NESTA on “people powered public services” and beyond the poverty of imagination

In my mind one of the most innovative organizations in the area of service design, cooperation and public services is NESTA.  They recently published a fascinating report,“The Human Factor”, that examines how co-creation with the public and patients within the context of the NHS can save both money and lives. The co-creation, cooperation, commons themes that run throughout the report are central to the work I’ve been highlighting on this blog around what I’m calling “open health”. The report is a must read for anyone interested in innovation in the healthcare or public health arenas. We’re going to have to become experts in this way of working in the future but getting organizations to think beyond traditional partnerships and anemic forms of ‘engagement’ will be challenging. Below I’ll provide some of the key insights from the report.

  • Beyond Efficiencies:  Just thinking in terms of saving money without changing the nature of service design will only get you so far.  What we need is radical redesign.  Think about how to design for desired outcomes rather than purely on existing, often dysfunctional and inappropriate infrastructures
  • A good case study of redesign is NeuroResponse, a social enterprise incubated by the Young Foundation’s Launchpad that addresses the unmet needs of patients with neurological disorders through the use of existing telecommunications infrastructures so that more patients can receive treatment at home. That is, moving from an acute care model to community care. The cost of a diagnosis of MS currently costs the system £17,000 per person or a total of £400 million of which the majority is for in-patient, hospital-based care. Telemedicine has the potential to save millions.
  • The Expert Patient Programme is another example of how self-care is being used to improve outcomes and patient satisfaction.  Hospital admissions have been reduced by 50% and visits to GPs reduced by between 40-69%.
  • Community-based initiatives tend to be better for behavioral change than top-down approaches. The Knowsley Primary Care Trust created a partnership for Wellbeing that focuses on cardio-vascular disease prevention at the community level and works through pubs, bingo halls and shopping centers. The result has been a 28% reduction in cancer morbidity rates and 32% decrease in smoking.
  • Well London is a consortium of health, environmental, education and arts organizations that invests in community projects for health behavioral change.  This includes projects like Healthy Spaces that transforms open spaces into greener, more attractive places.  Community mental health is one of the focus areas.
  • Transforming Innovation: perhaps the most difficult challenge is changing the way organizations think about innovation.  The US public health sector is in dire need of this change in mindset.  Getting funders AND organizations to take risks, experiment, move beyond dated ways of thinking about technologies and community is a challenge.  One of the platforms they’ve used in the UK is Patient Opinion, a platform that enables users of the NHS to provide feedback and develop networks of user-citizens to provide the essential feedback that innovators within the system can use to improve services.
  • Open Innovation for behavioral change: The Big Green Challengeis another initiative designed by NESTA focusing on climate change and how communities can reduce their carbon emissions. The program is essentially a platform that crowdsources ideas for innovative strategies and provides awards for the best proposals. The concept has been extended into the obesity/diabetes space through the Healthy Community Challenge Fund to test and evaluate ideas that make activity and healthier food choices easier.

In the month or so since I posted the draft white paper on open health and platforms for public health 2.0 below I’ve receive quite a bit of positive feedback from most quarters. One of the criticisms I receive from many within mainstream public health programs is that the content is bit ahead of where funders are in the present, too much in the future. I strongly disagree, these tools are here now. We’re at the BEGINNING of a prolonged financial crisis and the old ways of ‘doing’ health and public health are failing too frequently. This is the time to innovate and think about how to design more innovative approaches, innovative institutional cultures and experiment. I was listening to a conversation on stimulus funding in public health and how organizations are being asked to collaborate as they compete for funding from the federal government. We’re still thinking in terms of partnerships rather than networks. We rarely think of new business models that we could use in public health and couple these with user-led innovation and co-creation paradigms. We may not be able to fix the poverty of resources in the short-term but we can address the poverty of imagination in health if we open up to new paradigms.

Public Health 2.0: Re-Mixing Public Health Narrative Report

About a month ago I posted the presentation below on social media and public health. I’ve had quite a few requests to do more than provide a powerpoint so I’ve put together a very rough draft of a descriptive report on the presentation. My plan is to dig deeper into the content and do more analysis with some scenarios around concrete problems where we could apply these tools in a more robust way as well as to do some thinking about what social media means for health politics and policy innovation. Keep in mind that the report is merely a descriptive overview or scan at the moment. I welcome feedback and anyone with interesting case studies or experiences with the tools in both domestic and global health settings should feel free to share. You’ll note that the mobile health section is incredibly brief, but this is not an indication of my level of interest in the field as numerous posts on this blog indicate. I’m particularly interested in the emerging discussion on cloud computing and how this could play out in the health arena over time.  I’m also doing quite a bit of consulting in this area so if you know of any organizations that are in need of help on the open innovation, social media and health front please feel free to contact me.

