August 2009
"We need to convert the social safety net into a social safety
network through the creation of smarter communities that are
information-rich, interconnected, and able to provide opportunities for
all citizens." -Rosabeth Moss Kanter & Stanley Litow
-there are over 100 million videos on YouTube and YouTube is the
2nd largest search engine on the web
For many in the public health field the terms “web 2.0” and “social
media” were rather alien species until 2008-09 when Twitter became a
mainstream news item due to celebrity adoption of the tool. After the
Mumbai terrorist attacks the growth of Twitter took off due to the
attention it received on CNN for its role in late breaking news from
people on the scene. However, web 2.0 and social media have been
around since the early 2000s, if not earlier. What we’re really talking
about here is an eco-system of communications tools that evolved
online from the first generation of the internet that we all experienced
from the late-1980s through the 1990s. This was an internet of mostly
one-way communications tools where information was pushed out to
an audience in the traditional publishing mode. Tim O’Reilly coined
the term “web 2.0” around 2005 when, in the wake of the dotcom bust,
new “platforms” arose that enabled users of the sites to share and
create content, and find like-minded people. Most of these platforms
also offered free services and were very inexpensive companies to
create. In fact, many of the web 2.0 business models posed challenges
for venture capitalists who were often not as necessary to the
launching of companies as they had been in the 1990s dotcom boom.
Figure 1 below was the overview in 2005 of the platforms and tools
that made up the web 2.0 eco-system at the time.
Video and Photo Sharing: Social media tools also include video
platforms such as YouTube and Vimeo, photo-sharing sites such as
Flickr, document sharing such as Scribd, presentation sharing such as
SlideShare.
Twitter: Twitter has become one of the most popular social media
sites over the past year and is a service that enables users to generate
messages of up to 140 characters. The simplicity in design and use
betrays the power of the medium for building communities of like-
minded individuals who share links to content, generate discussions,
fundraising campaigns and collectively aggregate content through the
use of hashtags (using “#” in front of a keyword allows users to readily
search for the “tweet” (posting)). While there is a certain amount of
hype about the effects of twitter in various discourses there is no
denying that the social impact of the tool has been considerable when
we examine everything from the Mumbai terrorism attacks to the Iran
election protests to everyday development of online conversations
around social entrepreneurship, global health, healthcare reform and
technology development. I will attach an appendix of some of the most
important health professionals on Twitter.
Brian Solis has created the following social media map in Figure 2.
The reader should note that the map is somewhat dated and there are
additional entries under most headings and some of the companies on
this map have ceased to exist.
The Mobile Web. An important thing to keep in mind is that the web
is becoming increasingly mobile. With the release of the iPhone 3G in
July 2008 we witnessed a step-change in innovation and the number of
people accessing the web from a smart phone. In August 2009 the
European Information Technology Observatory (EITO) estimated that
the number of people worldwide using mobile phones rose from 3.9
billion in 2008 to 4.4 billion in 2009, an increase of 12% resulting in
nearly 2/3 of the global population now possessing a phone.3 Not all of
these phones are smartphones capable of accessing the worldwide
web, however one must conclude that overall access to mobiles
worldwide greatly exceeds the 2/3 of the population due to the fact
that the mobile is not always constructed as a “personal” device and is
3
http://www.egovmonitor.com/node/26957
frequently shared across households or communities in lower income
settings. The CDC noted in late 2008 that nearly 20% of all US
households no longer had landlines, a trend that was increasing due to
the recession. Some recent Pew Internet data is useful as well. When
one looks at traditional internet access points via broadband
approximately 46% of African-Americans have broadband at home
(Figure 3).
Some examples:
City of Toronto’s Transit Camp (http://transitcamp.wik.is/): When the
Toronto Transit Commission needed to develop a new transportation
policy they created the Transit Camp site and activities to engage the
citizenry. Rather than generate a policy prescription that is then
communicated to the public after the fact, their approach solicited
feedback on the community’s own framings of transportation issues
first and their ideas for solutions. Policy-makers could then build on
the “crowdsourced” proposals and suggestions.
