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November 27, 2012

Why Health Care is a Commons

For health care activist and researcher Jamie Harvie, good health depends on more than just a good doctor and the right medicine. “Only about 10 percent of our health is determined by medical care,” explains Harvie, who helped direct the campaign to ban toxic mercury thermometers. “The rest is environmental and behavioral—clean air, clean water, good food. We can’t be healthy people if our communities aren’t healthy.”

Executive Director of the Institute for a Sustainable Future based in Duluth, Minnesota, the focus of his work is now “commons health care”—which means taking a broader, deeper look at all the factors affecting our health.

Harvie says health care providers and institutions must begin connecting the dots that link disease with environmental pollution, climate change, toxic chemicals, poor nutrition and poverty. “It’s about clinicians and the community coming together to improve the health of the community. How does a hospital support local food, affordable housing and other benefits?”

In The Case for Commons Health Care, an article published earlier this year in Explore: The Journal of Science and Healing, he highlights how a tragedy of the commons is underway in health care, agriculture, and our global climate. “We are all to familiar with examples of how the unnecessary overutilization of healthcare, the race for medical technology and the entrenched medical interests is ultimately bankrupting our entire health care syste,” he writes.

Harvie goes on to reference Nobel Prize winner Elinor Ostrom’s work, which shows “the tragedy of the commons is not predestined. Moreover, that through a set of community based rules and conditions this tragedy can be averted.”

But how? Through the creation of “a commons healthcare system [that] would recognize, promote, and preserve health promoting activities and institutions such as farmers markets, community gardens, better food access, and increased farmland, clean air and clean water.”

In September, Harvie’s organization organization facilitated a network of clinicians and community members to urge hospitals to embrace three common sense prevention goals. The Commons Health Hospital Challenge, calls for health institutions to serve local, sustainable food, stop serving sugar-sweetened beverages and adopt the World Health Organization’s Baby Friendly Hospital Guidelines on breastfeeding. Pointing to spiraling healthcare costs, the global burden of obesity-related disease and the ecological impact of some medical practices, the document offers a “reminder that we all share in the health of one another, our communities and the health of the planet.”

Surprisingly, Harvie’s professional background is not in health care. He grew up in rural Quebec and studied civil engineering and physiology at McGill University in Montreal, applying his skills on development projects in rural Nicaragua before settling down to an engineering job in Toronto. But a romance drew him to Duluth, where he got involved with an EPA-funded pilot project to create a zero-discharge waste program in order to protect the waters of Lake Superior. That’s when Harvie realized the widespread dangers of mercury poisoning from hospitals and clinics. “What an incredible irony that health care was poisoning people around the planet!”

This led him to join Healthcare Without Harm an international coalition working to prevent environmental hazards health care industry and, in 2000, to form the Institute for a Sustainable Future. In recent years he’s found the commons framework valuable in exploring and explaining his mission. “I started hearing about the commons and it just made sense on all of this.”