b. DESIGN EPISTEMOLOGY

Community HEALTH Forum

A C H I E V I N G A S C E N D E N T H U M A N S U R V I V A L

Should begin

with a ‘Quantum informed’ and ‘Well-Being focused’

cluster of 36 inter-connected concepts for guiding

a Congressionally chartered, complex adaptive system

to improve the efficacy of our nation’s

POPULATION HEALTH and

its PRIMARY HEALTHCARE

67 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. Do you 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 its Primary Healthcare. It is likely that a high degree of Dissonance has occurred among the social-political-economic and scientific realms of knowledge that apply to preserving each resident person’s Well-Being. We refer to Cognitive Dissonance as initially proposed by Leon Festinger. (Festinger 1957) In short, assume that each of two people have uncertain beliefs about staying healthy. As a result, any commitment to collaborate with each other to achieve a shared belief about health would be very difficult.

To further aggravate the Cognitive Dissonance underlying our nation’s healthcare reform, any commitment to achieve a national agreement regarding certain definitions, such as for an independent person, health, family, or social cohesion must also account for the dimensions of Quantum Mechanics. In short, a person’s response to a falling child occurs by intuition, in less than 1/2 second and is not moral reasoning, which requires at a minimum 3-5 seconds. Human consciousness is best evaluated with the knowledge of Quantum Mechanics regarding its holographic memory. As a result, any effort to establish each of the core definitions for healthcare reform must reflect this level of complexity. In short, a Family is not just “two or more persons with a shared kinship.”

DESIGN EPISTEMOLOGY

The Merriam-Webster’s Collegiate Dictionary – Eleventh Edition (2014) defines Epistemology as “the study or a theory of the nature and grounds of knowledge, especially with reference to its limits and validity.” A Design Epistemology then implies that a philosophical endeavor is undertaken to more precisely assemble the knowledge applicable for a specific purpose as a guide to achieve a complex outcome. The initial analysis for a Design Epistemology may be attributable to Dino Karabeg, Ph.D., especially with three academic publications that began in 2005. He is a faculty member at the Institute for Informatics at the Univerity of Oslo in Oslo Norway. (Karabeg 2005, 2012, 2016) The 2016 essay represented a contribution to the 2016, 50th Anniversary, Conference of the Design Research Society. — 3 —

Anna Estany, Ph.D. as a faculty member in the Department of Philosophy at Universitat Autonoma de Barcelona has written published essays since 1981 with a focus on scientific Epistemological interests. She has collaborated with several colleagues as co-authors especially Rosa M. Herrera, Ph.D. and most recently, Alger Sans Pinillos, Ph.D. Most of her recent papers have focused on Design Epistemology (Sans Pinnilos & Estany 2023) This paper is unique in that it represents an analysis of ‘Design’ and its contribution to the formation of an Epistemology’s content.

INDEX

An intensely collaborative, intellectual commitment will be necessary to reconfigure the economic-social-political and scientific processes required to achieve Stable HEALTH For Each Resident Person within every community. Intentionally, 36 concepts inform the basis for implementing a 10-15 year, paradigm reconfiguration to achieve a comprehensively pursued, process to our improve our nation’s Population Health and its Primary Healthcare. The 36 concepts are Thematically categorized for establishing a new, nationally Chartered, semi-autonomous institution to inform and focus a continuing paradigm reconfiguration strategy into the future.

COSMOLOGY EVOLUTION, DISRUPTIVE PROCESSES, WELL-BEING, HUMAN DIGNITY, QUANTUM SIGNALING BRAIN, & COMPLEX ADAPTIVE SYSTEM; Pg 09
PERSON EPIGENETICS, CULTURAL SOCIAL-COGNITION, HUMAN CAPABILITY, HUMAN FETUS, PERSON, & BIRTHING PERSON; Pg 19
FAMILY SALUTARY GREETING, SOCIAL INTERACTION, CARING RELATIONSHIP, FAMILY CULTURE, EXTENDED FAMILY, & FAMILY; Pg 29
NEIGHBORHOOD PROSOCIALITY, NEIGHBORHOOD, HEALTH, SOCIAL STIGMA, POVERTY, & POPULATION HEALTH; Pg 39
COMMUNITY SOCIAL DILEMMA, INSTITUTION, COLLECTIVE ACTION, COMMUNITY, SOCIAL CAPITAL, & SURVIVAL COMMONS; AND Pg 51
NATION HEALTH CARE, PRIMARY HEALTHCARE, COMMUNITY DISTRICT, MANAGING THE COMMONS, SOCIAL COHESION, & COMMON GOOD. Pg 59
REFERENCES Pg 67

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, for a visit to the Tidal Basin. Amidst this awareness, we also should acknowledge the wisdom of a noted British historian. Sir Arnold Toynbee, Ph.D. is most widely known for his 12-volume, book set: A STUDY OF HISTORY. (Toynbee 1921-1961) I cite a quotation from Professor Toynbee: (brainyquotes 2023) — 5 —

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

nineteen of them collapsed when they reached

the moral state the United States is in now.”

Arnold Toynbee (1889 – 1975)

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

INTRODUCTION

As of 2023, it is now 60+ years ago that Leon Festinger, Ph.D. and Baron C. P. Snow coincidentally released their conceptual models which are now applicable to the future of Human Survival. Professor Festinger, then at Stanford University, released his book entitled “A Theory of Cognitive Dissonance” in 1957. Essentially, the book may be viewed as a systematic analysis of the problems associated with how certain concepts can be viewed by alternate persons with diverse perspectives. In effect, a high level of conflict, ambiguity, and inconsistency may occur and prevent a mutually acceptable explanation for the original concept. Similarly, Baron Snow (1957) described the cognitive dissonance that was occurring between the realms of knowledge involving the sciences and the humanities. His own life history represented an unusually precise experience as a basis to formulate his analysis.

