service

Mutual Help Medical Websites

Pattern ID: 
778
Pattern number within this pattern set: 
54
Andy Dearden
Sheffield Hallam University
Patricia Radin
Formerly, California State University-Hayward
Version: 
2
Problem: 

People suffering from chronic medical conditions need both information about their condition and the support of others who share their problems. How can such groups of people use the Internet to address their needs, and how can they design and operate a website for the best possible outcome?

Context: 

The Internet allows us to become content providers as well as users. A medically based Web community can become a powerful source of collective intelligence about a particular medical condition, with thousands of people sharing research results, articles, and personal observations with each other, thus breaking down the monopoly that doctors once held on medical information. Such a community also can be a source of comfort, wisdom, new friendships and material assistance. However, the nature of the medium also allows for casual, even abusive use of the information space.

Discussion: 

Breast Cancer Action Nova Scotia's (BCANS http://www.bca.ns.ca) interactive site is the world's largest and oldest breast cancer discussion site, indeed one of the oldest medical mutual-help sites in existence, dating from 1996 when it was started by a volunteer. The site began a period of fast growth in 1998 and in 2002 was reported to have about 400 closely involved "regulars", a wider circle of people who drop in now and then, and an unknown number of lurkers, some of them long-term. Not only women but a few men with breast cancer post to this group, as well as husbands, sisters, brothers, mothers, fathers, and friends. Although the majority of users are American, with about one-fourth Canadian, the site also hosts visitors from all the other continents, notably a large and active contingent from Australia and New Zealand, numerous Europeans, and participants from Turkey, South Africa, India, Hong Kong, and elsewhere.

Participants in the website can give and receive:
• reassurance and caring;
• informal advice to cope with the myriad sub-acute problems that arise;
• encouragement to stick with medical treatment regimens;
• professional medical information, such as details of new clinical trials;
• support for questioning conventional medical wisdom;
• material goods such as cards, gifts, and funds.

The site also includes tributes to those who have died; a collection of links to specific breast cancer topics; and a glossary of more than 400 breast cancer-related terms.

Since its launch with a single discussion forum, an interactive calendar for local (Halifax, Nova Scotia) activities, and a mission statement, BCANS has grown into a community that has written books, given conference presentations, appeared on TV and radio, launched a fundraising arm, and formed numerous in-person friendships.

To account for the success of BCANS, Patricia Radin turned to social capital theory, which analyzes the elements of beneficial social networks. According to the literature, trust is at the heart of a "virtuous circle" of activity wherein people voluntarily help each other, receive benefits in return, and again reach out to provide assistance. Although social capital theory was developed by looking at networks of people working face-to-face in bounded situations, it appears applicable to any context where mutual assistance is being rendered, such as an online medical mutual-help group.

Some specific features of site design and operations help to move visitors progressively toward a state of greater trust and reciprocity.

• An alert webmistress fiercely protects the community from hurtful messages, spam, and exploitation, thus promoting a high level of trust and goodwill.
• As well as the main forum discussing breast cancer issues, there are now additional sub-forums: e.g. one to accommodate groups planning get-togethers and one to allow for the swapping of recipes, jokes, and so on.
• A "prayer chain" section is available for users to post spiritual messages.
• Chat rooms are open 24 hours a day, but particular times are specified when a ‘host’ will be available to welcome newcomers to the chat room.
• There are two ways for participants to post permanent self-introductions (including photos): by filing a profile, which is then automatically linked with each message; and by posting an autobiography in a password-protected section accessible only to others who have filed a "biog." Many personal friendships have been formed and some community members visit the discussions as often as three times a day.

These features allow new visitors to size up the costs/benefits of participation in a risk-free environment; it allows longer-term users to stage their level of self-disclosure; choose from many ways to contribute and receive from the group; and to take part in shared experiences, both virtual and face-to-face; and it gives the more established community members chances to develop personal relationships and initiate projects of mutual benefit.

This pattern is in memory of Patricia Radin who is the original author.

Solution: 

Seek to build trust in stages:

1. Attract and reassure new visitors by giving visual messages explaining why the website was built and who for. Avoid advertising and show sponsorship from individuals clearly. Provide messages from others who share the condition.

2. Allow users to choose when and how to give out personal information. Separate publicly available profiles, from password protected areas where more personal information might be shared. Chat rooms can allow a more ephemeral form of "conversation". Sites should also permit people to send personal responses to posted comments, instead of posting to the whole forum.

3. Be alert to the potential problems of lurkers or abusive material. Active editors are needed to edit out abusive material, to act as hosts in chat rooms, and to maintain the site as a safe space.

4. Seek to build "thick trust," by supporting joint activities - doing things together, this gives people the opportunity to size up each other in a variety of situations.

Verbiage for pattern card: 

People suffering from chronic medical conditions need information and the support of others who share their problems. A web community can be a powerful source of collective intelligence, of comfort, wisdom, friendships and material assistance. Trust must built in stages through communication, privacy, and planning. Moreover, the organizers and the community itself should work together to build "thick trust" through collaborative activities.

Pattern status: 
Released

Online Deliberation

Pattern ID: 
430
Pattern number within this pattern set: 
52
Matt Powell
The Evergreen State College
Douglas Schuler
Version: 
2
Problem: 

People working together are often plagued by the clash of personalities and shifting rivalries of factions and subgroups. Also, without structure, a discussion can become random and rambling. It can be dominated by powerful individuals or other factors. The emergence of these negative group dynamics can adversely impact the ability of the group to achieve it's shared objectives. Other factors, such as distance to the meeting, inconvenient scheduling, or costs of getting to the meeting can obstruct effective and inclusive participation. Current online systems don't provide the structure that groups of people engaging in deliberative meetings or discussions need to help them efficiently move through a decision making process that is accessible and ensures equal participation by all.

Context: 

Board meetings, committee meetings, administrative panels, review boards, volunteer organizations, non-profit community groups.

Discussion: 

Everyday conversation, though often purposeful, is informal; it doesn't rely on an agenda, defined roles, or precisely delineated rules of interacton. To overcome the unpredictabilty of this type of human interaction, systematic rules have been created to facilitate purposeful group meetings whose objective is to produce collective decisions. One of the earliest set of "parliamentary procedures" was formulated in 1876 by Henry Robert in a treatise entitled "Roberts Rules of Order". "Roberts Rules", as they have come to be known, have been widely adopted as a means to fairly and equitably conduct the business of group meetings and provide a method to ensure that all parties within the group have the opportunity to participate in the decision making process. At the same time Roberts Rules ensure that no minority interest can exert undue influence on the process.

The advent of the Internet has provided an opportunity to combine the democratic principles (such as Roberts Rules of Order), with modern interactive communication technologies, to provide new web-based meeting facilitation systems. Ideally, online deliberations systems would allow people to come together as peers in an "on-line" environment and conduct "official" business meetings without being present in the same physical location. The plethora of online discussion systems, especially when contrasted to the scarcity of deliberative systems suggests the difficulty of this enterprise.

While working in and with a team of students at The Evergreen State College the authors of this pattern were involved in the development of eLiberate a working prototype developed using Linux, MySql, Apache, and PHP. The application provides facilities to create groups and to create and schedule meetings. Then, using written (typed) rather than spoken input, the system facilitates meeting by coordinating user interactions (such as making motions), conducting and tallying votes, and providing an archive facility for official minutes.

Online deliberation substitutes one set of advantages and disadvantages for the set that face-to-face deliberation offers. In general the broad criteria of either approach include access to the process, efficacy of the process (including individual involvement and process as a whole, and the context (including legal requirements, etc.). Of course these criteria overlap to some degree and influence each other.

