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Globalistyka (z łac. globare, "tworzyć kulę, gromadzić się") – nauka zajmująca się badaniem procesów politycznych, gospodarczych i kulturalnych w skali globalnej. Globalistyka korzysta z dorobku badawczego i pojęć innych dziedzin wiedzy takich jak: ekonomia, stosunki międzynarodowe czy handel międzynarodowy. Jednak w przeciwieństwie do wyżej wymienionych nauk, globalistyka nie postrzega świata jako skupiska oddziałujących na siebie 194 państw i ich gospodarek, lecz traktuje świat jako społeczną strukturę globalną, umożliwiającą międzynarodową wymianę idei, kapitału ludzi, itd.

Zakres zainteresowań globalistyki
Specjaliści różnie definiują przedmiot zainteresowania globalistyki:
 bada powiązania państw narodowych z korporacjami ponadnarodowymi w kontekście świata, który staje się ekonomiczną całością (J.Sigurdson, N. Thirft);
 procesy integracyjne na świecie (Antoni Kukliński);
 społeczeństwa i kraje przez pryzmat systemu światowego (A. Bergesen);
 procesy globalizacyjne i kwestie z nimi powiązane (Immanuel Wallerstein);
 postęp naukowo-techniczny;
 niwelowanie zacofania gospodarczego państw trzeciego świata.

Zakres problemów, przed którymi obecnie stoi ludzkość, powoduje, że w ich rozwiązywaniu uczestniczą rządy, organizacje międzynarodowe oraz ruchy społeczno-polityczne. Wiele zagadnień dotyczy grupy państw lub regionów i staje się przedmiotem prac organizacji międzynarodowych. Interesuje się nimi światowa opinia publiczna. W ten sposób w zależności od wagi i rozmiaru, problemy lokalne przekształcają się w międzynarodowe problemy polityczne, stają problemami globalnymi. Ewolucja  i złożoność problemów światowych powodują, iż często są one sumą wielu wzajemnie ze sobą powiązanych czynników, tak więc nie są to problemy wyłącznie polityczne, ekonomiczne czy społeczne.

Duże znaczenie w rozwoju globalistyki mają procesy integracyjne (pogłębiająca się współzależność istniejących państw), będące jednymi z najbardziej charakterystycznych zjawisk dzisiejszego świata. Proces integracyjny sprzyja także szybkiej transmisji najważniejszych przejawów życia międzynarodowego jego uczestników. Proces przekazu uległ ogromnemu przyśpieszeniu, dzięki rozwojowi komunikacji satelitarnej i zastosowaniu komputerów.

W szerszym ujęciu globalistykę należy traktować jako naukę zajmującą się badaniem systemu światowego. Jej głównym przedmiotem zainteresowań będzie rozwój światowej polityki i gospodarki. Przykładem takiego potraktowania problemu są prace różnych autorów na temat:
 studia nad nierównością w wymianie między centrum a peryferiami, gdzie centrum to Stany Zjednoczone, Rosja, Europa, Chiny i Japonia zaś peryferia to reszta świata;
 badania wpływów obcych inwestycji na wzrost gospodarczy i nierówność dochodów w krajach trzeciego świata;
 analizy struktur i procesów światowych;
 międzynarodowy system państw.

Tematyka jest dość zróżnicowana, jednak wszystkie prace nad systemem światowym, muszą uwzględniać 2 założenia:
 istnienie systemu światowego na zewnątrz społeczeństw narodowych (światowa gospodarka czy światowy system państw posiadają własną dynamikę i życie, które można opisać i modelować);
 system światowy wpływa na rozwój lub zacofanie społeczeństw narodowych, znajdujących się w strukturach globalnych. W rezultacie rozwój jakiegoś kraju zależy bardziej od zajmowanego miejsca przez dany kraj w światowy podziale pracy niż od jego potencjału narodowego.

Cechą charakterystyczną globalistyki jest jej interdyscyplinarność. Prace na temat globalistyki nigdy nie dotyczą jednej sfery problemu czy to politycznej czy ekonomicznej lub społecznej. Większość autorów za problemy globalne uznaje te, które powstają w wyniku obiektywnego rozwoju społecznego, powodują zagrożenia dla całego świata lub dużej jego części i wymagają zjednoczenia wysiłków w celu ich rozwiązania. Liczne publikacje z zakresu tej dziedziny wiedzy ukazały liczny zespół ściśle powiązanych ze sobą problemów. Problemy te ze względów merytorycznych jak i politycznych  traktowane są równorzędnie.

Problemy globalne
Zainteresowanie problemami określanymi jako globalne pojawiło się już w XIX stuleciu. W procesie rozwoju
globalistyki można wyróżnić 2 źródła jeśli chodzi o genezę problemów globalnych:
 Konieczność ratowania ludzkości. Utopiści, uważali, że na świecie brakuje właściwego ładu. Ich koncepcje choć oparte na wyobraźni, były chętnie akceptowane przez opinię publiczną. Do tego kierunku można zaliczyć: Thomasa Malthusa, Bertranda Russella, Johna von Neumanna oraz Arthura C.  Clarke'a. Należy także wspomnieć o pracach Klubu Rzymskiego, organizacji zajmującej się badaniem nad rozwojem ludzkości (raporty Klubu Rzymskiego).
 Potrzeba zarządzania globalnego i tworzenia jedności świata w celu rozwiązywania jego problemów. Twórcy tej koncepcji wiążą nadzieje z międzynarodowymi organizacjami, których celem jest rozwiązywanie bądź regulowanie piętrzących się problemów. Istotne są tu kwestie pogodzenia rozbieżności interesów ponadnarodowych organizacji gospodarczych i interesów państw w sensie politycznym. Należy także wspomnieć o dwóch typach globalizacji tzw. "od góry" - decyzje są podejmowane przez organizacje ponadnarodowe i przekazywane państwom (np. Unia Europejska) oraz globalizację "od dołu" będącej wynikiem wspierania przez różne inicjatywy międzynarodowe czy ruchy społeczne nie będące jednak organizacjami ponadpaństwowymi. Jako początki globalizacji odgórnej można potraktować powołanie do życia 3 organizacji, pełniące funkcję głównych regulatorów stosunków gospodarczych na świecie: Bank Światowy, Międzynarodowy Fundusz Walutowy oraz Układ Ogólny w sprawie Taryf Celnych i Handlu (od 1995 roku Światowa Organizacja Handlu). Do twórców zarządzania globalnego można zaliczyć: Johna M. Keynesa, Harry'ego Dextera White'a oraz ekonomistów i polityków pełniących funkcje kierownicze w organizacjach ponadpaństwowych.

Problemy określane mianem globalnych (światowych) charakteryzują się 3 podstawowymi cechami:
 ogólnoświatowa skala – problemy dotyczą całej ludzkości, mają charakter ponadpaństwowy i ponadregionalny, w mniejszym lub większym stopniu wpływają na rozwój wszystkich narodów;
 olbrzymia waga – problemy mają charakter zagrożeń krytycznych, powodują tak wiele reperkusji, że nieprzezwyciężone stawiają pod znakiem zapytania przyszłe losy i przetrwanie ludzkości;
 sposób rozwiązania – aby rozwiązać problemy jest potrzebna ścisła i szeroka współpraca wszystkich zainteresowanych stron, co z reguły wymaga angażowania i zjednoczenia wysiłków całej społeczności międzynarodowej.

Ze względu na różne definicje globalistyki, współcześnie wyróżnia się następujące grupy problemów globalnych:
 ogólnospołeczne – wojna i pokój, przezwyciężanie zacofania i zabezpieczenie wzrostu ekonomicznego;
 człowiek i społeczeństwo - postęp naukowo-techniczny, twórczość i kultura, eksplozja demograficzna, problemy zdrowotne;
 światowy system globalny;
 człowiek i przyroda – zasoby, aprowizacja, środowisko naturalne, polityka ekologiczna.

Na początku lat 90. XX wieku Klub Rzymski opublikował raport pod tytułem Pierwsza rewolucja globalna - jak przetrwać?. Raport składa się z 2 części w pierwszej autorzy skrótowo opisują najważniejsze przemiany społeczne jakie zaszły na świecie( złe samopoczucie oraz frustracje ludzkości) oraz powstałe w ich wyniku zagrożenia. Druga część raportu przedstawia działania jakie powinna przedsięwziąć  globalna społeczność, aby je rozwiązać. Zdaniem autorów konieczne jest porozumienie się państw i elit władzy.

