Monthly Archives: December 2010

A Complex View of New Year’s Resolutions

A Happy, Simple New Year (CC- WilliamCho)

The end of the year is coming and, despite good advice and the warning about how they don’t work, you’re still determined to come up with a really good New Year’s Resolution and this year, dammit, you’re going to stick with it.

It’s simple, right? Make a commitment, come up with a plan to stick to it, and you’re ready to go.

Firstly, change in human systems is rarely a matter of simplicity, which is why New Year’s resolutions tend to benefit the diet industry and fitness clubs, but few others.

Another reason lays in the meaning of the term simple. Simplicity implies that there are relatively straightforward mechanisms that underlie a cause and consequence, that these can be predicted with reasonable certainty and consistency, and that we can derive “best practices” from such events given their reliability and efficiency. When we see something as simple, we usually have a high level of control.

Yet, it is the very nature of human systems that makes control such an elusive concept when wish to change something. Complexity science provides us with a different way to handle these problems. It provides a means of understanding complex situations — those where there are multiple causes and consequences that interact and change dynamically — that represent the lives of human beings. Rather than predict what is going to happen based on flawed assumptions of control, complexity science helps anticipate change and prepares people to adapt to these changes wisely.

Diet and exercise tend to be near the top of New Year’s Resolutions. Typically, people will make a resolution to start an exercise plan and reform their diet all in one swoop. The thinking is akin to “go hard or go home”. The problem with this is that what we eat, how we eat, and the activities that we do on any given day are part of a complex weave of activities that shape our lives. Few of us have jobs or lifestyles where everything is the same day to day. If you have children, you’ll know firsthand that even with the most regimented schedule for them and you, every day brings new surprises. But for the most part, these are little surprises that happen consistently and, consistent with a complex system, you adapt.

If your diet consists of a lot of take-out food, pre-prepared foods like frozen dinners or canned goods, the idea that you will suddenly start cooking at home, eating healthy meals and changing the portion sizes right away is setting yourself up for failure. This change alone requires shifts in your time (now you need to shop, cook, clean, and plan in advance), which suddenly changes how you use the rest of your time as it might impact upon work, play, social activities and so on. This isn’t to suggest that such investments in this new lifestyle are not worth it, but that simple shift will drastically change not just your diet, but your lifestyle as a whole all at the same time. That’s a lot of stress to put on the system that is your life.

An alternative is to make small shifts, ones that don’t upset things too much like perhaps making one meal on the weekends. Once that is in place, perhaps change the meal to allow for leftovers so that one day or two you pack a lunch instead of eating out. Maybe then shift towards changing the lunch options you choose when you do eat out one or two days per week. The key is to take one thing, do it and do it well and then build upon it by introducing another thing. Over time, your schedule will adapt and you’ll find the ways to make the changes without them feeling so big.

Exercise is the same way. Rather than sign up for a year’s membership at the gym and workout 2 hours a day for the first week only to find yourself so sore and tired that you can’t imagine going back, try upping the activity level you engage in with different strategies. If you don’t go to the gym at all, starting there might not be the best option. Try walking a little more around your neighbourhood or take the stairs when there is an escalator. Maybe get off the bus one or two stops early and walk the rest of the way home.  Once you start doing that, try a day pass a gym and do some very light weights or some simple cardio workouts like walking on a treadmill. As you build up over time, you will find what works and doesn’t work in terms of your likes and dislikes and what seems to be effective. This is called feedback, another critical component of complex systems.

By paying attention — being mindful — of what you’re doing and how it is working, you can start to build a longer-term strategy or pattern of activity that moves you along to where you want to go. It also prevents you from the let down at having not achieved your goals, but setting yourself up for success rather than failure. In doing so, you work with the complexity of human systems and our daily lives rather than against them.

New Year’s Resolutions: If You Must…

We Resolve To No More New Years Resolutions! (CC - Meddy Garnet)

The holiday season now takes a shift away from the goodies and rich foods that start with Hanukah and (almost) end with Christmas. There’s one last big day left*: New Years Eve/ Day.

* In Canada, Australia, New Zealand and the UK we have Boxing Day today, the day when all the unsold merchandise for Christmas goes on sale and people do silly things like camp out overnight on Christmas Night so they can get a deal the next morning. It’s just like Black Friday in the US.