Re-Mixing Public Health: Platforms for Public Health Innovation

I’ve put together a rather long presentation that has an introduction to social media for public health and then moves to a series of examples of different types of platforms used for collaboration and innovation in the social sector, government 2.0, public health. The presentation highlights the growing challenges that we face in public health with complex, multi-sectoral problems and the changing way(s) we’re seeing organizations think about the problems. I’ve decided to include everything from mapping tools and data visualizations, open innovation platforms, mobile and urban computing, sensors, etc. The presentation highlights a number of technologies but the real gist of the story is that we need to rethink organizational structures and networks, governance, the politics of data, emergent forms of technological and biological citizenship and not just think in terms of technologies, but rather socio-technological change and how we’re going to engage with these changes. The tools are already here—it requires a shift in how we think, and that is where we need to innovate. I’ll be putting together a longer white paper on this later in the summer.

There’s Wiki Government, so what about “Wiki Public Health”: Public Health Innovation III

I recently read Beth Simone Noveck’s Wiki Government: How Technology can Make Government Better, Democracy Stronger and Citizens More Powerful as part of my research on rethinking public health and innovation in public health. From the outset Noveck hits a chord with me in asserting that it is time to rethink democratic theory and the design of governing institutions to bring them in line with the age of networks. Or as I like to put it, we’re constantly struggling in a world of analog institutions and practices embedded in network societies. Public health, a laggard in my opinion, is rapidly falling behind other disciplines in thinking about socio-technological change and the implications for the field despite the tremendous growth in interest in mobiles and social media widgets at the CDC. These are merely the tip of the iceburg.

Noveck begins with some examples of how networked platforms and practices are changing industry. From IBM’s World Jam that enables employees from all over the world to work collaboratively and create proposals for new projects which the CEO has allocated $100 million to implement the best ideas, to InnoCentive’s success as an open innovation platform (she illustrates the success with the following antidote–a difficult to solve chemistry problem (in industry) was solved in four hours! by a lawyer), we’re seeing some networks perform quite well in providing solutions to problems. That is, provided they are managed and constructed in the right manner. And this is where Noveck’s work is quite useful to the health practitioner who wants to innovate.

If you’re not familiar with Joy’s Law it might be time to acquaint yourself with this axiom that states that no matter who or where you are, most of the smartest people work for someone else. This then begs the question of how do I tap their knowledge and expertise to accomplish my goals. Recognizing this is not difficult for many in government, and in my experience, public health. We’re too accustomed with one-way communication channels and how often have you raised the issue of user-generated content and the health expert hands go up immediately to question laypersons’ knowledge claims? But face it, health experts no longer have a monopoly on health knowledge, particularly as our knowledge of the social determinants, environmental determinants, etc. grows. Noveck points to political theorist Roberto Unger’s notion of “institutional fetishism” whereby many institutions believe that only a select and known group of ‘experts’ can assess science and citizens are only really capable of expressing values and opinions, is clearly one of the hurdles we face in the new realm of what I prefer to call “open health”. Philip Tetlock observes that historically expertise has not translated into an ability to make better forecasts (eg. he uses the example of Gandhi who in 1940 greatly underestimated the violence that Hitler would bring to Europe).

Noveck provides a tour of the examples out there where government and industry have taken Joy’s Law to heart and actually built platforms to innovate in the public sector. Her main example is the one she was mostly intimately involved with “Peer-to-Patent” the US Patent Office’s platform to innovate around the process through which patent claims are examined. I won’t go into details here but would rather focus on the insights and bring this to how we might use these insights in health. One of the interesting examples she found in the public sector was Bridgeport, Connecticut’s CityScan (pdf) that was a platform city government created to work with local communities to rescue derelict land-use sites. Citizens worked with the city to rehabilitate, map and document the rehabilitation process. We’re now seeing a proliferation of platforms similar to this take off in the past year. Check out SeeClickFix that enables citizens to identify an issue in their community that needs remedied and then crowdsource responses and make the invisible visible through civic participation and engagement with community leaders.

What we’re seeing is a growth in tools that enable us to visualize problems and data which in turn can facilitate action. Platforms such as Many Eyes and Swivel as well as the open API of Google maps enable people to begin creating and using data. There’s even an open data movement in the UK that is working toward making taxpayer funded data sources in government more widely available and accessible. Rather than the traditional database/knowledge management ethos we’re accustomed to, we need to begin to think about the social life of information. Or, as Noveck puts it, we need to think of every piece of information as a potential community. To illustrate this point she looks at the policies of Vivek Kundra, the former CTO of Washington, DC who became the CIO in the Obama Administration due to his work on opening up data and building applications for citizens to engage with data. He made every agency in the DC government create feeds from their websites that alerted the public to new data sources. In essence, he was creating a “digital public square” and was recognized for the work he did in creating Apps for Democracy that enabled citizens to frame a problem and then programmers could submit software solutions. This co-created mode of governance produced over $2 million worth of software for $50k in prize money (see first round winners). When Bob Riley, the governor of Alabama recognized that the fragmentation in the DHS crisis information was going to be an impediment, he created the Virtual Alabama Platform that enabled greater sharing of data, mapping and aggregation situated in a cloud computing context rather than in localized databases. This took $150,000 and 10 days to create a system that works across multiple sectors. Some of the other tools that the public health community should be aware of and consider using are:

