The Earth System Governance Project is the largest social science research network in the area of governance and global environmental change. I look forward to framing sustainability policy with systems thinking. I am affiliated with the Global Economic System Group. Check out the organization!
I am pleased to announce this article as an interview based on this research is highlighted in my book!!!
Using systems thinking in state health policymaking: an educational initiative
Karen J Minyard, Rachel Ferencik, Mary Ann Phillips and Chris Soderquist
Health Systems advance online publication 17 January 2014; pp. 1-7. doi: 10.1057/hs.2013.17
In response to limited examples of opportunities for state policymakers to learn about and productively discuss the difficult, adaptive challenges of our health system, the Georgia Health Policy Center developed an educational initiative that applies systems thinking to health policymaking. We created the Legislative Health Policy Certificate Program – an in-depth, multi-session series for lawmakers and their staff – concentrating on building systems thinking competencies and health content knowledge by applying a range of systems thinking tools: behavior over time graphs, stock and flow maps, and a system dynamics-based learning lab (a simulatable model of childhood obesity). Legislators were taught to approach policy issues from the big picture, consider changing dynamics, and explore higher-leverage interventions to address Georgia’s most intractable health challenges. Our aim was to determine how we could improve the policymaking process by providing a systems thinking-focused educational program for legislators. Over 3 years, the training program resulted in policymakers’ who are able to think more broadly about difficult health issues. The program has yielded valuable insights into the design and delivery of policymaker education that could be applied to various disciplines outside the legislative process.
Let us begin with the pressing policy issue of HIV risk taking behavior among homelessness teens to take home this point of social bond (de)construction. In the work of Rice et al.’s (2012) study of HIV risk behavior, homeless adolescents were located within the core (that dense ball of spaghetti in the middle of the network graph), were more likely to be female and were more likely to have been homeless for at least 2 years. The longer the teen, particularly for the young woman, is outside of the family unit, the teens form strong, compact ties with a new “family”. Surprisingly, being on the outside of this tight “family” that is found in the periphery of the network was protective against HIV risk taking. Highly connected, dense core are great for galvanizing information within that group. But a dense group may be more difficult to infiltrate. If the dense ball of teens are passing misinformation and reinforcing risky HIV behaviors, it is best to go your own way. But where can a young person go with such marginalized circumstances?
If the public policy being developed pertains directly to HIV risk taking reduction, perhaps targeting the core network to diminish risk could be a first step. But in the work of being connected to other people, the low risk teens may help each other or could transfer into the high risk group. But policymakers must remain mindful of what systemic changes can flow from targeting that portion of the network. People come and go into each other’s lives. Policy must be mindful that the longer the teen is outside of a traditional household, human connections will be made with the people that they have the most contact with. Could the teens in periphery have formed cliques that supported less risk taking? This may help these teens. Keep the periphery teens supported in their low-risk behavior. In the world of networks, there is something called homophily (birds of a feather). This means more than living in the same place. Above that shared space, the teens are ties together by something stronger: love, support, shared values, shared behaviors (see Feld & Carter, 1998; Kadushin, 2012). In other world, people live by forming bonds wherever they land.
If the policy lumps the new cliques (core and periphery) together, network membership can change over time. Teens that tie together two completely separate networks are called bridges. By theory, the networks would not have connected if not for this new bridge. Often the bridge has enough prestige and power to convince two divergent groups to join forces (Granovetter, 1973). Will the new members from the outside possess adequate social currency to offset the peer influence of the core members? Thus we have complexity. Can one policy that is meant to affect teens as if they share the same life chances and social embeddedness work? Most likely answer is no. While there may be an overarching goal set up the policy, parse out how different attributes of the teens may affect how the proposed policy works.
