SALMA April 2025 Webinar - Ubuntu, Prosociality & Social Connection: Lessons for Lifestyle Medicine

Summary

In the April 2025 webinar hosted by the South African Lifestyle Medicine Association, Dr. Henrik Fulmink explores the integration of Ubuntu, prosociality, and social connection into lifestyle medicine. The session, geared towards enhancing patient care, delves into Ubuntu as a universal humanism emphasizing interconnectedness, and prosociality as selfless actions benefiting others. The discussion revolves around applying these frameworks to tackle social disconnection's health impacts, using theoretical and practical methodologies to strengthen patient relationships and communities. Dr. Fulmink proposes the innovative RIV model for social prescribing, encouraging reconciliation, inclusion, and volunteerism to enhance patient outcomes through meaningful social ties.

Highlights

• The webinar showcased how Ubuntu and prosociality can be integrated into lifestyle medicine to address social disconnection 🌐.
• Dr. Henrik shared a hypothetical case study to demonstrate practical applications of social connection frameworks in healthcare 🔍.
• Social connection has an immense impact on mortality, similar to well-known factors like smoking, thus vital for lifestyle medicine 🚨.
• Dr. Fulmink introduces the RIV model - focusing on reconciliation, inclusion, and volunteerism, to bolster social ties in patient care 🌱.
• This session highlighted the importance of addressing social factors in medical consultations and the systemic benefits of community connection 🏥.

Key Takeaways

• Ubuntu emphasizes interconnectedness among people and can be applied in lifestyle medicine to improve patient care 👐.
• Prosociality encourages selfless actions benefiting others and is integral in building healthier communities 🌍.
• The RIV model proposed by Dr. Fulmink offers a new approach in social prescribing, focusing on Reconciliation, Inclusion, and Volunteerism 🔧.
• Social disconnection is a significant health risk, comparable to other major risk factors like obesity and smoking 🚭.
• Practical integration of social frameworks in medicine can significantly enhance patient compliance and health outcomes by fostering trust and community connections 🤝.

Overview

In an engaging session, Dr. Henrik Fulmink guided attendees through the exciting possibilities of integrating Ubuntu and prosociality into lifestyle medicine. By focusing on these intrinsic human values, the aim is to enhance connection within the healthcare context, thereby improving health outcomes. These concepts challenge traditional views by adding a social dimension to medical practice, showing significance in tackling issues like social disconnection, a rising concern linked to increased mortality.

The presentation emphasized that Ubuntu, a term deeply rooted in African culture, represents universal humanism. It's the idea that people are interconnected and one's well-being is tied to others. Combined with prosociality, which involves selfless actions for the benefit of others, these frameworks provide a robust foundation for addressing social disconnection through a new patient care approach.

Dr. Fulmink's innovative RIV model—focusing on Reconciliation, Inclusion, and Volunteerism—was outlined as a novel method to incorporate these social concepts into practice. This initiative encourages healthcare professionals to proactively identify social risks and foster meaningful patient connections, enhancing compliance and overall health outcomes. The session concluded with discussions on practical applications and the systemic benefits of bridging healthcare with community connections.

Chapters

• 00:00 - 01:30: Introduction and Speaker Background The chapter introduces the speaker and provides background information for the webinar, emphasizing its significance as the first CPD accredited ethics webinar. Dr. Henrik Fulmink, a public health specialist known for his passion for innovation and transformational leadership, is the focus of the introduction. The chapter sets the stage for the discussion to follow, highlighting the credentials of Dr. Fulmink.
• 01:30 - 03:30: Presentation Overview The chapter titled 'Presentation Overview' introduces a highly accomplished individual associated with the Armandela School of Medicine. This individual holds a master's degree in public administration from the University of Warwick, UK, and another master's in medicine from Vitz University, both achieved with distinction. Additionally, he is a fellow of the College of Public Health Medicine of the College of Medicine in South Africa, where he was honored with the Henry Glman medal. These achievements highlight his strong academic background and dedication to his field.
• 03:30 - 04:30: Hypothetical Case Study Introduction The chapter introduces a senior lecturer in the Department of Global Health at Steel University, who is also a former member of Parliament in the National Assembly of South Africa. The individual sat on the portfolio committee on health and is involved in several startups. The speaker expresses gratitude and excitement about the insights and information the guest will share, leading to the guest taking the stage.
• 04:30 - 08:00: Social Disconnection as a Global Issue The chapter titled 'Social Disconnection as a Global Issue' opens with a warm welcome and introduction by the speaker, who thanks Nasha for her introduction. The speaker expresses excitement about discussing the topic and anticipates meaningful discussions to follow. They attempt to share their screen and seek confirmation from Nasha on its visibility.
• 08:00 - 13:00: Introduction to Ubuntu Henrik introduces himself as a public health medicine specialist and co-founder of PRMED, a precision medicine-focused healthcare company. He also mentions his involvement with the pro-social world board and the Ubuntu global network, hinting at the relevance of these affiliations for the discussion at hand.
• 13:00 - 18:00: Ubuntu's Philosophical and Practical Applications The chapter delves into the philosophical concept of Ubuntu and explores its potential connections to pro-sociality. It emphasizes the significance of these frameworks in enhancing social connections, particularly within the context of lifestyle medicine. The speaker is set to discuss whether and how these two frameworks are interrelated, highlighting the critical nature of this relationship.
• 18:00 - 24:00: Introduction to Pro-sociality The chapter 'Introduction to Pro-sociality' begins by questioning the applicability of various frameworks to lifestyle medicine, both theoretically and practically. It expresses particular interest in their potential use during patient consultations. The chapter highlights the excitement around discussions and meaningful engagement, particularly through a hypothetical case study that embodies the chapter's central themes.
• 24:00 - 30:30: Pro-sociality's Philosophical and Practical Applications The chapter titled 'Pro-sociality's Philosophical and Practical Applications' discusses a patient case study as a narrative throughout the presentation. It introduces Mr. JS, a 42-year-old male with a complex interplay of metabolic, psychological, and social risk factors. The chapter emphasizes exploring these social risk factors, while noting his history of fully controlled type diabetes.
• 30:30 - 40:30: Integrating Ubuntu and Pro-sociality into Lifestyle Medicine This chapter discusses the integration of Ubuntu and pro-sociality into lifestyle medicine with a focus on managing chronic diseases such as diabetes and hypertension. It uses a case example of a patient with sub-optimal control of type two diabetes and hypertension despite medication. The patient also experiences symptoms of moderate depression and anxiety. The chapter explores how lifestyle medicine can address both physical health issues and mental health concerns by fostering a pro-social environment and adopting principles of Ubuntu, which emphasizes community well-being and support.
