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Question 14-2/2: Telecommunications for e health
SOURCE:
TITLE: =
GUIDELINES
FOR MODERN ASCLEPIEIONS AND SETTING UP OF SERVICES
__________
Abstract:
This
document gives an overview of modern Asclepieions and guidelines for their
services.
Guidelines f=
or
Modern Asclepieions and Setting up of Services
Dimitrios Sot=
iriou,
Associate Professor of Medical Physics, School of Medicine
Ken Boddy, MB, BS FRCOG, School of
Medicine University of Edinburgh (retired)
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Version
1, August 2006
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A=
ugust
2006
Table of Contents
1. Modern Asclepieions: Origins and Changing Soc=
ietal
Views
2. The Pro-inclusion Principle:=
3. Guidelines on Service Quality and Ethical Con=
cerns:=
3.1 The Build of a Situation Ethic for MA Servic=
es
3.3 Ethical Value Statements as Proposed Guideli=
nes
for MA Services
4. Guidelines and Opportunities on Thematic Doma=
ins:=
The Framework for Modern Asclepieion Services:=
4.1.2
Health Education and Health Promotion. 19
4.1.3:
Health screening activities. 20
4.2.1:
The Benefit of Cultural Activities. 22
4.2.4:
Education, Training and Workshops. 23
4.2.5:
Activity Related Venues24
4.3: The External Environment=
4.3.1:
Activities related to the environment 25
4.4. Social Interaction (and the electronic forum
e-Pnyka)
4.4.1
Continued Education and Training. 26
Social
Work and Welfare systems26
Social
exclusion and integration. 26
Emergency
Measures and First Aid27
4.4.3:
Social Interaction by electronic means: “e-Pnyka”
5. The Best Exploitation of Technologies:=
=
5.1 The Opportunities for Electronic Services in
Modern Asclepieions:
5.2 The Advantages of Using Telematics in Modern
Asclepieions
6. Modern Asclepieions Infrastructure – La=
nd,
buildings and other Installations.
6.2 Buildings and other Installations
Athletic
facilities and fields31
Educational
and Healthcare Installations. 31
6.4. Telematic Infrastructures
6.4.1
The scenario of a user entering a MA park: 32
6.4.2
Personal Devices and Equipment (Medical or other)=
7. Initial MA services and their Service design<=
/span>
7.1 General Guidelines for the Initial Services<=
/span>
7.3 Priorities and Service Uptake
8. Modern Asclepieions Implementation
8.1 Initial Implementation Strategies
8.1.2
User and Expert Groups:36
Professional
Service Providers:
Business
Providers and Sponsors:37
8.2 A Suggested Management Structure for MAs
9.5 Evaluation and Assessment=
9.6 Usability (efficiency, effectiveness and
satisfaction)
10. New themes to be considered
11. =
Current
Asclepieion Services
Current
Content, Copyright and Intellectual Property Issues
1. &nbs=
p; Modern
Asclepieions: Origins and Changing Societal Views
In their
original concept Asclepieions were places of health promotion. They were
designed to promote the good interactions needed between the Health, Cultur=
e,
Environment and Social factors that are now known to provide for a continuo=
us
improvement in the quality of our multifaceted lives. The ancient Asclepiei=
ons
were open spaces in our urban environments and they were situated around or
alongside places of education and healing. The framework for modern
Asclepieions is therefore based on this approach and it concerns the best u=
se
of the open spaces in our urban environment in order to provide for a wealt=
h of
‘good opportunities’ that will assist everyone in achieving the=
ir
full potential both as individuals and as societies. In this regard the the=
mes
which require consideration are the same as those provided for in the ancie=
nt
Asclepieions and the following is a discussion concerning the origins of our
thinking regarding MAs and our changing societal views. This discussion lea=
ds
on to consider the guidelines to be followed in establishing a modern
Asclepieion in today’s post modern world.
In terms of human history all
societies have engaged in the process of providing their world view of man =
and
of his place in the natural order. The framework of understanding for ancie=
nt
societies was built on the metanarrative stories (the cultural myths) which
included that of ascribing the authority and the power over our lives to be=
ings
(gods) outside ourselves. The Greek god of health, Asclepius, was one of th=
ese.
In the modern world[1],
these ancient metanarrative stories (cultural myths) have been gradually
replaced by the reality of the factual observations of science and by a wor=
ld
view which emphasises both the importance of natural process and of our own
responsibilities. The post-modern era has now re-focussed our attention on =
the
importance of our individual (personal and societal) history (our story) an=
d on
the requirement for a combined (holistic) approach to human needs which
includes the knowledge gained from science and the truths gained from our
cultural embedding[2].
Since the
beginning of the 1900’s the scientific community has been stunned by =
its
discovery of how complex and sensitive a set of conditions must have been
present in order for the universe to permit the origin and the progress of =
life
here on planet earth. In the various fields of physics and astrophysics,
classical cosmology, quantum mechanics, biology and biochemistry as well as=
the
earth and the human sciences, numerous discoveries have repeatedly disclosed
that the existence of life as well as our overall wellbeing depends upon a
delicate balance of biological, physical and cosmological quantities, such =
that
were any one of these quantities to be slightly altered, the balance would =
be
destroyed and life would not exist.[3]=
This has always been a suspected t=
hing
even by our ancient scholars – it is known as the ‘anthropic
co-incidences’ or the ‘teleolonomic anthropic principle’
elucidated by Aristotle[4]=
- and it has now been re-discovered by all our new scientific observations =
and
measurements – moreover - it has been confirmed to be present in all =
the
natural systems and sub-systems that have been studied here on earth. The
anthropic principle appears to operate as ‘a natural process’ in
‘a positive direction’ to overcome the contingencies of life - =
all
the events we encounter in nature, all the chance/choice happenings, all the
interventions that may hold us back - and it provides for all the
‘good’ of our progress – it favours life in our universe -
and here on earth, it favours the progress from simple life-forms to the la=
rge
brained and complex organisms (such as man) in particular.
In the
ancient world the stress laid by Aristotle on natural process was supplemen=
ted
by Plato who looked for the evidence of an intelligence of some sort (a
demiurge) being behind it all.[5]=
In today’s world the natural process argument is seen in the work of =
The
writers of this document have drawn on the wisdom of others and would stress
the need for ‘verified knowledge’. The notions behind the
establishment of Modern Asclepieions are therefore presented as providing a
means whereby we take on board our own responsibility and we endeavour to l=
earn
about natural processes so that we can proceed to protect ourselves from
life’s contingencies. Through verified knowledge we are led to unders=
tand
the complex factors which are concerned with our wellbeing and we are also =
led
to consider the combination of services which best favour our overall healt=
h in
the light of our current understandings and in the type of environment that
best suits our human needs. In this regard all our faculties need to be
exercised by verified knowledge and where there are ‘gaps’ or
‘unknowns’ we should continue to seek and to discuss without
antipathy. [6]=
The
requirement for combined (holistic) services to fulfil our human needs is n=
ot
therefore a new concept. It was the basis behind the establishment of the
ancient Asclepieions and it is now seen as regaining for us the ancient
Aristotelian notion of there being a ‘teleonomic anthropic principle =
of
good’ at work in all our lives.[7]=
The
current holistic concept is that of providing services which are in tune wi=
th
natural processes by the bringing together of all the various service eleme=
nts
that we need, for the good of the whole. As a concept, it addresses all our
individual needs in the context of our own society and it brings together a=
ll the
scientific facts and the verified truths of all societal groups for the goo=
d of
the human society as a whole. The openness and the transparency needed to
forward this approach, requires verified knowledge which leads to integrated
services with the consideration of respect for the natural world and for ea=
ch
other. In this regard the services proposed will be required to meet our
ethical value concerns and to have codes of practise as well as service
standards or guidelines.
2.
&=
nbsp; The
Pro-inclusion Principle
The
establishment of Modern Asclepieions is intended to provide a goal directed
benefit for all individuals and for all societal groups and for all societi=
es,
therefore the services themselves require the design and the operational
characteristics that facilitate this - their impact should exclude no-one
(users or providers).[8]
3.
&=
nbsp; Guidelines
on Service Quality and Ethical Concerns
The
provision of holistic services based on human needs requires a client led
approach and the goal directed benefit requires the consideration of the
individual and their circumstances together with their value concerns and t=
heir
expectations. All this requires the setting out of ‘a service
structure’ based on a ‘situation ethic’ and ‘the
service quality guidelines’ whereby we can fulfil the intended benefi=
t.
It is impossible to separate the notions of ‘service quality’ a=
nd
‘service ethics’ because both of these are concerned with the g=
oal
directed ‘better things’ that make for improvements in our live=
s.
3.1
The
Build of a Situation Ethic for MA Services
From our
post modern viewpoint we can set out some current societal value concerns t=
hat
can be used as a starting point for further discussions and for the buildin=
g of
a situation ethic for MA services: <=
/span>
The
notion of our faith in fundamental human rights, e.g. as expressed in the UN Charter: =
the
equal dignity and the equal worth of all human persons, the equal rights of=
men
and women, the equal status of all nations and all regions large and small =
as
well as the equal promotion of social progress and of better standards of l=
ife
in a larger freedom for all.
Also, the
elaboration of these human rights in the Universal Declaration of Human
Rights, the International Covenant on Economic, Social and Cultural Rights =
and
the International Covenant on Civil and Political Rights and other declarat=
ions
to ensure the application of universal standards to particular societal gro=
ups.
These include the International Plan of Action on Ageing, adopted by the Wo=
rld
Assembly on Ageing and endorsed by the General UN Assembly in its resolution
37/51 of 3 December 1982
The
principles to be drawn out from the UN Charter and all the other elaboratio=
ns
that concern our new-found faith in fundamental human rights can be said to=
be
a hope or a vision of the ‘better things’ that most men and wom=
en
would verbally support and aspire to. A simple statement of ‘love your
neighbour as yourself’, could also replace all such iterations and co=
uld
be described as the fundamental situation ethic which provides the basis for
all human interactions and therefore for all the types of services envisage=
d in
Modern Asclepieions. When such expectations are applied to all the individu=
al
clients, (i.e. to all our individual stories) then the enormous diversity a=
nd
the complexity of both the service needs and the provider responses become
apparent. This is the problem of stating ethical concerns in
‘global’ terms. Many wise men including a few philosophers and
theologians have grappled with these concepts and found them wanting in the
real world of human interaction.
What can
be achieved in a given situation may be less than what we ‘ideally=
217;
hope for but there are still guiding principles that can underlie all our
efforts.
“No service to the more vulnerable
members of our society should exploit their vulnerability”, is a situation ethic that=
could
apply to all services. As a guiding principle this could be expressed as be=
ing
in conformance to the notion of =
216;my
equal status with others’. It provides the basis for expressing a=
no-harm
(no exploitation) stance as well as an equality of choice (my equal worth, =
my
equal dignity) stance.
My
freedom of choice (in spite of what others may think is best for me and for=
the
society I am part of) is a major focus of the current debate on larger free=
doms
for minority groups and in western societies the benefits of ‘my freedom to choose’
appear to outweigh the possible changes required in current societal norms.=
The
expression of ‘my freedom to choose’ is seen as being concerned
with ‘my dignity and my worth=
as an
equal with that of others’. It is the reality of the post-modern
world and it suggests an ethical stance that both users and providers would=
see
as being essential to the development and implementation of services that
influence our wellbeing. The situation ethic that expresses my freedom to
choose and that could be adopted in Modern Asclepieions would therefore be =
that
of “the equal status of all
citizens with that of others”. Such an ethic could be built into =
the
service development as well as into the service delivery structures. It wou=
ld
be well understood in most democratic societies although no society can say=
it
is currently perfect in this regard.
Freedom
of choice however has obvious implications that require the safeguarding of=
‘informed choice’ and =
the
formulation of an acceptable understanding of the ‘ability to choose’. In this sense my human right of
equal status with others, may not be an achievable goal. Where my ability to
choose is in doubt and where there is insufficient knowledge and informatio=
n to
make ‘informed choices’=
there
have been expressions of concern regarding ‘individual
client safety’ and regarding ‘adverse
societal responses’. The possible situation ethic of my equal sta=
tus
with others in terms of my freedom of choice will therefore need to be modi=
fied
to take account of these concerns. The direction that such a modification m=
ay
take will be dependant on other ethical and best practise service delivery =
is
An important
is
In order
to include the notion of ‘cho=
ice’,
this modified situation ethic could now be expressed in equality terms as ‘my equal participation with oth=
ers in
the processes that determine and repeatedly evaluate my own individual
needs’. In the determining of my own needs I will be equal to oth=
ers
until or unless I am unable to participate in the processes of determining =
my
own needs. My freedom of choice will therefore be preserved in my own hands=
so
long as I can participate in determining my own needs. When others, and not=
I,
are the only ones who can participate in the processes of determining my ne=
eds
then they will be the responsible ones for the preservation of my human rig=
hts
in terms of my equal dignity and my equal worth with others.
