Social policies are, more often than not, framed with the traditionalist rationalization of human intentionality. Be that as it may, policy tenders the protocols that are then acted up-on publically to bring social impact. Of course, a well-intended health policy must take into account on courses of action as well as funding priorities and constraints. I argue that socially based complexity puts into question the probability of purely rational public action. Social elements activated or retarded in a public policy can shift burden from one part of a healthcare system to another. In its most simple explanation, increased positive screening for disease within the safety net can lead to the probable increased usage of acute care treatment for individuals requiring more complicated care. While some level of desired social and health satisfaction may be experienced in the short term by shifting policy priorities, it is also probable that no tangible value is achieved toward to the overarching desire to elicit system wide impact. Will the positive changes last? I purport that living an illness with a public further complicates policy issues of keeping anything that is personally health related purely private.
According to network theory, naming a network is powerful. According to Trotter (1999), the existence of a boundary is defined by the rules of exit and entry. However, complex systems call for more intricate examinations of such boundaries. Unnamed groups are often identified by the observer and the boundaries are often most not agreed upon by the group members (Kadushin 2012). How might this idea work for special interests groups in making cohesion? According to Kadushin (2012), “a collectivity is structurally cohesive to the extent that the social relations of its members hold it together.” Further there are two mechanisms that support and disrupt this happy state of togetherness. First, if a “disruptive force” acts upon the group, will the network survive? Second, complexity is bound also to the health of its network. Like a game of Ker Plunk, disruption in a complex system occurs when one or more people are removed from the group (Kadushin 2012). The cohesion may or may not be able to survive. Then the process of community starts all over again with new set of actors and new structural relationships.
I do not recall an ICD code for attending family barbeques or activating one’s “social network” for staying healthy. Health care is not directly rewarded for healthy patients’ visits to Disneyland and the strength of the social support ties that keep patients well. More often than not, healthy patients demand less utilization of an already expensive and taxed health care system. Patients have social networks of confidantes of differing yields and compositions, but each member by association has the ability to persuade and dissuade if they wish. Often this network is an 800-pound gorilla in the examining room. This gorilla is a relative that has diabetes and complains of diabetic neuropathy while carefully sectioning the pecan pie with a surgeon’s precision. The sorority sister is a helpful “gorilla” that caresses your hand as you await medical results.
Failure is picking up a socially expected square peg after the innovative oval one fails to fit a conventional hole. If you really “need” the oval to work (and the world is not yet with the program), check out the board again. If there is no oval hole, darn it and chuck that board. Find a reamer and create your own or perhaps ask for a refund with no return shipping. Failure is the incessant attempt to satisfy others by hiding that socially acceptable square peg behind your back and asking for a few more days (in dog years) to work it out. Whittling that square peg with that dull pocket knife into a misshapen imposter of an oval peg serves no god. That imposter peg is not flush to the side of the hole. It is surrounded by slight flashes of open space. That open space created around the non-flush peg should extract with a slight tug. Trust me, that tug will be less taxing than the linear process that got that wrong peg there in the first place. Policy has little tolerance for misshapen pegs that bring with them unintended effects. Use a policy that works until it does not or admit that it never worked at all. Then make it work without the attribution errors gumming up the machinery. What works may not be the most apparent or popular choice.
At its simplest denominator, a citizen is by principle afforded the right of being included in a group’s decisions. But there is a special place for those who serve as policy experts. Sure, we could discuss until we are blue in the face how much a weight a vote in a representative democracy really holds. When I think of my job of being a citizen of any group, I am accountable in some manner to the group if I am not gerrymandered out of the process. Not unlike the idiom “we are in this together”, this cannot be truer in terms of health burden. The solidarity means that all of us have culpability in the collectives’ improving health. But each of our investment in this solidarity differs in our (re)actions, invocations and values. This knowledge should, in theory, affect the role that each of us plays in bettering health out-comes. But can and will citizenship overcome the medical reality that years of collective neglect have brought? How do we get people to give a darn and become a card-carrying Norma Rae? Those in policy hold a special role that should not be understated. A policy has the power to guide and mold the direction of societal movements or evade an unfortunate set-back. We are accountable but that job responsibility came with the rocky terrain. Necessary insights are gained from this systems approach. What is called for is the acknowledgement of the ligand and substrate nature of the two. In that regard, often a slanted pairwise comparison of objectivity to systems demonstrates the bias toward linearity. It is time for systems thinking to no longer be relegated to the kids’ table, peering around the corner and straining and wishing to bring its expertise to policy discussions.
Kadushin C (2012) Understanding Social Networks. Oxford, New York
Trotter R (1999) Friends, Relatives and Relevant Others: Conducting Ethnographic Network Studies. In: Schensul J, LeCompte, M, Trotter R, Cromley E, Singer M (eds.) Mapping social networks, spatial data and hidden populations. AltaMira Press. Lanham, MD