Retrospectively, the C. P. Snow analysis of cognitive dissonance between the humanities and the sciences has prompted a variety of historical reviews. There were many large worldwide ecological and cultural transitions that began to occur between 1950 and 1960. An essay by Guy Ortolano, Ph.D. uses the concept of meritocracy to assess the times surrounding the message of Baron C. P. Snow. (Ortolano 2016) Its title will likely prompt your curiosity: Breaking Ranks: C. P. Snow and the Crisis of Mid-Century Liberalism, 1930-1980. — 7 —

Given the analytic level of our scientifically positivist, reductionist traditions and the non-linear, poor measurability of an electromagnetic communication process between a birthing mother and her newborn might well represent the ultimate conundrum of human survival during 2023. Furthermore, is it possible that such an analysis might accurately identify the current status of the infant’s epigenetic as well as her genetic endowment for the future of her lifelong survival? Please remember that her mother’s and her father’s Family Cultural Traditions began to affect her uniquely-endowed Human Capability 2-3 generations before her birth.

KEY REFERENCE

Among an episodically diverse consideration of the DESIGN EPISTEMOLOGY concept, three essays by Dino Karabeg, Ph.D. from the Univeristy of Norway in Oslo, Norway may be the most approachable. (Karabeg 2005, 2012, 2016) Most recently, an essay by two newly collaborating authors offer a more precise philosophical evaluation of the Design component for a DESIGN EPISTEMOLOGY. Alger Sans Pinillos, Ph.D. (Univesity of Pavia in Pavia, Italy) and Anna Estany, Ph.D. (Autonomous University in Barcelona, Spain) co-authored their essay entitled “Concerning the Epistemology of Design: The role of the Eco-Cognitive Model of Abduction in Pragmatism.” (Sans Pinollos & Estany 2023)

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

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EVOLUTION — DISRUPTIVE PROCESS

HUMAN DIGNITY — WELL-BEING

QUANTUM SIGNALING BRAIN —

COMPLEX ADAPTIVE SYSTEM

EVOLUTION may be postulated for Health as

“a process of continuous change from a lower, simpler, or worsened

to a higher, more complex, or improving state.”

COMMENT Among the multiple attributes that define the English use of the word “Evolution,” I picked and slightly edited this definition from my Eleventh Edition of the Merriam-Webster’s Collegiate Dictionary. (Webster 2014)

One quickly accessed resource to frame this Design Epistemology can be found on the The COMMONWEALTH Fund website and its essay entitled “State Of Health System Performance.” Among the variously-represented data sets, the one that is most striking is our declining level of longevity at birth. The COMMONWEALTH Fund has periodically focused on our nation’s maternal mortality with a new analysis about every 4-5 years. Their most recent essay with a focus on maternal mortality is still posted on their website. — 9 —

To sharpen a sense of humility about our nation’s Population Health and its Primary Healthcare, I offer a collection of quotations that I selected from the “goodreads” website on 09/20/2023.

“If I have seen further,

it is by standing

on the shoulders of giants.”

Isaac Newton (1643 – 1727)

“The most beautiful experience we can have is the mysterious.

It is the fundamental emotion that stands

at the cradle of true art and true science.”

Albert Einstein (1879 – 1955)

“An expert is a person who has made

all the mistakes that can be made

in a very narrow field.”

Niels Bohr (1888 – 1962)

“A man who dares

to waste one hour of time has not

discovered the value of life.”

Charles Darwin (1809 – 1882)

“A thinker sees their own actions as experiments and questions —

as he attempts to find out something.

Success and failure are for us answers above all.”

Friedrich Nietzsche (1844 – 1900)

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

regardless of their circumstances,

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

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

in the companionship of a loving person,

that child could discover that he or she

was lovable and capable of loving in return.”

Fred Rogers (1928 – 2003)

As we explore the dimensions represented by the Design Epistemology, I suspect that this classic admonition from a media icon will eventually be understood as representing an electromagnetic connection between a child and a loving person. Now understood as an entanglement, the ultimate sequence of human knowledge involving the historical persons, cited above, would highlight the essential challenge of the twenty-first century: to assure Human Dignity for every worldwide person! Fred Rogers, Ph.D. had it right. — 11 —

DISRUPTIVE PROCESSES 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

multiple, unique Clusters of disturbances that variably interact

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 RECONFIGURED PARADIGM 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 unique, anthropological ethnography for “poverty” within each nation’s Population Health.

Here is a report about epigenetics. In 2021, 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 2021)

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.

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

represents Happiness In An Objectively Worthwhile Life.”

Neera H. Badhwar, Ph.D.

COMMENT Professor Badhwar validated this definition in her book (Badhwar 2014) with a philosophical analysis using alternate lines of reasoning originating from a diverse cluster of authors. She cites Julia Annis, Aristotle, Albert Einstein, Cicero, Victor Frankl, Stephen Hawking, Immanuel Kant, Carl Rogers, and Amartya Sen, among many others.

As an aside, the Merriam-Webster’s Collegiate Dictionary 11th Edition cites 1582 as the year when Well-Being was first used. It defines it as follows: “the state of being happy, healthy, or prosperous.” 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 interconnected. Population Health research has shown that “self-reported health” and “trust,” as in social norms, demonstrate reverse causality over extended periods of time. (Giordano & Lindstrom 2016)

As a result, a clear definition of HEALTH is included within the DESIGN EPISTEMOLOGY. This HEALTH definition refers to Well-Being that occurs lifelong after birth when a complex set of ecological and cultural anthropologically ethnographic processes that begin to unfold before, during, and after each person’s conception. See the NEIGHBORHOOD THEME set of definitions.

