Flirting With Anarchy: My Path to Understanding The Need For Good Governance: Part One.

NOTE: This was written a few years ago. I am publishing it now, after Trump's victory, because I believe that once we truly experience how a businessman runs the US economy, people are going to come to understand the need for government involvement in our lives.

During the 60s many people in the US were exploring many different ideologies and anarchism definitely struck a chord with many hippies. My father was a hippie and being raised by him gave me a unique introduction to Anarchism and an interest into Libertarianism. US history has seen many different movements that were influenced by libertarianism and/or anarchism. I have always been quite confused by the two ideologies.  During my years of trying to understand them, I have found that there are only slight differences between the extreme right and the extreme left. Anarchism is generally considered part of the left and libertarianism is generally with the right. The major difference between the two is that anarchism doesn’t not believe in a nation state at all where as the extreme right believes in one to protect the individual’s freedom. I know it is kind of weird to see the extreme right and extreme left being so close ideologically. It gets even weirder especially when you find out that liberalism is a term for fiscal conservatives but progressive liberals believe in increasing government intervention in business and fiscal conservatives and Christians that want to increase government’s role in limiting freedom when it comes to a women’s decision about abortion and whether people can be married and they want to continually make a drug like marijuana illegal when it is much safer than Alcohol. But let’s stick to the point. I am happy to know that many true libertarians, including Ron Paul want to legalize all drugs because the government doesn’t need to be regulating people’s behavior.

When Punk rock was just beginning to become popular I dropped out of college after deciding to be an artist and follow an anarchist way of life. I didn’t want anyone telling me what to do, especially not some faceless bureaucrat. I was young, strong, and smart, I could do anything.  With that attitude, the only job I could get was for a moving company, ironically named, Starving Students. When customers asked if we were actual students, we all answered, “students of life.” We were students of the school of hard knocks. Back then many people would have called me a radical but they probably couldn’t quite nail me down. I had this all too common American mix of libertarianism and anarchism and a definite distaste for socialism. My chosen path led me to a hard job. I worked there for two and half years and saw many people come and go, some people never showed up again after one day of work. So it was no surprise that I got injured while lifting a large upright piano up a few, very curvy, flights of stairs with only one other person helping.

My introduction to the US health care system began in 1994, with my boss at the moving company yelling at me for putting in a workman’s compensation claim. Then sitting in the doctor’s office waiting for what I thought would be a “visit,” but turned out to be me watching him write a prescription for painkillers. I was out of his office so quickly I am still not sure if we actually exchanged words. While I sat there wondering what the hell had just happened, he was back to his colleague discussing his golf form. I know that image is a trope but it really happened. However, those experiences were nothing in comparison to dealing with the insurance claims. I found that when you change jobs, you lose insurance coverage. When you get a new job you get new coverage after a six-month waiting period and when you submit a claim on the new account it gets denied. So you call a customer service rep and they say they “accidently” overlooked the new account and put it under the old one. This happened to me so many times I believe it was not simple mistakes by these clerks, but an orchestrated way of delaying payment.

It wasn’t long before I turned to alternative medicine, as so many in the US do. I had some amazing experiences but was still a little skeptical because the logic wasn’t adding up. None-the-less, I continued passionately seeking alternative care. In fact, my recovery went so well I was soon in the best shape of my life, and found myself wanting to become an alternative medicine practitioner. As I began researching careers and teaching Tai Chi, I wondered why these alternative practitioners were not fully integrated into the health system.

After experimenting with almost every type of alternative care in the US, my wife and I decided to embark on a life-changing trip to Asia. We went to India and Thailand for about 3 months. We sold our car put everything in storage and wandered around Asia. We received Ayurvedic treatments and Thai massage from different practitioners. It was amazing to experience traditional medicine practitioners in an ancient culture. I was in awe of these traditional practitioners with their natural cures. One highlight was when an Ayurvedic doctor brought me to Deepak Chopra’s family house in New Delhi, which was turned into an Ayurvedic medicine facility.  