Obecnie za najważniejsze problemy światowe są uznawane: problem głodu i nędzy, wyczerpujące się surowce, kwestia korporacji transnarodowych, problemy energetyczne oraz kwestia przebudowy systemu organizacji międzynarodowych.

Globalizacja świata
Globalizacja jest procesem występującym z różnym natężeniem. Na przyśpieszeniu tego procesu zaważyły 2 ważne wydarzenia
historyczne zakończenie II wojny światowej oraz upadek systemu komunistycznego. Świat nie jest teraz podzielony już żadnymi ideologiami. Obecnie rozwój tego procesu można rozpatrywać w kategoriach narodowych, regionalnych i globalnych. Zachodzące dziś transformacje o charakterze globalnym są bardzo dynamiczne jak i również chaotyczne. Są one fazą przemian: polityki, stosunków politycznych, teorii ekonomii, gospodarki, kultury filozofii i nauki. Stopień globalizacji można ocenić podstawie kilku czynników, ich dobór zależy od względów merytorycznych więc mogą to być mierniki wskazujące na aktywność państwa w tym procesie czyli: przynależność do organizacji międzynarodowych (IMF, IBRD, WTO), poziom rozwoju społecznego gwarantujący korzystanie z innowacji i zdobyczy globalizacji oraz uniformizacja wartości kulturowych. Na podstawie tych czynników można stwierdzić, że największe zainteresowanie globalizacją występuje w krajach Europy, USA, Kanadzie, Rosji i Australii. Najmniejsze zaś w regionie Afryki i Bliskiego Wschodu.

Zobacz też
 globalizacja
 glokalizacja
 globalizacja gospodarki
 Grupa Lizbońska
 regionalizacja
 Bank Światowy
 Klub Rzymski
 Unia Europejska

Bibliografia
 Gnitecki J.: Globalistyka, Wyd. Naukowe PTP 2002
 Czerny M., Łuczak R., Makowski J.: Globalistyka, PWN 2007
 Kaczmarek, Tadeusz Teofil: Globalistyka. Przyszłość globalnej gospodarki, Wyd. Difin 2007

Linki zewnętrzne
 Międzynarodowy Fundusz Walutowy
 Bank Światowy
 Unia Europejska

