Evaluating Health Promotion Social Media Strategies for Public Health Impact
Posted: April 11, 2013 Filed under: eHealth, evaluation, social media, systems thinking | Tags: developmental evaluation, evaluation, health promotion, public health, social media, strategy Leave a comment »
How is social media stacking up?
I recently spoke at an interactive workshop presentation at the 2013 Ontario Public Health Convention (TOPHC) looking at social media use in public health and the strategies available for evaluating those strategies in practice. The talk was focused on the tools, methods and approaches and the inherent challenges in dealing with a dynamic social communication environment.
Here are the slides from that presentation.
Evaluating Health Promotion Social Media Strategies for Public Health Impact
Image: Shutterstock (used under licence)
Contemplating Better Public Health: Perspective is Everything
Posted: May 31, 2012 Filed under: behaviour change, design thinking, health promotion, marketing, public health | Tags: cigarette use, contemplative inquiry, design, health promotion, mental health, mindfulness, perception, public health, Rory Sutherland, tobacco control 1 Comment »
Design No Smoking
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.
Photo No Smoking Poster 1 by Sempliok used under Creative Commons License from Deviant Art.
Social Media and Health: Leaders(hip) and Followers(hip)
Posted: May 18, 2012 Filed under: behaviour change, eHealth, health promotion, innovation, public health, social media, systems thinking | Tags: complexity, creativity, design thinking, developmental design, developmental evaluation, eHealth, evaluation, Facebook, health, health promotion, healthcare, innovation, medicine, organizational change, organizational design, public health, social media, systems thinking 2 Comments »
Social media is finally catching on with healthcare, public health, and health promotion. With a few recent articles published in the academic literature to rest on, academic health sciences has finally (and I might argue, begrudgingly) conceded that 900+ million users and $100B valuations (Facebook), and thousands of messages exchanged every milisecond (microblogs like Twitter and Sina Wiebo) might have some value for the public beyond entertainment.
If you note how long it took the health sector to start using the telephone as a serious means of engaging their patients or the public, this is lightning-quick adoption. Still, the barriers to adoption are high and the approach to using the technology is scattered. Indeed, just like the start of Internet-delivered telehealth (or cybermedicine (PDF), which has now evolved into eHealth), there is a mad rush to get liked, followed or some other metrics that most health professionals barely understand.
And that is part of the problem.
Meaningful Social Media Metrics
What is a meaningful metric for social media and health? A recently published article in Health Promotion Practice suggested four metrics that are taken from social marketing and applied to social media. These Key Performance Indicators (KPI’s) are:
- Insights (consumer feedback)
- Exposure (media impressions, visits, views, etc..)
- Reach (# people who connect to the social media application)
- Engagement (level of interaction with the content)
These are reasonable, but to to the uninitiated I would suggest a few words of caution and commentary to this list.
Firstly, the insights suggested by Neiger and colleagues “can be derived from practices such as sentiment analysis or data mining that uses algorithms to extract consumer attitudes and other perspectives on a particular topic” (p.162). While not incorrect, this makes the job sound relatively simple and it is not. Qualitative analysis + quantitative metrics such as those derived from data mining are key. Context counts immeasurably in social media use. It’s only in situations where social media is used as a broadcasting tool that gross measures of likes and sentiment analysis work with little qualification.
Even that is problematic. Counts of ‘likes’, ‘visits’, ‘follows’ and such are highly problematic and can be easily gamed. I am ‘followed’ on Twitter by people who have tens of thousands of followers, yet virtually no presence online. Most often they are from marketing fields where the standard practice is to always follow back those who follow you. Do this enough and pretty quickly you, too can have 23,000 followers and follow 20,000 more. This is meaningless from the perspective of developing relationships.
Engagement is the most meaningful of these metrics and the hardest to fully apply. This category gets us to consider the difference between “OMG! AWESOME!” and “That last post made me think of this situation [described here] and I suggest you read [reference] here for more” as comments. Without understanding the context in which these are made within the post, between posts (temporally and sequentially), and in relation to a larger social and informational context, simple text analysis won’t do.
