Tim Kelsey (NHS) on why patient and citizen participation is fundamental to high quality health and care services: “…But above all my priority is to improve the way in which health and care services listen to people – and can therefore act and change. The work of entrepreneurs and apps developers like Patients Like Me, Patient Opinion and iwantgreatcare confirms the benefits of real time patient and citizen participation. The challenge is to do this at scale: open the doors, invite the whole community into the job of improving our national health service. Share decision making. Everybody needs the opportunity – and should be encouraged – to participate.
In April, the NHS did something unprecedented – it launched the Friends and Family Test (FFT), the first time a health service has reported a single measure of patient satisfaction for every hospital. It asked people to say whether they would recommend local inpatient and A&E services; the results are published every month on NHS Choices. By October more than 1m people had participated and hundreds of thousands had volunteered additional real time comments and feedback to local hospitals. ‘Great news’, said David Cameron – who has championed FFT from the start – in a tweet to mark the milestone, ‘giving patients a stronger voice in the NHS’.
This is the boldest move yet to promote patient voice at volume in the NHS and to concentrate our collective focus on improvement in care. At Hillingdon Hospitals NHS Trust, patients reported they could not sleep at night so staff have launched a ‘comfort at night’ campaign and developed a protocol for patient experience ‘never events’. In Lewisham, patients complained about poor communication and staff attitudes. They now plan daily visits for each patient. In Hull, bereaved families complained they had to pay car parking fees; the Trust has now given free passes to relatives in mourning. Routine feedback enables a different kind of conversation between the patient and the clinician. It is a catalyst for change. Commissioners will have to demonstrate how they are improving FFT for local communities to qualify for Quality Premium incentives.
This kind of customer insight is fundamental to the way we make choices as consumers. The NHS is not a hotel chain, nor a city authority: but there are vital lessons it can learn from Amazon and Trip Adviser about the power of transparency and feedback. In New York, more than 90,000 people every day share their views by phone, email and tweet on rubbish collections, potholes and dangerous buildings – and the city has become safer and cleaner.
Friends and family has its critics: people worry about the potential for gaming, for example. But the evidence, after six months, is of overwhelming human benefit and that’s why every maternity unit started to offer FFT to patients in October and why every NHS service will do so from 2015. It’s also why we are now requiring that every local organisation should offer people the chance to comment on, as well as rate, services from next year (most already do).
Some people ask me how we are ensuring the focus on transparency and participation is inclusive. We have launched Care Connect, a pilot project to test how giving people access by telephone and social media could improve feedback and complaints. Recognising that digital exclusion is an issue in some of our communities, we have started a partnership with the Tinder Foundation to help 100,000 people learn how to go online for health benefit. None of these initiatives exist in isolation, nor do I see them as ‘silver bullets’. My aim is to work with and build on existing good practice to make people’s voices heard and help the NHS act on them.
In a characteristically thoughtful talk last week, MT Rainey, social activist and former marketing guru, issued this challenge to the NHS: ‘How will we make the wisdom of the crowd meet the kindness of strangers?’ How do the tools of our age – big data, the internet, the mobile phone – meet the values of our species: compassion and honesty and doing our best for others? Friends and family is a good start. We are witnessing the birth of a new knowledge economy and a new social movement. The future is open.”
Why government health departments are spending millions on mobile gaming
James Trew in Engadget : “Today sees the release of The Walk, an iOS and Android game backed by the UK’s Department of Health. It’s the second release in a collection of apps funded as part of the UK’s Small Business Research Initiative (SBRI). The first — StepJockey, an app that lets you map, locate, rate and log the calorific expenditure of staircases around your city — came out on Monday. All five apps in the program encourage you to move more, or change negative habits. Can an app improve your life? At the very least, we’re guessing the Department of Health — having just spent £2 million on this round of investment — thinks so. This is part of a growing trend, that could see government agencies in the UK taking a leaf out of Silicon Valley’s book when it comes to solving (health) problems. Read past the break to find out why it’s putting so much money on third-party digital initiatives.
