: Systemic Consequences of Our Evolutionary Natural Drift as Molecular Autopoietic Systems (Maturana et al., 2015).”

Here is its Abstract:

“Our purpose is to introduce new concepts (dynamic architexture and dynamic ecological organism-niche unity, among others) in a wide and recursive view of the systemic consequences of the following biological facts (as described previously by referenced Authors): 1.) that as living systems, we human beings are molecular autopoietic systems; 2.) that living systems live only as long as they find themselves in a medium that provides them with all the conditions that make the realization of their living possible, that is, in the continuous conservation of their relation of adaptation to the circumstances in which they find themselves; 3.) that as a living system exists only in a relation of adaptation with the medium that operates as its ecological niche, its reproduction necessarily occurs as a process of systemic duplication or multiplication of the ecological organism-niche unity that it integrates; 4.) that the worlds of doings that we generate as languaging beings in our conversations, explanations, reflections, and theories are part of our ecological-niche; and 5.) that we human beings as living beings that exist in languaging, are biological-cultural beings in which our cultural and our biological manners of existences can be distinguished but cannot be separated (Maturana et al., 2015).”

“Of the systemic consequences of these biological facts that we consider in this essay, we wish two as the principal: 1.) that the diversification of manners of living produced in biological evolution is the result of differential survival in a changing medium through the conservation of adaptation, and not through competitive survival of the best; and 2.) that we in our living as language human beings (observers) are the epistemological fundament of all that we do and know as such (End of Abstract – Maturana et al., 2015).”

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ANTHROPOLOGY – TWO

The Design Epistemology, herein, begins with a definition of Well-Being (p. 9) that is attributable to Professor Neera H. Badhwar, it is:

“When defined as a person’s eudaimonia, Well-Being represents Happiness in an objectively worthwhile life (Badhwar 2014).”
The Pastor of my church recommended this book to me. It was the Best Advice I had when first initiating my epistemological endeavor herein.
For further analysis of the definition and its collegial response, I recommend an article by Professor Badhwar entitled: “Replies to my Commentators (Badhwar 2016).” She responded to 4 colleagues and their own views of her book (Badhwar 2014).

^^^

Every person’s Human Quantum-Cognitive Brain (p. 18) and its evolving Cultural Social-Cognition (p. 25) creates each person’s resultant consciousness during their daily, life-long encounter with an intentional variety of developmental Social Interactions. I introduce an article by Mark Miller, Julian Kiverstein, and Erik Rietveld that is entitled: “The Predictive Dynamics of Happiness and Well-Being (Miller et al., 2022).” — 101 —

I cite the article’s Abstract: [Another CLASSIC]

“We offer an account of mental health and well-being using the predictive processing framework (PPF). According to this framework, the difference between mental health and psychopathology can be located in the goodness of the predictive model as a ‘regulator’ of action. What is crucial for avoiding the rigid patterns of thinking, feeling, and acting associated with psychopathology is the regulator of action based on the valence of affective states. In PPF, valence is modeled as error dynamics – the change in prediction errors over time. Our aim in the paper is to show how error dynamics can account for both momentary happiness and longer term well-being. What will emerge is a new neurocomputational framework for making sense of human flourishing. We have proposed that optimal psychological function should be thought of as emerging from maintaining a metastable poise. A system that is sensitive to how it deploys precision, and so is able to juggle multiple cares and concerns in an optimal way, will also be a system that is best able to meet unexpected uncertainty. It is this continual growth of skills and abilities and the optimal balancing of resources between these domains of learning that produces this optimal control. And it is this optimal control that is experienced by the agent as a background feeling of Well-Being – the felt experience that the system is set up to handle life’s many challenges (Miller et al., 2022).”

^^^

ANTHROPOLOGY – THREE

A Feature Review appeared in the July 2024 edition of Trends in Cognitive Sciences with the following title: The neurobiology of interoception and affect. M.J. Feldman, E. Bliss-Moreau, and K.A. Lindquist were its authors.

I cite the article’s Abstract:

“Scholars have argued for centuries that affective states involve interoception, or representations of the state of the body. Yet, we lack a mechanistic understanding of how signals from the body are transduced, transmitted, compressed, and integrated by the brains of humans to produce affective states. We suggest that to understand how the body contributes to affect, we first need to understand information flow through the nervous system’s interoceptive pathways. We outline such a model and discuss how unique anatomical and physiologic aspects of interoception pathways may give rise to the qualities of affective experiences in general and valence and arousal in particular. We conclude by considering implications and future directions for research on interoception, affect, emotions, and human mental experiences (Feldman et al., 2024).”

And, also from the Feature Review, I cite the last three sentences of its Concluding remarks:

“The framework opens many more questions than it answers (see Outstanding questions), and we hope it will be operative for future work. For instance, if affective experience is ultimately a product of predictions seeded within brain regions associated with meaning-making, semantics, and memories, then this would open avenues via which prior experiences, social learning, and culture can ultimately influence interoceptive and affective states. We look forward to this and other questions about how the brain, body, and social world would ultimately shape the mind (Feldman et al., 2024).”

