NATIONAL HEALTH usa

Community  Health  Forum

 

     

 A      R  A  T  I  O  N  A  L  E

    

To  establish  a  Congressionally  Chartered,

semi-autonomous  institution  for  improving  the 

HUMAN DIGNITY   of  each  resident  person’s   HEALTH

by  implementing  a   New Strategy   and   Four National Projects

that  is  *) governed  by  a   Complex Adaptive System   involving

9  separate  clusters  of  States  with  each  cluster  representing

a  nearly  equal  population  of  resident  persons,  *) funded

by  a  population-fixed  budget,  and  *) guided  by  a

dynamic   DESIGN EPISTEMOLOGY. 

 

 

 

47 pages                                                                              —   1   —

INTRODUCTION

 

 

“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)

 

 

“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)

 

 

“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)

 

 

“Never doubt that a few committed people

can change the world.

In the end, it’s the only thing that ever has.”

Margaret Meade    (1901 – 1978)

 

 

Before getting started, please take a moment to read again the quotations cited above.  As represented by these authors, their views about each person’s lifelong survival are similar to my own.  Do you also share a similar view of life?  If so, you’ll probably agree with the next sentence about our nation’s level of  Stable HEALTH.  The current strategy for its reform is unlikely to improve our nation’s Population Health or the Primary Healthcare that is offered for the Basic Healthcare Needs of each resident person within every community.  This Primary Healthcare is often ‘difficult’ to locate within a community, ‘difficult’ to use because of its inequitable payment systems; or ‘difficult’ to trust because of the subtle even if unintended stigma associated with its social interactions.

   For truly lasting HEALTH reform, any new ‘nationally sanctioned strategy’ must first, begin to promote enhanced Primary Healthcare that is equitably available as well as ecologically and culturally accessible by every resident person within their own community.  Most of the world’s advanced-developed nations, e.g., Australia, have their own ‘nationally sanctioned strategy’ to assure the equitable availability of enhanced Primary Healthcare within each of their nation’s communities.  The United States has never had such a strategy for Primary Healthcare.

   The deficiencies of our Primary Healthcare also aggravate the inability of our nation’s healthcare reform to improve our nation’s Population Health, especially its social determinants.  For this level of reform, I use the words ‘nationally sanctioned strategy’ to mean locally initiated, community-sponsored, regionally promoted, and nationally Chartered.  And, I use the word ‘enhanced’ to mean that this Primary Healthcare should offer enduring, caring relationships as a baseline priority to achieve ‘Stable HEALTH  For Each resident Person.’  In addition, each community would focus on their locally prominent SDOH  (Social Determinants Of Health) by refining their local Survival Commons, viz., augmented safety net, to improve the proportionality attributes for every resident person’s Human Dignity within their own community.   —   3   —

   Next, please accept my view that healthcare reform should also strive to improve our nation’s social cohesion and its associated incidence of poverty.  For poverty improvement, healthcare reform must become supportively connected with a “community by community” promotion of annually sustained, reciprocal investments of social capital among their contiguously-adjacent communities.  For uniform healthcare reform, each community would represent, on average, 400,000 resident persons.  Identifying at least 810 national communities who would then individually collaborate with their contiguously-adjacent communities may represent the most important nationally Chartered and regionally promoted strategy for improving each community’s Survival Commons, viz., their enhanced safety net.  I ask you, could this analysis represent the best platform for a steadily progressive improvement of our nation’s  Population HEALTH  as well as its Primary Healthcare?  If you only possibly agree, just keep on reading.

   The remainder of this DESIGN EPISTEMOLOGY Sub-Page takes about 45 minutes to read.  It describes a New Strategy to release the paradigm paralysis that currently prevents meaningful healthcare reform.  A precisely planned and steadily promoted paradigm reconfiguration will be required to realign the scientific and humanitarian mandates underlying each community’s social cohesion and its Primary Healthcare.  To release the current paradigm paralysis, this New Strategy including its associated Four National Projects should begin by slowly building momentum for 3-5 years and then achieve maturity more rapidly over another 5-10 years.  Most importantly, this reconfiguration strategy should refocus our nation’s social-political-economic priorities to substantially reduce the poverty underlying its Population Health attributes.  To prepare for the initial long-term phase, we must begin by improving both our nation’s social cohesion and the availability of enhanced Primary Healthcare for each resident person within every community. 

   Applicable to Population Health and its Primary Healthcare, a Design Epistemology (Karabeg 2005, 2012) would require an obligatory commitment to its use for guiding the systematic implementation of the broadly informed and precisely focused, New Strategy.  The use of the Design Epistemology as an intentional guide to inform our nation’s  ‘VISION’  for healthcare reform may be the best strategy to reduce the cognitive dissonance potentially associated with a multi-dimensional, paradigm reconfiguration.  This view refers to the complex paradigm that is no longer able to improve our nation’s Population Health as well as its Primary Healthcare. 

   The unique application of 30 inter-connected definitions from within the Design Epistemology to reduce the occurrence of cognitive dissonance may be the only available “yardstick” for promoting the affairs of  NATIONAL HEALTH  to successfully achieve its  GOALs  within 10-15 years.  To begin, here are the  GOALs: 1) decrease our nation’s annual maternal mortality incidence by 70%, 2) decrease our nation’s annual health spending as a portion of our GDP from 18% to 13%, and 3) obtain Legislative collaborative involvement by all 50 States.  These  GOALs  would be assigned to the formation of a new, nationally Chartered semi-autonomous institution, identifiable as  NATIONAL HEALTH.  The new institution would be established with precisely limited Federal funding, a Congressional Charter for an initial Visioning Statement, regionally distributed governance, a prohibition for any direct participation in the financial reimbursement of healthcare, and a sunset provision.

   The Design Epistemology would also guide the collaborative process necessary for a permanently evolving Complex Adaptive System (CAS).  The CAS would be formed by  NATIONAL HEALTH  from its roots originating within every community.  Currently, Design Epistemology lacks a nationally recognized institutional basis to integrate its definitions with an intent for its use to guide an evolving, interconnected implementation mandate for  NATIONAL HEALTH.  Eventually, the Design Epistemology’s original, 30 concepts will require periodic revision for its concurrent use to guide the permanent preservation of our nation’s  Population HEALTH  and its  Primary Healthcare.

   An intensely collaborative, intellectual commitment will be necessary to reconfigure the economic-social-political processes required to achieve   Stable HEALTH  For Each Person  within every community.  Intentionally, the 30 concepts inform the basis for implementing a 10-year, paradigm reconfiguration to achieve a comprehensively planned improvement of our nation’s Population HEALTH and its Primary Healthcare.  The 30 concepts are thematically categorized for establishing a new, nationally Chartered, semi-autonomous institution to inform and refocus the continuing paradigm reconfiguration into the future.  These five themes are as follows:                                                     —   5   —

 

• COSMOLOGICAL     POPULATION HEALTH,    DISRUPTIVE PROCESS,    HUMAN DIGNITY,    QUANTUM SIGNALING BRAIN,    COMPLEX ADAPTIVE SYSTEM,    &    MANAGING THE COMMONS;                                         p 7                                                                       
• INDIVIDUAL     WELL-BEING,    CLUSTER,    CULTURAL SOCIAL-COGNITION,    HUMAN CAPABILITY,    HUMAN FETUS,    &    PERSON;                                                   p17                 
• NEIGHBORHOOD     SALUTATORY GREETING,    SOCIAL INTERACTION,    CARING RELATIONSHIP,    FAMILY TRADITIONS,    EXTENDED FAMILY,    &    FAMILY;    p24                             
• COMMUNITY     PROSOCIALITY,    SOCIAL DILEMMA,    COLLECTIVE ACTION,    COMMUNITY,    SOCIAL CAPITAL,    &    HEALTH;    AND                                    p33                                                                    
• NATIONAL     HEALTH CARE,    PRIMARY HEALTHCARE,  INSTITUTION,    SURVIVAL COMMONS,    SOCIAL COHESION,    &    COMMON GOOD.                               p40

         

 

               

              

       ———-     D E S I G N     E P I S T E M O L O G Y     ———-

 

GETTING  STARTED  —  MODERATING  CHANGE

The Thomas Jefferson Presidential Memorial is located on the Tidal Basin south of the Mall in Washington, D.C.  Inscribed inside the Memorial on its Eastern wall is a quotation from President Jefferson.  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 progress 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.”