People often wake from the sugar-induced near-comtose generated by all the treats on Boxing Day to realize that their new holiday pants fit tighter than expected, that the number of wine bottles in the recycling are hard to count, and that the return to everyday life that comes after the holidays might not be as jolly given the absence of any holidays to look forward to. Add to that the myriad “year in review” lists and recaps on television, print and the Internet and its quite natural to want to make a New Year’s Resolution.

The answer to that is: don’t do it. They don’t work and the whole thing is one big fallacy.

But evidence never stopped people from doing things before — even physicians and scientists — so if you must make them, here are some recommendations from a person that teaches a graduate level health behaviour change course on how to be a little smarter about goal setting:

1. Be specific. Declaring that you’re going to be healthier in 2011 isn’t providing much to go on. Does that mean that you’re going to eat better? And if so, what does that mean? A big mistake is that people keep their goals too general and thus, never really know if they’ve acheived them. One rubric to use is the S.M.A.R.T system for goals. S.M.A.R.T. refers to goals that are Specific, Measurable, Achievable, Realistic and Time Framed. The closer you can adhere to these, the more likely you are to achieve them.

2. Keep quiet. There is a school of thought that suggests that advertising your goals to the world (make them public) is a strong way to motivate change. The thinking here is based on theories of social norming and pressure that suggest that the fear of letting others down will motivate you to succeed. That might have some currency, but it paradoxically fails for reasons that have little to do with others and much to do with our brain. Research from NYU psychologist Peter M. Gollwitzer and his colleagues (PDF) found:

When other people take notice of one’s identity-relevant behavioral intentions, one’s performance of the intended behaviors is compromised. This effect occurs both when the intentions are experimenter supplied and when they are self-generated, and is observed in both immediate performance and performance measured over a period of 1 week. It does not emerge when people are not committed to the superordinate identity goal.(p.616)

Some other resources on this are available here. This isn’t to say that you can’t share aspirations with people, but when you declare you’re going to do something out loud ( following S.M.A.R.T) and get feedback from others, your brain starts to imagine that you’ve already accomplished the goal and is already diminishing your motivational fire.

3. Do it for yourself. Another reason these publicly stated goals might cause problems is that often we announce goals that we want to believe in (or believe others approve of), rather than those we want for ourselves. A large body of evidence suggests that we’re much more likely to do things that fit with our self-concept and values than those that challenge or complicate it. Self-determination theory is the foundation for this concept. Author Daniel Pink wrote an accessible piece on this in his recent book Drive. This can be applied broadly or more specifically. For example, with regards to weight loss, there are a lot of options to assist that from changing the food you eat and the way you eat (not dieting, which is a far larger fallacy than New Years Resolutions and persists even more) to exercise. Perhaps running on a treadmill is something that bores you to tears, so try a group dance class instead. If you’re not a fan of salads, try doing more with beans, oatmeal, nuts, fruit or smoothies. There are lots of ways to get the same place, but choose the things that you really like first.

4. Be social and connect. Even if you’re not announcing your goals to the world on YouTube or doing all the things you want to do first, it is still important to be social. Research on social networks and health show remarkable links (pun intended) between our social networks and our health behaviours. Smoking, obesity and mental health are all enhanced by having strong social networks (however you connect — this isn’t just about Facebook or Twitter). Building strong connections with people can offer so much benefit in terms of keeping you healthy, informed and “human”.

5. Help yourself by helping others. If you want to reach your goals, try helping others reach theirs. Working with your friends and family to support them in reaching their goals can actually strengthen your own resolve. Communities of practice are groups of individuals that are motivated to support each other in solving particular problems that often fall outside of traditional lines of work, discipline or problem domain. These collectives are often self-organized and volunteer-oriented and because of that, they capitalize on many of the aforementioned points. Find a community of people tackling the same problems and offer your assistance and wisdom. In doing so, you might find that you start to work through your own challenges and issues. Research on complex systems shows that small, incremental changes over a long time will produce much more stable change than radical upheavals at once.

