Tomorrow’s Global Health Threats Require New Approaches: It’s Time to Experiment

When looking at what the World Health Organization lists as the 10 most pressing threats to global health right now, we see a series of challenges that cannot be framed as linear or clear-cut. Rather, their origins and ramifications are highly systemic, with multiple factors, actors, and drivers involved; as we learned through our recent work with independent health organization, Wellcome, where we collaborated to create conversations on a local level, in cities across the globe, that would help them in their mission to reduce antimicrobial resistance.

Air Pollution, Global Pandemics, Antimicrobial Resistance (AMR): while these are separate issues with different degrees of impact throughout the world, they all have something in common. With causes and consequences that go beyond national borders or individual behaviors or interests, they become hard to come to terms with – and crucially, respond to at the speed required. Framed in this way, they can be compared in nature with Climate Change, another highly systemic challenge – which is directly connected to most of today’s health threats. Just like Climate Change has been deemed almost impossible to tackle using the current systems, it’s becoming clear that we need to innovate on existing approaches if we want to be better prepared for the future.  This means overhauling dated models of disconnected efforts, centralized organizations, one-way directives and solutions that don’t delve deep into local and individual motivations. 

The need for coordinated, people-centered experimentation

Of course, there is no magic solution, or single piece of the puzzle that is missing. Instead, as we discovered through our collaboration with Wellcome, it is essential to keep experimenting with new approaches and efforts tackling different dimensions, which if properly coordinated can play a part in making individuals, societies and systems more prepared for current and future health challenges.

We believe that as Designers and Strategists, we can and should be joining in these experimentations. Our eyes and ears are hyper-sensitive to individuals’ needs, worries and aspirations; our hands and mindsets are eager to understand, fix and evolve complex systems. But more than anything, we should join not as protagonists, but as facilitators – to help translate needs and language, mend broken trust and enable innovation. 

How can we play our part in helping move from generalized, blanket solutions to ones that leverage cultural and contextual differences? From giving one-way directives to engaging people in two-way dialogue. From seeing health threats as vague, invisible mammoths to tangible, urgent challenges.

Here is an ever-evolving collection of dimensions that we have been exploring:

Two-way Intelligence

When dealing with complex health challenges, having a full picture and a constant stream of information is key, especially when it relates to human behaviors. The ongoing Covid-19 crisis has led governments to experiment with using technology to gather data and intelligence on people’s health and movements in their efforts to control the spread of the virus, with diverse approaches when it comes to privacy – from China and South Korea’s harsh but effective data gathering, to Israel’s advanced tools derived from its history in fighting terrorism, to other countries’ promise of anonymity.

These are intelligence measures that make sense in a state of emergency. However, we would argue that there is another, more nuanced and two-way type of intelligence that should also be experimented with. How can we keep our ears constantly open, to create a constantly updated bank of knowledge for decisionmakers to tap into when planning action? How can we inspire people to speak up and uncover not only what they do, but the motivations behind it – including their human stories, voices, worries, and aspirations? How can we make sure that we can gather information that is relevant locally – shining a light on cultural and contextual differences that might be key in nudging behaviors?

Actively engaging citizens with a hyper-local focus can be an opportunity to make people feel heard and mend broken relationships of trust, and to understand the contextual reasons behind actions, beliefs, attitudes, and behaviors in relation to health challenges. This can be especially effective when human behavior is, in part, a driver of the problem like in the case of Antimicrobial Resistance, where antibiotic abuse or misuse contributes to drug resistance; or in the recent case of the Covid-19 outbreak, where self-isolation measures caused irrational reactions that were deeply entrenched in cultural nuances and that could have been prevented and mitigated.

Within our own field research on Antimicrobial Resistance (AMR) in Italy, Thailand and Malawi, we identified and had conversations with people that seemed like the focal points around which communities naturally revolved. In lieu of a better name, we started referring to them as “Community Antennas”: vocal, outspoken and influential, they are able to broadcast and give a voice to stories, needs, and reasons behind behaviors of their community. This allowed us to pinpoint why a problem like AMR might have completely different causes and consequences in different parts of the world or even of a single country and might indeed require different responses. Lack of access to clean water is a driver of AMR in Malawi and a key priority to focus on there; self-medication is something to work on, for different reasons, in Thailand (driven by costs of healthcare) and Italy (driven by lack of trust in GPs).

