Tag: health promotion

art & designdesign thinking

Building Empathy and Other Odd Concepts

Do we really have to ask?

Design uses a language that at once seems inviting and human-centred while at the same time rather alien when considered in the realm of practice.

One of the great ironies of working in a field that is about human wellbeing and survival — public health — is how dehumanized the language we used is. Medicine is worse. It seems that the closer we get to those areas of human existence that deal with our vulnerability and potential the further our language gets from reflecting our humanity. That is one of the things I find about design that is so refreshing.

Designers use a language that speaks to the human condition much more than health sciences does, with terms like participation, empathy, listening, storytelling and understanding figuring prominently in many design texts.

While this design language refreshing, there is a part of the health sciences culture (particularly that of health promotion) that is appropriate to bring to bear to this issue and that is critical, reflexive, practice. It is here that I find a disconnect between the language used in design and the meaning of the words in a real sense.

Take empathy for example. The Oxford English Dictionary refers defines empathy as:

empathy |ˈempəθē| noun . the ability to understand and share the feelings of another.

Design giant IDEO refers to the concept of building empathy heavily in their work and has figured the concept prominently in its new plans for a non-profit start-up. A look throughout the literature on design and you’ll find this concept peak through the text and presentations and noted as something that defines good design practice.

Looking at the above definition of the word it is worth asking: can we really build empathy? What does building something imply? And who is the builder in this model?

Perhaps the definition here is problematic. Taking a look at Wikipedia, one finds a slightly more expanded definition:

Empathy is the capacity to recognize and, to some extent, share feelings (such as sadness or happiness) that are being experienced by another semi-sentient being. Someone may need to have a certain amount of empathy before they are able to feel compassion.

It’s interesting that design rarely uses the concept of compassion, just empathy; just building empathy. Or as the above image suggests, create empathy.

Why does all this matter?

The use of the term is important if we seek to understand the underlying motivation for design and the values that guide it. Building something implies a builder. A builder implies active construction of something, yet the definitions above refer to ability, something that might not be so amenable to building per se. It also is suggestive of a level of control and manipulation to create something from nothing. When building empathy, how that being constructed and for what purpose and who is asking the question and who is having their empathy built? These are concepts that are not always problematized or questions asked, but probably ought to be.

What can be built or designed are situations that allow people to tap into their empathic skills and apply them. Drawing from research in cognitive psychology, opportunities to apprentice and learn with others and copying others may be the way to engender empathic responses. It is certainly the case with infants (PDF):

Imitative experience with other people serves as a “discovery mechanism” for social cognition, engendering interpersonal understanding that outstrips the innate givens and leads to empathy, perspective-taking, and theory of mind.  (Meltzoff, 2002)

This imitative experience comes through engagement with material, not participation. Participation is another odd concept in design, health promotion, and community development that seems to be easy to use, but harder to define, and problematic in how it gets used. What does it mean to participate in something? Is it, as Woody Allen suggests, just showing up? Or is it true engagement with the material and others in a manner that creates these discovery mechanisms as Meltzoff refers to?

What this line of thinking gets us to is the crux of what makes design and health promotion different, but necessary complements for working in health. Without the critical questioning of the terms and the application of values in a particular way, you can get a Wizard of Oz like problem: one has all heart, but no brain, while the other has a brain without a heart, and courage is needed to bring the two together with the optimism that it can be done.

Empathy and compassion involve using your heart. Critical inquiry about empathy means using your brain to see the concept more clearly in terms of its purpose. Having the courage to put these into practice in a professional realm and the optimistic hope that we can do this to make things better for everyone is not just a fantasy, but a possibility. It is at the crux of social innovation, but also at the core of good, responsible, integral and authentic practice. Say what we mean, mean what we say.

In doing so, we can make these real, important concepts more meaningful in a real sense, not in some marketing, feel-good speak that we have now. By being much more authentic, we’ll also help build the credibility of these methods and ideas beyond design and beyond health.

Are we using our heart, brain, courage and optimism well?

** Photo by Bjornmeansbear used under Creative Commons license from Flickr

*** Photo by twm1340 used under Creative Commons license from Flickr.

design thinkinghealth promotionpublic healthsocial systems

Design for Sex, Gender and Health (Celebrating International Women’s Day)

Woman, (1965) Oil on wood by Willem de Kooning, American, born Rotterdam, The Netherlands, 1904 - 1997.

Today marks the 100th anniversary of International Women’s Day prompting some reflection on how we design for sex and gender in a world that often fails to consider either seriously enough.

Sex is important and it deserves attention in designing for health. Today the global community recognizes one half of the world’s population, their challenges, struggles and successes and I can think of fewer causes more worthy of such attention. Although sex is biological and brings its own issues with health, gender has social overlays incorporating role and identity that create more complex determinants of health, that require attention when designing programs and policies.

