From the AIDS epidemic in the 80s to the Ebola crisis in Western Africa in 2014-2016, we have learned —often at great cost to the most marginalised— that the only credible, evidence-based response to a significant public health crisis is one that puts communities in the driving seat, with institutions in a strong supplemental support role. The COVID-19 pandemic is no different, it will not be unilaterally addressed by a top-down deficit-based agency response. Our supposed pawns, the economically marginalised have felt the sharpest effects of the COVID-19 pandemic. Their shorn finances, added to mental health and domestic pressures combined with limitations on social, associational, and recreational life during various periods of “lockdown”, are the outstanding features of the pandemic. This note vigorously contends that mere citizens, organised through their associational, cultural and local-pockets, are precisely the generative, social-virus required in the moment to resist the malign effects that have been exacerbated by this biological virus. This is not a drill or a dress rehearsal either, nor is this the only public health crisis we face. Indeed, more health emergencies are coming. We must not let this one pass without an asset-based community development (ABCD) response and an ABCD-informed plan for the next pandemic.

Instead of professionals dedicating their heroic efforts to society's meek and helpless pawns, the inimitable capacities of communities must be deployed in a way that is termed generative. Top-down, reactive and poorly-communicated government decrees and mandates do not work when citizens-in-community are excluded and can have unintended degenerative effects on community capacities. Generative approaches, in contrast, are grounded in the belief that communities themselves are best placed to know what is best for them. With the right support and clear information, citizens are effective in creating locally sensitive solutions to challenges. Sancho Panza often knows more than Don Alonso. Sancho and the supposed pawns have more power to check the virus than we realise.

Our knights of the moment, professionals, must work alongside community-driven responses that manifest communal resilience and ownership of the issues. Such a generative approach has boundaries and limits and takes direction from science and safe practices. Instead of being passive spectators as the professionals charge the virus, citizens-in-community become agents acting in concert with their neighbours, while their horse-borne, knightly fellows work hard to develop epidemiological responses. Kretzmann and McKnight have warned against institutional overreach in local development, and they urged relocating authority to local citizens who have the knowledge and passion to mobilise assets within their own locale.1

Their prescription for local development applies even to locale-based responses to the pandemic. Effective implementation of ABCD relies on discovering and productively connecting individual, associational, institutional, physical (built and natural environment), economic, and cultural assets.2

The current ABCD work of Strathcarron Hospice, described below, offers an audaciously simple illustration of how impactful community building can be across the life course.

While many hospices have reached the limits of their capacity to support people at end of life to live well onto death during COVID-19, some have used the crises to re-imagine the Hospice Movement. Strathcarron Hospice, Scotland, is among those few pioneers who are not just weathering out the storm but are standing in operative solidarity with local communities so as to precipitate community capacities to respond with compassion to the suffering of their neighbours.

The leadership team at Strathcarron Hospice recognised that, while they may not be able to provide all the services or solutions traditionally thought to be the sole purview of a hospice, they could precipitate a collective local response and supplement where needed. In terms of practical action, the hospice has employed four ABCD community builders to work with four local villages; actively engaging and supporting people to meet the final challenge of life, safely supported by family and local people who care. Going beyond their organisational mission to provide end of life care, the Community Builders have also listened closely to what each of these communities consider to be their local priorities during the pandemic and have supported them to take action on those concerns.

By way of a practical example, in the villages of Denny and Dunnipace, citizens have found innovative ways to maintain important rituals and customs while observing public health guidelines. This was exemplified on Remembrance Sunday, when local residents found a way to negotiate the fact that they could not use natural poppies (the flower) as they had done previously, to commemorate those from their village who died during WWII. Their solution this year (2020), was to knit, weave, sew and draw poppies, and then to safely distribute them around the public square as both a symbol of remembrance and a statement of solidarity with each other. The message: we may need to physically stay apart, but we will do so while staying socially and culturally together. Proof not just of resilience but of antifragility and innovation.

Within the process of community building we can build communities of safety. Current approaches to human safety emphasise a safety-first concept, Safety-I,3 which is a simplistic model that aims to reduce ‘bugs’ in a safety (health) system where human fallibility is often considered the greatest bug. We propose a safety-too model, Safety-II, where the “as few things as possible go wrong” approach is subsumed by an “as many things as possible go right” approach.3 In the Safety-II paradigm, people are seen less as damsels in distress who must leave the real work to the knights and more as active citizens willing to contribute to the wellbeing of their communities. Intense lockdown restrictions, including staying within one's home, have not proved inimical to citizens’ desire to contribute to communal safety, particularly against social isolation. Fulham Football Club in London, UK invited club members in June 2020 to reach out by phone to fellow members and to maintain regular contact with them during “lockdown”. From serenading on the balconies in Spain to Street Bingo in Dublin, communities have generated caring, imaginative, surprising and sophisticated mitigations to the very real dangers of social isolation.

