Op-ed: How neglect of community undermines everything we value

Michael Rohwer, MD, is the Executive Director of Curandi. He wrote the following op-ed on the importance of community and collaboration in driving change in health care. 


Community is the source of all human value; there is no financial, physical or social capital without the human capital grown in communities. Yet since the 1980s we have systematically withdrawn direct support of human development within that most precious space. As a result, our ability to grow human capital as measured by the Institute for Health Metrics and Evaluation fell from 6th place in the world to 27th between 1990 and 2016. If a farmer does not improve the soil in which his or her crops grow, the harvest gets smaller every year.

Derek Cabrera, a system scientist from Cornell says, “All problems result from the mismatch between how real systems work, and how we think they work.” We got here because we paid too little attention to scientific principles and knowledge, and too much to unscientific economic theory.

 

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The completely backward idea that nature creates value through competition more than cooperation led to a detrimental reengineering of healthcare. As a result, we have the most expensive underperforming system in the world. The October 7, 2019 issue of the Journal of the American Medical Association, “Waste in the US Healthcare System,” examines six domains of waste that account for 25% of total health spending, and an accompanying editorial notes the lack of progress toward improvement.

There are many other places where we see the same mismatch causing trouble. The low labor participation rate and the increase in the number of people who have become unemployable, for example, as well as wealth inequality reaching levels not seen since 1928.

The ability for average people to get ahead is also getting harder. A world bank report in 2018 found upward mobility falling to 40% for a child born in 1980 – down from 90% when I was born. Data from the Pew Research Center shows the steady growth of poverty, with 29% of people in the U.S. at the bottom.

A social storm is forming. The American dream is dying. Think of community as a system like a biological ecosystem and it’s easy to understand that too many weak connections can cause cascading failures and lead to catastrophe. But we still have a chance to right the wrongs and undo the damage – if we begin paying attention to the importance of community and how it works as a self-organizing, complex adaptive network.

This begins with seeing relationships as the foundation of everything. At every level of nature, we find the elements of our world emerging from the intersection of relationships; just as you and I were born from the relationships surrounding and between our parents. Everything we know is part of the same network in which everything is connected in some way to everything else; ideas, things, animals, plants, other people and more.

We must therefore shift our emphasis away from competition, which has fragmented and pitted community services against each other in a zero-sum game for limited resources and inconsistent, short-term funding that prevents strategic planning.

If we instead emphasize collaboration around common goals, we can more effectively work toward changing culture and policy to support direct funding of human development. This can only be achieved if we start with an economic model grounded in empiric reality and informed by the science of networks, and implement change using systems tuned to the unique needs of each community.

We must also focus our work on important, measurable results and strive for alignment of goals more than alignment of service. The components of human capital formation, when connected to their downstream capital generation, could then become monetizable and support sustainable community business models.

The good news is that the foundational technology needed to create tools that will help us see and manage the world differently already exist. The last 20 years have produced a revolution in systems thinking and network power. All around us, we see networks hotwiring reality in ways that drive change. It is well within our capability to efficiently apply these technologies to building adaptive networks that support community collaboration and take advantage of the natural complexity of community.

But this won’t happen spontaneously; it will require coherent leadership in both the private and public sector. We can begin by creating a “Learning HUB for Community Systems.”  Rather than an enormously expensive, competitive, hierarchical model of healthcare, such a HUB would instead use the science of systems and the power of networks to collaboratively approach health – creating an ecosystem that creates real value, not just money.

Attend the Oregon State of Reform Conference Nov. 12, 2019 to learn more. I will be discussing the concept of “Whole Community Integration” with co-presenters Ted Quinn, CEO of ACT.md, and Josh Graves, deputy executive director of Catholic Community Services. We look forward to having you join the conversation – and the movement to revolutionize community care.