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Badhwar, Neera K. (2014). W E L L – B I N G Happiness in a Worthwhile Life. Oxford University Press, New York, New York

Badhwar, Neera K. (2016). Replies To My Commentators – Regarding Her Book (2014); WELL – BEING . https://link.springer.com/article/s10790-016-9544-y

Feldman, M. J. (2024), E. Bliss-Moreau, and K. A. Lindquist. THE NEUROBIOLOGY OF INTERCEPTION AND AFFECT. JOURNAL OF TRENDS IN COGNITIVE SCIENCES. 28(7): 643-661. https://doi.org/10.1016/j.tics.2024.01.009

Maturana, Humberto R. (2015), Ximena Davila Yanez, and Simon Ramirez Munoz. CULTURAL-BIOLOGY: SYSTEMIC CONSEQUENCES OF OUR EVOLUTIONARY NATURAL DRIFT as MOLECULAR AUTOPOIETIC SYSTEMS. FOUNDATIONS OF SCIENCE, 28 September 2015 DOI 10.1007/s10699-015-9431-1

Miller, Mark (2022), Julian Kiverstein, and Eik Rietveld. THE PREDICTIVE DYNAMICS OF HAPPINESS AND WELL-BEING. EMOTION REVIEW, 14(1): pp. 15-30 DOI:10.1177/17540739211063851

#5 of 42

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PRAXIS (action) – ONE

Charles Sanders Peirce (1839-1914) may be most prominently known as a result of his initial origination of Pragmatism. Two volumes of the Essential PEIRCE Selected Philosophical Writings have been assembled and edited by the Peirce Edition Project – Nathan Houser, General Editor. The Second volume incorporates his 1893-1913 writing and includes the SEVEN HARVARD LECTURES ON PRAGMATISM that occurred during 1903 at Harvard in Boston. — 103 —

I refer to Lecture VII – “Pragmatism as the Logic of Abduction” and its introductory notation as written by Nathan Houser:

“This lecture was added so that Peirce could extend his remarks about the relation of pragmatism to abduction. He elaborates in particular on three key points raised in the sixth lecture: (1) that nothing is in the intellect that is not first in the senses, (2) that perceptual judgments contain general elements, and (3) that abductive inference shades into perceptual judgment without any sharp line of demarcation between them. Pragmatism follows from these propositions. Peirce reiterates that the function of pragmatism is to help us identify unclear ideas and comprehend difficult ones. It is in this lecture that Peirce delivers his famous dictum: ‘The elements of every concept enter into logical thought at the gate of perception and make their exit at the gate of purposive action; and whatever cannot show its passports at both gates is to be arrested as unauthorized by reason.’ In developing these ideas, Peirce emphasizes that in making every conception equivalent to a conception of ‘conceivable practical effects,’ the maxim of pragmatism reaches far beyond the merely practical and allows for any ‘flight of imagination,’ provided only that this imagination ‘ultimately alights upon a possible ‘practical effect’ (Peirce 1998).”

^^^

To further explore the Peircian connection with Pragmatism, I recommend the following article, entitled: “Pragmatism with a More Scientific Spirit (Zhou & Cheng, 2025).”

Here, I cite from the second paragraph of its Introduction:

“Although Charles Sanders Peirce (1839-1914) is usually hailed as the father of pragmatism, even though he revised and restated his position four times. It should be clarified that we do not intend to view the four expositions as four stages in the development of Peircean pragmatism, but rather merely a glimpse into the process in which Peirce considered pragmatism. In his first exposition of pragmatism in 1877-1878, he emphasized that pragmatism was a method for understanding the meaning of concepts based on practical effects. This exposition had some traces of psychologism, which led to common misunderstandings. In sporadic revisions between 1891 and 1902, Peirce rejected the idea of understanding the meaning of concepts based on individual actions and mental feelings and instead emphasized the importance of understanding the general meaning of concepts through communal inquiry. In his third exposition in 1903, he emphasized that pragmatism was a logical method based on normative sciences and equated it to abduction. In his fourth and final exposition between 1905 and 1907, he analyzed general phenomena based on semiosis and focused on understanding the meaning of signs rather than concepts that presuppose the action of signs. By analyzing these four expositions, it can be seen that Peircean pragmatism has anti-psychological features and emphasizes the scientific exploration of the community to analyze universal phenomena, making it a more scientific pragmatism, This article hereafter sequentially focuses on each of the four expositions (Zhou & Cheng, 2025).”

And here, I cite the article’s Conclusion:

“Peirce called himself a pragmatist or a person embracing pragmatic philosophy in two slightly different contexts. In a narrow sense, pragmatism is a logical method of clarifying the meaning of signs and concepts. But broadly speaking, any philosophical theory that follows the pragmatic approach can be regarded as a pragmatic philosophy. In a broad sense, Peirce argued that pragmatism “appears to have been virtually the philosophy of Socrates” and “an old way of thinking “that had been practiced by Spinoza, Berkeley, and Kant.” However, we should not extend Peircean pragmatism too broadly to what James called a “corridor” where all kinds of theories can roam. In a narrow sense, Peirce emphasized throughout his career that pragmatism is a method using scientific logic to clarify the meanings of concepts. For him, pragmatism belongs to the branch of logic inside the normative science’s classification and normative sciences are based on phenomenology, so Peirce’s clarification of pragmatism progressed to the discussion about normative science and phenomenology. From this point of view, as the main aspects of Peircean Philosophy are characteristic of pragmatism, we can properly call Peirce’s thoughts pragmatic philosophy, and this review of Peircean pragmatism constitutes a prerequisite for “re-mining the gold mine” of Peirce’s thought (Zhou & Cheng 2025).” — 105 —

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PRAXIS (action) – TWO

COMMUNITY RESILIENCE and its local rejuvenation” forms the essence of three recent articles. I cite the last three sentences of the Abstract from each of the first two articles. I begin with the article by Nicolina Kirby, Dorota Stasiak, and Dirk von Schneidermesser (Kirby et al., 2024) entitled as: “Community resilience through bottom-up participation, when civil society drives urban transformation processes.”