Your mission is simple, ensure safe transit of a package from Inverness, to Edinburgh — and in the process save the world. Only one problem: a terrorist attack has rendered all motorised transport unusable — you’ll have to go on foot. That’s the premise behind The Walk. The concept isn’t complicated — encourage players to preambulate in the real world as part of an apocalyptic game narrative. Your phone’s accelerometer tracks your movements, unlocking levels and hours of story-telling audio which drive the plot along. Simple, fun, effective. The game’s predecessor (Zombies, Run!) uses similar mechanics, and currently encourages over 750,000 would-be Shauns (or Eds) to escape pursuing Zombies whenever they go for a jog. By lowering the requirement to walking, it’s hoped almost everyone can benefit this time. The focus is on increasing general daily movement, rather than dedicated, prescribed and sometimes prohibitive training routines.
There’s no question the theory is simple: apps that encourage activity, or responsible drinking, could cut down on healthcare requirements through prevention, negating the need for cure. In turn, it could also take a bite out of the estimated £8 billion that obesity and alcohol related diseases cost the UK’s health service each year. More interesting, is that the Department of Health is funding external mobile start-ups and indie developers at all. We asked it why, and were told it’s just as much about nurturing innovative ideas (where they can compete with more conventional fitness apps such as Nike+, MapMyFitness and Adidas miCoach) as it is about encouraging lifestyle change.
The motivation might initially be the potential (and hard to quantify) savings through a healthier public. But using apps to achieve this is an idea the US government is curious about also. ..”
Data isn't a four-letter word
Speech by Neelie Kroes, Vice-President of the European Commission responsible for the Digital Agenda: “I want to talk about data too: the opportunity as well as the threat.
Making data the engine of the European economy: safeguarding fundamental rights capturing the data boost, and strengthening our defences.
Data is at a cross-roads. We have opportunities; open data, big data, datamining, cloud computing. Tim Berners Lee, creator of the world wide web, saw the massive potential of open data. As he put it, if you put that data online, it will be used by other people to do wonderful things, in ways that you could never imagine.
On the other hand, we have threats: to our privacy and our values, and to the openness that makes it possible to innovate, trade and exchange.
Get it right and we can safeguard a better economic future. Get it wrong, and we cut competitiveness without protecting privacy. So we remain dependent on the digital developments of others: and just as vulnerable to them.
How do we find that balance? Not with hysteria; nor by paralysis. Not by stopping the wonderful things, simply to prevent the not-so-wonderful. Not by seeing data as a dirty word.
We are seeing a whole economy develop around data and cloud computing. Businesses using them, whole industries depending on them, data volumes are increasing exponentially. Data is not just an economic sideshow, it is a whole new asset class; requiring new skills and creating new jobs.
And with a huge range of applications. From decoding human genes to predicting the traffic, and even the economy. Whatever you’re doing these days, chances are you’re using big data (like translation, search, apps, etc).
There is increasing recognition of the data boost on offer. For example, open data can make public administrations more transparent and stimulate a rich innovative market. That is what the G8 Leaders recognised in June, with their Open Data Charter. For scientists too, open data and open access offer new ways to research and progress.
That is a philosophy the Commission has shared for some time. And that is what our ‘Open Data’ package of December 2011 is all about. With new EU laws to open up public administrations, and a new EU Open Data Portal. And all EU-funded scientific publications available under open access.
Now not just the G8 and the Commission are seeing this data opportunity: but the European Council too. Last October, they recognised the potential of big data innovation, the need for a single market in cloud computing; and the urgency of Europe capitalising on both.
We will be acting on that. Next spring, I plan a strategic agenda for research on data. Working with private partners and national research funders to shape that agenda, and get the most bang for our research euro.