However in India, my anarchist leanings started to waiver. Many in the US flirt with the idea but in India, at that time, there was little government control with scarce infrastructure. Electrical wires hanging on everything, everyone trying to get enough electricity for himself, by any means necessary resulted in daily power outages. Moreover, there wasn’t any kind of garbage collection service so people would dump their garbage in the streets for the wandering array of animals to glean nutrients from. Cars driving on the wrong side of road are a frequent occurrence and traffic accidents are one of the leading causes of death there. I could go on and on, but basically, I had seen enough of anarchy in action and began to see that there was a place for government involvement. Today, India is a great example because their laiseez-faire ways have raised their country’s prominence on to the world economic scene, however their Achilles heel is still infrastructure. The government is now investing heavily in this but whether it is enough to sustain growth remains to be seen. Many people in the US Romanticize less government because it seems more direct and they are tired with the red tape but they haven’t seen its application.  

If India opened my eyes to the pitfalls of minimal government involvement, Mississippi perfectly illustrated three major flaws in our health care system. Fresh from India and Thailand, I was ready to teach Tai Chi and Qigong and I soon found a job as an activity director in an elderly facility teaching Qigong to the residents. My wife and I moved there to find jobs with meaning, instead of becoming corporate drones. I began to see with my own eyes how elderly people’s dependency was a by-product of the health system. Since it is the case that the US health care system does not focus on prevention of chronic disease, it actually delivers what is called secondary and teriary prevention. Secondary prevention is making sure the patient doesn’t get worse or die from a disease they ready have, and tertiary prevention is when you have a long term illness and your treatment is focused on increasing quality of life. The focus is not curing or preventing disease in the first place. Many nights I laid awake wondering why are we not preventing the disease from entering the body in the first place. This type of prevention is known as primary prevention. It is the kind of prevention everyone wants but few achieve.

The second problem was that most of the resident assistants or RAs are paid around $7-10 per hour to clean bowel movements, assist the nurses and do whatever else was needed. Many were single moms and couldn’t afford health insurance. The irony here is the rich, mostly conservative, all white residents were always complaining about the quality of care but couldn’t see the connection to lack of funding of education in the US and certainly didn’t care that they were uninsured. Many of the RAs were afflicted by back problems because of lifting residents out of bed or on and off the toilet. Forget, for a second about any moral issues, just from a pure quality of care issue. It is most likely you will grow old and odds are really good you will probably end up in one of these places. Because you will not want to burden your children with your care, especially while they are trying to get the grandkids into good schools. So it seems obvious that it is in our own best interests to have healthy educated people helping? Do you think if you supported affordable health care and education that it would directly affect the quality of your end of life care?   

Thirdly, I saw by what means private care stays solvent. If your residents can’t pay they get kicked out. It was always a sad day when we had to drive one of our residents who ran out of money to the public nursing home. So it is easy to blame public care for poor quality or inefficiency when they do not turn anyone away.

The one question no one every asks Libertarians, fiscal conservatives on these television interviews is “What kind of society would we live in if we threw people on the streets?” “Do you really believe that is the kind of society that is healthy and good?”

After realizing the sum total of these experiences I began to have serious concerns about health care in the US, and I hadn’t even read any journal articles or even gotten involved in any political party. In addition, I certainly didn’t draw any connections to the huge conflict between libertarian ideals vs. socialist ones. I simply thought even if you were the most selfish person on the planet you would want a system that educates and provides health protection to even its lowest status citizens. I saw that it was inevitable that one day you will have to rely on them in and/or work with them.  Ironically, this is the exactly kind of probing that John Rawls did when he wrote about social justice.

And of course, we haven’t even discussed morality, I can’t believe that anyone thinks that the US has a great medical system when it has the highest infant and maternal deaths than any developed nation and that some middle income nations are doing better than us. I wonder what kind of measure those proponents of our system are using?  