The longer a teen is away, it becomes more likely that their family will be in the same dire social straits and may not be protective in navigating good social choices and decisions. But the longer a teen is away, human nature requires connection and closeness, a family broadly defined. Being on the outside (periphery) of the homeless core protects against HIV risk-taking. Let us not forget a social purgatory between the instability of homelessness and the perceived caustic environment that the teen desperately calls to escape. The peripherals may be at risk in other ways that may lead to a greater risk of HIV risk taking once the teen is in the core. But if that teen has the ability to persuade those at risk, there is a possibility that the low risk taking of a strong teen could start to cascade low risk attitudes and values. But there is also a possibility that the teen will become enveloped and become high risk himself. It may be too much to ask of that teen to work to overhaul the collectively held value of higher risk sexual practices (Long et. al., 2013).
So in using the research on social networks, I propose systemic factors that should be accounted when attacking HIV among homeless teens:
1. Every homeless teen is not the same and each with present a different set of connections.
2. Being deeply connected in the homeless culture may place these teens at higher risk for unsafe sexual behaviors.
3. Targeting low risk teens on the periphery will require a different intervention to support the low risk behavior.
4. While there may be opportunities to use low-risk teens as “bridges” to the high-risk teens, this should only be done with extreme care and oversight. The bridge is more susceptible to falling into the activities of the core and may suffer from burn-out for the heightened sense that change is on that teen’s shoulders.
5. Watch the movement of teens from the core to periphery (and back again). This movement brings a whole new set of structural realities both for the teen as well as the network.
Social networks are powerful and are often underutilized in uncovering the underlying structure of health policies. But the policy work that we should hold dear must account for the power to combatting ecological gaps and failures, such as the personal and societal failing of just one homeless teen.
Feld, S. & Carter, W. (1998). “Foci of Activities as Changing Contexts for Friendship.” In
Placing Friendship in Context, eds. Rebecca G. Adams and Graham Allan. Cambridge,
UK: Cambridge University Press.
Granovetter, M. (1973). The strength of weak ties. American Journal of Psychology. 78 (9),
Kadushin, C. (2012). Understanding Social Networks. New York: Oxford.
Long, J., Cunningham, F. & Braithwaite, J. (2013). Bridges, brokers and boundary spanners in collaborative networks: a systematic review BMC Health Services Research 2013, 13:158
Rice, E., Barman-Adhikari, A., Milburn, N. & Monro, W. (2012) Position-Specific HIV Risk in a Large Network of Homeless Youths. American Journal Of Public Health. 102(1), 141-147.
NOTE: This white paper is a revision of a blog written by the author. An early version was originally posted on the Orgcomplexity Blog (Orgcomplexity.wordpress.com) on February 28, 2013.
Let us give Chris Christie’s latest exploits a rest today. I was in a zombie mood today and decided to revisit a CDC zombie initiative from 2011. In the less comedic galaxy of public health, the world also needs saving from premature mortality and morbidity. The rightfully respected CDC made a venture into the “zombie apocalypse”, educating the public about emergency preparedness with a zombie novella. Unfortunately disaster planning leaves much in the public with obvious missteps in policy formulation and execution. Maggie Silver, a contributor to the CDC Public Health Matters blog, had even taken to giving the play by play on how to stay alive based on lessons learned (or not learned so well) based on the popular zombie feast, The Walking Dead (http://blogs.cdc.gov/publichealthmatters/2012/02/thewalkingdead/). It is an ingenious leverage of marketing hard to reach populations with health information in light of increasing occurrence of natural disasters (http://www.cdc.gov/phpr/zombies_novella.htm). It has been reported by the Washington Post that Twitter followers increased ten-fold for the unsexy CDC’s Emergency Preparedness division shortly after Silver’s blog went live (Bell, 2011).