“Whilst a positive effect on resilience can be found, we identify governance processes that would be necessary to enable the full potential of bottom-up participation for community resilience. Resilience, understood as the capacity of a community to thrive in times of change and uncertainty, is becoming increasingly important for the functioning of (urban) communities; hence, finding ways of strengthening it is deemed necessary (Kirby et al., 2024).”

Second, I present another article also by Nicolina Kirby (Kirby, 2025), entitled: “Strengthening community resilience through – a conceptual exploration.” Here is the last two sentences of its Abstract .

“Its individual, social, governance, and economic dimensions are interdependent upon each other and present community as a dynamic process. This process is impacted by drivers such as the polycrisis, which a community needs to be resilient against. Participation is discussed as a potentially enabling factor to strengthen community resilience (Kirby, 2025).”

For the third article, here is the ABSTRACT from an article by Yann le Polain de Waroux and eight co-authors (le Polain de Waroux et al., 2025) entitled as: “How do we study resilience – A systematic review.”

“We evaluate the operationalization of resilience in 463 papers based on whether they define the system of interest and disturbances, whether they define resilience, whether they evaluate resilience, and for papers focusing on socio-ecological systems (SESs), whether that evaluation integrates social and ecological dimensions. We find that 51% of empirical studies do not meet at least one of these operationalization criteria, and that even in the ones that do often lack key features for effective operationalization, such as clear system boundaries and ecological dimensions. Of the articles examining SESs and evaluating resilience, only 54% integrate social and ecological dimensions in that evaluation. Building on these findings, we propose some design guidelines for operationalizing future empirical studies of resilience (le Polain de Waroux et al., 2025).”

^^^

PRAXIS (action) – THREE

As a cautionary view, I cite a 1998 article by Simon A. Levin entitled: ECOSYSTEMS AND THE BIOSPHERE AS COMPLEX ADAPTIVE SYSTEMS (Levin, 1998). It is a brief 7-page paper with a cautionary undertow by its Princeton University Professor. Its 5th page lists ” 6 ” cautionary questions to use periodically assess the affairs of any complex adaptive system.

Here is the author’s Abstract:

“Ecosystems are prototypical examples of complex adaptive systems, in which patterns at higher levels emerge from localized interactions and selection processes at lower levels. An essential aspect of such systems is nonlinearity, leading to historical dependency and multiple possible outcomes of dynamics. Given this, it is essential to determine the degree to which system features are determined by environmental conditions and the degree to which they are the result of self-organization. Furthermore, given the multiple levels at which dynamics become apparent and at which selection can act, central issues relate to how evolution shapes an ecosystem’s properties, and whether ecosystems become buffered to changes (more resilient) over their ecological and evolutionary development or proceed to critical states and the edge of chaos (Levin 1998).”

[NOTE: It is possible that this aphorism should be periodically assessed by every CAS using the six questions listed on the article’s 5th page.] — 107 —

^^^

“Neither Resiliency-Trait nor Resilience-State: Transactional Resiliency/e” is the title of an article by Seffetulluh Kuldas and Mairead Foody (Kuldas & Foody, 2022). The last two sentences of its Abstract are:

“The present review of the concept argues that the trait-state dualism is likely to be a conceptual fallacy, one fundamental reason for the lack of consensus. To facilitate and build consensus, the present conceptual review calls for a transactional approach instead of the definition.”

^^^

Hereinafter, I cite a POPULATION HEALTH related article (Lantz et al., 2023). I chose this article by Paula M. Lantz and two co-authors from the January 2023 edition of The Milbank Quarterly entitled: “The Perils of Medicalization for Population Health and Health Equity.” I cite its Face-Page Policy Points:

“Medicalization is a historical process by which personal, behavioral, and social issues are increasingly viewed through a biomedical lens and ‘diagnosed and treated’ as individual pathologies and problems by medical authorities.
Medicalization in the United States has led to a conflation of ‘health’ and ‘health care’ with a confusion between individual social needs and their social, political, and economic determinants of health.
The essential and important work of Population Health science, public health practice, and health policy writ large is being thwarted by a medicalized view of health and an overemphasis on personal health services and the health care delivery system as the major focal point for addressing societal health issues and health inequality.
Increased recognition of the negative consequences of a medicalized view of health is essential, with its misplaced focus on the education and training of clinicians and health care managers, journalists, and policymakers (Lantz et al., 2023).”

