2021/22 Human Development Report: Uncertain Times, Unsettled Lives: Shaping our Future in a Transforming World

On Friday, 9 September 2022 at 00:37:02 BST, Dennis Raphael <draphael@yorku.ca> wrote:

Canada ranked 15^th… UK 18^th…

From: Pophealth <pophealth-bounces AT mailman13.u.washington.edu> On Behalf Of Stephen Bezruchka
Sent: Thursday, September 08, 2022 6:21 PM
To: pophealth AT u.washington.edu
Subject: [Pophealth] 2021 Health Olympics & vast US Health decline

Today the UN released its human development report with life expectancy for 2021. You can access it (Table 1) at http://report.hdr.undp.org.s3-website-us-east-1.amazonaws.com/

I've been using the UN rankings to create the health Olympics since the early 1990s for consistency. The U.S. ranks 44th, down from tied for 36 in 2019.  We are 7.6 years behind the longest lived country, Japan.  If we eradicated our three leading killers (heart disease, cancer, and COVID-19), we would be close to the first in the finish line.  In the UN rankings Thailand is now ahead of us!  And quite a few poorer nations.  

Trying to get action on our not being dead first is challenging.  

Stephen

Stephen Bezruchka MD, MPH
Departments of Health Systems and Population Health & of Global Health
School of Public Health 
Box 357660 
University of Washington 
Seattle, Washington 98195-7660

********************

My source - Dennis Raphael: draphael AT yorku.ca (with additional image c/o UNDP).

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Call for Papers: The Digital Movement in Nursing

Call for Papers: FOCUS The Digital Movement in Nursing

Focus Edition Guest Editor

Prof. Camille Cronin, Director of Research and Impact, School of Health and Social Care, University of Essex, UK

The Journal of Research in Nursing (JRN) is a leading peer-reviewed journal that underpins good research with current policy and aims to publish papers that will influence nursing practice and health- and social-care policy.

Over the last two years we have seen an unparalleled digital-technological response to the COVID-19 pandemic that has re-shaped the way health- and social-care functions, for better or worse. This change has been fast and relatively unevaluated, with little time or opportunity made available for the involvement of nurses, critical discussions or reflections. What did this do to the nursing world? JRN is commissioning this focussed edition to find out more.

We are seeking papers that showcase, describe, and highlight the impact of new digital technology and innovation on digital health related to nursing. These might include:

• showing how nurses are leading the development of such technologies or digital solutions; or
• how service users were involved in developing a digital resource using participatory practices; or
• the impact these innovations have had on nurses, and patients and their families – e.g. on accessing health care, on delivering and evaluating care; or
• what do we expect for the future and how do we enable the future health-care workforce to keep pace with such change?

Papers can be built around different research designs, case-studies, evaluations, or service improvement initiatives and may address any of these issues in relation to digital health:

• improving the quality of health-care and health, access, and safety through digital health;
• using digital health data to improve health- and social-care services;
• improving recruitment, deployment and retention of health- or social-care workers using digital technology;
• developing innovative technology and digital health strategies to improve care;
• developing or using technology;
• demonstrating initiatives that use technology to promote health and/or wellbeing; and
• what, if any, are the consequences of the rapid insurgence of digital health technology?

As JRN’s mission is to contribute knowledge to nursing practice, research and local, national and international health and social policy, the contribution of the paper to, or implications for, both nursing practice and health and social-care policy must be made explicit.

Authors interested in contributing to this edition of JRN should submit by 1 JANUARY 2023.

More details ...

LMIC: Opportunity to get involved with the National Institute for Health and Care Research, UK

Hello,

We have an exciting opportunity for people with lived experience based in low and middle income countries to get involved with the National Institute for Health and Care Research (NIHR) as funding committee members and reviewers, and we’d very much appreciate your help.

The NIHR is funded by the UK government and is a major funder of high quality global health research. Our next research programme is the Research and Innovation for Global Health Transformation (RIGHT) Call 5 , which is focused on strengthening health service delivery and resilience in low and middle income countries (LMICs) in the context of extreme weather events.

Would you be interested in joining us and giving your recommendations on which research proposals to fund? We are looking for people with lived experience of extreme weather events. Your insights and ideas can help shape research that is important to people living in LMICs, and improve healthcare services for some of the most vulnerable and marginalised communities.

The role of public committee member or reviewer involves reading funding proposals and providing a written summary of reflections. We pay a fee for involvement as a way of thanking you for your support. 

Please complete the Expression of Interest Form and submit this to us by Monday 16 May 2022.

If you have any questions or would like to discuss this in more detail, please get in touch with Razina Hussain at ccfcei AT nihr.ac.uk. 

