My focus has been on determinants of health. These are the causes of chronic illness that regular folks can perceive in themselves and their surroundings.
Perceive — at a minimum that means to recognize, but it also means to understand because seeing is not necessarily believing. You need to believe something is true and meaningful before you’re willing to take risks and action.
(Precisely what you do is the raison d’être of Humaginarium. We won’t go into that here.)
Much study and reflection had brought me to a conclusion that the determinants of health occur in four categories. I believed all causes of chronic illness fall into one or more of these, but I was wrong.
One category of determinant is the somatic, which is basically your physiology and biochemistry. The somatic is what you see in the mirror and in body scans like CT and MRI. If you are one of the gamers entertained by Humaginarium, you perceive very little of yourself that is somatic. Instead there is fantasy, memory, or even nothing at all.
Another category is the psychosomatic, which is basically your thought processes and emotions. The psychosomatic includes the rational mind and imagination. It also includes feelings that have little to do with cognition and more to do with nerves and hormones. Most regular folks perceive the faintest glimmer of their psychosomatic self, though many may live and die for it.
Yet another kind of determinant is the social, which is basically relationships, dependencies, culture and community. Social determinants of health are not of you or another; they are all that occurs between you and others; all that makes us valuable or useful to each other. Politics, which makes many of us sick, is a social determinant of health that most can’t fathom, as usual for the category.
I thought that the final category is the environmental, which is basically the space that supports life. Metabolism is the cardinal difference between living and not living, but nobody knows how or why it started. We only know it cannot happen without an environment that sustains it. There are no martians and there never will be, Elon.
Now I realize there is a fifth determinant of health; a fifth cause of chronic illness that is painfully obvious but often overlooked. It is healthcare, which is basically the medical industry. It is your primary and specialty care, medical devices, drugs, clinics, hospitals and god almighty insurer. I hate to say this about an industry that vacuums up nearly $4 trillion a year from our collective human capital, but most of us do not understand this determinant of our health, no more than the other four. We perceive only the faintest glimmer of what medicine is — even when it’s being practiced on ourselves.
Five determinants hints at an analogy with Peter Senge’s five disciplines for creating learning organizations. Let’s see if it works. Here they are:
- “Personal mastery is a discipline of continually clarifying and deepening our personal vision, of focusing our energies, of developing patience, and of seeing reality objectively.” Check! That’s what Humaginarium does with and for folks dealing with chronic illness.
- “Mental models are deeply ingrained assumptions, generalizations, or even pictures of images that influence how we understand the world and how we take action.” Roger that! Humaginarium is changing mental models of health from spectator to change agent.
- “Building shared vision — a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance.” Our concept of commitment and enrollment is not in an employer health plan, but in the individual sense of well-being that comes with self-actualization.
- “Team learning starts with ‘dialogue’, the capacity of members of a team to suspend assumptions and enter into genuine ‘thinking together’.” Our program is 1:1 with and for each individual to become more comfortable in their own skin. That looks to me like a prerequisite for thinking with others.
- “Systems thinking – The Fifth Discipline that integrates the other four.”
The Fifth Discipline is the title of Senge’s book and also an organizing principle of Humaginarium. Though we do not create learning organizations, we use systems thinking and dynamic models of health and healthcare for a far humbler purpose. To create learning individuals, one by one, millions at a time.
These individuals suffer with chronic illness that they do not control. We can’t cure their illness, but we can lessen their suffering by helping them perceive how much power they have, and can get, to live better.
Among the rain
I saw the figure 5
on a red
to gong clangs
and wheels rumbling
through the dark city.