• 40:30 - 44:00: Case Study Application and Conclusion The chapter discusses a case study focusing on an individual experiencing mild to moderate generalized anxiety disorder. The person also has low subjective well-being, scoring 32% on the well-being index, with anything below 50% being of concern. The subject has a sedentary job as an advertising executive and engages in minimal structured exercise. The chapter likely uses this case study to explore the interplay between professional lifestyle, physical activity, and mental health, concluding with potential applications or interventions.
• 44:00 - 54:00: Q&A Session The chapter titled 'Q&A Session' revolves around a patient's health issues, primarily focusing on obesity. The patient has a Body Mass Index (BMI) of 33 and a concerning waist-to-hip ratio of 1.1, indicating high central visceral adiposity and central obesity. His dietary habits are poor, consisting mainly of takeaways high in refined carbohydrates, trans fats, and sodium, with minimal healthy food intake. Additionally, there are concerns about his substance use, particularly a smoking history amounting to 15 pack years, which significantly elevates his cardiovascular risk.
• 54:00 - 55:00: Closing Remarks The chapter titled 'Closing Remarks' discusses an individual's health concerns, highlighting excessive alcohol consumption, especially during weekends, which raises the risk of binge drinking. This behavior exacerbates existing chronic health issues. The individual also suffers from poor quality sleep, averaging only six hours per night, likely due to poor sleep hygiene, influenced by stress and alcohol consumption. Additionally, chronic stress is a notable concern.

SALMA April 2025 Webinar - Ubuntu, Prosociality & Social Connection: Lessons for Lifestyle Medicine Transcription

• 00:00 - 00:30 Okay. Uh, good evening everybody. Thank you once again for joining us for our April webinar. Um, so today's webinar is actually our first CPD um, ethics CPD accredited webinar and we're so excited. Um, we have the privilege of being joined today by Dr. Henrik Fulmink who's a public health specialist and he's very passionate about innovation and transformational leadership. So um Henrik holds his MBBC from the Nelson
• 00:30 - 01:00 Armandela School of Medicine, his masters in public public administration from University of Warick in um the UK as well as his masters in medicine from um Vitz University and he achieved the latter two um with distinction. He's also a fellow of the college of public health medicine um of the college of essay of medicine and essay um from which he was also awarded the Henry Glman medal. So he's um very academically accomplished. He's also a
• 01:00 - 01:30 senior lecturer extraordinaire in the department of global health at steel university. Um he was also a previous member of parliament in the national assembly of South Africa um where he sat on the portfolio committee on health and he's involved in several startups which I'm sure he'll tell you all about. So um thank you once again Henrik. uh we're so grateful that you could join us and we just love to know more about you and we're very excited about what you have in store for us today. So yeah, I'll hand over to you Hinrich. Thank you.
• 01:30 - 02:00 Thank you Nasha for that very kind introduction. Um and um good evening colleagues. It's wonderful to have the opportunity to to present to you what hopefully will be an interesting topic. um uh and would really uh look forward to having uh some meaningful discussion at the end of the presentation. So I'm going to try to share my screen. Um hopefully it will share. Uh just to confirm, Nasha, are you able to see see the screen?
• 02:00 - 02:30 Yes. All good, Henrik. Perfect. Thank you so much for that. Um okay, so my name is Hinrich. Um I'm public health medicine specialist and the Ash has been way too kind in that introduction. Um but I um amongst other things have uh am a co-founder of PRMED which is a precision medicine based uh healthcare company. Um I I sit on the board of pro-social world and that becomes relevant uh during this conversation as does my my work in the Ubuntu global network and I I did see that we have some colleagues uh Monica from the Abuntu global network here from
• 02:30 - 03:00 Portugal. Thank you for joining uh and also as Nasha said I'm involved in academia at Stallies. So this evening I I want to speak about what Abuntu is. um and and then link it to another framework called pro-sociality. Um but the idea is how do these frameworks link to the pillar of social connection within lifestyle medicine and do they uh I guess would be the the first question and then how would be the second uh if it does so is a relationship though between these two frameworks that's another critical
• 03:00 - 03:30 question to address and um again what are what are the applicabilities of these frameworks either in isolation or together to lifestyle medicine at a theoretical or higher level and then very much at a practical level how can to assist us in our patient consultations. Uh and again, I'm really excited about the discussion portion uh because I think that's where a lot of the the meaningful kind of engagement will will come. So, I'd like to begin with a hypothetical case study. This is a hypothetical, but I think represents a
• 03:30 - 04:00 patient that any of us uh who who do practice uh may see um with very very common uh symptomology. So, let me describe this patient and then we will use this as an underlying narrative throughout the presentation. So, Mr. JS, our patient is a 42-y old male with a complex interplay of metabolic, psychological, and social risk factors. And of course, we want to highlight the social risk factors. He's got a history of fully controlled type diabetes, type
• 04:00 - 04:30 two diabetes, HBA1C 7.1. He's on 500 milligrams of of metformin, BD, so it's a gram a day and still not well controlled. hypertension also not well controlled 141 over 90 and he's on one uh tablet of 5 milligram analiprol a day. uh so sub-optimal control of these chronic diseases. He presents with symptoms suggestive of a moderate depression and his patient health questionnaire score is 11 which is just on the on the moderate side of the scale in terms of depression moderate anxiety
• 04:30 - 05:00 again just on the on the border between mild and moderate but on the moderate side of 10 the generalized anxiety disorder scale and then interestingly on the WH 5 well-being index he scores 32% and anything less than 50% uh on that index is of concern so he has low subjective well-being um he he isn't very physically active. He's an advertising executive um and so has a very sedentary occupation and also has very minimal structured exercise if any. And as a part of part of the presentation of this
• 05:00 - 05:30 is that he has obesity. So he's got a BMI of 33 and importantly a waist to hip ratio of 1.1 with a high central uh visceral atyposity and central obesity. Uh poor dietary habits. Mr. lives on takeaways and so he has lots of refined carbs, trans fats and sodium with very little mention of anything healthy in his diet. Um his substance use is also of worry. Uh he has a smoking history of 15 pack years. It's major cardiovascular risk
• 05:30 - 06:00 multiplier. Has a high alcohol intake and those 25 units cons on very in a very um worrying way uh are usually consumed over the weekend. So he has a potential for binge for binging and he of course all of this contributes to his other underlying chronic conditions. Poor sleep, disruptive sleep, 6 hours a day of poor quality and of course low probably low sleep hygiene with alcohol stress and screen heavy screen heavy occupation contributing to that. Um he also has chronic stress uh and a poor
