Collapse

1
Collapse What the mute Statues of Easter
Island have to tell us about health care
Ian G Rawson, PhD The Trillium Centre
2

• Many societies have disappeared from their
  original locations, leaving only traces of what
  their lives were like while they lived there.
• The ancient Maya, Easter Islanders, Greenland
  Norse, Anasazi, and other cultures leave only
  subtle clues as to why they abandoned their
  traditional homes.
• Jared Diamond, in his book, Collapse, chronicles
  the decline of these civilizations and finds that
  the causes were complex, but often shared several
  common themes.
• Primary among these is the over-exploitation of
  resources in a fragile environment, and a failure
  to interpret the danger signals which the
  ecological environment sends.
• The same may be said about health care in the US
  today.

3
Cooperation Fragile Ecosystem

Overexploitation
4
The Easter Islanders arrived from Polynesia and
found an island which looked very similar to the
ones they had left. Except it wasnt. The soil
was shallow and plants had a fragile
existence. The Easter Islanders built statues of
their ancestors, moai, near the coasts, rolling
them from the quarries over logs. The trees were
not replanted, and eventually the last one was
cut, and the deforestation affected the climate,
reducing crop production. As the residents
faced starvation, they abandoned their island
home. Diamond asks What was the Easter
Islander thinking when he cut the last tree on
the Island? How could the residents commit
ecocide, in which ecological collapse leads to a
threat to the population? Is there an analogy
with health care, with a limited resource base
(insurance) and continuing assaults on the
ecology (reimbursement, malpractice)?
5
Competition Ecocide Depopulation
6

• Much of the stress on the environment came from
  competition among the social groups to build
  larger and more complex statues, hoping to
  appease the spirits and return the islands
  productivity.
• The expenditure of caloric resources in
  unproductive activities only exacerbated the
  imbalance between the population and the
  environment.
• The pursuit of a miraculous salvation also
  impeded the development of more appropriate
  exploitation techniques.

7
Competition Edifice Complex
8

• The Maya also competed by building large temple
  complexes, and requiring the production of
  foodstuffs for economically unproductive workers.
• Eventually, food production in the peninsula
  declined so it did not support the needs of the
  residents, and competition for food increased,
  turning into violence.

9
Fragile Ecosystem Climate Cycles
10

• Instead of attempting to adapt to changing
  environments, the Maya attempted to control the
  environment through spiritual means.
• As the climate cycles in the Yucatan region
  passed through a series of droughts, more temples
  were built and ceremonies were conducted to
  change the course of nature.
• Can we see some similar trends in health care,
  in which a failure to interpret trends leads to
  unproductive and competitive strategies, rather
  than adapting to the changes?

11
Competition Conflict
Ecocide
12

• Ceremonial games were held between neighboring
  groups, and as the skulls on the wall of the ball
  court show, losing could be a dangerous
  proposition.

13
Fragile Ecosystems Climate Cycles
14

• The Norse came to Greenland seeking new lands,
  and thought that they had found a familiar
  environment.
• Greenland was not similar to their homeland it
  is a harsh and unforgiving environment, and the
  Norse lived through a number of climate cycles of
  increasing cold.
• This affected their food production, and
  eventually those who could not leave the island
  starved, or possibly reverted to cannibalism.

15
Imported Culture Overexploitation Class
Conflict
16

• The leaders of each settlement group controlled
  the resources, keeping much of them for
  themselves, and leaving the other residents with
  little to live with.
• In trying to maintain a traditional way of life
  with herds of cattle, which destroyed the shallow
  soil, the Norse changed the ecology and sowed the
  seeds of their own destruction.
• Is health care pursuing traditional strategies
  to exploit the environment, instead of adapting
  to the cycles of change? And what impact might
  this have on the populations we serve, especially
  the most vulnerable?

17
(No Transcript)
18

• While the Norse and their cows were starving,
  the Inuit residents of coastal Greenland pursued
  their traditional food production techniques, and
  maintained a balance between their population and
  the ecology. The Norse disappeared from
  Greenland, but the Inuit remain today.

19
Competition Fragile Ecosystem Over-Exploitation
Ecocide?
20

• Health systems continue to build dramatic new
  buildings, competing with other systems for
  control over services to populations, usually
  with adequate health insurance.
• Is this a productive use of scarce resources?
  What impact does this have on the environment of
  a diminishing economic resource base?

21
ISEP Its Someone Elses Problem
Suppression of doubt and critical thinking
Refusal to draw inferences from negative
signs Persistence in error
22

• Several tendencies guided the Maya, the Easter
  Islanders, the Greenland Norse and others toward
  self-destruction.
• Each individual told themselves that whatever
  was happening was not their problem, but someone
  elses.
• As the climate cycles became more extreme, the
  populations and their leaders continued to
  persist in their belief that the trend was not
  increasingly dangerous.
• Instead of shifting their exploitative
  techniques to methods which adapt to the
  environment, they continued their pursuit of
  traditional, and destructive, techniques.
• Are there analogies in health care today?
  A supression of doubt? A
  persistence in error?