And, beyond research, there is much we can do to align our work and support secure big data. From training skilled workers, to modernising copyright for data and text mining, to different actors in the value chain working together: for example through a public-private partnership.
…Empowering people is not always easy in this complex online world. I want to see technical solutions emerge that can do that, give users control over their desired level of privacy, how their data will be used, and making it easier to verify online rights are respected.
How can we do that? How can we ensure systems that are empowering, transparent, and secure? There are a number of subtleties in play. Here’s my take.
First, companies engaged in big data will need to start thinking about privacy protection at every stage: and from system development, to procedures and practices.
This is the principle of “privacy by design”, set out clearly in the proposed Data Protection Regulation. In other words, from now on new business ideas have two purposes: delivering a service and protecting privacy at the right level.
Second, also under the regulation, big data applications that might put fundamental rights at risk would require the company to carry out a “Privacy Impact Assessment”. This is another good way to combine innovation and privacy: ensuring you think about any risks from the start.
Third, sometimes, particularly for personal data, a company might realise they need user consent. Consent is a cornerstone of data protection rules, and should stay that way.
But we need to get smart, and apply common sense to consent. Users can’t be expected to know everything. Nor asked to consent to what they cannot realistically understand. Nor presented with false dilemmas, a black-and-white choice between consenting or getting shut out of services.
Fourth, we can also get smart when it comes to anonymisation. Sometimes, full anonymisation means losing important information, so you can no longer make the links between data. That could make the difference between progress or paralysis. But using pseudonyms can let you to analyse large amounts of data: to spot, for example, that people with genetic pattern X also respond well to therapy Y.
So it is understandable why the European Parliament has proposed a more flexible data protection regime for this type of data. Companies would be able to process the data on grounds of legitimate interest, rather than consent. That could make all the positive difference to big data: without endangering privacy.
Of course, in those cases, companies still to minimise privacy risks. Their internal processes and risk assessments must show how they comply with the guiding principles of data protection law. And – if something does go wrong – the company remains accountable.
Indeed company accountability is another key element of our proposal. And here again we welcome the European Parliament’s efforts to reinforce that. Clearly, you might assure accountability in different ways for different companies. But standards for compliance and processes could make a real difference.
A single data protection law for Europe would be a big step forward. National fortresses and single market barriers just make it harder for Europe to lead in digital, harder for Europe to become the natural home of secure online services. Data protection cannot mean data protectionism. Rather, it means safeguarding privacy does not come at the expense of innovation: with laws both flexible and future proof, pragmatic and proportionate, for a changing world….
But data protection rules are really just the start. They are only part of our response to the Snowden revelations….”
Using Cognitive-Behavioural Therapy to reduce crime
Paper of the week selected by the British Nudge Unit: “The paper we would like to highlight this week describes a large-scale randomised controlled trial aimed at improving life outcomes for disadvantaged youth.
Preventing youth violence and dropout: a randomized field experiment (April 25, 2013)
Sara B. Heller, Harold A. Pollack, Roseanna Ander and Jens Ludwig
The paper presents promising results from a trial in which teenagers were offered after-school programming in combination with Cognitive Behavioural Therapy. Cognitive Behavioural Therapy helps people reconsider biased beliefs they have about the world. In the domain of crime this includes learning to avoid overestimating the extent to which others want to hurt or harm someone else (i.e. hostile attribution bias).
The trial was run in 18 public schools in some of Chicago’s most disadvantaged neighbourhoods. 2,740 young males were offered either to participate in the programme (treatment group) or not (control group). Around half of those in the treatment group actually participated – on average for 13 sessions over the course of a year. Offering them the programme reduced the rate at which they were arrested for violent crime by 3.3 percentage points, from 16.7 percentage points in the control group. This is a fall of 20%.
