Worldbuilding 202: Healthcare
Greetings and slype! Well, I might be walking there, I might be walking there right now to sneak up on you… in your house. Anyway, as we know in life, there are two certainties in life: death and taxes. We might not be able to delay taxes, but we can make death come later with healthcare!
Definitions
I love me some good definitions! So what can we make this time? Well…
Healthcare is when one individual or group attempts to cure, heal, or remedy an illness or a disease.
Pretty straight forward, right? Yeah, not quite. If you read my blogpost on illnesses and diseases, you’ll see what constitutes an illness that is extremely difficult to define. Which brings us neatly too…
Cure the acurable
I know acurable is not a word, but I am going to define it here. A- means without, so acurable refers not to something that cannot be cured–that would be incurable–it refers to something that does not need a cure of anything. Having a right hand is acurable; having a sixth finger is most of the times acurable. Those weird skin growths that are not cancerous and pose no threat? Acurables. So, in essence, it’s anything “not normal” that people think doesn’t need to be in any way corrected or fixed.
Why do I bring this up? Well, to explain that, you will have to understand that acurable is somewhat culturally dependent, as I explained in the other blogpost about illnesses. What one culture might consider an acurable, another might consider in need of a cure. I am, of course, by no means saying all of those are equally valid or should be considered equal; I am saying that it is useful to understand this when making your own cultures. What do they consider acurable?
Now, the main point here is that as societies try to do healthcare and deal with illnesses, it is a matter of classifying what needs to be included in healthcare. When it comes to biology, variety is the name of the game. So there are a lot of differences that will range from “peculiar” to “extremely disruptive” and everything in between in not one dimension but seventy eleven different ones. Of course, what people put into the category of acurable depends on culture and views. They can, however, put a lot of things in the “not acurable” category that they want to fix. It can be because they believe something can be fixed, something must be fixed, something needs to have a way to cure even if they don’t know it now, etc.
Historically, considering something acurable to actually be something that needs a cure and is capable of being cured has happened a lot. Examples of acurables that got put into “not acurable”–should I say inacurable? Probably not, that will get confusing–include, to this day, anything queer, some queer elements of a person but not all, anything autism-related that is beyond “eccentric,” and lots of the more severe mental health issues. We even have examples of the opposite, where a lot of things were considered acurable which we today consider something to be cured. Again, a lot of mental health issues such as depression, anxiety, etc, were originally put there.
So, when you do your healthcare system, think on how they will throw various conditions and variations of people’s experience into the barrels of acurable and not-acurable, maybe nonacurable? Nah.
Stages of healthcare
Gasp! You’ve been diagnosed with an acute case of healthcare! What can you expect at each stage of development of the healthcare system?
Stage 0
AH! Someone is sick! What are we going to do? Nothing, there is nothing you can do. Medicine? What’s that? Sure, granny might know some homebrew concoctions that may or may not kill you in its attempt to actually cure you–honestly, most likely you’ll die anyway–but hey, you got chicken soup with cactus fluids in it!
This is more in the tribal era where people have not started forming large scale societies yet. Though, despite my joking, they can find, over a long period of time, a great deal of things that work for a myriad of conditions. There just isn’t any methodology to it. The one who gives healthcare here can be anything, granny, spiritual leader, or the guy who is weirdly defensive about that bush with strange berries.
Stage 1
Society has started, and people actually have writing! What a marvellous thing it is. With this, we, of course, have people who specialise in this and that. Some specialise in writing, others in blacksmithing, others in curing whatever ailment you happen to have.
This does change things in terms of society. Instead of most tasks being divided somewhat between everyone, and maybe an old granny that knows it all too much alone for comfort, you can have multiple people specialised and part of their job is to pass their knowledge on. This is likely where the hippocratic oath of your society will start to emerge.
This helps maintain knowledge but, as macabre as it might sound, this also helps a lot of exploration of medicine as you have more willing guinea pigs available. And by willing, it is more of a “We have nothing to lose trying” when it's a new maybe remedy.
Stage 2
Oh, you got a serious case of healthcare here! But we can still kill you, so no worries! At this stage of healthcare, people have truly started to understand that all kinds of things in nature and even not of nature can heal. They definitely start poking around inside to see what makes the body tick.
If you do this in your world, people are trying to be more systematic and even look inside the body to see how it works. Sure, you got that pesky problem of people actually DYING if you start removing organs and they lose that blood liquid. Who knows what that substance does, anyway? Only one way to find out!
Unfortunately, the quickest way to get information in this era is also the most unethical; honestly, it goes for all stages, but here, we have very little else. Doctors want to know about the body, and dead ones can only tell so much. Still a lot, but we are just getting started in our healthcare project.