New Year’s resolutions are problems because they often set us up for failure. Perhaps the one resolution that you will want to follow this year is to skip the resolution altogether and commit to doing something small often and enjoying yourself and those around you while you do it.

Embracing Complexity / Science

Seeing Complexity for What it Is (CC - Flickr by nerovivo)

SEED magazine recently posted on the concept of early warning signs in complex systems that I found quite provocative and important.

Science is a creative human enterprise. Discoveries are made in the context of our creations: our models and hypotheses about how the world works. Big failures, however, can be a wake-up call about entrenched views, and nothing
produces humility or gains attention faster than an event that blindsides so many so immediately.

There are so many key points in this one phrase that are worth discussing at length.

Science is a creative enterprise . For reasons I’ve discussed elsewhere, I think that science needs to embrace its creative side more than ever and embrace design. This isn’t a universal, but if we (scientists) approached problems from the multidimensional manner in which designers typically approach them, we might create new innovations and discoveries that are different than the ones we’ve made before. Why is this important (beyond the obvious to those whose business it is to discover)? Complexity. The problems we are dealing with now more than ever are likely to be complex ones, which require different ways of approaching them and (some) different science and practice.

And as Albert Einstein famously said (or at least many people have attributed this to him — I can’t verify it, but it works nonetheless):

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

Discoveries are made in the context of our creations: our models and hypotheses about how the world works. In public health where I work, the dominant models remain those rooted in reductionist science. We are asked to ‘prove’ the links between certain activity and the outcomes they produce. This works relatively well in areas like sanitation, toxicology, (some) pharmaceutical or vaccination interventions, and injury prevention. It is for these reasons that the top achievements in public health, including massive increases in life expectancy and reductions in premature death took place in the 20th century. But that was then. The challenges we face now are into the realm of complexity, unless we fail to support fundamentals in public health and then we’ll have both simple and complex challenges on our hands. The point here is that our models will only take us so far without some acknowledgement of the complexity of the problems they seek to explain. The context of our creations is complexity.

Big failures, however, can be a wake-up call about entrenched views. The key term here is “entrenched views” . My colleagues Alex Jadad, Murray Enkin, Shalom Glouberman and others once had a group called the Clinamen collaborative that wrote a great piece on the problem of complexity when dealing with entrenched health care practices. Their recommendations are essentially:

1) there are no recipes for universal success,

2) pay attention to local conditions,

3) intervene small and often and then scale,

4) aim for stability first, then change.

In science, we’re failing a lot and rather than see this as a potential positive, I see more conservative approaches to science based on risk aversion. Providing support for smaller, rapid response scientific studies that are encouraged to fail will do more than these big, non-adventurous team projects that provide high-level window dressing for grant funders and avoid making anyone look bad.

and nothing produces humility or gains attention faster than an event that blindsides so many so immediately. Humility is a word that is too often absent from my profession. I’m not talking about the kind of humility that comes from acknowledging the limitations of a scientific study or the recommendations of a report. I am speaking of true humility, where one “seeks to first understand, then to be understood”. Indeed, I would argue that we are lousy at both more often than we’re successful. Our understanding comes from a scientific perspective that holds us up as the experts. Once you’ve labelled someone or yourself an “expert” conversations immediately shift. Watch a classroom where the instructor insists on pure lecturing, being called “Dr.” and where “right” and “wrong” are regular parts of the conversation. Then watch a classroom where students learn from each other, are encouraged to share their experience and challenge the material, where the professor doesn’t push her or his titles and credentials, and where there is interaction between everyone. You’ll see a very different sense of humility from students and teachers alike.

When I encounter others on genuine, authentic and intimate level of learning I never cease to be left in awe. That comes from humility and is something I was fortunate to have modeled to me. I was once told by a retiring professor who was leaving on the day I was convocating from my undergraduate degree:

“When I was in my undergraduate, I new everything. Now that I am a retired professor, I realize I know nothing. Every year of learning serves to teach me that I know less and less.”

The SEED article goes on to point to the current problems in science in dealing with complexity and the imperative towards collaboration and cross-disciplinary engagement:

Examples of catastrophic and systemic changes have been gathering in a variety of fields, typically in specialized contexts with little cross-connection. Only recently have we begun to look for generic patterns in the web of linked causes and effects that puts disparate events into a common framework—a framework that operates on a sufficiently high level to include geologic climate shifts, epileptic seizures, market and fishery crashes, and rapid shifts from healthy ecosystems to biological deserts.

