Health care reform and reform for health: creating a health system for communities in the 21st century

If we are to improve the health of the population and reduce the inequalities in health that plague our communities and our planet, we will have to give greater attention to the determinants of health. The reform of the health care system, necessary though it is, will never be sufficient; we need to reform our whole society and in particular to focus on human rather than economic development. At the community level we need to create healthy communities that are “health-creating systems” of environmental, social and human development, as well as health care systems that focus first on improving and maintaining health. Such a “bottom-down” health care system would see the hospital become once again the place of last resort (but still a potentially important partner in creating healthier communities) and would focus instead on how to provide health promotion and health care from the household level up.     

Communities in a world of open systems

In the past, communities tended to be closed systems with relatively clear boundaries, stable memberships, and few linkages to other communities. We are now entering into an ‘age of open systems.' Mobility creates new communities and kinds of communities. The impacts of mobility are far less than those of information and communications technology. Cyberspace has become a new kind of social terrain, crowded with ‘virtual communities.' Television and radio create communities of people thinking and talking about the same things. Both mobility and the growth of communications networks reduce the predominance of geography as a force in shaping community. Many communities are much more fluid, and some are placeless. There are many different kinds of social groups and networks that people describe with the word ‘community.' Most people are multi-community individuals, with many memberships, and many kinds of memberships. Although the world's major religions still have some historic identification with specific regions, those geographic attachments are no longer as clear as they once were, and these religions are tending to become open systems. Some people prefer relatively closed social systems, while others flourish in freer environments. Choice is one of the most powerful forces in the lives of people being exposed to the forces of globalization. Community will continue to be a profound human need but will be redefined, perhaps many times over.     

A method for building community resilience to climate change in emerging coastal cities

Rapidly urbanising coastal locations represent prototypes of future cities. While these “sea change” locations will face a range of issues associated with rapid growth such as infrastructure provision and enhancement of social capital, anticipated environmental impacts are likely to add significant challenges. Climate change is likely to have dramatic impacts on sea change communities through diminished potable water supplies, rising sea levels, storm surges, and increased intensity of flood events - with indirect impacts on health, financial sectors, and biodiversity. Given the inherent diversity within sea change communities with regard to age, culture, and socio-economic status there are likely to be differences in ways of adapting, the ability to adapt, and the desired direction of any changes. Cognizant of the potential enormity of climate change impacts, the need for rapid responses, and the diversity within communities, this paper proposes a participatory and transformative method to work with communities in responding to climate change and variability within rapidly urbanising coastal locations. The method focuses on determining probable futures for various communities of place and interest within sea change areas and aims to build the capacity for dynamic on-going learning to achieve those futures, both within and between the communities. Through this process community members may be empowered with dynamic and future-orientated learning skills that build upon community knowledge, innovation, and resilience.     

Vulnerability and industrial hazards in industrializing countries: an integrative approach

The extra vulnerability of industrializing countries to environmental problems and industrial accidents cannot be understood or solved by a ‘normal’ scientific analysis. Aspects of the social and institutional context must be included, through analyses based on post-normal science. The standard two-dimensional classification of PNS is modified to have axes ‘social ‘and institutional vulnerabilities’ and ‘complexity of technological hazards’. The analysis is mainly applied to the case of the relatively rare accidents with catastrophic potential. In these, the deaths per accident in India, Mexico and Brazil are much greater than in the industrialized countries. This discrepancy arises partly from location of such plants near residential communities for marginalized workers and their families. Other socio-political factors are relevant, as the role of these countries in the global production system, the enforcement of safety and planning laws, quality of housing, and lifestyle of residents. Reducing the vulnerability of industrializing countries will therefore require major social policies and a comprehension of the limits of the normal scientific and economic approaches to such problems.     