• 06:00 - 06:30 work life balance and this is where the social risks which is the focus of our conversation this evening become really important. So he's got a high pressure job although he is he there's been a decline in performance and most of his time is focused on his work and yet his reviews have been increasingly uh worse and so this is of worry but really of of of of immediate concern is a minimal social support that Mr. JS has his main social interactions are with his parents both of them are elderly and in poor health he's estranged from his brother and this is a source of huge distress
• 06:30 - 07:00 for Mr. no romantic partners for the last 3 years. Um, and he has an occasional sort of social interaction. He hangs out with work colleagues every now and again, but but very seldom. And so he's socially isolated or socially disconnected. So we're going to pause the hypothetical case study for now, although it'll be threaded throughout the presentation. And I'd like to to to use that last point in social disconnection to to to introduce the talk. So we have an epidemic of social disconnection. And this is a very interesting quote from
• 07:00 - 07:30 the from the WHO. Um uh it showed that in a 25 2015 uh review that social isolation and loneliness was associated with a 29 and 26% increased likelihood of mortality respectively. Very very disconcerting. Um social isolation and loneliness affect mortality similar to wellestablished risk factors such as obesity, lack of physical activity, smoking and other forms of substance abuse. So all of these points obviously relevant to lifestyle medicine and then also pro poor access to healthare
• 07:30 - 08:00 unquote. Um and it's of such concern to the that to the WHO is looking has established in fact a commission on social connection and would that that that commission's aim would then be to develop a global agenda around social connection. So this is a a huge global issue and of course a huge local issue and just to give some some data behind some of those um very worrying uh points that were made. Uh so this is an excellent meta analysis by Halt Lonut
• 08:00 - 08:30 and just to interpret it very quickly what it's saying is that low social connection or low social support um or low social integration is as is as um much a contributor to mortality as smoking 15 cigarettes a day essentially being an alcoholic has a higher impact on mortality likelihood than obesity uh and a lack of physical activity for for controlling atyposity. And so it becomes striking um uh and of course this is a massive meta analysis. So it's fairly
• 08:30 - 09:00 strong data that's being presented here. So social disconnection is is contributing to people dying. I think this is not just disease but actual contributing to to risk and mortality. So since social connection or connection is part of the lifestyle arsenal, uh the question I'd like to ask this evening is um with connection to that pillar, can we draw on existing frameworks and knowledge systems to improve social prescribing as part of lifestyle medicine particularly in relation to uh
• 09:00 - 09:30 social disconnection. Uh and I'd like to offer uh that there are at least two frameworks we can look at and I'm going to delve into quite a bit of depth in these frameworks. one is Ubuntu as an indigenous knowledge system um uh that has tremendous value and the other is pro-sociality um which has emerged uh from a a wide range of scientific investigations and so the combination of these two uh I I would strongly argue may have value in
• 09:30 - 10:00 trying to answer this question but let's let's unpack each in turn so I'd like to begin with Ubuntu so of course many of us understand Ubuntu at least have a have a knowledge of what means uh it can be expressed through different aurorisms. So in in terms of maxims just with isulu and gumu and gabanu uh and of course there's a similar maxim incla but just on that you know if you look at umu a personu is a person gabanu by virtue
• 10:00 - 10:30 or through other people uh and so the idea is of course I am because we are we are because I am there's an interconnectedness between me as a person and those around me in my community and of course is this is this again is something that we hold quite precious in our context. Um, just to show that there's a dispersion of of of of um contracted phrases that speak to ibuntu across different uh languages in our country. Uh, and so this is this is fairly well dispersed. Uh, but beyond
• 10:30 - 11:00 our country uh there's also dispersion of of of expressions that again look like Ubuntu across our continent from the DRC to Mosmbique. uh and beyond that um there are expressions of Abuntu in the global context and all of this um comes through studies I did for my masters at Warrick and so just maybe to pause here if you look at you everywhere from from Brazil satia this idea of empathy uh to filimo love of honor including love and empathy towards
• 11:00 - 11:30 others from ancient Greece to the ancient concept in India of aimsa or the sanctity of life which links to abuntu and in Japan wow this idea of of harmony in society All of these are parallels to Ubuntu and then brought at a at a meta level western communitarianism and eastern Confucianism I would argue almost convergent in terms of Ubuntu. So what I found in this part of my study is that Ubuntu is an expression of a very universal sense of humanity a very
• 11:30 - 12:00 universal humanism. The sense this intuitive sense that has been held in cultures from time immemorial that we are profoundly interconnected as human beings. Um and so Ubuntu we are very fortunate in South Africa to have such a an incredible expression of this of this broad humanism. Uh Ubuntu that's kind of a rarification of this this ocean of humanism this this river that comes to us. Uh but there are other expressions that link to Ubuntu. And so anecdotally when I've gone to different countries and spoken to people from different
• 12:00 - 12:30 cultures and I've spoken about our concept of Ubuntu they said well yeah in my culture this is what it's called and it's called this and this is how we express it. But it all comes back to what we intuitively stand as human beings. Uh and again Ubuntu allows us a crystallized version of that to study and analyze. And that's what I did with my with my thesis which I'll come to in a moment. But maybe just to give a bit more um discussion around the philosophical concept of Ubuntu. If you take uh the idea of or the prefix ubu and the stem and this comes from
• 12:30 - 13:00 professor Ramos's work remosce from professor Ramosi from UNISA. uh if you split it up so we do a morphological dissection of that uh ubu speaks about becoming or being and then two about human or person uh the and so ubu has a distinctly onlogical uh ele aspect to it. In other words, it speaks about real meaning and ident identity and and and sort of the reality of being and then two is the expression of that how we know that we are how we
• 13:00 - 13:30 know that we're being is through our humanness. uh and uh and and I think this is a very powerful way of of dissecting Ubuntu. Um but of course from a more emotive and and a and a and a highly socially impactful way uh the late archbishop emeritus Desmond Tutu described Ubuntu as follows. A person with Ubuntu has proper self asssurance that comes from knowing that he or she belongs in a greater whole and is diminished when others are humiliated or diminished when others are tortured or oppressed. I think the key thing here colleagues is with this powerful
• 13:30 - 14:00 statement is that Ubuntu doesn't negate uh the individual um for the good of the community. It holds both. Right? So I am a person and in my personhood I have an individual component and I have a community or collective component and both of these inform who I am as a person. Doesn't negate the person. It actually expands the concept of personhood. And I think that's very important to remember that balance. And the other question just to link to the
