eHealth and the Trust Factor

In eHealth we trust?

In eHealth we trust?

Today it was reported that the Ontario Minister of Health has resigned, presumably on the wake of the eHealth scandal (which I discuss in an earlier post) that engulfed the current Liberal government since it was revealed that there were considerable questionable expenses made by eHealth Ontario. It’s all a mess, most notably because at its root eHealth is all about trust and that seems to be the element that is most absent in this political spectacle. The elected officials do not trust the bureaucrats at eHealth Ontario, while the public loses its trust in the elected officials. Mingled in with this is a problem with trust of the government to develop a reasonable eHealth information system on its own and the simultaneous distrust of the private sector to do it for a reasonable fee and deliver an effective and efficient service. So far, all these fears are well-grounded as played out in this scandal (and when you spend $1B on a system that can be delivered for a small fraction of that and wind up with little to show for it, it is a true scandal).

The irony in all of this is that eHealth is founded on trust. We trust that our records will be stored in a manner that is secure, but also accessible. We trust that the most appropriate use of health information gleaned from information we provide to health professionals or online will follow from having these systems in place. There are the tools and resources to do this and they are not that hard to develop. That isn’t to say that this is something one person can slap together in an afternoon on a PC, but it doesn’t take a billion dollars to do it either. In the United States, The Veteran’s Administration has its own eHealth University to train people on how to use the eHealth system they developed (and it is going to be open-source I might add, meaning that the world can take it and adapt it). They have put the resources into building trust among health care professionals by offering training, developing a transparent model, and in doing so, fostering trust in their patients.

eHealth in the public sphere is equally about trust. Social networks — the foundation of nearly all of the leading websites and tools from Google to Facebook to Twitter — are all based on trust. Karen Stephenson, a pioneer in the early research on social networks in organizations, says that trust and its ability to broker relationships serves as a kind of backbone of innovation, by leveraging social capital across organizational boundaries. From a systems science perspective, trust is the mechanism by which diversity can be better engaged in the system — whether that is diversity of ideas, opinions, cultural expression (example) , sexuality, and identity.

Marketers Chris Brogan and Julien Smith recently published a book that argues that marketing — the spreading of ideas about a topic or product — is essentially about creating and engaging trust agents. From a public eHealth perspective, this means providing ways to get people connected in a safe, secure manner that enables them to share their ideas, innovate and learn in a way that supports — even enhances — trust.

The challenge in Ontario is building that trust back up. eHealth has become a ‘four letter word’ and its name — fairly or unfairly — has been sullied by the events of the past few months. Let’s find some ways to build it back up and do it in a way that makes us all better for it. Ideas are welcome.

The Launch of Amazing Stuff

Today I am launching a new feature on my blog: Amazing Stuff. It is a way for me to share the neat ideas, hot innovations, challenging ideas and random bits of ‘stuff’ that I find quite compelling, inspiring or just fun that somehow touches on the myriad issues related to making ‘CENSE’ of the world around me. Yes, you can always follow my Delicious social bookmarks, or what I Stumbleupon, but I’m not always good at social bookmarking great ideas, particularly after a busy day away from my desk when I’m staring at 200 updates on my Google Reader feed.

My choice of the term amazing is inspired by comedian Louis C.K. from his appearance on Conan O’Brien’s show a few months back. Watching this, I think you’ll agree that we are living in amazing times and this is a sample of the amazing things I’ve found over the past week:

1. The Design Thinkers Reading List. This is a summary of the must-have books and documents for those interested in design thinking (like systems thinking, only for how we shape the human activities and environments we live in).

2. How to Turn Urban Spaces Into Food Spaces. Taking unused land and using it more efficiently to help feed the poor and create a more sustainable food system for urban centres.

3. How Our Moral Roots Damage Our Thinking. A blog post and interview at TED with social psychologist Jonathan Haidt who discusses how the U.S. Healthcare debate is being shaped by forces that are not likely to lead that country into a good place.

