An exercise in applications of the salience and representativeness heuristics at CleanMed Europe 2013. II: Ownership

Second of the reflections on CleanMed themes, this time on commodification, production, and alternative models of ownership. 

I’m fortunate enough not only to live in Sheffield, but to have grown up here. With the highest ratio of trees to people of any city in Europe, 61% of my home is what would currently be described as ‘urban green space’. Despite the cultural penetration of this vogueish terminology, the tree-scattered knoll near where I used to live still goes by another, rather older, name; the Common.

It is unsurprising in an era of enclosure that the language of the commons is no longer fashionable. But much of the discussion at the CleanMed Europe conference served to reinforce the principle that central to creating a sustainable health system (and political economy) lies the reinterpretation – or at least a pluralism of interpretations – of the relationship between individuals, society, and the material resources of land and labour.

An exercise in applications of the salience and representativeness heuristics at CleanMed Europe 2013. I: Responsibility

A few reflections on themes in the CleanMed Europe 2013 conference rendered salient by the heuristics and biases that cut the lens through which I viewed it. Some covered in depth, some conspicuous by their absence; many found regularly hanging around the margins of the presentations and debates, never quite daring to step into the limelight.  

The first of these: responsibility. Responsibility – whether being seized or shirked, assigned or misplaced, was always being talked about. Blair Sadler in the Tuesday evening plenary raised the question of employers’ responsibilities for their workers’ health; on Wednesday morning Dr Hugh Rayner regaled us of being in the bizarre situation of having reduced rates of renal failure in his community – and it being ‘his fault’; a rather pessimistic view reported from focus groups suggested that health professionals confronted with the reality of catastrophic climate changed “desperately wanted someone to handle it” – but assumed it would be someone else; rather more hopeful stories throughout told us of the many ways in which groups of health professionals had taken it upon themselves to act. 

One might rather call this two – albeit interrelated – themes; those of backward responsibility (or, whose fault is it that things are the way they are?) and forward responsibility (whose job is it to sort said things out?). Backward responsibility is predominantly a descriptive notion – let’s say that someone is historically responsible for some state of affairs just in case their actions were causally implicated in bringing about that state of affairs (there’s a lot of unpacking to be done there, but leave it there for now). Forward responsibility, meanwhile, is largely normative, both in the sense that is teleological – it describes a desired end to be achieved (‘sorting things out’) – and deontological – in that it makes achieving that end the particular duty of some agent(s). The two, however, are clearly interwoven; but not, I’d maintain, in the ways the dominant model of responsibility suggests. Rethinking that model is an implicit dimension of the radical transformation needed to achieve a more sustainable future.

The centre and the periphery: patient-centred care and the concrete individual

Note: This post was written a few weeks ago, in part intended to advertise the CleanMed Europe 2013 conference that took place over the past few days. Through an abject failure on my part to do anything about posting it anywhere, that never happened. But I thought I might post it here anyway.

Thanks to Izzy Braithwaite for her probably-in-vain attempts to make it slightly more readable; that it's still incomprehensible is solely my fault.

Would anyone dispute that healthcare systems ought to put their patients first?  The mantra has a near-unassailable status in discussions of the best foundations for healthcare.  The UK’s General Medical Council makes it first amongst the Duties of a Doctor; it provides the title of the Department of Health’s response to the findings of the Francis Report; and it lies (in its more-theorised form, ‘patient-centred care’) at the core of Don Berwick’s recent report into safety in the NHS.  No politician, of any political stripe, would see fit to enter into a debate on health without it taking pride of place in their rhetoric.  I’ve used it myself, campaigning for the priority of “patients before profits”.  Nonetheless, I’ve long had qualms about it.  It took a work of fantasy to figure out exactly why.

During a recent and all-too-brief summer break, I decided to read China Miéville’s Perdido Street Station. I had harboured the vague intent of doing so for several years,  but a fortuitous alignment of stars and an inability to access any of the books I was supposed to read  in the university library meant I finally did.  As a (somewhat lapsed) devotee of speculative fiction, I’d always expected to find more than simple escapism between its covers; however, I did not expect it to form the nucleus around which those nagging worries about patient-centred care would crystallise.