The Paradox of the Health Commons: The Benefits and Trouble about Participation and Co-Creation

Introduction

The contemporary media environment characterised by advances in the Internet and adoption of computing devices has contributed to the proliferation of health information freely available together with access to the World Wide Web. The obvious benefits are many: users have access to a richer array of sources from which they may gain useful and relevant information, and at the same time, contribute to existing knowledge. Yet there are many challenges: there may be conflicting information, and can lead to self-diagnoses which are wrong. More work is needed to understand the actual implications of creating and using health information. The paper seeks to address this gap by using the concept of the health commons.

Since the advent of the World Wide Web, researchers have argued for it as a type of knowledge commons (Hess & Ostrom, 2007). Historically, the term ‘commons’ refers to land or other resources used in common by a community. The concept was however criticised in the famous essay by Garrett Hardin (1968, p. 1244) who argued that the commons was a tragedy in the making:

In other words, freedom in a commons encourages overuse of resources in the commons. With resource scarcity, such overuse can lead to depreciation of the quality of resources and pollution. This is already evident even in many examples today, such as the depreciation of water quality and the problem of overgrazing in farming communities.

The knowledge commons, in extending the traditional concept of the commons, are sites supporting the creation, use, and storage of public knowledge which are free from market or regulatory constraints, and aims to be equally accessible to everyone who desires to access such knowledge. Public knowledge can refer to information resources, services, physical facilities in community institutions such as libraries and museums, and digital networks. Regardless of their forms, three salient characteristics can usually be found with the knowledge commons: a) resources that are shared and freely available to a target community, b) tools supporting participation in the production and use of co-created knowledge, and c) shared spaces or facilities facilitating personal and public discussions (Pang, 2011). The consciousness of knowledge as a commons when it is being shared have also been explored by many other scholars in terms of its issues, sustainable structural frameworks, and protection from enclosures (Hess & Ostrom, 2007; Bollier, 2002; Levine, 2003).

Although the concept of the knowledge commons shares similar characteristics with the traditional commons, the tragedy as hypothesised by Hardin (1968) is not applicable. Whilst overuse depreciates the quality and value of resources in the traditional commons, overuse in the knowledge commons does not have the same effect, especially for digital resources which could be easily copied and shared. This highlights two important characteristics of the knowledge commons. Resource scarcity, a common problem in the traditional commons, has little relevance in the knowledge commons. Additionally, instead of depreciating the value and quality of resources in the knowledge commons, overuse actually has the effect of increasing its perceived value and quality. An article in Wikipedia, for example, is more highly regarded than others if it has been viewed and edited many times more than other pages (Wilkinson & Huberman, 2007).

The irrelevance of the traditional tragedy of the commons begs a next question: if the tragedy of the commons does not apply to the knowledge commons, is there another tragedy we should be looking for instead? Perhaps the tragedy, if any, is not as evident, but there are potential challenges or pitfalls that we should be aware of. The paper seeks to highlight these potential challenges in the context of health information as a type of knowledge commons.