4. Interview with Paul Hawken on Our Environmental Future. Environmental economist and leader Paul Hawken discusses his views on the future of the planet and the reason he still has some hope.

5. The Dark Side of Political Discourse on the Internet. Tim Bevins from Wikinomics shows us what happens when democracy meets the unbridled opportunity of having everyone speak their mind and its not pretty.

eHealth Deja Vu All Over Again

"This social media stuff is like eHealth deja vu all over again"

"This social media stuff is like eHealth deja vu all over again"

Yesterday I had the privilege of speaking to Cancer Care Ontario‘s LEARN community of practice meeting in Toronto about social media and how it could be used to support their health promotion (specifically tobacco control) work with youth and young adults. This group does a lot of work with young adults so information technologies are not alien to them (indeed, many had blogs, Facebook pages and other social media tools), yet they were still uncertain about how best to use these tools and why they might want to in the first place. In preparing for the presentation and in the subsequent discussion afterwards I had this overwhelming sense of having been here (and there) before. It was, as Yogi Berra famously said: deja vu all over again.

My first study on the Internet was conducted in 1995, a time when the World Wide Web was just becoming known outside of academia and the best option for social support was UseNet groups. With a friend of mine, we did the first (to my knowledge) global survey on the use of the Internet for social support (note: this is why its important to publish your results as soon as you get them, otherwise it will never happen 😦 . I did, however, present findings at the Prairie Undergraduate Research Conference at the University of Winnipeg, perhaps the most remarkable event in support of student scholarship in psychology (or any other discipline) I’ve witnessed. But I digress…)

As I moved along in my career, I continued to work with the Internet as a tool — from discussion boards to interactive smoking cessation support tools and using qualitative methods and design principles to large randomized trials. All along I would hear (and still do) comments like “isn’t that (technology) stuff just for fun?” or “why would anyone want to use that?” .

The same pattern keeps repeating. 20 years ago if you were to describe using email as a serious means of communicating – something that one should devote work time to – most employers would scoff. Now, email is integrated deeply into the very fabric of nearly every knowledge-based enterprise to the point that the corporate market for mobile services to deliver email to its workforce is in likely in the billions. 10 years ago if you were found in your office searching the World Wide Web for content of a serious (i.e., work-related) nature, a similar scoff might come. Now? Open access journals are becoming top publishing venues in their field (see the Journal of Medical Internet Research in the Health Services Research area as one example) and tools like Google Scholar are invaluable resources for scientists and practitioners alike.  The LEARN group gets this. They are the ones who are trying things out and trying to push the boundaries of their organizations, changing mindsets and considering whether or not social media is for them or not and in what measure.

A few months ago I spoke to another, similar group of health practitioners about eHealth and asked the audience about their experience using social media. Many of these settings — particularly public health units — didn’t allow Facebook or YouTube to be accessed.  Presumably, it was to avoid people doing things that weren’t serious work. This all reflects a mindset pattern that repeats in many organizations — public health or otherwise: people don’t see how the new technology can help because it is not obvious (or they haven’t even tried it), therefore it is dismissed as irrelevant or even banned outright.

The challenge here — and one that I take up — is about lowering these barriers through education. I think it is imperative that those of us (perhaps you, dear reader) who work in social media and eHealth help others to support their efforts to change the culture of their organizations. The LEARN folk are doing this, just as I did so with them. No matter how much we as ‘experts’ like to showcase new tools, we are the early adopters and massive social change will not happen until we inspire the next wave of people to take it up.  One forum for this is at the eHealth Promotion social network, a Ning group formed out of the experiences at this year’s Health Promotion Summer School in Toronto, that was on the very topic of teaching people about eHealth in public health. Best of all, when we get these new adopters joining into the discussion and familiar with the tools, they can also help us determine what doesn’t work with these tools, what their limits are, and even what risks they bring in a manner that is informed, constructive and not dismissive.

