Positive Health Online

My health, your health and the health of all of us is more important than to leave it in the hands of medical experts alone.  People know that.  More and more often they come together in patient self-help groups, search information related to their symptoms on the Internet, or benefit from the services of community health champions.[1]

Both technological and person-to-person community solutions play an important role in building a sustainable people powered health system. Sustainable health solutions will only work if those who depend on them also produce them and take ownership of decisions and accountability structures. Not that the specialized medical knowledge of experts is not valuable; the problem is that they tend to use it focused on the parts, treating symptoms in isolation from each other and the functioning of the whole body, and treating illnesses with no relation to people’s life and work conditions that may have triggered them.

Experts themselves generally also work within hierarchical organizations within their own ‘silos’ rather than in an integrated way that takes account of the whole person within their context.

We need a better way for users and producers of healthcare, one that honours the whole person and the fact that healing is social. I imagine a Commons of health to be exactly that. It is supported by the following observations:

1. Personal health is a Commons

No matter how much we are able to learn about health, we can’t possibly know everything that there is to know, which could directly affect our wellbeing. For example, what do you do when you feel discomfort or pain? Many of us don't just visit a health practitioner relying on their knowledge and expertise, but first of all search online and offline for knowledge that may help our own understanding.  Also we talk to family, friends and colleagues to help us figure out what may be happening when we feel unwell and what could be done about it.  With access to the internet, more and more people do the same thing. They get information about problems from the internet before visiting a health practitioner and also join forums to exchange information and build relationships with others with similar or complementary needs.

With access to so much knowledge on the web it also makes us realize that the more we are able to learn about our human and social body, the more we learn how little we actually know. In our fast-moving world, to keep healthy and in balance is an art that requires complementary and collaborative practices. Realizing this makes it also obvious to me that my health is not simply a personal affair, but in fact it is a commons that has a better chance to thrive, the more openly and effectively we collaborate and share knowledge about issues of health and wellbeing.

2. Stewarding our Health, as a Common Response-Ability

My body and my health are not something that I can own like private property.  Not only do I benefit from the collaboration and sharing of knowledge around keeping well and in balance, but also, my existence is always connected with other human beings, starting with family, friends, other significant relationships, and colleagues.

Keeping well and healthy is a response-ability I have towards those I love and am in connection with. Realizing that we are all connected and not isolated atoms happens both on the cognitive and the heart level. Although such recognition may start on either level, it only becomes truly transformative when embodied in our attitude to each other and to the world around us.

Our understanding deepens when love and caring are a deeply felt reality that drives our thinking and doing. That awareness of connectedness emerges from an inner attitude that can’t be taught like math or other subjects. However it can be learned through conscious intention nurtured and strengthened by reflective practice.

How will a world be, if it is woven from webs of mutually caring relationships? How can we enable such a pre-sensed reality of the future to come forth? What is the role of the Commons of health in helping it happen? We need transformation towards a compassionate world on a large scale, starting with communities where personal relationships matter and build trust.

3. Building Communities and Relationships of Trust

It might be difficult to imagine, in humankind’s current predicament, that we can build systems and institutions that help us to realize our potential - who we really are as authentic individuals, communities, organizations and the one humanity in the one Life. Yet more and more of us think that a world is possible where the wellbeing and development of each part is the aim of the whole (and vice versa).

When images of a beautiful and possible future appear simultaneously in the imagination of a growing number of people and when those images become part of the emergent culture that is when they become a real force for change.

The possibility for such a powerful convergence of healing intentions is exactly what I sensed during the recent health commons seminar which made it a very special experience for me.[2]

Thirty of us from varied organizations and with varied skills gathered in a circle for a day of discovery and learning with James Quilligan who introduced us to the Commons Framework for Healthcare.[3]

We learned with each other, from each other and listened to the space between us to what wanted to emerge while sharing experiences, insights, dreams and aspirations. After a short silence, our host started the check-in by introducing us to the principles of the Art of Listening, of speaking and listening with intention. With this awareness in mind, we shared each in turn why this gathering was special to us, and why we had chosen to participate in this particular event rather than being anywhere else.

