Tag: health promotion

behaviour changecomplexityeducation & learningenvironmenthealth promotion

Complexity and the Information Landscape

 

This morning the newswires are buzzing with a story that alleges Britain’s Climatic Research Unit fudged some of its climate change data and suggesting that a ‘bunker mentality’ took hold in the unit, which led to this kind of skewing of the data and science. One scientist told Doug Saunders from the Globe and Mail that “It wouldn’t be an exaggeration to say that this has set the climate-change debate back 20 years.” Indeed, with the Copenhagen Climate Summit about to start, there is real concern that these allegations – whether proven true or not — will impair the delegates’ ability to reach a deal.

On a different, yet related note, yesterday I went and got my H1N1 shot and was told by the official guiding people through the clinic that about 37 percent of the population of Toronto have had the vaccination. I went to the downtown clinic and waited about 2 minutes to see someone, which is in stark contrast to what we saw a few weeks ago.Why? The threat of H1N1 seems much less in the here and now than it did a few weeks ago when, in the span of one weekend, when U.S. President Obama declared swine flu a national emergency, and two young people in Ottawa died from H1N1. Towards the end of October, H1N1 seemed a lot more scary and that made the issue a lot simpler: get protected or die (or so it seemed)

So what do these two stories have in common? Both illustrate the problem of complexity in the information landscape. H.L. Mencken is quoted as saying: “For every complex problem there is an answer that is clear, simple, and wrong“.

The problem that public health and scientific research faces is that it is in the business of complexity, yet the business of the media is too often in simplicity.  This caused that. That person is bad, this person is a hero and so on. The archetypes and stereotypes come in spades and that is the problem. On the issue of climate change, most scientists worth their salt looking at the data are concerned about what is happening to our climate, not because they know for sure, but because they don’t. In a complex system like the environment, the overlaying causes, consequences and potential confounders of data make it impossible to say for sure that something causes something else in a specific dose. What can be done is that we can observe large scale patterns of behaviour and anticipate changes based on models developed using past, current and possible future (estimated) data and scenario planning.

In public discourse however, this makes for a less compelling story. Many like to think that buying a hybrid car, recycling, and carrying a reusable shopping bag will help solve the problem of climate change, when the truth is an entire system of small changes needs to take place if we really want to make a difference. This speaks to a fundamental lack of understanding of complexity.

With the H1N1 example, complexity is less about the cause and effect relationship of the disease and host and more about the vaccine developed to help prevent it. There are an entire littany of websites, pundits and voices who have turned something that is complicated like a vaccine, with potential complex outcomes in rare events such as allergic reactions, into overly complex issues around patient safety, conspiracy theories and the like. I commented on some of these issues in a previous post. At issue here is a fundamental lack of understanding of statistics and probability.

The problem is that the two are related. For those of us in public health, this is an issue that can lead to sleepless nights. How to both make complex information accessible and interpretable to those without the interest, time or ability to sift through it and make reasoned, informed decisions AND how to enhance people’s understanding of probability? Just yesterday in my course on health behaviour change a student in epidemiology remarked that even something as fundamental as an odds ratio to her field gets debated and misunderstood among her peers. John Sterman at MIT has studied his students — ones that learn about system dynamics — and found that many of them have difficulty grasping the fundamentals of the ‘bathtub problem’ and accumulation, which I discussed in a previous post.

I would argue that this is one of our most fundamental challenges as educators, scientists and members of society.

Think you know about stats and complexity? You might be surprised (and entertained) by how randomness creeps into our lives by listening to the recent podcast on recent episode on stochasticity, or randomness, from WNYC’s Radio Lab.

education & learningeHealthsocial media

Amazing Stuff: The Film and Video Edition

 

Last week my class on Health Behaviour Change was on the topic of eHealth. So to make the point about how information technologies can play a role in supporting change I decided to create a series of YouTube-sized bits of content for my students rather than give a lecture. The ‘lecture’ became a series of short videos starring some of my teammates at the Youth Voices Research Group and brilliantly shot and edited (with next to no time) by our uber-talented  resident health promotion videographer, Andrea Yip. This experience, plus exposure to a number of serendipitous videos over the past week had me thinking that a special film and video edition of Amazing Stuff was warranted. So to welcome the month of December, the darkest month of the year for us here in the North, I thought I’d share some sites to visit when you’re huddled inside looking for knowledge, inspiration or amusement:

1. TED. This is fast becoming THE site to waste time on and learn about amazing things from. Originally started as a meeting of artistic and creative types in Monterrey California in 1984, this annual meeting (now spawned into many international meetings) features some of the leading thinkers in such diverse areas as design, science, the arts, politics and public life. You’ll come for one talk and stay for a dozen. This is must-see Web TV.

2. Fora.tv. This newish web channel is another feed for the soul of those interested in science, the economy, technology and other issues that are particularly nerd friendly to us academics. There are some high-quality videos here and some insightful lectures.

