Here at Design Council we have been partnering with the Local Government Association on a programme called Design in the Public Sector since 2014, looking at how adopting a design approach can help diverse teams navigate the complex social challenges they face in their communities. As we embark on our 10th cohort of teams next month, I wanted to reflect on what we’ve learnt from using design to rethink our approach to tackling public health and why we believe a multidisciplinary approach is the most effective way to create people-centred solutions.
The teams that participate in Design in the Public Sector programme are passionate about using the opportunity to make sustainable change in their environments. The increasingly challenging fiscal landscapes that they are faced with means that they are having to approach solutions differently. Design can be an effective tool to build new forms of collaboration.
The social determinants of health
We now know that our personal health journey is determined by a complex web of external conditions, many of which are beyond our control. The Health Foundation defines these factors as “the social determinants of health — the social, cultural, political, economic, commercial and environmental factors that shape the conditions in which people are born, grow, live, work and age”.
These factors range from our access to education and skills, money, work and resources to how we make decisions about what we eat, the access we have to our friends and families, and how able we are to feel part of a community. So rather than seeing health as a singular subject that can be tackled by healthcare alone, we understand that it’s the inter-relation between individual characteristics, lifestyle and the physical, social and economic environment. This complexity is reflected in the challenges the teams bring to the programme: from tackling air pollution in Portsmouth to increasing levels of physical activity in newly-built communities in Cambridge.
Dahlgren and Whitehead (1991) talk about the layers of influence on our health in their pioneering rainbow model below. They describe a social ecological theory to health mapping the relationship between the individual, their environment and disease.
Source: Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried?
What this clearly demonstrates is that the services which support us and the places we live in fundamentally define our future health journeys and that inequality means that not everyone has access to the support they need to thrive.
How can design help?
The design process allows teams to really get under the skin of a challenge by getting a wide range of people to collaborate and look it. We do this by often taking a diagonal slice of experience, from those working in strategy to the people delivering on the front line. What is at the core of the programme is getting those people to really explore and listen to the people who are affected by the challenge to help them understand how they are affected by it, in order to design a solution based on their need.
So instead of looking at health from the perspective of healthcare alone, the question is how can we use design methodologies to address the wider challenges set out by the social determinants of health.
We’ve had some great outcomes from our Design in the Public Sector programme which demonstrates how a multidisciplinary approach can be effective. During the programme the teams build their skills and capabilities, create new insights and evidence, and shape new opportunities that have the potential to deliver alternative and improved outcomes. Although the programme does not focus solely on health and wellbeing, it is one of the areas where we’ve seen a real appetite and drive from local authorities to try more innovative approaches to often longstanding, complex issues.
How Derbyshire gives babies the best start in life
Derbyshire came to the Design in Public Sector programme looking for support around helping pregnant women to stop smoking. Their ambition was to reduce rates of smoking in pregnancy to 6% by 2022. Their team was made up of a midwife, their public health team and their Live Life Better Derbyshire lifestyle service. Through using the Design Council’s Framework for Innovation they were able to get under the skin of the challenge by conducting deeper user-research.
Councillor Carol Hart, Cabinet Member for Health and Communities, Derbyshire Country Council explains “the person-centred principle shifted the focus from thinking about solutions from a professional perspective to one that focused on what matters to local women who smoke. The most important stories we gathered came from women who had smoked through their pregnancy, who shared the concerns they had and the barriers they’d faced that prevented them from quitting. These included family and friends continuing to smoke while they tried to stop, and women who have very little confidence in their own ability to quit”.
They used this insight to look at a range of wider, supportive services including the co-delivery of antenatal clinics by midwifery staff and stop smoking advisors. They are also now exploring other ideas which look at the social determinants impacting women’s ability to quit such as promoting getting active during pregnancy and involving family and friends in celebrating success.
Digital health checks in Southwark
As a result of their journey through the Design in the Public Sector programme in 2018, Southwark Council has become the first local authority to offer a digital version of the NHS health check to save people needing to book face-to-face appointments with their GP. At the time of entering the programme, half of those invited had not attended a NHS health check.
The new system will see all non-responders invited to take the new digital health check instead through a series of questions about health and their wider lifestyles to calculate the risk of cardiovascular disease. After completing the health check, residents will get advice and information about how to maintain a healthy lifestyle and reduce their risk of developing cardiovascular disease. Since the trial launched in January 2019, over 300 people who previously did not respond to an invite for a face to face health check have completed the digital version. Ten percent have been found to be at high risk of cardiovascular disease and have since been advised to contact their GPs.
The teams we work with are often trying to achieve the same outcome but struggling to find a way of working together. What the Design in Public Sector programme has demonstrated is the vital role that collaboration plays in tackling the complex social determinants of health. It is design which gives people the tools and the confidence to do it well. We are really interested in the role the Design Council can play in viewing health from a wider perspective, using our unique mix of skills in public sector innovation, architecture and built environment, business support and policy and insight to bring about systemic change that works for everyone.