^^^^

de Waroux, Yann le Polain (2024), Marie-Claude Carignan, Olivia del Giorgio, Leandro Diaz, Pedro Jaureguiberry, Maria Lucrecia Lipoma, Flavia Mazzini, and Sandra Diaz. HOW DO : WE STUDY RESILIENCE? A SYSTEMATIC REVIEW. PEOPLE and NATURE. 2024:6:474-486 DOI: 10:1002/pan3.10603

Kirby, Nicolina (2024). STRENGTHENING COMMUNITY RESILIENCE THROUGH PARTICIPATION – A CONCEPTUAL EXPLORATION. ENVIRONMENTAL SOCIOLOGY, DOI:10.1080/23251042.2025.2479666 https://doi.org/10.1080/23251042.2025.2479666

Kirby, Nicolina (2025). STRENGTHENING COMMUNITY RESILIENCE THROUGH PARTICIPATION – A Conceptual Exploration. ENVIRONMENTAL SOCIOLOGY, https://doi.org/10.1080/23251042.2025.2479666

Kuldas, Seffetullah (2022) & Mairread Foody. NEITHER RESILIENCY-TRAIT NOR RESILIENCE-STATE: TRANSACTIONAL RESILIENCY/E. Youth & Society, 54(8)pp 1352-1376 https://doi.org/10.1177/0044118X211029309

Lantz, Paula M. (2023), Daniel S. Goldberg, and Sarah E. Gollust. THE PERILS OF MEDICALIZATION FOR POPULATION HEALTH AND HEALTH EQUITY. THE MILBANK QUARTERLY, 101(S1) pp. 61-82

Levin, Simon A. (1998). ECOSYSTEMS AND THE BIOSPHERE AS COMPLEX ADAPTIVE SYSTEMS. ECOSYSTEMS, (1998) 1:431-146 [NOTE: This short essay becomes the most prescient of these references by its Concluding Remarks: The challenge represented by “6” Fundamental Questions to ask, about “ecosystems as complex adaptive systems.” ]

Peirce, Charles Sanders (1998 by the Peirce Edition Project) — #16 Pragmatism as the logic of Abduction – Lecture VII pp 226-241). THE ESSENTIAL PEIRCE Selected Philosophical Writings, Volume 2 (1893-1913), INDIANA UNIVERSITY PRESS, Bloomington, Indiana.

Zhou, Jing (2026) & Du Cheng. PRAGMATISM WITH A MORE SCIENTIFIC SPIRIT. EUROPEAN JOURNAL OF PRAGMATISM AND AMERICAN PHILOSOPHY. 17(1): 2025 https://doi.org/10.4000/13tp1

#8 of 42

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PUBLIC CHOICE – ONE

Here is the gist regarding our nation’s annual health spending. For 1960, it was 4% of our nation’s Gross Domestic Product (GDP). During 2019, it was 17.8%. The other advanced-developed nations allocated 13% or less of their economy to health spending during 2019 (OECD data). For 2019, the difference between 13% and 17.8% for our nation’s health spending was $1.04 trillion. — 109 —

^^^

There is Reason-To-Believe that our nation’s health spending would respond to its management as a Common Pool Resource as defined by Elinor Ostrom (Ostrom 1990). Its main benefit accrues from its connection with “THE QUEST OF MEANING IN PUBLIC CHOICE (E. Ostrom & V. Ostrom 2004).”

I cite its ABSTRACT :

“The logical foundations of constitutional government are of basic importance if people are to be self-governing. All forms of political order are Faustian bargains subject to numerous risks. If constitutional choice applies to all patterns of human association, the complexity of associated relationships and the potential threats to the viability of associated relationships in the aggregate exceed the limits of human cognition. The development of analytical capabilities depends on using frameworks, theories, and models for formulating hypotheses about conditions and consequences, undertaking diagnostic assessments, and conceptualizing and designing alternative possibilities. The relationship of ideas to deeds in an experimental epistemology is necessary to achieve a warrantable art and science of association.”

And now, I cite the last paragraph of its Conclusion:

Human societies endure across decades, centuries, and millennia. Citizens in democracies are mortal and endure only for a generation, so to speak. Memory, knowledge, and skill are erased with death. Open, democratic, self-governing societies face the challenge of transmitting information, knowledge, and skills from one generation to the next. Civic knowledge is necessary to sustain the continuity of civil society in the conduct of civic affairs by both drawing on past achievements and realizing new potentials. Human rationality is grounded in the condition of fallibility, with potentials for learning. How to realize such potentials will engage each of us in our quest for meaning about the conditions of life that we share with others (E. Ostrom & V. Ostrom, 2004).”

^^^

Most importantly, Elinor Ostrom (aka ‘Lin’) was the first woman to be awarded a Nobel Prize (2012) in political science. The focus of her research led to defining the attributes of a cluster of Design Principles associated with the successful management of a Common Pool Resource (CPR). They are listed on Page 86 of this Design Epistemology. Several months after the Nobel Ceremony, she died from pancreatic cancer. Three years later, one of her associates updated the character of the Design Principles based a more in-depth character of its associated phenomena. Michael D. McGinnis presented this paper at a “workshop” in December of 2015 entitled: “Polycentric Governance in Theory and Practice: Dimensions of Aspiration and Practical Limitations.” It was published the following year (M. McGinnis, 2016).

