social

Health as a Universal Right

Pattern ID: 
870
Pattern number within this pattern set: 
5
Douglas Schuler
Public Sphere Project (CPSR)
Version: 
2
Problem: 

The crisis in health care worldwide has reached catastrophic proportions. Each day 9,000 people die from AIDS and 11,000 children die from malnutrition. Over one billion people have no access to clean water and half the people in the world live on under $2 (US) per day. The worsening conditions of the world's impoverished people provide almost ideal conditions for the cultivation of disease, including those that could reach epidemic or pandemic proportions. In addition, a somewhat invisible epidemic of depression and other mental illnesses are taking a heavy toll on people throughout the developing world.

Context: 

The economic divisions between people have become astronomical — and they are still widening. Within this context, the majority of people are literally living from one day to the next. Understandably, the health of these people is severely compromised. People everywhere and in all walks of life have cause for alarm.

Discussion: 

Environmental changes are adding additional strains to the already imperiled lives of the world's poorest people. "Droughts will worsen. We will see deforestation, forest fires, a loss of diversity, and degradation of the environment" according to Michel Jarraud, secretary general of the World Meteorological Organization" (Stevenson, 2006). Not surprisingly, the poorest — and hence most vulnerable — people are often the first victims of the severely declining standards of health in much of the developing world. As Paul Epstein of Harvard Medical School said, "Today climate instability and the exhaustion of resources (forests, soils, water, biodiversity), together with the growing inequity and deepening poverty, are resulting in the emergence, resurgence and redistribution of infectious disease, stalking humans, plants and animals. The conditions are not sustainable, and the mounting social and economic costs are creating convergent agendas among members of civil society, international institutions and the economic sector."

Why are things different today? For one thing the sheer number of people on the planet seems to be approaching the limits to the world's capacities. Unfortunately the trends are all heading in the wrong direction. Furthermore people everywhere are more tightly connected. It is no longer true that we live in isolated communities. The tight connections, although remote, give rise to "causes" (although diffuse and multiple) that are often far away from the person who ultimately falls ill.

Clearly humankind has a moral obligation to establish health as a human right. That is a reasonable first step. More importantly, humankind has the obligation to act forcefully and diligently as if it actually believed that health was an inalienable human right. However, as Garrett and Rosenstein report, global health as an issue is "not only for do-gooders." They go on to say that, "A self-interest component to the global health debate has clearly emerged — thankfully, because purely altruistic efforts often fall short of international support and sustainability. The interconnected nature of the world makes ignorance of issues such as deadly infectious diseases not only immoral, but self-destructive."

Health must not, however, be viewed solely as providing medical care after disaster or disease strikes. While it's true that a pill or injection can save a life, the person whose life has just been saved will soon find him or herself back in an environment that leads inexorably to poor health, compromised ability to work gainfully, and a diminished life-span. Nor is health something that can be attained solely through research. A focus on "the cure" for this disease or that disease is a typically a type of welfare program for western researchers. It's a search for a magic" silver bullet" or technocratic approach that, while often very important, will be only effective in conjunction with other approaches.

Extreme and persistent poverty is the primary cause of ill-health and premature death around the world. If people weren't in desperate poverty, if they earned an adequate living, the incidence of disease would plummet. Especially today health is linked to poverty. This poverty is not confined to individuals, but covers large sections of the world's rural areas, towns and cities and, indeed, entire countries. If, for example, a person enters the hospital in many parts of the world he or she is likely to find infection, unsanitary conditions and a scarcity of drugs, bandages, surgical equipment and other vital medical supplies.

