Human-Centered Design and Social Issues in America
Why everything we are doing is wrong and why homelessness, mental illness, and addiction will only get worse.

Living and working in San Francisco, I cannot help but bear witness to the human tragedy which surrounds us. Each year more bodies are added to the stack, and as the tide of forsaken people rises, I find myself wondering…
Is this way of life, with me covering my nose to block the smell of unwashed bodies, eyes locked on the ground, feet dancing around needles, jumping over people strewn like barricades, is this too by design? I can say that I know what it is to be the jumper, but not the jumped over. I have never had someone leap over me while I lay down broken in the dirt. It makes monsters of us both.
I got into design by way of anthropology. I was interested in social change and human behavior in the aggregate, across both space and time, and I looked for insights wherever I could find them. 7,000 year old mound of cooked animal bones? I’ll take it. Shattered refuse from a demolished 1930s sorority house? Works for me.
I wanted the materials they once held in their hands, to hold them in mine, to try and remember those for whom no books were written, no monuments built, whose only legacy was loss. The hope here was to reconstruct their world through the objects in which they were surrounded, the materials that comprised their every day lives. Within the patterns of daily life, unweave then the threads of choice, and find the person amid their own decisions.
Consider here the needle.

When you look at a used needle on your way to work, what do you see?
What level of zoom do you go to?
What do you feel?
When I see a needle, I see a set of behaviors and choices made in the context of a life I do not understand. To me, a needle is but a medium through which a person builds a relationship with their own experience. In particular, their past. When I see a needle, I feel hopeless and overwhelmed.
Just about everyone living on the street, and I am speaking specifically of those with mental illness or addiction, carries with them a pain we cannot see, a pain sometimes built on years of abuse and trauma at the hands of other human beings. I struggle to even describe this sort of hurt. Is it emotional in nature? Psychological? Spiritual? On what plane of existence does this suffering reside and how might we even begin to confront it? How do we help people develop new relationships with their own experiences?
I ask such basic questions because if there is one thing in which I am quite convinced, it is that every solution we have designed for this problem has been an abject failure. When every solution begins and ends with the needle, and not with what it represents, there is hardly any room left over for the people we were leaping over from the start.
Social service programs are not, indeed were never, designed using a human-centered approach. In order to do human-centered design, you have to actually respect the people you are designing your product or service for. You have to empathize with them. You have to believe that they have agency, that they have freedom, that they have choice. Most importantly, you have to represent their voice. But who in power wants to listen to a homeless heroin addict? Who in power actually believes these people have anything of value to contribute at all?
Anyone can make a claim to speak on behalf of others. Those with great needs are especially vulnerable to being used as tokens and pawns, because rarely are people or institutions evaluated for fidelity against the very voices they claim to represent. Ask your favorite non-profit if they have stakeholder advisory boards, if they do stakeholder research, if stakeholders have decision making power at the programmatic level. Ask what criteria they have to define who a stakeholder even is. Find out what tangible methods they employ to “give people a voice,” as the cliche goes.
When it comes to resolving the most intractable social issues facing our society today, the predominant design methodology is straight out of the colonial era. Unfortunately, the solution is not simply just add human-centered design and stir, not even close.
The structures of society itself — the way funding operates at federal and county levels, the regulatory environment, the biomedical model, the paradigm of mental healthcare, stigma, generational trauma, political disagreement on the very role of government itself, are just some of the layers of complexity through which all of this is mediated, and through which all of this intersects. How does one simply focus group their way through all that?
For me I lean on my background, and engage ethnographically, but that is not enough. This is a collective effort or it is nothing at all. I’ve said my piece, for now.
Have you said yours?
