The power to the people gift rap

Paul Hodgkin, the chief executive of Patient Opinion, discusses gift economies, and how the digital world is making them into one of the phenomena of the 21st century.

The power to the people gift rap
Image: Paul Hodgkin

"I liked the love, care and attention of every member of staff, it was terrific .What needs improvement are the toilet seats - those on the wheel chairs and those fitted to the home toilet are useless.

“They are only made for women. Men cannot sit and urinate and open their bowels, as men’s genitals will not sit inside the opening. This means one has to open the bowels, then stand and turn to urinate. With a knee/hip replacement operation it becomes like mission impossible.” [Patient Opinion story 676]

Patients so often know how things could be better. Give them the chance to comment on their services anonymously and they are incredibly positive, thoughtful, specific and generous.

Far from being angry – even when things have been less than perfect – most people want to help the NHS.

Of the tens of thousands of stories on Patient Opinion, more than half are like the one that opens this column – positive but with a suggestion about how things could be better.

Serious or very serious stories account for around 20%. And fewer than one in four thousand contains an obscenity or swear-word.

Stumbling on the gift economy

So how is it that our experience at Patient Opinion is a million miles from the narcissism of Facebook or the rancour of the blogosphere?

People obviously use Patient Opinion for all sorts of reasons, from gratitude to rage. But the most interesting and useful stories are those that quietly assert their own insight, humanity and ability to help others.

Although it took us a while to see it, we eventually understood that we were running something more akin to the blood transfusion service than to the blogosphere.

People were donating stories because they knew it would be useful to other people and because it made them feel good about themselves.

Since information, unlike blood, can be used over and over again insights about post-operative commodes are as useful in Swansea as Southampton.

Quite by accident we had stumbled on one of the emerging phenomena of the 21st century – a digital gift economy. There are bigger and better examples - Wikipedia, Linux and Ushahidi - but all are exploring a new terrain quite unlike anything else.

Back to the future

Accustomed to the self-serving rhetoric of the market, we find the idea that significant parts of the human world are governed by giving not getting absurd. Yet, in reality, gift economies lie at the heart of families, teams, friendship – in fact much of what we value most.

Gift economies are systems of exchange driven by the rewards of giving not getting. They are destroyed by money (try paying your mother-in-law for the meal she has just cooked you). This means they are largely invisible to markets, businesses and economists.

Giving, and the web of mutual obligation and pleasure that it creates, has been the glue within kinship groups and tribes throughout pre-history.

Our predilection for giving is probably rooted in the cooperative childrearing practices that were needed to enable hunter-foragers to find the 13m calories required to raise a human infant to the age of 18 in pre-agricultural societies.

All of which fits with evidence that the act of giving, even when invisible to others, increases well being.

Of course, people aren’t stupid and they give stuff for good reasons - to enhance their reputations or create a sense of obligation. So, gift economies are run by ordinary people not angels.

On the other hand, they are very different from markets because the value of the gift is determined by relationship not scarcity. A birthday card made by a grandchild is more valuable than any card that has been bought.

Digital overcomes freeloading

The problem is that gift economies don’t scale well- precisely because they have to be rooted in a relationship. Giving stuff to strangers is a mug’s game.

More importantly, economies based on giving physical things tend to run out of either stuff (the empty cooking pot problem) or meaning (the too-many-socks-at-Christmas problem).

These constraints limit traditional gift economies to groups that can exchange physical stuff over existing webs of face-to-face relationships.

The digital world changes this. Gift economies based on the exchange of digital goods can access an infinite supply of free gifts to exchange to drive the giving.

The cost of distributing stuff - and tracking who is more generous than who - is also really easy on the web. This dramatically reduces the overheads required to run a digital gift economy.

However, the most important effect of the web is to solve the free-loader threat. Having 250 people turn up to eat your free lunch when you were only expecting the 25 who came with food is a supply problem and a social disaster.

By contrast, having 25,000 people download your (digital) software rather than the 25 you wrote it for is the pinnacle of success. In a digital world, freeloaders become audience and moral hazard becomes reputational pay-back.

Digital gift economies are exciting because they manage, as if by magic, to conjure massive commitment to common ends from a small minority who willingly contribute to the good of all for no financial reward whatsoever.

Digital gift economies have appeared because the web has lowered their transaction costs by several orders of magnitude. What was once expensive (Britannica) is now free and better (Wikipedia). All this has profound implications for solving human problems.

Looking for the modern campfire

Understanding digital gift economies matters a lot. Partly, this is because they can be subverted - for the jihadist suicide is the ultimate gift, dead bodies the currency, and video statements the means to gain reputation.

More importantly, digital gift economies are a way to release large amounts of free resources in ways that draw us together.

At some deep level, digital gift economies are the answer to what happens after market capitalism and its pursuit of ‘stuff’ has run its course.

Gift economies mediate the transactions of the heart and hearth that we still crave. The digital world liberates these economies to massively scalable platforms.