The line between influential and conceptual health policy is hazy. On one hand, the CDC policy behind green lighting such novel communication channels may have come from the need to increase knowledge of emergency preparedness (conceptual) in the light of recent natural disasters. But the CDC is also in the business of saving lives. In preparation for all hazards, many deaths and injuries can be averted by knowing what to do before the “zombie apocalypse”, the CDC’s allegory for natural disasters. The blogosphere was chockfull of pundits decrying with the use of the federal money to educate the living on not becoming undead. Dear pundits, zombies are not real. Such a falsehood was not disseminated by Federal Emergency Management Agency (FEMA). The CDC, as the trusted source, would eliminate the chance of a phishing hoax. Zombies did not spark alert on the Public Broadcast System. I did not hear any upheaval as in ,vis a vis, Orson Welles. Branscum & Sharma (2009) reviewed the use of comics in health promotions targeted at children. More often, the comics are not a standalone intervention (Branscum & Sharma, 2009). But from an ethical standpoint, could the realness of the campaign blur the lines between entertainment to inform versus realistic entertainment that “warns”. But let us get this straight. The undead’s purpose in life (generously defined as so) is to make more undead in order to have more slowly shuffling company of the Cesar Romero variety. I have yet to have met a nonliving zombie in my traverses about town. Art can and has been an effective vehicle to slyly introduce health information but care must be taken in assuring that there is no confusion in the public as to its purpose.
The CDC is working behind the scenes with evidence based public health interventions and is not trying to take over the pedestal of DC Comics. The jury is still out as to the effectiveness of the zombie campaign. In the area of viral impact, The Washington Post reported that social media interest in the zombies crashed the CDC website (Bell, 2011). I argue that this venture into comics (while perhaps not a novella about zombies in every case) has some lessons for the health policy set to see what the other side (promotion) is doing. Should there be a policy set that deals with entertainment for social change (See the work on edu-tainment from Arvind Singhal of UTEP)?
Branscum, Paul; Sharma, Manoj. COMIC BOOKS AN UNTAPPED MEDIUM FOR HEALTH PROMOTION.Source: American Journal of Health Studies . 2009, Vol. 24 Issue 4, p430-439. 10p.
Bell, Melissa. 5/20/11.Zombie apocalypse a coup for CDC emergency team.
CDC Office of Public Health Preparedness and Response.(http://www.cdc.gov/phpr/zombies_novella.htm)
Silver, Maggie. (February 7, 2012). Teachable Moments – Courtesy of The Walking Dead on AMC. Public Health Matters Blog. Retrieved on 12-6-13 from
Some selected work from Dr. Arvind Singhal:
Communication of Innovations (2006)
Organizing for Social Change (2006)
Entertainment-Education Worldwide: History, Research, and Practice (2004)
Entertainment-Education: A Communication Strategy for Social Change (1999)
I gladly accepted the post of co-editor as well as Lead Editor- Population Health section. It is affiliated with Duke University Center for Health Policy and Inequities Research and founded by Christopher J. Conover, PhD . This site is in my blogroll. Please follow!
by Karina Descartin
In the late 1990s, the summer before my senior year as an undergraduate in public health in the Philippines, I volunteered and participated in a summer immersion program through the university’s Volunteer Service Corps. Our group of eight medical and nursing students lived for almost five weeks with indigenous tribe families in the mountains of Bukidnon on the big island of Mindanao, south of Manila. Our task was to design and implement health programs for the small villages we visited. That summer was an entirely different life for us, city kids all. The homes we visited were far (sometimes whole mountains) apart. Walking for hours from point A to B was the norm. Electricity was rare and the physical and healthcare infrastructure was primitive, mostly inadequate to handle the communities’ needs. Extended family groups typically lived together in small clusters of modest homes, which left little room for privacy but reinforced the supportive and closely knit kinship networks that were part of the fabric of life. Local folks looked you in the eye unhurried, offered their best crops when sharing their meals, and embraced us with a warmth that shone through initial shyness. They laughed easily and their smiles lingered. Even during nights when they shared stories of sorrows and fear, I had a feeling they knew they’d be okay. Afterwards, when I returned for my final year at the university, the world looked different. I’d seen first-hand that even in a context of tremendous lack of external resources — and the near absence of the health support systems that I’d been learning about in my classes — the always-present embrace of a whole community built around the connectedness and sharing of family and friends could boost well-being from the inside-out.