Although face-to-face deliberation is basically "low-tech," physically getting to meetings may involve costly, "high-tech" travel. Then, once physically present at a face-to-face meeting, effective participation depends on the skills (including, for example, how to use Roberts Rules of Order), intentions and knowledge of the individuals. It also depends (of course!) on the skills, intentions and knowledge of the other participants in the meeting — including the chair.

By making access to a computer (connected to the Internet) a prerequisite to participation online deliberation adds an access hurdle comprised of cost, geography, and computer fluency. Depending on the characteristics of the potential attendees this barrier may be more than offset by the advantages that online deliberations could provide. If, for example, the meeting attendees are drawn from western Europe and the United States, it is likely the case that costs associated with computer communication will be less than transportation costs. As a matter of fact, online deliberation makes the prospect of more-or-less synchronous discussions / deliberations among people around the world possible, although here the tyranny of time zones and humankind's intrinsic circadian rhythms (which encourage us to sleep at night and stay awake in the daylight hours) become a mitigating factor: making decisions while many of the attendees are sleeping is one formula for dysfunctional meetings. The very fact that worldwide meetings become possible however provides an enormously fertile ground for civil society opportunities. (See, for example, the World Citizen Parliament pattern.)

Knowledge of the topics under discussion, knowledge of the process (Roberts Rules of Order, for example) and command of the language(s) being used in the discussion can also be obstacles to effective and equitable face-to-face as well online deliberation. Online environments, however, have the potential of alleviating, at least to some degree, some of the disadvantages that seem to be intrinsic to face-to-face settings. In the eLiberate example mentioned above attendees can select a "language pack" so that the appropriate Roberts Rules process word or phrase (such as "I second the motion") will be presented in the attendee's own language. Note that this is not machine ("on-the-fly") translation. Moreover it has no bearing whatsoever on the content of the meeting — what the participants actually contributed — it determines only which of several equivalent language sets of the Roberts Rules "meta-language" is displayed to each user. The possibility for automatic "machine translation" to be put to work on all attendee input so that attendee only saw input to the meeting in their own language. Of course machine translation is imperfect at best — and may always remain so. Try, for example, transforming some verbiage into another language and back again via a machine translation system on the web. The result generally bears no resemblance to the original. On the other hand, translation by humans is not perfect either; relying as it does on the skills of the human translator. For those reasons it may be well-advised for reasons of transparency and integrity of the process to make both (or all) original and machine-translated language versions available for inspection with the other meeting contributions in the database. (Today as I write this a transcript of an interview with me appeared in a Sao Paulo newspaper: my utterance "couldn't" was transcribed as "could" — an easy mistake that totally inverts the meaning!) So, while free and reliable electronic translation is desirable, high-quality human translation could be inserted into the process as appropriate. This could only be as "simultaneous" and as accurate as the skills and availability of the human translator interposed within the process would allow. The needs discussed above for multiple versions and for long-term storage are appropriate in the case of human translation as well.

The online environment offers other potential advantages. One obvious benefit is that only the actions that are allowable within the deliberation process at that time are displayed to the individual participants. This, in theory, can help reduce problems that are commonplace with meeting attendees who are not thoroughly familiar with the Roberts Rules conventions). Online systems can also provide online "help systems." Within eLiberate, for example, users can view descriptions of how and when specific actions are used. Also, as previously mentioned, a meeting transcript can be automatically created and votes can automatically be tabulated as well.

Solution: 

Development of a network-based application that will provide non-profit, community based organizations with the technology they need to conduct effective deliberative meetings when members can't easily get together in face-to-face meetings. Ideally the tools would increase their effectiveness in addressing their mission while requiring less time and money to conduct deliberative meetings.

Verbiage for pattern card: 

Group discussions are often plagued by personality clashes and rivalries. Also, without structure, discussions can become random and rambling, or dominated by powerful individuals. To overcome these problems, systematic rules have been created to facilitate meetings that encourage fair decisions. Now is the time to develop Online Deliberation systems that support effective deliberative meetings when getting together in-person is difficult or costly. 

Pattern status: 
Released
Preface: 
People working together to conduct business as a group are often plagued by the clash of personalities and shifting rivalries within the group. Also, without structure, a discussion can become random and rambling. And it can be dominated by powerful individuals. Other factors, such as distance to the meeting, inconvenient scheduling, or costs of getting to the meeting can obstruct effective and inclusive participation. To overcome the unpredictability of informal human interaction, systematic rules have been created to facilitate purposeful group meetings and encourage collective decisions. It's time to develop Online Deliberation applications that provide organizations with the technology they need to conduct effective deliberative meetings when members can't easily get together in-person. Ideally the tools would increase their effectiveness while requiring less time and money to conduct the meetings.
Information about introductory graphic: 
Photograph: Fiorella De Cindio
Information about summary graphic: 

e-Liberate online deliberation tool; Public Sphere Project

Truth and Reconciliation Commissions

Pattern ID: 
749
Pattern number within this pattern set: 
51
Helena Meyer-Knapp
The Evergreen State College
Version: 
2
Problem: 

Trauma and destruction are common results of war, religious conflict, gender oppression, and natural disaster. Unfortunately the way that societies deal with these issues can make a bad situation worse. Traditional systems of blame and punishment and even reparations all too often simply create additional harm.

Context: 

In the 21st Century formal judicial systems centered on a national government and the courts are losing ground to new models of adjudication and problem-solving. Some communities are reverting to long-standing traditions for healing, cleansing and restoring community balance. Others are taking up a more modern idea, the creation of a Truth Commission to take testimony from the victims and perpetrators in a conflict. These bodies range in scope and scale from the famous South African hearings covering thousands of cases spanning thirty years, to the Greensboro NC (USA) hearings about a single local catastrophe. Commission hearing rooms offer a forum for contact across previously insurmountable barriers of hostility, which can inspire a traditional enemies to build a newly shared investment in the future.

Discussion: 

Community organizations dealing with local traumatic events, families with a personal story of injustice, even an entity as large as the United States with its dark history of slavery can consider creating a Truth, Reconciliation and Amnesty Commission. A Commission holding hearings will allow the actual history to be revealed by taking testimony from a wide variety of perspectives, and will also become a forum in which adversaries can approach each other without insisting on punishment or revenge. Perhaps surprisingly, a narrative, anecdotal yet full recounting of painful truth contributes substantially to restoring the harmony and vitality of the community for the future.

South Africa’s is the most famous Truth and Reconciliation Commission, but there have been dozens of others.Many have played an important role in repairing community rifts without furthering the suffering for most people. In South Africa, an indigenously inspired and funded project, heard thousands of testimonies and disposed of over 3000 requests for amnesty. Guatemala’s TRC was more centralized and UN sponsored. A key outcome of the latter’s work came in an apology from the United States for its abusive interventions Guatemalan affairs.

TRCs offer a substitute for traditional disaster adjudication systems, which usually take one of the following three forms: insurance payments/liability law suits, government investigations/hearings, criminal trials and punishments. While each of these has its place, all three are concerned above all with blame for the past. Furthermore, legal and official procedures traditionally depend on arcane jargon and they tend to be expensive, long drawn out and highly centralized. Since they are dominated by experts, traditional dispute forums tend to marginalize the ordinary people who actually experience traumatic events. UN War Crimes Tribunals for Rwanda and Bosnia, which refuse to consider amnesty, have been bedeviled by the failings of court-based systems.

TRC style hearings are quite different. They are relatively informal so they are commensurately cheaper and can take place anywhere in an affected area. If they follow the South African model, hearings are not adversarial, they do not assign guilt or innocence and they are carried out in the local, natural language. In 2004 in Greensboro NC, hearings about 1979 slaughter of four civil rights activists offered an opportunity for people to continue on with a process that had actually been cut off in the courts.

