As technology and information systems further complicate our lives, our 19th and 20th century executive, legislative and judicial systems struggle to meet the challenge. We need to try something different.
One major problem is how we think about them. We tend to see challenges like housing, health care, education, poverty, hunger, food systems and the prison system in silos. We try to solve them individually rather than understand how they are all connected.
Fear of loss is another impediment. We tend to believe that change produces winners and losers and, with no understanding of how a loser can, in fact, become a winner in transformational change, those believing themselves at risk oppose change and defend the status quo.
For example, as higher ed shrinks and migrates away from the humanities toward emerging STEM markets, the liberal arts scholar may see only loss.
In redesigning the health care industry toward a goal of population health, universal access and affordability, hospitals see only revenue loss.
Or, as Vermont’s shrinking agricultural industry confronts a dairy glut, it sees its demise rather than an opportunity.
The prison industrial complex feels threatened by emerging changes in a criminal justice system that implements restorative justice, rehabilitation, reintegration, and so on.
But we cannot solve our problems unless we abandon these silos and imagine a future that thinks integrally about what we have, rather than just about tearing down old silos and building new ones.
This does not mean shuttering college campuses, hospitals and local schools. Instead, we must reimagine them. But that won’t happen without visionary leadership to help forge a shared view of what our future can be.
Arguably, health care reform that stresses community-based primary care as the point of entry, a few geographically distributed critical-access hospitals for imaging, emergencies and procedures, and relies on our two tertiary-care hospitals for major surgery and trauma interventions, would mean that Vermont will need fewer full-service community hospitals.
Right now, with our hospitals competing like businesses, costs and prices have escalated with their investments in new services and procedures. Like businesses, they want to entice and retain new patient income.
But the current trend back to tiered collaboration doesn’t necessarily mean we must close redundant hospitals, but rather reimagine them as expanded regional health centers that implement wellness education, prevention, telemedicine, chronic illness management, mental and dental health, primary care, and low acuity emergency care. Larger facilities may also include in-patient recovery and hospice.
This vision begins with the understanding that primary care belongs in our communities, since that is where it is most accessible and cost-efficient.
In higher ed, as some students question the cost-value equation of a college education and their willingness to assume debt, and hybrid online learning offers more temporal and geographic flexibility for working or low-income learners, student applications are dwindling and vacant dorms and classrooms proliferate.
But again, we don’t need to close colleges. As with our hospitals, we must reimagine them — in this case as lifelong-learning complexes that include affordable housing for young couples, retirees, new Americans and perhaps even ex-offenders seeking opportunity and a new life.
Young Vermonters are desperate for affordable, energy-efficient housing and many older people want to downsize. We can convert unused dorm space into apartments — some with shared dining spaces, libraries, gym spaces and cultural assembly areas — a new lifelong community of learners living among and learning with, and from, matriculated students. M
Middlebury and Norwich, having become retirement meccas because of the learning and cultural opportunities offered by their local colleges, give us a model for this. To keep pace with the accelerating developments in complex systems, we must adopt the principle of lifelong learning and apply it to our educational infrastructure.
Our shrinking population of young students has forced the closure of many community schools, for two centuries the heart of our communities. Could we not envisage our public schools as essential early education and health facilities that are open to children of all ages?
Why not imagine “child care” as early education with the added benefit of providing health care? Child psychologists and behavioral scientists are consistent on the optimum ages for learning different childhood skills. Pediatricians are consistent on how important health care screening and family support are at the earliest ages.
Imagine a community school that oversees the total well-being of all our children, screening for and treating adverse childhood experiences, developmental deficits (vision, hearing, speech, attention, learning, etc.), ensuring a safe play and learning environment, providing support systems for their families, overseeing physical and emotional well-being while engaging parents and grandparents in the school community.
We don’t need to close these priceless resources; we need to reimagine them. Nor do we need to build a separate “child care” infrastructure. Why can they not be one and the same?
I am struggling to imagine why we do not raze Vermont’s six prison facilities. The ones I’ve seen don’t lend themselves to affordable housing, learning, physical or mental health care, or the principle of restorative justice.
While we will always need some secure facility to separate the rare habitual or psychotic offender from society at large, an 8-by-10-foot prison cell with limited physical and mental health care and few training and learning opportunities offers no practical, not to mention redemptive, path to reentry for the person making bad choices in their lives.
As restorative justice makes headway against our punitive prison culture, perhaps we could convert one facility into a secure learning and training facility — a supportive learning environment for those who accept responsibility for their transgressions and wish to reenter society on society’s terms.
The women’s facility in Swanton was once such a facility, offering women carpentry and construction skills building prefab houses on site. Then it was summarily closed and the women were transferred to South Burlington, a prison designed for men with limited resources for reentry.
In all cases, we have the opportunity to do more with what we have rather than to build costly new infrastructure. We have the native skills to adapt to new opportunities. We just need the leadership and imagination to realize the opportunities in front of us.
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