Social Media Evidence: Problems and More Problems
One of the objections to the use of social media by some is that it is not evidence-based. To that extent I would largely agree that this is the case, but then we’ve been jumping out of airplanes with parachutes despite any randomized controlled trial to prove their worth.
Another article in Health Promotion Practice in 2011 highlights potential applications for social media and behaviour change without drawing on specific examples from the literature, but rather on theoretical and rhetorical arguments. An article published in the latest issue of Perspectives on Psychological Science highlights the current state of research on Facebook, which is timely given that its IPO is set for today. That review by Wilson and colleagues illustrates the largely descriptive nature of the field and offers some insight on to the motivation of Facebook users and their online activities, but rather little in what Facebook does to promote active change in individuals and communities when they leave the platform.
The answer to whether social media like platforms such as Facebook ‘work’ as methods of promoting change is simply: we don’t know.
Does social media provide support to people? Yes. Does it inform them? Yes to that too. Does that information produce something other than passive activity on the topic? We don’t know.
In order to answer these questions, health sciences professionals, evaluators, and tech developers need to consider not just followership, but leadership. In this respect, it means creating changes to the way we gather evidence, the tools and methods we use to analyse data, and the organizational structures necessary to support the kind of real-time, rapid cycle evaluation and developmental design work necessary to make programs and evidence relevant to a changing context.
As Facebook launches into its new role as a public company it is almost assured to be introducing new innovations at a rapid pace to ensure that investor expectations (which are enormous) are met. This means that today’s Facebook will not be next month’s. Having funding mechanisms, review and approval mechanisms, a staff trained and oriented to rapid response research, and an overall organizational support system for innovation is the key.
Right now, we are a long way from that. Hospitals are very large, risk averse organizations; public health units are not much different. They both operate in a command-and-control environment suited for complicated, not complex informational and social environments. Social media is largely within the latter.
Systems thinking, design thinking, developmental evaluation, creativity, networks and innovation: these are the keywords for health in the coming years. They are as author Eric Topol calls the dawning of the creative destruction of medicine.
The public is already using social media for health and now the time has come for health (care, promotion and protection) systems to get on board and make the changes necessary to join them.
Have We Turned the Page on Social Science Research for Health?
Posted: May 15, 2012 Filed under: knowledge translation, science & technology, social systems, systems science | Tags: funding, health promotion, knowledge translation, public health, research, research funding, science policy, social science 2 Comments »
Turning the Page on Social Science and Health Research
Over the last two weeks social science researchers across Canada began receiving the decisions from last autumn’s competition for a Social Science and Humanities Research Council (SSHRC) funding award. SSHRC is the principal funder of social science research in Canada, although notably is not in the business of funding heath-related research, which is supposed to be funded by the Canadian Institutes for Health Research (CIHR). [Full disclosure: I currently hold grants from both of these organizations]. The problem is that CIHR was born from a policy and programming body and the former Medical Research Council and has a rather awkward relationship with social science research given its medical focus. It has funded some social science programs, but not in a manner that has enabled social scientists to comfortably explore the range of issues that they might have under traditional SSHRC funding programs, particularly when social issues are not always obviously health issues (e.g., poverty, education) and can easily be dismissed as not being relevant in spite of the evidence that they are. Yet, SSHRC has decided to forgo any funding of health-related projects due in part to the absence of funding to support it when there are presumably options through CIHR or the disease-specific health charities like the Canadian Cancer Society, the Lung Association and others.
Yet, these options are not suitable. In a manifesto entitled “The end of medical anthropology in Canada” a group of leading social scientists painted the picture of the situation in grim terms in University Affairs. Although medical anthropology is the focus of the piece, the authors might as well be speaking for social sciences in general:
Health is inherently social and cultural. SSHRC has always understood this; CIHR, we fear, does not. We face the possible extermination of one of the most vibrant, high-demand and policy-relevant health disciplines, the only scholarly field that places culture at the centre of the analysis of health and that characteristically does so in both national and international contexts. In a multicultural, settler society with a substantial aboriginal population, and in a world where health is at the core of developmental, political and social issues in so many countries, where Canada otherwise wishes to have an impact, does this make any sense?