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 36 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. — 13 —

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

“Intrinsic Value” 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” represents 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 represents each person’s Constitutionally defined Human Rights and each person’s equal standing for their economic and political rights as compared to any other person. Any restrictions or advantages granted to a person must reflect justly applied, proportionality given the circumstances involved. This provision for Human Dignity requires a community 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. — 15 —

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.

COMMENT Among the thirty-six 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 intuitive 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 resident 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., to define each person’s Childhood Development and its sequential trajectory during their lifelong 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 would account for human consciousness, consider JUNG’S SPECTRAL TOPOLOGY OF THE PSYCHE: The Hidden Dimensions of Human Consciousness by Shelli R. Joye, Ph.D. (Joye 2023) For a recent biological review that is internet open-accessible, consider “Quantum Neurobiology” by Melanie Swan. This Review begins with a “common-sense” introduction to the quantum dimensions of brain signaling and memory. (Swan 2022) And finally, Takaaki Musha recently explained the basis for human holographic memory. (Musha 2022)

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 Community Districts 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. — 17 —

Further analysis and exploration of this concept should begin with four 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 2016); 3) Sylvia Grewatsch, Steve Kennedy, and Pratima (Tima) Bansal “TACKLING WICKED PROBLEMS IN STRATEGIC MANAGEMENT WITH SYSTEMS THINKING” (Grewatsch 2021), and 4) David Wilson, Michelle Gelfand, Steven C. Hayes, and Paul W. B. Atkins. “MULTILEVEL CULTURAL EVOLUTION: FROM NEW THEORY TO PRACTICAL APPLICATIONS.” (Wilson 2023)

A book written by Danah Zohar describes the quantum, governance perspective for any Complex Adaptive System: “ZERO DISTANCE Management in the Quantum Age.” (Zohar 2022) Each of the nationally designated, 810 Community Districts would then have the collective role to locally explore the basis of their own Survival COMMONS. With a collaborative connection with their neighboring District Communities, the NATIONAL HEALTH Proposal then represents a conceptual model to improve our nation’s, generational social cohesion.

————– P E R S O N T H E M E ————–

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EPIGENETICS — CULTURAL SOCIAL-COGNITION

HUMAN CAPABILITY — HUMAN FETUS

PERSON — BIRTHING PERSON

EPIGENETICS may be postulated for Population Health as

“…the interactions of genes with their environment,

by which genotype gives rise to phenotype and

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

Conrad H Waddington CBE FRS FRSE (1905 – 1975 )

COMMENT The Waddington quotation cited above is taken from the Lester et al 2012 essay that identified Conrad Waddington as having been the first to use the concept of “Epigenetics” in his book published in 1940 entitled as ORGANISERS AND GENES. Specifically, we are considering what occurs to the female ova as they historically evolve within each Birthing Person until maternal conception begins to nurture the origins of each person’s phenotype. So then, Epigenetics does not change or alter a person’s originating DNA. Epigenetics then may be recognized most importantly as the potential effects of its maternal environment on the eventual formation of each person’s uniquely-endowed Human Capability. — 19 —

The epigenetic, phenotypically developmental process then continues after birth, especially during the first 5-6 years of growth and development. Remember specifically, that the male sperm does not contribute any cytoplasm to a fertilized ovum, just DNA. As such, the overall role of a Birthing Person is defined at the end of this PERSON THEME.

Within the last 10 years, the processes that cause “environmental” effects on the expression of a person’s Human Dignity have become extensively studied. For this Epigenetic Definition, I cite a recent study. It was reported in April of 2022. (R Triplett et al 2022) The research identified 280 infants whose mother endured substantial social disadvantage (poverty) and psychological stress before and during their child’s prenatal gestation. The research identified substantially reduced brain volume after birth among the study’s infants. The study represented their initial findings as the basis for continuing follow-up from the prenatal epigenetic effects of poverty.

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, Family Culture, Extended Family,

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 and Call 1997, Tomasello 2019, & 2020 Tomasello)

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 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 close neighborhood (including “dependents”), then becomes the essential origin from which daily routines involving social interactions are acquired, learned, and generationally revised within a neighborhood’s “social network” and secondarily by its surrounding community. The learning micro-events of this process are delightfully described by a somewhat sardonic, ‘easy-to-read’ essay by Erving Goffman, 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. — 21 —

HUMAN CAPABILITY may be postulated for HEALTH as

each person’s genetically and epigenetically endowed,

unique 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 for initiating the person’s

eventual pursuit of Human Dignity;

initiates their consciousness at birth; AND

promotes their adaptive skills during

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

early childhood when nurtured by the caring relationships originating

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

Extended Family, and their Home’s close neighborhood

AND

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

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 intuitive spontaneity 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

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

their Home’s close neighborhood.

COMMENT The original conceptual exploration of “Human Capabilities” is primarily attributable to Martha Nussbaum, Ph.D. and Amartya Sen Ph.D. (Nussbaum and Sen 1993) They had 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 to become self-sufficient defines the Homo Sapiens species as substantially separate from all the other biological species. (Tomasello 2019)

HUMAN FETUS may be postulated for HEALTH as

identified initially 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 epigenetically molded 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,

its Family Culture, and their Home’s close neighborhood.

COMMENT Each resident person of every community should have a regular “nudge” that this phase of every person’s future survival hinges on the unique juxtaposition of multiple, generational traditions that coalesce for every Human Fetus. A sustained Family Culture is required to nurture the maternal, prenatal “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 will reliably identify when the onset of birth viability by a Human Fetus has already occurred or when it will eventually occur. — 23 —

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 mobilize the basic provisions for every person’s lifelong,

Family-originated Personal Survival Plan;

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

the housing, education, food, and safety adequacy

for 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 equitable participation

in the international marketplace arenas of its worldwide

Resources, Knowledge, and Human Dignity.

