Tuesday, December 29, 2009

Atul Gawande and improving

I make it a practice to pay attention when I find something by Atul Gawande.  He sometimes writes in The New Yorker and he has an article in the Dec. 14 issue on health care costs.  As usual, his subject doesn't sound like much and as you start reading, you may get depressed.  He recites facts and figures on US health costs and shows they are bad and getting worse.  But then he reveals that the US had very similar problems with food costs in the beginning of the 1900's.  That item covered 40% of the average household budget then.  Agriculture employed a great portion of all workers.  But with good government assistance and guidance, slowly and step by step, costs were driven down by research and communication.  Right now, the US is doing pretty well in that area.

There is such a thing as good government guidance and one version of it is the extension agent.  Growing up in the city, I had no experience with extension agents but they are a big part of Wisconsin.  A section of the University of Wisconsin is called UW Extension.  This is true of many other state universities, too.  The "Wisconsin idea" is that the "borders of the campus are the borders of the state".  It was seeing that idea in place and in practice that made me determined to move here.  The original idea of a university was knowledge of writers of the past.  It was thought that wisdom lay in the writings of the ancients, such as the Bible, Plato and Aristotle.  The educated and happy person gained wisdom and happiness by familiarity with such writings.  When I studied the history of higher education, it lld was still the case that universities all across the world tended to hold with that idea.  But when the Northwest Territory was opened for settlement in the US (the area we call the Midwest now), the law specified that a portion of each township should be set aside for a school.  In addition, each new state was not to be outdone by the eastern universities and founded a state university of its own.

Those new state universities were called on by the new settlers to solve problems, their current problems, not just be repositories of the past.  Of course, many of the problems related to agriculture and food.  So, extension agents were housed at scattered points throughout the state to bring problems to the campus for research and solutions to the citizens for use.  Thus, the motto that that borders of the campus are the borders of the state.

Note: Gawande is the son of two immigrants who are both physicians.  They are from India.  He is a staff writer for The New Yorker and an associate professor of medicine and public health at Harvard and he is a practicing surgeon.  Keep an eye out for his writing.

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