If public health is going to be innovative, that is doing things that haven’t been done or in new ways to address emerging problems, then it needs to understand social media. What and how much it adopts it is really a matter of need and circumstance, but as I pointed out in my talk yesterday, we cannot wait for the evidence to come in to make that leap. Last year, the research on Web-Assisted Tobacco Interventions (perhaps the leading domain of public eHealth research) finally reached a point where we could say with some confidence that the principal of using the Web to support smoking cessation and prevention is evidence-based. That was more than 15 years after the birth of WWW.

Are we going to have to wait another 15 years before public health widely adopts tools like microblogging (e.g. Twitter) or considers the use of mobile messaging and video or social networks in its work? By then the evidence might be in and if that is what it takes to get this adopted or accepted it will be deja vu all over again, and that’s not a good thing.

Standing Still

One of my favourite quotes is from Giuseppe Tomasi di Lampedusa‘s posthumously published novel: The Leopard. The story is about a artistocratic family and their fall from the ranks in society. In the book there is a marvellous quote that reflects the most fundamental challenges of system dynamics:”If we want things to stay as they are, things will have to change.”

I'm Forever Standing Still

I'm Forever Standing Still..Or Am I?

At its core, the message is that we cannot avoid change by standing still, rather only through change can we hope to achieve consistency. And that, is unlikely. We lose our position unless we move along with everyone else, even if in the process of moving it appears as if we are standing still. (Just think of cars on a highway. Two cars driving side-by-side at the same relative speed will look to each other as if they are not moving much at all, when in reality they may be cruising at a very high rate of speed).

We are rarely aware of the speed at which we are traveling, that is the rate of change that is taking place around us and within us. The human body renews itself many times over throughout the lifespan. Our cells are brand new, yet our looks appear at first to be quite similar from day to day. That is, until someone uncovers a picture of us as a child, a youth, a twenty-, thirty-, any-something that is far enough removed from our current state that we realize the profound change that has taken place.

Systems are enormously difficult to change for that very reason. There is not only constant movement, but lots of it and the impact of each component on everything else is different, dynamic and inconsistent. I am currently helping graduate students in public health learn about systems and, while the teaching is fun and the students are interested, the challenge to communicate the language of systems in a manner that is easy to understand is difficult. Indeed, there is little reason why teaching complexity science should be simple given that one of the principles of systems science is that complex problems require complex solutions.

But thankfully one of the other features of complex systems is the presence of paradox. And one of the tools I’ve found works wonderfully is mindfulness-based reflection. Mindfulness is the process of ‘standing still’ by calming the mind and attending the signals around us without trying to influence them. Remarkably, by keeping still and just paying attention to what is around you without ascribing feelings, thoughts, or attitudes towards something we can learn a great deal about what is going on around us. This is a strategy that has been highly effective as a technique in addressing complex health conditions like chronic pain and addictions and training those who work in areas like this.

The question I have is this: How do we get our social institutions and communities to do the equivalent of paying attention to its breath and relaxing its mind to see the systems that they are a part of in order to initiate healthy change?

That is the challenge I am putting to my students and myself and to you too, dear reader.

Order and the Problem of Change

I am Here for the Learning RevolutionThe new academic year is starting and with it the return to teaching.

Teaching brings with it many joys and demands and for those about to enter the teaching profession — at any level — you are undoubtedly going to encounter ‘problem’ students. But these may not be the ones who expect: the ones with serious learning difficulties, absent motivation, or a lack of focus. As much time and energy as these students demand, my experience has been that those who exceed expectations pose more problems than any others.

These are the ones that bring chaos to the order that we expect in ways that, if nurtured, is relentless.

I used to work in a school that had could have been called “Last Chance High”: the place for those youth who were not in custody or care, yet were too disruptive to be in a regular classroom. People would come into our special setting located in the basement of an older abandoned public school (the imagery brings a sad level of irony with it) and describe much of what happened in our school as chaotic or out of control. It might not have been “in control”, but there was much order to it. My colleagues and I were there because we were trained to work with adolescents with ‘special needs’ so for us ‘acting out’ didn’t cause us much difficulty. It was when students gained insight into themselves, found something positive, grabbed hold of it and transformed their behaviour into something much more constructive that things got tough.

