Among the many definitions of health, few describe how we create and relate to it within a dynamic world, leaving us with models that put the onus on individuals, not systems. That requires change. This is one of many “thinking through writing” posts that I’ll be publishing as I journey through how I see design for health.
This is not about shaping biology, clinical treatments for illness, nor is it about the social determinants of health. Rather, it’s on how we shape the services and systems that health professionals, advocates, and individuals use to promote health and wellbeing, treat illness, repair injury, manage care, and enhance accessibility, mobility and motility.
I’ve never been a fan of most published definitions of health, as I feel they often are too broad, vague, or reduce it to a few variables that are rarely ever within our control. Of course, our health is always in a state where control is — at best – limited. We have choices to make that we have agency over, but many of the conditions in which we make those choices are only partially amenable to our influence. It’s a dance, and maybe that’s the best way to think of it sometimes.
But it’s hard to design for a dance. We design everything from food, to activities, to where we live, and what our care systems look like, including the roles and responsibilities within those systems. We design healthcare systems. We design communities, too. Some of these things are badly designed, and some are designed as well as they can be, yet are subjected to forces for which no design is capable of withstanding.
In between the place of total control and utter helplessness, is where most of you readers inhabit. It’s where I do.
Health in Systems
A problem I have with much of the discussion on health and it’s relationship with care, promotion, and wellbeing. Part of this is that we too often frame health in terms of healthcare (which is — as a wise commenter and colleague Linda Peritz pointed out on my last post is more about illness and injury treatment, not so much care). But it can go other ways, too. The discourse on social determinants of health, while a vast improvement on the earlier generations of definitions, tends to get esoteric when it comes to practical recommendations for what to do at an operational level.
They are useful as heuristics, not as much in prescriptions for design.
One of the reasons is that we tend to create models of health that are descriptive and largely exist independent of the systems in which we operate health services, programs, policies, and care. So we can argue fully about the need to create economic support to promote health, but for those operating health service organizations this serves more as a situational factor, not an activity point.
If my patients at a mental health clinic are dealing with poverty, housing, food insecurity, and employment-related stressors, those are things to deal with (and advocate for action towards), but exist outside of the system in which we deliver services. Again, it’s a helpful heuristic, but it’s not a practical point to design with.
I’ve another suggestion for a starting place to begin thinking about health through the lens of design — the vehicle for shaping change.
A Strategic Design Approach To Health
If we are to consider where someone sits in relation to the world around them, I’d like to propose a starting point for discussion. It is just a discussion point, because this idea is still being developed. (More to come).
At the core, I see a relationship between four things for helping us to understand health in context, as it relates to how we experience it.
- Systems. These are the pattern of interconnections, relationships, structures, and governing rules or roles that influence or shape our world.
- Design. The manner in which we shape and seek to influence those systems and the services and programs we create through them.
- Psychology. The cognitive, social, spiritual, perceptive, emotional, and neurodiverse ways we relate to, and act on, health in context.
- Evaluation. The manner of fitting our values and what we value to the experiences we have and their related outcomes.
These exist in relationship with one another, much like a series of overlapping circles like a Venn diagram. How this exists, and relate to one another is something I’m still working through (and welcome comments).
The reason for these four are that they are the things that shape the human experience of health and addressing its context and circumstance.
We can design for each of these. These are all activities that can be done in service of health, in relation to the experience of healthcare, and as actions we can take as individuals, professionals, and policy makers. These are prescriptions for what to do or how, but what domains we can build expertise in — and pay attention to — that might allow us to better support health and wellbeing. These all affect individual actions, community, and care.
As I noted earlier, this is a start. It’s part of my thinking right now. I’d welcome your thoughts.
Photos by LOGAN WEAVER | @LGNWVR on Unsplash