For me one of the most fascinating aspects of systemic thinking is how it helps me to reflect on different issues that the media presents, and to reflect on how interconnected much of it is.
For example, I have just finished reading Robert and Edward Skidelsky's "How much is enough?", a thought-provoking read about how modern societies have moved away from people wanting just enough to give them 'a good life' to ones where people have an insatiable desire to acquire more and more, in the media- and advertising industry-given belief that this will make them happy. The Skidelsky's argue that this development has come as a result of the industrial revolution: mechanisation makes it possible to produce more and more, and in order to justify this production and ensure profit people need to have to consume more and more. Hence, in modern society we have completely lost the idea of being happy with 'just enough' and cannot see any alternatives to growth economies.
I then came across an article on the Guardian Online about child poverty. The article quoted the Conservative Party election manifesto as listing "… the root causes of poverty: entrenched worklessness, family breakdown, problem debt, and drug and alcohol dependency". It was the phrase 'root causes' which caught my eye: root causes being fundamental issues over which we have control but below which we cannot easily analyse any further. As a systemicist I could see a questionable boundary decision.
For example, to consider 'entrenched worklessness', the Skidelsky argument is that automation is leading to the mechanisation of more and more jobs in the middle of the employment market (for example as reported from Australia). People in the low-paid service sectors and higher paid senior management and executives are less affected at the moment, so those people who are being squeezed out of the middle are chasing the limited number of low paid, less skilled jobs. So maybe we should unpack the idea of 'entrenched worklessness' a little more and question the basis on which we are relentlessly automating the workplace.
Then the issue of 'problem debt'. Our society relies on people spending more and more in order to generate growth, and the only way in which this can be delivered is by encouraging household debt, so it is hardly any surprise that some of this debt becomes a problem. Again, is 'problem debt' a real root cause or should we probe further and question the morality of an economy which relies on credit?
As a systems thinker I would hope that our politicians reflect on the systemic nature of the problems that face modern society, and try to think of ways of dealing with real root causes. However, there are always elections coming and getting to grips with real problems and long-term solutions is just not a political priority.
Wednesday, 24 June 2015
Tuesday, 16 June 2015
A systemic view on radicalisation
Last night I went to bed after watching the news, which covered the story of a 17-year-old boy from West Yorkshire who had become an Islamic State suicide bomber. When I woke up, the radio news was talking about how to stop young people becoming 'radicalised'.
Tragic personal stories and a worrying topic of our time. But what seems to not be discussed is why young people can become radicalised this way. The standard government message is that there are 'bad people' who are indoctrinating others, and by focusing the message on this the solution becomes how to stop these bad people.
But surely there is more to it than that? To help clear my thinking I quickly drew a rich picture. A few things start to appear. The conflict in Syria must appear quite exciting and attracting to people whose immediate future does not seem very enticing. This is one thing that the media sometimes discusses, but I also wondered about how shoot 'em up computer games may also contribute to this, by creating a blurred connection between the gameplay and reality. The sophistication of modern games really do create an almost real experience, and could well make people think that real conflict is similar.
Then we have the questioning of belonging to the United Kingdom, which must be experienced by some people within the ethnic minorities. The anti-Muslim rhetoric which has been going on since September 11, 2001 means that a whole generation is growing up conscious of this negative message. What allegiance might they feel to the United Kingdom? Britain's colonial activities in the Middle East, and our post-colonial involvement in both Iraq wars are also highly relevant.
And another strand relates to a story which appeared a few days ago. Apparently, now that university education is widespread, quality employers are resorting to the 'posh test' to distinguish between people: if you have the right accent and class background you have a much better chance of getting a good job. How alienating would that be, cutting across all ethnic distinctions and affecting everyone from the working classes. Perhaps this is why radicalisation is not confined to people from ethnic minorities.
I am sure that this quickly drawn rich picture could be elaborated. However, my quick analysis illustrates how the current debate about 'radicalisation' really needs to move on from convenient, simplistic analyses to something more sophisticated if politically difficult.
Tragic personal stories and a worrying topic of our time. But what seems to not be discussed is why young people can become radicalised this way. The standard government message is that there are 'bad people' who are indoctrinating others, and by focusing the message on this the solution becomes how to stop these bad people.