This type
of situation ethic is already well known in the health and social care
environments and it caters for situations where ‘substitution decision making’ is required –
where the responsible carer(s), and not the individual client, determines t=
he
needs and the service delivery procedures. An example would be that of an
unconscious person. The responsible carer(s) could include relatives, paren=
ts,
first-aid persons as well as professionals such as doctors and nurses.
There are
also other considerations to be taken into account. The International Plan =
of
Action on Ageing has led the UN to appreciate the tremendous diversity in t=
he
situation of older persons, not only between the societal norms of different
countries but within a given country itself and between individuals within a
local community. Also, concentrating our effort on one group such as the
elderly may work to the disadvantage or even the exclusion of others in the=
ir
equal status concerns. A situation ethic that expresses equal status based =
on
needs would overcome a too narrowly focussed approach to client identificat=
ion.
Policy makers as well as service planners and service providers will theref=
ore
need to be persuaded to integrate their efforts in terms of the new holistic
service structures envisaged in MAs. Equality in the identification of all
clients is an equal ethical is
My
equality concerns should be seen as being based on both, ‘my equal participation with others in determining my access =
to
services’, as well as ‘my
equal participation with others in identifying my own service
requirements’. Only if I am unable to participate in these proces=
ses
will others be solely responsible for determining my access and my service
delivery needs as well as my equal status with others in order to preserve =
my
equal dignity and my equal worth.
Another
point of awareness that is currently apparent is the fact that in all
countries, individuals are reaching an advanced age in greater numbers and =
in
better health than ever before. The same is true for other at risk or suffe=
rer
groups who are not elderly but for whom the modern processes of care have
resulted in a better health for them than was enjoyed by their predecessors.
Their continued good health and their level of independence are therefore
important ethical as well as societal concerns. There is also a growing gen=
eral
awareness of the scientific research which is disproving many stereotypes a=
bout
the inevitable and irreversible declines that are said to be associated with
age and the same is also true regarding our views of the inevitability of
institutional care for those who are not elderly but have significant other
life difficulties. Achieving ‘=
;the
best potential’ and ̵=
6;the
correct level of independence’ for everyone – based on their
needs - is both an ethical as well as a societal concern that will need to =
be
addressed in the envisaged holistic services of MAs.
Because
of these is
Many are
now convinced that we live in a world characterised by an increasing number=
and
proportion of older persons, and a growing demand from those with learning =
and
other life difficulties. We need to know all their individual stories and we
need to provide opportunities, (for those who are willing and capable), to
participate in and to contribute to their ongoing lives as well as to the
ongoing activities of society as a whole. In this regard there is now a
requirement for a wider definition of ‘needs’ and for an integr=
ated
response that can determine ‘new requirements’ and ‘new
societal and service structures’. The playing field is different to w=
hat
it was and our value concerns have changed too.
3.2
Other
Holistic Concerns
It is not
just health and social services that are to be considered in this context -=
but
all aspects of our living. In establishing modern Asclepieions, there is a =
huge
opportunity, if we can get it right, to influence the way that societies wi=
ll
develop and the way that they will adapt to the postmodern world.
From the
point of view of the proposed services in MAs there is a pressing requireme=
nt
for the identification of ‘a set of needs’ and for the formulat=
ion
of ‘a code of practise&=
#8217;
that will take account of the wider and integrated definition of the new
holistic service requirements and the responses of service providers to
it. At the same time, any
expression of needs will form a significant part of any situation ethic tha=
t is
adopted into the new service developments and the new service delivery
structures.
Apart
from the recipient clients themselves there is also the recognition of the
needs of the providers of services as well volunteers and their families. T=
his
is so in both developed and developing countries and it requires recognitio=
n of
the correct provider supports in maximising and achieving the potential for
future service delivery and the improvements which will affect everyone.
Acceptable services and equal opportunities for everyone is an ethical and
societal concern that has been strongly expressed in previous trials of new
services related to health, culture, the environment and social interaction=
s.
The build of a situation ethic for a combined approach to these services can
now be seen to include is
In the
proposed MA service environment it is clear that all involved stakeholders,
including recipient clients, providers of all types, service planners and a=
ll
the relevant local as well as regional and national government agencies, ha=
ve
not yet come to a uniform viewpoint of how to proceed in their efforts to m=
ove
forward with holistic services which support the notion of individual and
societal betterment in terms of providing opportunities for engagement and =
for
the fulfilment of the needs that are related to independent living. There is
also not yet a uniform societal view regarding the currently loosely expres=
sed
notion of ‘equality with others’ in terms of determining both
individual and societal needs or the cost benefits of integrated holistic s=
ervice
provision. Such things will take time but the structures to make it all hap=
pen
are present in current services and there is now some urgency in moving the
debate forward.
3.3
Ethical
Value Statements as Proposed Guidelines for MA Services
Bearing
in mind the service standards already known, the guidelines for proposed MA
services can be expressed under the following headings,
3.3.1 Independence , Self-fulfilment and Societal Participation: (My Dignity and My Worth as a
Fundamental Human Right)
Support
for independent living should be an enabled process for all citizens and sh=
ould
include self-help as well as access to all the information and knowledge as
well as the holistic services needed to maintain a healthy lifestyle. In the
case of disadvantagement there should also be sufficient support in terms of
income (or exemptions from payment) for MA services as well as for housing,
food, clothing, home-care and the catering for any special needs including
modifications to the environment that are for safety purposes or are
adaptations to personal preferences and changing capacities.
Everyone
should be able to live in dignity and security and be free of exploitation =
and
physical or mental abuse. They should therefore be able to fully integrated
into their local society, to marry and to bear children where this is
appropriate for them and to participate actively in the formulation and
implementation of policies that directly affect their well-being. They shou=
ld
be treated fairly regardless of age, gender, racial or ethnic background,
disability or other status, and be valued independently of their economic
contribution. The young and the old should be favoured and different ethnic
groups should be catered for in a way that is acceptable to them.
Everyone
should have the opportunity to work or to have access to other
income-generating opportunities and should be enabled to participate in the
decision making which determines when and at what pace entry and withdrawal
from the labour force takes place.
Everyone
should be able to pur
Everyone
should be able to seek and to develop opportunities for service to the
community and to serve as volunteers in positions appropriate to their
interests and capabilities. They should be encouraged and enabled to share
their knowledge and skills with others.
Everyone
should be able to form movements or associations of others in similar
circumstances and to have the same rights as others in the political proces=
ses
of their local community and country of residence as well as on the world
stage.
3.3.2
Care Related
Services: (My Equality with O=
thers
in Determining My Needs)
Everyone
should have access to the combination of health and social services provide=
d in
their own society through the provision of processes which are acceptable to
them and in which their input to determining both access and service delive=
ry
needs has been taken into account. They should have access to the same serv=
ices
as others when travelling, visiting other regions of their own country or
outside their own national boundaries.
Everyone
should have access to health promotion services to help them to maintain or
regain the optimum level of physical, mental and emotional wellbeing and to
prevent or delay the onset of illness. They should have access to sports
facilities and outdoor pursuits suitable for them as well as to holiday
facilities.
Everyone
should be able to benefit from family and from local community care and
protection schemes in accordance with their own cultural and personal value=
s.
They should therefore be enabled to contribute to the development of such
support systems and to the tailoring of them according to their needs.
Everyone
should be able to utilise appropriate levels of institutional care providing
protection, respite, rehabilitation and social and mental stimulation in a
humane and secure environment.
Everyone
should be able to enjoy human rights and fundamental freedoms when residing=
in
any shelter, care or treatment facility, including full respect for their
dignity, beliefs, needs and privacy and for the right to make decisions abo=
ut
their continuing care and the quality of their lives.
Everyone
should have access to legal services to enhance their autonomy, protection =
and
care.
In the
case of disadvantagement and current inequalities and disengagement, all th=
ese
aspects of independent living should be specifically enabled.
It is
evident from this sort of situation approach that an ethical stance of comb=
ined
or holistic service provision with positive enablement for specific
circumstances has been set out. In this regard the above value statements h=
ave
not yet been subject to the scrutiny of the differing views of disparate
societies or the different societal and service sectors that may be involve=
d in
MA service provision. However, all these stated views have been gleaned fro=
m those
that have been explicitly expressed by the many different world authorities
including the UN and by various medical authorities including the British a=
nd
the American Medical Associations as well as others. They could therefore f=
orm
the basis for the writing of an ethical code of practise for MA services and
for consideration for inclusion in the development and implementation of su=
ch
services in any locality. They could also be used to encourage service
providers including government agencies and societal groups to incorporate =
them
into their national and other programmes whenever possible.
In
today’s world, the widened scope of identified needs simply emphasises
the already identified requirement for an integrated response from service
providers. This was the basis of the ancient Asclepieions and in today̵=
7;s
world it requires a cultural and structural change in the services and
technologies sectors. Hierarchical structures will no longer suffice and mu=
ch
more in the way of the sharing of both, information as well as knowledge and
expertise, will be required. Service providers of all types will need to li=
sten
to clients and to develop suitable structures for this to happen as well as
providing suitable safeguards for the privacy and security of personal info=
rmation
and the compliance with standards in all aspects of service provision inclu=
ding
that of training. Much of this already takes place but it is currently
‘unfocussed’ or ‘patchy’ and the ways of implementi=
ng
and supporting such services have not yet been fully evaluated. In this reg=
ard
the establishment of MAs will provide the opportunity for this to be done. =
It
will stimulate the integration of ‘inter-agency’ and of
‘mixed economic’ ways of service provision for a given community
and it will allow for future considerations to be further thought about. In=
the
services and technology sectors much more needs to be done in terms of the
overall as well as the individual service product(s) that need to be provid=
ed
to support our expectations.
No
consideration of these is
At
present there is no consensus and there is considerable doubt that our curr=
ent
progress in implementing new services and new technologies can actually ful=
ly
support our post modern vision. Research therefore needs to continue but su=
ch
activities must now take on board all the above identified aspects of what =
is
trying to be achieved. It is no longer sufficient to have a purely technica=
l or
business driven approach. “Toys for the boys”, “What can =
we
do with our new-found discoveries”, “How can we appear to be
progressing” are not the real is
The basic
groundwork of identifying ‘what are the needs’, ‘what can=
we
do now to satisfy those needs’ and ‘what technologies (old and =
new)
can assist us’ have not yet been properly thought through. Currently =
we
only have a snapshot of the possibilities for new technologies and for holi=
stic
services and whilst this is useful since it provides us with information th=
at
is valuable in appreciating the effort still required to identify needs and=
to
build acceptable future services, it is also useful in appreciating the eff=
ort
still required to get the new technology to work in a real-life environment!
The real lack and the missed opportunity to date however, has been in the
sidelining of the is
It would
appear that there is “a prima facie case” that independent livi=
ng
can improve the quality of our lives and the cost benefits of any support
services. This is a very valuable piece of information and should stimulate
service providers to make concerted efforts in this direction. The ethical
stance suggested above is one of positive discrimination toward currently
disengaged and disadvantaged groups with a foundation situation ethic of
‘my equality with others’. A full appreciation of all our needs=
is
therefore the first step in convincing others about the cost and benefits of
such an approach and hence the above attempt to categorise these needs (fro=
m an
ethical value viewpoint). These value statements can be used as a starting
point, to be built on by further case studies and by the establishment of
acceptable structures for all stakeholder inputs. The initial aim of this
effort is to produce consensus about what is required and to set out the pa=
th
of progress.
There is
nothing really new about this approach and there are already various lists =
of
user needs with their codes of practise (including those of service
guidelines), as well as process models and business models, that can be of
assistance and adapted to suit any local requirement. There are also
applications of current technology that have been shown to make a huge
difference to the wider uptake and the success of current services. We can
therefore use the above ethical value statements and the current codes of
practise and service guidelines that go with them, as a way forward to obta=
in
initial consensus about what should and can be done.
All these
things can be our starting point to stimulate discussion and to make
progress.
