Edited by Robert Geyer and Paul Cairney
Chapter 23: A case study of complexity and health policy: planning for a pandemic
The health sector has achieved many things by applying a reductionist approach to understanding health problems. People who can see following cataract surgery, who have been cured of TB with anti-tuberculous drugs or saved from smallpox because it was eradicated by immunization, have a lot to be grateful for. As a result of these successes the provision of healthcare in most Western countries is dominated by a reductionist approach of relying on ‘specialization’ to provide services, valuing detailed knowledge about a narrow area of human function over an understanding of the whole. There is increasing emphasis on ‘Evidence Based Medicine’ of which the gold standard evidence is the meta-analysis of multiple randomized controlled trials (Sackett et al., 1996). This is a method that relies on trying to eliminate all variables except one to study the outcome. There is also a focus on ‘universal’ ethical principles for doctors to follow, at least in the majority of cases. Medical practitioners are encouraged to adopt the same solution to individual problems based on the evidence and universal ethical principles. Yet the results of these trials and principles do not provide an adequate set of rules for practitioners to follow. They may be useful to address simple problems in which there is a universal solution, but not complicated or complex problems which defy simple solutions.
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