Freebase: an open database projects
Public Resource: enables people to buy public information and then post it freely on the web (goal is to make data searchable and usable)
Urban Institute’s National Neighborhood Indicator’s Partnership: an effort to democratize information that can be used at the local neighborhood level for policy-making and community building
FixMyStreet.com: user-generated input on problems at the neighborhood level
MyBikeLane.com: documenting bike lane violations to make cycling safer
F** This! via the blog, The Infrastructurist, a version of SeeClickFix.com

We need to think what the public health analogs of these platforms might look like? How can we make them available on mobile phones? How can we aggregate feedback on platforms to build policies collaboratively with publics? These are all data points for where innovation in public health, in my opinion, is going. Noveck points to these platforms as modes of organizing for innovation.

The challenge is to translate information into knowledge that people can work with and the growth in tools and thinking about infographics and visualization tools has been dramatic in the past year. Once again, thinking about how to make the invisible visible and build actionable data and platforms that can empower citizens and communities to use data, build policies, act on the data, change behaviors and environments.

One of the key challenges is the tasks of collaboration and cooperation and this is particularly relevant to public health. Policy wikis are one of the tools being developed to engage communities and work across silos. For example, rather than issuing a directive to the public as the final product one can create a wiki early on in the policy development process that contains relevant background materials, underlying research claims and then allow the public or selected members, depending on circumstances, to comment. Reputation systems and rating systems such as Digg-like tools can be used to rank or rate user contributions (these can help filter and prioritize ideas). Noveck views efforts in this space to be something akin to the IBM World Jam or “civic jams” to strengthen democratic institutions and input. We can use these internally with various public health partnerships where the growing complexity of issues and stakeholders represents a challenge to efficient collaboration. What about building a policy wiki for community benefit partners with non-profit hospitals, for example? Suggestions for best practices, innovative approaches and programs can be posted to seed the wiki and visualization tools could be created to compare approaches, impact and introduce transparency so that community benefit programs begin to share data and experiences with an eye to optimizing impact of investments. Visualization tools are also helpful in assisting organizations to reduce duplicity of services and to develop metrics and benchmarks for impact. Once these tools become used effectively the same institutions will have better data and a better facility for demonstrating benefits to the public and government.

So what are the lessons that Noveck learned from her work with “wiki government” in the past few years? She provides ten important lessons:

1) Ask the right questions: as with any open innovation process, asking the right question is central to success. You just can’t build a platform and people will come. You need to break problems into manageable chunks and provide the tools and resources for people to solve the problem

2) Ask the right people: there is a facile populism out there around ‘crowdsourcing’ and other open innovation models that can prove counter-productive. Just opening things up to a cast beyond the usual cast of characters does not automatically translate into new innovations. You still need to think about the standards of participation and who to open the process up to and when.

3) Design the process for the desired end: groups need to know what is being asked of them and you need to break processes and problems down into discrete steps.

4) Design for groups not individuals: here it is important to recognize that people often work in short bursts of time when working in groups. Participation needs to be enjoyable and engaging and reward in ways that working alone does not.

5) Use the screen to show the group back to itself: people need to see themselves as part of a group or “mini-movement” when they’re working at a distance or in virtual communities. There are visual tools for people to see who is doing what and to enable individuals to nudge one another toward desired outcomes. Mapping tools can be very helpful.

6) Divide work into roles and tasks: Parcel work into small tasks. People can assign themselves roles. A good example is Scratch developed at MIT Media Lab is a tool created to help students to write software by giving them visual building blocks, similar to Lego pieces. In other words, just as social movements have a division of labor, so do online communities.

7) Harness the Power of Reputation: most good collaborative platforms have ratings systems that enable participants to rate each other’s submissions. Many of the collaborative, open innovation websites use these tools to filter and prioritize. Here are some examples: Dell’s Ideastorm, Ameritocracy, Knol, White House 2.

8) Make policies, not websites: It is not just the technology, stupid! You need a systems-based approach that looks at the problem as a whole and look at policies and practices and how they must change to become more collaborative. Know where you have expertise and where you need help.

9) Pilot new ideas: Networks are experiments and probes. Not everything you start will succeed but you need to be able to, as they say in Silicon Valley, fail early and fail fast. Make it clear to participants when you’re piloting. I often hear public health folks wanting to get on the train now that these platforms are taking off and they scratch their heads why no one shows up to the wiki or blog. It takes some work and time so you need to try out new things, get over the build the site and they will come attitude and figure out who is going to be the idea gardener(s) for whatever approach you take.

10) Focus on outcomes, not inputs: Have a clear idea of what you want to accomplish. Is it legislative outcomes, community impact of programs, ideas for new approaches to a problem?