Alternative futures for communities

Scenario building is an essential element for working on, and creating, alternative futures. This paper, based on the work at the Institute of Alternative Futures, discusses the use of scenarios in the context of community development and explores three basic types of scenarios—‘the official future', ‘hard times' and paradigm shift or visionary scenarios. With examples from Washington and elsewhere, the paper tries to show how communities can reinvent themselves and meet the challenges of the future with the aid of scenarios.     

Australian futures: Freshwater ecosystems and human water usage

Historical legacies of land-use change together with growing demands for water resources from agricultural, industrial and urban sectors have extensively degraded many of the freshwater ecosystems of Australia. Recent and rapid declines in the condition of these ecosystems indicate that current patterns of water consumption are ecologically unsustainable, particularly in agricultural landscapes. We use three scenarios of water resource use and development over the next 50 years to examine the implications of each in terms of their likely impact on freshwater ecosystems. These scenarios encompass agricultural, industrial and urban water use, and propose trends in water use and management rather than a specific set of predictions. We see two of these scenarios, those of business-as-usual and economic growth, as being ecologically unsustainable, leading to significant declines in the biodiversity and functioning of freshwater ecosystems. Only under our ecological-sustainability scenario do we foresee possible large-scale improvements in the condition of Australia's aquatic ecosystems. This scenario will require major shifts in water use patterns and require careful planning and consideration of a range of social and economic issues. In all scenarios large-scale ecosystem drivers, such as climate change and salinity, will become major impediments to improvements in the ecological condition of aquatic ecosystems.     

Darwinian dystopia: the shape of things to come

Acknowledging that evolution is directionless, shaped only by context and history, and that predicting the future is, therefore, a risky business, scenarios for ‘short-term’ (next few centuries) and ‘long-term’ (10s-100s of thousands of years) futures are offered. The short-term future will be determined by the appearance of transnational corporations that represent levels of social complexity above that of the nation state. Best described as laissez-faire capitalism run amok, the rise of transnationals controlled by powerful managerial elites is warranted or justified by the simultaneous emergence of neo-conservative ideologies that resemble the pernicious social Darwinism of Victorian England. The long-term future will be shaped by the failure of humans to control their fertility. In the face of cultural barriers to rational control of population growth, and as global populations exceed the carrying capacity of the planet, countless millions of ignorant, miserable humans will barely eke out an existence, surviving only long enough to reproduce more of the same. The prospects for speciation are nil, given that high global population densities will preclude reproductive isolation.     

Communities of tomorrow

The social spotlight seems to be refocusing to the scale of local community at a time when globalisation of the economy is threatening the authority of nation-states. Certain small communities are in peril of falling out of the global economy while losing local customs to a globalised culture. Globally beleaguered nation-states are being squeezed in a two-pronged grip: from the growing weight of global capital and from local communities rising to global pressures by demanding local solutions. National authority is also being bypassed as new global communities of interest form on the Internet, expanding the meaning of the term community. But, is community more than common interest—a celebration of difference, negotiating symbiosis among diversity of ethnicity, lifestyle and aspirations for the future? This paper explores five scenarios of tomorrow’s communities. One scenario is a nostalgic return to the romantic notion of the white-picket fence. Then there is the drop-out feral community. In another future the fence becomes a fortress wall, or a ring of barbed wire. Yet another is a virtual community beyond place, where people sharing a common interest live in cyber-reality. The viable community is one for the long haul. To be viable in a global world it must make local-global links to create synergies by sharing resources and inspirations throughout a diverse, planetary society. Viable, local-global network communities of tomorrow set a global example for creativity by honouring difference and open exchange. They take responsibility for their own futures.Two powerful images from recent events remain with me, in juxtaposition. After considering the American attacks on Afghanistan, a well-experienced teacher feels isolated at the periphery, and powerless. In addition, she watches, in “quiet despair”, one of her pupils “virtually going crazy” before her eyes. She shares these words with me:

“Neither he nor I, it seems, have anywhere to run except to the graciousness and the care of the other children, that as classroom leader I’m tying daily to coalesce, in order to put a cocoon of community around him. Bit like the planet!”

