'Health - Illness': Status - presence - absence - Being

A pre-charity shop revisit: 

'So long as we are healthy, we do not notice that we are healthy. Health is one of those phenomena that we do not perceive as anything special because they are a part of everyday life. We discover them by their absence. Only illness enables us to see health as health. That I am healthy, and in what way I am healthy, is something I experience when, and to the extent that, I am or was not healthy, or when I perceive (but this it is difficult to do) that, and to what extent, someone else is or was not healthy. Being healthy is not the only 'being' that escapes our gaze precisely by being, and that appears to us by its absence. One could say the same of being as such.' p.257.

von Weizsäcker, Carl Friedrich (1971 [1980 trans.]). Einheit der Natur [The Unity of Nature] New York: Farrar Straus Giroux.

If we are to demonstrate ('prove') that Hodges' model can be applied, is relevant in:

• illness, disease, trauma (physical and mental);
• health and well-being; 
• human development, ageing, pregnancy;
• social care; 
• preventive medicine, health promotion, health education;
• life sciences, bioengineering; 
• public (community and mental) health;
• self care;
• spiritual health;
• and global - planetary (political) health ...

Then these observations by Friedrich, allied with definitions of health, as per the WHO's Constitution:

'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.'
https://www.who.int/about/governance/constitution

The oft cited (when I was a student nurse) definition of nursing by Virginia Henderson:

“Assisting the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that an individual would perform unaided if he had the necessary strength, will or knowledge”.
https://libguides.twu.edu/c.php?g=270174&p=1803121

We need to 'see' beyond these sources, to take in the global situation. But, being situated this is something Hodges' model is ideally equipped to achieve.

'Why is it so hard to find an NHS dentist?' BBC Radio 4 - Inside Health

'Dentistry is high on the public and political agenda. There have been dozens of headlines about access to NHS dentistry, with some people having to travel huge distances to find a dentist, or being put onto long waiting lists to get an NHS appointment.

In this episode of Inside Health, James Gallagher is joined by chairman of the British Dental Association Eddie Crouch, the Oral Health Foundation's Dr Rachael England, and consultant oral surgeon Tom Thayer. Together, they drill into the issues surrounding NHS dentistry. Along the way, they discuss possible solutions, whether contract reforms will help, and the potential future of dentistry in the UK.

Presenter: James Gallagher
Producers: Alice Lipscombe-Southwell and Thomas Hunt
Production coordinator: Stuart Laws
Content editor: Ilan Goodman'

Source & image: https://www.bbc.co.uk/programmes/m002r3nn

Latest paper re. Hodges' model:

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

v Book: Bill Ross - 'Order and the Virtual'

'The Philosophy and Science of Deleuzian Cosmology'

Systemists will find much here: 'principle of least action', 'principle of least resistance', equilibrium, open / closed systems, and entropy. A useful question is posed: 'Is complexity increasing? Is that average complexity across the universe; or the complexity of the most complex object? Deleuzes's Difference and Repetition is quoted:

'The values of implication are centres of envelopment. These centres  are not the intensive individuating factors themselves, but they are their representatives within a complex whole in the process of explication. ...' (p.255-6)'

Reading this I immediately thought of Bohm, who followed shortly after (still in Chapter 1!). In chapter 1, 'Chaos' could be read as Cosmos, hence the term rolling them together - chaosmos. This is the tract from which existence and becoming arise (re-reading). Deleuze's awareness of physics and quantum theory and its influence on his work is discussed, with chapter 2 providing continuity reaching to Leibniz (and 'The Calculating God'), also contributing is 'the complete concept', 'principle of sufficient reason', 'intensive individuating factors' and 'principle of identity of indiscernibles', for example. Even while the context is metaphysics (and it is not!), (for me) this seemingly presages a comprehensive health assessment:

Order and the Virtual

'The necessity in question is the necessary inclusion of all predicates pertaining to an individual in the complete concept of that individual.' p.24.

A reason to look up Lautman's philosophy is that it - 

'... entails a dialectic; a dialectic comprised of the movement of Ideas. While a given theory may achieve the desired tractability of the paradoxical element in question, this can only be the provisional resolution of the problem. This does not imply that the paradoxical element is in itself resolved; it retains its disruptive powers, its `remainder` within the explanatory framework, which will itself once again redistribute, redeploy, in an inevitable encounter with the next explanatory framework. In this sense (a sense which Deleuze embellishes), the 'problem' and the 'solution' are profoundly different in kind to question and answer. Whereas an answer might be understood to put a question to rest, the solution cannot resolve the problem finally.'