Public Health Innovation II

To continue with the Health Policy Innovation review and discussion, part II will focus on innovation systems and platforms that Kickbusch et al propose. We’ve all heard of the Personal Health Record, the elusive holy grail of “the next big thing” in health care. Now what would the public health analog of this be? The authors here point to the concept of a “Personal Health Information System” that forms the backbone of a public health innovation system that has shared, co-created aspects that distinguish it from the PHR. The goal is to use the PHIR as a “community-centered collaborative innovation system”. The old model of public health was one that focused on educating people to behave in a healthy way and the public health system will offer protection from epidemics, safe access to food and water, and access to medical care. We’re now shifting to a model where patients in the health care system are increasingly considered co-producers, citizens rather than consumers, and we’re seeing the creation of bottom-up health commons (a common theme in this blog).

The traditional model of biosurveillance and epidemiological models are more command and control types of regimes that are now shifting to what the authors call “integrated health governance”. This means a new vision of health services that is less vertically driven and fragmented to a more value-based, citizen-driven model based on health networks. This is where the PPPP model, of public-private-partnerships that are “people-driven” come in. In order to facilitate this model we’ll need to think about how to develop platforms that offer the tools, often co-created with citizens, that could promote desirable changes in behaviors. There are some interesting working examples of this way of thinking and doing innovation and one of the most impressive examples is NESTA in the UK which has been one of the leading centers for rethinking public services through the broad lens of open innovation, co-creation, design.

NESTA and the Young Foundation’s Health Launchpad could provide interesting conceptual approaches to what I have in mind with the “Public Health Innovation Center” concept I’m working on at the moment. This could be the basis of a node for the ePHIS mentioned above. This system, as structured in the Kickbusch volume, would bring together the health policy sector and the need for health information governance, to a market-driven sector that provides technology platforms, to localities where specific health strategies are generated, to professional health provider networks. The citizen health information node is at the center and provides the platform for each piece to feed in for health innovation through health knowledge networks (I’ll add a diagram at a later point that makes this easier to visualize). A model based on this concept has already been deployed in a rural community in Barreiro, Portugal with high diabetes rates. A community of 1050 with 65% prevalence rate of diabetes became the site of the iCitizen, a citizen-centered health information system that contains both PHR and ePHIR with a focus on digital literacy and participatory research was begun in 2008 to test the concept.

I’ll be adding part III of this series through a discussion of “Wiki Government” and soon to be followed by an analysis of transparency policies to create the building block of a more robust picture of Public Health 2.0.

Public Health Innovation I

I’ve been focusing on pulling some thoughts together to inform the creation of a new health innovation center and along the way I’ve been reading some interesting new books that have been quite helpful. I’m going to provide some nuggets from each and how they might be brought together to create something quite useful.

The first piece is Ilona Kickbusch’s edited volume “Policy Innovation for Health”.41oj-wTFujL._SS500_ Kickbusch begins by recognizing that we have undergone a transition from acute care to managing chronic diseases that must now be approached through a broader multi-sectoral lens (yes, we hear this all the time but can you find more than a handful of interventions that actually do it or do it well?) and, news for the public health community, we have to do this through partnerships with the private sector. Innovation in this new context will revolve around the following variables: affordability, quality, and efficiency. The problem with what we call innovation in the health sector has too frequently been about short-term reorganization of health care systems that lack any kind of long-term perspective. The OECD perspective on health innovation is rather typical–genetics and biotech remain the focus or framing disciplines/sectors for where innovation lies (OECD should really take a hard look at the numbers for biotech, they’re actually not that impressive to date). Framing health and health innovation is an important first step and to do that properly we must recognize that the boundaries of health are fluid and that most attempts at thinking about health innovation remain within the health system.

The organization of health is increasingly separated from the management of disease and illness so we’ll need to think about the health impact of policies ACROSS the policy spectrum (ie. transportation, agriculture, built environment, etc.). Most health professionals who still do not exist in the paleolithic age get this, but doing it is another thing. There are some examples such as the Canadian Index for Well-Being that have tried to create frameworks for putting this broader approach into place. And I like what this means for how we need to rethink what we mean by innovation (or what I am increasingly referring to as social innovation). Or, Kickbusch and colleagues term the “innovation of innovation”–health innovations change society but the societal processes of innovation in health changes the nature and characteristics of innovation. Or, as science and technology scholars may have it, innovation and health are mutually constituitive.

Open innovation as a paradigm for health is coming fast but faces some hurdles in the health sector. Even though we have a culture of peer review in medicine, medical organizations are far from transparent. This will get interesting in the US as the Obama Administration tries to bring more transparency to all sectors of government. We’re bound to hear the old story of how health is different and the privacy flags will go up to try to stop the conversation dead in it’s tracks. Nevertheless, open innovation demands a more networked governance model, greater attention to social determinants of health and greater reliance or partnerships (or I prefer networked models over traditional partnerships). And we do see some interesting efforts to put this into place such as the “Nordic Region as a Global Health Lab” project that aims to focus on prevention and build strong civil society organizations, open data, innovative science environments, and user-led innovation platforms to drive innovation in the health sector.

