Tag: public health

complexityinnovationpublic healthsystems sciencesystems thinking

Handbook of Systems and Complexity in Health

Handbook of Systems and Complexity in Health

Handbook of Systems and Complexity in Health

A brilliant and comprehensive new book has been launched that brings together the best scholars working in the area of systems thinking and complexity and applying it to health.

The book description can be found here along with a link to the abstract for a chapter I co-authored with Andrea Yip looking at the overlap between design thinking and systems science and complexity. This chapter takes a design lens on previous work developing the CoNEKTR model for engagement in complexity and health.

It’s a big book, but well worth a look if you’re wrestling with complexity and systems thinking in health and social innovation.

knowledge translationpublic healthscience & technologysocial media

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.

behaviour changeeducation & learninghealth promotioninnovationpublic health

How Serious Are We About Learning?

How Serious Are We About Learning?

When journalist and book author Daniel Pink tweeted the above image the other day it provoked thinking about what real learning means and what it takes to achieve it. We produce enormous amounts of knowledge, yet struggle to put it into use, but we also teach much and learn little because the systems we’ve designed for education and experience don’t match our expressed interest and rhetoric around learning. 

In my graduate course on behaviour change I would ask students on the first day why they were taking the class in the first place. Aside from the few students for whom the course was required everyone else was doing it by choice because there were many others to choose from. So why would they choose this one?

The answers would vary, but inevitably I’d hear over and again that students love learning and wanted to understand more about behaviour change, because they were interested in change and some would even say they were good at it and wanted to help others do it.

These are all well-meaning and said in a spirit that I think was honest and true. Except the reality is that it is likely a big, huge lie and one that we all share in its telling.

I would counter with two things:

  1. Loving the idea of learning something new is different than actually seeking out learning opportunities and that most of us love the former, but are not so enthused about the latter;
  2. The only people who regularly welcome change are babies with soiled diapers.

To illustrate the first point I simply ask people to consider the last conference they went to where there were options on what sessions to attend. How many of the sessions did they attend that featured content that confirmed or gently extended what they already knew versus content that was new? If you’re a health promoter doing community engagement work, sessions on Bayesian modelling for epidemics might offer far more learning than a session on working with diversity in communities (particularly if that is what you already do). Even more, how often do people go to sessions from people they know or have already seen speak? Chances are, many.

One could argue that there are subtleties that a conference presentation might offer on a familiar topic that are worth attending and while I would say that has merit, most learning that has impact is uncomfortable at some level. It extends our thinking, challenges our beliefs, or re-arranges our worldview — in ways small and large.

Wanting knowledge and living learning

Many people will say “I love change”, but that is usually in the context that everyone else is changing, not them. When I was the boss and said “things must change” it was very different than when my staff or my boss would say “things must change“. As a behaviour change educator and intervener, I need to be mindful of my own ironies and resistance to change. So should we all.

The same thing goes for knowledge. Academics are famous for ending studies with “more research is needed”. We never seem to have enough knowledge. There are two problems with this idea.

The first is that, in dynamic and evolving environments, we will never have  perfect knowledge that fits like a glove, because the contexts are always novel. This isn’t to say that evidence isn’t useful, but ‘good enough’ knowledge might be a more reasonable demand than ‘best evidence’ in many of the situations where complexity is high and so is change. That’s why data gathering techniques like developmental evaluation aren’t attractive to those who need certainty.

But there is another problem with the knowledge quest and that is one of integration. In our efforts to seek more knowledge, are we integrating what we are learning from what we already have? Are we savouring the data we collect, the articles we read, the Tweets and blogs that get forwarded are way?

We quest for more, but should we quest for better?

A newly published paper synthesized research on event horizons on memory and found that shifts in activities around an event — boundaries — can prompt forgetting and recall. We remember transitions between activities, but they also prompt forgetting depending on the mindfulness associated with the act. When we are deluging ourselves with more data, more media, more everything, we are increasing the potential remember rate, but due to the volume of content, I would surmise that we are increasing the forget rate much more. Simply reflect on your high school or undergraduate education and ask yourself if you remember more than you forgot about what you learned.

