Five Things I’ve Learned from Glass Cage

By Priya Banati

It is hard to talk about healthcare without the conversation becoming political.  We found Gita Ralleigh’s narrative about carers looking after a patient in his old age in a fictional 2031 to be politically astute, touching and intriguing. Priya Banati’s story is no less touching – and as a professional who is currently working with NHS staff at the Health Foundation, we think her take on ‘Glass Cage’ is a must-read. She also uses the Five Things I Learned format, but in a very different way to  Abadesi Osunsade. That’s why formats are so interesting – they’re structures that give the handrails, but allow for so much to happen in between.

We’re currently working on re-inventing an innovation project for a healthcare client, and have helped the Wellcome Trust explain why it’s important for governments to back Antimicrobial Resistance, as well as helping them visually represent their Theory of Change. We’d love to help you with any similar issues you’re grappling with – reach out for a chat!

My favourite genre for stories after romance is crime drama. The allure of an unsolvable mystery is hard to resist on screen or in life – is it because we crave certainty? Questions that arise in a story or in life charge us up. We feel compelled to find out what happens next and make sense of it through our lives.

Gita Ralleigh’s story begins with questions too – small ones that push against our understanding of what is normal. The protagonist, in this case, responds by trying to answer them. Her story feels familiar because it’s what humans do really well – we sleuth our way through uncertainty.

 Questions that arise in a story or in life charge us up. We feel compelled to find out what happens next and make sense of it through our lives.

The humans in ‘Glass Cage’ seem to be pitted against machines propped up by a health delivery system referred to in the story as ‘BioData’. And this – the equivalent of perhaps what ‘Star Wars’ meant for my generation – is the enduring mystery for the generations that follow us, for them to make sense of for the rest of our lives.

Where does health begin? How does it end? And what will support it through its many stops and starts in between? For me, the story took me back to when I felt most vulnerable in a health setting. In 2011, I lost my son. I gave birth to him and held him in my arms till his heart stopped beating. It was only in the taxi ride back home that the horrors of my inadequacy to support his life or mine set in. Though at that time, I mistook my tears for grief.

From there, my life unravelled: Like Hemingway’s character in ‘The Sun Also Rises’ who said that going bankrupt happened in two ways – gradually, then suddenly. Gradually I lost interest in my work. Suddenly, I quit my job of 16 years and found myself working for public institutions – those that support our health in the spaces between our hospitals and our homes.

Five things I’ve learned about health and relational bankruptcy: 

One

Our wealth is beyond the currency in our banks or the worth of our possessions – it is mostly relational. Nowhere does this lesson shine brighter than in our own health. Those who have reliable and enduring families, buddies, colleagues, bosses or service providers will live longer lives and most of it in reasonably good health. I reckon these people perhaps mirror the 3-5% of us who sit on the top of our traditional wealth pyramids. This is perhaps why we have become over-reliant on this notion of spending our way out of ill-health. The age old adage ‘Health is wealth’ is true but the converse is not. In ‘Glass Cage’, for example, being on a platinum care path seems to have prolonged the Professor’s life, but not sufficiently enough to deter him from giving it up.

…precision medicine is all about observing, addressing and monitoring life as measured by machines. The context of that life that is nurtured by our relationships is mostly ignored.

Two

Health settings, and the individuals who provide health and care, pay little attention to our relational wealth, the lack of it or the impact of acute or chronic relational bankruptcy on our health. People who show up at GP clinics or A&E, are individuals who can be physically assessed, treated and discharged back into society. The complexity of supporting our relational health in workplaces, communities and homes is not scientific enough to be observed, addressed or measured. Instead, precision medicine is all about observing, addressing and monitoring life as measured by machines. The context of that life that is nurtured by our relationships is mostly ignored. 

Three

There was a time when the relationship between an individual and their doctor was special, even sacrosanct. The medium they shared was relational. Individuals and their doctors participated in similar rituals in their local communities. They shopped in the same places. Their children went to similar schools. They prayed and celebrated together. 

People who experienced this once and have lost it since feel cheated, scared and ill-equipped to adapt. Those of us who have not experienced this find virtual consultations special. Our children will perhaps find receiving care from robots special. The transfer of the medium for care from relational to technological was perhaps gradual, then sudden. Like the protagonist in the story, I too find myself filling out forms on my mobile device when requesting care. When I click ‘Submit’ something happens silently somewhere and, if I am lucky, I will get to speak to a GP.

Four

Health and care management has been caught out by COVID and hopes to rebound with opportunities to further mechanise health and care work.  They will look to the Fords, Facebooks and Amazons of this world to ‘move fast and break things’, drawing from examples of how such organisations sell products by predicting needs through mass surveillance. Traditional boundaries – that afforded people some nurture, privacy and dignity before, during and after care – will most likely be sacrificed at the altar of big data. Human faculty will be sacrificed for technical ones. This too will happen gradually, then suddenly. The ‘huge boon’ of Artificial Intelligence as heralded (and lamented in my heart) in the story, is not fictional or futuristic. It is being constructed on the ‘broken glass’ of human relationships – gradually, then suddenly.

We can learn to observe, address and measure our relational wealth. If we can do this in health and care, we can reverse that pyramid and give more people the gift of a healthy life.

Five

Is there hope still then? Humans, like nature, are creative beings who adapt through learning. We can choose to put this unique human skill to work so that we can slow down and exit this seemingly inevitable and solitary road to ill-health. We can do this by renewing our relationships with ourselves and the spaces we cohabit with other living beings. We can learn to observe, address and measure our relational wealth. If we can do this in health and care, we can reverse that pyramid and give more people the gift of a healthy life. We need not, as the author suggests, ‘search in vain for the tiniest glint of broken glass’.

Priya Banati has over 20 years of experience leading diverse teams & communities through people-centred creative challenges that nurture the flow of ideas and equips them with the confidence and skills to take part in a collaborative design process. With a background in architecture, she brings her passion for places & spaces combined with insights from her research in human-machine collaboration to tackle a broad set of challenges across multiple industries. She is a devotee to the written word in all its expressions and an avid supporter of multicultural experiences. She currently works for the Health Foundation, has previously worked substantively for Accenture and is the founding director of Common Ground Design.

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