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Modernity is characterized by social complexity, the development of the nation state, disembedded processes of market exchange, an intrinsic logic of growth, increasing throughputs of energy and materials, and an expanding range of environmental impacts. Modern health systems reflect, at every level, the process of ‘disenchantment’ associated with...
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... There is significant potential to re-tool existing approaches for sectoral cost-effectiveness analysis for healthcare (long used in low and lower middle income countries) to support targeted degrowth of lower value healthcare while retaining and strengthening essential and high value services. Hensher and Zywert (2020) and Zywert and Quilley (2018) consider the challenges of maintaining essential functional levels of complexity in healthcare systems while wider societal complexity may be reducing, recognising that difficult choices and prioritisation will be inevitable. ...
... These building blocks will remain essential requirements for functional health systems in any of the foreseeable post-growth futures outlined above. Indeed, under collapse conditions, states and public authorities will need to fight even harder to maintain some basis for each of these building blocks, so that there is some foundation for rebuilding, "catagenesis" and creative renewal (Homer-Dixon, 2006;Zywert & Quilley, 2018). ...
... The possibility of involuntary degrowth arriving unannounced and unplanned always remains a plausible scenario. Different voices flag the ever-present risks of ecological and climate overshoot and tipping points (Steffen et al., 2018), of delayed action (Garrett, 2012) and system failure (Bonaiuti, 2017), all of which could plausibly lead to breakdowns in social and economic systems and a "massive reduction of institutional complexity" (Zywert & Quilley, 2018). Implications for health are relatively obvious, given the preceding discussions -ranging from the potential failure of long-established public health measures to control infectious diseases, through to significant unravelling of medical capabilities, both technologically and institutionally (Zywert & Quilley, 2018). ...
... Thus, it presents a serious challenge to both neoliberal/neoconservative right-wing politics (market liberalism) and the internationalist, cosmopolitan, and global solidarity of the left (social liberalism). The potential of the domain of informal, embedded "livelihood" economies as balance to the market-state resonates with both radical green political economy in the tradition of EF Schumacher, localist conservatism, and social catholic distributism [23,26,74,75]. ...
Environmentalists have long warned of a coming shock to the system. COVID-19 exposed fragility in the system and has the potential to result in radical social change. With socioeconomic interruptions cascading through tightly intertwined economic, social, environmental, and political systems, many are not working to find the opportunities for change. Prefigurative politics in communities have demonstrated rapid and successful responses to the pandemic. These successes, and others throughout history, demonstrate that prefigurative politics are important for response to crisis. Given the failure of mainstream environmentalism, we use systemic transformation literature to suggest novel strategies to strengthen cooperative prefigurative politics. In this paper, we look at ways in which COVID-19 shock is leveraged in local and global economic contexts. We also explore how the pandemic has exposed paradoxes of global connectivity and interdependence. While responses shed light on potential lessons for ecological sustainability governance, COVID-19 has also demonstrated the importance of local resilience strategies. We use local manufacturing as an example of a possible localized, yet globally connected, resilience strategy and explore some preliminary data that highlight possible tradeoffs of economic contraction.
... It could lead to a process of "re-embedding care in reemerging networks of family/community reciprocity." (Zywert and Quilley 2018) Perhaps reverse innovation might take place here as in LMICs pluralistic, albeit underfunded, adaptive health systems are the norm rather than the exception. (Crisp 2010) Missoni has written specifically on Degrowth economics and its impact on health care systems and builds on the Medical Nemesis thinking by Illich. ...
Over the last few decades, the global health workforce (HWF) gap has increased. This gap concerns the skilled HWF required for providing essential health care services across the world in an equitable manner. This thesis takes a cosmopolitan outlook, as coined by Ulrich Beck to describe a reflexive modernity, to study what is required to develop the global health workforce in an equitable manner. It looks into principles and policies of global health governance to assess what has been done to strengthen the health workforce. It also shows that there is a paradox in economic globalization, which leads to a structural problem to invest (sufficiently) in the health workforce at the national level. Via different methodologies, several levels of global health policy and health workforce development are studied. This includes a comparative policy analysis between countries as well as a specific study on health workforce investment in post –Ebola Guinea. Institutional reform of the WHO is studied alongside an analysis on the implementation of WHO’s Code of Practice on the international Recruitment of Health Personnel. The implications of the securitization of health policy on attacks against humanitarian health workers are researched. The thesis includes a critical analysis of the current resilience focus in health systems development. It analyses to what extent global health approaches in the Sustainable Development Goals are grounded in the Right to Health. The discussion then outlines the democratic space to reform and strengthen health workforce development across the different policy levels of global health governance. This is possible with a more cosmopolitan, transnational outlook to the health workforce challenge and international labour migration. This requires that countries take a shared sovereignty approach and find ways to regulate economic globalization so that it benefits the public good rather than the wealth of a few. However, current policy trends suggest that countries move away from these principles, instead of towards them. The thesis ends with suggestions on how to move beyond this ‘gridlock’ in global health workforce cooperation. It argues for moving beyond economic growth as a policy imperative, and instead take into account the planetary boundaries and social foundations as a basis for future global health workforce governance, known as the Doughnut Economics model.