We are so busy with our search for new knowledge that we interrupt opportunities to learn from what we have.

Serious learning means non-doing

Returning to the tweet from Dan Pink, it’s worthwhile considering what it means to learn and the systems we have in place to facilitate learning. The tweet links to a discussion of how German companies give their employees five days of off-site continuing education each year. This concept of Bildungsurlaub is a leave designed to allow employees to stretch their thinking and integrate something new. Not only is off-site learning important, but the time associated with integrating material is critical.

A read of the literature on innovation and research shows consistently how time off, quiet time, slow time and down time all contribute to discovery. Robert Scott Root-Bernstein’s brilliant Discovering, Jonah Lehrer’s Imagine, or Steven Johnson’s Where Good Ideas Come From are all books that dive deep into creative production and show that great discoveries and innovations come from having time (with limits) to integrate material to learn. Freedom to create, explore and sit and mindfully reflect are all united concepts in the pursuit of good learning. Not everything requires this, but big concepts and bold ideas do from mathematics to science to social science and philosophy.

Yet, at an organizational and systems level, where is the support for this? Even university faculty (the tenured ones at least) who have generous vacations and sabbaticals are finding themselves crunched for time between the fight for one of the ever-fewer grants, increasing numbers of students and teaching demands, and the added push to ensure knowledge is translated. The image of faculty sitting and reading and thinking is truly an imagination. Most of my colleagues in academia do little of this, because they are out of time.

In the corporate and non-profit world this is worse. Every hour and day is to be accounted for. The idea of sending people off to learn and to think seems anathema to productivity, yet research shows incredible powers associated with taking a break and doing less and not more.

Getting serious about learning

To illustrate the scope of the problem, the University of Toronto holds one of the finest academic library systems in the world and has over 11.5 million books and 5.7 million microform materials. It is one university (of many) in one city. Add in the local Toronto public library system, the network of universities and other libraries it is connected to, local and global bookstores and all the content freely available online that is not part of this system and I challenge anyone working in social innovation or public health to say with conviction that there is a lack of knowledge out there on any important topic. Yes, we don’t know it all, but we don’t do nearly enough with what we do know because there is so much.

We will not read it all nor can we hope to synthesize it all, but we can do much with what we have. Just looking at my own personal library of physical books (not including all I have in the digital realm between books and papers) it’s easy to see that I have more than enough knowledge to tackle most of what I am facing in my work. Most of us do. But do we have the wisdom to use it? Do we have the systems — organizations and personal — that allow us to take the time and soak this in, share our ideas with others, and be mindful of the world around us enough to learn, not just consume?

When we spend as much time creating those spaces, places and systems, then we can answer “yes” to the question of whether we’re serious about learning.

Enough knowledge here?

behaviour changecomplexitymarketingsystems thinking

Marketing Metaphors of Meaning in Complexity

Karl Heyden Eine interessante Geschichte

Metaphors and storytelling are ways to navigate through complex, inter-related ideas in a way that brings coherence and delight to them in narrative form. Stories are not just for children, but a serious tool for bringing complexity to life, making it accessible and usable to a world that can benefit from learning more about it.

Have you ever found yourself curled up in bed with a book that you can’t put down or found yourself up much later than you’d planned because of a TV program or movie you got caught up in? Ever have the same experience with a piece of academic writing? How about a technical report? I’ll bet the answer is yes to the former examples more than the latter (if there is a yes at all to the second two). Books — mostly, but not always, fiction books — magazine and newspaper, articles, poems and even blog posts thrive on a narrative that takes you a journey even if you don’t know the destination. That narrative, if its engaging, has consistency, a tone, a flow and a ‘texture’ that makes it enriching. It is perhaps the reason why so much scholarly writing is so dull: the texture is rather dry and lacks appeal.