Plato's perpetual questioning wins the day and night (that is 24 hour care). This is why, for me Hodges' model is powerful - "Nursing: Be the difference"^ - and more relevant than ever:

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Self-Knowledge/Care Literacies Reasoning*	KNOWLEDGE - FACTS ... Self-Knowledge for Self-care
Dialectic* Guided discovery Perpetual questioning	Education Government provision Access for all Voice(s): being heard*

Ross explains that Deleuze is not limited to the realm of mathematics: 

and: 'By Ideas, we do not mean models whose mathematical entities would only be copies, but in the true Platonic Idea sense of the term, the structural schemas acccording to which effective theories are organised.'

Is the 'paradoxical agent' at work here, now a digitalized homonculus ready to preside acting as a superior dialectic that runs over the stream of conciousness? Hodges' model is a conceptual framework and ever-ready (we hope) aide-mémoire:

'Problems are always dialectical; the dialectic has no other sense, nor do problems have any other sense. What is mathematical (or physical, biological, psychical or sociological) are the solutions' (DR, 179).' (p.43).

In Hodges' model, the solutions are fixed in time, for what is (usually) an ongoing situation and context. Certain results in mathematics may be fixed, appear as a standing wave, but the flux, dyanamic remains. And, with it noise that is incessant and increasingly political.

This is a challenging, but rewarding read. 

^Have constant regard for representation, creation, being, becoming and how this affects and impacts (the) becoming.

Many thanks to Edinburgh University Press for my review copy.

More to follow here ...

Bill Ross (2024) Order and the Virtual: The Philosophy and Science of Deleuzian Cosmology. Edinburgh: Edinburgh University Press.
https://edinburghuniversitypress.com/book-order-and-the-virtual.html

ii Comparison and Contrasting the Meikirch Model and Hodges' model

Meikirch Model

Quite some time has passed since June 1st and part 1. I don't think this post can wait 18 years like that preceding! It is good to see '(Biologically given) potential' emphasized in the Meikirch Model; and the arrows which refer to:

'Whenever the five components and the ten complex interactions (double arrows) cooperate in a purposeful way, health may result. More specifically, a person is healthy, if by the two potentials she or he is in a position to respond satisfactorily to the demands of life.'

The interactions are explained in more detail. Mental health (illness) is there in 'personally acquired potential', but I wonder if it needs to be more explicit? Although, is this a welcome 'break' from the mind-BODY Cartesian divide and its legacy? A shift that enables a more constructive (less stigmatizing) formulation?

Given the climate crisis and experience of COVID, we can hopefully retain a sense of our individual proximity to the environment and green spaces. The importance of access to 'green spaces' seems to be sustained, even if action on air quality (and plastics in the environment) is still playing catch up with WHO air quality recommendations. The interdependence of nations and geography crystallizes more each month. The need for international cooperation apparent in cities, such as Lahore (1). Pollution and smog in Pakistan depends on what happens in India. Water flows, the how, when and whether is noted as a potential trigger for future conflicts.

Both models, the Meikirch, and Hodges' are of course idealizations. As such there are inevitable limitations, assumptions, pros and cons. Like many concepts, environment is a compound or expansive term. Simultaneously, from a primary meaning, we can proceed from the physical environment, to the social, political and the mental environment that these invoke or foster. 

In the SCIENCES domain of Hodges' model we are in 'a' - the environment. Physical reality presents itself in raw and fundamental terms. Across the world climate change is threatening many homes and places a stress the importance of 'shelter' and the homeless. Natural disasters, and acute local weather events which are now repetitive disrupt life and population. Conflicts continue to displace people, climate refugees will follow: (https://www.unhcr.org/refugee-statistics). Contrast this with the ideals of housing design that is sustainable and also enables occupants and communities to feel the environment. 

'Ecosystem' is being applied in ways beyond its original articulation. This past N. summer-autumn reading and reviewing -

Capra and Luisi's (2014) The Systems View of Life - A Unifying Vision.

(i) https://hodges-model.blogspot.com/2024/09/i-systems-view-life.html

- there was much emphasis on complexity, ecosystems, emergence, education, and obviously systems.