We shared responsibility for the quality of our experience and were mindful of serving the whole rather than bringing our personal agendas. The day was rich with shared insights, new experiences and new learning especially regarding the emerging commons in healthcare. We listened to a number of presentations with the intention of drawing out the new, healthier principles and practices for a Commons Roadmap to Sustainable Healthcare which will parallel the existing NHS Sustainable Development Unit Routemap.[4]

The world-cafe style conversations in the afternoon gave us opportunity to explore commons principles and how we relate to them. Small groups allowed everyone to contribute and our table hosts became the connectors between different rounds of conversations.

I found it interesting how, when talking about commons principles in healthcare, the whole discourse during the event shifted from cure and disease to behaviour and well-being?

On an issues list for a shared community agenda the theme of ‘Building community and connection’ [3] ranked the highest.  Given that all of our lives and our work are connected to people and communities and everything arises out of that, it seems natural that this theme should have attracted most interest.  It is an acknowledgement of the vital importance of community and relationships in the creation of health. Answers to these questions will need to inform our Commons roadmap:

1. How do we heal a fractured world?
2. What are the resources we want to create and how are we going to take care of them in a sustainable and fair way?

The second theme: How do we organise to increase a commoning approach to health and wellbeing? shows the desire to find a common-ing language that engages people and organisations where they are at in order to develop a shared vision, a joint approach and wide enough support.

The theme which attracted most energy so far since the event is  How to scale prevention and self-care. It is here where we as practitioners and organizers are already making a noticeable difference and could do a lot more if we worked together in a more intentional and strategic way. It is precisely this area that is missing in our present healthcare system and if integrated could make the biggest difference in reducing suffering as well as cost in the long term. The questions this group is exploring show that we need nothing less than a shift towards holistic thinking and doing informed by an understanding of how all life on this planet is connected;  that each and everyone of us is part of the whole ecosystem of health.

Conversations have continued online on a hosted platform with open access called CommonsRising.  It has been purposely designed for building commons in various areas of our lives. Anyone passionate about health & social care with a curiosity about the commons is warmly invited to join the Commons of Health & Wellbeing group.[5]

One participant commented: “Here I was part of a circle of people who deeply cared about health and the care for health, and nobody had power or control over the other person. I enjoyed seeing “the Art of Hosting” in action, and to be part of this circle. I’m still struggling to get a clear image, what “the Commons of Health” actually is (besides being a Community of people), and what the main elements are of a Commons Routemap. But that’s not important in this moment in time, where I’ve just witnessed the birth of something new. I’m confident that the emergence of the health provisions of the Commons (next to provisions by Market and State) is what we need to realize our Common Good and the Good Life with a sustainable health and care for health. …  It’s not good that citizens needing help, once entering the doors of a hospital becoming patients, thereby giving the power to professionals in providing services needed (instead of co-producing services and co-creating health as two citizens in relationship). We started with a circle of about 30 people. We need to enlarge the circle and include more managers and workers in institutionalized, professional healthcare and continue the dialogue!”

The questions that emerged from our collective enquiry have been posted on the CommonsRising platform online.[3] They have become our most valued resources so far. It is the process of finding answers to them through collaborative enquiry and generative conversations that will help create a lively and creative community of commoners.

James Quilligan nailed it for me when he said: “By becoming a vital part of the commons building process even our motivations, knowledge and skills become part of the whole production process, leading us to a new way of coordinating social and economic life where the community of producers also decides how to manage its own resources and how to govern itself.”

This means that from a commons perspective, truly empowered communities and individuals are those that not only collaborate and co-create resources but also grow capability, capacity and skills to govern themselves and decide collectively about the allocation and use of these resources.

4. Accountability

The key to relationships and sustainable communities is accountability. 

Rather than waiting to be told what to do we ask ourselves: What can others count on us to contribute as our gift to the community? This creates different kind of motivations. Accountability means, what I offer to be accountable for in realizing and manifesting the desired and jointly agreed goals. Accountability should be extremely personal and not forced on anyone.

For example if as a reader you resonate with the ideas and feel inspired ( as we hope), then the natural next step would be to wake up to your response-ability and offer to be accountable for an action of your choice or any action you feel  could bring us all closer to realising our shared dreams and visions. Only bottom-up accountability that is offered as a gift to community can replace top down accountability and thus create a new social order.

