Handbook of Systems and Complexity in Health

Handbook of Systems and Complexity in Health

Handbook of Systems and Complexity in Health

A brilliant and comprehensive new book has been launched that brings together the best scholars working in the area of systems thinking and complexity and applying it to health.

The book description can be found here along with a link to the abstract for a chapter I co-authored with Andrea Yip looking at the overlap between design thinking and systems science and complexity. This chapter takes a design lens on previous work developing the CoNEKTR model for engagement in complexity and health.

It’s a big book, but well worth a look if you’re wrestling with complexity and systems thinking in health and social innovation.


Marketing the Narrative of Complexity

Sunset 2007-1Complexity, by its very nature, is not a simple concept to communicate, yet it is increasingly becoming one that will define our times and may be the key to ensuring human survival and wellbeing in the years to come. If society is to respond to complex challenges the meaning of complexity needs to be communicated to the world in a manner that is understandable to a wide audience. This is the first in a series of posts that are looking at the concept of complexity and the challenges and opportunities with marketing it to the world.

Across North America this week the temperatures are vastly exceeding normal levels into ranges more akin to places like India or East Africa. The climate is changing and regardless of what the causes are the complexities that this introduces require changes in our thinking and actions or human health and wellbeing will be at risk. To follow Einstein’s famous quote:

“We can’t solve problems by using the same kind of thinking we used when we created them”

Many U.S. States are suffering hurricane-like after-effects from a Derecho that hit last week, knocking out power at a time when temperatures are into the high 90′s and low 100′s. Derechos are rapid moving hot air systems that are difficult to predict and can only be anticipated under certain conditions. The heat wave combined with the lack of air conditioning and supplies left 13 dead, maybe more. The heat wave is continuing and is expected to last throughout the weekend.

But this post is not really about the weather, but the challenges with complexity that it represents and how we need to be better understanding what complexity is and how to work with it if we are to survive and thrive in the years to come.

Blog interrupted

It’s ironic that this post was delayed by blackout. I live in Toronto, Canada and we have a remarkably stable power supply, yet last night and through this morning I was without power  due to suspected overheated circuits attributed to high air conditioning use, shutting down my Internet and everything else with it. In many parts of the world, this kind of blackout is commonplace and a fact of daily living, but not here…yet. This fortuitous bit of timing illustrates the fragility of many of our systems given the reliance on power to fuel much of what we do (e.g., cooking, food storage, Internet, traffic signals, lighting, etc..).

Virtually all of the infrastructure of modern life (here and increasingly globally) is tied to electricity. If you’re interested in imagining what would happen if it all shuts off, I’d highly recommend reading The World Without Us by Alan Weisman. Weisman uses a complexity scientist and futurists’ tool called a thought experiment to craft a book about what New York City would look like if humans suddenly disappeared. The book illustrates how nature might take over, how the underground subways would flood and collapse because of the millions of litres of water needed to be pumped out of it each day, and how certain human-built structures would decay over time (some far faster than we might hope).

Thought experiments take data from things that have happened already, theories, and conjecture and project scenarios into the future based on the amalgam of these. It provides some grounded means of anticipating possible futures to guide present action.

From present delays to future/tense

The Guardian asked a number of scientists working on climate about whether this current spate of extreme weather events is attributable to global warming. The scientists offered a range of answers that (not surprisingly) lacked a definitive statement around cause-and-effect, yet the comments hint at a deep concern. These anomalous conditions are starting to move further towards the end of the normal curve, meaning that they are becoming less statistically plausible to be caused by chance. What this means for the weather, for climate, for our economies is not known; all we have is thought experiments and scenarios. But the future is coming and we may want to be prepared by helping create one we want, not just one we get.

Unfortunately, we cannot wait for the data to confirm that global warming is happening or determine that we are contributing to it and to what degree. This is not just a weather issue; the same situation is playing itself out with issues worldwide ranging from healthcare funding to immigration policies and migration patterns. Interconnected, interdependent and diverse agents and information forms are interacting to create, emergent patterns of activity.

It is for this reason that weather patterns — despite being one of the most monitored and studied phenomenon — can’t be accurately predicted outside of a few hours in advance, if at all. There is too much information coming together between air flows, humidity, land forms, physical structure and human intervention (e.g., airplane contrails) interacting simultaneously in a dynamic manner to create a reliable model of the data. David Orrell’s book Apollo’s Arrow is a terrific read if you want to understand complexity in relation to weather (and more) or see his talk at TEDX on YouTube.