In their model, Bircher and Hahn incorporate Complex Adaptive Systems (CAS).

https://meikirch-modell.ch/wp-content/uploads/2017/12/Health-and-diease-as-CAS.pdf

This is helpful as the ecosystem is transformed, before our eyes. Clearly, there isn't one ecosystem, but several and they are all dynami: even if, outdoor clothing and car manufacturers want us to believe that we can create our own private ecosystem that is trans-portable. Systems are like the whirls in moving water, they come and go. Ironically there are now more opportunities to study them - if we so choose. Now weather events reveal the risks of people trying to sustain these mindsets when a local catastrophe strikes. The website for the Meikirch Model includes the table below. 

Theories Concerning
Health and Disease

Type of thinking	Epistemology	Means for comprehension
Prescientific	Personal experience	Intuition
Scientific: Meikirch-Model	Scientific argumentation	Rational mind

This is constructive as models should encompass what can be presented as 'knowledge' and from there: data, information, facts, myth, wisdom and folk theory. Intuition is listed as a prescientific 'means for comprehension'. Intuition is highly subjective, in contrast to the (supposed) objectivity of the sciences. Intuition is nonetheless significant in mental health care - psychotherapy, and in truth more generally (interpersonal skills); even if it remains 'unscientific' and an enigmatic phenomena. 

On twi/X and here on W2tQ, I've suggested that the bio-medical, and the biopsychosocial models are inadequate as conceptualisations for healthcare and education. We need to fully encompass the subjective and humanistic dimensions of health care and lived experience, giving more attention, if not credence to 'personal experience'. In England and Wales these past months and to follow our parliament has been debating assisted dying for people with terminal illness. Both sides acknowledge the sorry state of palliative care. Policy and ethics - hence the politics of health needs to be explicit in a model of/for healthcare.

Working in mental health you quickly understand how critical it is being able to relate to others, and  develop therapeutic relationships. Get this wrong, and problems may follow. If interpersonal - communication are essential to a health professional's knowledge then awareness and competence in relational skills are also key. In the past two years or so, I've realised the importance of this for Hodges' model and trying to develop a theory to underpin Hodges' model. I believe that this is a strength of Hodges' model. So we need to extend the table above. 

Individual
   |

      INTERPERSONAL    :     SCIENCES               

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

 SOCIOLOGY  :   POLITICAL 

|

Group

choice - life style reasoning - rationality my literacy - responsibility mental illness - fear of stigma intuition / subjectivity	geography - environment air pollution - smog & plastics traffic regulation - metrics Planetary health 'truth' objectivity
community - relationships culture social systems family social (all) determinants	international cooperation transparency / accountability policies - funding determinants of health reporting - citizen science

As part 1 started, I will finish with the title of the paper that prompted these reflections:

Bircher J. und Hahn E. G., (2017). Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare? Cureus 9(3): e1081. DOI 10.7759/cureus.1081 

The Meikrich model is not alone in seeking to facilitate and deliver a paradigm shift in healthcare; and, at individual, collective, planetary levels, across social care and education and the disciplines - old and new.

 

(1) https://www.independent.co.uk/climate-change/news/pakistan-lahore-air-pollution-schools-shut-aqi-b2640783.html

i Comparison and contrasting the Meikirch Model and Hodges' model

Simplifying universal health coverage to achieve political action

'The narrative on universal health coverage should be centred around four core elements: universality, equity, adequate financing, and preparedness in public health emergencies, write Katri Bertram and Justin Koonin'.

Bertram K, Koonin J. Simplifying the universal health coverage narrative can help to achieve political action BMJ 2024; 387 :q2441 doi:10.1136/bmj.q2441

A RESPONSE^* 

Can this be true? Why, this is absolutely marvellous! I?

Yes! Me. 

I do count! I'm seen, heard and included in the health care system and can have a voice in the service's development (1.). 

Not only that, but everyone in my - our community - has access - too (2.) ...

client - person - individual - self - patient - citizen

|

INTERPERSONAL : SCIENCES              

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

SOCIOLOGY : POLITICAL   

|

couple - family - group - community - village/town - city

1. UNIVERSALITY	4. PREPAREDNESS
2. EQUITY	3. ADEQUATE FINANCING

... Now that health and social care are properly funded, they've finally done it! They've taken the key step to include education. This is crucial, critical to preventing poor health. Whenever possible we want people to self-care. The mother of all us has always whispered of the safety net. Now she shouts and rages. We all must listen to the stories of old.  Children should be brought up to be health and media... literate and recognise for them as an individual, the merit, the joy of health and well-being.

At last - the power's-that-be are addressing policy. Not just policy on paper, but implementing it, to assure the quality and cost of food, baby-formula, the air and water (3.).