The main themes of this framework are twofold: First, they are all complex systems of interconnected and interdependent parts. Second, they are nonlinear, non-equilibrium systems that can undergo rapid and drastic state changes.

Complex systems require the kind of deep attention that science brings, the spirit of engagement and problem solving that designers offer, and a space to bring them together. With their focus on reductionist science and the lack of embrace of design, universities haven’t been the home to this kind of thinking. But things can change because, after all, this is a complex dynamic system we’re talking about.

Design & Behavioural Science: It’s Time

Understanding the glass, whether its full or not, and why it matters (CC-Flickr SOCIALisBETTER)

What good is design and why should non-designers care? These are questions that designers ask a lot. As one who has developed his practice of design within public health (the behavioural sciences focus), I come from a world where the term “design” is viewed with disdain at worst or indifference or curiousity at best. The concept doesn’t resonate with that audience…yet.

As a designer of systems to promote the health and wellbeing of individuals through helping them solve complex problems individually and groups I find myself attracted to others who try to do the same, even if it is often from a perspective and focus other than health. That gets me into the world of graphic and industrial designers, interaction designers, and now those who use the term social designers or humanitarian designers.

Not surprisingly perhaps, this interaction brings with it much learning for me as it enables me to receive the gifts that diversity brings. The language, the culture and the context of design in design programs, studios and conversations is thrilling for me. As business has joined the conversation, that diversity has increased and programs like OCADU’s Masters in Strategic Foresight seem to capture this type of interaction between what might be called traditional and non-traditional design space.

From this vantage point I see a lot and being an ‘outsider’ provides a wider-angled lens on such phenomenon (while those inside have more telephoto lenses to enable them to see deeper, to extend the metaphor). There are a few things I see through this lens:

1. Designers care a lot about what others think they do and spend an inordinate amount of time coming up with definitions and terms used to describe their craft. On one hand, this is useful and encouraging to see such interest in communicating with the world the value of design, but what could be viewed as attention to education could also be seen as a sense of drifting priorities and a lack of focus or confidence within the field. This intense interest in using rhetoric to show the world designs value, exemplified in the videos, myriad books on design processes, thinking, types, and models is all useful to novices and getting the word out, but at some point the data need to speak.

2. Designers use the concept of “interdisciplinary” very differently than I do. I thought public health had a case of the interdisciplinary-itis, but clearly its endemic across different disciplines and fields and that the way it is used is very different. I already knew this from my own research that has looked at how interdisciplinary researchers collaborate on science problems, but it never ceases to amaze me how the terms get used in other fields and contexts. In design, interdisciplinary often means mixing graphics design folk with industrial designers and visual artists. Taken one step further and you get the IDEO model that expands this to include different fields like anthropology and engineering. This is much closer to what I think of when I consider interdisciplinary, but that is much more rare than I originally thought I’d find in the design world.

3. Designers have a strange relationship with psychology. The use of the word “empathy” is far more common in design than in public health. That excites me for design, but saddens me that it is so rare in public health, but I digress… Yet, while designers are great at getting to know their audience, the methods they use are rather small. Much of it relies on ethnographic study and (from what I can tell) fuzzy qualitative data collection. The methodology is not problematic, but the execution might be. In academia, particularly academic psychology (where I was trained), we are encouraged to explore two things in great depth when appraising others’ research: 1) the rigor of the application of method and analysis, and 2) the use of theory. In both cases I have found design research lacking. What is the theory of change or design used? How was the data analyzed? Why was [this] method used over [that] one? I rarely get good answers to this — at least the kind that my academic colleagues would appreciate.

Designers need behavioural scientists to help them step up their game as much as the world needs designers to help behavioural scientists step up theirs.

Many of the reasons I love design is that it goes to places where academia fails to look and where the public often lives. Many of the design methods and processes like sketching user experiences, empathic research and engaged interaction with clients are things that public health and other fields need to do. Many academics are so far removed from the real world that we’ve left little reason for the public to WANT to engage us. But the downside is that we’ve taken many of the theories, methods and tools that we’ve honed over thousands of trials and studies and produce some good data and synthesis with us. Designers need us to help them step up their game as much as we need designers to help behavioural scientists step up theirs.