All Hazards Consortium (http://www.ahcusa.org/) : Disaster
Preparedness involves many different sectors involved with evacuation
planning, infrastructure protection, food security and cybersecurity
(Nambisan 2009). This diverse eco-system not only has different
players but each may have a different framing of the problem and
ideas for how to best address the problem. The All Hazards
Consortium created this portal to bring together the different parties to
settle on a common framework for addressing the problem and then
bringing all of the stakeholders to the same table. Through the forum
they learned how different agencies constructed “special needs” and
shelter requirements differently. The Consortium was able to sponsor
working groups to generate discussion and consensus across agencies
The All Hazards Consortium example has become a very successful
case study in how to create a collaborative platform. The sponsor of
the platform had the responsibility of creating a collaborative
environment where all parties could voice their perspectives. In other
words, the role of government became less a matter of leading the
direction of change and more about developing and maintaining an
infrastructure for social knowledge creation.
Community: sustained collaboration is the basis of many professional
communities. From building a community around a conference so that
collective action and community can evolve post-conference to
maintaining effective collaborations among geographically dispersed
individuals, social media tools can be effective if the role of community
gardener is developed and the community is fertilized with good
content and effective (time-saving, ideational, etc.) tools and
relationships.
Social media, in my mind, is less about the technology (the media) and
a far more interesting story about the social practices that they can
inspire. Several years into the era of rapid growth of blogs and wikis
we witnessed a dramatic increase in activities frequently described as
“crowdsourcing” or new forms of cooperation emerged from the ability
of like-minded individuals to find one another and collectively produce
content, exchange ideas and work to solve problems. Howard
Rheingold in is 2003 book “Smart Mobs” captured the ethos of the
emerging assemblage of norms, technologies, and movements when
after the 1999 anti-WTO protests in Seattle, the overthrow of President
Estrada in the Philippines and the texting behaviors of Japanese teens
all pointed to the growth of new forms of cooperation that were being
enabled by pervasive computing, mobiles and what many refer to as
“new commons” in the knowledge society (Hess and Ostrom 2006).
6
The framing of obesity might also include the neglected ‘disease(s)’
called mental health and trauma given a growing body of research that
points to the role of childhood sexual violence as a causal factor in
obesity for a significant number of women.
efficient web-enabled scientific research. We identify
unnecessary barriers to research, craft policy guidelines and
legal agreements to lower those barriers, and develop
technology to make research, data and materials easier to find
and use.
Our goal is to speed the translation of data into discovery —
unlocking the value of research so more people can benefit from
the work scientists are doing”
There are insights here for how public health organizations can create
pooled resources that include data, knowledge assets, tools and
templates that can be adapted to specific contexts and problems.
Later in this report where we will examine mapping tools, data
visualizations and social networking platforms that hopefully will
illustrate the range of possibilities. The commons is also a space, either
physical or virtual or both, where users and contributors to the
commons can tinker and share tools. In other words, the commons can
become an innovation commons. Eric Von Hippel (2006) has coined
the term “user-led innovation” to describe how end-users of projects
often tinker with and modify products to suit their individual needs.
Companies that have developed relationships with end-users are then
in an ideal position to take advantage of these modifications and build
new lines of products and services from what they learn from end
users. Central to the concept of user-led innovation is the notion of the
“toolkit”. When you go to a hardware store to buy paint they have a
toolkit that readily creates any desired color from a toolkit of color
palettes and computerized mixing machines. In healthcare we have
not been that innovative in developing toolkits today despite many
options for doing so (Demonaco and Von Hippel 2007). For example,
with diabetes we trust people to prick their fingers and check their
glucose levels, then self-manage by injecting themselves with a
potentially very deadly drug, insulin. On the other hand, with
congestive heart failure or high blood pressure where there are simple
tools available for patients to measure their health status (scales for
weight with congestive heart failure and home monitoring kits for
HBP), yet management of congestive heart failure and high blood
pressure typically entails intensive, expensive clinical management.
