An open a discussion on the future of Cape Town cannot ignore the theme of healthcare. The consequences of which are not theoretical but practical, and in some cases mortally practical.
Antonio Bonaldi, a doctor, public health expert and founder of Slow Medicine in Italy, reminded us that health is made up of 25% of medicine and the remaining 75% is life. (1)
Life concerns our lifestyles, nutrition and the quality of the food we eat; it concerns the quality of our living conditions and our transport; it’s about the quality of the air we breathe and the water we drink; it’s about the jobs we do and in what conditions we do it.
Health is also affected by the quality of the information we receive because what information we receive impacts our ability to access and use health systems. Access to information is linked to our social relationships: who we know, who can help us in times of need, who has the knowledge and skills to help us understand the situation how to use available resources. Health is therefore also a form of social capital.
Health as a Social Capital
I attended a webinar organised by Vishwas Satgar entitled: Learning lessons from Kerala’s Covid-19 response. (2)
Two passages remained in my mind from the Dr T.M Thomas Isaac, Minister of Finance of Kerala presentation:
- Kerala’s government structured the creation of local governments through citizen participation in the definition of Local plans. People gathered and collaborated in the common definition of what to do in their local communities.
- Kerala’s government has structured its health system (one of the best in India) around local government and local plans, generating a high level of people’s trust in these services. The new budgetary allocations gave local governments control of 35 to 40% of the state budget (3)
The minister also told an interesting story. At the beginning of the emergency COVID-19, the central government of Kerala had given directions to the local government to start local soup kitchens to give food to those who need it, including immigrant workers. After this announcement, the government was discussing how to create a support system for soup kitchens but instead found that in a few days the local soup kitchens were working on their own. They had found the volunteers and support for food from citizens, associations, social movements and local business, in other words, they set up their system without waiting for the government. The minister concluded by saying: “Kerala has spent its social capital to deal with this crisis”.
There are two different approaches emerging on the international scene for tackling the COVID-19 crisis:
- One approach is based on total control of the State apparatus. It involves a worrying mixture of the State Health Services, the police (and/or military) and large multinational IT companies prescribing procedures and apps used to control of peoples’ movement.
- The second approach is based on the construction of local networks that nurture accurate and widespread common knowledge of the local situation. Similar to the Kerala example above, this knowledge is based on trust and collaboration, building systems that are effective without needing centralised control systems. Rather this common knowledge encourages democratic control over the information collected and its use.
Obviously this a schematic description. Many countries swing, often confusedly, between these two approaches.
Local health and wellbeing plans
A Local health and wellbeing plan is local because it starts from the local level, it is not the adaptation of the local situation into a predefined scheme, there is no “model” of Local health and wellbeing plans to be applied. The path is reversed, it start from local communities, looking at peoples experiences of healthcare, its strengths and failures. Local community members talk to each other and common elements are found, and possible synergies are examined and chosen. Through this process, which is a social weaving process, a Local and City Health and wellbeing plan can be outlined.
A Health and wellbeing plan can be conceived as a pair of glasses to collectively observe and ask questions like: what does health and wellbeing mean to us? What does partnership and collaboration mean? Who is absent, and why are absent, from this conversation? What skills and knowledge do we have collectively (nurses, doctors, therapists, epidemiologists ….) and which are missing? How can we find new knowledge and new skills? What can we learn? What should we ask others to do (Public Services, Government ..) and what can we start doing without having to wait for anyone?
Looking at things with different glasses helps us to see things again, to question, again, ourselves. A recent example of looking at health differently can be found in the Cape Town Together concept of Community Care Centres: a “home away from home” for people to safely self-isolate in their own neighbourhoods (see more at: https://cancaretogether.net/). It is important to note how some communities have started to self-organise to plan this new service and to find professionals to assist with health aspects and training.
Starting a process of defining Local health and wellbeing plans is a way to start making these relationships and stories visible, to change them and find new ones activating resources and actions in the field of health and wellbeing. They also create social capital. By social capital I mean the ability of social groups to build social relationships and personal relationships based on trust, on shared values, on shared sense of identity, and reciprocal forms of cooperation. Social capital represents all these shared resources, both tangible and intangible. Maybe it’s just a matter of making visible what’s there, or of seeing better the existing activities in order to change and/or improve it, or creating new relations where they don’t exist.
Visions and prefigurations
It is important to start from the bottom, from local practices and knowledge, from possible actions that respond to needs, but it is also important to imagine a different future.
“I want to stress that campaigning against privatisation is part of what we call in the feminist movement “prefiguring” an alternative. That means creating experiences in the present of the future that we would like to see, just as in the women’s movement we created changes in our lives that illustrated a future where men and women lived together equally. The successful campaigns against privatisation have been where public service workers collaborate with the users of the services and the communities to show how that service or common good could be managed and organised in a democratic and in a truly common way. This is vital to avoiding a situation where people’s understandable hostility to the existing state leads them to support privatisation, imagining there is no public path to reform.” Hilary Wainwright, Speech given to social movements in Greece, February 2013.
Possible visions and prefigurations:
- Build a Community Care Centres (CCCs) network
Advocate for the creation of network of GP doctors (beyond the private market) paid by the health system, or a system in which doctors can accept patients who are unable to pay whose costs are covered by the health system
- Create solidarity systems on a local scale a sort of local Collective Insurance or a Common Health Care.
- Reevaluate of the Health Committees not as a separate committee but as a point of the local network that connect the communities with the local clinic
- Establish partnerships, where possible, with all public services and individual professionals who are available to collaborate with local communities.
- Implement experiences of Community Foundation and social cooperatives to create community services that allows to enhance volunteering, but also create sustainable solutions and a job opportunity in the long term.
The responsibility and task of building Social Capital in Cape Town belongs to all of us. The ways and methods of this construction are varied, different and often unpredictable. In other words, a beautiful opportunity to change.
This is a second article, here the link to the first one
- Web-meeting “Verso un’ecologia della salute” [Towards an ecology of health] with Antonio Bonaldi and Roberto Romizi 18 June 2020
- Public Webinar: Learning from Kerala’s Covid-19 response – recording https://youtu.be/fVWpy4wrhbI
- Kerala, India: Decentralized governance and community engagement strengthen primary care https://improvingphc.org/promising-practices/kerala