iii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

'Elegy' by Gabriel Goliath - Venice Biennale

“Elegy is wound and medicine when mourning itself is under threat”

- Christina Sharpe & Rinaldo Walcott

Elegy is a life-work of mourning. It is a cry, a lament, a tender refrain of remembrance, repair and black feminist love.

For over a decade now, Gabrielle Goliath has staged performances of Elegy across South Africa and the world, invoking the absent presence of women and LGBTIQ+ people lost to fatal acts of racial-sexual violence. In each performance, a group of seven women singers enact a ritual of mourning, collectively sustaining a single, haunting tone for the course of an hour. As one singer falters, another steps up to pick up the note, and so it continues, a cyclic threading of shared breath and voice.

Each performance of Elegy is accompanied by a eulogistic text, scripted by a family member or friend of the individual commemorated: for Sinoxolo, Koketso, Noluvo, Lerato, Kerabo, and more… Other performances address historical cases of violence against women and otherwise-feminised bodies in colonial and slaveocratic contexts. For these, speculative texts by collaborating scholars reach across generations, geographies and archival erasures, recalling these ‘past’ losses and accounting for a present of anti-black, anti-femme violence.

Refusing spectacle and the objectification of bodies deemed rapeable and killable, Elegy asserts conditions of hope and avowal: affirming black, brown, indigenous, femme, queer and trans lives as loveable and grieveable. It is a work of regard, of specificity and care. For those immersed in its sonic vigil, it offers a space for shared grief and radical refusal - for the urgent, ongoing life-work of mourning.

. . .

Source: Gabriel Goliath - https://www.gabriellegoliath.com/

May 5 - July 31, elegyinvenice.com

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

reflection	temporal
Collective grief	violence

My source: Nadia Beard. A musical act of mourning, Venice Biennale, FTWeekend. 2/3 May 2026, p.5.

International Menstrual Hygiene Day 2026

Facts & figures about MH Day and menstrual health & hygiene

About Menstrual Hygiene Day (MH Day)

• MH Day is celebrated annually on 28 May to symbolize the average length of the menstrual cycle (28) and duration of menstruation (5).
• It was initiated by WASH United and was first celebrated in 2014. WASH United is an award-winning non-profit based in Berlin/Germany, founded in 2011, with a focus on menstrual health and hygiene (MHH). WASH United focuses on strengthening the global MHH ecosystem by offering free, easy-to-use solutions for awareness, advocacy, and education, and engages in strategic advocacy throughout the year.

• The mission of the MH Day movement is to create a period-friendly world.

A period-friendly world is a world in which menstruation is accepted as a normal fact of life and is no longer stigmatised. It is a world in which everyone is educated about menstruation from an early age. In a period-friendly world, everyone has access to quality and affordable period products of their choice. Everyone has access to period-friendly toilets. And in a period-friendly world, menstrual health services are available to everyone. It is a world where no one is held back just because they menstruate. (MH Day mission)

• The impact of MH Day 2025: reach of 971 million people, 25,026 pieces of media coverage, 198,132 social media contributions, more than 2,000 events, and 1,350 partner organizations.

 
About Menstrual Health and Hygiene (MHH)

Global perspective of menstruation

• Globally, 2.1 billion adolescent girls and women menstruate. 
  (WHO/ UNICEF, Progress on household drinking water, sanitation and hygiene 2000-2024. JMP, 2025)
• On any given day, approximately 375 million women and girls worldwide are menstruating. (Own calculation)

MHH-related challenges

• Number of persons in need: More than 500 million women do not have the resources and support that they need to manage their menstruation. 
  (Amaya L. et al., Advancing Gender Equity by Improving Menstrual Health. FSG, 2020)
• Period education: Globally, only around 2 out of 5 schools provide menstruation education. 
  (WHO/ UNICEF, Progress on drinking water, sanitation and hygiene in schools, 2015-2023. JMP, 2024)(MH Day mission)

1 of 3  April 2026                                         Continued ...                                       #PeriodFriendlyWorld 

By Helen Frankenthaler - 'A Green thought in a Green Shade'

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

Helen Frankenthaler: A Green Thought in a Green Shade, 1981 119 × 156 1/2 in. (302.3 × 397.5 cm). Acrylic on canvas

© 2026 Helen Frankenthaler Foundation, Inc. / Artists Rights Society (ARS), New York

Image used with kind permission of The Helen Frankenthaler Foundation - and with thanks.