Click here to access the paper”
Sara B. Heller, Harold A. Pollack, Roseanna Ander and Jens Ludwig
The paper presents promising results from a trial in which teenagers were offered after-school programming in combination with Cognitive Behavioural Therapy. Cognitive Behavioural Therapy helps people reconsider biased beliefs they have about the world. In the domain of crime this includes learning to avoid overestimating the extent to which others want to hurt or harm someone else (i.e. hostile attribution bias).
The trial was run in 18 public schools in some of Chicago’s most disadvantaged neighbourhoods. 2,740 young males were offered either to participate in the programme (treatment group) or not (control group). Around half of those in the treatment group actually participated – on average for 13 sessions over the course of a year. Offering them the programme reduced the rate at which they were arrested for violent crime by 3.3 percentage points, from 16.7 percentage points in the control group. This is a fall of 20%.
Click here to access the paper”
Phone Apps Help Government, Others Counter Violence Against Women
NextGov: “Smart and mobile phones have helped authorities solve crimes from beatings that occurred during the London riots to the Boston Marathon bombing. A panel of experts gathered on Monday said the devices can also help reduce and combat rapes and other gender-based violence.
Smartphone apps and text messaging services proliferated in India following a sharp rise in reported gang rapes, including the brutal 2012 rape and murder of a 23-year-old medical student in Delhi, according to panelists at the Wilson Center event on gender-based violence and innovative technologies.
The apps fall into four main categories, said Alex Dehgan, chief data scientist at the United States Agency for International Development: apps that aid sexual assault and domestic violence victims, apps that empower women to fight back against gender-based violence, apps focused on advocacy and apps that crowdsource and map cases of sexual assault.
The final category of apps is largely built on the Ushahidi platform, which was developed to track reports of missing people following the 2010 Haiti earthquake.
One of the apps, Safecity, offers real-time alerts about sexual assaults across India to help women identify unsafe areas.
Similar apps have been launched in Egypt and Syria, Dehgan said. In lower-tech countries the systems often operate using text messages rather than smartphone apps so they’re more widely accessible.
One of the greatest impediments to using mobile technology to reduce gender violence is third world nations in which women often don’t have access to their own mobile or smartphones and rural areas in the U.S. and abroad in which there is limited service or broadband, Christopher Burns, USAID’s team leader for mobile access, said.
Burns suggested international policymakers should align plans for expanding broadband and mobile service with crowdsourced reports of gender violence.
“One suggestion for policy makers to focus on is to take a look at the crowd maps we’ve talked about today and see where there are greater incidences of gender-based violence and violence against women,” he said. “In all likelihood, those pockets probably don’t have the connectivity, don’t have the infrastructure [and] don’t have the capacity in place for survivors to benefit from those tools.”
One tool that’s been used in the U.S. is Circle of 6, an app for women on college campuses to automatically draw on friends when they think they’re in danger. The app allows women to pick six friends they can automatically text if they think they’re in a dangerous situation, asking them to call with an excuse for them to leave.
The app is designed to look like a game so it isn’t clear women are using their phones to seek help, said Nancy Schwartzman, executive director of Tech 4 Good, which developed the app.
Schwartzman has heard reports of gay men on college campuses using the app as well, she said. The military has been in contact with Tech 4 Good about developing a version of the app to combat sexual assault on military bases, she said.”
Where Do You Want to Dwell?
Stephen Buckner @ Census Blog: “New Census Mobile App Showcases Local Statistics for People on the Go
America has always been a nation on the move. Whether you are looking for a career change or a new neighborhood to call home, life decisions affect each of us every day. With roughly half of Americans now owning smartphones, everyone should be able to access the wealth of statistics the Census Bureau collects to make informed decisions on the go, whether at home or on the road. What good are data if nobody but the experts can easily access them? The Census Bureau uses 21st century technology to meet its centuries-old mission, making the statistics that define our growing, changing nation more accessible to the public than ever before.
