Cigarette smoking remains among the most significant and pernicious global public health challenges. On World No Tobacco Day it’s time to consider re-designing our approach to public health and tobacco control in the hopes of meeting this challenge and others like it more effectively.
Today is World No Tobacco Day and offers us an opportunity to take a pause and think about the ways in which we approach tobacco control as an example for public health.
Marketing funnyman Rory Sutherland, and smoker, makes a terrific observation about smoking and its power to promote quiet contemplation in one of his recent TED talks (which is well worth watching for many reasons, only some related to tobacco use):
“Ever since they banned smoking in the UK in public places I’ve never enjoyed a drinks party ever again. The reason… is when you go to a drinks party and you hold up a glass of red wine and you stand up and talk endlessly to people sometimes you don’t actually want to spend the whole time talking. It’s really, really tiring. Sometimes you just want to stand their silently, alone with your thoughts. Sometimes you just want to stand in the corner and stare out of the window.
Now the problem is now that you can’t smoke, if you stand there and stare out of the window on your own you’re an antisocial, friendless idiot.
If you stand there and stare out of the window on your own with a cigarette, you’re a fucking philosopher.”
In this tongue-in-cheek presentation, Sutherland inadvertently hits on a powerful reason to smoke, but not for the reason you might first imagine. It is less about social perspective, but internal perspectives of the self and the opportunity to better acquaint oneself with them.
Sutherland speaks to the perception of others in this talk, but I am more interested in what this act of contemplation — the ‘fucking philosopher’ aspect of smoking for some and why public health sometimes gets it wrong when it comes to tobacco control, but could get it right with mental health with the right design.
Over the past year I’ve made a concerted effort to better understand the motivations and habits of cigarette smokers from the perspective of a designer, not a public health researcher. In doing so I have sought to pay greater attention — as Rory Sutherland does — to the actual experience of smoking. And what I have noticed is the powerful contemplative effect it has on many smokers.
By no means is this a by product of cigarettes, and I certainly cannot endorse their use on health grounds, but one positive by-product of the act of smoking is greater attention to the self in the moment. Sutherland speaks to how a cigarette gives him the license to take time out of a busy party and contemplate, reflect, and gain some perspective that might seem odd or “antisocial” without the prop created by a cigarette.
Strange that we seem unable to develop the same habits and social acceptance of everyday contemplative acts in public, yet fully recognize this as legitmate with smokers even if we question the device used to precipitate the “time out”.
Smokers take breaks throughout the day to engage their cigarettes. Even in cold weather, they will go outside and sit or stand for 10 minutes just to indulge their habit, compulsion or pleasure, sometimes in small groups. This act of smoking provides a sense of community (with other smokers), contemplative space, and a pause from the everyday rush of life. Indeed, as they engage in activities that threaten their physical health they also engage in an activity that is very healthy for their mental well-being.
This is potentially another area that requires further investigation both from a positive standpoint (designing healthy space for contemplative inquiry or reflection) and looking at negative impacts of our well-intentioned efforts to curb tobacco use. While the loss of potential smoking peers has been examined, I could not find any research that examines the loss of contemplative time and its impact on smokers who quit. Doing so firstly acknowledges that cigarette use has benefits, which is problematic for many in public health. It also means getting into a zone of complexity whereby we need to consider how something that is so demonstrably toxic to the human body and others around the smoker can have potentially positive effects in other ways.
From a design perspective, how might we apply the lessons from cigarette use to mental health promotion? How might we design programs, spaces, places, and social conventions that promote the quiet contemplative acts that smokers gain from taking that cigarette break and offer potentially great value to tobacco users without creating harmful effects for others? How can we promote the quitting of smoking without the loss of the contemplative benefits that come with the act of lighting up?
Engaging design, complexity and imagining the systems that influence them both might yield considerable insight into how we manage other public health problems and how we might better promote mental health in the protection of physical well-being.
The link above points to a great post by KMBeing that deserves some re-blogging here. It looks at the issue of hypocrisy in espousing the values of taking knowledge and putting it into practice, without practicing it. It’s worth a read.
There are a lot of professions and practices where we say one thing and mean another. This is something that can apply to health promotion, design, evaluation and social justice work in any guise.
What do the words and ideas mean and what do they mean in practice?
These two concepts are part of reflective practice and also require good communication, the kind that that allows people to find out what the meaning of their words are in the eyes and ears of another. Good communication requires speaking clearly, listening clearly, and clarifying clearly and doing so honestly and openly.
One of the issues with many of knowledge practitioners is that the rhetoric of knowledge translation/mobilization is so seductive. It is so common-sensical and even trendy. But the idea of sharing what we know, building relationships, and working together in true collaboration is much harder when viewed in reality where people have different resources, power structures, perceptions, reflective capacities, skills, knowledge, and time.
Knowledge mobilization is about not just strategy or tactics, but building up a system that supports it all. David Phipps, who wrote the original article looking at these hypocrisies was referring to this by commenting on the fact that there are too few incentives to change the way things are done and so without a top-level strategy to support change and no incentive from the bottom, the system remains the same.
Designing and living a system that works requires living and designing practices that support our values and communication now.
My colleague and design collaborator has proposed a way of viewing design thinking as something akin to a periodic table of elements. Beyond just posing a brilliant way of explicating and organizing the multiple facets of design thinking, Andrea Yip has shown the world that there is much we can learn from science, visualization and how they both apply to design.
Last weekend a group of design thinkers got together to discuss the concept of design thinking and what it means. The conference, summarized in another post, explored the language of design thinking, the need for visual thinking, and the importance of understanding the context of design and design thinking.