Thank you and best wishes,

Razina

Razina Hussain

Programme Manager, Community Engagement and Involvement | PPI and Engagement | NIHR Central Commissioning Facility (CCF)

e. razina.hussain AT nihr.ac.uk

Central Commissioning Facility

Grange House

15 Church Street

Twickenham

TW1 3NL

My source: HIFA

Draft figure: Selected processes and sources that can contribute/influence the content of Hodges' model

This draft figure is intended to ultimately show how the final application of Hodges' model, that is, the selection and placement of concepts in the care (knowledge) domains is not determined by a specific rule, 'law', or theory. The user of the model as a reflective, problem solving agent must justify their 'completed' matrix - addressing the four care domains. This could be a combined effort, with a colleague, fellow student, patient, or carer. 

Being situated the figure should highlight how the final result, output is not only dynamic, changing over time, but it is dependent upon context. Contrast using the model in a seminar, with a nurse and student reflecting on a forthcoming or post a best interests or safeguarding meeting.

The most important point here, across all healthcare, education and other use-cases, is that when applied the user of the model begins with a blank 'sheet' ... template 

Any thoughts welcome. [image updated 18 March 2022].

Draft figure: Selected processes and sources that can contribute/influence the content of Hodges' model

Gatekeeping: Across the care domains

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Cognitive gate (access): Mental state: Risk to Self/Others? Literacy: My articulation of my needs Understanding of Consultation/plan Service name: acronyms My understanding hence awareness of services, referral Opt-in Self-neglect	Physical gate (access): Physical state 'emergency'? Telephone call, reception Obtain appointment Phone/Video, Face-to-Face Surgery, Clinic, Hospital, Home Letter: 'x' days? [ Triage Assessment, Planning Intervention Evaluation ] Individual: Collective: WAIT data?
Social-Cultural gate: Cultural diversity/Accessibility Service - Semiotics/Semantics/Signage Family/Social commitments (access) Sociology of Illness/Sick role Carer role Community/Local Understanding & Involvement? Reporting, Info sharing	Political gate: Service Provision/Use [by postcode?] Referrer's knowledge ... "Policy says..." ... URGENT, routine, 1,5 days... Service Pathways/Signage/Appearances Work commitments (access) Previously known? [ MAIN GATE: Therapeutic Modality? ]

 

Open to suggestions... 

Tides: Tackling Inequalities and Discrimination Experiences in health Services

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group
 

 

"What is the TIDES study?

The Tackling Inequalities and Discrimination Experiences in health Services (TIDES) study investigates how discrimination experienced by both patients and healthcare practitioners may generate and perpetuate inequalities in health and health service use. The TIDES study is funded by the Wellcome Trust and the Economic and Social Research Council (ESRC)."

My source:

https://twitter.com/tides_study/status/1387089743742177289?s=20

Paper: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"Implementing NCD care in humanitarian crises requires the development of a context-adapted approach or ‘model of care’. A model of care may be characterized as a conceptual and pragmatic framework that describes how services are delivered within a health system (Davidson et al., 2006; Agency for Clinical Innovation, 2013)." Models of care "We found that there was no single unifying model of care for HTN/DM care in humanitarian crises, and the variance in care models included in this review was highly dependent on context. In order to descriptively synthesize the diverse models presented in the included studies, we created a typology based on the type of crisis, region and integration with the health system, since these factors likely influenced model design"   patient’s expectations

hypertension and diabetes (HTN/DM) Crisis type and Region Natural: Hurricane, Flood, Earthquake Palestine, Lebanon, Jordan,  China, Pakistan,  India, Philippines, Syria, Iraq, Turkey, Nepal Camp, Non-Camp; Rural, Urban Location of services - Location of people in need, transport, travel time, distance Refugee population - Local population forced displacement, disruption of treatment and support, interrupted health services, movement and attrition of health care workers (HCWs), insecurity, destruction of infrastructure,  breakdown in supply chains and data processes "The domains of access — availability, affordability, accessibility, accommodation, and acceptability — were derived from previously described measures of coverage (Penchansky and Thomas, 1981; Hernández-Quevedo and Papnicolas, 2013; Levesque et al., 2013)."

Refugees and Host Communities Humanitarian crises "Responsiveness has been defined as the ability of health services meet a patient’s holistic needs; in this framework, it also encompassed a model of care’s ability to respond to changing patient needs in a volatile context (.Hernández-Quevedo and Papnicolas, 2013; Kruk et al., 2018). Integration described the linkage between different levels and sites of care, such as facility-based care and community-based support as well as coordination between providers and institutions, while continuity of care referred to uninterrupted care throughout the patient’s disease and life course."