3. Current.com is Al Gore’s digital cable channel. There are some interesting things on it, but nothing and I mean nothing beats Infomania; my favourite show on TV, or the Web, or both . Sadly, Infomania is taking a break this week, but the witty satire of the entertainment biz will return in early December.

4. The National Film Board of Canada is one of this country’s gems. It is a treasure-trove of high-quality material and insightful documentaries on a wide range of topics. Perhaps the one that has my interest most piqued is the Filmmaker in Residence program that Kat Cizek has held for the past few years. Kat and her colleagues have done some amazing work at highlighting the perils of homelessness, inner-city health, and the plight of new mothers living in poverty. This is really health promotion video at work and something that I’d like to see a lot more of.

5. And lastly, I came across Publicvoice.tv this past week as I attended the Ivey Centre for Health Innovation and Leadership’s first annual Global Health Innovation conference in Toronto. Publicvoice has a great set of speakers and interviews with people out to change the world and influence Canadian and international public policy. The entire conference and interviews with the key leaders are available at Publicvoice.tv or will be available at the conference’s ongoing Ning community of practice site.

Now if anyone can help me find the time to watch all of this…

complexityeducation & learninghealth promotionpublic healthsocial systems

Our Unhealthy Hero Complex

I was walking through a hospital on the other day on my way to a presentation and a number of things crossed my mind. One of them is the concept of the hero. Specifically, there was a fundraising campaign that was being promoted in the hospital about recognizing the heros in your life.

In this case, health care workers were described as heros. I think that when we start down that road — from military personnel, firefighters, police officers, and health care workers — we further distance ourselves from the bigger mission these brave, hard-working people actually serve. Soldiers — professional ones anyway — are primarily serving to protect their country with the ultimate aim of peace. Police are similiar; “to serve and protect” is their motto. These are hard jobs and ones that often require a level of risk and committment that goes beyond normal. But defining them as heros can suggest something otherworldly that doesn’t fit — and I would argue sometimes hurts rather than helps.

Take for example the Toronto General Hospital’s ‘Honor Your Hero’ campaign to encourage patients and families to donate to the hospital to recognize (presumably) the heroic efforts of the health care teams in providing them care. The idea of supporting health care and hospitals (which most people in Canada don’t realize are still charities, not government entities despite receiving funding from these bodies) is a good one. The health care teams that work in these centres are made up of well-trained, generally well-paid professionals who are focused and committed to doing the best they can to improve the health of those who walk or are wheeled through the doors. In other words, they are doing their job and when they do it well, individuals lead healthier lives.

Contrast that with teachers, day care staff, or even social workers. They, too are doing jobs that require long hours, dedication, training and the ability to handle a lot of complexity at once. How often are they called heroes? Is their mission any less valuable to our overall health and wellbeing? When this group does its job, our society is healthier.

This is not meant to be a “who is more important” debate. It is also not an ‘either/or’ debate. From a systems perspective, both are vitally important groups to our society. Nor am I suggesting that healthcare workers should be paid less or that either group is any more worthy of the title of ‘hero’. What I am suggesting is that our frame of one as a hero and the other as not does us all a disservice (including those that have to wear that heavy label). It places inordinately heavy emphasis on one part of the system, rather than looking at the bigger picture of health in a social context.

In this month’s Walrus magazine, this point was given a further hue by Roger Martin, Dean of the University of Toronto’s Rotman School of Business. In this short, but very focused piece, he points to the cost of hero worship (my words, not his) and how we’ve protected health care at all costs while allowing education to spiral down to a point where it will be hard to recover. Looking at the implications surrounding the deficit cutting in the 1990’s by Canadian federal and provincial governments led by Chretien/Martin, Klein, & Harris and most others and how in the effort to protect health care they let education dwindle. A ‘teaser’ of the article is available here. Martin makes the case that our desire to protect health care at the expense of education may backfire and I agree.

If you look at what makes a society healthy or not, health care is only one of a number of contributing factors. Education is one of the biggest. So is a healthy economy, which is linked to productivity, which is spurred by education. Oh yes, and those who provide the services in health care can only do so if they’re well educated.

When we are most vulnerable and our physical or mental health and wellbeing is most compromised we want a trusted, competent health care professional to turn to. But if we want to reduce the severity, onset and extention of these problems and have a population who might best be able to help us in the community and prevent problems from occurring, we need education.

Perhaps it is time to look at this from a systems perspective and take the truly heroic steps of making all of our social determinants of public health professionals, not just those that fit a certain roles, the focus of our support.