“We all work to keep our very bright and fairly disturbed ADHD-labelled¹ learner connected to us in genuine relationship. That’s the foundation of authentic learning support. I’m not operating a medical model!”

Our leaders and the babbling mass media ignore this, the first image, and many similar to it.By contrast, the second image gets constant exposure. It gets instant recall from most TV viewers. It is the scramble of screen jockeys, on what is left of Wall Street, playing the casino economy, in a frenzy of greed. Curiously the main media focus emphasizes images that represent the world at the global scale. They largely ignore images of life at the scale of community.Why is this? Why does the second image of the so-called finance community, where the focus is the dollar, override the more basic image of a hometown community where the focus is human life-support? Are the media reflecting our true priorities, and have we got it wrong? Is money more important than community?     

Exploitation versus exploration in multinational firms: Implications for the future of international business

Given the economic weight of multinational corporations and their privileged access to resources, many different scenarios can be built about the future of international business and about the future impact of international business on economic, technological, and social development. In this paper, we argue that multinationals do not form a uniform organisational population, and we provide empirical evidence of the existence of traditional, rigid entities seeking benefits from low-risk exploitative strategies on one hand, and of flexible multinationals seeking higher performance levels by balancing the trade-offs between exploration and exploitation on the other hand. As these two sub-populations compete with one another for resources, we use a population ecology perspective to study likely ecological scenarios for the future. Our conclusion is that traditional multinationals tend to prevail over flexible multinationals, and the conditions required for a future society to allow a genuine growth of flexible multinationals are unlikely. This implies that multinationals remain primarily exploitative, and that as such, they will only be associated with marginal economic, technological, and social developments in the future. Other organisational forms, such as entrepreneurial small business and communities of practices are shown to be much more likely vehicles through which society can progress and innovate.     

Community and international business futures: Insights from software production

This article explores the role of community in the field of international business. In particular, the turn towards community in the general business environment is considered before the scope for international production and innovation to occur in global communities is investigated through the example of international software production. The global production of software is examined through a comparison of the commercial software organization of the Microsoft Corporation and the non-commercial Mozilla Open Source Software (OSS) community. Insights gained from this comparison together with findings from extant research are employed to construct a range of scenarios that capture potential roles for community in the prospective futures of international business.     

From authenticity to significance: Tourism on the frontier of culture and place

The tourism of the future will include greater demand on the part of citizens of economically emerging nations, as well as on the part of a growing number of retirement age persons in many of the more developed countries. There are important environmental, cultural, and social consequences associated with these demographic shifts. Trendsetters for the tourism of the near future are likely to be well-educated elites who are familiar with travel and comfortable in culturally diverse situations. They will have an understanding of the consequences of global economic development, and will better realize that their participation in tourism comes with a cost to communities and environments through which they pass. They will see value in tourism experiences that support principles of environmental sustainability, heritage preservation and cultural diversity, and human equality. This generation of tourists will have greater choice of travel venues and access to considerably more information on which to base their travel plans, and they will be more likely to expect travel experiences that have breadth as well as depth and that provide opportunities for self-improvement as well as leisure and entertainment.     

Future visioning of local climate change: A framework for community engagement and planning with scenarios and visualisation

There is an urgent need for meaningful information and effective public processes at the local level to build awareness, capacity, and agency on climate change, and support planning and decision-making. This paper describes a conceptual framework to meet these requirements by generating alternative, coherent, holistic climate change scenarios and visualizations at the local scale, in collaboration with local stakeholders and scientists. The framework provides a template for a process to integrate emission scenarios with both mitigation and adaptation strategies, and to link local manifestations of impacts and responses with global climate change scenarios. The article outlines the empirical application of this framework in the Local Climate Change Visioning Project in British Columbia, Canada. The project collaboratively localized, spatialized, and visualized possible climate change effects and community responses in the community's ‘backyards’. The article concludes with lessons learned and suggested principles for future visioning efforts to engage communities in possible policy and behavioural choices.     

