Designing Better Systems for People to Live In

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May 06, 2019
by Martin Silva Rey
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Designing Better Systems for People to Live In

Democracy Collaborative co-founder and president Ted Howard discusses existing inequalities in the United States Ted Howard, left, in conversation with a fellow participant during the Salzburg Global program, Bridging Worlds: How Can We Use Business and Economic Development Strategies to Support Better Health?

Co-founder and president of the Democracy Collaborative Ted Howard works toward creating stronger democracies.   A social justice advocate and activist, his entire career has been spent in the NGO world, as well as the United Nations. Almost 20 years ago, he co-founded an action-oriented think tank "at the grassroots, at the community level," that goes beyond producing papers.

What interests him?

"How do we redesign the system that we live in - that we call capitalism at this point - toward a system that can produce better environmental outcomes, better health for people, have people more at the center rather than objects of a system, and greater equity and equality in terms of economics?"

He aims at strengthening democratic practice. "So many of our national democracies are really threatened now. I think we see that in Europe, we certainly see it in my home country of the United States. And our belief is if you want a thriving national democracy—a 'big D' democracy—where it really is built is in community and in people's experiences."

Howard is behind a worker-owned cooperatives program in Cleveland, Ohio, partly based in Mondragon, Spain. Using the purchasing power of the city's anchor institutions, such as hospitals and universities, the model creates green jobs and builds wealth. This initiative blossomed in a hostile context.

"Twenty years ago, if I were to talk about worker ownership and cooperatives, and these kinds of different forms of enterprise, those were seen as 'Those aren't American. Maybe the Europeans will talk about that, but not here. Not Americans.' But now there is a very robust conversation in America about alternative forms of business and enterprise, and how you put more control in people's hands at the workplace."   

Concerned about health inequalities in the United States, he attended the Salzburg Global Seminar program, Bridging Worlds: How Can We Use Business and Economic Development Strategies to Support Better Health?

In the United States, Howard explains, "18 percent of our Gross Domestic Product is spent on our health care. And the truth is there are just many, many people in the United States that simply can't afford the kind of basic health care that they need. And in the United States, health care isn't seen as a right. We have civil rights, freedom of expression, right to have the religion you want. But health care is not seen as a right. It's something that you purchase in the market…

"In one sense, we have an extraordinary system if you have the money to pay for it… You can live in a neighborhood as I have for the last five or six years which is populated by African-American black population 98 percent, and there your health care winds up that you have the life expectancy as a man of 64 years. And eight miles away, in a white suburb, your life expectancy is 88 years. And so health systems now, and we work with lots of these health systems, are saying, 'We can't just passively sit back and allow people to be sick and come to us and try to treat them.'"

That shift in health systems makes him believe a European-style health care system is viable in the United States, as the issue has become part of the political agenda.

"We have a system for senior citizens like myself called Medicare when you hit the age of 65. And Bernie Sanders, the senator who ran for president and is running again back in the States, talked about 'Medicare for all,' which was sort of the way in America you could talk about some sort of national system… But when he said it, he was a complete outlier. People just thought he was kind of crazy… This time, there are 20 people running for president as a Democrat in the United States for the 2020 [presidential election], and most of them are talking about some sort of national health service or quasi-national health service. So the dialogue has changed very, very much."   

Not only for health but for all social outcomes to improve, he argues, the new system should lead to a "democratic economy." That is the subject of his last book, The Making of a Democratic Economy, to be published in summer 2019.   

"In my view, well, if you're really looking at population health, and the health of millions and millions of people, you really have to look at big order economic changes. Or you're simply not gonna get to where you need to get, given the impact of the social determinants of health on our communities, our lives, and our families."

The book features a critique of neoliberalism, which, he claims has produced a fundamental disruption in the United States. "The statistics are extraordinary… of the income gains of the last 30 years. Ninety-some percent of them have gone to less than 1 percent. It was always thought that every generation of Americans would be better off economically through social mobility than their parents were. That's just how it worked at least for the majority, for the white population. That's no longer the case.

According to Howard, the model that can replace today's capitalism would not be either state socialism or hyper-capitalism, but much more community based and from the ground up.

"It would emphasize broadening ownership over business and capital so that more people have a stake in their communities. It would emphasize leveraging the kinds of assets that we have in our communities to benefit our communities rather than always looking for some new giant corporation (‘Can we get Google to come in here?'). It would look at not just the number of jobs being created, but the quality of those jobs…"

The ultimate question for all of us, according to Howard, is: "Are we really trying to bring about really decisive change?"


The Salzburg Global Seminar program, Bridging Worlds: How Can We Use Business and Economic Development Strategies to Support Better Health?, is part of the Health and Health Care Innovation multi-year series. More information on this multi-year series is available here.