I’ve been working on the open health paradigm for the past several years and appreciate the attention this book gives to the proliferation of new sensors, diagnostics and mobile devices that are increasingly creating the tools and ability to create platforms for user-led innovation in the health sector. Recently I’ve been thinking about how we can build on the AppsforDemocracy.Org experience and build something akin to “AppsforHealth” to solve citizen-generated problems, for example in the Healthy Cities format. These authors point out that a focus on building health literacy will be important. However, I think this is going to have to be a two-way street–health professionals need to learn a lot more about actually existing and lived experience of chronic diseases and their broader context through, what the authors of this book view, PPPPs, that is, public-private partnerships with PEOPLE. Through true partnerships we can begin to build greater transparency and understanding of the social and environmental determinants of disease and give people the tools to see the connections. We talk a lot about the concept of “dashboards” in sustainability, such as the mpg dashboard in the Prius, or smart grids for the home to monitor electricity consumption. What would these look like in health given the rapid pace of development in the mobile health/bluetooth device space in health?

Networked governance and what the authors refer to as “Virtual Reorganization by Design” are going to be central to innovating in health in the future. First on the table is how to build networks across sectors and build trust, commitment and share risk are some of the issue that will need to be developed. And there are also different types of networks in terms of structure and function that will need to be considered. Some of the key competencies required to design and maintain these networked structures will range from the ability to manage non-hierarchical domains, managing interdependencies of stakeholders and having the ability to manage multiple roles and accountabilities across time and space. Furthermore, networked organizations require a change in thinking from one that focuses on inputs and outputs to a perspective informed by thinking in terms of investments and outcomes. Managing the white spaces in networks becomes extremely important since this is often where new innovations are discovered.

Much of the thinking about innovation in health has been about technologies. Witness the interest in social media and mobiles in health at the moment. But it is important to recognize that even in these areas, innovation is not just about the technologies. I don’t know how many mobile health conversations I’ve had of late where the consensus has been that we need policy innovation desperately for this space to take off and have the impact that we’re hoping for. Kickbusch et al. are correct to point out that innovation in health is not about technology, but rather creating value in a knowledge society. What this means in mobile health/health 2.0 and then some, is that we’re in a historical moment when we need to think about managing the mass customization of health information and creating tools to enhance health and digital literacies that lead to citizen (not that ridiculous health consumer fantasy) empowerment.

Healthy Cities 2.0

My post the other day on the gaps in thinking on resilience was motivated by an effort to pull together some threads from this literature, social media and transparency, public health 2.0 and urban planning 2.0 to help rethink innovative approaches to the Healthy Cities and Communities movement. This was a movement that began in the 1980s to bring together urban planning, public health and grassroots movements to improve health in cities and regions. Joe Flower has an excellent, but somewhat dated overview of the approach and resources here and the Center for Civic Partnerships has a lot of useful resources as well. One can also find some interesting examples of “participatory budgeting” used by municipalities around the world prior to the social media ‘revolution’ we’re witnessing today.

In the last year there has been a tremendous amount of innovative work around mobilizing social media and mobiles to open up city planning, opportunity mapping, smart grids, green cities, policy design, open data, and what I called “open health” (building on the work of the UK Design Council’s RED Project by the same name). I also think the idea that “Villes 2.0” has of the city as an open innovation platform could be an organizing theme to structure Healthy Cities 2.0 interventions around. I’d like to look at locative media and learn more from my colleague Andrea Saveri on open education and learning practices as well.

Here are some examples that we could potentially build on to rethink Healthy Cities in the so-called Network Society:
Wikiplanning
User-Generated Cities
DIY City
Vancouver’s open city concept
eParticipation in the EU
The Open Planning Project

Some resources:
via air roots, “Singular Text, Many Authors: User-Generated Urban Plans”
Michel Bauwen’s P2P Urbanism tags
health launchpad
Open Data is Civic Capital
Open Data Principles
refarmingthe city
The Where Project

And there are many more examples that I’ll be blogging about as we develop our thinking.

A Summary of Ecological Intelligence by Daniel Goleman and some thoughts…

I recently read Daniel Goleman’s “Ecological Intelligence. How Knowing the Hidden Impacts of What We Buy can Change Everything.”. I’ve been interested in the idea of transparency or what Goleman calls “radical transparency” that mobiles connected to databases on health, social and ecological effects of products can bring to how we think about consumers and markets. As readers of this blog are aware, I’m not very enthusiastic about the use of the word consumer and find it overly burdened with cliches and short on analytical insight on actually existing subjectivities in the marketplace. I find Andrew Barry’s work that provides insights into the development of “technological citizenship” or Adriana Petryna’s work on “biocitizenship” quite relevant to many things going on in the sustainability movement despite what the market researchers say. Goleman’s book does not delve into the politics of sustainability but he has some insights into how the platforms that foster radical transparency may work in the near future.