In Safety-II, everyone produces safety. Localised ways of managing risk lead to co-created safety founded on creativity and commitment rather than solely expecting compliance with top-down, benevolent rules and regulations. Practitioners of Safety-II culture precipitate citizen relationships in which people choose to be accountable for the well-being of the whole group - out of love and commitment, not fear, the optimum way of working with communities. Such an ABCD, Safety-II way ensures greater social acceptance of rigorous anti-virus measures for a gentler price from citizens.

Governments tend, during emergencies, to be reactive and to bring uniform solutions to public health problems experienced variously between population groups.4 It is a clunky, one dimensional, one-size-fits-all method. Utilising ABCD we can contain circulation of the virus while working in other dimensions to search for solutions to social and economic problems that accelerate the spread of this and other diseases.5 In the post-pandemic period when old and revived social ills such as unemployment, hunger, psychological maladies, and violence, reassert themselves6,7, a wider, wiser, participative, community-first, safety-too strategy will see us better through the crisis. ABCD sets a better course for the direction of social, economic and health policies.5

Efforts to address COVID-19 in the health and social care sectors should focus on pairing local not-for-profit agencies and community associations to build wider and deeper collaboration at local and regional levels. It is opportune to now relocate authority to local communities where co-created citizen solutions are supplemented, not usurped, by institutional and technological assets.8

Not-for-profit agencies vary between those with a broad national scope but with limited grassroots connections, and those that are organised in disaggregated localised ways, allowing power to percolate upwards from local communities as required. The latter are useful to community associations possessing the “DNA” of diverse and rich informal local relationships, and in which there is greater ownership of the problems combined with flexibility in responses. This relational and associational DNA can counter the social and economic impacts of the coronavirus as surely as the new vaccines neutralise the impact of the virus protein spike in an individual's biology. The deployment of not-for-profits alongside local associations, therefore, must occur in a way that decentres their influence while re-centring the role of local citizens and their associations in line with established democratic principles like subsidiarity.

Exposure to moderate stressors, particularly earlier in life, can confer resilience to potential detrimental factors in adulthood in a concept that has been called antifragility.9 This can be true for psychological stressors,9 or physical stressors such as exposure to environmental antigens which strengthen the immune system.10 There is a middle range of stress that contributes to antifragility, but severe stress can overwhelm a system, and minimal stress does not stimulate the development of protective measures.11 This concept can also be applied to how communities withstand and respond to a pandemic: success in past crises helps the community to deal with current problems, and after COVID-19 has subsided communities must be left in a stronger position to face future medical and non-medical catastrophes.

To survive and thrive communities must adapt and enhance, but institutional responses that check antifragility drives in communities diminish total societal antifragility to future shocks. Confident, connected communities may need to cut ties to ABCD-negative institutions and ‘re-wild’ to achieve a greater level of antifragility if exposed to hyper-institutional or knightly cures. Re-wilding and antifragility can be cultivated in communities and neighbourhoods to bear greater “response abilities” and to centre authority more appropriately whenever institutional systems hit their capacity limits or they overstep the boundaries of subsidiarity.12 This in no way affirms the hyper-individualism of conspiracy theorists who flout current public guidelines, instead, it offers them a more compelling summons to contribute to the wellbeing and freedoms of the whole community so that they, in turn, can be well and free.

Health properly understood is not a medical matter, it is a dynamic social, political, environmental, and economic challenge. In addressing the wider social determinants of health, it is critical therefore that paths towards community-driven change are cultivated.

Moreover, community participation matters because unpopular measures risk low adherence. With community leadership, there emerges creative, innovative, tailored solutions that meet the full range of needs in our diverse neighbourhoods and liberate the inventiveness and commitment needed to weather this crisis and move towards renewal. Approaches such as ABCD, while not sufficient on their own, will prove critical, especially in ensuring sufficiency of uptake of vaccines among marginalised groupings, for whom trust in medical systems is comparatively low.

Powerful and connected communities will increase the agency and self-determination of oppressed and marginalised neighbourhoods, liberating supposed “pawns” from the patronage and benevolence of knights.

The challenge for state bodies is to engage small not-for-profit institutions that are rooted in and committed to specific neighbourhoods and to support, and where needed, commission them to blend their efforts with those of resilient, antifragile communities, to reseed associational life. Community associations understand the people and the terrain, they can mobilise and connect the assets that abound there, to paraphrase Lincoln, a response to the virus of the people, by the people, for the people. We have an opportunity for communities to increase their strength, connectivity, and resilience, we should be audacious enough to take it. While vaccines and therapeutics are essential in addressing COVID-19, they will not be sufficient. Communities will need to adapt towards a pandemic conscious future where social solidarity permits us to flourish forward fairly.

Carlos Álvarez-Dardet.

Only the main author is listed.

Thomas Hayes, PhD, and Prof. Thomas Dewar for their incisive comments.

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