You can’t know what you can’t see

5 days ago

We tend not to see social problems, like homelessness, when the problems – and people experiencing them – are outside our own experience; separate and out of sight. For example, a family my wife knew from her work as a volunteer coordinator at a food pantry recently found themselves living in a car. Even with a full-time job and small savings, they were unable to find affordable housing. We invited the husband, wife and seven-year-old child to live with us for six weeks until they were able to save enough for a first, last and down payment on an apartment.

I had never known able-bodied, hard-working, physically, and mentally sound people with full time jobs who were unable to afford to meet their basic needs. And, because it was outside my personal experience, I had never stopped to think about how such a thing can happen.

This is true of many social problems. Communities are coming apart and most of us just don’t see it clearly. Even when we do, we lack the tools to make effective change.

This was my take-away from the recent Oregon Health Forum breakfast, where presenters such as Kent Thornburg,[i] Ph.D. and David Bangsberg,[ii] M.D. noted how social problems are exacerbating and/or generating medical illness and related costs faster than we can grow medical care management capability. The other panelists gave examples of how the existing medical system could be stretched to provide community support, but I was struck by how clearly the scale of the problem dwarfs such efforts. 

Why are we failing to significantly improve the health of communities?  I believe it is, at least in part, because our definition of health is too narrowly focused on physical (medical) illness. We aren’t seeing all the things which affect community health, of which medical care is only one factor. Social determinants that undermine health and drive up healthcare costs are ignored because our limited perspective obstructs our ability to understand community health as a complex adaptive system in need of a completely new approach. 

And that is a shame, because the core technology to make community dynamics visible is part of every 21st century network-based business. Consider, for example, the difference between how a brick and mortar store’s approach is different from Amazon’s, and why one model is dying while the other is ubiquitous. 

Due to the constraints of physical location and space, a brick and mortar store must limit its focus, providing a limited number of options from a limited number of suppliers to a target market defined by averages. By design, such a system – like our current medical system, which provides prescriptive services to a generically defined “population” – necessarily eliminates consideration of the individual in order to provide a product or service that can best meet the most needs at the lowest cost. 

It seems like a rational solution. But it is failing miserably to meet the demands of consumers who increasingly expect their individual needs to be met immediately. And, as big box bankruptcies rock the retail world, it is becoming clear that it is certainly not the most cost-effective way of doing business.

Meeting individuals’ needs while reducing cost is, of course, where Amazon excels. By employing technology that sees products and consumers as part of a complex network and adapts in real time to connect them, they are able to provide a customized shopping experience to consumers for a fraction of the cost.

Shouldn’t something as important as the systems we employ to keep our communities healthy be able to do the same? Wicked social problems persist because the way we think they work is different from the way they actually work.[iii]  Being able to see how the whole moves and changes in real time is critical for understanding how a system works, and for developing better scientific models and more reliable solutions to the individual problems within that system.

Every day our leaders implement policy and we make decisions based on ideas developed on an incomplete and often mistaken view of how society works. As a result, even though we are the most powerful nation on earth, communities have been slowing rotting for decades. 

This can change once we see the problem as it really is, instead of how outdated models have taught us to assume it is. A platform that uses the digital network technology of today so that we can see community health more realistically and imagine better, more economical solutions is at the heart of the change Curandi hopes to deliver. 

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[i] Director, Center for Developmental Health; Bob and Charlee Moore Institute for Nutrition and Wellness
[ii] Dean of OHSU-PSU School of Public Health
[iii] Derek and Laura Cabrera”, Systems Thinking Made Simple: New Hope for Solving Wicked Problems”.