Tag Archives: wellbeing

Antonovsky on Salutogenesis in Health, Stress, Coping

We’ve been doing so much work around social prescribing with Salford CVS, and salutogenesis is all over that literature. A concept developed by Aaron Antonovsky (1923-1994) for where the medical focus should lie: on how people become well, not on why they are sick. There’s some really good stuff in this sadly out-of-print book that I had to order on loan from the British Library.

It opens autobiographically — an intellectual history of Antonovsky’s work and the questions driving that work. I agree that this is the real question we need to be answering:

What are the stressors in the lives of poor people that underlie the brute fact that, with regard to everything related to health, illness, and patienthood, the poor are screwed? (3)

Given that, and all that follows, I can’t say it doesn’t trouble me greatly that Antonovsky moved from NY (and his work around studies of poverty and labour) to Israel, where it does not seem as though he undertook a study of mass Palestinian displacement into refugee camps or poverty or access to health care. Of course for him, understanding the echoes of the Holocaust in survivor’s health is clearly a driving question in his research, and this is where the example that he felt was foundational to his later theorising emerged from: In studying those camp survivors, he found that as a whole the group was unable to adapt as well as other groups to menopause. However, there were women within that group that adapted as well as anyone — so the question became to turn research around and ask why those women had adapted, and why they did so well despite their experiences? This led to what Antonovsky later came to call salutogenesis. Why people are ‘healthy’ not why they are sick. He makes the point that honestly, given how shit the world is, we should all be sick all of the time, so the real question becomes what is stopping that from happening?

It’s interesting, though, that the central concept of the book isn’t really this term salutogenesis, but what leads to it and ultimately what is at the foundation of health — what Antonovsky calls a ‘sense of coherence’:

a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected. (10)

This is what determines how well you deal with the daily bombardment of illness and disease. He also emphasizes that this is NOT the same as a feeling that ‘I am in control’. But more on that later.

I sit with this though. If this is true, then how thoroughly do we have to remake this world for health? Far beyond the policies I have seen Antonovsky quoted as a supporting reference for. For me, this becomes a new framework not only for the loss of my dad and many other people I have loved and lost to poverty and its many ills, but also for the millions of people now in hopelessness, precarity and movement across the planet.

Chapter One: Studying Health Instead of Disease

The problem of salutogenesis is one of the most mysterious, intriguing, and meaningful challenges for philosophy and the biological and social sciences… Pathogenesis–the origins of disease X, disease Y, disease Z–has preoccupied us … here, as in all of science, how one poses the question is crucial to the direction one takes in looking for the answers, (12)

We have looked for the origins of disease X, Y and Z and found them. He talks about the exogenous and endogenous bugs, the sets of agents that cause disease: ‘viruses, mutant cells, pollutants, or agents of physical trauma such as guns, knives, and motor vehicles, that pose a constant threat of damage…’ wait for it though, here it really comes:

And finally, there are those bugs variously called psychosocial stressors, presses, strains: alienation, rapid social change, identity crises, ends-means gaps, discrimination, anxiety, frustration. (14)

These are not, of course, considered working within a pathogenic model.

Our dominant ideological paradigm, which shapes our society’s clinical practice and scientific research, focuses on and responds to a particular disease or clinical entity. (15)

Near the end of the chapter, he gives three reasons why ‘the focus on pathogenesis is likely to handicap us in grappling with both the scientific problem of understanding why illness is far from deviant and the human problem of somewhat reducing pain… (my bullets, his words in what follows)

  1. the pathogenic approach pressures us to focus on the disease, on the illness, on the alteration of body fluids or structures, and to disregard the sickness… it blinds us to the subjective interpretation of the state of affairs of the person who is ill (36).
  2. thinking in pathogenic terms is most comfortable with the “magic-bullet” approach–one disease, one cure–which explains the resistance of many to the concept of multiple causation. … the assumption is that we are cleverer than the bugs and can eradicate them one by one (37)
  3. pathogenesis by definition is a model that postulates a state of disease that is qualitatively and dichotomously different from a state of nondisease…

And I’m going to separate this last bit of the paragraph out, because it better explains salutogenesis:

such dichotomization blinds us to a conceptualization made possible by a salutogenic model, namely, a multidimensional health-illness continuum between two poles that are useful only as heuristic devices and are never found in reality: absolute health and absolute illness. (38)

Chapter 2: Measuring Health on a Continuum

This returns to all the problems of thinking of health and illness as a dichotomy when the real question for Antanovsky is ‘Given the ubiquity of bugs, why does anyone ever stay alive and reasonably healthy?’ (39)

On epidemiology — I know it shouldn’t surprise me that the field of medicine is siloed within as much as without, and epidemiology is only one of those silos, and yet it does–he writes:

epidemiology is one of the major scientific disciplines that have developed in the service of the health care institution. There is no doubt in my mind that the epidemiological conceptualization of the health-illness phenomenon, the model or paradigm used by epidemiologists, is powerful and, for some purposes, far more powerful that the clinical model we have been discussing.