This brings me back to the beginning of this post and the announcement of the results of the last competition. Looking at the funding numbers released by SSHRC, a discouraging picture emerges. In 2011-12, 37 per cent of all applications in the open competition were deemed fundable, yet only 22.5 per cent were funded. These numbers are similar t0 2010-11, when 36 per cent were deemed fundable and 22 per cent were funded. What is not mentioned in these numbers was the level at which these grants were funded in the first place. I am a 2010-11 recipient of funding from SSHRC — meaning my grant proposal was within the top 22 per cent of all applications for that year — and the amount I received was approximately half of what I requested. That means that I had to take half of my budget and throw it away. So yes, I was successful providing I did either half of the research or found money elsewhere. I did the latter and my pocketbook is none the better for it.
Consider the implications of this change in funding. With one in five projects funded and many of those that are funded at levels well below what was requested the motivation for researchers is one of the first casualties. Researchers know that funding is tight and that it is highly competitive, but few alternative sources for research grants that lay outside of specific disease-focused areas, social scientists young and old are faced with little option. This creates another set of affected parties: students and trainees. Research funding not only supports the scientists themselves in many cases (see my previous posts on this), but those seeking to become scientists themselves or those who seek to get better acquainted with research. In health sciences and policy, this means just about everyone enrolled in such programs.
Now consider all of this in light of a trend towards increasing graduate education numbers. At the academic institution I am affiliated with (like many of its peers), the enrolment numbers are set to nearly double across many of the professional programs associated with health practice and policy in the coming years. Increased demand for training opportunities from the public has created a means for universities to cash in. Of course, what these students will do when they get there is unclear (let alone when they graduate), but it cannot be much in the way of research — at least as it pertains to social science and health. The funding is simply not there to support the kind of broad-based inquiry into the social factors that influence health, illness and well-being anymore. We have, as I call it, reached ‘the Turn’.
The Turn is that point where the system changes irrevocably towards a new direction. It is like a ‘tipping point‘. Dwindling numbers of social scientists working from funding from an institutional budget (e.g., tenure-stream faculty positions) + a doubling of the student cohort * half of the research dollars makes for rather toxic math. The Turn will fundamentally shape the way social science inquiry is done and the kind of questions that get asked. As question foci change, the quality of the research shifts, and the depth of inquiry is reduced, so too will the real impact that social science has on our health.
The gap between what we know, what we do, and what we can do to prevent illness, treat sickness, and promote well-being will grow.
Anecdotally speaking, this trend is not unique to the social sciences, but it is amplified in this domain. Social sciences in Canada and abroad are consistently funded at lower levels than that of basic research (see here for a starting point). But what is interesting is that many of the problems that we face within health require social science knowledge and research to address and social science — from knowledge translation, social network studies, technology adoption, innovation, management, to policy implementation and beyond .
Prevention of disease and chronic illness is often a social phenomenon (e.g., hand washing). Even the act of taking the best of basic science and translating it into practice or policy options (or other scientific research) is a social act that draws on social science research to execute. Social determinants of health are social in nature and require social science to understand their impact. Designing the policy and programmatic interventions that support creating a healthier society also falls to social science research and practice.
What will our health landscape look like without the ability to take what we know and translate it into action? Worse yet, what if we simply are unable to even know what to do because the research and evidence isn’t there in the first place to translate into anything? Without another turn towards something more positive in our research support, we are about to find out.
* Photo Turn the Page by Miaboas used under Creative Commons License from Deviant Art.
Disruption by Design
Posted: March 13, 2012 Filed under: design thinking, education & learning, innovation, social media | Tags: Andrea Yip, Clayton Christensen, design, disruptive innovation, education, graphic design, health, health promotion, human services, infographics, innovation, psychology, public health, social determinants of health, social innovation, social work, technology 1 Comment »
DISRUPT by Paul Woot
Innovation, new thinking, and a change in consciousness can upset the way we see our world and the manner in which we relate to it. This disruption can happen by happenstance or intention encouraging us to consider ways to design change before forces outside our influence change us.
disrupt |disˈrəpt|
verb [ with obj. ]
interrupt (an event, activity, or process) by causing a disturbance or problem: a rail strike that could disrupt both passenger and freight service.
