Remixing Public Health: Tools for Public Health Innovation

Re-mixing Public Health: A walk (long) through Open Health & the Emerging Social Mediascape Jody Ranck, DrPH Principal Investigator, Public Health Institute July 2009

Why Re-Mixing?
Because it sounds trendy?
Borrow and steal from already existing tools, disciplines
Recombinant innovation
Making the invisible visible and changing behaviors and policies—the mash-up is an important metaphor
Complexity of our problems—demands solutions coming from multiple sectors, geographies, etc.

Why should Public Health Care about social media?
New types of communities/knowledge systems emerging
Socio-techological change: not a question of WHETHER social media will change how we think, behave, etc. but rather, it is a question of HOW?
Complexity of health issues requires new thinking
New modes of governance & citizenship
Ways of delivering healthcare changing
Luddites will become irrelevant in many areas

Public Health Challenges
From command-control systems to distibuted systems and production
System built on 1910 Flexner Report
Health Society: expansion of territory of health  health is no longer just about health systems
Health outcomes linked as much to other sectors as health sector—perfect multi-sectoral issue, but many silos
Health competes with many other issues
Behavioralist paradigms-dated, not producing outcomes
Socio-technological change: health innovations change societies, social change changes innovation systems: New Meanings of Health AND Innovation!!!!!

Government/Civil Society Shift

Section 1: Social Media and Public Health
Introduction to Social Media Tools
Medicine 2.0
Health 2.0
How do we get to Public Health 2.0 and beyond? Why should we care about social media?

How do we respond: Social Media
Blogs, wikis, vlogs
Podcasts, photo-sharing
Social Networking Platforms
YouTube
RSS
Social Tagging, eg. Delicious
Microblogging: Twitter
Data Visualization/Infographics
Enterprise 2.0 Platforms
New and Old media ecosystems together

Social Media: an Ecosystem

Eco-system of ‘old’ and ‘new’

Convergence of old and new
Old media reporting on stories from social media, eg. Iran election & CNN
Campaigns that use social media to drive broader media strategy, eg. Obama campaign
In developing world use of mobiles and radio in agriculture and health
Online video growing rapidly, eg. Hulu
I’m sick of the word “new”

Public Health 2.0
Social Media
Architecture of Participation
Open Innovation
Crowdsourcing
Citizen Engagement through social media
Mobiles
Urban Informatics
Cloud Computing
Design Thinking

Medicine 2.0/Health 2.0

Medicine 2.0

If Medicine can do it…

Public Health 2.0? Can we do better than “cope”?

Why does it matter?
A new type of web: mobile, participatory
Demands for transparency, eg. Recovery.gov
Non-profit sector is adopting & innovating rapidly in the social media space
Convergence of old and new media: it’s not just about teens on MySpace anymore!
New forms of sociality emerging: biocitizenship and social networks in health
Ethos of cooperation
New commons  Health commons  New public health + spirit of innovation

Section 2: What do we do with Social Media?
Content
Community
Collaboration
Collective Action

Why social media?
Gaurav Mishra’s 4 C’s of Social Media:
Content: everyone can be a creator
Collaboration: conversation, co-creation, collective action
Community: Sustained collaboration
Collective Intelligence: Joy’s Law-the smartest people work somewhere else
See : http://www.gauravonomics.com/blog/the-4cs-social-media-framework/

Content

Content Aggregators

Hyper-local/citizen news

Hyperlocalities

Content: Neighborhood News

Content: New Journalism –business models

Content: blogging the city

What’s up with that “Twitter thing”

Twitter as listening post, filter…

Twitter and distributed surveillance

Twitter & misinformation

Twitter and civic engagement

Twitter Source: http://applicant.com/wp-content/uploads/2009/04/tweetcurrency1.jpg

Twitter for Public Health
Find interesting minds: @mindofandre, @AndrewPWilson, @bloodandmilk, etc.
Follow conferences, legislative updates, reports from field
Pool/aggregate data
Suite of Twitter tools
Social News Campaigns: podcast, blog, etc.