TRC Commissioners need to attend openheartedly to the voices of suffering, to ask probing questions about responsibility and action so as to determine if the truth has indeed been told. Their success depends on the integrity of these commissioners. It also depends on careful recording and distribution of the testimonies. Participation, both for witnesses and those accused of doing harm has traditionally been voluntary, in the sense that no-one faces additional legal sanctions from their society for failing to appear, though community hostility can be hard on those who reject the Commission’s request to appear.

The strongest argument against TRC proceedings is precisely the strongest argument in favor of them – that such hearings are not the forum for punishing a perpetrator. Victim opponents of TRCs fear being deprived of justice. Perpetrators worry that the hearings are merely fishing expeditions to search out the guilty who will then be punished. Theorists are concerned that perpetrators who are not prosecuted under such a system will find they can act with impunity In South Africa some victims remained critical to the end, but many discovered that the new knowledge they gleaned at the hearings about what happened and why proved much stronger in easing their hearts than the had expected. And nothing about these hearings need prevent judicial action. Indeed in recent years there have been examples of re-opening judicial proceedings with a similar intent, for example the 2005 recreation and new “trial” of Chief Leshi leading his exoneration in Washington State, a hundred years after his execution.

Establishing a successful commission depends on preparing the groundwork on many issues. The factors identified by the Truth Commission Project (see below) include
• By whom/under whose name the commission is established
• When the commission is established and how far back it reaches
• Prevailing focus on healing or justice
• Public support for a truth commission
• Geographic horizon for Investigation
• Legal Powers of Investigation
• Rejecting anonymous and confidential testimonies
• Visibility of Hearings
• Degree of Formality of Hearings
• Whether or not to offer Amnesty
• Completion, Publication and Distribution/ Accessibilityof report

While most actual TRC hearings have been conducted in former war zones, it is easy to discern other issues which could benefit from this process:

1) The United States government and the American people could people re-examine the costs of the slave trade and the centuries of slave labor and yet minimize the likelihood that the acknowledgement of history becomes the basis furious revenge.
2) Or the people and the different levels of government could investigate the events of the New Orleans 2005 catastrophe without focusing narrowly on blame and thereby prompting an onslaught of liability law suits.
3) Or the residents and former residents of Hanford-Washington, Chernobyl-Ukraine, and Ukraine, and Bikini Island and other nuclear sites could craft public history out of the secrecy which surrounded the nuclear programs of the 20th century. At the same time they would create a forum for dialogue with the builders of the weapons and power plants who have left behind a radioactive legacy that will last for millennia.

This pattern links to Memory and Responsibility, Witnessing, Transparency, Community Inquiry, International Law

Solution: 

Therefore, faced with a festering historical trauma in a specific community, create a Truth, Reconciliation and Amnesty commission, using either informal or official channels. A commission can hear victim testimonies about past suffering as well as explanations from those responsible and it can provide a forum in which adversaries can meet without fear of further harm or punishment.

Verbiage for pattern card: 

Societies recovering from wars and other traumas, can make a bad situation worse by focusing on blame or punishment. New models of adjudication and problem solving are emerging. Some communities are restoring long-standing healing and cleansing traditions. Truth and Reconciliation Commissions can help provide contact across previously insurmountable barriers of hostility and can inspire former enemies to build a shared investment in the future.

Pattern status: 
Released
Information about introductory graphic: 
A world map showing all the truth and reconciliation commissions in Museum of Memory and Human Rights, Santiago, Chile.

Conversational Support Across Boundaries

Pattern ID: 
439
Pattern number within this pattern set: 
50
John Thomas
IBM Research Hawthorne
Version: 
2
Problem: 

As Herb Simon pointed out in the "Architecture of Complexity", a common heuristic for dealing with complexity is to break complex problems into smaller, more or less independent components. When a complex organization is broken down into smaller units (such as divisions, departments, teams) each unit specializes. People are selected, trained, and motivated to optimize the performance of that unit. However, there remains the necessity for coordinating across units to deal with changes, exceptions, and errors in organizational design. In these cases, it is necessary for human beings to solve problems across organizational boundaries. However, since people in different organizations have been selected, trained, and motivated differently, such conversations are often very difficult.

Context: 

Context: Organizations strive to become more efficient partly through automation and partly through specialization of function. Organizations train one group of people to perform a function and then "hand off" the process to another group trained to perform another function, etc. Integration often extends across formal organizational boundaries so that; e.g., various participants in supply chains attempt to coordinate their efforts. Such larger scale integration can result in greater efficiency. Systems are not designed, however, with complete knowledge of every possible contingency. When design assumptions break down, it is important for people on both sides of a functional boundary to have a cooperative conversation in order to solve the problem left by the gap between reality and the design assumptions.

Discussion: 

Forces:

Many processes are too complex to be understood in detail by one person.
Performance on a task is generally a logarithmic function of time on task.
A person's time is limited.
Complex systems are typically designed and built by decomposition.
Systems to automate, semi-automate, or coordinate are generally designed by people who are not the people who actually do the tasks.
Designs can never anticipate all contingencies.
Human beings can negotiate to solve novel coordination problems via conversation.
People find conversation in the service of finding and solving problems rewarding.
People are subject to forming "in-groups" and "out-groups."
If "in-groups" and "out-groups" are formed, rather than negotiating a solution to a problem that is globally optimal, each group will try to "win" by forcing the solution that is optimal for their subfunction.

Examples:

Historically, many organizations have recognized the need for such informal conversational ties and have provided both special places (Officer's Club; Traditional Pub; Company Cafeterias) and events (Company Picnics; Religious Retreats; Holiday Parties; Clubs) to facilitate such interchanges. As organizations attempt integration across ever wider scales however, providing appropriate venues becomes increasingly challenging.
In some cases, two related functions report to a single manager and the manager may serve as a communication bridge. Clearly, however, in complex organizations, formal management methods alone will be insufficient for coordination across all the boundaries.
When links in a processing chain do not converse, inefficiency results. For example, telecommunications company Customer Service Reps gave out credit card numbers to business customers. However, they had to get these numbers from the accounting department. The customer service reps were only allowed to make outbound calls between 12 and 1. The accounting department generally had lunch between 12 and 1. As a result, it was often many days before customers were able to begin using their business accounts. The accounting department and the customer service reps also disliked each other, had no informal contact, and when other coordination problems arose, generally blamed each other.

The same general difficulty arises in attempting to deal with any complex problem; e.g., attempting to voluntarily and democratically facilitate social change. For instance, in the pattern, "Community of Communities" it is possible for various communities to develop plans that inadvertently interfer with each other. That is why it is useful, on a regular basis, to have conversations that cross community boundaries.

At IBM Research, I used to play a lot of tennis with other IBMers including an inter-company league. Here, I met someone in the corporate tax department named Frank.
I also used a system which returned the abstracts of scientific and technical articles that contained key-words of interest. Such systems return many false positives. One in particular had nothing whatever to do with my interests; it was about a new federal program that allowed highly profitable companies to trade tax credits with companies that were losing money. Instead of throwing this in the trash, because I had had conversations with Frank, I forwarded him the abstract. He looked into this program and saved a lot of money for IBM. This case illustrates that ideally even people with no obvious process connection should be able to converse informally.
In planning the first Universal Usability Conference (ACM SIGCHI), it was necessary to delegate various functions to various parties. We attempted to plan ahead of time by standard tools such as budgets and project timelines. A weekly conference call proved crucial in allowing us to identify and solve unanticipated problems effectively and efficiently.
In WorldJam (an on-line 3 day company-wide electronic meeting for all IBMers), moderators and facilitators used Babble (an electronic blended synchronous/asynchonous chat) and Sametime (a synchronous chat system) as backchannels to collectively solve problems and coordinate information among jam topics.
In Hanna Pavillion, a children's psychiatric hospital, each change of shift is marked by a short joint staff meeting in which critical issues are discussed so that a continuity of knowledge persists across shift boundaries (common in most medical settings). In addition, at least some people work double or rotating shifts and get to know people from various shifts. There are ample opportunties for informal conversation during the day as well as special outings. Then, staff members can coordinate treatment for a specific child across the boundaries of profession and shift.