From a
value and ethical point of view, deconstruction or total replacement of all
current services is not an option. Historical continuity and discontinuity =
are
the realities to work with. The re-creation of Asclepieions is a continuity
effort that can provide direction and content to the holistic services which
are currently envisaged as being a requirement for all societies. They can =
also
contribute to our understanding of the new services, the monetary costs and=
the
business enterprises that are needed in today’s world to support heal=
thy
living as a whole. The establishment of MAs is therefore a good way to fulf=
il
our past hopes and to make progress in fulfilling our equal needs as well a=
s to
evaluate the cost benefits of any proposed service changes.
The
difficulty for those expressing their ‘good intentions’ is that
like many politicians they are “long on values but short on
policies” and there is therefore a need to set out an implementation
strategy based on opportunities. To date the notions behind the establishme=
nt
of MAs including that of ‘Inclusion’ have been value driven and
even the expressed values have not been fully debated. The following is
therefore an attempt to further these discussions by providing some thematic
guidelines based on opportunities.
4.
&=
nbsp; Guidelines
and Opportunities on Thematic Domains:
Within
the Framework of Modern Asclepieion Services there are four main themes
concerning health, culture, the external environment and social interaction=
s.
The table
below indicates the opportunities to be addressed:
The Framework for Modern A=
sclepieion
Services: =
|
Themes |
Heal=
th |
Cult=
ure |
Envi=
ronment |
Soci=
al
Interaction |
Othe=
r |
|
MA Portal And Other New Technology and Telema=
tic
Services: Information;=
Knowledge; e-Pnyka; Mobile communication and portable as well as
personal monitoring devices |
The improvement of our health and wellbeing by
access to ‘verified knowledge’ and to ‘health promotion
advice’ The participation in the discussion and decis=
ion
making which concern our individual health promotion needs. e.g. the avoidance of risk; Health Screening;=
Managed care; Support for independent living; |
The improvement of our health and wellbeing by
uptake of the verified benefits from all forms of cultural norms. The history (the story) of all societies and =
all
societal groups and their norms The widespread understanding and uptake of |
The improvement of our health and wellbeing by
the understanding and the care of the environment that we live in. The verified knowledge concerning man and his
environment. The engagement in activities concerning the
wellbeing of ourselves and our planet. |
The improvement of our health and wellbeing
through societal integration and peaceful development Equal opportunities for access to information=
and
for engagement in societal is |
Links to Other MA Portals, and to national and
international Services and to Independent Experts; Posting of Educational and Training Opportuni=
ties
as well as job opportunities; Audit and Verification Procedures; |
|
MA Park: Health and wellbeing services and their relat=
ed
activities; |
Promoting a healthy society by providing a
‘fit for purpose’ local environment for all to benefit from. =
Improving the effectiveness of current health promotion services by the best use of urban spaces and new technologies;<= o:p> Combining all the currently known health
promoting factors that provide for a continuous improvement in the qualit=
y of
our lives. |
Promoting a healthy society by ‘learning
and doing’. Utilising the MA Park and new technologies for
extending ‘real-life’ and ‘life-long learning’ Engaging in verified health promoting activit=
ies
– all forms of beneficial exercise, art, drama, music etc. |
Promoting a healthy society by respect for the
natural environment and for one another – including for all species=
of
life. The provision of a natural space (the MA Park=
) in
which to experience and to study the importance of the world around us in=
the
determination of our wellbeing. . |
Promoting a healthy society and its peaceful
development by the engagement of all societal groups. The provision of |
Disaster Relief and professional support
agencies; Recreation Facilities; Festivals and Exhibitions; Social activities which promote integration a=
nd wellbeing through local support groups and
volunteering; |
|
Management: |
Promoting individual responsibility and
independent living through holistic service provision |
Promoting the best of our common heritage |
Promoting a common understanding and duty of =
care |
Promoting equal access to information and
knowledge and equal opportunities for engagement |
Identification of :Societal Norms; Ethical Value; Cost Benefits; Future Developments; |
|
Business |
Provision of ‘fit for purpose’ technologies and services for he=
alth
promotion |
Provision of the infrastructures and the
telematic educational networks for learning by doing |
Provision of ‘special facilities’=
for
display and research. |
Provision of electronic and other means for
engagement in discussions and decision making |
Provision of Resources including ‘mixed economic approaches’ to
funding |
4.1 <=
span
style=3D'mso-tab-count:1'> Healt=
h
In
general terms health is concerned with the physical part of our human exist=
ence
and it includes our bodily or physical wellbeing as well as our emoti=
onal
and mental capacities. The other aspect of our being is said to be concerned
with the spiritual man (sometimes identified with the soul or life force, g=
k:
psuke; latin: anima), which is reflected in our unique personalities (perso=
nhood)
and in our beliefs. The ancient Greeks had a saying «&=
#957;ους υγιής
The table below shows the
correspondence between the activities and the opportunities for the health
related services proposed to be offered in MAs.
|
ACTIVITIES |
OPPORTUNITIES |
|
Health Promotion/ Activities |
Modern Asclepieion Holistic Ser=
vices
to combine the good interactions between the Health, Culture, Environment=
and
Social factors that are known to provide for a continuous improvement in =
the
quality of our lives. |
|
Health Education, Health Training Activities |
Electronic information services combi=
ned
with learning through doing |
|
Improvement of current disparities in
health service provision with more opportunities for improved access and =
for
personal decision making |
Emphasis on personal responsibility a=
nd on
local primary healthcare services. New telematic services between medical
units at all levels and between users and the providers of health service=
s. |
|
Improved living conditions |
Environmental and Cultural dimensions=
of MA
parks |
|
Improved social integration and suppo=
rt |
Health Promotion Festivals with
Identification of needs and Improvement of services. Exploitation of
telematic technologies for improved engagement in local discussions and
decision making. |
|
Audit of Health Promotion with verifi=
cation
activities |
Creation of an enabling environment a=
nd of
suitable infrastructures for facilitating research and verification
activities including audit. The use of new technologies and services suit=
able
for individual health promotion and for verification purposes (e.g.
electronic health record systems, personal devices; interactive systems f=
or
decision support etc.) |
|
Longer Term Improvement (rationalisat=
ion)
of ways of living |
Identifying the possibilities for
interventions through adoption of different cultural norms and through the
uptake of new knowledge as well as new technologies and services which ha=
ve
been verified. |
4.1.1=
General Concerns=
We
all need reliable and accurate information on how our body is built and how=
it
functions, how it grows, declines and dies and how health is maintained. In=
its
trajectory from conception and birth to maturity and death the body faces
extraordinary challenges and yet it is programmed for life with the means to
face the factors that affect our wellbeing. Risk taking and extending our
physical, emotional and mental capacities as well as developing our spiritu=
al
side are all part of exploring the boundaries of normality but there are
guidelines that can help us to achieve our full potential within the
constraints of relative safety. [10]
Whilst
modernist societies have put in place sophisticated systems to prevent and
alleviate damage to our health and to help us to recover from diseases and
trauma, the main responsibility for our wellbeing still rests with ourselve=
s as
individuals and communities and there are many cultural norms which appear =
to
have benefit. In the post modern world high priority is now given to the no=
tion
of providing holistic services that give clients the information and the
knowledge they need to make informed choices and to have control over their=
own
circumstances. Autonomy and choice are the desired post-modern goals of
independent living and they really matter in today’s world. We are no
longer the sheep to be herded along by the captains of industry and the typ=
e of
progress that was seen in modernity. When help is required it is clear that=
the
vision described is one that expects such help to be delivered in an
individually appropriate, flexible and supportive way.
The
fulfilment of all our individual needs emphasises the importance of people =
in
their own environment - providing for my needs, means you need to know abou=
t me
and my story. Such value-driven expectations are of direct concern to the
establishment of Modern Asclepieion services and therefore they will need t=
o be
built in to such service delivery. They are quite different to the values t=
hat
drove the progress of modernity and we now need to consider all the aspects=
of
a client-led service (one that focuses on the needs of all individuals as w=
ell
as on all societal groups). All stakeholder views have to be taken into
account. Everyone’s story really does matter.
In the
framework of a modern Asclepieion, the main goal of the intended services i=
s to
bring together the use of the natural environment in maintaining a healthy
life-style with the use of the scientific and the cultural knowledge requir=
ed
to cater for all our needs. The effectiveness of such services will be
proportional to the accuracy of our knowledge as well as to the responsibil=
ity
that we all take for ourselves and the efforts of societal agencies to prov=
ide
for our engagement. It is therefore imperative for everyone to have access =
to
verified knowledge and to learn how to acquire it when needed and how to us=
e it
in order to maintain and improve their health.
We all
need to know how to prevent and to fight bodily and mental illness as well =
as
how to avoid and to recover from the damage caused by illness, accidents and
trauma. In the new or modern Asclepieion the expectation would be that
‘access’ to the verified knowledge we need as well as to the
guidance that will assist us in its application, would be made available to
everyone via the MA’s portal database and by the real-life interaction
with others including the professionals concerned.
In the
context of a MA park, the general guideline would be that professional advi=
sory
services and their assessments could be hosted by a given MA site but that
their content, delivery and service standards are not to be considered as b=
eing
the responsibility of the MA management - they will remain the responsibili=
ty
of the professions concerned and their institutions. This would be true for
medical, nursing and legal services as well as for professional counselling
services of all types.
Apart
from ‘hosting’ such services, an MA site (e.g. a park) can prov=
ide
the opportunity of access-links to the professionals concerned. This could =
be
achieved via the MA Portal or by utilising the presence of the professional=
s in
providing services and in organising and running special events (including
health promotion festivals) inside the MA site.
4.1.2=
Health Education and He=
alth
Promotion
Health
education programmes are currently offered in many venues including health =
and
sports facilities as well as schools and other educational establishments. =
The
general guideline for Modern Asclepieions would be to improve the current
effectiveness of these programmes by reaching a wider audience and by provi=
ding
services whenever they are required, to all who wish to learn more.
In
MAs the use of telematic technologies will provide an opportunity to make t=
his
possible and will enable specific training on health maintenance activities=
and
avoidance of risks to be targeted to specific groups and to specific indivi=
duals
whenever and wherever they are required. This will provide a means whereby
programmes of health education and training can be offered to all citizens =
as
well as to all specific societal groups in a way that is acceptable to them=
.
In
MAs the health education strategy is strengthened by the opportunities that=
can
be made available through the proposition that open spaces or other facilit=
ies
should be provided around or alongside the local educational, medical and/or
health maintenance units. By this strategy these units will have the
opportunity of taking the role of a lighthouse by sending positive messages=
to
those who utilise the facilities of the MA Park. In addition these units ha=
ve
one of the most important concentrations of the knowledge that we need, nam=
ely
the knowledge embedded in the professionals who work in them and this too c=
an
be capitalised on. This is particularly true in the case of smaller communi=
ties
where schools and healthcare and/or health maintenance units are often at t=
he centre
of community life.
Initially
the opportunity can be taken of providing the same content to the health
education and promotion programmes to be offered in MAs as the content that=
is
currently offered in the educational establishments such as schools and
universities and in the current healthcare facilities, but at a later stage=
the
opportunity exists of widening the content by developing new approaches to
cover specific topics that are of interest to all and that are in line with=
the
needs of all individuals, or are of interest to known ‘at risk’=
or
‘sufferer’ groups, or a particular section of society.
It is
evident that Modern Asclepieion services will require further definition and
trials as well as requiring further evaluations in terms of their content as
well as their service quality and their ethical concerns. The current
endeavours in Athens[11]
have provided a beginning to the identification of what might be appropriat=
e in
order to achieve the ‘better things’ promised by integrated,
holistic services. MAs will enable the implementation of a changed societal
vision that has been brought about by our post modern recognition of human
needs and the factors which have accompanied the progress of the modern wor=
ld
including the advances in the medical and social sciences as well as in the=
new
technologies and the expanding communications markets.
The
provision of open spaces or other facilities around or alongside our current
educational and healthcare facilities will therefore provide the opportunit=
y of
bringing the services and the professionals concerned into closer relations=
hip
with the society they serve. An example of this is the annual ‘Health
Mela’ which has been held since the year 2002 in Preston
4.1.3=
Health screening activi=
ties
The
general need for health screening activities can also be covered by
capitalising on the close proximity of current healthcare units and they ca=
n be
achieved utilising rather simple infrastructures such as mobile and/or
revocable units where telematic technologies are exploited.
Specific
campaigns of health screening provide benefits for the whole population as =
well
as for ‘at risk’ and ‘vulnerable’ groups such as
children and the elderly. Health screening is a very effective way of learn=
ing
about ourselves and it provides cost effective benefits to both individuals=
and
to society as a whole. In the Health Mela example the particular service ne=
eds
for a given community were able to be identified and discussions were gener=
ated
on how to improve the current services. Because a large number of the local
population took part it generated a wider understanding and an acceptance of
the conclusions reached.
