Health workforce development in the Age of Intelligence: a tragedy of the cognitive commons?

Skip to content

English

English

Français

Español

Português

Українська

العربية

Translate this page into any language

Powered by Google Translate. Loading it shares your visit with Google.

Search for:

Search

Ask anything

Two people, both of whom I have met versions of many times.

The first is a national programme manager at Nigeria’s National Primary Health Care Development Agency (NPHCDA), or at the Ghana Health Service.

She is formidable.

She has been through in-service training with credit points that counted toward her career progression, mid-level management modules, a field epidemiology programme where a designated mentor reviewed her outbreak investigation and sent it back for revision, and 15 years inside an institution with a memory.

She did not make it on her own, and she would be the first to say so.

Her organization has real frailties, chronic underfunding, cascade training that thins as it descends, mentorship budgets that vanish first when a grant closes.

It is still an organizational culture that formed her, and pretending otherwise insults both her and the colleagues who invested in her.

The second is a district immunization officer three administrative layers below.

She attended a two-day cascade workshop in the state capital four years ago, received a per diem and a slide deck, and then spent a decade figuring out alone why the children in three settlements kept being missed.

She has real expertise too.

Nobody designed the pathway that produced it.

Hold both of them in mind, because the difference between them is the whole argument of this article.

What is the ‘tragedy of the cognitive commons’?

Nolan Lovett’s “The tragedy of the cognitive commons: How AI could disrupt the regeneration of professional expertise”, published in Human Resource Development Review, lays out a fascinating argument about artificial intelligence and expertise.

Its claim is that we have been asking the wrong question.

The question is not whether workers can be reskilled.

The question is whether a profession can still replace its own experts.

Two old ideas, in plain language

The paper builds on two pieces of social science that are worth explaining, because the argument collapses without them.

The first is a parable.

In 1968, the biologist Garrett Hardin described a village pasture open to all.

Every herder gains personally from adding one more animal, and the cost of the extra grazing is spread across everybody.

Each decision is individually sensible.

Collectively they strip the pasture bare.

He called it the “tragedy of the commons”, and it became the standard way of describing how a shared resource can be destroyed by people who are each behaving reasonably.

Lovett is explicit that he borrows the shape of Hardin’s story and rejects its pessimism.

Which brings in the second idea, and the more hopeful one.

Elinor Ostrom won the Nobel Prize in economics for demonstrating that Hardin was empirically wrong about the ending.

She spent decades documenting real communities, irrigation systems in Spain and the Philippines, mountain pastures in Switzerland, Japanese village forests, that had shared a finite resource for centuries without destroying it.

They did it by making rules together: agreeing who has access, monitoring each other’s use, imposing modest and graduated consequences on people who take too much, and resolving disputes locally.

Crucially, Ostrom found these arrangements were almost never imposed from outside.

They were invented and adapted by the people who depended on the resource.

So when I say the paper follows Ostrom to the governance question, this is what I mean.

The tragedy is not a prophecy.

It is a diagnosis of what happens in the absence of institutions, which turns the analysis into a practical question: who makes the rules that keep this particular pasture alive, and at what level?

What is being grazed

The resource in Lovett’s account is what he calls the Cognitive Commons: the pool of practitioners in a field who hold deep domain knowledge, tacit understanding, and the judgment to work independently when a situation falls outside the protocol.

It is not human capital, which sits inside a person or a firm.

It is not a community of practice, which is a social process rather than a stock.

It is not workforce capacity, which recruitment can move around but cannot manufacture.

From there the paper makes four moves.

It separates Internalized Mastery , built through sustained cognitive struggle, from Distributed Mastery , the fluency of orchestrating AI systems.

It names the Validation Tether : catching a plausible but wrong answer requires the very expertise that AI adoption may be eroding.

Surface validation spots nonsense and bad formatting. Substantive validation spots the recommendation that is technically correct and wrong for this patient, this...