And continues, with bullets that are again my own

  1. epidemiologists are aware of the iceberg phenomenon. They assume, with adequate evidence, that for every case of a disease that has been brought to clinical attention…there are additional cases below the surface… (45)
  2. …they are kept in check by methodological sophistication and compulsiveness… [for clinicians] intuition, art and clinical skills are necessarily acceptable in arriving at a conclusion. The epidemiologist has the luxury of rejecting such subjectivism. (46)
  3. the sine qua non of the epidemiologist’s professional activity is to go beyond description and enter the field of analysis, to deal with causation. As such, it rounds out, complements, the field of laboratory and clinical research. But its core and strength are its understanding of causation as based on teh study of group rather than individual differences. (46)

Thus he gives the public health model higher marks than the clinical model (and I just read a splendid book about social epidemiology, but more on that later), yet it still suffers from this dichotomy of health and illness.

I was curious to find Antonovsky critiquing the WHO definition of health, not its utopian aspects but the way that it can’t be operationalized. He argues that this renders it harmless, and he might be right. He prefers Dubos’ definition of health (I am looking forward to reading Dubos) ‘a modus vivendi enabling imperfect men to achieve a rewarding and not too painful existence while they cope with an imperfect world (1968, p67).

Awesome definition, but I can see that not everyone would be inspired by that. Nor is this mapping of the continuum to inspirational either perhaps, but I found it useful:

As Antonovsky writes:

by defining health as coextensive with the many other dimensions of well-being, one makes the concept of health meaningless and impossible to study … Health wellbeing must be studied separately (68)

Chapter 3: Stressors, Tension, and Stress

Stressors are omnipresent in human existence … Poor tension management leads to the stress syndrome and movement toward dis-ease on the continuum. Good tension management pushes toward health ease. (71)

Everyone alive would agree with that statement. The list of stressors he gives:

accidents and the survivors; the untoward experiences of others in our social networks; the horrors of history in which we are involved; intrapsychic, unconscious conflicts and anxieties; the fear of aggression, mutilation, and destruction; the events of history brought into our living rooms; the changes of the narrower world in which we live; phase-specific psychosocial crises; other normative life-crises–role entries and exits, inadequate socialization, underload and overload; the inherent conflicts in all social relations; and the gap between culturally inculcated goals and socially structured means. (89-90)

Quite a list.

Chapter 4: Tension Management and Resources for Resistance

In moving towards an understanding of the foundations of salutogenesis, Antonovsky develops the concept of the Generalized Resistance Resource, or GRRs as those things that help keep us towards the healthy side of the continuum.

Antonovsky p 103

The principal individual characteristics include rationality, flexibility, farsightedness, but I’m most interested in what he calls Interpersonal-Relational GRRs, more generally known as social supports. These sit in opposition to social isolation — or what in those days seemed to have been termed ‘social isolates’ or ‘social destructs’. Goddamn, imagine being thought of as a social destruct. But we are finally working our way to understanding what Antonovsky means by coherence, ‘the GRR of deep, immediate, personal roots.’ (114) I haven’t read Malinowski since undergrad, but he’s cited here:

Malinowski says that culture gives each of us our place in the world…. In Chapter Three I defined a stressor as a demand made on one for which one does not have tan automatic and readily available response capacity. From this point of view, what culture does, in giving us our place in the world, is to give us an extraordinarily wide range of answers to demands. The demands and answers are routinized: from the psychological point of view, they are internalized; from the sociological point of view, they are institutionalized. (117)

A really fascinating way to think of culture in the abstract, but I can’t help but also think of the left’s too-often sneering attitudes to ‘identity politics’ and culture and struggle, and see how really this all ties in together. And just to repeat once again”

Ready answers provided by one’s culture and its social structure are probably the most powerful GRR of all. (119)

Chapter 5: Perceiving the World as Coherent

This is the central point of the book really, and the key idea for Antonovsky:

The sense of coherence is a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that one’s internal and external environments are predictable, and that there is a high probability that things will work out as well as can reasonably be expected. (123)

He doesn’t once, that I remember, quote Voltaire. It’s extraordinary. He continues:

A sense of coherence, as I trust has become clear, does not at all imply that one is in control. It does involve one as a participant in the processes shaping one’s destiny as well as one’s daily experience.

