Hilary Cottam: Participatory systems for the partner state

If the 20th century was the era of the global institution–the United Nations, the World Health Organization, the multinational corporation–then the 21st century will be the era of the participatory system.

Excerpted from Hilary Cottam:

(published for the Harvard International Review on January 1, 2010)

The UK’s Welfare State: An Outdated Institution

If we turn to the British welfare state, the canvas of my own work, the ways in which Illich’s predictions have come true are striking. Consider the field of health, where we see clearly an example of how simply investing in more professionals and buildings does not pay dividends. UK health spending has doubled since 1997. New hospitals have been opened, doctors’ pay has gone up, and patient waiting lists have gone down. And yet British society is not, on any indicator, healthier.

Such outcomes had ironically already been foreseen by William Beveridge, a 20th century giant and the author of the British welfare state. The Beveridge Report published in 1942 gave birth to a set of fiscal and institutional arrangements, including national insurance schemes and universal public provision of health and education, which were designed to tackle inequality and large social issues head on. These arrangements have since been exported globally.

These institutions have been remarkably successful at transforming British society. In the decades after World War II, Britain experienced significant improvements in levels of education, health outcomes, life expectancy, social mobility, employment opportunities, and prosperity. Internationally, institutions such as the National Health Service were widely admired and copied.

Despite these initial successes, however, Beveridge was less than certain. As he watched the development of his vision in practice, he became increasingly convinced that the system of institutions was encouraging citizens to be passive welfare consumers. He wrote a final, third report, concluding that his original reforms were encouraging individuals to focus on their needs at the expense of active contribution. The postwar welfare architecture, he argued, had both missed and limited the potential power and engagement of the citizen.

Of course, reform has altered the postwar model over the last 20 years, but it increasingly seems that these efforts have been fundamentally misplaced. The emphasis has been on the reform of outmoded institutions, rather than a much needed new approach to the often new problems. For example, training more health staff and building more hospitals, an extension of a 19th century model based on infectious disease, has been favored over designing systems which would support people themselves combatting preventative, chronic diseases (now 45 percent of the disease burden in the United Kingdom and United States) in their homes, communities, and workplaces.

Beveridge’s third report is the starting point for the work of Participle, an organization I co-founded three years ago, which has a mission statement called Beveridge 4.0. Our work is about building a new welfare state in practice–developing the thinking, the services, and the business models in a highly participatory manner. Our approach is about motivating deep participation to rethink big social issues. The results provide some practical examples of participatory systems.

Participative Systems in Practice

Consider aging. The so-called demographic time bomb is a global challenge, which the IMF predicts will dwarf the current financial crisis. By 2050 one in three people in the developed world will be over 60 (one in five globally). In the United Kingdom, this demographic shift is viewed almost universally as a source of panic because our 20th century welfare systems were not designed for a world where 60 percent of the population would be over 60. Indeed, the fiscal and social strains on our welfare institutions are already showing.

The policy dialogue has focused almost entirely on currently offered services and how to limit access through targets, gatekeeping, and so on–all of which are further sponges of limited resources.

What is striking about the UK over-60 population, however, is their wealth. They own over 80 percent of the United Kingdom’s financial assets and are a huge well of talent, time, skills, and knowledge. At Participle we asked what would happen if we built a system, with older people, which could pool this vast resource and support participants to live a rich third age. The result is Circle, a membership organization that is alive in London and from 2010 will be scaling nationally.

Circle is a concrete example of a participatory system and so warrants closer examination. Designed initially with 250 older people and their families, Circle is part social network and part concierge service. The system has a wide network of paid and voluntary helpers that help take care of members’ needs, from climbing a ladder to changing a light bulb, to accompanying someone on a hospital visit, to sorting someone’s paper work. Members also take part in a wide range of social activities.

Nothing is too small, too large, or too outlandish for the Circle team. Circle team members do not see themselves as running a traditional service but rather supporting a wide participatory network whose members range in age from their 50s to their 90s and who come from across the socioeconomic spectrum. Members do not sit on boards; they actively collaborate to shape Circle and its activities in real time.

A low basic membership fee encourages wide membership, while wealthier members have the option to pay more for additional support. This generates a surplus, which is then ploughed back into the network, whose legal framework includes an asset lock. At a time of financial crisis, Circle is actually multiplying the resources available on one shared platform, both monetary and non-monetary such as time and skills.

Emerging participative systems, like Circle, can be found across the globe. Successful participative systems are marked by development of a sustainable business model and combination of different types of knowledge and resources to provide a service or social solution. Examples include mobile farmer networks in Africa that combine world-leading science, economics, and local knowledge to extend farming techniques and achieve better market prices. Further, Pune University in India is radically extending the concept of a university to harness the participation of villages in developing both new ways of learning and communities of action. Interestingly, many of their efforts are targeted on climate change.

The Aravind Eye Care System, also based in India, is a different sort of participatory system from Circle, but one that also illustrates an alternative response to the 1950s institutional model. Started in 1976, Aravind is now the most productive eye care facility in the world, treating 6,000 patients a day, mostly in their own villages. Taking inspiration from McDonalds’ franchising (standard high quality product available to all) and a value system based on a spiritual consciousness that ensures both patient-oriented care and a highly motivated workforce, Aravind mobilizes the community as a partner to ensure that as many as possible are treated in their villages. Sixty percent of patients are treated for free, yet Aravind last year had a healthy margin on a US$20 million business. When comparable services are evaluated, Aravind costs 1 percent of the British National Health Service.

Aravind, like Circle, is an example of what Ivan Illich described as a good institution: “[They] encourage self assembly, re-use, and repair. They do not just serve people but create capabilities in them, and support initiative, rather than supplanting it.” Aravind’s manufacturing capability, started in a basement and based on re-use, is now a core and widely emulated part of the business.

The ways in which participatory systems, such as Aravind and Circle, can collate and generate knowledge are a key aspect of their transformative potential. Solving complex problems relies on rich knowledge networks. Circle combines the knowledge of international experts, professionals, and older people themselves. For the members, a rich third age means access to knowledge that is hyper-local and global: where is the most congenial place for a coffee and who has the latest thinking on Alzheimer’s. Modern participative systems are at once bottom-up and top-down.

They are also lateral and encourage surprising and fluid connections. Increasingly we are also coming to acknowledge that problem solving needs to combine not just different levels of knowledge, but different disciplinary perspectives. Recent decades have seen the startling global institutional dominance of the field of economics. The limitations of this disciplinary perspective are being recognized by economists themselves; consider, for example, recent interest in the field of behavioral science.

Since the birth of the 20th century global institution, there have been remarkable new intellectual developments in fields ranging from sociology and neuroscience, to the “psy” disciplines. But traditional institutions such as the welfare state and the policy paradigms within which they operate at best ignore and more often negate the potential of these insights into human emotions, despite the widespread understanding that emotions govern our motivations, provide insight into human relationships, and are the wellspring of our creativity. Aravind’s emphasis on spiritual compassion is interesting in this context.

Tim Brown, design thinker as well as advocate and creator of participatory systems, makes a simple but powerful argument about the importance of collecting knowledge together in these participatory ways.

Brown argues that the 20th century was all about convergent thinking–making choices through rational economic models, institutional funnelling through hierarchies, and dialogue through conferences. The 21st century will be about divergent thinking, creating new choices, developing new solutions through integrative thinking, and balancing opposites. His point is that we do not have the solutions to many of the big challenges we face this century. We need to go about creating them and we cannot do that if we play on the same canvas with the same tools. We need new ways of pooling diverse knowledge and tools that are simple to use and draw people in.”

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