The Role of Design Practice in Fighting Social Inequity
While design practice aims to improve outcomes, it can also reinforce social inequities and lead to unintended consequences.
Design’s Mission
Design practice has a monumental mission: to define the conditions of environment, behavior, and access that shape the way we grow, live, and work. If designers are to take on this aspiration, they must also be responsible for doing so ethically, informed, and with accountability for impact.
In February 2017, Mark Zuckerberg changed Facebook’s mission and published an open letter in response to the outcome of the 2016 U.S. presidential election. A stated mission with this degree of candor might be one of the few of its kind in silicon valley today, but Zuckerberg recognized Facebook’s responsibility to its users to take accountability for the tools created for them, and to be conscious of the consequences when they engage with those tools.
The way a mission is articulated, whether for a small project or a large organization, says a lot about how we perceive social responsibility. Taking a holistic view — the root causes and effects — of what is created is one way to address health and social equity challenges resulting from designed solutions, and is an important mindset to adopt in order to prevent unintended consequences of any project.
Who Defines Equity?
On any given day, news reports demonstrate the effects of disparity and injustice; some of the most visible consequences — to name just a few — are attributed to inequities of race, ethnicity, gender, and income. But are these issues of equality or equity? It’s important to understand the distinction between the two.
Equity aims to be fair and impartial in providing resources to reach a desired outcome. Equality is providing the same (equal) environments, resources, and opportunities.
There are challenges with defining equity; one is that its root causes are multi-dimensional; second, everyone has a different idea of what an equitable outcome looks like. Those who have the economic, social or political power to do so build structural barriers to ensure specific ideas of equity.

Johan Galtung introduced a model for thinking about the creation of structural barriers to social equity, defining them as “structural violence”(1). He defines structural violence as “the cause of the difference between the potential and the actual” that occurs when “the power to decide over the distribution of resources is unevenly distributed.”

We can see structural violence at play when looking at the cyclical effects of policies and practices that have the explicit intent of discriminating against groups of people. For example, the practice of redlining directly discriminates against people and communities of color, low income, and families with children, preventing them from accessing housing options, banking services, health services, and more (5). The effects of these practices are long-term, and prevent the growth of healthy and successful communities.
“Structural violence is one way of describing social arrangements that put individuals and populations in harm’s way… The arrangements are structural because they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people … neither culture nor pure individual will is at fault; rather, historically given (and often economically driven) processes and forces conspire to constrain individual agency. Structural violence is visited upon all those whose social status denies them access to the fruits of scientific and social progress.” (6)
— Paul Farmer, Co-founder of PIH, Pathologies of Power
The Social Determinants of Health
One set of factors that determine health equity are the Social Determinants of Health (SDH); the social structures and economic factors that shape the “circumstances in which people are born, grow, live, work, and age”(2). The World Health Organization (WHO) recognizes that these circumstances are “shaped by a wider set of forces: economics, social policies, and politics”(3).
The Center for Disease Control (CDC) has outlined five major groups of social determinants — biology and genetics, individual behaviors, social environment, physical environment, and health services.
While the SDH are used to contextualize health outcomes, the social determinants can be used as inputs to inform design decisions. In order to do so, it’s helpful to have a framework that defines the relationship between the social determinants. One such framework is from the Commission on Social Determinants of Health (CSDH) which emphasizes socioeconomic context and position as the primary determinants of outcomes (4).
What does design have to do with it?
Design Thinking tools and processes used today focus on individual behaviors over social structures. Solving for any of the three areas of design’s mission — environments, behaviors, and access to goods and services — is designing directly or indirectly for individual behaviors. While the Design Thinking toolkit is well-equipped to address individual needs, desired outcomes, and behaviors, methods that incorporate the structural components along with individual behavioral ones are missing.
“The question as to which of the two forms of violence — structural or behavioral — is more important, dangerous, or lethal is moot, for they are inextricably related to each other, as cause to effect.” (6)
Let’s consider two scenarios that both have direct social impact: Designing notifications of banking fees for an individual customers of [Bank X], and the one-for-one component of Toms business model.
Bank X
Many banks practice what is called “debit re-sequencing”, which allows institutions to re-sequence charges that occur in a single day to process the maximum number of overdraft transactions as possible. This results in more overdraft fees being issued. It is no surprise that this exploitative practice most adversely affects individuals who regularly do not have a lot of money in their accounts, and are both at higher risk of an over-draft transaction and of being unable to repay higher fees.
In designing a consumer-facing app for a basic bank account, how should designers approach this problem? Whose responsibility is it to be aware of not only the practices, but the effects of the practice? Even if design partners cannot change the practices of Bank X, they are responsible for being informed and providing meaningful assistance to the user.
Tom’s Shoes
What about a company that places social impact central to its business model. Let’s take Toms as an example of a one-for-one business model that has gained a relatively positive public opinion. For every purchase of a pair of shoes, Toms gives away another pair of shoes to someone who needs them. Often, these shoes go to poor communities around the world. That sounds like positive social impact and profit in one happy business model, right?
