Discovering What Works:

A Conversation With

Hazel Henderson

by Joe Flower


This article was published in the Healthcare Forum Journal,
Vol. 37 No. 5, September/October 1994
International Copyright 1994 Joe Flower All Rights Reserved
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Is your community a healthy community?

Are you making it healthier? Or are you having no effect? Are you possibly even hurting the overall health of the community?

How can you tell?

Your margin doesn't tell you. You could be doing a great business, without making your community one bit stronger. The strength of the local economy -- jobs, retail sales, land values -- doesn't tell you. There are certainly local economies that prosper by eating their futures and stripmining their workforces.

This is what killed the Soviet economy: there was no way to intelligently manage it, because nothing had a true price. There were no yardsticks, so there was no way to tell what worked and what didn't work.

In our economy, everything has a price -- but nothing, it seems, has a value. We find it hard to really tell whether the things we value are growing or dying.

For "anti-economist" Hazel Henderson, this is the exact center of the problem: the yardsticks we have chosen to measure our "progress" are economic ones: margin, GNP, jobs, the Dow Jones, the prime rate. Everything else -- the health of our children, clean air, the safety of our communities, the feeling of belonging, a sense of meaning -- has to compete on the same grounds, and the comparisons become absurd.

Environmental damage, stress on workers, or risk to consumers from the costs of things don't count at all in such economic measures, until they get turned into dollars by suits or regulatory action -- and then they get counted on the plus side.

A stabbing or a traffic accident actually adds to the GNP, because of the value of the emergency and medical services expended on the victim. The damage done to the victim does not have a dollar value. Similarly, an environmental disaster contributes to GNP, as does a frivolous lawsuit, or an unnecessary surgery. A low-weight premie adds much more to the GNP than does the outreach and nutritional counseling that might have prevented it.

"[GNP] values, for example, bombs and bullets since they are things that are produced for money," says Henderson. "It does not value the environment. It values salaries paid to teachers, but it does not value what people know -- how educated they are. It places no value on `human capital,' meaning people. It does not even place a value on the public infrastructure."

In building healthier communities, we are dealing with precisely those values that cannot be measured in dollars. That's why, over the past months, we have engaged Henderson in a long conversation around the question: how do we know when we are doing it right? How do we know what works?

Fritjof Capra calls Henderson a "self-educated futurist, environmentalist, and economic iconoclast." She has earned her "anti-economist" title by writing three books (Creating Alternative Futures: The End of Economics, Politics of the Solar Age: Alternatives to Economics, and the recent Paradigms in Progress: Life Beyond Economics) and hundreds of articles proposing alternatives to that murky science -- which she says is "not a science; it is merely politics in disguise." She lectures widely, has taught at the University of California, has founded a number of public service groups and is a director or advisor of many others, has advised legislatures both here and abroad, and served as an adviser to the Office of Technology Assessments in Washington.

Yet she is, indeed, self-educated: the only doctorate she holds is honorary, and she began her career not as an academic but as a housewife driven to articulate fury by the irresponsibility of corporate America. A British-born high-school dropout married to an IBM executive in New York, she was, she says, "as happy as you were supposed to be," until she became an activist the day in the early `60s that she sat in the park and watched the pollution falling out of the air over her 2-year-old daughter. She started a letter-writing campaign to the television networks, got ABC and CBS to establish an air-pollution index, and founded a group called "Citizens For Clean Air," launching a long and fruitful career as an activist. Years later she told Capra, "I had to teach myself economics, because every time I wanted to organize something there was always some economist telling me it would be uneconomic. I knew I was right in my activism; I felt it in my body. So there had to be something wrong with economics, and I decided that I had better find out just what it was that all those economists had got wrong."

Thirty years later, she says, "I always thought that my work in critiquing economic theory would never make any sense to anyone until long after I was dead." But her impact has spread enormously. At the 1992 Rio de Janeiro Conference 178 governments, (including the United States) agreed to re-calculate their GNP to take social and economic costs into account. These alternative measures formed the theme of this year's Earth Day. For several years the United Nations has put great effort into re-defining "human development." There is an increasing global recognition that traditional measures must be shifted to accommodate all costs and benefits, not just those measured in money.