Paul Farmer is one the most articulate and hardest-hitting advocate for health care for all of the world's inhabitants, especially those who are the poorest and most vulnerable. He identifies structural inequalities that often originate in the first world as sources of great of the misery that now exists in the third. The "roots" of the problem are likely to lead further upstream than exposure to a microbe in polluted water to a bank in London, an energy company in Houston, or a government office in Washington, D.C. As part of his work and study, Farmer traveled to prisons in the former Soviet Union and to Chiapas, Haiti, and other marginalized locations around the world to work with people in need of medical care and to witness firsthand how health conditions were being met — or not met — around the world. In his book, Pathologies of Power (2003), he proposes a "new agenda" for health and human rights" that includes the following five facets:

• Make Health and Healing the Symbolic Core of the Agenda
• Make Provision of Services Central to the Agenda
• Establish New Research Agendas
• Achieve Independence from Powerful Governments and Bureaucracies
• Secure More Resources for Health and Human Rights

Farmer's "new agenda" is comprehensive, holistic and ambitious. At the same time, it seems that anything less would be insufficient. NGOs and philanthropists, no matter how well-heeled, will not be able to do this work by themselves. The multi-pronged approach resembles the Open Research and Action Network pattern — but writ very large. He is not unrealistic about the chances for success. He lists a number of significant challenges to this agenda including the possibility that increasing the involvement of NGOs will help hasten, "the withdrawal of states from the basic business of providing housing, education, and medical resources usually means further erosion of the social and economic rights of the poor."

The "new agenda" would take a mammoth effort that would integrate direct care, research, and popular mobilization. Ultimately Farmer's recommendations could provide an umbrella for many types of efforts. Health care professionals could take Sabbaticals in developing countries to assist with health care. Religious people could put renewed vigor into projects to alleviate human suffering. The 400+ billionaires in the US (and everybody) could follow the lead of Bill Gates and others and donate substantial amounts of their amassed riches to the effort. At the same time, the rest of us could agitate for health-related initiatives including cheaper drugs from multi-national pharmacuetical companies and authentic foreign aid that wasn't based on arms or oil.

Garrett and Rosenstein (2005) point out that, "with very few exceptions, the disease amplifiers in the world today are manmade and therefore humanly controllable. ... exotic animal markets, unclean urban water supplies, lack of proper sewage systems, and unstable, conflict-ridded environments provide excellent breeding grounds for infectious diseases to spread and wreak havoc on vulnerable populations. Yet it would be short sided to think of infectious disease as a problem for solely the poor and powerless. These diseases do not discriminate; they are undeterred by state borders, party affiliation, or socioeconomic status. With air travel and human migration on the rise, so too is the possibility that deadly microbes can and will circumnavigate the globe with speed and precision."

Solution: 

Humankind is faced with the massive problem of declining public health. To be successful it will need to redirect its resources from activities that exacerbate the crisis to ones that overcome it. Ideologies, however dear, as well as ingrained habits and pursuit of short-term "self-interest" are likely to defeat any grand initiatives such as this. Regardless of whether that suspicion reflects cynicism or just realism is irrelevant: we must persevere.

Verbiage for pattern card: 

The worldwide health care crisis is profound. Each day 9,000 people die from AIDS and 11,000 children die from malnutrition. We need to redirect our resources from activities that exacerbate the crisis to ones that overcome it. Ideologies, ingrained habits, and pursuit of short-term "self-interest" work against the establishment of Health as a Universal Right.

Pattern status: 
Released

Social Dominance Attenuation

Pattern ID: 
830
Pattern number within this pattern set: 
4
Douglas Schuler
Public Sphere Project (CPSR)
Problem: 

Social dominance is arguably at the heart of many — if not most — of humankind's most shameful enterprises. It is embodied in ideology, economics, policy, education, the media, social perception and interactions, culture, and, even, our technological artifacts. In general the less-dominant group will have fewer opportunities for advancement, have poorer health and shorter life-spans, smaller incomes, higher likelihood of being incarcerated and live under more violent conditions than people do in more-dominant groups. Society as a whole too suffers from high level of inequality: the more equal the distribution of assets, the more economic growth the society will have (Dugan, 2004; World Bank, 2004). Political violence is also tied to social inequality (Gurr, 1971). At its most extreme, social dominance encourages oppression and wars, genocide, mob violence, and environmental destruction.

Context: 

This pattern pertains to any society, region, or organization where social dominance is entrenched; in other words, virtually everywhere.

Discussion: 

As humans evolved our species unwittingly took on characteristics that have persisted for centuries. Over the millennia, some aspects of our genetic makeup, as well as some psychological and cultural characteristics were encouraged while others were halted or slowed. As we all know, these basic changes generally came about hundreds of thousands of years ago when humans lived in small numbers and clung together in small bands for survival. That situation, once the norm, is now present only in the rarest of circumstances. We have been bred for a time and place that existed eons ago, an era that could only be recreated through pandemics, global war, massive climate change, or some combination.

