The Design4Health conference is on this week bringing together designers from different fields together with health policy, practice and research professionals. While the focus is on the relationship between design and health, it is also inspiring thoughts of how health itself is designed.
This week the first Design4Health conference is being held in Sheffield, UK. The conference attendees includes designers looking at interactions, service, interiors, architecture, fashion, and industrial areas of design. Mixed with is group are physicians, physiotherapists, psychologists sociologists, health promotion practitioners, artists, and policy researchers. This mix represents much of what makes the design and health intersection so exciting, but also the (somewhat) predictable “Tower of Babel” with many disciplines working to be understood by the others.
The language issues have been relatively minor, but on one level the more complicated area of confusion is not where one might guess (the application of design to health issues), but rather the understanding of health itself relative to design.
To illustrate, much has been presented on the way design has re-fashioned devices for those with some form of physical disability. From wheelchair designs that are aesthetically pleasing and light to female portable urinals to address issues of incontinence and the social issues women face trying to relieve themselves in non-toiletted spaces, the products being discussed have shown what some design thinking can do to potentially improve people’s lives. But what if those lives don’t need improvement in the way we think?
Consider the language of health in popular use, which focuses on the ability to control conditions and both be free of physical discomfort and mental stress. These are deficit-oriented models that focus on what must be absent or is undesirable, rather than what a person does with their life and their capabilities to act on their values and interests. What if we viewed health differently?
Further, what happens to design when we focus it’s talents on alleviating pain and discomfort as defined by some standard that is both ideal and unattainable at the expense of promoting personal wellness as defined by the person living their life? What we’ve not talked about is the idea that someone with a substandard medical device might have creative ways to live a life where the sub-standard product becomes nearly invisible. This is not to suggest that we lower the bar, but it does beg the question why we are so focused on ‘problems’ of a particular perceived nature and not opportunities?
We also seem to be poor at reflecting the diversity in the public and their relationship to their bodies, minds and lives that we embrace in our attendance at our conferences. Just as we come from different disciplines, so too do people’s sense of what is a ‘problem’ and what contribution design has to addressing that problem. This is about designing health, not the design for health.
Innovation grants are a misnomer, signifying one of the greatest problems with academic science and the quest to create novel solutions to important problems.
Yesterday the Canadian Cancer Society Research Institute (the research arm of the largest charitable agency that supports cancer programming in Canada) announced its new, revamped lineup of grant funded programs to be launched within the coming months. Among the first of these new programs is one called Innovation Grants (PDF)while another is called Impact Grants (PDF). In fact, both of these new program announcements include the definition of each of the key terms in their program call:
Innovation: The action of innovating; the introduction of novelties; the alteration of what is established by the introduction of new elements or forms. -Oxford English Dictionary
Impact: the action of one object coming forcibly into contact with another; a marked effect or influence -Oxford English Dictionary
This is impressive in how they can clearly and distinctly linked the definition of the word to the program call. Why? Because too often grant program calls and their expression in reality are too often separate. I once served on a grant panel that was looking at grants aimed at ensuring quality knowledge translation only to find that most reviewers were comfortable with things like “prepare academic manuscript based on research” and “present findings at major conference” to be acceptable knowledge translation goals by themselves. I was appalled.
Yet, I can’t help but think, despite the good intentions here, that these new programs are going to follow in similar footsteps. The problem is not the funder, but rather the way that funding is granted and the reliance on the system to change itself.
The innovation grants are designed to :
support unconventional concepts, approaches or methodologies to address problems in cancer research. Innovation projects will include elements of creativity, curiosity, investigation, exploration and opportunity. Successful projects may involve higher risk ideas, but will have the potential for “high reward”, i.e. to significantly impact our understanding of cancer and generate new possibilities to combat the disease by introducing novel ideas into use or practice
The mechanism by which these grants are to be decided are, as much as I can tell, by peer review. It is for that reason alone that we can feel some level of confidence that these grants will fail outright. Peer review is designed to judge the quality of content by what is and has been, not by what could be. “Innovation” is about doing things differently, often markedly so. Scientific panels are about supporting incrementalism, particularly in the social and behavioural sciences.
Innovation is also about risk and the potential for failure. These are two words that are highly problematic in present day academic science. Firstly, if you’re a junior scientist, you may be working desperately to fund yourself and your research (and research team). The price of failure is high. If you’re not able to publish meaningfully off your research, you will have a hard time getting your next grant and keeping yourself afloat. In public health sciences for example, CLTA (contract limited-term appointments) are dominant.
I should know as that’s the position I hold.
But the tenured faculty don’t have it much better. While they are more secure, their research teams, graduate student trainees who rely on projects to develop their skills, and the ability to develop coherent programs of research are at risk every time there is an unsuccessful grant. There are real opportunity costs to pursuing risky ventures so many don’t do it
As one who has tried to be innovative with his work and having the privilige (or curse, depending on the perspective) of having interests that have fallen into the innovation category (or “trendy” category to the cynic), I’ve seen how innovation is treated and it’s not good. Innovation programs tend to split committees. I’ve had too many comments returned to me that have some variant on “this is amazing, potentially leading edge research!” alongside “the use of non-conventional methods makes this suspect” or “I don’t understand what this is supposed to do“. As one who had to endure years of questions like “I don’t see how this Internet thing has anything to do with health” in the early days of the eHealth this kind of line of questioning is familiar to me.
I point this out not to gripe, but to illustrate how innovation can get treated in academia. When you get feedback like I described it is very hard to critically assess the true merits of the proposal for improvement. Did people not understand an idea because it could have been written more clearly or did they just not “get” the innovation? Were those who were excited just caught up in the “newness” or were they really in sync with my vision? As a scientist, I don’t know the answer and can’t improve because the feedback is so contradictory.
And because innovators often create, develop or define fields of inquiry or practice that does not exist or is in development there are few if any adequate and available reviewers with the appropriate background on the topic.
In academia, we rely on tradition, on evidence (which is part of tradition, what has been done before), not on strategic foresight and innovation to guide us. That is a problem in itself. Universities haven’t survived hundreds of years by being risky, they have because they were safe (in spite of the occasional radical shift here and there). With complex social problems and the challenges posed by things like cancer, something risky is needed because the traditional ways of doing things have either been exhausted or are no longer producing the necessary health gains. Academics just aren’t positioned to embrace this risk unless the system changes — with them helping drive that change — to support innovation and not just talk about it.
Until that happens, the opportunities to live up to the definition of innovation posed about to create the impact described above will be limited indeed.