But surely there is more to it than that? To help clear my thinking I quickly drew a rich picture. A few things start to appear. The conflict in Syria must appear quite exciting and attracting to people whose immediate future does not seem very enticing. This is one thing that the media sometimes discusses, but I also wondered about how shoot 'em up computer games may also contribute to this, by creating a blurred connection between the gameplay and reality. The sophistication of modern games really do create an almost real experience, and could well make people think that real conflict is similar.
Then we have the questioning of belonging to the United Kingdom, which must be experienced by some people within the ethnic minorities. The anti-Muslim rhetoric which has been going on since September 11, 2001 means that a whole generation is growing up conscious of this negative message. What allegiance might they feel to the United Kingdom? Britain's colonial activities in the Middle East, and our post-colonial involvement in both Iraq wars are also highly relevant.
And another strand relates to a story which appeared a few days ago. Apparently, now that university education is widespread, quality employers are resorting to the 'posh test' to distinguish between people: if you have the right accent and class background you have a much better chance of getting a good job. How alienating would that be, cutting across all ethnic distinctions and affecting everyone from the working classes. Perhaps this is why radicalisation is not confined to people from ethnic minorities.
I am sure that this quickly drawn rich picture could be elaborated. However, my quick analysis illustrates how the current debate about 'radicalisation' really needs to move on from convenient, simplistic analyses to something more sophisticated if politically difficult.
Friday, 30 January 2015
"Bitter Lake" - a plea for more sophisticated television
A few nights ago I logged into BBC iPlayer order to watch the latest Adam Curtis documentary "Bitter Lake".
At about 2 hours 20 minutes it is a substantial piece of work, and Curtis decided that it should be only available on iPlayer because he did not want to have to fit it into a standard television-sized slot. The reason is that the documentary, while focusing on the rise of Islamic fundamentalism and the recent western involvement in Afghanistan, is more broadly a criticism about how politicians and the media simplify messages.
They do this for various reasons: because the world around us is complex and issues such as Islamic fundamentalism are happening because of many different issues, to obscure actions taken which have contributed to a current crisis, to make it possible to explain what is happening in a few minutes on a news broadcast, for example.
By taking such a long time to present the story Curtis is able to weave together a story which includes an ill-planned irrigation scheme in Helmand province which massively increased the local capacity for producing opium, American complicity with Saudi Arabia in guaranteeing oil supplies in exchange for ignoring what that country did with fundamentalist beliefs, the 2008 financial crisis, the 1973 Arab-Israeli war, the rise of Islamic State in Iraq and many others.
Giving such time makes it possible to explore the complexity which has led to the current crisis in the Middle East, and is quite different to the typical media narrative which is that Islamic fundamentalists are basically evil and that it is the duty of Westerners, as representatives of good, to ride in and destroy them.
Of course, that is the narrative structure of the typical western film, and Curtis makes the point that one of the key moments in the development of the simplification of history was the election of Ronald Reagan, a former actor in western action movies, as US president.
Sadly until we can as a world learn to get to grips with complexity and stop seeing the world as an action film we are condemned to repeat the mistakes of the past, over and over and over.
At about 2 hours 20 minutes it is a substantial piece of work, and Curtis decided that it should be only available on iPlayer because he did not want to have to fit it into a standard television-sized slot. The reason is that the documentary, while focusing on the rise of Islamic fundamentalism and the recent western involvement in Afghanistan, is more broadly a criticism about how politicians and the media simplify messages.
They do this for various reasons: because the world around us is complex and issues such as Islamic fundamentalism are happening because of many different issues, to obscure actions taken which have contributed to a current crisis, to make it possible to explain what is happening in a few minutes on a news broadcast, for example.
By taking such a long time to present the story Curtis is able to weave together a story which includes an ill-planned irrigation scheme in Helmand province which massively increased the local capacity for producing opium, American complicity with Saudi Arabia in guaranteeing oil supplies in exchange for ignoring what that country did with fundamentalist beliefs, the 2008 financial crisis, the 1973 Arab-Israeli war, the rise of Islamic State in Iraq and many others.
Giving such time makes it possible to explore the complexity which has led to the current crisis in the Middle East, and is quite different to the typical media narrative which is that Islamic fundamentalists are basically evil and that it is the duty of Westerners, as representatives of good, to ride in and destroy them.
Of course, that is the narrative structure of the typical western film, and Curtis makes the point that one of the key moments in the development of the simplification of history was the election of Ronald Reagan, a former actor in western action movies, as US president.