Content in summary: Public Health 2.0
Citizenry as co-creators of content
Need for deeper listening to what matters
Use of social filters to highlight what is important
Experts are often poor prognosticators
Yet, we need to move beyond populist rhetoric of the crowd
New forms of biological/technological citizenship emerging-people can find like-minded people on social media platforms and build, curate content, eg. Blogs, wikis, Twitter hashtags (eg. #H1N1)

Collaboration
Content become center of conversations
Curation of aggregate content
At what point does content and conversation convert to meaningful collaboration?
How can you break problems down into modular, workable pieces that engage community?

Types of collaboration
Defining or framing a problem
Debate about strategies
Moving across silos/sectors
Filling in holes in data
Ongoing conversations around issues
Rapid response to emerging issues

Collaboration: platform for government & citizens

Toronto Transit Camp Case Study
TTC did not define problem to be solved
Sought ideas for reform from users
Used blogs, wikis, discussion boards, offline polling, etc.
Can use additional tools such as citizen study circles, citizen juries
Illustrates need to identify the “right” networks

Platforms: moving beyond silos

All Hazards Consortium Case Study
Involved VA, MD, DC
Brought together private sector, non-profits, universities, citizens, govt agencies
Govt Agencies are the “innovation champions” in the network: create collaborative environment
Govt role is about controlling the process
Govt creates infrastructure for social knowledge creation

Collaboration: defining a problem

Collaboration: mapping problems

Collaboration: open street map

Open Street Map: telling stories

More Telling Stories with Maps

Open Street Map: coordinating agencies

Collaboration: co-created problem definition

Collaboration: Gov 2.0 using the cloud to break down silos

Virtual Alabama Platform Results
$150,000 to build
10 days to create
Can now share data in the cloud across government sectors
The cloud is growing in importance—public health needs to be part of the discussion! But more on that later….

Collaboration Lessons
Sourcing knowledge from edges
Learn from outside of the health field
Collaborate with other sectors in more robust manner
Co-creation of knowledge with users
We’re often our own worst enemies: silos, blinders
Our value networks are more complex: need more debate, discussion to deal with complex ecosystem of partners
We deal with PUBLICS not a public
Collaborative problem-solving is central yet not typically funded by foundations

Collaboration: co-creation of knowledge Jason Corburn shows how citizens can challenge dominant risk assessment paradigms used by EPA and scientists. Citizens as co-producers of expertise or citizen-scientists

Community
Difficult to sustain engaged community
MyBarackObama, DailyKos, etc.
But we see PatientslikeMe.com with diverse patient communities
TuDiabetes
Sharing, aggregating, conversing- 
Translation into Collective Action

Community

Communities

Community of shared interests

Communities

Genetic Alliance
Information portal
Policy Advocacy
WikiGenetics, WikiAdvocacy
Resource Repository
Good Example of emerging bio-sociality & biocitizenship in action

Health 2.0 Communities
Communities around micro-macro issues
User-generated content, filters
Information  knowledge  new power relationships in clinical encounter
Platforms for fundraising, policy, advocacy
Data aggregators that move beyond HIPAA constraints
We’ve yet to see substantial movement in power structures of health & medicine
But they’re still potent “issue networks” and signal of new form of bio-sociality that has potential to shift health politics

Where does Public Health fit in?
Need to move from top-down approaches
Less control, democratization of expertise-we are no longer the privileged experts all the time: listen, engage
Think critically about populist hubris in social mediasphere without resorting back to PH knows best ethos
Who speaks for communities? Beyond bioethics to somatic ethics and relationships online
How can we cultivate democratic ethos of public health in social mediasphere?
Organizational design: how to incentivize collaboration and community building rather than maintenance of silos?

Thinking About ROI of Social Media http://blogs.forrester.com/groundswell/2007/01/new_roi_of_blog.html

ROI
Government 2.0 sites: transparency, accountability, efficiency
Open innovation platforms: valuations of each app or service
Citizen feedback and trust
Social capital from highlighting successes and even failures

ROI (Social Media)
http://www.frogloop.com/social-network-calculator
Beth Kanter: Return on Insight: http://beth.typepad.com/beths_blog/2009/02/nten-and-techsoup-webinar-share-your-story-roi-and-social-media-slides-and-notes.html
More than Math: Listen, Learn, Adapt
May need internal organizational/cultural changes
Pick the Right Metrics
Tangible and Intangible Benefits
Numbers and Stories

Section 3: Social Media Platforms
Collaboration: digging deeper
Typologies of collaborative platforms
What problem are you solving for?
What are some characteristics of collaborative organizations?
Network Organizations and Public Health

Collaborative Platforms: Some lessons from Satish Nambisan
Exploration: Defining a problem where dissensus exists
Experimentation: Testing out solutions
Execution: Disseminating solutions
Each of these is a form of crowdsourcing
See: Satish Nambisan (2009). Platforms for Collaboration. Stanford Social Innovation Review, Summer, Vol. 7, No. 3.

