The Heart of Complexity

A Web of Relationships

Roger Lewin, Ph.D. and Birute Regine, ED.D.

• How would you define "health?" Participants responded:
  • "Health is an absence of disease."
  • "Is systemic - physical, emotional, mental, spiritual."
  • "It is the opposite of sickness."
  • "A state of well being — socially, spiritually, etc. You can have a disease, but still have a state of well being."
  • "It's harmony. Health care is helping patients define that harmony."
  • "I don't care for the idea of defining health. It's too much of a box. We're doing parenting classes. We're involved in community. That's all health related. To me, the actions and programs define health."
  • "It's an optimal state of well being. Most of us aren't really in a business of health care. What we're doing is illness care."
  • "I look at health as being poised for maximum adaptability. Health care should develop and enhance those things — like relationships — that help us adapt. It's not a one spot state. It's emergent.

• One participant said: "I'm a physician in a community of approx. 100,000 people. I'm frustrated with dealing with people when it's almost too late. I've started to look at community level. What can we do at different scales? Our current systems are inhibitory. It blocks the emergence of health."
  
  
• Mark Levine shared: "I've been on an adventure in my own community. I see my community as a living being. Each of us is a cell in that system. Now I think of myself as a physician to that being, the community. It's an interesting journey that has just begun.What's emerging is better than what politics could have done. It's linking, setting up feed back... and letting behavior emerge. We're still early in the process, but I think it could be the beginning of a new health care system.
  
  
• "Part of the journey is identifying others in the system, and it's very diverse. We have sociologists, a philosopher, a business community link... And it's a changing group."

• We face issues like infant mortality or teen pregnancy... and someone just responds by creating a program. But programs aren't the solution. We're looking for those critical leverage points where little things can have big effects."
  
  
• "Once you adopt this inclusive view, you have to consider the educational system, and other systems as well. Education about AIDS is available... but highrisk behavior has started again. We don't need more education about AIDS. The answer lies elsewhere. We need to find out where that is."
  
  
• "This social cohesion truly does have an affect on health. Building a more cohesive environment is key to building health."
  
  
• "It's tempting for communities to say, 'oh, we already have a senior center,' and then not do anything else. We must find a way to increase social cohesion. One of the losses of the elderly is they have nothing to do. One senior center I know of is connected to day care center, where kids adopt an adult and the adults adopt a kid."
  
  
• "I can't prove this, but I think high-risk behavior has its roots in very needy people who are disconnected."
  
  
• "One school system in Georgia worked on pregnancy by having peer groups meet in high schools, which produced a 75% decrease in teen pregnancy. I think people have to want to do something more than have babies. Having a baby offers connection, someone to love..."

• "Someone said to me what is most important to you about work, and I said love. I've heard love defined as saying 'yes to belonging.' It's moving from you vs. me to it's just us. One of my markers in mid-life was to move from OB/GYN to say how can I improve women's health. What can I do about STDs? Eating disorders? Breast cancer? etc. There is some acute care that we're fabulous at. But I can't write a prescription for someone who needs more relationships."
  
  
• "We did a series of focus groups - women who received and provided services, and identified emergent themes. Physical answers only go to 10% of health solutions. The rest is social, psychological and spiritual!"
  
  
• "Women defined health and well being as relationships, having choices, being adaptable, liking themselves, having information... I realized my health care system addressed none of these."

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