Sadly until we can as a world learn to get to grips with complexity and stop seeing the world as an action film we are condemned to repeat the mistakes of the past, over and over and over.
Wednesday, 6 August 2014
The financial crash: rotten apples or rotten barrels?
I have just been reading Ha-Joon Chang's very interesting "Economics: The User's Guide". It was written for people just like me, who are conscious of the role economics plays in our lives but don' t really understand what it is. So it provides an explanation of key concepts and issues, relating them to the current economic difficulties in the world.
One chapter which particularly resonated with me as a systems person was Chapter 8, where he looks at the changing world of banking. What happened in 2008 was something of a mystery to me, as a crisis in the US housing market led to the collapse of the western economic system. Chang explains the phenomenon of 'asset-backed securities', and traces this back to the deregulation of the financial sector in the United Kingdom and United States back in the 1980s. Freed from the traditional role of taking savers' money and investing it, banks were increasingly able to create financial products that did not really exist and sell them on, over and over again.
What Chang describes is a classic feedback loop: deregulation made it possible for banks to create highly profitable financial products, the profit stimulated the creation of ever-more complex products which generated more profit and the merry-go-round just kept on turning. The risk protection that people thought was built into these products made it seem invincible, until, of course, the people at the bottom of the financial heap ran out of money. At which point it all came tumbling down.
At that time the British and American financial regulators said that this could not happen again, as the 'rotten apples in the barrel' lost their jobs (e.g. Sir Brian Pittman in 2009, or http://web.mit.edu/fnl/volume/215/silbey.html). Of course, no systems thinker would have believed that.
Apart from the dubious nature of this business, what also interested me were the emergent properties that Chang sees as coming out of this change.
Firstly, the magic of asset-backed securities encouraged even non-financial organisations to start playing in this new casino. In the short-term things were very profitable, much more so than tedious activities such as making things or research and development, and this made the shareholders very happy. Who cares what the future of the company is in the long-term if you can make big money in just a couple of years? So another feedback loop starts up.
Secondly, the banking industry suddenly became very attractive to young, clever people; people who in previous generations might have gone into manufacturing industry now became attracted to the big rewards and glamour of the banking world. So industry is deprived of talented people while the banking industry continues to grow. We can see here the start of another feedback loop where manufacturing in the UK and the United States becomes increasingly unfashionable and irrelevant.
If these feedback loops continue, the outlook, in my mind, is not very bright. The Chinese manufacturing economy will continue to grow and Britain and America will just become places to recycle money. That may be good for the tiny minority working in the financial industry, but it does not bode well for the great majority in the rest of these countries.
As Peter Senge pointed out, the system always wins. This is not a system that looks very healthy for most people in the world.
One chapter which particularly resonated with me as a systems person was Chapter 8, where he looks at the changing world of banking. What happened in 2008 was something of a mystery to me, as a crisis in the US housing market led to the collapse of the western economic system. Chang explains the phenomenon of 'asset-backed securities', and traces this back to the deregulation of the financial sector in the United Kingdom and United States back in the 1980s. Freed from the traditional role of taking savers' money and investing it, banks were increasingly able to create financial products that did not really exist and sell them on, over and over again.
What Chang describes is a classic feedback loop: deregulation made it possible for banks to create highly profitable financial products, the profit stimulated the creation of ever-more complex products which generated more profit and the merry-go-round just kept on turning. The risk protection that people thought was built into these products made it seem invincible, until, of course, the people at the bottom of the financial heap ran out of money. At which point it all came tumbling down.
At that time the British and American financial regulators said that this could not happen again, as the 'rotten apples in the barrel' lost their jobs (e.g. Sir Brian Pittman in 2009, or http://web.mit.edu/fnl/volume/215/silbey.html). Of course, no systems thinker would have believed that.
Apart from the dubious nature of this business, what also interested me were the emergent properties that Chang sees as coming out of this change.
Firstly, the magic of asset-backed securities encouraged even non-financial organisations to start playing in this new casino. In the short-term things were very profitable, much more so than tedious activities such as making things or research and development, and this made the shareholders very happy. Who cares what the future of the company is in the long-term if you can make big money in just a couple of years? So another feedback loop starts up.
Secondly, the banking industry suddenly became very attractive to young, clever people; people who in previous generations might have gone into manufacturing industry now became attracted to the big rewards and glamour of the banking world. So industry is deprived of talented people while the banking industry continues to grow. We can see here the start of another feedback loop where manufacturing in the UK and the United States becomes increasingly unfashionable and irrelevant.
