This interview series is part of First Mile Health, a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

COVID-19 made health mainstream discourse. Beyond public health, the health of the environment, health of the economy, and health of our democracy are all at stake. The question at the heart of all of this seems to be that as a society, how might we honor our diverse lived experiences while genuinely investing in our collective health and well-being?

In this interview, I speak with Abraham Verghese — physician, Professor for the Theory and Practice of Medicine at Stanford University Medical School, Senior Associate Chair of the Department of Internal Medicine, and author of the bestselling novel Cutting for Stone — to learn about how he’s thinking about “diversity” and how literature, in weaving together the “common threads of human behavior”, can help us deeply understand ourselves and in turn, enable us to meaningfully contribute to the health of our society.

Distance Traveled

Joanne: Diversity is critical to the health of the natural environment, human society, and even our mental well-being. As a champion of diversity who’s dedicated much of your career to bringing diversity into the field of medicine, what are some of the lessons you could share?

Abraham: Distance traveled matters. I’m much more impressed with the candidate who has made his way from a different starting point than someone who had the best education and the benefit of SAT or MCAT coaching, and then arrives looking perfect. As a result, too often I think all the best companies and universities are fighting over the same small pool of diverse candidates who look just like the best non-diverse candidates, when I think our real commitment to diversity is appreciating that we need a different threshold. This is not “lowering our standards” — it’s much more about realizing that talent and potential is too often latent and that we must appreciate distance traveled. If that realization starts to really sink in across the enterprise, then we are really onto a great thing.

We all clearly care about diversity, but I think at times we have the illusion that if we attend enough workshops, and do enough required on-line modules, then magically we are all suddenly on the same page. I think it’s much more complicated than that.

What’s really required is that we are moved by and truly understand the experience of the Other in a meaningful and emotional way.

Required workshops are a great start in finding out our own biases, but I think there’s another level to that.

I like to use the example of how slavery ended in America. It didn’t end because of a political scientist; it didn’t end because of a President; and it didn’t end because slavery abolished it themselves. It ended because one novel captured the public’s imagination — Uncle Tom’s Cabin — and it made the idea of slavery so unpalatable that it no longer was tenable. Similarly, the National Health Service in England did not begin because of the pressing need that people had, or because public health folks or economists thought it a good idea. It began because of one novel, The Citadel by A. J. Cronin, which by the way is a seminal book when it came to inspiring young people of a previous generation to go into medicine. The novel’s depiction of conditions in a small, coal-mining town in the UK was compelling and shocking enough to galvanize the public to the point that, suddenly, the idea of a national health service with uniform standards felt urgent. In each case, the reader experienced what it was like to be in the shoes of those who were suffering or put upon. In short, what is missing in the dialectic of diversity is the role of fiction and a shared literature in bringing about such an appreciation.

Joanne: From your perspective, what represents the fundamental tenets of humanism, and how do you think that could be embedded more in not only leadership, but in society in general?

Abraham: We need look no further than the current crisis we are living through as a globe and as a nation. We were woefully unprepared for this pandemic. First of all, we were unprepared because we shut down the Epidemic Intelligence warning systems that would have alerted us to the magnitude of what was coming, so we were not prepared in that concrete and practical sense. But even if the science has been just amazing, we have all been surprised by the human behavior around COVID-19 that has seemed illogical, and contrary to known facts. But if you read Camus’ book The Plague, for example, every single conflict that we’re now seeing in society, the turmoil and resistance to common sense measures, was already described very well by Camus. There are the people who roll up their sleeves and get going, the people who deny the epidemic, the people who profit, the people who flee at the first opportunity thinking only of themselves, and so on. In other words, we didn’t need to be surprised by all the agony of maskers versus non-maskers, of naysayers, of patients with COVID-19 who are dying of it, refusing to acknowledge that they have the disease even as it kills them. We didn’t need to be surprised by the stark differences in our society — a humanist, or the study of humanities and works like the Decameron, or Defoe’s A Journal of the Plague Years, not to mention The Plague, might have allowed our leaders to anticipate that just as they might have anticipated the dimensions of the epidemic.

Leaders in medicine — say, Chairs of Departments or Deans — wind up taking crash courses that teach physicians how to manage, how to budget, how to negotiate, and how to deal with personnel issues — not skills we normally have.

Similarly, I would say that a necessity for human leadership especially on the scale of nations and major government institutions should require that one be versed in scientific principles and the ability to distinguish fact from opinion (which admittedly seems a lot to ask) but also should require some education in humanities so that one knows the key narratives of our civilization which might help anticipate and inform human behavior.

Perhaps that is wishful thinking, but we seem to require standards and certifications for the professionals who care for patients; it would seem logical that those in elected office who hold the lives of an entire populace in their hands should also have a crash course in humanism and be certified as having enough of a knowledge of history not to be condemned to repeat mistakes of previous generations.

That’s what I mean by humanism. It’s not something to help you speak better at cocktail parties or make you appreciate art and literature; it’s an awareness of the common threads of human behavior as evidenced in novels, philosophy, and history to allow us to do better in modern times than ancient times.

Temporal Reflection

Joanne: Rethinking a “shared literature” from a truly humane standpoint is overdue in the field of design. What’s the pantheon of references that are perennial, that are also not entirely Eurocentric? Especially in this moment in America, a shared literature must also be a very diverse set of literature. It must be an expansion of the typical, required freshman-year reading at a liberal arts college, beyond the classics of Western civilization.

Abraham: I think there’s something very rich about coming to seminal works later in life than earlier in life, getting to revisit them. I don’t think reading the “great books” in college works as well as it might, only because at that tender age we may not be in a position to appreciate the life lessons. I would say that rather than thinking of it as a “great books” list for college, or any particular list, it’s much more about an education and a personal journey that allows you to know enough to seek out and revisit the Great Books types of list; it’s about finding the particular narratives that will aid you best, that will give your life meaning and allow you to act wisely for yourself and for others.

For example, in my era, there were a lot of different books that “called” people to medicine. It was a fairly standard list of books. And yet, I didn’t come to medicine because of books like Microbe Hunters or Arrowsmith; I came to medicine because of Of Human Bondage, the novel by William Somerset Maugham, which has the most minor medical element in it. I think people have to begin to find their own “great books” list and be open to that notion. Obviously, the particular list is going to vary from culture to culture. So, what I think is much more important is the journey of exploration, the desire to locate yourself as a human being on the arc of your personal history and on the arc of human evolution. For one person, their inspiration might be Darwin. For another person, it might be Somerset Maugham. For another person, it might be a seminal piece of poetry. So, I’m not sure if we can get too prescriptive for everyone; but for those in public administration and those in elected leadership we certainly can and need to have a list of useful books to understand the human side of governance.

I think we all need the invitation to take an inward journey to communicate with self, and then to start to articulate those ideas of self-knowledge to help us be in the world.

Joanne: I think this is reflecting a notion of health as something that’s individually driven, which restores agency to people to have health as something that’s part of their own individual journey. There’s so much attention focused on how your health is your responsibility, but there are so many systemic conditions that shape what choices people have, like whether they live in a food desert. On one hand, there is a need for agency and empowerment at the individual level, but also, it can’t be entirely up to people. There need to be certain conditions set so that the system supports health. Having this journey of exploration and locating oneself is crucial, though that can only happen in a supportive context.

Abraham: Yes, I agree. One way that companies can honor this is to create space — not mandate the form and shape of the discourse, but create space for self-exploration and self-dialogue.

For example, when I was running a humanities division at San Antonio Medical School we had a capstone course for the students’ last year of medical school. We unearthed their admission essays they wrote to apply to medical school, and four years later we presented those essays back to them. Then we asked the students to reflect on the person they had become.

In medicine, there’s a very profound phenomenon in which you become an entirely different person after your training than the one you when you started. I think that’s true of other fields, but it’s a very dramatic change in medicine. You can enter wanting to help the world and save the masses and unfortunately — because you’re forced to drink out of this firehose, and also because you become so disease-oriented as opposed to person-oriented — you can begin to lose their capacity to imagine the suffering of the patient. It’s not the student’s fault; it’s our fault because we mandate for good reasons that they learn the technical stuff, learn about disease. As a result, students can find themselves thinking of patients as the “heart attack” in Bed 2 and the “diabetic foot” in Bed 3, whereas in their first year, students would have never thought of patients that way. The good news is that most of us come back to some version of ourselves, a return to the curiosity about the individual and the suffering as opposed to their disease. But it can take many, many years to rediscover that.

Joanne: Can we speak about the role of fiction in thinking about the future? This is core to what design is; every time you’re designing something, you’re imagining something that isn’t there yet. There’s a nuance I want to tease out, which is the role of fiction and novels, in that they’re a critical lens into some of the core contradictions of the time in which they were written. Fiction is often not just making stuff up, but rather recounting something in a new way.

Abraham: That’s why I love the definition by Dorothy Allison. She says, “Fiction is the great lie that tells the truth about how the world lives.” In a successful novel — even if it’s taking place in the future, even if it’s taking place in outer space — the elements of truth are what make it resonate. The reader senses that it’s true, even though they know it’s made up. We only suspend disbelief if we’re drawn into a story that we feel has a possibility to be true and echoes our own lives. It’s usually relationships and the flaws in the characters that make them true. The characters truly reveal themselves by the actions they take under pressure.

When a character takes an action under pressure, that is the moment that character is defined.

I think there are countless lessons that we all take away. From our smallest age, we’re told stories by our parents — nursery stories and fables — and then we learn to tell our own stories, and we act in school plays. Stories are the instrument for human development and yet we become coy about fiction as we get older

In medicine, we became very left-brain in our orientation, where somehow the stories have vanished, as if it should be all science, or it’s not important. Yet, as William Osler, the father of American medicine, said, “It doesn’t really matter what disease the patient has, it matters what sort of patient has the disease.” And that’s timeless about medicine: it really needs human understanding.

