Witch Doctor to Doctor
The diagrams on the left represent approximate age distribution for that Level. Vertical axis represents age with 90 years at the peak. The left horizontal axis represents the numbers of men alive at each age range, and the right horizontal represents women.
1. Food Gathering Tribal Society, community care. Witch
-------------- Doctor central - part of the magico-
religious system. Some practical
. | . knowledge - but much ritual & auto-
. | . suggestion as main curing agents
._____|_____.
2. Agriculture If tribal as 1, with a little increase
----------- in skill. If military elite some
diminution in medical care for serf,
3.Simple Technology plus harsher conditions, increasing
----------------- death rates & giving concave-inward
.|. age distribution curves on left
. | .
._____|_____. More knowledge & less emphasis on
auto-suggestion. Health detaches itself
4. City State from magico-religious, & develops into a
--------- profession - knowledge acquired by learning
substitutes for magic
5. Empire (Roman)
-------------- Distinct profession with moderate skill.
. | . Military hospitals & others - eg spars & at
. | . temples. Simple surgery - not available to
._____|_____. poor
----------------------------------------------------------------
6. Medieval (Europe) Low level health care, little medical
----------------- profession - such care there was bound up
.|. with church & monasteries. Then demise of
. | . military feudalism sees a re-emergence of a
._____|_____. medical profession - due to Renaissance
7. Industrial Medical profession with basic skill,
Revolution increasing to moderate - only available to
---------- wealthy. Simple surgery. Military
hospitals
8. Consumer Society
---------------- Growth of knowledge & skill, and its
. | . availability. Hospitals. Surgery technology
. | . growing. Sanitation, water supply and better
._____|_____. town housing reduces illness & death
9.Mass Production Growth of technology of medicine & surgery.
Society More can afford treatment. Growth of
---------------- hospitals. Medical care available to all
. | . as they require it, by insurance and later
. | . by the state owning and controlling much of
._____|_____. medical facilities (in UK)
Cost soar and waiting lists form for
treatment
General feature is that Health care is provided by a certain amount of knowledge and skill, and a substantial amount of auto-suggestion.
As societies develop the amount of knowledge & skill increases, so the emphasis on auto-suggestion reduces (but not necessarily reducing its importance).
In early societies, health care is bound up with the prevailing Magico-religious system. As knowledge, skill and later technology increase it detaches itself from the magico-religious system, and becomes a distinct profession. The knowledge, skill & technology takes over from the magic. As these increase, so Health care moves predominately from the home and extended family into surgeries and hospitals - partly made necessary by technology.
In oppressive societies it seems that health care is often reduced:
The general effect of medical care is to reduce the death rate, and increase population - until other mechanisms come in to limit population (from Role of Women). The populous societies are those with medical care of at least a moderate order - Roman Empire, and from the Industrial Revolution. Medical care is not the only factor operating - from Construction - Dwellings - where features of wealthy societies make living conditions better.
It seems likely that these factors and medical care does not increase significantly the natural term of human life - about 90. But rather they reduce the incidence of death before it. Thus the age distribution diagrams do not grow in height from the simplest societies to the most advanced - its just that more people stay alive to nearer the natural term of human life.
Tribal societies at Levels 1, 2, 3 & 4 have an approximately constant risk of death and their age distribution diagrams approximate to triangles. Though at latter Levels medicine and housing are better, tribal men also have to be warriors for the tribe to survive, which increases death rates.
Oppressive societies reduce medical care and living standards including food supply, and increase death rates. Although we do not have actual data, it is inferred that the age distribution diagrams form-concave inward shapes.
By Levels 5, and again from 7, quite high levels of medical care and living standards became available - and with standing professional armies most men were relieved from warrior duties (anyway in peace time). The risk of death was reduced, and the age distribution diagrams begin to take on a convex-outward shape as more people survive nearer the natural term of human life. Even the slave population of the Roman Empire benefited - which anyway became nearer the wage-slave class of today (the Roman civil service were staffed by slaves, and managers of all large Roman organisations were owned by these organisations - and rewarded similarly to our present day managers and civil servants).
Now that we understand the process occurring, it is simple to see that the Constant Trend is for the risk of death to be reduced, so the age distribution diagram becomes more convex-outward - and in the limit will approach a rectangle (unless there is any significant increase in the natural span of human life of which at present there is no evidence).
Reducing the risk of death has the effect of increasing the population.
However from The Role of Women it is clear that from the time that
convex-outward age distribution diagrams occur women start to limit
the size of their families (for reasons not connected with Health).
By the end of Level 9 an approximately stable population occurs -
though at approximately 10 times the population at Levels 6 - 7.
Though substantial medical knowledge is available, there is likely to be
considerably more to find. Many patients go to the doctor for things
he cannot really help them on - and come away with a medicine
(auto-suggestion). These often are emotional problems, mind, life style
- which have a considerable influence on health and well being, and
give various symptoms and illnesses. This is a field in which
medical knowledge may increase.