Self-management regimes with adequate toolkits have proven to be
effective and cost-efficient. The barrier to adoption turns out to be the
way in which toolkits alter professional relationships and may shift
power relations in clinical encounters and roles. We might want to
think about how we can create new innovation commons and develop
toolkit and social networks of stakeholders with incentives in alignment
to surmount these barriers, but in ways that move beyond personal
healthcare and into the civic engagement arena of public health.
We can also use the commons to reframe problems as a community
issue rather than one of individual responsibility as has become the
case in recent years as the health sector becomes more consumer
focused and emphasizes consumer responsibility. This often leaves out
the structural issues and the issue of structural violence. Framing
issues in terms of responsibility or the commons is a political act.
The UK Design Council’s RED Project provides the most useful insights
into how to rethink health and healthcare from an “open” perspective
through its “Open Health” Project
(http://www.designcouncil.info/mt/RED/health/). Here, service design
meets smart mobs in an approach to diabetes management that
emphasizes designing for “desired health outcomes” rather than
creating a program on the basis of existing healthcare infrastructures
that are increasingly problematic for addressing chronic disease
management. ActivMobs and interventions that were co-created with
diabetics lie at the heart of the intervention. It is here that we see the
potential for social media to be deployed in a strategic manner to
change health outcomes and the institutions and policies that we will
use to drive the future of public health innovation. The fundamental
insight of the project was to build around desired incomes rather than
working from within a dysfunctional system poorly designed for chronic
disease conditions. As we experience the latest round of failed medical
care reform this could hold potential for how public health
professionals will need to think about social innovation that moves
beyond merely enhancing access to a poorly equipped system. There
are insights and tools for building bottom-up systems, particularly if we
look at the social innovations taking place in developing country
contexts such as India.7
7
See Aravind and Narayana Hrudayalaya Hospitals for example.
We will now look at some of the building blocks for creating an open
health framework for innovation. This will require a brief tutorial to
social media and the manner in which these tools are being deployed.
We’ll begin with a discussion on social networks and organizations.
If we think about the nature of most health issues we see that they are
outcomes of networks. There are networks of different service
providers, health outcomes are the result of different networks of
microbes, genetics, environmental factors, social structures, medical
and other forms of knowledge, transportation policies, the built
environment, etc.9 Health itself is a network phenomenon. Yet, we are
using analog structures to deal with network problems. Our
institutions have done little to evolve to match the nature of the
challenges. New technologies and social practices also mean new
organizational cultures are emerging. The 2003 SARS outbreak
provided some insights on how we will increasingly have to work.
When WHO created a network of collaborating institutions to identify
the unknown virus this work was accomplished in short order via
virtual collaboration. Too often we’re trapped within the iron cage of
bureaucratic hierarchies and organizational charts that can become a
significant barrier to innovation. Many of the practitioners of open
innovation have observed that innovations can come from anywhere in
the firm if we open our minds to who can innovate and why and
actually pay attention to informal networks as well as create
intentional innovation systems to bring knowledge in from the edges.
Here is an organizational hierarchy on paper vs. the social network of
the organization in practice to illustrate my point:
8
See James Surowiecki (2003). The High Cost of Illness. New Yorker,
May 12, 2003.
9
Actor-Network Theory developed by Bruno Latour should become part
of the public health curriculum and goes a long way in helping us to
understand the complex ecologies of health issues more broadly.
Figure XX: An organizational chart vs. actual organizational
networks
Social media are social in the sense that they enable “many-to-many”
communications and connections and they can be both real-time and
asynchronous. Scearce et al. highlight the nature of this networked
reality where people can:
10
See Yochai Benkler (2007)
work of others
6) come together and disassemble as needed to achieve goals (a
Hollywood studio model of working)
Now to take these insights to health policy and public health we need
to think where health policy innovation might move in the context that
we’ve been describing so far. Warner and Gould (in Kickbusch 2008)
write that health policy innovation only happens when high-level
intentions are linked up with and make a change to ‘practice’---what I
refer to as social innovation. Historically, policy changes have been
thought about in mostly vertical terms, however, the future will lie in
thinking about the horizontal connections across sectors and policies
and from the bottom-up. We’re very accustomed to the calls for
intersectoral collaboration and horizontal approaches, we just don’t see
the calls put into practice in a successful manner that often, if at all.