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Public eHealth & Collaboration Networks Talk

I will be giving a public lecture at the Dalla Lana School of Public Health on “Public eHealth & Collaboration Networks: A Systems Science Approach to Population Engagement for Health Promotion“. The talk will be held Thursday October 22, 2009 at 11am in Room 610, Health Sciences Building (155 College Street, Toronto). Everyone is welcome.

behaviour changeeducation & learningeHealthhealth promotionpublic health

eHealth Deja Vu All Over Again

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

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

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

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

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

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

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

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

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

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

health promotionpsychologysystems thinking

Specialized and Generalized Systems Thinking and Action

This weekend my wife and I had the pleasure to host one of my best friends in the world and his fiancee for a weekend visit to Toronto. It’s perhaps no surprise that we spent a lot of time talking and laughing over a meal. Last night we talked about the impact of our work and the focus we’ve chosen to take and it got me thinking about the challenge of finding balance between specialization and generalization in health promotion work relative to impact. My wife is a social worker who specializes in domestic violence issues. Although she is a trained psychoanalyst, she came to find her greatest opportunity to contribute to the world lay in tackling problems from a systems perspective. She builds multi-sector partnerships, collaborations and works to address the problem of domestic violence at its root and its consequences from multiple perspectives including treatment & prevention and policy & practice. It is a systems approach from the beginning to the end.

Readers of this blog will know that this is a similar approach I take to the problems that interest me like food systems change, tobacco control and gambling. These are often ‘wicked’ problems — those with no clear source or obvious solution requiring collaboration and broad stakeholder engagement to solve. I work and study in the field of health promotion, which is (I argue) a systems science and practice even if it doesn’t identify itself as such. It looks at the bigger picture and tries to use that lens as a means of understanding the world and solving social problems.

My friends are both quite attune to this and I would argue also apply systems thinking to their work, yet they do in a very different way. They are counseling psychologists and, for the most part, they work one-to-one or in small groups. What our conversation revealed was the myriad ways in which systems thinking can be applied to the big and small picture. Family systems therapy for example, is one way in which these ideas are applied to small groups or individuals. But there are many more.

This got me to thinking about the opportunities and challenges associated with promoting systems transformations at the macro and micro levels. The way my friends approach their work is fundamentally different even if it shares much of the same interests in systems change as the approach that I take. Yet, that difference has a huge impact on a few people (hundreds) rather than an almost imperceptible impact on thousands.  In applying systems thinking outside of the clinical encounter, the problem they face is that they are not paid (that is, they are not reimbursed for clinical time) when they go beyond the one-to-one and small-group approach; so even if they wanted to do that work, they couldn’t unless it was on their own time. Health promotion is almost the opposite: we have become so good at working with large groups that we’ve stopped developing strategies that can help individuals that fit with the health promotion values. It’s true, that there is a season for each of these approaches. Health promotion has worked hard to escape the individual-focus that other fields like health education still use and psychology is pretty good at doing the individual thing. It just seems that there is room for both specialized and generalized systems thinking and action working together. I just haven’t figured out how. Any suggestions?

food systemshealth promotionpublic healthsystems scienceUncategorized

The Organic – Health debate

This week the health blogosphere, newswires and cocktail party circuits were buzzing over the report from the report for the U.K. Food Standards Agency that came to the conclusion that organic food offered no more nutrients than ‘conventionally’ produced foodstuffs. (I find it strange to call the way we mass-produce food conventional, particularly when you think that most of what we eat today didn’t exist 50 years ago and the stuff that did exist is now produced in a way that is so foreign to the way its been done for the thousands of years before that calling it conventional is about as realistic as calling one of those ‘meal replacement‘ products a meal…but I digress — for an interesting take on this go see Food Inc. in theatres).

This finding didn’t surprise me at all. There isn’t any particular reason why ‘conventionally’ grown food should be any less nutrient rich than organics. But as Marion Nestle writes, that misses the point. It’s the same case that I’ve been making in my social circles the past few days as people talk about organics and how this has them reconsidering things. It shouldn’t — unless physical health is the only reason why you eat something. And I would argue that there are many good reasons to eat organics that have just as much to do with health, but do so in a way that goes beyond nutrients.

Organics are much more friendly to the planet for starters. The problems with birds & wildlife, and environmental degradation due to pesticides has been well-documented.

Pesticides are also highly toxic to those who are administering them — very often low educated, non-protected workers and their families – despite efforts to reduce this.

Organics also provide a vehicle for supporting local farmers, which brings added environmental and economic benefits.

All of these things produce health in our community. These are the social determinants of health of the food system and not just the nutrient portion of it. And there is much reason to believe that these social and environmental determinants play as big of a role in our health as anything we gain from nutrients.

Health is indeed a complex system both physically, socially, and as a concept in its own right. Viewing the link between organics and physical health (vis nutrients) as straightforward (and one that some organic supporters are doing through their critique of the report) reduces this complexity and potentially does the organics movement more harm than good. My suggestion would be to look at all the other benefits that organics can confer and focus on that.

This doesn’t mean the door is closed and that more research shouldn’t be done, but I think a lot of people will be happy enough knowing that the organic food they eat is doing the planet good, animals good and their local economies good and that is healthy in its own right.