What she advocates on a national and global scale works just as well on a local, community scale: devising alternative, "unbundled" yardsticks by which we can measure our progress. She talked to us from her home among the scrub palms and pines of Anastasia Island in St. Augustine, Florida. It was an appropriate spot for a conversation about community: St. Augustine is the oldest surviving European community in the United States, founded by the Spanish in 1565.


The conversation


Healthy communities

We have all experienced the traditional values of a healthy community. At the root of community is a sense that people don't have to be lonely, that they are related deeply to the members of that community. Healthy communities share a sense of trust and shared experience. There is a sense of cooperation, even as a context for competitive activities. People are willing to volunteer to help each other, and to take responsibility for those things that people can't handle totally on their own.

A healthy community protects the natural environment so that its use can be sustained for the foreseeable future. It makes certain that no member of the community is using the environment as a sink for waste, or exploiting resources that are needed by everybody, such as clean air and clean water. All of those elements are in our collective experience of what we mean by community.

A healthy community is built on the relationships between the people who are in the community, and between them and the people who will be there in the future.

Feedback loops

But to build healthy communities, we need to know what's working and what is not working. In earlier, simpler times, the feedback mechanisms in the village and in the small tribe were immediate. The consequences of behavior which was anti-community were clear, and the sanction -- the disapproval of the group -- was swift. It was all fairly self-regulating.

As human beings have multiplied on this planet we have a new set of issues around community. We have 5.5 billion members in the human family, living together in communities not dreamed of in earlier times, mega-cities on the order of Mexico City, with its 20 million people. You could look at the history of the 20th Century as a series of ghastly experiments in ways to re-create community at these vast and unprecedented numbers.

These issues of scale set the context for the thinking that we need to do about redesigning communities. At what scale do we lose that face-to-face regulation, and fall back on rules, police, and bureaucracies? How do you re-create the immediate feedback loops of the village and the tribe? In our complex society, when somebody does something antisocial, the rest of the community may not even know about it for ten years. If a company is polluting the groundwater, we may not hear about it until a group of children in that community develop leukemia.

New indicators

These are all unprecedented issues to which we don't have many good answers. For a place to start, we need new indicators that give us a handle on these issues, so that we can see in a fairly rapid time frame, for instance, what is the quality of the air. In New York, in Sao Paolo, Brazil, and in some other cities, they put it up on a skyscraper. We need to have rapid feedback loops about the state of our community, on everything from the physical quality of the natural environment to race relations.

With the right indicators of the quality of life, a community has a way of measuring itself in terms of its own goals, whether that means better education, better schools, cleaner streets, dealing with drugs or violent crimes, or any of the other issues that come up in our communities of today.

Some measurements, such as deteriorating air quality, water quality, or schools, are red flag indicators that say, "Whoops! If we keep on going down this course we are going to get to where we are going!" They give the community an early warning about where it needs to pay attention.

The Jacksonville example

The best operating example of using true broad-ranging indicators at the local level is in the city of Jacksonville, Florida. Their Quality Indicators For Progress have been functioning since 1983 in a process called Target 2000. They have 85 different indicators. Once a year the citizens of Jacksonville complete the feedback loop by getting together at meetings, and through TV, radio, and the newspapers. They review the indicators, and ask, "On which ones have we done so well that we can move the goal posts, to try for a higher goal? Which ones don't seem to be as relevant as they were last year?" The citizens can calibrate the goals and the indicators to the latest data. The vote is on what the goals are, what the community cares most about.

The Jacksonville community council puts out a manual about it. Other communities can avoid all the intellectual ditch digging that they went through in Jacksonville. This is not a cookie cutter that you could just pick up and take to your own community, but it would be a good basis on which to begin. For example, Jacksonville's experience contributed to the new "Sustainable Seattle" indicators. Many of theirs will be different from Jacksonville's, because every community has its own local value system. The city of Jacksonville considers mobility to be an important indicator, but it looks like Seattle is going to say, "It isn't so much mobility as what type of transportation is available, and can people live closer to where they work?"

Locally-appropriate measures

The measurements have to be locally appropriate. One of the measurements in Seattle, for instance, is the survival level of the salmon. It's not just that the people of Seattle love salmon. For that ecosystem a salmon is a sort of mine canary, an indicator of the health of the whole environment. If the people in Bali were constructing an indicator, part of it would have to do with art and music. To me, a very important indicator of the quality of life here in St. Augustine, Florida, is that you can still walk around in the streets and feel perfectly safe, even at night.