Part of this is our lack of understanding of how to think about
governance of network organizations and how to build network
organizations that are more than traditional partnerships. Warner and
Gould are attempting to identify the key challenges to working in this
manner and how we might move forward in thinking about network
governance. While rarely spoken about in public health, this will likely
be at the center of public health innovation in the future. The social
media technologies and tools that receive the focus around innovation,
should be viewed as tools to be appropriated for creating the next
generation of networked public health organizations and strategies
rather than stand alone technological innovations in their own terms.
Social innovation is about connecting the social technologies to
software or hardware technologies to produce social outcomes.
Leavitt Diamond
We see some early signs of what may be emerging in the public health
and social sectors with examples such as Habitat for Humanity Egypt’s
new network approach to housing that has enabled them to move from
a production rate of 200 houses per year to more than 1,000. 11
Scearce et al. also point to the work of Boston Green and the Healthy
Building Network (funded by the Barr Foundation) as another example
of a network mindset for their use of social network maps to bring
together public health and environmental advocates for policy
advocacy efforts around building standards. The concept of the
“platform” is growing in importance so I want to turn to one recent
example of how this has worked for the development of civic
applications in Washington, DC.
11
See Jane Wei-Skillern and Kerry Herman (2006). “Habitat for
Humanity-Egypt.” Harvard Business School Cases, October 3, 2006 (in
Scearce et al. 2009).
Citizen-Driven Innovation: Apps for Democracy and the City as
Platform for Innovation.
In 2008, Washington, DC’s Chief Technology Officer, Vivek Kundra,
launched a project “AppsforDemocracy” that remains one of the
leading citizen-driven innovation examples to date. Earlier in the year
Kundrek’s office adopted an open data policy that utilized RSS feeds
(RSS means “really simple syndication” and allows followers of a site to
be notified when the site is updated) to enable citizens to download all
sorts of local government data from trash collection to government
purchasing behaviors, in all, there were over 200 feeds. Once the data
were available the public was encouraged to identify problems that
were in need of a solution. Then developers could submit software
solutions for the problems. The first edition of Apps for Democracy
yielded 47 web, iPhone and Facebook apps in 30 days - a $2,300,000
value to the city at a cost of $50,000! 12 This represents a 4,000% ROI.
Compare this to the old way of doing municipal software applications:
several years of development to the tune of several million dollars and
less than stellar software produced. We are also learning that the more
people use data, the better the data become (Zittrain 2009).
Crowdsourcing solutions for citizens, businesses and government
employees produced better solutions in a matter of weeks and at a
fraction of the cost. In an era of dramatically reduced financial
resources the public health sector must search for new ways of
innovating within tighter constraints and we feel this is one potential
solution.
The recent debates (or some would argue, lack of debate) on health
care reform in the US illustrates the complexity of health issues and
political fragmentation. With deadlock in government producing
13
See http://blogs.law.harvard.edu/palfrey/2009/07/03/tim-oreilly-on-
the-history-and-future-of-government-20/
anemic policy responses to major health issues we will have to develop
additional strategies to create bottom-up approaches to health reform
in the future. We no longer, if ever, have A PUBLIC, but rather
multiple publics. Many health issues can no longer even effectively be
resolved through traditional partnerships but require much larger,
broader and more diverse networks, or what Robert Agranoff (see in
Siranni 2009: 16) calls “complex value creation networks”. This
demands new approaches to civic problem solving and the platforms
for collaboration, content co-creation and implementation as our
earlier discussion on platforms mentioned. These demands and
opportunities will likely change the way philanthropy and government
funding as well as public-private partnerships will work in the very near
future.