Thomas Jefferson    (1743 – 1826)

 

 

   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 and The Reverend Doctor Martin Luther King, Jr.  I would urge anyone who visits our nation’s capital to plan, at a minimum, a visit to the Tidal Basin.  Each of the three Memorials can be easily surveyed during a 2-hour walk.  The time really depends on the impact that you experience while integrating the expressions of these three giants within our nation’s heritage.  Amidst this awareness, we should acknowledge the wisdom of a noted British historian.  Sir Arnold Toynbee, Ph.D. is most widely known for his 12-volume, book set:  THE STUDY OF HISTORY.  (Toynbee 1920)  I cite two quotations from Professor Toynbee. 

 

“Of the twenty-two civilizations that have appeared in history,

nineteen collapsed when they reached the moral state

the United States is in now.”

^

“Civilizations die from suicide, not murder.”

 Arnold  Toynbee    (1889 – 1975)

 

                                                                                                                                                                                                       —   7   —

————–      C  O  S  M  O  L  O  G  Y      T  H  E  M  E      ————–

1    of    5

 

 

 

POPULATION  HEALTH   –   DISRUPTIVE  PROCESS

HUMAN  DIGNITY   –   QUANTUM  SIGNALING  BRAIN

COMPLEX  ADAPTIVE  SYSTEM – MANAGING  THE  COMMONS

 

 

POPULATION  HEALTH    may be postulated for a  NATION  as

^

its community by community patterns of  Unstable Health

that occur among their respective resident persons as a result

of each community’s multi-generational and concurrent encounters

with  Disruptive Processes  which variably disturb the resilience

of each resident person’s  HEALTH  and require a collaborative

commitment by their community’s  Survival Commons  to prevent,

mitigate, and ameliorate any harmful effects caused by these diverse

Disruptive Processes  and thereby minimize their disturbance

to the continuing resilience of each resident person’s

innate temperament and baseline homeostasis.

 

COMMENT    Beginning with  POPULATION  HEALTH,  there are another 29 definitions associated with this Design Epistemology.  For 20+ years, there has been a fitfully evolving attempt to propose  POPULATION HEALTH  as an independent phenomenon, but as yet it remains incomplete.  I cite the attempts of pre-eminent scholars to build a robust understanding of this concept.  The distant scholars include  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). 

      During 2021-22, an exuberant effort by several scholars led to a wider view regarding Population Health including  C. J. Peek (Peek et al 2021),  Mark Feinberg (Feinberg et al 2022),  David Kindig (Kindig 2022),  Craig McEwen (McEwen 2022), and  (Holland Vasquez et al 2022).  The Definition attempts to define the ebb and flow that affects each person’s  Stable HEALTH  throughout every community. 

   The  SURVIVAL  COMMONS  concept represents a definition for each community’s attempt, however configured, to sustain a community-originated process for a steady enhancement of their “safety net.”  Its definition may be found on page 44 of this Design Epistemology.  A  SURVIVAL COMMONS  would be established as a collaborative project by each of the 810 Community HEALTH Forums associated with the New Strategy of the  NATIONAL HEALTH  Proposal.

 

A  FAMILY  FOR  CHILDHOOD  AND  ADOLESCENT  DEVELOPMENT

The complexity underlying this definition for “Population Health” may be most fully appreciated by a quotation from a book published initially in 1981 and written by C. Margaret Hall, Ph.D. entitled:  THE BOWEN FAMILY THEORY AND ITS USES.  The book represents a composite review of the family therapy system developed and investigated by Murray Bowen, M.D. (1913-1990).  From its 1991 edition, I quote from pages 36-37 of  Professor Hall’s 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 an individual’s life situation at birth and in the years of early socialization, but they also strongly influence 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, adoption, 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 emotional 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 crises in the emotional relationships of the differentiating person’s family.  Differentiation of self may also consist of planned responsible behavior in major crises, such as the 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.”

 

COMMUNITY  BY  COMMUNITY

As a model for substantial change, Congress passed the Smith-Lever Act in 1915 to establish the Cooperative Extension Service.  “Extension” connected our nation’s farming industry with their State’s University-associated, Agriculture Colleges.  The connection informed the Agriculture Colleges about their unresolvable farming problems and the farmers received equal information about newly developed strategies for timely application.  As a result, our nation’s agriculture industry now produces food substantially more efficiently than any other nation, by a wide margin.  There is an estimate that 1% of our nation’s citizens produce the equivalent of 100% of our nation’s food needs.  The local and state-wide dimensions of the Cooperative Extension Service, aka “Extension,” assures that the training within each State’s Agricultural College is focused on the nuances of farming faced by all of their own State’s active farmers.  Simultaneously, this forms a means to implement new changes based on an evolving history of new information.   —   9   —

   For instance, our nation’s maternal mortality incidence continues to annually worsen, as it has since 1970.  It is curious that our nation’s healthcare industry seemingly has not achieved any appreciable change in this phenomenon.  An “antibiotic model” as a basis for identifying the root causes to eventually develop a treatment plan(s) for a curative outcome has, as yet, failed.  This result has not occurred because of a lack of focus, commitment, or urgency regarding the loss of Human Dignity that occurs with a maternal death. 

 

 

 

DISRUPTIVE  PROCESS    may be postulated for  HEALTH  as

^

an entanglement of  Cosmological,  Biological,  and  Human Dignity

disturbances, each occurring with paradoxical emergence and

diversely-intensive, time-course patterns that converge to form

a unique Cluster of disturbances which variably interacts

with a community’s resident persons to variously alter the

the resilience of each resident person’s current and future

Stable  HEALTH.

 

COMMENT    A specific Sub-Page for  DISRUPTIVE PROCESS  can be found under the  EXECUTIVE SUMMARY  PAGE.  It attempts to curate a summary of the current knowledge concerning the essential causes of Unstable HEALTH including their prevention, mitigation, and amelioration.  Recently new to this formulation, we must come to terms with the complex dimensions of epigenetics.  For instance, the scientific application of this concept for understanding poverty does not exist.  Its complexity will require a uniquely human understanding of “poverty” within every nation’s Population Health.

   Here is a report about epigenetics.  In 2020, the HAPO Follow-up Study Cooperative Research Group published a report from their multi-institutional group.  For the study’s CONCLUSION AND RELEVANCE, I cite its introductory 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 subsequent age of 10-14 years after birth.”   (Perak et al 2020)

   To understand a general recognition of  DISRUPTION,  its occurrence for industrial business institutions is often associated with the introduction of innovation that is described as associated with the occurrence of unpredictable chaos.  I cite Joshua Gans for this isolated arena of knowledge.   (Gans 2016)  The concept of chaos should be acknowledged given its association with certain Quantum phenomena. 

