Category: public health

Public and population health

complexitydesign thinkingpublic healthsystems sciencesystems thinking

Systems Thinking Perspectives on CQI and Public Health

Mapping the system

Mapping the system

Systems thinking involves taking account of where you stand, what you’re doing, and where the bounds of your influence and influences are. By learning how to think about systems, we are better able to design strategies to ensure that our engagements are producing the most beneficial results for our efforts and when combined with design thinking we gain further opportunities to shape the systems closer to what we aspire them to be.

I recently was invited to speak to the first meeting to advance CQI (Continuous Quality Improvement) in public health in Ontario (Canada) on the topic of systems thinking. The one day workshop was aimed at bringing together members from nearly every public health unit in the province to meet and discuss issues related to quality improvement and public health.

In twenty minutes we did a whirlwind through some of the key features of systems that are relevant to quality improvement by looking at the nature of systems (chaotic, complex and ordered) and steps that can be taken to understand them in terms of setting the appropriate targets, methods and tools for defining and assessing quality within such systems.

Understanding systems

By understanding the nature of systems we can avoid the trap of using linear metrics for non-linear problems. Much of the literature on quality improvement has its roots in manufacturing, which are largely linear systems that seek to predict, control and emphasize efficiencies and the elimination of waste. Yet, public health is largely about complexity. In a complex system, what might be considered inefficiencies could be natural byproducts of the system itself and cannot be necessarily avoided. Further, such ‘noise’ could be sources of innovation or weak signals that indicate something significant is to come.

Public health operates in a tricky space because it deals with highly complex problems and systems and linear, straightforward ones simultaneously.

Below is a summary set of slides used to highlight the talk (the original slides were more visual, but those don’t help you out if you hadn’t been in the room).

(For those who read this blog through subscription, you may not see the above presentation in your feed so here is the link)

Building Quality Into Systems Design

One of the central points I made was that systems can be (partly) designed and that developmental design is a process that integral to optimal functioning in a complex system. By paying attention to what is going on and the relationships that form within the system the feedback is set to allow for intentional development of the system itself. This does not assure control, but it allows for positive influence rather than being solely reactive to whatever the system produces. This is necessary if one is to promote quality and ensure quality not just measure it as if it was a static object.

Whether one uses linear, quantitative measures or more non-linear, multi-method approaches to assessing the quality of a public health product or service, the key is knowing what kind of system you are operating in.

My takeaway points were:

•CQI depends on seeing quality as embedded in and a product of systems;
•Systems are defined by where you stand in relation to them and how variation operates within the system;
•Where you stand determines your metrics for quality;
•Your metrics feed your improvement and (re)define quality by influencing where you stand.
The process then repeats iteratively and in an ongoing manner just as one repeats the use of the strategies below:
•Pay attention / pay intention;
•Map your system to intentions, people, settings, contexts based on what you see;
•Collect relevant, timely, useful data based on the context of your operations and strategy (build on what you map);
•Engage in collective sense-making of the data;
•Design & redesign your programs.
By setting up the appropriate processes and structures to monitor, assess, sense-make, and design programs in congruence with the type of systems programs and services are operating in, not only with public health professionals be better equipped to assess quality, they will be producing it along the way (and creating a learning organization in the process).
design thinkingfood systemspublic healthsocial systemssystems science

Systems and Design Thinking Go to the Ballpark

Fenway Park #boston #redsox #baseball #stadium

A recent trip to baseball’s legendary Fenway Park provided the ideal example of understanding systems and how they can create public health problems like obesity through structural means. Being aware of these systems, their boundaries, and their activities can help us better find the causes of individual activity by looking at what encourages behaviour and not just at what people do.

Take me out to the ballgame… and into systems

I am not an obsessive sports fan, but I do enjoy athletics and watching a variety of sporting events.  When it comes to the sport of baseball, I grew up as a Boston Red Sox fan. As a fan of the Red Sox I always dreamt of attending a game at Fenway Park, home of The Green Monster and perhaps the most eclectic and endearing stadium as you’ll find in pro sports anywhere in the world, so when I had the chance to see the Sox face off against their rivals the New York Yankees in Boston I was overjoyed.