COMMENT As anyone might observe, this collection of concepts is developmentally defined and may be viewed as overly convoluted. In response, the concept of cognitive dissonance needs further recognition. If we are all mutually committed to improving each community’s Social Cohesion for reducing its prevalence of poverty, then we will ALL need to understand how human development occurs. Otherwise, it would be very difficult to prevent, mitigate, and ameliorate each person’s developmental encounters with modest as well as substantially discordant, Disruptive Processes, and its resultant moral fatigue. The resultant occurrence of entrenched poverty explains why it becomes generationally sustained 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. — 25 —

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.

BIRTHING PERSON may be postulated for HEALTH as

an independent person who maintains or who

has maintained the biological resiliency to nurture

the development of a fertilized Human Ovum

until its birth and its vitality immediately thereinafter

as a dependent person to sustain

Human Survival and its Human Dignity.

COMMENT An immediate observation would likely prefer the use of the term Birthing People. With its connection with gender identity, this Design Epistemology prefers a basic commitment to support a uniform understanding and use of the definition for a PERSON. As conception eventually develops into a Human Fetus, a Birthing Person eventually assumes a connection with overall Human Survival when the Human Fetus has achieved survivability as a premature newborn. As such, the intentional termination of any viable Human Fetus then becomes a Population Health issue. From an ethical morality standpoint, any such intentional termination becomes a national “Social Choice” issue. Incest, rape, maternal Well-Being, and congenital anomalies, such as anencephaly, then become involved. As a contribution to social cohesion, a biologically precise ability to identify the transition to fetal survivability would promote the evolution of a broadly accepted accommodation of abortion and its ethical morality.

Putting aside the ultimate issues of fertility, the Well-Being of Birthing Persons within the 21st Century AD is ultimately the most historically disgraceful within the saga of Human Survival. It is second only to our continuing level of worldwide genocide and starvation. For our own nation, aka USA, the frequency of women who die in association with a pregnancy has annually worsened since 1978. Furthermore, the annual maternal mortality rate has especially worsened since 2018 and no one seems to know why! By comparison, we would need to reduce it by 80% to achieve maternal survivability at the level of ‘the Scandinavian’ and ‘the other English-speaking’ nations. This problem is the Keystone problem of our nation’s Population Health.

For many reasons, I propose that our Nation’s maternal health issues are directly related to how each community solves its own problems with homelessness and poverty, neighborhood by neighborhood. The continuing resolution of homelessness and poverty would concurrently promote the Well-Being of each Birthing Person. Now then, ask yourself? What are you and your family doing about this problem? Just find a way to volunteer for something, anything!

— 27 —

————– F A M I L Y T H E M E ————–

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SALUTARY GREETING — SOCIAL INTERACTION

CARING RELATIONSHIP — FAMILY CULTURE

EXTENDED FAMILY — FAMILY

SALUTARY GREETING may be postulated for HEALTH as

a person’s continuously renewed, adaptive skill for offering

a brief gesture of Kindness and Respect to each person who is

safely encountered while participating in their community’s

daily municipal life, especially if this person *) is recognizably

parenting an infant or toddler who also may initiate

shared eye contact with a brief smile,

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

close neighborhood of the person’s Family’s home. — 29 —

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

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

SOCIAL INTERACTION may be postulated as

a single encounter, or a variously connected series of encounters

involving two or more persons who recognize each other’s

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

assemble for its purpose, and participate in this situational scenario

based on each person’s understanding of its likely

purpose, rules, and time course.

COMMENT This definition represents a contemporary adaptation of the sociological concept originated by Erving Goffman (1922-1982) who initiated the field of study known as micro-sociology. Briefly considered, a Social Interaction refers to those actions within a social scenario that a person initiates with another person who responds in turn. Social Interactions apply to a very large array of human behavior that involve conditions other than a Salutary 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)

Within another similar humanitarian arena, Philosophy uses the term social relation rather than social interaction. 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 promoted by Professor Elinor Ostrom and others 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 person’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 priorities reflected *) warmth (viz., non-possessive positive regard); *) non-critical acceptance (viz., ecological and cultural dimensions); *) congruence (viz., coherent ‘actions, thoughts, and feelings’); and *) empathy (viz., the most difficult). (Rogers 1995) — 31 —

What may be new for this definition of a Caring Relationship is its 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 probably requires it to develop normally after birth.

Remarkably, the Editors of The Personnel and Guidance Journal eventually added a comment to the online version of an article they had published about the helping relationship. (Rogers 1958) Herein is their Comment: “This article, written in 1958, by Carl Rogers is his most quoted and reprinted article. It has been republished in sourcebooks, Harvard Business Review and many other publications. It helped introduce a profound change in the way people look at professional relationships. This article’s ripples still affect us today. This article includes Roger’s famous “Can I” questions.”

FAMILY CULTURE may be postulated for HEALTH as

a cluster of adaptive skills that a Family

acquires to perpetuate their shared identity,

applies to the daily encounters involving

their caring relationships, and periodically

adjusts to enhance their generational traditions

for mentoring each other’s Personal Survival Plan.