Formal health system and community-based formal or informal systems Non-governmental organisations Crisis type and Region Political: Conflict, Disaster Affordability, income, worth of service Accommodation Person :: Service centrednesss

 

"Availability was defined as the volume and type of existing services and whether this was adequate for the volume and needs of service users. Affordability constituted the patient’s capacity to use financial resources to obtain care balanced against their income and the perceived worth of the service. Accessibility addressed the match between the location of services vs the location of people in need, including transport, travel time, distance, and cost. The accommodation was defined as the organization of service delivery, such as opening times and ability of service users to accommodate to this. Acceptability was considered as the relationship between the services and the patient’s expectations of appropriate care."

(My emphasis)

NCD  - Non-communicable disease

My source: HIFA list

CITATION: Models of care for patients with hypertension and diabetes in humanitarian crises: a systematic review, Michael S Jaung, Ruth Willis, Piyu Sharma, Sigiriya Aebischer Perone, Signe Frederiksen, Claudia Truppa, Bayard Roberts, Pablo Perel, Karl Blanchet, Éimhín Ansbro

Health Policy and Planning, https://doi.org/10.1093/heapol/czab007

12.12.2019 International Universal Health Coverage Day

Every person—no matter who they are or where they live—should be able to get the quality health services they need without facing financial hardship. Three months after the historic UN High-Level Meeting on Universal Health Coverage, join us on 12 December to tell leaders to Keep the Promise of health for all.

Ask your government leaders to Keep the Promise by sending a tweet or an advocacy letter.  A toolkit is available: https://universalhealthcoverageday.org/toolkit/

• Primary Hashtags: #HealthForAll #UHCDay
• Secondary Hashtag: #KeepThePromise
• Handles: @UN @UHC2030 @CSOs4UHC @WHO @UHC_Day

To learn about specific Regional Initiatives check out the Pan American Health Organization's (PAHO/WHO) website:
https://www.paho.org/hq/index.php?option=com_content&view=article&id=14856:universal-health-day&Itemid=42091&lang=en

My source:

GANM (Global Alliance for Nursing and Midwifery)
https://knowledge-gateway.org/ganm

South Sudan Medical Journal - November 2018

 

Dear SSMJ Reader,

The November 2018 issue of the South Sudan Medical Journal is now on online and includes articles on Ebola, Caesarean Section and Obstetric fistula. You can download the complete issue as a pdf here or the individual articles listed below.

Please share this notice with your colleagues.

EDITORIAL
Keeping an eye on Ebola Virus Disease Edward Eremugo Kenyi
Between June and November 1976, the medical world was baffled by an outbreak of a ferocious haemorrhagic disease in Nzara, South Sudan (then part of Sudan). This became known as Ebola Virus Disease (EVD). The West African outbreak in Guinea, Liberia and Sierra Leone in 2014 was devastating.  A new outbreak in DR Congo in 2018 is a warning to South Sudan to be on high alert.

ORIGINAL RESEARCH
Knowledge of type 2 diabetes mellitus and adherence to management guidelines: a cross-sectional study in Juba, South Sudan Alexandre Ali M. Bili and Longying Zha
Inadequate education and the lack of efficient diabetes care centres compounded by high costs are common barriers for diabetes care. This study assesses the level of knowledge and adherence to guidelines for management of type 2 diabetes in South Sudan.

Knowledge, attitude and willingness to accept Caesarean Section among women in Ogbomoso, southwest Nigeria Olumuyiwa A Ogunlaja, Idowu P Ogunlaja, Samuel E Akinola, Olufemi O Aworinde
Caesarean Section (CS) is a common procedure in obstetrics and has contributed immensely to improving maternal and foetal outcome. The study which seeks to assess the level of knowledge, attitude and acceptance of women about CS in Ogbomoso, Nigeria, concludes that mothers should be educated on the process involved in Caesarean delivery.

Obstetric fistulae, birth outcomes, and surgical repair outcomes: a retrospective analysis of hospital-based data in Dodoma, Tanzania Athanase Lilungulua, Balthazar Gumodokab, Mzee Nassoroc, Patrice Sokac and Kibusi Stephen
Obstetric Fistula (OF) among pregnant women remains a widespread condition with devastating consequences and poses a significant challenge in a community as well as globally. The study concludes that timely fistula repair by experienced fistula surgeons will improve outcomes and limit the clinical insult and distress that OF invariably causes.

CLINICAL GUIDANCE
How to repair a vesico-vaginal fistula Brian Hancock
Most fistulae are caused by ischaemic necrosis of the genital tract and adjacent organs through prolonged obstructed labour. This article provides a brief overview and refers the reader to resources that cover the practical aspects of the surgery and holistic care of the patient.

MAIN ARTICLES
Ebola Virus Disease: epidemiology, management, prevention and control Gasim Abd-Elfarag
Ebola Virus Disease (EVD) is part of the group of illnesses known as viral haemorrhagic fevers, and was previously known as Ebola haemorrhagic fever. Infection with EVD is acute, severe and often fatal in humans. The paper provides an outline of what is known about EVD.