Finally fed up with privately run eldercare, I headed back to college. I had done some community work and I thought I could figure out a way to prove that Tai Chi has what it takes to prevent chronic disease. I became a psychology major and absorbed as much knowledge of research as possible.  With years of research and statistics courses, my critical thinking was raised to high level. After a more than a few social pyschology courses I started to understand the placebo effect and the power of authority. From there I went to Canada to study public health. I figured it would be there that I would finally be able to create my ideal public health program that changes the medical paradigm. I written about Canada’s excellent health system (here) and when the debate about US health care reform began to focus on our neighbor I was shocked at the outright lies being propagated by the conservative media.

In three years I lived in Canada, I never had heard of anyone having any of the experiences purported by these commentators and personally, I had to wait for one of many appointments, while every other interaction from the birth of our second child to many checkups was of a higher quality with less out-of-pocket cost than any experience I had within the US health system.

My experiences also made me look into the benefits of a single-payer, government run health care system and if you look at them from cost of healthcare and overall health indicators e.g. infant mortality, and life expectancy you can see that a single payer system is clearly the most efficient and viable option for providing health care for all. But the main substantial point of libertarians is that once the government tells you to buy something, or forces you to wear a seatbelt it can tell you to do anything. For them this is their driving motivation or the road to serfdom. They feel that the “gimme people,” the “slackers” and the poor will drive the economy in to ground and that they, the hard working, risk takers will be forced to give their hard earned money to people who made poor choices in life. But once again, there is a serious lack of evidence. If we look at most Northern European countries where there is strong government involvement in healthcare we don’t see a slippery slope. They are not slaves. To the contrary, the middle class is thriving in those countries with higher wages, longer lives, longer vacations and less out-of-pocket healthcare expenses, and most importantly, less people bankrupt by healthcare debt.  

I still enjoy an occasional punk rock song but the movement itself has led to a dead end. Some Libertarian ideas are good for a nation but there is a point where it doesn’t provide the solutions a nation needs to prosper. Once people come to understand the literal Libertarian end game and not the fantasy of some country where rational self-interest and freewill create the best steel and the best of everything. The single-payer system is inevitable just like gravity because just like every physical object has to obey its force. I predict Libertarianism will end up with the other litter of impractical ideas to heavy to lumber on in the long journey of history.  

In Part Two, I will go into how this decision to take this path affected my life on a personal level.

Sustainable Health Promotion

On February 2nd, Denise Stevens, the head of Matrix Public Health Solutions, the company that leads the Community Interventions for Health (CIH) project, was beamed into our classroom via Skype to present the CIH project strategy for chronic disease prevention. She laid out an extremely ambitious health promotion strategy that spanned 3 risk factors: tobacco, unhealthy diet, and physical activity; 3 countries: Mexico, India, and China; and 4 approaches: health education, social marketing, community mobilization, and structural change (Stevens, 2011).

The CIH intervention I think is the most emblematic of what it takes for sustainable health promotion is their tobacco reduction campaign in China, which has “smoking center inspectors” enforcing a city wide no-smoking ordinance. This one got my attention because not just anybody can waltz into China, a country that the WHO reports is “the world's largest producer and consumer of tobacco,” and establish an anti-smoking police force to enforce a CIH strategy. I had been studying sustainable health promotion for almost a decade, from WHO’s EPI to BRAC and including my own struggles with small-scale community health promotion. It seems I have never been able to grasp that elusive ingredient for sustainable health promotion. So here was someone drinking from the Holy Grail; I shot my hand up to ask, “how did you make that happen and who pays for it?”

It turned out that she knows the retired head of the Chinese version of the CDC and that the Pepsico foundation is a major funder behind CIH’s projects. She pointed out the prestige that comes from working with American partners is a bigger incentive for many of her international partners than money.