... One of the principle critiques of attempts at ameliorating the impacts of wicked problems -which, by default, contain some non-linearity -is that, all too often, reductionist habits of mind are uncritically applied which then leads to sub-optimal outcomes, and often the 'wickedness' is exacerbated as unintended consequences emerge (Zywert & Quilley, 2017). The uncritical, or naïve, application of reductionist responses to wicked problems has been described as "technocratic tyranny" because the technical habits of mind erases the non-linear properties from the analytical frame (Waltner-Toews, 2017:1, also see Sturmberg et al., 2017). ...
An article in New Generation Sciences with the title 'The Taming Wicked Problems Framework: reflections in the making', explained how community-university partnerships can contribute to building resilience to wicked problems by focusing on systems and complexity thinking. The purpose of this article is to provide a fuller explanation of the theoretical perspectives that underpin the design of the Taming Wicked Problems Framework (henceforth Framework). The Framework is an engaged action research technique that was designed in the genre of Mode 2 knowledge co-production to facilitate the opening of creative opportunities to build resilience to wicked problems. The Framework enables the identification and subsequent harnessing of the potentials of novel emergence within complex, anthropogenic systems during periods of transition for the benefits of engaged partnerships. At a theoretical level the Framework is underpinned by perspectives associated with transdisciplinary forms of complexity and, at an implementation level, associated with systemic action research techniques. Both are explored using a heuristic labelled as the 'metaphorical order-chaos continuum' in order to provide more detailed insights into the theoretical perspectives that underpin the Framework.
... Thus far, there has been rather little discussion of what a post-growth economic future might imply for health care systems. Exceptions include Zywert and Quilley (2017), Borowy and Aillon (2017) and Missoni (2015), all of whom approach the question from the perspectives of wider social theory or public health. In a recent paper (Hensher Forthcoming), I explore the potential economic consequences of different postgrowth models drawn from ecological macroeconomics (e.g. ...
Health is a central aspect of all conceptions of human well-being and flourishing. This chapter considers a number of contemporary challenges in human health through the lens of ecological economics, and makes suggestions for developing a more focused agenda for applying ecological economics to health. The chapter applies a framework based upon the World Health Organization’s Ten Threats to Global Health. Non-communicable diseases (NCD) overtook infectious diseases as the leading cause of deaths globally two decades ago; a significant portion of the preventable burden of NCDs is driven by harmful overconsumption, and there is growing recognition of the interlinked impacts of global syndemics such as malnutrition, obesity and climate change. Ecological economics will need to develop effective approaches to the impacts of ageing and longevity, and to persistent inequalities in health between and within nations, as understanding grows of the central role of social inequality in generating poor physical and mental health. Providing adequate access to health care in low income countries while simultaneously reducing the harmful and wasteful overconsumption of health care is a challenge to which ecological economics may be able to contribute. Climate change and environmental pollutants have significant adverse health impacts; meanwhile, the negative environmental impacts of health care systems are becoming more clearly understood. Finally, ecological economics may be well placed to contribute to addressing the twin threats of infectious diseases, pandemics and high-threat pathogens on the one hand, and of growing antimicrobial resistance on the other.
... One of the principle critiques of attempts at ameliorating the impacts of wicked problems -which, by default, contain some non-linearity -is that, all too often, reductionist habits of mind are uncritically applied which then leads to sub-optimal outcomes, and often the 'wickedness' is exacerbated as unintended consequences emerge (Zywert & Quilley, 2017). The uncritical, or naïve, application of reductionist responses to wicked problems has been described as "technocratic tyranny" because the technical habits of mind erases the non-linear properties from the analytical frame (Waltner-Toews, 2017:1, also see Sturmberg et al., 2017). ...
This article describes the rationale for the development of an engaged, Mode 3 research schema that aims to contribute to reducing the unintended consequences associated with medical pluralism in rural Limpopo Province, South Africa. The research schema re-frames medical pluralism from the perspective of resilience thinking, placing emphasis on resilience investment. The article critiques current efforts to reduce the unintended consequences of medical pluralism for being based on an imbalanced investment strategy. The imbalance is that current efforts to reduce the unintended consequences of medical pluralism typically focus on either ‘structure’ (healthcare systems) or ‘agency’ (health seeking practices) which tends to produce sub-optimal health-related outcomes. The research schema seeks to overcome this imbalance by reconceptualising the pluralistic healthcare environment in a way that is inclusive of both ‘structure’ and ‘agency’ — using indigenous decision making as the referential axis of enquiry. The research schema uses the Mauri Model decision making framework and intentionality as guiding heuristics which are activated using a research method called ‘AART (abduction, abstraction, retroduction and testing)’.