Ebola on our doorstep: Ebola Virus Disease preparedness in South Sudan Richard Lako and Otim Patrick Cossy Ramadan
South Sudan has previously experienced three EVD outbreaks in 1976, 1979 and 2004. With recent outbreaks in DR Congo, it is possible that a sporadic outbreak can happen in South Sudan, and so the country is always at risk. Preparedness is key.

COMMENTARIES
Internship training in South Sudan: the challenges and way forward Jessry Pasquali Oboya
The House Officer is the professional whom the patient meets most often when entering hospital and will remember for a long time. The extraordinary commitment and work load of the House Officers at Juba Teaching Hospital has received little recognition by the authorities despite the challenges they face in the course of their training.

The current crisis of human resource for health in Africa Brian Madison
Brain drain has been a source of despair for developing countries, and the healthcare sector arguably bears the biggest brunt imposed by this growing problem. The author argues that if Africa is to counter the healthcare human resources crisis, member states may need to adopt radical reforms in the healthcare sector.

SHORT ITEMS
Caesarean Section acceptability and rate in South Sudan
Call for submissions
Obituaries

BACK COVER
Neonatal resuscitation chart
This chart is designed with the ‘Helping Babies Breath’ training in mind. However, it incorporates external cardiac massage, which can be effective in some cases.

All previous issues of the journal are in the Archive section, and you can ‘search’ for particular articles.

Please support the journal by submitting items for future issues. We are interested in articles on your research, case reports, and clinical guidance, as well as news of projects, and relevant photographs. We can help you prepare these for publication (see our ‘Authors’ Guidelines’). We welcome letters to the editor and questions. Send your contributions to the Editor-in-Chief, Dr Edward Luka admin@southernsudanmedicaljournal.com. 

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Kind regards
The SSMJ team

Book Review: [iv] Health System Redesign - Part 3 & 4

Part 3 tackles the structure and dynamics of health system organisations. The introduction begins with how we perceive whole and part and teases out levels once again. These have their own concepts and language as we move through layers. This transition between layers means we also have to dispense with, or suspend the detail that a layer gives us - the 'cellular level' for example. Sturmberg describes the properties of layered systems that include, concepts, discovery, interaction and constraints. As is often the case through the book, table 1 (chapter 9) captures a great deal with figure 3 - health system phenomena and different levels of organisation. The final addendum of part 2 posed the questions: what to change?; what to change to?; and, how to cause the change (p.158)? This introduction reminds us of the constant need to consider parts (data) anbd the joining of wholes (wisdom).

Chapter 9 is about modelling, potentially a dense and jargon-ridden subject, but the treatment here retains the book's accessibility, clarity and interest. This chapter is like an answer to a soapbox of mine as it highlights the role and use of spatial modelling and geographic information tools. Admittedly, as clinicians (all disciplines) we cannot be service planners and public (mental) health specialists, but services should have access to such tools. (Teams could have a running list of 3 research questions that can be taken up, revised by students and team members, perhaps allied to CPD and other training/education commitments). Sturmberg gives us: mental health services in Helsinki; childhood obesity in Berlin; Life expectancy in a city and infection risk in Democratic Republic of Congo.

On first picking up the book, the arrangement of the parts with an introduction and the chapter introductions can be a little confusing. But the disorientation is brief. The book has some typos: 'intense' for 'intents' p.171; 'locking' for 'looking' p.179; 'build' for 'built' p.225; 'pleural' for 'plural' p.234; outlined, p.251. (I used to read papers for data definition standards.)

This does not detract from something special in 9.3 modelling system problems. The question is "What ... if..? and a series of scenarios in aged community care: What if -

• We double the number of nursing home beds?
• We double the social care workforce?
• We combine a 50% increase in both the above?

The addenda for chapter 9 are system diagrams and link to chapter 10 very nicely returning to micro, meso and macro levels. I could sketch out the multiple cause and sign graph diagram fig 10.1 for a patient and how deteriorating health results as much from the interdependent variables of his social context as basic physiology (p.197 - another case study).

With a book that can serve as a key reference for Hodges' model - it had to happen (sorry!). Here I have mapped some of the content of Table 10.1 (p.209) to h2cm:

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Mental Health	Hip replacement surgery Flu vaccination Multimorbidity management of polypharmacy Intensive Care Unit Managing a second degree burn Protocols - handwashing -
Community care for frail elderly Managing a natural disaster (social impact)	- policy Health financing Nurse unit manager ensuring staff record every patient incident regardless how trivial Surgeon managing theatre team Acute psychiatric Unit Bed management of a hospital (*see below)

This week driving between my community visits, a radio public health notice asked listeners: what is the 2nd most significant cause of cancer after smoking? It begins with 'O' and ends with 'Y'. Chapter 11 concerns obesity at the personal, personal-community, and community-whole society levels. This chapter relies on diagrams-figures, some are difficult to read and with no web reference to go to the detail is lost (figure 11.10). The message is not lost, however; a magnifying glass might help (figure 11.8). 'Obesity' must include the industrial and political dimensions.* 'Food sovereignty' is an important point (p.223). If blockchain technology does prove itself beyond cryptocurrencies could it find an governing application in food system regulation?

