Tag: evidence

education & learningresearchsystems thinking

The urban legends of learning (and other inconvenient truths)

Learning simulacrum, simulation or something else?

Learning simulacrum, simulation or something else?

Learning styles, technology-driven teaching, and self-direction are all concepts that anyone interested in education should be familiar with, yet the foundations for their adoption into the classroom, lab or boardroom are more suspect than you might think. Today we look at the three urban legends of learning and what that might mean for education, innovation and beyond. 

What kind of learner are you? Are you a visual learner perhaps, where you need information presented in a particular visual style to make sense of it? Maybe you need to problem-solve to learn because that’s the way you’ve been told is best for your education.

Perhaps you are a self-directed learner who is one that, when given the right encouragement and tools, will find your way through the muck to the answers and that others just need to get out of the way. With tools like the web and social media, you have the world’s knowledge at your disposal and have little need to be ‘taught’ that stuff, because its online.

And if you’re a digital native (PDF), this is all second nature to you because you’re able to use multiple technologies simultaneously to solve multiple problems together with ease if given the ability to do so. After all, you’ve had these tools your entire life.

A recent article by Paul Kirschner and Jeroen van Merriënboer published in the peer-reviewed journal Educational Psychologist challenges these ‘truths’ and many more, calling them urban legends:

An urban legend, urban myth, urban tale, or contemporary legend, is a form of modern folklore consisting of stories that may or may not have been believed by their tellers to be true.

The authors are quick to point out that there are differences in the way people approach material and prefer to learn, but they also illustrate that there is relatively little evidence to support much of the thinking that surrounds these practices, confusing learning preferences for learning outcomes. I’ve commented on this before, noting that too often learning is conflated with interest and enjoyment when they are different things and if we were really serious about it we might change the way we do a great deal many things in life.

In the paper, the authors debunk — or at least question — the evidence that supports the ‘legends’ of digital natives as a type of learner, the presence of specific learning styles and the need to customize learning to suit such styles of learning, and that of the lone self-educator. In each case, the authors present much evidence to challenge these ideas so as not to take them as truths, but hypotheses that have little support for them in practice.

Science and its inconvenient truths about learning

Science has a funny way of revealing truths that we may find uncomfortable or at least challenge our current orthodoxy.

This reminds me of a terrific quote from the movie Men in Black that illustrates the fragility of ideas in the presence and absence of evidence after one of the characters (played by Will Smith) uncovers that aliens were living on earth (in the film) and is consoled by his partner (played by Tommy Lee Jones) about what is known and unknown in the world:

Fifteen hundred years ago everybody knew the Earth was the center of the universe. Five hundred years ago, everybody knew the Earth was flat, and fifteen minutes ago, you knew that humans were alone on this planet. Imagine what you’ll know tomorrow.

One of the problems with learning is that there is a lot to learn and not all of it is the same in content, format and situational utility. Knowledge is not a ‘thing’ in the way that potatoes, shoes, patio furniture, orange juice, and pencils are things where you can have more or less of it and measure the increase, decrease and change in it over time. But we often treat it that way. Further, knowledge is also highly contextualized and combines elements that are stable, emergent, and transformative in new, complex arrangements simultaneously over time. It is a complex adaptive system.

Learning (in practice) resists simple truths.

It’s why we can be taught something over and again and not get it, while other things get picked up quickly within the same person even if the two ‘things’ seem alike. The conditions in which a person might learn are cultural (e.g., exposure to teaching styles at school, classroom designs, educational systems, availability and exposure to technology, life experiences, emphasis on reflective living/practice within society, time to reflect etc..) and psycho-social/biological (e.g., attention, intelligence, social proximity, literacy, cognitive capacity for information processing, ability to engage with others) so to reduce this complex phenomena to a series of statements about technology, preference and perception is highly problematic.

Science doesn’t have all the answers — far from it — but at least it can test out what is consistent and observable over time and build on that. In doing so, it exposes the responsibility we have as educators and learners.

With great power comes great responsibility…?

