By Winne van Woerden
For most people, healthcare is hospitals, nurses and the smell of antiseptics. Healthcare makes you think of professionals, in big buildings and institutions, for which you need years of training. But healthcare is about health and care and it is a much richer field of practice. In fact, once you start looking for it, you will notice that the act of caring is something that occurs at many places in society, both within and outside the formal healthcare system as we know it.
Last year, I collaborated with Commons Network to better understand the features of this informality in healthcare in the form of so-called ‘commoning practices’ at citizens’ initiatives in the Netherlands. We wanted to learn about the future of health and care in a post-growth society. In other words: a society that is by design not based on the premise of continued economic growth.
Today marks the kick-off of a series of blogs called Rethinking Healthcare at the End of Growth, which we will publish every two weeks. In May, we will officially publish our findings in the form of a report. In the meantime, we hope to hear from you with feedback, insights, tips and new ideas about this interesting and emerging field. Reach out to us at @CommonsNetwork on Twitter or by following our newsletter here or send us an email at thomas @ commonsnetwork . eu.
Post-growth thinking
An ideology based on the pursuit of continued economic growth is harmful, for the planet and for our health. More and more people are realising this now, fortunately. Activists, policy makers and scholars all over the world are exploring alternatives to growth-centric politics, towards a vision of ‘post-growth’. There is a movement of people who are rethinking and redesigning society beyond the hegemony of growth, sometimes called ‘degrowth’.
In essence, degrowth proponents argue that the pathway to a future of increased human well-being, social justice and enhanced ecological conditions is to be found in a democratic and redistributive downscaling of the biophysical size of the global economy. As such, degrowth can thus be understood as a paradigm for envisioning a process of socio-ecological transformation centered around the key values of care, autonomy and sufficiency.
Source: https://www.act.gov.au/wellbeing
As a fast-growing movement, degrowth currently brings together a wide variety of people, from academics to activists, around the world. Degrowth-thinking has many similarities with other post-growth lines of thinking that are becoming more popular these days, such as doughnut economics and well-being economics.
Creating snails in rich nations
It’s crucial to understand that degrowth advocates are specifically focusing their attention towards wealthy, high-income nations, the Netherlands included, calling on them to fundamentally decrease their energy use by shrinking the material throughput of their economies. In doing so, degrowth puts the cause and thus the solution for today’s interfering social and ecological crises in the hands of rich countries in the Global North, where economies are, as is well documented by now, severely overshooting the boundaries of the planet.
Furthermore, rather than simply arguing for the reduction of resource throughput and a top-down shrinking of GDP, degrowth implies the creation of a society with a metabolism that has a different structure, with new modes of organization that serve a new function. In other words, degrowth is not about making an elephant smaller (or shrinking GDP), it is about turning an elephant into a snail (or rejecting GDP as an adequate measure of societal well-being).
The elephant and the snail of degrowth, from: https://vocabulary.degrowth.org/
Degrowth aims to improve human well-being in its pursuit of designing an economy that is socially just and ecologically safe. Yet, the field of health has received little attention in the degrowth-scene. Little is known about what a degrowth transformation could mean for how we think about health and how we organize healthcare. What we do know, is this: during the socio-ecological transformation towards post-growth, all of society’s structures will need to be rethought and restructured, and the healthcare sector is not an exception.
The act of commoning as an alternative to growth
You may be wondering: Are there places where degrowth is put into practice? And if not: How do you study socio-ecological transformation and utopian thinking, when there is no place where degrowth exists?
This is where the act of commoning enters the equation. The fact is that all around the world, including in the Netherlands, examples can be found of people self-organizing where they live to take action on issues that concern them as a community, forming community-led, community-based citizens’ initiatives (CI’s). The social practice of organizing oneself around these self-defined community needs is what can be called the act of commoning. The ontological narrative revealed by this practice is the commons.
The commons and the act of commoning repeatedly pop up in literature on degrowth when so-called degrowth alternatives are being discussed. As one of the leading thinkers of the degrowth movement, Georgio Kallis, writes in his latest book In Defense of Degrowth: “As the formal economy is falling into a social and ecological crisis, degrowth alternatives are flourishing. (…) The commoning practices that can be found at these different initiatives display various facets of degrowth”.
The commons narrative provides the degrowth paradigm with essential vocabulary for making the story about socio-ecological transformation tangible and rooted in real-life practices. In the Dutch healthcare domain, we see many commoning initiatives and other innovative practices. If we want to understand what a degrowth transformation could mean for the field of health and the organization of healthcare, exploring the various commoning initiatives in the healthcare sphere thus seems like a good starting point.
Source: https://degrowth.org/
At Commons Network, that is exactly what I did. Last year, while an infectious disease was bringing the global economy to an involuntary standstill in a brutal and unjust way, we set up a study aiming to answer the question: How is the act of commoning translated into the domain of healthcare at citizens’ initiatives in the Netherlands and what does this mean for the organization of healthcare in a transformation as envisioned by the degrowth paradigm?
We performed a qualitative explorative case study with five citizens’ initiatives, all part of the Dutch national network for citizens’ initiative on care, housing and well-being, or NLZVE (short for ‘Nederland Zorgt Voor Elkaar’ or in English: The Netherlands Cares For Eachother) and spoke to several experts working on the topic of our research.
Sharing stories
There are many definitions of the commons and commoning and even more suggestive experiences and instructive patterns, but as Bollier and Helfrich write in their phenomenal book Free Fair and Alive, “the best way to become acquainted with the commons is by learning about them through real-life examples”. I have thrown myself into this learning process. In the upcoming months, I will take you with me on my journey of getting to know the Dutch healthcare commons. A world full of solidarity, cooperation, reciprocity and caring.
But before we get to the inspiring practices, I will first give you some more background about the theoretical foundation of this study, starting with next week’s blog about the degrowth paradigm and how it relates to the field of health. For now, I hope I sparked some curiosity in you and I hope that you will stay in the loop. If today’s article already gave you some thoughts you’d like to share with me, please do! Reach out to us at @CommonsNetwork on Twitter or by following our newsletter here or send us an email at thomas @ commonsnetwork . eu.
By Winne van Woerden