IN THE BUBBLE JOHN THACKARA - witz cultural

One online user of a support service who runs an online mental health
directory, Zyra, told Batty, ‘‘The internet is like Speaker’s Corner in Hyde
Park, except it has global coverage. It means that drug companies, professional
organisations and government can no longer ignore service users.’’
Mental health websites contain a wide array of information, news and
discussion, user feedback on medication and side effects, alternative approaches,
counseling, and therapy. Coping strategies for partners, friends,
family, and colleagues are important features. Care is a time issue, not a
technology issue. The biggest users of today’s health systems are people
with chronic conditions—those that are long-term, but not in need of instant
attention. In Britain, 60 percent of consultations with family doctors
relate to chronic disease management; in the United States, people with
chronic conditions consume 78 percent of all health care spending. And
yet health systems in these countries are configured to focus on acute illnesses—those
with a rapid onset that follow a short but severe course. This
mismatch between supply and demand is reflected in the results of a study
to identify five ‘‘key dimensions of patient experience’’ carried out by Britain’s
National Health Service. The study found that time—not staying
alive—is the most important factor for citizens: waiting times for appointments,
time needed to access services, and time given to discuss health/
medical problems face-to-face with health care professionals. A similar pattern
is found in the United States where, in 1997, doctors spent an average
of eight minutes talking to patients—less than half the time they spent a
decade earlier. ‘‘The average person with diabetes spends about three hours
a year with doctors, checking prescriptions and general health. That same
person spends thousands of hours a year self-managing their condition,’’
say Hilary Cottam and Charles Leadbeater in their book Health: Co-creating
Services. 28 Cottam and Leadbeater also point out that the largest health care
provider in Britain—and bearer of the largest time burden—is not the National
Health Service, but the family. Between 80 and 90 percent of health
incidents are dealt with at home—from giving aspirin to a child to the
long-term care of an elderly or sick relative.
Design for Our Future Selves
Conviviality 121
One of the greatest of human achievements—longer life spans for many of
us—also worries policymakers. They calculate what it will cost the state if