Underpinning the urban legends discussed by Kirschner and van Merriënboer and not discussed is the tendency for these legends to create a hands-off learning systems where workplaces, schools, and social systems are freed from the responsibility of shaping learning experiences and opportunities. It effectively reduces institutional knowledge, wisdom and experience to mere variables in a panoply of info-bites treated as all the same.

It also assumes that design doesn’t matter, which undermines the ability to create spaces and places that optimize learning options for people from diverse circumstances.

This mindset frees organizations from having to give time to learning, provide direction (i.e., do their own homework and set the conditions for effective learning and knowledge integration at the outset). It also frees us up from having to choose, to commit to certain ideas and theories, which means some form of discernment, priority setting, and strategy. That requires work up front and leadership and hard, critical, and time-consuming conversations about what is important, what we value in our work, and what we want to see.

When we assume everyone will just find their way we abdicate that responsibility.

Divesting resources and increasing distraction

In my home country of Canada, governments have been doing this with social investment for years where the federal government divests interest to the provinces who divest it to cities and towns who divest it to the public (and private) sector, which means our taxes never go up even if the demands on services do and we find that individual citizens are responsible for more of the process of generating collective benefit without the advantage of any scaled system to support resource allocation and deployment throughout society (which is why we have governments in the first place). It also means our services and supports — mostly — get smaller, lesser in quality, more spread thinly, and lose their impact because there isn’t the scaled allocation of resources to support them.

Learning is the same way. We divest our interests in it and before you know it, we learn less and do less with it because we haven’t the cultural capital, traditions or infrastructure to handle it. Universities turn campus life to an online experience. Secondary schools stop or reduce teaching physical education that involves actual physical activity.  Scholarly research is reduced to a Google search. Books are given up as learning vehicles because they take too long to read. It goes on.

It’s not that there are no advantages to some of these ideas in some bites, but that we are transforming the entire enterprise with next to no sense of the systems they are operating in, the mission they are to accomplish, a theory of change that is backed up by evidence, or the will to generate the evidence needed to advise and the resources to engage in the sensemaking needed to evaluate that evidence.

Science, systems and learning

It is time to start some serious conversations about systems, science and learning. It would help if we started getting serious about what we mean when we speak of learning, what theories we use to underpin that language and what evidence we have (or need) to understand what those theories mean in practice and for policy. This starts by asking better questions — and lots of them — about learning and its role in our lives and work.

Design thinking and systems thinking are two thinking tools that can help us find and frame these issues. Mindfulness and its ethics associated with non-judgement, open-mindedness, compassion and curiosity are also key tools. The less we judge, the more open we are to asking good questions about what we are seeing that can lead us to getting better answers rather than getting trapped by urban legends.

Doing this within a systems thinking frame also allows us to see how what we learn and where and how we learn is interconnected to better spot areas of leverage and problems in our assumptions.

This might allow us to make many of our urban legends obsolete instead of allowing them to grow like the alligators that live in the sewers of New York City. 

 

 

journalismknowledge translationpublic healthsocial media

Sane truths in Crazy Town: What Rob Ford’s story offers politics, science and journalism

Crazy Town

Crazy Town

A new book about Toronto’s (in)famous mayor reveals a great deal more than just a story of man known more for what he smokes and says than his governance, to what kind of world we want to live in. Robyn Doolittle’s ‘Crazy Town’ goes well beyond documenting one man’s troubling behaviour and its place in the city he governs to a broader understanding of politics, science and journalism in a day when all three are under threat. 

Toronto has been my adopted home for most of last 15 years. It’s dynamic, clean, safe and North America’s 4th largest city. Toronto is a place of tremendous ethno-cultural diversity (near 1/2 of the population is foreign-born), spectacular food, a thriving arts and culture scene, great universities, home to sports fans with a near pathological faith in their hockey team, and — even with all of that — it’s sometimes a bit dull (and that’s OK).

That last bit about being dull changed dramatically after 2010 and that has to do with one man: Rob Ford, our mayor. Maybe you’ve heard of him.

The narrative arc

Toronto Star reporter Robyn Doolittle was literally at the front line of journalists covering Toronto’s Chief Magistrate and recently published a book on that experience and the story behind the story called Crazy Town. It’s a terrific book that documents the almost surreal events and people behind Rob Ford’s rise to power and current reign as one of the world’s most well-known mayors. It’s a rare work that manages to marry true crime, history, political intrigue, suspense, biography, and a journalism textbook together. I devoured it.