The crucial issue is not whether power to determine such outcomes lies in our own hands or elsewhere. What is important is that the location of power where it is legitimately supposed to be. This may be within oneself; it may be in the hands of the head of the family, patriarchs, leaders, formal authorities, the party, history, or a deity. The element of legitimacy assures one that issues will, in the long run, be resolved by such authority in one’s own interests. Thus a strong sense of coherence is not at all endangered by not being in control oneself. (128)

It’s all about power over your fate — and in fact by this argument participation in struggle could be as powerful and positive a health determinant as being lucky enough to be born in the upper classes. Of course, Antonovsky also describes the way that certain kinds of faith stand in as much good stead. There is so much to think about here.

He gives case histories of Norman Cousins and Freud himself as examples — you have to like that. In thinking about the conditions under which a strong sense of coherence emerges, Antonovsky notes that one line of research might be investigating  how in the case studies given, the ‘one common substantive theme … is the continuous experience of participation in shaping one’s fate‘ (152).

Chapter 6: Relation of the Sense of Coherence to Health

A long chapter that states that as the sense of coherence has not been operationalized and therefore not tested, he is simply bringing together evidence for a ‘prima facie case for the plausibility of the hypothesis‘ (161). I think he manages.

Chapter 7: the Salutogenic Model of Health

And now back to salutogenesis, along with a helpful summary:

In Chapter One, I posed the problem of salutogenesis. Chapter Two proposed a solution to the problem of the measurement of health status consonant with the salutogenic orientation. At that point, the core of the question was put as the need to explain the location of a person near the ease end of the health ease/ dis-ease continuum. Chapter Three considered–and rejected–the hypothesis that the answer could be stressor avoidance. In Chapter Four, an initial alternative answer was presented: the availability of generalized resistance resources. The initial question was also broadened to consider maintenance or improvement of one’s position on the breakdown continuum, irrespective of location at any given time. Analysis of the nature of generalized resistance resources, of why they are hypothesized to facilitate tension management and avoid stress, led to the formulation of the central construct of the book, the sense of coherence, considered at length in Chapter Five. The final building block in which I call the salutogenic model appears in Chapter Six, which presents the evidence for linking the sense of coherence and health status. (182-183)

An amazing chart here to summarise the model. I give it to you:

Antonovsky -- The Salutogenic ModelAntonovsky -- The Salutogenic ModelAnd of course, as I’ve probably failed to make clear, salutogenesis really needs to be the focus of our current age, not instead of pathogenesis but after pathogenic success.

There is, indeed, good reason for the pathogenic model to have dominated thinking about disease for most of human history. The three-pronged power of stressors…which included perhaps above all nutritional deprivation and the most primitive level of sanitation, was sufficient to overcome even substantial resistance resources. When, however, the standard of living…reaches a rough level of adequacy, differences in health level no longer are overwhelmingly determined by biochemical and physical stressors (193).

Chapter 8: Implications for an Improved Health Care System

This isn’t easy, this is no ‘guide to the perplexed‘ — Antonovsky says that twice. But he has a few suggestions. One is to think of the doctor as a GRR — each encounter between doctor and patient a way to support a patient’s sense of coherence. This is particularly important as each encounter will generally involve ‘anxiety, uncertainty, unpredictability and dependence‘ for the patient. Above all this is key after a traumatic situation, when someone finds themselves, as Antonovsky writes, as generally ‘shattered‘. However routine encounters also important. For the most part, those encounters which allow the physician to see and to treat someone as a whole with a sense of their broader self and context are the best.

Near the end of the book, Antonovsky asks: ‘Can the medical profession and the individual physician engage in activities beyond the patient-doctor encounter that affect the sense of coherence?’ Yes of course, and there are four ways this might happen: ‘making health care available to all, promoting a preventive health orientation, buttressing faith in the physician, and reaching out to persons at high risk of damage to the sense of coherence‘. (217)

One of my favourite sentences:

A society, then, that has institutionalized a health care system that expresses consensus that health care is an inalienable right of all its citizens and is to be made available to all on the universalistic ground of being  a resident of that society is a society that has taken a step forward in strengthening the sense of coherence of its members. (217)

Those blocked from this due to poverty or race or rural living distant from health care necessarily lack this sense.