Just last night, we were walking about in the city. There had been a crafts fair in the main square during the day, and the people who had brought their wares to sell for the craft fare had just left them there in the booths -- beautiful, handmade furniture, sculptures, and pottery. They still had the price tags on them, and nobody was touching them. I thought that this, to me, is a very active kind of quality of life, which arises in a particularly small and cohesive community.

Volunteer hours

The number of hours volunteered in a community can be another important indicator of the quality of life. If the economy is being managed badly, and there is a lot of unemployment, or people have to work two jobs, it becomes harder for people to volunteer. It is also a measure of the level of interconnectedness within the community. People don't volunteer it they don't feel they know their neighbors.

The "business climate"

These indicators are very different from the traditional measures usually referred to as the local "business climate." The traditional measures try to take those money indicators, which are relatively easy to measure, and make them the measure of absolutely everything. And of course they can't be.

Many of things that we care about, such as a blue sky, or the ability to walk the streets at night without fear, cannot be counted in money. They must be conjugated in their own terms.

How to do it

Statistics are there

The statistics are there -- health parameters such as infant mortality and life expectancy, education parameters such as literacy rate and high school graduation rate. But they have to be displayed in their own terms, all with equal credibility, alongside those Chamber Of Commerce numbers. Then people can make a judgment for themselves and begin to see the connections.

I'm constructing, out of my indicator formula which I call Country Futures Indicators, a national quality of life measure for the U.S. We are going to distribute it with the Calvert Group in Washington, D.C., starting in the fall. We want to release our quality of life indicators, without putting money coefficients on them, at the same time that the government puts out the GNP. We are hoping to create a national debate.

This is not rocket science. Most of these indicators are already there, the information is around, you just have to identify and use it. If you want to know the amount of park space per capita, ask the Parks Department. It need not take that long, and it doesn't have to involve expensive consultants.

For example, The Healthcare Forum is going to be an advisor for our Calvert Group indicators, because THF has access to a lot of good numbers. And one of the top economists at the Urban Institute in Washington, D.C. is advising us on a lot of our indicators. We don't need to reinvent the wheel.

Get everybody involved

When you do this on a local scale, to try to understand if you are building a healthier community or not, the process, and who is involved in the process, is very important. That's the politics of who gets to name the game.

Until now, we have assumed that the means were the same as the ends. We have confused the two. We have assumed that our Chambers Of Commerce and our Economic Development Commission should be the people in charge of progress. But economic growth, measured by GNP, is only the means toward the end that we all desire, which is the development of human beings and human communities.

Now people from other sectors, people who deal with things like health, education, and the environment are saying, "Wait a minute." So any process of measuring the community should be as broadly participatory as possible. All of the stakeholders need to be involved -- minority groups, environmental groups, social justice groups, the health care industry, alternative healthcare groups. You name it, everybody has got to be involved.

Obviously you need some help. We are not all experts at this. In every major areas, we can go to a range of organizations. In some cases you may find economists who have learned to think more broadly, who no longer use the method of trying to put money coefficients on everything and then aggregating all those apples and oranges. You can get help from statisticians, from biologists, from doctors and educators.

The making of these indicators has to be an interdisciplinary, multicultural, multi-dimensional debate. The process alone can really invigorate our politics. Yet the concept is easy to sell to people, for one simple reason: there is no rule that says you all have to agree about any of it. All these groups have to do is to see their own indicators put on the list, and then they are happy. As long as the indicators that they care about are a part of it, they will all support the idea of an overall quality of life scorecard. You don't have end up saying that one education point is worth three environmental points.

Unpacking the values in indicators

Once you start talking about which indicators to put in a community assessment, and what those indicators mean, the complexity of our systems becomes increasingly evident. The influence of each indicator on the other becomes felt. Each indicator contains a set of values, and often those values need to be unpacked and examined separately. The automobile, for instance, is a socially and environmentally costly transportation system. You could look at it as a public health problem, because of the medical costs that it generates. You could look at it as an environmental problem, because of the costs of air pollution. But if we look through the other end of the telescope, for the community it may not be an environmental problem, it may be a matter of mobility, and the isolation of people. Or it may be a matter of zoning -- redesigning the community so that the zoning allows the people to work more in their electronic cottages, with fewer streets, calmer traffic, more mini parks and pedestrian malls, less emphasis on the automobile, more on rapid transit and bicycles.