• 14:00 - 14:30 thread of our our case study Mr. JS is um is you know if you look at this the statement in the work of of of the late archbishop in the truth and reconciliation commission you'll see that a huge thrust of Abuntu is around restoration reconciliation where possible to to to heal fractured relationships is key to the Iuntu philosophy. And if you look at Mr. JS and the the fractured relationship with his brother may there be potential utility here for Abuntu just to keep that in mind and we'll come back to it towards the
• 14:30 - 15:00 end. The second uh uh point I want to make around Iuntu again is is is my study on Iuntu. I looked at ibuntu through a different lens not through medicine per se but through a public policy lens where I ask questions around what is Ubuntu u uh in relation to global citizenship and governance and is there value in understanding this ideology in those contexts. I did that at the University of Warick. I did fairly in-depth structured interviews with uh participants from civil civil service, politics, academia, and civil
• 15:00 - 15:30 society or the NGO sector. Um I went through conceptualizations of Abuntu, how it's influenced us in South Africa and how it could be relevant to global governance and citizenship. But for this talk, I'd like to focus on conceptualizations because that's really what where I want to go to here and that is sort of unpacking a bit more of the philosophy of Ubuntu. What I found from a from a literature review is that Ubuntu is understood not as a single value but rather a value system and that in that value system interconnectedness and practical wisdom is important. In
• 15:30 - 16:00 fact, if I linger on interconnectedness, there's a there's another concept called bought a concept called Ukama which speaks about Ubuntu but with all of the cosmos. So ecological solidarity, not just human solidarity but with Ubuntu we you know the main focus is on human solidarity. So human interconnectedness and practical wisdom and that kind of is reflected in what I found in the interviews. It was understood that Abuntu is a social construct uh and that it has identity linking to interconnectedness and action linking to
• 16:00 - 16:30 practical wisdom as part of it. Um so a cultural value system which informs both collective and individual identity and action. Um now what's important here is that Ubuntu when understood in its truest form is I found almost invariably positive. But when there's a distortion of Ubuntu, it can become negative in in practice. And so not Abuntu itself but rather a contortion of Ubuntu can be negative. What I mean by that is that if we say as you know as Selma as this group we have essentially um a a unified
• 16:30 - 17:00 identity but that group in that other discipline or that other specialtity or that other area they don't have what we have. They don't have they essentially don't share the same traits as us. we at the risk of this distortion of Abuntu because what when you combine essentialism or particularism in other words my group versus other groups with Abuntu then I can let a lot happen in my group so patronage exclusion of others deferring responsibility um uh but I'll be harsh in other groups whereas Ubuntu in its truest understanding or not not
• 17:00 - 17:30 distorted uh speaks about ethical decision-m connectedness ethical behavior as a broad human uh uh value so for all people not just for a particular group and when it's understood in that way it becomes profoundly positive and I would argue of benefit to us in our discussion. So um just to to to very quickly go through this discussion and that is that for my my thesis I built a framework. So I said low expressions of abuntu or unabuntu like behavior or low
• 17:30 - 18:00 expressions of abuntu would be that narrow particularism I just described us versus them. Whereas the truest expression or high expression of abuntu would be with a broad humanism. Humanism is understood not in a philosophical doctrinal way but rather humanism in the form of human welfare and interest in in human welfare. Right? So so when we have a when we have a high level of focus on that we have a true expression of abuntu and that's on the identity axis and then on the action axis when we have narrow interest agreements. So in other words I'll only make decisions of value to my
• 18:00 - 18:30 group at the expense of others. That's low expression of Abuntu. But a high expression would be the broad consensus building we found uh being used a lot in decision-m and so that then describes high expression of Abuntu. So we put that framework together. What we then see is that um we can begin to uh sort of build up quadrants. So let's just quickly go through this. Quadrant one would be where there's a high understanding or understanding of that we have a shared identity but there's a limited commitment to consensus building. So if we use the experience of
• 18:30 - 19:00 the the co9 pandemic um to to give examples here let's let's see what that means. So it would mean that you know the the initial failures of reaching consensus around lockdown targets will be an expression of that quadrant. We we we have a shared identity in that we are all threatened by this virus but but we have limited consensus building a particular um uh group holding particular power within the within the the within the um the political system uh makes decisions on
• 19:00 - 19:30 behalf of the whole society and those decisions often times were in conflict with with other parts of society especially in the late lockdown. So so that could be an expression of of of um quadrant one. Quadrant two would be we have broad we have a broad aspiration to reach consensus but we don't really see a collective identity. So here you know the the broad commitments to delivering vaccines at a global level to those who need it but a failure to deliver on those commitments would be an expression of quadrant 4 um because of a lack of shared identity. Quadrant 3 is the worst
• 19:30 - 20:00 of all cases. So that's when we have narrow understandings of of of of sort of group identity and narrow interest agreements. So the vaccine hoarding that occurred during the pandemic would be an example of that. Even though there was a risk to the entire global community including the group doing the hoarding still be impulse to hoard vaccines would be an expression of quadrant 3 which is the which is really not an expression of Ubuntu and then the high end would be an ideal scenario where broad inclusion and humanism is combined with a desire to
• 20:00 - 20:30 build consensus across a range of interests. So here for example the move towards removing IP patents and vaccines and reaching equitable targets across the globe would be an expression of at least the ideal of reaching an ibuntu like outcome. So that concludes Ubuntu and I'll pause on ibuntu now um and we'll see how it integrates a bit later but what I'd like to now do is shift over to to pro-sociality. So of course deeply embedded indigenous knowledge system
• 20:30 - 21:00 that has great value pro-sociality um really comes to us through through um uh iterations of scientific endeavor uh uh but but also links to like Abuntu something we all intuitively understand uh uh and and so pro-sociality as a second framework essentially means action or taking action aimed at benefiting the other somebody around me. It's a form of or strongly related rather to altruism. I act on to the
• 21:00 - 21:30 benefit of those around me um in a way that is selfless. Um and as you can see u from um uh uh fahit fical um faal that there's been a rapid increase over the last uh really decade or two a decade and a half of um articles and publications that had uh pro-social uh as part of the uh as part of either the title or the methodology. um uh and this is quite an interest that
