Nurturing Communities of Care

How might we enable communities of care to flourish and sustain to create more resilient cities?

A year ago from now, The Care Lab and ELISAVA DESIS Lab co-hosted a Webinar that invited a global community of researchers and practitioners to reimagine new ways of nurturing community-based models of care to make our cities more resilient.

We invited speakers who have been exploring the relational dimension of care in improving community resilience to share their projects and invite a discussion on the challenges and opportunities that arise in a post-pandemic scenario. Ezio Manzini, Hilary Cottam (UK), Lluís Torrens (Barcelona), Dr Wong Sweet Fun (Singapore), Mirjam van Rijn (Rotterdam) and Pantxo Ramas (Trieste) shared their stories to an audience of over 200 people who participated in a timely and engaging debate.

At that time, we were ten months into the COVID-19 pandemic. A worldwide collapse revealed a crisis of care that existed but had remained invisible to most. The crisis of care developed due to the last decade’s social demographic trends — such as people living longer, women entering the workforce, and increasingly atomized family structures –, alongside the overburdened and underpaid working conditions of formal and informal caregivers, and the systematic industrialisation, privatisation and underfunding of our institutions of care. This led to a gap between people’s care needs — growing every year with the increase in chronic and lifestyle diseases — and the limited capacity of our society to provide proactive, compassionate and equitable care. As a result, citizens, families, caregivers and front-line professionals were gradually left disempowered and isolated, care infrastructures eroded and structural inequalities widened leaving the most vulnerable in the lurch.[1],[2],[3]

Whilst COVID-19 stretched our formal systems of care to breaking point, it also highlighted the importance of informal, community-based initiatives to reach that ‘last mile of care’ where formal systems could not arrive in time to support the most fragile when it was most needed.

In the following article, we take a chance to reflect upon how we might enable communities of care to flourish and sustain. We believe that the time is ripe for collaboration and experimentation to achieve more resilient cities, and with a renewed sense of urgency to define more sustainable models of care that harness the inherent capabilities and innate wisdom that lies in communities.

For this reason, we seek potential partners and collaborators from diverse disciplines — fellow care activists — who are keen to explore the challenges that have emerged from this initial conversation. To ultimately create opportunities to design, implement and test new enabling ecosystems in different communities around the world. With the overall intention of enhancing resilience, but also fortifying the systems of care in our cities.

Why communities of care matter.

Communities are formed by a web of human interactions that, over time, grow relationships — and relationships are one of the basic elements of care. Caring activities are usually made up of encounters and relationships that involve knotty issues of dependence, intimacy, vulnerability, and suffering, inevitably generating powerful bonds.[1],[4]

Communities of Care are usually born as grassroots initiatives; those formed by horizontal relationships of cooperation, mutual support and solidarity. They can be defined as intentional, self-organised, collective and localised environments in which to support each other and enable networks of belonging to flourish. Social infrastructures that work as an extended family –sometimes also intertwined with public and private care services –, which help break isolation, cooperate in daily care tasks and maintain a good life. To nurture our interdependencies and weave life in common.[5],[6]

Caring Communities contribute to making care actionable and accessible to all; harnessing the natural social dynamics of compassion and solidarity that already exist and more easily integrating care into our lives. However, they aren’t always seen as real and formal alternatives for care support in our society. There is no consistent connection between the institutions, grassroots and industry; and this leads to the fact that communities sometimes lack the social, political and institutional support and strength needed to outlast. So their significance in society remains invisible to most.

As designers, we believe we can contribute to designing urban environments that stimulate communities to flourish and strengthen social bonds around care. Although, relationships can’t be designed. Nevertheless, we can create the conditions, infrastructures and qualities to forge and sustain communities of care.[7],[8]

6 design principles to foster caring communities.

Six themes emerged as a result of the Webinar discussions. We propose them here as a set of design principles with which practitioners can create the frameworks and service ecosystems needed to foster communities of care.

1 / We belong together

The sense of belonging is a subjective feeling of value and respect derived from reciprocal relationships; built from shared experiences, beliefs, or personal characteristics. It is associated with bonding relationships; those created within a group of people with similar attributes based on the same location. And it usually contributes to creating a collective identity and meaning among all the actors of the community as they share norms, values and interests.[9],[10],[11]

According to Hillary Cottam, for a community to take root, apart from physical infrastructure, organisational ecology is needed to let emotional connections thrive and a shared culture emerge. About this, she highlighted the wide success of mutual-aid WhatsApp groups that spontaneously appeared at the horizontal street-level compared to the limited success of the top-down volunteering initiative launched by the UK government to support the National Health Service (NHS) during the first lockdown.

Dr Wong Sweet Fun shared the story of the Vertical Kampungs in Singapore. These are a set of community living rooms designed at the ground level of public housing blocks, that encourage elderly and frail neighbours to organise themselves around common interests such as eating, dancing or gardening. Thereby fostering healthy habits and making residents feel a sense of contribution to the community. The same sense of contribution we saw in La Colla Cuidadora, mentioned by Lluís Torrens, a self-organised community of family caregivers in Barcelona whose sense of belonging empowers them individually and collectively to better care for their loved ones and each other.[12]

In recent years, projects like these and similar lines of research have shown that neighbourhood cohesion and community belonging contribute to the overall quality of life. The result is a greater sense of personal identity and confidence, as opposed to anonymity and loneliness, and improvement of both general and mental health.[13],[14],[15]

In this way, unavoidable questions emerge: how might we grow evidence about the positive impact of community on people’s health and mental wellbeing? How might we emphasize the role of communities in our systems of care by proving their capacity to reduce the pressure in healthcare consultations and social care services?

2 / Time to trust

Trust in care relationships is a key ingredient of effective and meaningful experiences. Especially important for people suffering from chronic health and social conditions who need to feel a sense of loyalty, honesty and confidentiality from their caregivers given their long-term vulnerability and increased dependency. On the other hand, building trust in communities is increasingly proven to enhance members’ well-being, since regular contact boosts empathy, shared understanding, openness and confidence.[16],[17]

Yet creating trust takes time. Prior research shows that trust is context-sensitive and increases over time in human relationships.[16],[18],[19] Madeleine Bunting (2020) exposes in her newly published book Labours of Love that in recent decades the lack of time for relationships in the healthcare system has contributed to the growth of complementary medicine, such as acupuncture or osteopathy, since these are typically a series of 1-hour appointments where the relationship with the practitioner becomes central and continuous, as opposed to the 5-minute fragmented conversations of traditional healthcare consultations.

Hilary Cottam argues that care should not be seen as an economic activity provided in a factory line-style — clocking in and off –, and instead proposes creating infrastructures for care activities to develop in the kairos dimension of time: one that is held around connection, meaning and presence rather than anxiety, efficiency and checklists. She shared the case of Shared Lives Plus’ matching process as an example of how to build trust over time. In this program, social workers mediate the relationship of service users and professional caregivers during a first trial period to establish the connection and lay the foundation for long-term trust before they start living together.

So, the question here would be, in a world where time seems to become a scarce resource, how might we introduce simple trust-building mechanisms that enable citizens to steadily grow trust across their community?

3 / Proximity comes in 3 flavours

Relationships are woven in proximity. Therefore communities of care require a proximity perspective. The webinar helped us shed light on three dimensions of proximity: relational, territorial and tactile.

Relational proximity refers to the human connections that form at the neighbourhood scale: the feeling of being close to one other, the relationships built organically in a small, localized and familiar space. An example of this is the Barcelona Care Superblocks model, which organises home-care teams so service users are always attended by the same group of professionals. Another example here is Shared Lives Plus, which aims to forge one-to-one caring relationships between professional carers and users within the home environment. Two decentralised models of care that nurture proximity and show us how by creating connections at the neighbourhood level their presence and role are more easily recognisable by the community itself.[20]

The second dimension, territorial proximity, relates to public space and urban design. We learned during the webinar that densely populated cities such as Barcelona or Singapore enable urban design strategies to enhance spatial proximity and foster social interaction. As exposed by the authors of the ‘15-Minute City’, improving spatial proximity and facilitating access to basic facilities and public spaces may result in a higher quality of life as citizens get increased time and opportunities to interact with other members of the community and accomplish other social functions. As a result, co-owned public spaces emerge weaving a system of dynamic and caring interactions amongst individuals, objects, conversations and social tribes.[5],[21],[22]

The third dimension, tactile proximity, is the physical presence that is inherent to many care interactions — from the most mundane and practical, such as bathing, feeding, cleaning — to those of soothing and comforting, such as the holding of hands with a person in pain. Every care relationship is built from a mesh of intimate encounters and face-to-face conversations that develop the capacity for empathy and reciprocity.[1] As De la Bellacasa (2017) states, the sense of touch is the most reciprocal one — you cannot touch without being touched, and that is what makes care so intrinsically tactile.

Considering these 3 dimensions of proximity then, how might we catalyse a proximal urban infrastructure to foster caring communities in dense cities like Barcelona or Singapore? How might we employ a hybrid blend of physical and digital interactions to bring people closer, to better care for each other?

4 / Diversity breeds resilience

To be capable of responding to the change, uncertainty, unpredictability and surprise inherent in the world of care, communities of care should be able to nurture robustness (the ability to withstand stress and crises), redundancy (resource diversity), and rapidity (the ability to mobilize resources quickly).[23],[24]

Building a network of diverse people, assets and competencies — including organisational capabilities, skills, age, knowledge and cultural diversity — seems key to enriching interactions, reducing stigma and prejudice, and improving community members’ overall sense of wellbeing, thus enhancing a community’s resilience to care.[25],[26],[27] As Hilary Cottam put it, the more diverse a community is, the more possibilities there are to provide support in a myriad of ways.

However, Jane Jacobs argues that ‘if density and diversity give life, the life they breed is disorderly’.[28] A compact and diverse urban ecosystem is not always pretty; we need to be ready to embrace conflict and dissonance. And to expect that it is precisely within this messiness where unexpected encounters will occur, leading to surprising discoveries and innovation.

Three examples of how diversity can enhance community resilience –despite the inherent conflict in it– are the multidisciplinary working teams in Trieste’s Habitat Microaree, the group of parents with diverse professions and skills behind Team Toekomst and the intergenerational cohousing communities; usually formed by people from different age groups and with diverse education and professional backgrounds, that seem to be a preferred sustainable solution for ageing well in the community.[29]

Taking into consideration that feeling a sense of belonging and proximity is key to forging communities of care though, how might we facilitate diverse communities to discover common goals and shared values, whilst still harnessing the natural energy of conflict?

5 / Webs of solidarity and cooperation

Historically, one of the main challenges of our care systems has been the fragmentation of services and the lack of coordination between the social and health care realms.[30] As Ramas described, this model results in a paradox where care users become passive objects of services but are the only active actors to build the bridges and break down the barriers between silos.[31] In light of this context, support networks like the ones that emerged in Trieste become essential players to help patients and families navigate and weave their own continuum of care.

We saw this during the first lockdown in March 2020 when different communities spontaneously formed and collaborated remotely through digital platforms and social networks, bridging the gap when private and public systems failed to reach the last mile of care.[32] More structurally, we see it in approaches like the Asset-Based Community Development (ABCD), a model mentioned during the webinar which aims to identify, connect and mobilize existing, but often unrecognised, assets in the community to exchange tangible and intangible resources and enhance collective citizen visioning and production.[33] In Leeds, for example, this has been applied to support the elderly to be more connected to the community and enable them to age in place and avoid institutionalization.

When talking about health and social care, it is clear that no single organisation acting in isolation can connect all knowledge and resources involved in the wide range of determinants that originate from the complex challenges we face as a caring society.[34] Creating bridging relationships with other communities, neighbours and families to exchange skills and ideas can enable communities to get ahead and scale up their individual and collective capacity.[8],[10],[35] Needless to say, we’re stronger together.

In spite of this, we have learned that weaving relationships of cooperation amongst diverse groups or organizations may also come with conflict. Hence developing mutual recognition of interdependency, cultivating reciprocal respect, building associations from shared interests and values, and finding a common language with which to collaborate will be key to creating strong cooperative relationships and achieving goals.[35],[36]

In this manner, how might we highlight the interdependencies that exist between communities to enable cooperative relationships to flourish? How might we build effective bridges between one another? How might we enhance webs of cooperation in the urban context to weave care into citizens’ daily lives?