Public health needs to learn from this experience and create spaces
where targeted health innovations can be produced, or better, co-
produced. What if we were to begin building innovation platforms for
health, and more specifically public health, that would be capable to
developing tools to manage chronic diseases, map public health
problems locally and connect problem solvers to those in need of
solutions, or enhance the ability of marginalized communities to bring
attention to community development issues that bear on public health
outcomes? The ability to map and visualize connections between the
built environment, social determinants of health and health outcomes
is becoming much easier with the development of open APIs, Google
Maps, infographics and data visualization tools, and mobiles. Open
data programs are beginning to proliferate, and with the right software,
empower citizens to use data in their daily lives. And take a look at the
results. In the world of mash-ups Google Maps dominate with over
45% of all mash-ups on the open API of Google Maps as compared to
4% and 3% of all maps on MicroSoft Earth and Yahoo Maps that are
both closed systems. The healthcare space is full of market failures
where incentives do not exist to keep people healthy. We believe that
an open innovation portal that builds upon expressed needs of citizens
has the potential to address at least some of these market failures.
There is a gap when we think about the personal use of mobiles and
applications and creating citizen-driven, community computing
platforms for health, such as the ePHIR (electronic personal health
information record where data can be shared (Sakellarides et al 2008)).
We’re still living with the legacy of traditional public health approaches
based on command-and-control systems and need to rethink our
strategies to build upon the actual mobile practices of citizens. As we
move from a command-and-control system to a more integrated health
governance model the mobile will become increasingly important.
The cost of development of mobile applications is rather low but the
voice of public health has been noticeably absent. We would like to
change this and create a platform that can source some of the best
minds in programming with the needs of citizens concerned with public
health. Our platform can serve the larger citizenry as well as provide a
source of software solutions to cities and states around the US. We will
also have the potential to develop mobile health solutions for
developing country contexts as well as use the platform to adapt
successful innovations from the African context, for example, and
adapt these solutions to the US healthcare system.
In the US, organizations have used Open Street Map to tell compelling
stories about education policy reforms:
http://www.edwardtufte.com/bboard/q-and-a-fetch-
18
msg?msg_id=0001yB&topic_id=1
areas it would be naïve to dismiss much of the work we’re seeing
developed and to find ways to engage and actually improve the data
that public health practitioners are using.
In fact, numerous NGOs have developed guides and tools for the
general public and activists to take advantage of visualization tools
and technologies in their advocacy campaigns. The Tactical
Technology Collective (http://www.tacticaltech.org) has developed
numerous guides:
• Maps for Advocacy
(http://www.tacticaltech.org/mapsforadvocacy): demonstrates
how to create maps and host them on a site for advocacy
campaigns
• Visualizing Information for Advocacy
(http://www.tacticaltech.org/infodesign): a guide to best practices
in information design and data visualization for advocacy
campaigns
Columbia University’s Spatial Information Design Lab
(http://www.spatialinformationdesignlab.org/) provides an excellent
example of how data, mobiles and information design are coming
together to offer new opportunities for innovation in public health.
Based in the Graduate School of Architecture, Planning and
Preservation, they are a think-action tank focusing on how to creatively
use the visual display of information on cities, namely social data and
geographic data, to help make sense of a growing amount of data that
are available about cities and events. They recognize that the WAY we
present data can be as important as the data themselves. Aesthetics
matter (imagine that in your biostatistics course in a school of public
health!). The list of projects currently under way include
(http://www.spatialinformationdesignlab.org/projects.php):
The most interesting public health application involves visualizing data
on air pollution and asthma in local neighborhoods.