When I found out I was going I decided in advance that I would take in the fullest experience possible even down to the food. I am generally a mindful eater, preferring ethical, local and healthy options whenever possible so opting for an evening of beer, steamed hot dogs and ice cream was something as out of the ordinary as touring a legendary ballpark. But then, Fenway Park is not your your ordinary ballpark.

Thus began a look at systems thinking through the lens of food, design and culture. While this started being about a night at a baseball game it ended up being about so much more.

On the menu:

  • Fenway ‘Monster Dog’
  • Samuel Adams Draught Beer
  • Ice cream* served in a Boston Red Sox mini baseball helmet with Oreo cookie sprinkles (*soft serve – I have no idea if there is any real cream in it, or what is in it at all)
  • Popcorn

Take me out to the ball game #boston #redsox #fenway #stadium

An Anthropologist at Fenway

While I was at Fenway Park to enjoy America’s pastime, I couldn’t shut down the systems thinker, design thinker and psychologist parts of me. Add to the fact that I was attending it with a journalist with a health science and anthropology focus (who was seeing her first baseball game ever) and the experience quickly became a cultural study.

So what did we find? Entering the stadium via Yawkey Way one is immediately surrounded by souvenir and food vendors that, despite initial appearances, are nearly identical and plentiful. The same hats, shirts and banners are available at nearly every souvenir kiosk and nearly the identical foods related at most of the food vendors. Even though Fenway Park’s menu on the web suggests a variety of food options, the reality is that most vendors sell the same things, or near variants of them.  Hot dogs, burgers, fries and pretzels are dominant. Sometimes there’s ice cream.

You are enveloped in sales for products everywhere. It is nearly impossible to go anywhere in that ballpark save for the stairwells that some product isn’t in your face — for sale or advertisement.

Food is everywhere. I don’t think I’ve ever seen more food vendors anywhere per square feet in my life.

One of the things you notice quickly — by design — are the myriad ads lining the outfield fence. My companion was quick to note that Coca Cola had among the most noticeable of these ads (see photo above), which is far less ominous than the giant Coca Cola ad/bottle at San Francisco’s AT&T Park. A look to the other side will find a Budweiser sign prominently displayed (see photo below). Along the outfield wall one finds ads for other purveyors of foods laden with fat, excessive calories, salt and sugar.

None of this would come as any surprise to someone like Yoni Freedhoff, a bariatric medical professional** and prolific blogger on the relationship between (mostly fast, unhealthy) food and health (problems) and its marketing to the public. Dr. Freedhoff has made a social media career of pointing out how our food system is skewed towards particular types of products, quantities and how it is all pushed covertly and not-so-subtlely to all of us — including children — throughout our daily lives. I don’t know if Yoni’s a baseball fan, but he would certainly boo the visual team at Fenway.

Red Sox Win #fenway #boston #redsox #yankees #baseball

The hidden and not-so-hidden effects of systems

If one views the environment within and around the stadium and the game as a system, there is much that can be taken away from the experience I had at Fenway.

The availability of products is what is the explicit manifestation of the system on food choices. Fenway is a closed system so unless you smuggled some food from home, the only options for what to eat is determined by the management of the stadium. That substantially limits what you have available. While there are dozens of vendors throughout the stadium, I was shocked at how much of it was repeated as if to say: “You said no the first time; how about now? And now? And now?”. It wears you down, particularly if you spent a day walking through the city and up and down the stairs at the stadium with thousands of others.

Hot Dogs were available at nearly every second or third vendor; so was beer and nearly everyone sold pop. Salted peanuts, popcorn and pretzels were also highly available. Hamburgers? Maybe every 4th or 5th vendor. Ice cream? Maybe about every 7th vendor. Apparently there are some healthy options available at a single location on Yawkey Way, outside the stadium proper. I didn’t see them, but I am told they are there.