When I started to look at the connection between built environment and health, I found Dr. Richard Jackson’s (2012) book Designing Healthy Communities. As a physician and Master of Public Health student, I immediately connected with the words.
Jackson (2012) wrote that in the context of love and charity as residents of our will, the built environment is a manifestation of our intention and imagination. Further, in the context of genuine giving, he added that we get more than we give from truly “great built environments” (Jackson & Sinclair, 2012). But that great built environment bunkers us away from the din of social activity, what good is a custom home without a community to share it? Sometimes people can move mountains but they cannot move concrete walls without a building permit.
So when Atlanta’s Mayor Kasim Reed said in his TED City 2.0 Talk that “cities are where hope meets the street,” I agree. But I have to add that, often times, hope meets mountain paths and dusty village roads far from the city. Hope does not care whether we settle in on rolling hills or urban sprawl. Perhaps then, we should ask, where does this hope come from? Perhaps it’s not from the city street or rural lane, in particular, but wherever we are. It is our social connectiveness.
We are what we think.
All that we are arises with our thoughts.
With our thoughts, we make our world.
Christopher Young, Buddha Quotes, 2012
The directed purpose of the built environment depends on our intent. A long time ago, older cottages on tree lined streets had porches. Remember when people actually congregated on that porch to talk and yell at friends as they passed by. What are we trying to accomplish with strained decks in the back of our homes? Is our current goal to build and connect? Or is it to fortify and defend and isolate (Caldeira, 1996)? Isolation over the long term has been found to be detrimental to health. But when the heart is taken out of meeting friends by chance or making sure that a neighbor is okay today, we have another disease altogether. We have to work harder in establishing co-presence in our networks to actually stare another person in the eyeballs (Kadushin, 2012). What is co-presence in networks, you say? Sometimes people just share the same space and nothing more bonds them. That is known in networks as co-location. But if we hope to assure that built environment will not impede our ability to connect, co-presence is in order. If there is a neighborhood yard sale to unload unused Stairmasters and bound books, this is space with a social purpose for neighbors and bargain shoppers on the prowl, no matter how fleeting the communion may be.
Process and System
Community is ingrained for some (co-presence). For others, they live only in a zip code (co-location).
– Michele Battle-Fisher– Urban Greenspace
Cities of walls do not strengthen citizenship but rather contribute to its corrosion.
– Teresa P. R. Caldeira, Fortified Enclaves
We need open, inclusive exchange of ideas that will breathe fresh new life into this city. We need this. And when and if we get it, then the walls will come tumbling down.
– Dennis Dalton, TED City 2.0
Rydin et al. (2012), Lopez (2012), Rao et al. (2007), Kochitzky et al. (2006), and urban planner Gregor Wiltchko suggest that urban planning must be multidisciplinary and collaborative. This is key in ensuring that a common language is spoken among various disciplines and interests involved in defining our environments. Who has actually attended an urban planning public forum? I hear …silence. Wiltschko further puts this position in perspective— “not so much to design the site or the right area but designing the right process that collaboration can really happen.” Do you agree?
If we want to build something that best fits competing needs and makes more people just a little bit happier — perhaps allowing that frustrated driver above to get home in reasonable time even while the slow-pedaling cyclist in the next lane gets to enjoy the scenery. It takes more than a clever plan or smart siting by some architect, planner or engineer. This is parallel to Battle-Fisher (2013), Jackson & Sinclair (2012), and Caldeira’s (1996) explicit language of community, openness, freedom, belonging, and possibilities for people.
Cities, built by humans are complex systems (Rydin et al., 2012). In complex systems, health begets health (Battle-Fisher, 2013, April 5). In complex systems, we not only learn collaboration and participation, but we learn balance that is always under the threat of imbalance (Jackson & Sinclair, 2012; Carlson et al., 2012; Jackson, 2003; Mitchell, 2009; Miller & Page, 2007; Lidwell, Holden, & Butler, 2010; Luke & Stamatakis, 2012).
I wandered the streets in my vicinity to capture some of the many ways that intentions and process have manifested in the built environment of this city. Come walk with me to see for yourself…
The Cannery along Third Street, left, is a former factory repurposed as residential lofts and commercial storefronts in Downtown Dayton. The building on the right, roughly from the same period, is still an active (if underutilized) industrial facility.
The vacant Lindsey Building along Main Street. The building is boarded up with lively artwork that keeps the façade vibrant.
As humans, we create — we build. We may build structures — soaring art or hulking defense. As humans, we are responsive to our internal as well as our external environments. As humans, we have the propensity to connect, to share, to exchange, to receive, to give, to develop, to innovate, to thrive… or to wilt away.
Battle-Fisher, M. (2013). Urban Greenspace and Collective Health Ownership. Mindful Nature, 6(3), 33-35.
Battle-Fisher, M. (2013, April 5). The participant observer and engagement in the routine [Web Log Post]. Retrieved from https://orgcomplexity.wordpress.com/2013/04/05/the-participant-observer-and-engagement-in-the-routine/
Caldeira, T. P. R. (1996). Fortified Enclaves: The New Urban Segregation. Public Culture, 8, 303-328.
Carlson, C., Semra, A., Gardner, K., & Rogers, S. (2012). Complexity in Built Environment, Health,and Destination Walking: A Neighborhood-Scale Analysis. Journal of Urban Health: Bulletin of the New York Academy of Medicine, 89(2), 270-284.
Dalton, D. (2013, September 20). Session 2: Reinventing Urban Experience. [TED City 2.0] Retrieved from http://www.ted.com/pages/attend_tedcity2
Jackson, R. J. & Sinclair, S. (2012). Designing healthy communities. San Francisco, CA: Jossey-Bass.
Jackson, R. J. (2003). The Impact of the Built Environment on Health: An Emerging Field. American Journal of Public Health, 93(9), 1382-1384.
Kadushin, C. (2012). Understanding Social Networks. New York: Oxford.
Kochtitzky, C., Frumkin, H., Rodriguez, R., Dannenberg, A., Rayman, J., Rose, K.,…Kanter, T. (2006). Urban planning and public health at CDC.MMWR: Morbidity & Mortality Weekly Report, 55(2), 34-8.
Lidwell, W., Hodlen, K. & Butler, J. (2010). Feedback Loop. In Universal Principles of Design (2nd edition). Beverly, MA: Rockport Publishers.
Luke, D. & Stamatakis, K. (2012). Systems Science Methods in Public Health: Dynamics, Networks, and Agents. Annual Reviews of Public Health, 33, 357-376.
Miller, J., & Page, S. (2007). Complexity in Social Worlds. In Complex Adaptive Systems. Princeton, NJ: Princeton University Press.
Mitchell, M. (2009). What is Complexity? In Complexity: A Guided Tour. New York: Oxford.
Reed, K. (2013, September 20). Session 1: Redefining Citizen. [TED City 2.0] Retrieved fromhttp://www.ted.com/pages/attend_tedcity2
Rydin, Y., Bleahu, A., Davis, M., Davila, J., Friel, S., De Grandis, G.,… Wilson, J. (2012). Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet, 379(9831), 2079-2108. doi: 10.1016/S0140-6736(12)60435-8.
Wiltschko, G. (2013, September 20). Making Urban Planning Urban. [TEDxVienna]. Retrieved from http://www.youtube.com/watch?v=Q-0p8ZpBq04
Young, C. (2012). Buddha Quotes – 365 Days of Inspirational Quotes and Sayings in Buddhism [Kindle Edition]. USA: Amazon Digital.