I cite its Abstract:

“This paper offers a three-step (structure, process, outcome) definition of polycentric governance, a concept that constitutes the core of the research program of the Bloomington School of institutional analysis, as first articulated in the works of Vincent and Elinor Ostrom. The basic assertion of this paper is that certain kinds of fragmented governance structures, specifically those consisting of multiple authorities with overlapping jurisdictions, may impel policy actors to interact with each other through processes of mutual adjustment and continued expansion of institutional diversity in ways that may generate outcomes which exhibit positive characteristics of emergent order and scale economies. However, practical approximations of this ideal congruence of structure, process, and outcome will necessarily fall short of fully accomplishing all of its aspirations, and instead tend to fall into six traps of polycentric governance: structural inequities, incremental bias, high levels of complexity, structural fissures, coordination failures, and, ultimately, lack of normative clarity. Yet, even imperfect proto-polycentric systems of governance provide actors with continued access to multiple mechanisms for improvement that hold out the hope that the most negative consequences of these tendencies can be ameliorated. The paper concludes with a discussion of the merits of using polycentricity as a lens through which political, economic, and social interactions can be seen in a new light (M. McGinnis, 2016).” — 111 —

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PUBLIC CHOICE — TWO

Amid the vast knowledge arena that is focused on ‘common pool resource’ phenomena, we must remain focused on the concept of ‘Complex Adaptive Systems’ as our global institutional model. Within this model, the CPR model best fits for managing a risk-management system, viz. Primary Healthcare, to achieve a justly efficient character for our nation’s health spending.

Here, I cite an ABSTRACT: “From a classification of complex adaptive systems, from cells to societies, is a study of the interplay between processes operating at diverse scales of space, time, and organizational complexity. The key to such a study is an understanding of the interrelationships between microscopic processes and macroscopic patterns, and the evolutionary forces that shape systems. In particular, for ecosystems and socioeconomic systems, such interest is focused on broad scale features such as diversity and resiliency, while evolution most powerfully at the level of individual agents. Understanding the evolution and development of complex adaptive systems thus involves understanding how cooperation, coalitions, and networks of interaction emerge from individual behaviors and feed back to influence those behaviors. In this paper, some of the mathematical challenges are discussed (S. Levin, 2002).” Please note my Edit of its resiliency.

^^^

With the ‘que’ of resilience from Professor Simon, there is probably only one author who has ‘staked out’ a ‘niche essay’ for this subject (C. Folk, 2016).

I cite the ABSTRACT from his 2016 article:

“Resilience thinking in relation to the environment has emerged as a lens of inquiry that serves a platform for interdisciplinary dialogue and collaboration. Resilience is about cultivating the capacity to sustain development in the face of expected and surprising change and diverse pathways of development and potential thresholds between them. The evolution of resilience thinking is coupled to social-ecological systems and a truly intertwined human-environment planet. Resilience as persistence, adaptability, and transformability of complex adaptive social-ecological systems is the focus, clarifying the dynamic and forward-looking nature of the subject. Resilience thinking emphasizes that social-ecologic systems, from the individual, to community, to society as a whole, are embedded in the biosphere. The biosphere connection is an essential observation if sustainability is to be taken seriously. In the continuous advancement of resilience thinking there are efforts aimed at capturing resilience of social-ecologic systems and finding ways for people and institutions to govern social-ecological dynamics for improved human well-being, at the local, across levels and scales, to the global, Consequently, in resilience thinking, development issues for human well-being, for people and the planet, are framed in a context of understanding and governing complex social-ecologic dynamics for sustainability as part of a dynamic biosphere (C. Folk, 2016).”

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“Complex adaptive governance systems: a framework to understand institutions, organizations, and people in socio-ecologic systems.” is the title for an article by Professor Candace K. May (C. May, 2022). This is #1 of 5 articles that are proposed to help define the initial operational governance of NATIONAL HEALTH.

“Emerging resilience metrics in an intensely managed ecological system.” is the title for an article by Nikolanos Toumasis (N. Toumasis et al., 2024). This is #2 of 5 articles that are proposed to help define the initial operational governance of NATIONAL HEALTH.

“Understanding how governance emerges in social-ecological systems: insights from archetype analysis.” is the title for an article by Rimjhim M. Aggarwal and John M. Anderies (R. Aggarwal & J. Anderies, 2023). This is #3 of 5 articles that are proposed to help define the initial operational governance of NATIONAL HEALTH.

“From Adversity to Advantage: A Systematic Literature Review on Regional Economic Resilience.” is the title for an article by Mantas Rimidis and Mindaugus Butkus (M. Rimidis & M. Butkus, 2025). This is #4 of 5 articles that are proposed to help define the initial operational governance of NATIONAL HEALTH.

“Community resilience through bottom-up participation: when civil society drives urban transformation processes.” is the title for an article by Nicolina Kirby, Dorota Stasiak, and Dirk von Schneidemesser (N. Kirby, D. Stasiak, & D. von Schneidemesser, 2024). This is #5 of 5 articles with a focus on the initiation, substantial urban-participation, and resultant community-goal achievement. — 113 —

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PUBLIC CHOICE — THREE

From the Department of Computer and System Sciences, Stockholm University, Kista, Sweden, I cite an article by Joran Lindeberg, Martin Henkel, and Eric-Oluf Svee as entitled: “Towards a Model of Organizational Rules in Complex Adaptive Systems (J. Lindeberg, et al. 2014).”