The option is to spend thousands and get yourself a private luxury box or admittance to the private club where there is better quality food…at a price. For the common fan, these are simply too inaccessible.

These are the more obvious manifestations of the food system. But then there are the more insidious, subtle effects that influence food choices that are built into the experience. A professional baseball game is about 4 hours long if you consider the pre and post event ceremonies that take place. This can be longer if the game itself goes into extra innings or is high scoring . In a town like Boston, you can reasonably add another hour to the beginning and end of that due to transit time.  It’s not unreasonable to want to eat during all of this.

While the options for eating are not that healthy (or rather, are positively UNhealthy) the effect of these choices go beyond any guilt for having consumed a lot of empty calories. The foods themselves are designed to create more desire.

I’m not just speaking of the neurobiological impact of fat and salts on the brain (which is sufficient enough), but the actual feelings that these foods create. Hot dogs are served on white bread and actually make you feel hungry not long after you’ve eaten it, not full. The popcorn is so salty you need something to drink and the absence of any visible water fountains (a design choice) you reach for something like beer or soda/pop. More calories, more sugar and more profit.

Just imagine sitting there watching the game, hungry and thirsty and seeing a gigantic Coke or Budweiser sign lit up like a firework over a bland green wall? No ads for tap water that I could see (or means of getting it save for bringing your emptied beer cup into the bathrooms to fill it up in the bathroom sink).  And the bathrooms themselves? They are down a long corridor, down the stairs and along another corridor. So at least you get some exercise in place of the convenience.

Making design visible

Some have claimed that great design is invisible; implying that it is so useful that no one even notices it (see the latest issue of Wired for this argument writ out as the ‘Age of Invisible Design’). In the case of Fenway Park — and the many hundreds of stadiums like it around North America – the design choices are both obvious and invisible and in both case influence our health. What struck me when watching what was going around me was that this same situation plays out (pun intended) every night across the major leagues (and all major professional sports), but also at shopping malls and food courts across North America.

In most of these venues the volume of people is high, traffic is congested, and the ability to literally see all the choices before you is difficult. What you visually rely on are things that light up — to help us navigate our way — and those are not shaped like broccoli florets, bananas, or bowls of Quinoa. When you are designing fast food you are also bound by very limited preparation space, while refrigeration and disposal capacity is limited. It’s hard to make wholesome, interesting food that isn’t whole on its own — like fruit — without the space to do it. Frozen weenies don’t require a lot of work to prepare. Creating the space for this in the first place is critical.

And if there was space to prepare the food, where will people wait? The concourses of most arenas are not designed for you to wait for your sandwich or salad to be prepared unless you get ready-made (which can be done to high quality, nutritional and taste standards, but often is not).

And space costs money. I can assure you that at every mall, stadium and food pavilion there is a cost-per-square-foot calculation done that makes the cheap-and-easy solution much more profitable than slow food. Yet, there is a real health cost to these decisions and one we fail to add to the calculus of our wellbeing.

Next time you are out at the ballgame pay attention to what is around you, how you are being shaped by advertising, design and time. We all have choices in the matter, but over time they stop feeling like it and become more challenging to make. Consciously choosing to have a hot dog at the game knowing all you know about what the food is, why it is served, who it serves as well as how it is served is a decision open to those who are aware and have the means to absorb all of the costs. Sadly, this represents too few of us.

So will our designs and health hit a grand slam or strikeout?

(As for the game? The Red Sox won with a grand slam home run in the 8th inning, unlike my stomach)

** the original post mistakenly referred to Dr. Freedhoff as a surgeon. See comments below or find out more about his work by clicking here.

complexityemergencejournalismknowledge translationsocial media

Shaking the System of Knowledge Translation and Journalism

Media covering the media talking about the media #riptide #media #harvard #journalism

Leveraging systems change comes when you are willing to examine the system itself, not just the component parts. News media is struggling to remain financially viable in a time when readership / viewership is high and revenues low by considering ways to adapt to an online world and the way it thinks about the problem will go a long way to whether it can solve it.  