Joanne: In the arc of your career in medicine — working and exploring health in all these different, expansive ways — what’s your own temporal reflection?

Abraham: I’m not sure I have an easy answer for that. I think the nice thing about writing is that you’re always reflecting. It’s consolidated my belief that we are all absolutely unique, and that self-knowledge truly matters. Life is so fleeting that it’s poignant, and it’s important to cherish the best moments. We’re not going to be here forever. A rose would be a weed if it didn’t wither and die away; what makes roses beautiful is that they’re transient. In the same way, our lives are fleeting and therefore the moments poignant, and precious. The longer I’m alive, the more I’m conscious of how precious time is.

I also think the skill that is hardest to teach and most rewarding is the human connection, the art and science of connecting with people, particularly those who hold viewpoints different from yours.

The quantitative stuff and the science are easier to teach. In a difficult situation one looks to the data — which is great, we need the data — but the important things can also be buried in the anecdote, though the anecdote may not be statistically significant. Nevertheless, in the anecdotes are often very interesting human lessons. The abiding lesson is that we are complicated beings, and our responses are far from rational. True compassion is to anticipate such variety; it is the ability to embrace people whose views you might not share and to not be surprised or react in anger. There is little in human behavior that is new. History teaches that. The challenge remains: can we make things better for all despite our diverse views?

Health is everyone’s business. It’s time to invest in the first mile of health: where we live, learn, work, and play. This interview series is part of First Mile Health, a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

Our current health crisis is a leadership crisis. In a system as complex as health, where many communities, sectors, and industries, intersect, it’s hard to see where change could start — or who might lead the change. What does it look like to lead — to empower, heal, and support others — through today’s multilayered health crises?

In this interview, Steve Downs (Co-Founder of Building H) and I are speaking with community organizer-turned-teacher Marshall Ganz to learn about a form of leadership rooted in organizing and how leading with hands, head, and heart is the first step to systems change.

Joanne: It’s hard to be healthy in America for many different reasons, and it has been increasingly hard in the last few decades. So far, most solutions for making people healthier have been to ask people to work harder, but that doesn’t change the system. How could we align the choices we make around health with the structures that shape our everyday lives?

Marshall: It seems like a question of agency structure. In other words, there’s the domain of me choosing, but then there’s the conditions under which I choose. How do those two interact in a dynamic way? Neither one is static. Structure itself is always changing, but at a different pace. The dimension of agency becomes crucial.

We need to think in terms of virtuous institutions, not just virtuous people.

How do we create a context in which we can be our better selves? We need structures that enhance our capacity. We’re human beings, and we need that help.

Grounding choices in value

Steve: I wonder if we need more of an environmental change to make being healthy easier to do. What are some ways to make healthy choices easier?

Marshall:

One of the things I’ve noticed in organizing is that people tend to commit not because something is easy, but because it’s valuable.

And we confuse the two. As we try to make it seem easier, we trivialize it. If I’m convinced something is efficacious, I’m much more likely to commit to it. All this focus on the cost and difficulty misses the benefit, in a way.

It also seems like people need to be involved in changing the environment, not just changing themselves. And I think we’re seeing an example of this play out right now across the country with the protests against police brutality. Some people think it’s just one bad-apple cop and treat it as an individual problem, but really it’s an institutional one. It often takes people engaged in changing institutions for them to actually own it.

We’re in the midst of a very interesting experiment on making choices with respect to health. This dramatic shift that we’ve made since February has been unimaginable. Urgency became real, and we’ve undergone some drastic changes with not that much resistance. We radically altered our daily lives — our family life, our work life, everything — hugely. Everything that we thought was a given suddenly wasn’t. Everything that we thought could never be changed suddenly could. It opened up a whole opportunity for creativity and adaptation.

And I think it’s related to what’s happening right now with racial justice. It has created a context in which things we thought were impossible become possible. We’re experiencing this intense moment of possibility.

Story of self, story of us, story of now

Joanne: The pandemic is exposing deep injustices in the system. There is tremendous possibility but the complexity and the weight of it all can also feel daunting. Where do we start?

Marshall: We’ve learned to approach these types of challenges as a leadership challenge. The ground for our understanding of leadership was three questions posed by Rabbi Hillel, first century Jerusalem scholar: the first one, if I am not for myself, who will be for me? It’s not meant to be selfish but meant to be self regarding. In other words, if you presume to exercise leadership, then you’re very clear about what you bring to it. And the second question, if I am for myself alone, what am I? The implication being to be a human being is to recognize that everything we do is in relationship with others, our capacity to realize our objectives are inextricably relational. And finally, he says ask yourself, if not now, when? This is to avoid falling into what Jane Addams described as the snare of preparation, you know, that we’re going to have the perfect plan, then we’re going to launch, and the world will totally conform to our expectations. It never does. And it can’t, because the future is unknown.

In order to learn to do what we want to do, well, we have to begin to do it. So we have to build in learning in doing and not treat them as sequential, but treat them as simultaneous.

Leading with hands, head, and heart

Joanne: The type of leadership you’re describing is very different from leadership defined by hierarchy. It seems less predictable and more emergent. In what contexts do you see this type of leadership coming into play?

Marshall:

Leadership becomes highly relevant in dealing with challenges and contradictions.

Usually when people say, where’s the leadership or who’s in charge, it’s because there’s trouble. If you think of the domain of leadership as being dealing with that, there never is going to be this place of control. When you have a functioning system, it’s all routine and you don’t need the adaptive and creative dimension. When everything’s working, what do you need leadership for?

It’s time to articulate a notion of leadership that’s quite specific. Ask yourself questions like: Do I have the skills I will need? There’s new things requiring skills and we take that as a challenge to the hands. Can I use my resources in new ways to deal with this? That’s a strategic challenge, a challenge to the head. And there’s where do I get the courage and where do I get the hope, and how do I inspire the courage in others? That’s a challenge to the heart.

The practice of leadership

Joanne: These are important and tough questions! I imagine they can’t be answered in the abstract. What’s your process for building the culture and practice of leadership?

Marshall: We’ve focused on five practices that we anchor our work in: relationship-building, storytelling, strategy, structure, and action. I call them practices because they involve a skill, concepts, and values.

The first one is relationship building, to accept and understand the core texture within which this stuff happens is relational and how you do that with intentionality. Organizing is a particular form of leadership that starts by asking, Who are my people? In other words, with whom am I engaging to work, to accomplish whatever I’m trying to accomplish? Then the second question is, What is the change they want or need in terms of their lived experience? And what could help? And then thirdly, How can I help enable them to turn their resources into the power that they need to make the change? So it’s working with folks not like clients, not like customers, but as a constituency. The next question I would ask is, Who cares? For whom is this vital enough, urgent enough, that they would fight for it?

Then storytelling — the heart part. Stories are a way in which we learn to mobilize the emotional resources embedded in our values, to turn threats from which we flee in fear to challenges which we can approach with hope. In other words, it is creating the emotional conditions for the exercise of agency.

The third practice is strategy: how to turn what you have into what you need to get what you want. In other words, how you turn the resources you have into the power you need to get what you want.

The next is structure. In other words, how do we organize ourselves in order to do this? What are the commitments we make to one another? How are we going to work together? How are we going to handle authority resources?

And then in the end is action, which is how to actually make things happen on the ground. If you can’t count it, it didn’t happen. It’s a commitment to actual outcome and creating the kind of metrics so that you can learn as you’re doing.

Joanne: These practices probably aren’t linear, but rather as you said earlier, simultaneous. There seems to be a tension between the energy that can mobilize a movement and the stability needed to structure and organize ourselves.

Marshall: There’s a tension between change and continuity.

Organizations tend to be a whole lot about continuity and campaigns are really about change.

It’s a different rhythm. And so how do you balance the rhythm between change and continuity? It’s the university classic challenge Robert Michels writes about the iron law of oligarchy. You have your movement, your movement succeeds and you make it a successful organization. Guess what, sustaining the organization supplants the goals of the movement. And so then you don’t want to take risks. And eventually you become obsolete. Stephen Jay Gould talked about that in his book Time’s Arrow, Time’s Cycle. That’s kind of what a campaign is. It’s time as an arrow. It has a beginning and an end. It’s an intensely focused stream of activity that builds capacity in the course of what it’s trying to achieve.

Turning moment into movement

Steve: If you analogize the gradual, but steadily increasing prevalence of chronic diseases to the moment we’re in with racial justice, you could argue that it has been a growing problem — or a terrible problem that simply hasn’t gotten better — that’s punctuated by moments of acute visibility and outrage.

Marshall: And the question now is about turning the moment into movement. In other words, it’s whether those moments galvanize, whether people confront those moments with the capacity to use them, to turn them into something that goes beyond the moment.

I’ve been interested in how people take these moments and turn them into an opportunity to actually make structural change. It’s hard to plan these things. It’s like the problem with the climate change movement: the important is decoupled from the urgent. We will always respond to urgency, and urgency is an expression of extreme priority. There is a real, visceral understanding of urgency.

The other thing that we often talk about is anger. And by anger, I don’t mean rage — I mean outrage over a contradiction between world as it is and world as it ought to be. That moral dissonance, which is really important for generating courage, is not enough by itself. And that’s where the second set of emotions come in: hope, solidarity, and a sense of self-worth to balance the fear, isolation, and self-doubt.

In our own lives, we often learn what we care about through experiences of hurt. But we also have experiences of hope.

If we didn’t have the hurt, we wouldn’t think the world needed fixing. If we didn’t have the hope, we wouldn’t think we could.

