Mental Health and Physical Activity

You know you're on the right (running) track when there is a journal that seeks to address the fundamentals of parity of esteem that is mental and physical health:

Robertson, R., Robertson, A., Jepson, R., and Maxwell, M. (2012) Walking for depression or depressive symptoms: A systematic review and meta-analysis, Mental Health and Physical Activity, 5, 1, 66-75. ISSN 1755-2966 https://doi.org/10.1016/j.mhpa.2012.03.002.

Sometimes, geography matters too in terms of intervention choices and the population of a study:

Moran, R., Sperandei, S., Peel, N., Gray, T., and Reis, A. (2024) The long-term effect of surf therapy on posttraumatic stress, depression, and anxiety symptomology among current and former Australian defence force members - A nonrandomised controlled longitudinal study in a community setting. Mental Health and Physical Activity, 27, 100629, ISSN 1755-2966. https://doi.org/10.1016/j.mhpa.2024.100629.

While researchers seek an holistic view -

Ciaccioni, S. et al. (2026) Modifiable determinants of adolescents’ physical activity and sedentary behaviour in school, home and mixed settings: A DE-PASS systematic review and meta-analysis of self-reported data with a holistic analysis. Mental Health and Physical Activity, 31. 100803,
ISSN 1755-2966, https://doi.org/10.1016/j.mhpa.2026.100803.

- and the above journal 'Supports open access', I do not believe my individual circumstances would qualify for differential treatment of fees:

'Article Publishing Charge (APC): USD 3,190 (excluding taxes). Actual APCs may differ based on individual author circumstances.'

This is a pity, as surprisingly thus far, the journal does not appear to have explicitly referred to 'parity of esteem'? Clearly a soapbox for me, there is plenty of room for others to join in the debate. To acknowledge, however, severe mental illness is well represented.

Given the holistic scope of Hodges' model the lack of inclusion in such literature is a shame. 

Acutely so, as Hodges' model begs (demands!?) consideration of holistic bandwidth. The matter of exercise and activity as a therapeutic option in mental health care quickly gets intense and heated (even if the interlocutors are recumbent). Social prescribing seems well established. On social media ['X' still for me] voicing the benefits of exercise does not always go down well. 

Fabiano N, Puder D, Stubbs B. Could not prescribing exercise for depression be psychiatric malpractice?

British Journal of Sports Medicine 2025;59:1388-1389.

Ironically given the limitations of the bio-psycho-social model, the 'barricades' don't go up they are a permanent feature. As soon as we need to consider the political dimensions of health care, legal and professional accountability, policy, funding, accessibility, the minutiae of human rights (individual instances). Plus, in the UK the welfare benefits bill, the struggles of young adults not in employment, education or training; then division and oppositions are all that is. And, what can be individual and collective opportunities are missed.

My source:  https://x.com/NTFabiano/status/2103876655366521278?s=20

ii Thoughts re. Ecosia's AI Chat 'answer'

The previous post has been updated, to the prompt is added:

 'Please provide sources and references.

[If you are new here, and too Hodges' model please see the bibliography in the sidebar.] 

A 'human' reading (still) makes me wonder if the 'answer' is what I want to hear (as a user)? Is it worrying that the first provides a 'Conclusion' the latest does not. The table is helpful as I believe that Hodges' model has a role across research (and political!) -isms through methodologies and methods. The model can also encompass ('eat'!) aspects of scale, or level.

The reply still gives me quadraphonic joy (if read out-loud). Not only are the domains recognised, but the LLM/agent ai takes the intrapersonal / interpersonal in its stride (from the blog?). Subjects related to each of the domains are given in brackets. 

There is of course a bias (several) in the prompt, as the care domains were never intended to be comparable. It is positive that each domain is seen as having its own specific scope and function. Over twenty years notes were started on a paper on Hodges' model and its role/function in helping to define 'scope of practice'. Significantly, in the UK the rise of associate positions across disciplines has provoked much debate, vitriol (on X and union and lobbying) and soul searching in certain professional groups. Given the increasing importance of the global health and social care workforce this trend is reflected globally. A situation set to be extended with uncertainties and tensions exacerbated by artificial intelligence in practice.

Before 'explaining' the asymmetries (in points 1-4) it seems the domains are complementary (for all their differences), and provide a holistic underpinning for the model as a whole (my reading).

1. Scope and Focus 

Interesting, how the science and sociology domains are described as broad. Perhaps I am underestimating the depth/density of sociology, after all folk theory is found there? Unfortunately, we can also add a myriad of conspiracy theories? Sociology can also lay claim to quite a few constructions of its own. Including aesthetics as a bridge to architecture and design(?).