Last night The Joan Shorenstein Center  at Harvard University hosted an event launching the public face of an initiative called Riptide, which sought to create an oral history of journalism as it transmophizes from independent media like paper, television and radio into what I would say is transmedia and social mediaThe Riptide Project has already been criticized for its lack of diversity of its subject matter to the point of being called “The History of Internet News, as Told by Rich, White Men” , although for its many faults it does bring together individuals who have shaped the landscape of the English-language news. That story is still worth listening to and learning from.

The event was organized around a panel featuring AOL Chairman Tim Armstrong, Caroline Little – head of the Newspaper Association of America, and New York Times publisher Arthur Sulzberger Jr. The one hour event featured some wide-ranging discussion on how mainstream media has responded to digital challenges and is seeking to promote quality journalism amidst all these threats (A summary of key points are summarized in a Storify  (click link)).  Among the points that stood out was one NOT discussed and that was around the news systems themselves. While AOL, local newspapers and international publishers like the NY Times were exploring different media vehicles for news — such as AOL’s Huffington Post and recently scaled back local news network Patch — the way journalism was to be done was basically the same, except for journalists this means more work.

There was much handwringing over the threats to the system of journalism and publishing without seeing it as a system that itself requires adaptation at a fundamental level.

Seeing the system

While the event was focused on news and journalism, it could have easily been a parallel lecture in the world of health and scientific publishing and knowledge translation or knowledge mobilization. The leaders were speaking about how they were adding video, using social media and pointed to the well-known (and critiqued) ‘Snowfall‘ journalistic endeavour tried at the New York Times as an example of doing things differently. Snowfall is a multi-media story that brings video, text, and audio together under a NY Times digital umbrella and was intended to show how old and new media could work together. Yet, there are many critics who point out that the apparent success of this new multi-media, long form journalism was really just window dressing and that the numbers — 3 million visits — actually obscured a harder truth that indicated that very few of those readers went through it all. Most skimmed. Few got the whole story

The parallels with academic publishing are startling. For all the talk of high-impact scientific publications, the truth is that getting an article included in a top-flight academic journal is — if it is very well received — is likely to garner less than a few dozen citations. Yet the amount of energy and resources that go into these publications is enormous.

Academic journals are seeking to respond to this challenge by using open-access and web-based publishing, but the same fundamental challenge exists: adapting to new media while keeping the old. The publishing model is not developing, it is adapting to threats and not necessarily in a way that is resilient.

A developmental challenge

Developmental evaluation and design is about transforming the system as you move it along. It means being willing to examine or re-examine commonly held assumptions and working with changing conditions as they change, not just upon past reflection as we saw last night. It also means considering what developing a program is all about, not just improving it. Slide number 17 of the presentation below illustrates how this might look in practice. Developmental evaluation is not about program improvements, it is about developing them further to adapt and respond to changing conditions. The resulting program response might be something that is more effective at achieving goals, but that is not the primary focus.

For journalism the risk is that they will add all these additional layers to their product without questioning the assumptions behind what it means to do good journalism. Are journalist going to be videographers, photographers and web coders as well? The point was raised that the Huffington Post has a climate where journalists sit next to engineers. While creative and useful for looking at innovation, it doesn’t help if journalists, editors and publishers are still also doing all of what they used to do and now need to add on additional activities. At some point it all suffers. Yet, the panelists also argued that strong brands like the NY Times will do well when quality markers fail in the sea of low-brow content. How can this be if the resources to do good reporting aren’t there? You can’t act like a budget outfit, but claim to be bespoke.

Academics and scientists are in the same situation. They are being pushed to deliver high quality science and teaching in an age of diminishing resources, with few good metrics to assess outcome,  TED-worthy presentations, Tweet, blog and get into the community to speak to end-users. It is a lot and might even be possible if the system changed to support it. Instead, fewer resources are given, less support for excellence provided and the expectations rise.

