Designing Systems Interventions: The Lack of Access to Affordable Healthcare in Pittsburgh
Assignment #5: Designing Systems Interventions
Carnegie Mellon, Transition Design Seminar 2023
Team Diversity: Luis Garcia, Parrish Andre, Ariba Asad, Mary Priyanka Jacob, Emilie Zhou
To wrap up our semester-long research and exploration into understanding the Lack of Access to Affordable Healthcare in Pittsburgh, we designed systems interventions to address this wicked problem. Throughout the semester, each assignment has helped us piece together different parts of our wicked problem to allow us to understand how it has manifested and become so deeply rooted in Pittsburgh. Through previous assignments, we learned about how this wicked problem affects sectors of society (assignment 1), which groups are most affected by it (assignment 2), and how history has contributed to the evolution of this problem (assignment 3). We also envisioned a future where this wicked problem has been addressed and what practices would help us achieve a desirable future (assignment 4). This assignment serves as a culmination of our findings and learnings, as we can now use the insights we have gained to design sustainable and practical systems interventions. As we came up with both material and non-material interventions, we also envisioned what changes would look like at different levels of scale to ensure that these interventions would create positive systems-level change. As the last part of the Transition Design process, our systems interventions have been designed to be actionable steps that could inform efforts toward addressing this intricate issue.
Our process: applying the combined learning from previous assignments to design ecologies of systems interventions
For our final assignment, we had the challenge of coming up with first, tangible steps for a transition pathway toward a desired future. We initiated our process with a few ideation rounds to think about possible solutions based on four themes: dismantling, maintaining, innovating, and future finding. For example, ideas in the “dismantling” section had to do with significant changes to the current system, such as: “getting rid of high costs for medical education and treatments” or “implementing educational constructs to remove bias based on a racial and economic background in medical education.” At the same time, we brainstormed ideas about “maintaining” aspects of the system that could support a transition pathway towards an ideal future, for example, advancements in medical equipment and services or bolstering government funding for healthcare initiatives.
The next step in this assignment involved working in a matrix that combines the domains of everyday life along the horizontal axis and the five categories of STEEP on the vertical axis. This matrix gave us an initial frame of reference to plot our ideas and start looking for connections to develop synergistic solutions. One of our main goals was to connect solutions to each other while bridging long-term visions with more immediate interventions at different levels of scale. As you in the board, we used colors to differentiate between ideas located at different scales and gray lines to show how interconnectedness occurs between ideas. Each idea includes a title that allows the reader to get a first glance at the vision behind such an intervention, followed by a description that acts as a short project description.
Creating Interconnected Ecologies of Intervention
A critical first step involved identifying the scale and sector in which change is required, followed by interventions that have the capacity to affect the system at various scales. As mentioned by Tomar Pierson-Brown during our last class: “Access to healthcare is equally impacted by social determinants of health as much as it is by the unjust attitudes of stakeholders in power.” During her talk, she described this as the Social Determinants of Health (SDOH) framework, which includes Education, Healthy Neighborhood, Social and Community Context, and Economic Stability as factors to consider when trying to understand the problem of access to healthcare. Building on these attributes, we proposed a care App that has an easy interface and works on the idea of Time Banking. This intervention will connect elderly people to young individuals who can come in to help in doing their everyday activities or take care of them if needed. This is directly connected to our business intervention at the city scale that we call “Health Table” and is an organizational structure in place that specifies care needs for different age groups and involves various nonprofits to keep it more issue specific. This will provide more employment opportunities, such as help at care homes. At the state or regional level, there is a need to reform the steel Industry, which will be done by closing and relocating steel mills and factories in close proximity to residential neighborhoods, directly putting an end to environmental pollution causing air-borne and water-borne diseases.
At the political and governance level, we proposed a decentralized system that gives control to multiple stakeholders. This allows for more involvement from the disadvantaged groups allowing funds to be allocated to wellness centers at the neighborhood scale and community health fund, thus intervening at infrastructure and business levels. This adds to our intervention that we like to call “Gaia Economy,” which will encourage and promote economies prioritizing the equitable distribution of wealth, access to wellness, and nutrition in order to increase healthcare access. This socialized structure of healthcare will assist in dismantling the privatized healthcare model, which is the biggest obstacle in the system at the moment.
Conclusion
After semester-long research about our wicked problem, we developed a strong knowledge base about the causes of the lack of access to healthcare in Pittsburgh, such as industrial pollutants and biased urban planning, understood the stakeholders’ fears and concerns, and dreamed about an ideal future and our ultimate vision for the city.
Our interventions tried to outline short-term and long-term efforts to address this wicked problem. “Care For All” focuses on a more granular level of the problem, which attempts to satisfy economic needs with a Community Fund and infrastructural needs in the form of Wellness Centers. Neighborhood gardens and pop-up clinics would support the need for good nutrition and a healthy environment to ensure healthy neighborhoods. These places could also serve as grounds for medical training or sites to fulfill CSR requirements for big firms in order to earn income and run self-sustained, apart from government aid. Our long-term idea revolves around building a Gaia Economy where all stakeholders are empowered, allowing our healthcare and the overall economy to shift to a new structure motivated by peoples’ well-being.
Overall, our project has helped us understand that healthcare is still a privilege for many and that it is a money-minting machine with a history of converting from accessible to luxury. The different assignments we did during the course helped us dig deeper and put ourselves in the shoes of our different stakeholders while understanding the value of a zoomed-out system perspective. In a world where everyone is searching for the next big money-making idea, we ought to search for sustainable long-term interventions. We understand that no single idea can bring the change we want to see, but instead, multiple interventions at different points in the system are needed. Lastly, it was critical to understand how to draw connections to identify the often invisible interconnectedness of a complex system. Finally, through this process, we became more aware of the criticality that systems thinking plays in transitioning to ideal futures. Systems thinking is a very important concept we have left behind in modern education, making future generations more granular and localized in their thought process without seeing the big picture. It is essential that we reimagine our current education systems to form people capable of engaging in transdisciplinary and transformative work that can move us forward to a healthy environment and society.
A copy of our mapping exercise can be accessed here.