Not all scientific articles require such appeal. Indeed, the standardized methods of reporting experiments can be very useful in interpreting results and deriving meaning from complicated interactions. Yet, this application of the standard model of writing from science to other areas is perhaps taking scholarly work to places it didn’t need to go. Or perhaps it is preventing us from going places we need to go.

In terms of complexity, one of those places it needs to go is into widespread discourse on public policy, health promotion, and social program planning. Storytelling and metaphors are one vehicle.

Making metaphors and embodied cognition

A recent Scientific American blog post by explored the role of metaphors in some depth, bringing attention to some of the early work of psycholinguist pioneers George Lakoff and Noam Chomsky in looking at the role of embodied cognition, a concept where a metaphor actually gets integrated into the body (literally or figuratively). In the column Samuel McNerny looks at the history of the idea and the use of metaphor, drawing on interviews, literature and recent research.

As Lakoff points out, metaphors are more than mere language and literary devices, they are conceptual in nature and represented physically in the brain. As a result, such metaphorical brain circuitry can affect behavior. For example, in a study done by Yale psychologist John Bargh, participants holding warm as opposed to cold cups of coffee were more likely to judge a confederate as trustworthy after only a brief interaction. Similarly, at the University of Toronto, “subjects were asked to remember a time when they were either socially accepted or socially snubbed. Those with warm memories of acceptance judged the room to be 5 degrees warmer on the average than those who remembered being coldly snubbed. Another effect of Affection Is Warmth.” This means that we both physically and literary “warm up” to people.

Metaphors like “warming up” are therefore representations of real phenomena that become figurative in certain scenarios. McNerny adds:

The last few years have seen many complementary studies, all of which are grounded in primary experiences:

• Thinking about the future caused participants to lean slightly forward whilethinking about the past caused participants to lean slightly backwards. Future is Ahead

• Squeezing a soft ball influenced subjects to perceive gender neutral faces as female while squeezing a hard ball influenced subjects to perceive gender neutral faces as male. Female is Soft

• Those who held heavier clipboards judged currencies to be more valuable and their opinions and leaders to be more important. Important is Heavy.

• Subjects asked to think about a moral transgression like adultery or cheating on a test were more likely to request an antiseptic cloth after the experiment than those who had thought about good deeds. Morality is Purity

The challenge for complexity in social life is coming up with the right metaphor and finding one that is embodied within the systems we seek to influence.

Telling systems stories

One of the best examples of the use of storytelling and metaphors to explain complexity comes from Dave Snowden of Cognitive Edge with his humourous, insightful look at order and the art of organizing a children’s party.

What Snowden does is anchor something new (complexity) in a familiar frame of reference (a children’s party). While this is not something that directly translates to how we operate social organizations such as “warming up” does to explain relations between people, it offers something close.

Anchoring the novel in the familiar. Childhood is the one universal we adults all share. Travel the globe and watch children interact and you’ll see patterns repeated everywhere. Emotion is another universal: joy, fear, anger, contentment, curiosity, and such are all platforms that can be used to create and share stories about our world. For those of us working in communities, we need to understand what universals exist in those realms. This means paying deep attention to the systems we are a part of.

In short: systems thinkers may need to be participant observers to the systems they wish to influence and learn about the big and small things that drive them.

As systems are large, complicated and complex, it is unreasonable and perhaps impossible to know everything necessary to successfully navigate through it and maneuver the leverage points necessary to create responsible, sustained systems change. To do so, we need to enlist others and that means getting complexity into the minds of many operating in the system and not just a few ‘systems thinkers’.

We need to get better at telling stories and marketing metaphors of meaning.

Learning storytelling from marketers

Marketing is largely about identity and stories about identity. Marketers want to influence what you do (choose, use, purchase, etc..) and how you experience what you do when you do it. To do this, they know the importance of design and the stories to accompany that design. Design, when done well, is partly about creating empathy with those who are to benefit from the products of design and the best products out there are ones that apply empathy and guide behaviour at the same time. Steve Jobs and his design team led by Jonathan Ive were (are) famous for doing this at Apple.

