Mind & Matter

Mind & Matter

The Purpose of (Public Health) Institutions

Institutions evolve to perpetuate the problems they are supposed to eliminate. Has the American Diabetes Association evolved to perpetuate diabetes?

Nick Jikomes, PhD's avatar
Nick Jikomes, PhD
May 18, 2024
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“It is difficult to get a man to understand something when his salary depends on his not understanding it.” —Upton Sinclair

a pie sitting in a pan on a table

The Shirky Principle

“Institutions will try to preserve the problem to which they are the solution.”

Named after writer Clay Shirky, the principle describes the general tendency of organized groups to prolong the problem they’re meant to solve. Once you grasp it, you start to see it everywhere.

Apparent examples abound. The Department of Homelessness in San Francisco keeps securing a larger and larger annual budget to fight homelessness, which nonetheless continues rising. More and more is spent on public education, but student literacy has declined. Per capita healthcare expenditures go up, the population gets more sickly. Are institutions actually facilitating these problems? Or are they trying harder and harder to combat problems that are independently getting worse? It can be difficult to say for sure, but the pattern is common.

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