4.1.4=
Rehabilitation
Designated areas in MAs can be
designed where activities can be worked out to help those recovering form
illnesses or accidents in order to best achieve their rehabilitation.
Pedestrian areas, cross-country tracks, bicycle trajectories, areas to exer=
cise
and the safe regimens that go with them, can be made available to all who n=
eed
them. Trained personnel must also be involved in order to advise, to encour=
age
and to support and train.
4.1.5=
Exposure to risks
Everyone
should be aware that they are exposed continuously to various natural and
man-made (or artificial) circumstances and agents that put them at risk. The
agents concerned include micro-organisms and other environmental contaminan=
ts
as well as chemical and pharmaceutical substances and the various types of
radiation energy in use today. Exposure can stem from inadequate knowledge =
and
poor hygiene, from miscalculations and from the incorrect decisions associa=
ted
with human error. Lack of proper information, possession of irrelevant or
incorrect information and an inadequate understanding of our human capaciti=
es
can only lead to a failure in our wellbeing (e.g. over exposure to sunlight,
over extending our physical and mental capacities, accidental over dose of
prescribed medicines or medical radiation treatments, etc.).
Particular
sources of exposure to risk in today’s consumer world are the consump=
tion
of agents in food substances and the experimenting with extreme physical
activities and with drugs that can result in damage to our immediate health=
and
to long term incapacity or addiction. Although we can protect ourselves in =
many
situations, the risks associated with the dangerous agents contained in our
food, water and the air that we breathe are difficult to detect, control and
reduce. Their potentially harmful effects to our bodies may result in
definitive disease or merely in odd behaviours that are difficult to quanti=
fy.
Understanding these risks and the efforts of governments to legislate and to
control them will help both the individual and the society at large to make=
the
correct responses in a more widely acceptable way.
Risk is
also apparent in all modern societies due to the stressful circumstances
imposed on everyone to succeed. This includes the natural aggression and the
depression brought about by relative failure as well as the harmful stresses
concerned with the greed and aggression exhibited by the irresponsible
behaviour of others.
In MAs
the opportunity to learn by doing would provide an awareness of these facto=
rs
and should lead to their limitation whilst the normal expansion of our
boundaries and the normal competitiveness with the rewards of success would=
be
encouraged and be experienced by everyone.
4.2 Culture
‘Culture
is concerned with our intellectual development’, with the
‘improvement’ of our mental, physical and spiritual capacities =
by
‘training’ (Oxford Dictionary).
Culture
is therefore a product of our human activity and of our different collective
experiences. It is variable across different societies and its variability =
is
also a source of our learning. We can all benefit from the experiences (the
derived culture) of others. O=
ur
societal norms, our humour, our poetry, our literature, our drama and our m=
usic
as well as our architectural and other environmental structures can all
contribute to our wellbeing and they all have particular properties which c=
an
either stimulate or hold back our overall growth and development.
Again,
MAs provide a framework of combined (holistic) services which have guidelin=
es
that can help us to avoid risk and to promote a stable and acceptable way of
absorbing cultural norms. Whilst some aspects of our culture may be conside=
red
to be ‘good’ there are other aspects that can also be
‘harmful’. Society as a whole must make these distinctions and a
full discourse is necessary to provide a basis for proceeding. In democratic
societies, governments and law makers are subject to society as a whole and
therefore they are required to provide opportunities for all to participate=
in
this decision making and for all to benefit from the activities concerned. =
The
establishment of MAs would be seen as an appropriate way for this to be don=
e.
The general guideline would be that of providing opportunities for everyone
(all different social groups) to be engaged in cultural activities which ha=
ve
benefit to all and which militate against alienation and radicalisation.
Everyone
must be able to find the opportunities they need to achieve their full
potential and in cultural terms we can all learn from one another’s
experiences and guidelines. MAs would provide a suitable venue where the
information and the knowledge required can be made generally and electronic=
ally
available and where fruitful discussions and interactions can take place.
4.2.1 The
Benefit of Cultural Activities
Within
the framework and guidelines of MAs, the main goal of all activities is to
provide the opportunity for everyone to strengthen their body and mind in o=
rder
to achieve a better overall health. The cultural purpose is not that of
individualism or the creation of physical or mental champions. The guideline
would be to encourage engagement and social integration. There is no need f=
or
advanced sports equipment and state of the art gymnastic installations insi=
de
MAs. Neither is there the need for the intellectual training that produces a
hierarchy of top-down decision makers. Everyone must feel they are included=
and
that the benefits to them and to the society they live in are maximised. The
general guideline for a MA would be that of only providing the facilities f=
or
cultural health related activities that have proven benefit.
In
MAs, the intellectual and the field and track facilities are those that all=
ow
for the participation of teams or groups of people as opposed to those desi=
gned
to develop the pursuit of excellence or individualism. Examples would be the
provision of the knowledge and the training required to safely engage in ce=
rtain
forms of physical exercise and to play team sports or to participate in mus=
ic,
drama and dance groups as opposed to the intensive personal training of an
athlete or a tennis star or a professional singer or actor. There would als=
o be
no need for spectator installations but every effort should be made to expl=
oit
the benefits of the activities derived from the experiences of different
cultural groups and to use the anaglyph of the terrain for both the activit=
ies
themselves and for spectator purposes.
There
is however a complimentary mixture of active support and rewards which is s=
een
as being a stimulus to engagement, participation and achievement. The suppo=
rt
of experts with a system of rewards would therefore be built into the
programmes which are associated with the culture-related activities of a gi=
ven
individual or community. Also team displays as well as friendly team
competitions would be appropriate to stimulating engagement and active
participation and to promote the understanding of differences in a local
community setting.
4.2.2 The=
Arts
In
the same way, all forms of art and architecture must be encouraged and prom=
oted
in MAs. Experimental, unconventional, pioneering, unexpected, innovative,
iconoclastic and creative forms of art and architecture must be given a cha=
nce
to be worked out and their products to be exposed. Again an ‘Arts
Festival’ would be an appropriate way of achieving local understanding
and support.
In
MAs opportunities can given to all those who want to study any form of art =
to do
so. The main goal is to encourage all those who wish to express or to impro=
ve
their artistic knowledge and talents. Expert support is needed in order to
enable all participants to produce the drama, the poetry, the music, the wo=
rks
of art and architecture which are satisfying to their own internal creative
drive. Recognition and reward might follow, but this is not the main goal of
the activities designed and offered inside a MA. The guideline is to provide
the combination of knowledge and training that is needed to produce general
lifestyle and product improvements for all. This applies to all aspects of =
our
potential talents and to their relationship with a benefit to our personal =
and
societal health. The central themes that are the focus for all activities in
MAs are all concerned with improvement in our lifestyle. Whilst buildings m=
ay
influence this, MAs are not the appropriate place for experimenting with
architectural construction or city design. Electronic means can be used for
learning and for display, and exhibitions and competitions can also be arra=
nged
to provide for social interaction.
In
terms of effort and rewards, selection procedures by experts will need
consideration in order to support the best among the most promising and to
encourage everyone in producing the desired lifestyle and product improveme=
nts.
4.2.3 Sci=
ence
World
MAs
will also provide the opportunity for all citizens to understand the world =
of
science, its impact on our lives and how knowledge is transformed to provide
technology and future action. A Science Festival would again be appropriate=
but
in MA’s the essential ingredients of the general progress to be made =
are
the widespread provision of verified knowledge with the inclusion of everyo=
ne
in discussions and in accompanying participatory activities. These componen=
ts
are to be encouraged, designed and implemented in all the services offered =
in
MAs. In the world of science, they should help us to understand ourselves a=
nd
the environment we live in:
-
How=
our
bodies evolve and work, what are the threats and how we can protect ourselv=
es
against them
-
What
are the internal and external environmental factors that affect our health =
and
how they function and evolve
-
What
are the threats against the internal and external environments and what is =
the
impact of these threats on our wellbeing
-
What
makes us sensitive to colours, to odours, to forms, to feels, to sounds, to
language, to the different forms of works of art and architecture, etc.
-
Why=
we
are sensitive to the problems of others. Why do we feel the urge to protect=
, to
support and to encourage and to work to alleviate the burden of the
disadvantaged or the unfortunate person
Other
themes of interest might include (alphabetically): ageing, atoms, chemicals,
communications, computers, drugs, ecology, energy (heat), ions and molecule=
s,
radiation, reproduction, recycling, sensors, telecommunications etc.
4.2.4 Edu=
cation,
Training and Workshops
The
general guideline is that everyone should be encouraged to learn by doing.
Theories must be evaluated and benefits must be put into practise. MAs could
initially offer the opportunity to make available all the current school
curricula outside the normal school buildings and outside the normal school
hours but they should progress from there and should evolve in a natural and
continuing way. MAs offer a more attractive setting to teach specific topics
and to employ innovative teaching methods for a series of themes such as he=
alth
promotion, ecology and the natural environment, physics, chemistry, biology
etc. These advantages and opportunities need to be capitalised on by educat=
ion
service providers as well as by government and other employment agencies.
Specific programmes can also be developed to suit local cultural and busine=
ss
needs.
4.2.5 Act=
ivity
Related Venues
Areas
where displays or exhibitions are held and where children can learn by play=
and
everyone can learn by their involvement in health and culture related
activities must be designed and built as part of the structures needed for a
Modern Asclepieion. One particular site need not provide every type of
installation and currently available venues in a given community may be use=
d,
but the society served requires access to all the thematic aspects of a MA.
Provision must also be taken to allow for progress and for future developme=
nts
with the general acceptance of benefit. In this regard audit and verificati=
on
are required and a series of festivals could be arranged with local as well=
as
regional and national discussions regarding the future.
All
the above examples are related to aspects of our living that are relevant to
the ‘improvement’ of our mental, physical and spiritual capacit=
ies
by ‘training’. They are a product of our human activity and of =
our
collective experiences and are bound up in our disparate cultures. There wi=
ll
be different ways and means of achieving results in different societal and
ethnic groups and these should be capitalised on to the benefit of all.
4.3 &=
nbsp; The
External Environment
‘The
external environment is our surrounding and it refers to surrounding object=
s as
well as to surrounding regions, or circumstances’ (Oxford Dictionary)=
.
Human
beings are known to influence the external environment and they in turn can=
be
influenced by it. This influence can be positive or negative. As an example=
in
this regard, our ability to predict and to mitigate the results of natural
disasters is still very limited and whilst we understand that the forces of
Nature are enormous there still remains a requirement to teach respect rath=
er
than arrogance. Also, whilst individuals and societies are currently becomi=
ng
more aware of environmental is
Whilst
our negative influence on the environment may be regarded as being obvious,=
the
negative influence of the environment on ourselves is still very much a sub=
ject
of intense research and it is documented with difficulty. There is no doubt
that the environment, (our surroundings including the objects and buildings=
in
it), can have a positive or negative impact on us and can influence our hea=
lth,
our behaviour and our mental and physical capacities.
In
MAs the guideline would be for the natural environment to be used as a mean=
s of
providing for our recreation; for our enjoyment and relaxation; as a trigger
for pleasant thoughts and feelings; as an area where we can breathe fresh or
less polluted air and where plants and water play a significant part. The
environment of a MA is intended to promote the awareness of our everyday
surroundings and it can be used to facilitate educational activities. It can
serve as an example and a means of comparison. It can be used as a laborato=
ry
for scientific work and for education and training on environmental protect=
ion,
support, improvement, evolution, impact etc.
Respect
for the natural environment is an activity that can be pur
4.3.1=
Activities related to t=
he
environment
Activities
related to the environment can take the form of observations and
documentations, projects, experiments, research. They can also be combined =
with
many of the cultural and the health educational activities previously outli=
ned
including an ‘Environment Festival’.
MAs are
very well suited for the educational activities related to the Environment.=
For
example courses on environmental education can take place in the open space=
s of
a MA as opposed to the enclosed laboratory or classroom. The impact of this=
on
participants can be more stimulating and provide real-life experiences. The
curriculum can remain the same (at least initially) but the content and mea=
ns
will need adaptation and future development.
Among the
activities that can be pur
There are
many examples where open spaces have been used for educational and training
purposes. One of these is The Garden of Hippocrates[13].
Another example would be ’The Eden Project’ in
4.4 &=
nbsp; Social
Interaction (and the electronic forum e-Pnyka)
The
term social refers ‘to the mutual relations of men or classes of
men’ (Oxford Dictionary).
