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“Teleworking is here to stay” has become a repeated catchphrase of those gurus dedicated to predicting the future. You can substitute “teleworking” for “telemedicine”. But there is more than one thing wrong with the simplification that the catchphrase implies.

To start with, both working systems have been with us for decades. The broader use of both systems during the Covid-19 pandemic has been prompted by need, not by choice. Doctors and workers have been forced to use it in order to avoid physical contact with patients or peers; it was not an alternative, it was a must.

Most of them had to get used to the new system in a matter of days, if not hours. They lacked proper training and, mostly for teleworkers, they had to provide their own equipment and internet connection. Again, it was not an alternative; it was a take it or take it.

For teleworking and telemedicine to be included permanently in our everyday life, it has to be by choice. And for that, many things have to change in the way work is organized and supervised.

Nowadays, timing is, in most cases, the yardstick of how work is supervised. Doctors and workers have their working hours contractually regulated. Their supervisors make every effort to make sure that those hours are fulfilled, rather than controlling objectives. These are very rarely set and only instituted in the very upper echelons of the working pyramid.

In both teleworking and telemedicine, productivity becomes the most important aspect. Productivity is measured against the accomplishment of objectives. And objectives are difficult to set in most cases. It was easy for manual work; so many meters of weaving, so many bolts. In telemedicine, would you set a number of patients assisted as an objective regardless of the complexity of the illness? Of course not. Would you set as an objective the number of reports, regardless of the quality of the report? Of course not.

This is the main change in the way work has to be organized in case we adopt teleworking and telemedicine as a real alternative to on-site working. Supervision has to drastically change from working-hours-based to working-objectives-based. A real challenge to the working system.

When we talk about healthcare, even if nominally we are focusing on the patient, the reality is that we program the care process based on the capabilities and needs of the healthcare professional. If we didn’t do that, we still would have the family doctor coming home or, more realistically, Primary Care would be the prima donna of the healthcare process instead of the ugly duckling.

When we talk about social care, we rarely focus on the caregiver. We take for granted that the dear unmarried daughter will take care of her parents; is there anything better that she can do with her life? With that goes the assumption that the public purse does not need to divert its valuable resources to care for old people; there is always a family member willing to take care of the ageing person.

And this is the norm all over the world, and certainly all over the European Union.

In a previous post, “Beyond Covid-19”, in a back-of- the-envelope calculation, I estimated that Europe needs 23 million persons per year to work as caregivers. Let us assume that 10€ an hour is a reasonable medium wage in the EU, and we will get to a staggering 354,200 million € a year, roughly twice the annual budget of the EU.

I am not very optimistic about countries in the EU adding 2% of their GNP to their budgets. From now on, we will have to rely on imaginative approaches to care for our old people’s caregivers.

I am taking the title from one of the chapters of the book New Ageing by Matthias Hollwich. The introduction to the chapter reads “At some point in our lives, things will get a bit harder and we will need help in one way or another. The best kind of help eases the way forward without replacing the capabilities we still have”.

It is this last sentence that has been haunting me for years. And not only in reference to informal care but also with formal care, including institutional care. Many years ago, I directed a study for nursing homes all over Spain. Of the many months I was involved in the project one comment from the director of one of the nursing homes has been engraved in my head. He told me, and I quote, “We are a factory of dependent persons; put an independent person in a nursing home and, in less than six months, that person will become dependent”.

Add to that, the above average incidence in the mortality rate that Covid-19 has caused in nursing homes all over Europe, from Sweden to Spain, and you will get a much less  rosy picture of nursing homes as a recourse for old people’s care.

A recent paper by the European Commission, Informal care in Europe: Exploring Formalisation, Availability and Quality, states that “Informal care forms a cornerstone of all long-term care (LTC) systems in Europe and is often seen as a cost-effective way of preventing institutionalisation and enabling users to remain at home”.

What I see as a problem is that, because of their lack of proper training, informal caregivers, and more if they are family members,  tend to overpower the old person: “Don’t do that”; “I’ll get it for you”; “Be careful, you’ll fall”, etc.. So, we go back to the beginning: the problem is to help the old person “without replacing the[ir] capabilities.”

We need to train informal caregivers. Basically, we need somehow to care for informal caregivers, to train and support them, even provide financial support for them, as the EC maintains. But training should be the first objective, since a properly trained caregiver will know how to take care of the old person and, equally important, of him or herself.

I can understand that what happens today is more pressing than what will happen tomorrow, but that does not mean that today is more important. I think we should start looking at tomorrow and start planning what we will need for a world beyond Covid-19.

As of today, one of the few things we know for sure is that SARS-CoV-2, which produces the Covid-19, infects more old people and mainly those with previous chronicity. That means that it is old people who need more care.

