In our hyper-specialized society, our tragedies happen politely out of the public's gaze
While our hospitals struggle to avoid collapse, the rest of us order in a hot meal and put on a hockey game.
I wish I remembered where I read this. It was a book I was blowing through for a university paper; only one chapter was really of interest to me when I was trawling for footnotes but I stumbled upon an interesting section that talked about services and specialization in a modern economy. The author offered a simple explanation of service specialization that I've never forgotten. Imagine a village with 100 people, the author said. Now imagine what services are available there. There's probably a gas station, and maybe you can get a few services done to your car there, too. Basic repairs. Tire rotations. Oil changes. Things like that. There's probably also a convenience store, and the store might also have a place to send or receive mail, or maybe even to rent a movie. (Back when that was a thing we did.) You might have a coffee shop of some kind, maybe a diner. But that's marginal. You almost certainly don't have a school, full post office, bank branch or medical centre of any kind. Not in a village of 100 people.
When you itemize out all the services you can get, it's probably about five or maybe 10 — gas pumped, tires changed, oil changed, basic engine repairs, store clerk, movie rental, mail sent and received. Maybe someone to pour you a cup of coffee and get you a sandwich — but only maybe. The point isn't to be precise in our list or count, but just to contemplate the relationship between the population and the number and type of available services.
Now scale that village up 10 fold, the author said. Now it's a town of 1,000. The number of services explodes. You still have everything you did before. But now you've also got specialized shops, restaurants, a bank or two (and all the services they provide), probably a house of worship, medical services of various kinds (including eye care, dentistry, etc), personal-care services, better access to home and lawn care, various repair and maintenance service, technical services, a post office ... the list goes on. You also start to see competition and the efficiency that brings — our village of 100 would have a gas station and a convenience store (quite possibly at the same location!). But our town of 1,000 would have a few of each. You’d get more services, and start to see prices dropping for the commonly available offerings.
You get the idea — the more you scale up a population, the more specialized services that are available and the more accessible they become. And this includes not just categories of service, but also increasing degrees of specialization. Our village of 100 probably has no full-time doctor. Our town of 1,000 probably has a family physician. But after we bump things up to 10,000, 100,000 and then a million people, we're getting not just doctors, but highly trained, specialized physicians, surgeons and diagnosticians. Our town of 1,000 has a dentist, but our city of a million has dental surgeons who've specialized in repairing specific kinds of trauma and injury.
Anyway. I don't remember what book this was from. But I do remember this short section. I think about it a lot. We Canadians of 2021 are, for the most part, hyper-specialized. I've written columns about this before, including this one from 2019, which I'm going to quote liberally below:
Human history is, in one simplified viewing, the story of specialization. As our technology advanced, a smaller and smaller share of the labour pool was required just to keep everyone alive. Perhaps the easiest way to summarize this is to note that 150 years ago, even in the most advanced industrial countries, something close to 50 per cent of the population was directly engaged in agriculture — half the people tilled fields so the other half could eat. Today, in both Canada and the United States, it’s closer to two per cent — one person’s efforts feed 49 others. Those 49 can pursue any of the thousands of specialized jobs that allow our technological civilization to exist. ... Those 49 people are our artists and doctors and scientists and teachers. Human advancement depends on this — a civilization that’s scrambling to feed itself doesn’t build particle colliders or invent new neonatal surgeries and cancer-stopping wonderdrugs.
I stand by those remarks. But I've been pondering them of late with a different perspective. I've spent much of this week talking with doctors and medical experts in Ontario, where the third wave of COVID-19 is threatening to overwhelm the health-care system, with tragic results. And one recurring theme that comes up in these conversations is how this disaster is going to take place almost entirely out of public view. There won't be any general mobilizations or widespread damage. People are going to die, behind closed doors or tent flaps, and other people will be forever scarred by their inability to save those people. But for most of us — those who aren't sick, or highly specialized medical professionals — life is going to be something reasonably close to normal.