 

 

 

HUMAN  DIGNITY    may be postulated for  HEALTH  as 

^

a Homo Sapiens, fertilized ovum that survives its maternal gestation

to achieve sustainable viability at birth as a dependent person,

acquires developmental attributes during childhood and adolescence

in accord with their uniquely-endowed Human Capability

to become a variably self-sufficient person after adolescence, and 

survives with diversely self-sufficient attributes representing

Intrinsic Value,  Moral Autonomy,  and  Fundamental Equality.

 

COMMENT    Amid all the other 29 definitions of this Design Epistemology, this one has been the most difficult to establish since there is no historically definable heritage for its presence within a Design Epistemology.  To apply another frame of reference for understanding Human Dignity, we should all be indebted to the constitutional, international legal scholarship that has burgeoned since 1947.  While the United Nations was institutionally being formed in 1945, Eleanor Roosevelt convened a large number of international scholars to craft a  UNIVERSAL DECLARATION OF HUMAN RIGHTS.  It was approved by the United Nations in 1947 and includes a sentinel reference to Human Dignity.

   Since then, 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 infers the attributes of Human Dignity.  To date, only the State of Montana has specifically added a Human Dignity provision to its Constitution.  As a US protectorate, Puerto Rico has also.       —   11   —

   Since 1970, the Human Dignity concept has been most thoroughly analyzed by the scholarship of  Myres S. McDougal (McDougal, Lasswell & Chen 1969),  Oscar Schachter (Schachter 1983),  W. Michael Reisman (Reisman 1990),  Stephen J. Wermiel (Wermiel 1998, 2012),  Johanna Kalb (Kalb 2010),  Doron Shultzinger (2004, 2017),  Vicki C. Jackson (Jackson 2004),  and Kai Moller (Moller 2012, 2021).  The Professor Wermiel essay published in 2012 has a unique title: “Gazing into the future: The 100-Year Legacy of Justice William J. Brennan.”  Overall, these authors represent a systematically considered analysis of Human Dignity within International Law.  The analysis cited above by Professor Kai Moller best informs the application of  HUMAN DIGNITY  for enriching this Design Epistemology.  Of the essays cited “Since 1947”, it is the most succinct.  

   The Professor Moller essay carries a uniquely descriptive title, viz., “BEYOND REASONABLENESS: The Dignitarian Structure of Human and Constitutional Rights.”  With an explicit reference to cosmological dimensions, this Sub-Page’s application to the Design Epistemology intends to link three separate but interconnected and broadly recognizable “facets” of Human Dignity.  As defined by Professor Moller, they are intrinsic value, moral autonomy, and fundamental equality.  They also coincide with the terminology associated with an alternate definition of Human Dignity that originates from the Legal Dictionary at the   www.Duhaime.org   website.  Its terminology is cited as identified by “viz.” within the definition of Human Dignity that is described below.

   “Intrinsic Value,” viz.,  ‘Self-respect and Self-worth,’  represents each person’s contribution to their Homo Sapiens species.  In that role, each person contributes to the survival of their species, no matter how their contribution could have been defined.  As a result of this recognition, each person deserves equitably respectful acknowledgment of their personhood.  Therein lies the issues that degrade Humanity as in slavery, social caste systems, poverty, corporal punishment, or the occurrence of a substance disability.  The intersection of Human Dignity with the Constitutional provisions for Human Rights can become complex given a 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 major religious traditions.  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.  For that role, each person then becomes responsible, as viewed by proportionality, for maintaining the welfare of all the other biological entities including their reproduction.

   “Moral Autonomy,” viz.,  ‘Physical and Psychological Autonomy,’  would represent each person’s acquisition and subsequent expression of moral reasoning as a basis for achieving their ecological and cultural, self-sufficient survival.  In essence, this process is dependent on the options available within their neighborhood home’s community to acquire and maintain their adaptive skills for survival.  Ultimately, each community is obligated to assure 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 will then become responsible for the prevention, mitigation, and amelioration of the ecological and cultural issues associated with 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 long-term risk management and its associated social cohesion obligations.

   “Fundamental Equality,” viz.,  ‘Autonomy,’  would represent 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 by community, communal effort to prevent, mitigate, and ameliorate any inequitable ecological and cultural attributes of their own community’s  Survival Commons, viz., enhanced safety net, for each of its resident persons. 

 

 

 

QUANTUM  SIGNALING  BRAIN    may be postulated for  HEALTH  as

^

the centralized processing and memory functions

of every person’s nervous system that is modified

by each person’s uniquely-endowed Human Capability

 before becoming a viable Human Fetus to form

the 4D quantum processing of their contextual and sensory,

pattern recognition to achieve adequate resilience between

the person’s innate temperament and its baseline homeostasis as 

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

                    an Independent Person after adolescence.     —   13   —

 

COMMENT    Among the thirty concepts encompassed by this Design Epistemology, a Quantum Signaling Brain for each person is likely to 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 imagination to understand this new phenomenon.  For most quantum dimensions, they can not be measured by direct assessment.  Thus, ‘alternate statistical systems’ are required to assess the presence of quantum phenomena.  Devising an ‘alternate statistical system,’ using calculus, requires the exploration of alternate statistical models and thus the need for scientific imagination.

   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  THE STRUCTURE OF SCIENTIFIC REVOLUTIONS  initially published by Thomas S. Kuhn in 1962.  (Kuhn 2012)  It is best complemented by the Eric Hoffer book  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 human brain and its Cultural Social-cognition as the basis to understand each person’s substantially unique, survival among all the other biological species.  After birth, each person eventually achieves self-sufficient survival by the continuous acquisition of adaptive skills that eventually includes a cultural array of social interactions, moral reasoning, and an adaptive personality.  Importantly for understanding the origins of this ecological and cultural array of attributes, I refer to the career-long research commitment by Michael Tomasello, Ph.D., viz., to define each person’s Childhood Development and its sequential trajectory during their human development.  The breadth of this commitment should inform everyone’s knowledge arena for understanding Population Health.  Among several books and many research reports by Professor Tomasello, his capstone book is  BECOMING HUMAN – A THEORY OF ONTOGENY.  (Tomasello 2019)

   For the analysis of the various “quantum” alternatives that could account for human consciousness, consider  THE ELECTROMAGNETIC BRAIN – ELECTROMAGNETIC FIELD THEORIES ON THE NATURE OF CONSCIOUSNESS  by Shelli R. Joye, Ph.D. (Joye 2018)  For a recent biological-journal review that is internet open-accessible, consider  BIOMOLECULAR BASIS OF CELLULAR CONSCIOUSNESS VIA SUBCELLULAR NANOBRAINS.  (Baluska et al 2021)                                               

 

 

 

COMPLEX  ADAPTIVE  SYSTEM    may be postulated as

^

a minimally-nested cluster of diverse public and private institutions

with a large-scale, complex Human Dignity responsibility that becomes

established and sustained by the application of collective action

to define and periodically revise a quantum-informed

Visioning Statement for an Action Plan that is collaboratively

implemented to generationally function near the edge

of chaos to successfully achieve the  GOALS  of its  VISION.

