Design and Health Promotion

Seeing outside the hospital

If everything humans create is designed then bringing design into the conversation about human health is imperative. It is a wonder that the world of health and that of design seem so far apart.

Seth Godin, the plain spoken entrepreneur and source of much personal inspiration, released a new book this week. It’s a non-traditional format being offered through Amazon and designed more for small-bursts of reading, linking and digital consumption than a traditional book. In Poke the Box and the accompanying (free) workbook, Godin demonstrates as he has many times before the power of generosity and knowing your audience — building relationships with them – as a key to success in turbulent times.

I mention him because his key message is that the world is changing fast and we have to adapt, change our business models, take risks, and do things different (and consciously) lest we have change thrust upon us. Seth’s message is: design your future or have it done for you.

Our health systems are in this state right now. I use systems in plural because the most common thing that people think of when I say that I work on issues of health is the health care system. I work in health promotion — that branch of public health that seeks to keep people healthy, prevent illness, and design ways to help everyone achieve their best. I use design here consciously, because much of what health promotion does is seek to shape the conditions in which health is created, maintained or compromised – even if that word isn’t used explicitly. Many of these are what are called the social determinants of health. These include one’s level of education, race, relative income, employment opportunities, and access to health care, among others.

Yet, design is a foreign concept in public health. To many of my colleagues, design is something related to product development or something to that extent. Even as public health begins to embrace art as a means of engaging people, design and design thinking remain somewhat unknown. This is in spite of the fact that much of what public health does is design-oriented; it is the conscious shaping of settings, conditions and human activity to promote health and protect people from harm.

I’ve often said that my course on health behaviour change is about training public health professionals on ways to overcome bad (unhealthy) design in our communities, policies, and programs.

What I have been seeking to do is introduce the concept of design to a wider audience within the health professions and have been pleased with the early uptake. Speaking with colleagues in a variety of public health areas, there seems to be a growing discontent with the way things are being done and how our programs and policies are being created. The idea of engaging the public is something not unfamiliar to public health, yet it is something done out of a sense of values and respect, and less about purposive design. What health promotion adds is its explicit statement of values, while design adds value through its conscious application of strategic planning to the creative process.

There is a growing movement of design for health, including: conferences devoted exclusively to this idea, the engagement of major design firms in the development of health care institutions, and international health programs focused on better design. While exciting, these initiatives focus on either health care or product support for health promotion and very little on the social development of healthful conditions.

While designers have taken to contribute to social determinants like education, there has been much less attention paid to the ways in which people learn, the sources of that knowledge, who accesses education in the first place, and the literacies required to fully benefit from modern information production landscapes. This is the domain of health promotion. It is also where we can make the most impact.

Consider something like tobacco use, where more than 500 million people alive today are expected to die from it. From the cigarettes themselves to the ways in which they are used, sold, regulated and marketed are all designed solutions.

We are on the cusp of major food price increases and potential shortages on a global scale.  How we address these problems in ways that don’t exacerbate the gap between the rich and poor or create further unintended consequences is important. Without consideration of the ways we design our markets, our policies and the opportunities for people to engage in the decision making process, the creation of the solutions, and the discussion about what not just how such interventions can instill health we are losing an opportunity to get the best of design into health.

At the same time, we need design to go beyond simple end-user participation into true engagement with the public on a level that goes beyond strategy and tactics and more towards values.

Complex problems like chronic disease, health inequity, access to health care, civic engagement, global migration, and food security are ones that require a diverse set of perspectives, abductive (design) thinking, systems perspectives and ways to bring them all together. Design is a way to do that. Health promotion, rather than health care is the focus that will get us from treating problems to developing solutions.

** Photo – Health Sciences – by D’Arcy Norman (no relation) used under Creative Commons License via Flickr

Amazing Stuff: November 14th Edition

It’s been another busy week filled with lots of ideas, but little time to post them. Expect a lot more on the blog in the coming weeks however as there is too much going on not to discuss.

Thankfully, the rest of the world was still Tweeting, blogging, You-tubing and sharing all kinds of amazing things with us and here are the top ones that captured my attention this week:

1. I love food from all kinds of sources and certainly those that come from animals are the ones I spend the most time thinking about. A new book by Jonathan Safran Foer looks at the ethics and industry of eating animals. I haven’t read the book, but a detailed and insightful review in the New Yorker suggests that I might be thinking a lot more about this in the days and weeks to come based on the arguments that Foer puts forth. Natalie Portman is one who also has thought differently because of this book — this time about vegetarianism and veganism — and she writes her review in the Huffington Post. Read any of the reviews and you’ll know that this is a book making buzz and adding to our already considerable array of options when considering the merits of what we choose to eat. Tofu anyone?

2. Keeping with the contrarian perspectives: have you thought about how healthcare might actually be unhealthy for the planet? This week Ariel Schwartz posted an interesting article in Mother Jones (and replicated in Fast Company ) questioning the carbon footprint of the healthcare industry and whether we ought to be working harder to consider how green our care facilities are. Could a sick planet be coming from healthy humans?

3. While we’re on health care, The New York Times published a story about text messaging for teens as a possible way to engage young people more in health care using mobile phones. Seems like a no-brainer to me, but will it fly in the face of most healthcare organizations, which are a little slow to adopt technologies like this into practice?

4. The international social innovation leadership group, Ashoka, announced the winners of this year’s sustainable food (GMO: risk or rescue?) contest. The blog biofortified was the grand winner. There are some novel ideas and certainly opportunities to expand the dialogue on food safety and security in some new ways through this initiative. GMO good or bad? The answer seems to be: yes.

5. Lastly, Mobifest is coming to Toronto and I was captivated by some of the novel and creative films on display as the finalists in this year’s competition. Mobile filmmaking is getting bigger, better and more creative all the time and I’d encourage anyone interested in looking at one of the futures of film to check this mini and mobile film fest out.

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?

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