Yet, as a resident and politics fan I was amazed by what I read. I already knew most of the general details of what came out in the book (although chapter 12 is a complete shocker) because I lived through this news. Yet, it was only seeing all of this painted in one long narrative piece that it took a new life and in doing so brought me to a deeper understanding of many issues I’d thought I knew. The reason is largely the narrative arc that only a book (or long-form journalism) can offer.

On the surface, one could argue that what Doolittle did was piece together hundreds of stories she and others had written and compile them with a few additional quips to produce a compendium of Rob Ford’s life in the public’s eye. That in itself is a lot of work, but it doesn’t tell those who were paying attention to the story anything new. Yet, with each story that came out the backstory shows how what was reported — and picked up by others, reacted to, or ignored — was as important as what was learned about the subject and his environment. We read about how — not unlike with police work — the public is exposed to the “facts” but not how the authors chose to disclose (or not) those details and why.

When one considers what these ‘facts’ and the stories behind them entail, it is hard not to see some parallels between the world of political reporting at city hall and the world of science, social innovation, health promotion and policy that I live (and have lived) in. Crazy Town has many lessons for those not interested in Toronto, Rob Ford, politics, journalism or science, yet it is through all of those topics that such lessons are learned. The latter three stand out.

Politics

Rob Ford has defied nearly any explanation of how he has managed to maintain some form of support above 30% (as in, 3/10 polled would vote for him if the election was today). The best I’ve read is from former Canadian hockey legend, educator and parliamentarian Ken Dryden who wrote in the Globe and Mail newspaper about how Rob Ford has found a way to be visible and get the simple things done when other politicians get mired in complexity. He channels people’s frustrations and he makes his constituents feel listened to.

Doolittle’s treatment of Ford – despite the despicable treatment he’s given her, the Toronto Star and journalists overall — is fair and, in many cases, almost flattering when it comes to politics. Ford and his team have, despite appearances on the personal side of things, been very consistent and kept things simple. While Einstein might have challenged that Ford’s simple is too much so, there are lessons for all of us in this.

For those who deal in complexity, which is most human systems, it is easy to get mired in the details and interactions. Ford was steadfast in his over-arching narrative of “the gravy train” and that resonated with people. There is no reason why any other politician couldn’t have picked something similar to drive as their narrative and done much more good than Ford has, but they didn’t.

Ford made himself visible to those who mattered most: his constituents. And they have rewarded him with support.

How often do health care officials, educators, or policy leaders spend time with their key ‘constituents’ in settings that are natural to that audience? Politicos might challenge Ford’s proclivity for door-knocking and BBQ’s in an age of big data analytics, but that resonates with people. Why don’t more leaders get away from staid events in hotel ballrooms, well-crafted PR events, or their own offices to meet with their audiences where they live, work and play?

Good designers know that the design is only good if it gets used in the environment it was intended for and the only way to know that is to go into those environments. Ford knows this.

Science

To be fair, science is my term not Doolittles, but the term ‘evidence’ is one that links my term and her experience as a reporter. By science, I am talking capital ‘S’ science — the enterprise of scientific work as well as the activity.

What follows from the narrative arc that Ford delivered was the ability to frame the evidence held against him. He is masterful at reframing the arguments and keeping people focused on the messages that fit his ongoing  construction of a narrative. For a while, he was able to keep people talking about whether or not he smoked crack or drank alcohol excessively — two very serious issues — in a speculative way and away from the evidence he associated with drug dealers, violent criminals, and lied repeatedly to the press. He still does this.

In 2012 and 2013 the city spent time debating the minutiae of the law around whether or not he was in violation of conflict of interest. Lost in much of this debate was the larger pattern of Rob Ford consistently getting into trouble over all kinds of issues, big and small and how that wasn’t appropriate for any leader, political or not. Recently, Ford was in the news for being drunk in public and speaking in some faux Jamaican patois to customers at a local restaurant.