Additional Reviewers/Editors: Catalina Danis, Alison Lee, David Ing, Ian Simmonds
Image of Babble courtesty of: "Visual by www.PDImages.com"

Solution: 

At a minimum, Time, Space, and Means as well as Motivation must be provided for people who need to coordinate acoss units to carry on continuing informal conversation. People must have time to carry on such conversations. A space must be provided in which such conversations can take place. If a physical space convenient to both parties is not feasible, some means of support for informal distant collaboration and conversation is necessary. Payoffs must accrue to the parties across a boundary for jointly for solving problems, not for proving that the other party is to blame.

Verbiage for pattern card: 

We must often work together across organizational and other boundaries to solve problems. However, since other groups have different knowledge, norms, and expectations, conversations can be difficult. It is important for people on both sides to have cooperative conversations. Time, space, means, and motivation, must be provided. Payoffs must accrue to the parties for solving shared problems, not for proving that the other party is to blame.

Pattern status: 
Released
Information about summary graphic: 

Berlin Wall; Wikimedia Commons

Citizen Access to Simulations

Pattern ID: 
744
Pattern number within this pattern set: 
48
Alan Borning
University of Washington
Version: 
2
Problem: 

It can be difficult to understand and bring into public deliberation the long-term consequences of major public decisions, for example, the consequences of building a new rail system or a freeway in an urban area. Simulations can help illuminate these consequences (for example, a simulation of the long-term effects on land use, transportation, and environmental impacts of different choices). To be compelling and useful, the simulation results should presented in a way that they can be understood and used by a range of interested citizens. Further, ideally not just the results, but access to running the simulation, should be available to the public, to allow experimentation with alternatives. To aid in understanding and credibility, the simulation should be constructed in a transparent fashion, so that its operation is open to inspection and discussion.

Context: 

This pattern is potentially useful to advocacy groups, other community organizations, business associations, and local and regional governments. Using this pattern depends on a suitable simulation and data being available. Another factor (less important but useful) would be the existence of a community indicators program that tracks current trends using indicators, so that the *same* indicators can be used to both track current trends and to present the simulation results. (Doing this is particularly useful in applying the Reality Check pattern [link to Reality Check pattern], in which simulation results are compared with observed, real-world data.

Discussion: 

Community Indicators [link to Community and Civic Indicators pattern] can provide an important tool for monitoring current trends in a community. However, we will usually be interested in the values of these indicators in the future, not just the present - and which actions will result in more desirable outcomes as measured by the community indicators. Simulation and modeling can provide a powerful tool for informing such discussions, particularly if the results from the simulation can be presented using the same indicators as selected in a participatory Community and Civic Indicators project. For example, the summary graphic for this pattern shows the population densities in the Puget Sound region in Washington State in 2025 given the current land use and transportation plans, as projected by the UrbanSim simulation system. The results of the work should be made available using the web or printed reports. Using the web has the advantage that definitions of indicators, documentation, and related information can be conveniently linked together. Supporting public access to running the simulation, as well as the results, might be provided in several different ways, depending on the complexity and size of the simulation and input data. Particularly for complex simulations, with substantial data requirements, accessing a simulation hosted on a server via a web interface is a good technique. Smaller simulations might be downloaded and run on individual's computers. This is in general not an easy pattern to use. In addition to developing the set of indicators (including careful definitions and documentation), a simulation of the phenomenon of interest must exist or be developed, including the necessary data and calibration to apply it in the given community. For the example used here (land use and transportation), this typically requires that the local or regional government agency in charge of land use and transportation planning either undertake the simulation work itself, or be willing to work closely with another organization that does so. The game SimCity demonstrates that many people -- including grade school children -- can be highly engaged by what might have been thought to be a dry topic, namely urban planning. While games such as SimCity can provide valuable inspiration and interaction ideas, there are key differences between such games and the simulations suggested in this pattern. First, this pattern is concerned with producing simulations of actual phenomena, for example, simulating a specific, real, urban area, with the intent of producing useful forecasts of its long-term development to inform public deliberation and debate. Second, the interaction techniques available to its users should expose only the actions and "policy levers" available to real citizens and governments (for the urban simulation example, such as building light rail systems or changing zoning). Users of these simulations can't simply declare that an area will be redeveloped (or bring in Godzilla); rather, all they can do is change relevant policies in a scenario in hopes of influencing people in the simulated environment to redevelop the area and residents to move there. Potential challenges to the result include challenges to the accuracy and reliability of the simulation.

Solution: 

Develop a simulation of the system of interest (for example, of urban land use and transportation), and make the results of the simulation accessible to interested stakeholders using indicators. When possible, make running the simulation accessible to the public as well.

Verbiage for pattern card: 

Simulations can help illuminate long-term consequences of major public decisions on land use, transportation, and the environment. Citizen Access to Simulations can provide powerful capabilities for informing community discussions, particularly if the results are presented using the same indicators that were used in a participatory community and civic indicators project.

Pattern status: 
Released
Information about introductory graphic: 
UrbanSim

Alternative Progress Indices

Pattern ID: 
777
Pattern number within this pattern set: 
46
Burl Humana
Richard Reiss
one-country.com
Version: 
2
Problem: 

Economic indexes of various kinds attempt to measure the well being of nations, markets, corporations, individual people, and society. Most of these economic indexes express return only in monetary format and risk is calculated on the standard deviation of this monetary expression. These economic indexes need to also include information that makes life worth living, natural and social capital (living capital), so non-monetary rewards are also included in the standard deviation and risks to human well being can be indicated more accurately.

Context: 

Trading on the benchmark of indices has become increasingly popular over the last few years. As indexes become more widely used than ever before they become easy indicators, for those they benefit, in measuring how our world is doing, according to them, and skew the honest reality for mankind that we hope to protect. It is imperative to accurately measure the well being of nations, corporations, individual people, and societies through indexes that adequately reflect the true costs and benefits contributing to the well being of our world.

Discussion: 

Indexes take on a market theory notion that the “efficient frontier” has all the information needed to calculate an accurate return (reward) versus risk (cost) index. Following this notion is the idea that filtering the market for certain criteria of a specialized index lowers the amount of return received for risk taken, because filtered information is inefficient. This raises questions about the “efficiency” of markets because active managers filter economic information everyday to create specialized portfolios to increase return. On this, it would theoretically stand that an index measuring the well being of society could filter for criteria rewarding the common good with little to no ill effect from lack of the so called “efficiency” imbibed by the market.

Around the globe, there is an increase in the number of sustainability and social responsibility indexes (SRI). These indexes came out of first generation socially conscious investing that excluded corporate stock from investment portfolios on the basis of particular activities deemed to be unethical. From this, a second generation has emerged and the focus of SRI has changed primarily to identifying social and environmental issues that are “material” to business performance. This is an increased attempt by companies to assess the materiality of sustainability issues on (stock) value creation. These indices paint a picture that socially responsibility is only important when a financial gain is made by corporations or stockholders. This is not exactly what we are looking for when we hope to use indexes to help measure the well being of our world. When individual investors purchase SRI traded securities/indexes they still have to deal with the reality that the costs to living capital are making life less valuable even while their portfolios grow.