This funding and prestige revelation led me to research the Pepsico Foundation. Its goals and mission are in step with Pepsico’s own corporate mission and are found on the corporate website. CEO Indra Nooyi supports taking the lead in corporate responsibility and cultivating sustainability in the environment and health arenas (2010b). With Pepsico specifically in mind, I drew a concept map to illustrate the interaction between a corporation attempting to create a sustainable health promotion program in a globalized world and the communities it serves. With Pepsico’s war chest and corporate efficiency, they can fund community projects all over the world and gain access to academic and political elites “to help devise solutions to key global challenges” (Pepsico, 2010b). My map also shows the cycle of profits that fuel Pepsico, as their mission cannot be totally altruistic.

The hard truth is that health systems all over the world struggle to deliver primary care or health promotion, especially to the least fortunate (Frownfelter and Dean, 2006; Holman and Lorig, 2004). One of the main reasons for this is that the demand for secondary and tertiary care is less affected by price (Roberts et al, 2004). This means that when people are sick they are willing to pay whatever it costs to save their own life. This high demand creates a stable need for professionals and thus status becomes attached.

“Basic food” is another high demand commodity (Roberts et al., 2004 p. 164). There will always be a demand for food, and companies that control the food market are some of the richest and most powerful. Ironically, many of their products are partly responsible for exacerbating the prevalence of some chronic diseases.

In contrast, health promotion, and even primary care are extremely price sensitive and do not generate the high revenues like acute care services (Roberts et al., 2004). Simply put, people in general don’t value something that may prevent possible future costs and are less willing to create a demand for those services. This is why I believe that corporations are better poised to deliver health promotion. The new trend in corporate responsibility and sustainability provides the funding, visibility, and sustainability for health promotion in ways that other entities cannot support. Thus, it is important that we in public health can see this as an opportunity to develop public-private partnerships to ensure that such corporate campaigns deliver the right information.


References

Frownfelter, D., Dean, E. (2006). Cardiovascular and pulmonary physical therapy evidence and practice. St. Louis, Missouri: Mosby Inc.

Holman, H., Lorig, K. (2004). Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Reports, 119:239-243.

Pepisco. (2010a). Corporate fact sheet. Retreived on . Retrieved on February 6, 2011 from www.pepsico.com/Download/PepsiCoCorporateFactSheet.pdf

Pepisco. (2010b). Letter from Indra Nooyi. Retrieved on February 6, 2011 from http://www.pepsico.com/Purpose/Performance-with-Purpose/Letter-from-Indra-Nooyi.html

Roberts, M. J., Hsiao, W., Berman, P., Reich, M.R. (2004). Getting Health Reform Right: A Guide to Improving Perfomance and Equity. New York, Oxford University Press.

Stevens, D. (2011). A systems oriented solution to a complex public health problem. [PowerPoint slides] Retrieved on February 19, 2011 from Simon Fraser University webct http://webct.sfu.ca/webct/cobaltMainFrame.dowebct?appforward=/webct/viewMyWebCT.dowebct

WHO. Towards a tobacco-free China. Retrieved on February 16, 2011 from http://www.wpro.who.int/china/sites/tfi/

The History of Tai Chi and Health-Part III: Tai Chi’s Use for Health Promotion

When Mao Zedong took power of China in 1949, he outlawed all traditional practices, including TCM, Tai Chi, and Qigong, and viewed them as superstitious (Chen, 2004). However, during health reforms Mao and his advisors began to see Traditional Chinese Medicine, including Tai Chi and Qigong, as an opportunity to aid in primary healthcare (Xu, 2010). Mao saw individual physical fitness as a sign of a strong nation. Qigong and Tai Chi fit into his vision of active masses, and his efforts in primary care inspired much of the Alma Ata conference in 1978 (Janes, 1999; Xu, 2010). Because Mao was a modernist who believed in science, a tremendous research effort began to explore Tai Chi and Qigong. Thus, Tai Chi and Qigong had to prove not to be merely a mystical superstition through using tools of scientific observation, which at that time were mainly large case studies (Kaptchuk, 2000; Xu, 2010).