Pointing to the complexities of doing Life Cycle Assessments of products and the challenge of dealing with multiple framings of these assessments, Goleman, is interested in how we can get the right level of information to consumers at the right time so that consumption behaviors change and produce outcomes. Industrial ecologists who work in the area of LCA such as Dara O’Rourke, the founder of GoodGuide.com, are leading the charge in this arena through the creation of platforms that are capable of collecting the most important data and then finding ways to lower the costs of information access. Goleman quotes Nobel economist George Stigler who pointed out that information has a price and that is the “cost” of searching for it. When you’re looking at the impact of a product on the environment, the social costs of global supply chains or sorting through the health data on every component of a consumer product these costs remain extremely high, unless you have a Good Guide to do this work for you. GoodGuide.com currently has information on over 70,000 products that comes from hundreds of databases with over 80 million bits of information. Good Guide now has an iPhone ap that enables consumers to retrieve ratings of products as well as make lists based on the filters-social, ecological and/or health-that they prefer. They’re looking to the next generation of the service that will rely more heavily on sensors (RFID) and automatically alerts the shopper to the status of a product or an alternative route that analyzes one’s credit card purchases. While platforms and approaches may vary, the point is that new forms of transparency are making their way into the marketplace so that citizen-consumers will find it increasingly easy to consume through whatever normative filters they chose.

Some of the other chapters focus on the work of neuroeconomics and the experience of shopping, factors that Goleman claims need to be considered beyond just the provision of information or addressing information asymmetries for ecological outcomes to arise out of services such as GoodGuide.com. These platforms are proliferating with cosmetic examples such as Skin Deep and the Hannaford supermarket chain’s Guiding Stars nutritional guide (or see Adam Drewnowski’s Nutrient Rich system).

One of the key insights about the success of these platforms speaks to the criticism I have of the use of the word consumer. O’Rourke and others see the scaling up of these platforms as likely to work through engagement with small communities of activists and people passionate about a cause. He interviews Harvard’s Archon Fung who points out that the first and second generation transparency efforts were largely regulated approaches, or top-down. Third generation, as seen in Good Guide, are driven by vigilant, active consumers, or citizens as I would have it. This need not be an adversarial, hostile relationship either. Progressive companies can engage with these citizens and innovate through engagement with feedback. I would add that many of the current clean tech/green business innovations are precisely this form of innovation–through an engagement with activist and critical discourses that were once adversarial in nature but companies adopting a more constructivist/open approach who actually embraced permeable boundaries of the firm stand a better chance of innovating.

Goleman argues that while we see many examples of consumers exhibiting purely price sensitive shopping patterns that this will begin to change as these transparency platforms continue to grow and this will have profound effects on industries dependent on industrial chemicals. The chemical industry has a very different perspective on toxicity than consumers, particularly consumers demanding more access to data on the environment and their health, ie. biocitizens. And it is getting easier to find other biocitizens sharing your values and to amplify one’s voice. One of the key disruptors in development is Earthster, a B2B, free, open-source, web-based program that enables businesses to obtain a snapshot of their LCA-supply chains. This enables businesses to benchmark themselves against industry averages. Here information becomes power for purchasers who can use this data as leverage with suppliers. The public sector can use this data to combine efforts to exert more power in the marketplace. In essence, you have a data commons for LCA that becomes the market maker! There will be tremendous opportunities for companies able to take advantage of this information and drive disruptive innovation.

I’ll close with an idea. What would this look like in the health space, one that is notorious for information asymmetries and irrational pricing. What if we brought together the right mix of collaborators to develop the radical transparency platform for healthcare and work with employers tired of paying more and getting less in return? Not one purely focused on hospital reveiews and rates but one that focused on performance around prevention or who keeps people healthy? Who would benefit and who would lose? The beneficiaries of the current dysfunction would have much to fear….Now, listen to the hisses of the policy wonks who can tell us again, why it wouldn’t work…..

Resilience: some critical questions

Last week I met with a former colleague, Andrea Saveri, who has been thinking a lot about the literature on “resilience” that has been gaining a great deal of traction in the current economic environment. She has an interesting blog post here on it and we’re thinking about how we can use the concept with some ideas from social media and the literature on cooperation and social networks to re-think the Healthy Cities movement. Jamais Cascio has also been writing about this in Fast Company.

After reading Jamais’ piece I found there are some major holes in the work that we need to address to make this more useful for public health. Some of the most interesting conceptual work applicable for public health practitioners is actually coming out of the STEPS Centre (IDS, University of Sussex) and they have an excellent paper from a workshop they which focused on some of the gaps in the current literature. Below I’ll provide an overview of some of the top level critiques/issues they raise.