Visualization tools, as mentioned earlier are increasingly being
mobilized for advocacy campaigns as well. In many ways this is
nothing new---politics have always been influenced by visual cultures
and tools but now we have many more tools available to convert
complex data sets into visualizations that tell stories across a wider
range of communication platforms. Users can now take data sets and
create a variety of visualizations on platforms such as:
• Swivel.com
http://www.flickr.com/groups/innovation-dataviz/
In the most recent Apps For Democracy round the site, Datamasher.org
at the time of this writing was one of the finalists. Data Masher allows
users to select different datasets and create mashups or visualizations
of the datasets. Others are using the combination of graphic design
19
See http://beta.glucosebuddy.com, GlucoSurfer.org, SugarStats.com
(accessible via Twitter)
and visualization to produce tools for informal sector workers to protect
their rights in city spaces.
While the effects of public policies can be widespread, the discussion and
understanding of these policies are usually not. This series aims to make
information on policy truly public: accessible, meaningful, and shared. We
aim to add vitality to crucial debates about our future. At the same time,
we want to create opportunities for designers to engage social issues
without sacrificing experimentation and for advocacy organizations to
reach their constituencies better through design.
One of the forces behind the proliferation of data is the steady growth
of sensors. Mobile phones are being developed that have air sensors
and the ability for peer-to-peer monitoring (Motorola) and there are
some very interesting projects that have emerged in the past year to
take advantage of sensor data and visualization tools. Sensorpedia
(http://www.sensorpedia.org) is a new platform for sharing and
exploring sensor data from around the world. This type of platform is
going to be increasingly useful due to sensor data collection projects
such as Pachube (http://www.pachube.com) that is “a service that
enables you to connect, tag and share real time sensor data from
objects, devices, buildings and environments around the world. The
key aim is to facilitate interaction between remote environments, both
physical and virtual.” Individuals are able to connect their electricity
meters, iPhones, Second Life environments, architectural sensor data,
building management systems, wearable sensors, etc. and tag and/or
connect to other individuals and sensor environments to facilitate
interactions between real
3. Carbon impact
• CycleSense (http://urban.cens.ucla.edu/projects/cyclesense/):
“What if bike commuters could work together as a community to
document hazards to biking and make positive changes to their
local routes? UCLA’s Center for Embedded Networked Sensing
(CENS) is collaborating with Los Angeles bikers to make this
vision a reality. We are designing an application that runs on
mobile phones that enables bike commuters to log their bike
route using GPS and provide geo-tagged annotations (images,
text notes) along with automatic sensor data (accelerometer /
sound) to infer the roughness and traffic density of the road.
Using this information, we plan to create an interface to enable
bike commuters to plan their route based on both safety and
interest vectors.”
• DietSense (http://urban.cens.ucla.edu/projects/dietsense/):
“DietSense is an online service that allows you to self-monitor
your food choices and further request comments from dietary
specialists. Mobile phones with CENS participatory sensing
platform will let you record photographs of your meal everyday,
either automatically or by sensible notifications (based on time of
the day or location). In addition to photos, you are encouraged to
annotate the photos with voice or text messages providing
information not captured by the images (e.g. diet soda as
opposed to regular soda). Data (daily photos, timestamp,
location via localization techniques or user-reported), and
annotations (text/voice) are stored in password-protected
accounts on web servers for self-review and specialist assisted
analysis. When you log on to your DietSense profile you will see
personalized presentation of your dietary habit. Dietary
specialists can provide further analysis if you configure your
profile to be shared.”
• Family Dynamics
(http://urban.cens.ucla.edu/projects/familydynamics/):
“Increasingly, every family member has a mobile phone. Doctors,
therapists, and life coaches are recognizing that these phones
can help families collect and learn from data about their habits,
environment, and interpersonal dynamics. Working with the
Semel Institute, we are developing technologies to document key
features of a family’s daily interactions (e.g., co-location, family
meals, and consistency). Phone-based tools can collect data
otherwise invisible to wellness professionals who most commonly
rely on family member self-reporting. For example, families and
coaches can learn about behaviors such as consistency of
engagement at mealtimes using measures of proximity to one
another, as revealed by Bluetooth stumbling [Kotanen03]. Media
journals composed of images, video and audio from the phones
in combination with GPS and Bluetooth co-location data can
provide an evidence-based bridge between individuals, families,
and wellness professionals. We are also exploring similar
approaches to assess trends in the physical mobility and habits
of elders to enhance independent living. The first coaching tool
we are prototyping is Andwellness. It is a personal health self-
management application for the Android phones that supports
flexible geo-spatial, social and activity triggered reminders and
ecological momentary assessment.”
• Networked Naturalist
(http://urban.cens.ucla.edu/projects/naturalist/): “Engaging the
public in ecological research. We are creating a flexible
data collection campaigns for the modern, connected
citizen scientist. Citizen Science allows individual volunteers or
groups to observe, measure, and contribute to scientific
environmental studies. How have we made this experience even
better? Networked Naturalist is a collection of tools that
allows anybody to participate in the growing list of popular
citizen scientist projects, all designed to harness the power of
people who are not only concerned about their environments but
also want to do something about it. On-the-go, flexible data
collection schemes, tailored to your busy schedule, allow you to
use your cell phone text, email, and picture messages for data
collection, as well as sending us email or web forms from your
computer. You can see your data and how your data fits in
with other people’s data, and see how involved scientists
interpret those data — all in real-time.”
• Additional projects include the Walkability Project
(http://urban.cens.ucla.edu/projects/walkability/) , Surya (tracks
switch to clean cooking stoves in India,
http://urban.cens.ucla.edu/projects/surya/) and Remapping LA
(on the collective memory of neighborhoods in LA,
http://urban.cens.ucla.edu/projects/remappingla/
Source: http://captology.stanford.edu/
20
Russell, Ben (2004), "TCM Online Reader Introduction", Transcultural
Mapping Online Reader (Locative Media Lab), archived from the original
on 2006-07-20, retrieved 2005-11-13 (see in Wikipedia reference cited
above)
21
One can access videos on how this works in practice via
http://captology.tv
allows drivers to see the impact of their driving behavior on fuel
consumption. We can even find more public examples of persuasive
technologies in the sustainability field with examples such as the
carbon counter that was recently unveiled in New York City22. The
counter takes into account the major greenhouse gases and displays in
public the levels of gases in the atmosphere in real-time. The goal is to
get the public to think about their own contributions to global warming
and how they can change these behaviors. There are other examples
of public dashboards in public health where cities that have embarked
on obesity campaigns are using dashboards to track collective weight-
loss or BMI changes over time.
Fogg lists several factors below that are important design factors in
developing persuasive technologies.
22
http://www.scientificamerican.com/blog/60-second-
science/post.cfm?id=carbon-counter-unveiled-in-new-york-2009-06-18
Ian Bogost (2007) has developed a critique of BJ Fogg’s framing of
persuasion as running the risk of becoming overly coercive and lacking
the reflexivity to examine the framing of problems and finding
alternatives. Bogost approaches games through the discipline of
rhetoric to force the participant to rethink underlying assumptions
about the world or a particular issue. His company
persuasivegames.com has produced a number of interesting
‘persuasive games’ that either directly or indirectly touch on important
public health issues.
One of the goals of persuasive games is to stimulate critical thinking
through the use of rhetoric. In the games above everything from
portion size and profits of food companies (Stone City-Cold Stone
Creamery) to the contingencies of the geographical spread of
pandemic flu (Killer Flu) are scrutinized. Rather than playing to a
script where the user or participant is directed toward a pre-
determined outcome, as in Fogg’s use of persuasive technologies,
persuasive games can be useful in generating different framings of
problems and critical thinking skills.