Penultimate paragraph from the epilogue:

If we wish to see the present and future soberly in our world, we must use words like capitalism and totalitarianism.  The social structures in which most of humanity lives and the daily experiences to which we are exposed in these structure are far from conducive to a strong sense of coherence…Societies with a marketing mentality and fetishism of commodities, with terror and arbitrary recasting of history, with grinding poverty and starvation cannot foster a view of the world as one that provides information and music except for the fortunate few.

It would take another book and an extensive research effort to subject to serious analysis the concrete social structures and social positions that in our world foster a strong sense of coherence. Improvement in health status is contingent on such analysis and on a program of social action that could follow. This analysis is one of the crucial tasks of social epidemiological research (227).

He hopes this book is one of the tools that makes this possible, and I believe it is.

[Antonovsky, Aaron (1985) Health, Stress, and Coping. San Francisco and London: Josey-Bass Publishers.]

Learning from Civic Systems Lab: Designed to Scale

Civic Systems Lab - Designed to ScaleThe community garden is only one of many community projects we are looking to start up in my day job. Multiple linked efforts that will begin to create a strong, caring and supportive community here. Much of the inspiration has come from Civic Systems Lab, particularly Tessy Britton and Laura Billings, and it’s been wonderful to go through their team’s detailed (and free!) research report on The Open Works research project in West Norwood — just down the road from me now! If only I had moved a year earlier…

This report is for several different audiences — foundations like Lankelly Chase who helped fund it, politicians and government workers like those of Lambeth Council who partnered in this particular project and really should be funding similar projects in the future. For that reason it uses a certain language, but it also manages to be very geared towards those who wish to do similar things in their own community, particularly the last chapters.

It focuses on participatory culture, building on many years of work studying best practices and building this kind of connectivity — a most impressive work of praxis. Civic Systems Lab’s report on Open Works studied on a most basic level whether multiple small-scale community projects engaging people on a daily basis could create real and lasting change on a larger scale.

So much of my life has been spent assuming that that is so — and happily the report agrees. It notes, however, that neither government services and commissioning cycles nor top-down organisation of services operate to support such efforts. Rather they work (just as market forces do) to segment and separate people from each other — serving the elderly, the disabled, the Spanish speaking, etc.  Rather than building networks and collective efforts, they often destroy them to replace them with one-way relationships of dependency and service.

While I personally and politically am fully committed to full government funding for social services and a safety net, there were always fundamental issues with how these were delivered that no efforts to save them should ignore. We need full funding for better ways of creating healthy and caring communities — like this one. While this does actually fit into Cameron’s hated Big Society in many ways, it doesn’t have to — and this report for survival purposes I respect, has left either possibility open.

Civic Systems Lab – Designed to Scale

Their key findings in their own words:

  1. Building a dense participation ecology at scale is possible.
  2. A fully developed prototype of this dense participatory ecology is estimated to take 3 years to build.
  3. High levels of micro participation could be a key component for building local sustainability and resilience in a neighbourhood.
  4. Micro participation needs to reach a threshold to be effective. — early estimates are that around 10% – 15% of local residents would need to be participating regularly at any one time (c. 3 times a week) for multiplier effects to be achieved. This estimated level of participation greatly exceeds any current levels of participation through existing models.
  5. Two levels of participation typography are needed for the ecology to work… a fully developed participation ecology should consist of two levels of activity. The first level is a highly accessible and inclusive network of commons-based co-production activity built into everyday life. Building on this foundational level of mass participation in micro activities, the second level would see the development of community businesses, co-operatives and hybrid ventures through platform incubation programmes.
  6. Moving the centre of gravity through the platform approach has the potential to create a new collaborative model between citizens, government and other institutions.
  7. The estimated costs of building and maintaining a participatory ecology represent a low percentage of public spending for an area. (21)

Resilience

I don’t know when we forgot that a mutually supportive and connected community was key to our survival…perhaps when we no longer faced starvation and the need to build our own homes. But sometimes I feel like we are facing a starvation of the spirit here in the developed world, even as people starve in other places intimately connected to us through trade and consumption yet removed from our immediate knowledge. From exactly those places, the development literature grown around decades of aid (making little impact as you can see) has brought us terms such as resilience. It is still perhaps useful here, and will be ever more so through austerity’s bite and the onset of deeper poverty:

Resilience as an integrative construct

The construct of resilience offers a useful lens through which to discuss how neighbourhoods might be re-organised for both individual and collective wellbeing. People and families need to find ways to manage the ongoing ups and downs of life, and this is done through a combination of resources which are collectively referred to as ‘protective factors’.