Without quality knowledge translation — whether it be great science journalists or outstanding health scientist or clinical communicators — our entire system will collapse. There is too much information to sift through, it is too complex of a system to operate in, and there are far too many actors to navigate it well. Journalists and their institutions can provide common touch points for many across the system and the woes, challenges and systems issues they face are ones we face in health sciences. Learning from what they did and didn’t do in the realm of communication is worthy as is watching where they go as we seek to question if other areas of health communication need to follow.

Audience seeking direction on the future of #journalism by hearing from leaders of the past #riptide

art & designenvironmentpublic health

Design Space in Public Health

EmabarcaderoFountainIf design is everywhere humans are and shapes our interactions in the built environment, which dictates how we interact with the world around us should it not be considered important enough to be a part of public health?

I recently picked up a copy of the architecturally-inspired Arcade Magazine because of its theme on Science, Art and Inquiry. Inside was a piece by Andrew Dannenberg, Howard Frumpkin and Daniel Friedman. The first two are MD’s and the last author an architect and all are from the University of Washington . In that article, they outline a case for why design and public health should go together. The audience for the piece are those interested in architecture.

Indeed, Arcade’s purpose is to “incite dialogue about design and the built environment”. It makes me wonder why we don’t have something that “incites dialogue about design and public health?”.

Yet, I couldn’t help but think that same piece should be published in a public health space. In the article, the authors outline a few of the key areas where design can contribute to public health.

Among the first of these areas is promoting physical activity and the role that design can play in building and planning for spaces that encourage people to move in healthy ways:

Working together with public health professionals and planners, designers can help remedy what urban theorist Nan Ellin calls “place-deficit disorder,” starting with the basics – stairways, sidewalks, landscapes and contiguous urban spaces – which they can compose to attract greater pedestrian use.

Designing for resiliency is another of the areas where good design can benefit the public by creating a solid urban infrastructure to literally weather the storms that come upon us:

Evidence-based design can help reduce vulnerability and enhance the resilience of buildings and infrastructure, but most importantly, the communities who depend on them.

They also look at the role of design in enhancing sustainability and as a means for assisting environmental health while shaping the demand for sustainable products:

Designers possess the unique skills, knowledge and practices to specify the use of benign materials across scales based on life cycle analysis, energy conservation, carbon management, and environmental and health impacts. As designers expand these practices, they educate their clients, inform the public and shift the market.\

Lastly, they focus on how design can contribute to reducing social inequities by drawing on evidence looking at the connections between space and wellbeing for those in low-income neighbourhoods:

Recent studies demonstrate that links between greater access to green space and lower mortality are more pronounced among the poor than the wealthy. Housing initiatives that offer better homes for low-income persons, workplace design that protects workers, and universal design that improves access for activities by persons with disabilities—these practices benefit vulnerable populations and offer designers unlimited opportunities to help foster fuller, healthier lives.

Expanding the discourse of design and public health

It was refreshing to read a ‘conversation’ between public health and design and some taking the issue of space and health seriously from a design point of view. Some, like Emily Pilloton and her Project H design others have sought to use design as a bridge to social wellbeing by looking at space as being about communities and economics. Her video below explains how she has taken a design-driven approach to her work in promoting new sustainable ways to engage her adopted community of Bertie county.

Both of these examples of design in public health take a place-based approach, however there is much that can be done with designing the experience of health beyond place. Jon Kolko’s group at AC4D looked at design and homeless in their book Wicked Problems.  Andrew Shea has looked at the link between graphic design and social good in his book, which is explained further in his TEDX talk below. The design firm IDEO has been working on social good projects now for a few years through its IDEO.org platform and program.

  Bringing public health in

What seems to be missing and that the article in Arcade did and that was bring public health in. Emily Pilloton, Jon Kolko, Andrew Shea and many other terrific socially-minded designers are changing the way the public thinks about public health. Public health needs to be doing this too. It is striking that we have so few public health professionals — Drs Andrew Dannenberg and Howard Frumpkin as exceptions — doing the kind of design-oriented research and publishing in this area. It is ripe and public health and design both need it.