In this context, how do you make it real enough that it shakes you out of the ordinary? And how do you make it hopeful enough that you actually think you could do something about it? These are important questions for movements to consider.

Shifting power with a critical eye and hopeful hearts

Joanne: Emotions like anger, hurt, and hope are human to human-level expressions. How do institutions and systems fit into this?

Marshall: Well, if you think about it, there are values in the interests of institutions. If you think in terms of values, individuals have values of hurt and hope and so forth, so do communities, so does a family. They take shape in the kinds of norms that we establish or the rituals that we may have. I mean, that’s what religion is: a way of experiencing challenge and hope. In other words, yes, there is that individual level of experience, but it can be embedded in community and it can be embedded in institutions.

I think of interests as specific objectives that are rooted in your values. That’s where power comes in. In organizing, there are things you can do through collaboration. For example, you can build capacity by supporting one another, but you bump up against the reality that there are others whose resources you may need. You can try to convert them to join you, but that’s difficult if they have different interests. And so then the question is, How do we make it more costly for them to not do what we want them to do than to do it? Or you can think of it positively: How will it be more beneficial than costly? That’s the power calculus.

Joanne: Once you have your organizational narrative, does that change how you conceive of your own narrative? It seems like there are two different kinds of power coming from different places.

Marshall: Power’s really interesting. There’s this notion about three faces of power. There’s the obvious — for example, when somebody gets arrested and goes to jail. But then there’s a second face of power, which is: Who authorized that? And then there’s a third question: Who set up the conditions under which those people could be making those decisions? It takes you then from an individual to a structural level.

As an example, let’s look at Rosa Parks protesting bus segregation. The city council and the bus company made the decisions to segregate buses, but those decisions stemmed from a larger system of segregation. And that system, it turns out, stemmed from institutionalized racism.

[Sitting in the back of] the bus was a grievance, a daily grievance. The protestors had the resources called feet; by walking to work, they could deny the bus company bus fare. And if everybody did it, it was substantial. That is one answer to the question, How do you turn moral resources into economic and political resources? That’s often what’s involved in a movement. It’s a calculus of sacrifice: giving up certain things in order to create the capacity to actually change something much bigger.

Joanne: People who experience the most hurt tend to also bear the greatest burden. When we look at the changes that need to happen for us all to be healthy together, who do you think could shift the power and drive structural change?

Marshall: I think the practitioners — the people who are called to healing — are really important. Medical professionals have a really important role to play. Young people, also.

Young people come of age with a critical eye but also, almost as a necessity, hopeful hearts. That is such a valuable, critical social resource. So it could be a real movement. It really could.

And we need one. This whole virus experience has helped reveal all the radical dysfunction not just in our health system, but in everything — we are seeing how the most vulnerable are the most screwed. It’s just so visible now, and we can’t let it just go away. There’s huge potential to make this country healthy, to give children more of a future.

Health, Leadership, & Systems Change: A Conversation with Organizer Marshall Ganz was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is part of First Mile Health, a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

The food system is not broken, it’s designed with inequity as a built-in feature. The key to creating more equitable food systems lies in igniting innovation in systemically overlooked places: the places where people have the fewest resources, the lowest incomes, and the least choice.

In this interview, I speak with Nancy Roman, President and CEO of Partnership for a Healthier America, to learn about her latest initiatives to “build the ladder from free to affordable” and ultimately, create a market for food equity.

Joanne: Given your experience, what are the biggest barriers that get in the way of people eating healthy?

Nancy: It’s important to understand that in the food space, the barriers are different across the socioeconomic spectrum. At the top of the socioeconomic spectrum, the primary barrier to eating well is time: you have sixteen meetings back to back, so you’re eating snacks out of your drawer. For most of the rest of the country — the bottom of the socioeconomic pyramid — their barriers are many. Time is one of them, but more important are access and affordability.

I’ve also come to think of marketing as a barrier. By nature, we crave salt, fat, and sugar, and the advertising industry has figured out that it’s a lot easier to manipulate your taste buds around salt and sugar than to inspire you to eat a salad. A disproportionate share of advertising revenue goes to junk foods, and I think junk food marketing is one of the biggest barriers for low-income individuals, and then lack of access to healthy food.

Now, because it’s been so sustained over decades, it’s really become a generational problem. The culture has lost the habit of eating produce and cooking meals. The culture is purchasing fast food, which is perceived to solve the other barriers: time and lack of access.

Innovate for everyone

Joanne: Are you seeing any cultural changes due to the pandemic that may lead to changes for the next generation?

Nancy: I think one of the positives coming out of COVID-19 is how it revealed the gross inequity and fragility of the food system. Our just-in-time supply chain broke down in spectacular fashion early on, resulting in shortages in the grocery stores and tons of produce going to waste. I think there’s a real desire now to have a base of food within striking distance that doesn’t rely on a global supply chain.

That’s what we’re doing with our work now. We’ve created the COVID-19 Fresh Food Fund, which just launched in Colorado and New York. Families have access to fresh produce boxes for free or at a reduced cost. In the short term, it’s solving a critical problem: we hired furloughed workers to rescue produce from the composter to give it to families in need. But the bigger thing is, we’re collecting data on things like willingness to pay so that we can work towards affordable access. [The lack of] affordable access is the thing we’ve got to solve.

I keep saying to my staff and my peers in the space: this is our moment.

The current system is revealed to be flawed, and I’m saying, let’s build what we want.

It’s a really big job, obviously, that’s beyond the Partnership for Healthier America, but we’re using our resources to try to run this COVID-19 Fresh Food Fund in a way that gives data that we’ll use to incentivize innovators to come in at affordable price points. One of the things that drives me crazy is that innovation always stops at the top of the socioeconomic pyramid. Once in a while, you get enough volume that the price comes down and it becomes more accessible, but usually not. Fast Food chains were once an innovation for the people of means, and then it became everyman’s food. The ultra-processed carbs very quickly found their way down. Now we’re recognizing that ultra-processed isn’t good for you, but it’s hard to scale the things that aren’t ultra-processed at affordable price points. That’s really where we need innovation.

Joanne: What kind of impact have you seen from the COVID-19 Fresh Food Fund so far?

Nancy: I just read a message from the person delivering [produce] in Denver that said, “These families are crying because it’s been so long since they’ve had a piece of fruit or any fresh produce like this.” In food banks, we’re usually getting produce on its last legs. Of course, you always want to distribute with dignity, so we would never distribute anything rotten, but it’s not always gorgeous. This produce is fabulous. It’s the best way to expose people, and we’re also gathering data on willingness to pay because this box is worth about $50. At the end, we’re going to say, Would you be willing to pay $5 for the box? $10? Because the world can’t be everybody giving out free food forever. We have free food from food banks, and then we have beyond-reach food up here. How do you build the ladder from free to affordable?

Learn through iteration

Joanne: How has Partnership for Healthier America evolved over the years as the organization iterated and learned?

Nancy: Our mission used to be ending childhood obesity within a generation. We changed that, and our vision is now that children grow up healthy — free from obesity, diabetes, and all these chronic diseases. Our mission is to transform the landscape of food in pursuit of health equity. We’re trying different things now, and we’re thinking much more broadly about corporate engagement.

Joanne: What about how you measure success? Has that changed over the years?

Nancy: I’m a big metrics person, so I measure everything. We’re actually changing what we’re measuring at Partnerships for a Healthier America: we used to measure calories that we’re taking out of the marketplace, and we’re now measuring portions of healthy servings that are reaching people in need. It’s like a hunger heat map; you can see how we’re putting our partnerships in zip codes where they’ll have an impact.

Joanne: Data seems to play a critical role, both for iterating on the program and for catalyzing action.

Nancy: I think designing data is huge. You have to be super clear about what you want and not be naïve, especially gathering data among low-income populations. You have to have a backup system — you can never just throw a survey in a box and hope people take it — and of course, you have to be scientifically accurate, clean, and careful. Your data is better when you repeat it city to city. You learn, you iterate, and you improve as you move to the next city.

For example, for me, success coming out of the COVID-19 Fresh Food Fund will be high-quality data about produce that people prefer, their habits, how often they eat it, and what they would be willing to pay for that produce. If I get that high-quality dataset, then that partnership is a big success. There’s all this collateral good being done, but the data is the success for me in this instance.

Learn from failure

Joanne: I’d love to learn more about your leadership philosophy. What drives and inspires your work?

Nancy: One thing that might differentiate me from other leaders is that I have a high tolerance for both risk and for failure. I’m willing to try a lot, and I’ve probably failed more than most people, but I’ve also had more success than most people.

Joanne: Failure is widely recognized as important, but can be so emotionally challenging. Do you have any advice for getting comfortable with failure?

Nancy: Part of what makes me more comfortable with failure is that I see the learnings as a huge success even when I fail.

I’ve never had a project that has been a complete and total failure because I’ve never had anything that I didn’t learn a lot from.

If you’ve got a string of things that didn’t go all the way but that taught you something big that got you on to the next step, at the end of the day, it doesn’t look like a record of failures. It looks like a record of up.

The key is not to be afraid of it. I work really hard to succeed, but when a project doesn’t work out exactly like you want it to — and hardly any work out exactly like you want — you’re adapting your expectations and tweaking as you go. It’s actually sort of fun.

Joanne: What a great recommendation, especially in this time when it seems like the world is failing. I’m sure we’re also learning a lot.

Nancy: This is a hinge moment. It’s a scary moment, but I think this will be one of the big moments that reposition society. There’s been a lot of destruction, but there’s just a wide-open field of opportunity. It’s a perfect time to be doing what you’re doing.