Health Commons & Accountability in  James Quilligan’s words: [6]

“Rather than outsourcing responsibility for public service to government or to corporations, which creates top-down service delivery structure, new accountability structures must develop which allow communities to guarantee and manage healthcare for their members. Communities can form their own health trusts that would ensure that resource users are driving the health process, not resource providers or managers.

“By involving resource users in the process of producing their own resources, new forms of value, cooperation and trusteeship will emerge.

“The ‘commons’ highlights this shift to move healthcare into community, towards producers and users of the resources who in the commons are not separated but the same. Creating new political accountability structures through social charters and health trusts would enable communities to obtain quality health care services on their own terms.

“It would lead to improved equity of services, the reduction of institutional barriers of governments, enhancing participation in local government, strengthening civil society associations and creating healthy public policies which lead to improved health.”

We need a new infrastructure based on holistic thinking that helps healthy relationships and sustainable communities to flourish while being able to work with increasing complexity.

In addition to principles and practices that help us to re-design such a health care system, we need organizational approaches that achieve the aims set forth.  The gap can be filled by the Commons framework; by involving communities directly in building sustainable organisational structures that are responsive to peoples needs.

Relationships and networks that sustain communities will be most valued in a commons based society.  Users and producers will not be separated. Commons are based on an understanding that we all belong to the earth and not that the earth belongs to us. As commoners we experience ourselves as stewards of the earth’s resources and treat each other accordingly. There is a recognition that knowledge that is owned and enclosed will die out.

(The open source movement recognizes how knowledge increases, is updated and made useful when shared freely and continually added to and improved.) 

“Assuming that a group of trained experts will keep up the skill set to ensure optimal performance over time has become unrealistic. Too many elements are changing too drastically, too quickly; traditional safeguards for business models based on intellectual property rights are likely to impede evolution of new and better functioning solutions. With our current pace of change, we will need to find ways to spread the work to be done beyond narrow expert groups to the wider skill set within the non expert general community.” (Open source software as a model for health care by Andy Oram and Brigitte Piniewski).

Yochai Benkler, author of ‘Wealth of Networks’ has probably  provided the best known research on the topic.

Resources

1.Community Health Champions, Evidence Summary by Altogether Better.

South J, White J. and Raine, G. Leeds, Centre for Health Promotion Research, Leeds Metropolitan University. 2010.

2. Co-creating a people-powered healthcare. Anna Betz, October 2012.

www.schoolofcommoning.com/content/co-creating-people-powered-healthcare  Retrieved on 8th November 2012

3. Harvest of Co-creating people-powered healthcare. Anna Betz, October 2012.

http://commonsrising.ning.com/group/commons-of-health-and-well-being/page/harvest-of-co-%20creating-a-people-powered-healthcare-23rd-october    Retrieved on 8th November 2012.

4. NHS Sustainable Development Unit Roadmap. © Copyright 2012 - NHS Sustainable Development Unit - All rights reserved.

www.sdu.nhs.uk/publications-resources/55/Route-Map-for-Sustainable-Health--slides-graphs-and-pictures/  Retrieved on 8th November 2012.

5. CommonsRising online platform, Commons  of Health & Wellbeing group. Hosted up by the School of Commoning.

http://commonsrising.ning.com/group/commons-of-health-and-well-being  Retrieved on 8th November 2012.

6. Health Commons: A New Paradigm. James Quilligan, October 2012.

www.schoolofcommoning.com/content/health-commons-new-paradigm#overlay-context=content/past-events  Retrieved 8th November 2012.

7. Open Source Software as a model for Healthcare. Andy Oram, 11th October 2012.

http://strata.oreilly.com/2012/10/open-source-software-as-a-model-for-health-care.html  Retrieved 8th November 2012.

Other Useful Resources:

The Fannie E. Rippel Foundation, 14 Maple Avenue, Suite 200, Morristown, NJ 07960.

info@rippelfoundation.org

http://rippelfoundation.org/rethink-health/action/

http://rippelfoundation.org/rethink-health/stewardship/

Retrieved on 8th November 2012.

Kosmos Journal, free online journal, with regular articles about latest Commons thinking by James Quilligan.

www.kosmosjournal.org/articles/toward-a-common-theory-of-value-part-three-common-knowing   Retrieved on 8th November 2012.