As we settle into the 21st century, we are learning that many of the systems and institutions on which we’ve depended are in flux and crisis. In the United States, we are at or near the bottom of a variety of important national well-being indicators—including relative poverty, education, and social mobility—while the burdens of chronic disease and climate change spiral out of control.
It is in this context that this timely collection of articles about communities creating health arrives. At one level, the lessons various contributors have shared are deeply intuitive; they remind us that we humans are complex, deeply social beings with a shared need for love, belonging, respect, and connection. At another level, they force us to take a hard look and ask ourselves: How—despite many modern societies’ well-intended quest to support health and be caring—have we gone so far astray?
One misstep occurred when we traveled down the narrow path of measuring health only in terms of disease. As a linear approach, the bio-medical model has created an emphasis on mechanistic interventions, such as pharmaceuticals and medical devices. Clearly, these play an important role, yet over-reliance on these technologies has come at the expense of the “whole person” and their context—their communities and the planet.
We have sacrificed the whole for the parts.
We have become increasingly aware that the bio-medical model does not fully reflect the complexity of human experience—a particularly discomforting realization for the health care sector (which commands an increasingly crippling proportion of many countries’ GDP), because it suggests the need for fundamental change in the narrative of where and how we derive health.
We need a new narrative that shifts the focus of health from disease control and treatment, to the individual as a whole. With this shift will come the understanding that health is intimately local. Community assets such as parks, clean water, healthy food access, livable jobs, quality education, and affordable housing will become central pillars of a new health system. And given that these assets are the responsibility of many institutions—government, community, business, and education—these shared resources will become a shared community responsibility. Thus, this new narrative is also an uncomfortable wake-up call to society; it necessitates greater shared responsibility for health and means that we can no longer outsource “health” to health care.
Shifting to this new narrative necessarily requires that we emphasize and attend to relationships and individuals as systems, within systems. As physicist Fritjof Capra suggests, there is a unique quality to the connections between objects that deserves elevated attention beyond what we give to each object individually. By paying more attention to relationships, we build a new operating system—one characterized by networks and approaches such as collaboration, empathy, narrative, teamwork, empowerment, and connection, rather than linearity, hierarchies, and control. It is no surprise, then, that the articles in this series highlight these vital attributes and the importance of a new social architecture of health creation.
All of this points to the intimate connection between the strength of our local democracies and the health of our communities. The late Nobel Prize-winning economist Elinor Ostrom showed how ordinary people can develop principles to successfully manage their “commons”—shared resources such as water rights and fisheries that are central to the health of populations. At its core, management of the commons offers a guide to how we could develop community-driven health systems, with a fair set of rules, a means for equal say, and the right to well-being.
This series is an important clarion call to chart a new path—one that we ignore at our peril. Together, the articles demand a shift in our approach to health that reflects the needs and voices of people and their communities.
Thankfully, there are efforts that we can build on and that offer powerful glimmers of hope. CureTogether and Community Commons are exciting examples of health care-oriented social platforms. Tools and practices such as Art of Hosting are helping harness community wisdom through the application of complexity science, which allows for the natural emergence of solutions and strategies in complex adaptive systems—citizens and communities. The ecological, whole-person approach of “integrative medicine” is becoming an established part of the US healthcare system, and the Academy of Integrative Health & Medicine (AIHM) launched just last year. A recent report by the Institute of Medicine found that we will need systemic approaches to meet US food system challenges in the 21st century; Fresno, Calif., already offers a viable example of a food commons—a fully integrated, community-owned food system. In communities such as Cleveland and Springfield, Ill., hospitals and universities have worked to support the worker-owned collaborative business model. States and cities across the United States are adopting strategies, such as ranked-choice voting (RCV), to revitalize democracy. RCV allows voters to rank candidates in order of preference. This permits like-minded voters to elect candidates in proportion to their share of the vote in multi-member constituencies (avoiding split votes) and allows voters in a minority to win a fair share of representation. These are some of the many powerful threads of a new health narrative.
We have a limited window to act. Let us hope that we can build on these emerging examples to co-create the health-creating systems of the future.