Care that, we have also learned, would be better given at home than in nursing homes. Gathering vulnerable people in close quarters has proved not to be the best solution if we want to avoid the spread of a communicable disease.

Only if we are capable of building an army of caregivers will we be able to give home care in the EU to that 19% of the population aged 65 and older.

With a total population of almost 513 million people, we will need to take care of 97 million old people (all figures from Eurostat). Just for the sake of discussion, let us assume that we need one hour per day of care per old person. With an estimated 1.540 productive yearly hours per person, we will need almost 23 million caregivers. The fact that many of those 23 million will be informal caregivers does not make the hours and the people less essential.

Who will take care of that army of caregivers? Who will be providing training, moral and physical support for them? Very little is done today in that domain and almost nothing if we focus on informal caregivers. I think we must start getting ready to tackle caregivers’ needs, formal and informal, so that we will be able to provide our old people with the best possible care by the healthiest and most motivated caregivers.

I have been wondering what the connection between people, especially old people, and a resilient society could be.

What is more resilient than an old person? They have demonstrated their resilience through the years. An 80 or 90 year old European has gone through at least one war, if not several if he or she is from one of those unfortunate countries (the Balkans, Ukraine, …) which have suffered also their own national wars.

And yet, when devising processes for a resilient society, we do not look to those generations that have proved to be resilient. What have they done to survive in such an unwelcome surrounding?

My answer is simple: adaptation.

I had a teacher in high school who provided an easy explanation for the difference between democracy and dictatorship. Dictatorship is like a concrete wall; it withstands high winds but if the wind grows strong enough it collapses and disappears. Democracy is like a wall made up of a sheet of paper; it bents with the wind and, when the wind does not blow anymore, it falls back in place. That is adaptation.

Going back to how to design for old age or for resilient societies, I think we should look at the same characteristic: adaptation. We will survive if we can adapt ourselves and our society to a changing world, be it new technologies or climate change.

We all are moving fast. The baby-boomers (1946-1964) are coming of age … retirement age. If the silent generation (1920-1945) was the generation that absorbed the car and the telephone as routine communication tools, we would expect the baby-boomers to take information and communication technology (ICT) as their routine communication channel.

That is the case and, when dealing with today’s problems, the expectation becomes a truism. We all jump into using ICT to solve many of the aging problems that baby-boomers encounter. And, as it happens, this is the view that the European Commission holds: ICT is here to solve the ageing problem.

If we take the use of internet as a yardstick, the reality is that only 45% of the +65s use internet once a week or more in Europe. Descending to country level, the differences are striking: in Norway that figure is 82% and 12% in Bulgaria.

So, should we jump from analogic to digital in the blink of an eye or are we going to find the swimming pool empty? Wouldn’t it be more realistic to work on long-term structural change from analogic to digital transition, similar to the energy transition favored by the UN in the current COP25?

A transition of that kind will ensure that nobody will be left behind, a very important factor when we are talking about 55% of the +65s Europeans.

Flood risks

A few weeks ago, in September 2019, Spain’s south-east was hit by a coldfront, flooding several villages and cities along the Segura basin. The images of devastation were breath-taking. One of the areas that suffered the most damage was the San Javier-Los Alcázares villages in El Mar Menor.

By no means was it an unexpected event. The Spanish Meteorological Agency had warned of the possible devastating effect of the coldfront. Was the damage due to the fact that the area is not considered floodable?

Directive 2007/60/EC of the European Parliament and of the Council, of 23 October 2007, on the assessment and management of flood risks states in Article 7.5 that “Member States shall ensure that flood risk management plans are completed and published by 22 December 2015”. Spain in general, and the Confederación Hidrógráfica del Segura (entity in charge of the management of the basin) in particular, has complied with the provision of the article and, in March of 2014, issued the flood risk maps.

Let’s have a look at the one for the area in question in which the red marks mean more floodable areas:

And know have a look at Google maps of the area:

Just notice that the red on the first picture coincides almost exactly with the built-up areas of the villages of San Javier and Los Alcázares. So, the area was clearly floodable.

Maybe this event has been an isolated one and that is why nothing has been done to prevent flooding. Wrong again! In 2016 there was also extensive flooding in the area and six historical floods have been reported in the area according to the flood risk maps.

So, why has nothing been done? Why do residential buildings exist in an area that is floodable and that has gone through extensive damage several times in recent years? It may not be due to climate change but, whatever the underlying reason, the fact is that Spain is going through a period of more heat waves and more flooding. And, sadly, the fact is that nothing has been done and nothing is being done.

Either because it is mandatory or out of the realization that a disaster, natural or manmade, can put the soundest enterprise out of business, almost all big companies have a Business Continuity Plan (BCP) for proper Disaster Risk Management (DRM). Is it the same for SMEs? I am afraid it is not the case.