I don’t expect a lot of public health folks read Arcade, but maybe they should. And maybe we should be reading more about design in public health publications too.

psychologypublic healthresearch

Designing for Empathy and Health

Transparent Contemplation

Seeing Inside Others

When does common sense make little sense? How do we sense-make evidence when it seems to make little sense? The answers could lie in getting inside the heads of those we seek to influence and designing our communications for empathy and health.

Evidence in public / health

Last week there was a brief uproar in the mainstream media and on Twitter created by a tweet from Toronto Public Health to their Twitter followers suggesting they contact the producers of the TV show The View and protest their recent hiring of Jenny McCarthy a a co-host. Ms McCarthy is an outspoken critic of childhood vaccinations in spite of overwhelming evidence to show that they generate enormous benefits over the relative and small risk for many conditions and for promoting the falsified science used to prop up the myths that they cause autism (which is her primary concern).

That post led to much discussion, including posts on Censemaking and the Public Health and Social Media blog (reposted here) and Twitter on the challenges of communicating evidence, engaging the public, and the role of public health in these conversations. Watching comedy duo Penn & Teller offer a humourous if angry take on evidence for vaccinations and health might make the risks and benefits obvious, yet this isn’t the case. Why?

It turns out, that some of these supposed obvious connections still don’t impact those who support the anti-vaccination movement. Indeed, evidence from Australian researchers shows that engaging these audiences does relatively little to influence their behaviour. To some, they may be immune to the evidence (pardon the pun).

In a qualitative study of parents on their pro and anti-vaccination beliefs, the authors found a complex mix of beliefs that governed how information was received and processed. For example, expectations of guilt at the thought that a child would fall ill because of something that could have been prevented due to a vaccine or conversely due to a vaccine side-effect were prominent in the findings.

What arose in the dialogue arising from the Jenny McCarthy / Toronto Public Health flurry was familiar territory: health professionals using the moment to logically persuade the public to choose vaccination, hand-wringing over why people fail to believe evidence or why they believe celebrities, the awful use or mis-use of evidence in the media, and gasps of collective frustration at how out of sync public health is in its engagement with the public on these issues.

What was missing was empathy.

Stories trump evidence

The above quote has been uttered many times in public health circles when the use of evidence in health communication emerges in conversation. Journalists know this and that is why they tell stories in their reportage and not “just the facts”. All one needs is a story about the human experience on one side of an argument and all the evidence to suggest it is an anomaly or rare event gets covered over. It’s why we bristle at news stories of violent crimes  and fear for our safety despite wildly declining crime rates throughout countries in the ‘developed’ world.

A Problem of Perspective

Public health professionals — indeed all of us in any field — need to get out more. It’s easy to scoff at the ignorance of people when you have an advanced degree, spend great amounts of time contemplating or generating evidence, see the health effects of faulty reasoning firsthand, and associate with many others who share the same view. It’s obvious what the right course of action is.

But obvious is a matter of perspective. Health professionals tend to design their materials for themselves. Looking at much of what is developed for health promotion and communication with the public, we might make some assumptions:

  1. People are able to read and understand health related materials (and they like to read in the first place)
  2. They like printed materials and learn best from text
  3. They trust scientists, physicians and health professionals for information on health issues above all
  4. Health is something they think about a lot and always want to learn more about issues
  5. The public is invested in carefully weighing evidence claims to make the right choice
  6. Health behaviour change is a linear, knowledge-driven process

There are more, but let’s examine these briefly. I am not going to dive deeply into the evidence for each of these points (that is for another day) rather ask you to consider how true these are in your observations.

I Want to Believe

These are all assumptions and mostly based on a rational, linear model of decision making and behaviour. They are based on a model that correlates knowledge, expertise and authority and assumes that people respond to such authority. It emphasizes the use of media that is appropriate (and historically priviliged) for academic and technical communications, not public consumption.

On that last point, many educated professionals — particularly academics — are shocked to find people that neither need or want to read. Yet, we propel print materials and websites at people in text form to audiences that we imagine value the same things.

When you study health for a living or treat people with health problems you spend your entire day thinking about health. It may come as a surprise to realize that many others don’t really care much about their health until it’s compromised. They aren’t constantly mired in decisions about evidence, long-term implications of daily decisions, or the social determinants of their wellbeing. Health is just another thing to think about among many.

If we are to be better at communicating with our audiences, we need to empathize more and design our messages, media and services in ways that reflect the reality they perceive and the one they live in knowing that might not be the same thing and nor is it necessarily the same one we live in and perceive.

It also means confronting some big questions about what we are doing in the first place.

What is the destination and the journey we wish to take with the public? Do they want to take it with us in the first place? And if not, what might we do to inspire people to want what we have to offer — and do so in a manner that promotes what they want to accomplish, not just what we want them to.

This avoids us taking the approach to dealing with people who don’t speak our language by talking slower and louder as if they are deaf and stupid rather than unfamiliar with our native tongue.

This is the realm of design and empathic design thinking about communications and perhaps its time to start bringing more of it into our work. Maybe then we might not be so surprised when the obvious answers are no longer so.

Photos: Cameron Norman, Joe Ross (used under Creative Commons License via Flickr)

journalismpublic healthsocial media

Of digital riptides and original sin — was the decline of newspapers inevitable?

Matthew Ingram does a good job of doing a retrospective on the state of newspapers and questioning the fit their current predicament has with disruptive innovation. Interesting to consider that public health and its communications are facing similar challenges with how people get and use health information. I can’t help but think there is a lot to learn here about what was and wasn’t done by newspapers (who are still around).

Gigaom

At the Brainstorm tech conference on Wednesday, several media-industry heavyweights talked about a video project they did for Harvard University in which they interviewed leaders in the industry about the rise of digital and the decline of newspapers as a force in the media business, and also gave some of their own thoughts about whether media companies could have avoided what they called a “digital riptide” that sucked the business under.

Their answer was no — because the upheaval was too widespread to resist, and the disruption of their business model too financially painful. But is their analysis correct? Yes and no.

The three directors of the project, which was put together for Harvard’s Kennedy School of Government, are former Time Inc. editor-in-chief John Huey, former New York Times editor of digital Martin Nisenholtz and Paul Sagan, executive chairman of Akamai Technologies. They interviewed about 60 media insiders about the…

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public healthsocial media

Attack on Anti-vac – Toronto Public Health vs. Jenny McCarthy

Yesterday I posted on the story of Toronto Public Health tweeting a call for its followers to voice concerns to the TV show “The View” about the recent hiring of Jenny McCarthy, a prominent anti-vaccination advocate, as its new co-host. Today, Nicole Ghanie-Opondo reflects more deeply on what kind of impact such tweeting really has and the role of public health in voicing its concerns from that of an insider. What should we expect from these Tweets? What really drives change? Why is there resistance to engaging the public and how can we professionally do so in the complicated, messy work that comes with social media engagement? Huge questions to ask and the fact that people like Nicole and her blog collaborator Corey are doing it speaks to how much change potential we can expect. One of the best blog reads you’ll find on this topic.

Public Health and Social Media

I wanted to keep quiet on this issue, being the pioneer and former voice of Toronto Public Health’s Twitter for 3 years…but I think in the spirit of reflection – let’s blog on!

Cameron Norman explains the issue really well in his post ‘Public Health and Social Media: Catching Fire from Small Sparks. Here’s another opinion via Jim Garrow on why governments should have an opinion, as junk scientists do. To sum it up, Toronto Public Health tweeted at Jenny McCarthy regarding her anti-vaccine views and requested The View to change their mind about having her as a host.

2013-07-24 08.17.32 pm

My biased opinion.

I love my public health peeps and especially adored the pioneering and willing spirit Toronto Public Health had in the early days of its foray into social media. Like family, bureaucracy and public health practioners come with their own baggage. One large piece of baggage around public health messaging…

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