Within
the framework of a MA, the guideline would be to promote social awareness a=
nd
to provide opportunities for engagement and for learning by doing. One of t=
he
main reasons for the disappointment expressed in most modern societies
regarding current politics and societal is
MAs
are designed to offer everyone the opportunity to participate, to be engaged
and to influence their own wellbeing as well as to shape the future of the
society in which they live. This can be accomplished by providing more in t=
he
way of social interaction and by engaging more people in the is
4.4.1=
Continued Education and
Training
Continued
development in terms of education and training has a powerful influence on =
our
mutual relations and the direction taken by societal improvements. Educatio=
nal
programmes that are currently offered only in the context of the schooling
systems can be made available, in a seamless way, to all who are interested.
This will give the opportunity for education outside the school systems and=
provide
an attractive alternative for all who have missed their formal educational
opportunities or who now want to complement or to improve and widen their
education. The provision of life-long learning and training opportunities to
suit everyone’s needs would be the guideline for establishing continu=
ed
education and training services in MA’s.
4.4.2
Local Awareness
Below
there are several examples of services and support activities that can prov=
ide
the opportunity for improving local awareness as well as improving engageme=
nt
and stimulating social interaction.
Socia=
l Work and Welfare systems
In many
modern societies the support and welfare systems have come to be regarded as
being too bureaucratic and relatively unaccountable to the ones they serve.
Their aims are not understood and their methods are not well received. On t=
he
other hand there are many individuals who feel that they have a vocation to
work as volunteers and to be helpful to those in need and all governments h=
ave
a responsibility to provide for the safety and the welfare of all their
citizens,
MAs can
become the places where these is
Social exclusion and integration
All modern societies face problems with=
legal
or illegal immigration, with large numbers of visitors and with people wish=
ing
to pur
Emergency Measures and First Aid=
Individuals and families when caught by
surprise by unexpected events and circumstances might loose their orientati=
on,
faith and scope and become vulnerable and fragile. It is then that support =
from
trusted individuals and from societal organisations is needed.
MA’s can become sanctuaries for a=
ll
those hit by unexpected events. They can be the place in the local community
where societal solidarity can be expressed and where the adverse effects ca=
n be
mitigated. Local volunteers can be trained to provide first aid and initial
response activities as well as longer term counselling and support groups.<=
span
style=3D'mso-spacerun:yes'>
Victi=
ms of
social violence
Women,
children and even men may be abused or victimised by other members of their
family, by work or school colleagues, by companions, or by strangers. The
support of persons they trust including those who are willing to offer
specialist or trained support services is often difficult to obtain and MAs
could provide an attractive place where local volunteers can be trained and
where the programmes needed can be developed and implemented. The ethos of =
an
attractive natural environment, the character of refuge and the spirit of
healing associated with MAs will act in favour of these activities being mo=
re
widely available and accepted in a given local community.
Natural
Disasters=
No one is
safe under extreme natural phenomena and as current observations show, the frequ=
ency
and the intensity of natural phenomena with catastrophic results is becomin=
g a
more frequent concern for all societies.
This fact has to be taken into consideration in the
design of new urban areas and in the improvement of infrastructures in exis=
ting
ones. The current most promising view is that of preserving and making the =
best
use of urban open spaces by using them to provide suitable infrastructures =
for
a variety of recreational activities and for the relief of disaster victims.
The same areas can also be used as Modern Asclepieions and the holistic
services envisaged can be capitalised on at all times.
4.4.3=
Social Interaction by
electronic means: “e-Pnyka”
Pnyka was
the open forum in ancient
Within
the framework of a MA, the opportunity for participating or interacting with
others by electronic means is achieved through the MA portal. The activities
concerned have been given the name e-Pnyka (electronic Pnyka). The guidelin=
e to
be followed is that of providing open access to information and to encourage
the participation of all the members of a local community or a given societ=
y to
address the is
The
opportunity for all citizens to participate using electronic means will alw=
ays
remain as a noble target as long as there is not a widespread availability =
of
the requisite technology and as long as there is not a satisfactory mechani=
sm
for responding to large numbers of requests and for analysing complex
proposals. These are the weakest parts in the current chain of communicatio=
n.
Local and national leaders are frequently seen to announce great societal
projects but their implementation is not pur
In the
world of commerce there are many efficient and effective electronic systems
which satisfy the most demanding customers and handle huge numbers of reque=
sts.
These systems (e.g. air travel reservation systems and their subsystems), c=
ould
provide a model on which the electronic participatory system of e-Pnyka can=
be
based. The software support tools will have to be devised and implemented b=
ut
the handling of requests and the analysis of proposals can be modelled on e=
xisting
commercial software.
e-Pnyka must have the functionality that provides =
for
the following services:
- =
participation to open forums on topics designed by=
the
MAs management and/or proposed by citizens
- =
participation to surveys designed to capture user =
requirements,
to identify public opinion, to evaluate projects, programs, activities, and=
the
events which are organized in MAs
- =
to provide information and statistical data on cur=
rent
is
- =
to guide users to other relevant information (e.g.=
web
sites, libraries, museums etc.)
- =
to provide accurate information and user input on =
all
the is
Access to
these services can be provided by the MA portal so that everyone will have =
the
opportunity to be engaged even if they do not have the requisite technology=
at
home. Access can therefore be achieved in the MA itself or it can also be
achieved via the internet from the home or office or from other public buil=
dings
as well as from other public areas which might be deemed suitable for such
interactions to take place. Within a MA the electronic access is complement=
ed
by the real life opportunities to discuss and to interact with others and to
obtain information from experts and from exhibitions and hard copy and digi=
tal
media material. Special events relating to specific topics of concern can be
held in MAs and public meetings with interaction with the relevant authorit=
ies
or agencies can also be hosted.
5. &nbs=
p; The
Best Exploitation of Technologies
Modern
Asclepieions are intended to bring all users and all providers together in a
common effort to fulfil the information and the knowledge needs that relate=
to
our health, our culture and our environment and to facilitate our social
interactions. Such services will enable all individuals to be well informed
about themselves and about all aspects of a modern society. They therefore
require high quality information and verified knowledge that is both
understandable and accessible to all by making the best use of all the
available information technologies. The intended good will only be fulfille=
d if
all these is
MA
services will also evolve with time. It is therefore necessary to collect d=
ata
on the use and performance of the services for subsequent analysis and for
proposing service improvements. In this regard, everyone should be offered =
the
opportunity to express their views on both the quality and the content of t=
he
current services, including the depth, the spread, the relevance, the
comprehensiveness and the accuracy of the information provided and its cost
benefits. Suitable technologies (including hard copy) must be available whi=
ch
are easy for all to use. These must offer visibility of the outcomes and mu=
st
be accompanied by a reassurance mechanism, able to convince everyone that t=
heir
needs are considered in the design and the implementation of all services as
well as in the planning of any updates and improvements. In this regard the
safeguarding of provider and user rights - with their relevant legal; duty =
of
care; data protection; copyright and intellectual property concerns - will =
all
need consideration.
5.1
The
Opportunities for Electronic Services in Modern Asclepieions
· =
Pro=
vision
of Societal Information
· =
Pro=
vision
of Culture information
· =
Pro=
vision
of Scientific information
· =
Par=
ticipation
to Health promotion activities and training – individual electronic
assessments with personal advice regarding healthy living and eating and sa=
fe
personal training programmes; personal health assessments including the
monitoring of specific personal biological signals and screening tests for
specific disorders
· =
Par=
ticipation
to Educational activities – electronic access to school and other
educational curricula including tutors and board examinations to provide
certification
· =
Par=
ticipation
to Cultural and social Interaction activities including – e-Pnyka =
211;
the electronic participation to local decision making – voting on loc=
al
is
· =
Ele=
ctronic
access to professional advisory services of all types and to their assessme=
nt
procedures including access to professional counselling services and to
discussion groups
· =
The
electronic systems required to host specific events or festivals with the
provision of specific services in temporary units operating inside MA’=
;s
and the temporary means for group viewing of specially produced material e.=
g.
‘films’, ‘music’, ‘drama’,
‘documentary material’ etc.
5.2
The
Advantages of Using Telematics in Modern Asclepieions
Citizens
can exploit the advantages of the Information Society’s technologies =
(ICT
– Information and Communication Technologies) without the burden of the expense assoc=
iated
with the purchase of their own computers, access to the internet, use of
tele-communications etc. There are however some costs to be borne and the c=
ost
of access to information for example, is usually defined by its source.
In a MA
all information is considered as a ‘public good’ and every effo=
rt
should be undertaken for services to be free of charge to all or to at least
certain categories of users. In the case of some ‘state of the art
information’ and some ‘academic writing’ there may be a
requirement for it to be ‘rewritten’ or to be
‘interpreted’ or ‘translated’ with the consideratio=
n of
the costs of doing this as well as the costs concerned with intellectual pr=
operty
rights. For those who are not very familiar with telematic technologies or =
are
computer illiterate, technical support may also be required and there may
therefore be a number of different extra costs to be borne in order to allow
all citizens to benefit from the latest technologies and information servic=
es.
A combined public and private system with industrial input could be set up =
to
meet these costs as well as to meet the costs of future developments. This
model can have a significant impact to less developed societies, to people =
who
are socially excluded, people with low or no incomes, young persons with
limited means, and people wit=
h poor
knowledge of the language of the country in which they live, work or visit
(electronic translation to different languages is not a very difficult task=
any
longer), .
In
addition to these considerations MAs are intended to promote social interac=
tion
and their holistic approach means that all citizens must find it easy to
interact with others, to participate to groups with similar interests and to
obtain personal professional guidance and support when required. This is in
sharp contrast to the currently prevailing technology model of asking citiz=
ens
to confine themselves to a ‘smart box’ (i.e. to a room at home,=
or
to an office) which is equipped with a modern telematic device that only al=
lows
access to the ‘virtual world’ of the internet. The addition of
‘real-life interactions’ will provide motivation to users as we=
ll
as opportunities for providers.
6. Modern Asclepiei=
ons
Infrastructure – Land, buildings and other Installations
6.1 The MA Park <= o:p>
Modern
Asclepieions can be established anywhere – indoor or outdoor and they=
can
have any size and type. The best use of urban open spaces would be favoured=
in
all countries and if possible MAs should be sited alongside or around curre=
nt
educational and healthcare facilities. The open space model is particularly
appropriate in countries with climatic conditions that allow for outdoor
activities for long periods of the year, whilst indoor facilities (such as
public buildings including schools; libraries; museums as well as sports ar=
enas
and shopping centers) can be utilized at all times and in all countries.
An
outdoor park would be closer to the original model based on the ancient Gre=
ek
Asclepieions e.g. the Asclepieion of Epidaurus and the Asclepieion of Perga=
mum
in
6.2
Buildings
and other Installations
The
overall guideline for buildings and other installations in the open space
environment of a MA Park, their number and size, is that they should be
unobtrusive and must be capable of adaptation and be removable when require=
d.
The
holistic character of MAs must provide for experimentation, innovation, nov=
el
approaches, free expression, and openness to new and current trends and to
creativity. In such an environment all necessary installations should be
revocable. Permanent installations confine societies and people to certain
styles and conditions for long periods of times and they demand significant
budgets for their maintenance and operation. In addition the persons employ=
ed
tend to become ‘established’ and they usually promote their own
interests rather than the public interest.=
MAs are not places where architecture could demonstrate its
accomplishments and achievements. This can be done elsewhere. Man and his
relationship to the natural environment, to its monitoring, its well being =
and
its evolution must be the main focus rather than buildings.
All
societies are required to consider the best use of their urban open spaces =
and
these can be used for a variety of purposes including the hosting of people=
for
recreational activities as well as for sanctuary purposes in the case of lo=
cal
catastrophes and other large scale natural disasters (e.g. fires, earthquak=
es,
floods, etc.). Many governments and local government agencies regard this t=
ype
of use as being an indispensable requirement for today’s crowded citi=
es
where very few alternatives are available. The use of such open spaces can =
be
maximised by creating new or modern Asclepieions with close proximity to
healthcare and educational institutions. In this way the land will be retai=
ned
for the public good and it will be improved upon to provide a useful future
resource. The services provided in this environment will also be available
whenever required for the benefit of the community as a whole.