Two’s company, three’s complexity (and other analogies)

The above heading is taken from a title of another book on complexity and tries to simply point to how adding just a little bit of information (another person to a conversation perhaps) can radically alter the experience from being simple or complicated to complex. Just thinking about planning a night out with two people vs. three and you’ll know a little of what this means.

Analogies and metaphors are ways in which complexity scholars commonly seek to convey how the differences in conditions represent varying states of order. Brenda Zimmerman and others write about putting a rocket to the moon as being complicated and raising a child as being complex. One of my favourites is Dave Snowden‘s video on How to Organize a Children’s Party. One of the reasons we resort to analogies is that we need a narrative that fits with their experience. All of us were children and some of us have had them as parents so we can relate to Zimmerman and Snowden’s ideas because we’ve experienced it firsthand.

We haven’t experienced anything like what is anticipated from global warming. In the Americas, parts of Europe and Asia we are enormously fortunate to have entire generations that don’t know what it’s like to be hungry, have no healthcare, be without electricity, or have no access to safe water and proper sanitations. Stories about children’s parties might not bring these scenarios home. It is why Weisman’s book is so clever: it makes a plausible scenario fiction.

Science fact as science fiction

The role of fiction might be the key to opening the marketing vault to complexity. Scott Smith and others have been exploring how the use of science fiction helped pave the way for some of today’s modern technologies and innovations. By weaving together fantasy narratives and imaginations on the future, technologists have managed to re-create these tools for current life. Witness the Tricorder Project that seeks to develop the same multifunction health and information tool used by Dr. McCoy on Star Trek.

We are making headway with complex information as witnessed by the popularity of infographics and data visualizations. But there is much more to be done.

Complex problems require complex solutions. Artists, designers, scientists, marketers, journalists and anyone who can communicate well can play a role. Making complexity something that people not only know about, but want to know about is the task at hand. In doing so, we may find people reaching for and advocating for complex solutions rather than stop-gap, band-aid ones like buying a car with better fuel economy as the main strategy to combat carbon emissions.

It’s been done before. Marshall McLuhan wrote about esoteric, yet remarkably insightful and complex topics and became a household name in part to his appearance in Woody Allen‘s Annie Hall. Our media landscape is far more complex now (no pun intended) to think that a single appearance of any complexity superstar (if one existed) would change public perception of the topic in the same way that McLuhan’s did for his theories on media. Yet, Al Gore’s An Inconvenient Truth might have done more to get people talking about the environment than anything. And while Gore is not known for his witty storytelling, his slide show did a good job.

To begin our journey of marketing complexity we need to come up with our stories so that we can tell ones that are pleasant, rather than the ones that are less so. And if you want one that fits this latter category, I strongly recommend reading Gwynn Dyer’s chilling Climate Wars. Instead, let’s get closer to living what Peter Diamandis and Steven Kotler write about in Abundance.

The future is ours to write.

For more books and resources on complexity, check out the library page on Censemaking.


Social Media and Health: Leaders(hip) and Followers(hip)

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.


Disruption by Design

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.

 


The Complexity of Planning and Design in Social Innovation

The Architecture of Complex Plans

Planning works well for linear systems, but often runs into difficulty when we encounter complexity. How do we make use of plans without putting too much faith in their anticipated outcome and still design for change and can developmental design and developmental evaluation be a solution? 

It’s that time of year when most people are starting to feel the first pushback to their New Year’s Resolutions. That strict budget, the workout plan, the make-time-for-old-friends commitments are most likely encountering their first test. Part of the reasons is that most of us plan for linear activities, yet in reality most of these activities are complex and non-linear.

A couple interesting quotes about planning for complex environments:

No battle plan survives contact with the enemy – Colin Powell

In preparing for battle I have always found that plans are useless, but planning is indispensable – Dwight D. Eisenhower

Combat might be the quintessential complex system and both Gens Powell and Eisenhower knew about how to plan for it and what kind of limits planning had, yet it didn’t dissuade them from planning, acting and reacting. In war, the end result is what matters not whether the plan for battle went as outlined (although the costs and actions taken are not without scrutiny or concern). In human services, there is a disproportionate amount of concern about ‘getting it right’ and holding ourselves to account for how we got to our destination relative what happens at the destination itself.

Planning presents myriad challenges for those dealing with complex environments. Most of us, when we plan, expect things to go according to what we’ve set up. We develop programs to fit with this plan, set up evaluation models to assess the impact of this plan, and envisage entire strategies to support the delivery and full realization of this plan into action. For those working in social innovation, what is often realized falls short of what was outlined, which inevitably causes problems with funders and sponsors who expect a certain outcome.