If these feedback loops continue, the outlook, in my mind, is not very bright. The Chinese manufacturing economy will continue to grow and Britain and America will just become places to recycle money. That may be good for the tiny minority working in the financial industry, but it does not bode well for the great majority in the rest of these countries.
As Peter Senge pointed out, the system always wins. This is not a system that looks very healthy for most people in the world.
Tuesday, 29 July 2014
Music festivals, toilets and complexity
I spent three days last weekend at the magnificent WOMAD festival in Wiltshire, England, sitting in the sunshine listening to some of the world's best musicians doing their thing. It was a wonderfully therapeutic thing to do, leaving everyday worries and responsibilities behind.
But one thing none of us can leave behind is access to a toilet, and over the course of the weekend I started to become an observer of (largely) British toilet behaviour. If you have never been to a music festival I should explain that toilets are provided in specific areas, in a three-sided rectangular area. An occupied toilet is shown by a red indicator on the door and an empty toilet by a green indicator.
I started to watch how people behaved when approaching the toilets. At quiet times people could see a door with a green indicator and would go straight to one: at such times the toilet area would seem to be full of people moving in random straight lines. But when things got busier queues would form: in moderately busy times there would be a single queue and the first person would go to the next cubicle to become free, but at very busy times there would be separate queues in front of each cubicle. My wife also observed single queues forming in front of small clusters of toilets.
What was interesting to me were the transition points. When did a person or small group decide that the best strategy was to form a queue? When did queue formation stop? I reasoned that there were various factors such as the number of toilets, British social habits regarding queueing and so on.
It seemed to me that I was witnessing a complex adaptive system in action. How people behave in a situation that seems to be related to phenomena like birds flocking (which can be represented by a simple algorithm, such as in the various implementation of boids, e.g. http://processing.org/examples/flocking.html). Without any conscious decision-making, people change their behaviour in a way which suits the new situation that faces them.
Unlike me, most people were very happy in their unconscious decision-making and continued to enjoy the world music, untroubled by concerns about complexity and adaptation. What lucky people.
But one thing none of us can leave behind is access to a toilet, and over the course of the weekend I started to become an observer of (largely) British toilet behaviour. If you have never been to a music festival I should explain that toilets are provided in specific areas, in a three-sided rectangular area. An occupied toilet is shown by a red indicator on the door and an empty toilet by a green indicator.
I started to watch how people behaved when approaching the toilets. At quiet times people could see a door with a green indicator and would go straight to one: at such times the toilet area would seem to be full of people moving in random straight lines. But when things got busier queues would form: in moderately busy times there would be a single queue and the first person would go to the next cubicle to become free, but at very busy times there would be separate queues in front of each cubicle. My wife also observed single queues forming in front of small clusters of toilets.
What was interesting to me were the transition points. When did a person or small group decide that the best strategy was to form a queue? When did queue formation stop? I reasoned that there were various factors such as the number of toilets, British social habits regarding queueing and so on.
It seemed to me that I was witnessing a complex adaptive system in action. How people behave in a situation that seems to be related to phenomena like birds flocking (which can be represented by a simple algorithm, such as in the various implementation of boids, e.g. http://processing.org/examples/flocking.html). Without any conscious decision-making, people change their behaviour in a way which suits the new situation that faces them.
Unlike me, most people were very happy in their unconscious decision-making and continued to enjoy the world music, untroubled by concerns about complexity and adaptation. What lucky people.
Sunday, 13 July 2014
West Side Story - a parable for all times
Last night I went to see a stage production of "West Side Story". Although I seem to have known most of the songs throughout my life it was the first time I had actually seen it, either on stage or as a film, which was pretty surprising for someone of my generation.
Although it dates from 1957, its story is timeless. Racially-divided New York gangs fight over a small area of the city, one death leads to another and the cycle of revenge starts. It was relevant then, it was relevant to Shakespeare when he wrote the original 'screenplay' as "Romeo and Juliet", and it is relevant now.
When you think in systems and see a situation which never changes you recognise that there are systemic factors in play that are maintaining some sort of status quo. It then becomes possible to see the futility of many actions which are taken to try and stop the violence.