Athletic
facilities and fields
These
should be as simple as possible with no constructions for spectators. In the
case that projects and activities envisage the provision of spectator needs
then temporary enclosures, natural embankments or soil formations can be
exploited. The main goal is to encourage people to be active themselves, to
exercise but not to be competitive and not to be confined to using
technologically advanced material and equipment in their activities. People
must exercise for health purposes, to improve their performance, to learn a=
bout
themselves, to understand the procedures and techniques that can allow safe
participation in physical activities with others and to interact and to work
with fellow citizens. One of the main concepts should be that of
‘holistic regimens’ in the promotion of health. Priority should
therefore be given to the use of existing and new athletic grounds and fiel=
ds where
as many people as possible (groups of people) can participate in healthy
activities and where experts can support and train them for the good of the
society as a whole.
Educational
and Healthcare Installations
Whilst
MAs may be in close proximity to educational and healthcare buildings they =
are
not intended to provide their own health installations or their own health
programmes. They offer all citizens the opportunity of access to and
participation in the educational activities of the society concerned (i.e. =
the
formal knowledge taught in the school systems as well as the health promoti=
on
and other societal knowledge that governments and professional agencies
provide). In MAs these programmes are designed to be delivered beyond the
normal teaching schedules and hours and outside the educational and healthc=
are
facilities themselves. They are also combined with engagement in related
activities.
This
approach reaches a wider audience and it is more effective and efficient in
many topics such as learning about the environment and about the many social
themes that affect our lives. Since theory can easily be coupled with pract=
ical
applications and examples. MAs offer opportunities for real-life experiences
with the support of experts. This type of life-long learning beyond the nor=
mal
school age can provide for the acquisition of specific knowledge, skills and
qualifications as well as for general lifestyle improvements.
In
general terms, no particular installations are necessary and for those who =
are
house-bound the use of telematic technologies and volunteer visitors can
convert the home or any other domiciliary environment into the site of serv=
ice
delivery.
World
of Science
MAs
are intended to provide a new type of ‘open air science laboratory=
217;
where everyone and especially young people will be encouraged to participat=
e in
the care of the environment, to real-life demonstrations, presentations,
experiments and discussions on knowledge, technologies, techniques, process=
es
and procedures. No specific buildings are required but temporary installati=
ons
may be useful.
6.3 &nb=
sp; Access
and transportation
All
transportation to and inside the open space of a MA should be made using
environmentally friendly means i.e. on foot, or by bicycle or by other
environmentally friendly ways. For those with mobility problems, electric or
other specially adapted and environmentally friendly transport can be provi=
ded.
Where
distance is an access factor then public transport should be the means of
choice in order for everyone to have the opportunity of travel to the parks.
Only senior citizens and those who are not able to use the public transport
services as well as those who are to be admitted to the medical units along=
side
or inside the parks, will be allowed to use private transports such as spec=
ially
adapted cars. A system of identity-badges can be used to control this activ=
ity
but all persons with special needs should be supported by others including =
by
the park-volunteers who will offer their good services to those in need.
6.4. &n=
bsp; Telematic
Infrastructures
The
holistic services provided in MAs offer an opportunity for exploitation of =
the
possibilities offered by telematic technologies i.e. computers and
communication networks as well as mobile and personal telematic devices.
The
simplest infrastructure required to run the services is one ordinary desktop
computer with a CD-ROM drive. In terms of a MA park, the average telematic
infrastructure could consist of a communications network (wired or wireless=
or
a combination of both), servers, user terminals, one or more data and
information bases and the software tools for information storage, searching,
retrieval and display as well as tools for management and analysis of usage=
.
The
MA Park should dispose an intranet for making available the services at any
point inside the park. User terminals can be fixed or mobile. Mobile termin=
als
will soon be the technology of choice but fixed terminals, probably with
additional specialised equipment, should be available to all users whenever
large image formats must be displayed or when other special effects (e.g.
sounds, videos) must be displayed, processed and reproduced.
Voice
technologies should be used whenever possible in order to facilitate the
comprehension of the information by the users.
The
intranet proposed will also need to provide a secure environment to protect=
the
databases and the equipment from attacks of socially misbehaving parties.
6.4.1
The scenario of a=
user
entering a MA park:
At
the entrance to the park the network terminals will allow citizens to view a
plan of all the facilities. Browsing and clinking on particular spots of the
plan will provide information about the units operating inside the Park and=
the
activities taking place. All the information useful to orient oneself; how =
to arrive
to a place of interest; what services are offered and what relevant informa=
tion
at the task level is provided in the units and by the individual profession=
als,
will be able to be accessed. The detail of this information will alter and
improve with time.
Within
the MA, users will also have, as second option, the opportunity to use fixed
and mobile search facilities via the MA portal. This will allow them to
interrogate the data bases and to learn about the site they are currently
visiting. They will be able to access any information related to the activi=
ties
taking place and will be encouraged to join in ‘today’s events =
and
discussions’.
The search capabilities of the portal can also be used for accessing all the information pertaining to the main themes of Health, Culture, Environment a= nd Social interaction. Questions to the portal will be posed using free text.<= o:p>
Wireless terminals will be part of the park’s intended development in order to provide for increased mobility and to allow for parallel activities (e.g. listening to a scientific topic on health whilst exercising, running or wal= king at the same time). Wireless terminals will be used as well as personal devi= ces for locating a user inside a large park, to transmit information concerning= the management of the park, and to relay messages as well as providing an alarm= and safety measure. <= o:p>
6.4.2
Personal Devices =
and Equipment (Medical or other)
All
personal devices to be used in activities inside the park will require
certification of their safety.
The use
of modern digital technologies allows for direct coupling to computers and
therefore the output from personal medical devices can be captured and
processed via the park’s telematic infrastructures and can be sent to=
the
relevant healthcare institute and/or the healthcare professionals concerned.
Medical devices can therefore be used to assist in the provision of health
services inside the park such as population screening, health promotion, he=
alth
education, and campaigns for particular health is
- = safe for users and operators (power, EM radiation, ionising radiation, …)<= o:p>
-
minimal
annoyance to users (wearable, lightweight, miniaturisation, …)
-
simple
and easy to operate and read output
-
simple
and understandable user interface
-
easy
maintenance and replacement
-
wireless
connectivity to networks (intranet, internet, GSM, …)
-
minimum
training needs
-
affordable
costs for hire or purchase
Diagnostic
and/or therapeutic portable equipment (such as ultrasound and other scanning
devices) can also be provided in mobile units or in temporary medical
facilities that may operate from time to time inside the parks. This will
necessitate suitable infrastructures, trained operators and specialists for
analysing the findings and for providing management plans. For this type of=
use
the equipment specifications and the guideline recommendations will vary ac=
cording
to the health related service to be delivered – they will therefore
require to be described for each purpose at the appropriate time. In general
terms these services will be organised and run by the professionals concern=
ed
and therefore their own current guidelines can be used.
7. &nbs=
p; Initial
MA services and their Service design
7.1 &nb=
sp; General
Guidelines for the Initial Services
The
guidelines for the initial services and their design are not intended to
provide something new or to replace the current guidelines of service provi=
sion
used by the relevant experts. In general however MA services should not rem=
ove
the possibility of decision making from either the user or the provider. Th=
ey
should not be designed to exclude the relevant professionals or the business
community nor should they be designed to provide answers and judgements from
machines and computers. The general guideline is that everyone should be
encouraged to provider their input in decision making – everyone shou=
ld
be ‘engaged’ in the service design including the service
specification and its intended mode of delivery.
All
MA services are intended to provide easy access to all information irrespec=
tive
of time, educational background, identity, social position. The main goal i=
s to
help us to improve our understanding of ourselves (our body, our mind and o=
ur
society) and to help us to improve our health as well as to mitigate or sol=
ve
the local problems we face. They are intended to empower everyone to make
informed choices and to have control over their own circumstances.
Whilst
the initial service design will need to be made by experts the expectations=
of
the users should be canvassed beforehand. Proper mechanisms (e.g. using
electronic questionnaires accessible from the initial Portal) can be instal=
led
to extract and document the wishes of the users and their comments on all
aspects of the intended services, their design, operation and delivery. Once
the initial services prove themselves (after suitable adjustments and
improvements) the relevant documentation must be updated and made available=
so
that everyone can engage in discussions regarding future changes and
developments.
Apart
from time gains, the reason for not asking users to participate in the init=
ial
design of the services is that the innovative character of the services
requires expertise including that of being knowledgeable and having the
necessary ability to exploit advanced ICTs. It is not yet the case in many
societies that users will be able to contribute to this. However, users may=
be
able to express their value concerns and their expectations and these shoul=
d be
taken into account by the experts. <=
/span>
7.2 Content Creation<= o:p>
Information
content should be provided by the units responsible for the activities and =
the
services offered inside the park. Tools must be developed or employed to al=
low
authors to post their contributions directly to the portal data base. Autho=
rs
must be responsible for the regular updating of the information content whi=
ch
has to be accurate and to be available as soon as alterations, improvements
and/or additions need to be known. <=
/span>
Scientific
information will therefore be provided by University units, trusted public
institutions and other authorities. Authors must be encouraged and supporte=
d to
post their contributions directly to the MAs Portal data bases. All
contributions must be updated or revised so that no information can be
considered to be ‘out of date’. In a given country the scientific
content can also be provided by a collaboration of all the institutions
specialising in a certain domain. For example the content on Health can be
provided by the collaboration (or alliance) of all the Schools of Medicine.
This will be cost effective, less time will be needed to produce a sizeable
data base with information on many topics, no diverging strategies will be =
pur
Translation
from one language to another is another means for accelerating content
creation. In many countries that lack the resources to create the documents=
and
in particular to enrich them with pictures, drawings, sketches, videos,
narration the solution of translation from other MAs might be the most cost
effective and appropriate solution. In this way many countries and regions =
can
be benefited in a reasonable time frame and not be left behind.
7.3
Priorities
and Service Uptake
All
the four thematic areas of MAs are of importance and are relevant to the
quality of life in today’s world. No guidance is therefore given as to
where to give priorities or where to put emphasis. In this way every MA will
develop its own personality and will develop varieties of forms, content and
services.
The
opportunity to be exploited is that of providing health promotion to all
citizens and not that of providing the benefits of modern medicine to a giv=
en
society. The essential priority is therefore that of engaging everyone in
holistic ways of learning by doing.
Given
the sensitivity of societies to health and culture is
7.4 <=
span
style=3D'mso-tab-count:1'> Service
Attributes
Reliability
The
reliability of the information posted on the MA portal will be judged on the
reliability of its information sources and how well its strategy for regular
updating will be implemented.
Consistency
Users
must feel that they control the information and the equipment at their disp=
osal
(computers, mobile phones, written texts, audio devices) and not vice versa.
The services must always provide consistency in terms of availability, cont=
ent
and evaluation procedures.
Flexibility
The
information should be able to be extracted from the databases of the system
with minimum effort and by very simple queries in a natural language (writt=
en
or spoken).
Simplicity
The
service access and content should be easily available and comprehensible to
everyone. Appropriate use of multimedia tool should be used whenever possib=
le.
Users must not be overloaded with irrelevant information.
7.5 &nb=
sp; Training
Users
Citizens
with secondary education are expected to have no particular difficulties in
accessing the services offered via telematic means. However, the planning a=
nd
implementation of user support services for everyone will be a necessary
consideration. This is not a difficult task and might be viewed as an
opportunity for providing part time occupation to younger persons skilful in
computers and their applications. The needs will be obviously more pronounc=
ed
in less developed countries and regions but the is
Operator
Training
of the technical personnel will be necessary and must be part of the contra=
ct
of the telematic operator within the MA.
The
operator can be a secondary or tertiary level public or private institution
with technical expertise or a business concern.
7.6 &nb=
sp; Alerts
Particular
importance must be given to alerts that must be available to all citizens. =
They
will usually contain scientific information produced by competent authoriti=
es
(e.g. Ministry of Health, relay of information is
Information
on alerts must be concise, clear and signed by the appropriate authority or=
its
spokesperson. Additional information and knowledge sources must be availabl=
e to
users along with guidance on access and effective use.
8.
&=
nbsp; Modern
Asclepieions implementation
Despite
their attractive concepts and ideas, the establishment of MAs are currently
facing some formidable hurdles for their implementation. In part this is du=
e to
a lack of direction and in part to the established mentalities of individua=
ls
and groups in society with the scepticism that faces new ideas. This should
change as the opportunities are perceived and once definite plans for
implementation are laid out so that positive results can be seen to be
achievable in a reasonable time frame. In turn these factors will be improv=
ed
by forwarding the open discussion of societal value concerns and as agreeme=
nts
are reached concerning what needs to be done.