Gross Domestic Product (GDP)/Gross National Product (GNP) per capita has most lately been used as an index of standard of living in an economy. GDP/GNP only measures the populations ease in satisfying their material wants (an index of reward for risk taken) and all else that contributes to the sustainability of people and the environment is lost. "Adding up the monetary transactions in an economy and calling this prosperity obscures an honest account of the well being of nations." (Anielski, 2000)

Quality of life and standard of living should not be separate measurements in an index "A more complex index of standard of living than GDP must be employed to take into account not only the material standard of living but also other factors that contribute to human well-being such as leisure, safety, cultural resources, social life, mental health, and enironmental quality issues, to name a few." (Anielski, 2000)

Simon Kuznets' idea “…[in] favour of more inclusive measures, less dependent on markets..." (Anielski, 2000) rings true as a more realistic approach to well-being. "The eventual solution would obviously lie in devising a single yardstick of both economies [virtual wealth – money,debt, stock markets; and real wealth – human, natural and social capital]…that would perhaps lie outside the different economic and social institutions and be grounded in experimental science (of nutrition, warmth, health, shelter, etc.)." (Anielski, 2000) The business for this millennium is to take up this empirical economic challenge for a single bottom line index for national well-being.

“The U.S. Genuine Progress Indicator (GPI) and its predecessor, the Index for Sustainable Economic Welfare (ISEW) provide the basis for developing a new accountancy to address Kuznets’ challenge. The U.S. GPI released in 1995 and since updated…is one of the most ambitious attempts at calculating the total benefits and costs related to [economics for community] for the US. First developed by Clifford W. Cobb, GPI/ISEW remains one of the most important attempts to measure sustainable current welfare." (Anielski, 2000)

"The GPI adds a cost side to the growth ledger, begins to account for the aspects of the economy that lie outside the realm of monetary exchange, acknowledges that the economy exists for future generations as well as for the present one and adjusts for income disparities. The GPI begins with personal consumption expenditures as a baseline, the way the GDP does. Personal spending by households makes up roughly 65 percent of the US GDP. The GPI then make a series of 24 adjustments for unaccounted benefits, depreciation costs (for social and natural capital) and deducts regrettable social and environmental expenditures. Specific elements of the GPI include personal consumer expenditures, income, value and cost of consumer spending on durable goods and household capital, cost of household pollution abatement, cost of commuting, cost of crime, cost of automobile accidents, cost of family breakdown, value of housework and parenting, value of voluntary work, loss of leisure time, services of streets and highways, cost of underemployment, air pollution, ozone depletion, water pollution, noise pollution, cost of depletion of non renewable, loss of forests, long term environmental damage, loss of wetlands, net capital investment, net foreign lending/borrowing." (Anielski, 2000) The GPI has also set goals for itself "to improve its framework in the areas of human capital, technology, government spending, social infrastructure, natural capital and environmental accounts, ecological carrying capacity, genetic diversity, water projects, workplace environment, underground economy, and pollution and lifestyle induced disease." (Anielski, 2000)

The results of the GPI reveal that "…well being has declined while virtual wealth (debt, stock markets) have grown exponentially. One could say that while we are making more money we are effectively eroding the living capital which makes our lives worthwhile. “The primary benefit of the GPI is to provide decision makers with a more holistic account of the economic well-being of their community…." (Anielski, 2000)

"Any accounting system of well-being must be aligned with the values, experiences, and physical realities of the citizens of a community. The challenge in future GPI/ISEW accounting will be the ability of constructing accounts that are consistent with the held values, principles, and ethical foundation of a community or society." (Anielski, 2000)

Solution: 

Alternative indexes like the Genuine Progress Indicator that include natural and human capital can illuminate our world on the real picture of human well being that can be obfuscated by traditional economic indexes. "The ultimate utility of such measurement efforts is that the information provides evidence of trends in the welfare of society." (Aneilski, 2000)

Verbiage for pattern card: 

Economic indexes that measure the well-being of nations, markets, corporations, individual people, and society as a whole are expressed only in monetary terms and miss several important factors; they need to factor in information on positive factors such as volunteering and housework and negative factors such as pollution and crime.

Pattern status: 
Released
Information about introductory graphic: 
Wiki Commons. http://commons.wikimedia.org/wiki/File:Schoolgirls_in_Bamozai.JPG

International Networks of Alternative Media

Pattern ID: 
810
Pattern number within this pattern set: 
43
Dorothy Kidd
Dept. of Media Studies, University of San Francisc
Version: 
2
Problem: 

A key challenge facing movements for social change is the global commercial media. A handful of western-based trans-national media corporations, working in tandem with regional companies, control most programming, emphasising entertainment to recruit urban consumers, and circulating news primarily framed by the interests of corporate business and western foreign policy. Public programming to encourage dialogue and debate of public issues has withered. Stark inequalities are increasing, in both poor and rich countries, between those with the full means to produce communications and those without, especially if we factor in the violence of poverty, illiteracy, and patriarchal, racial, and caste oppression.

Context: 

A global network of communications activists, advocates and researchers is emerging to address these problems. This network of networks operates simultaneously on at least three planes, the construction of alternative communications media, the reform of the mainstream corporate and state media, and the support of trans-national communications networks for social change movements. Alternative media projects (zines, radio, video, television and internet sites and blogs) not only serve people seldom represented in the corporate media; they also demonstrate what democratic media might look like in their alternative content, modes of operation and overall philosophy. Communication reformers campaign to make existing local, national and global communications systems more accessible, representative, accountable and participatory.

Finally, media activists work in support of social change movements whose transnational communications networks also provide additional links for the movements to democratize media.

Why now? This is due to at least three inter-related global trends. First, the global shift to neo-liberalism presents people all over the world with a complicated, but very clear set of common problems. Secondly, the communications networks first emerged as links among social justice movements to address these common problems. Finally, the network of communications networks began to take its own shape, as groups everywhere inventively adapted the glut of consumer hardware and software from the transnational corporate market.

Discussion: 

A New World Information Communications Order (NWICO)
The trans-national movement to transform communications predates the shift to global neo-liberalism. During the 1970s, led by the Non-Aligned Movement (NAM), a coalition of national governments of the global south, mobilized to challenge the old imperial status quo in which news, information and entertainment media were controlled by western governments and corporate powers. They called within the UN System for a New World Information and Communications Order (NWICO), for an end to the dominance of the western colonial powers, the equitable distribution of the world’s information resources, the right to communicate, and the support of alternative and community based media in democratizing communications. Rejecting this multilateral consensus, the US and UK Governments withdrew from the Commission, arguing with the commercial media industry that any measures to limit western media corporations or journalists represented state censorship of the “free flow of information.”

The US instead shifted to what we now call neo-liberalism, or the Washington agenda. They called for market rules (privatization of public resources and deregulation of government oversight of corporations) at home and abroad. The Reagan Government successfully gutted anti-trust and public interest rules, as well as public support programs at home, and pushed for the implementation of similar policies in other countries through their powerful voice in the International Monetary Fund (IMF), and World Bank (WB). However, the US Government was still unable to win in the multilateral arena, failing to get culture (AV services) onto the trade block in the General Agreement on Trades and Tariffs (GATT), the precursor to the World Trade Organization (WTO). Instead, they decided to work on the less powerful countries one or two at a time, and began unilateral free trade talks with Taiwan, Canada and Mexico.

During the same decade, the number and sophistication of alternative media projects and networks grew around the world. These networks emerged both from the confluence of links between social movements, primarily from the countries of the south, mobilizing against the Washington agenda; and alternative media groups inventively seizing the newly available consumer production media. Primarily based in local geographic communities, media activists began to link across their own countries, national and regional boundaries to share resources, and campaign for greater access to radio, cable and satellite, and the newly emerging computer-linked systems. They also began to support one another on common issues, including the massive cuts in public spending and state-run services, the growth in global media conglomeration, and the US, Japanese and European calls for global standards in digital systems and copyright rules.

