Turning the Health World Upside Down

There’s a growing acceptance of the links between health, wealth and wider society. Not just the impact of wealth inequalities on measures like life expectancy. But the importance of fixing the underlying social causes of medical problems, rather than just administering the medicine and wondering why the patient doesn’t get better.

It’s convenient to frame this as a Third World problem. And while it is, it’s also a problem within and between developed countries. For example, people from one area of Glasgow (in Scotland) live a decade longer than people residing in another area of the same city, in spite of (theoretically) having access to precisely the same medical expertise.

A most basic analysis of Great Britain (and much of the developed world) reveals an organizational chasm, which most people are not prepared to cross: For example, medical services and social care provision are completely different activities – separate funding, differing structures, responsibilities, professional bodies. Even though individual “patients” shift seamlessly between them. It’s an organisational situation made worse by the difficulty both groups seem to have integrating with anything – in my experience (largely failing to integrate public transport into health and social services), a combination of:

  • The intrinsic (internal) complexity of the service itself, which leaves little mental capacity for also dealing with “external” factors.
  • The tendency to be staffed by those with people-orientated skills, who are often less able to think strategically or in abstract.
  • The dominance of the government, with a natural tendency towards bureaucracy and politicized (irrational) decision making.

Complexity is the biggest problem, because it keeps getting worse: More (medical) conditions and treatments to know about, higher public expectations, greater interdependence between different cultures and areas of the world. Inability to manage growing complexity ultimately threatens modern civilization – it will probably be one of the defining problems of the current age. So adding even further complexity in the form of understanding about “fringe issues” is far from straightforward.

Beyond these practicalities lurk difficult moral debates – literally, buying life. Public policy doesn’t come much harder than this.

Into this arena steps Nigel Crisp. Former holder of various senior positions within health administration, now a member of the UK‘s House of Lords. Lord Crisp’s ideas try to “kill 2 birds with one stone”: For the developed world to adopt some of the simple, but more holistic approaches to health/society found in the less developed world, rather than merely exporting the less-than-perfect approach developed in countries like Britain.

To understand Crisp’s argument requires several sacred cows to be scarified: That institutions like the National Health Service (which in Britain is increasingly synonymous with nationhood, and so beyond criticism) are not perfect. That places like Africa aren’t solely populated by people that “need aid” (the unfortunate, but popular image that emerged from the famines of the 1980s). That the highest level of training and attainment isn’t necessarily the optimum solution (counter to most capitalist cultures). If you’ve managed to get that far, the political and organisational changes implied are still genuinely revolutionary: To paraphrase one commenter, “government simply doesn’t turn itself upside down”.

While it is very easy to decry Nigel Crisp’s approach as idealistic, even naively impractical, he is addressing a serious contemporary problem. And his broad thinking exposes a lot of unpleasant truths. This article is based on a lecture Crisp gave to a (mostly) medical audience at the University of Edinburgh. And the response of his audience. The lecture was based on his book, Turning the World Upside Down: the search for global health in the 21st Century (which I have not read). Read More

Stanford Virtual Worlds Research

This article contains selected notes on the some of the research conducted at Stanford University on virtual worlds and the interaction of humans within virtual environments. It is based on sessions held during the Media X conference. Pat Hanrahan defined a virtual world as a “networked multi-user distributed environment”. But the audience reaction was altogether less technical, and more oriented towards the social implications of such environments.

Stanford is one of the few universities that can not simply be accused of climbing on the virtual worlds band-wagon: People like Nick Yee were examining these environments at long before they were regarded as a suitable topic for serious research. Related sessions on workplace application and DKP and the archiving of virtual worlds/games will be covered by separate articles.

Why Use Virtual Environments for Medical Training?

LeRoy Heinrichs spoke on the use of virtual medical rooms for training medical students.

It is cost effective, even when developing bespoke software: Conducting a live training exercise in a physical hospital costs about $50,000 per day, and can only train a relatively small group. Stanford’s first virtual patient model cost almost $1 million to develop, yet in the long run is still cheaper than physical-world exercises.

Initial analysis of performance is not yet conclusive, however early signs suggest knowledge does transfer to real practice, and virtual training is just as good as other methods.

The business case for virtual worlds is ultimately a critical driver to their success outside of their traditional (game or social) environments. Medicine is a fundamentally expensive business, so even with custom software, one user can make a saving. Other sectors may be slower to follow, waiting for the cost to drop. Cost are likely to drop by sharing development costs between multiple projects – either industry-wide initiatives, or through the development of platforms for virtual worlds, which will transfer most of the costs on to a single provider, who can then share those costs between many customers.

Size Matters

Renate Fruchter revealed that visual size does matter. Ideally people should appear on screen life-size: In most cases that means a bigger screen!

Jeremy Bailenson outlined some of Nick Yee’s research behind the “virtual mirror”. The virtual mirror is a technique that changes the visual identity of a person’s avatar while in a virtual world: Their avatars literally look into a mirror and take a different form.

The experiment is useful in understanding the consequences of an apparently fluid online identity, and determining whether self-perception theory (and similar) transfer to avatars: If you don’t know how to act, you look at yourself, particularly your uniform, and that determines your behaviour.

Height is important. In the physical world, height correlates to confidence and personal income. Through the use of an “ultimatum game”, where avatars negotiate a deal, it was possible to show that a 10cm difference in avatar height increased the value of that avatar’s deals in their favour.

Physical attractiveness of avatars was also tested by examining “interpersonal distance”: If you like someone, you will tend to stand closer to them. And they’ll disclose more information.

Finally the effects of age were tested by morphing pictures of one’s self to show the passing of years. The older the avatar, the more the subjects were prepared to invest in their retirement.

Further detail on some of these topics can be found at The Daedalus Project.