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

“1. Communicate and listen;

2. Affirm and support one another;

3. Teach respect for others;

4. Develop a sense of trust;

5. Have a sense of play and humor;

6. Exhibit a sense of shared responsibility;

7. Teach a sense of right and wrong;

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

9. Has a balance of interactions among its members;

10. Has a shared religious core;

11. Respect the privacy of one another;

12. Value service to others;

13. Foster family mealtimes and conversations;

14. Share leisure time together; and

15. Admit to and seek help for problems.”

Dolores Curran (1932 – 2022)

When questioned about how many of the Traits, viz., Cultural Practices, are required to be a Healthy Family, she refused to even study such a goal. In essence, she 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 research study.

She also wrote about Family Culture, viz., “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 Culture with more succinct or accurate precision. Her book continues to be published by her family. It is sensibly priced.

A succinct, analysis and literature review with a focus on “…Food Makes Family…” recently appeared. Mealtime gatherings are described in all their complexity. (ATS Ee 2023) — 33 —

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 ethnic

continuity of its generational Family Culture;

includes persons residing within the close neighborhood of their home

who share mutually reciprocating, helpful accessibility;

selects persons who offer situational, wisdom-guided mentoring

for the family members, such as 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.

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

For this Design Epistemology, an amalgamated version of a Convoy might be useful. The inclusion of a mentoring contribution to each Family member’s Personal Survival Plan recognizes the value of the Convoy tradition. Suffice it to say, 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, it virtually disappeared during the first half of the 20th Century. I would venture to say that it is currently an extremely rare occurrence in any District Community.

The historical occurrence of Extended Families applies to the kindred early-adult children or grandparents who live with a classic Family of mom, dad, baby Jane, and toddler Joe. This was prominent during th final quarter of 1800-99 in England. (Ruggles 1987) And, the nuclear family seems to have been applied to a triadic Family of mom, dad, and toddler Jane. Finally, a complex family cluster applies to a mom and dad who each may have custodial responsibilities for children from a previous marriage as well as their own marriage, viz., a blended family.

FAMILY may be postulated for HEALTH as

a cluster of two or more persons that

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

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

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

B. One ‘originating’ independent person who is not married, has a sustainable caring relationship with a dependent person, and accepts custodial responsibility for this dependent person as an ‘additional’ dependent person;

III. Engages their community by offering a Salutary Greeting to every person that each of their Family’s persons safely encounters during the municipal life of the Family’s community, irrespective of any ecological or cultural stigmata possibly represented by either a member of the person’s Family or the other person; (Goffman 1963) — 35 —

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

A. Establish a household, 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 Culture 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 a household person, especially during their adolescence and early adulthood;

C. Promote gatherings of the Family members within their Home

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

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

3. for the episodic events involving persons from within their Extended Family who share mutually supportive attributes about the household’s Family Culture including those persons residing within the family’s close neighborhood; (Gorrman 1966)

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 the first day of residence by the ‘additional’ independent person within their Home and

2. has an authentic Personal Survival Plan, or its next-of-kin approved equivalent, that includes: a. provisions to manage the ‘additional’ independent person’s HEALTH in the event that the ‘additional’ independent person becomes, or is possibly becoming, a ‘dependent person’ who would not qualify as an ‘additional’ dependent person within their Home and b. a notarized Will, power of attorney, and medical power of attorney including its provisions for an advanced directive.

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

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 Culture, their Extended Family, and their Home’s close neighborhood as sustained by their community’s Survival Commons, viz., its augmented safety net. — 37 —

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

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

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

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PROSOCIALITY — NEIGHBORHOOD

HEALTH — SOCIAL STIGMA

POVERTY — POPULATION HEALTH

PROSOCIALITY may be postulated for HEALTH as

a social interaction initiated by one or more persons

with or for, one or more other persons that variably represent attributes

of a caring relationship, a volunteer commitment, and altruism

to improve the other person’s or persons’ Human Dignity based on:

*) 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 — 39 —

*) 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 acquire a widening array of deference and demeanor skills, each person’s personality and moral reasoning begin to intuitively acquire the spontaneity for maintaining their self-sufficiency. A positive connection with a father helps their children manage their male social interactions. 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 institutionally sponsored strategy to generationally guide or sponsor this priority.

NEIGHBORHOOD may be postulated for HEALTH as

a cluster of a community’s resident persons who

reside within a geographically identifiable section of their community,

share certain cultural traditions within their community’s social networks,

establish caring relationships with close neighbors, and

initiate collective action when required to augment the public symbols

associated with their section of the community.

COMMENT Like so many of the other concepts of the Design Epistemology, this definition is another concept characterizable by the iconic rubric for quality, viz., “I know it when I see it.” As a result, I prefer to use the concept of a CLUSTER for defining a Neighborhood. A Cluster may be defined as “two or more components that form a sustainable capability when the components paradoxically interact as a result of the synergy occurring between the components, the affinity between or among the prominent components, and the salutary conditions surrounding the components.“

For a Neighborhood, there are TWO general components for every neighborhood: the PUBLIC obligations and the PRIVATE obligations. Their community’s municipal, county, & state PUBLIC obligations for roads, public transportation facilities, utilities, primary & secondary education, public & fire safety, parks &recreation, historical monuments, libraries, post office location, public health & its Primary Healthcare, Safety Net resilience, disaster preparedness, and promotion of its Social Cohesion. These functions should reflect municipal, county, state, and national fiscal responsibility.