The Science of Design & the Design of Science

Glasgow Science Centre (by bruce89, used under Creative Commons Licence)

As the holidays approach I’ve been spending an increasing amount of time looking at a field that has become my passion: design. Design is relevant to my work in part because it frequently deals with the complex, requires excellent communication, and as Herbert Simon would suggest, is all about those interest in changing existing situations into preferred ones.

Yet for all the creativity, innovation and practicality that design has I find it lacking in a certain scientific rigour that it requires to gain the widespread acceptance it deserves.

This is not to say that designers do not employ rigorous methods or that there is no science informing design. For example, architecture, a field where design is embedded and entwined, employs high levels of both rigour and science in its practice. The issue isn’t that these two concepts aren’t applied, they just aren’t applied to each other. I was heartened this week to see Dexigner profile a new pamphlet on the science of design. Although true in spirit, it wasn’t what I expected to see as it largely profiled ways to assess the quality of design projects from the perspective of design.

What if we could assess the impact of design on a larger scale, a social and human scale?

Interaction designers speak of this need to connect to the human in design work. The emergent field of social design exemplified by groups like Design 21 who aim to produce better products for social good. All of this is important, but it’s important largely because we say it is so. Rhetorical arguments are fine, but at some point design needs to confront the problem of evidence.

Does “good” design lead to better products than “bad” design?

What components of design thinking are best suited to addressing certain kinds of problems? Or are there simply problems that design thinking is just better at addressing than other ways of approaching them?

What methods of learning produce effective design thinkers? And what is effective design thinking anyway? Does it exist?

What is the comparative advantage of a design-forward approach to addressing complex problems than one where design is less articulated or not at all?

These are just some of the many questions that there seems to be little evidence in support of. A scientific approach to design might be one of the first ways of addressing this. In doing so, a scientifically-grounded design field is far more likely to garner support of decision makers who are the ones who will approve and fund the kind of projects that can have wide-scale impact. Design is making serious in-roads to fields such as business, education, and health, but it represents a niche market when it has the potential to be much larger.

Roger Martin has argued that the reliance on scientific approaches to problem solving runs counter to much of design thinking. This assumes that science is applied in a very detached, prescriptive manner, which is common, but not the only way. Micheal Gibbons and colleagues have described two forms of science, which they call Mode I and Mode II science. The first Mode is the one that most people think of when they hear the term “scientist”. It is of the (usually) lone researcher working in a lab on problems that are driven by curiosity with the aim of generating discoveries. For this reason, it is often referred to as discovery-oriented research.

Mode 2 research is designed to be problem-centred and aimed at answering questions posed by practical issues and has a strong emphasis on knowledge translation. This is an area more accustomed to the designer.

Design presents the opportunity to transcend both of these Modes into something akin to Mode 3 research, which I surmise is a blend of the abductive reasoning inherent in Roger Martin’s view of design thinking and the discovery-oriented approach that goes beyond just the problem to create value beyond the contracted issue. A design-oriented approach to the science of design would involve leveraging the creative processes of designers with some of the tools and methods accustomed to researchers in Mode 1 and 2 science. Can we not do detailed ethnographic studies looking at the process of design itself? Is there any reason why we cannot, with limits acknowledged and in appropriate contexts, attempt to do randomized controlled trials looking at certain design thinking activities and situations?

If design is to make a leap beyond niche market situations, a new field must dawn within design + science and that is the science of design and the design of science.

Spectrum Thinking and Complex Systems

Among the most frustrating aspects of being a systems thinker/actor/researcher is the “one thing” question: What is the one thing that we can do to solve this problem?

The answer is almost always: there isn’t one thing you can do, the problem requires a complex response*

*That isn’t always the case, but in my line of work, it pretty much is true that the problem and its solution fall within the realm of complexity.

When you work in complex systems, the problems are nearly always multifaceted, convoluted and multi-dimensional in their scope and impact. Yet the “one thing” request comes up all the time.