• 21:30 - 22:00 there's this huge interesting that there's this huge shift um of investigation towards pro-sociality. So fasc also provide us with really great descriptions of pro-sociality. They speak about pro-sociality firstly in terms of scope. So pro-social behavior that covers a range of uh of actions intended to benefit one or more people other than oneself. Very basic clear definition of what pro-sociality is. Then there's the intention. So it's behavior that is not performed with an expectation of either
• 22:00 - 22:30 receiving a reward or trying to avoid punishment. It's truly selfless. And then motivation that the ultimate goal is increasing another's welfare. So this is really I think a nice balanced way of describing pro-sociality. But let's look at pro-sociality in a way that we can more intuitively understand. And so there was this very very inspirational story in June of 2022 from Chicago when you had a 20-year-old uh uh named Anthony Perry who saw uh a stranger
• 22:30 - 23:00 lying on the railway track in in Chicago in the transit system uh and jumped onto the railway track um putting himself in danger of course uh pulled this unconscious stranger off of the track and together with another commuter administered TPR and and helped save this person's life. Now, what was interesting about this is, of course, this is a complete stranger to this to to to to Mr. Perry. He had never seen this person, didn't know who this person was. And what's interesting is what he said. He said, "I was hoping, quote, I would could just grab him and not feel
• 23:00 - 23:30 nothing, but I felt a shock. I felt it all through my body. Actually, I didn't let that stop me. Didn't let that stop me." Um, and I think that's really a key point there is that he he he he not only uh anticipated risk uh at a subconscious level but actually experienced risk in actually feeling the current move through him but he continued to act. Uh and that basic human impulse is so powerful and lies at the heart of pro-sociality. And in fact that that that links to a broader conversation uh
• 23:30 - 24:00 and this conflict conflict between the idea of the selfish gene that we we act in selfish ways in order to to evolve and the idea of the selfless gene and that in fact it is altruism, compassion, pro-sociality that allows us to evolve. Uh and and colleagues who are very much on the the latter part of that would be colleagues uh the colleagues Lynn, Professor um Eleanor Arstrom and David Slan Wilson. uh uh of course uh Lynn Ostram is is is has passed away she's
• 24:00 - 24:30 late but her work has was phenomenal uh in in describing pro-sociality through core design principles and David Stone Wilson who went on to found pro-social world of which I have um the the great opportunity to be a board member of um together they they they they developed this concept of pro-sociality as an evolutionary driver. So pro-sociality being as important as gene variation for example and survival uh uh from a physical trait perspective from a social
• 24:30 - 25:00 perspective pro-sociality is as important especially for group survival um what's important in the discussions is the idea of multi-level selection or group evolution and I want to use a very a very short example of this so you know pro-sociality is important at the individual level but also at the group level so you know there was some experiments at Purdue university uh where uh an academic William actually looked at um chickens and so a bit of a strange example to use I know but just bear with me. So there were different
• 25:00 - 25:30 chickens in different cages, different groups of chickens. So he had different natural groups uh and uh what what Mia wanted to do was was produce as many eggs as possible in a shorter period of time. So he thought, "Okay, fine. Let's find all the the hens in each cage that produce the most amount of eggs and let's put all of them together in a super producing cage that will produce the most amount of eggs." Right? In theory, it sounds about right. In practice, had an absolutely disastrous
• 25:30 - 26:00 effect. In fact, it was there was the opposite effect. Um the the chickens began to attack each other. And what what what they quickly found out is that the reason why those chickens produce so many eggs is that they were essentially acting in antisocial behavior, antisocial ways in the cages. They would bully the other hens and they would would take all the resources so they could produce uh the most eggs. So they they were really antisocial. So by putting all these super producing hens together, they began to attack each other. In fact, it was pretty gruesome. In some instances, they even killed each other. It was like scenes from the Hunger Games, right? So So that that was
• 26:00 - 26:30 very disconcerting. What they found is that if they went to groups that produced the most uh eggs and those groups had a balance almost like a pro-social balance within their within the their the small populations those were the ones actually that needed to be um focused on and that's that's ultimately how they they kind of ended the experiment. Uh and so what this multi-uh level selection tells us is that even if what I do as an individual um may may not be for my own benefit
• 26:30 - 27:00 often times if that's pro-social it'll have a benefit for the group and so the group becomes uh has an evolutionary advantage uh and so uh so again you know if I act in a selfish way uh in a competition I may win the competition but the group I'm part of will suffer but if as a group we act in pro-social way in empathetic ways and interconnectedness uh then in fact that group would usually win at the end of the day certainly the evolutionary ace. So just to just to unpack this a bit before we come back to
• 27:00 - 27:30 our example, I'd like to speak about Lynn Arstrom's core design principles. Again, Alan Arstrom, the late um Alan Arstrom uh did phenomenal work in this area and she won the Nobel Prize in fact for her work work around core design principles. And so I'd like to expand on this a bit because it does link back to what we'll be um sort of focusing on towards the end of this discussion. And as I as I speak about these core design principles, I'd ask colleagues to bear in mind two things. One, that altruism is is really embedded in these
• 27:30 - 28:00 principles. Uh and two, that in the case of Mr. JS, our case study, um you know, h if we were to to use these principles to connect him to groups that could reconstruct social relationships that would allow him to be included, how would we how could we do that? Could there be value there? So, so what I'd like to do here then coming back to these core design principles is to speak about Astram's core design principles and then show you how Ubuntu links to it as a way of actually meshing these two ideas together and I'm going to go
• 28:00 - 28:30 through this relatively quickly during the question and answer time. We can of course unpack this. So the the the first point around uh in fact maybe let me let me go back. Um so these core design principles were developed out of economic theory. Um and it's important to understand before we go into them the idea of the tragedy of the commons. Okay. So for those who maybe are unfamiliar with this concept of the tragedy of the commons, it kind of goes like this and this is a very rough example. But imagine we get in a time machine. We go back to the Paleolithic