What does this mean?^ It means health budgets can be better managed. Being prepared does not mean we reach immediately for the technical solution, write the prescription (for antibiotics). No. Being prepared means wising-up too. Together, we are ready to face each other, and right across the world: S-N and E-W. Now we can look to the future, climate change and Gaia: as ONE (4-5).

^O’Connell T, Rasanathan K, Chopra M. What does universal health coverage mean? Lancet 2014;383:277-9. doi:10.1016/S0140-6736(13)60955-1 pmid:23953765

(Cited by Bertram & Koonin)

5. Spiritual.

^*A response, that is both too simple and too complex. Discuss.

The 'future' ... it's up to you* (i)

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

Chief Future Self-Care Officer
	Chief Future Officer - CFO

*Well not entirely! ii to follow.

My source: TV - https://www.bloomberg.com/btv/series/chief-future-officer

Comparison and contrasting the Meikirch Model and Hodges' model

Learning of another conceptual framework, which helpfully is also described as a model, there is a website, publications and illustrations (well executed PNGs). Enter, the Meikirch Model:

Bircher J. und Hahn E. G., Will the Meikirch Model, a New Framework for Health, Induce a Paradigm Shift in Healthcare? Cureus 9(3): e1081. DOI 10.7759/cureus.1081

The title of the paper is impressive, and on reflection worthy because we really do need a paradigm shift in healthcare. 

How to achieve universal health coverage and do so sustainably? In turn, how to realise the Sustainable Development Goals, while having regards the dependencies, determinants of health? For Hodges' model this is factored in by Brian (Hodges') recognising the political in situations including health. (So, I would argue that the required paradigm shift extends much further, but more on that to follow.)

Below I will review some of the main arguments, facets, and principles of the Meikirch Model, drawing from their website: https://meikirch-modell.ch

 
Meikirch Model: Overview

The Meikirch begins with 'demands of life':

"Each living creature has to fulfill the demands life puts on him or her. In man these demands include biological, psychosocial and environmental shares."

From the outset the INDIVIDUAL being - as a living creature (hence animals, flora too?) is highlighted - as per the individual - self, in Hodges' model. Maslow's hierarchy is presented too in stressing the need for shelter to counter the demands of the environment.

I like the way the individual draws upon 'biological given' and 'personally acquired' "potentials". In Hodges' model the individual's interpersonal development, their intellectual abilities, motivation, attitude, personality and more all contribute to a person's self-actualisation.

Demands of life provides the basis for the Individual in the Meikirch model, as per the figure. In the notes the responsibility of the individual in the extent to which they achieve their potential appears to be emphasized. Responsibility extends to:

• how he or she cultivates the relationship to other human beings.
• how she or he participates with the life of the society.
• how he or she deals with the natural environment.

There is acknowledgement of how the biologically given potential can be reduced, and so:

"may compensate their defects to a large part by further developing their personally acquired potential. "

The Meikirch model is "A new concept of health based on science".

For the Individual, an example is given of type 1 diabetes were the person is able to become an proficient in management of their condition, possibly even an expert - and most likely the expert barring complications (infection ...).

I've blogged (I think!)* and Twi/Xed about the old joke (of course, it is not) of the N.H.S. being a misnomer. It really stands for the "National Ill-Health Service". Since drafting this in February, I'm sure I've heard this again on the radio, amid the ongoing UK election process. The website notes how generally:

"The health care system is 'sick'

This sickness results from a concept of health that is blind itself."

It is also not just just the need for change, as stressed by Meikirch; but how to make the transition to health education, promotion and prevention? Meikirch is a marvellous addition to the argument.

Moving further another common component with Hodges' model is the SOCIETY and social determinants in the Meikirch model, Sociology in Hodges' model. As Profs Bircher and Hahn note, relationships are key:

"The social context of a person encompasses the family, friends, acquaintances, schools, employers, including political institutions. Good lively personal relationships in family and social settings promote health. In contrast, burdensome relationships may compromise health. Whoever damages human relationships, exacerbates the development of the personally acquired potential of affected persons including his own."

The role of the law in the social framework is acknowledged, and how anxiety, greed and abuse can obviously impact on an individual's health. This extends from within the family, community, to the workplace; relationships between employees and managers for example.

Helpfully, society is also responsible for the health of (its) individuals. But this also relies upon mutuality with individuals:

"each individual must also contribute his or her part for a proper functioning of the society."

A reference that links the collaborative nature of society with public health:

Johannes Bircher, Shyama Kuruvilla, Defining health by addressing individual, social, and environmental determinants: New opportunities for health care and public health. Journal of Public Health Policy (2014) 35,363-368. (with link).