In an earlier post I mentioned the work of Rory Sutherland and his discussion of tobacco use as an illustration of the ways in which failing to empathize with a product user’s life can change the impact of policies and programs aimed to improve it. The case (made in the video below) is that there are some real, tangible benefits to smoking that get ignored when we aim to snuff it out (bad pun intended). For public health to enhance its effectiveness, we need to pay attention to these benefits and find ways for people to derive them in healthier contexts.

But listen to what Sutherland says not only here, but in another of his TED talks he points to ways in which small changes can have enormous consequences if done in a systems-forward manner (my term, not his).

What Sutherland does is not just provide good ideas, but tells good stories. Like Dave Snowden, he captures our interest and makes us want to think about concepts like behavioural economics and marketing just as Snowden inspires thinking about the differences between order and chaos.

Not all of us can be great storytellers or funnymen (and women), but we need to take this seriously if we wish to use complexity and systems thinking to advance change in our world purposefully, because massive change is happening whether we want it or not. The key is whether we will be telling stories in the future of how we helped shepherd change that helped us be more resilient and thrive or let these forces shape us in ways that caused unnecessary problems. It is, as Bruce Mau said, not about the world of design, but the design of the world.

behaviour changedesign thinkinghealth promotionmarketingpublic health

Contemplating Better Public Health: Perspective is Everything

Design No Smoking

Cigarette smoking remains among the most significant and pernicious global public health challenges. On World No Tobacco Day it’s time to consider re-designing our approach to public health and tobacco control in the hopes of meeting this challenge and others like it more effectively.

Today is World No Tobacco Day and offers us an opportunity to take a pause and think about the ways in which we approach tobacco control as an example for public health.

Marketing funnyman Rory Sutherland,  and smoker, makes a terrific observation about smoking and its power to promote quiet contemplation in one of his recent TED talks (which is well worth watching for many reasons, only some related to tobacco use):

“Ever since they banned smoking in the UK in public places I’ve never enjoyed a drinks party ever again. The reason… is when you go to a drinks party and you hold up a glass of red wine and you stand up and talk endlessly to people sometimes you don’t actually want to spend the whole time talking. It’s really, really tiring. Sometimes you just want to stand their silently, alone with your thoughts. Sometimes you just want to stand in the corner and stare out of the window.

Now the problem is now that you can’t smoke, if you stand there and stare out of the window on your own you’re an antisocial, friendless idiot.

If you stand there and stare out of the window on your own with a cigarette, you’re a fucking philosopher.”

In this  tongue-in-cheek presentation, Sutherland inadvertently hits on a powerful reason to smoke, but not for the reason you might first imagine. It is less about social perspective, but internal perspectives of the self and the opportunity to better acquaint oneself with them.

Sutherland speaks to the perception of others in this talk, but I am more interested in what this act of contemplation — the ‘fucking philosopher’ aspect of smoking for some and why public health sometimes gets it wrong when it comes to tobacco control, but could get it right with mental health with the right design.

Over the past year I’ve made a concerted effort to better understand the motivations and habits of cigarette smokers from the perspective of a designer, not a public health researcher. In doing so I have sought to pay greater attention — as Rory Sutherland does — to the actual experience of smoking. And what I have noticed is the powerful contemplative effect it has on many smokers.

By no means is this a by product of cigarettes, and I certainly cannot endorse their use on health grounds, but one positive by-product of the act of smoking is greater attention to the self in the moment. Sutherland speaks to how a cigarette gives him the license to take time out of a busy party and contemplate, reflect, and gain some perspective that might seem odd or “antisocial” without the prop created by a cigarette.

Strange that we seem unable to develop the same habits and social acceptance of everyday contemplative acts in public, yet fully recognize this as legitmate with smokers even if we question the device used to precipitate the “time out”.

Smokers take breaks throughout the day to engage their cigarettes. Even in cold weather, they will go outside and sit or stand for 10 minutes just to indulge their habit, compulsion or pleasure, sometimes in small groups. This act of smoking provides a sense of community (with other smokers), contemplative space, and a pause from the everyday rush of life. Indeed, as they engage in activities that threaten their physical health they also engage in an activity that is very healthy for their mental well-being.

This is potentially another area that requires further investigation both from a positive standpoint (designing healthy space for contemplative inquiry or reflection) and looking at negative impacts of our well-intentioned efforts to curb tobacco use. While the loss of potential smoking peers has been examined, I could not find any research that examines the loss of contemplative time and its impact on smokers who quit. Doing so firstly acknowledges that cigarette use has benefits, which is problematic for many in public health. It also means getting into a zone of complexity whereby we need to consider how something that is so demonstrably toxic to the human body and others around the smoker can have potentially positive effects in other ways.

From a design perspective, how might we apply the lessons from cigarette use to mental health promotion? How might we design programs, spaces, places, and social conventions that promote the quiet contemplative acts that smokers gain from taking that cigarette break and offer potentially great value to tobacco users without creating harmful effects for others? How can we promote the quitting of smoking without the loss of the contemplative benefits that come with the act of lighting up?

Engaging design, complexity and imagining the systems that influence them both might yield considerable insight into how we manage other public health problems and how we might better promote mental health in the protection of physical well-being.

Photo No Smoking Poster 1 by Sempliok used under Creative Commons License from Deviant Art.

behaviour changeeHealthhealth promotioninnovationpublic health

Social Media and Health: Leaders(hip) and Followers(hip)

Social media is finally catching on with healthcare, public health, and  health promotion. With a few recent articles published in the academic literature to rest on, academic health sciences has finally (and I might argue, begrudgingly) conceded that 900+ million users and $100B valuations (Facebook), and thousands of messages exchanged every milisecond (microblogs like Twitter and Sina Wiebo) might have some value for the public beyond entertainment.

If you note how long it took the health sector to start using the telephone as a serious means of engaging their patients or the public, this is lightning-quick adoption. Still, the barriers to adoption are high and the approach to using the technology is scattered. Indeed, just like the start of Internet-delivered telehealth (or cybermedicine (PDF), which has now evolved into eHealth), there is a mad rush to get liked, followed or some other metrics that most health professionals barely understand.

And that is part of the problem.

Meaningful Social Media Metrics

What is a meaningful metric for social media and health? A recently published article in Health Promotion Practice suggested four metrics that are taken from social marketing and applied to social media. These Key Performance Indicators (KPI’s) are:

  • Insights (consumer feedback)
  • Exposure (media impressions, visits, views, etc..)
  • Reach (# people who connect to the social media application)
  • Engagement (level of interaction with the content)

These are reasonable, but to to the uninitiated I would suggest a few words of caution and commentary to this list.

Firstly, the insights suggested by Neiger and colleagues “can be derived from practices such as sentiment analysis or data mining that uses algorithms to extract consumer attitudes and other perspectives on a particular topic” (p.162). While not incorrect, this makes the job sound relatively simple and it is not. Qualitative analysis + quantitative metrics such as those derived from data mining are key. Context counts immeasurably in social media use. It’s only in situations where social media is used as a broadcasting tool that gross measures of likes and sentiment analysis work with little qualification.

Even that is problematic. Counts of ‘likes’, ‘visits’, ‘follows’ and such are highly problematic and can be easily gamed. I am ‘followed’ on Twitter by people who have tens of thousands of followers, yet virtually no presence online. Most often they are from marketing fields where the standard practice is to always follow back those who follow you. Do this enough and pretty quickly you, too can have 23,000 followers and follow 20,000 more. This is meaningless from the perspective of developing relationships.