• 28:30 - 29:00 era, right? So we go back tens of thousands of years. We are in an agrarian society and we're sitting on a hill overlooking a field. So the field that we see is a common pool resource like forests or oceans. These are common resources that everyone has access to. So we we we sit on the hill, we look at this field and we see 10 dwellings around the field and each dwelling represents a household and each household has a farmer and each farmer has one cow and those cows are grazing. Those 10 cows are grazing this common
• 29:00 - 29:30 pool resource of this field and it goes well. The milk is produced. feeds the households used for binging until one day one farmer says, "Well, it'll be great if I have two cows because then I can get twice the amount of milk for my household and bart for more arrowheads and grain, etc." So, he he gets another cow and now every every other farmer says, "Well, I also want another cow." And so, now you've got 20 cows grazing the field. The field is a bit more deped uh uh but um it it can it can it can withstand that. Um, and then the fateful
• 29:30 - 30:00 day comes when another farmer says, "No, I think I should have three cows." And so that farmer brings in three cows. Everybody else adds another cow. Now we've got 30 cows. And the entire ecosystem of the field of the ecosystem of the field is is totally collapses. Uh, it becomes desiccated. Nobody has any milk anymore. And that is a tragedy of the commons. Now, Eleanor Arm countered that to say, well, yeah, okay. So, so people have used that argument to say, well, we either need top- down governmental control or we need the
• 30:00 - 30:30 so-called invisible hand of the market, but we need some kind of control because human beings will consume until there's nothing left. They are essentially agents of consumption. And Alan Arstrom said, "No, they are not. People understand common pool resource fragility and have for thousands of years, but it's those groups that can manage those resources in a pro-social way that survive that have survived the evolutionary race. and therefore it's part of who we are as as as as sort of human communities. And so the principles for those groups are outlined here very
• 30:30 - 31:00 briefly. Um the first is the core design principle of groups having shared identity and purpose. So pro-social groups that can manage these resources will share identity and purpose. There'll be an equal distribution of contribution and benefits of people who work and have equal reward for that work. And there'll be inclusive decision-making. And of course this links to Abuntu in many ways. Um the the identity dimension of Ubuntu uh links to the core design principle one. The emphasis on shared duty and benefit the action dimension links to core design
• 31:00 - 31:30 principle two. The the decision- making the consensus building of Abuntu links to core design principle 3. The next set of design principles are around what happens when people violate rules. So there's there's monitored and agreed upon behavior within these groups. Uh there's a graduated response when that when those principles are violated. So it's not just immediate punitive but a graduated response. It becomes more and more severe and this fair conflict resolution again geared towards
• 31:30 - 32:00 restoration. Abuntu links to principle four and the natural self-regulation that comes from that shared identity identity dimension. Um principle five the shared value system of course is a reference of how to respond in those graded ways to violations. And then restorative justice uh is very critical in conflict resolution. Uh and then very quickly uh core design principle 7 says groups must have some level of self-determination and should be able to collaborate with other groups in positive ways. This again links to the self-determination that that is vital to
• 32:00 - 32:30 Abuntu and the importance of the identity formation uh around uh um uh Ubuntu that then allows a systemwide change. So a group with Ubuntu can can help other groups see Ubuntu and so it can spread across an entire system. In fact, that last point I think prevents presents great value uh from a from a public health perspective and a social health perspective uh when we look at how Ubuntu and pro-sociality can spread across whole systems uh quite quickly. So this was just a very quick attempt to
• 32:30 - 33:00 show you that there are many points of intersection between pro-sociality and Ubuntu. So coming back to how does this all apply to lifestyle medicine. So I I I'd like to argue that we can we can distill a lot of the concepts we've spoken about a and we could we could we could enhance the social prescribing element of lifestyle medicine practice um again through a reference to Ubuntu and pro-sociality and I'd like to I'd like to propose
• 33:00 - 33:30 three three uh components of that. The first is a desire to see restoration in relationships. So where there are broken relationships around the patient to look where those can be um recovered where there can be reconciliation and again where that's where it's healthy and possible only right so where it's not healthy or possible helping the patient to come to appropriate closure uh is important. So the the the the impulse for restoration reconciliation where that's not possible closure would form
• 33:30 - 34:00 the first part uh of how these concepts could enhance social prescribing. The second is around inclusion. So help navigating guiding patients toward inclusive groups that display elements of pro-sociality where there's shared common values and where stable relationships, positive relationships of high quality and of great meaning can be established in a way of constructing a relationship support network around the patient would be the second component. And the third would be haven't discussed this but volunteerism. The aim here is
• 34:00 - 34:30 to provide opportunities uh for altruistic contributions that add demonstrable benefit. So it's not just any volunteer group but linking patients to groups where because of their past skills or their interests that can be of of of real benefit that's quite meaningful. It's authentic value uh that aligns with their sense of purpose and that can foster longerterm connections. And of course, volunteerism itself has been associated with a range of health benefits and as has been shown in fact through meta analytical studies uh to lower the risk of mortality. Um and so
• 34:30 - 35:00 so that that's a very important third component. And so how that then how that then fits into these frameworks restoration largely falls within the ibuntu domain. Uh inclusion kind of straddles both of these domains and pro-sociality that that that desire to act in the interest of others. um really captures the volunteerism domain. Of course, there's volunteerism in Abuntu and restoration and pro- sociality, but if we were to put these uh in in in its more immediate boxes,
• 35:00 - 35:30 this is probably how um with this VIN diagram, how how it would pan out. Um and so very practically then, how does this link to to to lifestyle medicine? Well, Martino at AL had a very interesting approach to social prescribing. They used the fit model that's oftentimes used in physical activity prescribing and they adapted it to the social prescribing model. So for frequency they asked you know they would see a patient and say or or or um propose that when we see patients we say what are the quantity of social
• 35:30 - 36:00 connections that that patient has and then map out what is the intensity of those those connections. Are they of high quality? Uh how much time is spent on those different connections and what are the types of connections? Can we classify them? Are they family gatherings? meeting friends, different types of of um of social connections. So what I'd like to propose in this in this webinar um is perhaps a novel addition uh and that is the uh the riv or riv modifier. So R stands for restoration, I