One consequence of this is the myriad institutional structures that perpetuate dominance of one group over others. The authors of a recent book on social dominance (Sidaneous and Pratto, 1999) make the case that our social psychology seems to propel us naturally towards oppression. Unfortunately at least for those of us who believe that racism and other insidious "isms" would make excellent candidates for the dustbins of history, there are several factors that help keep social dominance in vogue. The first is that there does seem to be a measurable propensity ("generalized ethnocentrism") that shows up in some percentage of any population for strong group identification; people in this group believe that their group is superior to others and that they must stick together. When in positions of power they generally promote laws and attitudes that favor their group over others. They will also encourage and cleave to a variety of "legitimizing myths," such as social Darwinism ("survival of the fittest"), manifest destiny, "clash of civilizations" (Huntington, 1993) and a myriad of racial, gender, and ethnic stereotypes, as "social frames" that help perpetuate social dominance. The second is that racial (and other) stereotypes are easily and readily (and subconsciously) learned, generally at an early age before advanced cognitive abilities come into play that could question the accuracy and the value of the stereotypes. Third, the stereotyping "trigger" is effortlessly and (again) subconsciously activated when "appropriate," thus making these people the hapless targets of manipulative politicians and others who can specifically reach out to these people with tailored messages. Finally, unfortunately, there is some evidence that people in dominated groups, due to a combination of factors, will in many cases, adopt characteristics that are specified by the stereotype thus helping unconsciously to reinforce the stereotype ("behavioral asymmetry"). All of these factors, then, help support, at least indirectly, the maintenance of institutions that operate under a variety of processes, mechanisms, and biases that serve to maintain the machinery of social dominance.

Once the holistic model that Sidaneous and Pratto propose (possibly with modifications) is well understood, it should be possible to run society's social domination machine’s "in reverse." Along these lines, it's important to note that according to many people who study this field, approaches to attenuating social dominance will require widespread, multi-sectoral actions that include integrated legislative, economic, and educational efforts among (and across) dominant and non-dominant groups. Here is a list of approaches that can be undertaken — while keeping in mind that articulation  between these approaches will be critical if any progress in reducing social dominance is to be made over time.

  • Role-reversal exercises (examples include "Walk a Mile in their shoes" where state legislators “became” welfare recipients for a day and an event in Wisconsin where youths in disadvantaged neighborhoods interrogated judges and police officers in a mock courtroom situation.
  • Additional research. Identify, for example, "markers” or other classification schemes that “sort” people into two groups and see how the "markers" are used implicitly or explicitly in policy, the media, etc. etc.
  • Development and promulgation of social frames like "love thy neighbor, turn the other cheek, human family, equal opportunity, and multiculturalism help characterize the theme.
  • Fighting local discrimination in, for example, education or public service.)
  • Moving beyond tokenism. There is evidence that hiring one or two people from a less-dominant group can actually backfire.
  • Childhood education. Children need multicultural education and familiarity with different cultures and groups. Seeing a diverse society at an early age and not growing up with active stereotyping is good.
  • Lawsuits as a tool to fight social dominance by business and government.
  • “Disciplining” the media by fighting stereotypes solidarity networks. Establishing networks of people from diverse communities to inform each other, advocate and Religious connection. Remind people of their religion’s commitment to human rights and brotherhood and would with in the church for social change.

 

According to Sidaneous and Pratto, "Arbitrary-set divisions" (those divisions devised by cultures themselves according to their own decisions like caste, religion, and race, unlike divisions shared by all cultures, basically gender and age, upon which to discriminate) "largely only occur in societies in which people are able to generate and sustain an economic surplus." These societies employ division of labor that, apparently, leads to various forms of arbitrary-set based social dominance techniques and institutions. One of the most difficult challenges of such a society is checking the power of its most powerful members.