This attention to sex, gender and health requires problematizing the issue in the first place and recognizing that one-size-fits all approaches to social planning and policy do little to address the complexity of how these social determinants manifest themselves and interrelate. Gender is one determinant that is highly knotted up with other health issues such as economic security and employment (PDF), safety, and education. It’s complexity and pervasiveness demand that we consider this as something worthy of attention in our design and health promotion work if we wish to create a more equitable, healthy society.

Designing for health requires that we pay attention to these issues and consider them deeply in all of our work. Sex issues manifest themselves in ways that are unacknowledged, unconscious, or may be at odds with our intentions for promoting better health. It is rare that I’ve seen designers speak of sex and gender in discussing their work. And while health promoters bring sex and gender issues into prominence in their work, yet do not explicitly refer to design principles in such discussion, missing an opportunity to more intentionally shape their actions.

Design is taking some steps to make this a bigger priority. Yesterday’s announcement that global design leader IDEO was creating a non-profit arm that would focus on developmental issues, many of which are related to women’s needs, is a place to put hope for design. Health promotion’s foray into design issues has been on the built environment and on promoting equitable policies for access to health care, which is itself a start.

Bringing both of these fields closer together has the potential to do women and everyone better by considering the locations — social and physical — in which sex influences health and wellbeing and consciously designing situations that improve it. Doing so also means acknowledging where both design and health promotion knowledge come from, ensuring gender equity not only in society, but specifically within the fields of health promotion and design. Can you think of many “rock star” designers that are women? Those numbers are few. And while women are well-represented in the field of health promotion, the key texts and theories largely are male-authored. How this translates into equitable policies and practices for both genders is unclear, but the absence of discussion of these issues in much of the design and health discourse is less so.

While ensuring better design for health equity and promotion it is important to also add health equity and promotion to design through an empowered woman-friendly environment for learning and practice in these two areas.

So as you celebrate this International Women’s Day, consider ways to make sex and gender more conscious in your work and how we might design for both at a foundational level and not just as a means of ameliorating problems that manifest from poor design.

** Picture of Woman, (1965) Oil on wood by Willem de Kooning, American, born Rotterdam, The Netherlands, 1904 – 1997. by Clif1066 used under Creative Commons License from Flickr

complexitydesign thinkingeHealthhealth promotionpublic health

Complexity, Interaction Design and Social Media

Social Media Targeting for Head & Heart

Social media, like all human activities, involves designed interactions in a complex environment. How we design for this space is as much about the social — and the complexity that results from it — as it is the media.

Yesterday I participated in a webinar on social media strategy hosted by the Program Training and Consultation Centre’s Media Network. The focus was on how public health professionals can use social media to engage their populations of interest to advance health promotion. Examples of how social media is being used were presented from ParticipACTION, the U.S. Centers for Disease Control and my own research group’s Youth4Health initiative to show how these tools could enhance health communications.

What might have caught some of attendees by surprise was the introduction of complexity science concepts and design thinking into the discussion. These terms are not often used in public health, but as I’ve argued many times in this space, they ought to play a much larger role.

The other potential surprise for some might have been the emphasis on relationships, connection and the kind of things that Brian Solis showcases (see infographic above). Solis describes social media as:

Social media is a deeply personal ecosystem that I lovingly refer to as the EGOsystem. As such, there is a “me” in social media for a reason. It is quite literally a world in which we are at the center of our online experiences, a place where everything and everyone revolves around us. – Brian Solis

When a person is at the centre of an experience that is human formed and technology mediated, design is very important. How one engages with others and the opportunities afforded within that environment or EGOsystem is largely a product of design. For example, Facebook provides a great deal of opportunity to bring in your close “friends” into a conversation, but is relatively poor at bringing in strangers. In contrast, Twitter is about bringing anyone into the conversation, particularly strangers. As I like to put it:

Twitter enables you to learn answers to questions you never thought to ask, have conversations you could have never planned, and meet people you never knew existed

In both of these contexts, the manner in which one designs for interactions has a profound influence on what kind of conversations take place. To use Solis’ model above, attention to interaction design qualities of the technological and social space helps amplify the white arrows, dampen the effect of the blue arrows, with an aim of enhancing the power of the red arrow (belevolence).

This attention to these kind of patterns is at the heart (no pun intended) of complexity oriented planning and why social media, design and complexity require mutual consideration in developing strategy. When in complex spaces, the tempo, rhythm, and pattern of information exchange shifts constantly, just like in a regular conversation. So approaching the program from the perspective of a traditional, more linear-focused mindset will inevitably lead to a misalignment between program activities and the outcomes produced.