As the second act moved towards its tragic conclusion I started to think about the news I had heard earlier about another escalation of violence in the Middle East. Israeli youngsters kidnapped and murdered, tit for tat murder of an Arab youth, more rockets coming out of Gaza, Israeli tanks massed to invade Gaza. Such has been the story of my life, it seems.
So what are the systemic factors going on here? In 2002 David Peter Stroh wrote an interesting article for "The Systems Thinker" magazine (Volume 13, number 5, "A systemic view of the Israeli-Palestinian conflict"). Using a system dynamics approach, he identified an endless cycle:
1. Both sides fight for the right to exist - each side denies the right of the other to exist, so coexistence cannot be an option.
2. Tension escalates - retaliation becomes the strategy, as each side sees itself as a victim, and in the short term retaliatory activity seems to justify the right to exist.
3. Pressure leads to negotiations - at some point in violence becomes unacceptable, internally or to the external international community and peace talks start.
4. Peace efforts break down - extremists on either side take some action calculated to provoke a reaction, and the peace talks break down.
The overall result is that actions intended to create peace (negotiations) actually have the opposite effect, and provoke violence. To a systems thinker, this is not unusual.
Stroh captures these dynamics in a causal flow diagram (here, clipped from the PDF of his article).
He uses this to identify leverage points, where changes in strategy could actually lead to progress in reducing violence. For example:
Disputes over land have always been problematic, whether it be in the Middle East or in the fictional New York of the 1950s. The deaths of Tony, Riff and Bernardo can serve as a parable to help us understand what we might be able to do better rather than embark on an endless cycle of violence.
Although it dates from 1957, its story is timeless. Racially-divided New York gangs fight over a small area of the city, one death leads to another and the cycle of revenge starts. It was relevant then, it was relevant to Shakespeare when he wrote the original 'screenplay' as "Romeo and Juliet", and it is relevant now.
When you think in systems and see a situation which never changes you recognise that there are systemic factors in play that are maintaining some sort of status quo. It then becomes possible to see the futility of many actions which are taken to try and stop the violence.
As the second act moved towards its tragic conclusion I started to think about the news I had heard earlier about another escalation of violence in the Middle East. Israeli youngsters kidnapped and murdered, tit for tat murder of an Arab youth, more rockets coming out of Gaza, Israeli tanks massed to invade Gaza. Such has been the story of my life, it seems.
So what are the systemic factors going on here? In 2002 David Peter Stroh wrote an interesting article for "The Systems Thinker" magazine (Volume 13, number 5, "A systemic view of the Israeli-Palestinian conflict"). Using a system dynamics approach, he identified an endless cycle:
1. Both sides fight for the right to exist - each side denies the right of the other to exist, so coexistence cannot be an option.
2. Tension escalates - retaliation becomes the strategy, as each side sees itself as a victim, and in the short term retaliatory activity seems to justify the right to exist.
3. Pressure leads to negotiations - at some point in violence becomes unacceptable, internally or to the external international community and peace talks start.
4. Peace efforts break down - extremists on either side take some action calculated to provoke a reaction, and the peace talks break down.
The overall result is that actions intended to create peace (negotiations) actually have the opposite effect, and provoke violence. To a systems thinker, this is not unusual.
Stroh captures these dynamics in a causal flow diagram (here, clipped from the PDF of his article).
He uses this to identify leverage points, where changes in strategy could actually lead to progress in reducing violence. For example:
- Each side should think about what it can do to initiate change by reducing threats to the other side.
- Administrations on each side need to take risks to stop the actions of extremists.
- Each side should affirm the goal of peaceful coexistence.
- The international community should not take sides and should come together to support both Israel and the Palestinian Administration to make the necessary internal changes.
Disputes over land have always been problematic, whether it be in the Middle East or in the fictional New York of the 1950s. The deaths of Tony, Riff and Bernardo can serve as a parable to help us understand what we might be able to do better rather than embark on an endless cycle of violence.
Monday, 30 June 2014
The NHS: fit for 1948 but for 2014?
This past weekend I decided to spend more time reading the newspapers and leaving the do-it-yourself projects for another day. Consequently I got stuck into an article in The Observer about the NHS' funding crisis, what might happen and what the King's Fund thought should happen.
All interesting stuff, but I felt that while many of their suggestions made some sense they were missing the point about what is really going on in healthcare in the United Kingdom. Maybe they need to reflect a little using Geoffery Vickers' idea of appreciative systems.