First a little background. Their focus is on how the resilience literature could be appropriated for discussions in international development framed by concerns for social justice, equity and poverty. Therefore the first question is resilience of what, for whom? Systems need to be disaggregated if we’re going to move from abstract discussions of complex systems to embodied knowledges and systems. The discussion also needs to be informed by the different framings of risk—from risk (that can be quantified) to uncertainty, ambiguity and ignorance (where neither outcomes nor probabilities are known). This opens up the possibility to talk about the politics of resilience and risk and how organizations/polities can occlude or marginalize particular framings of risk (eg. those who warned of the risks of derivatives for years prior to the collapse were frequently marginalized and ridiculed by the financial sector and business editors). Therefore strategies of resilience and sustainability are often about opening up the debates to new framings of risks.

Some of the respondents to the resilience discussion raised issues of the need to respond to threats that are raised first and foremost, but rather than just responding it is a question of the appropriate response in terms of timing, intensity and resources as Christo Fabricus would have it. Furthermore, the resilience literature comes out of the discipline of ecology, adaption from economics, and in political science/social sciences we have concerns over justice and democracy. These are normative positions that should be brought into the resilience discussion. For example, the World Bank privileges optimality, stability and control whereas many grassroots organizations would privilege equity, social justice, etc.

STS scholar Wieber Bijker notes that the resilience concept comes more directly from engineering and assumes rational actors and a foregrounding of technology in the discussion. He emphasizes that what he is looking at is the vulnerability of “technological cultures”–society and technology as co-produced (the central framework of most STS theoretical discussions). Bryan Turner (sociologist) criticizes the resilience literature for always privileging the biophysical over the social and we see this through the use of “adaptive cycles”, “collapse”, “renewal”, etc. An alternative would look at social, political and economic structures and how they shape access and control to resources and viewing the environment as both a setting and product of human action. Others raised similar issues and throught that the discussion needs to show greater attention to voice, reflexive governance and the politics of framing sustainability goals.

The framing issue was of central importance and always returning to whose resilience is at stake. Social scientists are extremely wary of the deployment of the term “system” for its inherently conservative meanings–preserving the system that may have produced the risks, inequities in the first place. Sheila Jasanoff asks which bonds in systems are worth preserving? She wonders how the resilience discourse can be framed to enable not just survival but rather normative dimensions of life from ethics to politics and justice or self-organizing and self-regulating systems in the context of larger, global systems of governance of sustainability regimes.

The workshop ended with some recommendations on future possible directions. These included the need to analyze networks and relationships in the systems at hand as well as attention to the alternative framings, narratives and imaginations that different actors may have about socio-ecological-technological processes. Re-surfacing normative concerns of various actors speaking about vulnerability, sustainability and resilence. This is part of understanding how power and politics are at the heart of the question of resilience and sustainability.

Rethinking Innovation Systems in Africa -CODIST Presentation

In late April I participated in the UN Economic Commission for Africa conference on Science, Technology and the Knowledge Economy in Africa conference. I gave a short talk for one of the plenary sessions that was ostensibly focused on innovation systems for African Science and Technology. An overview of the conference and some of the background papers as well as policy recommendations from the event are here. My talk was structured around the failure of some current models that were adopted from Western systems as Lydia Brito from Mozambique pointed out here. These are legacy systems largely based on linear Schumpeterian models that leave many gaps between each successive stage and result in few innovations making it into the market.

The presentation is below but here is the general flow. I began with the insight from Helga Nowotny’s work “Insatiable Curiosity” that begins with an insight taken from sign language. In American sign language the sign for the future points forward, in African (South) Sign Language the sign is the opposite. There is an important conceptual insight here for how to think about the future and innovation. The African sign tells us that what lies in front of us is the past, because only IT is already known. The future lies where we cannot see it. Therefore the future is not just about the new because we recognize the new in terms of the past (the known). This points out a tension that we often see when thinking about science, technology, innovation and the future. There are those who only see dark futures abundant with risk, and those who see techno-utopian futures. Fear of the future can suppress curiosity. Innovation is often a way of talking about a future that promises something new, it tries to tame the tensions. “Culture” is the issue that is often raised by those whose fear of loss of control of the future is jeopardized by innovation. This does not mean that every reference to culture is necessarily conservative, but rather we need to be aware of the politics of culture and who speaks for whom. Africans are not a monolith. We saw this during the week when I was doing a workshop on Science 2.0 and some of the francophone African scientists objected to web 2.0 tools. “These are tools created by Americans to exchange photos and are of little relevance to African science”, was the claim. This was echoed by one French observer, “We must be aware of the downside” of web 2.0 technologies (these went unstated, it was more a performative intervention). Of course, but what is really going on here? First, something was lost in translation but more than that. The thought of democratizing science does not sit well with every scientist, African or otherwise. This is a movement that has been going on for half a century and anytime you try to level the playing field through technologies or otherwise some people will lose. Science used to be the thing politicians called on to settle political disputes. Now, science is often part of the political debate and there are many who want to see science as above society. Those who think science is, as our Frenchman wanted to believe, a “rigid, rigorous discipline”–read, outside of politics–understand little about the way actually existing science works. There is an entire discipline of the history of science and science and technology studies that has demonstrated very convincingly that this worldview is, how should I say this, quaint.

