Category: health promotion

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Reflecting on Gratitude and Going Beyond Thanksgiving

Thanksgiving grace 1942

Today is the day that Americans come together to celebrate Thanksgiving, a day dedicated to gratitude (in Canada, we celebrate Thanksgiving in October, to traditionally align with the harvest).

What a wonderful holiday concept: spending time focused on gratitude for what one has.

There are many good reasons for giving thanks. Psychologist Robert Emmons and other researchers working within the emergent field of positive psychology  have looked intently at the psychological effects of gratitude and found it positively correlates with well-being and goal-attainment. For example, Emmons and McCullogh (2003) conducted a series of experiments comparing those with a grateful outlook to those who did not and found those who expressed gratitude more often reported higher levels of subjective wellbeing in some of those studies. (For those interested, Emmons’ 2007 book Thanks! is an accessible primer on the research on gratitude).

Giving thanks is a way of introducing a small disruption in the everyday and inspiring reflection on the present moment. Gratitude is a part of many meditiation and yoga practices, as well as mindfulness practice (PDF – example).

So in solidarity with my American friends who are giving thanks on this day and all of us who take time to express gratitude on any day, I offer a departure from the usual post and share some things I am thankful for (in no particular order):

  • To everyone who is willing to fail, get up again, improve and work to succeed and tell others about their story so others can be inspired to fail and succeed in new ways.
  • To teachers (and that doesn’t have to be the person at the front of the class). To those who take the time to help others to learn, really learn, and understand material. This could be trainers, classmates, or grandparents — anyone who cares that I learn something and tries to help myself and others toward that goal.
  • To students of life. Those who are willing to be taught, to learn, to adapt and to innovate when necessary. This includes clinicians and scientists using the best evidence to make decisions and pointing out where it doesn’t exist (and taking action on filling the gaps). It’s people asking hard, but important questions — including those about their own closely held beliefs. It’s those who see learning as fun and seek to infect that sense of joy in their fellow knowledge travellers. It also includes all of those who work in knowledge translation and exchange to help the learning process along in professional and personal life.
  • To the organizers, funders, sponsors and participants behind and in front of TED, Thinkr, the RSA, Google Zietgeist Minds and all the organizations and individuals out there sharing stories of success, creativity, and inspiring us all to think in new ways. It’s easy to take all this for granted so today, I am not.
  • To everyone who takes the time to listen and seeks to understand . We all don’t agree, but if we try to truly understand each other by listening, cultivate empathy, and mindfully reflect on our impact on the world, those differences can be sources of learning and creativity than unproductive conflict, hatred and ignorance. Too much of that and in a world of the 140-character sound bite, it’s too easy to be seduced by quick outrage and self-supported misconceptions.
  • To the individuals who work at inspiring others to be their best selves through compassion and creation. The diverse voices of people like Seth Godin, Jonathan Fields, Brene Brown, John Maeda, and Jon Kabat Zinn who all provide means of making sense of human life and inspiring a greater appreciation of what happens along its journey.
  • To the Internet and every person and organization responsible for developing it, delivering it, and maintaining it and fighting for the rights, freedoms and responsibilities that come with having so much knowledge, information and entertainment at our fingertips. It’s easy to take this enormous treasure trove of knowledge and services for granted.
  • To every administrator or department chair who marshalls power to change the structure of the workplace to make it more humane, by rewarding earnest effort while providing the space to slow time to pause and think, nurture the organization’s collective mental health, and allow everyone to genuinely learn and share their best with those they engage with. Work takes up a lot of our lifetime — imagine if it buoyed us and sustained us rather than trapped us?
  • To every person who says, means and listens to the message that we are all enough. The rat race is for rats and the human race is intended for human beings, not human doings.
  • To everyone who feeds us — from farm to market to fork to the earth. Most of us have little comprehension of where our food comes from, travels to, goes through, or ends up and if we did, we might act a little (or a lot) differently. We have the luxury of ignorance in North America, but should we? Spend time with a farmer and you’ll be amazed at what you don’t know about the very things that sustain us.
  • To every blogger and Tweeter out there who takes the time to share their thoughts and promote positive, critical thinking about topics that inspire new thinking. Thanks to the amazing blogosphere and Twittersphere, I have made a lot of wonderful friends I’ve never met in person, but who inspire me every week.

Thanks to everyone out there making the world better. Today is the day I give thanks to all of you.

What are you grateful for?

Photo By Marjory Collins, photographer for Farm Security Administration. [Public domain], via Wikimedia Commons

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How Serious Are We About Learning?

How Serious Are We About Learning?

When journalist and book author Daniel Pink tweeted the above image the other day it provoked thinking about what real learning means and what it takes to achieve it. We produce enormous amounts of knowledge, yet struggle to put it into use, but we also teach much and learn little because the systems we’ve designed for education and experience don’t match our expressed interest and rhetoric around learning. 

In my graduate course on behaviour change I would ask students on the first day why they were taking the class in the first place. Aside from the few students for whom the course was required everyone else was doing it by choice because there were many others to choose from. So why would they choose this one?

The answers would vary, but inevitably I’d hear over and again that students love learning and wanted to understand more about behaviour change, because they were interested in change and some would even say they were good at it and wanted to help others do it.

These are all well-meaning and said in a spirit that I think was honest and true. Except the reality is that it is likely a big, huge lie and one that we all share in its telling.

I would counter with two things:

  1. Loving the idea of learning something new is different than actually seeking out learning opportunities and that most of us love the former, but are not so enthused about the latter;
  2. The only people who regularly welcome change are babies with soiled diapers.