The Computer-Media will have an impact (already starting - see
Abbreviations).
Most doctors are in fact operating an information
retrieval systems - matching symptoms with a condition or illness -
which then leads to a treatment. This can easily be computerised -
enabling a preliminary diagnosis for symptoms provided by the
patient from his home. This is now started in the UK operated by nurses over
the phone, who can arrange hospital entry, or give an out of hours surgery
to go to. An itinerary for a doctor's daily calls could be
optimally worked out from a patient's urgency and location. Automatic
monitoring of patients in hospitals can be seen (started). These can be expected
to yield some reduction in the labour intensity of medical care,
reducing the supporting staff and making better use of the doctor.
Trends here have been going slower than once thought.
The State
Where the state gets deeply involved in running medical care the result
is soaring costs, with facilities often not matching demand. This is
a general problem with labour intensive activities especially in
the state sector. There is not the commercial pressure to improve
productivity, whereas people expect wages in line with other jobs -
whose wage levels are produced by the commercial productivity
increases. Financing such medical care will be a re-occurring problem.
With more people able to afford to pay for their treatment via insurance,
the private sector is likely to grow and flourish - eventually
overtaking that run by the state. In the US the private sector is the
mainstream - the state's involvement has come later
- and fears of the cost have discouraged development.
More recently attempts have been made again to provide care for all.
In the
UK the state led the way, and is struggling with the costs involved
- while the private sector has grown steadily. The US medical
system is more advanced than UK - to be expected in a system which is
mainly commercially led.
It is expected that there will continue to be slightly greater proportion
of economic resources devoted to medical care
(from Leisure & Wealth Deployment).
Risk of Death
The effect will be further reducing the risk of death,
and turning the age distribution diagram more towards a rectangle.
In fact it is quite near this already for the emerging Post Industrials:
The risk of death is already quite low until
the early 70s for men, and 80 for women. A mature Post Industrial
pattern would be near a rectangle at this scale:
A complete rectangle is not expected - there will always
be accidents, if not wars.
There will be a tapering from 80 to 90 years - giving a "roof" to the
diagram (already implied above).
But such a society would have more old
people (65 - 90) than children (0 - 15). There is an obvious interaction
with medical care which is already being felt - since old people make
much more intensive use of it.
We have not made allowance for an increase in the life span beyond
90 - so far there is no evidence that Health care or other mechanisms
do significantly increase the natural span.
The medical profession may not suffer from the Constant Trend of
Professional Services
(where professions decline once their knowledge
becomes widely available) to the same extent as others - because of the
central nature of a person's well being - which extenuates the
magico-religious element. Doctors will not lose their monopoly.
However, on-line data banks may well be set up where people can
feed in symptoms and obtain diagnosis and treatment suggestions. This
may enable people to deal with simpler problems themselves.
Other Parts of World
The History gives the natural medical care conditions for societies
at different levels of development. This is overlaid by:
The History suggests that there are broadly two factors impinging on
medical care:
There seems an argument that this western knowledge and aid may in many
cases be counter productive, and just substitute one problem for
another. Simple societies not only have problems with Health care,
but also food supply. If the natural risk of death in that society
is reduced by western medicine and aid it will inevitably increase
the population - and there is no point in doing that unless and
until the necessary food supply has been increased - or you will
simply substitute the prevailing illnesses for famine. Western countries
seem less able or willing to do anything about food shortages in
simple societies.
Of course food supply may not be the only problem if a population is
increased above its natural level by western medicine.
Where a society is developing, this is seen as it passes through Levels
7 onwards to be followed by an increase in population - the mechanisms
being discussed under Constant Trends. There is a danger that the
application of western medicine and aid will increase the population
further. It has to be appreciated that if a society is developing
that there are considerable strains: there has to be an increase in
overall wealth as well as per capita wealth. Increasing population
means more investment in infrastructure of housing, sanitation, water
supply, food production, education, as well as the substantial
business investment to give all the new people jobs. It is easy to
see that the development process may not be able to cope, with falling
per capita incomes resulting, if the delicate balance which the
present advanced countries went through is interfered with.
In considering the position in a particular part of the world, it
should be ascertained:
With this analysis, it is then possible to produce a Scenario
for that part of the world. This Scenario may be central to the
whole development process. If there is real economic growth, but
population increases are causing reducing per-capita incomes it
is doubtful if the development process is achieving anything.
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HEALTH - IMPACTED SCENARIO
. | . Age Distribution Late Level 9, early
. | . Level 10 (UK).
._____|_____. Axes as in start of History
. | . Theoretical Age Distribution
. | . Mature Level 10.
._____|_____.
If the population is growing at a Level where it may not naturally
do so, and\or the per-capita income is not growing even
though there is economic growth - then western medicine may be
behind it - which may be counter-productive. Great care must be taken
in using economic data as countries who compile them often exaggerate
the real economic growth (generally by not allowing correctly for
inflation). Only the advanced countries' figures can be accepted.
For others it is better to use figures produced by the World Bank
or IMF where they are available.