Nevertheless, Dr. Brito was quite correct in thinking that Africans need to rethink their innovation strategies and systems and find something that works in Africa and make it their own. The work from Peter Singer and Abdullah Daar (here) offers one alternative to the linear systems that Brito finds lacking. But we first need to rethink the “knowledge economy” meme to make these types of platforms actually work and to optimize outcomes. Often we face the legacy of broken knowledge architectures that treat knowledge as static. The colonial archive is rather typical of this. The tendency for institutions to ascribe to the “death by white paper” thing is another example. How can we make these documents become social knowledge (that is, contextualized and translated into constructive practices) and reflective of the realities that African scientists, technologists, policy-makers and end-users face? We can begin by recognizing that knowledge has a social life and this is illustrated quite well in the work of Steven Jackson and Geoffrey Bowker (here). Their work points to how we can move from legacy knowledge systems to ones that are more dynamic, collaborative and mapped to local contexts. While we need to take into account the barriers for African scientists we should not just build systems around the lowest common denominator of African technological connectivity. There are robust networks of people, artifacts and institutions as well as embodied indigenous knowledges linked to practices, they argue, that are not really about the knowledge storage or database paradigm. It will be important to develop creative strategies to move knowledge across sectors in these new innovation systems that we might want to create.

As the search for new innovation systems for Africa proceeds it would be useful to not fall in the trap of just saying anything non-Western is appropriate. Just take a look at the many examples of hybrid innovation all around us. From some of the creative uses of mobiles to the Liberian analog blogger to African musicians who wire up found objects to create brilliant compositions such as can be found with the Kinshasan band Konono No. 1., we see these hybrid practices all over the informal sector that constitutes the majority of African economic transactions. We might want to learn from these practices in how we rethink the ethos of innovation in science and technology development. While not science and technology examples per se, they do offer insights into a different mindset.

Another point is that we tend to look at Africa in terms of what it lacks or, to use the Paolo Freire approach, in terms of the deficit model. What this does is open up opportunities to impose models on what is seen as a vacuum rather than a resource rich environment. It reminds me of a meeting at Grameen Bank when I was a Fulbright Scholar there nearly 20 years ago when Muhammad Yunus mentioned that Grameen Bank was built upon the genius of the poor women who were his clients. He recognized that it took incredible ingenuity to survive in the contexts in which the bottom 10% of Bangladeshi society lived. How could Grameen build on this embodied knowledge? Grameen is built around what people already know and have and works to strengthen their assets as an aggregator. This reminded me of the Sudanese social theorist AbdouMaliq Simone’s notion of “people as infrastructure”. As Prahalad says, this is the innovation sandbox (albeit slightly different point but I’m hybridizing concepts myself here). Let’s find the pieces of things going on around the world that might be recombined with the assets and approaches already found in some African science and technology networks and experiment.

My presentation built upon these observations and brought these into a conversation with current thinking around open science, science 2.0 and open innovation. Some of the most important work that can bridge these issues come from Ikka Tuomi’s work on “Networks of Innovation” who focuses on ‘social innovation’, or how knowledge changes the way people do things. I like to use the term social innovation over the way that ‘innovation’ is thrown around to include pharmaceutical “me-too” products, for example, that may earn profits but do not actually produce noticeable health outcomes beyond pre-existing drug entities. In fact, I find these counter-innovations in that the impact on the health financing (non)system may be negative. So what I’m trying to do is bring together social networking, open science, social innovation, anti-deficit models and convergence platforms to conceptualize new innovation practices.

There is quite a bit of work being done on open protocols and open lab notebooks, science social networks, open innovation platforms and science commons so how can “we” appropriate these tools and practices to fix some of the innovation systems that are problematic at the moment and build on these tools given the assets Africans currently have? I honestly believe that a form of recombinant innovation that takes new and old or things that haven’t worked in the past but mobilized within new institutional structures and eco-systems of entrepreneurs, NGOs, distribution systems, etc. can go a long way in remedying the problem. Build the African wikipedia of failures as an innovation commons–we can learn as much from why things didn’t work as why they did work and change the attitude towards failure in a constructive way. Science blogs and IP trusts can be used to share knowledge faster and create new connections across the continent provided we create the networking tools to connect African scientists, technologists, business expertise and policy-makers to build enabling environments.

UN ECA has the ASKIA platform to enhance access to open access journals. This is an important first step but not an end in itself. There is a tremendous opportunity to develop creative business models downstream from an African science commons (think IBM’s strategy when they supported Apache when they realized hardware was not the future). There were other insights in our session from other speakers about developing new indices and measures of innovation for the African context. As the presentations become available I’ll try to post a few and comment in the near future. Below is my presentation: