A systemic approach is key to affect positive change in most medical domains.

Leadership observed in many countries in Asia during our travels was inspiring; we observed no delays, debates, uncertainty or chaos, we mainly observed clarity, consistency and congruency amongst the public, governmental officials and health professionals.  Messages within recommendations were evidence-based, brief, clear, informative, consistent, helpful to the public and instilled calm.  Governmental officials and health staff appeared clear regarding protocols and policies, and appeared to follow policies diligently; the public appeared to follow their lead.  The public did not present as confused or anxious, but as positive and confident regarding next steps.  The public appeared educated regarding risk and appeared to trust health professionals and government officials, who led by example.  We observed a sense of camaraderie and working together within the public, government and health systems.  These strategies contribute to good clinical outcomes, as per evidence-based research. 

We observed no Police or Military involvement or threats in the context of the pandemic during our travels in Asia. The public was educated in terms of risk and protective factors, and asked to make responsible decisions for themselves and their community. We observed no restriction, severe or otherwise, associated with deprivation of liberty or threat in general towards the public; this, from what we observed, contributed significantly to calm within the community.  Calm, lack of stress or lack of chronic anxiety supports and strengthens the immune system, and contributes to improved general health; resistance to infections, decreased complications, improved recovery times and prognosis, which is supported by longstanding well established evidence-based research.  

Most doctors would agree that ‘forcing’ an adult to do anything, in any context or health discipline, is very seldom, if ever, effective.  A systemic approach is essential.  Quality of communication is key.  Language used is key.  Consider Newton’s third law; a force in one direction promotes a force in the opposite direction of equal strength.  This is relevant in all cultural contexts.  As one doctor reflected “forcing anyone to do anything has never worked if you consider world history, it only serves to create chaos and disaster.”  Most doctors would agree that neglecting a systemic approach, by ‘putting an individual in a corner’, where there is no choice, is a sure measure to increase risk significantly; social, psychological and biological risk.  It is an approach that is seldom effective and often leads to significantly increased risk and harm.  Exceptions do exist, although clear evidence-based clinical indications or legal reasons are required and laws such as the Mental Health Act protect individuals in this context. 

The general systemic approach, quality of communication and language used in much of Asia, as observed, inspired calm, a positive environment and hope within the public, which affect clinical outcome significantly, as per evidence-based research.  These are significant protective factors for general and mental health, and initiatives that protect, support and strengthen the immune system significantly and in more than one way.  These are also evidence-based initiatives for crisis, risk or emergency management in Medicine and Health.  Current statistics also support this approach in these nations.

Let’s work together to protect our most vulnerable. A consistent, evidence-based, systemic approach is essential to achieve good clinical outcomes.

Thank you to the leaders of nations and international organisations who have raised concerns regarding systemic risk and protective factors for children and communities. You are shaping our tomorrow for our children.

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