我国农村养老保障事业发展的历程、现状与政策取向研究——基于制度分析的视角

老年人是社会的弱势群体,对这一弱势群体给予特定制度安排,来保障他们的基本生活权益,是国家与社会的基本责任。建国以来,我国农村养老保障除农业合作化和人民公社时期外,一直是土地保障和家庭保障占主导地位。当前,由于我国农村经济转换和社会变革进程加快,农村老年人社会保障制度建设明显滞后于经济社会发展速度,难以满足日益增长的养老需求,导致制度处于非均衡状态。本文在总结分析传统农村养老保障制度建设情况,借鉴国外经验的基础上,提出从“厘定职责,强化政府在农村养老保障体系建设中的主导作用”“立足实际,大力推进居家养老和社区养老”“着眼长远,构建多层次、广覆盖、可衔接的农村养老保障制度体系”三方面入手构建我国农村养老保障体系。     

The impact of community expectations on corporate community involvement disclosures in the UK

Despite increase mistrust between corporations and societies in the aftermath of the global corporate misbehaviours, the literature examining the impact of community concerns on corporate communications is undeveloped. Our paper is timely; it contributes to the literature on corporate social responsibility (CSR) by considering the impacts of community expectations on Corporate Community Involvement Disclosures (CCID) using a ten-year panel study. We advance CSR communication research by providing a fresh theoretical perspective – media-agenda-setting theory – to the broad CSR debate and the CCID subset of this debate. Our findings support the media-agenda theoretical expectation and provide important practice and policy recommendations for improving interactions between corporations and their communities.     

European territories confronted with climate change: Awaiting the events or timely preparation?

Today, climate change is viewed as one of the main global challenges. The EU has become a major player in the political arena and seeks to reach worldwide agreements on ‘mitigation’ policies to reduce greenhouse gas emissions. Despite speaking with one voice at the global scale, the effects of climate change on European territories vary widely according to local circumstances. The ESPON scenarios explore what those impacts could be, and what effect EU climate change adaptation policies would have. The first scenario envisions an EU policy limited to emergency funds following extreme events like floods and droughts. In the second scenario, the EU takes a much more proactive stance by funding radical and costly adaptation strategies. The exercise demonstrates the difficulty in identifying the cost-effectiveness of each approach. Territorial effects are often indirect and affect a variety of economic, social and ecological systems. Moreover, a great deal of uncertainty exists surrounding their magnitude and timing.     

Effacing the political future : A response to

Political change within industrial countries will accompany the restructuring of economies and international relations in the 1980s. The most detailed study of alternative scenarios involving the latter issues—the report—treats domestic politics in terms of notions of value change. This article criticises these widespread ideas. Futures studies need to take political trends seriously, including those towards corporatism and the strong state. In this light the development of the informal sector can be no panacea for problems of political and economic power.     

Large-scale participatory co-shaping of technological developments: First experiments with PARDIZIPP