 

COMMENT    To engage 810 communities of our nation by a Complex Adaptive System (CAS) of institutions after the end of a pandemic may seem totally unrealistic.  Especially, since the CAS would intentionally rebuild our nation’s Social Cohesion with a self-governed, decentralized span-of-control institution presumably involving 2,000 Associates who would represent the staff of  NATIONAL HEALTH  and the 900 Members of their 10 Governance Committees.  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 the local CommunityHEALTHforums’ governance membership would also need to be locally identified. 

   Further analysis and exploration of this concept should begin with three journal essays:  1) Kevin J. Dooley “A COMPLEX ADAPTIVE SYSTEMS MODEL OF ORGANIZATION CHANGE” (Donley 1997);  2) Marguerite Schneider and Mark Sommers “ORGANIZATIONS AS COMPLEX ADAPTIVE SYSTEMS: Implications of Complexity Theory for Leadership Research” (Schneider & Sommers 2006);  and  3) Sylvia Grewatsch, Steve Kennedy, and Pratima (Tima) Bansal “TACKLING WICKED PROBLEMS IN STRATEGIC MANAGEMENT WITH SYSTEMS THINKING” (Grewatsch et al 2021).  A book written by Danah Zohar describes the quantum perspective for this definition: “ZERO DISTANCE  Management in the Quantum Age.”  (Zohar 2022)                  —   15   —

 

 

 

MANAGING  THE  COMMONS    may be postulated for  HEALTH  as

^

the application of the Design Principles associated

with the successful management of a Common Pool Resource

to guide the formation of a Complex Adaptive System for achieving

a budgeted portion of a nation’s annual Gross Domestic Product

that is allocated to its national health spending

including the  HEALTH Security  certified Primary Healthcare that is

offered within every community to promote the occurrence of

Stable Health  For Each Resident Person.

 

COMMENT    The acceptance presentation given by Professor Elinor Ostrom on the occasion of her Nobel Prize ceremony in 2009 best describes her research for the validation of the Design Principles. A URL for the associated essay may be found on YouTube.

   A Design Epistemology would intentionally represent a guide to inform the introduction of a New Strategy for improve our nation’s Population Health.  This New Strategy would be managed primarily by 810 contiguously-designated communities and their locally planned and monitored strategy for implementing enhanced Primary Healthcare throughout their community.  Improving every community’s social cohesion as well as its Primary Healthcare will require a collective action strategy involving each community’s relevant stakeholders for the governance of their own Community HEALTH Forum.  These Forums would generationally focus on the resilience of its own  Survival Commons, viz., enhanced safety net.

   As noted above, 810 Community HEALTH Forums would be necessary, each nationally sanctioned to receive technical assistance from a newly formed & nationally chartered institution.  The Community HEALTH Forums would be constituted using county and state borders as contiguously-adjacent population clusters involving 100,000 to 600,000 resident persons (with a median of 400,000) depending on local population density levels, state by state.  Intentionally, every resident person within every state would be served by their own, locally supported Community HEALTH Forum.

   In addition to the New Strategy, one of the 4 National Projects would establish a financial, risk-sharing strategy based on the Design Principles that were defined and validated by Professor Ostrom.  The strategy would slowly incorporate all current payers and providers of Primary Healthcare in a deeply nested and stop-loss-protected, national re-insurance system. The system would be implemented with a slowly advancing, annually incremental process.  Current pricing and payment systems would remain unchanged other than their participation in the nationally integrated and enhanced financial monitoring processes that would also include any applicable coordination of benefits based on a first-payer process.

   As the annual health spending by a portion of the GDP devoted to healthcare begins to decrease, a strategy to achieve universal health insurance would be a consideration.  In addition, two other nationally focused, funding priorities should involve early childhood education beginning at 6 months of age and universal family leave. 

 

 

 

 

————–      I  N  D  I  V  I  D  U  A  L      T  H  E  M  E      ————–

2    of    5

 

 

 

WELL-BEING  –  CLUSTER  –  CULTURAL  SOCIAL-COGNITION

HUMAN  CAPABILITY   –   HUMAN  FETUS

PERSON

 

 

“WELL-BEING,  when defined as a person’s eudaimonia,

represents  ‘Happiness  In  An  Objectively  Worthwhile Life’. ”      (Badhwar 2014)

 

COMMENT    Professor Neera Badhwar validated this definition with a philosophical analysis using alternate lines of reasoning originating from a diverse cluster of authors.  The book cites Julia Annis, Aristotle, Albert Einstein, Cicero, Victor Frankl, Stephen Hawking, Immanuel Kant, C.S. Lewis, Abraham Maslow, Martha Nussbaum, Carl Rogers, and Amartya Sen, among many others.

   As an aside, Merriam-Webster’s Collegiate Dictionary  11th Edition  cites 1582 as the origin of the word and defines it as “the state of being happy, healthy, or prosperous.”  In addition, the same Dictionary defines “Health,” in part, as “WELL-BEING.”  My own bias is that WELL-BEING and a person’s trustworthy perception of their community’s municipal life are inexorably interconnected.  Population Health research has shown that “self-reported health” and “trust” demonstrate reverse causality.  (Giordano & Lindstrom 2015)                                              —   17   —

   In addition to the above definition for WELL-BEING, a clearly defined definition for HEALTH is needed to reduce the cognitive dissonance surrounding its use.  The Design Epistemology includes a definition for HEALTH on Page 38.  It is focused on how each person’s Well-Being becomes developmentally achieve after their birth by their uniquely-endowed Human Capability, especially its attributes of Cultural-Socia Cognition.  

 

 

 

  CLUSTER    may be postulated as

^

two or more components that form

a sustainable capability when the components

paradoxically interact as a result of their respective

Quantum-related contributions to

the  synergy occurring among the components,

the  affinity between or among the prominent components, and

the  salutary conditions surrounding the components.

 

COMMENT     Among many useful applications, Cluster phenomenon may be most recognizable by their use to explain biological evolution. Given Newton’s 2nd Law of Thermodynamics, Addy Pross Ph.D. proposed an analysis for biological evolution that, in effect, represented its preservation of entropy.  (Pross 2012)  Ultimately, the occurrence of human evolution and its associated mammalian species with the same closely associated cluster of sensory input information for brain function.  They may be recognized as vision and its depth perception, smell and its danger-alarm recognition, hearing and its directionality and depth perception, taste, blood pressure, oxygen blood level, and certain hormone blood levels.

   From a socio-economic standpoint, another scenario represents an odd cluster phenomenon.  Imagine that 4 gas stations are each separately located on the four corners of a busy intersection with a 4-way stop-light.  Each represents a different brand.  From a business viewpoint, the four gas stations will each and together do better than if they were separately located a city block from the same intersection. 

   For the  NATIONAL HEALTH Proposal,  the Cluster concept occurs frequently within the 30 definitions of this  DESIGN EPISTEMOLOGY.  Here are six concepts that require a Cluster configuration.  They are:  Collective Action,  Complex Adaptive System,  Cultural Social-cognition,  Community,  Family,  and  Survival Commons.  Within Cosmology, Cluster phenomena are associated with its Quantum dimensions.  For the preservation of a Common Pool Resource, its non-formalizable “elements that mutually interact” are labeled as “idle talk” by Professor Elinor Ostrom.

   Finally, there is no current, widely cited and clarified definition for a Cluster among its disparate applications.  The definition given above, represents a personal effort to accommodate these applications with a single definition.  This episodic effort began around 2005.  I do not claim any Creative Rights to its use or non-use. 