If you’re expecting to get a firm outcome from a social media strategy, you might be disappointed. If you are looking for surprises, consider more flexible outcomes, then social media may deliver the goods — but only if you design your strategy to suit the complexity of the context. A complex setting is one where there are multiple agents interacting and producing emergent new properties through such interaction. It it therefore fitting that the concept of interaction design be considered in examining how we engage in these environments.

Much of the discourse on social media from marketing and communication leaders hints at these concepts, but doesn’t name them. By explicitly making complexity, design and the social part of social media a focus we can more intentionally create better experiences that will engage our audiences, and in the case of public health, promote health.

art & designcomplexitydesign thinkinghealth promotion

Design + Love = Change

Design love, produce change

Sigmund Freud believed examination of life was useful for making people better at work and love. Designers are brought it to support the former, but have opportunities to contribute to the latter in ways that might be better for society than anything cupid has to offer.

It’s Valentine’s Day here in North America. Although the days’ modern expression is clearly commercial, the thought of having a day that is devoted to love is quite appropriate for those interested in design, social change and health.

Love is an uneasy bedfellow (to mix metaphors) with much of what we do in business, design, and health promotion. But not all designers or change agents avoid speaking of a term that may be the most profound expression of the compassion, attention and care that creates products, services and policies that produce healthier, happier societies. As designers, health promoters and change agents, there may be no greater goal than to produce love and no more powerful vehicle for this change than love itself.

Love and power are two of the great forces that underpin social change

Adam Kahane, an organizer and designer who has worked on creating social change on a grand scale, has written and spoken widely about this tension, arguing that we need to design conditions to promote love in partnership with a deep seated understanding of how power is manifest in the change relationship. Kahane uses the tools of design and systems thinking to get communities to visualize possible futures. By walking through various ways in which love and power can be wielded and cultivated, he helps groups struggling to promote change to be more attentive and aware of the role of love in encouraging healthful application of power. Creating scenarios in people’s heads shows how the affairs of the heart can influence design outcomes.

Fast company wrote back in 1998:

Kahane sees scenario planning as an instrument of social change. “I believe that we have a much greater capacity to shape the future than we allow ourselves to think,” he says.

Of the various labels Kahane has, one that he has embraced is that of designer. He uses love and its relationship to power as means of creating dialogue about possible futures on complex topics. This embrace of love also means acknowledging complexity, which just like love, is dynamic, multi-faceted and unpredictable. Power is the means to leverage love into social change.

Milton Glaser has described design as the introduction of intention into the stream of life to produce a specific change. or more broadly:

Design is the introduction of intention into human affairs

Intention is about awareness, focused attention and projection of consciousness to motivate action. In many ways, it is the application of love. Designers who work with the intention to produce healthy outcomes, may be using more than just creativity and social engagement as their tools, they may be employing their heart.

Arthur Zajonc has explored the role of intention and mindfulness as a means of designing greater learning environments and creating cultures of contemplative inquiry. His recent book on the subject, focuses on those points where knowing something — yourself, others, a subject matter — intimately through compassionate reflection produces love. This is the cultivation of intention and the purposeful expression of it to human affairs. Mindfulness and design go hand in hand.

If design is about introducing, provoking and facilitating change, and if such change must be guided by intention, then efforts aimed at social change for health most likely require attention to love. So consider the work that you do to make your community a better place the best Valentine of them all.

** Photo Love by Aunt Owee, used under Creative Commons License from Flickr.

art & designdesign thinkinghealth promotioninnovation

Design and Social Justice


Design employs the language of problem solving and features a great deal of tools that encourage participation in solution generation, yet what problems get solved and what solutions are generated for whom are, too often, left untouched.

Yesterday I had a long conversation with a fellow health promotion designer  that covered much ground, including the importance of making social justice as a focus for our work explicit. That is what makes us health promoters different when it comes to approaching problems of design. Hours later, the tweet shown above appeared in my Twitter stream illustrating similar concern, but from a design students’ perspective.

A colleague of mine recently used the metaphor of teaching someone to swim from a book to illustrate the problems associated with addressing complex topics using theory alone. Indeed, even if Michael Phelps sat down and outlined every single thought, feeling and physical movement associated with swimming and put it to page, it would be of little use to someone who has never, ever been in the water and swam. However, if a person was a swimmer, some of the lessons on this hypothetical Book of Swimming could be useful. In other words, one needs to act in order to make sense of theory.

That is the key distinction. Social scientists refer to the concept of praxis, the fusing of theory and experienced action, as a way of addressing this gap between the idea of something and its realization.