8.1
Initial
Implementation Strategies
Modern
Asclepieions require the willingness of communities and the relevant
authorities to be engaged in activities which focus on citizen empowerment =
and
on quality of life improvements. It is therefore necessary that all
stakeholders participate in discussing the notions and the opportunities
involved.
8.1.1 &=
nbsp; Citizens
/ Users
Citizens
will have the dual role of setting out their value concerns and priorities =
as
well as being service beneficiaries and evaluators. The stimulus for author=
ities
to consider the establishment of MAs will come from local needs being expre=
ssed
to elected representatives. There is therefore a requirement for informatio=
n on
Asclepieions to be widely available and this document and the
8.1.2 &=
nbsp; User
and Expert Groups
In
terms of initial implementation a clear mechanism needs to be considered for
the inclusion of users and experts alike.
The
proposal to establish MAs may best be received when there is a focus in the
development, or change of use, of a local area or of an inner city space. It
will engender the actions and reactions of a variety of ‘interest
groups’. Elected decision makers have their responsibilities just as
professionals and business interests do but, in today’s post modern
world, they need to bring their decision making into closer contact with th=
e needs
and the expectations of the society they serve. They need to canvass custom=
er
(user) needs and expectations and they need to consider providing services =
and
technologies that are appropriate to client led enterprises which are motiv=
ated
by a societal value philosophy.
The
establishment of user and expert groups (one or several) will enable the va=
lue
concerns and the opportunities of interested parties to be expressed in a
satisfactory way in order to engage the professional and the business
communities and to begin the process of representation to local authorities.
Also the provision of a WWW electronic Pnyka would provide the opportunity =
for
a wider discussion of the is
The
end-users and beneficiaries of MAs will be the local citizens as well as the
human society as a whole and therefore everyone must find a way of expressi=
ng
their views and being represented in their implementation and their future
progress.
In
western societies, the local elected representatives (mayors and councillor=
s)
are responsible for local land usage and for providing local services in he=
alth
and education. They are also responsible for local housing and welfare need=
s as
well as for local cultural concerns. There are also regional and national
government agencies who act as law-makers and resource providers. It would
therefore be appropriate for any of these authorities to be persuaded to se=
t up
an advisory structure (a working party or a committee) to consider the esta=
blishment
of MAs. There may already be a ‘Parks Committee’ and if so dire=
ct
representation to it should be made.
The
chairperson of a working party (committee) to advise on the establishment of
MAs would be responsible for ensuring democratic processes and for the
transparency of all documentation and decision making. The constitution of =
the
working party would be time-limited but would enable representations to be =
made
from all interested parties including the opportunity for all the local
stakeholders (local voters) to participate in electronic or other discussio=
ns
and in electronic or other voting mechanisms.
The
members of the working party (committee) could be appointed or elected but
should include experts from the intended MA service sectors (health, cultur=
e,
environment and social care) and from the IT and communications business se=
ctor
as well as representatives from local community leaders (e.g. youth leaders;
voluntary service leaders etc.).
The
working party chairperson should interact directly with the relevant counci=
l /
government departments (e.g. the land management; social services; educatio=
n;
health; culture departments) for their comments and input and will provide a
final report with an implementation strategy for consideration by the autho=
rity
concerned (e.g. to the local council chairperson, or Mayor). This report wi=
ll
include a business plan and would be made available to the local council
chamber for its discussion on appropriate land use and funding requirements=
and
for its agreement or otherwise on implementation and contractual
arrangements.
The
local Mayor and the elected councillors will also be responsible for making
available the economic and other resources required for the initial
establishment and running of the services and in this regard they may consi=
der
mixed economic means as well as government grants and research funding as a=
way
forward.
The
integrated services of MAs will also need to be agreed on and a time-line
should be set out for the planning and the initial implementation stages
together with the contractual obligations needed. This will include content
providers as well as professional and business service providers.
Content Providers
Content
providers will naturally form themselves into an expert group but this must
have input from the other expert and user groups and must provide content
examples for evaluation by them. The Universities, Schools, Libraries, Muse=
ums
and other content providers (e.g. public authorities) should form an
association whereby consideration can be given to the totality of the conte=
nt
required and to the associated standards to be maintained. The chairperson =
of
this association will be a member of the local council / government working
party to advise it on content provision.&n=
bsp;
Engagement
of all the relevant institutions is recommended as well as the sharing of t=
he
workload among institutions which have the same or similar mission. The cos=
ts
of content provision will need to be set out and mechanisms must be develop=
ed
to assure the coverage of the topics of interest, the quality of the
information, its reliability and its timeliness.
Professional Service Providers
The
provision of integrated professional services will not be an easy matter to
resolve. The training and certification procedures of professionals are
currently designed to provide a barrier to integration or rather they prosc=
ribe
a defined area of competence to the professionals concerned.
There
are however many areas where combined service structures with the sharing of
information and responsibility could be achieved. The quality of the servic=
es
provided including their reliability and effectiveness will be the
responsibility of the professionals concerned. This will include teachers,
doctors, nurses, lawyers, social service and other health, education, cultu=
re
and environment specialists. The value concerns and the guidelines set out =
in
this document could be used as a starting point and the organisation of spe=
cial
events (festivals) could initially be used to trial service requirements and
the possibilities and the opportunities for integration.
Business Providers and Sponsors<=
/a>
Any
private or public entity willing to support the establishment and running o=
f MA
services, either financially or in kind can be a sponsor. Such sponsors must
respect the ideals, the principles and the ethical/quality framework of MAs=
and
a vetting procedure as well as advertising guidelines will need to be set o=
ut.
There
are many charitable organisations that could provide services in MA’s=
. An
example would be “Riding for The Disabled” where there is a
verified health benefit. The advantage of hosting the activities of such
charitable organisations is that they have their own funding; they also enh=
ance
and focus the services provided for a given community and they have a cohor=
t of
ready made volunteers. It might also be appropriate for Modern Asclepieions
themselves to be registered as charities in order for them to be able to ra=
ise
non-taxable funding from a variety of sources including national lottery
schemes.
MA’s
will also provide business opportunities in terms of construction as well as
ancillary service provision. These will require contractual arrangements and
will need the consideration of local and national guidelines. The value
statements and the guidelines set out in this document can also be used as a
starting point. An example of ‘contracted-out’ services would be
the needs of visitors to a MA Park in terms of food and drink outlets as we=
ll
as rest-room facilities. The overall policy for contracting-out of these
services would be decided by the MA Board of Governors and the use of
volunteers should not be discounted. Other business interests would include=
the
network and the electronic services including the MA portal and the provisi=
on
of personal and other mobile devices.
8.2
A
Suggested Management Structure for MAs
MAs
should be organised and developed to suit the wider public interest. They a=
re
intended to provide a highly innovative environment in which client needs a=
re
addressed and the central concern is that of the promotion of citizens̵=
7;
rights and the quality of their living. Once the local authorities have
provided permission for a given site to be used consideration should then be
given to the formation of board of governors.
Every
effort has to be made to create a ‘management board structure’ =
with
a clear chain of command which will promote the interests of the society at
large and not the interests of ‘pressure groups’ or its own
members.
Three
quotations from Peter Drucker, the man who invented Management
are appropriate:
1.
On
Organisations: ‘Human beings tend to close out the outside. But effec=
tive
organisations exist not to satisfy themselves but to fill a customer need.
Leaders have the duty to focus an organisation on the outside in a way that
continually refreshes what everyone is doing inside the company’
2.
On
Making Decisions: ‘Every decision is risky. It is a commitment of pre=
sent
resources to an uncertain and unknown future. You haven’t made a deci=
sion
until you’ve found a way to implement it’
3.
On
Work: ‘Focus on opportunities rather than problems. Problem solving
prevents damage, but exploiting opportunities produces results. Exploit cha=
nge
as an opportunity and don’t view it as a threat’
Governing
Body=
The ethos
of management for MA’s should be characterised by:
·
Minimal
bureaucratic procedures
- Flexibili=
ty
- Innovativ=
eness
- Team spir=
it
- Cost
consciousness
- Intellige=
nce
- Impartial=
ity
- Humanism<= o:p>
- Altruism<= o:p>
- Professio=
nal
competence in all fields of activities (directly or indirectly)
The
adoption of the above properties suggests that the board chairperson should=
be
appointed by the local community. This could be done by the elected local
council who would advertise the post on the MA portal and in relevant journ=
als.
The candidate should be chosen from public figures with a business or
professional record and a personality that will be respected by the local
community. He/She should provide a proposal for the establishment and
development of the MA setting out a business plan and an implementation
schedule as well the intended sources of funding. He/She should be devoted =
to
the cause, be engaged full time with no other professional obligations and =
have
a strong sense of duty. Initially a five year contract could be entered into
and this would include the option to extend the term of office based on the
local community recommendation.
Other
board members should also be appointed by the local community. A list of job
descriptions (salaried or voluntary) can be posted on the initial MA portal=
and
in other relevant journals. Candidates can present their applications for t=
he
post that interests them and a date can be set for any public interviews and
for electronic or other voting procedures to take place. Initial full time =
or
part time contracts of two years can be entered into with the option to ext=
end
based on the board chairperson’s recommendation and the ratification =
by
the local community served. Performance reviews must be conducted by the bo=
ard
Chairperson and an annual review would contribute to the decision making
regarding continuity of appointments.
Type
of Institution
MAs are
‘a non-profit public entity’ and they are accountable to the lo=
cal
community they serve. All procedures and decisions must be transparent and
subject to public critique and regular (periodic and/or extraordinary)
financial audits.
Legal
Entity
The MAs
must be established by law or other type of government or local authority
decree. This will guarantee that possible objections and disagreements will=
be
defended in law up to the higher courts for arbitration.
Land
and Property
Once the
MA management board has been established the local council (elected authori=
ty)
will make the land concerned to be a property which is owned by the board of
governors - with all rights of use including those of construction and
landscaping. This could be in the form of long term lease (e.g.99years) or
could be in the form of a land sale or a land trust agreement. Whichever
mechanism is used, ownership and administration would pass to the board of
governors, which would ensure that the land would always be a public
possession. The board will be accountable to the local community and its
elected representatives through its mode of appointment as well as through =
its performance
reviews. In this way it will become more difficult for local authorities to
change their mind or to impose future developments on the board of governor=
s.
The board will not be given the authority to decrease the area of its MA but
only to increase it.
The
ownership documents of the park should specify the ‘open-space
strategy’ (outdoor or indoor) and the revocable nature of any
installations. Permanent buildings must not be constructed in a MA Park sin=
ce
they will be binding factors to the use, the aesthetics and the financial
resources of the Park.
Resources
MAs must
be financially independent to the largest possible degree. A MA can be
initiated as a project in which its initial budget would be guaranteed for a
short period (e.g. 3 to 5 years) beyond which it must become self sufficient
(i.e. produce income from its activities) or raise funds from various sourc=
es
or a combination of both.
It is
reasonable to assume that information provision to citizens will be underta=
ken
by Government agencies utilising tax revenue funding (either national or
local). This could also be true for the activities related to health, cultu=
re,
the environment and social interaction. Governments already allocate sizeab=
le
budgets to these activities and therefore the appropriate sums of money can=
be
transferred to MAs. A similar situation exists on social support activities=
and
programmes.
Policies
such as ‘free access for all’ can be tailored according to curr=
ent
government policies and may only be free to disadvantaged individuals and
groups.
A third
option could be a mixed economic model where funding from sponsors or busin=
ess
interests could be combined with funding from government agencies and resea=
rch
bodies as well as grants from national lotteries.
Some
income will also be generated by commercial activities (e.g. food, drinks,
product vending) within the park.
Other
more innovative solutions, (e.g. the is
9.3
Business
Plan=
A MA must
be an enterprise that is well organised, financially and must be a provider=
of
quality services.
All
operational and routine activities (e.g. network construction, operation,
maintenance and improvements/expansion, services delivery, data collection =
and
automatic analysis on use and user profiles and behaviour etc.) should be
outsourced to professional entities. Design and redesign of services,
activities and projects expansion plans, modernisation, new fields of inter=
est
etc. should be the responsibility of the relevant authorities and the Guara=
ntor
organisation, the MA governing body.
A well
thought out business plan must be produced for every MA. This must describe=
in
due detail the following:
·
MA’s
Vision/Mission
·=
; =
Overview
of the MA enterprise
·=
; =
Services
strategy
·=
; =
Market
analysis
·=
; =
Marketing
Plan
·=
; =
Financial
Plan
Several
parts of the BP can be fairly similar for every MA. Other (fewer) parts will
depend on local conditions and peoples’ (users) attitudes and cultura=
l and
social background. It is therefore possible that a model BP can be produced=
and
used as a template for all new MAs.