While many people would argue (myself included) that some degree of social dominance will probably always occur in society, there are also many people (myself included) who believe that a meaningful attenuation in social dominance is not only possible but necessary. Fighting against social dominance will always be an uphill battle: the forces that will rally against your campaign are, by definition, powerful and well-financed, and cozy with the media, government, and other elites. They will also have a ready supply of slogans handy to bring their minions into the fray. Sometimes trumping our own "intrinsic nature" to favor "our own, ' and, even, going against what may seem like "our own best interest" (maximizing short-term gain at another's expense) is the best long-range approach. And approaches that are actually win-win should be accompanied with public education that pre-empts the inevitable claim that the approach is discriminatory.

Although social dominance may be intrinsic to humankind, there are some grounds for hope. Some countries, Sweden, for example, have more-or-less eliminated social dominance based on gender. Studies relating to health care in Japan, New Zealand, Denmark and Sweden, also show that proper health care can be reached for all of a nation's citizens even if some social inequality still exists within that society.

Solution: 

Serious, ongoing and engaged commitment to social non-dominance is the core to "solving" the problems of social dominance. A society that genuinely wants to reduce its own inequity is obviously more likely to actually adopt new policies and perspectives over the long haul than one who begrudges every dime spend on schools for poor people or health care for the elderly and the foreign-born. Understanding how the “machines” of social dominance function provides important clues for the development of a counter machine.

Verbiage for pattern card: 

Social dominance is at the heart of many of humankind's most shameful enterprises. It is sustained through ideology, economics, policy, education, the media, social perception and interactions, culture, and technology. Understanding how social dominance is maintained can provide important clues as to how it can be countered.

Pattern status: 
Released

The Good Life

Pattern ID: 
776
Pattern number within this pattern set: 
3
Gary Chapman
University of Texas at Austin
Version: 
2
Problem: 

"What is the good life?" An answer to that question has so many variations today that the competition between answers can often paralyze the imaginations of people who want to implement positive social change. How can one break through the noise and violence of such competition and begin moving global society in a positive and deliberate direction?

Context: 

People who hope for a better world feel the need for a shared vision of the "good life," a vision that is flexible enough for innumerable individual circumstances but comprehensive enough to unite people in optimistic, deliberate, progressive social change. Ideally, this shared vision of the "good life" should promote and sustain conviviality and solidarity among people, as well as feelings of individual effectiveness, self-worth and purpose. A shared vision of the "good life" is never complete, but is always adapting; it should be "in harmony with the human condition," which means that it encompasses suffering, loss and conflict as well as pleasures, reverence and common goals of improvement. An emergent framework for the modern "good life" is based on some form of humanism, particularly pragmatic or civic humanism, but with room for a spiritual dimension of the mind that does not seek domination over the minds of others. Finally, the environmental crises of the planet require a broad vision of a "good life" that can harmonize human aspirations with natural limits. And all of this needs to be an ongoing and open-ended "conversation," best suited to small geographic groups, such as towns and neighborhoods, that can craft and then live an identity that reflects their vision of a "good life."

Discussion: 

Ever since people first began to understand the implications of the time-limits of the human life, there has been speculation on what constitutes the best use of this time, a human lifespan -- in other words, what is the "good life?"

Throughout human history and even today, the answer to this question, for most people, is provided by God and by ritual. That is, the fundamental guide for how to live life is religion expressed through ritual, not only the formal rituals of religious practice but the small daily rituals of an existence permeated with conventions derived from religious guidance. For billions of people today, this is so ingrained in their psyches that doubt about what constitutes the "good life" is absent -- or else a personal secret.

But there is are many other meanings attached to the phrase "the good life." Aristotle argued that the good life is the "bios theoretikos," the contemplative life, in which the aristos, the "best man," spends his life contemplating the order of the cosmos and his place in it. This was transformed by Christianity into the life of the cloister, in which monks and nuns were meant to spend their lives contemplating the wonder of God's work. But it was also embedded into the practice of philosophy in the Western tradition, both metaphysical and otherwise, so that there is still today a strong Aristotelian association between the "good life" and the life of the mind.

It was in Renassiance Italy that Western thinkers first ventured a potential break between the idea of the "good life" and religion, by suggesting that the best example of a good life was a man of "virtu," or the earthly qualities of courage, deliberate action and command -- someone who would be remembered in history, rather than rewarded in heaven. Machiavelli derided Christianity as a belief of meekness and submission, while he advocated a robust republican humanism that celebrated worldly success and the ability to turn one's life into a kind of work of art, not unlike the famous works of art of his time.