The issue as discussed in the media was the alcohol and the patois, not the fact that this is a man who, when under the public’s eye, has the judgement to: 1) get drunk in a public place 2) with the person who is accused of extortion related to the infamous crack video, 3) and then get up in front of everyone at the front of the restaurant to make a big, public proclamation.

Two weeks later, at a funeral for his friend’s mother in Vancouver, Ford decides to go to a crowded bar on a weekend night where nearly every young person there has a mobile phone and many proceed to take pictures of him or with him .

This is exactly how scientists and policy makers often behave. The intense focus on the small details leaves out the questions of relevancy and the bigger picture of what the point of the science is. Too often we get sidetracked with specifics and lose sight of a much larger set of issues.

For example, we’ll spend forever arguing the hypothetical possibility that someone might hack into an eHealth record as an argument for not allowing for easy portability and accessibility to that information (despite the fact that it can save lives, engage people, and that banks have been doing it with our life savings and credit for 20 years). (* Note that the details in science can matter a great deal, but just like walking and chewing gum, we can fret details in science and think of the big picture at the same time)

So far, people are willing to pay attention to Ford’s bigger message. Perhaps we need to consider what the bigger message is in our other enterprises and then worry about the details.

Journalism

I love ‘behind the scenes’ looks and this book provides lot to consider when thinking about how journalism is done, particularly that of the investigative kind. Doolittle has been steadfast that Crazy Town might have her name on the cover, but the investigative work that contributed to it was part of a huge team of journalists from the Toronto Star, the Globe and Mail and other outlets. Indeed, it takes a team and the kind of institutional support that the Star has put behind Doolittle.

Alas, this may be an exception. Many journalistic outlets are imploding due to poor management, change of readership habits, shifting business models, and also the public’s unwillingness to pay for things they value online. This last point is the one that we often let skate by in our discussions about media and one that Jaron Lanier has exposed as a major flaw in the modern Internet age.

Just this past week, web pioneer Mark Andreessen speculated on the future of media and — as many who have a stake in a faster, less in depth form of media often do — completely overlooked the role of the media as the a key role in communicating and uncovering key stories for society. To him, the model is dying. Maybe the business model is problematic, but unlike Andreessen I see a big need for journalism for society and as a model for science and health.

In health and science reporting, we are at great risk of losing voices like Andre Picard, Julia Belluz, Carly Weeks and Helen Branswell who have all brought to light many key issues that public health, healthcare and policy seem to forget, hide, complicate, or deny from emergent infectious disease patterns to drug regulation policy and practice.

Would we know about Rob Ford’s fitness for mayoralty if we didn’t have the Star? Would we be talking about the perversion of science and pharmaceuticals were it not for people like Ben Goldacre in the UK? What kind of knowledge would the world have about the NSA if Edward Snowden was a lone blogger and didn’t have The Guardian or New York Times to advance his disclosure? Crazy Town makes you realize what a debt we are owed to modern investigative journalism, journalists and those that support them (and are willing to pay for their products).

A bigger story

Crazy Town ends with the acknowledgement that there is much more of this story yet to be written. This is an election year and Rob Ford is one of the few who have already filed their papers to run for office again.

Crazy Town could have been told in 10,000 tweets, videos and Instagram pics. But it would have missed the point. The book is an argument for why in-depth journalism is needed and why — journalism, science, and politics — all often require a longer narrative arc to understand the bigger picture. Bigger stories don’t fit into a social media world, even if that very social media is part of the story itself.

The book is a great read whether you’re in Toronto, Ontario; Calgary, Alberta;  Madison, Wisconsin; or Phnom Phen, Cambodia. It’s a story as much about a man and a city as it is about ourselves and the world we live in. Read that way, you’ll find that not only is there more to tell of Rob Ford, there is a much bigger story to tell all around us.

complexityeducation & learningevaluationsystems science

Evaluation, Evidence and Moving Beyond the Tyranny of ‘I Think’

I think, you think

The concrete evidence for ‘I think’

Good evidence provides a foundation for decision-making in programs that is dispassionate, comparable and open to debate and view, yet often it is ignored in favour of opinion. Practice-based evidence allows that expert opinion in, however the way to get it into the discussion is through the very means we use to generate traditional evidence. 