Geografia polityczna
Globalizacja


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Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators
Jocelyn DeJong1,
Hala Ghattas1,2,
Hyam Bashour3,
Rima Mourtada1,
Chaza Akik2,
Amelia Reese-Masterson4
1 Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
2 Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
3 Department of Family and Community Medicine, Damascus University, Damascus, Syrian Arab Republic
4 Research Adviser in Nutrition, Food Security and Livelihoods, International Medical Corps, Beirut, Lebanon
Correspondence to Professor Jocelyn DeJong; jd16{at}aub.edu.lb
Introduction Women and children account for a disproportionate morbidity burden among conflict-affected populations, and yet they are not included in global accountability frameworks for women's and children's health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting.
Methods We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015. We met in person or emailed relevant key stakeholders in Lebanon, Jordan, Syria and Turkey to obtain any unpublished or missing data. We convened a meeting of experts working with these populations to discuss the results.
Results The following trends were found based on available data for these populations as compared with preconflict Syria. Birth registration in Syria and in host neighbouring countries decreased and was very low in Lebanon. In Syria, the infant mortality rate and under-five mortality rate increased, and coverage of antenatal care (one visit with a skilled attendant), skilled birth attendance and vaccination (except for DTP3 vaccine) declined. The number of Syrian refugee women attending more than four antenatal care visits was low in Lebanon and in non-camp settings in Jordan. Few data were available on these indicators among the internally displaced. In conflict settings such as that of Syria, coverage rates of interventions are often unknown or difficult to ascertain because of measurement challenges in accessing conflict-affected populations or to the inability to determine relevant denominators in this dynamic setting.
Conclusion Research, monitoring and evaluation in humanitarian settings could better inform public health interventions if findings were more widely shared, methodologies were more explicit and globally agreed definitions and indicators were used consistently.
This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
What is already known about this topic?
The health of women and children is disproportionately affected in conflict situations being heavily dependent on a functioning health system and vulnerable to economic and societal disruption induced by conflict.
Reaching conflict-affected populations was the unfinished agenda of the Millennium Development Goals and should be a priority of the sustainable development goals.
What are the new findings?
According to available data, coverage rates of most key evidence-based interventions in reproductive, maternal, newborn and child health declined in Syria; among refugees in neighbouring countries the picture was more mixed as compared with preconflict Syria.
In conflict settings such as that of Syria, coverage rates of such interventions are often unknown or difficult to ascertain.
Recommendations for policy
Much research is being done on those forcibly displaced from the Syrian conflict, but better and more accessible and timely data, more use of standardised definitions and more explicit methodological approaches would strengthen the evidence-base for intervention to improve their health.
Special attention to data constraints on the health situation of women and children in conflict settings – where both coverage and data availability are often undermined - is needed in global health accountability frameworks.
Women and children account for a disproportionate morbidity burden among conflict-affected populations,1 being heavily dependent on a functioning and responsive health system and vulnerable to economic and societal disruption induced by conflict. Yet conflict has not been, until now, sufficiently included in global accountability frameworks for the health of women and children.2 Addressing maternal health in conflict settings is in many ways the unfinished agenda of the Millennium Development Goals (MDGs). The Sustainable Development Goals (SDGs) note the need to focus on conflict-affected populations but do not provide specific goals in this regard.3 4
The Countdown to 2015 initiative for Reproductive, Maternal, Newborn and Child Health (RMNCH)5 6 focused on the 75 countries where more than 95% of all maternal and child deaths occur and tracked coverage, aimed to stimulate coverage assessment mechanisms and support country progress towards achieving MDG4 and MDG5. Countdown is now shifting emphasis to the SDGs and a new set of indicators is being agreed on to 2030.7
Countdown to 20156 did not deliberately select countries in conflict, yet of the 10 countries with the highest under-five mortality rates worldwide, eight are conflict affected.8 Globally, the nature of conflict is changing, becoming increasingly intrastate, with greater civilian toll and a shift from low-income to middle-income settings.9 These changing parameters of conflict make reaching those most in need through evidence-based public health interventions particularly challenging.
Within the Arab region, Countdown to 2015 included five countries—Egypt, Iraq, Morocco, Sudan and Yemen—four of which have experienced political instability or conflict during the past decade. Syria is not included, given the fact that, by 2008, it had achieved 85% of its MDG4 target and 68% of its MDG5 target.10 Syria's maternal mortality ratio fell from 107/100 000 in 1993 to 56 in 2008.10 Its infant mortality rate similarly dropped from 34.6 deaths per 1000 live births to 18 in the same period.10 Just before the conflict began, skilled attendance at delivery was at 96%.11 Nevertheless, inequalities across regions were evident preconflict.10 12
The current crisis in Syria has led to a widespread deterioration in what was a well-functioning and predominantly public healthcare system, with the destruction or disruption of health facilities, and exodus of health professionals. Additionally, population movement and the corrosion of public services and infrastructure13 14 have increased the risk of outbreaks of previously controlled epidemics.14 More than half the population now lives in poverty, with 7.9 million people becoming poor since the beginning of the crisis.15 These structural and economic realities reduce women's access to reproductive health (RH) services.16
Stark demographic shifts have also occurred, with 6.5 million Syrians internally displaced and 3.7 million living as refugees in neighbouring Turkey, Lebanon and Jordan (2016).17 Figure 1 shows current figures for internally displaced populations (IDPs) in 2014, and refugees in 2016 as a ratio over total country populations for countries hosting displaced Syrians, as well as their age and gender breakdowns. In total, women and children under the age of 18 account for 60% of IDPs and 76% of refugees in neighbouring countries, indicating a heavy burden on health and educational services in both Syria and host countries. Table S1 details the rights and status of Syrian refugees in host countries. Within Syria, public health responsibility is fragmented between opposing forces, which run parallel health systems with shifting geographic areas of coverage, making data collection particularly challenging.
[SP1.pdf]
A map illustrating the number and demographic breakdown of IDPs in Syria in 2014 and refugees in host countries in 2016.
In this paper, we use the Countdown to 20156 framework and set of RMNCH coverage and health status indicators to provide an up-to-date review and critique of the best available data focusing on the conflict-affected Syrian population both within Syria (including non-displaced and IDPs) and those living as refugees in neighbouring countries.18 19 We highlight potential challenges in so doing and insights that can be gained by using existing internationally endorsed monitoring frameworks to systematically analyse how conflict affects measures of health status and coverage of evidence-based interventions. In so doing, we aim to draw lessons of relevance for other conflict situations, particularly as the SDGs begin to be implemented.
We searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO EMR (WHO Eastern Mediterranean Region) databases for publications from January 2011 until December 2015. We used Medical Subject Heading Terms and keyword search strategies with various combinations of terms related to the relevant Countdown indicators, with the additional descriptor of Syria and Syrian refugees. A search strategy was developed for Medline and adapted for the other databases (online supplementary appendix 1). We omitted malaria and AIDS indicators as the former is not endemic in the study countries and the latter has very low prevalence.10 We further searched Google Scholar and conducted purposive searching of specific relevant journals and hand searching of bibliographies of included articles. We developed inclusion and exclusion criteria to assess the published literature. We included original research studies that reported on Countdown indicators or proxy determinants on preconflict Syria, and during conflict among the Syrian population resident in Syria, the internally displaced or refugees in the neighbouring host countries (Jordan, Lebanon and Turkey). Only peer-reviewed articles with primary data or secondary data analysis of relevant indicators were included. We extracted the following descriptive information from included sources: nationality, residence, institution of the first author; main data sources, year of main data source, study population (Syrian residents, internally displaced or refugees); sample size and characteristics; language; proxy determinants or direct indicators; research design and whether it was peer reviewed or not.
All retrieved articles were imported into EndNote reference manager, and duplicates were deleted. Title and abstract screening followed by full text screening were conducted by two researchers, and any disagreements were discussed with a third researcher to reach consensus.
We searched databases relevant to the humanitarian efforts concerning the Syrian conflict and regional development: Relief Web, UNHCR Syria Regional Refugee Response Portal, United Nations Development Programme and WHO Eastern Mediterranean Regional Office websites for the same time period.
The initial search retrieved thousands of documents of various types (such as situation reports, funding appeals, infographics and meeting minutes), which reported time periods extending from 1 week to 1 year. Consequently, the study team examined the content of each type of report and categorised them to assess comprehensiveness and relevance. Because data on the humanitarian crisis is constantly updated, we opted to include only data from quarterly, midyear and annual reports. Quality appraisal took into account whether the publication was data driven (based on original or secondary data) or not, and whether there was a specified study methodology. Because of inconsistencies and incompleteness in data reported in published reports, we contacted governmental and non-governmental entities to fill these gaps. Key informants and governmental agencies were not always responsive or ready to share data on certain indicators even when data were available. The tables on results therefore differentiate between data that were not available (N/A) (meaning they do not exist) and not obtainable (N/O) (meaning they exist but we could not obtain them).
Given the paucity in English published and grey literature on outcomes of interest among Syrian refugees in Turkey in particular, a team member travelled to Istanbul and Ankara to meet with representatives of key non-governmental organisations and academics.
An expert meeting was conducted in Beirut, Lebanon, in January 2016 with stakeholders working with IDPs or Syrian refugees from countries of interest (Syria, Lebanon, Jordan and Turkey) to review and discuss the results and to obtain any missing relevant data. The cut-off date for updating the statistics used in the paper was 15 March 2016.
Literature analysis and synthesis
We extracted all data on Countdown indicators from identified literature based on the following geotemporal categories: Syria preconflict, Syria since 2011 and Syrian refugees in Lebanon, Jordan, and Turkey. Data were tabulated using the Countdown to 20156 framework of indicators.
Additionally, we adapted an organisational framework20 21 to portray a model for how the Syrian conflict and responses to it have interacted with relevant health status and coverage indicators since the start of the conflict.
Role of funding source
The funder played no role in the collection, analysis or publication of data.
We retrieved 157 published articles (figure 2), two-thirds of which were editorials or correspondence articles referencing data from grey literature and were therefore excluded. Only 12 articles were based on primary or secondary data analysis of relevant indicators. Among these 12, only four articles had their first author from a host country of refugees and based in a local institution (one from Jordan, one from Lebanon and two from Turkey), and only four articles sought ethical approval while two reported that it was not required. Three studies targeted Syrian refugees in Jordan, five in Lebanon and three in Turkey, and one focused on health professionals working with refugees in Jordan; none were on the internally displaced. Over 3000 documents produced by over 150 agencies were identified through the grey literature search and screened for data extraction.
Flow diagram for review of published literature.
Organisational framework
Figure 3 presents an organisational framework based on the literature and identifies various pathways20–22 through which the armed conflict may have influenced public health23 24 and RMNCH indicators25 26 among Syrians in Syria and in host countries.
An organisational frame work describing the direct consequences of armed conflict and violence in Syria.
Countdown indicators
Findings from the review of published and available grey literature on the Syrian conflict relevant to RMNCH Countdown to 2015 indicators are presented for the populations in the three host countries and Syria.
Table 1 outlines numbers for the under 5-year-old population as well as birth, mortality and fertility rates.
Demographic indicators in Syria preconflict and in conflict and of Syrian refugees in neighbouring countries
In Syria and host countries, births to Syrian nationals often go unregistered due to security threats, missing identity documents and other legal or logistical barriers.27 This can have serious consequences, including increased risk of exposure to violence, abuse or exploitation; risk of statelessness; difficulty accessing healthcare and education; difficulty in voluntary return, crossing borders and proving Syrian citizenship on return; and difficulty obtaining work or legal services later in life.28
Birth registration among refugees in Lebanon is very low. In Jordan and Turkey, there are no representative numbers on birth registration among Syrian refugees. In Zaatari camp (Jordan), over 1400 children born between November 2012 and July 2013 did not receive birth certificates.28 The Turkish Prime Ministry Disaster and Emergency Management Authority (AFAD) registered about 30,000 Syrian births between 2011 and 201429 (out of some 60 000 births since the start of the crisis).30
Birth outcomes
Data on preterm birth rate and stillbirth are lacking for all settings. Reports indicate that 26% of Syrian refugee births in Lebanon were preterm,3160% of neonatal deaths in Zaatari refugee camp in Jordan were due to prematurity32 and 9.4 (per 1000 total births) were stillbirths in Zaatari (down from 14.2 the previous year).33 34
Limited data were available on adolescent birth rates; 8.5% of deliveries in Zaatari camp were to adolescent girls in 2014.
Table 1 outlines available data on maternal, neonatal, infant and child mortality. Given the difficulty of obtaining accurate data on maternal and child deaths due to the conflict, these figures are not disaggregated to include conflict-related mortality. Estimates indicate a reduction in neonatal mortality rate in Syria, possibly due to geographical exclusion of hard-to-reach areas. Part of the excess mortality burden due to conflict is occurring in under 5 year olds, which is partially due to reduced healthcare access in conflict-affected areas.35
Demand for family planning
In Syria in 2009, 83.6% of demand for family planning was met (table 2), and this is estimated to have increased within Syria to 88.7%11 36 and among non-camp refugees living in Amman, Jordan. These numbers are lower in Lebanon (63.9%) (table 2), where access to RH services is reportedly hindered by cost, travel and limited female healthcare providers.31
Indicators of maternal and newborn health in Syria preconflict and in conflict and in Syrian refugees in neighbouring countries
There were no reliable figures on fertility among refugees or within Syria. This issue of fertility and forced displacement internationally is a subject of debate, with some attributing a possible increase in fertility to the need to replace lost children, whereas others suggest that fertility is decreasing because of the stress and uncertainties of displacement.37–39
Antenatal care (ANC)
Within Syria, coverage of at least one ANC visit with a skilled professional has declined from 87.7% to 62%, likely related to the widespread displacement, the exodus of healthcare professionals and the destruction of health facilities. Coverage in Lebanon and Jordan remains at similar levels to prewar Syria, whereas coverage of at least four ANC visits is much lower (in non-camp refugee populations) (table 2). No data on ANC were available for Turkey.
Skilled attendant at delivery
Rates of skilled birth attendance at delivery have dropped in Syria from 96.2% to 72%, whereas they remain almost universal among refugees in neighbouring countries, likely as a result of special provisions by UNHCR in Lebanon and Jordan (table 2).
Caesarean section