Food Equity, Health, and Inclusive Innovation: A Conversation with Nancy Roman was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

Health is much more than a diagnosis, it represents an individual’s whole self. If we see health not as the absence of disease but rather the presence of vitality, then designing for health means designing for people’s diverse experiences, histories, and everyday lives. In this interview, I speak with Jen Horonjeff, Founder and CEO of Savvy Cooperative, to learn about how the cooperative business model gives patients voice and ownership, and in doing so, enables communities to build equity in their health.

From Extracted Value to Shared Ownership

Joanne: Running a cooperative startup in the health space is not the norm; why did you choose a shared-ownership structure and how do you see that as the way to make an impact?

Jen: There’s a personal reason and a business reason for why we do it.

The personal reason is that I consider myself a patient. I’ve grown up with several different chronic autoimmune conditions. Notably, I was diagnosed with juvenile idiopathic arthritis when I was an infant, and then I got a whole laundry list of other conditions added along the way. I had a brain tumor removed seven years ago. Being a patient has informed my desire to go into healthcare professionally.

The business aspect of it is that I’d been a patient for so long, being asked to share my insights for free while a company gets those insights and profits, and it made me uncomfortable to realize that what we were initially building [at Savvy] was a for-profit company. I did not want to be one of the people who are profiting off of my peers, the ones sharing their expertise. After some research, I realized that our company can be structured as a cooperative, where we share ownership with individual patients.

The co-op model gives patients a voice, and it makes sure that they’re equitably valued based on their contributions to the co-op.

Joanne: Do you think the changes caused by the pandemic might make it easier for more co-ops or more alternative business models to flourish?

Jen: I absolutely think that businesses will have to explore other models. The legacy of co-ops is that they’re more resilient. They are shown to continue on and prosper even in economic downturns. People think if they don’t keep growing, then they just go out of business, but no, there are other options. I know there’s a lot of interest in alternative financing models because the regular venture capital model isn’t necessarily working well right now. I’m hoping that Savvy may help inspire other businesses that aren’t right for traditional venture capitals.

Joanne: What are some of the biggest barriers to building genuinely patient-centered businesses?

Jen: I think a lot of people think they’re not allowed to talk to patients, which is not true. It’s also hard to find diverse patients — that’s really what Savvy set out to solve. Our co-op model is very effective at doing that because our members activate their own networks to find diverse individuals.

I also think many people think talking to people — the basis of qualitative research — is just cute, fluffy stuff. They don’t understand that this is a smart business decision. If you actually understand the needs, experiences, and use cases of your product or service, you’re going to find a better market fit, and you’re going to get to market faster.

Too often companies design a solution in a vacuum and think it will just integrate seamlessly, and that’s the problem. One of my least favorite terms in healthcare is “noncompliance.”

We blame the patient for not following their treatment plan, when the treatment plan was never designed with all of their unique needs in the first place.

Joanne: If one is trying to design something to benefit a group of patients, when is the most effective time to start gaining these insights and initiating the conversation? Is it iterative?

Jen: The answer is always yesterday. You can never do this soon enough. And you just said it: it should be iterative. It can feel like such an undertaking, but just start somewhere and then build upon it, learn, and continue to build.

Patient insights are valuable no matter where you are in your development, it just might look a little different. We want to remind people that patients are the end users of healthcare, so let’s make sure that we’re actually talking to them throughout any sort of development.

Joanne: As you built Savvy, you’ve designed different ways for the co-op members to interact with others who might be learning from and getting insights from them. What are some examples of interactions that happen?

Jen: I think the core offering is connecting individual patients or consumers directly with companies to interact and provide feedback. After an engagement, we always ask both the client and the patients how it went, and we share it back. A company might say, “Thank you for participating in these interviews. Your thoughts helped inform this new program that we’re rolling out.” And those individuals go, “I was part of that!” It helps ascribe purpose to the horrible experiences that they may have gone through, and they then can share that back with their communities with pride.

As a co-op, there’s nothing that makes me happier than when I see co-op members using language like “we,” “us” and “ours” on things like social media. It shows that they feel strongly that they have ownership in this organization.

That also makes it an authentic and easy way for somebody else to join.

From Disease Silos to Holistic Care

Joanne: You mentioned that people with chronic illnesses often get labeled as their illness. How do you navigate that at Savvy?

Jen: Savvy is deliberately disease-agnostic. I don’t believe in labeling a person as their diagnosis when so many of us live with co-morbidities. When we offered opportunities to discuss mental health, we were flooded by people who wanted to contribute because these individuals have oftentimes been labeled as their physical chronic condition, whether that be arthritis, MS, or cancer.

Joanne: In the context of the pandemic, are you seeing any changes that might enable more holistic care?

Jen: The first thing that comes to mind is the fact that so many people’s health insurance is tied to their employer. If we’re losing jobs, we need to rethink how we can make sure people have access to quality healthcare. What’s happening now with the pandemic is almost level-setting: there’s so much that we don’t know. I hope that we can just get a little bit comfortable with that and understand that we need to start to rebuild things from the ground up, because that’s a great starting-off point to have more community-driven research to understand what is important to those individuals.

Joanne: What is the connective tissue between healthcare and other parts of one person’s life, so that everything else can be created to support a person’s health in a holistic way?

In reality, these people are struggling with so many other things, and rarely has anybody ever asked them about their mental health.

We also have opportunities to discuss fertility, nutrition, exercise, and physical activity, so there are multiple ways that people can contribute. What’s really empowering is that these people are finally asked about something outside of just their clinical diagnosis.

Look at what’s happening now with the pandemic: everybody’s isolating, but there’s going to be different experiences and constraints for people who have things like a chronic health condition. We need to be cognizant of that because the way that they interact with the world is going to be different. A person’s health condition ties into every other aspect of their life.

Health, Wealth, and Cooperatives: A Conversation with Jen Horonjeff was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is part of First Mile Health, a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

The pandemic has completely transformed how we move around. Since life became more local, we’re rediscovering what’s close to home. Could these new patterns, behaviors, and rituals permanently shape our movements? Or will we revert back to our comfort zones?

In this interview, Steve Downs (Co-Founder of Building H) and I speak with Jim Sallis, Distinguished Professor in the Department of Family Medicine and Public Health at University of California, San Diego and the Director of Active Living Research, to learn about the relationship between physical movement and health and how to create the conditions to enable everyone to lead actives lives.

The New Local

Joanne: We’re in a moment where people are forced to exist in new and different ways. We’re taking stock of what our lives are like, shifting our personal values, and thinking about what’s worth keeping.

From your perspective, what are some shifts you’re seeing in society? Will they last?

Jim: I’m on the board of Rails to Trails Conservancy, and they noticed that almost immediately after the shutdown started, trail traffic picked up 100 to 200%. When people were prohibited from going to parks, I think they started valuing parks more.

When you’re cooped up, of course, the first thing you want is to be outside. I think there’s potential for people valuing being outdoors more highly. I think that value is pretty important because in the prior decades, people would walk out of their home, get in their car, go to their office, get back in the car, come home, and go to a shop on the way. I think being deprived of the outdoors has the potential to transform things. But I don’t think that transformation is going to be automatic. Unless there’s some way of acting on this moment of a different value, then it’ll just go back to the way it was.

Another change is staying local. That’s been one of my summary words for how this has changed life: It’s made life more local. One of my fantasies is that people will be more likely to consider what it would be like if they had a store in their neighborhood and be more open to mixed-use areas, which is kind of anathema in the suburbs. Also, not being stuck in rush-hour traffic for an hour and a half every day might make some people rethink how their commute contributes to their quality of life. If we can get people to reflect on how to make things better and advocate for things like better parks, wider sidewalks, or putting essential stores in their neighborhood, we may actually see some more permanent changes.

Joanne: There are systemic barriers in place, be they financial incentives or cultural or social norms, that lead to behaviors rebounding back to normal. Do you think systemic barriers might also be shifting as a result of COVID?

Jim: I think we’re at a time of disequilibrium. People are out of their comfort zones and routines, and they’re discovering new things, but what’s going to happen afterwards? If we don’t have some push in one direction or another, then the old patterns will just return. For example, car traffic has returned quickly after the national stay-at-home orders.

I don’t think I see this happening in a natural way. If somebody were to actually invest in finding ways to encourage less driving, putting more shops or a weekly farmers market in everybody’s neighborhood, making the sidewalks wider, putting bike paths in safe places to bike, those are potentially transformative things. If there’s not some force pushing in a healthier direction, we won’t see permanent change. What is that missing ingredient to encourage change?

Physical Opportunity Deficit

Steve: I wonder if it’s leadership. I’ve been looking with great envy at Paris lately. The mayor there has been running her reelection campaign on the idea of the “15-minute city,” that everybody should be within 15 minutes of everything they need.

Jim: I would completely agree with that — leadership is absolutely essential. When we look at cities that are really doing well with active living, low childhood obesity, better food supplies, and that sort of thing, I can’t think of any examples where that happened in a city that didn’t include leadership. It has to be at least supported by the top, if not initiated and driven from the top.

But I also think politicians are notable for being followers. If public opinion is going one way, they will find a way to jump on that. Most people want to be more active, but most people don’t do it.

That’s not an information deficit, it’s an opportunity deficit.

That’s why I think we need more ways for the public to become advocates for better ways of living, better neighborhoods, and better ways of doing things. I think that continues to be a missing ingredient.

So, what are the mechanisms of culture change? Well, I think part of it is some type of promotion of engagement. I started thinking about this during the big focus on childhood obesity. We had the whole federal government on our side, and we had businesses wanting to get involved, but what we didn’t have was the equivalent of grassroots movements like the Million Mom March to demand changes in schools, changes with restaurants, better parks, etc.

Joanne: What contributes to this physical activity deficit?

Jim: Well, that’s kind of everything — all of society. Think about how many of the world’s biggest industries only make money when you are inactive: cars, petroleum, virtually the whole entertainment industry, the technology industry, even restaurants. We’ve just structured our whole life and all of these industries around not being active.