 

 

 

CULTURAL  SOCIAL – COGNITION    may be postulated as

^

a unique cluster of cognitive attributes encompassing each person’s

Shared Intentionality,  Tribal Social Learning,  and  Symbolic Learning 

that is nurtured during each person’s childhood development

by their Family,  their Extended Family, their Family Traditions,

their Home’s close neighborhood, and the  Survival Commons

of their family’s community to prepare each person’s

prosocial contribution to the generational survival

of their  Homo Sapiens  species.

 

COMMENT    A detailed analysis by Professor Tomasello of the evolutionary progress of the Homo Sapiens species indicated an evolutionarily sudden transition 150,000 years ago that included an expanded set of 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 2019)               —  19  —

   Shared Intentionality  represents “…the ability to participate with others in collaborative activities and shared goals…” (Tomasello et al 2005)  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 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 Dunbar Number, of persons within a natural social network.  (Dunbar 2020)  This social network, alias tribe or 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, ‘fun-to-read’ essay by Erving Goffman, Ph.D.: “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, or not, with other Tribal units.                                                      

 

 

HUMAN  CAPABILITY    may be postulated for  HEALTH  as

^

each person’s genetically and epigenetically endowed

Quantum Signaling Brain that

emerges initially during their Human Fetus, Preparatory Phase;

begins to promote synergy between their innate temperament and

its baseline homeostasis to become a pre-viable Human Fetus;

configures their Cultural Social-cognition to become

a viable Human Fetus and eventually begin each person’s

lifelong pursuit of Human Dignity after birth;

initiates their consciousness at birth;   AND

promotes their adaptive skills during

^

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

early childhood when it is nurtured by the caring relationships originating

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

their Home’s close neighborhood

AND

ii. the person’s situationally socialized, cognitive development throughout

late childhood, adolescence, and early adulthood

to become sustainably self-sufficient 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 spontaneous immediacy to apply prosocial norms

for resolving the discordant social interactions encountered daily

within the metropolitan life of their Family’s community, especially

if these discordant social interactions also receive timely mentoring

by the caring relationships originating from within

the gatherings of their Family, their Extended Family, and

their Home’s close neighborhood.

 

COMMENT    The original conceptual exploration of “Human Capabilities” is primarily attributable to Martha Nussbaum, Ph.D. and Amartya Sen Ph.D. (Nussbaum and Sen 1993)  They have proposed that each person’s human capability dimensions represent a set of aspirational functionings as the basis to promote social justice within a social-choice based democracy.  This expanding philosophical exploration has now been somewhat codified by its designation as “the human capability approach.”  In contrast, the future of a NATIONAL HEALTH tradition implies that each person’s uniquely-endowed  HUMAN CAPABILITY  alone defines the Homo Sapiens species as substantially separate from all the other biological species.     (Tomasello 2019)                 —   21   —

 

 

 

HUMAN  FETUS    may be postulated for  HEALTH  as

^

identified initiall by the occurrence of a fertilized ovum

of the Homo Sapiens species and its gestational survival

during an initial 8-week Stage involving its uterine implantation,

germination, and embryonic phases

to then begin a variably 32-week fetal stage that

incorporates its generational genetic and epigenetic origins

into the endowment of its individually-unique Human Capability

to become a viable Human Fetus as enhanced

by the pregestational resilience of its mother’s Stable Health and

by the perinatally co-occurring caring relationships originating

from within its gestational parent’s Family, their Extended Family, and

their Home’s close neighborhood.

 

COMMENT    Each resident person of every community should have regular “nudge” that this phase of every person’s future survival hinges on the unique juxtaposition of multiple, generational traditions that coalesce for every Human Fetus.  Family Traditions are required to nurture the maternal, “gestational” survival with anticipatory courage and enduring hope, in spite of the physical and emotional risks that are not manageable alone by any “medical model.”  This Human Fetal stage begins a quest to gradually acquire a new beginning for its Family and their individually unique communal needs.  Its most important transition occurs after 16-20 weeks of gestation when birth viability occurs.  As of 2022, there are no physiologic resiliency tests that reliably identify when the onset of birth viability by a Human Fetus has occurred. 

   The Human Fetal stage ends at birth after the onset of a rapidly evolving and complicated, reversal of the maternal, immune-tolerant gestational status has occurred to induce the onset of labor.  With 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 its immune system.  And just as suddenly, the Quantum Signaling Brain is awakened by 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 in 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 slowly, but steadily, more difficult to anticipate.  

 

 

 

PERSON    may be postulated for a  NATION  as representing

^

a Human Fetus that becomes gestationally viable and survives

its birth as an additional ‘Dependent Person’ of their Family

to become a self-sufficient  ‘Independent person’ after adolescence,

unless it’s interrupted by an identifiable interval of Dependency

according to the proportionality provisions of their Nation’s 

Human Dignity which also mediates their nation’s priorities

*) to provide for the basic provisions of every person’s lifelong,

Family-originated  Personal Survival Plan;

*) to sustain each person’s Family Home as supported by

housing, educational, food, and violence safety

of this Home’s Close neighborhood;

*) to prioritize each community’s Community Health Forum and

its  Survival Commons  to enhance their nation’s

Social Cohesion;  and

*) to assure their nation’s participation in the international

marketplace arenas of its worldwide

                 Resources,   Knowledge,   and   Human Dignity.   —   23   —

 

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 poverty in every community, 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, Disruptive Processes.  The Poverty definition, below, explains why this becomes generationally important as a result of its socially epigenetic perpetuation.

   Within the Philosophy arena that focuses on a “Person,” I found that the collection of essays written by A. J. Ayer, Ph.D. were the most accessible for me: “THE CONCEPT OF A PERSON  and other Essays.” (Ayer 1964)  To advance this discipline, it is important to distinguish ‘independent persons’ from ‘dependent persons.’  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.  It becomes even more complicated as each community attempts to manage the free will of its resident persons that are affected by a debilitating mental illness.

   Eventually the issue of Free Will, viz., 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 Professor Ayer, a sentinel essay written by Professor Harry G. Frankfurt 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 or circumstances.  I defer any related discussion of authenticity to others.      

 

 

 

 

 

 

 

 

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

3    of    5

 

SALUTATORY  GREETING   –   SOCIAL  INTERACTION

CARING  RELATIONSHIP   –   FAMILY  TRADITIONS

EXTENDED  FAMILY   –   FAMILY

 

 

 

SALUTATORY  GREETING    may be postulated for  HEALTH  as

^   

a person’s continuously renewed, adaptive skill for offering

a brief gesture of Kindness and Respect to every person that is

safely encountered while participating in their community’s

daily municipal life, especially *for each person recognizably

parenting an infant or toddler and *the eyes of this person’s

infant or toddler with a very brief smile, *for each disabled or

possibly homeless person, and *for each person who lives

within your Family Home’s close neighborhood.

 

COMMENT    When expressed frequently within your Family, its Extended Family, and your Home’s neighborhood as well as your home’s adjacent communities, the persistent sharing of Kindness and Respect by every resident person then builds trustworthy communities.  Improving a community’s social cohesion then promotes each person’s healthy survival during the bad times as well as the good times. (Giordano 2016)  Importantly, every person needs to steadily revise their adaptive skills while encountering our increasingly complex society.  Remember that social stigmata must never be allowed to disturb our mutually shared expressions of Kindness and Respect.  Now, you will understand that a serious commitment is necessary to steadily improve the spontaneity of every person’s ‘Salutatory Greeting’ skills while participating in your community’s municipal life.

