One of my public health classes featured a group project using human-centered design. When we received the instructions, my fellow students responded with a collective “huh?” The group members have diverse backgrounds: Anne (these names are all changed) is the chief of a busy ambulance unit, with 40-year veteran first responders reporting to her. Joseph is an EMT hoping to go to medical school. Tasha works at a maternal wellness clinic. Crystal is in medical school and is also an optician. I explained HCD is all about finding out what people need, designing services with them to make sure they work, and then prototyping and testing those services. They were relieved. Astonished, even. “Why doesn’t every field do this?” “How else would things get done successfully in public health?” “This doesn’t seem hard! How have I not heard of this before?”
What led me to public health
In February 2020 my brother got really sick in New York City. Because of the rising COVID infection rate in that city, nearly all medical treatment unrelated to the virus was halted. As he got sicker and February turned to March, he couldn’t get the diagnostic tests he needed for a mysterious and rapidly progressive neurological condition that had him on a ventilator. By mid-March there were 700 patients in his Brooklyn hospital who had tested positive for coronavirus. He wasn’t one of them--yet. On the last day before the hospital barred visitors, he was still in a coma. My father and I left New York for our respective homes in Virginia, despondent and bitter at leaving my brother behind, and filled with adrenaline speeding down an empty I-95. It was dystopian. He died in May, surrounded by compassionate strangers, and with COVID on top of his existing undiagnosed condition. He leaves behind two children. It should never have happened.
This pandemic hit the US after decades of broken health policy that has seen US residents spend more and more out of pocket only to have some of the poorest health outcomes of the developed world. The cost of medical care is generally much higher than in most other countries. High costs lead people to avoid care for years and often results in financial distress, even bankruptcy for those who can’t pay their medical bills. For such a wealthy nation, we have too many people unable to get healthcare--and that was before a once-in-a-century pandemic.
I strongly believe healthcare is a human right. I’ve been working at the intersection of design and healthcare for most of my 25-year career. I have written about psychological science for policy makers, designed massive, internationally competitive healthcare system websites, and worked with Medicare to make the price of healthcare transparent.
I fell into human-centered design while translating psychological science findings and concepts for federal lawmakers and other organizations working to advance better healthcare for Americans. I later joined digital services teams focusing on federal healthcare. It’s only been in the past 10 years that I realized I’m not just a designer for the sake of the process, or for being super into empathy or interaction design or pixels or the perfect service blueprint. I’m designing better healthcare. I’ve always worked to help fix our broken healthcare system--but I came at it from the design side.
My brother’s death during the pandemic that our country should have been ready to deal with was a catalyst. Now, I’m coming at fixing our healthcare system from the health policy side. I enrolled in George Washington University’s Master's of Public Health program last summer in order to use my background in human-centered design to contribute to reforming US health policy.
The 10 Essential Public Health Services
Public health is the discipline of promoting and protecting the health of people where they live, work, and play. Medicine is the practice of treating people who are sick. People working in public health try to prevent disease before it occurs, and to mitigate the effects of disease (such as a coronavirus pandemic) when it does occur. Epidemiology, environmental science, occupational health, community disease prevention programs, setting safety standards, developing health policy recommendations based on scientific findings--all of these are elements of public health work.
The 10 Essential Public Health Services (EPHS) provide a framework for public health to protect and promote the health of all people in all communities. The 10 essential services were developed by public health experts, leaders, and practitioners, including experts from federal agencies such as the Centers for Disease Control and Prevention (CDC). The purpose of the framework: “To achieve equity, the Essential Public Health Services actively promote policies, systems, and overall community conditions that enable optimal health for all and seek to remove systemic and structural barriers that have resulted in health inequities.” (CDC) Policy makers who use legal and regulatory constructs to effect changes in healthcare rely on scientific evidence such as that gained from health surveillance programs in the community, or by conducting longitudinal studies, or by constructing hypotheses and analyzing options for policy changes. That evidence is used to examine multiple policy options that may help solve big healthcare challenges. It turns out that health policy analysis has a lot in common with human-centered design!
Designing Health Policy
What if we used HCD to help develop new health policy? What would it look like to co-design equitable health policy inclusive of diverse, poor, uninsured, and underinsured populations? How might we inject empathy for our fellow Americans into health policy that actually helps people achieve good health and well-being? How might we create humane policy that serves providers and patients?
Policies are designed to influence behavior--of patients, of payers, of providers. Poorly designed policies are at risk for producing unintended consequences or failure to influence behavior. Misunderstanding the problems that policies are intended to address is a primary reason health policies fail. Problem definition is at the heart of human-centered design.
Knowing the price of healthcare before people receive treatment (policies in the works right now) isn’t enough if the policies governing their access to or use of that healthcare does not improve their outcomes or their ability to afford their necessary care. A poorly designed website might mean degraded healthcare access (for example if you can’t find a dermatologist using a mobile app from your insurer). More broadly, a poorly designed healthcare delivery program or health policy can degrade clinical outcomes and contribute to higher death rates, as with the current pandemic. The policies governing US healthcare should be designed with people, not for them. Healthcare software designers have learned this the hard way.
The best way the US can achieve optimal, equitable public health using the 10 Essential Public Health Services is:
- Learn what people need
- Have empathy for patients, caregivers, and providers
- Define the right problems to solve
- Co-design equitable health policies with the people they affect
- Prototype and test multiple possible solutions
- Put in place the policies that test well
To sum up, apply human-centered design to health policy.
I’ll keep you posted here on my progress. In the meantime, I have to get back to my epidemiology case study.