• drastically alter or destroy the structure of (something): alcohol can disrupt the chromosomes of an unfertilized egg.
DERIVATIVES
disrupter (also disruptor |-tər|)noun
Observing the city I live in, the media I consume, and the way I learn, I can’t help but be amazed at how much of my life has been disrupted over the past few years. I can access nearly everything I need to run my business and do my research from my handheld or a tablet computer. I can hand that tablet or handheld to someone else and allow them to interact with the content on it by using gestural movements, not a keyboard.
If I am engaged in health communications or scholarly research, I look to places like Twitter and blogs as much if not more than I do academic databases. Many of the journals I respect and publish content that counts in fields like public health, such as the Journal of Medical Internet Research, are open access and free to anyone who wants to read them. And these open access publications are becoming leaders in their fields, not just cheap versions of “real” journals. This makes the content of my academic work and that of my many colleagues accessible and much more likely to be used.
If you’re a graphic designer your work has never been more important. Whether websites, infographics, high-quality interpretations of traditional media (for a great example see the re-imagined journal article by my colleague Andrea Yip) the world has become more visual and the weight of good graphic design is heavier than ever. At the same time, tools like easel.ly allow anyone to make an infographic, or WordPress for those who want websites (this one included), and even offers to do a $42 logo as reported in Creative Review.
Want to raise awareness of issues? Grab a film camera and put together a small film like Kony 2012, the most viral success story of any video to date.
Or write a book on an important, if somewhat arcane, topic like the meaning of making and get people from all over the world to invest in it on Kickstarter (that’s what Seung Chan Lim or Slim as he is known did and I invested in this venture with enthusiasm).
Or charge a mere $5 like comedian Louis C.K. did for a high-quality copy of his recent comedy show filmed at the Beacon Theatre in New York and let your buyers download up to five copies at once for one price.
Or write a book and let your customers determine its price (including free!) like Jon Kolko and his AC4D colleagues have done with Wicked Problems.
This couldn’t have happened five years ago. The production costs were too high, the distribution channels too primitive, and the bandwidth too low. Now, it’s all different and the disruptions are no longer happenstance, but designed.
Harvard professor Clayton Christensen coined the term ‘disruptive innovation‘ which ”describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves ‘up market’, eventually displacing established competitors.”
Christensen adds:
An innovation that is disruptive allows a whole new population of consumers access to a product or service that was historically only accessible to consumers with a lot of money or a lot of skill. Characteristics of disruptive businesses, at least in their initial stages, can include: lower gross margins, smaller target markets, and simpler products and services that may not appear as attractive as existing solutions when compared against traditional performance metrics.
Health promotion and public health are fields ripe for this kind of innovation, so is healthcare. Indeed, movements like those embodied in Patients Like Me, a social network portal aimed at supporting human empowerment in health care.
We are on the cusp of this taking place in health promotion and human services — whether they are governmental, non-profit or social enterprise based. Health promotion is largely about enabling individuals, groups and communities to better adapt to change, support themselves and gain greater control over the social determinants of health. At present, we teach students theory and research, but what about business dynamics or systems thinking or visual methods of presentation or social innovation? These are the tools and strategies that the abovementioned examples used. Many of them also used design.
The same challenge holds true for social work, psychology and education.
These are the fields that are key supports for promoting wellbeing in our community. It is perhaps not surprising that the concept of design is noticeably absent from all of these fields.
That doesn’t need to be the case.
This past week I had the privilege of spending an afternoon with Scott Conti and his staff at the New Design High School in New York City. There I saw students working through everyday problems using design, building business ideas to support themselves and their communities, and applying their various creativities to making a difference in their lives using design as the lens. This environment was where social work, education, psychology and health promotion intersect. Scott — who delivers a great talk on his work as part of TEDX Dumbo — is a health promoter and social innovator. So are his teachers.
None of them were trained for what they do. They have adapted, modified, created and innovated. They disrupted their own patterns of work and learning so that they could better disrupt those around them, for good. They did this by design.