Part of the problem is the mindset that shapes the planning process in the first place. Planning is designed largely around the cognitive rational approach to decision making (PDF), which is based on reductionist science and philosophy. Like the image above, a plan is often seen as a blueprint for laying out how a program or service is to unfold over time. Such models of outlining a strategy is quite suitable for building a physical structure like an office where everything from the materials to the machines used to put them together can be counted, measured and bound. This is much less relevant for services that involve interactions between autonomous agents who’s actions have influence on the outcome of that service and that result might vary from context to context as a consequence.

For evaluators, this is problematic because it reduces the control (and increases variance and ‘noise’) into models that are designed to reveal specific outcomes using particular tools. For program implementers, it is troublesome because rigid planning can drive actions away from where people are and for them into activities that might not be contextually appropriate due to some change in the system.

For this reason the twin concepts of developmental evaluation and developmental design require some attention. Developmental evaluation is a complexity-oriented approach to feedback generation and strategic learning that is intended for programs where there is a high degree of novelty and innovation. Programs where the evidence is low or non-existent, the context is shifting, and there are numerable strong and diverse influences are those where developmental evaluations are not only appropriate, but perhaps one of the only viable models of data collection and monitoring available.

Developmental design is a concept I’ve been working on as a reference to the need to incorporate ongoing design and re-design into programs even after they have been initially launched. Thus, a program evolves over time drawing in information from feedback gained through processes like evaluation to tweak its components to meet changing circumstances and needs. Rather than have a static program, a developmental design is one that systematically incorporates design thinking into the evolutionary fabric of the activities and decision making involved.

Both developmental design and evaluation work together to provide data required to allow program planners to constantly adapt their offerings to meet changing conditions, thus avoiding the problem of having outcomes becoming decoupled from program activities and working with complexity rather than against it. For example, developmental evaluation can determine what are the key attractors shaping program activities while developmental design can work with those attractors to amplify them or dampen them depending on the level of beneficial coherence they offer a program. In two joined processes we can acknowledge complexity while creating more realistic and responsive plans.

Such approaches to design and evaluation are not without contention to traditional practitioners, leaving questions about the integrity of the finished product (for design) and the robustness of the evaluation methods, but without alternative models that take complexity into account, we are simply left with bad planning instead of making it like Eisenhower wanted it to be: indispensable .


Merry Christmas 2011

Light Up This Holiday Season

As we begin to say goodbye to 2011 and hello to the holidays that greet the end of one year and the beginning of a new one, I am writing to wish all my visitors and reader the warmest wishes for health, happiness, creativity, joy and love in these times. 

Christmas has been a special time for most of my life. In my family, the creative spirit is expressed most at the holidays with decorations, food, and the giving of gifts and time to each other and themselves. We read, watch movies, sleep, and care for ourselves and each other in ways that sometimes get a little neglected the rest of the year.  It’s the kind of spirit that, like many of the holiday songs suggest, really should be with us all year long. It’s also a time of gratitude for the things we have, a time of memoriam for those we lost or neglected, but mostly about the joy of coming together and giving of ourselves.

CENSEMaking has been a wonderful forum for expression, exploration of ideas, and a space to share reflections on what I see as the intersection of systems thinking, design, health and the ways we learn through engaging with it all. Thanks to all who’ve share their thoughts on the posts and added to them. It’s inspiring to consider how powerful the Internet is a force for sharing ideas, learning from each other, and meeting new people and I learned that more than ever this year.

For those of you celebrating Christmas, may it be merry.

For my friends of the Jewish faith, may your Hanukah celebrations continue with joy and light.

For those who are not of any particular faith tradition, may you find much in life to celebrate just because we don’t need a holiday to make our world bright.

In the bigger system of interactions, these small acts of kindness and good intention can make a substantial impact.

Complexity science shows us how small things working in consort can produce large effects.

Design offers us the means to channel these good acts and intentions into something positive.

And the act of creation is a sign of health.

How we make sense of it all is what brings us to life.

The warmest wishes of the season to all of you. — Cameron


Health for Design

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.


The Design of Health

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.


Gaming the Health System for Innovation and Change

Yesterday I attended the Cure4Kids Global Health Summit at St. Jude Children’s Research Hospital in Memphis, Tennessee. The three day event (continuing for the next two days) aims to bring together researchers, practitioners, and clinicians working on issues of importance to child and youth health — including an emphasis on the role of engaging young people. Of the many presentations and conversations that were had on the first day of the event, the ones that struck me the most were on the potential of games and gaming to engage people and promote literacy.

