Tag: public health

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.

complexityhealth promotionsocial systemssystems thinking

Cohesion vs. Diversity

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

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

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

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

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

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

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

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

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

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

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Obesity the new tobacco?

This week the widely-cited peer-reviewed journal, Health Affairs, published a paper looking at the link between obesity and the costs to the U.S. health system. The paper, based on research conducted by the Centers for Disease Control, suggests that obesity could cost the system close to $150 billion dollars in the coming years if not put in check. Obesity is a fascinating area of study for many reasons and one of them is that it elicits such visceral reactions from different groups. Like tobacco, there are sides that are considered to be ‘good’ (public health) and ‘bad’ (fast food industry) by some.

But unlike tobacco, which has a clear industry that produces its product behind it, obesity is not as clear cut. As NYU professor of public health and nutrition and well-known author Marion Nestle writes, there are other groups that are challenging the CDC data. In her recent blog post, Nestle points to groups like the American Council on Science and Health that have come out strongly against data linking obesity and health problems. Nestle raises the question about where their funding comes from. Just like tobacco has a lot of groups that it sponsors to lobby and support on behalf of policies that are friendly to it – including funding “science” to support claims.

I am not an obesity expert, but I do an increasingly large amount of my work within the food system and bring over a decade of experience in tobacco control. What I see between the two areas is looking a lot alike.

If these numbers are correct, it is most likely another sign that a major campaign is about to be declared on obsesity, just like it was with tobacco. If so (and there is lots to suggest that it is already underway), it will be interesting to see if we get the same patterns of action that we had in tobacco like:

1. Faux science groups funded by those that create the very products under scrutiny claiming that the current research is flawed;

2. On the other side, an ‘obesity’ industry that becomes empowered but also resistant to new perspectives;

3. Stigmatization of those that are obese;

4. Major systems change in the way products are regulated

These are just some of the possible options. But I think that there may be some interesting parallels to note as this moves forward.

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Censemaking

Censemaking is intended to serve as a creative outlet to express ideas about Complexity science, E-health, Networks, Systems thinking, and Evaluation (CENSE — get it?). This is the environment that I have chosen to immerse myself in as a person and a professional. Now certainly, the idea of living systems might make sense to some — but evaluation? e-Health? Why are they connected? Well, it has a lot to do with my vocation: a professor of public health at the Dalla Lana School of Public Health at the University of Toronto. Through a long and windy road I’ve come to believe that we’re at a nexus of unprecedented opportunity and danger and that the linear mindset that has served us for so long and brought us the technological and social marvels we have today is pushing up against a wall. Climate change, chronic and infectious diseases, food security, mass migration, and globalization are just some of the ‘wicked problems’ that will only be solved by many people working together, self-organizing, and being creative. Indeed, the ‘C’ in CENSE is really a placeholder for a lot of things: creativity, collaboration, complexity, convergence, conservation… All of these things are essential for us to continue to have the life of relative comfort that comes from the plenty that those of us in places like Canada have come to enjoy.

But not all of us — even in Canada — are so well off. It’s easy to put a head in the sand and ignore the realities experienced by our First Nations peoples, new immigrants, and those billions who live on less than $2 a day worldwide. It is easy to forget that while I have access to an abundance of fresh water, clean air, medical care, safe and abundant food supplies, and educational opportunities, I am in the minority. I have been given a lot of opportunity to do well, and I’ve created a lot of opportunities too. The point of this blog isn’t to talk about how good or bad things are, but to imagine how we can collectively create a glocal (global+local) system of support and care that enables the world to have opportunities like I’ve had in a manner that is sustainable and just.

A tall order? Yes. But why live a life nestled on the ground when you can also reach for the stars?

Blogging is tough. I am an avid microblogger on Twitter (@cdnorman), but a long form blog is something that I’ve been wanting to commit to for some time. After much debate about what platform to use, I’ve decided to start Censemaking here, now and hopefully for the years to come. Watch this space for ideas, insights, ramblings and musings about the issues that intertwine to reflect the reality of my personal and professional life. You’ll see a lot on technology — information tools to communicate, share and collaborate. There will also be a lot on public engagement and learning. I am an educator, so you’ll see some things on that. I’m also a foodie and believe that transforming our food system — from its production to its packaging and transportation to its marketing, consumption and through to its disposal — is the issue that will define the 21st century (along with water, which I relate to it). So you’ll see a lot on that. And, I’m a public health professor, so there will be musings on topics like disease, health promotion, tobacco control, obesity and many other things that are relevant to the health of populations.

I hope that whoever you are, you enjoy my blog.