In seeking to improve public health through the provision of relevant infrastructure, would this in any way reduce employment opportunities for those whose work involves delivering healthcare interventions?
Firstly, I wonder about the idea of independent "health policy advice as infrastructure" too. That is that "emic" views (in the sense of being from within the system) pose a risk, of not seeing "the wood for the trees".
Secondly, if we take a systems, particularly a safety systems lens to health policy and build on the first, it's whether "orthodoxy" poses a potential failure mode (in the sense of FMEA theory).
Hello HELLO! ... We in rural America HAVE BEEN SAYING EXACTLY THIS FOR DECADES ... TENS OF YEARS! We have seen - for DECADES - that our infrastructure is failing, and worse even than failing, it is LEAVING. In the past 2 decades about 200 or more rural hospitals or clinics closed. Beckers Review reports over 700 rural hospitals are 'at risk' of closure. And before they close entirely they close units or services that are particularly costly, particularly pregnancy, delivery and postpartum specialities. And struggling, frayed, failing public health departments cannot fix this. So - apt to your argument here - what have academia, PH intelligentsia in think tanks and consulting firms advocated: lots of technology ideas - Internet providers, AI tools, gadgets called 'wearables' that talk to satellites or other far away non-humans or humans who have not experience with or of the rural communities we live in, etc. As your argument asserts 'maintenance' is ignored and left to fail, with attention and resources given to 'innovation' But even that is b-s to many/most rural folks because many/most rural communities - way down this dirt road, over in the next mountain hollar, a hundred miles through that frontier emptiness, in that once-thriving rural town that isn't much of anything other than boarded up establishments, etc - do not have high quality, accessible, affordable tech infrastructures, and many/most rural working class folks don't have it handily and affordably available to them, in their homes, easily nearby, etc. Thank you very much for the argument. But most is it is truly just more b-s to many/most rural ears. When we read the visionary statement - "When we see health in these terms, we can then build a world that better supports health at every level of experience, and invest accordingly, so that our collective health rests on the strongest possible foundation." - we know FROM DECADES of direct experience that ya'll DO NOT mean us, you must MEAN some other people that you like better than us, because you've ignored and neglected our infrastructure for DECADES.
The hardest part of the infrastructure frame is that its successes are counterfactual. A drug can point to the patient who recovered. A functioning water system can only point to the cholera that never came, and an absence has no owner. You cannot prove which outbreak you prevented, only that the feared one never arrived.
That is also why it is so easy to defund. The harm of cutting maintenance is itself a non-event. It does not happen now, it happens later, to someone who will never trace it back to the budget line that caused it. The decision and its consequence never meet in the same accountable moment, so the cut looks free, and the collapse, when it comes, looks like fate.
Maybe that is the deepest part of the frame. A healthy community is not a place where nothing happened. It is a place where a great many things were quietly prevented from happening, by people no one will ever think to thank.
It's more of a "both/and" (thinking of human agency, in general, and primary prevention, in particular) yet appreciate the eloquent argument for the structural scaffolds underpinning successful efforts. Surfacing strong ROI evidence for demonstrating value strikes me as one of the more important means for deciding upon which structures to prioritize and push
It never went viral, but I had coined #PSAHA as an acronym to reveal these unfortunate dynamics that end up undercutting public support for vital and shared services and capacities.
Public Service Availability Heuristic Asymmetry
So much that govt does is only observed in its absence or failure. Successes are rarely heralded and many times secret. This leads to the public holding false beliefs. Just ask Michael Lewis.
In seeking to improve public health through the provision of relevant infrastructure, would this in any way reduce employment opportunities for those whose work involves delivering healthcare interventions?
Two thoughts here Sandro.
Firstly, I wonder about the idea of independent "health policy advice as infrastructure" too. That is that "emic" views (in the sense of being from within the system) pose a risk, of not seeing "the wood for the trees".
Secondly, if we take a systems, particularly a safety systems lens to health policy and build on the first, it's whether "orthodoxy" poses a potential failure mode (in the sense of FMEA theory).
Having the One Health concept of humans/other creatures/environment in mind is essential when building the infrastructure.
Hello HELLO! ... We in rural America HAVE BEEN SAYING EXACTLY THIS FOR DECADES ... TENS OF YEARS! We have seen - for DECADES - that our infrastructure is failing, and worse even than failing, it is LEAVING. In the past 2 decades about 200 or more rural hospitals or clinics closed. Beckers Review reports over 700 rural hospitals are 'at risk' of closure. And before they close entirely they close units or services that are particularly costly, particularly pregnancy, delivery and postpartum specialities. And struggling, frayed, failing public health departments cannot fix this. So - apt to your argument here - what have academia, PH intelligentsia in think tanks and consulting firms advocated: lots of technology ideas - Internet providers, AI tools, gadgets called 'wearables' that talk to satellites or other far away non-humans or humans who have not experience with or of the rural communities we live in, etc. As your argument asserts 'maintenance' is ignored and left to fail, with attention and resources given to 'innovation' But even that is b-s to many/most rural folks because many/most rural communities - way down this dirt road, over in the next mountain hollar, a hundred miles through that frontier emptiness, in that once-thriving rural town that isn't much of anything other than boarded up establishments, etc - do not have high quality, accessible, affordable tech infrastructures, and many/most rural working class folks don't have it handily and affordably available to them, in their homes, easily nearby, etc. Thank you very much for the argument. But most is it is truly just more b-s to many/most rural ears. When we read the visionary statement - "When we see health in these terms, we can then build a world that better supports health at every level of experience, and invest accordingly, so that our collective health rests on the strongest possible foundation." - we know FROM DECADES of direct experience that ya'll DO NOT mean us, you must MEAN some other people that you like better than us, because you've ignored and neglected our infrastructure for DECADES.
The hardest part of the infrastructure frame is that its successes are counterfactual. A drug can point to the patient who recovered. A functioning water system can only point to the cholera that never came, and an absence has no owner. You cannot prove which outbreak you prevented, only that the feared one never arrived.
That is also why it is so easy to defund. The harm of cutting maintenance is itself a non-event. It does not happen now, it happens later, to someone who will never trace it back to the budget line that caused it. The decision and its consequence never meet in the same accountable moment, so the cut looks free, and the collapse, when it comes, looks like fate.
Maybe that is the deepest part of the frame. A healthy community is not a place where nothing happened. It is a place where a great many things were quietly prevented from happening, by people no one will ever think to thank.
It's more of a "both/and" (thinking of human agency, in general, and primary prevention, in particular) yet appreciate the eloquent argument for the structural scaffolds underpinning successful efforts. Surfacing strong ROI evidence for demonstrating value strikes me as one of the more important means for deciding upon which structures to prioritize and push
It never went viral, but I had coined #PSAHA as an acronym to reveal these unfortunate dynamics that end up undercutting public support for vital and shared services and capacities.
Public Service Availability Heuristic Asymmetry
So much that govt does is only observed in its absence or failure. Successes are rarely heralded and many times secret. This leads to the public holding false beliefs. Just ask Michael Lewis.