The Anti-Fragility of Health

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NEW YORK –Mareeg,com- Nassim Nicholas Taleb, perhaps best known as the author of The Black
Swan, has written a wonderful new book called Antifragile: Things That Gain from
Disorder. According to Taleb, things that are anti-fragile – mostly living things –
not only resist being broken; they actually grow stronger under stress. When coddled
too much, they grow weaker. Evolution is an anti-fragile process.

In the broader physical world, occasional minor forest fires eliminate underbrush,
reducing the risk of major conflagrations. Small ground tremors can ease seismic
tension and forestall big earthquakes.

Likewise, a healthy economy is anti-fragile, and requires more than just the absence
of poverty. In a strong economy, stress improves productive capacity: a short
recession or a minor shock gets rid of weaker players, so that employees and capital
can shift to more promising companies and sectors.

The same logic applies to organized violence. To quote the playwright Jonathan
Larson, “The opposite of war is creation.” The non-profit organization Peace Direct
seeks to foster not just a state of peace, but an activity that it calls
“peace-building” – active collaboration, conflict resolution, and the like.

What are the equivalent terms for health? Most dictionaries define health as the
“absence of disease.” But, in those terms, it is not a compelling proposition for
people to “invest in health.” How can you invest in a vacuum?

Of course, we do invest in health care. But that is like investing in auto repair –
allocating resources to repairing damage, rather than to improving safety technology
or brightening traffic lights. Health care is what we wield when inactive “health”
has failed to keep us healthy: the immune system has been overcome by a pathogen, or
too much (bad) food, alcohol, smoking, recreational drugs, or stress – perhaps
compounded by too little sleep and exercise – have compromised the body’s normal
operation. Even if we are unlucky and suffer from a genetic condition that cannot be
prevented, it often will still be easier to address in an otherwise healthy person.

Health itself is the capacity to undergo stress and react positively to it –
anti-fragility in a specific context. For example, without exposure to infectious
agents, the human immune system will never learn how to ward off invaders and may
even turn inward, as in auto-immune diseases. Muscles need to work (and be stressed)
to grow strong. The discomfort of hunger impels us to eat.

At first, the notion of producing health sounds a bit pompous, like “ideating
solutions” or listing “legal intervention” (by a policeman’s bullet) as a cause of
death. But it is a concept worth exploring and promoting.

First of all, producing health connotes an activity, not a state. You cannot simply
avoid disease; you have to do something to promote creation of the desired capacity.
Like education, health ultimately demands the active participation of the
individuals involved.

Producing health requires investment – in good food, in a pleasant and non-toxic
environment, and in jobs that motivate people to work and feel productive. (And
perhaps it requires investment in, say, making bad food unappealing, if only by
making good food cheaper – or even subsidized – and more convenient.)

But producing health also requires “co-investment” by the people involved – that is,
getting them to exert themselves to increase their “health productivity,” just as a
company needs to motivate its workers to increase productivity. And, as in
companies, intrinsic rewards, challenges, competitions, and the like are often more
effective inducements than money.

In short, in a world of empowered consumers who book their own seats online, we need
empowered “health producers” as well. Of course, the benefits of booking online are
fairly immediate, while the benefits of health production may be more distant (and
less tangible). But at least we are developing better measurement tools – not just
mobile self-monitors and games, but soon also non-invasive blood tests – to make
that easier.

Players in the health-production business include not just companies and employers,
but also national and local governments, health systems, schools, and buildings. All
of them have a long-term interest in the health of the people they serve and in
building up their anti-fragile capacity.

Yet I confess to doubt. Getting the language right is easy compared to actually
delivering on the promise.

To extend the analogies a little further, over the past few years, employers have
discovered the importance of a good environment – everything from comfortable chairs
and easier-to-use software to better coaching and more useful feedback. In good
companies, employees are treated like volunteers and motivated, not manipulated, to
produce heroically. People enjoy their jobs, work harder to please their managers,
and are more productive. But there are lots of places – we all know them – where
that knowledge just is not applied.

I cannot imagine that it will be all that different with health production. When it
comes to producing health, virtually everyone is a volunteer. (The sick people are
the non-volunteers.) And, just as some companies are role models, so we will have
health-production role models. With the right language to understand what they are
doing, we are more likely to be able to emulate them.

Esther Dyson, principal of EDventure Holdings, is an entrepreneur and investor
concentrating on emerging markets and technologies. Her interests include
information technology, health care, private aviation, and space travel.

Project Syndicate, 2014

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