Stage 3
Aw man, you are almost certain to live now! Well, we’ll keep doing our best to kill you! Medicine is a good and proper discipline, and not only that, people are starting to realise it is a bigger issue than the individual. Hospitals come about more frequently in order to help the patients better. Not because having lots of sick people in close quarters is the best; it is terrible. But because it is more efficient with specialists.
Medicine has now started to advance to the point where doctors have to specialise in very narrow disciplines. The body of knowledge and understanding of how diseases work is growing exponentially, and we no longer even need to sacrifice people to Nurgle! Please don’t sue me, Game Workshop! 😨 At this stage of healthcare, diseases become less of issues and even heavy injuries start to become more survivable if they don’t kill you immediately. Vaccines pop up either here or late stage 2. This is where humans currently are.
Stage 4
I’m giving up; you’re gonna live now no matter what we try! This is when healthcare and medicine have gone so far that the people can cure anything that is possible to cure and might even be able to cure the incurable! Now, that is some shit that needs to be done more of, and not just genetic engineering like in Gattaca. But in general, what happens in a society that can cure anything in biology that they for any reason think is wrong? Scary.
So yeah, at this stage, short of instantaneous death, most injuries can be healed. Most diseases are curable. Cancer is no more, etc. Aging can even be a forgotten thing. For obvious reasons, taking this to the logical extreme is incredibly boring for any storytelling unless that is the point you are exploring. You can decide how godlike the people are at this stage as a creator, but be careful here. It is easy to get cogs that don't fit if you are not careful.
Healthcare pill
So how is healthcare ACTUALLY provided? It depends a lot on at which stage your society is. Stage 0 is pretty much “Hope you survive long enough for it to have a miniscule maybe effect.” Stage 1 and 2 tend to have a much more personal touch to them. The doctor, shaman, whatever you call them, have a much higher proclivity to know the patient intimately.
This is because most people will, in those later eras, live in small villages doing farming where if you are lucky you have a specialised doctor, or if you live in a town or city, you might have less than a handful to go to. So unless it is a one time drop in, they’ll get to know you fairly quickly and know the ins and outs of your life. You might even pay for the services with food and, well, your own services. This is also the era where a lot of it is “Endure it until it stops being a problem” so many things we today would go to a doctor for would never be something you go to get help for.
At stage 3, however, the sheer volume of patients and illnesses to deal with is too much. This is where a lot of the holistic idea of healing gets lost. Holistic healing is the idea that to heal, you need to focus on the entire body to heal it rather than the aching issue. Leaving the holistic idea behind was a necessity historically, and, if you ask me, an inevitable outcome as knowledge progresses and you start focusing on healing specific parts of the body, resulting in the person getting better.
While stage 3 requires moving away from holistic healing, lately, in our world, it has been getting a lot more traction. Who would have thought that a complicated interconnected object like the human body could have a lot of things affecting a lot of the issues that people experience?
I am mocking it, but it is easy to fall into the trap that you’ve done all that is needed. And for a huge swath of ailments, you only need to address one part, and once that is done, the person is better. Infection? Kill bacteria. Viruses? Kill them. Broken leg? Heal that damn thing. The success rate of this focus is so high that it is inevitable with how the human mind works that it will result in focusing on the specific system, and people forgetting holistic thinking.
For stage 4, I cannot say how it would be because, well, it hasn’t happened yet. But I think there will be a mix. Holistic thinking will be back and flourish, but at the same time, you will have to focus on specific areas for the simple reason that the amount one has to know is simply too much. Even with AI eventually helping, the human must be there to make the final call. But you can make it entirely automatic if that is how you imagine it; I just won’t be going to your doctors.
Universal healthcare
I’ll say right out of the gate: if you are at stage 2 or earlier, you can kiss this goodbye. It ain’t happening. States are not strong or wealthy enough (well, they are at stage 2, they just focus it on other more pressing matters). As we know, war is more important than healing people! These coincide with the mentality that land equals wealth. In that kind of mindset, why does healing people matter? They are not the producers of wealth, that is land.
But as the value and producers of a nation's wealth goes from land to the workers, well, a sick worker doesn’t produce work, which means no wealth is made. And worse, they cost money! Even if you say, “Eh fuck’em,” they cost! They can’t get food, might be cast onto the street, and what do hungry, desperate people do? They steal and commit other kinds of crimes! Which means you need law enforcement and courts and… it gets expensive FAST. So someone had an idea… What if we help people be healthy and productive, and if they can’t work, content enough to not become a problem?
I know, an amazing idea. Would you believe me if I said it was a strong conservative man that came up with the first form of universal healthcare and the welfare state? It was! Otto Von Bismarck, to be exact. It was partially to improve workers productivity and keep the Prussian, and eventually German, state stronger. It was also a giant middle finger to the growing socialist movement. His idea there was that if he gives the workers universal healthcare that benefits the state and people anyway, then the socialists have one less platform to gain any support on. And you know what? He was right.