A future-oriented participatory procedure on the basis of the Delphi method was developed and empirically tested a first time with the goal to improve the shaping of technological developments. The technology under study here was micro-electronics or rather their relationship with labor and the test took place in NorthRhine-Westphalia.Today problems exist in all walks of life. There is a lot of talk about today's problems as if they were new, though one has heard similar arguments throughout history. How do we assess if we are really in danger of bringing the world to an end? Although this danger appears real, it would not be the first time in history that people have thought and felt like this--However, one thing that is new are the consequences of modern sciences and technology, which are not suited to given social and environmental requirements. They have given rise to questions concerning the quality of the decision-makers. The questioning of many of these decisions has increased for some time and is now getting more and more specific, with a demand for quality and information rather than managerial skills and competitiveness from the decision-makers. The term ‘decision-maker’ describes those who determine the application of technology, science and technical equipment which has either existed for a long time already or has recently been developed.--It is not easy to change the structures and processes of decision-making so that new structures and processes will be more suited to social and environmental requirements. We have tested our ideas as to how this could be done, in an empirical project. Although we called it ‘Project NRW-2000’, it would probably be better described as an experiment.--We persuaded 90 ordinary people to participate in this project as ‘experts on daily life and work’. This group was asked to work in six regional sub-groups and discuss, with reference to three given normative societal scenarios for the year 2020, the relationship between microelectronics and labour markets of the year 2020, on the basis of a participatory Delphi procedure. Before we elaborate on the concept of our project in Section 3, we would like to outline it in terms of the mainstream of the sociology of technology as well as with research on ‘acceptance’ in Section 1. In Section 2 we will briefly illustrate the framework of the research programme ‘Socially Oriented Shaping of Technology’ of the state of Northrhine-Westphalia, which funded our research project. Section 4 particularly deals with the participatory elements of our project, while Section 5 is devoted to the development of the scenarios. Section 6 sums up the results of the ‘scenario-construction’. Regarding specific elements, we restrict ourselves to topics concerning technology, labour, and the relationship between women workers/employees and technology. As a final outlook we deal with the political implications of our approach. All that is left is to remind our readers that we regard this project as a first application or experiment within our overall approach.     

Die demographische Entwicklung in Deutschland und ihre Bedeutung für das Kapitaldeckungsverfahren von Lebensversicherern,privaten Krankenversicherern und Pensionsfonds

The decline in population will increase dramatically after the year 2030; this development is accompanied by a dramatic change of the social structure of the German society and the aging of the population. Policyholders of annuity contracts who are now in the age of 35 will probably retire in the year 2037 and their death can be actuarially awaited near 2060. That means those people are completely affected by the development after 2030. The annuity contracts with a guaranteed interest rate (legally fixed for the duration of the contracts) dominate the new business of life insurance companies. The period of time of the interest rate guarantee can be up to 40 or 50 years. Our demographic profile leads to the assumption that in 2050 we will miss 15 million people of our working population; this represents the actual figure of the working population of Belgium, Denmark, Finland, Ireland and Austria. Consumption, overall investments and the demand of borrowed funds will decrease. The level of the rate of return of bonds or other interest bearing assets will decline. On the other hand, the value of shares of those companies who belong to the winners of the global transition process we have started right now will increase. Unfortunately life insurance companies and pension funds — when they take investment risk — are forced mainly to invest in bonds or other debentures. The consequence can be a not attractive level of return of the premiums paid. A solution would be to reinforce the development and business of non guaranteed annuities and a higher quote of shares in the portfolios. Then it would be the duty of each policyholder to protect himself by diversification     

Resurrection of traditional communities in postmodern societies

Modern societies seem to have recognised the importance of communities and the community capacity to be self reliant, and to reduce burden on the state, at least to some degree. Thus it is hardly surprising that several western countries’ current policies have been reverberating with the idea and vision of community responsibilities, participation and decision making. What kind of communities do these policies envision? Can western societies resurrect traditional communities in postmodern societies? To address such questions, this paper argues that though highly challenging, it is possible to rebuild some elements of traditional communities in postmodern societies. In fact, such creation is an ideal world to live in. For that to occur western societies should give adequate time, resources and commitment to it, as they did to create modern societies. Most importantly, they also need to somewhat alter their ‘life style’: “When you throw ‘individuals’ from the window, communities rush in through the door”.     

Alternative funding: Looking beyond the nation-state

The challenge for the UN and for all publicly funded institutions that distribute surpluses for international needs is nothing less than to devise new global mechanisms for the collection and distribution of the surplus generated in a global economy. A minimalist interpretation of when individual governments can and cannot provide public goods has exercised strong influences on perceptions as to what is appropriate at international levels and with regard to the financing of international institutions. There is a strong consensus on an important range of international social goods. Three kinds of financing alternatives should be accorded priority in policy research—charges for the use of the global commons, monetary measures, and international taxation.