9.4
Auditing
Financial
auditing must be done once a year by a competent and licensed company. The
results must be published on the MA portal and in the local press.
All
documents and records of activities and procedures must be kept in digital
format in computers for the easy retrieval and processing of data. Back-up
digital and hard copies must also be made.
MAs must
be organised following the ISO 9000 standard and seek service quality
certification.
9.5
Evaluation
and Assessment
Evaluation
of all activities and the performance of the MA as an entity must be done e=
very
2 or 3 years.
Self
assessment procedures must be described and pur
Questionnaires
on evaluation and assessment must be designed and be available to all users=
via
the MAs portal. Their findings must be also published via the portal and in=
the
local press.
9.6
Usability
(efficiency, effectiveness and satisfaction)
In
specifying the strategy to extract information on usability of the MAs and =
the
services provided the ISO 9241-11:1998 and ISO 13407:1999 standards can be
considered for guidance[14].
The
outcome of the usability monitoring of the entire MAs and the services prov=
ided
will be used to identify which components of the whole system are amenable =
to
change and can bring overall improvements.
9.7
Ethics
/ Quality issue<=
/span> s
In
MAs the ethical value statements in this document can be used as a starting
point for gaining acceptance and for setting out the path of progress. In
general terms the clauses on fundamental human rights as expressed in the UN
Charter, the Universal Declaration of Human Rights, the International Coven=
ant
on Civil and political Rights, the International Plan of Action on Ageing
(endorsed by the General UN Assembly - Resolution 37/51 of December 3, 1982)
should be implemented for the benefit of all users.
MAs should also be granted the st=
atus
of a ‘university asylum’ (shelter, refuge) with the Greek meani=
ng
of the word – i.e. a place where people are free to express their
beliefs, views and ideas and never to be prosecuted, ignored or excluded fo=
rm
any social activity because of them.
Beyond
the general framework described above, MAs should operate in a developing w=
ay
with the following general directions:
· =
Equ=
ity
of access must become a reality (i.e. have equal status with others in term=
s of
our individual freedom of choice)
· =
Ind=
ividual
must have freedom of choice so long as they able to participate in the
processes required. If substitution decision making is required then the
benefits of the fulfilment of individual needs will be the guiding principle
and will outweigh the possible costs of the intrusion of privacy and the
possible costs of the denial of choice.
· =
Eve=
ryone
should be helped and supported to:
o=
=
Live in dignity, security and be free of exploitat=
ion
and physical or mental abuse
o=
=
Be integrated in society, be treated fairly and be
respected for what they are
o=
=
Have their quest for independent living to be real=
ised
o<=
span
style=3D'font:7.0pt "Times New Roman"'> =
Have access to legal services (to enhance their
autonomy, protection and care)
· =
Eve=
ryone
should have the same opportunities:
o=
=
for self development
o=
=
to participate to personal and societal improvements
o=
=
to work for income generation or for voluntary
purposes
· =
All
Services should:
o=
=
Respect the users’ cultural and personal val=
ues
o=
=
Provide
assurance to the users through continuous evaluation of performance,
(including that of all products)
o=
=
Have defined ‘best practises’ in order=
to
improve the trust of users in the procedures and processes.
· =
All
providers should have certification of their competencies and all integrated
tasks should have defined responsibilities.
MAs
must organise themselves in such a way as to be compliant with ISO 9000-2000
Quality standard, ISO 14000 Environmental standard and ISO 13407 Human-cent=
red
design processes for interactive systems standard.
9.8
Guardian
/ Guarantor
An
authority such as a tertiary education institution or a government body can
assume the role of the guardian of the implementation of the rules and
regulations pertinent to a MA Park. For example for Health is
Similar
arrangements can be considered for environmental, cultural and social
interaction is
10. &n=
bsp; New
themes to be considered
The
initiators of this document believe that the endeavour to establish MAs sho=
uld
be an open ended one. It must provide all the necessary flexibility to allow
interested parties and organisations to participate and to suggest and deve=
lop
new and innovative ideas for discussion by all.
There are
more is
·
Special
Talents
Although MAs are not intended to develop
individualism, all societies need their champions and the identification and
nurture of special talents will need consideration. Facilities for the furt=
her
development of special talent will exist outside of MAs but links between s=
uch
facilities and MAs can be made. Also the champions themselves can provide
voluntary services within the MA so that society as a whole may benefit from
their success. The sharing of knowledge and expertise is part of the service
philosophy of MAs and promoting the fulfilment of individual potential as w=
ell
as societal advancement are factors which influence the wellbeing that is
intended for all.
·
The
role of MAs in spreading the benefits of the Information Society
o&nb=
sp;
R&D
concerning the shaping of e-Health policies and new health and social servi=
ce
developments
- R&D of new trends in the roles and designs of Medical and
Social Care Units
- R&D =
of
societal Systems to manage Electronic Health Records and Social Profi=
le
Records
- R&D =
of New
Combined Telematic Services on Health, Culture, Environment and Social
Interaction
- HiTech a=
reas
around and inside Modern Asclepieions – R&D of new technolo=
gy
- Networks= of MAs and other organisations at regional, national or international level<= o:p>
·
Social
Responsibility Is
The pro-inclusion principle and the lea=
rning
by doing philosophy of MAs provides for many opportunities that relate to
social interaction and social integration. Such is
The role of MAs in promoting both social
integration and independent living are not in opposition to each other but =
are
to be seen as being part of a combined effort to enhance the wellbeing of
everyone.
New technologies can assist these endea=
vours
and consideration will need to be given to the development of new services =
and
new technologies to cover a wide area of needs. The use of GPS systems comb=
ined
with mobile communication could be of great advantage to the incapacitated =
but
they will need to be tailored for this purpose and the services provided wi=
ll
require new processes and new quality assurance procedures.
11.
Current
Asclepieion Services
Current
Content, Copyright and Intellectual Property Issue s
This
document and the current ideas on Modern Asclepieions were developed in
The
Asclepieion Park of Athens was proposed by FAPA in order to create the first
Modern Asclepieion on the site of the original Ancient Asclepieion. The urb=
an
space concerned is a large area inside the greater
Details
concerning Modern Asclepieions can be found in the portal http://=
panacea.med.uoa.gr. In August 2003, the association of=
FAPA
was dissolved and all subsequent activities concerning Modern Asclepieions =
and
the Asclepieion Park of Athens were undertaken by the
Other
initiatives aimed to provide services of Health and Culture to citizens bas=
ed
on the concept of Modern Asclepieions can make use of all the current mater=
ial
available through the relevant web sites, portals and blogs and any publish=
ed
material in any form can be used with due mention of the School of Medicine=
of
the University of Athens as the originator and source of the material
concerned.
Intellectual
property rights of designers, innovators, authors and contributors to the
services, the activities and the projects inside the APA and IASPIS park (t=
he
Modern Asclepieion Park of the School of Medicine of the University of Athe=
ns)
are those described by The World Intellectual Property Organization (WIPO) =
(http://www.wipo.int/copyright/en/).
Permission to reuse the material for
commercial purposes must be sought from the authors. The material can be fr=
eely
used either in the original language or in translation in any not-for-profit
activity provided that its source is mentioned and a notification is send to
the
References<=
/b>
1.
2. Ken
Boddy, Tony Kinder and Dimitrios Sotiriou, Ethics in Telemedicine Services,
private communication, Project Proposal to the CEU, 2003
3. Ken
Boddy and Dimitrios Sotiriou, HERMES Question Set, HERMES Project, 1998
4. Documents
on Principles and Action Plan, WSIS, ITU Web site, 2003
5.
Principles for Health in the 21st Century, WHO, 2000
6. Resolution on eHealth (EB115.R20), Fifty-eighth World
Health Assembly, 115th Session, J=
anuary
2005
_____________
[1] Note: By the 'modern' world is meant, broa=
dly, the
western world from the eighteenth century to the present. The European
Enlightenment at the intellectual level, and the Industrial Revolution at t=
he
social level. These events produced enormous changes in how societies worke=
d,
and in how people thought. Men and women learnt to think for themselves in =
the
Enlightenment and then in the Industrial Revolution, those who learnt to ma=
ke
things for themselves rather than having to grow them, acquired a new
confidence: they could take on the world. There thus grew up the
‘modernist approach’ to continuous progress through learning and
doing. New societal values and new ethical stances replaced the ancient
traditions and there were ‘wars to end all wars’. In the modern
world we could use our new found science to show up barbarity and superstit=
ion,
to free ourselves from tyranny and frpm the rules (religious and other ethi=
cs)
which governed our lives in the past. It is this heady combination that peo=
ple
regularly refer to, when they talk about 'living in the modern world.' The
freedom to think and do for ourselves, or not to think and do at all (if
that’s what we choose to do), is a very powerful determinant of who we
are and what we become.
[2]=
Note: The societal changes brought about by modernity a=
re
also the context for the rise of ‘post-modernism’ in which we s=
ee
the so-called 'death of the metanarrative' - the critique applied to the gr=
eat
stories (beliefs) of both the ancient and the modern world. These big stori=
es
(beliefs) are now being deconstructed, or demythologised and there is the
recognition that we still have the ‘real is
[3] Note: See the compilations by John D. Barrow and Frank J. Tipler, The Anthropic Cosmological Principle (Oxford: Clarendon Press, 1986) – and - John Leslie, "The Prerequisites of Life in Our Universe," i= n Newton and the New Direction in Science, ed. G.V. Coyne, M. Heller, J. Zycinski (Vatican: Citta del Vaticano, 1988).
[4] Note: In his observations of the natural w=
orld
Aristotle perceived that the organs and tis
[5] Note: Aristotle takes the ordered characte= r of the physical world for granted. Unlike most of his predecessors, he did not ask about origins. His listing of the canonical types of explanation stops at f= our; there is no entry for genetic explanation, for queries as to how particular kinds or particular forms of order came to be in the first place. In an ete= rnal universe, he seems to say, things must work together for the good, and ther= e is nothing more to say. This can be contrasted with Plato's quest in the Timae= us for the source of all cosmic order. His concern is first and foremost with ‘agent cause’, not ‘final cause’. His aim is to show that everywhere in the sensible order, notably in the realm of planetary motions and in the structures of the human body, there are the traces of ‘the shaping reason’ – the demiurge - that must have fashioned them. He seeks for evidences of design, for features whose intelligibility requires that they be the work of ‘intelligence’= ;. About the Demiurge or ‘the shaping reason’ itself, he has littl= e to say - Plato scholars have long since made up this deficit!
[6] Note: A number of our great scientists from
Galileo to Lavoisier and Faraday - and from
Note: The Times (London) Weekend Review’, May 21=
st.
2005, concerning Richard Dawkins views of intelligent design was followed b=
y two
‘Letters To The Editor’ of The Times (London) Newspaper for
Wednesday May 25th 2005, from Dr. Milton Wainwright and from Pro=
f.
Andy C. McIntosh respectively. These two UK scientists, a Molecular Biologi=
st
and a Professor of Thermodynamics and Combustion Theory, respectively, oppo=
sed
the views of Richard Dawkins and his suggestion that the theory of intellig=
ent
design is merely a bigoted fundamentalist attack on the veracity of evoluti=
on.
Wainwright and McIntosh however suggest that the bigotry comes from the
relentless propaganda of evolutionists such as Dawkins who ignore the real
facts of science in favour of their atheistic prejudices!
Note: Recent legal judgements in the
[7] Note: As societal structures with interactive processes that relate to our
wellbeing, combined (holistic) services can be seen as having the same
“goal directed benefit” which is described by Aristotle. They a=
re
applicable to ‘for the sake of’ everyone as individuals as well=
as
to all societies as a whole. The holistic service viewpoint, which is at the
basis of both the ancient and the modern Asclepieions, can therefore be see=
n to
be concordant with the ancient notion of a teleological anthropic principle=
of
good as well as being concordant with current science.
[8] Martin Luther King Jr. “In a real sense all life is interrelated.= All persons are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly…I can never be what I ought to be until you are what you o= ught to be, and you can never be what you ought to be until I am what I ought to= be. This is the interrelated structure of reality”
[9] Note: The ancient Asclepieion Parks included a spiritual aspect – na=
mely
the
[10] <= span lang=3DEN-GB style=3D'font-size:9.0pt;font-family:"Times New Roman";color:w= indowtext; mso-ansi-language:EN-GB'>Note: