Some People I Admire

Morihei Ueshiba 1883 - 1969

“Those who are enlightened never stop forging themselves. The realizations of such masters cannot be expressed well in words or theories. The most perfect action echo the patterns found in  nature.” 

To me, O'Sensei is the person I admire most. He is the epitome of never giving up. He persisted and developed himself until the end. 

Wang Zhang Zhai 1885 - 1963

Wang Xiang Zhai, brought standing meditation into the modern age. He was once asked to demonstrate his martial art in public; he just stood there and said this it it. 

Tuvia Bielski 1906 - 1987 

“Our revenge is to live. We may be hunted like animals but we will not become animals. We have all chosen this - to live free, like human beings, for as long as we can. Each day of freedom is a victory. And if we die trying to live, at least we die like human beings.”

Tuvia might seem like a weird choice but I can't think of anyone who fought against the Nazis and saved many people. After the war he came to NY started a moving company and taxi service. To think thousands of people got a ride by him never knowing he waged a serious resistance against the Nazi forces. You can see Daniel Craig play him a dramatization of his life called, Defiance

John Snow 1813 - 1858

Through his own intellectual desire about the 1854 cholera outbreak, he created epidemiology, John Snow tracked down all the cases of cholera in his neighborhood on his own time, he was an anesthesiologist at the time. He also created a dosage scale for the use of choloform and ether as an anesthetic. Pure genius!  You can read about him in the book Ghost Map. 

Leonardo Davinci 1452 - 1519

“It had long since come to my attention that people of accomplishment rarely sat back and let things happen to them. They went out and happened to things.” My grandfather told me about Davinci when I was a child. We often revere names like Gandalf and Merlin but truly if there real wizards Davinci would be one. 

Barak Obama 1961 - 

During the 2012 debate with Romney, Barak encouraged Romney to attack a point of that he made. After patiently waiting he totally did an intellectual Aikido move and turned it around on Romney.  I knew at that moment he would win the election. Some of Obama's best lines can be seen here. Republicans tried to tear this guy down, and time and time again they failed. He outclassed them.

“I am the son of a black man from Kenya and a white woman from Kansas.... I am married to a black American who carries within her the blood of slaves and slave owners-- an inheritance we pass on to our two precious daughters. I have brothers, sisters, nieces, nephews, uncles and cousins of every race and every hue scattered across three continents, and for as long as I live, I will never forget that in no other country on Earth is my story even possible.”

Charles Darwin 1809 - 1882

“Ignorance more frequently begets confidence than does knowledge: it is those who know little, and not those who know much, who so positively assert that  this or that problem will never be solved by science.” Darwin's persistence and drive to understand nature changed the world. 

Michelangelo di Lodovico Buonarroti Simon 1475- 1564

"If people knew how hard I worked to get my mastery, it wouldn't seem so wonderful at all." He is here because of his love of the human body. Looking at his work you can see he had an amazing view of humanity. He also hauled his own stones, made his own tools and hid in the caves when political fanatics went against his patrons.  

Constantine Brancusi  1876 - 1957

“They are imbeciles who call my work abstract. That which they call abstract is the most realistic, because what is real is not the exterior but the idea, the essence of things.” He made absolutely beautiful sculptures and taught me about universal beauty and the importance of relativism.  

Paul Cézanne 1839 - 1906 

“One had to immerse oneself in one's surroundings and intensely study nature or one's subject to understand how to recreate it,” and “With an apple I will astonish Paris.” Cezanne didn't have a show until he was in his late 50s. I love his paintings but most of all I admire his commitment to understanding nature. 

Why I am passionate about Epidemiology! 

"We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. Never again can we afford to live with the narrow, provincial "outside agitator" idea. Anyone who lives inside the United States can never be considered an outsider anywhere within its bounds." from The Letter from Birmingham Jail written on April 16, 1963, by MLK.

Over the past few years there has been a strong push for Libertarian ideas in the public arena using constant hyperbolic speech about the rights of individuals. Although, every policy, before being enacted, should face rigorous scrutiny about individual rights, we should keep in mind that if individual rights always win we will get blind-sided by disease.

That is why epidemiology (methods to understand the distribution of disease, exposures and behavior) are so important to society. They confirm the idea put forth above by MLK. Epidemiology teaches us that people are not independent agents walled in and isolated from disease.

