We consider chronic diseases as the status quo, but we find that for the most part, such maladies crept into existence, growing from a very small base. They grew with poor habits, sedentary lifestyles, and excesses. The U.S. Institute of Medicine published a curious book recently, one that provided an explanation for poor health outcomes in the United States. Americans, according to the work, suffer due to a structural or an endemic disadvantage. Although we spend far more money on health care, our poor choices and a stubborn insistence on individual liberty doom us to have shorter, more healthy lives than the rest of the world.

There is a deeper concern here, of course. Aren't Americans known to be better educated than most? Higher education is an area of relative strength in North America, after all. Education should count for something. Is it possible that some kinds of education are counter-productive with regard to health habits? Maybe it is a post-modern, post-Cold War thing. More than likely, it is a very "redneck", very “glued to the television” thing.

The culture of consumers

As it stands, there is an ebb and flow to what we have inherited in terms of our food. Once commercial interests get committed to something, it is very difficult to “right the course”. The question, though, is what can credibly offered to them to turn the tide. The fictional society represented by the Pixar movie Wall-E provides an interesting example. The people on the “endless spaceship cruise” had evolved in ways that most would of us not like. In a sense, you want say that no one would want. Their limbs had atrophied. Their shapes had rounded themselves. There was little that their bodies could do to bend and articulate articulate, and they couldn't really navigate any kind of surface. Perhaps they could have learned to swim.

Spending time in public, particularly in the richer parts of the world, one can observe something of this phenomenon. Many, particularly from older generations, have lost much of the ability to move, to walk and to engage in daily activities in normal ways. We are not really talking about people with disabilities per se. This state of affairs is largely becoming the mainstream of society.

Much of what these people have lost, they surely attribute to age. Some degradation of performance surely can be associated with aging, but not all. Much of the problem, in fact, has nothing to do with age, and in fact, given wisdom and perspective, many aspects of our physical selves and our appreciation of them grow and improve as we get older.

We often hear the statement from people that they would never give up a certain food item or dietary pattern, not under any circumstance. On the face of this, you would have to ask, would you give it up if you were to learn that that is the thing that has taken all of these things away from you, not age? Assuredly, the declaration of what people will not “give up” often can be attributed to a fear that, experiencing the loss of abilities and associated joy, attributed to age, they certainly are not going to abandon about the only thing left that they enjoy, taste.

The fear of giving up that last source of joy seems rational under the circumstances, as it is fed by experience. Often, it is wrong. We learn from the success of the integrative medicine practice that people can reclaim much of what we had before in terms of mobility, strength, and physical capacity – and lack of pain – and enjoy heightened taste and satisfaction from food.

The Fischer/UK solution to the culture of providers

The recent Fischer Inquiry in the UK constituted a great service to the public in general even if UK authorities do not honor it with sufficient reforms. Indeed, a continuation of the status quo is unacceptable. Whether it is a cultural element that serves to discourage meaningful changes or other economic or social interests, no level of scientific breakthroughs will be sufficient to change the system.

Culture is a murky thing. Drawing on the culture card by Robert Fischer can be considered something of a drastic and vague act. What can be easier than to refer to culture as the cause of anything, as in “the culture made me do it”. Indeed, there is some vagary in all of this but there are such things as organizational and sociological patterns. Persistent work in an ambiguous environment is burdensome. With time, it can encourage the kinds of callous, counterproductive behavior as described in the UK study. In the medical field, where the stakes are high, particularly in acute situations, the results can be catastrophic.

This is not the unrelenting fate of mankind. This review of knowledge-driven universal coverage focusing on the history of organizational perfection and other positive developments demonstrates working environments and work cultures based on high levels of performance. One factor is clear, ongoing vigilance is needed. Many things can conspire to stop progress. At this time, however, we are in position to bring together the science, the technology, the models, and the commitment to achieve organizational perfection in a more permanent way.