Exploration Platform

Exploration/Innovation Platform

Exploration Platforms
Used to help frame issues
Create communities around different aspects of a problem—modular approach
Science of asking the right question
Used to build consensus around vision, strategy, approaches
Participants need to know what they’re being asked to accomplish

Experimentation Platform

Experimentation Platforms

Experimentation Platforms
Too many organizations go from idea to implementation without testing idea
Neutral environments for testing things out—rapid prototypying
Virtual innovation labs: Y Combinator
Need agreement on success metrics
Uncover implementation challenges

Platforms for Implementation

Implementation Platforms
Used for rolling out findings
Create and distribute templates to assist replication
Coordinate efforts of those in network
Connected to offline sessions for sharing information, experiences

Innovation Platform: turning ideas into action, social businesses

Sambisan’s Ingredients for Platforms
Need a Network Perspective: embrace non-traditional partners
Modular or Plug-and-Play Expertise: agile
Portfolio of Success Metrics
Ability to dismantle barriers between government, business, non-profits

Networked Public Health
Different types of networks: loosely coupled, centralized, distributed, etc.
Partnerships and Networks are not the same thing
Rather than broad social movements-see more micro-movement
Coordination and Control of Networks—governance
Designing Networks: building relationships, managing in less hierarchical domains, interdependencies, roles and accountability
What would the PHR for public health look like: collaborative platform that enables citizens to build, share, use data

Section 4: Apps for Democracy Example
New way of driving innovation through engagement with citizenry
Democratizing data
Improving the quality of data
Building platforms for win-wins for gov/citizens
What can we learn from this for public health?

Platforms: Apps for Democracy

AppsforDemocracy examples..

Apps for Democracy

Apps for Democracy Lessons
How can we do more with less?
Some initial apps may appear trivial, incentivize for quality
Helps move out of silos, command/control structures that hinder civic engagement
Many agencies will resist change and not release data—incentives? What are costs for non-engagement?
Opening up data creates conditions for innovation, better data
Respond to citizens, not customers

Apps for Health?
Crowdsourcing new tools for citizen engagement in public health
Multiple rounds on different themes
A way to drive innovation in tough economic climate
Apps for Healthy Cities 2.0?
Highlight neglected public health issues
Incentivize multi-sectoral collaboration

Challenges for AppsForHealth
Privacy issues with health data
Development of open standards
Apps for individuals vs. community health outcomes: difficult translation
Lack of good behavioral change models: crowdsource alternative paradigms?
Complexity of chronic diseases vs. simplicity of apps

Section 5: The City and Public Health as Platform
City as Platform
Open Innovation Platform
Tools to think with

City as Platform

The City as Open Innovation Platform

Villes 2.0
Can the city be re-imagined as a platform that can be modified by its users?
What resources can be shared and mobilized for re-thinking the city?
The suite of web 2.0 tools available can be used to re-fashion urban services, make user-friendly
New Ethos embodied in Apps for Democracy

Government-Citizen Cooperation

Co-created Govt services

Responding and Engaging in a world of Tweets Gavin Newsom claims using free service like Twitter saved 100k over using SMS for 311 service

Disaster planning Use of social media platforms to cross silos and help build more resilient infrastructures—avoiding future Hurricane Katrinas

Civic Partnerships

Civic Engagement

The tools are here…
Mapping
Open data
Transparency
Data visualization
Platform integration for services
How to tie it all together and make sense?
We need to rethink organizations, networks, communities
In many ways this is what AppsForDemocracy points toward…

Opportunity Mapping: how to make it user friendly? GIS is enabling greater use of maps and geo-coded data to make patterns more visible