But even thinking about bicycles brings its own complexity: why don't people use them more? The bicycle is a genius invention. I spent quite a lot of time in China. I remember arriving in Shanghai and waking up the next morning with the sun streaming in the window. It was deadly quiet, and I thought that it must Sunday. Then I got up and looked out of the window, and it wasn't Sunday at all. It was a workday morning, and a sea of quiet bicycles filled the street from wall to wall. The dads had the little kids on the front, and grandma in the side cars, and little carts behind with three sofas on them. I couldn't believe how well the whole thing worked. Yet it does. Shanghai, with more than 15 million people, would be unlivable if everybody had automobiles.

In this country, the city where the bicycle would be the most appropriate and the transformation would be the most visible would be New York. I lived in New York for ten years, where walking is often faster than taking a taxi or bus. And bicycling is even faster than walking. If they just made most of New York's streets into bicycle lanes, with a bus lane, and a taxi lane, then everybody would get to where they were going faster, the air would be cleaned up overnight, and living in New York would be a lot healthier for everybody.

It may seem like a small example, but it illustrates a lot about the complexity of our living systems. One of the main reasons that New Yorkers don't bicycle as much as, say, the citizens of Davis, California, is security -- they feel vulnerable, both to violence and to traffic. Bicycling to work is a system that works best when everybody does it, much the way that it was possible to walk in the evening in New York without feeling vulnerable, when everybody used to sit out on their stoops in the evening.

The golden rule for a systems thinker in a complex environment is not only "Do as you would be done by," but also, "What would happen if everybody did what I am about to do?"

The core of building healthier communities is precisely this kind of systems thinking -- asking ourselves, with intelligence and study, what are the true results of our actions.

Community-based healthy alternatives

When we do this at the local level, it will begin to make profound changes in the ways we view health and medicine. For one thing, it will bring to the fore a number of community-based health alternatives.

At the national level, our health care policy is hostage to the powerful lobbies of the five industries that have profited from the status quo -- the insurance companies, the pharmaceutical companies, the doctors, the for-profit hospitals and the high-tech medical suppliers. Yet there is an alternative wellness industry that consists of a lot of small enterprises -- midwives, alternative home care, birthing centers, the fitness industry, health clubs, health food stores, organic farmers and growers, people who offer inspirational workshops, biofeedback, massage. If you look at them in total they are not only growing as an industry, they are getting more and more profitable.

They represent community-based alternatives that provide people with wellness, primary care, prevention and counseling -- much of it at an early stage, before the problem starts presenting itself in physical, somatic, acute form. To the extent that these alternatives are effective, inexpensive, and popular, any true effort at building healthier communities will bring them into closer cooperation with traditional medicine. When we get around to re-defining health, hospitals will be bound to be much smaller, serving just the most acute and intensive cases, unless they can get out and compete with, and get involved with the rest of the health business. Even within the traditional matrix of medicine, healthcare will be forced into a more clinic-based and neighborhood-based approach. Pre-natal care, family planning, STDs, immunization, nutrition, eldercare -- the medical parts of building a healthier community are all things that involve a lot of people at the local level. The same thing will happen to healthcare that is happening in sector after sector: once you get the prices right you are forced to simplify.

Margin and mission

For a hospital or a health network, getting involved in measuring the health of the community, and dedicating itself to building that health, can be quite a challenge. A healthcare organization is an economic organism. It has its capital costs, its operating costs, its sources of income, and these all have to be in balance. The old-paradigm measurements must be satisfied or the institution can't survive. Yet these ways of measuring may well conflict with the values of the quality of life scorecard. A lot of current providers will fight a rear-guard action, trying to fend off change.

Yet challenging as it is, it is necessary and important. That contrast, the cognitive dissonance that it presents to a community or to an institution, is precisely the learning agenda. It allows communities and institutions to organize themselves around these real trade offs.

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