Picture a meeting of educators or health practitioners or social workers discussing a case or an issue about a program. Envision those people presenting evidence for a particular decision based on what they know and can find. If they are operating in a complex, dynamic field the chances are that the evidence will be incomplete, but there might be some. Once these studies and cases are presented, invariably the switch comes when someone says “I think...” and offers their opinion.

Incomplete evidence is not useful and complex systems require a very different use of evidence. As Ray Pawson illustrates in his most recent book, science in the realm of complexity requires a type of sensemaking and deliberations that differ greatly from extrapolating findings from simple or even complicated program data.

Practice-based evidence: The education case

Larry Green, a thought leader in health promotion, has been advocating to the health services community that if we want more evidence based practice we need more practice based evidence (video). Green argues that systems science has much to offer by drawing in connections between the program as a system and the systems that the program operates in. He further argues that we are not truly creating evidence-based programs without adding in the practice-based knowledge to the equation.

Yet, practice-based evidence can quickly devolve into “I think” statements that are opinion based on un-reflective bias, personal prejudice, convenience and lack of information. To illustrate, I need only consider a curriculum decision-making process at universities (and likely many primary and secondary schools too). Having been a part of training programs at different institutions — in-house degree programs and multi-centre networks between universities — I can say I’ve rarely seen evidence come into play in decisions about what to teach, how to teach, what is learned and what the purpose of the programs are, yet always see “I think”.

Part of the reason for this is that there is little useful data for designing programs. In post-secondary education we use remarkably crude metrics to assess student learning and progress. Most often, we use some imperfect time-series data like assignments that are aggregated together to form a grade. If this is undergraduate education, most likely we are using multiple-choice exams because they are easier to distribute and grade and use within the resource constraints. For graduate students, we still use exams, but perhaps we use papers as well. But rarely, do we have any process data to make decisions on.

Yet, we recruit students based on quotas and rarely look to where the intellectual and career ‘markets’ are going to set our programs. Instead, we use opinion. “I think we should be teaching X” or “I think we should teach X this way” with little evidence for why these decisions are made. It is remarkable how learning — whether formal or informal — in organizations is left without a clear sense of what the point is. Asking why we teach something, why people need to learn something, and what they are expected to do with that knowledge is a question that is well beyond a luxury. To get a sense of this absurdity, NYC principal Scott Conti’s talk at TEDX Dumbo is worth a watch. He points to the mis-match between what we seek to teach and what we expect from students in their lives.

Going small to go big

There is, as Green points out, a need for a systems approach to understanding the problem of taking these anecdotes and opinion and making them useful. Many of the issues with education have to do with resources and policy directions made at levels well beyond the classroom, which is why a systems approach to evaluation is important.Evaluation applied across the system using a systems approach that takes into account the structures and complexity in that system can be an enormous asset. But how does this work for teachers or anyone who operates at the front line of their profession?

Evaluation can provide the raw materials for discussion in a program. By systematically collecting data on the way we form decisions, design our programs, and make changes we create a layer of transparency and an opportunity to better integrate practice-based evidence more fully. The term “system” in evaluation or programming often invokes a sense of despair due to a perception of size. Yet, systems happen at multiple scales and a classroom and the teaching within it are systems.

One of the best ways to cultivate practice-based evidence is to design evaluations that take into account the way people learn and make decisions. It requires initially using a design-oriented approach to paying attention to how people operate in the classroom — both as teachers and learners. From there, we can match those activities to the goals of the classroom — the larger goals, the ones that ask “what’s the point of people being here” and also what the metrics for assessment are within the culture of the school. Next, consider ways to collect data on a smaller scale through things like reflective practice journals, recorded videos of teaching, observational notes, and markers of significance such as moments of insight, heightened emotion, or decisions.

By capturing the small decisions it is possible to generate practice-based evidence that goes beyond “I think”. It also allows others in. Rather than ideas being formed exclusively in one’s own head, we can illustrate where people’s knowledge comes from and permit greater learning from those around that person. Too often, the talents and tools of great leaders and teachers are accessible only in formal settings — like lectures or discussions — and not evident to others in the fire of everyday practice.