Urban Eco-Maps

Green Maps

Crime Mapping

Open data

Open Data

Democratizing Data

DBpedia

Databases

Linked Data Linked data and semantic web are next stage of where the internet is heading

Open City Data (San Francisco)

Wikis and linking communities

Transparency

Transparency: legal

Crowdsourcing Health Politics & Transparency

Transparency: Food Safety

Transparency

Transparency: Corporate

‘ Radical’ Transparency

Transparency policies

Transparency Policies:
Need to provide info that is easy to use
Target transparency systems towards interested parties
Be nimble in responding to changed priorities of users
Create benefits for disclosers of information
Design with metrics for accuracy and compatibility
Design for comprehension: eg. Visualization/infographic tools
Incorporate analysis and feedback
Sanctions for non-reporting

Data Visualization tools

Services for Creating Visual tools

Data Visualization

Infographics

Widgetization of Web

Mapping Services

GeoCommons

Geoweb
More data are geocoded, web-based and mobile
Growth in use of Google maps, etc.
GIS becoming more ubiquitous, user-friendly
Peer-to-peer geo-based services on iPhone
More bottom-up, co-created maps
Power of place and information in policies
Participatory mapping and planning

Planning differently…

Participatory Budgeting Social media tools and Wiki Government + Mapping and Visualization Tools can re-make the participatory budgeting movement

Planning: Wiki Government

Geosimulation

DIY: tools for building urban tools

Section 6: More tools and signals
Making the Invisible Visible
Mobiles and Urban computing
Persuasive Technologies and Games

Tools for making the invisible visible
Low cost diagnostics
Sensors
Visual Tools
Augmented Reality
Mash-ups
Mobiles
=Tools for Collective Action on Health Issues

Making the invisible visible…

Spatial Information Design Lab

Making it Political VISIBLE

Aesthetics of Political Visibility

Augmented Reality

Urban Computing
Urban infrastructures
Maps, traffic info
Sense of place
Mobile devices, sensors
Social computing/networking: familiar strangers
City info, open data
Augmented Reality—now on mobiles

Urban Computing
City Sense: San Franciso-Hot Spots
Understand behaviors of “users” of the city
Citizen Science, eg. Working with SF Street Sweepers on air quality
Ergo—mobile air quality

Urban computing: sensors

Urban Computing (cont.)

Urban Sensing: mobile computing

CENS:(Cont)

CENS: (cont)

CENS: Feedback Loops

Persuasive Tech Example: Prius dashboard: changing behavior

Persuasive Technologies—mobile web

Persuasive Technologies: BJ Fogg
Captology: computers as persuasive tech
About intentions of designers of products persuading user: goal focused
Less concerned with altering framing of perception that user has already developed

Persuasive Technologies
Reduction: reduce complex behavior to simple tasks
Tunneling: leading user through pre-determined set of actions
Suggestion: suggest behavior at most opportune moment
Self-Monitoring: monitor behaviors to achieve pre-determined goal
Surveillance: one party monitors behavior of another
Conditioning: using operant conditioning to change behaviors, eg. Telecycle—when pedaled to a target speed and image is clarified on screen

Persuasive Games

Persuasive Games: Ian Bogost
More focused on using rhetoric to engage user in a discourse about behavior itself, more reflexive
Does not accept as a given that user understands or accepts the larger reason for a behavior
Persuasive Tech is largely framed around psychology, Persuasive Games around rhetoric

Persuasive Games
Stimulate critical thinking: not the same as “serious games” that do not question established norms
“ Killer Flu”: helps to understand how pandemic flus mutate and the geographical contingencies of the epidemiology
“ Fat World”: politics of Nutrition
“ Food Import Folly”: interrogates role of FDA, in collaboration with NY Times
“ Bacteria Salad”: on agri-business, food safety
“ Stone City: Cold Stone Creamery”: on portion size and profits

Public Dashboards as Persuasive Technologies

Urban-Mobile Computing

Hypercities

Hypercities
Layers of historical information about cities
Puts the archives of cultural histories and diverse communities on the web
Encourages exploration of the history and layers of the city
Goal is to change the way we interact with information on the city and with each other

Mobile Health

Mobile Health: Frontline Medic/Open MRS Source: Josh Nesbitt, http://www.jopsa.org/?p=404