While this was going on in Vancouver, another designer (my colleague, Andrea Yip) was back in Toronto taking these same ideas independently and transforming them into an organizational structure that should create much room for thought among those interested in design thinking. The model she has developed is one not based on areas that are familiar to design – architecture, art, graphic design, business strategy, or engineering — but science.
Designers often speak of a need for multidisciplinarity in their work. While laudable, this commonly refers to the inclusion of multiple perspectives on a design problems from within the broad field of design. It is indeed rare to find such multidisciplinary teams comprised of scientists. Andrea has turned that upside down by proposing a model of design thinking based on the periodic table of elements. The table, shown below, is a first draft, but a highly sophisticated one and something that ought to be taken seriously.
By using the structure and format of a bedrock of science, Andrea has shown that there are ways of thinking about design that transcend the boundaries that we often unconsciously bind around it. This new model inverses the terms posed by the creative arts or the applied disciplines of engineering or architecture, each that have made enormous contributions to the field, yet all rely on a level of subjectivity, and replaces them with a model based on a more universal language: science.
Science and design are uneasy partners. Some, like Nigel Cross, have pointed to the challenges with the use of terms design science and the science of design, while others, like Buckminster Fuller, use the term design and science in ways that are open to challenge from those who identify as practicing scientists. Ms Yip, a designer trained in science (biology) and social science (health promotion) fields, sees things in ways that transcend these perspectives to propose using science as a guide to inform the way we understand design.
In doing so, she provides a bridge between the worlds of science, with its emphasis on evidence and strict adherence to protocols, and design, with its flexible, rapidly evolving, yet often non-specific methods. Indeed, Andrea’s blog showcases many examples of how design and fields like health promotion fit together and differ. It is time for both designers and scientists to listen more intently to this conversation.
By using methods, theories, analogies and conceptual models that extend our thinking beyond the realm of conventional design and science, we offer opportunities to make things better — and in doing so shape our world for the greatest benefit for us all.
And if the Periodic Table of Design is not enough, Andrea’s also developed a prototype set of trading cards based on the table for those more inclined to school-yard forms of collaborating around design that are also up on her blog.
For more dialogue on design thinking, stay tuned to this space and the Twitter feed @d_bracket for the upcoming launch of the Design Thinking Foundations project and corresponding site. And wouldn’t you know? Andrea Yip is the coordinator of that project.
“Art is an intimation of the fundamental reconciliation of contradicting possibilities” – Joel Upton
Without contradiction, there is no art. Art itself is about juxtaposing ideas, tensions, concepts and working with form and space. The artist, whether consciously or not, is balancing contradictions in space, medium and form to challenge themselves and their audience to explore an idea, a feeling, concept or all three.
Engaging with art is about beholding. To behold requires focus, attention and some enthusiasm for the subject matter (knowledge doesn’t hurt much either). It requires time to contemplate the elements above and explore the contradictions and the perspective of the artist and the beholding audience. Health promotion and social change is full of contradictions. For example, how to promote freedom and self-determination while ensuring appropriate regulation to protect those who’s self-determined choices put others at risk? How do we create community and common space while respecting diversity and uniqueness — including those perspectives that don’t support commonly held values?
The list can go on. Art and the art of beholding can offer some ways to address this complexity through contemplative inquiry and learning about perspective and perspective taking.
Claude Monet in painting the Maintee sur la Siene did so from the river in his boat. By being on the river Monet was able to gain a perspective that is fundamentally different than had he painted from the shore, which he also did in other works. To behold Monet’s painting yields insights that cannot be gained by simply passing the image over.
Spending time before the work yields perspectives that cannot be obtained through mere casual observation. One is immune to the overlaying circles, the misty cornering of the Siene, or the fact that nearly all of the painting exists in reflection. When one looks at the painting in the context of others using the same angle and different colour shades, we see that this is a work that is distinct. Searching through the various forms of the work, one sees new layers of possibility and complexity emerge as the tones change, the textures shift and the intensity of the work alters. The version held at the Mead Art Museum at Amherst College, where Professor Upton teaches, is particularly complex in how subtle the reflections and use of colour and texture are parlayed on the canvas.
Learning more about Monet at the time he did this painting, his life, the fact that it wasn’t like he painted it from the water, he DID paint it from the water.
But we might have known that had we not spent the time in contemplation of the painting. Got to know it, and understand it deeply. Submitted ourselves to the work with a level of intimacy that can only be obtained through the act of contemplation and engagement with the art. The longer one beholds the work and sees the various forms within it, the greater the complexity that emerges — qualities unknown or unknowable without the contemplation of the work in depth.
Monet knew that he had to survive, to produce a work of art that was in demand and could sell. He had to survive, but also did art to ensure that people were inspired and challenged. His wrestling with contradiction, his application of knowledge to a medium, and the expression of his creativity through both is what made him one of the most widely renowned impressionist painters who ever lived.
Health promotion is about contradiction. It deals with complexity all the time. How do we inspire change in others and still support self-determination? How can we change a system when that system has no single voice? How do we get individuals to do what we want, yet simultaneously respect what they want?
Health promotion also seeks to respect diversity, but at the same time, what does it do to truly understand this diversity? Do we take the time to get to know the communities it deals with. Really, truly know these communities. Do we give the time to be intimate with them?
My experience is sadly, no. In public health we use focus groups — which were initially designed to focus a research question, not serve as a means of research unto itself — to generalize from a group-think scenario to an entire community and then claim that we know them. Really? Is this beholding? Is this the kind of contemplative inquiry that makes sense for public health.
Could we learn more from artists? Our methods certainly could (see art of public health), but perhaps the way of the artist is also something we could learn more from.