Resilience resource indices include:

  • Biological factors (e.g. regular physical exercise, genetic resilience factors).

  • Individual factors (e.g. optimism, agency and executive functioning).

  • Interpersonal/family factors (e.g. secure family relations and close social ties).

  • Community/organisational factors (e.g. green space, volunteering).

The resources used to cope in challenging circumstances are not evenly distributed in or across neighbourhoods – perpetuating unequal access to resilience resources. (24)

I translate that in my mind to more concrete things like access to healthy foods and time for exercise, access to education and the ability to have power over your own life and the political and economic forces impacting you, close and supportive relationships that provide love and intellectual discussion and laughter, and a networked and supportive community.

I think that physical space should be separated from that as its own factor — access to nature, to growing things, to earth, safe and decent housing that makes you feel like you’re home, safe neighbourhoods that encourage you to spend time outside rather than flee, public spaces that encourage chance meetings and bring different people together, perhaps also transportation that ensure no one is trapped and all have good access to all parts of the city. All these things that Gehl, Appleyard, Whyte, Adams and Cullen among others describe.

An Ecology of Place

They don’t quite engage with that literature or work on space, but it fits in well with the thinking embodied in terms like ecology and ecosystems, it fits in also with thinking around networks and emergence, and the growing body of work on permaculture I’ve just started to dig back into.

Where roads and pipes allow for the efficient flow of transport, water and power, this participatory ecosystem aims to create a new and essential piece of connecting social infrastructure for our individual and collective wellbeing.

The report does bring us to the geography of it all — how place and people connect and the fact that ‘Resilient places support resilient people’. Hardly a surprise, though I am amazed at how many development experts consider the two to be separate. So returning to their thoughts on what a resilient place would look like:

An ecology of place:

The projection for a fully formed ecology after 3 years of development would see life experienced through the following participation opportunities:

  • Within a 5 to 15 minute walk from your home you would have approximately 140 opportunities every week (20 opportunities every day) to participate in free activities with neighbours. These might be in spaces on your nearest high street, or in kitchens, workshops or gardens on your own housing estate.
  • These activities would be practical, low commitment, low barrier opportunities that would be open to everyone, that you could decide to join at short notice, depending on your other home or work commitments.
  • These opportunities would be imaginative and creative project ideas, some of which you would find particularly interesting and which would also help you with your day-to-day life. For example, some projects could save
    you money through bulk cooking or bulk buying, you
    could learn new things and share what you know through
    weekly short lesson skill sharing, you could share, fix or
    make things that you need everyday such as equipment,
    food, clothing or furniture.
  • The network of opportunities would also include free regular incubation programmes which might help you cultivate new interests or livelihoods. These peer-to-peer incubators would allow you to develop your ideas without any formal qualifications and could lead to self-employment or employment.
  • Through these activities you would be able to get to know many local people in very informal and enjoyable settings. These people might be like you, but also might come from a wide range of backgrounds, ages and cultures, many of whom might have very different social and work networks, and these could be helpful for you to learn or progress to employment.
  • The new local community businesses, including collaborative childcare, energy, retail, or urban farming would create opportunities for you to balance your work and family commitments more easily and affordably.
  • For families there are projects, kitchens and workshops which enable you to make baby food, toys and clothing in social settings, which save you money and build supportive social networks and friendships.
  • Your new local networks would enable you to understand what public resources and benefits would be available to you, and help you easily access professional support when you need it. (26)

I love the illustrations in this evaluation/manual, this is just one example:

Civic Systems Lab - Designed to Scale
These diagrams ‘demonstrate how this ecosystem of social projects and activities creates opportunities for people to lead sustainable lives, through self-direction, and for producing direct, collective and networked outcomes for themselves, their family and the neighbourhood. (p 27)

I quite love their ambitions as well:

A UNIVERSAL VISION
Active, connected neighbourhoods as a universal ambition

People want to live in places where they know and like their neighbours, where they can do things together regularly, where they can help to create welcoming and safe communities in which to raise their children and grow old.