Engagement is the most meaningful of these metrics and the hardest to fully apply. This category gets us to consider the difference between “OMG! AWESOME!” and “That last post made me think of this situation [described here] and I suggest you read [reference] here for more” as comments. Without understanding the context in which these are made within the post, between posts (temporally and sequentially), and in relation to a larger social and informational context, simple text analysis won’t do.

Social Media Evidence: Problems and More Problems

One of the objections to the use of social media by some is that it is not evidence-based. To that extent I would largely agree that this is the case, but then we’ve been jumping out of airplanes with parachutes despite any randomized controlled trial to prove their worth.

Another article in Health Promotion Practice in 2011 highlights potential applications for social media and behaviour change without drawing on specific examples from the literature, but rather on theoretical and rhetorical arguments. An article published in the latest issue of Perspectives on Psychological Science highlights the current state of research on Facebook, which is timely given that its IPO is set for today. That review by Wilson and colleagues illustrates the largely descriptive nature of the field and offers some insight on to the motivation of Facebook users and their online activities, but rather little in what Facebook does to promote active change in individuals and communities when they leave the platform.

The answer to whether social media like platforms such as Facebook ‘work’ as methods of promoting change is simply: we don’t know.

Does social media provide support to people? Yes. Does it inform them? Yes to that too. Does that information produce something other than passive activity on the topic? We don’t know.

In order to answer these questions, health sciences professionals, evaluators, and tech developers need to consider not just followership, but leadership. In this respect, it means creating changes to the way we gather evidence, the tools and methods we use to analyse data, and the organizational structures necessary to support the kind of real-time, rapid cycle evaluation and developmental design work necessary to make programs and evidence relevant to a changing context.

As Facebook launches into its new role as a public company it is almost assured to be introducing new innovations at a rapid pace to ensure that investor expectations (which are enormous) are met. This means that today’s Facebook will not be next month’s. Having funding mechanisms, review and approval mechanisms, a staff trained and oriented to rapid response research, and an overall organizational support system for innovation is the key.

Right now, we are a long way from that. Hospitals are very large, risk averse organizations; public health units are not much different. They both operate in a command-and-control environment suited for complicated, not complex informational and social environments. Social media is largely within the latter.

Systems thinking, design thinking, developmental evaluation, creativity, networks and innovation: these are the keywords for health in the coming years. They are as author Eric Topol calls the dawning of the creative destruction of medicine.

The public is already using social media for health and now the time has come for health (care, promotion and protection) systems to get on board and make the changes necessary to join them.

knowledge translationscience & technologysocial systemssystems science

Have We Turned the Page on Social Science Research for Health?

Turning the Page on Social Science and Health Research

Over the last two weeks social science researchers across Canada began receiving the decisions from last autumn’s competition for a Social Science and Humanities Research Council (SSHRC) funding award. SSHRC is the principal funder of social science research in Canada, although notably is not in the business of funding heath-related research, which is supposed to be funded by the Canadian Institutes for Health Research (CIHR). [Full disclosure: I currently hold grants from both of these organizations]. The problem is that CIHR was born from a policy and programming body and the former Medical Research Council and has a rather awkward relationship with social science research given its medical focus. It has funded some social science programs, but not in a manner that has enabled social scientists to comfortably explore the range of issues that they might have under traditional SSHRC funding programs, particularly when social issues are not always obviously health issues (e.g., poverty, education) and can easily be dismissed as not being relevant in spite of the evidence that they are.  Yet, SSHRC has decided to forgo any funding of health-related projects due in part to the absence of funding to support it when there are presumably options through CIHR or the disease-specific health charities like the Canadian Cancer Society, the Lung Association and others.