6 / Equitable power

One of the transversal concerns that surfaced across the different stories we heard during the webinar was the long-term sustainability of resources, funding and infrastructure to keep the community running and going beyond pilot mode or standalone demonstration projects. Additionally, experience suggests grassroots initiatives spend 90% of their time simply surviving and only 10% evolving their activities; meaning bottom-up and self-organised communities will require more structural support to flourish over time and evolve.[5],[37]

Furthermore, it has been proven that the amount of care needed in light of society’s increasingly complex realities cannot be provided solely by either the families, the state, the market or the community.3 Hence, a sense of co-responsibility amongst these four spheres is required and novel co-governance approaches become particularly necessary to uphold communities of care in a way that, without undermining their essence and values with institutional and corporate logics and agendas, can contribute sustainably and robustly.

As designers, we see the need for public governments and private organisations to be more open to the “creative tension” that arises from that dialogue with the grassroots; to be comfortable with the ambiguity and organic nature of these interactions that counterbalance the usual rigidity of governing and corporate institutions.[28]

The opportunity is to create governance approaches that are both bottom-rooted and capable to perform strategically; community-led as well as institutionally-supported in terms of technical and material resources, as well as political and knowledge networks. Community support mechanisms thus need to be complemented by mediation processes and inclusive participation in a way to reframe what is governed, how and by whom.38 A strong example here is Decidim, a digital platform born in Barcelona and now spread to other cities, that enables citizens to share responsibility with the local government in a variety of city-wide actions. Via participatory budgeting schemes, residents can propose as well as vote for specific infrastructure improvements in their neighbourhood, thus influencing the flow of public funds towards the projects they find the most meaningful.

In this sense, Emma Dowling (2017) proposes the so-called care municipalism. From her point of view, as a society we should think about the kind of institutions we need to guarantee equal participation, to ensure that citizens are as capable as possible of participating in collective decision-making processes related to care responsibilities. Which requires building community capacity, leadership and accountability structures.[39] In light of this, municipalism offers a manageable-sized community that enables bidirectional communication and grounded face-to-face engagements. Hence, it emphasises proximity, in both a physical and political sense, as a crucial basis for developing meaningful relationships with which to forge caring communities.

So here we could ask, how might we facilitate an equitable dialogue amongst grass-roots, public governments and private organisations to guarantee sustainable development without undermining communities’ essence? How might we reframe sustainability by identifying value-based indicators that counterbalance the economic ones and ensure communities of care keep up over time?

A call to action to nurture communities of care.

Last year’s webinar gathered researchers and practitioners from around the globe and from across diverse disciplines and practices, and we are excited to continue this rich conversation, as well as facilitate leading it to action.

Each principle above reveals new challenges and potential research questions to further explore. The combination of the 6 uncovers countless opportunities to build new meaningful solutions and strategies to nurture communities of care.

As designers, we can contribute to empowering the voices of different stakeholders –from the grassroots to the institutions–, creating accessible and engaging tools and mechanisms for people to drive the transformation of their own communities and cities. We can provide designerly skills and hands-on capabilities, as well as maximise learning to make solutions spreadable, scaleable and relevant –ensuring that implemented ecosystems are designed with sustainable impact in mind to prove the viability of such new models of care.

Nevertheless, we believe this requires a collective effort. We are keen to imagine new ways to partner with industry, academia, public sectors, community leaders and citizens; to view the pandemic as an opportunity to challenge old assumptions around care and design more equitable, humane and resilient cities. COVID-19 responses from around the world have already shown us how this is possible, and a variety of structured innovation programs and initiatives have since been launched — such as the New European Bauhaus platform –that are encouraging cities to develop towards more sustainable and inclusive ways of living.

Would you care to join us?

Authors

Ezio Manzini (Desis Network, Politecnico di Milano)

Julia Benini (Elisava Barcelona School of Design and Engineering)

Lekshmy Parameswaran (The Care Lab)

László Herczeg (The Care Lab)

Airí Dordas (The Care Lab)

Citations

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