Dave Snowden, from Cognitive Edge,  in his work with the Cynefin Framework nicely points to the difference between best, good, and emergent practice. In public health and medicine, the term “best practice” has been so dominant that it is hard for people to lose the terminology, even if they acknowledge that it sometimes doesn’t fit (the concept of “better” practice is often snuck in as a way to placate those who subscribe a model of thinking that challenges “best” practice thinking). While this is very useful, the problem that even useful frameworks like Cynefin produce is a tendency for people to put whatever they are doing into boxes.

Looking at Cynefin, you can see the world compartmentalized into four nifty quadrants, making the world simple — or at least complicated, but certainly not complex. Dave Snowden himself has been critical of this tendency in his writings on Cognitive Edge’s blog, yet time and again I see this type of thinking come alive. I currently am teaching a course for graduate students on systems science perspectives in public health and this is one of the pitfalls that I hope the learners in my class can avoid.

It’s not easy. We humans love to compartmentalize things. Charles Darwin, one of the founders of modern science, famously began his career putting things in literal and metaphorical boxes. Classification is something we do from our earliest years and do all the way through school. Indeed, a brilliant and somewhat depressing look at how engrained this thinking is can be seen in Sir Ken Robinson’s animated TED Talk on the history and possible future of education.

Systems thinking requires spectrum thinking. People must be able to see things on a gradient, rather than in absolute compartments. Students can’t be faulted too much for having a hard time with this when they are graded based on letters where a B+ is a 79 and an A- is one percentage point higher, yet the mere presence of a B (anything) on a transcript can mean the difference between an award, admission, or a job and not.

This is in no way a criticism of Cynefin or other frameworks used to explain or assist in the understanding of complexity, but rather a statement of the problems inherent in our quest to teach others about complexity that is intellectually honest, reasonably accurate, yet also effective in helping people understand the gravity and scope of complexity in practice. I don’t have an answer for this, but do find using a spectrum useful.

And on a side note, the multi-coloured palette of the spectrum also allows for an introduction of the concept of diversity and human relations at the same time as it illustrates a way of thinking about complex systems.

 

Coffee Culture and Ideas: A Need for A Break

A little departure this week. Think of it as a coffee break.

There is a theory that the Industrial Revolution and the intellectual flourishing that came from it in England was due to one thing: coffee. Up until then, people were mostly, well drunk. When water sanitation is poor and the options for getting water intake few, beer and wine were among the only options for people seeking means to hydrate. So for centuries there were entire generations of people who largely pickled from day to day (no wonder the lifespan was less than 40 for many).
Then along came coffee, allowing you do something with boiled water that tasted — well, better than boiled water. (Although as one who is a bit of a coffee connoisseur, I can only imagine that it tasted horrible back then, but I digress). Coffee had a bonus effect: it is a stimulant. So instead of swilling back a pint of ale at the pub, which leads to sleepiness, proclivity for getting into fights or having unwanted/unplanned sex, and general unwellness (not mention a big gut), we had people perky, with neurons firing wanting to chat and coming up with ideas — lots of them. And the recipe for coming up with a good idea, is to come up with lots and lots of ideas. The author Steven Johnson talks (and writes) about this in a very interesting and recent TED talk .

For me coffee has had a very special place in my heart (and tummy I suppose). I discovered coffee in the dog days of high school when coffee shops were one of the only places we could hang out. But it was in university that I really enhanced my love of the bean and used it various ways. It was an escape from studying: “I’m just going for a coffee”

Or work: “coffee break time”.

Sometimes it was to help me wake up, and sometimes it was used to help me stay up.

But what I loved most about it were those times when it was the catalyst for the kind of discussions that Steven Johnson talks about. I had three different places I frequented, but none were as enjoyable as Stone’s Throw, which was literally a stone’s throw from the university campus, where I lived for the last two years of my degree. During my time there I made friends, and grew friendships, but also found solace in books and my journals that I kept. It really was a time when my ideas lived large and ruled my life as I somehow managed to find a way to fit my friends, loved ones, work, academic pursuits, hobbies and down time.