Steve: And that desire to be inactive probably derives from our evolutionary history, right?

Jim: Yeah, exactly.

We have mastered evolution.

What have we wanted all throughout evolution? We wanted all the food we could possibly have — check. We wanted to just sit around and not have to move — check. Those options used to be only available to kings and queens. We’re now living the life of royalty. We should be perfectly happy with it — and in a lot of ways, we are, because people resist changing those things. But the problem is, these behaviors, plus smoking, are what’s killing us 80% of the time.

Happiness Measures Health

Joanne: What are some of the most important conditions that need to be in place for people to lead active lifestyles?

Jim: The social dimension of physical activity is very important. There’s certainly something valuable about being active together, though it’s not necessary. But having other people encourage you — somebody you can talk about your activity with — is very good. It could be somebody in your household, it could be a coworker, it could be an old college friend who lives across the country — it doesn’t really matter. That social aspect is really important. If everybody you hang out with hates exercise, so will you.

Steve: Is there data on what modes people tend to get their physical activity from? For example, commuting vs. discrete workout vs. running errands or walking the dog?

Jim: The bottom line is simple. Throughout the lifespan, except for small children, walking is the most common activity. So a message to walk more, or roll if you can’t walk, works for most everybody. But it’s also useful to look closely at activity for various purposes. The more occupational activity you do, the less leisure activity you tend to do. Throughout history, people were active because they had to be, so there was no reason for them to go out for a run. Transportation activity tends not to be related to either of those; it’s basically related to where you live. In a walkable neighborhood, you’re going to walk places because it’s easier or nicer. You may or may not do leisure activity in addition. Transportation activity is really not as motivationally driven as exercise — it’s environmentally driven.

You see dramatic differences worldwide.

In our international studies, we see places where they’re doing no leisure activities and tons more transportation activities than the U.S. In the U.S., almost all of our activity is leisure.

Joanne: It’s easy to know when we’re sick, but how do we know when we’re healthy? How would you define health in a positive way — as in, not the absence of disease, but rather the presence of something?

Jim: How about happiness? Most people have a pretty positive conception of happiness, and physical activity will reliably take you there. Physical activity has so many beneficial mental health effects. I always say that teachers and parents should be super motivated to make sure their kids are active because those kids are going to be in a better mood. It’s to everyone’s benefit.

Joanne: That reminds me of one of my favorite poems by Mary Oliver, “Lingering In Happiness”, from her book Why I Wake Early. I’d like to read it to you to conclude our interview:

Lingering In Happiness

After rain after many days without rain,

it stays cool, private and cleansed, under the trees,

and the dampness there, married now to gravity,

falls branch to branch, leaf to leaf, down to the ground

where it will disappear–but not, of course, vanish

except to our eyes. The roots of the oaks will have their share,

and the white threads of the grasses, and the cushion of moss;

a few drops, round as pearls, will enter the mole’s tunnel;

and soon so many small stones, buried for a thousand years,

will feel themselves being touched.

Movement, Health, and “The New Local”: A Conversation with Jim Sallis was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is part of First Mile Health, a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

The mind, the body, and the spirit are deeply connected — so how might we design for all three as a whole? How might we do that now, when damages to all three seem too much to fathom?

In this interview, Ryushin Paul Haller, teacher, former Abbot of the San Francisco Zen Center, and a member of the Zen Caregiving Project’s board of directors, helps us put 2020 in the context of a thousand-year-old spiritual practice. His hope? That history might offer clues for how, even in the hardest of times, we can become more in touch with ourselves and, as a result, with the world.

Joanne: From a Zen perspective, what does health mean to you?

Paul: I think “health” has a lot of overlap with wellness. The healthcare system narrows it down to something that I think of as the “fruition” of wellness. When the wellness factors are active, they will influence the organism in a way that brings forth health. That perspective is the foundation of the Zen approach.

When Buddhism started in India, there was a penchant for analysis of the workings of being into lists — and then as it moved to China, analysis became almost more poetic, a synergy of factors that don’t have to be parsed out and thoroughly understood in an analytical way. Given my own background in Zen, my thought is that you don’t have to know how the factors of health interact. You can trust the process of ripening them or bringing them into a vibrant expression. It’s an extraordinary combination between engaging in a long tradition and then bringing it into expression in the moment. In creating an intimate relationship to the process of well-being, you earn your own trust.

Putting the pandemic in perspective

Joanne: This pandemic is often portrayed as an “ahistorical moment”: “nothing like this has happened before”, “this is once in a hundred years”, “unprecedented”… In order to regain our bearings in a time like this, we need a reference point to the past and to engage with tradition. With such a wealth of tradition and history, are there particular Zen teachings that have become anchor points for you?

Paul: I would say that Zen, like many of the wisdom traditions, tries to get at the fundamental, existential proposition of life: what it is to be alive. Then, within that, find insights into the relationship between wellness and the fruition of health. In Zen that is not just a singular event. It’s a continuously unfolding relational event, not just humans, rather it’s the ecology of existence that includes all the different forms of being.

If I was to think about this pandemic from that perspective, I could say, “Yes, never before have we have faced this set of circumstances, this time in our development, these particularities of our social structure, this level of global interaction and movement of people.” But we have faced illness, we’ve had pandemics. We’ve had times when different forms of viruses or illnesses made a very significant impact on the global population.

There are things we can learn from our previous experience: see what’s implicated and find the insight to learn from what’s happening. From that perspective, you could look at all this and say, “This is so rich, we’re going to learn so much from the way the American healthcare system was just laid bare in its inadequacy, from the intertwining with politics, and how people rebelled when corralled into a certain lack of sociability.”

That’s very much the Zen methodology. So what are you experiencing? What do you see as implicated and what’s being learned? That could be anything from how you related to a moment or person, to how you’re relating to an issue in your life.

From a Zen perspective, you’re never done learning about how to get in touch.

Zen has traditional practices that help us explore how the mind, the emotions and the behaviors are expressing themselves and through those explorations, discover the fundamental qualities of existence that promote well-being. That is a tool that helps create the capacity to learn from what’s happening in the moment and then applies the learnings to the multiple dimensions of being alive.

Experiencing extraordinary moments

Joanne: The ability to draw from the depth of history seems to require a fundamental reorientation of how we structure time in everyday life. Do you think the collective perception of time has changed and is that inhibiting our ability to learn on a more fundamental level?

Paul: When we return to being in the moment, time becomes a variable — the notion of time as a constant metric or a scarce commodity becomes a possibility but not an absolute. When time is distant or separate from what we are, it is susceptible to being related to as an objective truth. One of the founders of Zen, Dōgen Zenji, wrote a series of essays in the 13th century. One of the essays which was called “Being-Time” was very similar to Heidegger’s notion of time as an experience. I think that everybody has experienced an extraordinary moment when the experience of time intensified and expanded.

Given the way we’re barraged with experiences, it’s now much more challenging to create an extraordinary moment.

Being bombarded with rapidly changing images, music and concepts disrupts the capacity to be in the here and now and creates an ungroundedness that is susceptible to distraction and anxiety. In the Zen Center, we’re seeing the effects on young people who’ve grown up immersed in multimedia and one of the characteristics is anxiety.

There are two elements to it. One is experiencing what’s happening now, without some agenda that it should be anything different from what it is. Attending to physical sensations, the thoughts going through your mind, the emotions that are coming up supports body and mind to settle. Additionally the ability to make contact with the experience invites an acceptance of the psychological processes . These are the fundamental elements of wellness: acceptance and contact. They’re both a lifelong study.They will teach us about how we’re experiencing difficulties and joys of our life. And they will teach us how to relate to society and all the beings of our planet.

As people become more grounded in themselves and have worked through what’s painful and rewarding for them, they’re more available for advocacy and more skillful in administering it.

Starting to notice our own suffering that makes us empathetic. As we acknowledge what’s happening internally, we’re more inclined to see what’s happening relationally. In relating to many workers in hospitals, from the nurses to the gardener, I’m astounded by the consistency of their empathy. I just marvel at it thinking, “You do this eight or 10 hours every day, and you still do it with such an open heart.”

Empathy as a path to resolving our differences

Joanne: “Consistency” is an interesting word choice. What do you think creates the ability to be consistently empathetic? For example, if I have a certain experience that’s very deep for me, it allows me to empathize when I see that experience elsewhere, but it also makes me blind to things that are different. That’s kind of the opposite of consistency. Here I’m thinking about polarizing beliefs, and how there’s a lot of empathy within each bubble. In practice, a consistency of empathy is extremely difficult to do, because it potentially invalidates something about oneself.

Paul: I think that’s a profound question. You could go back to Margaret Mead, an anthropologist of over 50 years ago, and her saying, “In these primal cultures, this tribe would view this other tribe as other and they would be enemies.” There is something in us that tends to view other people who are different. And I guess it’s open to discussion as to whether that’s an evolutionary influence.

But I would also say, from the Zen perspective, it comes back to how deeply we get in touch with what’s going on for us. And then how thoroughly we can see that it is universal. We all want to love and be loved. We all want to eat and stay safe. We all want to express our being. The more we get into touch with those, what we might call fundamental drives, like Maslow’s hierarchy of needs, the more we can see that there are countless ways to address those needs.

The practice of humanizing others and then empathizing with their humaneness is the ground of our well-being and also the impetus for our advocacy.

Joanne: As a species, we share certain universal needs, but we also tend to disagree on process, on how we get there. It seems very hard to understand, trust, or gain empathy for different processes. And perhaps in some cases, certain processes are false.

Paul: I think the processes of trying to resolve our differences through violence are unskillful, although as humans it seems to be an attractive proposition. To just follow that point a little bit, if you look at our evolution over the last 10,000 years, we’re a lot less violent.