Where money accelerates transactions in the marketplace of desires, digital goods and the on-line accounting of reputations accelerate transactions in these new economies of the heart. The hidden hand of the market is becoming matched by the hidden heart of the digital gift economy.

And along the way, when we strike the magic Wikipedia moment, massive social wealth is created as if for free.

No matter that constructing working digital gift economies is a hit and miss affair just at the moment. The point is that we are on the way home, that we have found the other half of the market, the half that existed around the campfire before the market was dreamt up.

Digital gift economies release creativity, action and meaning from their tribal roots and allow them to embrace the global.

Fixing the toilet seat

And what of the toilet seat? Well, when the matron saw the posting, she rounded up as many different kinds of commode as she could and asked the next cohort of men to decide which they liked best - and that is what they use now.

Paul Hodgkin

Paul Hodgkin is chief executive of Patient Opinion, a website on which patients, service users, carers and staff can share their stories of care across the UK. Patient Opinion is a not-for-profit social enterprise based in Sheffield.

Until 2011 Paul also worked as a GP and has published widely including in the BMJ, British Journal of General Practice and the Guardian and the Independent. Follow him on Twitter @paulhodgkin.

Last updated: 1 May 2013 15:39

29 April 2013

Most continuing care is a partneship with patients and families

Richard Fitton156 weeks ago

Most medication and monitoring for side effects is performed by patients - with the appropriate information and tools. The managemrnt of chronic children's diseases are managed by parents and legal guardians - ie asthma, epilepsy, intellectual impairment and behavioural disorders suiatble applications could be useful for all of these situations. Health promotion also will icreasingly take place in families and applications could be useful for these situations too.





Open-source software

Rob Dyke156 weeks ago

By way of a perfect example of gift economy culture the following paragraph comes from wikipedia ( )

"In his essay "Homesteading the Noosphere", noted computer programmer Eric S. Raymond said that free and open source software developers have created "a 'gift culture' in which participants compete for prestige by giving time, energy, and creativity away". Prestige gained as a result of contributions to source code fosters a social network for the developer; the open-source community will recognize the developer's accomplishments and intelligence. Consequently, the developer may find more opportunities to work with other developers. However, prestige is not the only motivator for the giving of lines of code. An anthropological study of the Fedora community, as part of a master's study at the University of North Texas in 2010-11, found that common reasons given by contributors were "learning for the joy of learning and collaborating with interesting and smart people". Motivation for personal gain, such as career benefits, was more rarely reported. Many of those surveyed said things like, "Mainly I contribute just to make it work for me", and "programmers develop software to 'scratch an itch'". The International Institute of Infonomics at the University of Maastricht, in the Netherlands, reported in 2002 that in addition to the above, large corporations, and they specifically mentioned IBM, also spend large annual sums employing developers specifically for them to contribute to open source projects. The firms' and the employees' motivations in such cases are less clear.

Members of the Linux community often speak of their community as a gift economy. The IT research firm IDC valued the Linux kernel at $18 billion USD in 2007 and projected its value at $40 billion USD in 2010. The Debian distribution of the GNU/Linux operating system offers over 37,000 free open-source software packages via their AMD64 repositories alone."





Derek Wanless was keen on releasing an engaged public

Richard Fitton157 weeks ago

Wanless Report


Summary and Implications

Population health improvements envisaged under the %u21Cfully engaged%u21D scenario would require large

changes in individual behaviour across the whole population. The aggregated actions of individuals

will ultimately be responsible for whether or not such a scenario unfolds. However, people need

to be supported to make better decisions about their own health and welfare because there are

widespread, systematic barriers to decision making.

People have limited and often conflicting information on healthy lifestyle choices, they differ in

their ability to understand and interpret the consequences of their actions and there are not

always mechanisms which encourage individuals to take full account of the wider social costs of

their decisions (such as second hand smoke). Engrained social attitudes are not always conducive

to individuals pursuing healthy lifestyles. Persistent socio-economic inequalities in the UK,

combined with a greater severity of market failures affecting lower socio-economic groups, seem

to have contributed to significant inequalities in health outcomes which, unless tackled, will

present a significant barrier to many in society becoming %u21Cfully engaged%u21D.

These failures should be recognised and can be tackled, not only by individuals, but also by public

services, government, media, businesses, society at large, through families, and the voluntary and

community sector. Collective action must however respect the individual%u219s right to choose

whether or not to be %u21Cfully engaged%u21D.

Consequently, the following principles are suggested for adoption by government:

1. Interventions should tackle public health objectives and the causes of any decision-making

failures as directly as possible;

2. Interventions should be evidence-based, though the lack of conclusive evidence should not,

where there is serious risk to the nation%u219s health, block action proportionate to that risk;

3. The total costs of an intervention to the government and society must be kept to a minimum

and be less than the expected benefits over the life of the policy: interventions should be

prioritised to select those which represent best value;

4. The distributional effects of any programme of interventions should be acceptable; and

5. The right of the individual to choose their own lifestyle must be balanced against any adverse

impacts those choices have on the quality of life of others.





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