Supporting community participation in a pandemic.

The invariable governmental approach to the impact of the COVID-19 pandemic has been to effect the White Knight stance of Don Quixote, defending the population from the "Virus Dragon" and dedicating its knight-errantry to the damsel Dulcinea. Though essential, new therapeutics, vaccines, physical distancing, rigorous hygiene standards and efficient health systems are not sufficient to counter the effects of the virus. Individual compliance to public health guidelines also matters, while remaining similarly insufficient to diminish the threat. Earthier, citizen-led, community participation strategies, however, lead to innovative, tailored solutions that better fulfil the needs of diverse neighbourhoods and assures greater virus resistance and increase in population health compared to a top-down, knightly approach or isolated individual efforts. The challenge of COVID-19 offers communities a moment to build more resilient, antifragile communities that not only survive the current crisis, but that thrive after it, and that are better equipped for the next challenge. This is not the time for the singular heroics of the White Knight, or the antics of Don Quixote, tilting at windmills. It is the time of Sancho Panza, which is to say of regular non-credentialed citizens, and their collective efforts, who up to now have largely been considered pawns in this contest. Asset-based community development (ABCD) rejects both the individual as an island and the institutional, knightly emphasis on assessing needs and deficits within communities. It favours identifying and mobilising available and latent assets within a community to forge closer connections among all people, the better to collectivise problem-solving efforts. Community-driven initiatives are assisted in this by localised not-for-profit agencies that practice subsidiarity.

Does more medicine make us sicker? Ivan Illich revisited.

A proper understanding of health is a social and political challenge, the modern social medicine approach to public health and health approaches more generally tend to minimise this, making the isolated individual the primary unit of health. Ivan Illich, social critic and philosopher, was at the forefront of arguing for a collective health approach and challenging medical hegemony. His theories of institutional counter-productivity, proportionality and his critique of the medical model which he argued was entrenched within an economics of scarcity are as relevant today as they were at their height of popularity, in the 1970s. Applying his analysis to current trends in health approaches I conclude, as did he, that beyond a certain institutional scale or intensity more medicine is making us sicker. Therefore public health requires a dramatic shift away from a focus on individual deficits, lifestyle diseases, behaviour change and health promotion approaches towards genuine community building and significant political investment in the health creation of local communities. Moreover, there is need for more resolute regulation of the marketplace to prevent the health-harming behaviours of industrial and other institutional interests, including public sector and third sector organisations engaged in institutional overreach.