The Census Bureau’s new mobile app, dwellr, provides those on the go with immediate, personalized access to the latest demographic, socio-economic and housing statistics from the American Community Survey for neighborhoods across the nation. Using the level of importance you place on a location’s characteristics, the app generates a list of top 25 towns or cities most suitable for you. Once you have used the app, it saves your selections on your phone so you can see how they match up against each new place you visit.
With more than 30 million Americans moving last year, dwellr allows for quick and easy access to information to help make the decision, including the ages of residents, how many families have children, median income and housing costs. Dwellr allows Apple and Android smartphone users to explore a range of questions making it a powerful tool for homebuyers, members of the military being deployed domestically, real estate agents, new businesses and teachers helping students learn about their communities….
The app is just the latest product from the Census Bureau’s digital transformation and provides statistics to more Americans in a new and user-friendly way. It follows the successful release of our hugely popular America’s Economy mobile app, which now has more than 100,000 downloads. Coming soon, you will see an upgraded census.gov website with enhanced search and navigation features that are based on several years of customer feedback. We continue to open up more of our data to developers as part of our API, including 30 years of decennial statistics, in addition to the American Community Survey statistics that power dwellr.
As we continue to align ourselves with the Digital Government Strategy, our free mobile apps are just one way we are making our statistics available anytime, anywhere, and on nearly any device.”
We must create a culture of “open data makers”
Rufus Pollock (@rufuspollock), Founder and Director of the Open Knowledge Foundation: “Open data and open knowledge are fundamentally about empowerment, about giving people – citizens, journalists, NGOs, companies and policy-makers – access to the information they need to understand and shape the world around them.
Through openness, we can ensure that technology and data improve science, governance, and society. Without it, we may see the increasing centralisation of knowledge – and therefore power – in the hands of the few, and a huge loss in our potential, individually and collectively, to innovate, understand, and improve the world around us.
Open data is data that can be freely accessed, used, built upon and shared by anyone, for any purpose. With digital technology – from mobiles to the internet – increasingly everywhere, we’re seeing a data revolution. Its a revolution both in the amount of data available and in our ability to use, and share, that data. And it’s changing everything we do – from how we travel home from work to how scientists do research, to how government set policy….
its about people, the people who use data, and the people who use the insights from that data to drive change. We need to create a culture of “open data makers”, people able and ready to make apps and insights with open data. We need to connect open data with those who have the best questions and the biggest needs – a healthcare worker in Zambia, the London commuter travelling home – and go beyond the data geeks and the tech savvy.”
The Decay of American Political Institutions
Francis Fukuyamain the American Interest: “Many political institutions in the United States are decaying. This is not the same thing as the broader phenomenon of societal or civilization decline, which has become a highly politicized topic in the discourse about America. Political decay in this instance simply means that a specific political process—sometimes an individual government agency—has become dysfunctional. This is the result of intellectual rigidity and the growing power of entrenched political actors that prevent reform and rebalancing. This doesn’t mean that America is set on a permanent course of decline, or that its power relative to other countries will necessarily diminish. Institutional reform is, however, an extremely difficult thing to bring about, and there is no guarantee that it can be accomplished without a major disruption of the political order. So while decay is not the same as decline, neither are the two discussions unrelated.
There are many diagnoses of America’s current woes. In my view, there is no single “silver bullet” cause of institutional decay, or of the more expansive notion of decline. In general, however, the historical context of American political development is all too often given short shrift in much analysis. If we look more closely at American history as compared to that of other liberal democracies, we notice three key structural characteristics of American political culture that, however they developed and however effective they have been in the past, have become problematic in the present.
The first is that, relative to other liberal democracies, the judiciary and the legislature (including the roles played by the two major political parties) continue to play outsized roles in American government at the expense of Executive Branch bureaucracies. Americans’ traditional distrust of government thus leads to judicial solutions for administrative problems. Over time this has become a very expensive and inefficient way to manage administrative requirements.
