Root causes of illness in communities
The importance of root causes
Understanding illness in terms of the quality of community is about looking at the root causes of health and illness. You could argue that this is what being holistic demands of healthcare professionals. But surely it does not require a medical qualification to recognise the symptoms and signs of a sick community! These are obvious in ‘deprived’ communities where everyone will be aware of (and probably overwhelmed by) the social problems and the disease and suffering that attends them. But the social determinants of health operate at all levels of wealth and privation and we may not be so aware of the indicators of community sickness in wealthier neighbourhoods. Perhaps the easiest to notice is a certain quietness. Instead of people on the streets, there are cars on the drive and the doors of the houses are closed even in warm weather. If you chance to meet a stranger they avert their eyes.
Sooner or later most healthcare professionals will perhaps be alarmed to realise that by treating only the illness of individuals, not only do they leave the community sickness untouched, they unwittingly perpetuate the root causes by masking their effects. They are (often very expensively) treating the wrong problem. Perhaps ignoring the root causes of illness is an inevitable concomitant of over-medicalising the management of disease? It seems that medics are playing our part in keeping up the pretense that everything is basically alright. The shadow side of all this medicine is the blind eye turned towards ultimate causes. This is a significant factor in frustrating and demoralising the workforce: severe stress and burnout are very common in the NHS. In fact, this can be understood as a fractal – repeating patterns at different scales of magnitude – the problems in the NHS mirror the problems of wider society. (See http://fractalfoundation.org and follow links: Fractal Shows/ Educator’s Guide). More on fractals and complexity later in the Community-minded dimension.