On 'X', Hodges' model has been described negatively as inviting / fostering generalism. So, this is a bad thing? Is it not strange then that your Advanced Nurse Practitioner, Consultant doctors (all specialities) and students cross-curricula can all use Hodges' model? The fact that my own responses were never engaged has helped train my thought. Here the relevance of the model to students and continued professional development is made through generalizable knowledge.

The response to the political domain is supportive, acknowledging resource allocation and the distinction between individual and collective (see for example):

S. Bettiol, P. Jones, H. A. Onyedikachi, and W. G. Kernohan, (2026) Bridging Gaps in Oral Health Frameworks: Mapping With Hodges' Health Career - Care Domains - Model, Journal of Public Health Dentistry. 1–14, https://doi.org/10.1111/jphd.70034.  

I've seen tweets today regards IQ reductions in younger people. This is one reason for support of the top-left mental domain being designated as 'Intrapersonal – Interpersonal'. Our interpersonal skills and awareness are surely dependent upon our achieving a given level of inner mental life? Encouraging to see how subjectivity and objectivity is assigned too. Although, I think I'm in an echo chamber!

2. Epistemological Differences

In arguing for a model of health and social care that goes beyond:

• medical model;
• bio-medical model;
• bio-psycho-social model.

Reading 1-2 from the perspective of the Intrapersonal – Interpersonal domain you see how limiting this is, if an individual in a mental health/illness/mental capacity context can only point to sciences and sociological domains. Indeed, they may be relying guardians and advocates as they are unable to does this and raise the political matter of their rights. Without the POLITICAL domain (or as a result of it - neglect, structural racism) there is no law enshrining independent advocacy...

3. Practical Application in Care

To care is to act. Think about triage and emergency response.

Now in the 21st century 'care' must include self-care, health and social care, and (delayed or not you decide?) planetary care.

This necessitates a change of mindset at an individual and collective level. Consider the literacies that (again) young people must master to be effective, productive and happy citizens tomorrow?

So the following is a gift (in my eyes): 

"This means the intrapersonal-interpersonal domain is not just another 'content area' but a lens through which all other domains are experienced and integrated."

4. Hierarchy of Integration

'While the domains are conceptually equal in Hodges’ model' ..

This is interesting in itself.

[There does seem a emphasis upon the Intrapersonal – Interpersonal domain in this answer?]

This is quite a step, as the idea of a nexus and integration are picked up; and pointing to what are the determinants of health:

'For example:

• A scientific understanding of depression (e.g., serotonin levels) must be interpreted through the intrapersonal experience of the individual.
• A sociological analysis of healthcare disparities must be understood through the political structures that enable or inhibit change.
• A political decision about resource allocation must be filtered through intrapersonal values and priorities.'

I'm pleased I did this, as long as I'm not being trapped in an epistemological cocoon: otherwise known as a circle. Apart from a few occasions, I have not used AI/LLMs, perhaps it is time to explore more? I'd like to preserve my naivety, especially were maths is concerned. I'm not sure of what baggage I may pick up and lack the knowledge to interpret?

Previous post:  https://hodges-model.blogspot.com/2026/06/h2cm-domains-symmetry.html

Person-centredness, Holistic approach, Prevention c/o Hippocrates

“It is more important to know what sort of person 
has a disease than to know 
what sort of disease a person has.” Hippocrates

 

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

To say that Hippocrates was ahead of his time is a gross understatement. Hippocrates recognised the importance of person-centredness and prevention, and contributed to the emergence of several medical specialties. (Kostakopoulos, et al., 2024).

'Holistic Approach One of the most significant innovations of the founding father of clinical medicine was the holistic approach for the diagnosis and treatment of disease. This approach is based on the assumption that the human body is a sum of many parts that function in harmony and that if one part is ill, the balance will be affected and the whole person will suffer. Hippocrates considered that patients consisted of body, mind, and spirit and this is also the modern physicians' approach when treating a disease [2].'

Health and social care are still playing catch-up. The vitriolic 'debate' on X over psychiatry - anti-psychiatry and DSM-X. The total inability now to shift to preventive healthcare due to the perverse, entrenched economic incentives, which facilitate increasing inequity, inequality. Whichever Government does switch to preventive medicine, perhaps other governments had better take note?  I think Hippocrates would have approved - wholeheartedly - of Hodges' model.

'Prevention of Disease Another important aspect of Hippocrates' works that is widely applied in 21st-century medicine is the prevention of disease. The phrase “Κάλλιον το προλαμβάνειν του θεραπεύειν,” which means that it is better to prevent than to treat a disease, was the cornerstone of his teachings and is based on the observation that healthy Mediterranean diet and daily moderate physical activity can prevent disease. The ancient Greeks believed that all maladies started from the gut and that walking was the best available medicine [2].'

Kostakopoulos NA, Bellos TC, Katsimperis S, Tzelves L. Hippocrates of Kos (460-377 BC): The Founder and Pioneer of Clinical Medicine. Cureus. 2024 Oct 1;16(10):e70602. doi: 10.7759/cureus.70602. PMID: 39483540; PMCID: PMC11526839.

Gabbard, G. The Person with the Diagnosis. Psychiatric News. 49;6. 19 March 2014. 
https://doi.org/10.1176/appi.pn.2014.3b19.

Brigić, A., Hasanović, M., Pajević, I., Aljukić, N., Hamidović, J., & Jakovljević, M. (2021). Principles of Hippocratic Medicine from the Perspective of Modern Medicine. Psychiatria Danubina, 33(Suppl 4), 1210–1217. 

See also: 'medicine' : 'person' : 'diagnosis' : 'prevention'

'Connected Knowledge' - 4MAT

'Very different is the 4MAT system, which classifies students along two axes according to their answers to a multiple-choice questionaire. One axis measures the student's preference for acquiring knowledge concretely versus abstractly, and the other measures his preference for applying knowledge concretely versus abstractly (McCarthy, 1980). His scores on these axes places the student into one of the four quadrants: 

1. Innovative Learners (acquire concretely, apply abstractly); 
2. Analvtic Learners (acquire abstractly, apply abstractly; 
3. Common Sense Learners (acquire abstractly, apply concretely);
4. Dynamic Learners (acquire concretely, apply concretely). 

Each of these quadrants is divided again, according to whether the student prefers processing information analytically (left-brain mode) or holistically (right-brain mode). The 4MAT System trains teachers to write lesson plans that cycle through all eight learning styles and brain modes.

Such more-or-less arbitrary classification schemes abound in the social sciences. They are easy to dream up, and virtually impossible to validate (Wilkerson and White, 1988). This doesn't mean that they're totally useless. ...' pp.63-64. 
(Edited 1-4 for readability.)

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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Group

Abstract   Personhood	Concrete Objecthood

The notion of 'learning styles' is sticky: especially when you look back several decades to the literature?

Cromer, A. (1997) Connected Knowledge: Science, Philosophy, and Education, Oxford: Oxford University Press.

McCarthy, B. (2000). About Teaching: 4MAT® in the Classroom. Wauconda, IL: About Learning, Inc.

McCarthy, B. (1980). The 4MAT® System: Teaching to Learning Styles with Right/Left Mode Techniques. Barrington, IL: EXCEL, Inc.

Wilkerson, R. and White, K. (1988). Effects of the 4MAT system of instruction on students' achievement, retention, and attitudes. Elementary School Journal 88, pp.257 - 368.

Subjective-Objective: Thinking of Holistic Cake and Eating it

'Our natural awareness of our own activities is holistic. We experience ourselves as embodied beings, complete organisms, directly perceiving physical objects, making choices, engaging in conversation with other people. The attempt to split the human being into a combination of immaterial self and physical body makes a coherent account of these processes impossible. As Heidegger says, “The ‘scandal of philosophy’ is not that this proof has yet to be given, but that such proofs are expected and attempted again and again.”35 Given the Cartesian conception of the “real world”, organisms are “really” mechanisms, while “choices” and “actions” have no place in a world where there are only events, subject to the laws of mechanistic cause and effect. The whole person becomes a metaphysical oddity, straddling two incompatible metaphysical realms.

A theoretical framework that renders the previously straightforward inherently problematic is by no means an unequivocal advance. Materialist authors have attempted to “solve” this problem by denying the reality of the subjective side of the Cartesian picture, replacing his dualism with radical metaphysical reductionism.36 Such authors insist that the “objective” world (still understood as something devoid of phenomenal properties, containing only causes and effects as understood in reductionist science) is all there really is. On this view, we do not have to bridge the gap generated by Descartes, between the subjective and the objective features of human life, because the objective features are the only ones that exist.' p.20.

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group-population

My Mind Subjective	My Body Objective

Mitchell, D., Loughlin, M. (2023) The philosophy of person-centred healthcare, Cambridge: Cambridge Scholars Publishing. https://cambridgescholars.com/product/978-1-5275-9058-8/

Previously: 'Descartes' : 'mind' : 'body'

RCN Older People's Forum “Frailty & Falls – A holistic approach to safer mobility and reablement"

Dear Colleagues,

The Royal College of Nursing Older People's Forum is hosting an online webinar, “Frailty & Falls – A holistic approach to safer mobility and reablement,” on 12th November 2025, 12:30–14:00.

This webinar explores frailty, ageing, and falls from a multidisciplinary perspective, with speakers from occupational therapy, older-people nursing, and orthopaedic care. It’s a great opportunity to update knowledge and share good practice in fall prevention and reablement.

You can find full details and register here:
https://www.rcn.org.uk/news-and-events/events/frailty-and-falls

Kind regards,

Steph Craig
RCN OPF Chair

Apologies for short-notice. PJ

The creation of Hodges' model: "All aboard!" 200 years

28th May 1997

When I interviewed (Mr.) Brian Hodges in Manchester on 28th May 1997, I learned he had created the model in 1983, mainly while commuting to Manchester Polytechnical College by train from (Totley) Sheffield, and back. 

I wish I could have been sat by him, to strike up a conversation. Although (among other points) I'm not sure how much he relied upon, or was chasing down the visual side of the model, with some skethces and drawings. So would I have noticed him thinking, drawing, crossing-out, and labelling? This I would have noticed, not that I have a habit of 'spying' and being nosey. Although nowadays, with the repeated announcements on the trains: ‘See it. Say it. Sorted’; perhaps I should?

In 1983 I was a general student nurse (SRN), and still over a decade away from becoming a community psychiatric nurse in 1985, and being (well) taught by Brian and colleagues in 1987.

I also enjoy a (reliable!) train journey, and used to read a lot travelling from the NW England through the London underground (Euston-Waterloo) to Plymoth, and later to Portsmouth in the 1970s. Happy days, then and today; with the railways reasserting their relevance. A quality shared with a certain little-big model I know.

Individual

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

	Rail 200
	Nationalised - Private Private - Nationalised Charity - CIC

Nurses - Ask 5 complimentary questions

I received an email from RCNi subject heading - 'Q. What questions are nurses asking?'

An invitation to sign-up and ask five free questions: https://rcni.com/ask 

Question 1

Is there a model of care, or nursing that encompasses the sciences, mental health, sociology and political domains of care?

Several models of care and nursing frameworks integrate diverse domains beyond purely biological aspects, encompassing scientific, mental health, sociological, and even political dimensions. These models emphasise a holistic approach to patient well-being, recognising the complex interplay of various factors in health outcomes.

• Social Model of Health: This model focuses on salutogenesis, examining what contributes to health rather than just illness, by considering broad social, economic, environmental, and cultural influences on an individual's well-being .
• Person-Centred Nursing Framework: This framework extends beyond individual biological health to include the person's intricate cultural context, family, spirituality, and life experiences, defining health as encompassing intellectual, social, and spiritual dimensions .
• Biopsychosocial Model of Care: This approach integrates biological, psychological, and social factors to address a patient's holistic needs, moving beyond the biomedical model's sole focus on physical illness .
• Dual Registration Degrees: Educational programmes for nurses and social workers combine life sciences with social work principles, law, and policy, preparing professionals to understand factors influencing health, social justice, structural inequalities, and anti-discriminatory practises .
• Multidisciplinary Team (MDT) Care Model: While not a nursing model itself, the MDT approach enhances patient care by integrating expertise from various professionals, including specialist doctors, nurses, psychology counsellors, dietitians, and pharmacists, to deliver individualised treatment plans and coordinate care .

Modern healthcare increasingly recognises the necessity of comprehensive care models that extend beyond traditional medical approaches. These integrated frameworks, including the social model of health, person-centred nursing, and the biopsychosocial model, provide a foundation for understanding and addressing the multifaceted nature of health, incorporating scientific, mental health, sociological, and policy-related aspects to improve patient outcomes. [Five references provided - hence poor formatting in transfer.]

Question 2

What model of care has the conceptual scope to critique parity of esteem in mental health nursing?

Critiquing the concept of parity of esteem in mental health nursing requires models that move beyond a purely biomedical focus to embrace holistic, person-centred, and culturally sensitive approaches. These models emphasise equality, social justice, and comprehensive care, addressing the historical imbalance between physical and mental health provision.

• Biopsychosocial Model: This model offers a conceptual framework to critique parity of esteem by considering biological, psychological, and social factors in a patient's health, aiming for holistic needs rather than just biological ones . It contrasts with the biomedical model, which has historically led to paternalistic decision-making in healthcare .
• Culturally Sensitive and Competent Care: Essential for critiquing parity of esteem, culturally sensitive care requires nurses to appreciate diverse cultures and adopt personalised, flexible approaches to mental health support . Culturally competent care, underpinned by equality and diversity principles, involves behaviours and attitudes that value patients' diverse backgrounds, improving satisfaction and outcomes .
• Person Centred Care: This approach is crucial for addressing the historical paternalism in healthcare, ensuring patients participate in decisions about their care and re viewed as individuals with unique experiences rather than just labels or symptoms . Recent mental health reforms, such as the Mental Health Bill 2025, aim to embed person-centred and equitable care further .
• Holistic Care: The Nursing and Midwifery Council (2024) emphasises assessing spiritual needs to provide effective holistic care, recognising that "seeing the whole person supports better care" . This aligns with the biopsychosocial model's aim to meet holistic needs and challenges the organisational and practice divisions between mental and physical healthcare .

Effective critique of parity of esteem in mental health nursing necessitates a shift towards models that integrate biopsychosocial, culturally sensitive, and person-centred approaches. These frameworks are vital for fostering equality, social justice, and comprehensive care, moving beyond traditional biomedical limitations to address the full spectrum of patient needs. [Eight references.]

I'll leave it there. I think. PJ

<>

My emphasis: In the spring I tried to engage and see if I could write a short article about Hodges' model for RCNi. After an online chat and following up by email, Hodges' model isn't for them apparently. It was kindly suggested that I try another journal.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

I must improve my prompt writing.

Nurse, you must improve your prompt writing ...

ii Editorial: Persistent Positive Change in Challenging Times ...

To Howden's editorial it's worth highlighting that Hodges' model is situated. So, whether the 'challenge' that is faced is individual, or collective Hodges' model can help to identify the issues, problems, strengths, opportunities, threats, where we are, where we would like to be and more. Surely, reflection, critical thinking is about confiming, or regaining our perspective, correcting our orientation or improving alignment and synchronisation with others? The time this entails, whether exercised on paper, or cognitively (yes, humans thinking is still an option) this is equivalent to a time-out even if momentary. This can be critical in clinical encounters, were emotions are raised, or there is risk of escalation.

So whether the challenge is personal, lived experience, bullying, finance, physical, or mental health, simulation (fidelity, testing), ethical ...; or collective (a team) - service and organisational change, major incident, policy, clinical or management supervision, whistleblowing, public / patient engagement, complaints and challenging relationships; Hodges' model is a tool (one of many) to call upon.

It could be the context causes you to focus on one or two care (knowledge) domains. Or, there is a need to step back in order to 'see' the big picture (integrated care, risk assessment, holistic care, psychosocial view ...) - the spiritual too.

While Hodges' model is simple, please consider this: there aren't many tools that can facilitate articulation and dissemination of the 'big picture' in a form that is (imho) readily transferable and translatable.

Howden, S. (2025). Editorial: Persistent Positive Change in Challenging Times. International Journal of Practice-based Learning in Health and Social Care, 13(1), ii-iii.

Sets in Hodges' model

INDIVIDUAL
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     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

'The emotions that we want to infer are the seven basic emotion categories. Concretely this set is E = {Anger,  Contempt, Disgust, Fear, Happy, Sadness, Surprise}.' p.111.*	Sets - Venn diagrams Physical obs = { Temperature, Pulse, Respiration, Blood Pressure, Gait ... }
Social = { Friends, Family, Work colleagues, Neighbours ... }	Politics { [Freedom], - Elections, Law, Policy, Government, MPs, Ministers, PM-President ... }

David Sanchez-Mendoza, David Masip, Xavier Baro, and Agata Lapedriza. Emotion Detection Using Hybrid Structural and Appearance Descriptors. In. MDAI 2013: Proceedings of the 10th International Conference on Modeling Decisions for Artificial Intelligence - Volume 8234 November 2013. Pages 105–116 https://doi.org/10.1007/978-3-642-41550-0_10

*I am unable to double-check this reference and hope it is correct(?).

See also:

UNIVERSAL EMOTIONS: Paul Ekman Group

Venn : diagram

Book review: #4 - Handbook on the Ethics of AI

Chapter 7 is no doubt one of the engine rooms of this book. In AI Ethics and Machine Ethics, John-Stewart Gordon follows preceding authors citing Nyholm and others. This probably helps the overall coherence of the book, and underlines what is a dynamic and emerging field. Reading 'What is AI ethics?' (p.98), I made a note about our humanity's cognitive house-keeping (and other life-forms?) executed through sleep, the ability to unlearn, and forget. Efforts to mitigate machine bias are provided in a list 1-5 (p.100). As observed previously, this author is also thinking on their feet (and very well too) with 'Source: Author's own' in a figure for the systemic place of machine ethics and another (table) 7.1 'Four approaches to machine ethics'.

3.4 considers the challenges involved in developing ethical AI systems. As in healthcare, we see where the (problem of) 'many hands' emerges from:

'Developing ethical AI systems requires collaboration between computer scientists, ethicists, and other stakeholders, which can be challenging due to differences in expertise, terminology, and perspectives. Computer scientists bring technical expertise to the table, while ethicists provide insights on moral principles and values that should guide AI behavior. However, these experts often operate within their own domains and may lack a common language to effectively communicate and collaborate. 

Other stakeholders, such as policymakers, industry professionals, and end-users, also play vital roles in shaping the ethical development of AI systems. They bring diverse perspectives, needs and expectations that need to be considered and balanced during the design, implementation, and regulation of AI technologies. For instance, policymakers are responsible for creating guidelines and regulations that ensure the safe and responsible use of AI, while industry professionals must adhere to these standards and navigate the practical challenges of integrating ethical considerations into their AI-driven products and services.' p.104.

The solution includes having interdisciplinary and ethnically diverse teams, cross-disciplinary training, and a more holistic and comprehensive approach to AI development. Unintended consequences (a news item today (13th Feb 2025) are discussed, the dual-use nature of AI and technological 'delivery' surveillance acting for good and potentially ill (China's - Social Credit Point System).

AI ethics is also itself apparently a conceptual framework (p. 99,107).

What is permitted by law in a State clearly varies. Chapter 8 deals with From Ethics to Law: Why, When, and How to Regulate AI. Collingridge is another recurring citation, and presents a dilemma no-less (Section 3. p.116); one to follow up  (Coeckelbergh too, chap 9). I've always felt that some knowledge of social and economic history is a good foundation. History is reflected here in resort to 'masterly inactivity' (p.118) and regulatory approaches - as debated this past week at an AI Action Summit in France. 

I can still recall the sense of competition in having time in the sandpit at infants school.* Software developers will use sandboxes to develop and revise code in an isolated environment, before it goes live, or wild. With AI the book refers to mishaps, projects that have gone wrong. We need to take care regards the nature of the 'sandboxes' that are used. In a way this speaks to the utility of Hodges' model as a resource for lifelong learning, a learner being fully socialised into a profession and its evolving disciplines:

INDIVIDUAL

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

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GROUP

box	sand-
box	box

I had to look up the CREEPER (Curbing Realistic Exploitative Electronic Pedophilic Robots) ACT (p.121). We are accustomed to outsourcing, and its perverse effects facilitated through globalisation, with nations transferring their pollution - plastics, and e-wastes. There are efforts as Chesterman writes to limit outsourcing to AI in terms of the decisions (pp.122-123). I enjoyed the nods to Isaac Asimov too. 

Gellers in chapter 9 AI, Design, and More-than-Human Justice provides another cylinder to drive the text not just forward but acknowledges the future for all: organic and inorganic. Gellers is argues for attention to AI and justice, not merely the moral and legal status of AI. Reading of  'communities of justice' (p.128) the established notion of 'communities of practice' or the collective of users - socio-technically. Gellers highlights our being in the anthropocene and how the environment and nature is figuring in law. So, not just legal questions for humans but natural 'things' and entities also (posted previously: Person & Sense of Place: A River runs through it ...).

INDIVIDUAL

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      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

GROUP

person- [what >] 'Who'	-hood (p.129) algorithmic
collective communities of practice	justice communities of justice

I don't think we are there yet? Even, accepting that built-in obsolescence is an established and legal thing. But AI could turn materialism on its head. Looking at the materials, metals, rare earth elements ... that goes in how long do they last and how are the materials recovered? AI, computing desperately needs the doughnut economy, must epitomize the doughnut. Looking for a place to live, you notice the way probably quite serviceable bathrooms and kitchens are ripped out. The suites on a skip. That is quite a scene on the rubbish tip in the film: 'A.I. Artificial Intelligence'. The amount of energy in total production and materials is still not wholly valued, even before other values are 'added'? The focus on design here is integral to such questions. It has brought me to care design, and care architecture. Socio-technical aspects are highlighted again by Gellers (for me, as noted on W2tQ, that hyphen matters). 

Unsurprisingly, Descartes also figures in this chapter, section -Technology in the anthropocene:

'First, for philosophers of technology, the Anthropocene obliterates the nature/culture divide intrinsic to Cartesian thinking (Conty, 2017) that altered the course of history by rebranding technical objects as artificial and thus divorced from nature (Hui, 2017).' p.131.

It is encouraging that there is now recognition that 'we are nature too'. While we can record thought - brain activity on an EEG, from the outset (school studies of biology, then human biology) I've always associated intelligence, mind, thought, emotion, hope, dreams and cognition .. with the intra- interpersonal domain. If you adopt a socio-technical approach (overview - mindset) then invariably the technosphere will straddle the HUMANISTIC <-> MECHANISTIC axis of Hodges' model:

'So far, I hope to have established that technology plays a prominent, if complicated, role in the Anthropocene. But how does this relate to justice? Technology's relationship to ecological systems holds important implications for determining who belongs to communities of justice. To begin, the Earth system consists of interrelated biological, physical, and mental "worlds" (Kotzé, 2020, p. 80). The mental world, also referred to as the "technosphere," is an autonomous amalgamation of energy, communication, transportation, and financial systems, along with cities, governments, factories, farms, and other built systems and their constituent parts (Haff, 2014, P. 127). Technological artifacts such as AI are therefore part of the technosphere.' p.132.

Hodges' model: axes and care domains

We read of robots-in-ecology and robots-for-ecology. I was reminded of the SF film 'Silent Running' here. The real merit and encouragement for me in Geller's contribution, is section 4 which compares how we can approach more-than-human justice. Total eclipses are supposed to be rare, irrespective of what they might portend, now AI, the climate and life on Earth keep eclipsing each other: thus far partially. 4.1 Multispecies justice - Peter Singer really is ahead of his time (chapter 11 - here!); following socio-ecological justice 4.2, we arrive at planetary justice. Note (in Hodges' model) the 'distance' of what is generally deemed social and where the ecological in reality - physically resides. In the margin I'd scribbled 'Less a case of "take me to your leader" and more a case of "show me all your cards!"'. The synthesis and closing section on the design of robots specifically for more-than-human-justice helps here by including relationality, intersectionality and and contexts. 'Design justice' is something the book prompts me to carry forward (p.137).

Handbook on the Ethics of AI

One final post on HEoAI to follow ...

Handbook on the Ethics of Artificial Intelligence. David J. Gunkel (ed.). Cheltenham, UK: Edward Elgar Publishing Ltd. ISBN: 978 1 80392 671 1245
https://www.e-elgar.com/shop/gbp/handbook-on-the-ethics-of-artificial-intelligence-9781803926711.html

Book review: Handbook on the Ethics of AI #1

Book review: Handbook on the Ethics of AI #2

Book review #3: Handbook on the Ethics of AI

Related previous posts: 'general + AI'

*That early streak of competitiveness was clearly educated out of me.

Be proactive: Evidence supporting proactive care for older people with frailty

'These BGS publications outline evidence and delivery recommendations for proactive care and support for older adults with moderate to severe frailty. 

We set out how to deliver proactive care against core components and key enablers, with recommendations for success of a proactive care service. Building on NHS England's proactive care guidance, Proactive care: providing care and support for people living at home with moderate or severe frailty, we also outline key recommendations for the successful implementation of proactive care services across the UK. 

We hope that users will be able to use all three documents when designing proactive care services, with the NHS England guidance document acting as key framework and starting point, BGS’s Be proactive: Evidence supporting proactive care for older people with frailty as a business case, and Be proactive: Delivering proactive care for older people with frailty  as a roadmap for implementing the NHS England framework and delivering services. ...'

https://www.bgs.org.uk/ProactiveCare

[All best Charlie (on your Christening Day), Casper and Jamie]. #hope #love #future #action #HealthCareer #LifeChances

"Integrated - care": What's in a word, or two?

This blog post was sat in 'drafts' since 28/01/2007 (yes, I know what that suggests). It concerns an issue, or more properly a theoretical and experiential aspiration in health AND social care that should in truth have provoked many papers for Hodges' model by now.

In the almost 18 years since, I wonder about the total number of papers devoted to this subject, the service's delivery, policy, outcomes, reviews and reports on integrated care? In nursing theory, philosophy and the start of many 'learned papers', it is customary to begin with a definition of terms. What happens when we divide 'integrated care' and first treat integrated and care separately? Does this aid our understanding? Do we divide and conquer? Is there a difference in results? Conceptual analysis would see us do both, and conduct a literature search.

In practice, (and clinical - especially) we often use words in rather lackadaisical way. Not surprising really, after all we've got a job to do! When pronouncements are made regards health and social policy I hear it as good intentions. I also reach for my soap box. It is often hyperbole, rhetoric. The same applies to the related idea and ideal(?) of holistic care, and person-centredness. I'm biased, of course, but I believe that Hodges' model can help to scope, and define these idealised features of health and social care (and education). As noted, people don't have the luxury of time to stop and deliberate on the precise meaning of the language they routinely use. As noted, at the end of the day - if it gets the job done then that's sound.

In a poll of words that are both much used and the meaning taken for granted integrated must be near the top for several reasons:

• its seniority: it has been around for decades.
• its scope across sectors and day-to-day life.
• our dependence on its fulfillment.

N-Gram suggests some possible insights into integrated and related forms of care:

https://books.google.com/ngrams/graph?content=integrated+care,holistic+care,person-centered+care&year_start=1800&year_end=2022&corpus=en&smoothing=3 

[Trying to embed, results in 1/3 white space at the bottom?]

It seems that integrated care [IC] has been a standing agenda item in health and social care media, education, the workforce, conference, exhibition and policy for several decades. Perhaps, things have calmed somewhat? So either IC is either very important, complex, a hard thing in practice or maybe it's all of these and more besides? IC is a undeniably a compound concept. Is this a cop-out though? You declare something 'compound' then sit back - job-done? I've suggested the same of threshold concepts in health (and probably other contexts?). Time will tell. In the meantime I have reflected on 'integrated care' across the domains of Hodges' model:

self

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

other

INTEGRATION OF: PRACTITIONER; Team; service; org... Philosophy* assessments threshold for acceptance into service (referral criteria) patient experience & engagement health education / literacies programmes spiritual research involvement	INTEGRATION OF: health record (e- or paper) location - team base care disciplines geographical area referral sources assessments - tools/scales data and statistics research involvement
INTEGRATION OF: HEALTH & SOCIAL CARE public engagement hospital  carer (parent/guardian) experience community services social care - NHS family experience public engagement in research Patient / Public Community Advocacy Treat demand :: Support prevention	INTEGRATION OF: funding leadership / management accountability - complaints (not the same thing!) outcome measures ILLNESS - PREVENTION / education self-care <> planetary care -  Sustainability assisted dying! palliative care! Public - Private - Voluntary Sectors Provider :: Purchaser [Systems] All-Party Parliamentary Groups^

*ethics, values.

^One aspect of so-called 'joined-up government'.

'Holistic pluralism'

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

Rational choice theory	Natural sciences theoretical & methodological pluralism functionalism
Social sciences - Humanities	policy

from Abstract:

"The theoretical and methodological pluralism that we suggest here, holistic pluralism, is one way to overcome incommensurability between the natural and the social sciences while avoiding functionalism, technological and environmental determinism, and over-reliance on rational choice theory." 

from Introduction:

"The fact that sustainability science is “dealing with interconnected problems” (Kauffman and Arico 2014:413) requires that researchers in the field take a comprehensive, integrated, and participatory approach to science and reality (Sala et al. 2013). This explicit ambition to integrate knowledge—across scales, sectors, and substance domains, and across the nature-society, science-society, and knowledge-action divides—implies that sustainability science must inherently live up to (at least) three things. It must build on several foundational disciplines and have the capacity for interdisciplinarity; it must embrace theoretical and methodological pluralism and have the capacity for reflexivity (Isgren et al. 2017); and it must integrate knowledge generated from engaging with different disciplines, theories, methods, and contexts, and thus aspire to transdisciplinarity. Rather than merging or unifying the actual disciplines or their theories and methods into integrated frameworks, we argue that pluralism is the best way forward for dealing with sustainability challenges, such as biodiversity loss, climate change, land use change, water scarcity, and ill health. In this article, we use ontological, epistemological, and theoretical reasoning to support our argument. The critical ambition is to provide the rationale for a new approach that has the potential to capture the best available knowledge on social and natural dimensions of sustainability; we call it social fields and natural systems. The problem-solving ambition is to describe the approach and illustrate it in two empirical examples. If successful, this will show how holistic pluralism is one possible way of integrating knowledge across the social and natural science divide."

Figure 2 Olsson, L., & Jerneck, A. (2018).

It may be useful to consider figure 2, using the domains of Hodges' model?

Note how in Hodges' model, as 'political ecology' seeks to interrogate the relationship between society and nature (the environment, the sciences): we see a diametric relation. Inevitably then, the political ecologist must also negotiate, interpret, seek the policy evidence from within; perhaps an output, a creation of citizens?

Olsson, L., & Jerneck, A. (2018). Social fields and natural systems: integrating knowledge about society and nature. Ecology and Society, 23(3). https://www.jstor.org/stable/26799148