So, I tried to do a kind of semantic clarification in which praxis—if not on the thither side of this divide—was perhaps somehow between the theoretical and the practical as they are generally understood, and particularly as they are understood in modern philosophy. Praxis as the manner in which we are engaged in the world and with others has its own insight or understanding prior to any explicit formulation of that understanding…Of course, it must be understood that praxis, as I understand it, is always entwined with communication. —Calvin O. Schrag. [1]

Design thinking and its potential applications to support social justice is readily apparent to someone with an imagination. The use of combined logical, emotional and abductive reasoning, participatory forms of knowledge generation, the attention to context, and the prototyping of ideas to ensure that what is communicated is heard are all highly consistent with an agenda more familiar to those who work in social justice initiatives and health promotion. Yet is social justice a part of the praxis of design? The above tweet suggests that some designers are questioning that.

The question I have is that has the social justice language been infused with action, or are designers simply talking and not doing?

Observing much of the work by prominent design firms such as IDEO and Bruce Mau Design would suggest that design and social justice are a good fit and that it is being practiced vigorously. Perhaps. But a closer look at a lot of the initiatives that focus on addressing social problems reveals a dearth of questioning about the systems in which these situations are produced. A recent example is the work of IDEO and their collaboration with the Acumen Fund looking at issues of water quality and safety in India.

“There is no silver bullet to the world water crisis. Addressing the crisis certainly is not simply a matter of better product design — we will need a range of options that accommodate for the myriad varying climatic, hydrological, terrestrial, and cultural dimensions of the problem,” noted Jonathan Greenblatt of Worldchanging.org. “New players like IDEO can offer highly useful lessons from the field of design that, when adapted to the water sector, could yield interesting results.” – From IDEO.

And indeed they have. In a webinar yesterday from Stanford’s Social Innovation Review, IDEO’s lead in that area, Joceleyn Watt, used this project as an example of ways to apply design thinking to social problems and how this approach led to a deeper understanding of why women in India were often not choosing water from a treatment plant over water from a polluted well. The answer had much to do with the design of the size of container of water that the treatment plant required the women to use (it was too big), the cumbersome hours the plant was open, and pricing models that required women to buy much more water than they needed each month.

From a designer’s perspective, this problem was addressed quite well. But from a perspective of social justice, it could be argued that much less was achieved. Did the process call into question why the treatment plant opted to use 5 gallon jugs (too big for women to carry) in the first place? Did it probe into the rationale for pricing models that clearly encouraged waste in a system that can ill-afford it? Were the power dynamics that were established when the treatment facility was created looked at in how it affected those people most likely to benefit from it? Although women provided insight into the problem, were they given opportunities to develop skills that would encourage them to address future problems without a designer on hand?

When IDEO and Acumen leave, the community may find itself facing new problems of the same nature, yet without the designers around, those problems may go unsolved.

The answer to some or all of these questions may be yes, but if so, it wasn’t apparent. My review of the design briefs and project reports of most social design projects suggest that “no” is the more likely response.

There is an opportunity for designers to make a bigger impact beyond the product. It follows what Jane Winhall writes on Core 77’s blog more than 5 years ago:

Designers must find new ways of working that enable them to apply their skills where they are most needed – to tackle problems such as chronic health care, climate change and an ageing population.

I would argue that this new way of working should consider a praxis focused on social justice as a vehicle for sustainability.

behaviour changehealth promotionknowledge translationpublic health

Health Communication in the Age of Pamphlets

Although social media is all around us, there is a tendency to forget that it is still new and, in the case of public health, very new. What would / did our health communications system look like if it was designed for pamphlets instead of apps, door-to-door visits instead of Facebook, and libraries instead of websites?

I was at a meeting today and caught the phrase “health communication in the age of pamphlets” as a frank, but concerning assessment of how much we rely on models of communication that emphasize written text, paper-based materials, professionals handing them out or information racks as the distribution channel, and authority and fear as the driver.

If we designed our communications systems for pamphlets, we might have a system that looks like this:

1. Public health officials (mostly physicians) would tell the public what was good for them, how to act in case of emergencies, and they would be doing it with confidence.

2. That confidence would come from experience and some evidence and both of those would have largely complete information, or at least good enough information.

3. Messages would be crafted using mostly text in language (almost exclusively English, except maybe French in some cases here in Canada) that was authoritative and technical.

4. Information could be easily found in doctors offices and some public libraries (you wouldn’t want to put too much information in the library because there are no health professionals there).

5. The conditions that caused illness were straightforward, could be diagnosed and treated and that the reasons people got sick in the first place was that they were largely not taking care of themselves.

It seems to me that this system isn’t that different than what we have now.

The only difference is that people have options and that is what they are seeking. They are also seeking relationships,
…are recognizing that illness is caused by social as well as other determinants,
…that their peers and lay helpers have a lot to offer,
…that professionals’ knowledge is limited, but that they are still very important for specific things,
…that they would rather be in partnership with health professionals than not
…there are limits to what we know and that being an informed consumer is an important skill in the world these days
… that there are as many questions as answers.

Information technology, networks, and a newfound sense of empowerment is changing a lot and maybe soon it will change public health communications.