Mobile Health Applications
Education and Awareness
Data collection (for public health or clinical domains)
Remote monitoring
Communication and Training for Healthcare Workers
Disease Surveillance and Epidemic Outbreak Tracking (Malaria, HIV/AIDS, TB, Avian Flu, chronic diseases- esp. diabetes)
Diagnostics and Treatment Support
mLearning, mobile health 2.0 (citizen facing)
Emergency Response
Decision Support Systems
Remote Patient Monitoring
Health Extension Services

Smart Mobs for Health

RED: Open Health
Design: don’t improve existing services but design for desired outcomes
Design begins with point of view of individual, not the system
Co-creation
Smart Mobs in Health=ActivMobs
Redesign the patient-professional relationship
Use this ethos for designing next gen mHealth ?

Convergence of social media and mobiles, eg. InSTEDD

InSTEDD

Mobile Health Research: CITRIS

Mobile Crowdsourcing

Mobile crowdsourcing: micro-volunteering

Section 7: Innovation Systems and Public Health
Open Innovation
User-led Innovation
Peer-to-Peer
New Commons
Prevention Economies
Design Thinking
Forecasting

How we think about innovation is changing…

NESTA (UK) Innovation: Cooperation and the Commons

New Innovation Approaches: User-led Innovation

Peer-to-Peer

P2P Health

Commons: Science/Health Commons

Prevention Economies: Nordic Region as Global Health Lab

Nordic Region Health Lab
Prevention as top policy priority
Open access to data
Engagement with Civil Society organizations
Collaborative Ethos
Innovative science, strong industry participation
Equal access to health
Citizens and User-driven innovation

Lessons
Health as a goal in itself
Steps toward a prevention economy rather than sickness economy
Health as economic driver rather than drain on resources
Multi-sectoral
Demands open health model

New Innovation Architectures
Clayton Christensen’s “Network Facilitation Model”
Need to move beyond single slice, blockbuster product or service
Cooperative models with Health Commons
Public Health as the Platform for “plug and play”
Enabler of innovation

Design Thinking: IDEO’s Human Centered Design
What do people desire?
What is technologically and organizationally feasible?
What can be financially feasible?

Desireability Feasibility Viability

Design Thinking
Observations
Stories
Themes
Opportunities
Solutions
Prototypes
Implementation Plan

Service Design

Scenarios and Forecasting for Public Health
Making visible the drivers of change and trends
Identification of emerging opportunities and threats
Building more resilient systems in a system that is not centered around command/control systems

Innovation, Risk & Failure
Woody Allen: If you’re not failing every now and again, it’s a sign you’re not doing anything very innovative

Wikipedia of Failures as Innovation Platform
Failure as forgotten data point
But understanding why things fail can help drive innovation
Rapid (Slow) prototyping in Public Health
Take risks, learn, rethink and innovate

Section 8: Future Issues
Cloud Computing and Identities
Technological Citizenship
Resilience
Public Health Platforms in the Cloud

Pointing toward the Future: The Cloud…
“ At the end of August [2008], as Hurricane Gustav threatened the coast of Texas, the Obama campaign called the Red Cross to say it would be routing donations to it via the Red Cross home page. “Get your servers ready—our guys can be pretty nuts”, Team Obama said. “Sure, sure, whatever”, the Red Cross responded. “We’ve been through 9/11, Katrina, we can handle it.” The surge of Obama dollars crashed the Red Cross website in less than 15 minutes. —Newsweek
See J.D. Lascia (2009). Identity in an Age of Cloud Computing, Aspen Institute, Boulder CO.

