Overcoming Barriers to Health Equity, by Samantha Dempsey and Olga Elizarova
Whose health are we designing for?
Often the answer is “people a lot like me.” People with a job, health insurance, a stable home. But what about people who don’t have the resources we take for granted? What does it mean to design “for health?”
The first step is designing what health means. Getting 10k steps in a day? Eating 5 servings of vegetables? Really it’s more than the sum of our health-related behaviors. According to WHO, it’s “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” We align ourselves closely with the healthcare system and what it says is healthy/unhealthy. But healthcare is responsible for only about 10% of health. Social and environmental factors, genetics – these matter significantly more. These are determinants of health.
Determinants of Health
- Public safety impacts everything from asthma to illness
- Housing issues cut life expectancy
- Education is linked to mortality rates
Health disparities are preventable differences. They tend to correlate with race, gender, and socioeconomic status.
“Your zip code is abetter predictor of your health than your genetic code.” – Melody Goodman
The same areas with high poverty rates also have high rates of illness, gun violence, and communicable diseases.
Designing for Health
How does this change the way we design for the root causes of health?
We need to address the actual causes – the root causes. We need to design for health equity.
Focus our resources on reducing the barriers to social and environmental health. We need to design for the community, not just the individual, and design for those with the worst health.
Health inequity costs the US $1 trillion annually.
- Participatory City: a group in the UK engaging residents to participate in practical and sociable activities to strengthen the community.
- Harlem Children’s Zone: working to improve the graduation rates of children in an underserved Harlem neighborhood by providing health, social, family, and community services
- Way to Wellville: a ten-year project to produce visible improvements in health and economic vitality in 5 under-resourced communities across the US.
Redefining Health Interventions
These aren’t about apps. They are about complex social issues, integrated into the lives of the community.
There are systemic barriers making it difficult to design these. Our current Health models may not support equitable change.
- Financial incentives in healthcare create profit from sickness
- Social determinants have a long ROI cycle, not a quick return
- Gaps in knowledge about when/where/how to intervene to address social factors to improve health and reduce inequity
Our current design models may not support equitable change.
- Designers aren’t hired to define the problems
- Evaluations and iterations are often cut out of our scope
- Co-creation is rarely in scope
How do we overcome barriers?
- Design for Health, not healthcare
- Commit to “radical” partnerships with organizations who are experts in social determinants of health
- Design with, not for communities
- Recognize that healthcare data doesn’t tell the whole story
- Acknowledge our own bias
- Foster diversity within design