Monthly Archives: January 2013

Healthcare Politics 1

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1) Great health care should be universally accessible to all. I tweeted recently that I was pleased that Obama was re-elected, not because I think his politics are particularly more radical or really that different from those of Romney, but so that Obama Care could have a chance. A chap from the states tweeted back that nothing in life is free, it’s just not the ‘American Way’. The politics of Jesus is clear. He goes to the poor, the marginalised, the rejects and the outcasts. He never creates loopholes to exclude them! He treats the foreigner with dignity and cares for the unlovely. His politics are far more challenging that we would ever allow ourselves to believe! There is no toxic distinction made between the ‘deserving’ and ‘undeserving’ poor. That is a repulsive notion that we must not allow ourselves to be aligned with.

Homeless ManWhere the rich can access better healthcare more easily in the ‘christianised’ west, we need to ask ourselves how and why on earth we have let this happen – the answer is not a comfortable one. When 50 million americans cannot access health care, and a black man living in New York has a life expectancy of just over 40, also true of a homeless person living in London, we have to wonder about our priorities. You are far more likely to die young in an inner city estate from chronic disease than if you live in a middle class suburb. And that is only the health injustice in the west.

We bury our heads when we begin to think of the life expectancy of our brothers and sisters in Africa, in South America, in parts of Asia.kevin-carter-vulture We focus on increasing the life expectancy of the rich (white) ones in the UK to 85 or more, and feel a deep sense of achievement, while all the time, children die of diarrhoea (can you imagine if that happened here?), starvation, malaria, things that are genuinely and inexpensively preventable?! I don’t come at this naively. I don’t think the answer is a quick fix, but there is a kenarchic challenge – to those whom much is given, much is required. So often we hang on to human rights, and make them about me and my rights. We want to become our own mini emperors, where we demand the best for ourselves and the self protectionism sadly drowns out the cry of others. The truth is, we don’t need to make healthcare everywhere worse for good health care to happen everywhere for everyone.

However, we need to allow ourselves to be uncomfortable about the amount that is currently spent per head on healthcare for a wealthy child compared to a poor one…….we need to find new ways to protest, new ways to give, new ways to redistribute resource. But we cannot remain silent and we cannot do nothing. We cannot be like the fat cats who sing our happy songs and forget about justice for the poor. The millenium development goals are now, sadly, a total joke, and yet we could have gone further…….we blame, amongst other things the banking crisis. This is plainly a lie. If we want to live in a way that is like God, and really see justice and mercy filling the earth we live in, then we must learn to prioritise those He prioritises.

Kenarchy and Healthcare – Paradigm

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I think a lot of the time about healthcare. I guess, it’s because it’s the arena in which I spend a huge bulk of my time. I’ve studied and worked within this sphere for nearly 14 years now and it’s something I care deeply about. I think what I will write here will be helpful and applicable to other realms of work, but this is what I know, and so this is where I start – ha! though it won’t be where I finish!!

If kenarchy is about emptying out the places of power, lives laid down in loving and serving other people, then caring about the health of others is a good place to apply it! If kenarchy can be applied to our paradigms, praxis (or politics) and person, then wherever we work, whatever we do, we can use its lens to help us get some focus in each of these areas.

Were I to try to blog all in one go on a kenarchic paradigm, politic and the personal impacts on healthcare, then this could end up being the longest blog post in all of history! So I will break it down into the three subsections, starting with a kenarchic paradigm (the way we see the world). This is big picture stuff and doesn’t massively deal with specifics! For some, these thoughts are nothing new, for others I hope they spark challenge and debate!

Paradigm (with some politics thrown in for good measure!)

These are some initial thoughts on how my thinking about health care has been shaped in terms of the big picture.

1) Great health care should be universally accessible to all, and all should have access to the same standard of excellence, love, and care. I do not see health care as something which is earned or a privilege, but something which is freely given. Of course there are economic implications here, but perhaps if we stop thinking in terms of an economy of buying and selling (trade) and rather think of services that are given and received (exchange) then this may help us. It also questions the huge drive to privatise healthcare, in which money and profit are dangerously the motivating factors, rather than equity. Many of political philosophers writing currently, are calling for a new moral foundation or frame-work from which to establish new ways of being and living. The kenarchic basis here is that God is love and God is healer. God calls us to be like him and we too are therefore to be those who primarily function out of love and to be those who bring healing. Freely you receive, freely give…..