Here is it’s Abstract:

“Organizational rules, which guide and constrain enterprise agents’ actions, are essential to maintaining structure and coherence in dynamic environments. However, these rules often exist in complex and interconnected networks, leading to ambiguity, contradictions, and lack of comprehensibility. By applying Complex Adaptive Systems (CAS) theory, this research develops a conceptual model of rules to understand the multi-level interactions between organizational agents and the constraints that influence their behavior. In addition to organizational agents and their interconnections, the model represents concepts from complexity theory, as well as emergent properties, feedback loops, and adaptation. Future work will iterate on this model, incorporating practitioner insights to refine the concepts and identify relevant elements for a modeling language for systems of organizational rules (J. Lindeberg, et al., 2014).”

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Oddly, a mutually supportive article for the last article eventually appeared 9 years later in 2023. Seven authors from 3 Universities in the Netherlands authored an article entitled: “Smart Governance Toolbox: A Systematic Literature Review (E. Ruijer et al., 2023).”

Here is its Abstract:

“Smart city projects rely upon dynamic and complex multi-stakeholder collaboration. This collaboration can be challenging. In this study, we use an instrumental lens and argue that tools can help public professionals in dealing with government challenges. Building upon smart governance and collaborative governance models, we conceptualize smart governance as a toolbox. Based on our “smart governance toolbox,” we assess the variety of tools available for professionals to initiate and support multi-stakeholder collaboration by reviewing academic and grey literature. This review results in the identification of a broad range of tools that research and practice have developed. However, we also demonstrate that certain parts of the ‘smart governance toolbox’ remain almost empty. There are too few tools for assessing the smart collaborative governance context, facilitating the collaborative structure, tackling technology issues, and measuring outcomes of smart city practices. Future design research should focus on developing instruments needed to make the smart governance toolbox complete (Ruijer et al., 2023).

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Last but not least, another article appeared in 2023 with a title of “Smart Cities—A Structured Literature Review (J. Gracias et al., 2023).” Five authors are, collectively, from either the University of Arkansas or Mississippi. It’s above normal in layout and content. I especially liked its ‘Word Cloud.’ Here are the first and last sentences, respectively, of its Abstract and its Conclusion: “As cities continue to grow and face increasingly complex challenges, the integration of advanced technologies and data-driven solutions can help to create more sustainable communities. […] Future research could focus on strategies for overcoming the challenges involved in smart city implementation, as well as ways to measure and compare the benefits and costs of these initiatives (Gracias et al., 2023).”

^^^

Aggarwal, Rimjhim (2023) & John M. Anderies. UNDERSTANDING HOW GOVERNANCE EMERGES IN SOCIAL-ECOLOGICAL SYSTEMS: INSIGHTS FROM ARCHETYPE ANALYSIS. Ecology and Society, 28(2):2. https://doi.org/10.5751/ES-14061-280202

Folke, Carl (2016). RESILIENCE (REPUBLISHED). ECOLOGY & SOCIETY, 21(4):44 https://doi.org/10.5751/ES-09088-210444

Gracias, Jose Sanchez (2023), Gregory S. Parnell, Eric Specking, Edward A. Pohl, and Randy Buchanan. SMART CITIES — A STRUCTURED LITERATURE REVIEW. Smart Cities 2023, 6 pp. 1719-1743 https://doi.org/10.3390/smartcities6040080

Kirby, Nicolina (2024), Dorota Stasiak, and Dirk von Schneidemesser. COMMUNITY RESILIENCE THROUGH BOTTOM-UP PARTICIPATION: WHEN CIVIL SOCIETY DRIVES TRANSFORMATION PROCESS. Community Development Journal, 60(3),2025, pp 528-547 https://creativecommons.org/licenses/by/4.0/

Kirby, Nicolina (2025). STRENGTHENING COMMUNITY RESILIENCE THROUGH PARTICIPATION – A Conceptual Exploration. ENVIRONMENTAL SOCIOLOGY, https://doi.org/10.1080/23251042.2025.2479666

Levin, Simon A. (2002). COMPLEX ADAPTIVE SYSTEMS EXPLORING THE KNOWN, THE UNKNOWN, AND THE UNKNOWABLE. Bulletin of the American Mathematical Society, 40(1):3-19

Lindeberg, Joran (2024), Martin Henkel, and Eric-Olaf Svee. TOWARDS A MODEL OF ORGANIZATIONAL RULES IN COMPLEX ADAPTIVE SYSTEMS. Proceedings of the 17th IFIP WG 8.1 Working Conference on the Practice of Enterprise Modeling Forum. Stockholm, Sweden. December 3-5, 2024. — 115 —

May, Candace K. (2022). COMPLEX ADAPTIVE GOVERNANCE SYSTEMS: A FRAMEWORK TO UNDERSTAND INSTITUTIONS OR ORGANIZATIONS, AND PEOPLE IN SOCIO-ECOLOGICAL SYSTEMS. Socio-Ecological Practice Research, (2022) 4:39-54 https://doi.org/10.1007/s42532-021-00101-

Ostrom, Elinor (2004) & Vincent Ostrom. THE QUEST FOR MEANING IN PUBLIC CHOICE. American Journal of Economics and Sociology, 63(1) 2004 pp. 105-147 http://www.jstor.org/stable/3488034

Rimidis, Mantus (2025) & Mindaugas Butkus. FROM ADVERSITY TO ADVANTAGE: A SYSTEMATIC LITERATURE REVIEW ON REGIONAL ECONOMIC RESILIENCE. Urban Science, 2025, 9,118