The great break of modernity, the separation of modern thinking with that of the past, is the idea that the "good life" is a matter of individual choice -- "the pursuit of happiness," as the U.S. Declaration of Independence puts it. English rationalists, Marxian communists and even conservative thinkers like Edmund Burke all shared this premise: the goal of life is happiness and self-fulfillment.

Thus it has been the explosion of interpretations of the path to happiness that has produced so many competing conceptions of the good life. For many people today, the phrase "the good life" conjures up fantasies of unlimited wealth, leisure and luxury. This has certainly been the interpretation of marketers in a consumerist economy like our own.

On the other hand, for large numbers of people, the "good life" means simplicity and even austerity, an escape from the stress and bustle of urban life, pure air and water, the conviviality of a small rural community and good health. This is a model promoted by a series of books written in the 1930s by Scott and Helen Nearing, who moved to a farm in Vermont in 1932 and then published "The Good Life," a book about "simple, frugal and purposeful living," which was followed by more books and national speaking tours. The Good Life Center, a modern example of the Nearings' work, is still in operation in Harborside, Maine. Elements of this interpretation of the good life are now found in the "Slow Food" movement of southern Europe (and in some groups in the U.S.), and its spin-off in Italy, the Slow Cities (Slow Cittá) movement. This trend has even acquired a label: "downshifting."

The challenge of the current situation in the modern world is to develop the vision of a "good life" that is not anti-technological nor anti-spiritual, but which is serious about the limits of the global enviroment and critical of the emptiness, anomie and hectic "busy-ness" of consumerism. But cities are not going away -- they're growing, around the world -- so we need models of the "good life" that embrace urban living; indeed, population density is likely to be a necessity in the future.

There is an emerging concept of what might be called "reverent humanism," borrowing terms from philosophers Paul Woodruff (Reverence: Renewing a Forgotten Virtue) and Luc Ferry (What Is the Good Life?). This proposes a blend of rational and practical humanism with an appreciation of the transcendent, whether it be beauty, the law, or the ineffable spirit of human perseverance. Such a worldview depends on the support of a social context, a community of equals engaged in open-ended dialog that rejects absolute knowledge -- a modernized version of the res publica, the ideal of the Italian Renaissance. The inspiring ideas of the "Slow Food" movement bring in the pleasures of good food, drink, conviviality and ecological balance, while globalization and communications technologies -- especially the Internet -- make possible a sharing of innovations and the development of an appreciation for diversity and peace.

Solution: 

A revitalization of the idea of the "good life" should reinvigorate the ancient appeal of civic humanism, or "reverent humanism," that can embrace human potential, limits to consumerism but yet technological innovation, diversity and transcendence. The development of such an ideal should be a project -- explicit or implicit -- among groups dedicated to progressive social change. And "living the change you want" should become an essential part of the mission of all such groups.

Verbiage for pattern card: 

People who hope for a better world feel the need for a shared vision of The Good Life. The environmental crises of the planet require a broad vision of a good life that harmonizes human aspirations and natural limits. A framework for the modern good life should be based on some form of humanism with room for a spiritual dimension that does not seek domination.

Pattern status: 
Released

The Commons

Pattern ID: 
453
Pattern number within this pattern set: 
2
David Bollier
Author
Version: 
2
Problem: 

One of the biggest problems in contemporary life is the unchecked growth of market values as a way to govern resources and ourselves. This is resulting in the privatization and commodification or "enclosure" of the commons. Resources that morally or legally belong to everyone are increasingly coming under the control of markets. Not only does enclosure result in higher prices and the need to ask for permission to use something previously available to all, it shifts ownership and control to private companies. The market efficiencies that businesses seek can be illusory, however, because they often depend upon unacknowledged subsidies from the commons (for example, discount access to public resources) and the displacement of costs onto the commons (pollution, social disruption, harm to future generations). Enclosure does not add value in the aggregate; it merely privatizes value at the expense of the common wealth.