For most of these young people they had been given a message that they were bad, inferior, screw ups, unwanted, or any number of negative qualities. Positive comments, when they were offered, were often conditional.

The same situation happens in university — even in graduate school, where students are perhaps more likely to be self-motivated and success oriented. We expect students to want to change the world and become the best scientists and scholars in the world. But we want that ‘best’ to look like something we know (i.e., what we are expecting). For researchers in public health that means publishing papers, going to presentations, using methods and theories that are familiar to us, and doing so within the usual constraints of 4 month courses. And let’s forget about teaching — there aren’t many ways to learn how to do it at most universities.

I have students (and some colleagues) that want to do things different.


  • They want to use video to communicate, take pictures, create blogs and not just text, because they believe in reaching a broader audience than just those with university level education and high literacy rates. They also want to use these media forms as research tools;
  • They want to partner with the community — not in the imaginary way that we often do in many community-based research studies — but in real partnerships. The kind that are messy and unpredictable, like any relationship;
  • They want to put on the conferences, not just attend them;
  • They want classes that aren’t just lectures and PowerPoint. The want to learn by doing;
  • They want to get out more and see the world– and want us faculty and administration to do the same;
  • They want to translate knowledge to everyone, not just in some manner that fits with a theoretical framework for how it should be done, using the tools that might not be convention (blogs, Twitter, Facebook, YouTube, podcasting)

This is ALL problematic, because there aren’t the structures in place to support this. Right now. This is introducing a little chaos to an environment that is based on a certain order that expects people to innovate in certain ways that follow a linear path. Education is not linear. Learning is a complex adaptive system, yet our education system treats it like a linear, closed system.

This all gives me a headache and creates loads of work for me and my colleagues, just like those kids at the school I taught at years ago.

And just like it did many years ago, these participating in these transformative learning experiences continues to be the best part of teaching.


Bring on the Advil.

eHealth and the Means-Ends Problem

Prescribing ChangeIt’s been a busy week and one that has focused on means and ends and provided me with many examples of how those two things get confused and become de-linked.

I started the week off in Vancouver with meetings focused on my ongoing research looking at collaboration and outcomes associated with the study and evaluation of the Life Sciences Institute at the University of British Colombia. Our research is trying to ascertain the means from the ends — and even what those ends are or should be. Does increasing interaction between scientists of different disciplines produce more research? better research? different research? and if so, is this a factor of the people?, the setting?, facilitators within the LSI and outside?, something else? or some combination? It’s the kind of problem that makes researchers squirm or jump (thankfully, I’m in the latter).

These kinds of means and ends are important for not only research, but understanding innovation in practice and creating better strategies to facilitate that. Nowhere was that more clear than in the two days of presentations and discussion at Medicine 2.0, perhaps the most important gathering of people — researchers, clinicians, decision makers, patients and advocates — interested in learning more about how collaborative e-tools brings about change. Events like these are dangerous; for those in eHealth and those outside it.

For those outside, the danger comes from having a group of innovators share with the world how ‘Web 2.0’ tools can facilitate self-organization, community engagement, and patient involvement in ways that challenge the status quo quickly and with tremendous force. As I tell my students in my Health Behaviour Change course at the U of T : the only people who truly welcome change are wet babies.

Take the eHealth Ontario debacle, which continues to roll along. It now has come to the attention of the public that Ontario already has an eHealth record system linking close to 100 facilities only it is focused solely on child health (i.e., those under the age of 19), when its spent millions on developing a completely new one, presumably for the other part of the population (?). What is required here is changing the tools to address a larger population, but more importantly, changing a mindset that there needs to be new tools, rather than adapting existing ones. The means (a centralized database for health records in this case) is confused with the end (a healthier province & a more efficient and effective health care system). A quest for getting the ‘right’ means or getting a particular ‘means’ is delaying our ability to move towards the healthy end.