My source: Phoebe Evans. Opening Shot, FT.com/HTSI FTWeekend. 23rd April, 2026, p.13.

 
Gagosian. Helen Frankenthaler: The Moment and the Distance
April 30–July 2, 2026 West 21st Street, New York 

 

ii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

I didn't have time to finish reading Frankel et al. before WCCS26. This book has an index which was very useful, to efficiently check certain points. It is amazing the number of books without an index.

Chapter 1 is 'Guiding Principles' and links really well with the index. At two pages it is brief and yet also constitutes Part 1. 

Part II The Clinical Situation, continues an introductory thread. Chapter 2 The “Clinical Situation”: An Introduction to Its Structure and Complexity is what attracted me to the book. At five pages, there was more in this vein. I looked ahead and found that the chapters all seemed short. Checking the book's web page, 50 chapters in 270 pages, so just over 5 pages and well referenced too.

Initially, you might feel short-changed, of course, I didn't with a review copy. But don't worry. You are in patient- person-centred hands here. Sometimes content matters. The three authors work and are researchers in psychiatry. For me, the guiding principles and part II provide a handshake with the index. The person here then, is given a literary hug. Immediately, there is a link between the variables of care and the structure of a case (or caseness). 

'But importantly that "structure" is dynamic changing over time. We classify variables as "clinical" as they are brought into play for the purpose of treatment, i.e., the goal of healing.

The clinician is not just challenged to unravel this complicated situation but also to represent the patient accurately, including his or her "human" elements as represented by temperament and personal attitudes. What are the patient's essential needs. tolerances, preferences? Yet, there is even more to know about each patient. Does she have children? What is her financial status, her ethnicity? What are her attitudes about medical professionals. Does she believe in medicine, or even in science?

Beware! None of these factors are dispensable when trying to understand a patient. Just try to leave out a few and you are left with a gutted rendering of that person, not a living human being.' p.7. 

(and continued in fragmented form below ...)

individual

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INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group

'The result even when this level of detail, is available may still be an anemic version of the patient.    Traditionally a medical patient is subjected to an extensive workup that includes a mental status examination, in addition to a detailed past and present history, ...	... and an extensive "review of (organ) systems.
Now add the multiplicity of problems, psychiatric and systemic medical, from which the patient suffers. ...	Multiplicity may include systemic medical, psychiatric, social, financial, and lack of access to health providers.' p.7.

'From this description it seems logical that complex patients presenting with mixed medical-psychiatric disorders be managed with an ongoing collaborative approach delivered by a multispecialty team. Included may be a primary care physician, psychiatrist, and/or psychotherapists. One or more of the collaborating professionals may be a nurse practitioner and/or a physician's assistant.' p.7

I will return to the 'logical' in the final quoted paragraph above. The author's declare their intent from the outset, and by the literature-to-date they achieve this (may I please add? 'in spades!').

 

Over the years and as raised on W2tQ, several colleagues and contacts have asked "Where is the book on Hodges' model?" Not to sound weird, but this book asks that same question through some challenges to the usual 'medical' text. There are several lessons to take away here, even if only to keep a dream alive. While the physical size of a textbook, its practical appeal and stance makes it appear as something to pop in your top shirt/jacket pocket. A pocket guide: quite an impression just 10-20 pages in, and in this digital age.

 

As you would expect from mental health practitioners - psychiatrists - psychotherapists, interpersonal, subjective-objective and intersubjective factors are integral to how complexity is defined and measured. In Chapter 2, pp.11-12 there is mention and reference to the Value-Based Integrated Case Management Complexity Assessment Grid:

Specker, S., Andrew, R., Drexler, E., Koithan, E., Thurber, S., & Frankel, S. (2026). Development of the Self-Administered Health Complexity Screening Instrument. Professional case management, 31(2), 81–89. https://doi.org/10.1097/NCM.0000000000000845

I will check this instrument as I complete this review. As noted on April 9th this book was published in 2023, so I remain grateful to Daniela and colleagues at SpringerNature for the review copy (which also enjoyed WCCS!).

