A Little More Summer Reading

Written by: Christopher Plein, Ph.D.  West Virginia University and MFLN Military Caregiving Concentration Team Member

What do astrophysics, environmental science, and healthcare delivery have in common?  Through some summer reading, I have found a unifying thread – systems and change.  During the time between academic semesters, I try to find some time to read books and articles that busier times will not allow.  Sometimes a general theme or topic guides my reading journey. For example, last year I concentrated on healthcare in general and Medicaid in specific, and shared some thoughts in one of our MFLN caregiving blogs.  At other times, I read broadly to see what themes emerge.  For me, this has been the summer of systems and change.

For those who interact with healthcare delivery, either as providers, caregivers, professionals, or patients, it is common knowledge that it is system that is at once complex and dynamic.  Our work with the MFLN Caregiving team often seeks to reveal and share changes in this system.  For example, we recently hosted a webinar on recent changes in TRICARE benefits relating to mental health care.  It is important to share perspective on changes and why they occur in the healthcare system.  A deeper understanding comes from understanding how various environmental, socio-economic, and technological factors influence the nature of systems and contribute to changes.  I emphasize this with my students and encourage them to take a systems based approach to the study of healthcare by recognizing now only the organizations, providers, policies, and regulations involved in the process, but to appreciate underlying factors that affect population health and may influence the need for, and development of, new medical technologies and healthcare practices.  If you are interested in learning more about this in depth, I recommend Managing Health Services Organizations and Systems by Beaufort Longest Jr. and Kurt Darr.  It is a long textbook, but essential reading for those who work with the healthcare system.

A more immediate and certainly gripping example of how these factors come into play to influence healthcare system can be found in an article published in this month’s Atlantic Magazine which raises concerns about our preparedness for pandemics. Written by Ed Yong, the article describes how pandemics might severely stress and overwhelm our health care system.  Just as importantly, he shows how ecological and technological changes are disrupting existing environmental systems that can lead to the rapid migration of disease from species to species and from place to place.

And it is this idea of disruption that ties things to astrophysics, environmental science and a great American novel.  In his book, Losing the Nobel Prize, astrophysicist Brian Keating, provides a very accessible review of different theories on how the universe was created.  The big bang theory instantly comes to mind.  What is at the heart of the discussion is accounting for events or effects that disrupt existing arrangements and create new and ever changing systems – like our universe.   This notion of system instability and transience is also crucial to our understanding our how we live on earth and our interactions with ecosystems.  Concepts like sustainability and resilience are hot topics now as debates emerge over climate change, population growth, and scarce resources.  In their book, Resilience Thinking, Brian Walker and David Salt remind us that, “The systems we live in and depend on are usually configured and reconfigured by extreme events, not average conditions” (page 6).

What is important then for us to remember that when thinking about systems, be they cosmological, environmental or healthcare related, is that they are always in flux and not in a steady state.  As both astrophysicists and environmental scientists tell us is that systems have the capacity to remain somewhat stable but that factors may contribute to a threshold moment where systems fundamentally change.  If change is great enough, we will not return to things as they were and our surroundings too will be transformed.  In less than a blink of an eye the cosmos might change or an epidemic may be upon us.  Over a long frame of time, we may realize that fisheries have been depleted or that a forest has changed.  It is human nature to find pattern and organization in the world around us, this is important to help us guide and understand, but what my broad summer reading is reminding me is that we should not assume that things will not always be as they are.

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