2) As my great friend, Roger Mitchell says “all knowledge is relational”. Too often, especially with intellectual copyright laws and big pharma, knowledge is power. But it shouldn’t be. If we gain knowledge, it is for the benefit of others, for their empowerment, for their betterment. That doesn’t mean there isn’t expertise, or specialism, far from it. We need one another’s knowledge, to honour and draw on one another’s gift, but if we hide it when it could help millions of people, or focus our knowledge on helping those who can pay us most, we need to question our humanity. So much of what we do in medicine, is a symbiotic relationship of learning and teaching. ‘Knowledge power’, just like any power, is not there to be lorded over others or enslave them to us in any way, rather it is for the service of others. An uncomfortable challenge. Knowledge needs wisdom for it to be used properly. The wisdom of God is found in a cross, where the human one, Jesus, gives his life in ‘foolishness’, refusing to bow to the status quo or powers that “know what to do”….but when we keep knowledge for our selves, or use it to make ourselves look clever and wonderful in the sight of others…..we are being less than human…..

3) Health care is diverse. Health care is not just about curing people. It involves some curing, but also some discovery, some therapy and some suffering with others over long periods of time. It is mental and physical and spiritual. It is natural and supernatural. It is about helping people to live well, die well and choose well. We must be very resistant to that which commodifies it into being about cures and results. We need to ensure we honour and use the vast breadth of care available especially for those, who don’t make financial sense or produce obviously fast results!

4) Healthcare is most effective when there is collaboration in place of competition. Time and again studies show that where teams work together to bring out the best in one another and collaborate together, outcomes are far better and those working are far happier than where competition is used as the model. The Kings fund and others have done so much work into this, and there is little else to comment on.

5) Healthcare is service. It is not about profit, or glory or self promotion. It is about serving people. That’s why I love that the health system we have in the UK is called the NHS. Working in this environment should remind us what we’re here for and what our motivation is.

6) Universal healthcare is affordable. It is a complete myth and a lie that we couldn’t afford to give good health care to every one on the planet. We make ridiculous choices as humanity to destroy one another, when we could be living very differently. Healthcare for everyone does not mean poor health care for everyone. Here is a brilliant TED talk by a truly excellent thinker, Thomas Pogge.

7) Healthcare involves joined up thinking and new partnerships emerging. We are stuck in a crazy cycle of a lack of joined up thinking between so many aspects of life and the economy. Plenty of examples of this in the next blog……but for example, health, education, international development, media, sport, as a starter for 10!

My hope is to take these 7 paradigms of kenarchic healthcare and apply them politically and personally……As it says at the top of my blog, when paradigms change, the world changes with them……

Kenarchy – the beginning of a series

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Yoda_SWSBI was watching ‘The Empire Strikes Back’ with my eldest son a few days ago – love that film. There’s a brilliant bit in which (for those odd ones of you, who aren’t into Star Wars) Yoda (the Jedi Master) is training Luke Skywalker to become a Jedi. Luke catches a glimpse of the future and asks Yoda what will happen. Yoda tells him that the future is always moving, and so it is difficult to see. We live in a moment in time, when so much of what we have taken for granted until now is crumbling around us. The ‘rich west’ is no longer the great power that it once was. The globe is changing. Free market capitalism is failing, democracy is being revealed to be the child of empire that it really is and the nation-state project isn’t working. Yet, at a time when everything is shaking, and uncertainty taints our sense of stability I feel a deep hope that there is a future, which though uncertain on one level, due to the dynamics of human interactions, complex choices and external pressures beyond our control, could be one in which the peace and love that humanity longs for, could be more real.

There’s a guy, I like a whole lot! His name is Walter Brueggemann. One of the things he says is that “we must be unafraid to subvert the dominant realities of our time.” There are things, which we assumeWalter Brueggemann to be true, things deep in our psyche which we hold fast that are not really in line with what it means to be fully human. These mindsets, fit into three main categories – firstly, our paradigm, or worldview, secondly our praxis, politics or how we live and thirdly our personhood, or how we see ourselves. If we don’t face up to some of the ways we think and challenge those things then maybe the future is inevitable……

Over the Christmas period, I always love listening to Handel’s ‘Messiah’. I especially love that famous piece from the book of Isaiah, found in chapter 9 v 6 and 7. It says: ‘For to us, a child is born, to us, a son is given. And the government will be on His shoulders. And He will be called Wonderful Counsellor, Mighty God, Everlasting Father, Prince of Peace. Of the increase of His government and of Peace there will be no end.’

Jesus was born at a moment in history when Caesar Augustus, the first emperor to call himself the ‘Son of God’ was in power, in Rome. He comes onto the scene telling people to ‘Repent, for the Kingdom of God is near’. Repent, change the way you think about God, the world, the way you live and who you are. Think differently about the future and what is possible.