Previously: 'complex' : 'holistic bandwidth' : 'mental health' : 'person(-centred)'

More to follow ...

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

South Sudan Medical Journal Vol 19 No 2 May 2026

 

Dear Reader,

The May 2026 issue is online here; we thank all the copyeditors and reviewers who helped prepare these papers. SSMJ is indexed by African Journals Online (AJOL) – go here to see who reads us.


 

Editorial 

• Ebola: The Bundibugyo virus is back Edward Eremugo Kenyi
  
  

RESEARCH ARTICLES

• Risk factors in glaucoma: Insights from a prospective case–control study, Belagavi, India Asawari Kabure, Bhushan Kulkarni, Shilpa Kodkany, Murigendra Hiremath
• OV16 antibody seropositivity reveals persistent onchocerciasis transmission and cross-border risk in Magwi County, South Sudan: a population-based survey Ezbon WApary, Yak Yak, Benson Ojara, Wilson Ladu, David Oguttu, Ian Hennessee, Pita Jane, Johan Willems, Thok Chol, Kamulete Horasio, Okot William, Amanya Jacob
• Prevalence of urinary schistosomiasis in communities along the River Niger Basin areas, North-Central Nigeria Nyamngee Amase, Ikpe Raphael Terlumun, Kayode Yusuf Abel, Sulaiman Mariam Kehinde, Akanbi II Aliu Ajibola
• Developing a communicable and infectious diseases research agenda in South Sudan: A multi-stakeholder prioritisation approach Amanya Jacob, Ezbon WApary, Dhieu Daniel, Atemthi Dau, Matur T. Tieng, John Rumunu, Cicilia Konga, Bol Atem, Betty Eyobo, Robert Napoleon, Joseph Panyuon, Kenneth L Sube, Kon Alier, Joseph Lako, John Suraj, Abuelguasim M. Hassan, Mapuor Areu, Lazarus Atem, Aja Kuol, Pizzi Wilson, Achcer Adup Mou
• Determinants of disaster preparedness among public health facilities in Juba City, South Sudan Dumba Samuel Kenyi, Muthoni Mwangi Eunice, Musa Olouch
• Evaluating the role of the health information system infrastructure in enhancing data quality in Central Equatoria State, South Sudan Matur T. Tieng, Karani Magutah, Joseph Muchiri
• Impact of developmental stimulation education on maternal knowledge and caregiving practices in stunting: a longitudinal study Ning Iswati, Azizan Omar, Sukhbeer Kaur Darsin Singh, Putra Agina Widyaswara Suwaryo 
• Holding the line: lived experiences of mental health, moral injury, and organizational support among public-health professionals in the Rohingya Camp, Bangladesh — phenomenological study Md. Ruhul Amin

CASE REPORTS 

• Endoscopic endonasal repair of post-traumatic sphenoid sinus cerebrospinal fluid leak with encephalocele Justin Rubena, Khalid Coco, Francis Swaka, Othwonh Twong 
• A rare pathological feature of portal vein thrombosis complicated by portal hypertension and haematemesis Hamidine Illa, Ganiou Tidjani Kabirou, Amadou Magagi Mahamane Ibrahim, Maman Brah Moustapha, Soumaila Abdou, Habou Garba Abdoul Malik, Adamou Harissou

REVIEW ARTICLE

• Interpersonal and community-level factors influencing intimate partner violence in South Sudan: a literature review Nyinypiu Tong Chol Adong 

SHORT COMMUNICATIONS

• Letter to the Editor J. Clarke McIntosh
• Letter to the Editor Eluzai A. Hakim
• News from the Gordon Memorial College Trust Fund Eluzai A. Hakim

BACKCOVER: CDC Poster: Flu or Ebola? 

Thanks to everyone who supports SSMJ. Tell your colleagues they can join our mailing list here.

The SSMJ team
Email: southsudanmedicaljournal AT gmail.com
Website: http://www.southsudanmedicaljournal.com
Follow us on X: @SSMedJournal and our Facebook Group,

Glossaries - calques, standards and what is, or can be canonical?

Post Marrakech and WCCS26 I'm still contemplating on matters 'complex' and 'complexity', across complex systems and complex care. We humans (and this one in-particular) have a penchant for compunding complexity, adding complications. Our languages are a case in point. 