There was another point that I wanted to make there and it’s about how we relate to our differences. When there’s more connection to our humaneness, then we’re less frightened by our differences. They’re less of a threat to our well-being and then we can listen to them. Usually, when we listen deeply to our differences, our perspective and our appreciation of what’s happening broadens. When we touch humaneness, then there’s trust, and out of that trust, there’s empathy and a tolerance of difference. Within Buddhism and Zen, that humaneness and that tolerance of difference are fundamental tenants: direct your mind and your heart towards the benevolence of others rather than the hostility of difference. Everyone’s well-being will be enhanced.

Zen and Health: A Conversation with Ryushin Paul Haller was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is a part of a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

To make everyday life healthy by design, we need to understand what happens not just at the individual level but also what the trends are at the scale of communities and populations.

In this interview, we’re speaking with Sam Pottinger, a data scientist and data visualization artist at IDEO, to learn about a form of data science called natural language processing and how listening to public conversations happening online helps build empathy at scale.

Joanne: As a data scientist, how do you look at systems as complex as health or as big as everyday life? Where did you start your exploration?

Sam: Health is massively complex but it’s also something to which all of us have a relationship. So, the internet is full of stories and perspectives if you know how to look for them. Researchers can learn a lot about a problem space by listening to and honoring those experiences. This broad perspective lets more voices influence design and offers an additional important source of inspiration. I start with questions like, “what topics are discussed in different parts of the internet? How are topics interconnected? What can those connections tell us about systems and opportunities for design?” Some of what we found in qualitative interviews influenced this. The team heard how COVID is prompting people to think about their health and values in a new way. This inspired analysis to focus on not just what is in these discussions but ask how has conversation changed from before COVID to during?

Joanne: As you were researching this topic, where do you look for data?

In the context of everyday health and COVID, we looked at public information in a bunch of places, trying to see how conversation differs across different parts of the internet and for different topics. All that said, the three that really had an impact on my thinking in the space were Tumblr, Crunchbase, and a sample of news media (see data note for rationale & limitations) because they give you a really rich window into very different communities.

Joanne: What did you learn about how the public thinks about health?

Sam: We learned a lot, but something that stuck with me is that, while many efforts focus on education around the importance of “key inputs” like diet and exercise, analysis suggests that the public already discuss these ideas frequently. This is important because these are the behaviors that can help reduce many chronic illnesses. Therefore, I think this observation challenges us to build on this valuable awareness by helping individuals on the health journeys they are already taking instead of adding an additional program to lecture on the importance of those key inputs. Also, in addition to information about frequency of topics, the connection between topics also informed our thinking. For example, encouragement and community become valuable elements for design because the data suggest they may have a connection with diet and exercise. Furthermore, similar overlaps between loneliness and mental health in the data further emphasize that nurturing human connection may help foster health in everyday life.

Joanne: Going back to what you said earlier, what has changed since COVID-19?

Sam: Examining health-related posts but comparing data from before the pandemic to during, analysis highlights important changes in the public conversation, especially in mental health. The list of hashtags with significantly heightened volume on Tumblr includes entries like “anxiety” and “depressed” (see data note). In fact, mental health related tags account for 1 in 3 of the hashtags showing significant increases in volume on the site’s health related posts, a finding in line with other early research into mental health during the pandemic. This may be social media underscoring the importance of mental health during COVID. Given what I mentioned earlier with loneliness, there’s hints that there’s a resounding need for human connection, especially now.

Joanne: What are some emerging themes that we should all pay more attention to?

Sam: In terms of themes, I think the observations around mental health and loneliness make me wonder how we might encourage greater human connection, especially during COVID. Meanwhile, the findings around inspiration make me wonder how we can care for and motivate each other.

That said, in addition to these themes, I also saw “gaps” in the data that might tell us where we need to be paying more attention. For example, I analyzed how the topics found in the Tumblr research compare to similar analysis in news articles and Crunchbase. Here, the data show that the “key inputs” of diet, exercise, and mental health each appear relatively more often in Tumblr discussion than in both news media and industry (see data note). This might suggest that the public are already thinking about health in an everyday context but that potential lies in bringing more institutional or entrepreneurial efforts to bear in these key inputs.

Joanne: Going forward, how do you see data science changing how we design systems?

Sam: These kinds of data science-based explorations broaden the perspective of teams and, for this project, I think help us look at a space from “above” in a way that is difficult through other ways of seeing. It lets us look at a system more broadly. For this project, for example, all of this helped build towards a deeper understanding of a health system and economy that understands the importance of community and nurturing human connection.

Joanne: Are there limitations to this approach or your findings? And given more time, what are you curious to explore next?

Sam: Absolutely! Just like in traditional qualitative research, we have to consider where we are listening and who does or does not have access to those spaces. During design, we have to be thoughtful about those blind spots and consider how different methods of research can complement each other to increase inclusivity and broaden our perspective. To that end, I have a data note on some of the limitations and assumptions around the findings I mentioned earlier. That note discusses some future work opportunities in greater detail but, in general, I’d definitely spend some time in more communities and more languages.

Natural Language Processing: A new way to listen to people about health was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

Health is very much about relationships. If anything, COVID-19 has made it abundantly clear not only how our individual health is connected, but also how interconnected the world is — between individuals and their communities, humans and their environments, present-day experiences and the histories and stories that set their context.

In this interview, we’re speaking with Emmanuel Vaughan-Lee — filmmaker, composer, Naqshbandi Sufi teacher, and Executive Editor of Emergence Magazine — to learn about the role culture plays in health and the importance of relating to the nonhuman world.

Joanne: As an editor of a magazine, how would you define health and has that changed since Covid-19?

Emmanuel: In many ways, we’re a magazine about health, but if we say we’re a magazine about health then you would assume it’s medical or about healthy eating and exercise. I think Americans have a very simplified view of what health is…we put it in a box and say, “‘That is health’ and an expert is going to tell us how to be healthy”.

Yet, it’s almost impossible to be “healthy” if you define it as a relationship with yourself without acknowledging that you’re part of a larger “culture” including both human and nonhuman things. If you are healthy but what is around you is unhealthy, then that doesn’t make a lot of sense. I think many of the problems that we’re dealing with are a result of that worldview. We may be a very healthy person because we are in the position to have a healthy diet or exercise or make choices. But those are almost irrelevant to what happens around us, including the detriment that we may cause other people by being able to take those choices, or how choices are made possible by multi-generational privilege.

So in relation to your question about COVID, ironically, our next issue was going to be on the theme of “Apocalypse”. It was scheduled to come out in June, so we were three months late.

One of the first conversations we had was with David Quammen, a wonderful science writer who wrote the book Spillover, which in a sense predicted the pandemic occurring. It was about the root causes of zoonotic diseases, which stem from how we interface with the natural world. It was peeling back the layers of information bombardment to “Where did it come from?”

The root causes of these diseases are from how we relate to the living world and encroach without thinking of consequence.

Relating to the Nonhuman World

Joanne: What are some of the themes you’re exploring now?

Emmanuel: Our editorial ethos is ecology, culture, and spirituality, stories that weave those threads together and explore how those threads have become separated to the point of unhealthiness. We explore all the ways that storytelling can function as a tool for healing and weave those threads back together to help us understand, question, orient ourselves, and hopefully provide a foundation to process and adjust to this new reality.

One of the first things that we were talking about was vulnerability, and how we’re all ultimately in a space of vulnerability and unknowing. Those are themes that we’ve been exploring in content for a long time, but now they’re easy to frame in a very immediately relatable, collective context.

We can no longer pretend that we aren’t interconnected.

We’ve been saying at the magazine, “The cracks in the system that is this country are now chasms, and those chasms can’t be ignored”. It’s a tremendous opportunity to get to the root of what’s happening. There is a role for the storyteller right now to reveal those chasms in different ways and to share their experience, their perspective — not necessarily the answers because all good stories are mostly questions rather than answers.

This is the first time since World War II that we’ve had a collective experience that gives us the opportunity to re-examine what a healthy society looks like. The unfortunate thing is that we are trying to respond to the virus following the same pattern that led us here in the first place, we aren’t examining the health of society and responding with that in mind.

Joanne: I really love the framing health as a part of a relationship. I think so often health is seen as this very objective measurement: “one person’s health”, your framing makes me think of the role of storytelling in the pandemic. Now everybody has a story to tell. So it seems stories have also become more participatory as an outcome of the pandemic. It might reinforce this notion that we must be connected in order to be healthy.

Emmanuel: Perhaps what they’re sharing is of more interest and has more meaning. Before, it seemed like everybody wanted to share their story on social media. Now, the pandemic created a collective, real experience where the entire world is sharing in one connected experience. So it’s like every story has a relational point that is much more accessible than what you had before. The work of a storyteller in all the mediums is to find that relational point of entry for the audience to connect. We don’t need to do that right now, and so that just changes the whole dynamic.

Stories As Seeds, Stories As Threads

Joanne: When we’re separated from the living world, it’s impossible to define health in a singular. The word in itself has no meaning unless it’s contextualized in relation to another word. This is also making me realize that in this collective experience, we’re all storytellers.

Emmanuel: There is no one story. There are many stories that need to be told at this time that help us orient ourselves, process, understand, move forward, stay still, whatever is needed. I think that we need stories that are willing to abandon the dominant story of progress and constant growth. The more we can question that narrative, from lots of different perspectives, the more we will be able to take full advantage of this moment. This moment is really showing that the dominant narrative is, in my view, dead — and we’re trying to keep it alive. Much like how the American dream has been dead for quite a long time, but we’re unwilling to let it go.