The trans-national networks begun in this era include the World Association of Community Radio (AMARC) , and the Association of Progressive Communicators (APC ). AMARC now operates via regional organizations, programme sharing through special theme-connected collaborations (against, for example, discrimination against women, and racism) and global media reform coalitions. Formed to support the global network of women, labour, ecologists, indigenous peoples, and of activists organizing against free trade and corporate globalization, APC continues to build on the idea of communication rights, prioritizing the capacity building of women, rural and poor people, and the media reform efforts of member groups.

During the 1990s, a new set of activists demonstrated the more tactical use of the technologies and networks in political change. In 1989, the pro-democracy activists of Tienanmen Square in Beijing China used fax machines to get their message out to the world . In 1994, the Zapatista National Liberation Army built on what Harry Cleaver called the emerging trans-national “electronic fabric of struggle,” employing old and new media, and global media networks, to challenge the North American Free Trade Agreement (NAFTA). Then, in 1997, the Korean labor and social movement activists use highly sophisticated broadband media to demonstrate against the International Monetary Fund (IMF), and also opened Jinbonet, the first Web-based interactive peoples’ news service. This alternative vision of communications took another leap forward in 1999 when the first Independent Media Center (IMC) formed in Seattle to support the protests against the World Trade Organization (WTO). Drawing from the Zapatistas, the IMCistas created a global news network. Building on the existing networks opposed to corporate globalization, and providing easy-to-use open-publishing software, the global IMC quickly grew to over 150 centers around the world.

International Network for Communications Reform
In the last five years, the network of networks has begun to flex its collective muscles to reform the dominant global media system. Coalitions of activists, often in tandem with progressive government representatives, are calling for more democratic communications at the World Summit on the Information Society (WSIS) (); against the US push for the free trade of culture, with a Convention on Cultural Diversity, adopted by UNESCO in 2005 (http://www.cdc-ccd.org>); and for the protection of the global knowledge commons with a Development Agenda and a Treaty on Access to Knowledge and Technology at the World Intellectual Property Organization (WIPO).

Solution: 

More than a coalition of “Nos,” this new network of networks demonstrates that another communications is possible and already happening. Its strength is based in cooperation via social movement organizing, media reform campaigns and the adaptation of information and communications for the greater use of all. Almost all are severely challenged by their lack of sustainable funds and technical resources, and continuing inequities between members of racialized and gendered class differences and of cultural capital. However, faced with the stark realities of neo-liberal immiseration, the network continues to build, creating a complex lattice of local-local, regional (especially south-south), and trans-national links that circumvent the old colonial north-south linkages and power dynamics. If there is one glaring structural vacuum, it is the lack of involvement of US activists, and particularly those based in US communities and social justice movements. In the next five years, one of the key challenges will be for US activists to bring together efforts for media justice in the US, recognize the leadership of the rest of the world, and assist in mobilizing against the Washington agenda at home.

What can people do to help build this network? In their own area, they can help support or produce programming for their local alternative communications media. They can also find and support the existing local, national and global campaigns to reform the mainstream corporate and state media. This is especially crucial in the US, whose media and media policy affect so much of the world. Finally they can educate themselves about what’s going on in their own communities, national and especially internationally, and then help link the work of the local and global justice networks.

Verbiage for pattern card: 

A handful of Western-based transnational corporations control most media programming. They emphasize entertainment and news acceptable to business and Western foreign policy. A global network of communications activists, advocates, and researchers is working to reform the mainstream media and to construct alternative media. Alternative media projects not only serve people; they also demonstrate what democratic media might look like.

Pattern status: 
Released
Information about introductory graphic: 
March of Indigenous Peoples, Colombia 2008. Tejido (social fabric) of communication was key to mobilization, Victoria Maldonado, Waves of Change

World Citizen Parliament

Pattern ID: 
484
Pattern number within this pattern set: 
40
Douglas Schuler
Public Sphere Project (CPSR)
Version: 
2
Problem: 

Economic inequality is steadily rising worldwide: Nearly everywhere the rich are getting richer and the poor are getting poorer. Although the world's economy has grown considerably over the past few decades, half of the world's population subsists on less than $2 (US) per day. At the same time, meaningful representation among the world's population is steadily declining. This lack of representation results from — and engenders — increasing power and diminishing accountability of the world's corporate and governmental institutions.

Context: 

The social world as it now exists: vast needs — and intriguing possibilities — for citizen engagement with global affairs. The United Nations is an assembly for the world's nation's. Business, likewise, has an incredible assortment of institutions and events such as the World Economics Forum, the Chamber of Commerce, etc.

Discussion: 

"The tremendous growth in the commitment to, and practice of, democracy in domestic settings juxtaposed against globalization's large-scale transfer of political decision-making to international institutions has made the almost complete lack of democracy at the international level the most glaring anomaly of the global system today." — Andrew Strauss

Richard Falk and Andrew Strauss have explored the possibility of a "Global Parliament" for several years. It is their work which inspires this pattern and many of the ideas advanced in this pattern originated in their writings. Disclaimer: The concept of a "Global Peoples Parliament" comes from Richard Falk and Andrew Strauss. The version advocated here is not "official" (nor authoritative).

Civil society is obligated to create institutions that are strong enough to challenge other organization -- governments, businesses, criminal groups, extremists -- but not on their terms.

This pattern has only partial analogs in the "real world." This is due, generally, to the extremely broad scope of its coverage — it is supposed to address all of the world's inhabitants! The very fact of globalization provides the most solid support (and for the need) of the World Citizen Parliament pattern. Smaller versions that approximate some aspects of this pattern do, of course, exist, and we can learn a lot from these experiments as we attempt to cultivate and grow democratic forms that are more wide-ranging. The European Parliament may be the most prominent example of a large civic society institution whose representatives are democratically elected by people from various countries.

This pattern is related to INDEPENDENT REGIONS, the first pattern in A Pattern Language. Alexander was striving to identify the right level of autonomy based on "natural limits to the size of groups that can govern themselves in a human way." Metropolitan regions will not come to balance until each one is small and autonomous enough to be an independent sphere of culture. That pattern's solution states that, "Wherever possible, work toward the evolution of independent regions in the world; each with a population between 2 and 10 million; each with its own natural and geographic boundaries; each with its own economy; each one autonomous and self-governing; each with a seat in a world government, without the intervening power of larger states or countries."

Alexander's pattern and ours have similarities and differences. Both presuppose an increased voice of the citizen through additional opportunities for participation and new collective bodies that are independent from governments as they now exist. At first glance the two approaches might seem incompatible — Alexander's pattern does not call for an all-citizen's body nor does this pattern mention autonomous regions. The parliament concept, however, does not rule out autonomous, independent regions per se, only that individual people would have a forum for addressing issues was outside of their independent region — or what looks very much like a country but with new boundaries that better reflected cultural and natural boundaries (which does little or nothing about addressing the realities of various cultural or ethnic or religious groups "stranded" behind redrawn boundaries). Moreover, the state conceptualized in Alexander's pattern could actually be attained in a more "natural" evolutionary way through this pattern.

Developing a top-down approach is neither viable nor consonant with the principles of civil society. This leaves us with the option of developing principles and ideas that are we believe are at the core of what a federation should be and allows the parliament grow or evolve, built from the seeds that we envision today. This envisioned global federation would then become a type of ecosystem for collective bodies. [Ideally it would be principled and explicitly cooperative -- but how to ensure? At the same time we would need to ensure that it doesn't become just another arena for people to exploit for their own interests. Use the Commons ideas from Bollier, Ostrom and others, for one thing. The World Social Forum provides many important ideas about how this could be accomplished. What distinguishes this from how things exist already is an explicit declaration and decision to participate in the project, to share information with others and to communicate with other collectives in the federation.