Speaking face-to-face, however, is not the only option: technology is key to hyper-local intelligence in ways that go way beyond geo-tracking. Rio de Janeiro’s Meu Rio is a team that actively listens to citizens on a daily basis to identify hyper-local problems and possible solutions. Whenever an urgent action opportunity is identified they immediately notify the members through WhatsApp: not only listening to citizens, but also responding and communicating with them to create a two-way bridge. What if this approach was applied to health, too?

Think of the possibilities of having systems that used online and offline methods to constantly map behavioral and cultural differences, becoming open channels of listening and contributing – not “complaint dumps” but productive sources of information and suggestions. Imagine policymakers engaging citizens to co-ideate and co-design solutions and policy asks meant to prevent and react to health challenges, but with a hyper-local focus, ensuring that any new measures would actually be respected and that they work for people and not against them.

Hyper-local Collective Wisdom

Global threats are, by definition, issues that have no borders, with broad impacts on the whole world. It makes sense that there’s an emphasis on communicating simple, universal messages to the public worldwide, something that can help coordinate actions and response. Again, think of the ongoing Covid-19 situation and the struggle of organizations like WHO in stressing official recommendations, indicating correct behaviors and dispelling false myths. The same approach applies to most global health issues, AMR included, with governments leveraging these general messages in local awareness campaigns.

While these issues are global, they do take very different shapes depending on location. Since they are often framed as global issues, however, they end up being perceived as something that will eventually happen someday to some other people – especially in the case of AMR, the impact of which is less sudden and linear than pandemics. AMR is an example of something considered distant, overly scientific and disconnected from real people’s lives, language and context.

How can we then experiment on ways to communicate a global issue with a message that is coherent in its baseline content and especially in its effect, but that adapts and mutates in terms of nuance, language, storytelling country by country, region by region, even village by village? What if, rather than a singular, global message, there were millions of coherent stories tailored to go straight to the heart and mind of individual communities?

The starting point might focus on the drivers and implications that the health issue has on the specific, local context – making people feel like we are all “possible patients”. To explain such a complex issue, simplicity is key. Content should be easy to understand, accurate and relatable. We might build up a personal connection to the threat, driving empathy and urgency, and communicate how it affects everyone by using real-life stories that show the personal impact it’s already having on people and compelling, relatable, localized data that highlight the impact on the overall health, economy, wellbeing and living standards.

Communities can be involved in creating a unique and local story to connect the threat we are exploring with people’s everyday priorities, needs and worries, in a process of hyper-local Collective Wisdom creation.

Why don’t we ask the public to explain the topic in their own words, as they would explain it to someone they know? Letting the citizens co-create their own translation of the message, using metaphors or just examples that fit their life and community, might be the key to turn the topic into something that can have a resonance in their local community. It might be tricky to let public translate messages when it comes to scientific content such as medicine and health, that’s why the role of moderators and experts is essential in double checking and correcting any misunderstanding or unintended effects (like what happened to researchers in Thailand after a workshop aimed at raising awareness on AMR – after which a participant felt so much more confident that she began selling antibiotics from her village shop.). 

When people’s creativity is matched with the right message, magic happens: think of Wash Your Lyrics, which turned important but sterile 20-second hand-washing recommendations into an exponentially more effective and joyful communication tool. Or again, think of the unique role of African textiles as “Social Fabrics” – signifiers of culture and carriers of essential information.  In our own research in Malawi, we witnessed examples of women having co-created cloths, as well as songs and dances, that carried information about health, nutrition and hygiene that made sense for their community and that became part of the local culture and norms. 

What if you could create your own translation of health challenges, have an expert double-check its validity, and make it public for others to consult, as it happens for complex tech terminology made easy through user-generated platforms like the Sideways Dictionary? What if a complex issue like AMR could be explained in the same easy Ikea-style instruction that Oscar Gierup used to explain “The $wedish Justice System” to the President Trump?