23
http://www.gov2expo.com/gov2expo2009/public/schedule/detail/103
60
mHealth: As the cellphone has rapidly become the primary
computing platform for the majority of the world, most of whom live in
developing countries we’ve seen a great deal of innovation in a rather
short period of time. From mBanking (eg. M-Pesa) and m-payments to
m-agriculture and mHealth ventures, there is a rapid rush to develop
new services on mobile platforms. The Rockefeller Foundation’s Health
System Transformation programmatic area is putting eHealth at the
center of health system transformation and mHealth is a major piece of
the eHealth eco-system. In early 2009 the UN Foundation, Vodafone
and Rockefeller Foundation launched the mHealth Alliance to help
catalyze the development of standards, business models and
regulatory frameworks for mHealth to take off
What does this mean for how we think about innovation? It means
moving from a manufacturing perspective on innovation that
emphasizes the next great thing or piece of technology to social
innovations where platforms and technologies form part of an
assemblage of social practices, local histories, norms and values and
politics and how these can come together in the right form to construct
wellbeing and social outcomes. Often this means reconfiguring power
and expertise, new organizational forms, democratizing knowledge,
new ways of thinking about leadership. Open Health presumes
organizational forms that can move beyond command and control
systems based solely on professional expertise and that we can create
platforms based on new health commons (eg. shared data,
participatory budgeting, co-created knowledge, expert patients and
citizen scientists, risk commons/pools). Imagine a movement for
health reform that builds on a framing of health as an investment in
society, one focused on health and not exclusively medical care, an
ethics based on democratized knowledge and trust rather than
formalized and abstract bioethics, and outcomes based on broad
framings of health rather than absence or presence of disease, and one
based on networks (see Sakellarides 2008 and Kickbusch 2008).
From within this context Sakellarides asks how we can move from a
focus on the Electronic Health Record (HER) focused on individual
ownership of data for use in health decision-making to the Electronic
Personal Health Information System (ePHIS) framed as a “collaborative
innovation system” that promotes health literacy and citizen
empowerment. Below is a diagram of the building blocks of the ePHIS.
ePHIS Building Blocks
With the social media platforms and tools that I’ve presented in this
report we could envisage a collaborative platform that goes well
beyond the platform pictured above. Already cities are creating
collaborative platforms for catalyzing “collaborative communities”25.
The technological tools are here for creating a more open,
collaborative form of public health-citizen engagement if we look at
the tools below.
25
See the Future Melbourne example here:
http://cpd.org.au/article/collaborating-crowd-better-policy-development
While the literature of the “social media revolution” continues to
expand almost daily, less attention has been given to the political or
socio-technological aspects of what could drive the next generation
of public health practice. It is clear that new forms of cooperation
have emerged and are having important political, social and
economic effects. We are obtaining a better understanding of the
roles that social networks can play in health outcomes and there is
an increasing amount of attention paid to new organizational forms
and I have touched on each of these trends.
http://blogs.forrester.com/groundswell/2007/01/new_roi_of_blog.html
REFERENCES
Breaking Time Blog (2009). O’Reilly’s Quest: The problem (and benefit)
of technologist politics. August 25, 2009,
http://thebreakingtime.typepad.com (and response by Tim O’Reilly
August 26, 2009, iPhone Government: Tim O’Reilly responds to my
critique.
Demonaco, Harold and Eric Von Hippel (2007). Reducing Medical Costs
and Improving Quality via Self-Management Tools. PLOS Medicine,
4(4):e104.
Elliott, Mark; Darren Sharp and Matt Cooperider (2009). Case Study:
Collaborating with the Crowd for Better Policy Development.
http://cpd.org.au/article/collaborating-crowd-better-policy-development
Fung, Archon; Mary Graham, and David Weil (2007). Full Disclosure:
The Perils and Promise of Transparency. Cambridge University Press.
Miettinen, Satu and Mikko Koivisto eds. (2009). Designing Services with
Innovative Methods. University of Art and Design, Helsinki, Finland.
O’Reilly, Tim and John Battelle (2009). Web Squared: Web 2.0 Five
Years On. Web2summit.com.
Pew Internet and American Life Project (2009). Wireless Internet Use.
Pew Foundation.
Rose, Nikolas (2006). The Politics of Life Itself: Biomedicine, Power, and
Subjectivity in the Twenty-First Century. Princeton University Press.