A Call to Be Whole
No product can be better than the system that produces it.
No system can be better than the relationships among its stakeholders.
And all relationships hang by the thin thread of conversation.
The multiple, conflicting, inconsistent answers to What is health? What is care? How much is enough? and Who is responsible? tell us that the health care system is in trouble. So do the rising costs of health care, the inequities of access, the inadequacies of technology to care for those with chronic and life-threatening conditions, and the inability of biomedicine to care for the health of the population. These are all signs of systemic instability.
Unstable systems are dysfunctional, and dysfunctional systems are unproductive. Systemic instability means that the system is not accomplishing its purpose, necessary elements are not included, or the relationships among its elements are not cooperative and resources are wasted. All three causes of instability are perturbing the current health care system.
Our earlier inquiries illuminated the concepts, the stakeholders, and the elements—healer, patient, remedy, and cause—that compose the health care system. So where do we direct our efforts for health care reform, and why do we choose certain interventions over others? To clearly see the cause and effect of our efforts requires that we return to our Russian doll analogy—in which each doll in a nested set is enveloped by a larger doll (Figure 2.1)—and unpack the nested hierarchy of systems: self, health care, market economy, and worldview.