Available data indicate increases in C-section rates both within Syria (where nationally the rate was 26.4% preconflict) and among refugees since the conflict began (table 2).11 Data from the largest public maternity hospital in Damascus show C-section rates increasing from 29% in 2010 to 46% in 2014 (Personal communication with Bashar Kurdi, 2015). This could be explained by the need for women and their physicians to schedule delivery around the security situation. It could however also be an unintended consequence of interventions introduced to help women reach RH services, such as the voucher system introduced to enable women to obtain free maternal health and emergency obstetric services including C-section.
In Lebanon, in 2013, 35.3% of Syrian refugee deliveries in UNHCR-contracted hospitals were C-sections,40 and the corresponding figures were 36% in 2014 and 33.7% in 2015 out of all referrals for delivery (Personal communication with Marie Akiki and Dr Diana Aoun, UNHCR, 2016). Potential explanations for this high rate are limited access to and utilisation of ANC increasing the risk for high-risk pregnancies, privatised healthcare system, predominance of male obstetric providers or UNHCR's financial coverage of most C-sections.40
Postnatal visits to health facilities were low at 27% in Syria in 2009 (table 2). Limited data are available for an analysis of changes since the crisis; however, within a camp setting in Jordan, where several specialised RH facilities have been established, postnatal care is higher at approximately 50%. No data on postnatal care coverage for the newborn were identified.
Table 3 shows that available data on coverage of measles, diphtheria-tetanus-pertussis (DTP3) and Haemophilus influenzae type B (Hib) vaccinations in Syria was high prior to the conflict (at 81.9%, 99% and 82.1%, respectively) and has suffered setbacks during the war except for DTP3 vaccine coverage, which increased. Refugee children are also reported to have lower than optimal coverage rates with scarce data showing large variations in coverage.41–43 Other indicators of child health were also high prior to the conflict, but no data on care seeking and antibiotic treatment for pneumonia nor for oral rehydration therapy for diarrhoea in Syria or neighbouring countries exist for the period since the conflict began (table 3). This highlights the partial development and implementation of health policies concerning these interventions in this context and the lack of surveillance data.
Indicators of child health in Syria preconflict and in conflict and in Syrian refugees in neighbouring countries
Underweight, wasting, stunting prevalence
The nutritional status of under-5-year-old children in preconflict Syria reflected medium levels of underweight, wasting and stunting (table 4); these have remained relatively constant. It is probable that these data do not cover hard-to-reach and besieged areas and are underestimates of the true magnitude of malnutrition. In contrast, surveys of Syrian refugees in Lebanon and Jordan show much lower rates of undernutrition (table 4). Where data exist on differentials between camp and non-camp populations in Jordan, camp-dwelling children were shown to have higher rates of undernutrition, although lower than those inside Syria. Improved indicators in refugee settings may reflect the large investments made in capacity building for the management of malnutrition, as well as the implementation of screening and treatment protocols.44
Nutritional profile of Syrian children, preconflict, in conflict and as refugees in neighbouring countries
Infant and young child feeding (IYCF)
Early initiation of breastfeeding in preconflict Syria was estimated at around 45% (table 4) and is lower in refugees in Lebanon and higher in Jordan. Parallel trends in breastfeeding exclusivity in under 6 month olds were observed (lower rates in Lebanon and non-camp settings in Jordan, and higher rates in Zaatari camp). Reduced breastfeeding in refugees may result from maternal stress related to displacement,20 possibly mitigated by the implementation of IYCF programmes45 46 in Zaatari. Interestingly, exclusive breastfeeding is reported to be higher in Syria in conflict at 59.1%44 than preconflict at 42.6%11 (table 4), possibly due to financial constraints or disruption of infant formula supplies and markets. Complementary feeding data are lacking.
Vitamin A supplementation
A recent meta-analysis has shown that vitamin A supplementation (VAS) results in child mortality reductions of 11%.47 About one-third of 6-month-old to 59-month-old Syrian children received at least one vitamin A dose preconflict, and VAS programs have been implemented for Syrian refugees in host countries, achieving over 50% coverage in Lebanon, 33% in Zaatari and under 5% in children living outside of camps in Jordan (table 4). Although numbers for children who received VAS are unavailable for Syria in conflict, UNICEF was able to dispense 34% of its target of VAS, administered with the measles, mumps and rubella vaccination.48
Table S2 summarises the status of Countdown policy indicators in Syria preconflict and postconflict and in host countries postconflict.
Table S3 summarises Countdown financing indicators in Syria preconflict and during conflict, as well as in host countries.
In this paper, we have used the Countdown to 20156 set of RMNCH indicators applied to the case of populations affected by the Syrian conflict and summarised available (and obtainable) data on coverage of evidence-based interventions across the continuum of care. Demographic data show a decline in birth registration among Syrians in Syria and Lebanon. Mortality data among refugees in host countries were lacking. The available mortality data in Syria during conflict showed an increase in infant mortality and under-five mortality rates and maternal mortality ratio, although it was not possible to provide accurate data on conflict-related casualties among women, children and adolescents. Internationally, excess mortality due to conflict has been shown to be difficult to quantify,49 and the numbers are typically both difficult to obtain and disputed for political reasons.50 51
In Syria, available data show a decline in coverage of ANC, skilled birth attendance and child immunisation. Finally, as compared with rates in preconflict Syria, nutrition data demonstrate a decrease in undernutrition levels across all populations studied and an improvement in key IYCF behaviours in some populations in Syria and Jordan (although a decline in Lebanon).
A partial explanation for these observed trends may be differential access to healthcare across the study settings. IDPs in Syria have generally received less international attention compared with Syrian refugees. As noted above, none of the published articles identified through the literature search reported on the health of the internally displaced within Syria. Two-thirds of primary healthcare centres14 and 43% of public hospitals in Syria were reported to be fully functioning, with others either destroyed or compromised by severe shortages and overburdening of staff and medical equipment.52 Syrian refugees residing in host countries where health resources were already strained have difficulties accessing key services, largely due to cost and lack of knowledge or confusion about health services for refugees.31 53–55 Box 1 highlights differential access and entitlement to healthcare services in the different countries hosting Syrian refugees.
Differential access to healthcare in countries hosting Syrian refugees
Although Syrians in Lebanon have the same healthcare access rights as Lebanese citizens,80 a recent survey of healthcare access among Syrian refugees (2015) found that only 24%–36% perceived healthcare as affordable and accessible, with 96% citing cost as the primary reason for not seeking healthcare for their children.53 The privatised, largely sectarian and comparatively expensive healthcare system is a primary barrier for care seeking.31 In Turkey, camp-based refugees can access healthcare through field hospitals and clinics.81 Non-camp refugees can access medical treatment from public hospitals, mother and child centres, and public or NGO-run clinics largely free of charge, and can obtain pharmaceuticals at 20% cost.55 Despite this, only about 60% of non-camp Syrian refugees accessed health services in Turkey, compared with over 90% of camp-based refugees.41 Language was a major barrier in accessing and providing healthcare in Turkey, with implications for refugees' knowledge of existing health services and on vaccination coverage.82 The Turkish government has recently allowed Syrian doctors to staff its newly established migrant health clinics to redress linguistic barriers.83 In Jordan, camp-based refugees can access healthcare through UN and NGO-supported health services free of charge, whereas non-camp refugees (83% of Syrian refugees) access healthcare through a mix of government and private facilities.84 In camps, there is a referral system in place to transfer patients to hospitals outside the camp when medical services are lacking.64 Although healthcare was provided free of charge for all non-camp Syrian refugees in Jordan through 2014, it became not fully subsidised in 2015, resulting in reductions in access from 96% to 87% between 2014 and 2015.54 Lack of refugee registration, with UNHCR or AFAD, reduces access, particularly in Turkey where 31% of non-camp refugees are unregistered and an identification number is required to use hospitals.41
Most critically, our comprehensive review has found that in conflict-affected populations, coverage rates of key RMNCH interventions and health indicators are often unknown or difficult to ascertain. As we have shown, the vast majority of literature on these concerns has been focused on the Syrian refugees, often for reasons of access, and only a minority of the published literature is data driven. Big gaps remain in knowledge on public health within Syria during the conflict. A lack of representative primary data, inconsistencies across sources and measurement challenges were identified in addition to an inability to determine relevant denominators in such a dynamic setting. Where trend data were available, it was difficult to assess whether observed changes were real or a product of the changing nature of denominators.
Among the 12 articles identified by this review that included relevant primary or secondary data, only four articles had their first author based in a host country of refugees. It is particularly concerning that an academic public health team based in a conflict setting—Syria and its neighbouring countries—was not able to obtain data that were known to be available but were inaccessible despite extensive efforts by email and in person. Collaborations need to be encouraged across humanitarian agencies, governmental bodies as well as academic institutions in the regions affected by conflict in recognition of the potential comparative advantage and contributions of each type of institution.
This case study on the RMNCH needs of middle-income conflict-affected countries, where a minimum standard of care exists, shows that health challenges differ substantially from those faced by lower income countries with weaker infrastructure; IDPs and refugees from the Syrian conflict are not the typical camp dwellers seen in other conflict settings, but rather are often dispersed and integrated into host communities (with whom they share a common language in the case of Lebanon and Jordan), predominantly in urban areas. This necessitates creative approaches to reaching and addressing the health needs of these populations. At the same time, the nature of host-country health systems influences both entitlements of displaced populations and data collection on their health conditions given differences in national health information systems.
At the global level, our analysis identifies many challenges in systematically extracting data on key internationally agreed health indicators of the forcibly displaced. The fact that many institutions active in humanitarian contexts do not always use standardised, evidence-based definitions (in this case, the Countdown to 20156 definitions of indicators) and do not always specify their methodology, including the sampling approach, has hampered our ability to draw valid conclusions.
A great deal of resources is currently being spent on data assessing health needs among Syrian refugees and the IDPs, yet this research could be more useful to inform public health interventions if it were more widely shared, if methodologies were more explicit and if comparable definitions and indicators were used and denominators clearly stated. The reluctance to share data across humanitarian agencies, governmental bodies and academic institutions must be overcome urgently for more effective responses, although there are some efforts underway to develop data-sharing systems in humanitarian contexts.i
Who is accountable for the health and well-being of the forcibly displaced? And who is responsible for collecting and reporting data on these populations? Within Syria, public health responsibility is deeply fragmented between government and opposing forces, which run parallel health systems with shifting geographic areas of coverage, and with available data often being restricted to government-controlled areas. Were full data disclosure and availability possible in this conflict context, with data-sharing across opposing forces and between countries, the results obtained here could well be worse, but at present this cannot be determined. In neighbouring countries, as in most complex emergencies, there remain ambiguities around accountability and problems of coordination between multiple humanitarian agencies and host governments. At the same time, the impact of the political conflict and influx of refugees undermines administrative capacity and reach of government services in host countries. Moreover, their accountability to the nationals of their country—and the competing needs of 'host communities' who are often the poorest and least well served—creates reluctance to underscore the needs of the refugees. Both governments and humanitarian agencies lack incentives to adopt more inclusive approaches that would seek input from the displaced themselves to inform service delivery or support community organisations to address their own needs. Legal restrictions on employment especially limit the ability of Syrian professionals and others within refugee communities to respond to community needs. There is evidence, however, that this trend is changing; Turkey has recently granted work permits to Syrian refugees56 and has allowed Syrian doctors to staff its newly established migrant health clinics. Jordan is also under international pressure to formalise employment for Syrian refugees.57
It is critical to include the forcibly displaced in global health accountability frameworks. The SDGs, as presently formulated, do not accord enough importance to the forcibly displaced, a topic that is covered in the preamble of the final SDG document but is not a subject of the final goals.3 Moreover, as in the earlier MDGs, the monitoring process foreseen for the SDGs as yet makes no distinction between citizens and non-citizens in data collection or in goals (even in countries with a very high proportion of non-nationals).3 States have clear obligations to produce vital statistics on their entire resident population, differentiated by nationality.58
As noted at the outset, Syria did not fit data-based inclusion criteria for the Countdown to 20156 initiative, although were national data to become available, it could be eligible for inclusion today. Syria's experience points to the fact that conflict may undermine, and even reverse, past progress towards achieving global RMNCH goals yet information on conflict settings is often lacking. In this paper, the Countdown to 20156 framework of indicators was used as a lens to analyse the devastating effects of the Syrian conflict on the health of women and children because this framework represents internationally agreed indicators on which countries are required to report for global monitoring purposes. Although Countdown indicators are most useful as development indicators for low-income contexts where RMNCH is poor, there remains a need to ensure that a set of agreed RMNCH indicators are included when data are being collected in humanitarian contexts.
The research team gratefully acknowledges the support of Countdown, and specifically Dr Jennifer Bryce, formerly of Johns Hopkins University and former co-chair of the Coverage Working Group of Countdown to 2015, for encouraging this work. We acknowledge the US Fund for Unicef for providing financial support as part of the Gates Foundation grant to Countdown. We thank the experts from Syria, Jordan, Lebanon and Turkey who participated in a stakeholder meeting to discuss findings from this study. Finally, we are grateful to all organisations and individuals who provided data and information presented here.
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↵i Such as the Global Humanitarian Data Exchange (https://data.hdx.rwlabs.org/) and the Syrian Regional Refugee Response—Inter-agency Information Sharing Portal (http://data.unhcr.org/syrianrefugees/regional.php).
Contributors JD initiated and led the overall research project and the writing of this manuscript, had full access to all data collected and took the final decision to publish. HG supervised the data extraction and oversaw the quality control on the data collected. HB took the lead in providing the Syrian public health perspective and data sources particularly on the internally displaced within Syria. RM served as study coordinator and travelled to Turkey to meet with stakeholders. RM, CA and AR conducted the literature search and data extraction and contributed sections of the text. All authors had access to the full data, contributed to the conceptualisation and execution of the project and to the literature review and writing, and approved the final draft.
Funding US Fund for UNICEF (as part of the Gates Foundation grant to Countdown to 2015: Maternal, Newborn and Child Survival).
Competing interests The authors declare no conflict of interests. Jocelyn DeJong is a member of the Countdown to 2030 Coverage Working Group and has argued for the inclusion of conflict countries in the Countdown to 2030 process, and is currently contributing to a strategy for so doing.
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