If we are to expect that the fields most connected to social action and the promotion of wellbeing are to contribute to our betterment in the future, they need to change. Disruptive design for programs, services and the ways we fund such things is what is necessary if these fields are to have benefit beyond themselves. Long past are the days when doing good was something that belonged to those with a title (e.g., doctor, health promoter, social worker) or that what we called ourselves (e.g., teacher) meant we did something else unequivocally (e.g., educate). Now we are all teachers, all health promoters, all designers, and all entrepreneurs if we want to be. Some will be better than others and some will be more effective than others, but by disrupting these ideas we can design a better future.
Knowledge Hypocrites: Take Two!
Posted: February 4, 2012 Filed under: knowledge translation, public health, systems thinking | Tags: beliefs, health promotion, hypocrisy, knowledge mobilization, knowledge translation, reflective practice, values 3 Comments »Knowledge Hypocrites: Take Two!.
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.
The Science of Design Thinking
Posted: August 27, 2011 Filed under: art & design, design thinking | Tags: Andrea Yip, Buckminster Fuller, design, design science, design thinking, health promotion, Nigel Cross, periodic table of design., science, visualization 10 Comments »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.
Periodic Table of Design (version 1.0) by Andrea L. Yip on DrawedIt
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.
Andrea’s blog is called Drawed and can be visited at: http://drawedit.wordpress.com/ . She welcomes feedback on her ideas.
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.
The Art of Complexity and Public Health
Posted: August 14, 2011 Filed under: art & design, complexity, emergence, health promotion, public health | Tags: art, beholding, contemplative inquiry, health promotion, public health Comments Off
“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.
Design for Social Norms or Social Change?
Posted: August 6, 2011 Filed under: behaviour change, design thinking, health promotion, systems thinking | Tags: complexity, creativity, danah boyd, design, emergence, health inequity, health promotion, Keith Sawyer, social change, social design, social justice, social media Comments Off
Social change or social norm?
Designing for how people live is part of good design practice, but what about designing for the way people could be? What does it mean to design for social norms and what role does design have in changing them?
Media scholar and youth researcher danah boyd recently wrote on the need for designers to consider social norms as part of their media creations. The post received a lot of attention in the mediasphere and came on the heels of another interesting post by Keith Sawyer on Chinese social norms and the Tiger Mom phenomenon (that I also wrote on a while back). Returning to boyd’s argument, she makes the case that designers don’t dictate the behaviour of people in the systems they create, the people tthemselves do:
Social norms aren’t designed into the system. They don’t emerge by telling people how they should behave. And they don’t necessarily follow market logic. Social norms emerge as people – dare we say “users” – work out how a technology makes sense and fits into their lives. Social norms take hold as people bring their own personal values and beliefs to a system and help frame how future users can understand the system. And just as “first impressions matter” for social interactions, I cannot underestimate the importance of early adopters. Early adopters configure the technology in critical ways and they play a central role in shaping the social norms that surround a particular system.
What boyd is arguing (using my words and concepts from complexity science) is that emergence and path dependency shape design’s manifestation in the social realm. In technology-oriented systems, the ‘early adopters’ are the ones who set the stage for how the next wave of users interact with the system and boyd points to examples from Friendster about how attempts to control its community helped drive people away from the site (ultimately leading to its demise).
People don’t like to be configured. They don’t like to be forcibly told how they should use a service. They don’t want to be told to behave like the designers intended them to be. Heavy-handed policies don’t make for good behavior; they make for pissed off users.
This doesn’t mean that you can’t or shouldn’t design to encourage certain behaviors. Of course you should. The whole point of design is to help create an environment where people engage in the most fruitful and healthy way possible. But designing a system to encourage the growth of healthy social norms is fundamentally different than coming in and forcefully telling people how they must behave. No one likes being spanked, especially not a crowd of opinionated adults.
The focus here is more on social media and online spaces, but the argument could be made for the same thing in social design. But unlike information technology, which favours a very particular group of people, social design has the potential to intentionally engage specific populations. Using boyd’s argument, one might assert that much of the technology we use from Foursquare to Instagram to the iPhone itself is shaped by the under-40 set of educated, middle class, largely white male hipster knowledge workers as they are typically the earliest visible adopters for such technologies (even if that is changing) .