The ENVIRONMENT makes up the outer-most ring in the diagram. The Meikirch author's connection with Switzerland is evident in the protective examples of avalanche barriers and a natural deficiency of iodine and fluorine. 

"iodization of cooking and table salt and fluoridation of tooth pastes to prevent thyroid diseases and dental caries. Construction of avalanche barriers and of houses resistant to earthquakes also protects health."

Sadly we have seen backward steps in dental services provision in the UK; and recent earthquakes have demonstrated the tragic consequences of lapse building regulation when buildings 'pancake' in a progressive collapse. 

I contacted the authors https://meikirch-modell.ch/en/authors/ but no response has been received.

I will reflect further - adding a table with concepts related to Hodges' model and discuss the table at: https://meikirch-modell.ch/en/model/

Theories Concerning Health and Disease

Type of thinking

Epistemology

Means for comprehension

Prescientific

Personal experience

Intuition

Scientific: Meikirch-Model

Scientific argumentation

Rational mind

*Salutogenic Perspectives and Supertankers - Public Health

The dimensions and directions of self-care

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

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

SOCIOLOGY  :   POLITICAL 

|

GROUP

Mental capacity Personal autonomy My choice Subjective (lived-) experience Quality of (my) life Mood - mental state (assessment) Psychic pain - trauma Expectations - 'desired outcome' Can't keep a job "If it's all in my head - that's what one of the doctors said - I said, if it's an imaginary pain, how is the swelling there?" Nick	Physical pain - cause not identified Injury - trauma: history - playing football Goalpost collision - snapped - posterior cruciate ligament 28 years ago On feet leg swells Leg amputation 'best' option Twelve operations to date - Still in constant pain Clinical experience specialists, advice Guidance Evidence base Aggregated outcomes
Brown Housebound for days Feels guilty - holding family back Living pain-free ... would be a "New lease of life" Experience & expectations of family, friends .. Holiday, spoke to a veteran four years ago ..	Fundraising Mental Capacity Act Medical accountability Professional opinion - general outcomes NHS - "no" - 'Cosmetic'? Pain management (clinics)? Private operation £18,000 'desired outcome'

Chappell, P. Injured man fundraises for own leg amputation, The Times, August 10, 2022, p.19.

https://thetimes.pressreader.com/article/282080575609624

ii from Learning Health Systems journal - to case studies

Returning to this journal, reference #47 -

MacQuarrie C. Holistic designs. Encyclopedia of Case Study Research.Thousand Oaks, CA: SAGE; 2010:442-443.

In -

From “Invented here” to “Use it everywhere!”: A Learning health system from bottom and/or top?

Christian Colldén, Andreas Hellström

- led me to (with my emphasis) 

Encyclopedia of case study research/edited by Albert J. Mills, Gabrielle Durepos, and Elden Wiebe. London: SAGE Publications Ltd. 2010.

"Case study methodology can be a rich source for understanding the multiple structures that support and sustain organizational life and business units. Its strengths are in its ability to gain an insider’s viewpoint during the research process, the more in-depth and nuanced findings based on that, and in its flexibility in using different methods. Its challenges are in the theoretical framework and in the development of concepts based on empirical findings. When these are taken into account, fruitful and nuanced research results are possible, and through the study it is possible to gain an overall and holistic picture of the research object." p.76.

"To reach the intended effect for the learners, these teaching cases must fulfill certain conditions and prerequisites. For this, Bernd Weitz proposes three essential criteria: exemplarity, clearness, and practical orientation.

Exemplarity means that the study must exemplify not just an arbitrary and subjective case, but also one that is objective, unique, or representative. Clearness requires that cases are not trivial; on the contrary, they have to make use of all possible and appropriate alternatives of illustration for a comprehensive understanding. This demands holism, traceability, visualization, and supplementation with additional information. The last point, practical orientation, aims for the highest integration of theory and practice for an integrated learning process." p.77.

    (And many other sources.)

Hodges' model provides a portal. As a frame, not just one type of portal but several including information (portal). A portal that can function as a learning health system. Could this in combination with health literacy* even be extended to represent a definition of self-care? Long identified as a research approach for Hodges' model, case studies are the logical fit. If they were not, then the whole clinical, nursing, healthcare rationale for the model would be lost. A clinical, medical, health care episode begins as a result of case-ness being achieved. In the case that follows in practice, we are looking to assure person-centered care in the midst of criteria, processes, (gate-keeping) thresholds that are inherently service-centred and possibly also influenced by targets and a series of constraints.