From the inside eHealth, these kinds of events are dangerous for reasons that are not that different than those of outsiders. In this case, there is a tendency to focus on the means without consideration of the environment in which those methods are deployed. At Medicine 2.0 there were talks ranging from a focus on patient support needs and portals, public health support strategies, wiki-based clinical practice guidelines, and a variety of ways to engage various audiences with tools like Facebook and Twitter. In nearly every presentation the focus was on the novel ways in which technology could facilitating change. Yet in the audience and at the breaks these presenters (myself included) found ourselves talking less about the tools, but the organizational cultures and shifts that need to take place to make these tools work. Indeed, the tools can do a lot, but without an organizational mindshift within our health and public health systems, even the most innovative, responsive and affordable tools will not truly make the change that is espoused.

We are clear on our end, now its time to reconsider our means in light of the tools and the culture that exists around them.

The Book is Dead, Long Live the Book! Learning and Social Media

The Book is Dead, Long Live the Book!

Is this a library or a graveyard? P.S. Where's the power outlet?

Is this a library or a graveyard? P.S. Where's the power outlet?

I found myself in a strange situation the other day: I was listening to a podcast of a panel of Web 2.0 marketers talk about their new books and the power of old media in a new media age. No matter how digital a person is, there is still something to hold on to (literally) with a book.

The panel was hosted by Mitch Joel on his podcast Six Pixels of Separation (which is also the title of his new book), and included folk like marketer Chris Brogan and his co-author Julien Smith and others discussing social media and the perils of sticking with the old ways of marketing, yet highlighting the importance (and honour) of being a New York Times Bestseller (i.e., being recognized by a print newspaper as a top seller of paper books). There’s lots involved in this, but most notably I think it actually reflects what Robert Fulford once called “the triumph of narrative” . This is the appeal of storytelling, depth and coherence in communication — things that most new media does quite badly. Twitter, on a tweet-by-tweet basis is largely incoherent. I might have areas I tweet on and may seek people who tweet about other things, but because not everyone stays ‘on message’ and that people tend to have diverse interests (including Twitter follows), that leaves a mass of information that is left up to the user to make sense of.

Facebook, because it is more closely tied to relationships or ‘friends’ we are familiar with, has at least some over-arching thematic consistency to it, but it still isn’t largely a place to tell or learn from stories.

That’s where books come in. Amazon has released the Kindle, while others are trying to digitize text into books. My colleagues at the Strategic Innovation Lab at the Ontario College of Art & Design are looking at the future of the book, trying to understand how to add the searchable features of a regular webpage and the linking features of hypertext within the codex form of book — electronic or otherwise. Seems like a lot of energy is going into a ‘dead’ technology.

Formal education can be a lot like a book. While anyone can pull together the content within a course — textbooks, slides, recordings – few people will learn in the same way at a distance, in chunks, than being part of a coherent narrative provided through a good course (** i.e., one that teaches people to learn, not shovels content at them). That is no reason not to accumulate chunks. Twitter is great — at what it does. So are books.

So much of our discussions of eHealth, eLearning, and education is that we take an either/or approach. Is distance learning better than face-to-face? Books are dead, all the information is on the Web. These arguments are not helpful. I don’t suspect the book — the paper and cloth codex of today — will last, but I do think the book as a long-form manuscript (digital or otherwise) will survive. Our storytelling — at a distance anyway — depends on it.

Another issue is related to complexity. Complex problems require solutions that can reflect this complexity. Those complex responses are much less likely to emerge through a 140 character tweet. They may emerge over 1000’s of tweets, but without any obvious ways to derive coherence from these without mining the data for it. The book, because of its focus on organizing a lot of information into a narrative is one of the best ways to do this. So while we celebrate the rise of new tools and technologies, let’s also give a cheer to the ones we already have.

Lastly, when I came up with the title for this post, I suspected that I wasn’t the only one who’d uttered such a phrase. So in the name of acknowledging the efforts of others, you can see the many different posts using this title here, here, here, here and here (and many other places).

Back to School and the Lesson of Accumulation

For millions of kids and young adults and the many faculty and family members associated with the noble profession of teaching, today is the biggest day of the year. It’s back to school.

School and learning are clearly on the minds of many these days. As I posted last week, there is much to be concerned with how education is (or is not, depending on your point of view) being funded. Yesterday I read an editorial on the CBC’s website from a teacher who pointed to the stress that his profession is under and how it is killing those who choose to remain in it.

“I think that the whole idea of teaching has changed in the last 15 to 20 years,” says Emily Noble, past-president of the Canadian Teachers’ Federation.

“People are dealing with more high-need students, with more multicultural issues and with no-fail policies.

“Teachers want to make a difference, but the supports are just not there.”

It’s not a particularly rosy time for educators of any stripe.

Anyone who’s been at the head of the classroom (myself included) knows that teaching is as much of a vocation or calling as it is a job. It is not something you do from 9-5 or whatever the set hours are. If you ran an education system on ‘work to rule’ where people did just what their job required of them within normal hours, paid them an hourly wage and had them account for every minute they worked, the system would collapse within weeks. I can’t imagine that there has ever been a greater gap between what teachers actually do and what they are perceived to do by those outside of the profession. As a professor, I routinely shock people who think that I have 4 months off each summer and spend the remaining 8 wandering the hallowed halls of academe ‘thinking big thoughts’, reading books and conversing with grad students in between teaching duties. Between ongoing grant writing, doing research, conference presentations, thesis defences, supervising staff, writing, and preparing our courses for the fall (including adding in the H1N1 provisions this year) summers are anything but idyllic times off. There’s a lot of stress in this job and, as a recent double issue of the Journal of Human Behavior in the Social Environment explored, it manifests itself in many (mostly harmful) ways. Still, most of us do it because we believe in our profession and, mostly, enjoy what we do.

Whether at university or primary or secondary school, teaching as a whole is undergoing a major change. As Smol writes:

There is a general understanding that things “are not the same as they once were.”

Teaching has always been a tough, but rewarding job in part because there’s always new things to learn and we, as humans, are wired for learning. Teaching is also a dynamic profession aimed at supporting this learning, but as Smol and others have written, the changes that are happening in education are great and fast and without the structural supports in place to help these changes take place. I wrote of resliency in my last post, arguing that we’re testing the resilience of our education system with this imbalance between demands and resources. Today I want to focus on another important systems concept: accumulation.

It turns out, people are lousy at understanding how things build up over time. A study by John Sterman from MIT, one of the leading scholars in system dynamics, found that even among his students — some of the best, brightest and well-equipped to handle this topic given that it is part of their studies — most have a poor sense of what accumulation really means. So do educational policy makers I suspect. The reason this is important for education is that as accumulation of stress builds the likelihood of something going amiss increases dramatically. A tipping point, that term popularized by Malcolm Gladwell in his book by the same name, is an expression of accumulation.

In our case of education, the tipping point could come when people no longer want to become teachers en masse. Or, it becomes nearly impossible to hire good, quality educators for anything other top salaries, which in an age when even the basics aren’t funded, seems unlikely. Or, teachers begin to amass more sick days than ever before (which is already happening) creating disruptions in the classroom. (Note: Remember those days when the substitute teacher came to class? Were those ever days filled with lots of learning and orderly classrooms? Not often. Imagine that on the rise as teachers start to miss days on the job a little more)

The unintended consequences could see parents fleeing the public system of education for private institutions, leaving a growing gap between the education of the haves and have nots  even more than exists today. Another option is that some other market form of education replaces our current system. Among the many scenarios that could play out, most suggest that the system could break. And when systems break suddenly and quickly, the stress increases, which seems a little counterproductive given that it is one of the problems in the first place.

The Arab proverb about ‘the straw that broke the camel’s back’ comes to mind here. The mistake is thinking that a single straw caused all that damage. It did, but only because of its relationship to all the other straws. Each straw weighs the same and presumably has the same relative impact on the camel. What tipping points show is that, despite this similarity between objects (straws, stressors, whatever…) not all are created equal in terms of their impact. While it is true that each individual object taken on its own is relatively the same, the cumulative impact makes each of them quite different. That ‘last straw’ (which, incidentally, is the name of a great teaching game on the social determinants of health) , has far more influence than any other straw. What we don’t often know is which straw will serve as the ‘last’ one. How resilient is the system? What is its carrying capacity? We don’t know, but by paying attention we can anticipate problems ahead and potentially avoid this last straw scenario and the tipping points that follow.

So as you go back to school, consider bringing something other than just an apple for the teacher.  Perhaps a lesson in accumulation for the principal, school board officials, the public taxpayer, and educational policymakers will do.

The Food Bank Model of Education and the Tyranny of Resiliency

Teaching the basics

Did this teacher pay for her chalk through bake sales?

This morning’s Globe and Mail introduced me to a new term “The food bank model of education” . Just reading the headline spurred a deep sense of empathy in me and a good idea (proved correct as I read the article) about what that term meant. As you might guess, the analogy of the food bank is one centred on the concept of donations to support those in need. As Wendy Stueck writes, an approach that was once used around fundraising for special events and activities — those ‘extras’ — is now being used to support the foundation of the educational system. It’s no longer about paying for students to go to special exhibit at the major art gallery and more about paying for pencils, pens and paints — the basics.

Big bucks raised by parent groups are becoming more prominent on the Canadian education scene and resulting in gaps between schools backed by well-off, well-educated parents and those in less-affluent communities, says Annie Kidder, president of the Toronto-based advocacy group People for Education.

“Fundraising has always been a feature [of the school system] and it’s not inherently wrong,” Ms. Kidder says, adding that festivals and silent auctions can be fun and boost morale. “The issue now is that parents are becoming the food banks of the education system.”

It’s easy to forget that food banks were temporary measures meant to serve as a stop-gap to serve communities when times were tough and there wasn’t the necessary resources in place to ensure that everyone had access to food when they needed it. Second Harvest in Santa Cruz area, was the United States’ second food bank (first in California), opening in 1972. That’s not long ago. It shouldn’t be around today, but it is. That’s not because they don’t do good work, but rather because unlike other banks, these weren’t meant to last.

However a funny thing happened while people were patching away at food security, these banks started evolving into social education resources that not only provide food, but also learning about food systems and training centres for policy advocates working to address food security issues. The Daily Bread Food Bank in Toronto is another great example of this type of transformation in action.

What these groups represent is resiliency in action. Resiliency is the ability of a system to adapt to adversity and capitalize on opportunities to make positive transformation in spite of challenges or catastrophe. It is held up as a positive trait in humans and social systems. One reason is that the world is a dynamic place and change (as much as we resist it) is inevitable. As the memorable quote from Guiseppe di Lampedusa’s bookThe Leopard:  “If we want things to stay as they are, things will have to change”..

But that is the problem here with education and food security. We’ve become really good at adapting. Our educators, our communities are exceptionally resilient, creative and adaptive. As the Globe piece points out, a lot of creative stuff is happening to keep the system moving:

But while the routine may be the same, Ms. Whiteaker and others worry that parent groups face increasing pressure to raise money – a kind of fundraising creep – as school boards across the country tighten their belts in the face of government cutbacks.

“Because of the funding cuts, you are going to see an increased demand for fundraising,” she says. “Because parents want to provide the best for their students – right now. Not by the time the government gets around to increasing the funding for certain areas.”

But this isn’t just belt-tightening. It’s unlikely we’ll see these funds restored anytime soon. Think about it: in North America we just experienced the longest run of economic success and wealth creation than at any time in human history. Yet, food banks and educational erosion has continued and remained ‘reslient’ through all of this. Is this a good thing?

Resiliency is almost always used as a positive trait, because adaptation in systems and psychological terms is healthy. But such demands for adaptation can be excessive and actually weaken the system over time. Resiliency is like an elastic band. It has a lot of give and stretch at the beginning, but as anyone with a well-worn pair of yoga pants can attest, the elasticity starts to dissipate after much use. Systems are the same way. Our educational system or food security systems are highly plastic and those working within them are creative. But at some point that elasticity will fade to the point where, like an elastic band, it will eventually crumble into pieces.

How many bake sales are we away from that happening in our schools?

Cohesion vs. Diversity

I just watched (yet another!) great TED talk that solidified something that’s been on my mind all week: diversity.

The talk by Cary Fowler, the leader of the global seed bank, a remarkable initiative aimed at saving the world’s seed for future use should that day (or many days) come when we need to draw upon the diversity on our planet to support life. Even though we think we live in a world of apparent dietary diversity (after all the average supermarket literally carries thousands of products — just look at the number of types of yogurt you can buy at a typical store), the truth is that we are in deep trouble when it comes to the diversity of natural food choices available to us. It is estimated that there are about 7500 different types of apples alone. But we rarely see that expressed in food choices. Shop your local supermarket and you’ll find that variety sharply drops down to about a dozen or less. And this dozen or less is the same at most of the other shops. The truth is, we are limiting our diversity in food dramatically and are potentially harming our potential survival in the process.

In Canada, we praise ourselves for being an accepting society and our social, cultural and linguistic diversity. My home, Toronto, may be the most ethnoculturally diverse city in the world when measured by these aforementioned characteristics. Scott Page, a systems scientist from the University of Michigan, has written a fantastic book on diversity that provides a strong case for diversity in many different contexts from school to work to community life.

But diversity has a dark side. The less we have in common (i.e., the more diverse we are) the less cohesion we are likely to experience as a duo, group or society. It was that very topic that Michael Valpy wrote about in the Globe and Mail this week. In his article, he quotes another Canadian and now Liberal Party leader Michael Ignatieff from his new book:

“We need a public life in common,” he writes, “some set of reference points and allegiances to give us a way to relate to the strangers among whom we live. Without this feeling of belonging, even if only imagined, we would live in fear and dread of each other. When we can call the strangers citizens, we can feel at home with them and with ourselves.

And reaching for a codicil from his intellectual hero, he adds: “Isaiah Berlin described this sense of belonging well. He said that to feel at home is to feel that people understand not only what you say, but also what you mean.””

Anyone who has worked on projects where there is a diversity of opinion knows the benefit of having someone not only understand what you say, but also what you mean. That trait alone may be the reason we commit to working together at all and, when it doesn’t happen, why we might choose to do things apart. A healthy system has both diversity (represented by chaos at its extreme) and cohesion (represented by rigid order at its opposite pole). Having watched Cary Fowler’s talk shortly after reading Michael Valpy’s article has me questioning what the balance is in fostering diversity within a system. How does one know when you’re ‘diverse enough’ or when you’re too rigid and inflexible? In the case of Cary Fowler, he’s not planning to have all 7500 apples growing at the same time and place if he even gets all those seeds saved, but he’s not planning on saving just the tastiest, crispest or hearty of them either. That strikes me as a good thing.

In my eyes, a great community is one that is diverse and cohesive — living at the ‘edge of chaos’ in systems terms. Toronto is one of those cities, with many small villages within it, and has been highlighted by urban thinkers like the late Jane Jacobs and Richard Florida as a place that does diverse urbanism rather well. As imperfect as it is, Toronto is pretty cohesive.

But it is also seeing a large gap between the wealthy and the poor – and likely the healthy and the unhealthy. This gap was driven home yesterday as I took part on a panel on the social determinants of health at the Dalla Lana School of Public Health.The concept of ‘poverty by postal code‘ and the gap between those with choices and those without was clear. Along with Carol Timmins and Stephen Hwang, we spoke separately and as a panel about issues of public health practice, homelessness, and youth. As we explored these issues I thought about this ‘cohesion’ amongst the diversity and wondered whether this is as good as it gets? Can we create greater social cohesion than this or are we doomed to some level of diversity that has lots of upsides, but also many downsides. Can we have it all?

What is the balance here and would we know it if we achieved it?

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