All photos copyright ©2013 Karina S. Descartin.
Here is a quick discussion of how insurance should work under Obamacare-
· The young peoples’ premiums which should theoretically have the lower probability of catastrophic illness should offset the increased utilization of healthcare by the graying Baby Boomers.
· More money from 20 year old, less office visits should offsets visits of Grandmother who will have higher premiums but also more health care utilization.
· Voila! A healthful societal success!
Take this paradox for a spin—
Got some job history, young one? Believe me, it is not enough quite yet to offset the need to get covered now during the start of your economic productivity. For those young people from the most disenfranchised families with a history of lack of insurance and unstable work histories, the decisions revolved around accepting the Medicaid expansion along party lines leaves many kids in a lurch.
Medicaid expansion is concentric to Obamacare. Take the arduous tabulation of “reported” enrollments in the state-based health exchanges shouldered by the Advisory Board Company (ABC). Two weeks after the roll out, the Advisory Board Company (2013) reported that 130,000 people have applied for coverage through the health exchanges across 15 states that offered up the goods (the data).
The proof some say is in the pudding but this pudding is more of a murky gruel. Having applied for coverage does not mean covered right now. Many applications in some states default to being Medicaid eligible, not exchanges in the traditional sense. Some states continue to poo-poo on Medicaid expansion, though my home state of Ohio got on board. As ABC pointed out, nobody has paid a premium let alone a penalty yet. The applicants have only expressed intent to become covered. What happens when a young person decides not paying that exchange premium and take the penalty ruler to the knuckles versus not defaulting on that student loan that cannot remain in deferment?
The invincibles are once again invisible to Obamacare’s safety net. How are we set to navigate them back once the media spin of ACA’s hiccups and the economic downturn takes hold in getting covered? I say that we must account for perceptions of DC Comics-flavored invincibility, modernization of youth culture, social marketing with a dash of brain function for good measure.
Invincibility may couple with increased risk taking within this young cohort. Rice (1996) defined youth culture as “the sum of the ways of living of adolescents; it refers to the body of norms, values, and practices recognized and shared by members of the adolescent society as appropriate guides to action”. It must be said that youth culture is a relatively new phenomenon. Do we forget that children were given adult responsibilities such as child labor that gave them no ability to “find themselves”? Inadequate neurotransmitter levels may lead to impulsivity. That darn frontal lobe has not been kissed with the ability to have a reliable gut instinct (defined as following the adult world rules). Lastly, youth are less able to make connections between experience and memory.
Now if that memory does not trigger an “a-ha, maybe that hit of salvia is not a good idea this time”, what are we left with?
We must account for this youth reality as it is now. The child worker of yesteryear was forced to take an economically derived “adult “identity covered in soot all the while his brain remained woefully underdeveloped. Youth today have been protected from unfair child labor and celebrated autonomy (within reason) so the youth can relish in a period of an English Rumspringa that bleeds into their 30’s. They have a more fair life course. With that newly allowed time of this new life, young people have time to build social networks of friends. This is not a big surprise to parents who have tried to evoke “if your friends jumped off a bridge”. If the social network of friends using their influence to make a belief or action contagious, young people have an affinity to being a part of the in-group. Let’s all bungee over the Colorado together.
One, two, three, hell yeahhhhhhhhhhhhhhhhhhhhhhhhhh!
It is that social influence within networks that works to get people to adopt health behaviors. That is if we frame the intervention to account for these conforming networks (Smith & Christakis, 2008). Yes, they can make up their own minds to take the coverage or the penalty. Will that take that insured baptism in the end? Young people (18-35) still have high rates of risk factors that would really require health care intervention (such as smoking, drinking, serious mental health impairments). It is amazing how the body accumulates the follies and unfortunates of youth in its cells. Unless something is catastrophic (which is in itself not a guarantee that care will be sought), the body does not tell its unfortunate tale for many years to come.
