Thursday, August 27, 2009

Hierarchies are bad for health

Hierarchies are bad for health.

Marmot studied British workers in the government. The clerical workers had 11.67 mortality while senior administrators had 4.73, less than half as much. Profssional were in the middle at eight. All had white collar jobs--so they weren't subject to occupational hazards such as chemicals. They all had the same National Health Service Health Care and as civil service employees were not subject to the stress of job insecurity. (Medical Sociology by William C. Cockerham citing:

  1. Marmot, Michael, M. J. Shipley and Geoffrey Rose, 1984, "Inequalities in death--Specific explanations of a general pattern." Lancet 83, 1003 to 1006.
  2. Marmot M. G. George Davey Smith, Stephen Stansfeld, Chandra Patel, Fiona North, Jenny Head, Ian White, Eric Brunner and Amanda Feeney 1991, "Health inequalities among British Civil Servants: The WhiteHall II Study" Lancet 337 1387.

Participatory democracy eliminates hierarchies in two ways. People report to randomly selected sets of jurors, rather than Everyone serves as jurors. They will serve as jurors for decisions made by the government. So everyone has an opportunity to be in charge. Some of these jurors would be for the companies in which they invest or have a share.

But the biggest change will be eliminating rules in making decisions. For example, a clerk in the welfare office distributes benefits as per a very precise set of rules. A juror would hear the story of many potential beneficiaries. They would then vote how a limited fund would be distributed among them. A health insurance company determines the precise rules for how much to pay medical claims. This is to attempt to ensure that the money going out to the doctors does not exceed their revenue. A claims handler in this insurance company, thus obeys precise rules, and is at the bottom of the hierarchy.

In my proposals for participatory democracy, the individuals vote on how much to spend on health care, or each type of health care. Then each juror gets a set of claims and a budget and decides the most just way to distribute the money. The jurors decide how to organize the work and what to look at and the order in which to look at it. Marmot reports that low control negatively impacts health and recognizes "workplace democracy." The jurors discuss this and hopefully arrive at a consensus.

Obviously, by following a set of rules, one achieves an efficiency, in terms of less time per case. In a sortition-based system, each decision is made from first principles each time. Each decision requires a large number of people, say twenty people per decision. In a system where rules are specified, one person can apply them. It is an empirical question, is the unpleasantness of having individuals apply rules greater than the unpleasantnwss of individuals discussing things from first principles.

The Wikipedia article for the study and one by Marmot himself. He provides his full paper on how to prevent job related disorders, none of which look at the issues herein.

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