International Journal for Quality in Health Care Advance Access originally published online on June 20, 2005
International Journal for Quality in Health Care 2005 17(6):541-545; doi:10.1093/intqhc/mzi060
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Perspectives on Quality
Hunter-gatherer human nature and health system safety: an evolutionary cleft stick?
Centre for Clinical Governance Research, University of New South Wales, Randwick, New South Wales, Australia
The stunning archaeological find of a new species of human dubbed the hobbit, formally named Homo floresiensis, is a reminder that humans and hobbits are evolved for transient lives, subsisting in an environment radically different from that of contemporary societies. Although the problems facing health systems are well documented, few scholars have taken an evolutionary-level approach to understanding them. By considering the nature of humans as adapted not for modern societies but for hunter-gatherer existence, and examining what humans were evolved for, new light can be shed on contemporary behaviours exposed by the medical inquiries into what is going wrong in acute health systems. Investigation of two of these inquiries shows how health professionals under pressure typically default to tribal behaviours, have recourse to hierarchies and engage in turf protection routines. Those who have conducted studies into iatrogenic harm or presided over the medical inquiries have argued that culture change is the solution to health care’s ills. This is likely to be much harder to institute than some people realize, especially given our underlying hunter-gatherer nature. This is an evolutionary cleft stick that has not been factored in by those optimistic about health sector reform. The implications are that we need a deep understanding of human nature in addressing health system problems and to recognize that profound culture change is more challenging than many believe. Paradoxically, it is when humans are faced with seemingly intractable problems that a collective way forward might emerge.
Keywords: cooperation, evolution, health systems reform, human nature, hunter-gatherers, iatrogenic harm, medical inquiries
Address reprint requests to Jeffrey Braithwaite, Associate Professor, Director, Centre for Clinical Governance Research, Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia. E-mail: j.braithwaite{at}unsw.edu.au
Accepted for publication May 26, 2005.
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