After that, the world noticed that it was indeed boosting productivity, and a lot of experimentation on how to do it was done. The earliest attempts were insurances that people paid for on their own, which had some mild success. But Bismarck really went for the one insurer for everyone, if I recall correctly. I talked about various scales in my post on socialism, and we have here the monoinfinite payer scale that I discussed, which is the scale between mono, where one entity pays for all, and infinite, where everyone pays for their own.
Early on, you have the infinite one, where all pay for healthcare on their own, and most nations have settled on one payer for all healthcare of the citizens. It is simply the most efficient for any state that wants to maximise the productivity of its citizens, and once people are the producers of wealth, that is what states tend to want, even in dictatorships. Albeit they might be incentivized to not have it because too healthy of people can start a revolution. Oh crap, I think Supreme Revolutionary Leader is approaching!
Success becomes failure
As medical science progresses, and you get into stage 3 and beyond, healthcare becomes susceptible to its own success and the damage this success is causing. What damage, are you asking? Well, let me paint you an image: you live in 1600, tech level-wise, and life is going well as you work on the farm. It is a heavy day, but as a Raixhe, you’re used to hardship.
One day, your friend comes over, coughing and looking horrible. All over their teal skin are thorns growing out. Thorns here and there are normal, but the quantity looks horrendous, and worse, each and every one is at a varying stage of decay and outright rot. Some are falling off, revealing open wounds where coagulated blood has patched it up. They have thornrot and are a dead man walking, or as good as dead, as far as you know. If your children catch it, they are certain to die, and there is nothing you or anyone can do about it. It is a scourge that has plagued your people longer than civilization has existed, even if you have no clue beyond it being a recurring plague.
I used a fictional disease because smallpox is absolutely disgusting and has been eradicated. Thornrot has, in my fictional universe, suffered the same fate as smallpox, namely eradication. The point is that when you are surrounded by such horrors, and you expect to lose family members to it, you know how bad it is. It is tuberculosis, in a way, except it is way kinder but sneakier.
As medication improves, vaccines will be discovered and diseases will disappear, albeit most will remain. But with how rare they become, people forget the horrors that once were and because of how stupid the brain works, it is hard for it to understand the horrors even if written or in pictures. It has to be seen directly, experienced by loved ones or oneself, before people start internalising the emotions and horrors.
But they don’t; thanks to the success of healthcare, they become complacent and imagine it was nothing like the stories told, not realising they are right. It was never as the stories told; it was a thousand times worse. With this complacency comes a rise in cases, a disregard for the healthcare, and a continuous cycle of diseases increasing only to sink down again, and rise, and down, over and over as the complacency spikes, goes down, and so on.
It is tragic, isn’t it? That the one thing that can destroy healthcare is its own success. But it is important to know this will happen in all settings where healthcare is predominately extremely successful. Keep in mind, though, that I am not only talking about science denial or healthcare denial. Those are the worst of the worst here, but I am also talking about the complacency that strikes a large swath of the population even if they mostly listen. The deniers are a product of this, but they are products of much else that I will not go into.
It is important to know this and know where in the cycle you are, or if you are right at the beginning of extreme success. When the horrors of diseases rear their ugly heads and the harm becomes visible, people are much more prone to listen afterward when the horrors are still in the mind. But if it is in the lull of comfort, people are more prone to be too calm. You can even have characters that do this, and they are not evil, deniers or the like, they are just humans.
Summa Summarum
Healthcare is a complicated bitch, and I have only barely scratched the surface of it. Use the 4 stages of healthcare as a guide to decide where your society’s ability and behaviour is likely to be. Stage 3 is the big difference, and stage 4 is entirely speculative in how it goes. It depends on how you do your world.
Make certain you also think about what are acurables in your society and what are not acurables. It will inform the opinions and views of the society. Remember also that if you do 20th century or after, you are likely to have single payer systems for healthcare as that is what most reach. If you chose to not do that, what is your society REALLY after? Because it is not after productive workers then.
I think that will be all for today, now I will run before the Supreme Revolutionary Leader finds me!
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Copyright ©️ 2024 Vivian Sayan. Original ideas belong to the respective authors. Generic concepts such as acurables, healthcare, and stages of healthcare are copyrighted under Creative Commons with attribution, and any derivatives must also be Creative Commons. However, specific ideas such as thornrot and Raixhe and all language or exact phrasing are individually copyrighted by the respective authors. Contact them for information on usage and questions if uncertain what falls under Creative Commons. We’re almost always happy to give permission. Please contact the authors through this website’s contact page.
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