   Remember also, good neighborhoods become possible for every family when Kindness and Respect are mutually shared with and among each other’s neighbors,  ALL TOGETHER.                                   —   25   —

 

 

 

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 the 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, 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 involve conditions other than a Salutatory Greeting and can be viewed as representing the cursory events occurring between two or three persons during their community’s municipal life.  The use of Social Interactions became a fixture within Sociology following the publication of Professor Goffman’s book entitled “THE PRESENTATION OF SELF.”  (Goffman 1959/2008)

   Within another similar humanitarian arena, Philosophy uses the term social relations rather than social interactions.  With 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 arena of social capital, social dilemma, and social cohesion as originated by Professor Elinor Ostrom for the analysis of Common Pool Resource management.

 

 

 

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 other’s autonomy,

thrives when each person steadily renews their adaptive skills, and

flourishes from a shared intent 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 process reflected  warmth (viz., non-possessive positive regard);  non-critical acceptance (viz., ecological and cultural dimensions);  congruence (viz., congruent ‘actions, thoughts, and feelings’); and  empathy (viz., the most difficult).  (Rogers 1961)

   What may be new for this definition is the use of the phrase ‘in harmony’: the continuing ability of two persons to interact with a spontaneously forming 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 with a close friendship or family relationship.  There is current research 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, as ‘in harmony.’  Importantly, every infant’s brain requires it to develop normally after birth.        —   27   —

 

 

 

FAMILY  TRADITIONS    may be postulated for  HEALTH  as

^

the adaptive skills of a Family’s persons that

promote each person’s self-sufficient survival when

their social interactions tend to occur with certain attributes

most succinctly describable as 

^

“1. Communicates and listens; 

             2. Affirms and supports one another;   

  3. Teaches respect for others;

4. Develops a sense of trust;   

  5. Has a sense of play and humor;   

                      6. Exhibits a sense of shared responsibility;   

  7. Teaches 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. Respects the privacy of one another; 

  12. Values service to others;      

 13. Fosters family mealtime and conversations;

   14. Shares leisure time together; 

 15. Admits to and seeks help for problems.”     (Curran 1963)  

Delores  Curran      (1932 – 2022)

 

COMMENT     Dolores Curran found herself as having been appointed to coordinate family education within a Catholic parish located in Denver, Colorado.  With her post-graduate education in journalism, she initiated a research project to define what was known about how families best-function to prepare their children as they become independent persons.  As described in her book  TRAITS  OF A  HEALTHY  FAMILY,  an extended survey process produced the list above.  Now some 60 years later, her book continues to be the gold standard.  Written with a warm-hearted hint of Irma Bombeck, it still remains current.

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

   “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 1963)   No one, from my perspective, has defined  FAMILY TRADITIONS with more succinct or accurate precision.

 

 

 

EXTENDED  FAMILY    may be postulated for  HEALTH  as

^

a social network of persons assembled by a family,

commonly involving 3-4 persons per family member, for whom

each member of the social network 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 sustain the ecological and

cultural continuity of its generational Family Traditions;

includes close, nearby residents within the family’s home neighborhood

who share mutually reciprocating, continuous accessibility;

selects persons who offer situational, wisdom-guided mentoring

for the family members, such as  God-Parents;

evolves periodically from the replacement of certain persons according

to the family’s needs for prosocial adaptive skills,

contact frequency, or 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 Family member.                     —   29   —

 

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 2020)  Presumably, this combined version of a Convoy for each parent would then prepare their children’s skills for eventually maintaining their own personal Convoy or a Personal “Board of Directors.” 

   For this Design Epistemology, an amalgamated version of a Convoy might be useful.  However, the scientific and humanitarian association of a convoy as warships at sea would only lessen the overall integrity of the Design Epistemology.  Suffice it to say, an Extended Family has many obligations, 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 virtually disappeared during the first half of the 20th Century.  And, I would venture to say that it currently does not occur.  Another use of Extended Family might apply to the occurrence of early-adult children or grandparents that live with a classic family of mom, dad, baby Jane, and toddler Joe.  Finally, a nuclear family seems to have been applied to a triadic family of mom, dad, and toddler Joe.  Oh yes and finally, a blended family applies to a mom and dad who each have custodial responsibilities for children from a previous marriage as well as their own marriage, viz., a blended family.  

 

 

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;

^

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 Salutatory Greeting to every person that each of their Family’s persons safely encounters during the municipal life of the family’s community, irrespective of any ecological or cultural stigmata possibly represented by either the Family’s person or the other person;

^

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;

^

V. Assembles a collection of Family Traditions to enhance 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, their Home, for their Family within a neighborhood of their municipal or rural community for the purpose of protecting the resilience of each person’s uniquely-endowed Human Capability,

      B. Identify an evolving group of independent persons who would function together as the household’s Extended Family and 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 Extended Family persons variously participate in the gatherings involving their Family Traditions with an intent to enrich its cultural heritage for the family’s communal identity, and

            3. offers courageous mentorship when requested during a substantial disruptive process affecting the survival resilience of any household person, especially during their adolescence and early adulthood;                                                                     —   31   —

      C. Promote gatherings of the Family members within their Home

            1. for a weekly pattern of 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 Traditions, 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 Traditions including those persons residing within the family’s neighborhood;

      D. Define a Personal Survival Plan for each person of the Family with a goal 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 person;  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 their 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.”  Even so, it describes the ecological and cultural requirements for promoting each person’s lifelong  Stable HEALTH.

   The traditions of each person’s ecological and cultural heritage is now withering under a contemporary barrage of discordant social interactions.  More than ever, we all need a very clear basis to reinvigorate the Survival Commons of our own community.  Repeated multiple times, remember that POPULATION HEALTH is ultimately about each person’s Family, their Family Traditions, their Extended Family, and their Home’s close neighborhood as sustained by their community’s Survival Commons, viz., augmented safety net.

   One wonders why there is no substantial arena of research recognition for a clearly understood and recognized ethnography about the basic functional dimensions of a family.  My favorite dictionary uses just 14 words.  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.  Even more unusual, there are now several studies that connect late childhood obesity to the lack of at least 5 family mealtimes weekly during infancy and early childhood.  One wonders whether or not, the lack of a clear recognition of family dynamics has led to an excessively driven ‘live and let live’ acceptance about our nation’s obligations to prioritize Family Traditions.  If so, it represents another example of cognitive dissonance that has “run amok.”                                                                               —   33   —

 

 

 

 

 

 

————–      C  O  M  M  U  N  I  T  Y      T  H  E  M  E      ————–

4    of    5

 

 

PROSOCIALITY   –   SOCIAL  DILEMMA

COLLECTIVE  ACTION   –   COMMUNITY

SOCIAL  CAPITAL  –  HEALTH

 

 

 

PROSOCIALITY    may be postulated for HEALTH as

^

a social interaction initiated by one or more persons

in behalf of one or more other persons that is typically based on

caring relationships, volunteer commitments, and an altruistic purpose

to improve their Human Dignity with a shared acknowledgment of

*) certain Principles, e.g., Autonomy, Beneficence,

Nonmaleficence, and Justice;

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

Privacy, and Fidelity;

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

Compassion, or Kindness;  AND

*) certain Social Norms for Collective Action, such as Trust,

Reciprocity,  Cooperation, and  Idle Talk.   