The second is that the accretion of interest group and lobbying influences has distorted democratic processes and eroded the ability of the government to operate effectively. What biologists label kin selection and reciprocal altruism (the favoring of family and friends with whom one has exchanged favors) are the two natural modes of human sociability. It is to these types of relationships that people revert when modern, impersonal government breaks down.
The third is that under conditions of ideological polarization in a federal governance structure, the American system of checks and balances, originally designed to prevent the emergence of too strong an executive authority, has become a vetocracy. The decision system has become too porous—too democratic—for its own good, giving too many actors the means to stifle adjustments in public policy. We need stronger mechanisms to force collective decisions but, because of the judicialization of government and the outsized role of interest groups, we are unlikely to acquire such mechanisms short of a systemic crisis. In that sense these three structural characteristics have become intertwined….
In short, the problems of American government flow from a structural imbalance between the strength and competence of the state, on the one hand, and the institutions that were originally designed to constrain the state, on the other. There is too much law and too much “democracy”, in the form of legislative intervention, relative to American state capacity. Some history can make this assertion clearer….
In well-functioning governance systems, moreover, a great deal of deliberation occurs not just in legislatures but within bureaucracies. This is not a matter of bureaucrats simply talking to one another, but rather a complex series of consultations between government officials and businesses, outside implementers and service providers, civil society groups, the media and other sources of information about societal interests and opinions. The Congress wisely mandated consultation in the landmark 1946 Administrative Procedures Act, which requires regulatory agencies to publicly post proposed rule changes and to solicit comment about them. But these consultative procedures have become highly routinized and pro forma, with actual decisions being the outcome not of genuine deliberation, but of political confrontations between well organized interest groups….”
Book Review: Three Harbingers of Change
Howard Rheingold reviews the following books in Strategy and Business:
Viktor Mayer-Schönberger and Kenneth Cukier
Big Data: A Revolution That Will Transform How We Live, Work, and Think
(Houghton Mifflin Harcourt, 2013)
Marina Gorbis
The Nature of the Future: Dispatches from the Socialstructed World
(Free Press, 2013)
Henry Jenkins, Sam Ford, and Joshua Green
Spreadable Media: Creating Value and Meaning in a Networked Culture
(New York University Press, 2013)
“Whether you invest, build, teach, research, regulate, investigate, heal, entertain, or sell, major changes in how you do what you do are looming. “Big data,” much in the media spotlight recently—particularly for the revelations of the National Security Agency’s (NSA’s) surveillance of “metadata”—is probably already changing how you do your work. But socialstructing and spreadable media, two new terms that signal similarly momentous shifts, may still be unfamiliar. This year’s best business books on digitization can equip you to better understand all three phenomena and the changes that they will enable and engender….”
The Age of Democracy
Xavier Marquez at Abandoned Footnotes: “This is the age of democracy, ideologically speaking. As I noted in an earlier post, almost every state in the world mentions the word “democracy” or “democratic” in its constitutional documents today. But the public acknowledgment of the idea of democracy is not something that began just a few years ago; in fact, it goes back much further, all the way back to the nineteenth century in a surprising number of cases.
Here is a figure I’ve been wanting to make for a while that makes this point nicely (based on data graciously made available by the Comparative Constitutions Project). The figure shows all countries that have ever had some kind of identifiable constitutional document (broadly defined) that mentions the word “democracy” or “democratic” (in any context – new constitution, amendment, interim constitution, bill of rights, etc.), arranged from earliest to latest mention. Each symbol represents a “constitutional event” – a new constitution adopted, an amendment passed, a constitution suspended, etc. – and colored symbols indicate that the text associated with the constitutional event in question mentions the word “democracy” or “democratic”…
The earliest mentions of the word “democracy” or “democratic” in a constitutional document occurred in Switzerland and France in 1848, as far as I can tell.[1] Participatory Switzerland and revolutionary France look like obvious candidates for being the first countries to embrace the “democratic” self-description; yet the next set of countries to embrace this self-description (until the outbreak of WWI) might seem more surprising: they are all Latin American or Caribbean (Haiti), followed by countries in Eastern Europe (various bits and pieces of the Austro-Hungarian empire), Southern Europe (Portugal, Spain), Russia, and Cuba. Indeed, most “core” countries in the global system did not mention democracy in their constitutions until much later, if at all, despite many of them having long constitutional histories; even French constitutions after the fall of the Second Republic in 1851 did not mention “democracy” until after WWII. In other words, the idea of democracy as a value to be publicly affirmed seems to have caught on first not in the metropolis but in the periphery. Democracy is the post-imperial and post-revolutionary public value par excellence, asserted after national liberation (as in most of the countries that became independent after WWII) or revolutions against hated monarchs (e.g., Egypt 1956, Iran 1979, both of them the first mentions of democracy in these countries but not their first constitutions).