Sturmberg anticipates there is/will be resistance and refers to the need:

"to overcome some of the false and unhelpful conceptual dichotomies in the debate about the obesity epidemic"p.227.

What follows then is a need for informed debate and argumentation?

Part IV brings to life the book's subtitle and achieving this goal: Chapter 12 how things ought to be. The introduction here is rich - 6 pages, 16 references mainly tables but informative.

Personomics p.246 is a gift to me and unsurprisingly it is allied with person-centredness. Sturmberg rightly stresses how we need to put the person at the centre of the system. Although referred to constantly - to the point of rhetoric? in the literature, politicval media. In Hodges' model I have stressed how 'work' is involved in achieving person-centredness and being person-centred. In the model the individual needs to 'moved' conceptually, in the first instance to the centre of the model.

With figure 12.2 I'm still sore from the back-flip. I've possibly seen this before, but the version on p.249 is again very meaningful and vital to holistic and integrated care.

https://www.storybasedstrategy.org/the4thbox

I would switch this slightly for h2cm, thus:



EQUITY :: EQUALITY


REALITY :: LIBERATION

The book ends on design and design thinking. H2cm leads inevitably to structure and content and as such care architecture and so design. Here the book is talking 'problem solving strategies' and hence Health System Redesign. Such ambition needs to attend to barriers and once again in 13.4 we consider "what might stand in the way". Even at the end Sturmberg is clarifying and extending definitions: Adam Smith - the Public Good AND the free market; 'social' and 'socialised'. This is not an oversight but helps close a fascinating circle and excellent book.


The 'blurb' as they say refers to the book as a "forward-looking volume" - together with the knowledge here - and crucially the combined wisdom that results - we can make it here-and-now.

I would like to express my many thanks to Prof. Sturmberg and Springer for the review copy.

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

See also:

Book Review: [i]

Book Review: [ii]

Book Review: [iii]

Book Review: [iii] Health System Redesign - Part 2

In part 2 from chapter 5 the focus is "Best Adapted" Health System. Such a system simultaneously addresses person-centredness, equity and sustainability. The healthcare system is one of many subsystems of a complex adapted health system, comprised of primary, secondary and tertiary care. Quaternary prevention may deserve mention? The quaternary approach being sympathetic and resonating with the book's aims as a whole (scope: humanistic - mechanistic and sustainability) .

Chapter 5 uses the Vortex model to represent the vision of a seamlessly integrated complex adapted health system from that which so often exists. The graphics are small but there is a url (Figure 5.1). Several avenues of continuity and links to part 1 are provided, disease, the purposes and goals of existing health systems versus the new vision and the values and need to disambiguate between patient needs and wants. This calls for definitions which are also provided; to logically lead to underlying philosophies which are extended in the addenda.

Chapter 6 prepares the reader for some real world examples to follow. I have long found discussion of scale fascinating. The levels here extend across:

• Macro
• Meso
• Micro
• Nano

"Food regulation" is rendered as an influence diagram showing the various agents and their operations. Copious tables shed light in the four levels. The real world examples in chapter 7 are geographically, Kenya and Brazil concerned with AIDS and the NUKA primary care system in Washington (USA). Sturmberg contrasts the possibly theoretical emphasis of the previous two chapters with this more practical focus. The visualisation methods vortex and Cynefin models are well used here. The case studies help to reveal different degrees of complexity while also showing what they have in common.

You cannot move in social media without reading or hearing about leaders and leadership. Chapter 8 is not paying lip-service to this cultural preoccupation, but marries how can we better understand what is unpredictable. Sturmberg explains VUCA, that is, volatility, uncertainty, complexity and ambiguity; wicked problems and how we can use VUKA and transform these challenges into understanding for learning and transfer of knowledge. Again the book carries the content forward, combining four learning frameworks to shift mindsets and world views through use of the Cynefin framework.

In the management of system constraints a multidiscipinary (multi-domain) approach is used, as in leadership involves psychological work. To better appreciate leadership, leaders are contrasted with managers (Table 8.2, p.139). An example of contrast is also used characterising organisations as Banyans (which expand their own empires) and Dandelions (which while prolific allow others to thrive). The references range in chapter 8 from 1958-2017 - Argyris, Mintzberg, Polyani and Schön. The addenda closing chapter 8 and part 2 are once again philosophical - "History of Reductionism" and very much add to the text.