Ruijer, Erna (2023), Anouk Van Twist, Timber Haaker, Thierry Tartarin, Noel Schuurman, Mark Melenhorst, and Albert Meijer. SMART GOVERNANCE TOOLBOX: A SYSTEMATIC LITERATURE REVIEW. Smart Cities, 2023 6 pp. 878-896 https://doi.org/10.3390/smartcities6020042

Toumasis, Nikolaos (2024), Daniel Simms, Will Rust, Jim HARRIS, John R. White, Joanna Zawadzka, and Ron Corstanje. EMERGING RESILIENCE METRICS IN AN INTENSELY MANAGED ECOLOGIC SYSTEM. Journal of Ecological Engineering, 200 (2024) 107151 https://doi.org/10.1016/j.ecoleng.2023.107151

#12 of 42

^^^^^

EMERGENCE — ONE SAFETY NET

The Russell Sage Foundation organized the ‘Poverty and Family Functioning Research Network’ that eventually prompted this and the following citation, among others. These articles formed one edition (2022) of the Russell Sage Foundation, Journal of Social Sciences. Marcia Carlson, Christopher Wimer, and Ron Haskins co-authored an article entitled: “Changing Work, Changing Families, and Public Policies Toward Low-Income Families (Carlson et al., 2020).”

I cite its second paragraph:

“In this issue, we aim to provide new research evidence about work and family issues in the 21st century for low-income families brought about by broad societal changes in the labor market and family patterns, and to high-light promising policy options to meet ongoing and emerging needs. We hope that this volume informs efforts to develop, reform, and implement public policies and programs that effectively support low-income workers and their families. We first describe the broad historical trends in both work and family issues that these trends have brought about for today’s low-income families and children. We then describe the ways in which public policies have and have not evolved to meet the current times, as well as the opportunities for change that now exist in the new landscape created by the COVID-19 pandemic. We conclude with brief summaries of each article, including the other one cited next (Carlson et al., 2022).” [italicised words, pjn edit]

^^^

Jennifer Randles authored the other article from the Russell Sage Journal that I have chosen to cite. With a tell-tale aphorism, the article is entitled as: “Fixing a Leaky U.S. Social Safety Net: Diapers, Policy, and Low-Income Families (Randles, 2022).” I cite its ‘likely abstract’:

“Changing work, family, and policy trends converged to increase diaper need in recent decades. Safety net programs do not cover diapers, and diaper policy proposals have met limited success. Based on interviews with seventy mothers who experienced diaper need, this article examines how diapers shape low-income Parents’ caregiving and why income and public aid are not always enough to cover diapers. Mothers described stigma associated with lacking diapers and mixed experiences seeking diaper support. These experiences suggest effective diaper responses, including diaper vouchers and extending changes to tax credit policies (Randles, 2022).”

As cited in the Design Epistemology for “poverty,” the lack of respect, aka sociality, is common with any contact with their community’s Safety Net. The lack of respect for a person’s Human Dignity further aggravates their already-established, daily cognitive fatigue. When combined with their neighborhood’s unpredictable violence and food insecurity, life can be intolerable.

^^^

It is a rare pleasure to cite the career-long economist who prominently documented ‘The Value of Early Childhood Education,’ Nobel prize awardee, James J. Heckman. I cite from his article entitled: “THE ECONOMICS OF INEQUALITY The Value of Early Childhood Education (Heckman 2011).” — 117 —

Here are the first and last paragraphs of this article:

“Educational equity is often discussed as a moral issue. Another way to think about equity is as a way to promote productivity and economic efficiency. As an economist, I focus on the economic value of equalizing educational opportunities and achievement in order to identify the most effective way to increase the productivity of the American economy. We need a capable and productive workforce that will compete successfully in the global economy. […] The logic is quite clear from an economic standpoint. We can invest early to close disparities and prevent achievement gaps, or we can pay to remediate disparities when they are harder and more expensive to close. Either way, we are going to pay. And, we’ll have to do both for a while. But there is an important difference between the two approaches. Investing early allows us to shape the future; investing later chains us to fixing the missed opportunities of the past (Heckman 9011).”

As a companion to the First Heckman article, I offer another related article: “The Case for Investing in Disadvantaged Young Children (Heckman 2008).”

I cite from the first paragraph of the article’s ‘Introduction’ and its ‘Summary:’

“In a series of papers with distinguished authors, I developed the case for intervening in the lives of disadvantaged children. This paper reviews the arguments developed in: ‘Cunha, Heckman, Lochner and Masterov (2006), Heckman and Masterov (2007), and Heckman (2000, 2008).’ [,,,] About 50 percent of the variance in lifetime earnings is determined by age 18. The family plays a powerful role in shaping adult outcomes that is not fully appreciated in current policies around the world (Heckman 2011).”

EMERGENCE — TWO CHAOTIC DISRUPTION

A brief definition for the concept of “Chaotic Disruption” may be found on page 8 of the Design Epistemology. When directly applied to the underlying theme of “Population Health,” it may be found on Page 65 of the Design Epistemology. For “Population Health,” any definition for “Chaotic Disruption” can become encumbered by a complicated array of impairments to a person’s Well-Being and its resilience. Of three articles, I begin with an article entitled: “NETWORKING IN ACTION: TAKING COLLABORATIVE CAPACITY DEVELOPMENT SERIOUSLY FOR DISASTER RISK MANAGEMENT ‘DRM’ (Iao-Jorgensen 2024).” NOTE: It is a Typology.