"Case studies of the elderly tend to embrace normativism. If health, as in naturalism, amounts to preserving the organic functional ability to make species-typical contributions to survival and reproduction, then health can be objectively and statistically determined—that is, subjects’ perceptions or awareness are not relevant. But if a normative evaluation of the person’s body and mind is a necessary element in the care of the elderly, then case studies are necessary." p.127.

Demographics, and intergenerational factors, plus the (probable) rise of appeals to transdisciplinarity^ means that for policy, governance and assurance case studies and mixed-methods will increase in research.

The orientation of Hodges' model is also inevitably practical and hence pragmatic.

I have only scratched the surface here, and probably not in the most itchy of spots (Encyclopedia and not the only one).

More to follow ... and if you have observations, advice I'd be pleased to hear from you.

*All the literacies and schools of informatics.
^Such are the problems we face.

See also: Contents: Learning Health Systems,6,3, July 2022

Book: v "Foundations of Global Health & Human Rights"

 

A few points from the book to close:

Extending Human Rights beyond HIV: The Struggle against Tuberculosis (pp.229-231).

Afterword: Resilience in the Fight for Human Rights in Global Health - 

the first lesson of first aid.

"You can best care for the world when you take care of yourself." (p.459).

 

The index is very good. I might have expected more on corruption, fraud, and counterfeit healthcare products, but then this could be a distraction. It is alarming to read of the ongoing criminalization of groups in Asia, Africa and globally concerned with substance misuse and sexual health.

Even though I can extend thanks to OUP for my copy. Reading this book is a great investment in time.

individual
|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

"You are not alone. Together, we can build a brighter future." p.460. The book's closing sentence is an appeal to practitioners and as the past 18 months and the future will surely continue to reveal places a stress on self-care.	Tuberculosis HIV Ebola COVID Malaria ...
'laws on the streets*' ETHNO- 'duty to assist' p.448 UK?	'laws on the books' -NATIONALISM (chapter 20) Human rights literacy (p.143.) Universal Periodic Review - "a basis to assess the human rights situation in states throughout the world, seeking a holistic, equitable, and balanced approach to reviewing the situation of all human rights in all countries." (p. 166.)

 

 

Many thanks to OUP.

 

*Do people have an address? p.145.

[ Previously: https://hodges-model.blogspot.com/2021/01/book-review-iii-leave-no-one-behind-lnob.html ]

Foundations of Global Health & Human Rights. (2020) Lawrence O. Gostin and Benjamin Mason Meier (Eds.), Oxford: OUP. ISBN: 9780197528303.

 

Covid-19 survey: our selfcare and its effects

 Tell us about your experience during the Covid-19 pandemic!

Twelve universities in countries across the globe have come together to find out what works – and what doesn’t work – to prevent and treat Covid-19. This research is funded by the National Institute of Health Research in the UK and Antenna Foundation in Switzerland. We have no funding or links with private companies.

We need to learn from your experience!

We are interested in replies from people from all ages, whether you are at low risk or high risk from Covid-19, and whether or not you have had symptoms of Covid-19. Whatever age you are, whether or not you have any long-standing health problem, please complete the questionnaire.

What have you done to prevent yourself from catching Covid-19? Has it worked?

If you became ill, what did you do? Did it work? Whether you have used conventional medication, alternative medicines, herbs, vitamins, special diet, sports activity or no treatment, we are interested in your experience.

For more details and to take part ... 

 

See also (from the survey website link above):

United Kingdom

University of Southampton webpage about the survey.

Switzerland (French-speaking)

Écouter l'interview de Dr. Bertrand Graz au sujet de l'enquête dans l'émission Drôle d'été (RTS, 9 juillet 2020).

Lire l'article publié dans la Revue Médical Suisse.

La fédération des consommateurs de Suisse romande a relayé l'enquête.

L'émission 36.9 a relayé l'enquête sur Facebook (RTS, 13 septembre 2020).

'Reflection' c/o Evelyn Sinclair

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Credit: 'Reflection' image © www.evelynsinclair.co.uk

 

From the book 'Through the Locking Glass' exploring Cumbrian artists' responses to the (first) Covid-19 Lockdown.

With thanks to E. Sinclair.

Patient-centred + Treatment = Self Care Week

This week 18-24th November is Self Care Week

Hodges' model might tend to have us equate 'self care' with the humanistic half of the model. As Self Care Week begins I could not help but suggest on twitter that what self care means to me is 4-fold care (or 5-fold taking in the spiritual also).