redpajama_set_name: RedPajamaCommonCrawl


Today we are going to do math. Hang in with me, I promise it is not going to hurt! I am going to show you how I break borders into blocks to place designs. I have done this for as long as I have quilted, way before I got my Quilt Path.
We are going to use the measurements of the quilt, which I am working on today. Normally when we measure quilts we do an edge measurement. This quilt is 44.5 inches X 68.5. It has two borders. I am going to set blocks into the outer border that is 4.25 inches wide, seam to outer edge. Because I am setting blocks, I will also need to know the length of the seam line that is joining the outer and inner border.
For our sample the seams are 36 inches on the width and 60 inches on the length. Here is where the math comes in.
The first thing we need to do is take into account the space the binding will cover. I like to end my designs a little bit inside where my customer are going to bind. For most quilters that is somewhere between 1/4 and 3/8 of an inch. So, I take 1/2 inch off the width of the border strip measurement.
I really did not plan this, but in this cause is divides evenly. We also need to divide the width seam by 3.75.
Coming up with strange number like that is going to be more normal then getting a whole number. We get to decide how we are going to quilt .6 of a block. Can't you just see that squished block jumping off the border at you? Blech! What I am really going to do is simple rounding. In our sample... under .5 do 9 blocks, over .5 do 10 blocks.
For our 3.75 inch blocks we are looking at needing to reduce each of the block with by .15 inches. Seriously, just fudge them a little smaller. I don't sit here with a measuring tape making each block the exact same size at that small of a difference. I get them close, but I don't stress over it. If was .25 per block, or larger, I would get out a ruler. The more you do it the more you will trust your ability to fudge.
For a printable version click here!