In this model those with the most power, privilege and social capital at the outset greatly determine what comes next. This might be OK for technology, but is highly problematic for social justice and social inequities. A health promoting social design has the potential to change this by seeding that early adoption cycle with different people with potentially different values to shape outcomes not defined by a narrow set of social groups.
Keith Sawyer’s article points to the social norming around Chinese parenting (as defined through Amy Chua’s Tiger Mom) and how it clashes with a particular type of parenting model that dominates in the United States and our ideas of creativity. In describing his reaction to a recent review of Chua’s book and its contents, Sawyer points to the unease it creates in him when comparing norms and what it means for creativity and innovation:
I ought to be lined up with all of the horrified American parents who hate this book. But I just can’t side with them on this one. Creativity is hard work, and you don’t get creativity without paying your dues. No one magically learns how to play piano or violin (I’m reminded of the old joke: “Do you play the violin?” “I don’t know, I haven’t tried it yet.”) And as Amy Chua points out, there’s nothing like the joy that comes from being able to do something well, knowing that you earned it with hours, months, and years of hard work. As a child, I took piano lessons for eight years, and now thirty years later it’s a major source of joy in my life.
Chua’s parenting is an issue because it doesn’t fit with the dominant social norms, just as the self-esteem-at-all-cost approach that Sawyer rightly exposes as problematic in its own right would be in China.
These are designed systems. Just as we create path dependencies for one set of values, so too can we do the same for others and with other people. The focus on the outcomes of systems rather than their design is problematic if we want change. Starting with design and values at the outset, being conscious of who we invite in and how we engage them and by remaining contemplative about how these systems unfold and the emergent patterns that shape them, designers of all stripes may be better positioned to create social change rather than just for social norms.
The Design of Health
Posted: June 24, 2011 Filed under: design thinking, health promotion, innovation | Tags: design, health, health promotion, innovation, public health, social innovation Comments Off
The Pulse of Health Promotion & Design is Different
Design and health promotion have a great deal in common and enough to complement one another that makes them a great match. However, it is the scale and rhythm of the two that brings them together and keeps them apart.
Although the two fields are distinct, design and health promotion are a natural fit. Health promotion is a field that seeks to address social, environmental and care-related factors that keep people well and reduce the resource gap between those that have good health and those that do not.
Designers seek to develop products — objects, services, structures — that meet the needs of their client and, in the cases of social design, the larger society that they are a part of.
Both fields operate systems thinking environments and consider the opportunities for engagement of wide-scale participation in the creation of their products. But where the two fields differ is where the greatest opportunity for collaboration lies.
Health promoters — and health professionals in general — are not great designers. While they are good at engaging the community in assessing need and opportunity, there is a bias in the sector to looking to what is to inspire what could be. This means drawing on current evidence and spending considerable time defining the issue at hand in the first place in light of this. Health promoters are adept theorists and practitioners, however the theories used are often contested and widely debated — something health promoters embrace. The risk for health promotion is that they will use the solutions already developed or they will get mired in debate over the meaning of potential solutions to come.
Designers on the other hand are great dreamers and doers when it comes to creating things that are novel. Designers are comfortable with working with conflicting information and abductive reasoning to solve problems before them. And then they move on. Design’s focus on the here and now for the product or service gives them focus, but loses the thinking about the wider implications of their product – something that keeps health promotion in debate.
There are exceptions to the examples provided above, but they are exceptions and not the rule.
In a health context, designers systems think about the way their product is established, where health promoters think about the values that underpin that product and the wider implications for its use beyond its creation. Bringing these two fields together provides an opportunity to make health promotion more innovative and action-oriented and design more evidence-based and socially responsive.
The social challenges from chronic disease, environmental threats, social migration, aging populations, economic disparities, and a more globalized, multicultural world require strategies that bring the best ideas to the table, strategies to realize them, and values that make these actions more equitable for everyone. Health promotion + design is one way to achieve this.