There's an important quote on page 140:

"It is the common cause of an organisation that defines its identity and must reside in the heads and hearts of its members. Thus, in the absence of an externalised bureaucratic structure, it becomes more important to have an internalised cognitive structure of what the organisation stands for and where it intends to go - in short, a clear sense of the organisation's identity. A sense of identity serves as a rudder for navigating difficult waters.'

I think 'identity' for the individual (micro) and organisation (meso-macro) levels could be emphasised more and should be indexed. Parts 3 & 4 follows.

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

See also:

Book Review: [i]

Book Review: [ii]

Book Review: [ii] Health System Redesign - How to Make Health Care Person-Centered, Equitable, and Sustainable

Part 1 gets straight to the matter of "challenging the orthodoxy" with a two page introduction to complexity and health. Part 1 covers:

• systems sciences
• visualization of complex systems (Capra's vortex metaphor)
• understanding the co-existence of different degrees of complexity and their dynamics within complex adaptive organisations based on Kurtz and Snowden's Cynefin model.
• health as a "complex adaptive experiential state"

All four points here are very pertinent to where we are in health and healthcare (the book rightly stresses this differentiation) and current and ongoing 21st century issues. The use of Capra helps to distinguish scale and the levels inevitably existent, experienced, and described in health and healthcare systems.

If you are familiar with Hodges' model and the Cynefin model, then the answer is yes - seeing the Cynefin model did make me hoot. (I remember Dave Snowden's work from Plaxo and a presentation he did in Lancaster back in 2007). More importantly, part 1 introduces where the focus needs to be to facilitate change; on the core driver of the system, the system's long-term direction, a specific system view and the need for a solid grounding in theoretical and applied approaches. This is were the visual tools and producing a view - perspective are so important. Chapter 2 contrasts the simple scientific world view and the complex scientific. The reader is asked to consider numerous background points, from the colloquial meaning of complex/complexity to the scientific. How do the words 'complex' and 'complicated' differ? At small scale the result is greater certainty BUT loss of context, while at the large scale we find greater uncertainty AND loss of detail.

Figure 2.3 shows the key features of complex systems (also indicating the dynamics - '+' '-'):

• System boundaries
• Interconnectedness
• Feedback
• Impact of starting (initial) condition

Some of the figures point to their means of creation "The essence of systems thinking" (Figure 2.4) produced through Insightmaker. Sturmberg's seeks to ground the discussion too by reference to the everyday. Table 2.1 runs through how systems can be related to the experience of a 'Long day at work'. Addenda are put to immediate effect with a reference to a map of the history of complexity science; the philosophy of complex adaptive systems; and the complexity and difficult questions.

As already suggested Chapter 3 on the visualisation of complex adaptive systems had my attention. The vortex metaphor (Capra) seems trite on first encounter, but it works.* The four different ways to map a system:

1. Systems map
2. Influence map
3. Multiple case diagram
4. Sign graph diagram

are quite important as if you can take the explanations onboard you really will be on the way to fully understanding and utilising theoretical and applied approaches. The learning here is allied with understanding common system dynamic behaviours which are also illustrated and explained. Figure 3.4 shows the Cynefin framework, which is still in my head. The Cynefin model deals with the continua of:

• uncertain - certain
• non-linear - linear

• Contrasts - Learning and Teaching
• and four quadrants that combine what is complex, knowable or complicated, chaos, and known or obvious (simple). The three references here span 1996-2003.

At chapter 4 - I was worried - 'Defining Health' (now there's a task) but this is also interesting, rewarding and well placed. Core notions of health are tabled (4.1) from 1911 to 2007. Health is distinguished from dis-ease. I must follow up the footnote on p.59 Marja Jylhä and her framework of self-perception of health. 

The illustrations on pp.60-61 are frustrating.

Very!

Not because they shouldn't be there, but because they are a gift that remain (as far as I am aware) unrealised in respect of those of us working in the humanities. We still lack the visualisation tools that we need.

If I mention Figure 4.1 "The somato-psycho-socio-semiotic model of health" you will get the drift and overlap with Hodges' model. There is more with 4.2 on Attractors in Health and Illness and the system dynamics of health. The political attractor is missing (and its 'gravitational' impact) in this rendering, but the barriers to progress are also raised at the book's end. Given the topic of health, the text is not science light, with the physiology of health and disease also used to explain points, so we have, gene networks, the autonomic nervous system, the hypothalamic-pituitary-adrenal axis and bioenergetics in the mitochondrion. While not in-depth the potential application across external factors-personal experiences and internal mechanisms are demonstrated. The role of the patient, public and carers are central today and realised to various degree in theory, practice, management and policy. Self-rated health is briefly mentioned and with community health and health services utilisation this closes part 1.

