Rashawan Raziur Rouf :
The overall health of the population has always been the most valuable asset of every developed nation in the world. However, when it comes to developing and underdeveloped countries (such as Bangladesh) or even low socioeconomic countries, the results are drastically different. The tables are substantially lowered. Furthermore, in critical cases, when these poor socioeconomic nations are hit by catastrophic health risks like the COVID-19 pandemic, the situation deteriorates significantly. Many valuable lives get sacrificed as a result of the pandemic’s delayed emergency response.
One of the major and burning causes of this mass catastrophe is the misalignment of health-care components with disease epidemiology. A magnified view of the nation’s health status indices reveals that the subfields and sub disciplines inside the health system are divided in so many ways that the cumulative choice involving all of the system’s cornerstones against the causality of the problem remains unresolved.
Everyone is aware that Public Health Research is the primary subject for investigating the health state of the general population and the progression of disease. However, this Public Health paradigm is now divided into silos and in a number of autonomous branches that determine the depth of knowledge in the individual sector. Though we have learned a lot about individuality as a result of this, we have also been introduced to the ocean of non-synchronized systems. In the case of major health threats such as COVID-19, this has ultimately made conditions worse rather than better. So, rather than making policy decisions as positivists, we must embrace all of the pillars of public health concerns in health system policy to ensure the general health of the population in the face of major health threats.
Recently, Ritu Priya and her team did a research study that revealed the remedy to this prevalent mis-coordination and came up with a solution to this problem: the critical holistic approach.
What is this critical holism and critical holistic approach?
The term Critical Holism was coined by sociologist Vincent Tucker for health and by Ulrich for ecological thinking and sustainable solutions. Tucker proposed it as a paradigm for merging the holism of complementary medicine at the individual level with the holism of public health. This holistic approach evaluated health in its environmental, social, economic, cultural, and political contexts. Thus, he portrayed it as a solution to the reductionism of conventional biomedicine at both the individual and population levels, with an emphasis on merging completeness and difference. Ulrich proposed Critical Holism as an ecological and systematic thinking approach to address two issues: the impracticality of “holism” in “considering everything relevant” to the problem environment, and the complexity of diverse “rationalities” in ways that can lead to practical resolution in favor of those at the bottom of the power equation. And the approach involving this Critical Holism is the Critical Holistic Approach.
What are the main considerations of this Critical Holistic Approach?
The main considerations and attributes of critical holistic approach are as follows:
1. Critical Holistic approach is a theoretical framework which is elucidated for knowledge generation with a practical purpose of improving population health through means that have been empowering and are emancipatory for all. Thereby, it also encompases the diversity of variability, uncertainty and dynamicity of health, and of its human understanding, as social realities.
2. This approach implies the understanding of health as the capacity to maintain balance under diverse conditions and through diverse biological, psychological, environmental, social, material, cultural, technological and political processes. It explains health inequalities through all these determinants and pathways. It also encounters the power imbalances in society and evolves ways to address them.
3. Critical Holism tends to adopt a value-critical systematic approach which envisages a multi-level, multi-dimensional holistic understanding derived from the perspectives of diverse social segments and actors. Considering the power differentials across them, it gives special attention to voices of the marginalized so as to place them in relation to each other and within the whole.
Conscious epistemic shift to critical holistic approach and bringing causation more centrally is the demand at the peak when another form of COVID-19, Omicron, is knocking on the door to ensure the highest health quality of the population. Cornerstones such as the clinical biopsychosocial model and systems biology, ecological and social understandings of health and illness, realism and complexity theory, all of which are now well established and have advanced over the last four to five decades, must be merged.
How can critical holism be implemented:
The initial stage in critical holism must be the conception or imagining of the system as a whole, a 360 degree-three-dimensional vision. The beginning point would be to establish the broadest possible bounds based on the objective, research questions, and context of the study site(s). The boundary can then be delimited, sub-systems identified, all actors in the problem space identified, social segments with special vulnerabilities in the population identified, critical nodes of relevance identified, all while drawing on existing research and experiential or tacit knowledge of patients, providers, and administrators, as well as diverse communities and sections of society. This formative research would aid in the development of research that takes a critical holistic perspective in a practical and practicable manner. At each stage, the researchers must consider the options accessible to them and explain the reasoning behind the decisions they made while developing and carrying out the research. While being critical about this, they should also document their findings as transparently as possible for readers of their research. The questions should be asked of oneself at each stage of the inquiry providing ‘value criticality,’ as outlined by the formulators.
Thus, considering all these aspects, in order to immediately counter the pre-existing flaws, and for coming to a rational and robust conclusion; the adoption of this overarching theoretical framework of critical holistic approach is the perfect key to the lock.
(Rashawan Raziur Rouf Designation: 4th year student, Shaheed Suhrawardy Medical College,
Sher-E-Bangla Nagar, Dhaka-1207.)