What are you doing to support evaluation at a small scale and allowing others to access your practice-based knowledge to create that practice-based evidence?

References:

Green, L. W. (2006). Public health asks of systems science: to advance our evidence-based practice, can you help us get more practice-based evidence? American Journal of Public Health, 96(3), 406–9.

Green, L. W. (2008). Making research relevant: if it is an evidence-based practice, where’s the practice-based evidence? Family practice, 25 Suppl 1(suppl_1), i20–4.

Pawson, R. (2013). The science of evaluation: A realist manifesto. London, UK: Sage Publications.

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)

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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public healthsocial mediasystems thinking

The Importance of Journalism to Public Health: 10 Years After SARS How Are We Doing?

Image

Risk communication in public health with Julie Leask

If a health scare manifested itself in the world and there were no journalists to cover the story, what would the impact on the public be?

That is a question that lingered with me throughout the start of the 2013 Ontario Public Health Convention (TOPHC) which began with a morning dedicated to improving public health communication. Opening up the conference was a series of linked keynote presentations from a risk communications researcher (Julie Leask); a former newspaper editor, journalism professor and social media advocate (Wayne MacPhail), and one of Canada’s leading health specialist reporters (Helen Branswell).

The Academic’s Perspective

Keynote speaker Julie Leask (pictured above) and her colleague Dr. Claire Hooker (a good friend of mine) have been looking at the ways journalists engage in risk communication with the public on matters of public health from immunization to SARS to understanding the health priorities of professionals. In 2010 they published a paper looking at how the media covers health topics and argued that the health professions need to be aware of how stories are made, communicated and to be an active partner with reporters if they are to have positive impact in moments of health scares.

“It’s too late when the crisis comes up” – Julie Leask speaking on the need for public health to get engaged with the public using social media

In a previous post I wrote about how journalism is the fourth estate of medicine and public health. Journalists are the storytellers that the public listen to and are charged with looking at a problem from many perspectives to develop that coherent narrative that speaks to their audience. These are qualities that most scientists and public health professionals don’t bring to their jobs, nor are they always expected to or even should. As such, journalists play an important role for this very reason.

Nonetheless, the health sector has an uneasy relationship with journalism. Health professionals – particularly researchers — poorly understand the world of journalists and sometimes view the profession with suspicion. Julie Leask and her colleagues have found this to be the case, but argue that it is no reason to shy away from engaging the public using the tools that are comfortable to journalists. She spoke to the invaluable role of specialist health journalists in acting not only as producers of high quality health content in the news, but also guardians against low quality content making into press. In speaking to her research, she pointed out that specialist health journalists help educate their peers and editors on health issues, which are often complex and require more than a passing understanding of context to communicate well, as key gatekeepers for quality in the health landscape.

The Editor’s Perspective

To this end, Wayne MacPhail, a former editor of the Hamilton Spectator,  argued that public health has a near ethical imperative (my choice of term) to be in the social media space to not only promote good health, but counter and challenge myths and misinformation. This isn’t some naive pronouncement that we’ll eliminate the snake oil sales or quackery that proliferates in the public sphere and media, but rather a simple observation that we have no chance of making impact if we are not even engaged in the space at all.

Like Leask, MacPhail says that it’s too late to engage the public when a health crisis comes up and that public health needs to be in the conversation stream before that happens.

The Reporter’s Perspective

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Reporting through SARS to today: Helen Branswell

Helen Branswell, a reporter from The Canadian Press, rounded out the panel and spoke frankly about the dwindling resources and rapidly changing landscape in journalism. She was on the front lines of reporting the 2003 SARS outbreak and showed a picture taken during that time of an empty newsroom and remarked how that the scene is the same now only for different reasons (limited budgets due to decreased ad revenue and the related shift to digital information on the web being two such reasons, among others).

Branswell paints a bleak picture of the present and future in many areas of health journalism. Stories are increasingly being covered by general reporters who may treat the story the same as they would a traffic incident, political story, or crime; journalists who are unlikely to know the context and details that are critical to communicating the nuances present in health matters. Interns are replacing some full time or veteran reporters in the newsroom and there are only a handful of specialists in practice.