I have written before about how individuals should take control of their own safety. This post is an extension of the need for SMEs to be an active part of a disaster resilient society.

So far, I haven’t been able to identify too many actions directed at helping SMEs implement actions enabling them to be prepared for a disaster. As a matter of fact, according to a paper by Juan Pablo Sarmiento et al of the University of Florida (USA), only 14,1% of business with fewer than 100 employees had a BCP in place (2013). The recent flooding in south-east Spain, one of the vegetable gardens of Europe, has shown that only 37% of the 50,000 damaged hectares have something as simple as an insurance policy, let alone a BCP.

Are we going to do anything about it? If we look at the last issue of the H2020 WP in Security, this is something that has not even been contemplated, except for cybersecurity risks. Do we assume that SMEs are not an important part of society? This is not the case. According to Eurostat, SMEs provide 66,3% of the employment in EU28, approximately 137 million people. Imagine if we could get 137 million people involved in a resilient society? Imagine if we could get 99,8% of the total number of enterprises involved in a resilient society?

Maybe it is worth a try.

Taking control

Most people in the developed world rely on the authorities for most of their basic needs, be it daily needs, such as healthcare, or emergency response, such as forest fires.

Healthcare professionals are intent that we, as individuals, take a more active attitude in preserving our health. Obviously, those most interested in preserving our health is we ourselves.

Is it the same when we face emergencies? Do we take responsibility for acting as knowledgeable first-responders in case of an emergency? I want to underline KNOWLEDGABLE; I am not talking about acting for the sake of acting. Most of those impromptu UNKNOWLEDGEABLE actions are nothing more than running around like headless chickens, making noise without any contribution to ameliorating the consequences of the event.

This is the gordian knot of emergency prevention and response: should citizens be the first first-responders in case of an emergency? Taking control of our lives seems to be a good winning strategy; consequently I would say that citizens should be able to respond efficiently in case of an emergency. They are in the front line of the incident. If they know how to behave, critical time can be gained with a prompt and efficient response before professionals arrive.

Furthermore, a knowledgeable citizenry is essential in the prevention stage. Forest fires could be prevented if people take responsibility for keeping forests clean, clearing up plastic bags, glass bottles, underbrush and so forth.

Assuming, as I and most people do, that informed citizens should be a goal in our societies, why is it that in developed countries -with the possible exception of Japan- authorities have been neglecting actions to train citizens in emergency prevention and response? I don’t have the answer, but something should be done soon if we don´t want to hear again “our response emergency protocols should be re-evaluated”.

REACHING OUT

Dealing with the unexpected is always difficult. It is difficult for the individual, and it is more difficult for society. Faced with the unexpected, predicting how people behave becomes almost impossible.

Imagine a building on fire. A lot of individuals will shout out the window for help, making the situation more problematic. Others will run to save their relatives, endangering more lives. Some individuals will even try to be heroes, but with out the proper training and equipment they will end joining the body count. Hopefully, some of the individuals will stay calm, close all windows and doors, and wait for the fire department to arrive; these will be the ones who will, most probably, survive. There is another group of individuals, those who will have their minute of glory in the evening news, reporting on all the things that they haven’t seen and spreading false information or, if you prefer, “fake news”.

How can we make a mass of people behave in a rational way? How can we be certain that people, when faced with the unexpected, will react in a way that will not cause more harm?

I can only think of one solution, and it is something that has been tried for centuries: teaching people how to behave. In other words: prevention. Certainly, prevention has been on the menu for a long time and, still, few people act rationally. We must conclude that the way we are trying to bring prevention to people is not the correct way or, alternatively, we are not reaching most individuals.

Since public authorities and NGOs spend quite a few euros on prevention campaigns, let’s not assume they do not know what they are doing. As a matter of fact, there are quite a few examples of very good media campaigns. We are going to focus on the second cause: not reaching most people. We have reached a level of information about almost anything that, to say the least, is overwhelming. But most of the time we must look for the information, the information does not come to us. The information is there but we will seek it out only if we are aware of our needs.

Take earthquakes: Unless we live in certain areas of the world, no one will seek information about how to behave in case of an earthquake. The result is that in San Francisco only very strong earthquakes cause human casualties, but a mild earthquake in south-eastern Spain in 2011 caused 9 deaths and 324 injured. Why? Because we, as a society, have failed to reach out to every individual in the region.

Reaching out to each individual and transmitting proper behavior in case of an unexpected situation should be the main objective of Civil Protection (Civil Defense in some countries). It means making effective use of the risk maps that most countries have; identifying the most vulnerable individuals within the area; and reaching out to those individuals and the population at large so that they know how to behave in case of emergency. No small task, but until we devise an effective system to accomplish that, every time there is an incident, there will be talk about “we should update our protocols for emergency response” and real prevention will be, again, forgotten.