One of the important lessons we have just learned from Ebola is that you can not block out disease by isolation. We need to use all our analytic methods to understand how disease travels. So  keeping people together and listening to them is essential to our individual survival.

One last message, if you feel like there are exposures, like GMOs, Vaccines, Fluoridation, etc that are not being addressed to your satisfaction then get together and ask for better information. Please don't poo poo on the medical field or create some elaborate conspiracy theory. If there TRULY is an effect, the tools in epidemiology can demonstrate it much more powerfully than saying the whole system is corrupt!

Concept Mapping: Quelling the Anxiety of Complex Problems

Some public health problems are pretty straightforward. Implementing a vaccination program in an area of high incidence of polio, for example, might be fraught with political or infrastructure obstacles, but we know if we administer the vaccine to the population, polio will decrease and lives will be saved. This is a “tame problem.” On the other hand, there are large, abstract issues whose boundaries are unclear, which are aptly called “wicked problems” (Rittel and Webber, 1973).

One such wicked problem is insidious, spanning all levels of society, from the cell to the population, and it has kept me up for more nights than I care to admit. This is the social determinants of health, the complex web of socioeconomic conditions that affect the health of individuals as well as communities (Raphael, 2004).

A video on the social determinants of health by Lemongrass Media commissioned by Vancouver Coastal Health clearly demonstrates the predicament. It features a married couple representing people of high socioeconomic status (SES) and two unmarried individuals representing people of low SES. This cinematic juxtaposition of high and low SES brings home the message that social factors and money affect the quality of one’s life and health. That stark contrast also brought up many emotions for me when witnessing how people of lower SES struggle with being able to access the services needed to raise a child or even pay for necessary medications (2010).

One of the obstacles endemic to addressing wicked problems is how overwhelming they can be, setting in a kind of stress-induced paralysis (Finegood, 2011). A common stress management tool is to break down a large problem into smaller problems and tackle them one by one. This is where the process of concept mapping can be extremely useful.

Another way of looking at concept mapping is creating a “thinking tool,” which can help access one’s tacit beliefs regarding an intractable problem. The authors of Sketching at Work describe their book as a guide to visual problem solving, stating that concept mapping “invites the drawer to explore a change in perspective” (Eppler and Pfister, 2010, p. 7).

In my own process of concept mapping of the social determinants of health, I realized that I previously thought researching causation and helping people were the same thing. But making a concept map helped me realize that this wicked problem is so complex that if we took the time to fully determine causation before acting, more and more people would be lost.

When I sketched out the pathways that led to poor health I saw how one’s level of education is clearly connected to the kinds of jobs one can attain and how that leads directly to the amount of income one can make. Those pathways are interconnected with healthcare access, food choices, autonomy, security, and awareness of risk and disease. All of these factors are interrelated and extremely complex. Real people are dying every day, and there comes a time when scientists have to put the search for causation on hold and apply their powers to ameliorating the problem. I finally understood why Kreiger and Zierler call for epidemiologic theory to go beyond the narrow focus of “modeling causation and explaining error” (1996) and instead espouse that whatever the means of causation, be it direct or indirect, intervening in social determinants such as education and early childhood development is a high priority.

Because drawing a concept map helped me get to a deeper understanding of this wicked problem, others on the causation bandwagon might be served by making their own map. Fixating on causation in part perpetuates the problem by creating a delay in action. Changing perspective is important in helping science become more aware of the complexity of the problem and move towards figuring out solutions without understanding exact casual mechanisms.

References:

Eppler, M.J., Pfister, R. (2010). Sketching at Work. Switzerland:University of St. Gallen.

Finegood, D.T. (2011).The complex systems science of obesity In J. Cawley, (Ed.), Handbook of the social science of obesity. (p 1-48). USA: Oxford University Press.

Krieger, N., Zierler, S. (1996). What explains the public’s health?: A call for epidemiologic theory. Epidemiology, 7(1):107-109.

Lemongrass Media (2010). Videos: Social Determinants of Health. Retrieved on January 26, 2011 from http://mainsite.lemongrassmedia.net/pop-health-the-new-agenda/

Raphael, D.(2004) editor. Social Determinants of Health:Canadian Perspective: Canadian Scholars’ Press Inc. Toronto

Rittle H.W.J., Webber, M.M., (1973). Dilemmas in a general theory of planning. Policy Sciences, 4: 155-169.