We are our ideas and what we do with them and its that simple act of taking pause over a cup of coffee (or tea, or matcha latte, or ….) that can remind us of what those ideas are and, in the process, who we are as people. The idea of the “to go” cup is anathema in some cultures, because it takes the act of communion that coffee brings out of the equation and just leaves you with a pressed drink of beans, water, and maybe some milk. I agree to some extent, but even the act of going out for coffee — particularly with friends or people who love (who are often both) — is a way of creating possibilities by engaging people in dialogue, through a shared experience of a drink.

You cannot travel to any culture where food and drink is not part of a welcome or hosting arrangement. To offer someone something to drink is a sign of hospitality. I’ve been reminded of the importance of this a lot over the last few weeks and with it, what ideas have been nurtured along with it.

Our ideas and the sharing of those ideas are the utmost expression of who we are. It is creativity: to create something. By offering tools and technologies, knowledge and opportunities to connect people to helpful services, we are inspiring in them ideas about how to engage in the world.

With a Starbucks on nearly every corner, it should be easy to generate ideas and get good ones. But it seems that what is missing is the break. Sit in any Starbucks or related cafe and you’ll see that most orders are “to-go”, creating all kinds of waste and also potentially stifling the opportunity to sit and reflect. What we’ve done is taken all the caffeine benefits from coffee, added sugar to it, and upped the calories without adding the most essential ingredient: time.

As the holidays approach, the days get shorter, and the number of demands increase, I am reminded about the benefits of coffee beyond the warmth it brings and how, with time (and maybe a little sugar), it can do wonders to stoke innovation.

Systems Thinking, eHealth and Changing Public Health

Tomorrow is my last class in CHL 5804: Health Behaviour Change for the 2010 year. Like every year, it was filled with the expected, unexpected and everything in between. I love teaching the course and interacting with about 30 graduate students from different disciplines, research backgrounds and educational levels. And while we often don’t admit it to our peers, one of the biggest reasons to teach is that we learn a lot, maybe more, than the students in our courses.

This year I was quite surprised by the interest in two areas: systems thinking and eHealth. Now these are my areas of interest so this is not a surprise on the surface, but then I’ve had these interests for a few years and are about equally passionate today than in past years. Another argument is that I am a better teacher today, which I suppose is possible, but as I look more into my own teaching practice I can’t imagine that the quality of teaching is significantly different than in past years.

I am taking this as a sign of maturity of both fields relative to public health. Both of these fields are relatively new. Depending on your definitions — of which there are many — eHealth has been around for about 15 years, evolving with the World Wide Web. Systems thinking and public health is a little younger, with its rise beginning less than 10 years ago. The publication of the US National Cancer Institute’s monograph on systems thinking and tobacco control, Greater than the Sum, published a couple years ago and the special issue of the American Journal of Preventive Medicine and the American Journal of Public Health, both signaled the rise of systems thinking and public health.

As we know from work in knowledge translation, it can take a long time to get knowledge into practice and this year I think the knowledge about the potential of tools like social media, mobile technologies and consumer-oriented databases has translated into action. My students do presentations each year pitching a hypothetical version of a Framework Convention similar to the one on tobacco control. This year, to my surprise (and with no coaching, particularly given that my eHealth “lectures” are all delivered electronically) most of the groups included some type of eHealth or mHealth intervention in their plans.

These were not just ideas aimed at impressing the professor, rather they represented some remarkably creative ideas on how to use technology to support health promotion, disease prevention, and public eHealth all around.

Attached to this idea of technology aiding the development of interventions for change was the idea that these eHealth tools exist within a larger system. When you speak of social networks or systems dynamics, you are in the realm of systems thinking. The idea that things are connected and intertwined is an idea that seems to hold a lot of appeal for many students and this is growing, particularly as more of my students have real world experience each year. This is important because once you’ve spent time dealing with problems at anything other than a theoretical level, you begin to see the breakdown in linear approaches to problem solving and the need for thinking in systems.

At the same time, as you spend time in that world you also see the problems and costs associated with relying solely on face-to-face methods of intervening. There simply isn’t enough funds, people or other resources to sustain a model that relies exclusively on physical, one-to-one care and prevention efforts. eHealth provides an avenue to consider ways of doing things at a distance and, for some conditions, this translates into interest in doing things that can reach more people for less money, hence the interest in eHealth.

This makes me quite pleased.

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