I cite the first 2 and the last 2 sentences of Iao-Jorgensen article’s ABSTRACT:

“This study investigates the role of multi-stakeholder networks in Disaster Risk Management (DRM) capacity development and how it aligns with the principles of the Sendai Framework for Disaster Risk Reduction. While the Framework emphasises collaboration, coordination, and partnerships among diverse stakeholders, there remains a gap in understanding how networks foster and sustain collaborative DRM capacity in the context of international development projects.[…]Our findings enhance our knowledge of informal multi-stakeholder networks in DRM and other practical insights for optimising institutional designs and networking strategies within and beyond international development projects. The research underscores the importance of scalability, adaptability, and holistic approaches in fostering sustainable collaborative DRM capacity development (Iao-Jorgensen 2024).”

^^^

Four authors, two from Canada, one from Sweden, and one from Australia for this article entitled as: “LINKING DISASTER RISK MANAGEMENT AND HUMAN DEVELOPMENT (Raikes, et al., 2021).” NOTE: A phenomenology.

Here, I cite the first and last sentences of the article’s ABSTRACT:

“As disaster risks from floods and droughts continue to increase and affect communities, the relationship between disaster risk and human development becomes increasingly important.[…] While an integrated approach to DRM and human development challenges the political and programmatic complexities for flood and drought risk reduction, approaches to disaster risk governance that reflect the capacities and needs of individuals and vulnerable populations must be developed (Raikes et al., 2021).”

^^^

EMERGENCE — THREE POPULATION HEALTH & ITS PRIMARY HEALTHCARE

Barbara Starfield, M.D., M.P.H. (1932 – 2011) began her professional career at Johns Hopkins University, College of Medicine in 1959, beginning with an evolving professional involvement with the importance of PRIMARY CARE within the realm of our nation’s Population Health. The evolving breadth of her early career is best represented by her first book entitled; “PRIMARY CARE Concept, Evaluation, and Policy (Starfield 1996).” — 119 —

Here, I cite the first paragraph of this book’s Preface: “In its most highly developed form, primary care is the point of entry into the health services system and the locus of responsibility for organizing care for patients and populations over time. There is a universally held belief that the substance of primary care is simple. Nothing could be further from the truth. This book is testimony to the challenges of primary care.”
And now, I cite the last paragraph of its Preface: “Primary care is complex; its challenges will require concerted efforts at research and systematic translation of knowledge into policy. If this book stimulates these activities, it will have achieved its purposes (Starfield 1996).”

^^^

Some ten years after her book’s publication, she and her associates compiled an article for The Milbank Quarterly, entitled as: “Contribution of Primary Care to Health Systems and Health (Starfield et al., 2005).”

Here is its remarkable Abstract: “Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been verified, thus suggesting ways to improve overall health and reduce differences in health across major population sub-groups (Starfield et al., 2005).”

^^^

At the age of 78 years, Doctor Starfield died on June 11, 2011. Then a periodic visiting Professor at the Manchester University in the United Kingdom since 2005. Beginning in 2010 and ending before her death, Doctor Starfield had written and published 11 articles in 18 months. One article has the following title: “Challenges to primary care from the co-occurrence of multi-morbidity (Starfield 2011).”

Here is the last paragraph for this 1 & 1/2 page Editorial for the Journal of Primary Care Research & Development: “In conclusion, we know that multi-morbidity is increasing. We also know that it is not ‘chronic diseases’ by themselves that are the challenge. What we do not know is the appropriate role of specialists (and hence, referrals) in the management of people with multi-morbidity. Because of changing health needs, disease-oriented care must be replaced by person-oriented care over time. That is, we need more and better primary care (Starfield 2011).”

^^^

Carlson, Marcia J. (2022), Christopher Wimer, & Ron Haskins. Changing Work, Changing Families, and Public Policies Toward Low-Income Families. RSF: Journal of the Social Sciences, 8(5):1-22. DOI: 10.7758/RSF.2022.8.5.01

Heckman, James J. (2008). The Case for Investing in Disadvantaged Young Children. http://.handle.net/10419/166932

Heckman, James J. (2012). THE ECONOMICS OF INEQUALITY. The Value of Early Life Education, AMERICAN EDUCATOR, Spring 2011

Iao-Jorgensen, Jennt (2024). Networking in Action: Taking collaborative capacity development seriously for disaster risk management. Progress Disaster Science, 21 (2024) 100311

Raikes, Jonathan (2021), Timothy F. Smith, Claudia Baldwin, and Daniel Henstra. Linking disaster risk reduction and human development. Climate Risk Management, 32 (2021) 100291.

Randless, Jennifer (2022). Fixing a Leaky U.S. Social Safety Net: Diapers, Policy, and Low-Income Families. RSF: Journal of the Social Sciences, 8(5): 166-83. DOI: 10.7758/RSF.2022.8.5.08.

Starfield, Barbara (1992). PRIMARY CARE Concept, Evaluation, and Policy. Oxford University Press, Inc. New York, New York 10016

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Sarfield, Barbara (2011). Challenges to primary care from the co-occurrence of multi-morbidity. Primary Health Care Research and Development. 2011; 12:1-2 https://doi.org/10.1017/S14634223610000484

#9 of 42 — 121 —

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For the DESIGN EPISTEMOLOGY

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