Merge pull request #723 from lauerj/main

Update 6-2-health.md

contents/english/6-2-health.md

@@ -56,7 +56,7 @@ In fact, the main alternative to private or national health insurance, which pre
 
 Accordingly, we reimagine health insurance as a '⿻ good' (see the discussion on public goods in [05-07 Social Markets](https://www.plurality.net/v/chapters/5-7/eng/)). A ⿻ good is similar to a network good but with a characteristic size that depends on the size of the network of users/producers and on the strength of the relationships betweeen users/producers: bigger is not always better. A ⿻ good builds on the strength of common belief across diverse scales and shapes embodied by ⿻ publics (see our chapter [04-02 Association and ⿻ Publics](https://www.plurality.net/v/chapters/4-2/eng/)).  Of note is that the social model of health insurance began with the fact of 'association', namely, the creation of shared space for the enactment of common belief, shielded from full public surveillance and financed by ⿻ mechanisms (see [05-07 Social Markets](https://www.plurality.net/v/chapters/5-7/eng/) and [06-00 From ⿻ to Reality](https://www.plurality.net/v/chapters/6-0/eng/)).  In our ⿻ vision, therefore, health insurance premiums might well be employed to contract directly for the provision of interventions producing the *conditions required for* health, rather than merely for the payment of services to treat disease or infirmity after arising[^Hanson].  Health insurance might then look more like life insurance, and, as Hanson also notes, there is no strong reason for the two to be segmented and several strong reasons for them not to be.  Essentially, such an insurance fund could act as a mutual-aid society to foster coordination in the joint production of health rather than merely in its restoration: not only 'healthy minds in healthy bodies' but also healthy persons in healthy families and communities (see Figure 1, above).  Like national health insurance, health production societies prioritize prepayment, risk pooling and redistribution but do so at multiple scales not necessarily related to jurisdiction.  
 
-In certain cases, a health production society might be formed to ensure the provision of clean water, sanitation, or adequate nutrition (such as the UNDP, UN-Water or the World Food Programme), or to address global infectious diseases such as malaria, HIV or tuberculosis (such as the Global Fund), or to purchase vaccines for children in lower-income countries (such as Gavi).  But in cases relevant to those living in rich countries, a health production society might promote health agency through education and social support (e.g. online communities on the *Strava* model) in order to counteract prevalent determinants of poor health such as tobacco use, alcohol misuse, the consumption of ultra-processed foods, and the burning of fossil fuels.  Though together these four risk factors account for more than 20 million global deaths per year[^LancetCommDet], i.e. they are twice as fatal as COVID initially was, there is yet no evidence of a commensurate response to our commercially determined pandemics.  This lack of action is not due to a technical barrier but rather a mental and social one.  ⿻ technologies can in principle escape both public (i.e. state) and private (i.e. commercial) capture through privacy enhancing technologies (see our chapter [04-02 Association and ⿻ Publics](https://www.plurality.net/v/chapters/4-2/eng/)) allowing for cryptographically secure and, if required, anonymized means of collaboration such as, for example *pol.is* or *Gov4Git* (see [06-00 From ⿻ to Reality](https://www.plurality.net/v/chapters/6-0/eng/)).  ⿻ technologies also allow for collective action in health to occur at the *right scale*, through a principle of subsidiarity emerging organically based on the shared experience of health problems, through funding pools aligned around a standardized set of health impact indicators.  (We discuss health impact in the following section.)  
+In certain cases, a health production society might be formed to ensure the provision of clean water, sanitation, or adequate nutrition (such as the UNDP, UN-Water or the World Food Programme), or to address global infectious diseases such as malaria, HIV or tuberculosis (such as the Global Fund), or to purchase vaccines for children in lower-income countries (such as Gavi).  But in cases relevant to those living in rich countries, a health production society might promote health agency through education and social support (e.g. online communities on the *Strava* model) in order to counteract prevalent determinants of poor health such as tobacco use, alcohol misuse, the consumption of ultra-processed foods, and the burning of fossil fuels.  Though together these four risk factors account for more than 20 million global deaths per year[^LancetCommDet], i.e. they are twice as fatal as COVID initially was, there is yet no evidence of a commensurate response to our commercially determined pandemics.  This lack of action is not due to a technical barrier but rather a mental and social one.  ⿻ technologies can in principle escape both public (i.e. state) and private (i.e. commercial) capture through privacy enhancing technologies (see our chapter [04-02 Association and ⿻ Publics](https://www.plurality.net/v/chapters/4-2/eng/)) allowing for cryptographically secure and, if required, anonymized means of collaboration such as, for example *Polis* or *Gov4Git* (see [06-00 From ⿻ to Reality](https://www.plurality.net/v/chapters/6-0/eng/)).  ⿻ technologies also allow for collective action in health to occur at the *right scale*, through a principle of subsidiarity emerging organically based on the shared experience of health problems, through funding pools aligned around a standardized set of health impact indicators.  (We discuss health impact in the following section.)  
 