It's good to pause every so often as you are trying to make a point, if only to ensure that your latest statement is consistent with what got you going in the first place. You might well be making a worthwhile claim, but if in the meantime you have wandered so far off the path and run out of breadcrumbs, your audience will grow tired and let you go.
My starting point was the question about the role of religion in human development, and how religion itself evolves with the advancement of individual consciousness over the lifespan. One of my basic claims is that individual consciousness engages reality at three distinct mental locations, each location opening out to a realm of experience corresponding to this point of contact.
Thus body, ego, and soul are not pieces or separate parts of a human being, but mental locations where individual consciousness opens out to the animal, personal, and spiritual realms. I've done my best to head off the tendency of regarding these so-called realms as metaphysical planes of existence. Alas, metaphysical realism is a sticky trance to shake off. Another gross misreading identifies the ego-soul (a disastrous conflation that leads to numerous corruptions) as "the real me," literally throwing off the body like a cheap coat or temporal costume.
Body is our animal nature, animated by the life-force (anima), and the mental location where consciousness is involved in animality (i.e., in the dynamics of animal life). Ego is our personal identity, which is acted out through a variety of personae (social roles and masks), and serves as the executive center of our personality. And soul is our spiritual presence, the inner wellspring of spirituality and deep ground of the human spirit. Their associated realms comprise the sensory-physical (body), socio-cultural (ego), and intuitive-esoteric (soul) – as long as I can rescue the term "esoteric" (literally inner) from the secret-knowledge (gnostic) spiritualists and crackpot metaphysicians.
As the above diagram illustrates, these three mental locations are oriented respectively on the three concerns of life (body), self (ego), and being (soul), with each concern attracting secondary concerns and values into a coherent system of motivation and behavior. We are interested in different things depending on where (at what mental location) we are engaging reality at the moment. It's also important to see that this arrangement of concerns is not static, but rather evolves dynamically over the course of a lifespan.
Infancy and early childhood is a "body-dominant" developmental period that gives rise to an "ego-dominant" period in later childhood and adolescence, which may in turn break through to a "soul-dominant" mode of being. To a certain degree the success of each of these transitions is a function of how well things went in preceding periods. A body that wasn't providently supported in early life, for instance, will become an insecure base for the developing personality.
The neurotic styles are "adaptive" not because they support higher health and wholeness, but because they help our juvenile personality resolve the body's underlying insecurity by taking control – "acting childish" in some way. Throw a tantrum and a higher power will pay attention and try to pacify you: that's how you get your way. Of course, the effectiveness of such tactics drops off dramatically as we enter the adult sphere of relationships and responsibilities.
Needless to say, ego formation is a complicated business and none of us comes through the gauntlet without some emotional bruises, scars, hooks, and quirks to show for it. One way that we compensate for insecurity is by gripping down on what we believe – about ourselves, others, or god; about the way it was, is now, or will be. Cognitive certainty, as unshakable confidence in the absolute truth of our statements about reality, doesn't really address the insecurity knotted up inside us. But with time and practice we can eventually fall under the spell of our own convictions.
In my post "God Above and The Ground of Being" I took a closer look at the phases through which personal identity develops, along with the type of religion (theism) that orients, guides, spurs and attracts its development. Those phases are labeled in the diagram above: the dawn of identity in storytelling (imagination, fantasy, role-play), through the midday of ceremony where the broken time of secular life is ritually joined to the deep time of sacred story, and at last entering that twilight phase of orthodoxy, with its blessed certainty concerning the ultimate nature of things.
While this cognitive certainty (or dogmatic orthodoxy) might serve as adjustment therapy for the insecure ego, it is dangerous indeed in the way it blocks progress into a more spiritually grounded existence. Holding fast to belief may calm anxiety and shush our doubts, but it also pumps more energy into something that needs to be dropped and left behind: the ego itself. As a legitimate mental location of consciousness, ego engages us with the realm of tribal membership, conventional morality, and social recognition. It's here that we work out who we are and hope that God Above is pleased with us.
But what happens when the deeper impetus of our human development, which must ultimately transgress the boundaries of social identity to engage the soul and its grounding mystery – what happens when this gets held up and pulled back into the ego? My word is inflation: the ego becomes even more dogmatic, conceited, bigoted, and defensive. At this point, its counterpart in God Above starts to take on the character of a judgmental, glory-seeking, and vengeful deity. Coincidence? I bet you can look down through history to those periods when God Above was especially stern, vindictive, unforgiving and merciless, and you will find insecurity and ego-inflation running rampant among his devotees.
Don't get me wrong, as a system of religious support and orientation theism promotes human fulfillment – or I should say, healthy theism does this. As long as egos are around and people live in societies where membership means something, theism and its patron deity are here to stay.
In the best of all possible worlds, orthodoxy wouldn't exist. Believers would be encouraged to the edge of certainty and allowed to contemplate the mystery that can't be named. They would be challenged to let go of their need to be right, to let go of their need for assurance, to let go even of their god.
And with a gentle push, they would learn that they can fly.
It's interesting how the evolution of life, the development of a species, and the maturation of individuals within a species all tend to proceed from simpler to more complex forms and stages of existence. The human embryo carries vestigial gills and a tail from our prehuman ancestors. In a not entirely dissimilar fashion, children grow into mental abilities following the same sequence as our species over many thousands of years. What we see at one level (life, species, individual) is evident in the other levels as well.
Culture is the construction zone where the degree of advancement in our human species gets transmitted from individual-level breakthroughs, into the collective consciousness of society, and back again to the individual in the form of innovations in the traditional way of life.
In the interest of social cohesion and stability, a preferred path of change would be able to keep some of what has been (as tradition), as it moves forward into what will be. The role of institutions can be understood in this sense, as conservative and stabilizing structures in the flow of cultural change. The very definition of religion, from the Latin religare meaning "to connect or tie back," identifies it as an institution in this sense – indeed as the conservative and stabilizing structure in culture.
When the European Enlightenment got the intelligentsia excited about the possibility of throwing off the superstitions of the past to embrace a future of science, religion was the obvious and easy target. Without a doubt, there was much about the institution of Christendom that wouldn't listen and constructively respond to new discoveries and developments going on at the ground level of human experience.
As the official Church condemned new theories and excommunicated the brave souls who dared contradict its now-archaic orthodoxy, the best (and perhaps the only) recourse for many was to simply push the whole outfit into the ditch and move on with progress. The modern West turned its attention to factual evidence and the technical possibilities of this world, content to leave spirituality, religion, and God Above in an early chapter of its new autobiography: The Enlightened Man's Emancipation from Ignorance and Myth.
The Christianity we all know (and fewer of us love) is a type of religion known as theism, for the way it is oriented on and organized around the belief in a supreme being who is large and in charge. Our fortunate birth and prosperity in this life, followed (hopefully, if we get it right) by beatitude in the hereafter, is our Pilgrim's Progress supervised by God Above.
We happen to be living in the twilight of theism, during a late phase known as orthodoxy. At this point it is primarily about believing the right things, and doing whatever it takes to defend and propagate "the one true faith" around the world. By now, for a large majority of Christian true believers, the present mystery (we can even call it the real presence) of God has receded permanently behind something much more pressing and important – and manageable: the right opinion (ortho+doxa) about God.
At the end of the day it's all a very heady enterprise and increasingly irrelevant to everyday life. People are leaving the Church in droves, with the Enlightenment campaign of atheism once again on the rise. As a counter-measure, the engines of orthodoxy are locking into gear and plowing full steam ahead, until Jesus comes again or all hell breaks loose (rumor has it these might be the same event).
Fundamentalists, ultra-conservatives, and right-wing evangelicals are certainly not helping their cause, as bright and reasonable people who continue their quest for a grounded, connected, and personally relevant spiritual life are leaving the crazies to their end-game.
I spend more time than I would like trying to explain how the impulse to cast theism out with the dirty bathwater of dogmatic and dysfunctional religion, while certainly understandable to some extent, is not the real solution to our problem. For one thing, the theistic paradigm and its role in society should not be simply identified with any of its historical incarnations.
In other words, a corrupt version of theism is not necessarily a reason to reject theism itself outright. It happens that every institution is prone to desperate measures when threatened by the natural course of change. In this way, an institution is the cultural equivalent of an individual ego – a conservative and stabilizing construct of identity that resists becoming what it isn't used to being.
What follows is a perspective on theistic religion, exploring its development through distinct phases starting with its rise out of animism and following through its twilight into post-theistic forms of spirituality. My model for this developmental schema is not only based in the evidence of archaeology, but, just as important and even more useful, on the phases stretching from early childhood to maturity in the living individual today.
Earliest theism, just like early childhood, was lived in a world constructed of stories. There was no obvious boundary separating "fact" from "fiction," the given facts of reality from the make-believe of fantasy. Theism was born in mythology (from the Greek mythos referring to a narrative plot, which is the structural arch that serves as the unifying spine of a story).
Its gods began as literary figures personifying the causal agencies behind the order and change of the sensory-physical realm. Myths were not regarded as explanations of reality (as a kind of primitive science), but instead were performances of meaning that conjured the gods into being with each rendition.
It's difficult to appreciate or understand this phenomenon as we try to grasp it with adult minds, but perhaps you can remember how it was for you back then. The fantasy world of myth doesn't merely fade into the metaphysical background when the story concludes. Rather, that world exists only in the myth and is called into expression every time the myth is performed afresh.
We modern adults entertain a delusion which assumes the persistence of reality in the way we imagine it to be, even when our stories (at this later stage known as theories) aren't actively spinning in our minds. The paradigm-stretching frontier of quantum physics is confirming how mistaken this assumption is, and how much we really understood (though perhaps not consciously) as children.
At some point in late childhood and early adolescence the individual recognizes that real life requires an adjustment from imaginary friends, magical time warps, and free-spirited performances of backyard fantasy, to the daily grind of household chores and lesson plans.
A more complex and complicated social experience means that opportunities for reigniting the creative imagination must be "staged," that is, relegated to a consecrated time and location that will be relatively free of interruptions. Here, in this sacred space, the stories will be recited; but in view of limited time, only the major scenes and signature events are called to mind.
The required investment of time, attention, and energy in social responsibilities will not return the degree of enchantment and inspiration an individual needs to be happy. There needs to be a place for mythic performance and reconnecting with the grounding mystery. Besides, the mythological god can't be left hanging in suspended narrative when it's time to get back to the grindstone.
Theism had to adapt along with this emerging division between sacred and secular (temporal, daily) concerns. It did this by creating a special precinct where the majority could enter and observe an ordained minority dress up, recite the stories, and enact mythic events linking their broken time (divided and parsed out among countless duties) back to the deep time of an eternal (timeless) life.
Just as the holy precinct of ceremony served to connect a profane existence "outside the temple" (Latin profanus) to the sacred stories that weaved a tapestry of higher meaning, the god who originally lived in those stories was relocated to a supernatural realm overhead, standing by and watching over the business below. Even if the stories weren't actively spinning, people could take comfort in knowing (technically believing) that he was in his place and doing his job.
On a designated day the community gathered in the temple, and at just the right moment an official would sound a bell, light a candle, unveil an icon, or recite a scripted prayer invoking (calling in) the presence of the god. At that very moment, all were in agreement (at least those paying attention) that the deity would descend from his abode in heaven and receive their worship.