***

Through the participatory ecology described in this report, neighbourhoods could be re-organised not just for practicality, but also to be inspiring and exciting places to live: expanding our horizons, growing ideas and projects, inventing new livelihoods. Examples of which already exist.(28)

Civic Systems Lab - Designed to Scale

(29)

Not bad at all.

From a community organising background (and one more built around popular education, positive community projects and working with individuals and families rather than a focus on working through institutions to amass power to challenge power which is more IAF’s model), so much of this seems self-evident. Still, I know well from working with many service-providers that this is often opposite to their normal practice (and demands of funders and government and often academics), and key to emphasise how this differs just to be very clear:

  1. People participate on an equal footing
  2. There are self-directed pathways of progression from
    micro levels of participation through to employment
  3. There are new dense networks for friendship, support
    and resources, as well as opportunities to develop new
    skills informally… (30-31)

These networks and participation need to reflect the community and all of its diversity — a challenge in a world that works to effect the opposite. I write and obsess about racism, and there are multiple other factors involved here that such an approach needs to work hard not to sustain, much less to undo — and there isn’t a great deal here about to how to do that, but I think this is an approach that can begin to tackle these issues despite the challenges:

Traditional attempts have largely failed to bring people from a wide range of different backgrounds, with different abilities and cultures, into the same spaces regularly enough to develop the connections and friendships necessary to build large bridging networks.

Experience has shown that creating and sustaining dense and diverse networks is harder than it looks. The way our systems are currently organised shows that these relationships do not develop as naturally as we would hope or as easily as they once did. (42)

This is one place where I think we definitely need to put more work and thought.

Building Platforms and Building to Scale

They also start to struggle with scale — again for us as community organisers this was always a big issue that we never quite cracked and debated endlessly.

The challenge of scale
One of the key strengths of many new participatory models is that they are small scale in nature. Typically, practical activities are done in functional local settings in small groups – and it is these highly personal peer-to-peer experiences that are proving to build relationships and generate mutual benefits. Study of many of these successful projects identified that they offer whole sets of different outcomes, and that they are productive, imaginative and engaging at a time when interest in some traditional community activity is declining in many places.

However, despite all these obvious strengths of participatory culture, we concluded that participatory projects of this kind are unlikely to fulfil their promise to transform places and people’s lives if they remain scattered, unsupported and small scale.

The reality that when things get too big, their truly participatory nature becomes harder and harder to maintain. I think, however, a broad base of people used to this kind of ecology of daily participation in multiple smaller projects with multiple relationships of trust and respect in an area could make a much more participatory society work on many different levels. I think if we created it, we could much more easily start to talk about scale with some integrity. In its absence, everything seems a little hollow and I myself haven’t much hope.

I also like their idea of platform, as a goal, as a foundation, as a construct and invention:

The Open Works project set out to discover if we could invent a platform approach that would allow us to change a whole set of existing participatory infrastructures, and accompany this with a change process that could build a larger system of these small scale experiences. (42)

More on the platform idea, that I’m still trying to get my head around:

Platforms for participation and mutualism: Unlike many government or third-sector led projects of the past, the new participatory project and civic ventures don’t seek to involve people in processes or representative structures, but are direct opportunities for participation. They operate on a platform logic: thriving on uncovering, inviting and combining multiple, unpredictable sources of input such as dormant existing resources or ideas from multiple sources, rather than just focusing on creating new products. For example with overcrowded hospitals a platform approach would look to system redesign, prevention and needs reduction, a products approach would procure more hospital beds. The former is a highly generative approach, as the wide range of unplanned, indirectly facilitated exchanges between platform participants can generate independent momentum. (151)

The scaling ideas they present are really impressive, showing how small projects could grow or serve as groundwork for or even federate into larger, more transformative ones. Here is just one example around growing and energy:

Civic Systems Lab - Designed to Scale

 

A question of Agency

Much of the literature they draw on is far removed from that of critical theory (not surprising) or community building and organising or even health and wellbeing (a little surprising but not too much). I enjoyed it, and how it presented small snippets of unfamiliar theory that I found quite thought provoking around social change and democracy, like this summary of agency as described through social cognitive theory by Albert Bandura (2006), which ‘incorporates the concept of a humans are both products and producers of their environments.’ Lefebvre says that too of course, a major innovation of critical geography, and I wonder if there is cross-pollination there, but that is to digress. They quote Bandura at length and so shall I:

Social cognitive theory distinguishes among three modes of agency, each of which is founded in people’s beliefs that they can influence the course of events by their actions. These include individual, proxy and collective agency.