                    (Beauchamp & Childress 7th Edit  2013)

 

COMMENT    During the transition from early to late childhood, each person normally begins to more closely engage their home’s neighborhood and the municipal life of its community.  As the encounters with diverse social interactions begin to require a widening array of deference and demeanor skills, each person’s personality and moral reasoning indirectly begin to acquire the spontaneity for maintaining their self-sufficiency.  A positive connection with a father helps their children manage their male social interactions.  Obviously, the reverse occurs for the children of a mother and their female social interactions. Provided in this Design Epistemology, there is a provision for an Extended Family to promote contact between adolescent family members and familiar adults.  This represents the mentoring of prosocial behavior (see above).  Lost in all of this, we have no means to encourage community-specific, norms of deference and demeanor to encourage prosociality. Ultimately, High Schools, Vocational certification, and Baccalaureate Degree granting schools and colleges might be the best collaboratively sponsored strategy to generationally guide or sponsor this priority. 

 

 

 

SOCIAL  DILEMMA    may be postulated as

^

a social interaction involving two or more persons,

commonly occurring as a public-goods scenario

with a brief time dimension, for which

one person or a small group of persons chooses

to acquire a short-term benefit for themselves rather

than expressing the prosocial norms that are necessary

for all of the persons to receive a long-term 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 followed sequentially by the other three cars.  One of the remaining cars might get through next, but the other two would need to stop suddenly to avoid a crash.  Thus, a public goods, social dilemma has occurred in which there was a conflict between the individual and collective interests among the participants.

   Collective Action situations have been studied extensively.  The results indicate that participants are more likely to make cooperative decisions when they spontaneously apply the prosocial norms of “trust, cooperation, and reciprocity” during the social dilemmas they encounter daily within their community’s municipal life.  Increasing each community’s expression of prosocial norms, its prosociality, then becomes the basis for monitoring every community’s Survival Commons, viz., Safety Net, and its responsively-appropriate, proportionality among their resident persons. 

 

 

 

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 associated attributes of prosociality to achieve 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 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, and  c. an incorporated private or public institution selected by the initial cluster.                                                —   35   —

 

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 with population clusters averaging @400,000 resident persons.  Each Forum would manage their own community’s Survival Commons, viz., enhanced Safety Net, in association with their contiguously adjacent communities within each State.  This Design Epistemology includes a definition for each community’s Survival Commons.  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 lynch-pin strategy for ultimately improving our nation’s social cohesion.

   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 contribute their own resident persons to each other’s Extended Family?”           

 

 

 

COMMUNITY    may be postulated for  HEALTH  as

^

a cluster of multiple persons,

most commonly recognized as the persons residing

within a municipality’s geographic border and its associated

with a uniquely-local ecological and cultural heritage,

who participate in more than one social network of the cluster

to obtain certain prosocial benefits from each network’s

inter-connected spontaneity and to acquire a valued awareness

about the identity of these social networks that is borne out

of the 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.  It appeared in the May 15, 2015 edition of the Stanford SOCIAL INNOVATION Review.  It has been augmented to account for the large variety of social networks occurring within most communities.  The evolution of these prosocial, social networks then promotes their community’s social capital that mediates each community’s contribution to their nation’s continuously improving level of Social Cohesion.                                                       —   37   —

   For this Design Epistemology, each community would represent on average 400,000 resident persons within the border of each State as primarily defined by each Forum’s county borders.  Any community with low-density distribution 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 involving individually the number of resident persons above and below a median number. 

 

 

SOCIAL  CAPITAL     may be postulated for  HEALTH  as

^

the bystander immediacy of a community’s resident persons

to spontaneously apply prosocial norms for resolving the social dilemmas

they encounter daily 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 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 meso and macro network members.  For a uniquely comprehensive bibliography and periodic analysis of Social Capital, visit   www.socialcapitalresearch.com  .  Tristan Claridge, MS initiated his Institute for Social Capital in 2005.  Notably, he lives in New Zealand.

   Ultimately, the prevalence of each community’s prosociality and its steady improvement over time contributes to their nation’s 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.  

 

 

HEALTH    may be postulated for a Nation’s resident persons as

each person’s daily experience of  Well-Being  which

occurs when each person’s lifelong survival has been initially

^

A. Endowed by the prenatal, generational Family Traditions

of both parents for initiating the occurrence of a fetal conception that,

when recognized, begins to intensify the level of  ‘shared intentionality’

among the caring relationships of the parental Extended Family for

mentoring the maternally-nurtured  synergy between the fetal person’s

innate temperament and baseline homeostasis to achieve sufficient

resilience for the fetal person’s survival  immediately after birth and

vitality thereafter from a parent-originated, Personal Survival Plan

as a happy ‘Dependent Person’;

^

B. Nurtured by the person’s caring relationships that originate

from within the person’s Family, their 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

while becoming a joyful ‘Dependent Person’   AND   2) during

Late Childhood and Adolescence with a goal to mentor

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

of their uniquely-endowed Human Capability while becoming

a courageous and sustainably self-sufficient ‘Independent Person’

within their Home’s community after Adolescence;

^

C. Challenged by the person’s daily encounters with a disruptive process

involving discordant social interactions that begin before birth,

 occur as interacting combinations and patterns, and

cause variably-reversible beneficent and maleficent changes

to the adaptive resilience of the person’s Quantum Signaling Brain

 as variously prevented, mitigated, and ameliorated lifelong

by  their Family Traditions,  by  the courageous

caring relationships originating from within the person’s Family^

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

by  their Personal Survival Plan, as well as 

by  the Survival Commons of their Home’s community;

^

D. Matured by the person’s episodic encounters with a disruptive process

involving diversely-complex traumatic events that begin before birth, 

occur as interacting combinations and patterns, and cause 

variably-irreversible, maleficent changes to the adaptive resilience

of the person’s uniquely-endowed Human Capability including

its innate temperament and baseline homeostasis as prevented,

mitigated, and ameliorated lifelong  by  their Family Traditions,

by  the courageous caring relationships originating from within

the person’s Family^ their Extended Family^ and their Home’s

close neighborhood,  by  their Personal Survival PLAN, as well as

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

                                   ^                     —   39   —

E. Sustained  by  the person’s Family Traditions,

by  the hopeful caring relationships originating from

within their Family^ their Extended Family^ and

their Home’s close neighborhood,

by  their Personal Survival Plan, as well as

by  the Survival Commons of their Home’s community

until eventually the entropy-ladened, resilience of the person’s

uniquely-endowed Human Capability is no longer sufficient

to maintain the person’s survival as a result of their lifelong

encounters with a disruptive process.

 

COMMENT    MILLMAN, an actuarial consulting company, has reported that their analysis of the essential causes of Unstable Health are: Social determinants 40%, Behavioral 30%, Healthcare quality 20%, and  DNA Genetics 10%.  Healthcare Reform that is solely directed at our healthcare for each resident person’s Basic and Complex Healthcare Needs is unlikely to ever be successful.  Any healthcare, reform strategy must be paired with a commitment to promote the locally initiated improvement of their own community’s Survival Commons.  This commitment must also be associated with a strategy to improve their community’s social cohesion by pursuing a collaborative connection with their contiguously adjacent communities to annually review each other’s Survival Commons and its Master Disaster Planning Strategy.  

