Agriculture and…healthcare?

I’ve been making my way through a pile of back issues of the New Yorker, and came across this interesting piece from Atul Gawande, their great medical writer, from last winter about the analogies between health care reform and agricultural reform a century ago.

Part of the reason OMB couldn’t estimate cost savings in the healthcare bill was that so much of it was made up of pilot programs, the expected savings of which it was very difficult to calculate.

While this might seem like a problem given the crippling effect of healthcare costs on the economy, Gawande argues that a pilot-heavy approach is actually good, because that’s in essence how agriculture was reformed in the early 20th century, through piecemeal “agricultural extension” (educating farmers about more efficient practices) efforts that gradually helped bring food prices down.

I’ve written about agriculture vs. engineering as metaphors for social change, so this analogy is fascinating to me. Here’s Gawande:

The history of American agriculture suggests that you can have transformation without a master plan, without knowing all the answers up front. Government has a crucial role to play here–not running the system but guiding it, by looking for the best strategies and practices and finding ways to get them adopted, county by county. Transforming health care everywhere starts with transforming it somewhere.

This is where local knowledge becomes important. Gawande has a nice vignette about the agricultural extension agent in his hometown of Athens, Ohio, and his quiet, patient efforts to help farmers by providing access to technical knowledge that can mean the difference between survival and insolvency. That person knows the terroir of Athens, in the sense of its folkways, climate, and culture, so he can adapt technical knowledge to local needs, and find a practical, short-term solution.

Malcolm Gladwell talks about “Connectors” within a network in The Tipping Point (HT Fast Company for the term). I wonder if people like Gawande’s agricultural extension agent aren’t another kind of node, an informational one that allow for the localization of general knowledge. (I think of the Spanish verb aterrizar, to come down to earth or to land.) Rather than propagating a trend virally, they stay in one place and bring the rest of the world to that place.

I’m reminded of what my charming, mustachioed Austrian poli sci professor Kurt Tauber once told me about Marx: his conception of a “rich man” is someone who has access to and can enjoy all forms of human creativity. (This tells me I’m not completely misremembering that idea.) What he didn’t say is, “while staying in one place,” but agricultural extension is kind of about that, bringing the world to your door and helping you get the most out of your local context.

So if agriculture is a metaphor for social change, agricultural extension may be a metaphor for the kind of learning that needs to happen to make social change possible. Agriculture suggests that you have to start by understanding the land on which you stand, as well as the seasons (which go beyond the moment you happen to be in) and what kinds of crops grow well under those conditions. Agricultural extension is about bringing scientific and technical knowledge to bear in a bottom-up fashion – to solve a specific problem you have (why aren’t my crops growing) rather than to answer a general question that you may or may not have (what makes X crops grow fastest?). The thing to notice is the role of the extension agent, the person whose job it is to know the climate and the people, and to have access to the right kinds of knowledge.

“I just try to help make farming better in Athens County,” says Gawande’s extension agent. Such a simple goal, so easy to state – and that involves so much….


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One Response to “Agriculture and…healthcare?”

  1. The Blog Briefly Known as "Democratizing Philanthropy?" » Blog Archive » Local knowledge (part 4, Nobel Prize-winning edition) Says:

    […] Local knowledge is interesting in philanthropy because it’s a bipartisan issue that folks on the left and right would encourage foundations to privilege more than they do. Presumably this is because the people meant to benefit from foundation-supported programs should be involved in the development of the programs meant to benefit them. So in this case local knowledge is about how resources should be allocated, what problems and their solutions are. Ostrom’s work seems to suggest that local knowledge is also about how disputes can be resolved. What’s the lesson for philanthropy? Seems worth exploring…. Share/Save/Email/Bookmark […]

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