 In the current environment, however, there is limited ability for funders of pro-health services to discover or engage with a diverse set of organizations that provide healthcare services or create the conditions for healthy flourishing; there is also a limited ability for implementers of health interventions, or their beneficiaries, to identify and access relevant streams of financing.  ⿻ health associations would not replace existing institutions, such as national health systems, international health agencies, or private health philanthropies, but they would fill an important know/do gap at the macro-, meso-, and micro-scales.  All early forms of 'insurance', not merely those for health, involved prepayment, risk pooling, and redistribution by and for people sharing common beliefs who banded together to produce a specific 'public good', whether professional such as reliable service in the trades, religious such as the observance of feast days and celebrations, the maintenance of social order by the medieval *frith* guilds, or the payment of disability and death benefits by the Roman *collegia* and medieval German *knappschaften*.  Social media communities based on the production of positive-sum social goods, such as in these historical examples, have so far mainly remained mere ideas, overshadowed perhaps by the massive scale of online disinformation promoting collective action *contrary* to health and engendering consequent disempowerment, doubt and stasis (e.g. the massive rise in vaccine hesitancy since COVID-19).  Recreating the spirit of the guilds with ⿻ technologies that bridge profession, place, and parentage in the service of health action will open new avenues for healthy human flourishing.
 
@@ -106,7 +106,7 @@ The principle of democracy requires that all stakeholders (a partial list includ
 
 The world has experienced an increasing wave of pandemics, with 6 occurring already this century. In circumstances such as those in which COVID-19 emerged, one principle stands out: public health policy must be formulated in the presence of massive uncertainty about basic facts. For example, in early 2020, we knew we were confronted with two important unknowns: Q1. *How long would it take to develop an effective COVID vaccine?* and Q2. *Would populations tolerate the imposition of social distancing measures?*  In the UK, as in many other settings, we got the answer to both of these questions badly wrong, with disastrous consequences.  For example, policy-makers in the UK were convinced (though for no good reason) that the answer to Q1 was '*At least 18 months*' and that the answer to Q2 was '*No*'.  With hindsight we now know that the correct answer to Q1 in March 2020 was '*About 5 months*' and that the correct answer to Q2 at that time was a clear '*Yes*'.  Yet because there was no concerted effort to elicit what was known about these facts, or what could reasonably be conjectured, we reached mistaken conclusions and *as a direct result* of those errors delayed far too long in imposing social distancing measures.  In the UK, we delayed so long, in fact, that people and organizations themselves - independently and without explicit guidance - started practicing widespread social distancing on Friday 13 March 2020, a full 10 days before the UK authorities officially called for such measures.  
 
-The single most important point that stands out from these facts is the following: if diffuse populations of individuals or loosely organized non-health associations, such as soccer clubs, can formulate *objectively better pandemic policy* than a government that is advised by the world's top epidemiological experts, then clearly governments are turning a blind eye to a critical source of information and analysis.  The use of online tools such as expert-elicitation[^Cooke] databases maintained on a variety of collaborative, deliberative, voting or prediction-market (i.e. 'governance') technologies (see Section 5 on Democracy) would have multiplied by orders of magnitude the power of 'the wisdom of the crowd' such as witnessed in the UK between 10 and 23 March 2020.  Indeed, in the long run, more important than 'getting policy right' is preserving social cohesion and public engagement with and trust in policy-makers, since without these 'policy' rapidly becomes meaningless.  Taiwan followed a very different path, with rapid government support of citizen-led initiatives for, for example, tracking the supply of masks.  By moving quickly to empower citizen-led online initiatives (HackMD, g0v, pol.is), Taiwan was able to harvest the power of localized and contextual knowledge as a ⿻ good without imposing centralized control but also while respecting privacy.  Taiwan's extitutional approach was so successful it has now been institutionalized.  With such clearly contrasting examples as these, it follows that policy during the next novel pandemic is certain not to be the sole province or prerogative of epidemiological experts in closed-room consultations.  ⿻ technologies will be widely used for the large-scale formulation of and coordination around collective action.  
+The single most important point that stands out from these facts is the following: if diffuse populations of individuals or loosely organized non-health associations, such as soccer clubs, can formulate *objectively better pandemic policy* than a government that is advised by the world's top epidemiological experts, then clearly governments are turning a blind eye to a critical source of information and analysis.  The use of online tools such as expert-elicitation[^Cooke] databases maintained on a variety of collaborative, deliberative, voting or prediction-market (i.e. 'governance') technologies (see Section 5 on Democracy) would have multiplied by orders of magnitude the power of 'the wisdom of the crowd' such as witnessed in the UK between 10 and 23 March 2020.  Indeed, in the long run, more important than 'getting policy right' is preserving social cohesion and public engagement with and trust in policy-makers, since without these 'policy' rapidly becomes meaningless.  Taiwan followed a very different path, with rapid government support of citizen-led initiatives for, for example, tracking the supply of masks.  By moving quickly to empower citizen-led online initiatives (g0v, Polis), Taiwan was able to harvest the power of localized and contextual knowledge as a ⿻ good without imposing centralized control but also while respecting privacy.  Taiwan's extitutional approach was so successful it has now been institutionalized.  With such clearly contrasting examples as these, it follows that policy during the next novel pandemic is certain not to be the sole province or prerogative of epidemiological experts in closed-room consultations.  ⿻ technologies will be widely used for the large-scale formulation of and coordination around collective action.  
 
 #### Human-centered redesign of healthcare administration