... There has recently been a resurgence of interest in wicked problems in the context of shocks and resilience. It has been argued that wicked problems persist in part due to quasi-reductionist mind-sets that do not incorporate nonlinear dynamics into either the problem-framing or problem-solving efforts (Zywert & Quilley, 2017). Such mind-sets have been described as leading to a form of "technocratic tyranny" (Waltner-Toews, 2017, p. 1) enabled by the assumption, despite evidence to the contrary, that increased access to scientific information-implicitly derived through reductionist mind-sets-is the key ingredient required to tame the growl of wicked problems (Newman & Head, 2017). ...
... The Framework was developed to put distance between the project design and the restrictive quasi-reductionist parameters that Zywert and Quilley (2017) and others have been critical of because-in the spirit of Pacanowsky (1995)-both anthropogenic systems and wicked problems contain some nonlinearity. In contradistinction, the Framework design set out from the premise that (1) anthropogenic systems contain both linear and nonlinear dynamics and (2) people, unlike machines, are capable of responding to a change in context (i.e., it is normal for anthropogenic systems to move within the metaphorical order/chaos continuum). ...
This article provides insights into the utility of applying theories associated with the complexity sciences to engaged research. The article reflects on a 4-year health-related engagement between the University of Limpopo and the Waterberg Welfare Society in the Limpopo Province, South Africa. The introduction presents the focus of the partnership and the outputs to date. The sections that follow introduce (1) background information about the partnership, (2) the notion of "wicked problems" and resilience, (3) theory relating to anthropogenic complexity that influenced the project, and (4) a description of the taming wicked problems framework, which was developed to facilitate the intervention. The discussion reflects on learning from the project in the context of engaged research, wicked problems, and resilience. It is suggested that building resilience to wicked problems represents a useful addition to engaged scholarship's armamentarium of toolkits from both conceptual and practical perspectives.
... The reassertion of Livelihood-i.e., the household, the informal/DIY economy, and the culture and rituals of reciprocation-is disruptive in that it both precludes many cherished policy commitments associated with social democracy, whilst opening up opportunities for political-economic transformation that have greater overlap with anarchist, paleo-conservative, religious and libertarian traditions. Building on ideas developed in a sequence of papers published over the last five years [1][2][3][4][5][6][7][8] and taking a cue from both Polanyi and the early Herman Daly, this paper will argue that Livelihood is a foundational domain-necessary to reign in both State and Market, and to create a 'three-legged' political economy for an alternative Sustainability 2019, 11, 4082 2 of 23 modernity. Grounded in a triptych survival unit composed of Livelihood, State and Market, this alternative political economy has the potential to realize many of the ecological and social goals championed by ecological economics and the broader field of sustainability. ...
... We have explored the tension between the ecological politics of growth and the welfare state extensively elsewhere [1][2][3][4][5]. Here, it is sufficient to reiterate that if ecological economists are serious about limits to growth, they must necessarily be willing to rethink the nature of the welfare state and more generally the kind of survival unit that is conceivable and possible on the one hand and perhaps more (or less) palatable on the other. ...
Ecological economics has relied too much on priorities and institutional conventions defined by the high energy/throughput era of social democracy. Future research should focus on the political economy of a survival unit (Elias) based upon Livelihood as counterbalance to both State and Market. Drawing on the work of Polanyi, Elias, Gellner and Ong, capitalist modernization is analyzed in terms of the emergence of a society of individuals and the replacement of the survival units of place-bound bound family and community by one in which the State acts in concert with the Market. The operation of welfare systems is shown to depend upon ongoing economic growth and a continual flow of fiscal resources. The politics of this survival unit depends upon high levels of mutual identification and an affective-cognitive ‘we imaginary’. Increasing diversity, a political rejection of nationalism as a basis for politics and limits to economic growth, are likely to present an existential threat to the State–Market survival unit. A reversal of globalization, reconsolidation of the nation-state, a reduction in the scope of national and global markets and the expansion of informal processes of manufacture and distribution may provide a plausible basis for a hybrid Livelihood–Market–State survival unit. The politics of such a reorientation would straddle the existing left–right divide in disruptive and unsettling ways. Examples are given of pre-figurative forms of reciprocation and association that may be indicative of future arrangements.
... An IUD requires the creation of plastic and mining of copper, and pills require exact measurements of hormones in a laboratory -all of which require highly complex systems and an economic division of labour involving hundreds of millions of people working. And as with the other examples, following Odum (2007), the associated embodied energy footprint is not just embodied in the particular artefact or processes of development, but distributed across an incredibly complex networked hierarchy of energy transformations (Zywert 2017). Exactly the same considerations apply to childcare arrangements. ...
In the Anthropocene, as ecological disruptions intensify and economic growth becomes increasingly untenable, health and health systems must be reimagined. At issue is not only the health of individual human beings but also community wellbeing and planetary health. Promising prefigurative practices that could enable such a transition: (1) create mutual benefits across social-ecological scales; (2) disrupt dominant Anthropocene trajectories; (3) reduce the ecological and economic costs of health and care; and (4) operate within re-embedded networks of community reciprocity.