A ritual enactment of sacred story would typically culminate at a point where the congregation was invited to step into deep time once again. Afterwards a signal was given bringing the ceremony to an end, and the people would depart to their workaday worlds.
With a growing population and the inevitable pluralism that comes with it, getting to the chapel on time becomes more of a challenge for a lot of people. How can theism survive when the ceremonies and sacred performances start losing attendance? What happens when god above no longer has an official invitation to condescend to the supplications of his gathered assembly of devotees?
This is what happens: former true believers give up their denominational affiliation and do their best to continue on their own. They will still look up when they speak of god, point to heaven and cross themselves when they score a goal, and perhaps bow their heads and say a prayer before breakfast.
Once in a while they might make their way back to the chapel (maybe on time) to observe a performance of one of the really big stories. As they watch, a dim memory of childhood enchantment will stir somewhere deep inside them and they will feel the magic once more.
How can theism hold on when its ceremonial system – the land and buildings, the gold-plated symbols and silken vestments, the professional staff of ordained ministers, and the hard-won market share of rapidly defecting souls – is sliding into obsolescence and bankruptcy? The answer brings us to the third and final phase in the lifespan of theism, the twilight of institutionalized religion known as orthodoxy.
The enchanted storytelling of early childhood gives way to staged ceremony in young adulthood, which in turn and with further reduction eventually gets packaged up into neat boxes of truth called doctrines. An obvious advantage of this reduction of theism to doctrines lies in its handy portability, in the way it can be carried conveniently inside the head and transferred into more heads by rote memorization and Sunday School curricula.
If the first phase of theism (storytelling) featured the bard, and the second phase (ceremony) depended on the mediation of priests, this third phase (orthodoxy) belongs to the theologians. They are the experts who tell us what to believe about god and other metaphysical things.
Since theism at this point has become a rather sophisticated set of beliefs, the best (and perhaps only) way to impress their importance on its members is to make the doctrines necessary to what more and more people are lacking and so desperately looking for: security and longevity – specifically that odd fusion of security and longevity defined in the doctrine of everlasting life.
As time goes on, this notion of a future escape from a life burdened by fatigue, boredom, and absurdity grows more attractive, until the true believer is willing to give up everything – or, if necessary, to destroy everything – for its sake.
In the Age of Orthodoxy people still speak of the god above, of the miracles of long ago, or of a coming apocalypse and future rapture of the saints, but you'll notice that the critical point of reference is consistently outside the present world. Celebrity hucksters and pulpiteers try to fill the vacuum with staged demonstrations of "faith healing" and prophetic clairvoyance, but the inspiration is cheap and unsatisfying. Mega-churches and sports stadiums become personality cults centered on the success, charisma, theatrics, and alluring ideal of their alpha leaders.
In a sense, this transformation of old-style sermon auditions into entertaining religious theater represents a final attempt of theism to push back the coming night. There's no getting around the fact that orthodoxy just isn't that interesting, and as it rapidly loses currency in the marketplace of relevant concerns, more and more people are saying good-bye to church, to organized religion and its god-in-a-box.
As a cultural transition, the crossover from managed religion to something more experiential and inwardly grounded corresponds to that phase for the individual, when a deeper thirst for life in its fullness forces him or her to push back from the table of conventional orthodoxy and its bland concoction of spiritual sedatives.
In the twilight of theism, people are starting to give voice to their doubts, but also, increasingly, to their questions, their long-buried intuitions, and their rising new-world aspirations. They want more than anything to be real, to be fully present, and deeply engaged in life with creative authority.
This inward turn is the critical move of post-theism. It's not about pulling down orthodoxy or refuting its god, but rather simply letting go and quietly sinking into being. Quietly is a reminder that words at this point are like hooks that can snag and slow one's descent, running the risk of turning even this into another religion with its own esoteric orthodoxy.
The ego and its constructed word-world of meaning need to be left behind so that consciousness can softly settle into the still center of contemplative awareness. Here all is one. There is only this.
Here is born (or reborn) that singular insight which inspired us to tell stories in the first place. Now, perhaps, with a lifetime of experience and some wisdom in our bones, we can tell new stories.
It's always been and will always be here and now.
In "The Mythic Quest of Captain Ego" I offered a model that helps us track individual identity through a gauntlet of developmental challenges that both shape the ego and continue to influence it throughout the lifespan by way of deep patterns called archetypes. These archetypes belong to larger clusters that correspond to the formative phases of birth (the perinatal cluster), early childhood (the developmental cluster), and a critical passage that is unlocked only to the degree that these earlier challenges were relatively successful, opening into an experience of the grounding mystery of being itself (esoteric cluster).
It is at this threshold, in fact, where ego (identity) is surrendered to soul (communion), that theism as a paradigm of religion gives way to post-theism. Indeed, if we can better understand how it goes (or gets blocked) for the ego, we will have in hand a key insight into the evolutionary purpose (and common pathologies) of theism as well. This is because theism and ego are coeval (of the same age and equal duration). How it goes with ego, so it goes with theism – and vice versa. In this post I will explore the healthy and dysfunctional forms of both.
Before I begin, however, perhaps that last statement – about ego and theism developing together – needs to be explained. The essential idea is that ego, as the executive center of the personality, has its counterpart in the deity who is executive-in-charge of the tribe and its world. "Tribe" is here playing a mediating role, shaping the individual's identity as "one of us" according to the moral ideal represented in the patron deity. At this stage (in theism) the game is all about clear roles and rule-bound relationships, as the arena where the social constructs of identity, membership, and obligation are set in place.
The patron deity serves a dual function as the sovereign authority behind the tribe's moral code, and as the focus of worship and aspiration in its members. In obeying their god, individuals are cooperating for the common good, while in glorifying the divine virtues of grace, mercy, compassion, patience, wisdom, forgiveness (etc.) – and seeking all the while to be like the deity in these ways – they are gradually growing toward that ideal. Along the way, what had been addressed as outside the self (i.e., the patron deity) is slowly internalized, as it were, until the individual is able to drop the identifier of "me and mine" altogether and simply be one with everything.
It happens, and all too frequently, that ego development gets hung up (or blocked), which, if the hang-up is fairly widespread across the tribe, can have a distortion-effect on the deity as represented in art, story, theory and doctrine. As a people regress, so does their patron deity. Just as in positive development the deity contains dormant or newborn virtues of a morally advanced community, when its official custodians (the priests and theologians) slip or get pulled into degenerate vices such as dogmatism, bigotry, vengeance and cruelty, the deity undergoes a similar makeover and soon the tribe as a whole falls into its gravity.
So what is a healthy ego and deity, and what are their contrasting pathologies? First we should recall that ego-formation comes about, initially at least, through a process of restraint-and-redirection, as the impulsive drives and animal urgencies of the body are trained into socially appropriate behavior. Of course, the underlying urgency of biology and instinct doesn't just stop doing what nature requires, which means that ego is first gained and thereafter suspended just above the borderline separating the personality from this primordial (deeper, darker) animality.
Added to this responsibility of managing the animal impulses of the body – at least the small percentage of milder inclinations that can be controlled – is the task of establishing a center in the personality where moods can be kept in balance. As distinct from urges and impulses, moods are global and sustained internal states that work to match an organism to its environment and motivate behavior that is adaptive to the challenge at hand. Because circumstances change and new challenges are always presenting themselves, particularly in the social arena where ego is at home, the personality needs to adjust quickly.
A third factor of ego strength is its ability to hold the personality together as a whole. Various and sometimes divergent streams of affect (feeling), motivation, thought, and disposition need to be supervised, coordinated, or reconciled for the sake of maintaining a unified self. There are times when a certain stream comes close to breaching the ego's hold, which, if successful, could result in guilt, embarrassment, or personal injury. As the executive center, ego serves the important function of self-integrity.
In summary, then, healthy ego development – and let's remember that this will be true of the divine ego of the patron deity as well – is demonstrated in a stable, balanced, and unified identity. The personality is kept from falling through the floor into animal urgency, it is able to maintain a center of emotional composure, and it is held together under a governing director who monitors all things "me and mine" (our Captain Ego). From this stable, balanced, and unified platform, an individual is capable of leaping out into a larger reality, transcend the self entirely, and consciously join the present communion of all things – which is the mystical experience of spirituality.
Against this profile of healthy identity we can more easily describe the different types of pathology that afflict both ego and the patron deity.
With that said, my description of pathology in the ego and theism's deity is not intended to deny the legitimate cases where something is really, and deeply, wrong with the brain (in ego's case). While I have chosen the names of a few outstanding and "popular" pathologies for my purpose, I readily concede that there are times when biology has "gone wrong" and a patient needs medical (drug and/or surgical) intervention. But such cases are much rarer than is commonly believed, which is part of the delusion that the conspiracy is intent on perpetuating. So here we go. When the boundary separating ego from the lower animal urgencies is not very strong, the personality is not able to control the border and keep spontaneous impulses in check. Consequently the identity system will unpredictably collapse and be overtaken by sudden urges or reactions, making the person behave in socially inappropriate ways that end up damaging relationships. Do you know anyone like this?
What I'm calling borderline personality, then, is not so much a clinical disorder as an extreme variance in identity formation where ego strength is insufficient to keep the personality above the surface of animal urgencies. Individuals who lack a stable ego often suffer from loneliness from having offended their former friends, and a chronic restlessness in never knowing when the floor might fall out from beneath them.
What happens when the missing part of ego strength is the center that would otherwise hold a person's moods in balance? Wide and erratic swings, and not only of the familiar "manic" to "depressive" poles. Wild fluctuations in mood inevitably land the individual in situations where the body's internal state is completely incompatible with his or her present circumstances. Because moods are more global and enduring than the momentary feeling responses that naturally occur in the course of normal experience, a bipolar person can be so totally possessed by a mood that he or she is insensitive to the surrounding cues.
The bipolar personality is also socially disruptive, but in a different way from the borderline personality. While the borderline issue puts everyone on the edge of not knowing when the next outburst or collapse is going to happen, bipolarity trains those around the individual to withhold confidences and responsibilities from him or her out of concern that they won't be followed through to completion. Do you know anyone like that?
Finally, when ego strength is unable to hold the personality together as a unified system, the numerous undercurrents of identity, attitude, motivation and behavior that might normally be allowed expression by Captain Ego in appropriate social environments and situations, can simply and unexpectedly "show up." Roberto Assagioli, the Italian founder of psychosynthesis – stressing the necessary work of constructing a healthy self, as opposed to Freud's strategy of taking apart the sick self with psychoanalysis – referred to these relatively self-contained minor identities within the dominant personality as "subpersonalities." They are normal components in the normally complex personality system.
But when the ego is too weak to maintain a unified self, the personality "dissociates," giving way to any one or a number of these subpersonalities. Observers of this phenomenon are often perplexed at how so-and-so is suddenly "an entirely different person" than he or she was just moments before. This isn't about impulses breaking through the floor, but rather coherent substreams of alter-identity that take over in a social situation.
Now that we have a model of ego strength before us, along with an understanding of the major pathologies that compromise it, I will return to my original suggestion. Just as there is a developmental partnership between the healthy ego and its patron deity, where the external causality and higher virtues represented in the deity are gradually internalized by the caring and self-responsible ego, so we should expect to find instances where ego pathology (borderline, bipolar, dissociative) is reflected in depictions of God – for example as temperamental, capricious, and internally divided (think of the subpersonalities of Yahweh in the Bible as threatening and wrathful, or as compassionate and forgiving).
Do you know a religion like that?


