I was struck this week by an insightful essay in the Financial Times on the new £188m library that has been opened in Birmingham, England. The bit that got me was a quote from Brian Gambles, the library’s project director:
“When the public library service started in the 1850s, it was about how to give opportunities to those who didn’t have opportunities to learn through the formal system. Over time we lost that and the library became about transaction, about finding and borrowing products. That transactional function is withering as there are now so many more media than just the book.” (Bold by me)
There are parallels to health and health care here. Increasingly available health care has given people the “opportunity” to enjoy good and sustained health. But as we have become more and more accustomed to health care’s availability, perhaps we have started to take it for granted such that we see it as a mere “transaction” – I’m sick, give me something.
Seeing health care as a transaction makes health an end in itself. But that doesn’t make any sense. What matters is what you do with your life assisted by good health. Going back to the library, although one can learn for the sake of learning, more often than not we learn in order to share and apply our knowledge; we do things with it. If health becomes an end in itself, we lose perspective on what it’s for.
Earlier in the essay, Gambles says:
“[The library] must be inclusive, transparent and inviting – a public space in the city which is welcoming to all.” (Bold by me)
One can draw an obvious parallel between the library and hospital here (they should both be inclusive, transparent and inviting) but I am more inclined to think about health than health care. Is it the case that health, like knowledge, is somehow a “public” good? And if so, what does it mean for our responsibility towards our health and the health of others?
I have a romantic notion that “traditional communities” considered one’s health a societal responsibility and found ways to take care of one another. To help me steer clear of romance, Naomi Adelson, a medical anthropologist at York University, Canada, has joined the Wellthcare Explorers. The Explorers are going to debate whether there is health-related value in intimate communities (or “nano-networks”, as I have started to call them). Naomi not only studies the cultural meanings of health in traditional communities but also how they might use e-health making her insights a fascinating blend of traditional and modern.
Finding people willing to debate a new idea is not easy. Most people think you're crazy, although they usually mask it through polite encouragement. Some express their concern by sharing numerous articles with you, perhaps to suggest the idea is not new or to tidy you into an existing concept. And yet we really do need new ideas in health and health care.
Luckily for me, straight after launching Wellthcare’s website and receiving “polite encouragement” and “numerous articles”, I went to TEDMED to start the editorial process for the 2014 event. In preparation, I read Imagination First, the excellent book by Liu and Noppe-Brandon on “unlocking the power of possibility”. Their over-arching argument is that imagination precedes creativity and innovation, and that we don’t imagine enough, which is why our innovations are only ever incremental.
I was intrigued by this quote from the book:
“There is nothing like knowing it all to kill the imagination…what we know constrains our ability to imagine what we don’t know.”
This pretty much describes how Wellthcare has been received to date. I don’t say this in acrimony or accusation, but it does make me wonder what happened to our willingness to imagine in health and health care, and what the consequences are of being mired downstream in “innovation”.
Liu and Noppe-Brandon talk of the need to create the right environment for people to imagine and this idea takes me back to Birmingham’s new library and its project director, Brian Gambles:
“We need to make [the foyer] a landing strip for people who may not be culturally attuned to using a public building.”
The foyer, or “landing strip” as Gambles called it, has been designed to help people re-learn that libraries are not just transactional places, they’re places with civic value. Do we need something similar to remind ourselves that health, like knowledge, is somehow a “public” good?
The problem with talking to people in health care about leveraging civic value is that their patriarchy comes shining through. When I described Wellthcare to an academic in health care last week he replied: “Yeah, but the problem is people put beans up their noses to cure kidney cancer”. My answer is perhaps they do, but it’s their beans and their nose; it seems to me they can make whatever decisions they want. Perhaps, going with my earlier question, they should consider their health from a civic perspective (someone could have eaten those beans!) but is it the health care’s industry to tell people what’s right or wrong?
Health care likes to believe it knows what’s right and yet it’s an industry that rolls out things like proton beam accelerators to treat prostate cancer, even though there appears to be no known medical value over cheaper alternatives. Can we really abdicate our thinking to an industry that makes such decisions on our behalf?
For me, it’s time to open the debate up, to create the public space in which we can imagine. It’s only by doing that will we be able to create the opportunity to see health in a new light, beyond a mere transaction in the health care industry.