More to follow...

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

See also first part...

Book Review: [i] Health System Redesign - How to Make Health Care Person-Centered, Equitable, and Sustainable

Health System Redesign

The 'summer reading' is almost complete (p.245/290) and described as such due to it being a review and a specific deadline is not helpful. (You may have noticed with Drupal and the new site!). Fortuitously, starting the book coincided with my attending the UKSS conference in Portsmouth. The exposure to systems and complexity - as in complexity science was welcome. I would really like to write a paper on Hodges' model and complexity and this book would be a primary reference.

The foreword is by the President of the Lown Institute, this is a think-tank "advocating a radically better and uniquely American health system that overturns high-cost, low-value care." Sturmberg provides the means for this over-turning whilst beforehand explaining what is happening in the health system and health care systems worldwide. There is a difference, as we must change mindsets and facilitate the health system reducing the impact, dependence and expense of existing health care systems. What we have is no longer sustainable.

Even in Sturmberg's preface I can see why this book through its title had an instant appeal to me and should do so to others in the health, social care, policy and educational communities.

The book addresses three key themes:

1. Understanding complexity—what are complexity sciences, and how does complexity thinking shape our understanding of health
2. Envisioning a “best adapted” health system
3. Achieving a person-centred, equitable and sustainable health system

The promised references follow the chapters (as expected!), but often with addenda that provide more background, insight and further reading if needed. Page 2 provides the first of many figures throughout the book, as with copious footnotes. Some people and publishers find footnotes untidy or contributing noise. I found these informative, pointing in some instance to video resources and copies of diagrams that are too detailed for a book. Inclusion still conveys some meaning given the subject matter of complexity and scale through the levels of nano, micro, meso and macro.

The book is clearly laid out, chapter 1 precedes Part 1 to set the context and agenda. Sturmberg explains this is not a theory book, but the explanations are progressive and a good foundation for further study (that must follow). Some of the challenges in teaching and learning systems thinking and health(care) systems redesign are discussed, as students are bound to encounter them not only in the literature, but in many of the assumptions that they are being socialised into in practice. A good example, is Table 1.1 Disambiguation of systems complexity (p.5). Like the use of figures, tables are liberally but effectively distributed throughout to reinforce the discussion. I like the way that systems thinking tools are set out in Table 1.2 across three pages. The tables and figures are not just page-fillers though, but sources to return to.

The differing sections that apply systems thinking are set with the implications for health care. As already mentioned some of the figures are colour reproductions and suffer due to the print size. To compensate the original source is usually provided (Addendum 2, Obamacare Health System Chart is a prime example that also time places pressure on any text). This works well as the author grapples to illustrate scale from the individual to the organisational level, industrial and processes and policy makers.

I know a review is about the book, but in this case especially I cannot but help see how this topic supports and validates (imho!) my own work and interests. Page 9 confirms how h2cm not only incorporates "design thinking" as it can readily combine the sciences and the arts (as in various blog posts). As I have stated (for 30 years) the POLITICAL domain in Hodges' model is crucial in the 21st century. So, even as I reach Part 1 for this review, the importance of global health; policy, organisations, public engagement are stressed if change is to follow. Many sections have a short introduction that ends with questions for readers to reflect on their own health systems experiences. As a summer reading project through to part 1 I was very pleased to have an 'ice-cream' of my favourite flavour that was going to run and run...

Sturmberg JP. Health System Redesign. How to Make Health Care Person-Centered, Equitable, and Sustainable. Cham, Switzerland: Springer; 2018.

More to follow three - four posts in total?

Book: Health System Redesign How to Make Health Care Person-Centered, Equitable, and Sustainable

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SYSTEM	REDESIGN

Thanks to Prof. Sturmberg and Springer I have some summer reading. Having received the book it really does look well-worth reading. Review to follow here...

Chunks of Pi - the public expenditure round

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	3.14159265359 NHS Funding "the next public expenditure round" Jeremy_Hunt 4% hmtreasury 2%

"... the settlement would need to "at least have a 3 in front of it" in order to be credible." p.2.

Sarah Neville and George Parker, Hunt's tax comments widen divisions over NHS funding. FT Weekend, 26-27 May, 2018. p.2.

The Socio-Politics of Migration...?

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Julian Simpson (2018) Migrant architects of the NHS - South Asian doctors and the reinvention of British general practice (1940s-1980s). University of Manchester Press.

Alex Matthews-King. The Independent, Jeremy Hunt backs special visa for foreign people coming to work for NHS. 9 May, 2018.

My source (book): Noted in Blackwells, Manchester, £25 from £75.