As the conference demonstrated mathematical is central to the discovery of chaotic and complex systems. Maths itself preempted the discovery of the Lorenz System, and the Mandelbrot Set.

Efforts to look at Hodges' model mathematically has resulted in a small draft comparative glossary (4-5 terms). In addition to the history of chemistry and its adaptation of mathematical symbols, I soon came across complex numbers, complex dynamics, complex mathematics (don't worry I know my limits). But, symplectic geometry! What is that?

Apparently, 'The term "symplectic" is a calque of "complex" introduced by Hermann Weyl in 1939.'
(https://en.wikipedia.org/wiki/Symplectic).

So, over decades of ward meetings, reviews, care plans it was symplectic patients, symplectic care and situations all the time? Where am I heading with this? Probably nowhere in particular. There's still the risk of a meeting c/o gravity with the floor. I've been fascinated with the way words such as design and architecture are conjoined and added to things that do not qualify, at least from the purists perspective. This is joy of languages, they change constantly. 

Familiar with 'standard' in the clinical and informatics sense; 'canonical (form)' has come up within maths. It occurs in health too:

Graham, M., Winter, A. K., Ferrari, M., Grenfell, B., Moss, W. J., Azman, A. S., Metcalf, C. J. E., & Lessler, J. (2019). Measles and the canonical path to elimination. Science, 364(6440), 584–587. https://www.jstor.org/stable/26649426 

Sepehri, A. (2015). A Critique of Grossman’s Canonical Model of Health Capital. International Journal of Health Services, 45(4), 762–778. http://www.jstor.org/stable/45140527

Lee, H.-S., Paik, M. C., & Lee, J. H. (2009). Estimating a Multivariate Familial Correlation Using Joint Models for Canonical Correlations: Application to Memory Score Analysis from Familial Hispanic Alzheimer’s Disease Study. Biometrics, 65(2), 463–469. http://www.jstor.org/stable/25502307 

Voit, E. O. (2000). Canonical Modeling: Review of Concepts with Emphasis on Environmental Health. Environmental Health Perspectives, 108, 895–909. https://doi.org/10.2307/3454323 

 

Goddu, A. (1985). The Effect of Canonical Prohibitions on the Faculty of Medicine at the University of Paris in the Middle Ages. Medizinhistorisches Journal, 20(4), 342–362. http://www.jstor.org/stable/25803849

 In drawing up a glossary, and starting with a blank sheet (that is not Hodges' model) this is all worth consideration. Could Hodges' model find a place as a canonical form - even clinically?

The alchemy of terminology, symbols, and signs ...

Or, 'What is a nurse doing … in a chemistry class?' [Ack. See Estrada]

In reading, I was reminded that chemistry adopted mathematical symbols for its own use. Not only that, but as a core science (with physics and biology, emerging from natural philosophy) there is a historical development from the time of alchemy:

Please see (with a graphical abstract):

C.Wentrup, The Transition from Alchemical to Modern Chemical Symbolism: from Bergman and Guiton de Morveau to Hassenfratz and Adet, Higgins, Richter, Dalton, and Berzelius. ChemPlusChem. 2024, 89, e202400033. https://doi.org/10.1002/cplu.202400033

This journey matters today as the use of symbols, in mathematics or other fields can be a barrier to learning and hence personal and disciplinary progress:

Ollie Hunter. Lost in translation: Demystify scientific symbolic language to help your chemistry students overcome any potential learning barriers. Royal Society of Chemistry, 23 May 2022.

As acknowledged many times, it is easy to take a word, or concept from one discipline and 'fit' it to - or in another. Or is it? Estrada concludes:

“The complexities of modern science and modern society have created a need for scientific generalists, for men trained in many fields of science.” This is a paradigm of science in the XXI century, where the advent of such fields like the study of complex systems requires multidisciplinary approaches. But the previous phrase was not written in the XXI century. It is the starting sentence in The education of a scientific generalist” published in Science in 1949 (Bode et al. 1949).' p.161. 