It's become a cliche to note that the pandemic has not landed evenly on people. We usually mean that in terms of economic status, or racial identity (with an obvious massive overlap between those things). But your professional status matters, too. The small business owner has suffered more than I have. But I bet that small business-owner wouldn't trade their problems for those of an ICU nurse.
Specialization is good. It's what lets us do almost everything we do. But it also creates problems, where there is tremendous suffering and danger — often avoidable! — that falls so perfectly and narrowly on a small number of people that for the rest of us, it's basically invisible. I know, on an intellectual level, what's happening right now in our hospitals. And it's terrifying. But at 7 p.m. last night, when the Leaf game came on, I shut out the disaster in our medical facilities to focus on the disaster of our offence against Winnipeg and shaky goaltending. And then I went to bed and slept soundly, knowing that a nice hot breakfast and a relaxing day were all I had scheduled for Friday.
There are probably other problems with specialization worth contemplating. I've written before about how our way of fighting modern wars is going to take a horrific toll on the shrinking cadre of professional soldiers we turn to to fight our battles, over and over, while the civilian population forgets there's a war at all. And in a more mundane consequence, I have wondered if our increasing professional specialization is causing a form of career path dependency for many of us, where we keep doing the same job over and over again not because we love it, not because it's stable or pays well, but because we literally don't know how to do anything else, and can't imagine doing anything else. Indeed, doing something else might not really ever have occurred at all.
I'd still rather live in a world with neurosurgeons and particle colliders than in a simpler era, before specialization really took off (and you'd probably have to go back to the dawn of civilization to really get ahead of that). But we should perhaps consider the consequences. In Ontario, people are struggling and dying, out of sight and out of mind. We shouldn't ignore that. But gosh, it's easy to.
This week was the delayed March Break holiday for Ontario school kids, so I took it (mostly) off. No radio and no videos. But writers gonna write, so I stayed busy on that front.
On Monday, at TVO.org, I took aim at the Ontario government’s completely flailing response to the crisis of the third wave. “There is something very wrong with our provincial leadership — either the elected leadership, the appointed public-health leaders, or both,” I said. “After the past few weeks of wildly fluctuating decisions and public statements, it’s difficult not to wonder whether the people in charge have any idea what the hell they’re doing.”
Later in the week, I recounted a frustrating experience. I was shopping at a pharmacy when extra vaccine doses were offered to anyone who wanted one. I wanted one! But I fell outside the authorized range, due to incredibly remote risks of blood clots. '“Any vaccine carries risk, as does any medical procedure,” I said. “Life entails risks. Leaving the house to get your son some chips for the hockey game entails risks, particularly now. But given the deteriorating situation in Ontario, where we seem to be doing worse than the worst-case scenarios, getting doses into willing arms seems like the greater good. Give me a little legalese spiel and then have me sign a form. And then stick the damn needle in my arm — and into the arms of as many other willing people as possible. Time is not on our side here. This is an emergency, and we should act like it.”
That was also at TVO. Click here for that one.
Over at the Post, I started the week writing about the bizarre situation involving the Halifax International Security Forum. It’s hard to explain in a snappy recap, so I’m not going to try. Suffice it to say, it looks like, yet again, our federal government has been intimidated by Beijing. If you care about this issue, and you should definitely care about this issue, you should read the column. Please find it here.
I wrapped up the week with a reaction to the proposed new Conservative climate change plan that is, simultaneously, really, really weird and dumb, but also probably about the best the Tories can actually come up with. “O’Toole must deal with politics,” I noted. “So we get this convoluted kludge of a plan, where lower prices will produce worse results for the environment than the Liberal plan, at the expense of bigger government and less personal choice, and all so that O’Toole can tell voters that he’s doing something while assuring his own base that whatever this is, it’s not a tax.
“It doesn’t make any sense. But it might actually be about as good a policy as this iteration of the Conservative party — which has spent years demonizing a simple, clear-cut carbon tax but now finds itself needing to offer up something if it ever hopes to win — can possibly come up with.”
Thanks as always for reading, Code 47 readers. I hope you have a wonderful weekend. Stay safe.
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