World Health Day 2018: Universal Health Coverage

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Stamp	World Health Day 2018 Stamps
Stamp	NY postmark

WHO: World Health Day 2018

Description (UNSTAMPS)

"Today, at least half of the world’s people are unable to obtain essential health services. Many households are being pushed into poverty because they are forced to pay for health coverage out of their own pockets. This strain on the populace seriously undermines a country’s ability to develop socially and economically.
This is why Member States of the United Nations have pledged to provide universal health coverage for all people globally by 2030 as part of the Sustainable Development Goals (SDG 3.8). This means ensuring that all people have access to the health services they need. Countries have pledged to ensure that these services will be of sufficient quality to be effective and also that their people will not suffer financial hardship when paying for these services.
When this happens, people’s health will improve. Universal health coverage reduces poverty, creates jobs, drives economic growth for all, helps improve gender equality and can stop disease outbreaks turning into epidemics.
Each year, WHO offices, Member States, civil society and partners around the world observe the Organization’s signing of its Constitution and founding on 7 April, World Health Day. In 2018, WHO is dedicating World Health Day, its seventieth birthday, to universal health coverage: #HealthForAll.
The World Health Organization is delighted to be working with the United Nations Postal Administration to promote worldwide awareness and action to achieve health for everyone everywhere."

Free online course - Global Health and Disability c/o HIFA

Dear all,

I hope that you are well.

We are super-excited as we are just putting the final touches on our online course on Global Health and Disability. It features key global leaders in disability and many testimonials and videos from people with disabilities from around the world. It argues strongly for the inclusion of people with disabilities in development.

I would be very grateful if you would share the information below with colleagues or others who may be interested in joining the course. It is suited to anyone with an interest in health and disability, from low or high income settings, and should take up about 2-3 hours per week for 3 weeks. The launch is Feb 26. Let me know if you have any questions.

All the best,
Hannah


Global Health and Disability

Leaving no one behind: disability, health and wellbeing in global development

A 3 week (maximum 4 hours per week) free online course from the International Centre for Evidence in Disability at the London School of Hygiene & Tropical Medicine

Course starts 26th February 2018

For more details, to check out the trailer or to register your free place on the course, click here:

https://www.futurelearn.com/courses/global-disability/1

Why join the course:

Around 15% of the world’s population, or 1 billion people, live with some form of disability, with numbers continuing to rise over the coming decades.

People with disabilities are often overlooked in national and international development, and can face widespread barriers in accessing services, including health and rehabilitation services, even though simple initiatives are available to enable access. Our three week course aims to raise awareness about the importance of health and well-being of people with disabilities in the context of the global development agenda: Leaving no one behind.

What topics will you cover?

• The magnitude of disability and relevance of disability to the global development agenda
• Defining disability and how it can be understood and measured
• The challenges to health and wellbeing amongst people with disabilities and why people with disabilities might have poorer health
• Why people with disabilities may have difficulty in accessing health services
• Links among longer term health conditions and disability
• How to improve access to health care and rehabilitation for people with disabilities
• Community based inclusive development for improving access to health and rehabilitation for people with disabilities

For more details, to check out the trailer or to register your free place on the course, click here

Source: Dorothy Boggs and Hannah Kuper of London School of Hygiene and Tropical Medicine via HIFA.

Care with a Smile: For a Smile in Care Homes

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Self-esteem, self-image anxiety, worry, depression Able to express needs communication Ability to ask, remind, argue - self-advocate Challenging behaviours, agitation, aggression Irritability, poor sleep reduced attention and concentration Observation of staff - pain? Loss of dentures, memory

Changes in gums, gum disease, weight loss cleaning teeth, false dentures, fit, marking dentures, care plans Access to toothbrush, toothpaste, mouth wash, Oral hygiene Sugar – sweets (one of few pleasures?) Risk of thrush and other infections (cardiac?) Mobility of the resident Appearance and sense of well-being Pain of toothache, analgesia – tiredness Avoiding eating and drinking properly Access to dental surgery Changes with speech Equipment challenges of remote care, technology changes Mobile clinics

Responding to expressed distress - whether explicit or implicit (listening - caring) Confidence. Isolation Avoiding other people. Having friends and family to advocate for dental care Impatience with others, argumentative, shouting Family expectations

Guidelines Commissioning of dental care in the residential / nursing home sectors Local authorities, Health, CQC Asessment - Evaluation Referral process Staff  awareness and knowledge The nursing home make the referral? The family must make the referral? Payment National standards Domiciliary visits paid in advance. Dental service packs packs circulated to residential and nursing homes across a Region. Global access to Dental care?

Universal Health Coverage (UHC): WHO is Listening?

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COGNITIVE ACCESS	PHYSICAL ACCESS
SOCIAL ACCESS