Then, continuing to read Kinchin more on threshold concepts, care and caring:

"In the case of 'caring' within the clinical sciences (e.g. Clouder, 2005), the concept may link the salient points of the personal perspective (patient-centred discourse) with the biomedical (treatment) discourse (Figure 32).

Here 'care' is seen to occupy the space that links caring as a therapeutic intervention (to the left) and caring as the nurse-patient interpersonal relationship (to the right), as described by Morse et al. (1990). This positioning enables the carer and the patient to be active partners in linking the chains of clinical practice with the networks of understanding that relate to the patient's wider needs. The key factor within this model is the 'care' that includes consultation with the patient and carer that allows them to relate the two halves of the model - something that is required for learner agency (Kinchin & Wilkinson, 2016)." p.90.

The halves referred to in Figure 32 are those within Hodges' model, merely switched left-right. I will add a photograph soon.

Self care must encompass ALL of Hodges' model.

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

The patient (questions) Capacity, Motivation, Ability - Knowledge and Skills to Self Care	Medical science Clinical medicine
Carers	Consultation Choices, Engagement

Clouder, L. (2005) Caring as a ‘threshold concept’: transforming students in higher education into health(care) professionals, Teaching in Higher Education, 10:4,505-517,DOI: 10.1080/13562510500239141

Kinchin, I. M., & Wilkinson, I. (2016) A single-case study of carer agency. Journal of Nursing Education and Practice, 6, 34–45.

Morse, J.M., Solberg, S.M., Neander, W.L., Bottorff, J.L., Johnson, J.L. (1990) Concepts of caring and caring as a concept. Advances in Nursing Science. Sep;13(1):1-14.

Kinchin, I.M. (2016) Visualising Powerful Knowledge to Develop the Expert Student: A Knowledge Structures Perspective on Teaching and Learning at University, Rotterdam: Sense Publishing. p.90.

Book: Narrative Economics - "Happy Care-day to me!"

"Stories matter. It's a truism for journalists, but not much for economists. Robert Shiller, the Yale professor and Nobel laureate who predicted the housing crisis and also put behavioural economics on the map, aims to change that in a book dedicated to the thriving field of narrative economics."

Narrative Economics:
How Stories Go Viral and Drive Major Economic Events

narrative medicine

INDIVIDUAL

|

INTRA- INTER-PERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

GROUP

(My) mental health (My) narrative	(My) physical health "While many economists are still busy creating mathematical formulas to decode and contextualise our supposedly "rational" behaviour -
... people's actions are more often based on human interest stories than hard data." narrative behavioural	(Who owns your story?) economics economics

"Novelty often catches on - Shiller explains how the "Happy birthday" song, which used the same tune as an earlier piece of music, was much more successful because it allows us to place our own name in the lyrics."

Just imagine if there was a tool in health care, social care, education - formative, professional and lifelong learning, that was generic and suited to personalisation whatever the context - whatever the name and story?

My life chances - my health career ...

Rana Foroohar, Stories of value, FT Weekend. Life&Arts, 2-3 November 2019, p.10.

Quotidian Care

Hodges' model #h2cm -
Is this your 'daily' paper?
Is care integrated on a daily basis
(or any other basis)?

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group - population

Quotidian: fancy word for daily, ordinary Quotidian: is this 'ordinary' care truly personalised then according to the person's choices? BEING - dressed & washed, content Don't get lost in a preoccupation with tasks and what 'quotidian' means here. A smile a day* My name: my day, my night	Quotidian IS night & day Basic Nursing Care Hygiene, Skin, Activity, Mobility BEING: Getting Dressed & Washed, content Quotidian Malaria: paroxysms occur daily (Malaria: Non-Quotidian - DEEP time) being ALIVE.. The Handover That apple* - balanced diet ...
Basic Social - Personal - Care  Social Visits, Relationships Quotidian: OR "Not seen you in Ages!" Social Activities, community The Daily, Weekly Routine Our time :together - our day, our night	Quotidian: (Reports?) By the Book Work policy Health and Safety Are you/we overworked today? Was there NO work today: ZERO hours? The (Comprehensive) Record

*It's the attitude and effort that counts and knowing you're not alone.

The number of pages count (in a medical MOT)

Received in the post: an invitation.

For a medical MOT that would cost me £129 - which is a saving of £141.

I am informed that a competitor charges £564 for a "360" Health Assessment and £424 for an "Essential" Health Assessment.