Collective groups are generally composed of people in a geographically delimited area (some of whom have passed certain formal requirements for membership and attained the status of citizen), of people with similar professional interests (e.g. medical associations or labor unions), or social aims or philosophy (American Civil Liberties Union, American Rifle Association, etc. )

The draft statement that I proposed at the Online Deliberation Conference / Directions and Implications of Advanced Computing Symposium, Stanford University, on May 22, 2005, sums up the important aspects of this pattern.

In many places attempts are being made to trivialize citizenship and reconstitute citizens as (everyday) consumers and (sporadic) voters. Real power is in many ways being transferred to large corporations and other unelected organizations such as the World Trade Organization.

Realizing the growing and critical importance of citizens and civic society in addressing humankind's common problems, we the undersigned propose the initiation of a "Grand Challenge" whose ultimate objective is the development of a World Citizen Parliament. We realize that this is an extremely complex project that will require years of complex, nuanced, creative and thoughtful negotiation and collaboration. We are aware that this project will have to address an extremely broad range of social and cross-cultural factors. We, however, believe that beginning this discussion in an explicit and open way is preferable to many other varieties of globalization that lack this transparency.

Moreover, we realize that precisely defining an ideal system in advance is impossible. For that reason, we propose to begin a principled, long-term, incremental, participatory design process that integrates experimental, educational, community mobilization, research and policy work all within a common intellectual orientation: specifically to provide an inclusive intellectual umbrella for a diverse, distributed civil society effort. We realize — of course — that this is an audacious proposal. However, we agree with Richard Falk, that a parliament or forum like this is critical for the future of humankind and our planet. Civil society historically is the birthplace of socially ameliorative visions. This effort is intended to help build a more effective platform for these efforts, to help address humankind's shared problems — such as environmental degradation, human rights abuses, economic injustice and war — that other sectors — notably government and business — are seemingly powerless to stem.

Ultimately we would expect that the recommendations that are issued will play important roles in policy development of the future as well as in our ways of thinking. Each of the experiments that we undertake in the next few years will undoubtedly have drawbacks, some of which will be revealed only as people attempt to address real concerns. Information and communication technology will play an important role in many of these projects and people in these fields will need to work with social scientists, representatives from civil society organizations and many others if a World Citizen Parliament that sensitively, fairly, and wisely explores and addresses the concerns of the under-represented citizens of the world is ever created.

Solution: 

Launch a non-centralized, heterogeneous, loosely-linked network of people, online and offline resources, institutions, deliberative and other collaborative settings. Develop articles, scholarly papers, opinion papers, manifestos, research findings, and anything else that is relevant to this effort. Develop concepts, design principles, and experiments that lay the groundwork for a World Citizen Parliament. The new deliberative bodies that we develop over the next few years will necessarily be advisory only at the onset.

Verbiage for pattern card: 

Governments and corporations have forums that further their interests. Civil society must create institutions that are strong enough to assert theirs. The deliberative bodies that we develop are likely to be advisory at the onset but hopefully will lay the groundwork for a more integrated and influential World Citizen Parliament as time goes on.

Pattern status: 
Released
Information about introductory graphic: 
Feijaocomarroz from pt, Passeada de abertura do Forum Social Mundial de 2003, que reuniu mais de 150 mil pessoas, Creative Commons Attribution-Share Alike 3.0 Unported

Whole Cost

Pattern ID: 
456
Pattern number within this pattern set: 
28
Douglas Schuler
Public Sphere Project
Version: 
2
Problem: 

Through the clothes we buy, the food we eat, the cars we drive, the way we dispose of our trash or sewage, where and how we live, and how we make a living or recreate, people everyday and everywhere make impacts — large and small, good and bad — on the world. Many of the problems in the world are compounded by people who are unaware of the damage they are inadvertently perpetuating through their daily lives. Costs are determined in overly simplistic ways such as monetary costs or immediate convenience — throwing trash out the window or into a river, for example.

Not only are these problems debilitating to people in less developed countries (thus presenting moral and ethical challenges to their more fortunate brethren), they also have a peculiar way of ultimately affecting developed countries as well (over 20% of the air pollution in the Pacific Northwest region of the U.S. has blown in from China). If people had a better idea what the entire "cost" of their actions were — not just their own personal costs at that moment — there is a higher likelihood that they'd change their behavior to encourage positive changes and discourage negative ones.

Context: 

People in developed countries are always buying — things — often from developing countries — and are generally unaware of the legacy of the product. People may be morally opposed, for example, to the child labor that went into, say, a pair of athletic shoes, yet they implicitly condone the practice with their purchase. The one economic point of view holds is that the whole cost should be reflected in the price tag, but this is rarely possible. Many of the costs are impossible to put a number on, and they may even differ from the point of view of different people. (What is the "true" cost of taking away a wetland used by geese on their migration?) So the pattern includes in some sense the common economic understanding but goes beyond it. All people need to live consciously in this world.

Discussion: 

In an increasingly globalized world people are connected to each other in ways that are often unknown to each other. One of the main ways that people in developed countries and less developed countries are linked is through products. When a person in a developed country buys clothing, consumer electronics, or other items all the buyer sees is a purchase price. Missing, of course, is the entire chain of lineage that was effectuated in order to place that product within purchasing range and its enduring effects on the environment has been dispatched of. Often the price on the product obscures a sordid legacy that could include child labor, environmental abuse such as pesticides in ground water, air pollution or soil depletion, or aspects that are harder to quantify like migration of youth to the urban areas or loss of cultural heritage.

One of the basic uses of this pattern is understanding the "whole cost" of an object or a service that one is purchasing. Ultimately the intent of this pattern is identifying the whole cost of something and using the information (that a single price obscures) to promote broader public consciousness and ultimately improved social good. There are a great number of ways that the information can be used — and a great number of ways left to be discovered. Ideally the information behind the price tag will take on greater significance while the price tag itself can also be made to reflect the previously hidden information more accurately including, for example, labeling that tag to include additional information about contents or relevant environmental effects or labor practices.

Understanding the "whole cost is primarily a process of education that can be done individually (by people of virtually any age) or in more public ways through any number of ways. This "understanding" can be via a narrative or story or it can be more quantified, including, for example, information about who got paid how much for what at every step in the chain. One approach is using the origin of the product as an indicator; not buying a product, for example, if it were made by non-union, child, or slave labor or because it was produced by a repressive regime.

A more nuanced process with a distinctively quantitative feel is illustrated by the work done by the International Center for Technology Assessment in their "The Real Price of Oil" report (1998). In that report based on gasoline prices from a U.S. perspective, the authors reveal how ultimately deceptive the idea of the "price at the pump" actually is to the actual monetary cost expressed in a specific currency, dollars, for example. And while their approach, like other economically based approaches, ignores (or, at least, re-interprets) the human story, it goes a long way towards developing (and ultimately using) a unitary "price" as a meaningful attachment to a commodity or service that’s available for purchase. In the case of gasoline, the authors show how multiple government subsidies (huge tax breaks, direct support for research development and other business costs, and "protection subsidies" often of a military nature) and a multitude of "externalities" (problems as diverse as air pollution, automobile crashes, suburban sprawl and climate change that are "costs" which the oil industry is not going to address and are not reflected in any way by the price one pays "at the pump") result in a public price-tag for gasoline that distorts the real price by 5 to 15 times. The "free" television programming that occupy so much of the time of the U.S. citizenry shows another perversion of the ideas of price and costs. The shows of course are not "free" at all — at least not to the viewers (and non-viewers) who pay for the ads every time they purchase something that’s advertised on television.