 

 

 

 

————–      N  A  T  I  O  N  A  L      ————–

5    of    5

 

 

HEALTH  CARE   –   PRIMARY  HEALTHCARE

INSTITUTION   –   SURVIVAL  COMMONS

SOCIAL  COHESION   –   COMMON  GOOD

 

 

 

HEALTH  CARE    may be postulated for  HEALTH  as

^

the preservation of a person’s Stable Health

by a specific health service that is

recognizable by its designation as a uniformly identifiable,

unit of services for research, education, or financial reimbursement;

provided during a social interaction with a professionally licensed

person involving a Caring Relationship;  and

becomes  HEALTHCARE  when it is characterized by a cluster

of interconnected encounters occurring during an extended period of time.

 

COMMENT    Both Health Care and Healthcare usually involve many unpredictable professional activities to improve the precision of each specific encounter.  The frequent shifts between alternate, diagnostic hypotheses, and their associated deductive and inductive reasoning processes require extended periods of study and experience usually involving 8-10 year trends for a physician, especially to acquire the adaptive skills for managing the associated pattern recognition scenarios by their own Cultural-Social cognition.

   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 for mentoring a person’s priorities for preserving their uniquely-endowed Human Capability and its supportive biologic systems, 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 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 to sustain their Stable HEALTH, coordination of this Plan with any co-occurring Complex Healthcare Needs, and provisions for their personal Survival plan.                         —   41   —

   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. 

 

 

 

PRIMARY  HEALTHCARE    may be postulated for a  NATION  as

^

the health care for each of its resident persons that every community’s

municipal leaders and its applicable stakeholders promote to assure

that  equitably available,  ecologically & culturally accessible, 

justly efficient, and  dependably effective  healthcare exists

for the Basic Healthcare Needs of every resident person

within each community for the coordination of these Needs

with any Healthcare 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 its subcategories, and PRIMARY PHYSICIAN.  They are defined on the GLOSSARY For HEALTHCARE  Sub-Page of the  APPENDIX  PAGE.        

   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.  It ascribes more clearly an emphasis for Primary Healthcare as necessary for honoring a nation’s social contract, viz., Common Good.  I quote (WHO 1975):          

• “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 and its associated social-political-economic turmoil, the WHO definition for our Primary Healthcare should incessantly remind us that the Population Health of a community’s resident persons evolves in the context of every Nation’s Common Good, viz., Clovid Pandemic.  The need to promote international Social Cohesion will not resolve with solutions solely focused on climate change and the pandemic. 

 

 

 

INSTITUTION    may be postulated as

^

” . . . 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.”   (Ostrom 2009)

 

COMMENT    For improving our focus during any paradigm shift process, one small tradition would decrease the occurrence of cognitive dissonance.  Population Health and its Healthcare should no longer be identified with ‘Organization,’ since the use of ‘Institution’ would be more precise.  This nuance would then begin to standardize the basic structural character of any cluster of persons who cooperate to maintain a social interaction involving the performance of inter-connected Global Tasks.  Global Tasks may be most generally recognizable as  Organize Governance,  Pursue VISION,  Build Community,  Manage Resources,  and  Develop Skills.                             —   43   —

   If you look back at the quotation from President Thomas Jefferson initially cited within the INTRODUCTION, you will note that it ends with two words, “barbarous ancestors.”  Looking back at the definition of an institution by Professor Ostrom, you will note that it ends with two specious words, “disastrous results.”  Living nearly two hundred years apart, the expression of these two person’s Human Dignity would likely have represented a modern-day recognition of two kindred spirits.

 

 

SURVIVAL  COMMONS    may be postulated for a  COMMUNITY  as

^

the cluster of community capabilities, viz., enhanced Safety Net,

that each municipal community assembles to protect their resident persons

from the sudden or sustained occurrence of certain disruptive processes

when this cluster of community capabilities is

^

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

at all jurisdictionally nested scales, that

apply to the public and private institutions within their community

which promote the  Well-Being  of its resident persons;

 ^

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

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

especially when each resident person safely offers

a salutatory greeting to each person they encounter and

each of the persons reciprocates with an appreciative gesture;

^

C. Offered by each municipal community to its resident persons

who each may select, from among the cluster of community capabilities,

those benefits and obligations most suitable for the needs

of their own Personal Survival Plan and locally offered from within

the ecological and cultural traditions of their municipal community;

^

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

who become aware that the cluster of community capabilities

has certain discontinuities for which a collective action strategy

will be necessary to resolve these discontinuities with an

equitably available, ecologically & culturally accessible,

justly efficient,  and dependently effective  VISION and Action Plan;

^

E. Augmented by the collective action strategies that originate

from within each municipal community’s private and public institutions

as well as its social networks to prevent, mitigate, or ameliorate

any ‘newly recognizable adversity’ encountered by its resident persons

that is related to a locally prominent discontinuity

among their municipal community’s cluster of community capabilities or

their associated Benefits and Obligations,

especially if the ‘newly recognizable adversity’ represents a deficiency

among the Benefits and Obligations currently intended

to prevent, mitigate, and ameliorate generational poverty;

                                        ^                          —   45   —

F. Protected by each municipal community’s

Master Disaster Planning Strategy that is reviewed and revised

annually to prevent, mitigate, and ameliorate

certain locally reoccurring disasters and the effects

of their associated disruptive processes which variably impair

each resident person’s ability to maintain a Personal Survival Plan,

especially by the community’s vulnerably susceptible resident persons

who have become afflicted by enduring poverty;  AND

^

G. Supported by each 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 nation’s

               Resources,  Knowledge,  and  Human Dignity.

     

COMMENT    Locally initiated and supported, each NATIONAL HEALTH recognized community would form a Community HEALTH Forum (Forum) to assure that its own SURVIVAL Commons is actively invigorated by their community’s public and private stakeholders, at all jurisdictional national, regional, state, county, township, city, neighborhood, and family levels. 

 

 

 

 

 

SOCIAL  COHESION    may be postulated for a  NATION  as

^

the national expectation among the resident persons

of each municipal community that the resident persons of all

the other municipal communities are trustworthy and that

the continuing prevalence of these trustworthy persons will be

sustainably improved when each municipal community

continuously collaborates with their adjacent communities

to 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’s steady loss of social cohesion since the Civil War represents the fundamental cause of the stress that we all encounter within our daily lives.  The definition above would not be recognizable by most Population Health experts.  No matter how it is construed, this Design Epistemology for improving Population Health as well as its Primary Healthcare would likely fail without a process to engage every resident person’s own community in a nationally sanctioned, self-sustained strategy to rebuild our nation’s social cohesion, community by community. 

 

 

 

 

 

 

COMMON  GOOD    may be postulated as

^

the cooperative obligation of every nation

to sustain their prosocial, institutional responsibilities

for promoting the broadest expression of each resident person’s

uniquely-endowed Human Capability and also

 to sustain their continuously reciprocating exchange of social capital

among contiguously adjacent nations for enhancing

the  Stable HEALTH

of every worldwide community’s resident persons.

 

COMMENT    The “Universal Declaration for the Common Good of Humanity Project” may represent the most concise, yet comprehensive, statement with a purpose to achieve a nation’s COMMON GOOD.  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 Tunisia.  In addition, the “Convention on the Rights of Persons with Disabilities and Optional Protocol” adopted by the United Nations in 2008 might apply to expand any consideration of the Common Good.                                                                                                 —   47   —