The roll out has done little to entice with its social media machine to make and counter this invincibility point. While the jury is still out, there is a possible untapped potential of using larger- scale social media campaigns to support behavior change (Centola, 2013).The Obama administration fills my inbox until my box “runneth over”. Now is the time to leverage social media to engage health behaviors such as signing up for Obamacare with an empirically sound research design. Maybe these social marketing messages could outshine the latest meme of cats with witty words just long enough to support that conscious jump over to the health exchange website. And the Advisory Board Company will keep the ticker of those jumps.
Centola, D. (2013) Social Media and the Science of Health Behavior. Circulation. 127: 2135-2144.
Diamond, D. (October 16, 2013). More than 130,000 people have applied for coverage through ACA exchanges. Retrieved on October 16, 2013 from The Advisory Board Company Daily Briefing Blog at http://www.advisory.com/Daily-Briefing/Blog/2013/10/More-than-130000-people-have-applied-for-Obamacare.
Rice, F. (1996). The adolescent: Development, relationships and culture (7th ed.). Boston: Allyn & Bacon.
Smith, K. & Christakis, N. (2008). Social Networks and Health. Annual Review of Sociology. 34: 409-29.
It is 12:01am EST on October 1, 2013. This is a day of mourning. The government is indefinitely out to lunch. It is time to acknowledge the “Cliff hanger” risks. As I am writing this, the hatchet has gone down. Please start the funeral dirge.
Obamacare is in danger once again. More families will struggle from government stoppages. Obamacare has more lives than a cat. Defunding Obamacare and delaying private health insurance exchanges are risks that we should not take only later see the error of our ways. But there is an undisclosed system on the Congressional game show of who can “come on down”. Throwing money at a creepy Uncle Sam that did not pass his medical boards should not silence the throngs of citizens calling for the moral imperative to protect the nation’s health.
On The Price is Right, there are contestants in T shirts embossed with phrases such as “I spayed Muffin for Betty White” vying for hot tub and dinette sets. The show is based on the fascination of the possibility of success, not its realization of success. Each guess in the Cliff Hanger game has a one-dimensional yodeler in front of cardboard Alps moving precariously towards the cliff and his impending doom.
But what is unique to The Price is Right is that the contestant often calls upon the help of the audience for help. But he does not have to listen. Each studio audience member at the Price Is Right works their uvulas in a frenzy to be picked and give contestants’ help. Please listen to me then you can decide what you will do! That goes for you too, Congress.
According to a 2013 survey performed by Rassumen Reports, only 8% of those surveyed reported that his legislator “listened to him most”. In 2013, Rebekah Herrick wrote in a timely article published in State Politics and Policy Quarterly that often agreement between constituents’ desires and the legislator’s outcomes is defined as the pinnacle of policy success. Absolute agreement among constituents will never happen in the purest sense. However, Herrick said that legislators must constantly reassess the opinions of their publics to inform their legislative decisions. Listen before the guy in Lederhosen or that latest Obamacare initiative goes over the cliff.
There is that adage, “those who cannot remember the past are condemned to repeat it”. Leaving millions of Americans uninsured and sick is a past warranting an encore? In this healthcare debate, we have to do more than just remember the decisions affecting public health problems and the health victories (which do certainly exist).But a holding pattern based on political ideology does not progress make.
Fixing a healthcare “system” requires more than a falsely disjointed approach to its separate elements. Sure, the healthcare decisions are far more complicated than arriving at a price of that Belgian waffle maker. We cannot afford to fall miserably off the “cliff”. We have been doing too much of that lately. The ideological rigidness and that pouting in the corner until your face is blue are not working. We have more than a hot tub at stake.
NOTE: This is a Reworking of “Making sense of healthcare systems using sensemaking and the Price is Right” (Orgcomplexity Blog August 30, 2013).