Firstly, He challenges the paradigms of the day. Who is this Messiah you wereimgres expecting? You wanted a warrior? Oh, different kind of warrior am I (I’d love it if Jesus spoke like Yoda!). What do you think it means for this Messiah to be called ‘the human one’ by the prophet Daniel? Who do think God is? You think God is a Sovereign Dominator who needs all to submit to Him? “No”, says Jesus, ‘if you have seen me, then you have seen the Father. I and the Father are one. And I have come as a servant, one who pours out his life for others.” Caesar, the one who calls himself Son of God, has not even begun to understand the nature of God. Jesus declares himself to be God and shatters any other understanding we may have.

Secondly, He challenges the politics. He prioritises those most forgotten and marginalised in society. He is the champion of children, he breaks cultural taboos and promotes women. He goes to the poor and the sick. He associates with those of disrepute. He champions the foreigner and the refugee. He declares a new Houses of Parliamenteconomics in which you either serve money or you serve God. He devalues money to be a resource not a ruling power. He stands in the shadow of temple mount, and declares that ‘if you have seed as small as a grain of mustard seed, you could say to this mountain (this whole system established over centuries, which has ended up oppressing and suppressing people) be thrown into the sea, and it would be done.’ At a time when the romans were establishing ‘ecclesia’ as the ruling councils of their cities, Jesus establishes his ‘ecclesia’ made up of a mixed bag of the un-elite, whom he wants to learn how to steward the resources of a city for the good and peace of those who live there. He comes to a contested city, Jerusalem and declares that we are to love our enemies and turn the other cheek…….Shane Claibourne has recently written a phenomenal piece on what Jesus would say to the NRA, in the Huffington Post and it is worth a read.

Prodigal SonThirdly, He calls us to see ourselves differently. To be those who carry light into dark places, hope beyond hope to those who have lost their way in disillusionment, peace to those who are torn apart and warring, love to those filled with hate and grace to those who are broken and rotting. He calls us to recover our humanity, to become like him, the human one. To be those who forgive and so find forgiveness and freedom. To be free from all that which makes us less than human (aka sin), that which destroys ourselves, relationships, other people or the planet.

And so, in challenging the paradigms of the day, the politics (and economics) and even the person as to what it even means to be human, he challenges the powers. It turns out, the powers don’t like it. And so they kill God! And as they kill him, instead of smiting them all, Coventry Crosshe declares forgiveness, he sucks up all the ‘sin’ into himself, like a cosmic sewer, and then declares all things new. A chance to start again. A chance to live and hope for something other.  You see, the powers never counted on resurrection, but love wins! It is, as Aslan calls it, the deeper magic. Love is stronger than death. And so the one who is love, defeats death and brings life. Then He gives us the substance of Himself, the Holy Spirit to fill us and help us and calls us to follow Him, to the same radical, life-laying down love that holds no fear of death because in Him is life in all its fullness.

But something terrible happened. In the 4th century, a theologian called Eusebius and the Emperor Constantine worked together on a theology, or way of thinking about God, that led us to believe that GodConstantine is not just like Jesus, he is, rather, like an angry emperor that wants to dominate other people and have them all come and bow down. So church and empire got into bed together to try to create peace through dominance and created a mish-mash of children, including the Nation State, Western Democracy, Free Market Capitalism, Communism, but none of them come close to the radical Kingdom of God that Jesus spoke of. Too often christians have aligned themselves with these things, rather than having railed against them. Too often, christians find themselves yearning or harking for the ‘good old days’ of the ‘christian nation’. There is no such thing. A nation is not ‘christian’, just because it seems restrained, or has the ‘right’ kind of laws in place. The days of ‘christian dominance’, or christendom, are over. We cannot go back. The context we find ourselves in now, is completely different. It is the future that calls us forward. That does not mean a society cannot be transformed, but top down dominance is not the way of Jesus!

Empire, in any of its forms has nothing to do with Jesus or his life-laying down kingdom of peace.

My friend, Roger Mitchell, honorary research fellow at Lancaster University calls this emptying out of power – ‘kenarchy’, a word coined from the greek – ‘keno’ to empty and ‘archy’ power. It is this that I want to explore more in the next few blogs and what it might be like if we were to embrace this way of life more fully.

What if to have a ‘God complex’ was not to misuse power but to be servant-hearted and to be a one who facilitates and makes room for others so that they can become fully what they can be? What if we were those who chose collaboration and partnership instead of control, manipulation and dominance through competition? What if business, The Futurehealthcare, education, government, finance, media etc were based on these kind of principles? What stories might be told to future generations? My challenge this New Year is to realign my mindsets again with those of the One who is Love. My allegiance is not to any flag or nation-state. I believe our hope for the future comes from embracing an altogether different paradigm, politic and personhood. It is peace I hope for, and peace I pursue and that is going to mean some radically different choices for us as humanity than the ones we are currently making. This year, I resolve to choose life.