i have done the b.com tell me what will i do MCA OR MBA ?
AND I GOT EASY JOB WITH WHICH DEGREE?????
There is no degree in this world which can guarantee an easy JOB . You will have to work hard and drain sweats for success.
So do not hanker after a easy job getting degree.
If you have passed Maths in 10+2 level or in Graduation degree, then only you are eligible for MCA course.
Since , you have got your Bachelors degree in Commerce, I would suggest you to go for MBA.Through this course you can utilize your previous educational qualification in a more efficient way.
Decide your career based on your interest, aptitude and personality and not on the easiness to get a job.
There is number amount in this world which can promise a simple JOB.You will need to work hard and strain knits for success.
So do not hanker following a simple job finding degree.
MCA means Experts in Computer Applications while MBA means Experts in Organization Administration.
Both are postgraduate amount and there is always a MCA versus MBA debate.
I should in order to guarantee you that the courses has immense making potential .
A year ago the best salary agreed to a MCA graduate was approximately 70 lakhs p.a for offshore posting( Highest salary stands at 1.5 crores).
Same may be the case with MBA course.A year ago best salary to a IIM -Ahmadabad was 1.2 crores.
So making potential is almost same and greatly raises with work and experience.
When you yourself have passed Maths in 10+2 stage or in Graduation amount, then just you are qualified to receive MCA course.
Since , you 've got your Bachelors amount in Commerce, I would suggest you to go for MBA.Through that course you can employ your prior academic qualification in a better way.
Choose your career centered in your fascination, aptitude and character and perhaps not on the easiness to acquire a job.