Cloud Computing
Virtual Platform, eg. SalesForce, web mail, Delicious, YouTube
Transition from self-generated power to the grid (transition we’re going through now)
Software as a Service (SaaS), eg. Amazon Web Services
Enables greater customization
Can lower the carbon footprint of IT for orgs

Cloud Computing
Now, you use cloud computing at home, but your CTO doesn’t allow you to use it at work
But we may have “inter-clouds” between orgs to facilitate cooperation, eg. Virtual Alabama
Therefore, public and private identities emerging
Boundaries as socio-cultural constructs
How can public health take advantage of cloud? What are the risks?
We need to start a discussion

Cloud Computing & Identities
Management of multiple identities, eg. Biz identity, health identity, friend profiles
Open identities that reveal just enough data
So this cloud is a mash-up of lots of social objects with different rules
And markets are becoming cooperative ecosystems, not zero-sum competitive markets

Cloud Eco-systems
Drive for open identities and equalities comes up against old biz models  conflict
Privacy and security mean different things to different people  HIPAA = blunt instrument, regulatory regimes are not the final word…
Reputation systems/management not decentralized  digital footprints
Reputation as value

Cloud Computing and Innovation
Greater customization
Reduced barriers to entry
Combinatorial innovation
Benefits of scope may outweigh scale
Greater organizational complexity and info transparency—more distributed, collaborative approaches
Rapid proliferation of best practices and change
Innovation models themselves will change
Move from marketing push to customer (citizen) pull
But have to deal with risks as well

Risks of the Cloud
Security of data
Reliability and backup systems
Data interoperability
Compliance and liability
PHRs and privacy in the cloud
Crime mapping
Broader privacy politics in context(s)

Technological Citizenship and Public Health
Responsibility to know how to use these techs, understand rights
Techno-social inclusion: need to build the tools and awareness to engage
What are the new axes of inequalities?
Re-configuring public health as platform
Emergence of OPEN HEALTH paradigms
Whose transparency counts for whom?

Public Health 2.0
Public Health for the Network Society: re-think organizational forms
Public Health as Platform: enabler of user-led innovation
Public Health as Multi-sector outcome: Health impact of all policies and actually creating multi-sectoral interventions that work
Public Health & Social Inclusion in Network Society
Public Health as resilient system(s)

Social Status Education Physical Environment Parenting Quality of Life Physical Health Incomes Work Mental Health Determinants of Health: How do we design for this? Source: Welling Project, Scotland

Resilience and Public Health
Resilience from the non-system called the health system
Substantive reform unlikely to come from federal govt
Multiple layers of sustainability: ecological, financial
Sense, learn, create, re-organize (Andrea Saveri)
Design platforms for managing complexity
Increase ability of organizations to absorb threats (pandemics, State of California dysfunctional system, etc.)
The tools for doing this are already available

How can we respond to this vision of health? From PHRs to ePHIS
ePHIS= personal health information systems as open platform for community-driven innovation
Data + networking/communication
Connected to tools and platforms presented throughout this presentation
Eg. Portugal created i-Citizen project for rural diabetic community

Public Health Innovation
Not just new products & services
Prevention is rarely more than 2.9% of overall health budget: need policy innovation
Will have to be open innovation: open health
Network governance, new partnerships, taking social determinants seriously
Become experts at building and maintaining open systems, ie. open health, cooperation, managing new health commons, city as platform
See KickBusch, ed. (2008), Policy Innovation for Health

Challenges
Dynamics of network organizations?
New governance models
How to manage the commons formed through interdependencies?
Moving from innovation being about tech to innovation concerned with knowledge that creates value
PPP-P: the extra P = People

The tools are here…
Social networks and new governance
Participatory approaches
Co-created, peer-to-peer, sharing economies
Maps, data, platforms
Mobiles as platform but need more than just mobile talk—policies, strategies
Need new approaches to behavior, communications, health politics
We lack coherent strategies and platforms in public health
Mindset shift towards innovation, open approaches, prevention, decentering expertise

Resources
Us Now documentary: http://www.vimeo.com/4489849
Wiki Government, by Beth Simone Noveck
http://www.gauravonomics.com/blog/
Full Disclosure, by Archon Fung et al.
Investing in Democracy by Carmen Sirianni
Platforms for Collaboration by Satish Nambisan, Stanford Social Innovation Review, Summer 2009
Smart Mobs by Howard Rheingold
https://www.taik.fi/kirjakauppa/product_info.php?cPath=11&products_id=134
Policy Innovation for Health ed. By Ilona Kickbusch
IDEO Human Centered Design Handbook
Here Comes Everybody by Clay Shirky

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Remixing Public Health: Tools for Public Health Innovation

by Jody Ranck on Jul 23, 2009

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Remixing Public Health: Tools for Public Health Innovation — Presentation Transcript