Vickers suggested that we observe the flux of time passing as manifested by ideas and events, compare them with our internalised standards and then decide how to respond. The NHS as it currently operates is based on society's needs in 1948: a war-wracked society where infectious diseases and poor living conditions were major problems. Illnesses could be treated and the people would return home to live out the rest of their harder but shorter lives.
But the flux of time moves on and by the time we react the situation has changed: our responses are therefore always that bit too late. So it is with healthcare: we now have a relatively affluent society characterised by good general levels of health leading to an ageing population where chronic diseases of old age are much more prevalent, and one where lifestyle illnesses such as obesity and lack of general fitness are placing increasing demands on the NHS. But the standards used in the monitoring process seem to be unchanged. Organisations like the King's Fund still look for ways to make the NHS work better within the 1948 paradigm.
The rich picture below tries to capture some of the issues that are affecting health today.
The food and drinks industry encourages people to drink sugar and alcohol and eat fat, all of which when consumed to excess cause health problems. The running down of public leisure facilities through austerity programmes, selling school playing fields and minimising the importance of competitive games in schools (as just a few policies) mean that people take less exercise and keep less healthily fit. Big Pharma relies on medicalising life so that it can sell drugs and treatments to the healthcare industry, so has little interest in a healthy population.
Seen in this light, current government policies to encourage more private enterprise to run parts of the health service seem like plans to let lunatics run the asylum - it's a great business plan if one part of the corporate empire makes people sick while another makes them better so they can keep consuming. Other plans to review targets and enforce more inspections and regulation will just drive problems to another part of the system. Scandals like that in the Mid Staffordshire NHS Trust will continue to reappear in different guises.
The problem is therefore one of system boundaries. While the NHS is seen to be there to treat illness rather than to promote health neither it nor associated politicians will look to take on the real causes of poor health, the systemic ones of poor public health policies, corporate interests in promoting illness and an increasingly sedentary population. Powerful systemic factors mean that it is likely to stay as it is.
The NHS is a fantastic service we in the UK should be proud of. But perhaps its past successes are stopping us from looking at what health systems should be about in 2014?
All interesting stuff, but I felt that while many of their suggestions made some sense they were missing the point about what is really going on in healthcare in the United Kingdom. Maybe they need to reflect a little using Geoffery Vickers' idea of appreciative systems.
Vickers suggested that we observe the flux of time passing as manifested by ideas and events, compare them with our internalised standards and then decide how to respond. The NHS as it currently operates is based on society's needs in 1948: a war-wracked society where infectious diseases and poor living conditions were major problems. Illnesses could be treated and the people would return home to live out the rest of their harder but shorter lives.
But the flux of time moves on and by the time we react the situation has changed: our responses are therefore always that bit too late. So it is with healthcare: we now have a relatively affluent society characterised by good general levels of health leading to an ageing population where chronic diseases of old age are much more prevalent, and one where lifestyle illnesses such as obesity and lack of general fitness are placing increasing demands on the NHS. But the standards used in the monitoring process seem to be unchanged. Organisations like the King's Fund still look for ways to make the NHS work better within the 1948 paradigm.
The rich picture below tries to capture some of the issues that are affecting health today.
The food and drinks industry encourages people to drink sugar and alcohol and eat fat, all of which when consumed to excess cause health problems. The running down of public leisure facilities through austerity programmes, selling school playing fields and minimising the importance of competitive games in schools (as just a few policies) mean that people take less exercise and keep less healthily fit. Big Pharma relies on medicalising life so that it can sell drugs and treatments to the healthcare industry, so has little interest in a healthy population.
Seen in this light, current government policies to encourage more private enterprise to run parts of the health service seem like plans to let lunatics run the asylum - it's a great business plan if one part of the corporate empire makes people sick while another makes them better so they can keep consuming. Other plans to review targets and enforce more inspections and regulation will just drive problems to another part of the system. Scandals like that in the Mid Staffordshire NHS Trust will continue to reappear in different guises.
The problem is therefore one of system boundaries. While the NHS is seen to be there to treat illness rather than to promote health neither it nor associated politicians will look to take on the real causes of poor health, the systemic ones of poor public health policies, corporate interests in promoting illness and an increasingly sedentary population. Powerful systemic factors mean that it is likely to stay as it is.
The NHS is a fantastic service we in the UK should be proud of. But perhaps its past successes are stopping us from looking at what health systems should be about in 2014?
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