Games are entered into voluntarily and allow for natural collaboration, creative exploration, and constant, developmental learning.

Developing serious games for health often requires artists, designers, users, engineers, social scientists, educators and health professionals working collaboratively so it provides a natural laboratory for design research and studies on participatory engagement on health issues.

But what excited me the most was seeing how games were being developed through games themselves. Small competitions, limited budgets and compressed timelines along with mentorship produced some amazing results (which will be discussed in a later post).

Watching it all, it opened my eyes to how gaming — the games and the process of creating the game itself – could offer so much to learning about innovation, discovery and collaboration.


Branded Knowledge: Does This Make Sense for Health?

Commercial products relying heavily on branding to entice their purchase and use in a crowded marketplace. Is this something that the health sector should consider and, if so, what might it look like?

I’ve just spent a rare free weekend in Chicago walking around, taking in the sights, and doing what a lot of other people do when they travel to another country or city: shop. It is hard to avoid some shopping when down in the Loop on Saturday or Sunday as that is what much of Chicago’s core is made for. The same can be true of most major centers, if you exclude the office buildings that are often semi-vacant on weekends.

A brief tour of many of the shops, from the discounters (Filene’s Basement, TJ Maxx, and Nordstrom Rack) to the mid-range stores (Macy’s) to the higher end department stores (Nordstrom) and the many boutiques, one is easily amazed by the abundance of goods on sale. But what intrigued me as I stood and watched what was around me was that many of the branded goods available at all of these places (including many of the boutiques) were the same. Big names in fashion were at all of them. And the products themselves were virtually indistinguishable from one another except for 1) price and 2) seasonality.

The first is perhaps the most obvious, but as one who is not as attuned to the seasons in fashion beyond the warm-weather/cold weather distinction as many, it the second part that I find most interesting. What makes last year’s $150 pair of Lacoste sunglasses worth $25 this year is nothing other than its seasonality. In other words, they are last year’s model and no longer as coveted.

It struck me that we do this in the health sciences all the time. If your reference list isn’t up to date, people question the sources and the validity of the findings. While probably appropriate for work in basic and clinical sciences, it seems less true for health promotion. It also seems less appropriate for areas where there is great complexity.

Brands also matter with regards to where something is published. A premium is placed on scholarly work that is published in journals with high impact factors over those that are in lesser-known journals. The underlying assumption here is that the more people cite something and the more we believe a source to be high quality the higher the quality the knowledge. The strength of the brand of sources like JAMA, Science, the New England Journal of Medicine and the Lancet exceed the rest of the health field.

While this respect for such “brands” sounds reasonable, there are many problems associated with it. Most notable among these is that they publish a certain type of knowledge in a particular format that adheres to particular models of discovery and rewards particular ways of expressing information. This has advantages, but it also creates path dependencies that shape knowledge itself and restrict the sharing of other forms of knowledge. In doing so, there is some assumption that the “best” knowledge (i.e., that which fits with the brand) looks a certain way and fits a certain way.

An alternative is to create different brands, just as we see in the marketplace for clothing and other retail goods. Apple, once a brand favored by a small, but fervent group of supporters in the early 80′s, is now the world’s most valued brand. It was the small, scruffy underdog and now is the leader. The same might be said for other forms of knowledge. If we were to package health promotion into a form that had the same appeal as other sources, could we create a demand and cache for it in a manner that drew people to it? And would this be a good thing?

I’m not sure. But I do believe it is possible. A colleague of mine once did a study looking at factors that predicted uptake and citation of research knowledge in a particular domain by looking at study qualities across a number of dimensions including design, home institution, discipline and others. After all was considered only one factor predicted uptake: the study used an acronym. Yep, if you branded your study it was more likely to achieve uptake than if you didn’t. To my knowledge this data was never published, presumably because it was so embarrassing to us scientists as it provided evidence that evidence isn’t just what drives our work. Whether it holds over time is worth considering, but it does suggest that brands might matter.

Marketers and companies work hard to distinguish themselves in a crowded marketplace. In a world where there are literally tens of thousands of venues for publishing our findings that are chosen every week, the market is filled. And do we want to rely only on the big brands to fill our knowledge? If so, we run into the same scenario as I did shopping by seeing the same brand everywhere and, because of that, seeing its value discounted because there is so much of it and it expires quickly.

The comparison is not perfect, but neither is it outrageous. Could branding knowledge and knowledge translation be coming to an inbox, book, or library near you?


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