Pressures from time, budget and competing interests in the newsroom are all contributing to an environment where quality health reporting is threatened.

What Next?

I asked the panel what they thought public health should do to ensure that the healthy stories are reported well and there was little answers. Helen Branswell said, truthfully and somewhat cheekily: “buy newspapers”. She reminded us that we should be paying for the quality content and supporting good journalism in practice if we want it to survive, which is hard to argue against.

But that alone will not do all the work needed to preserve good journalism. I spoke to another conference attendee, a formally trained journalist who is now working with a research firm, about the ways in which journalists have helped other organizations craft their messages and engaging the public citing the Calgary Police Service’s social media team as an example. This pointed to ways in which journalists can make a difference in matters of public health and social services.

Yet, what about investigative journalism? What about the potential conflicts that come from being paid to report on issues that might be critical of the organization who does the paying (e.g., Ministries of Health, Departments of Public Health, Universities and colleges etc..)? This model doesn’t solve that, but it is at least another option.

Yet, the examples from public health taking this challenge of working with journalists up are few. Many still believe that social media is another means of broadcasting, which misses the mark. Others still view social media, journalism, engaging with the public through the media, with suspicion on the grounds that much of the work out there is not evidence based.

But what evidence did we have when SARS hit us 10 years ago? We had lots of epidemiological data on infectious disease, but that was only part of the story. Many of the leading health scientists were adapting their models, creating new ones and only after the disease left did we really have a full sense of what happened. We learned as we went.

This is what social media is all about, too. The lessons from major health events — disasters, outbreaks, and pandemics — parallel social media. It is innovation space at its clearest and thus there is an imperative to view it as innovation space with the tools and lenses that best support movement within complex adaptive system. From a communications standpoint, social media and the tools of modern journalism (and the style of communication they employ) are one thing to consider. Developmental design and evaluation are also among these tools combined with systems thinking.

Linear thinking and action will not work in a complex system and as this panel pointed out, there is much reason to be concerned if we are not prepared to communicate and support those that communicate well in such times when — not if — they come back.

Ten years after SARS how better off are we? And if we are better, how are we communicating that to the public?

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The Fourth Estate of Health and Medicine

Who Will Hold Evidence To Account?

Journalists occupy an important, yet often unacknowledged, role in the health system by providing a dispassionate account of the system’s strengths, weaknesses, and opportunities to the public. It is through journalists that much of the research we scientists and practitioners produce gets communicated to the audiences likely to use them. This fourth estate is also a  place where hard questions can be asked and answered, holding governments, business and the health system itself to account because journalists operate apart from this space, unlike scientists and clinicians. We are at risk of losing this and it’s time to consider what that means for our collective health and wellbeing.

Disrupted Media

The news business is going through a massive upheaval, part of a larger overall disruption in media. Many newspapers are reducing the size of their print offerings, publishing less frequently or ceasing operations altogether.

This reduction in the capacity and size of the fourth estate begs two simple questions: Who will hold health scientists, clinicians, pharmaceutical companies, health product manufacturers, and policy makers to account? and who will tell the stories of science, health and medicine in public?

While we have some activist academics doing great work on influencing broader audiences like policy makers, they are exceptions not the norm. Stanton Glantz, a major tobacco control champion from UCSF who taken to blogging as a means of communicating to professionals and the public directly, is one of these such people. But Stan is atypical and holds a tenured position at a major university, something he’s acknowledged protected him when pursuing issues of evidence withholding from the tobacco companies in the 1990’s and beyond. Many faculty (particularly younger ones) are not this secure and even fewer independently funded scientists are. Academia is changing and not in ways that favour security and stability, which has implications for the kind of stories that get told.

Journalists have traditionally relied on protection from their publisher or producer under the name of journalistic freedom (the fourth estate) as a key pillar of their profession. It’s hard to imagine the Watergate scandal coming to light had Bob Woodward, Carl Bernstein and the other reporters working for the Washington Post, Time Magazine and New York Times not had the resources, stability and support provided by their newspapers . But what happens when these resources are no longer available or there are no institutions to support journalists in serving as watchdogs to hold people or institutions to account for what they do and don’t do?