'Mathematics has been defined as the science of patterns. Thus, mathematicians search for “numerical patterns, patterns of shape, patterns of motion, patterns of behavior, voting patterns in a population, patterns of repeating chance events, and so on” (Byers 2010). Once a pattern is identified either in chemistry or in mathematics, the researcher can proceed to the clarification of the systematic rule which is behind that pattern. This is evident in the analogy used here between code-breaking and structure elucidation. This attachment to patterns makes both chemists and mathematicians very prone to the use of pictures. An organic chemist hardly can say anything about the chemical reactivity (or any physical or chemical property) of a molecule from its exact quantum-mechanical Hamiltonian. However, she will construct a complete narrative about the physical and chemical properties of a molecular structure drawn in a piece of paper, even if such a molecule is completely imagined. The power of pictures in mathematics is discussed in the book Mathematics and the Unexpected by Ivar Ekeland (1990) where its value is recognized as fundamental in the early stages of the development of mathematical ideas. This also introduces a very important analogy among chemists and mathematicians. Namely, that they use a proper language in their respective fields. While physicists use the mathematical language in their investigations, chemists use the sophisticated language of chemical formulas and specific symbols to represent charges, rearrangements, partial equilibria, etc. These “invented” languages mainly appear only in Chemistry and in Mathematics, making them unique intellectual activities.' p.162.

With thanks to the author, Ernesto Estrada IFISC for additional thoughts and insights:

Estrada, E. What is a mathematician doing…in a chemistry class?. Found Chem 26, 141–166 (2024). https://doi.org/10.1007/s10698-023-09497-4

RCN Congress: The Systems Table and the Missing Cog

Across two maillists: SDOH Social Determinants of Health and POHG Politics of Health Group a discussion and debate regards public health, longevity and policy, was provoked by a study:

'At least 80% responsibility for ill health in old age down to individual'

https://www.theguardian.com/society/2026/may/20/responsibility-ill-health-old-age-oxford-longevity-project-study

'... Individuals bear at least 80% of the responsibility for their ill health in old age, according to a report aimed at challenging the belief that physical decline is either inevitable or primarily the responsibility of the state.

The report, launched at the Smart Ageing Summit in Oxford last week, argues that individuals have far greater control over their longevity than is commonly understood. The authors call on the government to take legislative action on alcohol comparable to restrictions on smoking.

Living Longer, Better – the Oxford Longevity Project’s first Age-less report – was co-authored by an interdisciplinary panel of UK-based experts in medicine, physiology, ageing and education policy. It was sponsored by Oxford Healthspan.

The report’s authors, Sir Christopher Ball, Sir Muir Gray, Dr Paul Ch’en, Leslie Kenny and Prof Denis Noble, present the figure of 80% as a conservative estimate.

Ball, a 91-year-old former Parachute regiment officer who intends to reach 100, said: “Some have gone higher and said it’s approaching 90%. But I think 80% seems about fair.”The claim, however, has been described as simplistic and said to neglect wider arguments about whether people are genuinely in control of individual choices when it comes to issues including poverty, pollution and healthcare access.

Nancy Krieger, professor of social epidemiology at Harvard TH Chan school of public health, said: “The report is to be commended for rejecting genetic determinism but it problematically avoids engaging with the societal determination of health and health inequities; the role of work, economic deprivation and government policies that give corporations free rein to sell unhealthy products.”

Steven Woolf, professor of family medicine and population health and director of the Virginia Commonwealth University Center on Society and Health, agreed, saying the paper “ignores and oversimplifies the actual, multilayered root causes of the conditions that foster poor health in a population”.

Woolf added: “There are factors affecting health that are beyond personal choice. So while it’s good to give people clear guidance on how their choices affect their health, it’s taking policymakers and others off the hook.” ...'

This provides me with evidence (well it would - wouldn't it^) on the need for, the purposes, and applications of Hodges' model.

More philosophically (perhaps), I'm reminded of the work of several academics - thinkers, Michel Serres stands out for me. Serres felt that positional adverbs were important, e.g. between, above, and under.

He also wrote of life (as per many philosophers), and the universe e.g. his writings on Physics and Lucretius - as flow - a river.

For new life, the options are seemingly infinite, far, far upstream: at source - not recognisable even as a trickle... but soon a rivulet, a stream, a river of so many tributaries.

As we grow older we get closer to the sea (of the 'eternal'), the options open to us shrink gradually, but ultimately radically - inevitably.

But looking back the turbulence, uncertainty, unpredictability (trauma and joy), all contribute, not just to where we end (up) but how this came about.