Yet, these options are not suitable. In a manifesto entitled “The end of medical anthropology in Canada” a group of leading social scientists painted the picture of the situation in grim terms in University Affairs. Although medical anthropology is the focus of the piece, the authors might as well be speaking for social sciences in general:

Health is inherently social and cultural. SSHRC has always understood this; CIHR, we fear, does not. We face the possible extermination of one of the most vibrant, high-demand and policy-relevant health disciplines, the only scholarly field that places culture at the centre of the analysis of health and that characteristically does so in both national and international contexts. In a multicultural, settler society with a substantial aboriginal population, and in a world where health is at the core of developmental, political and social issues in so many countries, where Canada otherwise wishes to have an impact, does this make any sense?

This brings me back to the beginning of this post and the announcement of the results of the last competition. Looking at the funding numbers released by SSHRC, a discouraging picture emerges. In 2011-12, 37 per cent of all applications in the open competition were deemed fundable, yet only 22.5 per cent were funded. These numbers are similar t0 2010-11, when 36  per cent were deemed fundable and 22 per cent were funded. What is not mentioned in these numbers was the level at which these grants were funded in the first place. I am a 2010-11 recipient of funding from SSHRC — meaning my grant proposal was within the top 22 per cent of all applications for that year — and the amount I received was approximately half of what I requested. That means that I had to take half of my budget and throw it away. So yes, I was successful providing I did either half of the research or found money elsewhere. I did the latter and my pocketbook is none the better for it.

Consider the implications of this change in funding. With one in five projects funded and many of those that are funded at levels well below what was requested the motivation for researchers is one of the first casualties. Researchers know that funding is tight and that it is highly competitive, but few alternative sources for research grants that lay outside of specific disease-focused areas, social scientists young and old are faced with little option. This creates another set of affected parties: students and trainees. Research funding not only supports the scientists themselves in many cases (see my previous posts on this), but those seeking to become scientists themselves or those who seek to get better acquainted with research. In health sciences and policy, this means just about everyone enrolled in such programs.

Now consider all of this in light of a trend towards increasing graduate education numbers. At the academic institution I am affiliated with (like many of its peers), the enrolment numbers are set to nearly double across many of the professional programs associated with health practice and policy in the coming years. Increased demand for training opportunities from the public has created a means for universities to cash in. Of course, what these students will do when they get there is unclear (let alone when they graduate), but it cannot be much in the way of research — at least as it pertains to social science and health. The funding is simply not there to support the kind of broad-based inquiry into the social factors that influence health, illness and well-being anymore. We have, as I call it, reached ‘the Turn’.

The Turn is that point where the system changes irrevocably towards a new direction. It is like a ‘tipping point‘.  Dwindling numbers of social scientists working from funding from an institutional budget (e.g., tenure-stream faculty positions) + a doubling of the student cohort * half of the research dollars makes for rather toxic math. The Turn will fundamentally shape the way social science inquiry is done and the kind of questions that get asked. As question foci change, the quality of the research shifts, and the depth of inquiry is reduced, so too will the real impact that social science has on our health.

The gap between what we know, what we do, and what we can do to prevent illness, treat sickness, and promote well-being will grow.

Anecdotally speaking, this trend is not unique to the social sciences, but it is amplified in this domain. Social sciences in Canada and abroad are consistently funded at lower levels than that of basic research (see here for a starting point). But what is interesting is that many of the problems that we face within health require social science knowledge and research to address and social science — from knowledge translation, social network studies, technology adoption, innovation, management, to policy implementation and beyond .

Prevention of disease and chronic illness is often a social phenomenon (e.g., hand washing). Even the act of taking the best of basic science and translating it into practice or policy options (or other scientific research) is a social act that draws on social science research to execute. Social determinants of health are social in nature and require social science to understand their impact. Designing the policy and programmatic interventions that support creating a healthier society also falls to social science research and practice.

What will our health landscape look like without the ability to take what we know and translate it into action? Worse yet, what if we simply are unable to even know what to do because the research and evidence isn’t there in the first place to translate into anything? Without another turn towards something more positive in our research support, we are about to find out.

* Photo Turn the Page by Miaboas used under Creative Commons License from Deviant Art.