So stories that challenge the dominant narrative offer a way forward through examples, questions, or just through that exploration. Stories are like seeds, and the role of the storyteller is to plant that seed. This is something we think about at the magazine a lot. When someone listens, reads, or watches a story, it’s like someone’s watering and engaging with that seed and it becomes alive — a plant. And that plant might bear fruit, it might live and pollinate in relationship to other plants. Then all of a sudden it’s creating shade and allowing other species of seeds that were planted a long time ago, or maybe planted now, to come up. Then maybe all of a sudden, there’s a different microclimate.

The other metaphor that we use a lot is that stories are threads. When you put lots of threads together, they weave a fabric, And that fabric is something that can clothe us, or that can hold us. There are so many ways you can think about the use of a fabric. It can be a carpet on the floor that invites people to sit on it. It’s a very ancient archetypal metaphor. We need stories that can help weave containers to help and hold us at this time. If you’re held in a fabric, suddenly you can rest, you’re secure.

What we’re experiencing right now is a tremendous opportunity to decide what we take with us into this uncharted unknown future and what we leave behind.

We can each examine what we can leave behind. Very practically, do I need to travel as much in order to find meaning? Can I reconnect to where I live with a new understanding and appreciation? The things that we decide to leave behind will be diverse and varied and that’s the beauty of it, because it will hopefully cause us to take stock of who we are, where we are, and what gives us meaning. Then, on the bigger level, we can leave behind this ridiculous notion that everyone in America should pull themselves up by their bootstraps without government support for basic things like healthcare. As a result of the pandemic we’ve put more money into our economic system than anybody else in the world and it hasn’t resolved things because it didn’t in any way try to respond to it from the root cause.

Collective Experience, Collective Narrative

Joanne: Now is both the time to think about the content of stories as well as form. We’re in this moment where it’s extremely participatory and everyone is having this shared experience. Is there a new form of story that might emerge that accounts for this collective experience?

Emmanuel: The role of participatory storytelling is really interesting. But I also think that we have a limited view of what a story is. It’s a limited idea that in order to have a participatory story, we all have to be contributing as creators. I really believe that stories are alive, but only if you relate to them as alive. We view stories as entertainment or information, but in cultures that existed for thousands of years stories were alive, they were myths that had meaning, you related to them, your relationship to them was what allowed them to exist.

We have separated ourselves as audience and storyteller.

I think that we actually can engage with stories in a shared collective experience if we relate to them as something that is made alive by listening. Going back to the metaphor of the seed, if the storyteller plants the seed in the ground, it’s the person who is listening who makes it grow and come alive.

Who you are in relationship to that story means you are going to experience it differently. That’s something that isn’t taught. In school, it wasn’t said, “Everybody in this classroom should have a different interpretation of Lord of the Flies”. No, “Lord of the Flies is this, Kill a Mockingbird is this” and as you get older, it’s almost even worse. We move away from the child experience of a story, where they can see themselves as those characters. When we get older, it’s frowned upon in some circles to believe in a story that is seen as not real. You know, we’re real in this world, the story is the fantasy.

Re-Centering on the Nonhuman World

Joanne: Going back to the fact that we are inseparable from the living world, I think in the past it has been very easy to ignore these connections. I wonder if there’s something that might be learned from how stories grow or how one nurtures a story. How might we maintain the life of the story? I think that’s actually very much related to how we might think about health as well.

Emmanuel: I think we need more stories that do not put the human experience at the center. We’re so used to the idea that it’s the human experience that makes the story. But that’s a very Western-dominant way of looking at stories — that wasn’t always the case. I think we need to return to certain older ways of telling stories, which included the nonhuman experience as something that was valid and alive. The more we can actually talk about the world as something that is living, the more we will not distance it.

If you go somewhere that has been very negatively impacted by our actions to the environment, it has a real impact on you, it becomes part of your story, your experience. One of the equalizers that climate change is going to bring forth is that we will suddenly not just be looking at other parts of the world dealing with this, we will be dealing with it ourselves. I spent quite a bit of time working on a film that took place in the tar sands up in Alberta. It’s a very impactful experience just seeing that space. You can smell the expanse of it. You can’t go back from there.

For me, storytelling is about remembering what is alive so that we’re reminded that we are in a shared relationship with it.

I think that’s really going to be the great journey that we take on over the next several generations — having to reconnect to the living world.

We’re all sharing in one experience within this living world, but each one of us has a different individual experience and relationship within that shared collective experience. Can we hold those two experiences together without destroying the living world? We really struggle to hold them because we view them as paradoxes and competing worldviews, but it is possible. Many Indigenous societies, spiritual traditions, and cultures knew how to hold multiple experiences at the same time and maintain a balance. The individual need and the collective need are not separate, but they function differently while still being in relationship to each other.

Culture and Health: A Chat with Emmanuel Vaughan-Lee was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

This interview series is a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

To make everyday life healthy by design, we need to understand what health means for people personally and for the systems shaping everyday life.

In this interview, we’re unpacking experiences of food. Food is not just what we eat; it’s how we eat it, who we enjoy it with, where it comes from, and so much more. What food means to us emotionally, socially, politically, as well as physically, all have significant impact on how it affects our health. To learn more, we’re speaking with Christopher Gardner, professor at the Stanford Prevention Research Center, who has spent over 20 years researching the potential health benefits of various dietary components or food patterns.

Joanne: You’ve studied the many barriers individuals and institutions face when making food choices. Have you noticed any shifts on the individual or institutional level in the last few years and since COVID-19?

Christopher: Over the last 5 years I’ve been seeing Gen Z show up for social justice. I’ve been teaching at Stanford for 27 years and I’ve seen a shift with more students caring about food and the environment. More recently, in the last three or four years, social justice has started to overwhelm the environmental aspect. The students in class want fair access. I want to talk about greenhouse gas and water, but they’re bringing up laborers and minimum wage.

And now COVID-19 has had a huge impact on decreasing how much we eat out. When we eat out, the choices we make are often driven by the food industry tantalizing us with taste — by salt, sugar, fat. But cooking at home should be better.

Stealth Nutrition

Joanne: There are parallel conversations around ethics of meatpacking industries, ethics around climate justice, as well as ethics of technology. What are other social issues that shape how people make food choices?

Christopher: A term that I use a lot now is “stealth nutrition”—it’s not stealth in the way of deception. About 15 years ago my colleague Tom Robinson and I started a class called “Food and Society” that focused on environmental, social, economic, and political issues. Personally, I felt a shift in my career trajectory after listening to the students discuss and wrestle with the class topics. At the end of the first year I asked the students to tell me what resonated the most so I could apply this to teaching the class again the next year.

One student with tears in her eyes said, “Oh my God, the animal rights thing. I went vegetarian.” And the next said, “I grew up on a ranch. We don’t treat our animals poorly. We treat them really well. I think that was an unfair portrayal. But the greenhouse gas thing blew me away. So I’ll only eat pasture raised, organic, and antibiotic free meat now.” The next student said, “I grew up Republican and that global warming climate change thing, that’s a total hoax. But, in Eric Schlosser’s book I was mad when I learned the fast food companies don’t make money off their burgers, they make money off the real estate. The franchise owners can get small business loans and they are the ones taking the risk. There’s a story in the book of 13 Wendy’s that opened up in Harlem and 10 went bankrupt, and some of the small business loans didn’t get repaid, but Wendy’s didn’t lose a dime. I stopped going to fast food restaurants as a point of fiscal responsibility.”

So I just stopped and said, wow, this is amazing. You went vegetarian, you’re only eating pastured meat, and you stopped eating fast food, all for different reasons. There wasn’t one reason that resonated across the whole class.

For some it was animal welfare, for others it was social justice, and others climate change, but they all aligned on eating better even leaving nutrition out of it.

Unapologetic Deliciousness

Joanne: It seems that food choices are about more than values. It also has to do with visceral experience.

Christopher: Definitely, some people think, “I don’t want to know that [shocking fact about the food industry] because if I do, I won’t feel comfortable continuing to buy and eat that, and I’m gonna miss this thing that I really like.” So one approach I’ve learned for addressing this came from Greg Drescher at the Culinary Institute of America — the idea of “unapologetic deliciousness”.

Lead with taste, unapologetically great taste.

That resonates particularly well with me because I realize as health professionals, many of us have been apologizing for a decade. I remember saying, “I know you really want the indulgent cookie or the ice cream, but I really think you should consider the stuff with more fiber, more antioxidants, and less saturated fat…” And in essence I would be apologizing by saying, “Please have the thing that tastes worse because of health”. Now, there’s no apologizing. I say, “I have got this global fusion flavored dish. It’s a bed of heritage grains and legumes, topped with seared vegetables, maybe with some chicken or fish on top with a tantalizing blend of Moroccan spices, it’s gonna blow your taste buds away”.

Along the way, my work with chefs has involved moving more and more towards “plant forward” dishes, and one thing that has really aligned everything is a protein flip. What I am referring to there goes back to how I traditionally remember people referring to what they were having for dinner, as “steak” or “chicken” or “roast beef” — not the entire meal, but just what was going to be at the center of the plate — high protein meat. Instead, for the protein flip, think about the center of the plate as being plant based foods, with smaller portions of meat or fish or chicken in there. This way it can still include meat, without taking it completely away and going vegetarian, which can turn a lot of people off.

Joanne: What are some ways of elevating the values-to-action conversation, that’s so successful at the individual level, to an institutional or corporate level?

Christopher: So, I do the most work with Google, Stanford University, and a little bit with Stanford Hospital. We’ve been working with the Culinary Institute of America and the chefs are strutting their stuff there. When I go to these meetings, it’s almost obscene the foods that they’re serving that are plant-based and unapologetically delicious. They’re using their craft.

So, we had a cool project with Google, where they were going to try to use less sodium, but we didn’t frame it as using less sodium. We said, “How else can you flavor your food? Try something crazy.” And they came up with these herb blends and other things without noticing they were using less salt.