Giving free shoes temporarily solves the problem of not having shoes for an individual. It also immediately undermines demand for local shoemakers, crippling the local economy and shuttering businesses that provide goods and services for shoes. Once the free shoes begin to wear, there are fewer businesses that can service them, causing a demand that cannot be met. Another consideration are the objects themselves. Toms shoes, as designed objects, may not be culturally or socially relevant to the communities they are provided to (a consideration that Warby Parker — an eyeglasses company that opts for a subsidized donation model explicitly to avoid the issues outlined above — recognizes as an important factor to their global distribution of product).
While Toms has augmented how they deliver on their one-to-one model in the past few years, there is still a lot of work to do to ensuring not only equitable effects of charity.
“All organizations are perfectly designed to get the results they get.”
— Arthur Jones
Design should be guided by more than a set of functional requirements. Where can consideration of the long-term effects of products and services be included in that process? Until it is acknowledged social inequity as a direct input that informs design decisions, design practice will continue to reinforce — and potentially create — barriers.
What can design do?
…“we cannot impact health disparities solely through refining processes. It takes a more holistic approach, one that considers a broader set of factors that impact population health.” (8)
Designers in any field must find ways to identify potential repercussions and their root causes in order to create ethical and equitable products and services.
Articulate a clear mission
Projects will generally define a set of KPIs to map success. But a mission for a project should be more than simply achieving metrics. Establishing a mission that defines broader outcomes and responsibilities keeps both the working teams on track to achieving business goals within the bounds of “do no harm”, as well as provide a north star for what questions we should be asking of the work.
Identify social determinants
Most projects have target audiences and use tools like persona development to highlight representative information about types of users (e.g. by demographic, mind-set, geography, etc). Taking a broader look at the determinants and their effects on an audience’s ability to engage with the intervention in the short and long term can surface barriers that may not become apparent until well past the product or service is released.
Map related, non-target users
Ask, ‘who are we explicitly not designing for and why?’ Not only can this question surface important considerations about why we are designing for the target audience, it can also surface potential missed opportunities to engage with audiences otherwise not considered.
Establish a theory of change and logic model
Mapping the impact of a non-existent intervention is a challenge. Program evaluation tools, such as establishing a theory of change, mapping the counterfactual, and creating a logic model help codify the dimensions in which the program is set to affect, and create a molecular map of the physical, programmed, and required actions of an intervention.
Co-design & rigorous research practices
Participatory design practice is having a resurgence, but rigorous research, co-design, and evaluation is still constrained by the ambitious timelines of digital product creation. Design practice is in many ways an anthropological practice, and therefore requires a much higher level of engagement with audience and communities than is common practice today.
An example of a design research approach that integrates these practices is the Living Lab. Living Labs are a design and innovation initiatives that call for design practice to take place in a collaborative, open ecosystem. “In practice, Living Labs place the citizen at the centre of innovation, and have thus shown the ability to better mould the opportunities offered by new ICT concepts and solutions to the specific needs and aspirations of local contexts, cultures, and creativity potentials.” (10)
Monitoring
So much of what is created is simply delivered and never seen again. Monitoring after a designed solution goes out into the market is not only a part of the “iterate” step of most of design’s ubiquitous process presentations, but ensures that the desired outcomes are met, and unintended ones are evaluated and adjusted for. While design teams working in agencies and consultancies may not have the ability to directly monitor outcomes, a method for evaluation must be a deliverable.
Address the Social Impact of Design Practice
One cannot ignore the social impact of the technology industry itself. Areas with a booming tech economy also have some of the highest income disparities and inequality in the United States, in no small part because the “technology-driven economy greatly favors a small group of successful individuals by amplifying their talent and luck”(9). How design practice is structured — diverse hiring practices, engagement with local communities, and democratizing design practice— is just as important as considering the impact of project work.
Everything that is created has some degree of social impact which can reinforce and create new opportunities for social inequities. Designers in any field must identify potential repercussions and their root causes in order to create ethical and equitable products and services.
(1) Galtung, Johan. Violence, Peace, and Peace Research. Journal of Peace Research, Vol. 6, №3, 1969.
(2) CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization.
(3) Social determinants of health: Key Concepts. World Health Organization, n.d. Web
(4) Målqvist et al.: Causes and determinants of inequity in maternal and child health in Vietnam. BMC Public Health 2012
(5) Serpas, Sarah. “For Low-Income People of Color in NYC, Segregation Is a Regional Problem.” CityLimits, 24 Mar. 2017. Web.
(6) Farmer, Paul. Pathologies Of Power : Health, Human Rights, and the New War on the Poor. Berkeley:University of California Press, 2005.
(7) Gilligan, James (1997). Violence: Reflections on a National Epidemic. Vintage Books. p. 196
(8) Graham, Garth N. Why Your ZIP Code Matters More Than Your Genetic Code: Promoting Healthy Outcomes from Mother to Child. Breastfeeding Medicine Volume 11, Number 8, 2016
(9) Rotman, David. “What Role Does Technology Play in Record Levels of Income Inequality?”MIT Technology Review. MIT Technology Review, 01 Sept. 2016. Web.
(10) Open Living Labs | The First Step towards a New Innovation System. N.p., n.d. Web.
