Collapse What the mute Statues of Easter Island have to tell us about health care Ian G Rawson, PhD The Trillium Centre

Many societies have disappeared from their original locations, leaving only traces of what their lives were like while they lived there. The ancient Maya, Easter Islanders, Greenland Norse, Anasazi, and other cultures leave only subtle clues as to why they abandoned their traditional homes. Jared Diamond, in his book, Collapse, chronicles the decline of these civilizations and finds that the causes were complex, but often shared several common themes. Primary among these is the over-exploitation of resources in a fragile environment, and a failure to interpret the danger signals which the ecological environment sends. The same may be said about health care in the US today.

Cooperation Fragile Ecosystem Overexploitation

The Easter Islanders arrived from Polynesia and found an island which looked very similar to the ones they had left. Except it wasn’t. The soil was shallow and plants had a fragile existence. The Easter Islanders built statues of their ancestors, moai, near the coasts, rolling them from the quarries over logs. The trees were not replanted, and eventually the last one was cut, and the deforestation affected the climate, reducing crop production. As the residents faced starvation, they abandoned their island home. Diamond asks: “What was the Easter Islander thinking when he cut the last tree on the Island?” How could the residents commit ecocide, in which ecological collapse leads to a threat to the population? Is there an analogy with health care, with a limited resource base (insurance) and continuing assaults on the ecology (reimbursement, malpractice)?

Competition Ecocide Depopulation

Much of the stress on the environment came from competition among the social groups to build larger and more complex statues, hoping to appease the spirits and return the island’s productivity. The expenditure of caloric resources in unproductive activities only exacerbated the imbalance between the population and the environment. The pursuit of a miraculous salvation also impeded the development of more appropriate exploitation techniques.

Competition Edifice Complex

The Maya also competed by building large temple complexes, and requiring the production of foodstuffs for economically unproductive workers. Eventually, food production in the peninsula declined so it did not support the needs of the residents, and competition for food increased, turning into violence.

Fragile Ecosystem Climate Cycles

Instead of attempting to adapt to changing environments, the Maya attempted to control the environment through spiritual means. As the climate cycles in the Yucatan region passed through a series of droughts, more temples were built and ceremonies were conducted to change the course of nature. Can we see some similar trends in health care, in which a failure to interpret trends leads to unproductive and competitive strategies, rather than adapting to the changes?

Competition Conflict Ecocide

Ceremonial games were held between neighboring groups, and as the skulls on the wall of the ball court show, losing could be a dangerous proposition.

Fragile Ecosystems Climate Cycles

The Norse came to Greenland seeking new lands, and thought that they had found a familiar environment. Greenland was not similar to their homeland; it is a harsh and unforgiving environment, and the Norse lived through a number of climate cycles of increasing cold. This affected their food production, and eventually those who could not leave the island starved, or possibly reverted to cannibalism.

Imported Culture Overexploitation Class Conflict

The leaders of each settlement group controlled the resources, keeping much of them for themselves, and leaving the other residents with little to live with. In trying to maintain a traditional way of life with herds of cattle, which destroyed the shallow soil, the Norse changed the ecology and sowed the seeds of their own destruction. Is health care pursuing traditional strategies to exploit the environment, instead of adapting to the cycles of change? And what impact might this have on the populations we serve, especially the most vulnerable?

While the Norse and their cows were starving, the Inuit residents of coastal Greenland pursued their traditional food production techniques, and maintained a balance between their population and the ecology. The Norse disappeared from Greenland, but the Inuit remain today.

Competition Fragile Ecosystem Over-Exploitation Ecocide?

Health systems continue to build dramatic new buildings, competing with other systems for control over services to populations, usually with adequate health insurance. Is this a productive use of scarce resources? What impact does this have on the environment of a diminishing economic resource base?

ISEP “It’s Someone Else’s Problem” Suppression of doubt and critical thinking Refusal to draw inferences from negative signs Persistence in error

Several tendencies guided the Maya, the Easter Islanders, the Greenland Norse and others toward self- destruction. Each individual told themselves that whatever was happening was not their problem, but someone else’s. As the climate cycles became more extreme, the populations and their leaders continued to persist in their belief that the trend was not increasingly dangerous. Instead of shifting their exploitative techniques to methods which adapt to the environment, they continued their pursuit of traditional, and destructive, techniques. Are there analogies in health care today? A suppression of doubt? A persistence in error?