Today only 16 countries have ever failed to mention their “democratic” character in their constitutional documents (Australia, Brunei, Denmark, Japan, Jordan, Malaysia, Monaco, Nauru, Oman, Samoa, Saudi Arabia, Singapore, Tonga, the United Kingdom, the USA, and Vatican City).[2] And no country that has ever mentioned “democracy” in an earlier constitutional document fails to mention it in its current constitutional documents (though some countries in the 19th and early 20th centuries went back and forth – mentioning democracy in one constitution, not mentioning it in the next). Indeed, after WWII the first mention of democracy in constitutions tended to be contemporaneous with the first post-independence constitution of the country; and with time, even countries with old and settled constitutional traditions seem to be more and more likely to mention “democracy” or “democratic” in some form as amendments or bills of rights accumulate (e.g., Belgium in 2013, New Zealand in 1990, Canada in 1982, Finland in 1995). The probability of a new constitution mentioning “democracy” appears to be asymptotically approaching 1. To use the language of biology, the democratic “meme” has nearly achieved “fixation” in the population, despite short-term fluctuations, and despite the fact that there appears to be no particular correlation between a state calling itself democratic and actually being democratic, either today or in the past.[3]
Though the actual measured level of democracy around the world has trended upwards (with some ups and downs) over the last two centuries, I don’t think this is the reason why the idea of democracy has achieved near-universal recognition in public documents. Countries do not first become democratic and then call themselves democracies; if anything, most mentions of democracy seem to be rather aspirational, if not entirely cynical. (Though many constitutions that mention democracy were also produced by people who seem to have been genuinely committed to some such ideal, even if the regimes that eventually developed under these constitutions were not particularly democratic). What we see, instead, is a broad process in which earlier normative claims about the basis of authority – monarchical, imperial, etc. – get almost completely replaced, regardless of the country’s cultural context, by democratic claims, regardless of the latter’s effectiveness as an actual basis for authority or the existence of working mechanisms for participation or vertical accountability. (These democratic claims to authority also sometimes coexist in uneasy tension with other claims to authority based on divine revelation, ideological knowledge, or tradition, invented or otherwise; consider the Chinese constitution‘s claims about the “people’s democratic dictatorship” led by the CCP).
I thus suspect the conquest of ideological space by “democratic” language did not happen just because democratic claims to authority (especially in the absence of actual democracy) have proved more persuasive than other claims to authority. Rather, I think the same processes that resulted in the emergence of modern national communities – e.g. the rituals associated with nationalism, which tended to “sacralize” a particular kind of imagined community – led to the symbolic production of the nation not only as the proper object of government but also as its proper active agent (the people, actively ruling itself), regardless of whether or not “the people” had any ability to rule or even to exercise minimal control over the rulers.[4] There thus seems to have been a kind of co-evolution of symbols of nationality and symbols of democracy, helped along by the practice/ritual of drafting constitutions and approving them through plebiscites or other forms of mass politics, a ritual that already makes democratic assumptions about “social contracts.” The question is whether the symbolic politics of democracy eventually has any sort of impact on actual institutions. But more on this later….”