Are ‘Monkeys in Coats’ A Healthy Story?

It’s been suggested that the Internet will take care of this. Citizen journalists, armed with camera-laden handsets connected to social media will fill the news gap. For example, it was citizens, not journalists, who first captured the story of Darwin the monkey, dressed in a shearling coat, walking around an Ikea parking lot in Toronto that went viral on a global scale on December 10, 2012. This is great for those interested in simian fashions and retail adventures, but the reason it was captured was because the story was obvious and in the face (or at the ankles) of those who told it. (For those of you not familiar with Toronto, coat-wearing monkeys are not typically seen at shopping centres or anywhere around town for that matter.)

Health and medicine is not the same as monkeys wearing coats (no matter what kind of joke you want to make). There is nuance, debate and reason that requires sustained attention and focus that someone with an iPhone and Twitter account is less likely to convey. Reasoned arguments for citizen journalism’s potential suggest it can complement the work of traditional journalism, not replace it. Yet, is this belief in one form (citizen journalism) undermining support for the other (traditional journalism) and serving as a fix that ultimately fails? If free-and-easy content is available, how likely are publishers willing to pay for professional work? Particularly if the choice of stories of one group (e.g., monkeys in coats) are more likely to garner the kind of attention that drives advertising than that of another (e.g., health care financing). Only one of these stories will impact our collective health.

Why does this matter? Trained journalists are required to be good communicators to a broad audience, scientists are not. Clinicians are slightly better, but decades of research has shown it is still highly problematic across areas of practice. This will not be solved overnight, if at all. Scientists and clinicians have told me they are already burdened with enough job expectations and adding knowledge translation skills to that list is asking too much.

As I have argued previously, there is a valued place for synthetics in research: those are who are good at taking ideas and weaving them together into an accessible narrative. Journalists are ideally suited to play or support this role. They do the job that many scientists can’t or won’t do and have better to tools, skills and strategies to do it. They write in a style that is suited to broad audiences in a way that suit those audiences’ needs, not what funders, disciplinary traditions, universities, or scientific peers demand (without evidence that those methods of communication are effective). There are reasons why journalists assess the reach of their work in the thousands and social scientists in the dozens (by citations in their field of practice).

Going Deeper to See Clearer

Although we have more information about health available to us than ever before, this may not be healthy for patients. The potential for those uninformed about medical diagnostics, evidence, and the nature of health itself to make poor choices based on incomplete, incorrect or overwhelming information is high. Further, without the kind of dispassionate examination of evidence in a synthetic manner that is tied to the way in which that evidence is expressed in the world through public opinion, policy making and healthcare practices, we lose a major accountability mechanism and means of informing public discourse.

In October I co-delivered a workshop on health evidence for students at the University of Toronto with the 2012 Hancock Lecturer and journalist Julia Belluz. Julia writes the Science-ish blog for Macleans Magazine and is an Associate Editor with the Medical Post. Julia`s lecture was on the role that social media plays in our health system and how its power to leverage the attention of the masses — for good and ill — is shaping the public understanding of health and medicine often in the absence of evidence for effects of conditions, processes, and practice. The lecture is summarized online on Science-ish beginning here.

Reading through the lecture notes one sees a depth of study that would be unlikely to be found anywhere within the formal health system. The reasons are that it blends evidence with commentary, observation with carefully selected sources, and takes a perspective that seeks to inform a wide, not narrow audience in both practical and intellectually stimulating ways. Taken together, this is a collection of activities that are not within the scope of practice for scientists and practitioners. There are reasons why the greatest contributors to public discourse on many scientific issues has come from journalists, not the scientists who generate the research. They tell the story better.

Malcolm Gladwell, Steven Johnson, Mitch Waldrop, Julia Belluz, Andre Picard and others are a big part of the reasons most of the those who vote to support funding of science, who donate to research-related causes, and fight for policies to keep us healthy know of the research that backs those ideas up.

Imperfect as journalism is, it serves the public when done with integrity. It’s worth spending some time considering what can be done to support the fourth estate so it supports us.

Photo credit: DBduo Photography on Flickr used under Creative Commons Licence.