Not Sentimentalizing Community

Pritpal S Tamber

October 2, 2019

He said it was all down to the bench outside. 

Whenever there was a tricky moment in the community center, he, as one of its leaders, would take colleagues across the street, often with cups of tea in hand, and work through the issues. There was something about being out of the building, being separated from their formal roles, that made it possible for them to work through even the most challenging of issues. 

There was no magic to the bench. It wasn’t more comfortable than other benches. The surroundings weren’t particularly picturesque. And yet, the process of walking out there, perhaps commenting on the litter in the street or the state of the neighboring houses, made it possible for him to find new ways to care for the community he serves. 

That’s a true story, and it came to mind last week as I spoke with Andrew Binet, a PhD student in the Department of Urban Studies and Planning at MIT. Andrew calls the above process part of the ‘infrastructure of care’. The idea came to him while watching social service organizations in Toronto, Canada, respond to a massive regeneration program in Regent Park, the country’s oldest and largest public housing estate. 

“I set out to study how [social service] organizations weathered the rapid and drastic changes in the social, economic and built environment of the community”, he says. What he found was that the organizations scrambled, fought, and built. 

They scrambled to stabilize residents as their lives were disrupted. They fought for space for the community to grieve about lost homes and maintain community ties. And they built political capacity and economic opportunity for residents.

“I spent a long time confused about what to call what I was witnessing”, he admits. But then the penny dropped. This process, this scrambling, fighting and building, was, in fact, ‘care’ – the term is as applicable to how the organizations act as it is to the outcomes of their actions. And he saw that their actions effectively mediated between the developers and the residents. 

The role of the social service organizations wasn’t planned for. They simply stepped in, despite often being under-resourced and over-worked, because they knew it’d be important for residents’ health and well-being. Andrew, as a planner, sees this ‘stepping in’ as the flow and distribution of an essential resource – care. He describes this view as an infrastructural approach.

“We typically think of infrastructure as physical networks facilitating the flow and distribution of goods, such as water or electricity, or people through space, such as roads. If we understand care to be an essential resource for health and wellbeing, then there is arguably much to gain from taking an infrastructural perspective on the networks that care is dependent on.”

As Andrew knows, he’s not the first to explore the networks that care is dependent on. In 1988, the radical general practitioner (primary care physician), Julian Tudor Hart argued that, although communities were fraying, they still existed and health care needed to remember that it is only an “adjunct” to the “self-organised mutual aid” that arises through social cohesion. 

But Dr Hart, a pioneer in tackling the social causes of sickness, warned against “sentimentalizing” the role of community. In his view, the aforementioned social cohesion in industrial communities was the result of “a necessary unity” required in the “struggle with ruthless employers”. Many of those employers have disappeared as high-income countries have de-industrialized, not only taking with them jobs but also an important catalyst for social cohesion. 

He also encouraged us to truly understand how ‘care’ was possible – as he describes it, through “the army of unmarried women who previously gave lifetimes of underpaid or completely unpaid service to aged parents, the chronic sick and the surplus children of their married brothers and sisters”. This army no longer exists, partly because families are smaller and more women have entered the workforce. 

Dr Hart’s book chapter is not an easy read. Committed to social justice and inspired by Karl Marx, he argued that because “effective clinical medicine is not possible without a community dimension” primary care should be overseen by the local community. He went as far as postulating that this “participative democracy” approach might even help to prevent the “de-civilization of society”. 

You’ll have to read the chapter to better understand why he says that. Some of you may balk at the idea of reading something under the banner of the Socialist Health Association. I have to admit that it made me uncomfortable. And yet, I also have to admit that as a winner in the inequitable status quo of health, it is only right that I’m uncomfortable now and then. 

In August, I published my own contribution to creating discomfort – an updated version of our tool to apply the 12 Principles to your community health work (you can read the introduction here and download the full tool from here). I gleaned the principles from over 100 community-oriented practitioners and what they point to is the profound imbalance that exists between the health sector and communities.

Socialism. Imbalance. Scrambling, fighting, building. This week’s newsletter is not an easy read. And yet, getting to the solutions may not be as hard as it seems. If you’re in a community health meeting this week, ask yourself if you really understand the infrastructure of care in the community that you’re an adjunct to – and whether a bench might help.

Further Reading 

Previous issues of Community & Health

Recent Interviews

The photo behind the title is by Eric X on Unsplash (but it’s not the actual bench).

Pritpal S Tamber

Independent Writer, Researcher & Consultant | pritpal@pstamber.com

I'm an independent writer, researcher and consultant focussing on community health and medical information. I'm a former physician, medical editor and medical publisher, and also the former Physician Editor of TEDMED. I began my career at The BMJ. For more information, see the About page.

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