• 36:00 - 36:30 for inclusion and those link to the intensity quality of connection element of the fit model and then volunteerism of course links the type uh element of the fit model. And so when we do kind of fit uh uh uh social prescribing, can we add the RIV modifiers? Uh that's the that's the um the offering I'd like to to share with colleagues. So we come back to uh Mr. JS. Uh if you look at at at at at sort of firstly in terms of um is lifestyle medicine of course dietary
• 36:30 - 37:00 modification is important. Reducing alcohol uh uh shifting diet reducing processed food physical activity uh ratcheting up to ultimately you know a fairly substantive amount of minutes per week and adding resistance training. smoking sessation, combined smoking sessation therapy with medicines and and groups and individual behaval support, stress resilience, mindfulness, uh perhaps referring for cognitive behaval therapy and considering an SSRI, improving slight sleep hygiene, and of course looking at um then shifting away
• 37:00 - 37:30 from li pure lifestyle med medication optimization, perhaps adding an SGLT2 inhibitor because that can help with reducing cardiovascular risk. uh reassessing anti-hypertension uh control uh once lifestyle if lifestyle changes fail. So that's kind of all the components except for the social bit. So so on the social bit um you know looking at a fit mapping for the individual and then adding rifts so for Mr. JS can we look at restoration? Can we explore reconciliation with his brother through
• 37:30 - 38:00 family mediation? Is it feasible? We know that there's a huge source of distress and in that if that relationship can be restored, it can enhance that that that pivotal family unit um uh that is so important to Mr. JS uh JS's health. Um if not, of course, then we can move towards closure inclusion. Can we guide Mr. JS to groups that he would have or experience meaningful connections with? uh again groups that displays pro-social characteristics where there would be inclusion where there'd be common shared
• 38:00 - 38:30 values and where we could construct around Mr. JS a a a a a sort of support of healthy social uh connections and relationships and then volunteerism in terms of meaning um uh can we engage can we help Mr. JS find volunteer organizations, nonprofits perhaps that link to his interests and his and his in life and his and his past skills where he can make meaningful contributions and where he could build uh connections perhaps in a mentoring role with a with a youth organization
• 38:30 - 39:00 helping youth in marginalized communities. And so if you put all that together and add that to our arsenal, I would argue would enhance it. Um and of course we do monitoring and follow-up monitoring in terms of biomarkry monthly repeat on a monthly basis of mental health inventories and of course importantly track uh he his weight loss especially waist to hip ratio and so there then we have a holistic approach uh that's been enhanced by social prescribing. One point in terms of practice here is that we may want to add
• 39:00 - 39:30 um uh in our preparation or in our uh practice uh management an element of mapping. So we may want to map out uh what relevant mediation or family therapy services exist within our patient population area and practice area and also identify social groups and volunteer groups perhaps separately. Um that could appeal to a range of patients because some patients may prefer a particular type or may be more
• 39:30 - 40:00 predisposed for healthy relationship building in a particular type of social group and in a particular type of volunteer group. uh but the key thing is that they need to display levels of pro-sociality which which we've described in depth and so mapping out in our practice area where these services and groups exist may be good to do as a proactive step. So when we see patients there's a range of options we have in terms of referral. So concluding thoughts social disconnection represents a major public health challenge and we've seen that and we've experienced
• 40:00 - 40:30 probably many of that subjectively u in our practices. Uh so drawing on and combining the frameworks of Ubuntu and pro-sociality can provide practical tools for improving social connection. Um from a practice perspective modifying the social fit model with the Riv uh with the with the Riv components. So having a modifi Riv modified fit model social fit model may be a value to lifestyle medicine practice. And then also from a practical perspective mapping out uh doing preliminary mapping
• 40:30 - 41:00 out of services and groups may be of value. Um and then as a possible future development um can we have lifestyle medicine infused public health interventions that combine the core design principles of pro-sociality with the ideological drivers of abuntu connectedness and wisdom and action uh to enhance the health and well-being of whole groups uh and and whole uh uh sort of social groups and social systems institutions and again uh perhaps even broader than that uh entire uh
• 41:00 - 41:30 communities. uh and so this may be an interesting future area of public health uh uh um in uh in in sort of inquiry that's infused again by lifestyle medicine and on that these are my references I'd like to thank Mavela for her great assistance in reviewing the presentation and of course welcome questions thank you Nasha thank you so much Hanik that was really lovely
• 41:30 - 42:00 presentation Um, I'm just going to look now to see if anybody has any questions. So, if you have a question, um, could you just raise your hand in the
• 42:00 - 42:30 Okay, we have a comment from Odet um boss saying very interesting thoughts and case study. Thank you. Um, okay. I'm not seeing many questions now, but Hinrich, I think I'll ask a question. So, how do you think that um
• 42:30 - 43:00 we as um clinicians or practitioners, how can we sort of begin to um bring pro-sociality and Ubuntu into our um consultations? And then um like in terms of time management, how much time should you be dedicating to sort of getting into these kinds of issues and our consultations? Great. Thank you for that question. Um Nasha I think it's um it's dependent on case by case basis. So, so you know where you have prominent features of
• 43:00 - 43:30 social disconnection um shifting the consultation to allow space for mapping is important and I'd say if anything just do fit social fit mapping so sitting with the individual getting a sense of what are the frequency of those connections the intensity how much time is spent in those connections and what type of connections are there's an imbalance there and actually doing that with the with the patient is a great exercise because it begins to open their understanding planning to um to to to
• 43:30 - 44:00 where the deficits may be you know seeing that on paper is sometimes quite striking so oh my gosh problem is I've been lonely I've really been isolated um so at least doing that but then you know again you know where again on a case by case basis where there's been where there have been fractured relationships suggest gently um that perhaps restoration can be sought and if the patient is open to that referring them to mediation um where there there isn't for example um an immediate involvement in a in a in a positive social group. Um maybe help the patient think to ways in
• 44:00 - 44:30 which that can be formed. So in Mr. JS's case, you know, say perhaps he had I don't know a a background when he was young, he used to play soccer, you know, can he form a soccer group within his workplace, I don't know, or and also at the same time, you know, volunteer and teach young people soccer in in marginalized communities and build meaningful relationships out of that. So you link the patient to those groups in meaningful ways. Um and so th those are practical ways in which you can inculcate I think the model into practice.