Life's signature at death.

In "Hodges' Health Career Model" 'health career' refers specifically to the idea of life chances (of course) and how other careers, education, work, retirement, caring (self - others - planet) .. are impacted through life and death's course.

This morning at RCN Congress, Liverpool (the home of District Nursing) there was discussion re. nurses being engaged in preparation for the next pandemic.

So often 'Nursing' is absent from the POLITICAL / POLICY table:

• Workforce planning
• Safety
• Higher Education?
• Research funding?
• Information / Health infomatics policy?

Speaking for myself, nursing is not interested in the four-course meal, but being involved and engaged in the after dinner discourse can be critical.

Politicians, policy makers, business, management consultants and lobbyists are so quick to point to and extol the 'SYSTEMS' perspective, and the need for 'systems thinking'.

Guilty of systemic neglect, they clearly have no idea of what a system is, an inability to appreciate and apprehend scope, scale and the 'whole'.

In mitigation (or not), for all groups: voice matters. Especially the voices of foresight, balance, advocacy, Their ability to ascend always proves an issue. 

Related papers listed in the sidebar:

Jones, P. (2008) Exploring Serres’ Atlas, Hodges’ Knowledge Domains and the Fusion of Informatics and Cultural Horizons, IN Kidd, T., Chen, I. (Eds.) Social Information Technology Connecting Society and Cultural Issues, Idea Group Publishing, Inc. Chap. 7, pp. 96-109.

Jones, P. (2009) Socio-Technical Structures, the Scope of Informatics and Hodges’ model, IN, Staudinger, R., Ostermann, H., Bettina Staudinger, B. (Eds.), Handbook of Research in Nursing Informatics and Socio-Technical Structures, Idea Group Publishing, Inc. Chap. 11, pp. 160-174.

Jones, P. (2012). Exploring several dimensions of local, global and glocal using the generic conceptual framework Hodges's model. The Journal Of Community Informatics. 8(3). Retrieved from https://www.academia.edu/3794699/Reflecting_on_the_glocal_through_the_conceptual_framework_of_Hodges_s_model

^Because these days you need to make every kernel - found or created on the continuum of evidence - count.

Previously: 'life chances' : 'health career' : 'Serres' : 'APPGs'

Liverpool, UK. RCN Congress 2026 - 
n.b. See you in Liverpool 2027?

June 4-5 'Ecologies of Care' - London, UK

With more to follow from RCN Congress, this morning I received the agenda for next month's conference 'Ecologies of Care'. I am speaking, first session on the Thursday, which is a good to know and see the broad range of presentations. 

The focus on attention, is helpful for a possible further event in October. In the meantime, the Call for Papers began:

Chancellor’s Hall, Senate House London

June 4 & 5, 2026

Keynote lecture by Professor Yves Citton

How do increasing demands on our attention influence what we know, and how we act, in response to climate change? Despite a strong scientific consensus that climate change is ongoing and anthropogenic, political and legal action remains fragmented. Ecologies of Care asks to what extent the environmental crisis is a crisis of attention. Speaking to the dynamics of the attention economy, Yves Citton notes that “the new scarcity is no longer to be situated on the side of material goods to be produced, but on the attention necessary to consume them.” The word ‘attention’ is etymologically linked to the notion of care, or that which one attends to. This relationship (of subject and object) is fundamentally collective, insofar as collective attentional regimes influence what each one of us pays attention to on a daily basis, and how we navigate the barrage of informational flows from popular media.

Terms such as "the Anthropocene" and "planetary boundaries" function both as scientific descriptors and attempts to provoke action commensurate to the urgency that scientists believe their research demonstrates. The recent decision not to formalize the Anthropocene as an official geological unit, for example, highlights growing unease concerning intensifying media attention directed at scientific expertise. Under conditions of increasing disparity between what we know, and how we act, in response to climate change, the role of scientific expertise plays an increasingly normative, and not only informative, function. Scientific expertise attempts to direct what we attend to, and consequently, how (or if) we care. This is a collective practice of narrating and internalizing mythologies, whereby informational flows draw attention to some thing that needs to be cared for: Earth, the planetary, capital, or each other.

Continued ...

 c/o Law and the Environmental Humanities Network

n.b. With little time, I'm not going to transfer the pdf text, but may add here.