Economy, as a system of exchanges for goods and services, can include the exchange of monetary or social commodities such as good will, money, health/wellness, and pharmaceuticals. As a ‘transaction’ that involves providing good quality of life for an individual and community, this exchange can be part of a larger moral economy that exists at the basic unit of the relationship, all the way to the overall community level. Even in the busiest clinics, you are not simply purchasing good health.
I recently had a full physical at a conventional biomedical clinic, which included providing a urine and blood sample, monitoring my ECG, examining my body fat percentage, my lung capacity, vision, hearing, what my hazards I was exposed to through my job and hobbies, and other tests of “good health”. Without much social interaction with my nurses and doctor, I provided the most personal details about my body from the microscopic level to the social level. Ostensibly, all of these tests, samples, and biographic information will provide some overall picture of me as an organism, while remaining purely transactional and mostly anonymous. I may have engaged in casual conversation with my providers, but out of my own friendliness, rather than out of necessity for the physical.
The absence of relationships in this health interaction reveals an attitude in medicine that is quick, invasive, and nearly entirely quantitative. However, there are subjective experiences of the patient that also need to be taken into account that are part of the larger moral economy that governs healthcare. As an individual, the patient has a physiological reaction to the mere presence of a healthcare provider, known as the white coat effect. His treatment begins with just the utterance of a diagnosis by the doctor. That is to say, there is a physiological change in the body by way of endorphins being released into the brain, which in turn promotes healing.
In the context of community healthcare, and especially community acupuncture clinics, the one-on-one relationship is the most important part of the process and is the basic unit of the community. As we've seen, the mere interaction with a healthcare provider can elicit a response in the body. The economic transaction that occurs includes the exchange of social goods and services by providing a space for the community to heal together. When you walk into a community clinic, often the staff and practitioners know you by name and what you have been treated for. You may see the same set of patients every Saturday morning, sit in the same chair, and chat with your acupuncturist briefly before resting for an hour. This routine solidifies social bonds, which helps with the healing process.
The moral economy of the exchange of a social experience includes a smaller financial input and greater input of your time. The practitioner may not gather samples or take tests (beyond pulse and viewing the tongue), but instead builds confidence. The moral economy still exists at the large-scale clinical level, but is muted, magnifying other components of care such as quality and cost of care. While these two models are not entirely incompatible, there is room for improvement to include more of the community-building aspects of health and healthcare.
Tanvi Avasthi is a writer and administrative assistant at OurSpace Acupuncture. Her passion is exploring plural forms of medicine in our current healthcare environment.