• 44:30 - 45:00 Thank you. Um I have a question from Dumi in the chat. Um she says very interesting talk. What are your thoughts on pro- sociality and the current health system South Africa? So specifically do you think it's possible to address in a resource limited setting in government regarding time and funding? Yeah to me those are excellent questions. Um I think you know pro-sociality has huge uh potential uh for our context and our health system. Um you know if you look
• 45:00 - 45:30 though at the principles of pro-sociality you know a lot a lot of that again linking to Abuntu is this idea of kind of consensus building and so you know where health system um reaches communities. Is there is there is there enough of a depth of consensus building around the nature of the health services that are being provided or you know does government say well you know we feel this needs to be provided and we've had consultation but this wasn't really of any depth and so then those
• 45:30 - 46:00 health services aren't really owned by community but part of bringing pro-sociality to a health system is not just around consensus building and shared agreements it's also about um you know bringing us back to Ubuntu the idea that we you know we are interconnected and the health of one part of our community affects the entire community. One one community in fact affects the entire South Africa and so how do we how do we bring altruism and and remind people of the power of altruism is important. Uh and the other though is a sensitization around how important
• 46:00 - 46:30 social connection is. Many people live very lonely lives. um if you especially around our urban areas with urbanization we've seen an increase in that and people simply don't are probably often unaware of the impact of the social isolation on their health and so part of bringing this into a health system would be um a a health promotion campaign um maybe maybe taking notes from the the global commission who on social connection and actually having an awareness raising exercise around the importance of social con healthy
• 46:30 - 47:00 pro-social or buntu-shaped social connection in terms of time of course it's very difficult um and certain you know certain areas in in terms of practice would be more um amendable to the introduction of this model so psychiatry psychology probably a lot more opportunity um you know milder patients in psychiatry and in psychotherapy introducing the the social or the river social model um but I would argue even in general practice and whether that be you know in in kind of general medicine
• 47:00 - 47:30 or general sort of family medicine to to just again on a case-by case basis where it's clear that social isolation is important to just spend a bit more time on that component. Um and it can have real practical value. You know, identifying a social disconnection can have real value in terms of reducing non-compliance or non-adherence because if you can help the person identify social uh networks around them that can assist them in terms of getting transport to and from a healthcare institution for example uh or or helping
• 47:30 - 48:00 you know or working with a group that has a shared sort of condition uh to to improve compliance for that individual patient. So there's very very very practical compliance related issues to introducing this into the consultation even in a busy busy government healthcare setting. Thank you so much um for that answer. Hinrich um I have another comment. Um it just says from Janette, thank you for sharing your work and your passion. Um I don't see any more questions but I think I'll just um end off with one question
• 48:00 - 48:30 from my side. So just in terms of um fractured relationships, what's what are some of the features of fractured relationships that would sort of make you tend towards closure versus reconciliation? So just um how can we identify those? That's a very very very important uh question. I mean of course there are hard factors. So history of abuse um you know uh whether that be physical, emotional, whatever the how it expresses itself would be an
• 48:30 - 49:00 immediate um sort of sort of red uh in terms of you know hazard and so that would be one and in fact there you may want to involve social work and and other and other um disciplines. That's very important. Um but then there kind of more nuanced levels of emotional toxicity and so and so actually just you know the patient has wisdom engaging with the patient. You know if the patient says you know I've tried it to build a relationship with this particular person who was previously close to me it's only harmed me um and I
• 49:00 - 49:30 I've tried multiple times for reconciliation hasn't worked. Then again it falls on the amber to redside. But if it's, you know, you know, I I used to have a healthy relationship with this person. Uh, we've had a particular event that's broken this apart. Um, or there's been a drifting apart and I feel that need to to pull that pull that person back into my social network. But I don't know how to approach this. Um, and even where there has been fairly strong contestation, provided it isn't on the again the abusive side, there may be opportunity for mediation. um you know
• 49:30 - 50:00 helping remind the patient in those health previously healthy relationships of the value of that relationship may then um encourage them towards having some form of reconciliation. That's very good. I love how you said um if a previously healthy relationship existed then yeah that's really interesting. Thank you so much for that. Um I have another um question from Odette and then Odette says can tele medicine be forcing a
• 50:00 - 50:30 disconnect between patients and doctors. For me social connection with our patients drives trust and promotion to change other unhealthy lifestyle behaviors. Yeah that's really a great question. Thank you for that. So you know I I I don't I haven't done enough research um in terms of um the impact on of tele medicine on disconnection. Of course we know that the virtual um environment or the virtual connections that have been built around um around um uh the covid period
• 50:30 - 51:00 and that stays with us have certain limitations. I mean I think that's been well documented. It does contribute to social isolation. It cannot replicate the experience of being in the presence of others. And from a work productivity perspective all the way to an emotional health perspective, of course, it has ramifications. And so perhaps I'd offer that tele medicine may has some of the similar types of of limitations. Its convenience of course is a huge factor and its ability to reach people um quite
• 51:00 - 51:30 easily across great distances is is is there's like a cost benefit uh that has to be balanced there. But I would argue you know if you if you're trying to do especially social prescribing um that there would be limitations perhaps in teley medicine um you know it's it's you know there is this remoteness there's a disconnect and when you speak about social connection and social mapping there's kind of an emotive element to it that requires emotional intelligence and that often times is expressed in many non-verbal ways that may be lost in in in a virtual
• 51:30 - 52:00 consult. And so again, you if there's patients that have huge levels of social isolation, um that where possible in addition to teley medicine or as a as a as a compliment to teley medicine to have some in-person consultation scheduled, I would think from at at a service level would be would be um advised. Thank you. Thank you for that. Um we have another question in the chat. Um John says, "Ubuntu is one of our constitutional
• 52:00 - 52:30 values. What about pro-sociality? Very interesting presentation. Thank you. Thank you for that. Yeah. So, so of course Abuntu is again woven into what we understand um uh and and it's intuitive to us uh across many different communities in South Africa. Pro-sociality seems like a newer concept but again from Lyn Arm's work we can see it's actually woven into the history of humanity over thousands of years. So like Ubuntu it's something that we actually intuitively understand. We pro-sociality at a most basic level I
• 52:30 - 53:00 think drives us in the health profession. Right? I mean we came into health generally because we wanted to help others and we wanted to do it and often have to do it in selfless ways. Right? So so people on this call whether or not they're in health but people the fact that they're here today means that you you have a very fundamental orientation towards pro-sociality. That's how intuitive it is. Um and so perhaps making that more broadly understood would be part of that campaign I spoke about earlier. You know this is what pro-sociality is. This is why pro- sociality is so important for
• 53:00 - 53:30 us as a country beyond health. If you look at this great schism schisms that exist in our country across economic and sort of racial barriers that's that that we need to overcome. Um you know can pro- sociality be of value there. I would say yes. Uh and so I think that it's time for a healthy discussion debate around how pro-ociality can become part of our social fabric in South Africa. Thank you. Thank you so much. Um well I think that was the last question Henrik. Um once again thank you so much for that
• 53:30 - 54:00 presentation. It was absolutely incredible. Um and I think all of us on this call really enjoyed um learning about your research and how we can incorporate um Ubuntu and sociality in our consultations um and even with ourselves because we always send out summits and you know we're the first patients. So that's really very helpful. Um so if there no further questions I think we can end it here tonight. So, thank you everybody for joining us and have a lovely evening. Bye everyone.
• 54:00 - 54:30 Bye.