In personal agency exercised individually, people bring their influence to bear on their own functioning and on environmental events.

In many spheres of functioning, people do not have direct control over the social conditions and institutional practices that affect their everyday lives. In those circumstances, they seek their well-being, security and valued outcomes through the exercise of proxy agency. In this socially mediated mode of agency, people try by one means or another to get those who have access to resources or expertise or wield influence to act on their behest to secure the outcomes they desire. For example, children work through parents, marital partners through spouses, employees through labor unions, and the general public through their elected officials.

People do not live in isolation. Many of the things they seek are achievable only through socially interdependent effort. In the exercise of collective agency people pool their knowledge, skills and resources, provide mutual support, form alliances, and work together to secure what they cannot  accomplish on their own. People’s shared beliefs in their joint capabilities to bring about desired changes in their lives is the foundation of collective agency. Perceived collective efficacy raises people’s vision of what they wish to achieve, enhances motivational commitment to their endeavours, strengthens resilience to adversity, and enhances group accomplishments.” (123)

I quite love that definition of collective agency, particularly in thinking about organising and what so much of my life’s work has been about. It’s interesting arriving at these thoughts not through Freire or Horton or Camilo Torres, but social cognitive theory.

So, a recap from Civic Systems Lab on just what is key to these participatory projects:

Emergent: The projects we have studied have all been
started by citizens as ‘ordinary people’. Not primarily in
a formal role such as community organisers, or to make
money, nor because they were invited to by governing
authority or organisation, or given a pot of money to entice
them into action.

‘Live’ and ‘lean’ development: The initiatives are not efforts to compel some other party to solve a problem, but are
rooted in practical DIY ethos.

Oblique approaches: These initiatives develop oblique or
secondary ways of addressing social, environmental, and
economic issues. (150)

Scale: Most of these projects work on a local scale. They tend to be rooted in the very tangible opportunities and problems of people’s lived experience in local areas and the social networks embedded in them. (151)

I think DIY can only get you so far and sometimes you have to fight bad things, too often really, but it’s true that the building of positive local initiatives has not received nearly enough study or attention. In some ways I agree with this, being always optimistic about what local people working together can achieve — and utterly pessimistic about how long it will take it to be smashed. But that’s for another post maybe, the rougher things become, the more necessary these initiatives will become, and in imagining an ideal base from which to create a different world, I cannot think of a much better one.

This foundational research suggests that a radical re-think of our institutions needs to occur: because of their valuable multiple social outcomes, the autonomous activities of civic initiatives and ventures are worth supporting as a complement to current developments in public service reform and innovation. The challenge is to create structures and investment mechanisms that work with the grain of what citizens are already doing together in this domain. This will be an important next step in the evolution of the relations between the state, the market and citizens in the UK and beyond. There is growing case study evidence on how, at the scale of individual projects, neighbourhoods and whole cities, this evolution is already underway, giving ample cause for optimism. (132)

I found this interesting too, a curious mix of things that on the whole I’m not sure I agree with — and it’s paragraphs like this that make me feel most that I am not the intended audience as this is not a critical study, but a practical one demonstrating not just how to do this, but why it should be funded.

What characterises the participation culture and civic entrepreneurialism we are witnessing now is that it brings together the diverse values of civic society with the new approaches and culture of 21st century start-ups. Where in the 20th Century, civic action was frequently focussed on protest against the state or market, or on demands to be included and represented in government decision-making, the new citizen participation and entrepreneurship firmly focuses on seizing opportunities that make life better or create more enjoyable places through practical action. They are marked by innovative and energetic hands-on design processes and a DIY ethos, drawing on existing resources where possible – whether physical resources in the locality, online tools or collaborative relations with people.

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In sum, a ‘many to many’ culture has grown. People now have the access to tools and platforms to act independently of established players: market and state institutions, but also traditional local community power structures. (136)

I’m not sure what I think of ‘civic entrepreneurialism’. So I will let that go for now…and keep thinking about how this approach could lead to a deeper transformation of injustice and oppression in our society than such paragraphs allow. More nuts and bolts to follow, but this is already far too long…

For more on building social spaces…

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