Our final case study on the five provocations comes from Porto Alegre, Brazil, where the concept of participatory budgeting was born in 1989. Participatory budgeting involves ceding power to local people and enabling them to decide how local budgets should be spent. It can be an entire community setting their spending priorities or a specific group deciding what projects, services and support should be funded in line with their needs. The model is now spreading around the world and there is an increasing amount of participatory budgeting activity taking place in Scotland.
The Nuka System of Care embodies many of our Five Provocations for the Future of Health and Social Care, including Ceding Power and Nurturing Transformation, but what stands out most about the model is its strength in Emphasising Humanity. ‘Nuka’ is an Alaska Native word which means ‘strong, giant structures and living things.’ The strength of the Nuka system’s structure is based upon the relationships between those accessing care and support and those providing it. The ‘living thing’ element comes from involving people in every part of the decision-making process and aiming to support their physical, mental and spiritual wellbeing as whole people.
Today’s case study takes a more global view of our Five Provocations. The Target Culture provocation has a double meaning: firstly it calls for a rethink of the way targets are used in our health and social care services and secondly it calls for a cultural shift towards everyone taking responsibility for their health and wellbeing. This case study focusses on the second aspect, looking at what it is about Nordic culture that results in their populations having such high levels of health and wellbeing.