Michele Battle-Fisher

Parental Invasive and Children's Defensive Behaviors at Home and Away at College: Mediated Communication and Privacy Boundary Management

Following recent discussion of close parent-undergraduate contact via mediated communication, this manuscript reports an empirical study of parental invasive behaviors and childrens defensive behaviors. Results reveal patterns of parent/child boundary management via mediated communication, including decreased frequency of invasive/defensive behaviors than in a similar study by Petronio (1994). Telephone invasion at home was associated with invasions when away at college. Discussion of results considers how technology choices might alter the character of parent-child boundary management.

The Public, Private, and “Stepping on Toes” in Healthcare

What is public and what is private? Systems can be seen as exchanges and feedbacks of energies. Those energies certainly may be heat. They may be kinetic. They might be based on discourse. The energies could perhaps manifest as the directives and choices made by individuals in the public. Public health as a mission seeks to save collective lives from often avoidable premature mortality and morbidity. And those private “lives” that we wish to affect can then be collected together as the “population” of interest, or a public. We let the words, public health, roll off our tongues with ease. But how often do we take time to understand the ontological meaning of “public?” Discovering “publics” would be quite at home with Aristotle. But how often do health professionals take a moment to give the philosophical less than a fleeting thought. This chapter supports a deeper discussion of the political and ethical implications of private illness and public health.

The Concentric Model of Health-Bound Networks

The roles become muddled with roles that support health and others that result from nonmedical reasons. It may be a foredawn conclusion that the person’s quality of life (QOL) stays just that—inherent to a personal experience with disease. Moreover, QOL is often analogous to length of life and prognosis. What if the patient believes that life is fine as it has been dealt, imperfect clinically but personally acceptable (or tolerated)? What happens when the self-care decisions of a patient run counter to the evidence-based prescriptivism of medical care? There is a blurring of the penumbras of the public and private spheres in our understanding of QOL. The complexity of social relationships and support require policy for social integration has been shown to be linked to both physical and mental health. As the patient is embedded into a support network, I additionally posit that there is a “shared” collective QOL on the microlevel by which caring others are affected by the life state of the patient. It is an interesting question to explore the final victor in QOL: the psychometrically measured QOL, which is constructed by the “others” in the medical establishment or a patient’s subjective understandings of a sick existence. In light of generational issues of longevity with decreased physical and mental functionalities of patients, what must not be ignored is the network of support.

The Menagerie of Social Agents: People and Their Connections

Society lives under influences, some which are uncomfortably exogenous and beyond their control. A dynamic flow of networked relationships must be navigated and negotiated. Social networks are powerful and are often underutilized in uncovering the underlying social structure of public policy. But the work that is held dear must be acknowledged for its power to illuminate macrolevel ecological gaps and failures. The following chapter will lay the groundwork to introduce social network analysis as a necessary framework in developing sound health policies.

Framing and Revisiting Ethical Policy with a Systems Perspective

Policy exists to guide and, if at all possible, to standardize decision-making and actionable outcomes that affect a community. After the policies are ready to be activated, the governance mechanisms act upon its political authority to place the rules into action. The whole of health policy breaks down the parts that may paralyze or inhibit optimal population health and support change and transformative mechanisms. Policymaking and governance are contained and constrained by politics. Politics can pull policies in directions that possess political benefit to the detriment of social benefits. Once a policy is in place, every policy leaves a path of the continuing effect on the public that it is proposed to benefit. There are elements that work within a policy that interact in both anticipated and in unforeseen ways. The public acts unpredictably in such a fashion that a policy ignoring social complexity in the development of the initial policy or in the retooling of existing policies has less possibility of success. If biases toward linear decision-making in policy need to be upended, the basic ideas underlying what constitutes a social “system” must first be grappled with. Policymakers must move beyond the ill-advised, singularly focused intervention that counters systemic realities. Quick policy pacifications silence critics over a short term but this narrow act is often at the expense of wrecking the system, thereby moving the policy farther from the chance for achievement.

Communication and Politics in Healthcare

No one stakeholder corners the market on innovation. Those in politics come together based on the perceptions of togetherness. But is consensus within a collective politically feasible? Systems and modeling takes us beyond anecdotal. Ideas from policymakers are cobbled together in spaces allowing debate. It no longer is the way I have always known and understood it to happen. How is it happening right now and how might this present condition play out later? Ask, what do policymakers, or rather we as a policy collective with constituents, not see on the horizon?

Mental and Simulated Models in Health Policy Making

Models are approximations. We make mental models all the time. These mental models start the process but it does not end there. Whether they on their own are helpful is another story altogether. System thinking, by way of formal models, offers policymakers’ microworlds to offset attribution errors and faulty sense making that can lead policy astray. This chapter offers a brief descriptive of simulation as applications of system thinking education to state policymaking, system dynamics modeling of prescription opiate abuse as well as a look at avatar-like simulation of health-care data based on mathematical models for policy.

Social Disparity, Policy, and Sharing in Public Health

In formulating dynamic hypotheses of what is happening in the system, a distinction must be made between endogenous and exogenous factors to a system. Systems are based on structure but this whole book serves to continue to remind the reader that social systems cannot help but be framed with the “outside” in mind. To this end, the question that must be asked is how race and gender fit into the qualified model. The state of gaping disparities in healthcare access has placed a time-based premium on access to patient care, often tying reimbursement to a preexisting cost-saving market. There are social costs that policy balances with great care. A disparity essentially means that in the whole scheme of things, some individuals that tend to share certain characteristics are left behind disproportionately. It is wise investing our policy efforts that leverage the most return for limited resources and effort. This chapter frames systems structure in light of health-related disparities found in appropriate housing policy to uplift struggling urban populations.

Ethical and Systematic Approaches to Health Policy

Ethics are, in the end, a study of moral justification of our actions (or inaction) based on group-held rules. More simply put, ethics are a set of moral judgments that can influence and later thought to dictate a person’s or a group’s behavior. This supports for an often overlooked but necessary link to “system thinking” to ethics. Ethics has often ascribed to the negotiation of needs and morality as a linear action with no acknowledged feedbacks. But how do we really grapple with our moral compass? We are social. People set rules of moral expectation. We are embedded with people, and are buoyed about by decisions made amid environmental stressors. Often it is the people who hold most dear that affect us the most.

Health Disparities in Public Health

Can and will a person become an organ donor? Before such an altruistic act occurs, there is the ethic behind the action. There is an internalization of an ethic that the person agrees or disagrees with organ donation, no matter the variant. There is a large sense of agency and responsibility over the integrity of one’s body. The public does care what the “network” thinks about our personally held norms of living donation and sanctity of the body. I present the position that understanding of the norms of living organ donation requires an examination of the personal social “network” surrounding the potential donor. Networks rely on connection which may lead to deliberate consensus building (or a reason to conform in order to limit disharmony). There will be some level of network-level engagement with others in this process (for better or for worse). Also, a symptom of personal framing of experience may affect the public’s proclivity to donate organs in insufficient numbers to satisfy the overwhelming need for life-sustaining kidneys. “Strength in numbers” hurts—according to scope-severity paradox and its close kin, scope insensitivity. There appears to be less of an incentive to upset rational choice and side with emotion if enlarging health awareness is required to turn the tide of disease. But I argue that this emotive will more likely activate a collective empathy if an end-stage renal disease (ESRD) patient that needs a kidney is personally known to us.