Recently I spoke to someone who had major surgery and they remarked on the lack of assessment not on the medical side, but the social, especially in relation to discharge and the circumstances they would be returning to.

This example of apparent disinterest in a social assessment contrasts with practice in the past - several decades ago.

Apart from an awareness of  'silver clouds' and rose-tinted glasses what struck me was securing a sale by a manifest of paper:

The various blood tests that would be completed are detailed using medical terminology across four A4 pages. Depending on age there is a free respiratory screening too.

The following quotations (Alber, et al., 2017) state clearly the risks:

"There is a growing awareness among clinicians and health care scientists, that medical overuse comprises unnecessary health care lacking benefit for patients [3] or putting them at risk of harm outweighing a potential benefit [4]. Moreover, unnecessary medicine adds to rising health care expenditures [5] and a misallocation of scarce resources [6]. Asymptomatic individuals are at risk of being labelled as patients, causing anxiety and affecting their quality of life [7]." ...

"Moreover, in secondary prevention, risk factors are increasingly treated as diseases [8]. There is a tendency to screen asymptomatic populations at low risk and to label pre-diseases as manifest diseases [1]. Serum cholesterol levels are a good example of threshold lowering by shifting the boundary between health and disease [9]."

Over-treatment is also a problem in two critical and concurrent senses, as follows:

Developed health systems Need to transform to health promoting, educational, preventive, self-caring systems.

Developing health systems Need to prevent the inheritance of commodified health care and over-treatment.*

Alber et al. also provide a useful diagram preceded with more background:

"In primary care, the “quaternary prevention concept” [11] was introduced (see Fig. 1 ) in order to protect individuals from unnecessary investigations and treatment. Quaternary prevention is a “new term for an old concept: first, do not harm” [12]. It refers to actions “taken to identify [a] patient at risk of overmedicalisation [= in the sense of medical overuse, author’s note], to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable” [13]."

Fig 1

The concept of quaternary prevention. Source: [11] Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010;10:350–4, and [12] Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag. 2015;4:61–4

Without being dismissive of screening and its relation to health and well-being, I have removed myself from this particular mailing list.

At some point I must really apply Hodges' model to this discussion. The model is ideally suited to navigating and arguing this debate; from self-care, primary care, prevention, population and global health. I have posted previously about the damaging ideal of the comprehensive health record and the way that records seem oriented to assessment and risk reduction with outcomes and relapse prevention an after-thought. This defensiveness is critical for public safety, professionalism and accountability, but as a thread on twitter shows it can have a negative impact too.


*There is an additional confounding factor at work in developing nations, the incursion of digital technologies from outside.


Alber, K., Kuehlein, T., Schedlbauer, A., & Schaffer, S. (2017). Medical overuse and quaternary prevention in primary care - A qualitative study with general practitioners. BMC family practice, 18(1), 99. doi:10.1186/s12875-017-0667-4

Tsoi, G.W.W. (2014). Update On Prevention - An Introduction to Quaternary Prevention, Medical Bulletin 19, 11, NOVEMBER 2014.

Ack.
I am subscribed to a mail list that is an invaluable resource on the status of medicine and health care, with contributors including, Mohammad Zakaria Pezeshki, Juan Gérvas, Karenleigh A. Overmann, Gene Tsoi and others.

MOT: Ministry of Transport test

AffecTech Workshop: Lancaster Tuesday May 14th 2019, 9-1pm

Presented by Lancaster University

Help shape the future of innovative technologies for mental health

We hope you will join us as a guest of Lancaster University, for a special workshop and networking opportunity exploring interactive mental health technologies being developed here in Lancaster. This is a first of a kind opportunity for professionals and public to engage with new prototypes being developed as part of the AffecTech network – a major international research project developing personal technologies for affective health.

Where: Reading and Writing Room, Storey Arts Centre, in Lancaster City Centre
(Next to Lancaster Railway Station)

When: Tuesday May 14th 2019, 9.00 am to 13.30 pm

Why: Learn about personal technologies for affective health, and help shape a major initiative dedicated to delivering self-help technologies to help sufferers of affective health conditions such as depression, anxiety and bipolar disorder.

More information and registration (free). 


[Hope to see you there!]

The Compass Rose in Care

^*"A compass rose

is a diagram of

directions that is located

on every map or globe."

individual

|

INTERPERSONAL : SCIENCES

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

SOCIOLOGY : POLITICAL

|

group

The Health Career rose

is a diagram,
a conceptual map of care 

that can be located within every 

care plan and health record?

^*Source: https://slideplayer.com/slide/5847408/