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健康、医疗保健与系统科学:新兴范式

Health, Health Care, and Systems Science: Emerging Paradigm.

作者信息

Janecka Ivo

机构信息

Research and Education, Foundation for Systems.

出版信息

Cureus. 2017 Feb 15;9(2):e1030. doi: 10.7759/cureus.1030.

DOI:10.7759/cureus.1030
PMID:28357162
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5354392/
Abstract

Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public's health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite of our incongruous decisions that are detrimental to health. A biologic system/a human body originates from structural, deterministic genes as well as shared epigenetic memory of our ancestors affecting our bodily function and structure. The political governing systems' vertical hierarchy has control over money and laws, neither of which materially affect individual lifestyle/behavioral choices toward health. Improved health comes from focusing on enhancing the biologic age and not the chronologic one, which simply represents a linear time from a birth certificate to a death certificate and is applicable only in its extremes. "Age-related diseases" are simply reflections of a given culture. Biologic age, reflecting the actual state of health, could be used in all health-related assessments including health-life insurance premiums, licensing of job categories, etc., all with a broader and healthy societal impact.

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/c9de4f093016/cureus-0009-00000001030-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/936bc3168807/cureus-0009-00000001030-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/9bb2849de54a/cureus-0009-00000001030-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/a349953c97a7/cureus-0009-00000001030-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/542779edefff/cureus-0009-00000001030-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/aff7aeee35bf/cureus-0009-00000001030-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/4e6de5f7c922/cureus-0009-00000001030-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/f5b36b2a148a/cureus-0009-00000001030-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/8b11c2c80828/cureus-0009-00000001030-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/a069f21e68fb/cureus-0009-00000001030-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/b7fb62568e14/cureus-0009-00000001030-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/c9de4f093016/cureus-0009-00000001030-i11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/936bc3168807/cureus-0009-00000001030-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/9bb2849de54a/cureus-0009-00000001030-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/a349953c97a7/cureus-0009-00000001030-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/542779edefff/cureus-0009-00000001030-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/aff7aeee35bf/cureus-0009-00000001030-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/4e6de5f7c922/cureus-0009-00000001030-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/f5b36b2a148a/cureus-0009-00000001030-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/8b11c2c80828/cureus-0009-00000001030-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/a069f21e68fb/cureus-0009-00000001030-i09.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/b7fb62568e14/cureus-0009-00000001030-i10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c786/5354392/c9de4f093016/cureus-0009-00000001030-i11.jpg
摘要

健康是生物系统优化状态的连续统一体,是与自我及他人建立积极关系的结果。健康的系统遵循源自对自然观察的系统科学原则,强调关系的性质是关键决定因素。关系源于我们的决策,这些决策对我们生物系统在各个层面的功能都有影响,包括基因组层面,表观遗传学在该层面影响我们的形态。在健康的系统中,决策源自海马体记忆与前额叶执行皮层的相互协作。我们可以通过选择来决定改变关系。然而,所选择的内容仅代表我们有限感官认知的认知解读;它强烈反映了对优化状态(使生物系统健康)或非优化状态的固有偏见。健康与否便是结果;不存在无关紧要的选择。公共卫生工作不应专注于惩罚性措施(如对不健康产品或行为征税)以实现更高水平的公众健康。它应教导人们做出健康决策的过程;否则,人们只会从一种不健康产品/行为转向另一种,善意的惩罚性措施不会有太大作用。体育活动,辅以营养和压力管理,对塑造健康的影响最大,同时也是最具成本效益的措施。适度至剧烈运动不仅能提高有氧适能,还能对认知产生积极影响,包括记忆和感官。这样就能预期做出集体、理性的社会决策。医疗保健是一个商业系统,主要由其组成部分的自我最大化决策所支配;在这样一个未优化的系统中,会产生不均衡和矛盾的结果。健康不等同于医疗保健。尽管我们做出了不利于健康的不协调决策,但我们仍是受生物学规律支配的生物系统。生物系统/人体起源于结构性、决定性的基因以及我们祖先的共享表观遗传记忆,这些影响着我们的身体功能和结构。政治治理系统的垂直层级控制着金钱和法律,而这两者都不会实质性地影响个人对健康的生活方式/行为选择。改善健康应专注于提高生物年龄而非仅仅代表从出生证明到死亡证明的线性时间且仅在极端情况下适用的实际年龄。“与年龄相关的疾病”仅仅是特定文化的反映。反映实际健康状况的生物年龄可用于所有与健康相关的评估,包括健康人寿保险费、职业类别许可等,所有这些都具有更广泛且有益健康的社会影响。

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