26. Defunding downstream, moving upstream, taking care, making repair
By: Dan Hill
Tags: Covid-19, Policy, Defundthepolice, Environment, Healthcare

The architecture of this system

In an emotional New York Times interview in August, reflecting on the broader context around the killing of George Floyd, the mayor of Minneapolis Jacob Frey described how he can’t remove police “due to issues with both contract and arbitration.” Frey lamented that he is “hamstrung by the architecture of this system that prevents change.”

Frey’s phrase, “hamstrung by the architecture of this system” indicates that we might focus our sense of progress not on economic growth or cost-effective police, but on the social infrastructures that trace, shape, and direct our patterns of living and structure of feeling. That is where design can be most powerful, increasingly — in understanding that built architecture and social architecture are the same thing, joined at the hip. And therefore, the linked questions of safety, crime, and social justice, for instance, can be hosted and pursued by design practices.

Of course this isn’t easy. And yet the heightened sensibilities due to current events make quite radical proposals at least possible. Indeed, as I started writing this set of Papers, the Minneapolis city council pledged to dismantle the city’s police department and replace it with a new system of public safety, promising to invest instead in finding “non-police solutions to the problems poor people face.”

This suggests a shift of emphasis towards creating and nurturing places and communities that intrinsically reduce and avoid harm, rather than reacting when harm happens. Better still, using the language of mental health and wellbeing, producing places and communities that enable people to thrive, moving into promotion beyond prevention. For example, this would be akin to designing streets that are intrinsically healthy, sustainable, vibrant, open, and diverse in the first place.

Dan Heath’s book ‘Upstream’ indicates the broader value of prevention rather than cure, in investing in preventing crimes and illnesses which subsequently cost vast amounts to society, in numerous ways. The book was written upstream of COVID-19, as it happens, but turns out to be useful in understanding many aspects of why the USA’s healthcare system is both as unnecessarily expensive as it is hopelessly inadequate. Heath describes how the $3.5 trillion health care industry, almost a fifth of the American economy, is “designed almost exclusively for reaction … It’s hard to find someone in the system whose job it is to address the question ‘How do we make you healthier?’” As he points out, “We spend billions to recover from hurricanes and earthquakes while disaster preparedness work is perpetually starved for resources.”

In this sense, we can file COVID-19 alongside hurricanes Katrina and Sandy, in revealing an endemic lack of ‘disaster preparedness’. The virus’s ability to locate and exploit the weak points in our systems is particularly obvious in a nation rendered fundamentally unhealthy (and for the USA, see also the UK.)

More broadly, this funding and focus on the reactive ‘hospital end of things’, rather a proactive addressing the root cause of why people might end up in hospitals, has been a debate for decades, clearly, and continues to be so. Ever since the American-Israeli medical sociologist Aaron Antonofsky articulated the notion of salutogenesis (as opposed to pathogenesis) in the 1980s, we have had a ‘new way of seeing’ at hand. Yet little has been done to truly absorb these principles into the multiple arena it would apply, and thus health is still pinned as a downstream practice, rather than upstream. This makes healthcare itself ultimately unsustainable in welfare states like the Nordic countries, just as much as it is already broken in countries who attempt to fund healthcare privately and individually, rather than collectively.

The question of shifting upstream applies both within the health sector—Gillian Tett noting that “We need to treasure — and fund — medical innovation, not just in a crisis but in “normal” times as well”—as well as without, including the broader public health concerns, often positioned outside of the formal healthcare sector, as well as within those sectors whose decisions and actions fundamentally produce good or bad health. These include the obvious candidates of transport, urban planning, employment legislation, architecture, education, food, social services, and so on, yet there are very few areas of government or sectors of industry that have no impact on health. Yet most are run as if this is not the case at all; thus, the healthcare industry has to pick up the pieces ‘downstream’. It will be interesting to see if we manage to invest the 2% of COVID-19’s economic damage required to prevent future viruses.

Antonofsky‘s core idea was that we should address what causes health and wellbeing (salutogenesis), not what are the reasons for disease (pathogenesis). Under the current circumstances, we might equally ask what causes the coronavirus (see Slowdown Paper 2: We make the virus and the virus makes us), not simply how do we make a vaccine. We might also ask what causes crime, not simply how big is our police station.

The Black Lives Matter protests have placed this question of ‘upstream’ strategy and policy directly on the table, yet framed through the question of policing, rather than healthcare per se—although of course public health and community resilience are intrinsically linked. The potentially radical moves to ‘defund the police’ in Minneapolis and elsewhere, triggered by the actions on the street, are entirely in this ‘upstream’ direction. Similarly, the traffic-oriented moves to transform the street itself—in fact, to repair the street—are triggered by actions to mitigate COVID-19. This is also in this upstream direction.

The transformation of housing, education, physical activity, community clubs and societies, and social services are all upstream targets, if addressed coherently and ethically. The revisioning of policing itself is of course radically upstream. These all in turn suggest, and even demand, a radical revisioning of design at some point: around relational principles, around care and repair, around a deeper examination, and then articulation, of the value we are producing, and the values we stand for. We cannot defund the police unless we redesign the environment that fundamentally produces crime, whether social, cultural and political, or the built fabric that enshrines, enables, or engenders these things.

This does not mean that design is the sole answer to the question of how we defund the police. Any chance to prick the last remaining shreds of hubris around ‘design thinking’ must still be taken, clearly, and no doubt some will be too quick to claim this is all a design problem. That must be resisted, as there are no doubt more fundamental approaches required. Listening to Mayor Lori Lightfoot of Chicago and William Finnegan on the role of the police unions around the NYPD makes that crystal clear. Similarly, no amount of restorative landscape design can counterpoint punishing working hours; a holistic answer includes the wellbeing benefits of a shorter working week, as well as environmental improvements.