The PRIVATE obligations then are generally related to the support of higher education opportunities, employment alternatives, household shopping accessibility, diverse fine arts & their performance/exhibition facilities, philanthropy, ecologic & cultural heritage, and social capital. For a common sense reference, the MODELS OF NEIGHBORHOOD CHANGE essay by Kent P. Schwirian, Ph.D. (1961-2020) still remains as a stalwart level of sensibility. (Schwirian 1983)

Of interest for this concept, most research focuses on a neighborhood’s adaptability to endure ecological and cultural change. Gentrification, racial & ethnic evolution, climate change, zip-code-associated longevity & homicide, social isolation, and poverty are among the most prevalent arenas of knowledge warranting continuing sociological research. For a cluster, its sustainability then is also connected to its geographic location, especially as it becomes connected to its surrounding historically-associated economic, political, and economic connections. — 41 —

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

HEALTH may be postulated for a nation’s COMMON GOOD

as the experience of Well-Being that occurs for each

of its resident persons when their lifelong survival has been:

A. Endowed initially by their prenatal, generational Family Culture

of both their parents before fetal conception and, once occurred

and socially recognized, begins to intensify the ‘shared intentionality’

among the caring relationships of the parental Extended Family to

sustain 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

to become 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 to

become a joyful ‘Dependendent person’ AND 2) during

Late Childhood and early Adolescence with a goal to mentor

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

of their uniquely-endowed Human Capability to become

a courageous and sustainably self-sufficient ‘Independent person’

within their Home’s community after Adolescence;

C. Challenged by the person’s encounters with Disruptive Processes

involving discordant social interactions that begin before birth,

occur daily as interacting combinations and patterns, and cause

variably-reversible beneficent and maleficent changes

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

as variously prevented, mitigated, and ameliorated lifelong

by the person’s Family Culture, by the courageous

caring relationships originating from within the person’s i) Family,

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

by their Personal Survival Plan, and

by the Survival Commons of their Home’s community;

D. Matured by the person’s encounters with Disruptive Processes

involving diversely-complex, traumatic events that begin before birth,

occur episodically as interacting combinations and patterns, and cause

variably-irreversible, maleficent changes to the adaptive resilience

of the person’s uniquely-endowed Human Capability including

its innate temperament and baseline homeostasis as prevented,

mitigated, and ameliorated lifelong by their Family Culture,

by the courageous caring relationships originating from within

the person’s i) Family, ii) Extended Family, and iii) Home’s

close neighborhood as well as by their Personal Survival Plan, and

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

E. Sustained by the person’s Family Culture,

by the hopeful caring relationships originating from

their i) Family, ii) Extended Family, and iii) Home’s

close neighborhood as well as

by their Personal Survival Plan and

the Survival COMMONS of their Home’s community

until 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 Disruptive Processes.

COMMENT Milliman is a nationally recognized consulting company with periodic business connections involving the actuarial consultation needs of various health insurance companies. They have publically reported their analysis of the basic causes of Unstable Health. They are: Social Determinants – 40%, Behavioral – 30%, Healthcare Quality – 20%; and Genetics – 10%. — 43 —

Given the Milliman findings, it is unlikely that the improvement of our nation’s Population Health will improve with a strategy that is focused primarily on improving our healthcare. Remember that our nation’s maternal mortality incidence has worsened nearly every year since 1978. Every year, there are nearly 700 Birthing Persons who die in association with pregnancy only because they lived in the wrong nation at the time of conception.

Ultimately, any reform strategy must simultaneously begin in each of 810 contiguously connected, Community Districts: each comprising on average 400,000 resident persons. Each District would form its own collaborative Community HEALTH Forum to promote equitably available as well as ecologically & culturally accessible Primary Healthcare throughout their District. In addition, each Forum would establish a broadly collaborative Survival COMMONS to assure the existence of their community’s:

1. safe and walkable NEIGHBORHOODS,

2. nutritional adequacy for every Family,

3. dependably enhanced Primary Healthcare,

4. minimum standards for every family’s housing adequacy,

5. Safety Net and its Immediacy Preparedness Plan,

6. a social responsibility based on HUMAN DIGNITY, and

6. each resident person’s lifelong pursuit of personal adaptive skills.

SOCIAL STIGMA may be postulated for PERSON as

a social interaction involving 2 or more persons that

lasts episodically for variable intervals of time, occurs

within a social interaction involving a Human Dignity scenario,

and eventually excludes one or more of the participating persons

based on the perception of their “Spoiled Identity”

by one or more of the other participating persons.

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

POVERTY may be postulated for a Community as

the resiliency impairment occurring among its resident persons

that represents cognitive fatigue by their Quantum Signaling Brain

from the hypervigilant expression of adaptive skills

i) during the discordant social interactions that occur during

encounters with their community’s Survival COMMONS

to access its Benefits and Obligations for their survival and

ii) during the Disruptive Processes they encounter daily

while maintaining their household to promote a

Personal Survival Plan for themself and, if any,

for the additional resident persons of their Family.

COMMENT A person and their Family including its Family Culture, Extended Family, and their close neighborhood, viz. tribal unit, thus becomes the anthropologically fundamental unit for evolutionary human survival. The increasingly rapid, worldwide population growth since 1800 has encountered a steady increase in the cultural social-complexity occurring within the occurrence of very large cities and their densely populated attributes. — 45 —

Each of these communities struggles with the complexities of housing needs, food scarcity, neighborhood safety, educational needs at a variety of levels, and the complexities of their Population Health. Increasingly, Families need both parents to work for their Family’s survival. Even so, Poverty afflicts too many families and especially their parental responsibilities. Within this scenario, the parental role of women for their children, when employed, contributes substantially to their own cognitive fatigue.

Considering the effects of cognitive fatigue for parents who are coping with poverty, it is likely that 30-40% of all children may have missed the developmental process described above by Fred Rogers Ph.D. That is, learning how to be lovable as the basis for acquiring the skills necessary to love others. Importantly, the intuitive character of these skills then underlie the caring relationships that are required within any Family. These adaptive skills then ameliorate the occurrence of cognitive fatigue for anyone. Importantly, cognitive fatigue is known to degrade a person’s moral reasoning processes while also responding to complex social interactions involving multiple alternatives for deciding what is best to do. This concept is more thoughtfully explored by Shane Timmons and Ruth MJ Byrne. (Timmons & Byrne 2018)

The complexity of POVERTY is immense. The SOCIAL TRADITIONS Sub-Page of the VINTAGE TRADITIONS Page attempts to explore its complexity. After a preliminary summary, it proposes a future view of our nation’s Population Health, as reflected by the next definition.