Depending on the specific situation we can make use of different strategies to create a unique story to tell. In order to be effective, the content of our communication should be local and relevant to the context, which is only possible if the public (or at least their “Community Antennas”) is engaged at different levels in the process of translation, and in the delivery of the message.

Invisibility, Made Real

One thing that issues like Climate Change and AMR have in common is their sneaky invisibility. While some people and authorities are aware of their current and projected impact, too often many don’t take any notice before it’s too late – preferring to go on in “business as usual” mode.

How can we break this spell of invisibility and raise urgency in a way that inspires prevention and reaction, rather than inertia, indifference or panic?

Emergency preparation can provide some inspiration in how to communicate risks of natural disasters and change people’s mindsets in time, as shown by examples from North America to Asia. In Mexico City’s Iztapalapa Municipality, locals are already a few steps ahead in getting prepared – as a community – for potential risks. They not only use street art festivals to tighten community bonds and improve their neighborhoods, but they also have youth brigades, neighbourhood volunteers and a mobile class room that educates the people of Iztapalapa in a fun and entertaining, yet informative way on a daily basis and for free. This includes games to enhance capacity-building. By helping people to understand causes and consequences of risks, it is easier to improve their understanding and implementation of protection measures. First aid courses, firefighting strategies and evacuation drills are also part of the awareness building done by the civil protection service. Various simulation games teach everyone how the different alarms sound and in a role play simulation, neighbours pretend to be local authorities in order to decide danger levels. 

With the recent Covid-19 wake-up call, many voices are bringing attention back to the importance of preparedness in the field of health too, in terms of systems, tools, and responses. The example from Mexico shows us that it is just as important to prepare people and communities too, in terms of mindsets and behaviors.

Imagine engaging communities in role-playing a world affected by AMR in 5, 10, 20 years from now, and understanding together how their actions, ideas and asks can matter in changing future paths.

Community Wellbeing

The health of healthcare systems is central to ensure we are ready for future challenges, an idea only reinforced by recent events. Health challenges break through the illusions of individualism, reminding us how interconnected we all are as communities. To cite an example that is close to home for us at EPAM Continuum in Italy, it has been reported how our notoriously individualistic Milan, in the region of Italy worst-hit by Covid-19, has re-discovered a closeness and solidarity that many didn’t think likely. Younger people helping older ones, private-public synergies are examples of this, and rare silver-linings in otherwise awful times.

In our own research we uncovered how peer-to-peer support in relation to health has been, and continues to be, a reality in many locations where community ties have always been stronger, and where healthcare systems struggle to reach all corners of the territories. In rural Thailand, Village Health Volunteers are still central in extending the reach of healthcare to even the most remote communities and in tackling health challenges. Some researchers think the presence of hands-on volunteers that come from the communities themselves contributes to lower AMR incidence compared to suburban communities where sick poorer citizens don’t have this option and are left to their own devices and have to rely on over-crowded hospitals.

Rural Malawi also relies heavily on Health Surveillance Assistants and Village Health Committees, which take a lot of pride in the role they have in changing behaviors and organizing action within their own communities. Again, knowledge of local culture and priorities is key: many rural Malawians avoid hospitals at all costs, fearing long journeys and social distance in relation to health professionals, and preferring traditional healers from their own communities instead, who they know personally and could better relate to their day-to-day problems. Having understood this, Malawian Health authorities have taken a creative approach and begun experimenting with collaborations between traditional healers central to some communities and public hospitals. The healers agree to refer patients that are in need of modern medicine to the hospital, while in turn focusing on spiritual and social treatments. In return, public hospitals refer end-of-life patients to the healers, for palliative and emotional care.

How can we learn from these examples, changing the paradigm of individuals having 1:1 connections with centralized healthcare systems? Should years of shifts towards more and more individualistic societies be inverted if we hope to face tomorrow’s health challenges? Could communities be engaged in a more systematic way to become an “extra arm” for when health systems cannot help or for where they cannot reach?

We see these as thought provocations for everyone that already has a stake in shaping tomorrow’s health response, or those who want to start making a contribution. To actually make progress in this field, coordination, openness, and building on each other’s ideas is key.        

Original article found here.