To illustrate the first point I simply ask people to consider the last conference they went to where there were options on what sessions to attend. How many of the sessions did they attend that featured content that confirmed or gently extended what they already knew versus content that was new? If you’re a health promoter doing community engagement work, sessions on Bayesian modelling for epidemics might offer far more learning than a session on working with diversity in communities (particularly if that is what you already do). Even more, how often do people go to sessions from people they know or have already seen speak? Chances are, many.

One could argue that there are subtleties that a conference presentation might offer on a familiar topic that are worth attending and while I would say that has merit, most learning that has impact is uncomfortable at some level. It extends our thinking, challenges our beliefs, or re-arranges our worldview — in ways small and large.

Wanting knowledge and living learning

Many people will say “I love change”, but that is usually in the context that everyone else is changing, not them. When I was the boss and said “things must change” it was very different than when my staff or my boss would say “things must change“. As a behaviour change educator and intervener, I need to be mindful of my own ironies and resistance to change. So should we all.

The same thing goes for knowledge. Academics are famous for ending studies with “more research is needed”. We never seem to have enough knowledge. There are two problems with this idea.

The first is that, in dynamic and evolving environments, we will never have  perfect knowledge that fits like a glove, because the contexts are always novel. This isn’t to say that evidence isn’t useful, but ‘good enough’ knowledge might be a more reasonable demand than ‘best evidence’ in many of the situations where complexity is high and so is change. That’s why data gathering techniques like developmental evaluation aren’t attractive to those who need certainty.

But there is another problem with the knowledge quest and that is one of integration. In our efforts to seek more knowledge, are we integrating what we are learning from what we already have? Are we savouring the data we collect, the articles we read, the Tweets and blogs that get forwarded are way?

We quest for more, but should we quest for better?

A newly published paper synthesized research on event horizons on memory and found that shifts in activities around an event — boundaries — can prompt forgetting and recall. We remember transitions between activities, but they also prompt forgetting depending on the mindfulness associated with the act. When we are deluging ourselves with more data, more media, more everything, we are increasing the potential remember rate, but due to the volume of content, I would surmise that we are increasing the forget rate much more. Simply reflect on your high school or undergraduate education and ask yourself if you remember more than you forgot about what you learned.

We are so busy with our search for new knowledge that we interrupt opportunities to learn from what we have.

Serious learning means non-doing

Returning to the tweet from Dan Pink, it’s worthwhile considering what it means to learn and the systems we have in place to facilitate learning. The tweet links to a discussion of how German companies give their employees five days of off-site continuing education each year. This concept of Bildungsurlaub is a leave designed to allow employees to stretch their thinking and integrate something new. Not only is off-site learning important, but the time associated with integrating material is critical.

A read of the literature on innovation and research shows consistently how time off, quiet time, slow time and down time all contribute to discovery. Robert Scott Root-Bernstein’s brilliant Discovering, Jonah Lehrer’s Imagine, or Steven Johnson’s Where Good Ideas Come From are all books that dive deep into creative production and show that great discoveries and innovations come from having time (with limits) to integrate material to learn. Freedom to create, explore and sit and mindfully reflect are all united concepts in the pursuit of good learning. Not everything requires this, but big concepts and bold ideas do from mathematics to science to social science and philosophy.

Yet, at an organizational and systems level, where is the support for this? Even university faculty (the tenured ones at least) who have generous vacations and sabbaticals are finding themselves crunched for time between the fight for one of the ever-fewer grants, increasing numbers of students and teaching demands, and the added push to ensure knowledge is translated. The image of faculty sitting and reading and thinking is truly an imagination. Most of my colleagues in academia do little of this, because they are out of time.

In the corporate and non-profit world this is worse. Every hour and day is to be accounted for. The idea of sending people off to learn and to think seems anathema to productivity, yet research shows incredible powers associated with taking a break and doing less and not more.

Getting serious about learning

To illustrate the scope of the problem, the University of Toronto holds one of the finest academic library systems in the world and has over 11.5 million books and 5.7 million microform materials. It is one university (of many) in one city. Add in the local Toronto public library system, the network of universities and other libraries it is connected to, local and global bookstores and all the content freely available online that is not part of this system and I challenge anyone working in social innovation or public health to say with conviction that there is a lack of knowledge out there on any important topic. Yes, we don’t know it all, but we don’t do nearly enough with what we do know because there is so much.

We will not read it all nor can we hope to synthesize it all, but we can do much with what we have. Just looking at my own personal library of physical books (not including all I have in the digital realm between books and papers) it’s easy to see that I have more than enough knowledge to tackle most of what I am facing in my work. Most of us do. But do we have the wisdom to use it? Do we have the systems — organizations and personal — that allow us to take the time and soak this in, share our ideas with others, and be mindful of the world around us enough to learn, not just consume?

When we spend as much time creating those spaces, places and systems, then we can answer “yes” to the question of whether we’re serious about learning.

Enough knowledge here?

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Ines Mergel, a researcher who has worked extensively with social media and government provides a simple outline for what Pages can offer those engaged in social media work for public engagement.

Digital Innovations in the Public Sector

Facebook has introduced new roles for pages (see graphic). The manager of a page can assign the following roles:

  • Content Creator
  • Moderator
  • Advertiser
  • Insight Analyst

What is unclear to me is that the manager of the page does not have the same rights as the other roles and is not able to create content, edits the page, add apps, respond to and delete comments, send message, create ads, or view insights. It’s probably a typo or formatting issue of the table and does not reflect the actual functions those different roles can perform. Moreover, why shouldn’t manager know exactly what the impact of the site is? This is where top management needs to be informed: Help people understand that the organization’s social media efforts are making an impact and in case they don’t, initiate changes in the organizational social media tactics.

Especially for local government agencies defining 5-6 different roles…

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Contemplating Better Public Health: Perspective is Everything

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.

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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.

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The Art of Complexity and Public Health

 

“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.

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Design for Social Norms or Social Change?

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.