POPULATION HEALTH may be postulated for a NATION as

its community by community patterns of Unstable HEALTH that

occurs among their neighborhoods’ resident persons as a result

of each community’s multi-generational and real-time 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 the 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 for Stable HEALTH.

COMMENT Prior to the above definition, there has been a fitful effort for 20+ years to define POPULATION HEALTH as an independent phenomenon. As yet, there seems to be minimal progress to achieve a converging consensus. An initial surge of multiple proposals by pre-eminent scholars occurred 15-20 years ago to explore a robust conception. These eminent scholars included Barabara 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, another effort by several scholars suggested an even wider consideration for defining POPULATION HEALTH. I recognize the contributions from C.J. Peek (Peek et al 2021), Mark Fineberg (Fineberg et al 2022), David Kindig (Kindig 2022), and Craig McEwen (McEwen 2022) The definition proposed herein attempts to encompass the Cosmological, Biological, and HUMAN DIGNITY dimensions of every community’s resident persons within their nation.

SURVIVAL COMMONS (See Page 55 for complete definition)

The Population Health definition, cited above, refers to a Survival COMMONS. The Survival COMMONS concept represents a definition that proposes to formally establish each community’s responsibility to assess and refine the immediacy of their own Safety Net. Since the generational heritage of each community is unique, its Safety Net will identify a uniquely evolving occurrence of individual and family disaster needs, especially for Families with a responsibility for early childhood development. — 47 —

ADOLESCENT DEVELOPMENT

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

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

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

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

COMMUNITY BY COMMUNITY

As a model for substantial change, the 63rd Congress passed the Smith-Lever Act in 1915 to establish the Cooperative Extension Service in connection with each State’s federally supported College of Agriculture. “Extension” developed an intentional connection between the College of Agriculture and its state’s farmer-operated food production. Thus, the “Ag Colleges became more familiar with their unresolved problems, and the farmers learned more precisely about newly evolving farming methods. As a result, our nation’s farming industry represented approximately 80% of national total employment by around 1930. Recently, it was 1%. No other worldwide nation even approaches that level of efficiency. Argentina is the only nation that comes close at around 50% as efficient compared to the USA.

The 63rd Congress also passed legislation for the Federal Reserve. It functions as a semi-autonomous Federal institution with the responsibility to stabilize the value of the dollar within the international exchange of monetary assets.

Obviously, we should not want for possible models to improve our nation’s Population Health. Noteworthy, our nation’s maternal mortality incidence has worsened steadily since 1978, especially since 2019. There is a very large commitment to improve the “quality” of maternal healthcare. There is essentially no pervasive evidence that it will be substantially successful. The “antibiotic model” for identifying a curative model to reduce maternal mortality is unlikely to succeed, especially for certain racial Birthing Persons. This result has not occurred because of a lack of focus, commitment, or urgency from within our nation’s healthcare industry regarding this devastating loss of Human Dignity.

Given the paralysis afflicting our nation’s Federally centralized and autocratic government, we will eventually need to consider a State-by-State strategic process.

———— C O M M U N I T Y T H E M E ———–

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SOCIAL DILEMMA — INSTITUTION

COLLECTIVE ACTION — COMMUNITY

SOCIAL CAPITAL — SURVIVAL COMMONS

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.

— 51 —

COMMENT Imagine an event involving four cars that arrive at a four-way, stop-sign regulated with no stop-light intersection at about the same time. The first arrival, not fully stopping, goes first. One of the remaining three cars suddenly goes next, followed sequentially by the other two cars. The cars following the first and second cars are susceptible to an accident amidst their suddenly evolving “Social Dilemma.” This represents a classic, public goods event in which there was a conflict between the individual and collective interests involving various expressions of cooperation, reciprocity, and trust among the participants.

Collective action situations are studied extensively. The results generally indicate that some participants are also more likely to apply trustworthy, cooperative, and reciprocity rules to spontaneously or intuitively resolve Social Dilemmas encountered within a research study when they do the same during their participation in the municipal life of their community. Increasing each community’s expression of prosocial norms, its prosociality, then becomes the basis for monitoring every community’s Survival COMMONS, viz., enhanced Safety-Net.

INSTITUTION may be postulated for NATION as

” . . . the prescriptions that human 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)

COLLECTIVE ACTION may be postulated as

a social interaction involving an initial cluster of three or more persons who collaborate with diverse combinations of ecological and cultural congruence and their attributes of prosociality to achieve a Goal for improving 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.

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. — 53 —

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 and Population Health.

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

COMMUNITY may be postulated for HEALTH as

a cluster of multiple resident persons,

most commonly recognized as the persons residing

within a municipality’s geographic border and their associated

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.

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 spontaneous immediacy to apply prosocial norms

for resolving the social dilemmas encountered daily

by the resident persons 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 nano, micro, meso, and macro social networks.

