Health and Healthcare Institutions as Commons

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Tommaso Fattori:

"Exactly the same considerations can be made concerning healthcare and healthcare institutions as commons, starting from the need to commodify and democratize the public healthcare system1 and bearing in mind what was just said about education and training institutions, starting from the fact that access to healthcare takes place also through healthcare institutions in their narrowest sense, but not only through them, because it involves the most disparate services: think, for example, of the integrated water system and the enormous contribution that universal access to clean drinking water and sanitation has historically brought the collectivity, in terms of public health  and containing illnesses and epidemics. Moreover, similar considerations to those made on the function of school and university services also impact the health system: it is a question of having the community of doctors, health workers and patient-users (with their experience and their knowledges) produce new commons, which the collectivity in a broader sense can use.

To ensure social justice and to fully include the interests of future generations, it is necessary to adopt a systemic approach, taking into consideration the network of interconnected elements which together make up the “health system as commons”, that is, generate collective health, inclusion and realization of the universal right to health. Adopting such an approach and opening one’s gaze, one cannot but see the enormous barriers which currently limit production of and access to the commons health: barriers constructed by the present organization of global pharmaceutical research and production, directed solely towards maximizing profits. We cannot dwell here on more general problems, such as the forms of bio piracy or surreptitious extraction and private appropriation by corporations of data and knowledge gleaned from studying individuals or groups of people (such as their gene pool, commons par excellence) without their knowledge: “discoveries” which they then patent. The fundamental issue is that the right to access and use common resources such as scientific conquests and technological innovations is ever more stringently limited by the closures of intellectual property. Biomedical research itself is bound up and blocked by a close network of ownership of patents and by a plethora of rights holders behind them, with serious damage to the right to health of present and future generations.

This is one aspect of the so-called “tragedy of the anticommons”: as Heller’s studies showed, biomedical research is one of the many sectors of research and innovation where many property rights and competing patent rights create “gridlock”, and consequently cooperation breaks down. Research and innovation require the assembly of countless separately-owned resources and the gridlock is blocking the process.

Democratization of decisions in these areas and the elimination of proprietary barriers to research may perhaps seem a Utopian and excessive broadening of the concept of health as commons and of the function of research and healthcare institutions, but the reappropriation of commons proceeds through integrated plans and needs a long-term vision." (draft manuscript)

Source info: Excerpts from a text prepared by Tommaso Fattori as part of the book-project "Protecting Future Generations Through Commons", organized by Directorate General of Social Cohesion of the Council of Europe in collaboration with the International University College of Turin. The text will be published soon in “Trends in Social Cohesion” Series, Council of Europe publications