The administrators and dining operators in institutional food settings are important stakeholders in this and they are another story. One thing I learned from them is that even though grains, beans, and vegetables can be less expensive ingredients than meat, preparing vegetables to be unapologetically delicious can involve higher costs in terms of more labor. And in this area I am learning there are some amazing institutional-sized cooking equipment that can help, including vegetable prep slicers and dicers. But it’s not as simple as vegetables cost less than meat.

Choice Architecture

Christopher: In some of these institutional food settings they’re playing with related issues like buffets versus plating. They’ve done a lot of work with “choice architecture” — where is the food placed, and how? Is it a square bowl, a round bowl? One particular institutional food setting with a lot of room for improvement is hospital food. Hospitals have a primary mission of promoting health, yet hospitals are often shamed for having some of the worst food anywhere. Some hospitals are now leading the way in improving the taste and healthfulness of their menus.

One interesting issue related to institutional food is employee productivity. Some worksites offer snacks to their employees, and many times those are unhealthy, high-sugar snacks. This can lead to a sugar coma in the middle of the day and a drop in productivity. Some worksites like Google are trying to find solutions to this that will be better for employee health and better for productivity. Maybe there is a choice architecture solution? Some easy-to-grab snacks are much healthier than others that look and taste better than the less healthy snacks. There are many levers to push.

Long-term, I have to say, I think the only way we’re going to get meaningful shifts in healthier food choices is to change agriculture.

We have to grow different foods. If you and I go and choose one different thing at the local market, that’s not going to do it… but if all the schools, hospitals, and worksites order and offer different food, farmers would grow something different. But only if they know there’s a market.

Systemic Shock

Joanne: We were talking about the role of familiarity but also indulgent language. Have you worked with a decision-making psychologist on if people would rather start with something that’s familiar? Or is it language that drives people to make a choice that’s a little bit out of the norm?

Christopher: That idea about “a little bit out of the norm” reminds me of some work I did in my class with Tom Robinson where we realized that people respond differently to different levels of shock. One of the things that can get people to change their behavior is to shock them that the thing that they did is bad. So, for example, “Oh, it’s horrible for animal rights.”, “It’s horrible for the environment.” But the really fascinating thing we learned was that there are different levels of shock that are required to get someone’s attention.

The challenge is to figure out how much information you give them before you get their attention. If you give them too much it can be overwhelming or frightening. Whereas other people may think, “I heard that. That’s boring.” You have to kind of ramp it up like, “Did you know how bad it was? Yeah. Did you know this? Or this?” until you get to the point of shock where someone is willing to rethink their decision. It’s complicated trying to figure how to scale that up to engage them at the point where, “This is new, and I’m willing to think about it because it seems important but not too threatening.”

Joanne: That’s fascinating especially considering how the shock from the pandemic is making businesses rethink systems.

Christopher: Well, turning that back to the topic of changing agriculture, I wonder how many farmers just lost a whole season’s worth of their crop due to COVID-related changes in food distribution systems and said, “Wow, my model is vulnerable.” Maybe it’ll inspire people to grow different food or have different vendors and consumers so they’re less vulnerable next time. Certainly, it’s got to be going through somebody’s head.

Food and Health: A Chat with Christopher Gardner was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.

Nature and Health in the Time of COVID-19: A Chat with Author Florence Williams

This interview series is a part of a collaboration between IDEO, Robert Wood Johnson Foundation, and Building H to imagine how we might design health into everyday life.

To design health back into everyday life, we need to understand what health means for people in this new context. Starting here, even the most unexpected moments can be optimized for health and wellbeing.

For our first interview, we’re unpacking the value of experiencing nature. When we think of the environment, it’s easy to think of natural wonders — mountain peaks, river valleys — and take everyday nature for granted. Yet, even a casual bird call or the tree outside your window can play a surprisingly essential role in your health. To learn more, we’re speaking with Florence Williams: journalist, podcaster, and author of The Nature Fix: Why Nature Makes Us Happier, Healthier, and More Creative.

Joanne Cheung, IDEO CoLab: You’ve done wonderful research on the benefits of nature and being outdoors. COVID-19 has drastically changed the relationship between people and being outside. 74 miles of streets in Oakland are now open to pedestrians. Things that were improbable before may now indicate more permanent trends, such as cities privileging people over cars. Are you seeing any shifts that might point to positive, long-lasting change?

Florence Williams: This is really a moment and an opportunity. Science is showing that when we experience “awe”, our brains stop and our nervous systems slow down. We’re trying to take in this new information and process it in a new way. In that moment, there’s a window for cognitive shifting that opens up, and the same thing happens in an event like this pandemic.

It’s “awe” because it’s on a scale that we cannot really comprehend.

There’s a way to look at health and the environment together that people are newly appreciating. Right now, being outdoors is much safer than being in populated indoor spaces. I’m also interested in this concept of “urgent biophilia.” After natural disasters, people want to rebuild nature, they find a lot of comfort in planting trees or building parks. For example, there was a lot of tree planting after Katrina, Hurricane Sandy, and after the tornado in Joplin, Missouri, which wiped out 1000 trees. There’s now this incredible butterfly park as a memorial to the people who died, but also just a place to find solace. Similar to how we’re talking about stockpiling medical equipment, we also need to be thinking about stockpiling nature and stockpiling high quality parks.

Nature as our mental health resource

Joanne: Before COVID-19, there were many barriers keeping people from spending time outdoors and preventing the creation of green spaces in cities. Are you seeing any of those previously immovable barriers becoming more mobile?

Florence: I think one of the barriers has been cognitive. I don’t think people thought of their parks as a mental health resource, and there’s this new awareness of the mental health benefits of nature. So I think that cognitive barrier is moving a little bit as people realize, “I have to get out for a walk, I’m going crazy in my house.”

Nature as our preventative medicine

Joanne: It’s interesting thinking about the types of nature that are available to people in the built environment. I’m wondering whether these spaces can offer the kinds of mental physical restoration and rejuvenation that you’re speaking about. Do you have a mental taxonomy of different types of nature and the different forms of restorations they offer?

Florence: 100 million Americans do not live within a 10 minute walk of a park. So, I look quite a bit at this dosage and intensity question: How much nature do you need to gain these benefits? It seems that there’s a dose curve — there are benefits to be gained even from a window view of green space.

I think there’s a huge role for institutional nature. If we believe that access is important on a daily level, we need to have nature pervasive in our schools, workplaces, and neighborhoods. Then every school should have some kind of schoolyard, and there are some really interesting studies on the exercise kids get in these various schoolyards. Boys, for example, typically run around more than girls in conventional urban play spaces. But as soon as you go into green, natural play spaces, the girls start running around just as much. So it’s become this kind of gender equalizer, as well as a kind of social equalizer.

Nature as our subconscious home

Joanne: The equalizer is a compelling metaphor for health. Have you found other metaphors or analogies that can broaden how we think about health?

Florence: I think it’s important to micro-dose nature, micro-dose some quiet. Finding moments of peace throughout the day that can be facilitated by time outside. When we see an interesting pattern in a tree, it provides this little micro pulse of something calming to our nervous system that we don’t necessarily notice because it’s almost subconscious.

Now that people are seeing their cities in this new way, I’m hoping that there’s momentum behind “Hey, let’s leave this street open”. Maybe we can leave some places quieter. Let’s advocate for — this is my pet peeve — electric leaf blowers instead of gas powered leaf blowers.

Nature as our healthcare companion

Joanne: That makes me think about the people who form a web of care around an individual. Typically when we think about health, we think only of the healthcare professionals, but in your example the person who’s using the leaf blower has a health relationship with me because that’s a source of noise. We’re meshed within a network that very much contributes to our health and wellbeing.

Florence: Well, sometimes we’re not very good at even noticing the people around us. The people we share our cities with…we put them out of mind quite easily.

When we access moments of beauty, even in small doses during our day, studies show that they make us more pro-social. So after looking at something beautiful, even a photo of a whale as opposed to a photo of a shopping mall, the people looking at the beautiful photos will donate more money, they will perform better in teams. The studies are pretty clear on this, that there’s something about nature that is actually good for civilization. Again, it’s super subtle, but it brings us out of the internal soundtrack of our own problems and makes us think about ourselves as a community. It pulls us out of our drama. Seeing nature gives us a little bit of humility. In Western cultures that can seem like a negative concept—we don’t want to feel “lesser than”, but when we do, we feel more connected to other people. It’s not that our self-esteem drops, it’s just that other things take on significance as they should.

Nature as our lifelong gift

Joanne: How could designers navigate the fine line between creating awe-inspiring experiences as well as the freedom of thought and choice? There’s an interesting tension between designing for agency as well as the experience of collective awe.

Florence: I think it’s really important to think about how we educate children and what we expose them to. It starts an appreciation for beauty or arts-based education. This is like one of the first things that gets cut all the time. And yet an appreciation for beauty is really important to being able to live a fulfilling, rich, and healthy life. We are learning this more and more from science.

You can cultivate also in children a connection to nature, and once you do that, it’s a gift and a tool that they have for their entire lives.

It’s a way for them to be able to access an environment of restoration, to be able to find a time out for themselves, for their entire lives if they’re a learned to love tree. We need to design for art and beauty, and design a connection to it early on through education.

Joanne: I love the thought of the gift — the gift has a net positive and regenerative component that is not like you use it, it’s used up, then you get another one, but it’s something that’s continuously nourishing. It’s a wonderful prompt to think about when designing objects.

Nature and Health in the Time of COVID-19: A Chat with Author Florence Williams. was originally published in IDEO CoLab Ventures on Medium, where people are continuing the conversation by highlighting and responding to this story.