COMMENT This definition of Social Capital is uniquely phrased for this Design Epistemology. It reflects an emphasis on the character of the social networks within a community and how they do, or do not, maintain caring relationships among and between their 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. — 55 —

SURVIVAL COMMONS may be postulated for a COMMUNITY as

an evolving cluster of functioning that are intended

to protect the community’s resident persons from

the sudden or prolonged occurrence of Unstable HEALTH

from Disruptive Processes and are:

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

at all jurisdictional nested scales which apply

to the public and private institutions within their community

and promote the Well-Being of its resident resident persons;

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

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

especially when each resident person safely offers

a Salutary gesture to each person they encounter and

each of these persons responds with an appreciative gesture;

C. Offered by each municipal community to its resident persons

who each may select from among their community’s

cluster of functionings, those Benefits and Obligations

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

for needs of their family’s Personal Survival Plan(s) and is offered

from within their community’s ecological and cultural traditions;

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

who become aware that their community’s cluster of functionings

has certain discontinuities for which a collective action strategy

will be required to resolve these discontinuities with an

equitably available, ecologically & culturally accessible,

justly efficient, and dependably effective Vision and Action Plan;

E. Augmented by the collective action strategies originating from

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

its social networks to prevent, mitigate, and ameliorate any

‘newly recognizable adversity’ encountered by its resident persons

that is related to a locally prominent discontinuity among

their community’s cluster of functionings or

their associated Benefits and Obligations, especially

if the ‘newly recognizable adversity’ is associated with

homelessness or poverty;

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

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

ameliorate the Disruptive Processes occurring from

certain locally reoccurring disasters which variously impair

the neighborhoods of the community’s resident persons and

their ability to maintain a Personal Survival Plan, especially

for those residents person’s afflicted by social isolation; AND

G. Supported by the community’s reciprocating collaboration

with their contiguously adjacent communities and

by their nation’s expression of social cohesion when interacting

within the worldwide, marketplace arenas for every nation’s

Resources, Knowledge, and Human Dignity.

COMMENT Assuming the Congressionally chartered formation of NATIONAL HEALTH, each of its nationally recognized communities would form a Community HEALTH Forum. Each Forum would pursue certain responsibilities for this recognition, such as the community’s support for a locally constituted collaboration to maintain their community’s Survival Commons. This phenomenon has already been formed to manage a variety of state-wide problems, especially for maternal mortality. — 57 —

————– N A T I O N ————–

6 of 6

HEALTH CARE — PRIMARY HEALTHCARE

COMMUNITY DISTRICT — MANAGING THE 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. — 59 —

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 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 Complex Adaptive 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.

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): — 61 —

“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 within the context of every Nation’s Common Good, viz., Covid Pandemic. The need to promote international Social Cohesion will not resolve with solutions that are primarily focused on climate change and the pandemic.

COMMUNITY DISTRICT may be postulated for HEALTH as

one of the 810 separate clusters of resident persons that

individually encompass, on average, 400,000 resident persons

who contiguously reside within one, or more than one,

county of a State as the basis for establishing a

nationally sanctioned Community HEALTH Forum.

COMMENT The Chartered provisions for the national governance of NATIONAL HEALTH form a triadic structure. The top level of Governance would reflect the formation of 9 Regions of one, or more than one, states. Each Region would encompass a nearly equal number of National citizens. Since each State’s population density varies considerably, the actual number of resident persons within a DISTRICT COMMUNITY may vary between 100,000 and 800,000. As sanctioned by their Region’s governance, each DISTRICT COMMUNITY would form a locally supported Community HEALTH Forum in collaboration with the other Community HEALTH Forums. Each FORUM would establish a locally collaborative process to maintain their Survival COMMONS with a responsibility to augment their safety net to prevent, mitigate, and ameliorate their community’s social determinants of Unstable Health.

The middle level of governance would be associated with each of the 9 Regions. The top level of governance would represent a Board of Trustees involving 1 Member selected on a 9-year rotating schedule by each of the Regions. The Home office for each level of governance would be located near the population center of the Nation, cluster of regional States, and cluster of District Community counties.

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 national Primary Healthcare Efficacy Plan

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

that is annually allocated to its health spending that originates

from within the HEALTH SECURITY certified Primary Healthcare

offered within every Community District.

COMMENT Professor Elinor Ostrom, Ph.D. offered an acceptance presentation upon receiving her Nobel Prize in 2009 for Economics. The presentation best describes her research for the validation of the Design Principles associated with the successful Common Pool Resource (CPR). A video URL for the presentation is internet accessible. It may represent the best introduction to this far-ranging concept. Importantly, she was the first woman awarded a Nobel Prize in economics. — 63 —

Conceiving our nation’s health spending as limited to a certain portion of our nation’s overall economic activity, its Gross National Product, may strike most people as representing a strategy that involves rationing by a highly centralized, Federal bureaucracy. The research of Professor Ostrom establishes a cooperative process among the payers and providers of healthcare to become more efficient as well as more effective. To describe a recently successful project within the arena of the CPR concept, I refer to the Cincinnati Children’s Hospital Medical Center’s 2012-2018 project to manage the pediatric, complex healthcare needs of a high-utilization neighborhood. (Andrew F. Beck et al 2009) From a baseline 3-year interval to a subsequent 3-year intervention interval, the annual pediatric hospital-utilization was decreased by 20%. To understand the resulting complexity of this project, please make an effort to read it. It is easily internet accessible by Google Scholar.

SOCIAL COHESION may be postulated for a NATION as

the expectation among the resident persons

within each of its municipal communities that the resident persons

within the other municipal communities are trustworthy and that

the continuing prevalence of these trustworthy persons will be

sustainably enhanced 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 has endured a decline in our social cohesion since the Civil War and especially since WW II. This trend represents the fundamental cause of the stress that each resident person encounters within their daily life. The definition above would not be recognizable by most Population Health experts. Of many thoughtful efforts to define Social Cohesion, I prefer the essay by David Schiefer and Jolanda van der Noll (2016): The Essentials of Social Cohesion: A Literature Review.

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

the occurrence of Stable HEALTH

for 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.

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