Today in North America, Tai Chi has a variable and intense research history. It has been used and studied as an intervention on AIDS patients, haemophiliacs and just about every type of disease imaginable. One search on Google Scholar using the search term “Tai Chi” yielded 24,700 hits, and a search of the Cochrane Library website brought up reviews on Tai Chi and hypertension, headaches, depression, rheumatoid arthritis, fall reduction, and dementia.

One of the first influential studies on Tai Chi in the US was in 1996, when a team of researchers received funding from the National Institutes of Health to study Tai Chi and fall reduction (Wolf et al., 1996). There have been many studies replicating its efficacy in fall reduction, and it is included in many recommended guidelines for that purpose, including those issued by the Canadian Society of Exercise Physiology (CSEP, 2008), the US Department of Health and Human Services (US DHHS, 2008) and the American Physical Therapy Association (APTA, 1999).

Not many studies have been conducted on exploring its potential use in primary prevention, meaning preventing disease before people get a disease. I think this lack of research has to do with many preconceived notions people have linking Tai Chi with elderly people or because it is slow. Also, there is some controversy in exercise science fields as to how much of a role VO2max plays in prevention of cardiovascular disease. Recently, there has been some research that suggests musculo-skeletal strength plays a larger role than previously thought. If that is the case Tai Chi can maybe a good exercise for the primary prevention of cardiovascular disease.

Next The History of Tai Chi and Health-Part IV: Tai Chi and Chronic Disease

The History of Tai Chi and Health-Part II: The origin of Tai Chi

The origins of Tai Chi are rooted in mythical Chinese culture. The Chinese credit the celebrated hero Zhang San Feng with the creation of Tai Chi. Legend has it that he observed a hawk attacking a snake. As the battle between the two animals ensued, the snake repeatedly used relaxed evasive movements to elude the aggressive attacks of the hawk. Finally, the exhausted and frustrated hawk flew away. There are several versions, using different birds, but this is the basic myth (Frank, 2003). However, the true origins of Tai Chi are in dispute. The first historical record shows Tai Chi was developed in the 17th century in Chen Village (Yang, 2010). Later, Tai Chi was passed on to Yang Lu Chan, who developed the Yang style, which is now the most popular and most researched.

Yang Lu Chan’s grandson Yang Cheng Fu became the inheritor of the Yang tradition. He defined Tai Chi as “the art of concealing hardness within softness, like a needle in cotton” and asserted that “its technique, physiology, and mechanics all involve considerable philosophic principles” (Wile, 1983, p.3). He popularized Tai Chi for the masses and distinguished two levels, the civil and the martial (Wile, 1983). The civil is the “essence” and can be used for development of health, which is referred to as a type of gong, or practice or skill. In this way it falls under the umbrella of Qigong, a type of Qi-based exercise that literally means the practice (gong) of moving life’s vital energy (Qi) (Cohen, 1997). The martial is the “function,” which has the civil in mind but can be used for self-defense (Wile, 1983). Traditionally, Tai Chi is often taught in this martial manner, in which learning the form is not an end unto itself but a first step in which the basics are internalized. Then, after a year or so, the student learns push hands and sword practice. Thus, Tai Chi is a martial art that contains within it self-healing principles intertwined in martial movements.

As Tai Chi has developed through the centuries and through various schools of practice, it has become not one specific set of movements but can be practiced in different forms. Empty hand forms are usually the main focus of most Tai Chi classes. “Long forms” contain many more movements than “short forms,” which are not traditional but are modified to ease the learning curve. Different traditional styles are descended from the Chen but have evolved as various families transformed them, including the Yang, Wu, Sun, and Li styles. The variability of forms and intensities of physical activity among them is one of the challenges in understanding Tai Chi.

This infusion of healing movements with martial movements signifies Tai Chi as a unique exercise. Many people compare it to Yoga but it is quite different because of this martial aspect. I know of many people who study Tai Chi solely for martial practices but predominantly Tai Chi is a healing exercise. This is especially the case in the US, where so many combative styles are promoted. Tai Chi has a comparative advantage in that it offers a mindfulness Qi-based exercise.

The next post will explore Tai Chi’s involvement in Health Promotion