Context: 

"The commons" is a useful term for contemporary political discourse because it provides a new lexicon for re-situating market activity in a social and political context. It helps us identify resources that should not be alienated for market use, but should remain non-propertized and "owned" (in a civic or democratic sense) by everyone. Our culture has no serious vocabulary for contextualizing "the free market" in a social framework; it assumes that it is a universal, ahistorical force of nature. The commons helps rectify this conceptual problem by offering a rich, countervailing template to the market paradigm, one that can speak about the economic and legal aspects of a commons as intelligibly as its social and personal aspects.

Discussion: 

The commons insists that certain things should not be alienated that is, sold and converted into money. Thus, it is inappropriate to express the value of a worker's life or an endangered species as a dollar sum, in a cost-benefit analysis. It may be morally repugnant to sell off the "naming rights" of public institutions much as it is considered unacceptable to allow people to sell their bodies, babies, ova or genes. The commons gives us a language for talking about extra-market values and their importance. The commons, for example, allows us to talk about the human necessities of life food, water, fuel, medicine that may otherwise be seen as market commodities alone. The commons allows us to talk about the need for open, non-propertized spaces available to all; if too much of that space for example, scientific knowledge, musical works, cultural symbols is "locked up" through copyrights, patents or contracts, it can greatly impede future creativity and progress. We are already seeing the effects of such enclosure in medical research as a result of overly broad patents on "upstream" research. By contrast, when information and creativity are non-propertized and non-monetized as we see most frequently on the Internet the resulting collaborations and exchanges generate a huge surplus value that can be enjoyed by everyone, and not be privatized. This is one reason there is such an epic struggle underway on the Internet non-market modes of creativity and production are frequently more efficient in a strict economic sense, compared to conventional "real world" markets. There is a cornucopia of the commons, not a tragedy, as economists otherwise claim. Despite the different ways in which commons and market create value, the two do not necessarily operate in separate and distinct spheres, but are interdependent. The point is to strike an appropriate balance between the two so that the value-creating capacities of each can be optimized. There are a wide variety of effective commons-management models that belie the tragedy of the commons metaphor invoked by Garrett Hardin in his famous 1968 essay. While Hardin was talking about an open access regime in which no one owns or manages a shared resource, an actual commons has specific rules and social norms for preventing over-use, excluding outsiders, and managing the resource in long-term, sustainable ways. Increasingly, the Internet is the host for countless self-organized commons such as free and open source software, social networking communities, Wikipedia, Craigslist, and websites for sharing photos, videos and other creative works. One useful tool in creating these commons are Creative Commons licenses, which enable ordinary people to freely share their creative works while retaining copyrights for commercial purposes. The public library and the land trust are familiar, highly effective types of commons. More people are starting to realize that public spaces like parks, community gardens, farmers' markets and festivals are also important to the economic and social health of a community. There is a dawning awareness that commons-based infrastructure like wireless Internet access is a great way to use a public resource, the airwaves, to help people connect with each other. There are many other types of legal and institutional solutions for managing the commons, although most are not mentally grouped with other legal or institutional models as commons solutions. It is time for more people to see the kinship of these solutions and their holistic advantages over so-called free market.

Solution: 

Using "the commons" as a new discourse helps us re-frame the terms of discussion for many issues and declare our personal stake in protecting shared public resources. It helps draw new linkages among disparate market enclosures, and in this sense, helps fragmented public-interest constituencies develop a new, shared language. At the same time the discourse of the commons validates a number of specific governance models — civic institutions, stakeholder trusts, legal mechanisms, social customs and norms — that can help us protect and manage our common assets effectively. The emerging commons sector won't replace corporations or markets, but it will complement and temper them. In so doing, it will provide benefits corporations can't supply: healthy ecosystems, economic security, stronger communities and a participatory culture. And it will curb the corporate invasion of realms that we hold dear — nature, our minds, our food and our democracy.

Verbiage for pattern card: 

The human genome, seeds, and groundwater should belong to everybody —not corporations. The public library, community garden, farmer's market, and land trust are familiar and highly effective local Commons. The emerging commons sector provides benefits that corporations can’t provide such as healthy ecosystems, economic security, stronger communities and a participatory culture.

Pattern status: 
Released
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