A simple use of the information (at least in the gasoline case above) would be eliminate or otherwise lower the government subsidies — especially the ones that actually hurt the environment and lead to wars and other problems and let the price creep (leap?) up to the actual price (or at least closer to it). This at the least would test the citizenry’s commitment to the automobile in a fair comparison with competing approaches to transportation. A related approach is of course un-externalizing the externalities by bringing the costs back home to the companies that are making them possible. This can be done by imposing a "green tax" on the companies, which would be used to help try to reverse the damage caused by the company’s business practices. Unfortunately, as Peter Dorman explains “There is a general distrust of the effectiveness of government, a fear that green taxes will be more regressive than some of our current ones. The alternative is the creation of environmental trusts, which would collect the money on behalf of the beneficiaries, which could include current people, future people and natural entities. The trust would pay back some of the money directly (per capita rebates) and also finance ecological conversion. Vermont and Massachusetts are in the process of setting up a trust of this sort for carbon and New York and California are possibly going this route too.

The city of San Francisco recently showed another innovative use of the Whole Cost concept. In the spring of 2005, San Francisco became the first city in the U.S. to enact legislation requiring the city to consider the environmental and health implications when making purchases for the city. Since the city spends about $600 million every year on a multitude of purchases (including, for example, 87,000 fluorescent light tubes) this type of legislation could conceivably have some effect, especially since city officials are hoping that the "Environmentally Preferable Purchasing for Commodities Ordinance" will serve as model for other cities. The city is working with community groups, technical experts and other city staff to establish criteria. Debbie Raphael, the city's toxics reduction program manager, stated that "Traditionally, we have a list of specifications we use to decide which computer to buy," she said. "Those specifications do not include things like how much lead is in them? Can you recycle them? What is their energy use? What it does not mean is that cost and performance is ignored. We're expanding the universe of criteria" (Gordon, 2005).

A final use of the Whole Cost pattern is to consider the Whole Cost in more of a global "whole" way. Looking just in this the area of health reveals the importance of this approach. In a short article called "The Price of Life" by Glennerster, Kremer, and Williams (2005) point out that Africa "generates less than one half of one percent of sales by global pharmaceutical firms but accounts for nearly 25 percent of the world's disease burden." The lion's share of pharmaceutical research and development is for the health problems of rich countries. Sadly the economic equations of the world's corporations exclude the vast majority of world's population. Lacking money, the "whole costs" that are borne by them don't show up on anybody's balance sheet or business plan.

Solution: 

The first thing to realize is that the price one sees on a price tag is rarely the "Whole Cost." The second thing to realize is that the Whole Cost of a good or service is educational as well as inspirational. People have been very innovative in this area but there is room for much more. It's important to publicize the "whole cost" of a product as well as the monetary price. This could include what percentage of the monetary price goes to worker and other costs to the environment, quality of life, and other important factors.

Verbiage for pattern card: 

We leave our mark on the world through the clothes we buy, the food we eat, the cars we drive, the way we dispose of our waste, or how we work or play. The price tag on a product can hide environmental abuse, or aspects that are harder to quantify such as the loss of cultural heritage. The amount on a price tag doesn't represent all the present or future costs. Knowing the Whole Cost of a good or service can be educational and it can inspire action.

Pattern status: 
Released

Big-Picture Health Information

Pattern ID: 
742
Pattern number within this pattern set: 
27
Jenny Epstein
Version: 
2
Problem: 

Health information cannot focus solely on individual change. Many detriments to health cannot be eradicated without changes to the physical and social world that people inhabit. If environmental and social changes are necessary to get well, individual patients cannot do so solely by seeking health care and avoiding health risks. Expert medical information and advice is inadequate to create a healthy environment that in turn creates healthy people.

Context: 

Poor people bear a disproportionate burden of global ill-health, such as diabetes, malaria, HIV/AIDS and TB. Health discrepancies between rich and poor will not be solved through better access to information alone. Good food, less stress, clean air and water, and a life with a purpose will increase health and healthy behaviors. Real change to improve health comes from a shift away from acknowledging only expert clinical opinion and toward a real-world awareness of the effect of environment on health: a shift from passive diagnosis and treatment to active engagement with the causes of and solutions to health problems.

Discussion: 

We are not, for the most part, born unhealthy. We become unhealthy. And even for those born unhealthy, a great deal of ill health may have been preventable. The campaign to find the cure for breast cancer is a good example of health information that neglects any causal connection between ill-health and the environment (in this instance, an environment which includes the use of estrogen in prescription medication), and ignores political or social change that might address environmental causes of the disease. This pattern of information, in which action comes only after the individual becomes ill but nothing has been done to prevent illness in first place, focuses on individual responsibility with no questioning of the established social order. The unspoken message is that breast cancer just happens. It is up to the individual to get involved with a screening program for early detection and treatment. Information on research that investigates environmental effects to the development of breast cancer is not part of mainstream health information.

Public health information about diabetes further illustrates the lack of emphasis on the connection between environment and health. Among Native Americans, diabetes (like most other non-infectious chronic diseases) was virtually unknown before World War II. Now, in some tribes, over 60% of adults have diabetes and the age of onset is decreasing with each generation. Much of the research on diabetes among Native Americans focuses on genetic causes or on molecular level differentiations of diabetic types. It gives short shrift to how the disruption in traditional diet and life style and the devaluation of traditional medicine correspond with the dramatic increase in the disease. The connection of indigenous people to the environment that they come from, the types of foods they eat, and activities they perform to prepare those foods are not considered an active component in their health. Diabetic health information focuses on what the individual can do to access mainstream diets and medicine. It does not validate traditional knowledge that prevented diabetes in the past, and ignores how the community as a whole can work together to recreate that knowledge. This does not mean trying to reestablish life as it was 60 years ago, but it does mean putting the current problem in a holistic context that includes history, indigenous knowledge, the interaction between diet and environment, and reasons for lack of access even to non-traditional healthy food.

In 1854, John Snow removed the handle from a London neighborhood water pump that was located a few feet from a sewer ("John Snow Pub," 2006). He believed that this sewage was causing the epidemic of cholera deaths in the neighborhood. Epidemiology textbooks emphasize Snow's connection of cause and effect as the first public health intervention of the modern era. They ignore an analysis of cause: industrialization and dislocation, poverty, over-crowding etc. What options for water did people in the neighborhood have without the pump? Seldom mentioned is that, due to the demand of a thirsty public, the handle was replaced six weeks after its removal.

Public health programs must include methods to share power with communities they hope to help. What are the contributors to ill health in their communities? What are the barriers to good health that the communities identify? Information needs to realistically address what is within the control of the individual and what will take groups of people working together to solve. Methods to improve health in disadvantaged communities must reflect the larger social change and shift in power needed.

Health information such as Fast Food Nation (Schlosser, 2002) needs to be the norm, not the exception. This book chronicles the entire environment that produces fast food, including social norms and values. Similarly, the documentary film “Life and Debt” (www.lifeanddebt.org) shows the destruction of healthy, local food production in Jamaica by the combination of multinational food businesses and international government policy.

Health information needs to do more than simply inform. What does not question the present state of affairs will not, for example, bring affordable nutritious food to poor neighborhoods. Nor will it create safe neighborhoods in areas where children cannot exercise. Better access to information may improve health care decisions to some extent; unless it also generates momentum and optimism for social change then it simply perpetuates a focus on individual behavior and treatment of symptoms that have already occurred. Health information needs to look honestly at the conditions that cause ill health, and engage not only those who suffer illness but the entire social and regulatory apparatus that can play a role in improving the conditions that people live in.

Solution: 

Demand and produce health information that identifies environmental and social causes of ill-health. Analyze the interconnection between these causes and their solutions, and bring individuals, communities and governments together in putting the solutions into effect. If the struggle with disease becomes a struggle with established power, you may be on the right track.

Verbiage for pattern card: 

Real change in improving health means shifting away from expert clinical opinion only and towards awareness of the effect of environment. Demand and produce health information that identifies environmental and social causes of ill-health. Analyze the links between causes and solutions, and bring individuals, communities and governments together in putting the solutions into effect.

Pattern status: 
Released
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